The men and women who serve in the armed forces, in the words of Major General Joseph Caravalho, “sign a blank check, co-signed by their families, payable to the Army, Navy, Air Force, or Marines, up to and including their lives.” It is human nature to consider such a pact in polarized terms; the pact concludes in either a celebratory homecoming or funereal mourning. But in reality, surviving catastrophic injury may incur the greatest debt. The small but real possibility of (...) losing the ability to bear biological children due to genitourinary combat injury has been a topic of discussion in hushed tones, behind closed doors. But as policy changes move the conversation into the open, we must be fully aware of the far-reaching and long-term impacts of decisions on those who have sustained genitourinary injury. In January 2016, Secretary of Defense Ashton Carter outlined a set of reforms that would improve the quality of life for military families by recognizing the importance of maintaining fertility, even in the face of severe injury. This first promising step could build a solid foundation of insuring fertility preservation for wounded service members with genitourinary injury, and it could set a precedent beyond the military for insuring treatment for people who have lost their reproductive capacity. Thus, the ethical challenges raised by the new policy require careful analysis. (shrink)

ABSTRACT:In a world filled with poverty, environmental degradation, and moral injustice, social enterprises offer a ray of hope. These organizations seek to achieve social missions through business ventures. Yet social missions and business ventures are associated with divergent goals, values, norms, and identities. Attending to them simultaneously creates tensions, competing demands, and ethical dilemmas. Effectively understanding social enterprises therefore depends on insight into the nature and management of these tensions. While existing research recognizes tensions between social missions and business ventures, (...) we lack any systematic analysis. Our paper addresses this issue. We first categorize the types of tensions that arise between social missions and business ventures, emphasizing their prevalence and variety. We then explore how four different organizational theories offer insight into these tensions, and we develop an agenda for future research. We end by arguing that a focus on social-business tensions not only expands insight into social enterprises, but also provides an opportunity for research on social enterprises to inform traditional organizational theories. Taken together, our analysis of tensions in social enterprises integrates and seeks to energize research on this expanding phenomenon. (shrink)

This target article presents a plausible evolutionary scenario for the emergence of the neural preconditions for language in the hominid lineage. In pleistocene primate lineages there was a paired evolutionary expansion of frontal and parietal neocortex (through certain well-documented adaptive changes associated with manipulative behaviors) resulting, in ancestral hominids, in an incipient Broca's region and in a configurationally unique junction of the parietal, occipital, and temporal lobes of the brain (the POT). On our view, the development of the POT in (...) our ancestors resulted in the neuroanatomical substrate consistent with the ability for representations in modality-neutral association cortex and, as a result of structure-imposing interaction with Broca's area, the hierarchically structured Evidence from paleoneurology and comparative primate neuroanatomy is used to argue that Homo habilis (2.5–2 million years ago) was the first hominid to have the appropriate gross neuroanatomical configuration to support conceptual structure. We thus suggest that the neural preconditions for language are met in H. habilis. Finally, we advocate a theory of language acquisition that uses conceptual structure as input to the learning procedures, thus bridging the gap between it and language. (shrink)

Recent efforts to introduce competition, consistent with microeconomic theory, into the United States health care system raise questions of distributive justice. Similarities between microeconomic theory and libertarian philosophy suggest the possibility of confusing economic goals of efficiency and cost containment with social goals of equity of access to care. This paper raises the fear that if the two are confused, society may unwittingly abandon any serious effort to ensure that the poor have access to essential types of medical care, because (...) libertarian philosophy cannot justify placing any constraints, however beneficient, on the actual distribution of benefits and burdens of illness resulting from free trade. (shrink)

The increased competition for a share of the market of insured patients, which arose in the wake of failed comprehensive health care reform, has provoked questions about what, if any, standards will govern new “competitive” health care organizations. Managed care arrangements, which typically shift to providers and patients some or all of the financial risk for patient care, are of special concern because they can create incentives to withhold beneficial care from patients. Of course, fee-for-service medical practice creates incentives to (...) provide unnecessary services, and managed care can avoid that type of harm. Still, as Edmund Pellegrino has noted, “managed care, by its nature, places the good of the patient into conflict with … the good of all the other patients served by the plan; the good of the plan and the organization, themselves…; and the self-interest of the physician. (shrink)

This response to continuing commentary addresses brain-hand relationships in Cebus apella (as introduced in West-ergaard's commentary), the evolutionary and acquisition parallels between music and language (suggested by Lynch), and the potential behavioral linguistic consequences of the evolutionary neurobiology in Australopithecus africanus and Homo habilis (discussed by Tobias). Finally, we reiterate the importance of well informed, multidisciplinary approaches to the study of the emergence of human species-specific cognition, especially linguistic capacity.

This response clarifies the nature of reappropriation and the definition of language. It explicates the relationship between neural systems and language and between homology and evolutionary gradualism. Through a review of ape capacities in the realms of language and tool use, it distinguishes human language acquisition from nonhuman learning. Finally, it suggests the appropriate sorts of evidence on which to base further evolutionary arguments relevant to the origins of language.

This comprehensive reader represents the history, intellectual breadth and diversity of feminist theory.

Following the seemingly endless debate over managed care liability, I cannot suppress thoughts of Yeats’s poem, “The Second Coming.” It is not the wellknown phrase, “Things fall apart; the centre cannot hold,” that comes to mind; although that could describe the feeling of a health-care system unraveling. The poem’s depiction of lost innocence — “The best lack all conviction, while the worst/Are full of passionate intensity” — does not allude to the legislature, the industry, the public, or the medical or (...) legal profession. What resonates is the poem’s evocation of humanity’s cyclical history of expectation and disappointment, with ideas as grand as justice and occupations as pedestrian as managed care. Writing in 1919, Yeats described the end of an era with images of war’s destructive forces. The poem expresses a universal desire for some miraculous rebirth or resolution of all problems: “Surely some revelation is at hand.” But instead, the brutish Sphinx-like creature emerges, possibly the Antichrist. New gods displace old gods in the cycle of civilization, and man must muddle on. (shrink)

Qualitative comparative analysis (QCA) opens up two new forms of knowledge: (1) knowing about alternative pathways to one outcome (equifinality) and (2) perceiving nuances of necessary cause and sufficient cause. Several misunderstandings of QCA occur in the article by Lucas and Szatrowski (this volume, p. 1). First, there are minor problems with expressions. Second, there are differences between their philosophy of science (arguments 1, 2, and 3 below) and a realist approach. Third, they misinterpret what was meant by sufficient and (...) necessary cause (arguments 4 and 5 below). The minor problems with expressions arise in sections 2.2 and 3. In section 2.2, the authors define consistency, but here they miss out on two key points. First, they neglect to say that this particular measure of consistency is a measure of sufficiency of cause, not of necessary cause. Second, they ignore the way that the consistency level exists for each possible configuration of characteristics. A configuration can be shown in one row of a truth table, with n1 = 28, n2 = 17 within a larger sample of 155, and so on (see Byrne 2009:262). Using QCA’s definition of “consistency,” we can discern more about the pattern of causality than one might initially expect. This learning is possible whether N overall is 155, or just 39, or thousands of cases. The essential task is to simplify and rank the list of configurations (Ragin 2001, 2006). (shrink)

Genomic research—including whole genome sequencing and whole exome sequencing—has a growing presence in contemporary biomedical investigation. The capacity of sequencing techniques to generate results that go beyond the primary aims of the research—historically referred to as “incidental findings”—has generated considerable discussion as to how this information should be handled—that is, whether incidental results should be returned, and if so, which ones.Federal regulations governing most human subjects research in the United States require the disclosure of “the procedures to be followed” in (...) the research as part of the informed consent process. It seems reasonable to assume—and indeed, many commentators have concluded—that genomic investigators will be expected to inform participants about, among other procedures, the prospect that incidental findings will become available and the mechanisms for dealing with them. Investigators, most of whom will not have dealt with these issues before, will face considerable challenges in framing meaningful disclosures for research participants.To help in this task, we undertook to identify the elements that should be included in the informed consent process related to incidental findings. We did this by surveying a large number of genomic researchers (n = 241) and by conducting in‐depth interviews with a smaller number of researchers (n = 28) and genomic research participants (n = 20). Based on these findings, it seems clear to us that routine approaches to informed consent are not likely to be effective in genomic research in which the prospect of incidental findings exists. Ensuring that participants’ decisions are informed and meaningful will require innovative approaches to dealing with the consent issue. We have identified four prototypical models of a consent process for return of incidental findings. (shrink)

Background: People with traumatic brain injury face a range of mental health challenges during the adjustment process post-injury, but access to treatment can be difficult, particularly for those who live in regional and remote regions. eHealth provides the potential to improve access to evidence-based psychological therapy for people with a severe TBI. The aim of the current study is to assess the efficacy of a psychological intervention delivered via video consulting to reduce psychological distress in people with TBI.Methods: This paper (...) outlines the protocol for a multi-center, three-arm, parallel, non-inferiority randomized controlled trial of an evidence-based manualized psychological intervention, ACT-Adjust. ACT-Adjust provides nine sessions for adults with a moderate to severe TBI experiencing clinical levels of psychological distress. Fifty-six participants referred from Brain Injury Rehabilitation Units across New South Wales and the NSW icare scheme will be randomly allocated to three conditions; video consulting, face-to-face and, a waitlist control.Discussion: This is the first RCT to evaluate the efficacy of a psychological therapy delivered via video consulting for individuals with a moderate to severe TBI.Trial Registration:www.anzctr.org.au, Australian New Zealand Clinical Trials Registry ANZCTRN2619001602112. (shrink)

Until recently, medicine has had little to offer most of the millions of patients suffering from rare and ultrarare genetic conditions. But the development in 2019 of Milasen, the first genetic intervention developed for and administered to a single patient suffering from an ultrarare genetic disorder, has offered hope to patients and families. In addition, Milasen raised a series of conceptual and ethical questions about how individualised genetic interventions should be developed, assessed for safety and efficacy and financially supported. The (...) answers to these questions depend in large part on whether individualised therapies are understood as human subjects research or clinical innovation, different domains of biomedicine that are regulated by different modes of oversight, funding and professional norms. In this article, with development and administration of the drug Milasen as our case study, we argue that at least some individualised genetic therapies are not, as some have argued, either research or treatment. Instead, they are research-treatment hybrids, a category that has both epistemological and pragmatic repercussions for funding, ethics oversight and regulation. (shrink)

Background Autism self-advocates’ views regarding genetic tests for autism are important, but critical questions about their perspectives arise.Methods We interviewed 11 autism self-advocates, recruited through autism self-advocacy websites, for 1 h each.Results Interviewees viewed genetic testing and its potential pros and cons through the lens of their own indiviudal perceived challenges, needs and struggles, especially concerning stigma and discrimination, lack of accommodations and misunderstandings from society about autism, their particular needs for services, and being blamed by others and by themselves (...) for autistic traits. Their views of genetic testing tended not to be binary, but rather depended on how the genetic test results would be used. Interviewees perceived pros of genetic testing both in general and with regard to themselves (e.g., by providing “scientific proof” of autism as a diagnosis and possibly increasing availability of services). But they also perceived disadvantages and limitations of testing (e.g., possible eugenic applications). Participants distinguished between what they felt would be best for themselves and for the autistic community as a whole. When asked if they would undergo testing for themselves, if offered, interviewees added several considerations (e.g., undergoing testing because they support science in general). Interviewees were divided whether a genetic diagnosis would or should reduce self-blame, and several were wary of testing unless treatment, prevention or societal attitudes changed. Weighing these competing pros and cons could be difficult.Conclusions This study, the first to use in-depth qualitative interviews to assess views of autism self-advocates regarding genetic testing, highlights key complexities. Respondents felt that such testing is neither wholly good or bad in itself, but rather may be acceptable depending on how it is used, and should be employed in beneficial, not harmful ways. These findings have important implications for practice, education of multiple stakeholders, research, and policy. (shrink)

This study provides an evaluation of ethical business perception of busIness students from three countries: Australia, Taiwan and the United States. Although statistically significant differences do exist there is significant agreement with the way students perceive ethical/unethical practices in business. The findings of this paper indicate a universality of business ethical perceptions.

Moral injury occurs when a person perpetrates, bears witness to, or fails to prevent an act that transgresses their deeply held moral beliefs. The deeply held moral belief that physicians share is the oath they take when completing their lengthy training and embarking on their career: Put the needs of patients first. In today's American healthcare system, doctors, nurses, and other healthcare providers are increasingly forced to consider the demands of other stakeholders -- insurers, hospitals, even their own financial security (...) -- before the needs of their patients. Whenever they are forced to make a decision that contravenes their patient's best interest, they feel a sting of moral injustice. Over time, these repetitive insults amass into moral injury. Moral injury and its causes help explain why healthcare workers started leaving the field in droves long before the COVID-19 pandemic exposed weaknesses in the US system, why a rich country has such poor outcomes in certain categories, why there is a shortage of young doctors training for critical areas, and why patients feel so frustrated. In If I Betray These Words, Wendy Dean explores and exposes the impacts of moral injury through vividly told stories that are at once bewildering and eye-opening. Her book serves as a roadmap through a healthcare landscape that can be confounding, and at times even hellish, for those who must navigate it, and it suggest alternative routes for healers and their patients. (shrink)

Placebo-controlled surgical trials can provide important information about the efficacy of surgical interventions. However, they are ethically contentious as placebo surgery entails the risk of harms to recipients, such as pain, scarring or anaesthetic misadventure. This has led to claims that placebo-controlled surgical trials are inherently unethical. On the other hand, without placebo-controlled surgical trials, it may be impossible to know whether an apparent benefit from surgery is due to the intervention itself or to the placebo effect.

On one hand, Chinese consumers are well known for conspicuous consumption and the adoption of luxury products and named brands. On the other hand, they also have a bad reputation for buying counterfeit products. Their simultaneous preferences for two contrasting types of product present a paradox that has not been addressed in the literature. This study attempts to present an explanation of this paradox by examining the effects of traditional Chinese cultural values and consumer values on consumers’ deontological judgment of (...) pirated CDs and the amount of social benefits they perceive they gain from them. We interviewed 300 Hong Kong Chinese consumers, and found that face consciousness increased materialism and risk aversion, thereby producing a favorable deontological judgment of pirated CDs. Face consciousness also has a direct effect on the amount of social benefits perceived in pirated CDs. Both favorable deontological judgment and perceived social benefits contributed to a strong intention to buy pirated CDs. The results are discussed in a cultural perspective. (shrink)

RESUMO Em detrimento do acúmulo de 10.000 horas de prática antes do domínio sobre algo - o famoso tipping point de Ericsson - intérpretes médicos podem ganhar considerável experiência ao analisar vídeos de interações médico-paciente, mesmo quando esse par fala a mesma língua. Os hospitais-escola comumente filmam tais interações usando pacientes simulados. Tais filmes têm sido usados em instruções de aula com intérpretes. Aqui, é descrito o uso recente de filmes com PS em um ambiente de aprendizado online, no qual (...) fóruns de discussão e fichas de atividade suplantaram os métodos de trabalho convencionais. Nessa abordagem de aprendizagem baseada em problemas, típica da educação médica, estudantes de pós-graduação em interpretação em serviços de saúde se familiarizam com o discurso típico de diagnóstico e tratamento. Os alunos relataram que essa familiarização os ajudou a liberar seus recursos cognitivos para planejar e monitorar traduções e outras decisões imediatas. Os materiais e métodos de aprendizado usados nessa abordagem online são descritos detalhadamente. O valor do contexto da ABP é descrito em relação às abordagens educacionais de interpretação para o sistema de saúde de modo geral.ABSTRACT Rather than amassing 10,000 hours of practice before mastery is achieved - Ericsson’s famed tipping point - medical interpreters can gain considerable, concomitant experience by analyzing videos of provider-patient interactions, even when the pair speak the same language. Teaching hospitals commonly film such interactions using standardized patients. Such films have been effectively used in classroom-based instruction with interpreters. The novel use of SP films in an on-line learning environment is described herein, where discussion boards and worksheets supplanted traditional instruction methods. In this problem-based learning approach, typical of medical education, graduate-level medical interpreting students became familiar with common diagnostic and treatment discourse. Students reported that this familiarity helped free their cognitive resources for planning and monitoring translations and other decisions on-the-job. The learning materials and methods used in this on-line approach are detailed. The value of the PBL context is described in relation to healthcare interpreting education approaches generally. (shrink)

Discussions of surface pattern in Islamic art resonate within broader tensions about the role of figural representation in communicating meaning. The question of whether geometric pattern communicates—whether it functions as a language without a code—reflects broader tensions about the relationship between secular and spiritual communication. Poised between discussions of modernism and Islam, the attribution of linguistic capacity to geometry serves as a measure for the possibility of abstracting pure reason from the religious roots of representationalism. This paper explores this question (...) in four parts. First, it examines the articulation of geometric meaning in Islamic discourses. It then explores European discussions of geometry between language and ornament poised between a search for universal reason and universal spiritualism, both in modernist painting and in modern exhibitions. The final section the expressive capacity of artistic responses to historical Islamic isometric geometries in the adaptive reuse of historical Iranian arts as contemporary abstraction in the sculptures of Monir Shahroudy Farmanfarmaian and in the popular transformation prints of M. C. Escher. It argues that the frequent recognition of intrinsic meaning in geometry, expressed in both premodern Islamic and modern secular interpretations, undermines art historical expectations of theorization as a necessary intermediary for communication. Geometry thereby functions as a language without a code. (shrink)

This volume comprises papers presented at a conference marking the 50th anniversary of Joachim Wach's death, and the centennial of Mircea Eliade's birth.

Bringing together the expertise of rhetoricians in English and communication as well as media studies scholars, Arguments about Animal Ethics delves into the rhetorical and discursive practices of participants in controversies over the use of nonhuman animals for meat, entertainment, fur, and vivisection. Both sides of the debate are carefully analyzed, as the contributors examine how stakeholders persuade or fail to persuade audiences about the ethics of animal rights or the value of using animals.

The challenges public comprehensive universities face today are expanding—they have been challenged to enroll and graduate more students, adopt new technologies that lower cost without sacrificing quality, and align program and curricular offerings with the skills that employers require. While these universities have a long history of adapting to change, today’s environment will likely test the capabilities of even the most adaptive institutions. This volume assembles a team of experts from a variety of disciplines to examine both the history of (...) the comprehensive university and what lies ahead. Overall, the book grapples with such questions as: How do these institutions adapt to serve the growing population of non-traditional students? How well do they prepare graduates for the labor market? Can partnerships between community colleges and comprehensive universities bolster student success? The University Next Door draws much-needed attention to a set of institutions that has historically received little notice, yet play an important role in meeting our new attainment goals and helping the American economy grow. Book Features: Examines the role of comprehensive universities from start to finish—their history and future. Uses empirical analysis to explore complex questions about which students choose these universities and why. Explores how these institutions might struggle under a federal ratings system such as the one proposed by President Obama. Discusses how these institutions can better monitor the needs of the economy and better educate students to fill those needs. Provides recommendations to inform future decisions about higher education policy. (shrink)

Postmodern view of Australian multiculturalism. Discusses the ways in which identity and imagery merge and interact in a multicultural society, within a postmodern theoretical framework, and examines topics such as liberalism and multiculturalism, and cultural postmodernity. Includes chapter notes, a bibliography and an index. Clark is director of the Institute of Ethics and Public Policy at Monash University, Forbes is professor of geography at Flinders University of South Australia, and Francis is a postgraduate student at Monash University. The contributors include (...) sociologists, literary theorists, geographers and a philosopher. (shrink)

This book provides practical and research-based chapters that offer greater clarity about the particular kinds of teacher reflection that matter and avoids talking about teacher reflection generically, which implies that all kinds of reflection are of equal value.

Many scientists and philosophers of science are troubled by the relative isolation of developmental from evolutionary biology. Reconciling the science of development with the science of heredity preoccupied a minority of biologists for much of the twentieth century, but these efforts were not corporately successful. Mainly in the past fifteen years, however, these previously dispersed integrating programmes have been themselves synthesized and so reinvigorated. Two of these more recent synthesizing endeavours are evolutionary developmental biology and developmental systems theory. While the (...) former is a bourgeoning and scientifically well-respected biological discipline, the same cannot be said of DST, which is virtually unknown among biologists. In this review, we provide overviews of DST and EDB, summarize their key tenets, examine how they relate to one another and to the study of epigenetics, and survey the impact that DST and EDB have had on biological theory and practice. (shrink)

Ethical decision-making frameworks assist in identifying the issues at stake in a particular setting and thinking through, in a methodical manner, the ethical issues that require consideration as well as the values that need to be considered and promoted. Decisions made about the use, sharing, and re-use of big data are complex and laden with values. This paper sets out an Ethics Framework for Big Data in Health and Research developed by a working group convened by the Science, Health and (...) Policy-relevant Ethics in Singapore Initiative. It presents the aim and rationale for this framework supported by the underlying ethical concerns that relate to all health and research contexts. It also describes a set of substantive and procedural values that can be weighed up in addressing these concerns, and a step-by-step process for identifying, considering, and resolving the ethical issues arising from big data uses in health and research. This Framework is subsequently applied in the papers published in this Special Issue. These papers each address one of six domains where big data is currently employed: openness in big data and data repositories, precision medicine and big data, real-world data to generate evidence about healthcare interventions, AI-assisted decision-making in healthcare, public-private partnerships in healthcare and research, and cross-sectoral big data. (shrink)

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

Clinical trials of xenotransplantation (XTx) may begin early in the next decade, with kidneys from genetically modified pigs transplanted into adult humans. If successful, transplanting pig hearts into children with advanced heart failure may be the next step. Typically, clinical trials have a specified end date, and participants are aware of the amount of time they will be in the study. This is not so with XTx. The current ethical consensus is that XTx recipients must consent to lifelong monitoring. While (...) this presents challenges to the right to withdraw in the adult population, additional and unanswered questions also linger in the paediatric population. In paediatric XTx, parents or guardians consent not only to the initial treatment of the child but also to lifelong monitoring, thus making a decision whose consequences will remain present as the child develops the capacity for assent, and finally the capacity for informed consent or refusal. This article presents and evaluates unanswered paediatric ethical questions in regard to the right to withdraw from XTx follow-up in the paediatric population. (shrink)