Three major trends in American health policy are intersecting in a fascinating way. First, managed care has grown to become the most dominant form of health-care delivery, leading to reductions in health-care costs as insurers are able to influence health-care providers with financial incentives. Second, the present growth of managed care has slowed, almost to a standstill, largely on account of consumers questioning what effects these financial incentives are having on the care of patients — questioning that has been expressed (...) in particular through lawsuits against managed care companies.Third, we are experiencing a renewed interest in the existence of medical error and how it may be reduced as a result of the Institute of Medicine’s report, To Err Is Human: Building a Safer Health System. The most important aspect of this renaissance in error reduction has been its emphasis on health care as a system that can be made better through system-oriented change. The most frustrating aspect is that the IOM did not endorse change in malpractice liability, which consistently puts the impetus for reducing medical error on the individual provider rather than the system as a whole. (shrink)

It is an observed fact that human populations differ in genetic composition. Some of the inherited diversity is due to combined effects of many genes. Although it would be interesting to know the magnitude and nature of the genetic contribution to some characters under polygenic control, such as intelligence or physique, environmental effects may be so great that no genetic analysis is possible—as Thoday has pointed out earlier in this symposium. With other polygenic characters, such as skin colour, the genetic (...) component is more obvious but still difficult to analyse precisely. The number of genes involved, their frequency and dominance have not been established. This is one of the reasons why selective effects on such characters are not readily measured, although they probably exist. (shrink)

Background Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses’ experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. Research aim To analyze frontline U.S. nurses’ experiences of ethics during the COVID-19 pandemic. Research design Qualitative analysis using a directed content (...) methodology. Participants and research context The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. Ethical considerations Participant privacy and data confidentiality were addressed. Findings Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. Discussion This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. Conclusions Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available. (shrink)

Background Healthcare worker retention and burnout are confounding issues. Trust among workers and their employer, that is, organization, is an important yet underexplored concept in research. Research aim The aim of this qualitative study is to explore organizational actions and systems that promote or denigrate trust among registered nurses and patient care aides (aides). Research design The study uses the Model of Psychological Contract as a theoretical framework. Focus groups were conducted to explore the concept of organizational trust and the (...) consequences of broken trust. Participants Registered nurses (RNs) (n=6) and aides (n=6) participated in the study. Six focus groups (three RN and three aide) were conducted, with two participants per group. Focus groups were conducted online. Ethical considerations The study's methods were reviewed by the University of Pittsburgh Institutional Review Board. Findings Among RNs and aides, a sense of trust and feeling valued were important to their sense of relationship with their employers. Trust was breached when resources were scarce, employees did not feel validated and listened to, and problems were not addressed. RNs and aides described feeling devalued when compensation practices were unjust or inequitable, they had limited autonomy, and the employer created an organizational climate where business needs superceded human caring. Consequences of trust breach included burnout, dejection, and feelings of non-belonging. Discussion Tangible organizational resources (compensation and staffing) and intangible resources (value, respect, autonomy) are important to RNs and aides alike. Inability to provide these resources diminishes trust and even causes a sense of betrayal. Conclusion Future research can explore the concepts of organizational justice and interventions to restore lost trust and improve healthcare worker well-being. This is one of only a few identified studies to explore organizational factors and well-being among aides and more research among this healthcare worker population is warranted. (shrink)

_Just Doctoring_ draws the doctor-patient relationship out of the consulting room and into the middle of the legal and political arenas where it more and more frequently appears. Traditionally, medical ethics has focused on the isolated relationship of physician to patient in a setting that has left the physician virtually untouched by market constraints or government regulation. Arguing that changes in health care institutions and legal attention to patient rights have made conventional approaches obsolete, Troyen Brennan points the way (...) to a new, more aware and engaged medical ethics. The medical profession is no longer isolated, even theoretically, from the liberal, market-dominated state. Old ideas of physician beneficence and altruism must make way for a justice-based medical ethics, assuming a relationship between equals more compatible with liberal political philosophy. Brennan offers clinical examples of many of today's most challenging medical problems—from informed consent to care rationing and the repercussions of the HIV epidemic—and gives his recommendation for a new ethical perspective. This lively and controversial plea for a rethinking of medical ethics goes right to the heart of medical care at the end of the twentieth century. (shrink)

Mood disorders, including major depressive disorder and bipolar disorder, are highly prevalent, frequently disabling, and sometimes deadly. Additional research and more effective medications are desperately needed, but clinical trials research in mood disorders is fraught with ethical issues. Although many authors have discussed these issues, most do so from a theoretical viewpoint. This manuscript uses available empirical data to inform a discussion of the primary ethical issues raised in mood disorders research. These include issues of consent and decision-making capacity, including (...) patients’ motivations for participating in research. We also address drug withdrawals, placebo controls, and the overall safety of research. Finally, we examine the extant literature for studies discussing potential indirect benefits of clinical trials research to participants. Taken together, the evidence suggests that clinical trials research incorporating drug withdrawals and placebo controls can be conducted safely and ethically, even in patients with severe or treatment-resistant mood disorders. In fact, given the dearth of effective treatment options for this population, it is our opinion that a moral imperative exists to extend the offer of research participation to severely ill or treatment-resistant groups. (shrink)

Horizontal gene transfer (HGT) is a major mechanism responsible for the spread of antibiotic resistance. Conversely, it is often assumed that antibiotics promote HGT. Careful dissection of the literature, however, suggests a lack of conclusive evidence supporting this notion in general. This is largely due to the lack of well‐defined quantitative experiments to address this question in an unambiguous manner. In this review, we discuss the extent to which HGT is responsible for the spread of antibiotic resistance and examine what (...) is known about the effect of antibiotics on the HGT dynamics. We focus on conjugation, which is the dominant mode of HGT responsible for spreading antibiotic resistance on the global scale. Our analysis reveals a need to design experiments to quantify HGT in such a way to facilitate rigorous data interpretation. Such measurements are critical for developing novel strategies to combat resistance spread through HGT. -/- . (shrink)

In this unique volume, some of today's most eminent political philosophers examine the thought of John Rawls, focusing in particular on his most recent work. These original essays explore diverse issues, including the problem of pluralism, the relationship between constitutive commitment and liberal institutions, just treatment of dissident minorities, the constitutional implications of liberalism, international relations, and the structure of international law. The first comprehensive study of Rawls's recent work, The Idea of Political Liberalism will be indispensable for political philosophers (...) and theorists interested in contemporary political thought. (shrink)

Book reviewed in this article: Just Doctoring: Medical Ethics in the Liberal State. By Troyen A. Brennan. The Ends of Human Life: Medical Ethics in a Liberal Polity. By Ezekiel J. Emanuel.

Training in the responsible conduct of research (RCR) is required for many research trainees nationwide, but little is known about its effectiveness. For a preliminary assessment of the effectiveness of a short-term course in RCR, medical students participating in an NIH-funded summer research program at the University of California, San Diego (UCSD) were surveyed using an instrument developed through focus group discussions. In the summer of 2003, surveys were administered before and after a short-term RCR course, as well as to (...) alumni of the courses given in the summers of 2002 and 2001. Survey responses were analyzed in the areas of knowledge, ethical decision-making skills, attitudes about responsible conduct of research, and frequency of discussions about RCR outside of class. The only statistically significant improvement associated with the course was an increase in knowledge, while there was a non-significant tendency toward improvements in ethical decision-making skills and attitudes about the importance of RCR training. The nominal impact of a short-term training course should not be surprising, but it does raise the possibility that other options for delivering information only, such as an Internet-based tutorial, might be considered as comparable alternatives when longer courses are not possible. (shrink)

We examine how the shift to remote work altered responsibilities for domestic labor among partnered couples and single parents. The study draws on data from a nationally representative survey of 2,200 US adults, including 478 partnered parents and 151 single parents, in April 2020. The closing of schools and child care centers significantly increased demands on working parents in the United States, and in many circumstances reinforced an unequal domestic division of labor.

Michael A. Petersa and Fazal Rizvib aBeijing Normal University, Beijing, PR China; bMelbourne University, Melbourne, Australia Our minds are still racing back and forth, longing for a return to ‘no...

Spatial localization, often demarcated by food miles, has emerged as the dominant theme in movements for more socially just and environmentally benign alternative food systems, especially in industrialized countries such as the United States. We analyze how an emphasis on spatial localization, combined with the difficulty of defining and measuring adequate indicators for alternative food systems, can challenge efforts by food system researchers, environmental writers, the engaged public, and advocacy groups wanting to contribute to alternative food systems, and facilitates exploitation (...) by the mainstream players using “localwash” to maintain the status quo. New indicators are urgently needed because research shows that spatial localization in general and minimized food miles in particular are not adequate or even required for most of the goals of alternative food systems. Creating indicators to operationalize goals for alternative, local food systems requires asking the right questions to make sure indicators are not misleading us: What are the goals of alternative food systems? What actions and policies will most effectively achieve those goals? What is the potential of reducing food miles as an action and a policy for achieving goals? What are the best indicators for measuring progress toward goals? We discuss how these questions can be answered for a wide range of alternative food system goals via four categories according to the role of food miles reduction as an action and policy in promoting them: necessary and sufficient, necessary but not sufficient, potentially important, and potentially supportive. (shrink)

In 2022, students at North American universities with third-dose COVID-19 vaccine mandates risk disenrolment if unvaccinated. To assess the appropriateness of booster mandates in this age group, we combine empirical risk-benefit assessment and ethical analysis. To prevent one COVID-19 hospitalisation over a 6-month period, we estimate that 31 207–42 836 young adults aged 18–29 years must receive a third mRNA vaccine. Booster mandates in young adults are expected to cause a net harm: per COVID-19 hospitalisation prevented, we anticipate at least (...) 18.5 serious adverse events from mRNA vaccines, including 1.5–4.6 booster-associated myopericarditis cases in males (typically requiring hospitalisation). We also anticipate 1430–4626 cases of grade ≥3 reactogenicity interfering with daily activities (although typically not requiring hospitalisation). University booster mandates are unethical because they: (1) are not based on an updated (Omicron era) stratified risk-benefit assessment for this age group; (2) may result in a net harm to healthy young adults; (3) are not proportionate: expected harms are not outweighed by public health benefits given modest and transient effectiveness of vaccines against transmission; (4) violate the reciprocity principle because serious vaccine-related harms are not reliably compensated due to gaps in vaccine injury schemes; and (5) may result in wider social harms. We consider counterarguments including efforts to increase safety on campus but find these are fraught with limitations and little scientific support. Finally, we discuss the policy relevance of our analysis for primary series COVID-19 vaccine mandates. (shrink)

The inclusion of engineering standards in US science education standards is potentially important because of how limited engineering education for K-12 learners is, despite the ubiquity of engineering in students’ lives. However, the majority of learners experience science education throughout their compulsory schooling. If improved engineering literacy is to be achieved, then its inclusion in science curricula is perhaps the most efficient means. One significant challenge that arises, however, is in the framing of engineering relative to science by both teachers (...) and curriculum. Science and engineering are both distinct and interdependent. The nature of the contributions of science and engineering to one another has been an area of some examination in philosophy of technology and engineering, but little framing of this relationship has been conducted with K-12 science and engineering education contexts in mind. Nature of science is a critical layer of scientific understanding that has been used to explicitly support literacy in K-16 science classrooms for decades. However, engineering cannot be authentically and appropriately supported by NOS framing. There is an immediate need for discourse on the nature of engineering knowledge but not in isolation of NOS. Given the increasing inclusion of engineering in science classrooms, relationships between NOS and NOEK are in need of explication and argument. Our purpose is to promote a discussion about NOS, engineering, and the relationship between them without misrepresenting engineering as a subdomain of science or as an oversimplification of itself. (shrink)

Parfit argues that survival, Not identity, Is the important thing in cases of personal resurrection, Fission, Etc. I argue that parfit's and dennett's well known cases--And fantasies about cloning and telecloning--Suggest a distinction between type and token persons, Memories, Intentions, Etc. Parfit is wrong, I suggest, To think survival more determinate than identity; with quine I hold that there is no objective matter to be right or wrong about.

Work on dispositions focuses chiefly on dispositions that are manifested in dynamic causal processes. Williams, Neil. 2005. “Static and Dynamic Dispositions.” Synthese 146: 303–24 has argued that the focus on dynamic dispositions has been at the expense of a richer ontology of dispositions. He contends that we ought to distinguish between dynamic and static dispositions. The manifestation of a dynamic disposition involves some change in the world. The manifestation of a static disposition does not involve any change in the world. (...) In this paper, we concede that making a conceptual distinction between dynamic and static dispositions is useful and we allow that we can truthfully represent objects as manifesting static dispositions. However, we argue that the distinction is not ontologically deep. Rather, the truthmakers for our representations of static dispositions are actually dynamic dispositions to whose manifestations we may fail to be sensitive. (shrink)

Pickering & Garrod's (P&G's) call to study language processing in dialogue context is an appealing one. Their interactive alignment model is ambitious, aiming to explain the converging behavior of dialogue partners via both intra- and interpersonal priming. However, they ignore the flexible, partner-specific processing demonstrated by some recent dialogue studies. We discuss implications of these data.

_Just Doctoring_ draws the doctor-patient relationship out of the consulting room and into the middle of the legal and political arenas where it more and more frequently appears. Traditionally, medical ethics has focused on the isolated relationship of physician to patient in a setting that has left the physician virtually untouched by market constraints or government regulation. Arguing that changes in health care institutions and legal attention to patient rights have made conventional approaches obsolete, Troyen Brennan points the way (...) to a new, more aware and engaged medical ethics. The medical profession is no longer isolated, even theoretically, from the liberal, market-dominated state. Old ideas of physician beneficence and altruism must make way for a justice-based medical ethics, assuming a relationship between equals more compatible with liberal political philosophy. Brennan offers clinical examples of many of today's most challenging medical problems—from informed consent to care rationing and the repercussions of the HIV epidemic—and gives his recommendation for a new ethical perspective. This lively and controversial plea for a rethinking of medical ethics goes right to the heart of medical care at the end of the twentieth century. (shrink)

History and Systems of Psychology provides an engaging introduction to the rich story of psychology's past. Retaining the clarity and accessibility praised by readers of earlier editions, this classic textbook provides a chronological history of psychology from the pre-Socratic Greeks to contemporary systems, research, and applications. The new edition also features expanded coverage of Eastern as well as Western traditions, influential women in psychology, professional psychology in clinical, educational, and social settings, and new directions in twenty-first century psychology as a (...) cognitive and a positive science. Assuming little prerequisite knowledge, the authors discuss the people, places, and concepts that have shaped psychology's story, and show that we remain fascinated by the same enduring questions that confronted our ancestors - namely, our wonder at our subjectivity and consciousness of self. The seventh edition is fully supported by robust pedagogical features, instructor resources, and a companion website to aid student learning. (shrink)

Hobbits and hooligans -- Ignorant, irrational, misinformed nationalists -- Political participation corrupts -- Politics doesn't empower you or me -- Politics is not a poem -- The right to competent government -- Is democracy competent? -- The rule of the knowers -- Civic enemies.

The last fifteen years have seen an increasing social science scholarship into the nature and pervasiveness of hooking up amongst college students,1 but research on the philosophical and ethical issues within hookup culture and practice has not kept pace. To the extent that hooking up has been taken up by philosophers, it has been as part of a larger conversation about the ethics of casual sex, broadly construed; a conversation which is dominated by questions of objectification. As such, investigations into (...) the ethics of hookup sex have been limited to questions of whether someone was used in the encounter.2 This essay aims to change this by utilizing Ann Cahill’s recent book, Overcoming Objectification, to argue that the ethical problems with hookup sex in Guyland are not rooted in women’s objectification but rather their derivatization. (shrink)

Many opponents of BIG programs believe that receiving guaranteed subsistence income would act as a strong disincentive to work. In contrast, various areas of empirical research in psychology suggest that a BIG would not lead to meaningful reductions in work. To test these competing predictions, a comprehensive review of BIG outcome studies reporting data on adult labor responses was conducted. The results indicate that 93 % of reported outcomes support the prediction of no meaningful work reductions when the criterion for (...) support is set at less than a 5 % decrease in either average hours worked per week or the rate of labor participation. Overall, these results indicate that adult labor responses would show no substantial impact following a BIG intervention. (shrink)

The purpose of our article is to describe the initial development process of the subordinate influence ethics (SIE) measure, an instrument that was crossculturally conceived, designed, and validity tested to measure upward influence ethics strategies of professional subordinates across different societies, as well as within a single society. Development of the SIE began by defining the SIE constructs through theoretical review and empirical (nominal group technique) assessments in Germany, France, Hong Kong, and the U. S. In the present measurement development (...) phase, the SIE has been found to consist of three distinct dimensions: pro-organizational behaviors, self-serving behaviors, and maliciously intended behaviors. The construct validity of the SIE was examined across 4113 subjects from 30 countries. A reduced model of the SIE was developed empirically to represent the "best model" for the three-factor scale. (shrink)

Allison Trowbridge harnesses the power of story in a series of letters to an imagined young woman wrestling with the questions that arise as she stands on the precipice of adulthood.

The American Institute of Certified Public Accountants (AICPA) is responsible for the Code of Professional Conduct that governs the actions of CPAs. In 1988, the Code was revised by the AICPA, but a number of issues still remain unresolved or confounded by the new Code. These issues are examined in light of the profession''s stated commitment to the public good, a commitment that is discussed at length in the new Code.Specifically, this paper reviews the following issues: (1) client confidentiality and (...) whistleblowing, (2) limited liability, and (3) auditor independence. We argue that, in each of these areas, the AICPA promotes a position that is potentially harmful to the public good. (shrink)

Christians, Allison, Benoît-Guay, Nicolas.

This exploratory study assessed the use of functional Near Infrared Spectroscopy (fNIRS) to examine hemodynamic response patterns during sentence processing. Four groups of participants: monolingual English children, bilingual Chinese-English children, bilingual Chinese-English adults and monolingual English adults were given an agent selection syntactic processing task. Bilingual child participants were classified as simultaneous or sequential bilinguals to examine the impact of first language, age of second-language acquisition (AoL2A), and the length of second language experience on behavioral performance and cortical activation. Participants (...) were asked to select the agent of four types of sentences: subject-verb-object (SVO), passive (PAS), subject-extracted relative clause (SR), and object-extracted relative clause (OR) adopted from the “Whatdunit” task by Montgomery et al. (2016). Semantic cues were removed by using inanimate nouns for agents and patients, which constrained participants to make decisions based on syntactic knowledge. Behavioral results showed greater accuracy for canonical SVO and SR sentence types than for noncanonical OR and PAS sentence types, which aligns with prior studies. Neuroimaging results revealed greater hemodynamic responses to relative clauses (i.e., SR and OR sentences) than to simple sentences (SVO and PAS), especially for Chinese-English bilinguals suggesting first-language transfer influencing sentence processing in English. The effects AoL2A and the length of second language experience showed no significant differences between simultaneous and sequential bilinguals or between bilingual adults and children for identifying the correct agent in each sentence. However, neuroimaging results demonstrated greater hemodynamic responses in right dorsolateral prefrontal cortex (DLPFC) and left inferior parietal lobule (IPL) in simultaneous bilinguals compared to sequential bilinguals and greater hemodynamic responses in left and right DLPFC and left IPL among bilingual adults. Different behavioral and neural hemodynamic response patterns afford new insights into the effects of syntactic knowledge on sentence processing. (shrink)