Whole-genome analysis and whole-exome analysis generate many more clinically actionable findings than traditional targeted genetic analysis. These findings may be relevant to research participants themselves as well as for members of their families. Though researchers performing genomic analyses are likely to find medically significant genetic variations for nearly every research participant, what they will find for any given participant is unpredictable. The ubiquity and diversity of these findings complicate questions about disclosing individual genetic test results. We outline an approach for (...) disclosing a select range of genetic results to the relatives of research participants who have died, developed in response to relatives? requests during a pilot study of large-scale medical genetic sequencing. We also argue that studies that disclose individual research results to participants should, at a minimum, passively disclose individual results to deceased participants? relatives. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

Emerging technologies can have profound conceptual implications. Their emergence frequently calls for the articulation of new concepts, or for modifications and novel applications of concepts that are already entrenched in communication and thought. In this paper, we introduce the notion of “conceptual appropriation” to capture the dynamics between concepts and emerging technologies. By conceptual appropriation, we mean the novel application of a value-laden concept to lay a contestable claim on an underdetermined phenomenon. We illustrate the dynamics of conceptual appropriation by (...) analyzing the concept NATURE and its uptake in three discourses of emerging technology: cellular agriculture, solar geo-engineering, and biomimicry. We argue that NATURE and its cognate NATURALNESS are strongly valanced concepts upon which different stakeholders lay a claim. In doing so, stakeholders advance distinct conceptions of nature, typically to suit their own interests. Our case-studies illustrate how in discourses on emerging technology, the application of value-concepts is entangled with ideological stakes and power dynamics. (shrink)

Scientific endeavor is the pursuit of knowledge with the aim of advancing the welfare of all human beings. This endeavor is built on the ideology of science; thus, society relies on the integrity of the practice of science and of scientists themselves. The responsible conduct of research is the essence of good science; however, many of the pedagogical approaches used to instill integrity in science accentuate the negative rather than exemplify ideal professionalism. This paper makes an argument for the inculcation (...) of the appropriate conduct of research via a positive approach. We address the acclimation to the culture of science that supersedes diverse cultural backgrounds of students. We suggest techniques for the implementation of positive strategies and reinforce the benefit of approaching the teaching of ethical behavior as a competitive advantage. We highlight ways in which this approach can empower the individual scientist and the scientific community as a whole. Transmission of the culture of scientific professionalism formalizes the aims of an ideal scientific professional and encourages assimilation and identification as a member of the scientific profession. We purport that instilling scientific professionalism will spur responsible conduct of research. (shrink)

Different types of consent are used to obtain human biospecimens for future research. This variation has resulted in confusion regarding what research is permitted, inadvertent constraints on future research, and research proceeding without consent. The National Institutes of Health Clinical Center's Department of Bioethics held a workshop to consider the ethical acceptability of addressing these concerns by using broad consent for future research on stored biospecimens. Multiple bioethics scholars, who have written on these issues, discussed the reasons for consent, the (...) range of consent strategies, and gaps in our understanding, and concluded with a proposal for broad initial consent coupled with oversight and, when feasible, ongoing provision of information to donors. This article describes areas of agreement and areas that need more research and dialogue. Given recent proposed changes to the Common Rule, and new guidance regarding storing and sharing data and samples, this is an important and tim.. (shrink)

Lysophosphatidic acid (LPA) is a lipid mediator with a wide variety of biological actions, particularly as an inducer of cell proliferation, migration and survival. LPA binds to specific G‐protein‐coupled receptors and thereby activates multiple signal transduction pathways, including those initiated by the small GTPases Ras, Rho, and Rac. LPA signaling has been implicated in such diverse processes as wound healing, brain development, vascular remodeling and tumor progression. Knowledge of precisely how and where LPA is produced has long proved elusive. Excitingly, (...) it has recently been discovered that LPA is generated from precursors by ‘autotaxin’, a once enigmatic exo‐phosphodiesterase implicated in tumor cell motility. Exogenous phospholipases D can also produce LPA, which may contribute to their toxicity. Here we review recent progress in our understanding of LPA bioactivity, signaling and synthesis. BioEssays 26:870–881, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

According to G. E. Moore, moral expertise requires abilities of several kinds: the ability to factor judgments of right and wrong into (a) judgments of good and bad and (b) judgments of cause and effect, (2) the ability to use intuition to make the requisite judgments of good and bad, and (3) the ability to use empirical investigation to make the requisite judgments of cause and effect. Moore’s conception of moral expertise is thus extremely demanding, but he supplements it with (...) some very simple practical guidance. (shrink)

Accoding to G.E. Moore, something''s intrinsic valuedepends solely on its intrinsic nature. Recently Thomas Hurka andShelly Kagan have argued, contra Moore, that something''s intrinsic valuemay depend on its extrinsic properties. Call this view the ConditionalView of intrinsic value. In this paper I demonstrate how a Mooreancan account for purported counterexamples given by Hurka and Kagan. I thenargue that certain organic unities pose difficulties for the ConditionalView.

Virtue epistemology is among the dominant influences in mainstream epistemology today. An important commitment of one strand of virtue epistemology – responsibilist virtue epistemology (e.g., Montmarquet 1993; Zagzebski 1996; Battaly 2006; Baehr 2011) – is that it must provide regulative normative guidance for good thinking. Recently, a number of virtue epistemologists (most notably Baehr, 2013) have held that virtue epistemology not only can provide regulative normative guidance, but moreover that we should reconceive the primary epistemic aim of all education as (...) the inculcation of the intellectual virtues. Baehr’s picture contrasts with another well-known position – that the primary aim of education is the promotion of critical thinking (Scheffler 1989; Siegel 1988; 1997; 2017). In this paper – that we hold makes a contribution to both philosophy of education and epistemology and, a fortiori, epistemology of education – we challenge this picture. We outline three criteria that any putative aim of education must meet and hold that it is the aim of critical thinking, rather than the aim of instilling intellectual virtue, that best meets these criteria. On this basis, we propose a new challenge for intellectual virtue epistemology, next to the well-known empirically-driven ‘situationist challenge’. What we call the ‘pedagogical challenge’ maintains that the intellectual virtues approach does not have available a suitably effective pedagogy to qualify the acquisition of intellectual virtue as the primary aim of education. This is because the pedagogic model of the intellectual virtues approach (borrowed largely from exemplarist thinking) is not properly action-guiding. Instead, we hold that, without much further development in virtue-based theory, logic and critical thinking must still play the primary role in the epistemology of education. (shrink)

This article argues that Rawlsian liberal political institutions are incapable of ensuring that the basic welfare needs of the worst off are met. This argument consists of two steps. First, I show that institutions are incapable of ensuring that the basic needs of the worst off are met without pursuing certain non-taxation-based courses of action that are designed to alter the work choices of citizens. Second, I argue that such actions are not permissible for Rawlsian institutions. It follows that a (...) state governed by a Rawls-type political conception of justice is parasitic on the willingness of citizens to be sufficiently motivated by concern for the worst off, but it cannot require or even encourage them to be so motivated. (shrink)

Existing regulation of end-of-life care is flawed. Problems include poorly-designed laws, policies, ethical codes, training, and funding programs, which often are neither effective nor helpful in guiding decision-making. This leads to adverse outcomes for patients, families, health professionals, and the health system as a whole. A key factor contributing to the harms of current regulation is a siloed approach to regulating end-of-life care. Existing approaches to regulation, and research into how that regulation could be improved, have tended to focus on (...) a single regulatory instrument (e.g., just law or just ethical codes). As a result, there has been a failure to capture holistically the various forces that guide end-of-life care. This article proposes a response to address this, identifying “regulatory space” theory as a candidate to provide the much-needed holistic insight into improving regulation of end-of-life care. The article concludes with practical implications of this approach for regulators and researchers. (shrink)

The effect of upper bounds on message delivery times in a computer network upon the dynamics of knowledge gain is investigated. Recent work has identified centipedes and brooms—causal structures that combine message chains with time bound information—as necessary conditions for knowledge gain and common knowledge gain, respectively. This paper shows that, under the full-information protocol, these structures are both necessary and sufficient for such epistemic gain. We then apply this analysis to gain insights into the relation between “everyone knows” and (...) common knowledge. We prove a tight threshold on the depth k, beyond which Ek G (everyone in G knows nested to depth k) collapses into CG (common knowledge), when this knowledge concerns the occurrence of a spontaneous event. The threshold depends on the size of the group G of agents, as well as the time that has elapsed since the event of interest occurred. The existence of such a threshold is not guaranteed for all protocols, which is demonstrated here by presenting a counterexample in which no such threshold exists. (shrink)

The Argument from Disagreement (AD) (Mackie, 1977) depends upon empirical evidence for ‘fundamental’ moral disagreement (FMD) (Doris and Stich, 2005; Doris and Plakias, 2008). Research on the Southern ‘culture of honour’ (Nisbett and Cohen, 1996) has been presented as evidence for FMD between Northerners and Southerners within the US. We raise some doubts about the usefulness of such data in settling AD. We offer an alternative based on recent work in moral psychology that targets the potential universality of morally significant (...) distinctions (e.g. means vs. side-effects, actions versus omissions). More specifically, we argue that a recent study showing that a rural Mayan population fails to perceive as morally significant the distinction between actions and omissions provides a plausible case of FMD between Mayans and Westerners. (shrink)

The article distinguishes two models of human organization: the organic community and the atomistic society. It maintains that the organic paradigm stresses (a) the ideal unity of the whole; (b) internal relations; (c) teleological or dialectical processes; (d) co- or inter-dependent members (e. g. the human body or face); (e) a role-orientation; (f) living functions; (g) freedom defined as doing as you should; and (h) qualitative factors prevail. By contrast, the atomistic model emphasizes (a) the value of individual freedom; (b) (...) external relations; (c) mechanical or causal explanations; (d) separate “parts”(e.g. a machine); (e) a rule orientation; (f) formal, legal, or artificial frameworks; (g) freedom defined as doing as you please; and (h) quantitative factors prevail. The article contends that the sense of individual loneliness or alienation experienced is generally much greater in the atomistic society. And since both the American family and its surrounding society are, in the main, atomisticly-structured, it follows that loneliness is more pronounced and prevalent in American society. The article concludes by offering some programmatic ideals and measures to reverse and mitigate the present tendency toward increasing loneliness in the United States. (shrink)

The paper addresses the issue of how indemocratic societies a procedure might be formulatedto facilitate ethical judgements on modernbiotechnologies used in food production. A frameworkfor rational ethical analysis, the Ethical Matrix, isproposed. The Matrix adapts the principles describedby Beauchamp and Childress for application to medicalissues, to interest groups (e.g., producers,consumers, and the biotic environment) affected bythese technologies. The use of the Matrix isillustrated by applying it to an example of a ``novelfood,'' viz., a form of genetically modified maize.

In lieu of an abstract, here is a brief excerpt of the content:The Future of Environmental PhilosophyBen A. Minteer (bio)I think we should be deeply concerned about the future of environmental philosophy. It is the most marginalized of the applied ethics fields (which are often marginalized as a whole within traditional philosophy departments) and with few exceptions, it still has not made significant inroads into neighboring territories—including schools of public policy, natural resources/environment, planning, life sciences, and so on. In my (...) opinion, this is partly due to the general ideological pitch of the field and its narrow methodological orientation, at least historically. The neglect of alternative methods of inquiry, especially qualitative and quantitative work in the social sciences, is particularly troubling.Environmental ethics also has an image problem. In my experience, most natural resource professionals, policy scholars, engineers, and life scientists view our field with considerable skepticism, shaking their heads at what they see as arcane debates that do not touch upon the issues and challenges that motivate their own work. Many of our colleagues in the natural and environmental social sciences, for example, have little patience for the kind of metaethical discussions about intrinsic value, moral pluralism, etc., that have captured much of our attention in the past. They do not see what these kinds of arguments contribute to the scientific, policy, and management curricula, or what they add to their graduate students' training, or to their own research proposals. Typically, if a role for an environmental ethicist is recognized in such settings, it is often just to plug a personnel hole in an National Science Foundation proposal or to serve as a third or fourth reader on a graduate studies committee. Environmental ethics is at best an elective pursuit, it is not seen as essential.I'll be the first to admit that I have blood on my hands here (as do all of us, at least to the extent we have spent time and energy on debates over metaphilosophical issues in the field). And, of course, just because our environmental science and policy colleagues often do not see the true value of the field does not mean that it has no value. Still, I worry that the field seems to be falling into the chasm between traditional philosophy departments and environmental science, policy, and management programs. It is frequently deemed too applied and practical by many [End Page 132] philosophy departments, and too esoteric for schools of public policy, life sciences, and so on. This is not a good situation.How can we fix the image problem? Perhaps one approach would be to develop more solid links with our bioethics cousins (both philosophically and institutionally). There is a revealing story here about the different fortunes of bio- and environmental ethics, and I think we might learn from the success of the former. There will be barriers to such an alliance, however, some of which are intellectual (e.g., the rejection of conventional ethical categories and theories by many environmental ethicists is not shared by most bioethicists) while others are institutional (e.g., What practical shape would a "clinical" model of environmental ethics take? What is the market for this service? and so on).Another route would be to provide more organized and systematic attention to emerging, large-scale environmental science and policy issues—climate change, sustainability, poverty alleviation, and biodiversity loss, to name a few—that are (unfortunately, given their seriousness) viewed as "growth areas" in environmental science and policy studies. At my own institution (Arizona State University) we are moving away from an older departmental and disciplinary model to a more integrative institutional form and a transdisciplinary research culture. So, for example, we have a new school of global studies, a new school of sustainability, and so on. These are composed of a range of disciplines cutting across the natural, technical, and social sciences. There is certainly room in these initiatives and programs for a practical and progressive environmental ethics, but it must be conversant in subjects such as intergenerational equity, conservation science, economic valuation, environmental justice, and the normative dimensions of environmental science policy. I think there is an important role for us to play in these sorts of endeavors (which are popping... (shrink)