This article on the potential for patient online records access (ORA) to increase the likelihood of nocebo effects is timely, 1 given the recent introduction of full prospective records access for primary care patients in England. 2 Blease provides a convincing overview of the evidence for the nocebo effect and examines the complex interplay with health inequities. The article proposes two mechanisms for ORA augmenting nocebo effects through: (A) patients reading about possible negative outcomes of treatments and (B) a negative (...) clinician tone or less supportive content in the notes diminishing patient trust and setting up negative expectations. Blease notes a small percentage of those who had used ORA at least once during the previous year in one study reported feeling more worried about their medications, 3 and that those with mental health diagnoses were significantly more prone to this than those without such diagnoses.shrink)

Socially responsible publishers, such as the BMJ Publishing Group, have demonstrated a commitment to health equity and working towards rectifying the structural racism that exists both in healthcare and in medical publishing.1 The commitment of academic publishers to collecting information relevant to promoting equity and diversity is important and commendable where it leads to that result.2 However, collecting sensitive demographic data is not a morally neutral activity. Rather, it carries with it both known and potential risks. Among these are issues (...) around privacy or data misuse, as well as more basic concerns about how, when or why people should be categorised in certain ways and/or prompted to conceive of themselves or their identities in certain terms.3 If such data are to be collected, therefore, their effectiveness in achieving the stated ends must have a sufficiently compelling evidence base so as to justify the various risks involved. And where possible, these risks must also be identified and minimised. As Varcoe et al 4 argue, > While most leaders and healthcare workers and some patients [in their study] envisioned potential benefits associated with having ethnicity data, these benefits were seen as largely contingent upon action being taken to [actually] ameliorate inequities. Overwhelmingly, however, leaders from ethno-cultural communities and patients of diverse identities anticipated potential harm arising both from having ethnicity data and the process of collection. The analysis illustrates that in today’s sociopolitical context, collecting ethnicity data in clinical contexts may engender considerable harm, particularly for racialized, vulnerable patients. (p1569) Varcoe et al refer to ‘ethnicity’ data, which as they note is an ambiguous concept, potentially encompassing such diverse notions as ancestry, language, religion or culture. It is also a term that is in some contexts—for example, the USA—often used interchangeably with a different, more highly charged term: ‘race’. Data …. (shrink)

Generative AI programs can produce high-quality written and visual content that may be used for good or ill. We argue that a credit–blame asymmetry arises for assigning responsibility for these outputs and discuss urgent ethical and policy implications focused on large-scale language models.

Since their public launch, a little over a year ago, large language models (LLMs) have inspired a flurry of analysis about what their implications might be for medical ethics, and for society more broadly. 1 Much of the recent debate has moved beyond categorical evaluations of the permissibility or impermissibility of LLM use in different general contexts (eg, at work or school), to more fine-grained discussions of the criteria that should govern their appropriate use in specific domains or towards certain (...) ends. 2 With each passing week, it seems more and more inevitable that LLMs will be a pervasive feature of many, if not most, of our lives. It would not be possible—and would not be desirable—to prohibit them across the board. We need to learn how to live with LLMs; to identify and mitigate the risks they pose to us, to our fellow creatures, and the... (shrink)

The COVID-19 pandemic will generate vexing ethical issues for the foreseeable future and many journals will be open to content that is relevant to our collective effort to meet this challenge. While the pandemic is clearly the critical issue of the moment, it’s important that other issues in medical ethics continue to be addressed as well. As can be seen in this issue, the Journal of Medical Ethics will uphold its commitment to publishing high quality papers on the full array (...) of medical ethics. At the same time, JME aims to be a premiere home for ground-breaking scholarship on the ethical issues raised by COVID-19. Toward this end, we have a number of papers that are freely available online and for which production has been fast-tracked.1–5 A challenge for authors who want to write about the pandemic is the rapidly evolving nature of the situation and the time it takes for journal content to be reviewed and published, even when fast-tracked. For that reason, all authors who would like to submit a paper on the pandemic can also submit a post to the JME blog prior to submitting a full paper to the journal. Those interested in writing for the JME blog should contact one of its editors, Hazem Zohny or Mike King. Over the last 3 weeks, 30 high-quality commentaries on the pandemic have been posted to the blog. These posts are circulated widely via the JME Twitter and Facebook feeds and have stimulated significant …. (shrink)

The editors of the _Journal of Medical Ethics_ support the call of the UK Health Alliance on Climate for urgent action to ensure that the current Conference of the Parties to the United Nations Framework Convention on Climate Change ‘finally delivers climate justice for Africa and vulnerable countries’. 1 As they note ‘Africa has suffered disproportionately although it has done little to cause the crisis’. The burden of climate change has thus far fallen disproportionately on Global South countries. The monsoon (...) in Pakistan this year killed over 1100 people and the public health implications of the flooding might affect the health of over 5 million people. 2 The South Asian monsoon impacts the lives of a billion people and the flooding associated with wet seasons is likely to occur eight times more frequently in future years than at present. 3 For many pacific islands such as Kiribati,... (shrink)

Nursing programs are complex systems that articulate values of relationality and holism, while developing curriculums that privilege metric‐driven competency‐based pedagogies. This study used an interpretive approach to analyze interviews from 20 nursing students at two Canadian Baccalaureate programs to understand how nursing's educational context, including its hidden curriculums, impacted student writing activities. We viewed this qualitative data through the lens of activity theory. Students spoke about navigating a rigid writing context. This resulted in a hyper‐focus on “figuring out” the teacher (...) with minimal focus on the act of writing. Students used a form of behavioral “code‐switching” to maximize their grade while considering how their “valuing” of the assignment fit within their writing motives. Hidden curriculum messages taught students that academic success was assured whether their writing mirrored instructor preferences. Instructional practices of rigidity reinforced unequal social conditions for some minority students. Faculty can counteract the impact of the hidden curriculum through encouragement of choice and independent thinking about writing activities. Acknowledging power relationships and their influence on how students navigate writing assignments and nursing discourse may relieve pressures on students who fear penalties for countering norms and result in a more flexible learning environment. (shrink)

This Paper suggests that the answer to the question “what is domestic labor law for?”—commonly regarded as securing “justice against markets” or a justified tax on market activity—has informed the search for the answer for the question “what is international labor law for.” This is reflected in what this Paper refers to as P2, which provides that “the failure of any country to adopt humane conditions of labor is an obstacle in the way of other nations which desire to improve (...) the conditions in their own countries.” P2 envisions a “race to the bottom” by rational states trapped in a Prisoner’s Dilemma game. The author maintains that this cannot be the objective of ILO which cannot stop “the race” given its deficient enforcement mechanisms to ensure compliance. This Paper suggests an alternative raison d’etre for the ILO, which is called P1, namely social justice: “universal peace can only be established if it is based upon social justice.” P1 reflects what states actually seek to achieve. Following Sen, this Paper suggests that there is no tradeoff between social justice and economic efficiency. Therefore the promotion of labor rights by the ILO will contribute both to social justice and to economic success. Thus the ILO should promote international labor law so as to lead member states to pursue their self-interest which is consistent with the collective goal of humanity. (shrink)

Within the context of Carruthers’ general analysis of the relation between language and thought, I present a specific hypothesis about how grammar uses perspective flow to unify disparate cognitions. This perspective hypothesis allows us to understand the neolithic burst in creativity as a cultural advance in methods for knitting together thoughts.

In this article, I suggest that post‐modernism is in essence a return, under radically different circumstances and with a cultural inheritance from the modernist era , to a kind of medievalism. The view that the ‘trend of our times’ is towards a ‘post‐modern medievalism’ is based mainly upon a consideration of the decline of the nation‐state, the replacement of ‘absolute’ with a kind of ‘moderated’ national sovereignty and the fact that the nations and regional assemblies of Europe are beginning to (...) look increasingly like the duchies and baronies of feudal Europe. (shrink)

The article describes the nature of a faceted classification, and its application in document retrieval. The kinds of facet used are illustrated. Procedures are then discussed for identifying facets in a subject field, populating the facets with individual subject terms, arranging these in helpful sequences, using the scheme to classify documents, and searching the resultant classified index, with particular reference to Internet search.

Trading on non-public material information is fertile ground for a discussion of ethical behavior. The long-running legal tug-of-war over what constitutes illegal insider trading delivers challenges to regulatory authorities charged with detecting and enforcing the law, and is likely one of the reasons that prosecution of insider trading events remains rather uncommon. One can observe both increased volume in the equity and option markets and run-ups in the stock price prior to the announcement of the acquisitions; however, the detection of (...) illegal or unethical insider trading can be difficult. Given the legal uncertainty around insider trading and the circumstantial evidence from the trading activity, it is almost impossible to identify unethical insider trades unless there is a whistleblower or trades are large in size and impeccable in timing. Using call option trading around two merger announcements with similar firms that resulted in different ultimate treatment from the SEC, we illustrate the struggle regulators and prosecutors have with identifying and enforcing unethical insider trades. (shrink)

This chapter contains sections titled: Why Do We Climb? Why Should We Climb? Building the Best Person Climbing and Self‐Cultivation The Only Rule Is There Are No Rules (Except the Ones That Matter) Courage Humility Reverence for the Natural World Cultivating Virtue in a Domesticated World Why Climb? Notes.

Is critical disinterestedness possible? Or, is it, for that matter, even desirable? These are the major questions that hover above this essay - large questions which we face at the outset. For the moment we need to establish, first, what might be meant by 'disinterestedness'. For those whose major business is with the English literary tradition, the first name that will unfailingly come to mind when the term is mentioned is that of Matthew Arnold. The word 'disinterestedness' famously occurs in (...) what remains one of the most widely read of Arnold's critical essays, 'The Function of Criticism at the Present Time'. Arnold pauses to ask, what rule ought to condition the activity of English criticism? His answer is as follows: The rule may be summed up in one word - disinterestedness. And how is criticism to show disinterestedness? By keeping aloof from what is called 'the practical view of things'; by resolutely following the law of its own nature, which is to be a free play of the mind on all subjects which it touches. (shrink)