Little is known about how people living with HIV should be engaged in the decision-making process for returning individual pharmacogenomic research results. This study explored the role people living with HIV want to play in making decisions about whether and how individual results of pharmacogenomic research should be presented to them. A convergent parallel mixed methods study was conducted, comprising a survey of 221 research participants and five deliberative focus group discussions with 30 purposively selected research participants. Most participants (122, (...) 55.2%) preferred the collaborative role, 67 (30.3%) preferred the active role and 32 (14.5%) preferred the passive role. Factors that significantly influenced preference for an active role compared with a collaborative role were marital status (OR: 0.282, p = 0.013), research experience (OR: 4.37, p = 0.028), and religion (OR: 2.346, p = 0.041). The reasons proffered for the active role included prior experience with antiretroviral treatment and increased exposure to research activities. The reasons given for preferring the passive role included limited level of awareness about the interaction between patients’ genes and drugs, trust in researchers to make the right decision, and fear of making decisions with harmful implications. Overall, findings from our study show that participants want to be engaged in the decision-making process. Research teams ought to provide adequate and simple information about the pharmacogenomic research and implications of the results to support participants’ informed decisions. (shrink)

The enhancement debate in neuroscience and biomedical ethics tends to focus on the augmentation of certain capacities or functions: memory, learning, attention, and the like. Typically, the point of contention is whether these augmentative enhancements should be considered permissible for individuals with no particular “medical” disadvantage along any of the dimensions of interest. Less frequently addressed in the literature, however, is the fact that sometimes the _diminishment_ of a capacity or function, under the right set of circumstances, could plausibly contribute (...) to an individual's overall well-being: more is not always better, and sometimes less is more. Such cases may be especially likely, we suggest, when trade-offs in our modern environment have shifted since the environment of evolutionary adaptation. In this article, we introduce the notion of “diminishment as enhancement” and go on to defend a _welfarist_ conception of enhancement. We show how this conception resolves a number of definitional ambiguities in the enhancement literature, and we suggest that it can provide a useful framework for thinking about the use of emerging neurotechnologies to promote human flourishing. (shrink)

In this chapter Alessandro Capone’s claim as the intimate relationship between legal reasoning and indirect reports is investigated through looking at legal citation practices, use of case law, and statutory and constitutional interpretation. Capone’s thought is informed in the chapter through a reference to the work of Ronald Dworkin and Edward H. Levi. The conclusion of the chapter is that Capone is correct that use of indirect reporting in law is ubiquitous and therefore warrants careful study. Further, and opposite of (...) Dworkin’s hope for a univocal use of indirect reports, Levi’s analysis emphasizes the bottom-up, conversational and polyvocal aspects of legal reasoning as is noted by Capone. This in turn requires eliminating the hope for finding or imposing a determinate and univocal meaning on legal citation, case law, and statutory and constitutional interpretation. Instead, continuing dialogue is required. Indeed, legal process should try to include as many voices in the construction of meaning as possible. (shrink)

The paper offers a partial, broad-stroke sketch of visual perception, and argues that certain kinds of normal visual misperceptions are systematic and widespread.

A counterpossible is a counterfactual whose antecedent is impossible. The vacuity thesis says all counterpossibles are true solely because their antecedents are impossible. Recently, some have rejected the vacuity thesis by citing purported non-vacuous counterpossibles in science. One limitation of this work, however, is that it is not grounded in experimental data. Do scientists actually reason non-vacuously about counterpossibles? If so, what is their basis for doing so? We presented biologists (N = 86) with two counterfactual formulations of a well-known (...) model in biology, the antecedents of which contain what many philosophers would characterize as a metaphysical impossibility. Participants consistently judged one counterfactual to be true, the other to be false, and they explained that they formed these judgments based on what they perceived to be the mathematical relationship between the antecedent and consequent. Moreover, we found no relationship between participants’ judgments about the (im)possibility of the antecedent and whether they judged a counterfactual to be true or false. These are the first experimental results on counterpossibles in science with which we are familiar. We present a modal semantics that can capture these judgments, and we deal with a host of potential objections that a defender of the vacuity thesis might make. (shrink)

While top-down descriptors have received much attention in explaining corruption, we develop a grassroots model to describe structural factors that may influence the emergence and spread of an individual’s (un)ethical behavior within organizations. We begin with a discussion of the economics justification of the benefits of competition, a rationale used by firms to adopt structural aides such as the ‹stacking’ practice that was implemented at Enron. We discuss and develop an individual-level theory of planned behavior, then extend it to the (...) dyadic level in an internally competitive organization, and finally extend the dyadic model to the social network. We apply social network theory to predict favorable and unfavorable conditions for the emergence and diffusion of an intraorganizational instance of unethical behavior and find that network conditions favoring the suppression of the emergence of unethical behavior also promote its diffusion. For illustrative purposes, we utilize examples from Enron’s internally competitive structure to embed our arguments in a real world context and bring reality to our theorizing. Implications for both researchers and managers are discussed. (shrink)

Male circumcision—partial or total removal of the penile prepuce—has been proposed as a public health measure in Sub-Saharan Africa, based on the results of three randomized control trials showing a relative risk reduction of approximately 60 per cent for voluntary, adult male circumcision against female-to-male human immunodeficiency virus transmission in that context. More recently, long-time advocates of infant male circumcision have argued that these findings justify involuntary circumcision of babies and children in dissimilar public health environments, such as the USA, (...) Australasia and Europe. In this article, we take a close look at the necessary ethical and empirical steps that would be needed to bridge the gap between the African RCTs and responsible public health policy in developed countries. In the course of doing so, we discuss some of the main disagreements about the moral permissibility of performing a nontherapeutic surgery on a child to benefit potential future sexual partners of his. In this context, we raise concerns not only about weaknesses in the available evidence concerning such claims of benefit, but also about a child’s moral interest in future autonomy and the preservation of his bodily integrity. We conclude that circumcision of minors in developed countries on public health grounds is much harder to justify than proponents of the surgery suggest. (shrink)

The primary objective of this article is to detail how two teachers in the same school site, in the American Southeast, taught war to the children of soldiers. Taken from an extensive qualitative case study involving eight teachers, this article examines the pedagogies engaged in by two teachers who expressed a desire to teach war more critically to their students. Critically here means but is not exclusive to raising student consciousness to issues of war not typically taught including investigating how (...) power, race, gender, and sex operate in war, more closely examining decisions evaluating them for their justness or unjustness. In short a more authentic exploration of war. One teacher engaged a pedagogy of tension the other a pedagogy of facts. Both resulted in a less than critical examination of war. A pedagogy of tension reflected this teacher's reaction to pressure from the community and fear of surfacing or inflicting trauma upon students. A pedagogy of facts reflected the second teachers’ beliefs that focusing teaching on facts will allow her to teach a more critical rendition of war. A qualitative empirical study, data was collected through interview and classroom observation. (shrink)

As the author ofJustice as Impartiality, I am not ashamed to admit that I was delighted by the liveliness of the discussion generated by it at the meeting on which this symposium is based. I am likewise grateful to the six authors for finding the book worthy of the careful attention that they have bestowed on it. Between them, the symposiasts take up many more points than I can cover in this response. I shall therefore focus on some themes that (...) cluster round the contractual device that I associate with the notion of justice as impartiality. Is it necessary? If it is not necessary is it nevertheless useful? Within an overall contractual framework is the form of contract that I propose uniquely justifiable? And does the form of contract that I defend generate the implications that I claim for it? (shrink)

The Life and World of... biographies tell the life-story of key people from history - the part they played in shaping events, and how their lives touched other people.

Adolescents present a puzzle. There are foundational unclarities about how they should be regarded as decision-makers. Although superficially adolescents may appear to have mature decisional capacity, their decision-making is in many ways unlike that of adults. Despite this seemingly obvious fact, a concern for the claims of autonomy has led to the development of the legal doctrine of the mature minor. This legal construct considers adolescents, as far as possible, as equivalent to adults for the purpose of medical decision-making. The (...) movement to support independent decision-making by adolescents through providing information to them and securing their consent apart from their parents is encouraged by those legal understandings that hold that unemancipated minors should generally be considered as possessing effective decisional capacity. Such legal structures, however, do not adequately take account of the wide variations in adolescent capacities, the immaturity of most adolescent decision-makers, or the important contributions made by parents to the development of their adolescents through parental partnering in the adolescent’s decision-making. The data available indicate that in general adolescents should be regarded as apprentice decision-makers who should make decisions in collaboration with their parents until at least the age of 18. Steps should not be taken pre-emptively to isolate adolescents from the guidance of their parents. As a general rule, what Piker has referred to as “collaborative paternalism” appears most likely both to protect adolescents from their own untoward choices, while also very importantly helping them with parental guidance to develop into mature decision-makers with the capacity to make medical choices on their own. (shrink)

The values which are definitive of the humanist project, such as freedom and self-determination, are of central concern to environmentalism. This means, according to Lewis P. Hinchman, that environmentalists should seek a rapprochement with humanism, rather than rejecting it for its apparent anthropocentrism. He argues that this requires in turn the acceptance of those approaches to human self-understanding which are central to the hermeneutic traditions and the rejection of naturalist approaches, such as sociobiology, which is accused of producing deterministic, reifying, (...) reductionist, dehumanising forms of understanding of human beings and human life. This paper seeks to show that sociobiology does not pose the kinds of threat to humanism and environmentalism outlined by Hinchman. (shrink)

In the philosophy of action, it is generally understood that action presupposes an agent performing or guiding the action. Action is also generally understood as distinct form the kind of motion that happens in nature. Together these common perspectives on action rule out both action without agency and natural action. And yet, there are times when action can seem qualitatively both natural and lacking a sense of agency. Recently, David Velleman, referring to work by Mihaly Csikszentmihalyi and Zhuangzi, has considered (...) the possibility of agency without agency. In this chapter, I build on Velleman's work and posit the notion of self-organization (which in the natural sciences serves as the basis for many familiar kinds of motion in nature) to also serve as the basis for human behavior. If action is a variety of behavior, conceiving of human behavior as fundamentally an instance of self-organization unifies human action with nature from the beginning and allows us to conceptualize the possibility of human action without presupposing the necessity of agency. I go on to entertain three types of human behavior in which the sense of agency is significantly absent and which progressively qualify as action. (shrink)

The opening sentence of Christopher Meyers’ Target Article is “Lying to one’s patient is wrong”. The author continues, “This truism is one that bioethicists have heartedly endorsed fo...

In this chapter, I argue that in addition to the generally accepted aim of reducing traffic-related injuries and deaths as much as possible, a principle of fairness in the distribution of risk should inform our thinking about how firms that produce autonomous vehicles ought to program them to respond in conflict situations involving human-driven vehicles. This principle, I claim, rules out programming autonomous vehicles to systematically prioritize the interests of their occupants over those of the occupants of other vehicles, including (...) human-driven vehicles. Because there is reason to think that most consumers would prefer to purchase autonomous vehicles that do systematically prioritize the interests of occupants over those of others, if my argument is correct it generates a substantial ethical restriction on firms’ efforts to gain market share in the initial stages of the introduction of autonomous vehicles onto the road. (shrink)

This article draws from theories of business-government relations and Austrian economics to develop a model relating firm performance to the firm’s market and nonmarket actions. Nonmarket actions represent one mechanism for the implementation of firm strategies. The model is tested using an original data set covering airlines serving international routes in the North Atlantic region. Results suggest that nonmarket actions have a positive and significant impact on performance, measured in three ways: profits, market share, and capacity utilization.

Moral and legal notions engaged in clinical ethics should not only possess analytic clarity but a sound basis in empirical findings. The latter condition brings into question the expansion of the mature minor exception. The mature minor exception in the healthcare law of the United States has served to enable those under the legal age to consent to medical treatment. Although originally developed primarily for minors in emergency or quasi-emergency need for health care, it was expanded especially from the 1970s (...) in order to cover unemancipated minors older than 14 years. This expansion initially appeared plausible, given psychological data that showed the intellectual capacity of minors over 14 to recognize the causal connection between their choices and the consequences of their choices. However, subsequent psychological studies have shown that minors generally fail to have realistic affective and evaluative appreciations of the consequences of their decisions, because they tend to over-emphasize short-term benefits and underestimate long-term risks. Also, unlike most decisionmakers over 21, the decisions of minors are more often marked by the lack of adequate impulse control, all of which is reflected in the far higher involvement of adolescents in acts of violence, intentional injury, and serious automobile accidents. These effects are more evident in circumstances that elicit elevated affective responses. The advent of brain imaging has allowed the actual visualization of qualitative differences between how minors versus persons over the age of 21 generally assess risks and benefits and make decisions. In the case of most under the age of 21, subcortical systems fail adequately to be checked by the prefrontal systems that are involved in adult executive decisions. The neuroanatomical and psychological model developed by Casey, Jones, and Summerville offers an empirical insight into the qualitative differences in the neuroanatomical and neuropsychological bases of adolescent versus adult decision making. These and other data, as well as developing law bearing on the culpability of juvenile criminal offenders, argue for critically re-evaluating the expansion of the mature minor exception with regard to medical decision making, as well as in support of a rebuttable presumption in favor of treating minors as immature decisionmakers. The clinical ethics of adolescent medical decision making will need foundationally to be reconsidered. (shrink)

Evolutionary biology – or, more precisely, two (purported) applications of Darwin's theory of evolution by natural selection, namely, evolutionary psychology and what has been called human behavioral biology – is on the cusp of becoming the new rage among legal scholars looking for interdisciplinary insights into the law. We argue that as the actual science stands today, evolutionary biology offers nothing to help with questions about legal regulation of behavior. Only systematic misrepresentations or lack of understanding of the relevant biology, (...) together with far-reaching analytical and philosophical confusions, have led anyone to think otherwise. Evolutionary accounts are etiological accounts of how a trait evolved. We argue that an account of causal etiology could be relevant to law if (1) the account of causal etiology is scientifically well-confirmed, and (2) there is an explanation of how the well-confirmed etiology bears on questions of development (what we call the Environmental Gap Objection). We then show that the accounts of causal etiology that might be relevant are not remotely well-confirmed by scientific standards. We argue, in particular, that (a) evolutionary psychology is not entitled to assume selectionist accounts of human behaviors, (b) the assumptions necessary for the selectionist accounts to be true are not warranted by standard criteria for theory choice, and (c) only confusions about levels of explanation of human behavior create the appearance that understanding the biology of behavior is important. We also note that no response to the Environmental Gap Objection has been proffered. In the concluding section of the article, we turn directly to the work of Owen Jones, a leading proponent of the relevance of evolutionary biology to law, and show that he does not come to terms with any of the fundamental problems identified in this article. (shrink)