AimsThis study evaluates a protocol for early, routine ethics consultation for patients on extracorporeal membrane oxygenation to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.MethodsWe conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019. Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of (...) treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.ResultsLimited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.ConclusionData from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages. (shrink)

The Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision, first leaked to the public on 2 May 2022 and officially released on 24 June 2022, overturned Roe v. Wade and thereby determined that abortion is no longer a federally protected right under the Constitution. Instead, the decision gives individual states the right to regulate abortion. Since the Dobbs decision first leaked, our institution has received numerous requests for permanent contraception from individuals stating that their motivation to pursue permanent contraception (...) was influenced by the Dobbs decision and concerns about their reproductive autonomy. Discussions with patients seeking permanent contraception since the Supreme Court’s leaked decision have led us to ask ourselves, is legislative anxiety an indication for surgery? This article presents a case series consisting of a convenience sample of 17 young, nulliparous individuals who sought out permanent contraception in the six months following the leak of the Dobbs decision. Healthcare professionals often feel discomfort in offering permanent contraception to young and nulliparous individuals. Accordingly, we discuss pertinent legal issues, review relevant ethical considerations, and offer a framework for these discussions intended to empower the consulting healthcare professional to center the bodily autonomy of every patient regardless of age, parity, or indication for permanent contraception. (shrink)

While the origin and development of the just war tradition until the early modern period blended concerns, ideas, and practices from the moral, legal, political, and military spheres, from the mid-seventeenth century until the mid-twentieth it largely disappeared as a conscious source of moral reflection about war and its restraint. Beginning in the 1960s, however, American theologian Paul Ramsey initiated a recovery of just war thinking in a series of writings applying the principles of discrimination and proportionality, ideas he traced (...) both to Augustinian theology and to natural law, to the debate over nuclear weapons and later to the Vietnam War. Ramsey's work directly engaged both theological and policy debate over military force, initiating lines of reflection that have since developed further and become increasingly institutionalized. This brief essay examines the nature of Ramsey's just war thought and its influence over the last 40 years. (shrink)

SummaryThe Gainj of highland Papua New Guinea do not use contraception but have a total fertility rate of only 4·3 live births per woman, one of the lowest ever recorded in a natural fertility setting. From an analysis of cross-sectional demographic and endocrinological data, the causes of low reproductive output have been identified in women of this population as: late menarche and marriage, a long interval between marriage and first birth, a high probability of widowhood at later reproductive ages, low (...) effective fecundability and prolonged lactational amenorrhoea. These are combined with near-universal marriage, a low prevalence of primary sterility and a pattern of onset of secondary sterility similar to that found in other populations. Of all the factors limiting fertility, by far the most important are those involved in birth spacing, especially lactational amenorrhoea. (shrink)

In the Platonic work Alcibiades I, a divinely guided Socrates adopts the guise of a lover in order to divert Alcibiades from an unthinking political career. The contributors to this carefully focussed volume cover aspects of the background to the work; its arguments and the philosophical issues it raises; its relationship to other Platonic texts, and its subsequent history up to the time of the Neoplatonists. Despite its ancient prominence, the authorship of Alcibiades I is still unsettled; the essays and (...) two appendices, one historical and one stylometric, come together to suggest answers to this tantalising question. (shrink)

Given a basic conditional of the form, If A then C, individuals usually list three cases as possible: A and C, not‐A and not‐C, not‐A and C. This result corroborates the theory of mental models. By contrast, individuals often judge that the conditional is true only in the case of A and C, and that cases of not‐A are irrelevant to its truth or falsity. This result corroborates other theories of conditionals. To resolve the discrepancy, we devised two new tasks: (...) the “collective” truth task, in which participants judged whether sets of assertions about a specific individual, such as: If A then C, not‐A, C, could all be true at the same time; and one in which participants judged the truth of conditional predictions about specific future events. The results consistently matched the three possibilities, thereby corroborating the model theory. They also showed a massive violation of the probability calculus in estimates of the probabilities of the four cases in the partition of conditionals (A and C, A and not‐C, not‐A and C, and not‐A and not‐C), which summed to over 200%. (shrink)

Alternative currencies are means of payment that circulate alongside—as an alternative or complement to—official currencies. While these currencies have existed for a long time, both society and academia have shown a renewed interest in their potential to decentralize the governance of monetary affairs and to bring people and organizations together in more ethical or sustainable ways. This article is a review of the ethical and philosophical implications of these alternative monetary projects. We first discuss various classifications of these currencies before (...) analyzing the ethical challenges linked to the way they tackle social and environmental issues. We also examine the incentive-based and coercive mechanisms used by these currencies from an ethical perspective and debate the promises and perils of monetary decentralization and democracy. We conclude by identifying an agenda for future research. (shrink)

We often describe actions as good, bad, right, wrong, fair, unkind, deserved, disrespectful, a bit much, and so on. This article asks: Do these terms describe facts about our actions? And do those facts tell us to perform certain actions and refrain from performing others? If so, what exactly does that mean? And, if not, what are we doing when we describe actions in these various ways?

Now that mankind has created the capability of destroying itself through nuclear technology, is it still possible to think in terms of a "just war"? Johnson argues that it is, and in the context of specific case studies he offers moral guidelines for addressing such major contemporary problems as terrorist activity in a foreign country, an individual’s conscientious objection to military service, and an American defense policy that requires development of weapons that may be morally employed in case of (...) need. "Remarkable.... A thoughtful and even profound book, which can be warmly recommended."—Adam Roberts, _New Society_ __ "[A] wise, prudential, and moral thesis.... A most important book, one that all Americans who can should read."—George Armstrong Kelly, _Political Science Quarterly_ __ "At its heart, _Can Modern War be Just? _Is a challenge to the common assumption that any modern war must be total—an unrestrained, spasmodic release of one’s entire destructive capacity against the whole of the enemy’s population."—Richard Allen, _Journal of Religious Ethics_ __ "Johnson... seriously attempt[s] to balance principles and respect facts. For this he is to be praised."—Gary Jason, _Chronicles of Culture_ __ "Johnson’s application of just war doctrine to the hardest problems of contemporary warfare is both morally sensitive and intellectually bold. Readers will sometimes disagree with his arguments, but they will be forced to think hard, and they will learn what it is to work within a moral tradition."—Michael Walzer. (shrink)

Entrepreneurs of contested commodities often face stakeholders engaged in market excluding boundary work driven by ethical considerations. For example, the conversion of academic scientific knowledge into technologies that can be owned and sold is a growing global trend and key stakeholders have different ethical responses to this contested commodity. Commercialization of science can be viewed as a good thing because people believe it bolsters economic growth and broadly benefits society. Others view it as bad because they believe it discourages basic (...) research that ought to be freely shared without concern for profit. Taking a descriptive sociological approach, we posit that the stance of a religious tradition toward capitalism will help shape individual scientists’ views on science commercialization and test whether the religious tradition of scientists correlates with their attitude toward the commercialization of science. To maximize variance on the religious tradition dimension, we analyze pooled data from a cross-national survey of university biologists and physicists encompassing France, Hong Kong, India, Italy, Taiwan, Turkey, UK and the USA. We indeed find religious tradition differences. Hindus and scientists with no religious tradition are more likely to agree that commercialization of science “harms a university’s commitment to knowledge production” than Protestants. We end with a discussion on business ethics and the moral limits of the market as well as implications for entrepreneurs of contested commodities. (shrink)

This research was designed to understand better the patterns of agricultural intensification and transformation occurring in Africa south of the Sahara using the Ghanaian case. The paper examines changes in farming systems and the role of various endogenous and exogenous factors in driving the conversion of arable lands to agricultural uses in four villages within two agro-ecologically distinct zones of Ghana: the Guinea Savannah and Transition zones. Using historical narratives and land-cover maps supplemented with quantitative data at regional levels, the (...) research shows that farming has intensified in the villages, as farmers increased their farm size in response to factors such as population growth, market access, and changing rural lifestyle. The overall trend suggests a gradual move toward intensification through increasing use of labor-saving technologies rather than land-saving inputs—a pattern that contrasts with Asia’s path to its Green Revolution. The findings in this paper provide evidence of the dynamism occurring in African farming systems; hence, they point toward a departure from stagnation narratives that have come to prevail in the debate on agricultural transformation and intensification in Africa south of the Sahara. We conclude that it is essential for future research to expand the scope of this work, while policies should focus on lessons learned from these historical processes of genuine change and adaptation. (shrink)

For evolutionary biologists, the concept of chance has always played a significant role in the formation of evolutionary theory. As far back as Greek antiquity, chance and "luck" were key factors in understanding the natural world. Chance is not just an important concept; it is an entire way of thinking about nature. And as Curtis Johnson shows, it is also one of the key ideas that separates Charles Darwin from other systematic biologists of his time. Studying the concept of (...) chance in Darwin's writing reveals core ideas in his theory of evolution, as well as his reflections on design, purpose, and randomness in nature's progression over the course of history.In Darwin's Dice: The Idea of Chance in the Thought of Charles Darwin, Curtis Johnson examines Darwin's early notebooks, his collected correspondence, and most of his published writing to trace the evolution of his ideas about chance in evolution. This proved to be one of Darwin's most controversial ideas among his reading public, so much so that it drew hostile reactions even from Darwin's scientific friends, not to mention the more general reader. The firestorm of criticism forced Darwin to forge a retreat, not in terms of removing chance from his theory--his commitment to it was unshakable--but in terms of how he chose to present his theory. Briefly, by changing his wording and by introducing metaphors and images, Darwin succeeded in making his ideas seem less threatening than before without actually changing his views. Randomness remained a focal point for Darwin throughout his life. Through the lens of randomness, Johnson reveals implications of Darwin's views for religion, free will, and moral theory. Darwin's Dice presents a new way to look at Darwinist thought and the writings of Charles Darwin. (shrink)

This study examines firms that have experienced an industrial and/or environ-mental crisis and proposes that top management team (TMT) characteristics will affect a firm's ability to minimize the severity of these crisis events. Specifically, heterogeneity in the TMT will exhibit a curvilinear (U-shaped) relationship with the severity of firm crises. Our results suggest that a moderate level of age and tenure heterogeneity are positively related to a firm's ability to successfully minimize the severity of crises. Variance in educational backgrounds was (...) unrelated to crisis severity. Functional background heterogeneity exhibited a curvilinear relationship with crisis severity but was not U-shaped as hypothesized. (shrink)

Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly fund (...) access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long-term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations. (shrink)

Charles Darwin's "Historical Sketch" has appeared as a preface to nearly every authorized edition of Darwin's Origin of Species since the second English edition was published in 1860. The "Historical Sketch" provides a brief history of opinion about the species question as a prelude to Darwin's own independent contribution to the subject, but its provenance is somewhat obscure. While some previous thinkers anticipated portions of Darwin's theory long before he did, none of them saw the complete picture as clearly as (...) Darwin. As such, he was able to claim originality and priority for the idea that has transformed our understanding of nature. His "Historical Sketch" was written as an attempt to address these issues. Some things are known about its production, such as when it first appeared and what changes were made to it between its first appearance in 1860 and its final form in 1866. Other questions remain unanswered. How did it evolve in Darwin's mind? Why did he write it at all? What did he think he was accomplishing by prefacing it to Origin of Species? Curtis Johnson approaches these questions, offering some clarity on the originality of Darwin's work. Darwin's "Historical Sketch" is the first comprehensive study of Darwin's "Preface" to Origin of Species. Johnson conveys the pressure Darwin felt from friends and other correspondents to showcase the originality of his theory, and he tackles questions of originality by carefully examining the 35 authors Darwin referenced in this monumental text. (shrink)

U.S. journalists must walk a fine line when reporting on hate speech. Journalists have a vested interest in standing up for the First Amendment, which gives them the freedom to do their work. Howev...

Pursuing Justice in Africa focuses on the many actors pursuing many visions of justice across the African continent--their aspirations, divergent practices, and articulations of international and vernacular idioms of justice. The essays selected by editors Jessica Johnson and George H. Karekwaivanane engage with topics at the cutting edge of contemporary scholarship across a wide range of disciplines. These include activism, land tenure, international legal institutions, and post-conflict reconciliation. Building on recent work in sociolegal studies that foregrounds justice over and (...) above concepts such as human rights and legal pluralism, the contributors grapple with alternative approaches to the concept of justice and its relationships with law, morality, and rights. While the chapters are grounded in local experiences, they also attend to the ways in which national and international actors and processes influence, for better or worse, local experiences and understandings of justice. The result is a timely and original addition to scholarship on a topic of major scholarly and pragmatic interest. Contributors: Felicitas Becker, Jonathon L. Earle, Patrick Hoenig, Stacey Hynd, Fred Nyongesa Ikanda, Ngeyi Ruth Kanyongolo, Anna Macdonald, Bernadette Malunga, Alan Msosa, Benson A. Mulemi, Holly Porter, Duncan Scott, Olaf Zenker. (shrink)

The author, head of a teaching hospital surgical unit, argues that the medical curriculum must ensure that all students are exposed to a minimum of ethical discussion and decision-making. In describing his own approach he emphasises the need to show students that it is 'an intensely practical subject'. Moreover, he reminds them that moral dilemmas in medicine--perhaps a better term than medical ethics--are unavoidable in clinical practice. Professor Johnson emphasises the need for small group teaching and discussion of real (...) cases, preferably chosen and 'worked up' by individual students. He suggests that ethical issues could profitably be introduced into written, oral and clinical examinations. (shrink)

The extant marketing literature provides little guidance for theory development or practice with regard to questions of ethical conformity and the resulting market response. To begin to bridge this research gap, we advance a theoretical framework of ethical conformity in marketing, appealing to marketing ethics, management strategy, and sociological foundations. We set the stage for our theoretical arguments by considering the role of normative expectations related to marketing practices and behaviors held by societal constituents. Against this backdrop, we propose drivers (...) of conformity in marketing, including practices consistent with both overconformity and underconformity. The framework allows us to advance testable research propositions by which questions of ethical conformity may be explored. We conclude by suggesting additional future research needed to develop the domain, specifically in the form of empirical inquiries uncovering firm strategic decisions with ethical implications. (shrink)

Patterned after Strunk and White's classic The Elements of Style , this handy reference concisely summarizes the substantial existing research on the delicate balance of professional ethics. Johnson and Ridley reduce the wealth of published material on the topic to the seventy-five most important and pithy truths for supervisors in all fields. These explore questions of integrity, loyalty, justice, respect, and delivering one's best in the business environment. Succinct and comprehensive, this is a must-have for any professional or business (...) leader striving to create an ethical workplace. (shrink)

Humanely Killed? Jeff Johnson St. Catherine University, Saint Paul, Minnesota. Standard philosophical approaches to the issue of eating animals who are thought to have been humanely killed typically turn on decisions around the issue of moral status or on weighing benefits and harms of killing. Rather than pursuing these lines of inquiry, I bring out circumstances that have gotten lost in thinking we can take moral cover under the idea that farmed animals are killed humanely. In thinking about whether (...) farmed animals have been killed humanely, we are asked to focus on the whether the deaths of these animals are painful. But much more is involved when we attend to other cases in which animals are thought to have been killed humanely. In view of these discrepancies, I argue that it is much more difficult than we might suppose to take moral cover under the idea that farmed animals can be killed humanely. (shrink)

Altruism is a well-established reason underlying research participation. Less is known about altruism in adolescent-parent decision-making about clinical trials enrolling healthy adolescents. This qualitative investigation focused on identifying spontaneous statements of altruism within adolescent-parent (dyadic) discussions of participation in a hypothetical phase I clinical trial related to adolescent sexual health. Content analysis revealed several response patterns to each other’s altruistic reasoning. Across 70 adolescent-parent dyads in which adolescents were 14 to 17 years of age and 91% of their parents were (...) mothers, a majority (61%) of dyadic discussions included a statement reflecting altruism. Parents responded to adolescents’ statements of altruism more frequently than adolescents responded to parents’ statements. Responses included: expresses concern, reiterates altruistic reasoning, agrees with altruistic reasoning, and adds to/expands altruistic reasoning. Since an altruistic perspective was often balanced with concerns about risk or study procedures, researchers cannot assume that altruism will directly lead to study participation. Optimizing the informed consent process for early phase clinical trials involving healthy adolescents may include supporting parents to have conversations with their adolescents which will enhance their capacity to consider all aspects of trial participation. (shrink)

I take up the challenge of whyfalsebeliefs are better than “cautious actionpolicies” (target article, sect. 9) in navigating adaptive problems with asymmetric errors. I then suggest that there areinteractionsbetween supernatural beliefs, self-deception, and positive illusions, rendering elements of all such misbeliefs adaptive. Finally, I argue that supernatural beliefs cannot be rejected as adaptive simply because recent experiments are inconclusive. The great costs of religion betray its even greater adaptive benefits – we just have not yet nailed down exactly what they (...) are. (shrink)

Some of the traditions and cultural beliefs and practices of the Idoma people of Nigeria have been influenced both positively and negatively as a result of the advent of Christianity in the area. The aim of this research is to investigate some of the cultural beliefs and practices of the Idoma people before the advent of Christianity, the people’s response to the new faith and the propelling factors behind the responses of the people. In doing so, a comparative study on (...) these beliefs and practices after the advent of Christianity in Idoma traditional society was done. The study adopts a qualitative phenomenological research design and descriptive method for data analysis. Personal interviews form a primary source of data collection, while the secondary source includes library sources. This method of study was chosen to allow the data collected to speak for themselves without any interference from the researchers. The study unveils that the advent of Christianity in the Idoma traditional society had some impact and consequences on the traditional and cultural practices of the people, such as death and burial ceremonies, the Aje-alekwu festival and widowhood practices among others. The study recommends that there should be a synergy between Idoma traditional beliefs and practices and Christianity for peaceful co-existence, progress and development in the area. Contribution: It is erroneously believed that in the contemporary society, traditional religious practices are going to die and become a thing of the past. However, one would observe from this study that Idoma people still hold their traditional beliefs and practices in high esteem despite the influence of Christianity in the area. (shrink)

To date, bioethics and health policy scholarship has given little consideration to questions of aging and intergenerational justice in the developing world. Demographic changes are precipitating rapid population aging in developing nations, however, and ethical issues regarding older people’s claim to scarce healthcare resources must be addressed. This paper posits that the traditional arguments about generational justice and age-based rationing of healthcare resources, which were developed primarily in more industrialized nations, fail to adequately address the unique challenges facing older persons (...) in developing nations. Existing philosophical approaches to age-based resource allocation underemphasize the importance of older persons for developing countries and fail to adequately consider the rights and interests of older persons in these settings. Ultimately, the paper concludes that the most appropriate framework for thinking about generational justice in developing nations is a rights-based approach that allows for the interests of all age groups, including the oldest, to be considered in the determination of health resource allocation. (shrink)