The United States is in its fifth year of what is now widely referred to as “the new medical malpractice crisis.” Although some professional liability insurers have begun to report improvements in their overall financial margins, there are few signs that the trend toward higher costs is reversing itself - particularly for doctors and hospitals. In 2003-2004, the presidential election and tort reform proposals in Congress brought heightened public attention to the need for some type of policy intervention to ease (...) the effects of the crisis.The darling of tort reformers at both the federal and state levels has been legislation to limit, or “cap,” damages awarded to plaintiffs in malpractice cases. Health care provider groups, liability insurers, and the Bush Administration have all seized on the example of California's MICRA law, which since 1975 has capped noneconomic damages in malpractice cases at a flat $250,000, as the path to financial recovery. (shrink)

Identifying corporate governance mechanisms to improve firm performance has been at the forefront of policy discussion and research in recent years. Existing research in this area focuses on large-capitalisation firms, and has not provided much insight on smaller firms. This paper tests for the optimality of deployment of governance mechanisms for Canadian small-cap firms by estimating a simultaneous equation system that links four control mechanisms to firm performance, using recent data. The results confirm simultaneity between several governance mechanisms and Canadian (...) small-cap firm performance. CEO ownership and shareholder rights are shown to determine board independence. CEO ownership in turn is shown to depend on the extent of shareholder rights and whether the CEO is also Chairperson of the board. Canadian small-cap firms appear to overutilise debt as a control mechanism. There is somewhat weaker evidence that board independence and CEO ownership are beyond the optimum. The latter, given the relatively high degree of CEO ownership in Canadian small-cap firms, is consistent with management entrenchment. We also do not find any significant discount to performance for Quebec-based firms, or for firms with dual or multiple voting class shares structures. (shrink)

Ethical guidance for genomic research is increasingly sought and perceived to be necessary. Although there are pressing ethical issues in genomic research – concerning for example the recruitment of patients/participants; the process of taking consent; data sharing; and returning results to patients/participants – there is still limited useful guidance available for researchers/clinicians or for the research ethics committees who review such projects. This report outlines the ethical principles and guidance for genomic research co-produced with stakeholders during two workshops which took (...) place in the UK between November 2016 and May 2017. The stakeholders involved in these workshops included: healthcare professionals, genomic research teams, academics, patients, biobank managers, and representatives from the Health Research Authority, NHS Research Ethics Committees, patient support groups, pharmaceutical industry, and health policy think tanks. The co-produced principles and guidance are specifical... (shrink)

Erving Goffman’s “Asylums” is a key text in the development of contemporary, community-orientated mental health practice. It has survived as a trenchant critique of the asylum as total institution, and its publication in 1961 in book form marked a further stage in the discrediting of the asylum model of mental health care. In this paper, some responses from a range of disciplines to this text, 50 years on, are presented. A consultant psychiatrist with a special interest in cultural psychiatry and (...) mental health legislation, two collaborating psychotherapists in adult and forensic mental health, a philosopher, and a recent medical graduate, present their varying responses to the text. The editors present these with the hope of encouraging further dialogue and debate from service users, carers, clinicians, and academics and researchers across a range of disciplines. (shrink)

Recent developments in genomic science hold out the tantalizing prospect of soon being able to treat and prevent a wide variety of medical conditions through gene therapy. In time, it may be possible to use similar techniques not simply to combat disease but also to enhance, or improve on, normal human functioning.

This chapter aims to show that prospective parents are not bound in their reproductive decision making by a principle of procreative beneficence. That is, they have no obligation (as Julian Savulescu, the principle’s originator, famously thinks they have) to choose the possible child, from a range of possible children they might have, who is likely to lead the best life. I will summarise and clarify the content of previous papers of mine, in which I argue that since the sorts of (...) considerations that underlie the principle of procreative beneficence do not constitute reasons when viewed from a perspective that it is fitting and appropriate for a prospective parent to take up, there can be no requirement for prospective parents to be moved by those considerations. (shrink)

Tom Beauchamp and James Childress have always maintained that their four principles approach (otherwise known as principlism) is a globally applicable framework for biomedical ethics. This claim is grounded in their belief that the principles of respect for autonomy, non-maleficence, beneficence and justice form part of a 'common morality', or collection of very general norms to which everyone who is committed to morality subscribes. The difficulty, however, has always been how to demonstrate, at least in the absence of a full-blooded (...) analysis of the concept of morality, whether the four principles are foundational, and so globally applicable, in this way. In the recently published sixth edition of Principles of Biomedical Ethics, an imaginative and non-question-begging empirical method of determining the common morality's norms is suggested. In this paper, I outline this method, before arguing that it is difficult to see how it might be thought to achieve its purpose. (shrink)

Recent political turmoil has focused international attention on Egypt, yet there is little awareness of the country’s stateless populations—those who lack legal nationality to any state—or the challenges they face. Individuals in situations of protracted statelessness are denied their right to a nationality, resulting in an array of additional rights violations. Such violations include denied freedom of movement, equality before the law, and access to economic and social rights. Drawing from two years’ of fieldwork data, this study highlights the plight (...) of those who are unable to achieve legal status in a country with harsh punishments for illegal presence, entry, and exit. It also evaluates potential solutions for eliminating statelessness in Egypt and protecting the rights of stateless populations. As Egypt seeks to move beyond revolution, it is vital that the government addresses the pervasive and systemic inequalities that deny individuals their right to a nationality. (shrink)

In Pacificare Health Systems, Inc. v. Jefrey Book, the US. Supreme Court ruled that the mandatory arbitration clause in an HMO contract should be enforced to compel a physician to arbitrate his RICO charges against the health plan, even though the clause could be construed to limit the arbitrator’s authority to award full damages under the RICO statute. The ruling could prevent physicians with health plan arbitration agreements from taking future reimbursement claims against insurance companies directly to court, even when (...) the allegations involve a potential statutory breach outside of the explicit scope of the provider contract.Dr. Book’s arbitration claim was part of a larger class action lawsuit filed in August of 2000 by a group of physicians and patients seeking reimbursement from eight managed care companies for unpaid health insurance claims. (shrink)

In recent decades, scientists have begun to identify the brain processes and neurochemicals associated with the different stages of love, including the all-important stage of attachment. Experimental findings—readily seized upon by those bioethicists who want to urge that we sometimes have good reason pharmaceutically to enhance flagging relationships—are presented as demonstrating that attachment is regulated and strengthened by the neuropeptides oxytocin and vasopressin. I shall argue, however, that often what the experimental data in fact show is only that exogenous administration (...) of such chemicals can control and intensify the trappings of attachment, not attachment itself. That this is sometimes overlooked by both scientists and ethicists, is due to attachment being miscategorised as a set of feelings or a drive, rather than as a disposition to think about, feel toward, and behave toward its object in certain distinctive ways. (shrink)

A critical analysis of contemporary strategic management theory and practice suggests that modernist, linear thinking has facilitated the development of an abstracted reality which is misleading to managers and fundamentally flawed. It is argued that formulaic strategic tools such as those propounded by Porter fail to capture the reality of the complex environments that confront firms and falsely suggest that an answer can be derived from a predetermined toolbox. As an alternative to this dominant paradigm, the complexity of markets is (...) presented not as something to be feared and ignored, but rather as a truth to be embraced. As a basis of taking this step, current knowledge on how complex environments work, perspectives on how they can be better understood and how people and organizations can engage within them, is presented. Ultimately it is recognised that both theoretical and practical foundations need significant, further development. (shrink)

Randomized control trials (RCTs) are the gold standard for estimating causal effects, but often use samples that are non-representative of the actual population of interest. We propose a reweighting method for estimating population average treatment effects in settings with noncompliance. Simulations show the proposed compliance-adjusted population estimator outperforms its unadjusted counterpart when compliance is relatively low and can be predicted by observed covariates. We apply the method to evaluate the effect of Medicaid coverage on health care use for a target (...) population of adults who may benefit from expansions to the Medicaid program. We draw RCT data from the Oregon Health Insurance Experiment, where less than one-third of those randomly selected to receive Medicaid benefits actually enrolled. (shrink)

In amblyopia, abnormal visual experience during development leads to an enduring loss of visual acuity in adulthood. Physiological studies in animal models suggest that intracortical GABAergic inhibition may mediate visual deficits in amblyopia. To better understand the relationship between visual cortical γ-aminobutyric acid (GABA) and perceptual suppression in persons with amblyopia (PWA), we employed magnetic resonance spectroscopy (MRS) to quantify GABA levels in both PWA and normally-sighted persons (NSP). In the same individuals, we obtained psychophysical measures of perceptual suppression for (...) a variety of ocular configurations. In PWA, we found a robust negative correlation between the depth of amblyopia (the difference in visual acuity between the amblyopic and non-amblyopic eyes) and GABA concentration that was specific to visual cortex and was not observed in a sensorimotor cortical control region. Moreover, lower levels of visual cortical GABA were associated with weaker perceptual suppression of the fellow eye by the amblyopic eye and stronger suppression of the amblyopic eye by the fellow eye. Taken together, our findings provide evidence that intracortical GABAergic inhibition is an important component of the pathology of human amblyopia and suggest possible therapeutic interventions to restore vision in the amblyopic eye through enhancement of visual cortical GABAergic signaling in PWA. (shrink)

Research shows that early scientific interest is associated with science degree completion and career selection. However, little is known about the conditions that support early scientific interest. Using a “funds of knowledge” theoretical framework, this study examined the role of parents, family, and extended social networks in fostering early interest in science. Using interview narratives from 116 scientists (physicists and chemists) in the United States, we conducted a qualitative thematic content analysis. Findings suggest that children who become scientists in adulthood (...) often received early, informal opportunities to use and manipulate material objects and discover how the world works. Second, families used a wide variety of scientific terms at home and encouraged children to pursue their interests whether in science or other fields. Third, these future scientists were often networked with extended family members or friends to observe and do science when they were quite young. Collectively, these findings highlight the specific ways in which families fostered early scientific interest and aided in supporting a student-directed learning environment. (shrink)

Sober (1992) has recently evaluated Brandon's (1982, 1990; see also 1985, 1988) use of Salmon's (1971) concept of screening-off in the philosophy of biology. He critiques three particular issues, each of which will be considered in this discussion.

No longer is pregnancy a repulsive or shameful condition in Hollywood films, but an attractive attribute, often enhancing the romantic or comedic storyline of a female character. Kelly Oliver investigates this curious shift and its reflection of changing attitudes toward women's roles in reproduction and the family. Not all representations signify progress. Oliver finds that in many pregnancy films, our anxieties over modern reproductive practices and technologies are made manifest, and in some cases perpetuate conventions curtailing women's freedom. Reading (...) such films as _Where the Heart Is_ (2000), _Riding in Cars with Boys_ (2001), _Palindromes_ (2004), _Saved!_ (2004), _Quinceañera_ (2006), _Children of Men_ (2006), _Knocked Up_ (2007), _Juno_ (2007), _Baby Mama_ (2008), _Away We Go_ (2009), _Precious_ (2009), _The Back-up Plan_ (2010), _Due Date_ (2010), and _Twilight: Breaking Dawn_ (2011), Oliver investigates pregnancy as a vehicle for romance, a political issue of "choice," a representation of the hosting of "others," a prism for fears of miscegenation, and a screen for modern technological anxieties. (shrink)

Dramatic modern advances in emergency and resuscitation medicine, starting perhaps with the development of effective mechanical ventilators in the mid-20th century, have created a large class of persons who in earlier times would almost certainly have died, but who can now go on existing, suspended at least temporarily in a state somewhere between death and the conscious life they formerly pursued. A very wide range of brain injuries lead first to coma, in which the patient shows no sign of conscious (...) awareness, or even of wakefulness, in which eye openings and closings indicate the presence of a sleep/wake cycle unconsciously mediated by structures in the brain stem. Following emergence from coma, which may take days to months or more if it happens at all, patients typically show signs of wakefulness without conscious awareness – they are then in a so-called vegetative state (VS). For many this state becomes permanent, but some go on to a more recently described condition called the minimally conscious state (MCS), in which signs of conscious awareness can be detected by careful neurological examination (see Laureys & Tononi, 2009, chapter 14). A very few such persons ultimately progress to more or less full recovery, but another and particularly horrifying possible outcome is the “locked-in” state, in which a patient is fully conscious but has extremely little or no capacity for voluntary motor action. A famous modern example is that of Jean-Dominique Bauby, author of The Diving Bell and the Butterfly, who suffered a stroke to his upper brainstem and awakened 20 days later to find himself fully conscious but capable only of blinking his left eye. A tiny fraction of surgical patients find themselves in similarly terrifying conditions caused by the combination of muscle relaxants with insufficient levels of anesthetic agents (Kelly et al., 2007, p. 387 n. 18). (shrink)

We agree with many of the principles proposed by Frost but highlight crucial caveats and report research findings that challenge several assertions made in the target article. We discuss the roles that visual processing, development, and bilingualism play in visual word recognition and reading. These are overlooked in all current models, but are fundamental to any universal model of reading.

Schools may be one important context where adolescents learn and shape the behaviors necessary for promoting global inclusivity in adulthood. Given the importance of bystanders in halting bullying and peer aggression, the focus of this study is on both moral judgments regarding one type of bullying, social exclusion, and factors that are associated with bystander intervention. The study includes 896 adolescents, who were 6th (N= 450,Mage= 11.73), and 9th (N= 446,Mage= 14.82) graders, approximately evenly divided by gender. Participants were primarily (...) European–American (63.3%). Results revealed that girls and participants who perceived better relationships between students and teachers were more likely to judge exclusion to be wrong. Further, ethnic minority participants, those who were more anxious about being rejected by their teachers and reported more teacher discrimination were less likely to judge exclusion as wrong. Participants who reported more positive student–teacher relationships, perceptions of a more positive school social environment and more prior experiences of teacher discrimination were more likely to report that they would seek help for the victim. On the other hand, participants who reported being more angry about teacher rejection, experiencing either peer or teacher discrimination, and perceiving they are excluded from opportunities at school were less likely to intervene to come to the aid of a peer who is being excluded. The results document the complex interplay of school and teacher factors in shaping adolescents’ bystander responses to social exclusion. Our findings suggest that positive school climate can promote intentions to intervene. However, findings indicate that adolescents who are marginalized in their school environments, and who report experiences of rejection, exclusion or discrimination are not willing or likely to intervene to prevent others from experiencing exclusion. (shrink)

The right to health is enshrined in the constitution of the World Health Organization and numerous other international agreements. Yet today, an estimated 5.7 million people die each year from treatable infectious diseases, most of which are susceptible to existing antimicrobials if they were accessible. These deaths occur predominantly among populations living in poverty in low- and middle-income countries, and they greatly exceed the estimated 700,000 annual deaths worldwide currently attributed to antimicrobial resistance. Ensuring universal appropriate access to antimicrobials is (...) not only a critical part of realizing the right to health, it is necessary for mobilizing effective collective action against the development and spread of AMR. (shrink)

One of the projects Shaun Nichols takes up in Bound is to provide a folk psychological diagnosis of the problem of free will. As part of this diagnosis, Nichols suggests that the dispute between eliminativists and preservationists depends to some extent on assumptions about the way ‘free will’ refers. In light of this, he argues that we might have good reason to accept a discretionary view of free will. Here, I will focus on teasing out some of the more fine-grained (...) features of the discretionary view Nichols proposes. In so doing I will challenge the idea that there is a tenable strategy for consistently preserving two main features of the view: that eliminativists and preservationists can both speak truly, and that the apparent disagreement between them can be diffused by appealing to the role that different practical interests play in the context of utterance. I will conclude with some suggestive remarks on how the spirit of the discretionary view Nichols offers might still be preserved despite the challenge I raise, and why there are good reasons to pursue this kind of view further. (shrink)

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

Research has documented that individuals consider outcomes, intentions, and transgressor negligence when making morally relevant judgments (Nobes, Panagiotaki, & Engelhardt, 2017). However, less is known about whether individuals attend to both victim and transgressor negligence in their evaluations. The current study measured 3‐ to 6‐year‐olds (N = 70), 7‐ to 12‐year‐olds (N = 54), and adults' (N = 97, ages 18–25 years) moral judgments about scenarios in which an accidental transgression occurred involving property damage or physical harm. Participants were either (...) assigned to conditions where the victim or the transgressor was negligent. Results revealed attention to negligence among all participants across a range of different moral judgment measures (including acceptability judgments, punishment judgments, and attributions of blame), with age‐related increases in attention to negligence evident. Results provide novel evidence that children and adults consider not just outcomes and intentions, but also the role of negligence in both victims and transgressors, when making social decisions. (shrink)

Today there is a tendency to do ethics on the basis of what I should like to call the “self-other model.” On this view, an action has no moral worth unless it benefits others–and not even then, unless it is motivated by altruism rather than selfishness. This radical rift between self-interest and virtue traces back at least to Philo of Alexandria, according to whom, “lovers of self, when they have stripped and prepared for conflict with those who value virtue, keep (...) up the boxing and wrestling until they have either forced their opponents to give in, or have completely destroyed them.” More recently, the distinction between those who value themselves and those who “value virtue” has been drawn sharply by Bernard Williams: “[I]n moral theory … it is not the Kantian leap from the particular and the affective to the rational and universal that makes all the difference; it is rather the Humean step–that is to say, the first Humean step–from the self to someone else.”. (shrink)

Experiences of embodied remembering are familiar and diverse. We settle bodily into familiar chairs or find our way easily round familiar rooms. We inhabit our own kitchens or cars or workspaces effectively and comfortably, and feel disrupted when our habitual and accustomed objects or technologies change or break or are not available. Hearing a particular song can viscerally bring back either one conversation long ago, or just the urge to dance. Some people explicitly use their bodies to record, store, or (...) cue memories. Others can move skilfully, without stopping to think, in complex and changing environments thanks to the cumulative expertise accrued in their history of fighting fires, or dancing, or playing hockey. The forms of memory involved in these cases may be distinct, operating at different timescales and levels, and by way of different mechanisms and media, but they often cooperate in the many contexts of our practices of remembering. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

The explicit objective for the 2014 Symposium hosted by the University of North Florida, which serves as the basis for this collection of papers, was to explore the relationship and potential for mutual support between the disciplines of child rights and pediatric bioethics in advancing the health and well-being of children in the United States and around the world. The U.N. Convention on the Rights of the Child served as the locus for this discussion. A significant question emerged in the (...) Symposium about whether the CRC could serve any beneficial purpose in the United States, where it has not yet been ratified. Further, there was.. (shrink)

This article reports the effects of a science, technology, and society (STS) teaching approach on the knowledge and attitudes of preservice science and mathematics teachers in Uganda toward global science and technology-based problems and/or threats. The responses of a baseline or control group (N = 50) and an experimental group (N = 50) to five questions on the preassessment indicated how little knowledge these preservice teachers had regarding these issues; however, the responses of the experimental group on the postassessment also (...) showed how quickly a short treatment using an STS teaching approach could improve their knowledge. These results also inform planning for science education in Uganda to achieve science literacy in general, and particularly the understanding of environmental science problems and/or threats facing Ugandan citizens. (shrink)

From a religious studies perspective, Atran & Norenzayan (A&N) succeed in arguing for the influence of evolved cognitive functions in religious phenomena. To develop their argument further, four suggestions are offered: (1) Look beyond the ordinary to the extraordinary; (2) culture matters more than ever; (3) theists need not despair, atheists ought not celebrate; and (4) dreaming is a primal wellspring of religion.

then essentially characterized the hypotheses that mechanical scientists can successfully decide in the limit in terms of arithmetic complexity. These ideas were developed still further by Peter Kugel [4]. In this paper, I extend this approach to obtain characterizations of identification in the limit, identification with bounded mind-changes, and identification in the short run, both for computers and for ideal agents with unbounded computational abilities. The characterization of identification with n mind-changes entails, as a corollary, an exact arithmetic characterization of (...) Putnam's n-trial predicates, which closes a gap of a factor of two in Putnam's original characterization [12]. (shrink)

FOUNDATIONALISM IN PHILOSOPHY n his autobiographical work, The Education of Henry Adams, this I brooding and disillusioned offspring of American presidents confronted, at age sixty, his own perplexity concerning the new scientific world-view that was emerging at the end of the century. He noted that the unity of things, long guaranteed morally by the teachings of Christianity and scientifically by the Newtonian world-view, was being challenged by a newer vision of things that found only incomprehensible multiplicity at the root of (...) the world: What happened if one dropped the sounder into the ab yss-let it go-frankly gave up Unity altogether? What was Unity? Why was one to be forced to affirm it? Here every body flatly refused help.... [Adams] got out his Descartes again; dipped into his Hume and Berkeley; wrestled anew with his Kant; pondered solemnly over his Hegel and Scho penhauer and Hartmann; strayed gaily away with his Greeks-all merely to ask what Unity meant, and what happened when one denied it. Apparently one never denied it. Every philosopher, whether sane or insane, naturally af firmed it. I Adams, then approaching with heavy pessimism a new century, felt instinc tively that, were one to attack the notion of unity, the entire edifice of human knowledge would quickly collapse. For understanding requires the unification of apparently different phenomena. (shrink)