This target article focuses on dynamics that arise in three typical ethically complex cases in which psychiatric consultations are requested by physicians: a dying patient refuses life-prolonging treatment, an uncooperative patient demands to be allowed to go outside and smoke, and an angry patient demands to be admitted to the hospital. The discussion canvasses what is at stake morally and clinically in each of these cases and explores clinician–patient interactions, dynamics in relationships between consulting physicians and consultant psychiatrists, patient transference, (...) and physician countertransference. The article defines legalism and countertransference and argues that an ethically and clinically important consequence of these phenomena for patients is distortion of clinicians' perceptions of patients' decisions and vulnerabilities. The discussion also describes how legalism and countertransference adversely affect how clinicians treat their psychiatrist colleagues. Finally, the article suggests how the effects of legalism and countertransference can be mitigated. (shrink)

The term "callous" has not, to this point, been studied empirically or considered philosophically in the context of healthcare professionalism. It should be, however, because its uses seem peculiar. Sometimes "callous" is used to suggest that becoming callous confers a benefit of some protection against emotional distress, which might be considered expedient in the healthcare work environment. But, "callous" also refers to a person's unappealing demeanor of hardened insensitivity. The tension between these different moral connotations of "callous" prompts several empirical, (...) psychological, and moral questions; I introduce and entertain a few here. I also suggest a distinction between callousness and inurement and argue for why this distinction is important to appreciate and uphold in health professions education. (shrink)

This essay describes an example of how we—one professor of the elective course Art, Medicine, and Clinical Moral Perception at Creighton University School of Medicine, one Director of Adult Programs at the Joslyn Museum of Art in Omaha, Nebraska, and fourth year medical students—practice perception skills using art objects. This essay presents one example of the journal assignments to which students respond in written narratives about their own perception habits. We also share questions any health professions educator can use to (...) guide students’ study of their habits of perception using art objects. (shrink)

Beginning with a discussion of why value neutrality on the part of the genetics counselor does not necessarily preserve autonomy of the counselee, the idea that social values unavoidably underlie the articulation of risks and benefits of genetic testing is made explicit. Despite the best efforts of a counselor to convey value neutral facts, risk assessment by the counselee and family is done according to normative analysis, experience with illness, and definitions of health. Each of these factors must be known (...) by the genetic counselor in order to relate those facts which she acknowledges as relevant to the decisions that will be made by those people seeking the genetic information. (shrink)

In an earlier edition of CambridgeQuarterly, in the section (CQ Vol 9, No 4), Larry Gottlieb sought advice on ethics committee assembly and policy implementation for a community mental health center. One concern mentioned is that staff members frequently encounter ethical issuesregarding the care of clients whose decisionmaking abilities are impaired by chronic mental illness and/or substance abuse. My response offers a suggestion for policy development and implementation, which may be integrated into guiding staff members of community mental health centers (...) toward a model of care planning that is centered on clients' experiences of their treatments and on relationship-building among clients, community members, and mental health professionals. (shrink)

In this paper, we explore best practices for asynchronous discussions in graduate online bioethics education. We explain that online approaches have advantages and challenges in contrast to in-person discussions. Online challenges are lack of visual or auditory cues and technical access. Advantages include extended opportunities for specific focus, thoughtful reflection, and critical review. We found no significant review of related best practices in bioethics. Our more general literature review of graduate education and online approaches, plus experience in our own bioethics (...) graduate program, suggest provisional best practices that we detail. We reason that online graduate discussion provisionally should aim for a “community of inquiry” framework that incorporates cognitive, social, and teaching “presences,” as well as a learning presence. However, we also note unresolved concerns about whether the framework sufficiently addresses learning, is complete, and captures communicative functions. Drawing further on the literature, we also suggest best practices for instructor feedback to students about their discussion performance, including that remarks should be timely and specific. Summaries from two courses in our graduate bioethics program illustrate how we implement discussion strategies. Finally, we review assessment strategies and suggest that embedded formative assessments in discussion support and demonstrate deeper learning. Limitations in generalizability include that our review targets asynchronous and text-based online discussion, our program assessments do not necessarily detail best practices, student expectations and approaches could be rather particular to our program, and specific bioethics content in principle could alter best practices. (shrink)

This book is a defense of political liberalism as a feminist liberalism. A novel and restrictive account of public reason is defended. Then it is argued that political liberalism's core commitments restrict reasonable conceptions of justice to those that secure genuine, substantive equality for women and other marginalized groups.

Understanding the clinical significance of variants associated with hereditary cancer risk requires access to a pooled data resource or network of resources—a “cancer gene variant commons”—incorporating representative, well-characterized genetic data, metadata, and, for some purposes, pathways to case-level data. Several initiatives have invested significant resources into collecting and sharing cancer gene variant data, but further progress hinges on identifying and addressing unresolved policy issues. This commentary provides insights from a modified policy Delphi process involving experts from a range of stakeholder (...) groups involved in the data-sharing ecosystem. In particular, we describe policy issues and options generated by Delphi participants in five domains critical to the development of an effective cancer gene variant commons: incentives, financial sustainability, privacy and security, equity, and data quality. Our intention is to stimulate wider discussion and lay a foundation for further work evaluating policy options more in-depth and mapping them to those who have the power to bring about change. Addressing issues in these five domains will contribute to a cancer gene variant commons that supports better care for at-risk and affected patients, empowers patient communities, and advances research on hereditary cancers. (shrink)

Background Citizen science is increasingly prevalent in the biomedical sciences, including the field of human genomics. Genomic citizen science initiatives present new opportunities to engage individuals in scientific discovery, but they also are provoking new questions regarding who owns the outputs of the research, including intangible ideas and discoveries and tangible writings, tools, technologies, and products. The legal and ethical claims of participants to research outputs become stronger—and also more likely to conflict with those of institution-based researchers and other stakeholders—as (...) participants become more involved, quantitatively and qualitatively, in the research process. It is not yet known, however, how genomic citizen science initiatives are managing the interests of their participants in accessing and controlling research outputs in practice. To help fill this gap, we conducted an in-depth review of relevant policies and practices of U.S.-based genomic citizen science initiatives. Methods We queried the peer-reviewed literature and grey literature to identify 22 genomic citizen science initiatives that satisfied six inclusion criteria. A data collection form was used to capture initiative features, policies, and practices relevant to participants’ access to and control over research outputs. Results This analysis revealed that the genomic citizen science landscape is diverse and includes many initiatives that do not have institutional affiliations. Two trends that are in apparent tension were identified: commercialization and operationalization of a philosophy of openness. While most initiatives supported participants’ access to research outputs, including datasets and published findings, none supported participants’ control over results via intellectual property, licensing, or commercialization rights. However, several initiatives disclaimed their own rights to profit from outputs. Conclusions There are opportunities for citizen science initiatives to incorporate more features that support participants’ access to and control over research outputs, consistent with their specific objectives, operations, and technical capabilities. (shrink)

Internalists and externalists disagree over how intimately normative judgment and motivation are linked. Proponents on both sides typically try to settle the issue by descriptively interpreting our concept of a normative judgment. Unfortunately, this approach has resulted in deep and apparently intractable disagreement. It is time to consider alternative strategies. In this paper, I argue that the internalist/externalist debate is particularly ripe for revisionary arguments that evaluate conceptions of normative judgment in light of the costs and benefits of their adoption. (...) I then develop a revisionary case for externalism by identifying three practical hazards that come with internalist conceptions of normative judgment. Along the way, I show how these internalist hazards are mirrored by externalist benefits. I also argue that two potential benefits of internalism are not very beneficial. Together, these considerations give us strong practical reasons to adopt externalist conceptions of normative judgment, regardless of which account is descriptively accurate. (shrink)

The Protein Ontology (PRO; http://proconsortium.org) formally defines protein entities and explicitly represents their major forms and interrelations. Protein entities represented in PRO corresponding to single amino acid chains are categorized by level of specificity into family, gene, sequence and modification metaclasses, and there is a separate metaclass for protein complexes. All metaclasses also have organism-specific derivatives. PRO complements established sequence databases such as UniProtKB, and interoperates with other biomedical and biological ontologies such as the Gene Ontology (GO). PRO relates to (...) UniProtKB in that PRO’s organism-specific classes of proteins encoded by a specific gene correspond to entities documented in UniProtKB entries. PRO relates to the GO in that PRO’s representations of organism-specific protein complexes are subclasses of the organism-agnostic protein complex terms in the GO Cellular Component Ontology. The past few years have seen growth and changes to the PRO, as well as new points of access to the data and new applications of PRO in immunology and proteomics. Here we describe some of these developments. (shrink)

The Ozone Layer: A Philosophy of Science Perspective provides the first thorough and accessible history of stratospheric ozone, from the discovery of ozone in the nineteenth century to current investigations of the Antarctic ozone hole. Drawing directly on the extensive scientific literature, Christie uses the story of ozone as a case study for examining fundamental issues relating to the collection and evaluation of evidence, the conduct of scientific debate and the construction of scientific consensus. By linking key debates in (...) the philosophy of science to an example of real-world science, the author not only provides an excellent introduction to the philosophy of science but also challenges many of its preconceptions. This accessible book will interest students and academics concerned with the history, philosophy and sociology of science, as well as having general appeal on this topic of contemporary relevance and concern. (shrink)

The distinction between the Bible as literature and the Bible as scripture is largely artificial. The church can properly hear its Bible as scripture only when it reads it as literature.

A philosopher and mother mines classic Daoist texts of Chinese philosophy for wisdom relevant to today's parents. The ancient Chinese philosopher Mencius compared children to tender sprouts, shaped by soil, sunlight, water, and, importantly, the efforts of patient farmers and gardeners. At times children require our protection, other times we need to take a step back and allow them to grow. Like sprouts, a child's character, tendencies, virtues, and vices are at once observable and ever-changing. A practical parenting manual, philosophical (...) reflection on the relationship between parent and child, and necessary response to modern stereotypes of Chinese parenting, Little Sprouts reconsiders cultural definitions of success and explores how we might support and nourish young people. Engaging deeply with foundational Daoist and Confucian thinkers, Georgetown philosopher Erin Cline offers accessible, provocative musings on key parenting issues-from family rituals to learning and vocation to challenges and disabilities-and helps us grow into better parents of joyful, fulfilled children. (shrink)

Background Intestinal transplant in infants with severe short bowel syndrome (SBS) is an emerging therapy, yet without sufficient long-term data or established guidelines, resulting in possible variation in practice. Objectives To assess current attitudes and counselling practices among physicians regarding intestinal transplant in infants with SBS, and to determine whether counselling and management vary between subspecialists or centres. Methods A national sample of practicing paediatric surgeons and neonatologists was surveyed via the American Academy of Paediatrics listserves. Results were analysed by (...) physician subspecialty and again by presence or absence of intestinal transplant at respondent's centre. Results The survey was completed by 433 respondents, consisting of 363 neonatologists and 70 paediatric surgeons. Fifty-seven respondents (13.2%) practiced at a centre that performed intestinal transplants in children. The vast majority of respondents (91% for preterm, 95% for term neonates) felt that maintaining a neonate with SBS on total parenteral nutrition for intestinal transplant was ethically optional (neither impermissible nor obligatory), and that parents should be given an informed choice whether to pursue that option. However, only 33% indicated they often/always offer intestinal transplant as a treatment option to families in this situation. Conclusions There is a marked disparity between individual physicians’ beliefs regarding the acceptability of intestinal transplant for severe SBS and their reported practice. Wide variability exists among physicians with respect to their knowledge, beliefs and practice regarding severe SBS, raising concerns about transparency and justice. Survival data prior to transplant, currently unavailable, are essential to rational decision making and informed parental permission. (shrink)

This book draws upon original research at a celebrated flagship secondary school, to explore how new forms of neoliberal governmentality are reproducing raced, classed and gendered inequalities. Considering the complex narratives of students, teachers and parents, the book examines the stories underlying the school’s glossy veneer of success, highlighting the persistent structural inequalities concealed beneath its rhetoric of aspirational citizenship. Chapters demonstrate how hopes and dreams are harnessed and mobilized to exact social control, and how marketized education systems reshape inequality, (...) foreclosing spaces of democratic participation through the imposition of authoritarian discipline and self-belief. (shrink)