The authors reject arguments by Professor Joseph Fletcher (author of Situation Ethics) that in some circumstances parents may be held responsible for producing genetically defective offspring, but offer arguments of their own for the same conclusion. Their arguments could, they suggest, justify `wrongful life' claims by the genetically defective infant against the mother. While researching this paper both authors were postdoctoral fellows in medical ethics in the Program on Human Values and Ethics at the University of Tennessee Center for the (...) Health Sciences. (shrink)

Sex determination in most organisms involves a simple binary fate choice between male or female development; the outcome of this decision has profound effects on organismal biology, biochemistry and behaviour. In the nematode C. elegans, there is also a binary choice, either male or hermaphrodite. In C. elegans, distinct genetic pathways control somatic and germline sexual cell fate. Both pathways share a common set of globally acting regulatory genes; however, germline-specific regulatory genes also participate in the decision to make male (...) or female gametes. The determination of sexual fate in the germline of the facultative hermaphrodite poses a special problem, because first sperm then oocytes are produced. It has emerged that additional layers of post-transcriptional regulation have been imposed to modulate the activities of the global sex-determining genes, tra-2 and fem-3; the balance between these activities is crucial in controlling sexual cell fate in the hermaphrodite germline. BioEssays 23:596–604, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

The diffusion of technology in the US has taken place in an environment of both regulation and free enterprise. Each has been subject to manipulation by doctors and medical administrators that has fostered unprecedented ethical dilemmas and legal challenges. Understanding these developments and historical precedents may allow a more rational diffusion policy for medical technology in the future.

The empirical literature exploring lawyers and their moral decision making is limited despite the “crisis” of unethical and unprofessional behavior in the bar that has been well documented for over a decade. In particular we are unaware of any empirical studies that investigate the moral landscape of the health lawyer’s practice. In an effort to address this gap in the literature, an interdisciplinary team of researchers at Vanderbilt University designed an empirical study to gather preliminary evidence regarding the moral reasoning (...) of health care attorneys. The primary research question was how health lawyers respond when they encounter ethical or moral dilemmas in their practice for which the law fails to offer a bright-line solution. In exploring this question, we sought to understand better what motivations or influences guide action when health lawyers confront ethical quandaries, and whether there are specific differences, e.g., gender, experience, or religiosity, that are associated with specific responses to situations testing ethical or moral boundaries. (shrink)

In our society, some aspects of life are off-limits to commerce. We prohibit the selling of children and the buying of wives, juries, and kidneys. Tainted blood is an inevitable consequence of paying blood donors; even sophisticated laboratory tests cannot supplant the gift-giving relationship as a safeguard of the purity of blood. Like blood, health care is too precious, intimate, and corruptible to entrust to the market.The hospice movement in the United States is approximately 40 years old. During these past (...) four decades, the concept of holistic, multidisciplinary care for patients who are suffering from a terminal illness has evolved from a modest, grassroots constellation of primarily volunteer-run and community-governed endeavors to a multimillion dollar industry where the surviving nonprofits compete with for-profit providers, often publicly traded, managed by M.B.A.-trained executives, and governed by corporate boards. The relatively recent emergence of for-profit hospice reflects an increasing commercialization of health care in the United States, the potentially adverse impact of which has been well documented. (shrink)

Financial relationships and business transactions between physicians and the health care industry are common. These relationships take a variety of forms, including payments to physicians in exchange for consulting services, reimbursement of physician travel expenses when attending medical device and pharmaceutical educational conferences, physician ownership in life science company stocks, and the provision of free drug samples. Such practices are not intrinsic to medical practice, but as the Institute of Medicine described in its 2009 report, these relationships have the potential (...) to produce positive collaborations that improve patient care and public health, and most physicians view it as “ethically proper to accept items ranging from drug samples to a lucrative consultantship.”However, financial relationships between physicians and pharmaceutical, medical device and biotechnology companies can also create negative influences on physician judgment that compromise patient care and jeopardize the public’s trust. (shrink)

"Thinking like a lawyer" is a phrase familiar to every law student, and the development of these analytical skills are, of course, essential. In this essay, however, I reflect on the value of a more expansive approach to professional formation. I argue that legal education best serves students, the bar, and the society when it takes seriously the importance of moral imagination, interpersonal relationships, and personal wellness.

Background: Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives (to implement research protocols and advance science), setting (research facilities), and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether (...) research nurses experience unique ethical challenges distinct from those experienced by nurses in traditional patient-care settings. Research objectives: The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice. Research design: The study utilized a qualitative descriptive design with individual interviews. Participants and research context: Participating nurses (N = 12) self-identified as having experienced ethical challenges during screening. The majority were Caucasian (90%), female (83%), and worked in outpatient settings (67%). Approximately 50% had > 10 years of research experience. Ethical considerations: The human subjects review board approved the study. Written informed consent was obtained. Findings: Predominant themes were revealed: (1) the inability to provide a probable good, or/do no harm, and (2) dual obligations (identity as a nurse vs a research nurse). The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship. Discussion: Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science. Conclusion: Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

Epilepsy surgery is the most effective therapeutic approach for children with drug resistant epilepsy. Recent advances in neurosurgery, such as the Laser Interstitial Thermal Therapy, improved the safety and non-invasiveness of this method. Electric and magnetic source imaging plays critical role in the delineation of the epileptogenic focus during the presurgical evaluation of children with DRE. Yet, they are currently underutilized even in tertiary epilepsy centers. Here, we present a case of an adolescent who suffered from DRE for 16 years (...) and underwent surgery at Cook Children's Medical Center. The patient was previously evaluated in a level 4 epilepsy center and treated with multiple antiseizure medications for several years. Presurgical evaluation at CCMC included long-term video electroencephalography, magnetoencephalography with simultaneous conventional EEG and high-density EEG in two consecutive sessions, MRI, and fluorodeoxyglucose - positron emission tomography. Video long-term EEG captured nine focal-onset clinical seizures with a maximal evolution over the right frontal/frontal midline areas. MRI was initially interpreted as non-lesional. FDG-PET revealed a small region of hypometabolism at the anterior right superior temporal gyrus. ESI and MSI performed with dipole clustering showed a tight cluster of dipoles in the right anterior insula. The patient underwent intracranial EEG which indicated the right anterior insular as seizure onset zone. Eventually LITT rendered the patient seizure free. Retrospective analysis of ESI and MSI clustered dipoles found a mean distance of dipoles from the ablated volume ranging from 10 to 25 mm. Our findings highlight the importance of recent technological advances in the presurgical evaluation and surgical treatment of children with DRE, and the underutilization of epilepsy surgery in children with DRE. (shrink)

Though we agree with their argument that language is shaped by domain-general learning processes, Christiansen & Chater (C&C) neglect to detail how the development of these processes shapes language change. We discuss a number of examples that show how developmental processes at multiple levels and timescales are critical to understanding the origin of domain-general mechanisms that shape language evolution.

Alasdair MacIntyre described the late modern West as driven by two moral values: efficiency and effectiveness. Regardless of whether you accept MacIntyre's overarching story, it seems clear that efficiency and effectiveness have achieved a zenith in institutional health care structures, such that these two aspects of care become the final arbiters of what counts as “good” care. At the very least, they are dominant in many clinical contexts and act as the interpretative lens for the judgments of successful health care (...) managers. The drive of efficiency can also be seen in “lean” management methods (originally imported from the automotive manufacturing industry) increasingly deployed in the intensive care unit. This drive gives us pause. The high stress of the ICU is exacerbated by the enormous complexity of technological interventions designed to maintain physiological functioning as the body heals, as well as the ever‐present concerns related to cost, effectiveness, and efficiency. The ICU, therefore, provides an illustrative view of the challenges facing clinicians, as well as resource managers, in terms of delivering care. In short, the goal of technocratic efficiency often ends up at odds with humane purposes. To better understand these contemporary health care dynamics, we conducted a limited series of focus group discussions and interviews with residents experienced in the challenges of delivering care in the ICU environment. In what follows, we highlight some narrative observations drawn from these focus groups. We found a recurrent and disconcerting refrain among our informants that has not been adequately described or addressed in the literature: technocratic management techniques have crept into and bifurcated clinical care strategies in the ICU. Specifically, we highlight the influence of concerns around efficiency and effectiveness and the ways in which these foci have contributed to a bifurcation in care in the ICU along two trajectories: either compassionate care or curative care. (shrink)

Much of the discussion surrounding the ethics of abortion has centered around the notion of personhood. This is because many philosophers hold that the morality of abortion is contingent on whether the fetus is a person - though, of course, some famous philosophers have rejected this thesis (e.g. Judith Thomson and Don Marquis). In this article, I construct a novel argument for the immorality of abortion based on the notion of impairment. This argument does not assume that the fetus is (...) a person - indeed, I concede (for the sake of argument) that the fetus is not a person - and hence the morality of abortion is not contingent on whether the fetus is a person. I finish by answering a plethora of objections to my argument, concluding that none of them are successful. (shrink)

P-zombies are creatures that are physically (functionally, behaviourally) like you and I and yet lack phenomenal consciousness. If such creatures are possible, it’s (typically) taken to show property dualism is true: phenomenal consciousness isn’t reducible to – nor does it supervene on – physical states. If inverted qualia are possible, it’s possible that you and I have identical physical states and yet you see tomatoes as green and I see tomatoes as red. If this is the case, then (again) property (...) dualism is (typically) taken to be true. In this article, I???ll show that p-zombies and inverted qualia – if they are actually possible – prove more than previously thought: if one thinks p-zombies or inverted qualia are possible, then one should endorse one of the four following theses: (i) substance dualism, (ii) we have even more reason to reject p-zombies and inverted qualia since they entail an even more radical conclusion than previously thought (i.e. substance dualism), (iii) eliminativism about selves, or (iv) friends of p-zombies and inverted qualia have homework: they need to show a relevant, plausible disanalogy between arguments for p-zombies and inverted qualia as traditionally stated and my parallel arguments that entail substance dualism. My purpose here isn’t to defend any of these particular options. Instead, my purpose is to highlight that these are the four options available to take. (shrink)

This study investigates the determinants of paternal investment by birth fathers and stepfathers. Inclusive fitness theory predicts higher parental investment in birth children than stepchildren, and this has consistently been found in previous studies. Here we investigate whether paternal investment varies with childhood co-residence duration and differs between stepfathers and divorced birth fathers by comparing the investment of (1) stepfathers, (2) birth fathers who are separated from the child’s mother, and (3) birth fathers who still are in a relationship with (...) her. Path analysis was conducted using cross-sectional data from adolescents and younger adults (aged 17–19, 27–29, and 37–39 years) from the German Family Panel (pairfam), collected in 2010–2011 (_n_ = 8326). As proxies of paternal investment, we used financial and practical help, emotional support, intimacy, and emotional closeness, as reported by the children. We found that birth fathers who were still in a relationship with the mother invested the most, and stepfathers invested the least. Furthermore, the investment of both separated fathers and stepfathers increased with the duration of co-residence with the child. However, in the case of financial help and intimacy, the effect of childhood co-residence duration was stronger in stepfathers than in separated fathers. Our findings support inclusive fitness theory and mating effort theory in explaining social behavior and family dynamics in this population. Furthermore, social environment, such as childhood co-residence was associated with paternal investment. (shrink)

This article is a response to Stephen Law's article ‘The evil-god challenge’. In his article, Law argues that if belief in evil-god is unreasonable, then belief in good-god is unreasonable; that the antecedent is true; and hence so is the consequent. In this article, I show that Law's affirmation of the antecedent is predicated on the problem of good (i.e. the problem of whether an all-evil, all-powerful, and all-knowing God would allow there to be as much good in the world (...) as there is), and argue that the problem of good fails. Thus, the antecedent is unmotivated, which renders the consequent unmotivated. Law's challenge for good-god theists is to show that good-god theism is not rendered unreasonable by the problem of evil in the same way that evil-god theism is rendered unreasonable by the problem of good. Insofar as the problem of good does not render belief in evil-god unreasonable, Law's challenge has been answered: since it is not unreasonable to believe in evil-god (at least for the reasons that Law gives) it is not unreasonable to believe in good-god. Finally, I show that – my criticism aside – the evil-god challenge turns out to be more complicated and controversial than it initially appears, for it relies on the (previously unacknowledged) contentious assumption that sceptical theism is false. (shrink)

The following is a joint report of the Committee on Philosophy in Education of the American Philosophical Association and of the Committee on Cooperation with the American Philosophical Association of the Philosophy of Education Society. The report has been approved by the Executive Committee of the Philosophy of Education Society and by the Board of Officers of the American Philosophical Association. The Committee of the American Philosophical Association was composed of the following: C. W. Hendel, Chairman, H. G. Alexander, R. (...) M. Chisholm, Max Fisch, Lucius Garvin, Douglas Morgan, A. E. Murphy, Charner Perry and R. G. Turnbull. The Committee of the Philosophy of Education Society consisted of Fr. R. J. Henle, S.J., Chairman, and Professors Barton, Clayton, Drake, and Hullfish. The American Philosophical Association subcommittee with primary responsibility for this report was composed of Charner Perry, Chairman, and Douglas Morgan. (shrink)

The “Embryo Rescue Case” (ERC) refers to a thought experiment that is used to argue against the view that embryos have a right to life (i.e. are persons). I will argue that cognitive science undermines the intuition elicited by the ERC; I will show that whether or not embryos have a right to life, our mental tools will make it very difficult to believe that embryos have said right. This suggests that the intuition elicited by the ERC is not truth (...) indicative. The upshot of this is that we have an undercutting defeater for our intuition that embryos do not have a right to life. (shrink)

The following statement is a report of the Committee on Philosophy in Education of the American Philosophical Association and was approved by the Association's Board of Officers in December, 1958. The Committee was composed of the following: C. W. Hendel, Chairman, H. G. Alexander, R. M. Chisholm, Max Fisch, Lucius Garvin, Douglas Morgan, A. E. Murphy, Charner Perry and R. G. Turnbull. Primary responsibility for the preparation of this report belonged to a subcommittee composed of Douglas N. Morgan, Chairman, (...) and Charner Perry. (shrink)

Disturbances of consciousness, including fluctuations in attention and awareness, are a common and clinically important symptom in dementia with Lewy bodies. In the present study we investigate potential mechanisms of such disturbances of consciousness in a clinicopathological study evaluating specific components of the cholinergic system. [3H]Epibatidine binding to the high-affinity nicotinic receptor in the temporal cortex differentiated DLB cases with and without DOC, being 62–66% higher in those with DOC. The were no differences between DLB patients with or without DOC (...) in 125I-labeled α-bungaratoxin binding to the low-affinity nicotinic receptor, [3H]pirenzepine binding to the muscarinic M1 receptor, or in choline acetyltransferase activity. These findings provide support for the hypothesis that cholinergic activity is an important neural correlate if consciousness and suggest a mechanism of DOC in DLB involving alterations in the nicotinic receptor, composed of predominantly α4 and β2 subunits. (shrink)

G. E. Moore famously noted that saying 'I went to the movies, but I don't believe it' is absurd, while saying 'I went to the movies, but he doesn't believe it' is not in the least absurd. The problem is to explain this fact without supposing that the semantic contribution of 'believes' changes across first-person and third-person uses, and without making the absurdity out to be merely pragmatic. We offer a new solution to the paradox. Our solution is that the (...) truth conditions of any moorean utterance contradict its accuracy conditions. Thus we diagnose a contradiction in how the moorean utterance represents things as being; so we can do justice to the intuition that a Moore-paradoxical utterance is in some way senseless, even if we know what proposition it expresses. (shrink)