This article describes the situated nature of two intertwined dimensions of the context of medical encounters - expertise and compliance - within the interactional practices of referrals and accounts of referrals. Families who display their expertise and compliance have referral and account sequences with notably different features compared to sequences with families who display a lack of compliance and expertise. The display of expertise significantly affects the course of the interaction, and asymmetrical sequences often occur in interactions when the professionals (...) see families' expertise and compliance as problematic. (shrink)

Wisdom is a multi-component trait that is important for mental health and well-being. In this study, we sought to understand gender differences in relative strengths in wisdom. A total of 659 individuals aged 27–103 years completed surveys including the 3-Dimensional Wisdom Scale and the San Diego Wisdom Scale. Analyses assessed gender differences in wisdom and gender’s moderating effect on the relationship between wisdom and associated constructs including depression, loneliness, well-being, optimism, and resilience. Women scored higher on average on the 3D-WS (...) but not on the SD-WISE. Women scored higher on compassion-related domains and on SD-WISE Self-Reflection. Men scored higher on cognitive-related domains and on SD-WISE Emotion Regulation. There was no impact of gender on the relationships between wisdom and associated constructs. Women and men have different relative strengths in wisdom, likely driven by sociocultural and biological factors. Tailoring wisdom interventions to individuals based on their profiles is an important next step. (shrink)

Context: Although ethics consultation is commonplace in United States (U.S.) hospitals, descriptive data about this health service are lacking. Objective: To describe the prevalence, practitioners, and processes of ethics consultation in U.S. hospitals. Design: A 56-item phone or questionnaire survey of the "best informant" within each hospital. Participants: Random sample of 600 U.S. general hospitals, stratified by bed size. Results: The response rate was 87.4%. Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and (...) in 100% of hospitals with more than 400 beds. The median number of consults performed by ECSs in the year prior to survey was 3. Most individuals performing ethics consultation were physicians (34%), nurses (31%), social workers (11%), or chaplains (10%). Only 41% had formal supervised training in ethics consultation. Consultation practices varied widely both within and between ECSs. For example, 65% of ECSs always made recommendations, whereas 6% never did. These findings highlight a need to clarify standards for ethics consultation practices. (shrink)

It is not rare in philosophy and psychology to see theorists fall into dichotomous thinking about mental phenomena. On one side of the dichotomy there are processes that I will label “unintelligent.” These processes are thought to be unconscious, implicit, automatic, unintentional, involuntary, procedural, and non-cognitive. On the other side, there are “intelligent” processes that are conscious, explicit, controlled, intentional, voluntary, declarative, and cognitive. Often, if a process or behavior is characterized by one of the features from either of the (...) above lists, the process or behavior is classified as falling under the category to which the feature belongs. For example, if a process is implicit this is usually considered sufficient for classifying it as “unintelligent” and for assuming that the remaining features that fall under the “unintelligent” grouping will apply to it as well. Accordingly, if a process or behavior is automatic, philosophers often consider it to be unintelligent. It is my goal in this paper to challenge the conceptual slip from “automatic” to “unintelligent”. I will argue that there are a whole range of properties highlighted by the existing psychological literature that make automaticity a much more complex phenomenon than is usually appreciated. I will then go on to discuss two further important relationships between automatic processes and controlled processes that arise when we think about automatic processes in the context of skilled behavior. These interactions should add to our resistance to classifying automaticity as unintelligent or mindless. In Sect. 1, I present a few representative cases of philosophers classifying automatic processes and behaviors as mindless or unintelligent. In Sect. 2, I review trends in the psychology of automaticity in order highlight a complex set of features that are characteristic, though not definitive, of automatic processes and behaviors. In Sect. 3, I argue that at least some automatic processes are likely cognitively penetrable. In Sect. 4, I argue that the structure of skilled automatic processes is shaped diachronically by practice, training and learning. Taken together, these considerations should dislodge the temptation to equate “automatic” with “unintelligent”. (shrink)

To design effective strategies to improve ethics consultation (EC) practices, it is important to understand the views of ethics practitioners. Previous U.S. studies of ethics practitioners have overrepresented the views of academic bioethicists. To help inform EC improvement efforts, we surveyed a random stratified sample of U.S. hospitals, examining ethics practitioners’ opinions on EC in general, on their own EC service, on strategies to improve EC, and on ASBH practice standards. Respondents across all categories of hospitals had very positive perceptions (...) of their own ethics consultation service (ECS) and few concerns about quality. Our findings suggest that the ethics-related needs of small, rural, non-teaching hospitals may be very different from those of academic medical centers, and therefore, different approaches to addressing ethical issues might be warranted. (shrink)

In recent years, a debate concerning the nature of knowing-how has emerged between intellectualists who claim that knowledge-how is reducible to knowledge-that and anti-intellectualists who claim that knowledge-how comprises a unique and irreducible knowledge category. The arguments between these two camps have clustered largely around two issues: intellectualists object to Gilbert Ryle's assertion that knowing-how is a kind of ability, and anti-intellectualists take issue with Jason Stanley and Timothy Williamson's positive, intellectualist account of knowing-how. Like most anti-intellectualists, in this paper (...) I will raise objections to Stanley and Williamson's account of knowing-how and also defend the claim that ability is necessary for knowing-how attributions. Unlike most discussions of knowing-how, however, I will return to more Rylean considerations in order to illustrate that any intellectualist account of knowing-how, not simply Stanley and Williamson's preferred variety, will fail because it will be unable to account for fundamental differences in the knowledge required to instantiate an ability and the knowledge involved in propositional thought. (shrink)

To address the current lack of knowledge about clinical ethics fellowship programs (CEFPs), we surveyed all 36 programs in the U.S. and Canada. The number of CEFPs has grown exponentially over the last 40 years and far exceeds previous estimates. Commonalities among CEFPs include: 88.8% require an advanced degree or rarely accept applicants without one; 91.7% of programs do not restrict applicants to a specific background such as medicine or philosophy; and 88.9% of programs compensate fellows. CEFPs vary widely on (...) numbers of fellows trained in the last 3 years (1–111), numbers of consultations performed by each fellow (0–450), and salaries paid ($0-$95,000). Less than half of programs meet CEFP standards established by ABPD. Nonpaying programs and larger programs tend to have lower admission standards and lower expectations for fellows. We hope these data will help inform CEFP standards that promote quality and consistency without stifling desirable diversity and innovation. (shrink)

In the past 20 years or so, the psychological research on imitation has flourished. However, our working definition of imitation has not adequately adapted in order to reflect this research. The closest that we've come to a revamped conception of imitation comes from the work of Michael Tomasello. Despite its numerous virtues, Tomasello's definition is in need of at least two significant amendments, if it is to reflect the current state of knowledge. Accordingly, it is our goal in this paper (...) to reformulate Tomasello's definition of imitation in order to account for both the latest empirical findings and the conceptual considerations that follow from them. Specifically, we argue that a satisfactory definition of imitation ought to be formulated as follows: imitation is the reproduction of an observed behavior where the agent imitating recognizes the behavior of the demonstrator as goal-directed and has some particular interest in or concern for replicating the precise technique performed by the aut.. (shrink)

Arid Waters is a photographic response to the growing crisis of water scarcity, which exists because our culture thinks of water as a commodity, or an abstract legal right, rather than the most basic physical source of life. The Water in the West Project began as a collaborative effort designed to present an artistic response to water as a social issue. Photography historian Ellen Manchester and the photographers - Mark Klett, Terry Evans, Laurie Brown, Peter Goin, Robert Dawson, Martin (...) Stupich, Gregory Conniff, and Wanda Hammerbeck - address the question: How can photography contribute to the urgent public debate over water use and allocation? Project members prepared an exhibition of their work, defining it as a laboratory and emphasizing the process of working through ideas. Contact prints and numerous work prints were displayed on the walls of the Sheppard Fine Art Gallery at the University of Nevada, Reno, and simultaneously the Nevada Humanities Committee sponsored a conference entitled "Water in the Arid West." Participants included historians, writers, ranchers, politicians, lawyers, students, and community members. Arid Waters documents the evolution of the Water in the West Project from its inception as a group collaboration to the foundation of an archive. Ellen Manchester, codirector of the Water in the West Project, has written an informative introduction that provides a historical perspective for the collaboration. Including 59 photographs from the eight photographers, Arid Waters is a testimony to the role photography has played in western history. (shrink)

In formulating a theory of perception that does justice to the embodied and enactive nature of perceptual experience, proprioception can play a valuable role. Since proprioception is necessarily embodied, and since proprioceptive experience is particularly integrated with one’s bodily actions, it seems clear that proprioception, in addition to, e.g., vision or audition, can provide us with valuable insights into the role of an agent’s corporal skills and capacities in constituting or structuring perceptual experience. However, if we are going to have (...) the opportunity to argue from analogy with proprioception to vision, audition, touch, taste, or smell, then it is necessary to eschew any doubts about the legitimacy of proprioception’s inclusion into the category of perceptual modalities. To this end, in this article, I (1) respond to two arguments that Shaun Gallagher ( 2003 ) presents in “Bodily self-awareness and objectperception” against proprioception’s ability to meet the criteria of object perception, (2) present a diagnosis of Gallagher’s position by locating a misunderstanding in the distinction between proprioceptive information and proprioceptive awareness, and (3) show that treating proprioception as a perceptual modality allows us to account for the interaction of proprioception with the other sensory modalities, to apply the lessons we learn from proprioception to the other sensory modalities, and to account for proprioceptive learning. Finally, (4) I examine Sydney Shoemaker’s ( 1994 ) identification constraint and suggest that a full-fledged notion of object-hood is unnecessary to ground a theory of perception. (shrink)

In the current literature, discussions of cognitive penetrability focus largely either on interpreting empirical evidence in ways that is relevant to the question of modularity :343–391, 1999; Wu Philos Stud 165:647–669, 2012; Macpherson Philos Phenomenol Res, 84:24–62, 2012) or in offering epistemological considerations regarding which properties are represented in perception :519–540, 2009, Noûs 46:201–222, 2011; Prinz Perceptual experience, Oxford University Press, Oxford, pp 434–460, 2006). In contrast to these debates, in this paper, I explore conceptual issues regarding how we ought (...) to understand the “cognitive” side of cognitive penetrability. I argue that it is only on its most narrow construal that a full-fledged defense of cognitive impenetrability has been forwarded. Specifically, I argue that the defenders of modularity have tacitly identified cognitive states with propositional states, and have thus only defended the idea that early perceptual systems are immune to the impacts of propositional knowledge. My aim then is to raise doubts about the identification of cognitive states with propositional ones. In particular, by focusing on skill, I will broaden the conceptual space for a greater number of states to have the potential to impact perceptual processing in a way that would constitute a genuine instance of cognitive penetrability. (shrink)

Coverage error is an important type of error that occurs in survey studies when there is a mismatch between the target population and the sampling frame from which a sample is drawn. Coverage error...

Interdisciplinary hospital ethics committees have been the most common response to the mandates for ethical review procedures set forth by the Joint Commission for the Accreditation of Health Care Organizations, the American Hospital Association, and within institutions themselves. A 1989 national survey reported that 60% of hospitals had ethics committees. However, little is still known about the current state of these committees in hospitals, their composition, what functions are performed, or what issues are discussed.

Mukti Barton’s 2000 paper, ‘The Skin of Miriam Became as White as Snow: The Bible, Western Feminism and Colour Politics’, reflected on interpretations of the story of Miriam and her sister-in-law Zipporah, that have focused mainly on Miriam becoming white, as indicative of the effect of colour politics on biblical hermeneutics. Updating that article, the focus was on Zipporah and the main text was again Numbers 12. What are the lessons for Feminist Theology?

This editorial presents the background for the article collection ‘ELSA and RRI’. It sets the stage for the topics discussed in the collection and briefly presents the different contributions. It concludes by opening up for continued discussion of the relations between ELSA and RRI.

I argue for the usefulness of the evolutionary kind of biological individual.

Regional planning for improved agricultural capacity to supply produce, legumes, and whole grains has the potential to improve population health as well as the local food economy. This case study of Waterloo Region (WR), Canada, had two objectives. First, we estimate the quantity of locally grown vegetables, fruits, legumes, and whole grains needed to help meet the Region of Waterloo population’s optimal nutritional requirements currently and in 2026. Secondly, we estimate how much of these healthy food requirements for the WR (...) population could realistically be produced through local agriculture by the year 2026. Results show that a shift of approximately 10% of currently cropped hectares to the production of key nutritious foods would be both agriculturally feasible and nutritionally significant to the growing population. We supplement our findings with some agronomic considerations and community-level strategies that would inform and support such change. The methodology of this study could be applied to other regions: more such analyses would create a broader picture of the diverse qualitative and quantitative agricultural shifts that could synchronize optimal land use with dietary recommendations, thus informing coordinated policy and planning. (shrink)

Revolutions in semiconductor device miniaturization, bioelectronics, and applied neural control technologies are enabling scientists to create machine-assisted minds, science fiction's “cyborgs.” In a paper published in 1999, we sought to draw attention to the advances in prosthetic devices, to the myriad of artificial implants, and to the early developments of this technology in cochlear and retinal implants. Our concern, then and now, was to draw attention to the ethical issues arising from these innovations. Since that time, breakthroughs have occurred at (...) a breathtaking pace. Scientists, researchers, and engineers using differing methodologies are pursuing the possibilities of direct interfaces between brains and machines. Technological innovations as such are neither good nor evil; it is the uses devised for them that create moral implications. As there can be ethical problems inherent in the proper human uses of technologies and because brain chips are a very likely future technology, it is prudent to formulate policies and regulations that will mitigate their ill effects before the technologies are widespread. Unlike genetic technologies, which have received widespread scrutiny within the scientific community, national governments, and international forums, brain–machine interfaces have received little social or ethical scrutiny. However, the potential of this technology to change and significantly affect humans is potentially far greater than that of genetic enhancements, because genetic enhancements are inherently limited by biology and the single location of an individual, whereas hybrids of human and machine are not so restricted. Today, intense interest is focused on the development of drugs to enhance memory; yet, these drugs merely promise an improvement of normal memory, not the encyclopedic recall of a computer-enhanced mind combined with the ability to share information at a distance. The potential of brain chips for transforming humanity are astounding. This paper describes advances in hybrid brain–machine interfaces, offers some likely hypotheses concerning future developments, reflects on the implications of combining cloning and transplanted brain chips, and suggests some potential methods of regulating these technologies. (shrink)

Extensive research has documented the harmful effects associated with working for a narcissistic supervisor. However, little effort has been made to investigate ways for victims to alleviate the burdens associated with exposure to such aversive persons. Building on the tenets of conservation of resources theory and the documented efficacy of functional assets to combat job-related stress, we hypothesized that subordinates’ resource management ability would buffer the detrimental impact of narcissistic supervisors on affective, cognitive, and behavioral work outcomes for subordinates. We (...) found support for our hypotheses across three independent samples of US workers. Specifically, higher levels of subordinate resource management ability attenuated the harmful effects of supervisor narcissism on employee-reported emotional exhaustion, job tension, depressed mood, task performance, and citizenship behavior. Conversely, these relationships further deteriorated for subordinates with lower levels of resource management ability. Overall, our research contributes to the literature that, although extensively documenting the harmful ramifications of narcissism in organizations, has neglected to investigate potentially mitigating factors. (shrink)

BackgroundThis paper represents a portion of the findings from one of the first research studies eliciting the lived experience of adults with an early diagnosis of Phenylketonuria living in Ireland. Ireland has one of the highest prevalence rates of PKU in Europe, however, little is known about the experience of Irish adults with PKU. Furthermore, Ireland is one of the first countries in the world to introduce neonatal screening followed by the introduction of long-term dietary therapy over 50 years ago. (...) This study presents the first comprehensive assessment of the lived experience of Irish adults with PKU on long term dietary therapy.MethodsNarrative data was collected from eleven self-selected participants, using semi-structured interviews. The interviews were divided into five sections focused on eliciting a holistic understanding of the lived experience of adults with PKU living in Ireland. Thematic analysis was guided by Colaizzi's Framework in conjunction with NVivo qualitative data analysis software.FindingsFindings from the original research encompassed a broad understanding of the lived experience of adults with PKU living in Ireland, including factors influencing dietary therapy and managing PHE blood levels. The themes being discussed within this article are those which appear to be least represented within current literature: living with PKU, including reproductive health, the importance of self-management and establishing routine, support networks in adulthood and concerns regarding aging with PKU.ConclusionIt was evident from the findings that a diagnosis of PKU can influence how adults with PKU may experience aging and their own mortality. These findings offer new insight into the vulnerability attached to the experience of aging with PKU and may be beneficial to advocacy groups and for future development of policy and practice. (shrink)

Over one in five adults in the United States and around the world are estimated to live with chronic pain. How are we to attend well to persons living with pain? This is a difficult, pressing question for both healthcare institutions and Christian communities, and it is only made more complex both by the contemporary opioid crisis and by how experiences of pain and addiction are shaped in the American context by race, gender, and class. Attending faithfully to persons in (...) pain demands thoughtful, creative resources on both practical and conceptual levels. In this special issue of Christian Bioethics, eight scholars from different disciplines—Sarah Barton, Farr Curlin, Jaime Konerman-Sease, Brett McCarty, Joel Shuman, Devan Stahl, John Swinton, and Emmy Yang—engage the meaning of attending to persons in pain for Christian bioethics and for faithful Christian practice. (shrink)

Intersex—the fact of bodies neither typically male nor female, together with the grim history of its medical management—was a topic for feminist theory before there was such a thing as intersex activism. Indeed, critical academic scholarship about intersex supported the consciousness raising that made an intersex activist movement possible. Activist engagement, in turn, has expanded the understanding of the theorists whose work is responsive to that activism. Central to the thinking about intersex are the questions of identity and its limits (...) that are an important focus of the work of Gloria Anzaldúa, whose narrative suggests she had a condition associated with intersex. While her work largely predates intersex activism, it powerfully encapsulates the tensions displayed in contests over identity that have become central over the last 15 years, and furthermore offers insight into the challenges that lie ahead. (shrink)

In his review of Getting Even: Revenge as a Form of Justice (Open Court: Chicago. 1999). Michael Davis challenges the view put forward in the book that revenge is personal retributive punishment. Davis also claims that “the purpose Barton seeks to achieve under the banner of ‘victims rights’ has no more to do with punishment than with revenge.” In my response, I argue that Davis’s views and conclusions are based partly on a misreading of Getting Even, and partly on (...) mistaken assumptions about the nature of victim rights, justice, punishment, and revenge. (shrink)

Risk is an ubiquitous entity in the biomedical domain. Thus, a coherent ontological characterization of risk, which can be used by informatical tools named "applied ontologies", is necessary to help with the exchange and the collection of data for clinical and research uses. We analyze some definitions of risk and draw two general characteristics that risks and dispositions share. We thus suggest that a risk is a disposition which has an undesirable realization for an agent. This definition conciliates the objective (...) dimension and the subjective dimension of risk : a risk exist independantly of our knowledge about it, but the status of risk of a given disposition for an agent depends of the preferences of this agent. (shrink)

This article reconsiders the issue of Luce Irigaray's proximity to Jacques Derrida on the question of woman. I use Derrida's reading of Nietzsche in Spurs: Nietzsche's Styles (1979) and Irigaray's reading of Heidegger in L'Oubli de l'air (1983) to argue that reading them as supplements to one another is more accurate and more productive for feminism than separating one from the other. I conclude by laying out the benefits for feminism that such a reading would offer.

- How can anthropology improve our understanding of the interrelationship between nature and culture? - What can anthropology contribute to practical debates which depend on particular definitions of nature, such as that concerning sustainable development? Humankind has evolved over several million years by living in and utilizing 'nature' and by assimilating it into 'culture'. Indeed, the technological and cultural advancement of the species has been widely acknowledged to rest upon human domination and control of nature. Yet, by the 1960s, the (...) idea of culture in confrontation with nature was being challenged by science, philosophy and the environmental movement. Anthropology is increasingly concerned with such issues as they become more urgent for humankind as a whole. This important book reviews the current state of the concepts of 'nature' we use, both as scientific devices and ideological constructs, and is organised around three themes: - nature as a cultural construction; - the cultural management of the environment; and - relations between plants, animals and humans. (shrink)

Even as feminist analyses have contributed in important ways to discussions of how gender is raced and race is gendered, there has been little in the way of comparative analysis of the specific mechanisms that are at work in the production of each. Feder argues that in Michel Foucault's analytics of power we find tools to understand the reproduction of whiteness as a complex interaction of distinctive expressions of power associated with these categories of difference.

The philosophy of family‐centered care (FCC) promotes partnerships between families and staff to plan, deliver, and evaluate services for children and has been officially adopted by a majority of pediatric hospitals throughout North America. However, studies indicated that many parents have continued to be dissatisfied with their decision‐making roles in their child's care. This is particularly salient for parents of children with chronic ongoing complex health problems. These children are dependent upon medical technology and require frequent hospitalizations during which parents (...) must contribute to difficult decisions regarding their child's care. Given this clinical issue, an alternative theoretical perspective was explored to redress this problem. Pierre Bourdieu's theoretical concepts of field, capital, and habitus were used to analyze the hierarchical relationships in pediatric acute care hospitals and to design a briefing intervention aimed at improving parents' satisfaction with decision making in that health care setting. (shrink)

To succeed, an accreditation process for clinical ethics fellowship programs (CEFPs) would need support from CEFP directors. To assess CEFP directors’ opinions, we surveyed all 36 CEFP directors in the United States and Canada, achieving a 100% response rate. We found that support for accreditation is strong, with 30.6% strongly supportive, 44.4% supportive, 22.2% neutral, 2.8% opposed, and 0% strongly opposed. Most directors (77.8%) would be likely to apply for accreditation within the next five years regardless of the availability of (...) government funding; even more (86.1%) would apply if government funding became available for accredited programs. Most directors thought that lack of a national accreditation process (75.0%), lack of agreed-upon standards (90.0%), and lack of funding for CEFPs (91.7%) were at least moderate problems for the field. When directors were asked what they thought was the greatest challenge or barrier to developing an accreditation process, many mentioned the diversity of programs and the challenge of achieving consensus on accreditation standards. Directors offered a variety of suggestions for how to overcome or manage challenges or barriers, including collecting data on existing programs, mirroring standards established for other health professions, and setting clear expectations on the need for compromise. When directors were asked how they expected that accreditation and government funding would affect their own programs, the field of clinical ethics, and patient care, directors mostly had very positive expectations; no director expected negative effects in any of these areas. Overall, this study provides evidence that developing an accreditation process for CEFPs would be both possible and desirable. Our findings have immediate practical implications for the field and will inform efforts that are already underway to establish an accreditation process for CEFPs. (shrink)