In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

Abstract:Vulnerability is an important criterion to assess the ethical justification of the inclusion of participants in research trials. Currently, vulnerability is often understood as an attribute inherent to a participant by nature of a diagnosed condition. Accordingly, a common ethical concern relates to the participant’s decisionmaking capacity and ability to provide free and informed consent. We propose an expanded view of vulnerability that moves beyond a focus on consent and the intrinsic attributes of participants. We offer specific suggestions for how (...) relational aspects and the dynamic features of vulnerability could be more fully captured in current discussions and research practices. (shrink)

This article briefly considers current positions about whether the inclusion of the perspectives and interests of marginalised groups in the construction of knowledge is of epistemic value. It is then argued that applied social epistemology is the proper epistemic stance to take in evaluating this question. Theorists who have held that diversity makes an epistemic contribution are interpreted as attempting to reform social pathways to knowledge in ways that make true belief more likely. Thus, the demand for diversity challenges the (...) individualistic and a priori nature of traditional epistemology. This stance has consequences for education. It supports greater attention to helping students examine the testimonial bases for their beliefs. And it prepares students for their role as citizens in supporting policies that maintain credible inclusive institutions of public knowledge. (shrink)

. In Moderating the Debate: Rationality and the Promise of American Education, Michael Feuer argues that insights from cognitive science and the theory of bounded rationality can help us understand why educational policy makers overreach in seeking optimal solutions to educational problems. In this essay, Emily Robertson argues that cognitive science is of limited help for two reasons. First, since the findings of the theory of bounded rationality are supposed to describe how we actually do make decisions under (...) conditions of uncertainty, it is unclear how those findings can help us explain why educational policy makers have apparently used different decision‐making strategies. Second, the idea that educational reform can be set right by being made the province of more fully rational policy makers neglects the public, value dimension of education, and thus obscures some of the true sources of overpromising. (shrink)

The first-ever compilation of articles that highlights the intersection of Derridean and feminist theories--a work that represents the extensive and diverse response feminist theorists have had to Derrida, particularly to the issues of gender, identity, and the construction of the subject.

Although beef and dairy production in Alberta, Canada, enjoys strong public support, there are enduring public concerns, including farm animal welfare. Evolving codes of practice and animal care councils prescribe changes and improvements to many areas of farm management, and may be seen by farmers as an appropriate response to public animal welfare concerns. However, codes of practice do not address every animal welfare concern, and new concerns can arise over time. Drawing on social practice theory and in-depth field research (...) with 36 cattle and dairy farmers, this paper explores the materials, competencies, and meanings of four animal husbandry practices: branding, dehorning, weaning, and on-farm handling and moving. Findings show that branding and dehorning are evolving slowly with attention to pain management, but remain firmly rooted in ranching tradition and communities of practice. Weaning and animal handling practices are evolving more quickly with attention to changing materials, attitudes, and values that are more prevalent within producer communities. (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)

In this issue of American Journal of Bioethics, Childress et al. address one of the most challenging modern clinical ethical dilemmas: the awake, competent patient dependent on extracorporeal membr...

Focus on the evolutionary origins of musicality has been neglected relative to attention on language, so these new proposals are welcome stimulants. We argue for a broad comparative approach to understanding how the elements of musicality evolved, and against the use of overly simplistic evolutionary accounts.

Under the Canadian labour laws that govern workplace safety, wage, and other work conditions, ‘family’ workers are not covered by the law under special rules for agriculture. Among other legal exclusions, the family farm exclusion contributes to a dearth of basic work, health, and safety standards in the sector, despite the commercialization and industrialization of family farming activities. Through a focus on Alberta, Canada—where farm labour rules have only applied to agriculture since 2016—this article explores the family exclusion in relation (...) to family farming experiences with work and risk, based on interviews with farm operators, their family members, and farm employees in Alberta. While some participants continued to press for exemptions for farms from labour rules under the rationale that there is intrinsic safety within families, the findings also reveal how other participants have begun questioning this rationale, despite their overall support for the family farm exemption in Alberta. Using the lens of legal geography and critical perspectives on the family, we argue that the family is a significant but under-examined dynamic in the legal regimes governing farm labour and agricultural safety and health. Together, the law and dominant narratives about family farming treat farm operations as hyper-private domains, where operators have disproportionate power to dispose of their own work and the work of others how they wish. These legal geographies of hyper-privacy contribute to the indecent work conditions that characterize farm labour systems in Alberta and other jurisdictions. (shrink)

The lung allocation score system in the United States and several European countries gives more weight to risk of death without transplantation than to survival following transplantation. As a result, centers transplant sicker patients, leading to increased length of initial hospitalization. The care of patients who have accumulated functional deficits or additional organ dysfunction during their prolonged stay can be ethically complex. Disagreement occurs between the transplant team, patients and families, and non-transplant health care professionals over the burdens of ongoing (...) intensive intervention. These cases highlight important ethical issues in organ transplantation, including the nature and requirements of transplant informed consent, the limits of physician prognostication, patient autonomy and decision-making capacity following transplant, obligations to organ donors and to other potential recipients, and the impact of program metrics on individualized recipient care. We outline general ethical principles for the care of lung transplant recipients with prolonged hospitalization and give regulatory, research, and patient-centered recommendations for these cases. (shrink)

This chapter contains sections titled: The Early Decades of Analytical Philosophy Analytic Philosophy of Education Criticism Contemporary Practice.

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

Aircraft with increasingly high performance were important to the war effort in World War II. Changes in technology allowed aircraft to reach faster speeds and to complete missions at higher altitudes. With these changes came new obstacles for pilots who had to tolerate these stresses. Of primary concern to the U.S. War Department was the loss of consciousness that often occurred with high-speed maneuvers and especially during pull-up after dive-bombing missions. In some cases, pilots would experience up to 9G of (...) force during rapid ascent, much more than the 6G threshold that typically leads to loss of consciousness. In 1941, a research team in Red Wing, MN, proposed experiments to elucidate the mechanism .. (shrink)

Delivering high quality genomics-informed care to patients requires accurate test results whose clinical implications are understood. While other actors, including state agencies, professional organizations, and clinicians, are involved, this article focuses on the extent to which the federal agencies that play the most prominent roles — the Centers for Medicare and Medicaid Services enforcing CLIA and the FDA — effectively ensure that these elements are met and concludes by suggesting possible ways to improve their oversight of genomic testing.

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

The articles published in our Winter 2016 edition are connected loosely under the themes of pop culture and public memory. Our annual conference, held in late April, featured Dr. Kelly MacFarlane as our keynote lecture to speak on the interplay between history, public memory, and pop culture. We are thrilled to present to you eight excellent articles in our Winter 2016 edition: An ideological examination of the US-Russian Space Race and public memory of the event during the cold war is (...) offered in "Narrative Memory in the Space Race"; The article "The Swastika and the Maple Leaf: National-socialism and anti-semitism in Canada" returns to the 1930s to explore anti-semitist ideologies in our country preceeding the second world war;"The Monumentalization of our Disgrace" is a captivating look at the manner in which concentration and death camps standing after the Holocaust are memorialized today and the local residents' public perception of such memorials; "Hegemony without Tears: Defenitions and uses of hegemony from Gramsci onwards" explores the works of Marxist writer Antonio Gramsci and his influence upon other writers through several case studies, ultimately commenting on the subsequent reinterpretation of Gramsci's definition of hegemony; "Confrontation and Cooperation: the hidden history of national parks and Indigenous groups in Canada" takes the reader through a historical analysis of Canada's national parks and the indigenous groups originally inhabiting them, arguing the erasure of these groups by the National Parks system; "War and Faith: Memories of the Great Patriotic War in the Russian Orthodox church" examines the Church's modern conceptualization of the Soviet Union as a "holy battle for survival; "Administering State Legislation: The kirk and witchcraft in early modern Scotland" is a fascinating look at the relationship between the duties performed by the Royal Court and the Calivinist church in Scotland; and finally, we have "The Limits of Rationalism: Early modern geography and the idea of Europe", an investigation of cartogropher's contributions in the 16th and 17th century towards the concept of 'Europe' and the growth of a scientific worldview. We wholly hope you enjoy our Winter 2016 edition as much as our staff has enjoyed curating it. Editors Emily Kaliel Ellen Sutherland Assistant Editors Jean Middleton Kayla Pituka Senior Reviewers Kyler Chittick Emily Hoven Katarina Hoven Faculty Advisor Jeremy Caradonna. (shrink)

Institutional Review Board decisions hinge on the availability and interpretation of information. This is demonstrated by the following well-known historical example. In 2001, 24-year-old Ellen Roche died from respiratory distress and organ failure as a result of her participation in a study at Johns Hopkins Asthma and Allergy Center. The non-therapeutic physiological study, “Mechanisms of Deep Inspiration-Induced Airway Relaxation,” was designed to examine airway hyperresponsiveness in healthy individuals in order to better understand the pathophysiology of asthma. Participants inhaled hexamethonium, (...) a chemical ganglionic blocker that was not FDA-approved for use as specified in the experimental protocol. Risks of inhaling hexamethonium, including lung damage, had been reported in the 1950s and ‘60s. An investigation conducted after Roche's death determined that the study's principal investigator had failed to adequately search the medical literature; the protocol submitted for IRB review cited articles indexed in online literature databases that went back only as far as the 1970s. (shrink)

Derrida and Feminism is a collection of critical essays about deconstruction and the question of "Woman." The question of "Woman" refers to the traditional philosophical problem of defining being or essence: what makes a woman a "Woman"? Derrida's answer is that the concept of "Woman" is undecidable as are all such proper names and concepts: the meanings of our words are not univocal, fully determined, or stable. Meaning slips across uses and contexts. The same word never means exactly the same (...) thing twice—such is the active, dynamic function of language. However, although the essence of a woman can, therefore, never be decided once and for all, has deconstruction helped the feminist project? For what reasons ought Derrida's readers to be wary of his implicit collusion with the phallogocentrism he allegedly undermines? (shrink)

Previous research reported that college students' symbolic addition and subtraction fluency improved after training with non-symbolic, approximate addition and subtraction. These findings were widely interpreted as strong support for the hypothesis that the Approximate Number System (ANS) plays a causal role in symbolic mathematics, and that this relation holds into adulthood. Here we report four experiments that fail to find evidence for this causal relation. Experiment 1 examined whether the approximate arithmetic training effect exists within a shorter training period than (...) originally reported (2 vs 6 days of training). Experiment 2 attempted to replicate and compare the approximate arithmetic training effect to a control training condition matched in working memory load. Experiments 3 and 4 replicated the original approximate arithmetic training experiments with a larger sample size. Across all four experiments (N = 318) approximate arithmetic training was no more effective at improving the arithmetic fluency of adults than training with control tasks. Results call into question any causal relationship between approximate, non-symbolic arithmetic and precise symbolic arithmetic. (shrink)

I argue that the Oxford school Everett interpretation is internally incoherent, because we cannot claim that in an Everettian universe the kinds of reasoning we have used to arrive at our beliefs about quantum mechanics would lead us to form true beliefs. I show that in an Everettian context, the experimental evidence that we have available could not provide empirical confirmation for quantum mechanics, and moreover that we would not even be able to establish reference to the theoretical entities of (...) quantum mechanics. I then consider a range of existing Everettian approaches to the probability problem and show that they do not succeed in overcoming this incoherence. (shrink)

This article examines the regulation of Latina youth sexualities in the context of sexual and reproductive health care provision. In-depth interviews with health care providers working in two Latino-serving community health centers are analyzed for how they interpret and respond to the sexual and reproductive practices of their low-income Latina teen patients. The author finds that providers emphasize teenage pregnancy as a social problem among this population to the exclusion of other dimensions of youth sexualities and encourage Latina girls’ adherence (...) to a life course trajectory that conforms to middle-class, heteronormative ideals as a solution to this problem. By relying on such understandings, providers construct meanings of sexual citizenship that require participation in bourgeois heteronormativity. These findings suggest that Latino-serving community health centers, their providers, and their teen patients could benefit from questioning the assumptions that inform providers’ appraisals of Latina youth and developing a more inclusive approach to Latina youth sexualities beyond a discourse of pregnancy prevention. Such efforts could allow community health centers to actively participate in disrupting the structural inequalities that shape their young patients’ lives. (shrink)

In Physics 2.4–6, Aristotle offers an account of things that happen “by luck” and “spontaneously”. Many of these things are what we might think of as “lucky breaks”: cases where things go well for us, even though we don’t expect them to. In Physics 2.5, Aristotle illustrates this idea with the case of a man who goes to the market for some reason unrelated to collecting a debt he is owed. While he is there, this man just so happens to (...) run into his debtor and get his money back—which is what he “wanted” all along. This case has a number of features that have proved puzzling. Most notably, Aristotle seems to think that while “it happened accidentally to him to come and to do this for the sake of getting the money”, nevertheless the man “did not come for the sake of this”—though he “would have”. What must such a proceeding be like to be described in these ways? Physics 2.4–6 makes several important moves towards answering this question. One of them—among the earliest and seemingly a foundational one—is the claim that “for the sake of something are as many things as could be done by thought and by nature”. The aim of this paper is to identify the role that this claim plays in Aristotle’s account of spontaneous proceedings. It defends two main claims. First, Aristotle’s suggestion that spontaneous proceedings could be done by nature and by thought is the product of a more general strategy. His approach is to sketch an intuitive pattern of explanation for proceedings that happen for the sake of something in the ordinary—non-spontaneous—way, and then to try to extend that model to the case of things that do so spontaneously, preserving as much of it as possible. Applying this strategy reveals that whereas nature and thought in fact function as efficient causes of ordinary proceedings that are for the sake of something, this cannot be the case in spontaneous ones. Instead, nature and thought could function as their causes. Second, I argue that Aristotle’s implementation of this strategy is rooted in his account of causation and especially Physics 2.3’s list of “modes” of causes. When he claims that spontaneous proceedings “could” be done by nature and by thought, he is saying that nature and thought are their efficient causes in capacity. In the practical case, spontaneous proceedings are caused by agents who have certain capacities, connected with their desires and abilities. In the right circumstances, these agents would actively exercise those capacities in acting for the sake of a given end. (shrink)

Most research on the corporate philanthropy of organizations has focused on the external benefits of such initiatives for firms, such as benefits for firm reputation and opportunities. However, many firms justify their giving, in part, due to the positive impact it has on their employees. Little is known about the effectiveness of such efforts, or how they can be managed strategically to maximize impact. We hypothesize a main effect of office-level corporate philanthropy on average employee attitudes in that office, but (...) also investigate three strategies that offices may use to enhance this impact. Testing our hypotheses with 3 years of data on attitudes of an average of 14,577 employees in 53 offices we find support for the main effect, but mixed support for the specific strategies used to enhance impact. (shrink)