Recently, two prescription drugs have become salient to breast cancer prevention. With the advent of these drugs, referred to as “chemoprevention,” a mandate has emerged to classify certain women as high risk for breast cancer to determine a group of legitimate users of the drugs. This article examines the development and standardization of the model used to create such a group of high-risk women. The author argues that while the model remains uncertain and controversial, it has become the standard tool (...) for the many jobs associated with legitimizing chemoprevention use in the United States. It has become the assumed standard—shaping practices, identities, and definitions—through its organizational embeddedness in the multiple practices and public images of chemoprevention despite its uncertainty and widespread critique. (shrink)

Background: In the ever-changing and complex healthcare environment, nurses encounter challenging situations that may involve a clash between their personal and professional values resulting in a profound impact on their practice. Nevertheless, there is a dearth of literature on how nurses develop their personal–professional values. Aim: The aim of this study was to understand how nurses develop their foundational values as the base for their value system. Research design: A constructivist grounded theory methodology was employed to collect multiple data sets, (...) including face-to-face focus group and individual interviews, along with anecdote and reflective stories. Participants and research context: Fifty-four nurses working across various nursing settings in Indonesia were recruited to participate. Ethical considerations: Ethics approval was obtained from the Monash University Human Ethics Committee, project approval number 1553. Findings: Foundational values acquisition was achieved through family upbringing, professional nurse education and organisational/institutional values reinforcement. These values are framed through three reference points: religious lens, humanity perspective and professionalism. This framing results in a unique combination of personal–professional values that comprise nurses’ values system. Values are transferred to other nurses either in a formal or informal way as part of one’s professional responsibility and customary social interaction via telling and sharing in person or through social media. Discussion: Values and ethics are inherently interweaved during nursing practice. Ethical and moral values are part of professional training, but other values are often buried in a hidden curriculum, and attained and activated through interactions during nurses’ training. Conclusion: Developing a value system is a complex undertaking that involves basic social processes of attaining, enacting and socialising values. These processes encompass several intertwined entities such as the sources of values, the pool of foundational values, value perspectives and framings, initial value structures, and methods of value transference. (shrink)

In the United States, police use of force experts often maintain that controversial police shootings where an unarmed person’s hand gesture was interpreted as their “going for a gun” are justifiable. If an officer waits to confirm that a weapon is indeed being pulled from a jacket pocket or waistband, it may be too late to defend against a lethal attack. This article examines police policy norms for self-defense against “uncertain threats” in three contexts: (1) known in-progress violent crimes, (2) (...) interactions with civilians behaving non-aggressively, and (3) interactions with civilians behaving aggressively. It is argued that the context of a known in-progress violent crime gives rise to threat probability-, fairness-, and lesser evil-based reasons for a norm permitting police officers to use lethal force. However, in the contexts of civilians behaving non-aggressively and civilians behaving aggressively, such a norm is not justifiable. In the former case, I introduce two conditions, the Justification condition and the Valuing Civilian Lives condition, which I argue are not presently met. In the latter case, these two conditions again are not met; aggression may moreover be excused or justified due to background injustices around race and the criminal justice system. (shrink)

n both the philosophy and psychology of emotion there is disagreement regarding the role of biology/genetics and culture/sociality in emotional development and experience. Using recent insights from developmental psychology and biology, and particularly recent developments in metaphysics of mind, I argue that distinctly human emotionality requires the complex interaction of both. Human neonates and caregivers are genetically preadapted to enable emotional ontogenesis in the context only of a complexly interdependent linguistically-mediated social relationship. This relationship provides the requisite sensory-perceptual stimulation to (...) excite intracellular genetic activity and the resultant development/maturation of emotion-related neural substrata. This genetic preadaptation and the close linguistically-mediated social relationship together provide the necessary and sufficient conditions for the gradual development of human adult emotionality. (shrink)

Melanie presented at twenty weeks of gestation to an obstetrics clinic in a critical access hospital in rural Vermont. She was excited to undergo routine fetal ultrasonography, but her obstetrician gave her grave news: the ultrasound revealed hypoplastic left heart syndrome, a devastating congenital heart defect. Initially, Melanie agreed in general to pursue surgical care for her fetus—a three‐stage process that has somewhat uncertain results and could only be done in tertiary care facilities far from her home in Vermont. A (...) week later, while the maternal fetal medicine and pediatric cardiology units made arrangements with colleagues in Boston, Melanie began having second thoughts. An ethics meeting was called to discuss conflicting clinician reactions to Melanie's dilemma. Most of the clinicians were stunned that the patient would change her mind. What advice should the ethics consultant offer the team about caring for Melanie? (shrink)

Jennifer Trusted's new book argues that metaphysical beliefs are essential for scientific inquiry. The theories, presuppositions and beliefs that neither science nor everyday experience can justify are the realm of metaphysics, literally `beyond physics'. These basic beliefs form a framework for our activities and can be discovered in science, common sense and religion. By examining the history of science from the eleventh century to the present, this book shows how religious and mystical beliefs, as well as philosophical speculation have (...) had a considerable role in motivating scientists and inspiring scientific inquiry. _Physics and Metaphysics_ presupposes no technical knowledge of either philosophy or science. It is an ideal introduction to science and the important forces that have shaped its history and ideas. (shrink)

Video‐recording healthcare interactions provides important opportunities for research and service improvement. However, this method brings about tensions, especially when recording sensitive topics. Subsequent reflection may compel the researcher to engage in ethical and moral deliberations. This paper presents experiences from a South African genetic counselling study which made use of video‐recordings to understand communicative processes in routine practice. Video‐recording as a research method, as well as contextual and process considerations are discussed, such as researching one's own field, issues of trust (...) and anonymity, the challenge of providing true informed consent and capturing details which may cause psychological harm. Several recommendations for research practice in diverse healthcare settings are made. This includes the value of reflective pieces, the importance of retrospective consent, disclosure of the limitations to anonymity, as well as the collective responsibility of those involved to produce ethical research. These recommendations have value for genetic counselling and other healthcare fields. (shrink)

We outline some ways in which motor neglect (the underutilization of a limb despite adequate strength) and hysterical paralysis (failure to move a limb despite no relevant structural damage or disease) may throw light on the pathophysiology of catatonia. We also comment on the manifold inadequacies of distinguishing too firmly between symptoms of “neurologic origin” and of “psychiatric origin.”.

Issues-driven shareholder activism suggests that specific issue characteristics brought by shareholders, a group to which firms are obligated to respond, interact in a way that affects the materiality of the issue in the eyes of the modern corporation. Relevant issue characteristics include: issue type, social significance, and issue life cycle stage.

We use the format of a hypothetical case study to review issues related to pharmaceutical product approval and physician prescribing practices. In this case, a new FDA-approved drug is recommended for a patient who subsequently experiences an adverse event that may or may not be related to the prescription. This case raises a number of ethical and legal considerations physicians routinely face when deciding whether to recommend such drugs for their patients. Despite the need for ongoing observation by the regulatory (...) apparatus, physicians should be cognizant of the limitations of the drug approval system and the post-approval prescription drug surveillance system. We discuss physicians’ ethical obligations when faced with a newly approved drug, including seeking out independent sources of learning, reporting adverse effects, and notifying patients about limitations in available knowledge about therapeutic recommendations. (shrink)

Hom and colleagues (2016) argue in favor of allowing religious exemptions to congenital critical heart disease (CCHD) newborn screening, but the logic of their position is at odds with the moral ju...

These are the words Achilles speaks to Hektor, whom he has just struck with a fatal blow. He reminds the son of Priam how, after stripping Patroklos’ fallen body, Hektor made off with the fallen man's armour, which is Achilles’ own.

Through examination of a case study of Liberian refugee participation in the Truth and Reconciliation Commission of Liberia, this article highlights concerns about the lack of opportunity for refugee participation in peacebuilding generally. The experience of the authors working with refugees in the Buduburam Settlement near Accra, Ghana, demonstrates the overwhelming desire of refugees to participate in the processes that directly impact their lives, as well as the future of their home and host countries. The article concludes with the suggestion (...) that the Liberian Truth and Reconciliation Commission’s work with refugees can serve as a model of how refugee participation can be enhanced in similar processes in the future. (shrink)

In this essay Robert Rhoads, Jennifer Berdan, and Brit Toven-Lindsey examine some of the key literature related to the open courseware (OCW) movement (including the emergence and expansion of massive open online courses, or MOOCs), focusing particular attention on the movement's democratic potential. The discussion is organized around three central problems, all relating in some manner or form to issues of power: the problem of epistemology, the problem of pedagogy, and the problem of hegemony. More specifically, the authors raise (...) issues related to the narrow notion of knowledge typically conveyed in the OCW movement, a limited understanding of what constitutes empowering pedagogy, and the lack of treatment of inequities associated with the production of courseware materials. The authors go on to argue that the lack of critical analysis of the OCW movement is tied to its relative alignment with educational reforms driven by neoliberal ideology and that such alignment serves to limit the movement's democratic possibilities. (shrink)

Jennifer Anna Gosetti-Ferencei demonstrates that the exotic, as reflected in major works of German literature and in the philosophy and art that inspires it,..

Because of historical mistreatment of ethnic minorities by research and medical institutions, it is particularly important for researchers to be mindful of ethical issues that arise when conducting research with ethnic minority populations. In this article, we focus on the ethical issues related to the inclusion of ethnic minorities in clinical trials of psychosocial treatments. We highlight 2 factors, skepticism and mistrust by ethnic minorities about research and current inequities in the mental health care system, that researchers should consider when (...) developing psychosocial interventions studies that include ethnic minorities. (shrink)

While the words “utopia” and “anticipation” frequently appear together in discussions of the concepts of utopia and dystopia, little attention to the relationship of Anticipation Studies to utopian studies exists. Moreover, the relevance of literature and the arts to Anticipation Studies seems almost invisible. This essay focuses on the structuring of the original utopian narrative, Sir Thomas More’s Utopia, in order to understand how this seminal text conceptualizes utopia’s relation to past, present, and future. This analysis focuses on the complex (...) framing devices characteristic of utopian narrative, as well as its open-endedness. The embedding of narratives sets up the dynamic movement between past, present, and future – the various forms of temporality – that allows us to clarify the nature of utopian anticipation.Throughout the chapter, I attempt to connect utopian textual and conceptual theory to specific concepts in the emerging field of Anticipation Studies, with which Utopian Studies, a long-established interdisciplinary field, have not yet engaged. Of particular interest is the notion, promoted by Miguel Abensour, that utopia is always a disruption and thus not an anticipation in any “natural” or logical sense: “what matters is the orientation toward what is different, the wish for the advent of a radical alterity here and now” : 407, 2008). From this premise, we can reintroduce a neglected literary term from science fiction theorist, Darko Suvin: the novum. The eruption of a future from a point of radical alterity – an ontological accident – opens up radical implication for the nature of utopian anticipation and futurity.Finally the essay suggests that Robert Poli’s and Robert Rosen’s description of an anticipatory system as comprising “the predictive model of itself” within the genre’s formal characteristics is in fact present in the structure of the utopian narratives: that is, that the persistence of utopia – as a literary genre and as a political concept – inheres in the narratological structuring of the possibility of another story and another listener. Utopian narrative thus ultimately anticipates not only temporal relationality, but an ethical relation between the outside narrator, the utopian traveler/narrator, and the reader. It anticipates another story. (shrink)

The relative reinforcing value of food measures how hard someone will work for a high-energy-dense food when an alternative reward is concurrently available. Higher RRV for HED food has been linked to obesity, yet this association has not been examined in low-income preschool-age children. Further, the development of individual differences in the RRV of food in early childhood is poorly understood. This cross-sectional study tested the hypothesis that the RRV of HED to low-energy-dense food would be greater in children with (...) obesity compared to children without obesity in a sample of 130 low-income 3- to 5-year-olds enrolled in Head Start classrooms in Central Pennsylvania. In addition, we examined individual differences in the RRV of food by child characteristics and food security status. The RRV of food was measured on concurrent progressive-ratio schedules of reinforcement. RRV outcomes included the last schedule reached for cookies and fruit, the breakpoint for cookies in proportion to the total breakpoint for cookies and fruit combined, and response rates. Parents completed the 18-item food security module to assess household food security status and the Behavioral Activation System scale to assess reward sensitivity. Pearson’s correlations and mixed models assessed associations between continuous and discrete child characteristics with RRV outcomes, respectively. Two-way mixed effects interaction models examined age and sex as moderators of the association between RRV and Body Mass Index z-scores. Statistical significance was defined as p < 0.05. Children with obesity had a greater cookie Pmax [F = 4.95, p = 0.03], higher RRV cookie [F = 4.28, p = 0.04], and responded at a faster rate for cookies [F = 17.27, p < 0.001] compared to children without obesity. Children with higher cookie response rates had higher BMIZ ; and RRV cookie was positively associated with BMIZ for older children and boys, but not younger children or girls. The RRV of food did not differ by household food security status. Low-income children with obesity showed greater motivation to work for cookies than fruit compared to their peers without obesity. The RRV of HED food may be an important contributor to increased weight status in boys and future research is needed to better understand developmental trajectories of the RRV of food across childhood. (shrink)

The assessment of text quality is a transdisciplinary issue concerning the research areas of educational assessment, language technology, and classroom instruction. Text length has been found to strongly influence human judgment of text quality. The question of whether text length is a construct-relevant aspect of writing competence or a source of judgment bias has been discussed controversially. This paper used both a correlational and an experimental approach to investigate this question. Secondary analyses were performed on a large-scale dataset with highly (...) trained raters, showing an effect of text length beyond language proficiency. Furthermore, an experimental study found that pre-service teachers tended to undervalue text length when compared to professional ratings. The findings are discussed with respect to the role of training and context in writing assessment. (shrink)

From the jumping bean controversy, through his jousts with Malraux, to his charge against Picasso, Roger Caillois's attitude remained the same: a fear of the seductions of misunderstood originality, a condemnation of the fear of influence that characterized the moderns, and praise for imitation, conceived as the only true school of art. Originality, according to the formula he was fond of repeating time and again in the most varied contexts, consists not in refraining from imitating anyone else, but rather in (...) beine inimitable. (shrink)

Stellen Kondome einen potenten Schutz sowohl vor HIV als auch von anderen sexuell übertragbaren Infektionen (STIs) dar, und besteht außerdem ein barrierefreier Zugang zur HIV-Postexpositionsprophylaxe (PEP) (z. B. nach Kondom-Fatigue), muss präzise sondiert werden, wann die sich zunehmend etablierende HIV-Präexpositionsprophylaxe (PrEP) die bessere Wahl darstellt. Vor dem Hintergrund einer generalisierten everyone at risk-Annahme über MSM wird die PrEP zunehmend zu einem standard of care. Zwar kann kein Zweifel daran bestehen, dass dies für bestimmte MSM mit einem bestimmten Risikoprofil wünschenswert ist. (...) Es ist aber von Variabilitäten (z. B. casual condomless sex versus random condomless sex) auszugehen, die zur Vermeidung einer unverhältnismäßigen Medikalisierung berücksichtigt werden müssen. Im Spannungsfeld von hochpotenter HIV-Prävention und Medikalisierung insbesondere von Männern, die Sex mit Männern praktizieren, soll im Sinn einer Güterabwägung gefragt werden, wann genau eine PrEP (dauerhaft oder on demand) mehr Vorteile und weniger Nachteile bietet als der Gebrauch von Kondom oder PEP. Dazu gehört ein Fokus auf den aktuellen Stand der klinischen Forschung und ein Fokus auf die medizinethische Debatte. Die Medizingeschichte der Prävention und der HIV-Erkrankung erweist sich dabei als relevanter Erörterungszusammenhang für die weitgehend noch ausstehende ethische Untersuchung der PrEP. Methodisch basiert diese Arbeit auf einer Auswertung der interdisziplinären Fachliteratur über die HIV-Präexpositionsprophylaxe im Besonderen und über HIV-Prävention im Allgemeinen. Basierend auf den PRISMA (Prefered Reporting Items for Systematic Reviews and Meta-Analyses) Guidelines wurden aus der Datenbank PubMed/MEDLINE solche Studien ausgewählt, die die aktuelle klinische Praxis der PrEP oder eine medizinethische Diskussion der PrEP zum Gegenstand haben. Auf der Basis dieser Literatur erfolgt eine diskursive Erörterung und Abwägung der verfügbaren Pros und Cons zur PrEP. Präventionsmaßnahmen treten regelmäßig als ambivalente Instrumente der Gesundheitsförderung zwischen Liberalisierung und Restringierung des Individuums hervor. Insgesamt bietet daher die PrEP on demand gegenüber der kontinuierlichen PrEP im Sinne der Personalisierung die Option einer individuellen Anpassung an konkretes Risikoverhalten. Auch im Sinne einer Güterabwägung hat die PrEP gewichtige Vorteile gegenüber der kontinuierlichen PrEP und gegenüber einer PEP, wenn kein dauerhaft gleichhohes Risiko vorliegt. In dieser medizinethischen Untersuchung wird darauf hingewiesen, dass es sich bei MSM um eine heterogene Gruppe handelt, deren individuelles Sexualverhalten eine ebenfalls individualisierte HIV-Präventions-Strategie benötigt. Diese Studie argumentiert daher für ein stark personalisiertes decision making bei möglicher Indikation für eine PrEP bei MSM. Damit soll ein wesentlicher Faktor zur Vermeidung einer Medikalisierung von MSM dargestellt werden. (shrink)

Slurs have been standardly assumed to bear a very direct, very distinctive semantic relationship to what philosophers have called “neutral counterpart” terms. I argue that this is mistaken: the general relationship between paradigmatic slurs and their “neutral counterparts” should be assumed to be the same one that obtains between ‘chick flick’ and ‘romantic comedy’, as well a huge number of other more prosaic pairs of derogatory and “less derogatory” expressions. The most plausible general relationship between these latter expressions — and (...) thus, I argue, between paradigmatic slurs and “neutral counterpart” terms — is one of overlap in presumed extension, grounded in overlap in associated stereotypes. The resulting framework has the advantages of being simple, unified, and, unlike its orthodox rivals, neatly accommodating of a much wider range of data than has previously been considered. More importantly, it positions us to better understand, identify, and confront the insidious mechanisms of ordinary bigotry. (shrink)

Many philosophers have called for elimination of racial taxonomies in biomedical contexts, basing their arguments on one of two claims: that the use of racial terminology is unjust, and that the use of racial terminology in scientific contexts is inappropriate because race is scientifically meaningless. I argue that each of these claims is flawed, because justice sometimes demands the use of racial terminology, and because the utility of race in biomedical contexts makes it scientifically meaningful. I suggest a third argument (...) that eliminativists might utilize: in spite of its usefulness, we should forego racialized medicine because given our long history of racism, any use of race will tend to crowd out other relevant factors. So, instead of continuing to use race as a convenient proxy for unknown “x-factors,” we ought to forego race and insist that researchers name the x-factors. The result will be better science, both morally and epistemically. (shrink)

This manuscript highlights examples of strategies that have made strides in improving the quality of health care environments, systems-level improvements to support self-management, and collaborations between primary care and public health to support effective approaches to prevent obesity among children and adults in the U.S.

This paper argues that Puddifoot’s arguments in How Stereotypes Deceive Us have more radical consequences than those argued for in the book. It does this by pointing out two problems for evaluating stereotypes via Evaluative Dispositionalism, Puddifoot’s view. The first problem concerns the very large number of dispositions associated with any stereotype, and the second the difficulty of evaluating a stereotype in isolation from other elements of a person’s psychology. The paper suggests that, when we take seriously Puddifoot’s arguments, we’ll (...) end up concluding that it’s not possible to assess the epistemic worth of any individual belief or stereotype. We could still discuss the epistemic merits of how it was formed, and discuss the epistemic consequences that this belief or stereotype has for a particular person in a particular situation. But overall epistemic evaluations of stereotypes, or even acts of stereotyping, would be something that we should try to avoid. (shrink)

A vaccine for hepatitis B became available in the UK from 1982, but it did not solve the public health dilemmas presented by the disease. In the decade that followed, epidemiologically important groups such as intravenous drug users and gay men were not targetted, while the groups of health workers at the centre of policy concern received little vaccine. This paper draws on models of diffusion, the pattern of the disease, and previous policies on screening, to explain the restricted vaccine (...) policy which was a field for contention through the 1980s and into the 1990s. (shrink)

Our aim in this article is twofold. First, we challenge the essentialized notion of adolescents and young people as perpetually driven to resist the authority of adults. At the same time, we disrupt linguistic conceptions of adolescent discourse, along with the discourse of youth at risk, by analyzing a transcript of classroom discourse that reflects an exchange between a highly regarded and well liked preservice teacher and his students. This representative transcript highlights the preservice teacher's ability to query, without a (...) concomitant ability to listen, respond, and build a classroom dialogue with his students; what we call here a Socratic monologue. Second, we link the notions of dialogue and responsiveness to Bakhtin's concept of answerability, emphasizing the joint construction of classroom discourse as an ethically answerable relation between teacher and students. He is currently doing research on new Asian pedagogies. Her research interests include applying sociocultural and critical lenses to the study of identity construction, in particular, the social construction of “at risk” identities for young people. Her current research documents the experiences of students and teachers in alternative high school programs. She is co-editor of Re/constructing “the adolescent”: Sign, symbol and body forthcoming from Peter Lang, Educational imaginings: On the play of texts and contexts with Shaun Rawolle published by Australian Academic Press, and Crossing boundaries: Perspectives across paradigms in educational research, with Paula Jervis-Tracey, also published by Australian Academic Press. (shrink)

Long viewed as an example of effective multilateralism, UN peace operations are facing mounting challenges. Transformations in the landscape of conflict are outpacing their ability to respond. Rising expectations of peacekeeping have led to disenchantment with what they can deliver, while dis- and misinformation tactics undermine the efforts of the UN to make and build peace. As UN peace operations risk becoming another casualty of intensifying international tensions, great power rivalry, and the erosion of the rules and norms that govern (...) international cooperation, we consider the future of UN peace operations. In the debate between a “pragmatic” and an “adaptive” approach to peacekeeping, we argue that a fundamental question is the ability of both alternatives to address three recurring issues that have shaped the effectiveness and legitimacy of peace operations: the mismatch between ambitious mandates and limited resources; the gap between the protection of civilians objective and its implementation in practice; and growing difficulties in honoring the principles of impartiality. We argue that policymakers and researchers should not lose sight of the fact that peacekeeping's legitimacy depends on its adherence to some version of host-state consent and some kind of restriction on when and how force is used. The expectation of civilian populations that the UN stands for protection also means that the UN must continue to safeguard some key norms associated with peacekeeping. (shrink)