The status of constructivism as a metaethical or metanormative theory is unclear partly due to the lack of a clear semantics for central normative terms such as ‘reason’ and ‘ought’. In a series of recent papers, Sharon Street has attempted to clarify the central commitments of constructivism by focusing on the idea of a practical point of view and what follows from it. We improve upon the informal understanding provided by Street and attempt to provide a semantics for ‘ought’. Our (...) semantics respects the core intuition of the constructivist that normative claims are made true because of our practical commitments as agents and also reflects the constructivist’s commitment to the centrality of practical deliberation to normative truth. On our view, a normative claim of the form ⌜S ought to ϕ⌝ is true if ϕ is entailed from S’s set of evaluative attitudes. We argue that a virtue of our definition is that it allows us to see precisely what is distinctive about constructivism as opposed to realism and expressivism. (shrink)

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown (...) substantially in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

By focusing on the caloric composition of hunted prey species, optimal foraging research has shown that hunters usually make economically rational prey choice decisions. However, research by meat scientists suggests that the gustatory appeal of wildlife meats may vary dramatically. In this study, behavioral research indicates that Mayangna and Miskito hunters in Nicaragua inconsistently pursue multiple prey types in the optimal diet set. We use cognitive methods, including unconstrained pile sorts and cultural consensus analysis, to investigate the hypothesis that these (...) partial preferences are influenced by considerations of meat flavor. Native informants exhibit high agreement on the relative appeal of different meats. Given the absence of other noteworthy differences between spider monkeys (Ateles geoffroyi) and howler monkeys (Alouatta palliata), the unappealing flavor of howler monkeys seems to be a factor in the partial preference for this species. (shrink)

[COMMENTARY on Walter Veit's "A Philosophy for the Science of Animal Consciousness"] The framework Veit introduces for animal consciousness turns on finding and articulating its evolutionary origins. Veit argues that consciousness first evolved as affective experience in the Cambrian period. His argument centers around the plausible need of organisms in the Cambrian for a common currency of subjective valuation. I argue that such an adaptive pressure is unlikely to result in affective experience. I review other processes that instantiate common currencies (...) of subjective valuation: unconscious (non-experiential) affect and the reward learning system and argue that each is likely to have evolved prior to affective experience. (shrink)

Accounts of spiritual formation which depend overmuch on individualism are likely distorted by that individualism, and this article argues that an account of collective-personhood can provide a necessary corrective to this anthropological distortion. The article begins by diagnosing the problem of individualism in formation, utilizing Charles Taylor’s Sources of the Self, and critiquing several common practices of spiritual formation. Following this, we consider Bonhoeffer’s theological vision for the collective-person from his first book, Sanctorum Communio. Next, we examine Murray Bowen’s Family (...) Systems Theory to help us envision, from a social scientific perspective, how such a collective-personhood might look. The article concludes with a provisional model for spiritual formation of collective-persons. (shrink)

Backdating of stock options is an example of an agency problem. It has emerged despite all the measures (i.e., new regulations and additional corporate governance mechanisms) aimed at addressing such problems? Beyond such negative controlling measures, a more positive empowering approach based on ethics may also be necessary. What ethical measures need to be taken to address the agency problem? What values and norms should guide the board of directors in protecting the shareholders' interests? To examine these issues, we first (...) discuss the role values and norms can play with respect to underlying corporate governance and the proper role of directors, such as transparency, accountability, integrity (which is reflected in proper mechanisms of checks and balances), and public responsibility. Second, we discuss various stakeholder approaches (e.g., government, directors, managers, and shareholders) by which conflicts of interest (i.e., the agency problem) can be addressed. Third, we assess the practice of backdating stock options, as an illustration of the agency problem, in terms of whether the practice is legally acceptable or ethically justifiable. Fourth, we proceed to an analysis of good corporate governance practice involving backdating options based on a series of ethical standards including: (1) trustworthiness; (2) utilitarianism; (3) justice; and (4) Kantianism. We conclude that while executive compensation schemes (e. g., stock options) were originally intended to help remedy the agency problem by tying together the interests of the executives and shareholders, these schemes may have actually become "part of the problem," and that the solution ultimately depends upon whether directors and executives accept that all of their actions must be based on a set of core ethical values. (shrink)

In this study, we examined the learning of new grapheme-phoneme correspondences in individuals with and without dyslexia. Additionally, we investigated the relation between grapheme-phoneme learning and measures of phonological awareness, orthographic knowledge and rapid automatized naming, with a focus on the unique joint variance of grapheme-phoneme learning to word and non-word reading achievement. Training of grapheme-phoneme associations consisted of a 20-min training program in which eight novel letters (Hebrew) needed to be paired with speech sounds taken from the participant's native (...) language (Dutch). Eighty-four third grade students, of whom 20 were diagnosed with dyslexia, participated in the training and testing. Our results indicate a reduced ability of dyslexic readers in applying newly learned grapheme-phoneme correspondences while reading words which consist of these novel letters. However, we did not observe a significant independent contribution of grapheme-phoneme learning to reading outcomes. Alternatively, results from the regression analysis indicate that failure to read may be due to differences in phonological and/or orthographic knowledge but not to differences in the grapheme-phoneme-conversion process itself. (shrink)

In 1859, Charles Darwin proposed a mechanism for biological evolution in his most famous work, On the Origin of Species. However, Origin makes little mention of humans. Despite this, Darwin thought deeply about humans and in 1871 published The Descent of Man, his influential and controversial book in which he applied evolutionary theory to humans and detailed his theory of sexual selection. February 2021 will mark the 150th anniversay of it's publication. In A Most Interesting Problem, twelve leading anthropologists, biologists, (...) and journalists revisit The Descent. Following the same organization as the first edition of Descent - less the large section on sexual selection -- each author reviews what Darwin wrote in Descent, comparing his words to what we now know now. There are chapters on evidence for human evolution, our place in the family tree, the origins of civilization, human races, intelligence, and sex differences. An introduction by Darwin biolographer and historian Janet Browne provides context for Descent and a conclusion by Science magazine journalist Ann Gibbons looks to the future of the study of human evolution. All the chapters are written with a broad audience in mind. Ultimately, readers learn that Darwin was remarkably prophetic in some of his predictions, such as that the earliest human fossils would be discovered in Africa. But he was wrong in other areas, particularly in regards to variations between the sexes and races. Thus, A Most Interesting Problem is not so much a celebration of Darwin as it is a tribute to how science works, how scientific ideas are tested, and the role of evidence in helping structure narratives of human origins. The reader is left with a view of how far we have come in our quest for understanding human origins, biological variation, behavior, and evolution. (shrink)

On the True Sense of Art collects essays by philosophers responding to John Sallis's Transfigurements: On the True Sense of Art as well as his other works on the philosophy of art, including Force of Imagination and Logic of Imagination. Each of the chapters, by some of the leading thinkers in Continental philosophy, engages Sallis's work on both ancient and new senses of aesthetics--a transfiguration of aesthetics--as a beginning that is always beginning again. With a responsive essay by Sallis himself, (...) On the True Sense of Art forms a critical introduction to the thought of this generation's most important aesthetician. (shrink)

Ethics should guide the design of electronic health records (EHR), and recognized principles of bioethics can play an important role. This approach was adopted recently by a team of informaticists designing and testing a system where patients exert granular control over who views their personal health information. While this method of building ethics in from the start of the design process has significant benefits, questions remain about how useful the application of bioethics principles can be in this process, especially when (...) principles conflict. For instance, while the ethical principle of respect for autonomy supports a robust system of granular control, the principles of beneficence and non-maleficence counsel restraint due to the danger of patients being harmed by restrictions on provider access to data. Conflict between principles has long been recognized by ethicists and has even motivated attacks on approaches that state and apply principles. In this paper we show how using ethical principles can help in the design of EHRs by first, explaining how ethical principles can and should be used generally, and then by, discuss how attention to details in specific cases can show that the tension between principles is not as bad as it initially appeared. We conclude by suggesting further ways in which the application of these (and other) principles can add value to the ongoing discussion of patient involvement in their health care. This is a new approach to linking principles to informatics design that we expect will stimulate further interest. (shrink)

Workplace ethics perceptions drive ethical behaviors, but our understanding of how context shapes the nature of this relationship is limited. Consequently, this article uses contingency theory to explore how perceptions of ethical priorities in the workplace—ethical work climate (EWC)—are differentially associated with ethical behavior based on the broader context. Specifically, we meta-analytically test theoretically relevant cultural values (i.e., collectivism, power distance) and work context factors (i.e., consequence of errors, job autonomy) as moderators of the connection between EWC perceptions and ethical (...) behavior. Our findings reveal that while higher power-distance societal contexts strengthen the connection between EWC perceptions and ethical behavior, work contexts with higher autonomy _weaken_ the connection. We found mixed support for collectivism as a contextual moderator, with results supporting theoretical expectations with one cultural conceptualization but not another. Contrary to expectations, the consequences of errors in work contexts did not moderate the association between EWC perceptions and ethical behavior. Taken together, this meta-analytic investigation highlights the meaningful role of the broader organizational context as a potential boundary condition for the influence of EWC perceptions on ethical behavior. (shrink)

Most people do not know there are different kinds of medical studies; some are conducted on people who already have a disease or medical condition, and others are performed on healthy volunteers who want to help science find answers. No matter what sort of research you are invited to participate in, or whether you are a patient when you are asked, it’s entirely up to you whether or not to do it. This decision is important and may have many implications (...) for your health and well-being, as well as those of other patients now and in the future. Making a good decision – the right one for you – requires you to become educated about topics you may not have thought about before, some of which may be quite complicated. This chapter explains the key issues to help you make a good decision. (shrink)

Workplace ethics perceptions drive ethical behaviors, but our understanding of how context shapes the nature of this relationship is limited. Consequently, this article uses contingency theory to explore how perceptions of ethical priorities in the workplace—ethical work climate (EWC)—are differentially associated with ethical behavior based on the broader context. Specifically, we meta-analytically test theoretically relevant cultural values (i.e., collectivism, power distance) and work context factors (i.e., consequence of errors, job autonomy) as moderators of the connection between EWC perceptions and ethical (...) behavior. Our findings reveal that while higher power-distance societal contexts strengthen the connection between EWC perceptions and ethical behavior, work contexts with higher autonomy weaken the connection. We found mixed support for collectivism as a contextual moderator, with results supporting theoretical expectations with one cultural conceptualization but not another. Contrary to expectations, the consequences of errors in work contexts did not moderate the association between EWC perceptions and ethical behavior. Taken together, this meta-analytic investigation highlights the meaningful role of the broader organizational context as a potential boundary condition for the influence of EWC perceptions on ethical behavior. (shrink)

Although there is a growing recognition that older adults and those with extensive comorbid conditions undergo cancer screening too frequently, there is little information about patients’ perceptions regarding cessation of cancer screening. Information on older adults’ views of screening cessation would be helpful both for clinicians and for those designing interventions to reduce overscreening.

Background Biobank participants often do not understand much of the information they are provided as part of the informed consent process, despite numerous attempts at simplifying consent forms and improving their readability. We report the first assessment of biobank enrollees’ comprehension under an "integrated consent” process, where patients were asked to enroll in a research biobank as part of their normal healthcare experience. A number of healthcare systems have implemented similar integrated consent processes for biobanking, but it is unknown how (...) much patients understand after enrolling under these conditions. Methods: We recruited patients who enrolled in a biobank while in a healthcare setting when receiving ordinary care. We assessed knowledge of consent materials using 11 true/false questions drawn from a well-known biobank knowledge test. After reviewing the results from 114 participants, we revised the consent form and repeated the knowledge assessment with 144 different participants. Results: Participants scored poorly on the knowledge test in both rounds, with no significant differences in overall scores or individual items between the rounds. In Phase 1, participants answered 53% of the questions correctly, 25% incorrectly, and 22% “I don’t know.” In Phase 2, participants answered 53% of questions correctly, 24% incorrectly, and 23% “I don’t know.” Participants scored particularly poorly on questions about data sharing and accessing medical records. Conclusions: Enrollees under an integrated consent model had significant misunderstandings that persisted despite an attempt to improve information specifically about those topics in a consent form. These results raise challenges for current approaches that attribute misunderstanding to overly complex consent forms. They also suggest that the pressures of the clinic may compound other problems with patient understanding of biobank consent. As health systems increasingly blend research and care, they may need to rethink their approach to educating patients about participation in a biobank. (shrink)

Intended for courses in sensation and perception, this book covers the anatomy, physiology and phenomenology of the way humans sense and perceive the world. It is grounded in physiology to explain perceptual phenomena, on the theory that understanding sensation and perception is based in the physiology of the sensory organs and the brain.

SummaryThe dichotomy between ‘scientific’ and ‘practical’ approaches to guideline development is false and divisive. Instead we should concentrate on developing mechanisms to develop and implement valid guidelines to improve patient care. The development of valid guidelines requires considerable expertise and is time consuming and expensive. It is most efficiently done at a regional or national level. The implementation of valid guidelines requires local action including the identification and modification of valid guidelines and a coordinated evidence-based implementation strategy (Grimshaw & Eccles (...) 1998). (shrink)

Quality and service improvement (QSI) research employs a broad range of methods to enhance the efficiency of healthcare delivery. QSI research differs from traditional healthcare research and poses unique ethical questions. Since QSI research aims to generate knowledge to enhance quality improvement efforts, should it be considered research for regulatory purposes? Is review by a research ethics committee required? Should healthcare providers be considered research participants? If participation in QSI research entails no more than minimal risk, is consent required? The (...) lack of consensus on answers to these questions highlights the need for ethical guidance. Three distinct approaches to classifying QSI research in accordance with existing ethical principles and regulations can be found in the literature. In the first approach, QSI research is viewed as distinct from other types of healthcare research and does not require regulation. In the second approach, QSI research falls within regulatory guidelines but is exempt from research ethics committee review. In the third approach, QSI research is deemed to be part of the learning healthcare system and, as such, is subject to a different set of ethical principles entirely. In this paper, we critically assess each of these views. While none of these approaches is entirely satisfactory, we argue that use of the ethical principles governing research provides the best means of addressing the numerous questions posed by QSI research. (shrink)

Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)

The Continental tradition has always placed great emphasis on the Logos. The Gift of Logos: Essays in Continental Philosophy celebrates and situates this emphasis in the genre of the gift and its giving. The process of receiving, or giving, of the gift overcomes the existential alienation and separation that is so present in the human condition. To ritualize giving and its gifting is to provide a syntax of solidarity that bespeaks our desire for cohesion and need for identities beyond our (...) own. To give a gift is to befriend. The gift of logos is more than a gift from the gods and goddesses; it is an act of giving for those friends of wisdom for those philosophers who give to each other and to their worlds and receive the blessings of logos from each other. The increasing objectification of human being has mobilized a regressive narcissism that shows the ego's reassertion in the light of the meaningless quantifying forces from without. By not reflecting deeply enough upon its conditions of existence in the modern world and on its orginary moments, philosophy itself has not been immune from this besotted sense of self. Although not an invective against thinking nor against modern and contemporary philosophy's genuine advances, The Gift of Logos portends to shed the delusion that theoretical re-description is somehow the same as transforming who we are. This transformation is our greatest gift to each other. To give it voice is the gift of Logos and what this collection of essays commemorates. (shrink)

We use screams to explore ideas presented in the target article. Evolving first in animals as a response to predation, screams reveal more complex social use in nonhuman primates and, in humans, uniquely, are associated with a much greater variety of emotional contexts including fear, anger, surprise, and happiness. This expansion, and the potential for manipulation, promotes listener social vigilance.