In order to receive controlled pain medications for chronic non-oncologic pain, patients often must sign a “narcotic contract” or “opioid treatment agreement” in which they promise not to give pills to others, use illegal drugs, or seek controlled medications from health care providers. In addition, they must agree to use the medication as prescribed and to come to the clinic for drug testing and pill counts. Patients acknowledge that if they violate the opioid treatment agreement, they may no longer receive (...) controlled medications. OTAs have been widely implemented since they were recommended by multiple national bodies to decrease misuse and diversion of narcotic medications. But critics argue that OTAs are ethically suspect, if not unethical, and should be used with extreme care if at all. We agree that OTAs pose real dangers and must be implemented carefully. But we also believe that the most serious criticisms stem from a mistaken understanding of OTAs’ purpose and ethical basis. (shrink)

The paper examines both the phenomenology of the manic self as well as critical aspects of manic neurobiology, focusing, with respect to both domains, on manic temporality. We argue that the distortions of lived time in mania exceed mere acceleration and are fundamental for manic affectivity. Mania involves radical acceleration and radical asynchronicity, which result in an instantaneous existence. People with mania rebel against the facticity of reality and suffer from an existential leap towards the future, in which the self (...) abandons normal temporal boundaries. Excerpts from the interviews with persons with mania who experienced psychosis illustrate this phenomenon. Commenting upon disrupted circadian rhythms in mania and the role of lithium in its treatment the paper posits manic temporality as the link through which manic phenomenology and manic neurobiology intertwine. (shrink)

This article explores the accounts of Canadian-trained health professionals working in humanitarian and development organizations who considered not treating a patient or group of patients because of resource limitations. In the narratives, not treating the patient(s) was sometimes understood as the right thing to do, and sometimes as wrong. In analyzing participants’ narratives we draw attention to how medications and equipment are represented. In one type of narrative, medications and equipment are represented primarily as scarce resources; in another, they are (...) represented as patient care. In the contexts respondents were working, medications and equipment were often both patient care interventions and scarce resources. The analytic point is that health professionals tend to emphasize one conceptualization over the other in coming to assert that not treating is right, or wrong. Rendering tacit ethical frameworks more explicit makes them available for reflection and debate. (shrink)

ABSTRACT The emergence of the coronavirus disease 2019 pandemic has wide-ranging implications for the field of professional psychology. As clinical practice has rapidly adapted to ensure continuity of care, doctoral students have encountered unique opportunities for ethics-related competency development across practicum training settings. This article discusses the relevant American Psychological Association Ethics Code standards and additional ethical considerations facing trainees as they navigate their foundational clinical experiences and develop as professional psychologists in light of a pandemic.

College students from small, medium, and large institutions with either a modified or no honor code were presented with cheating scenarios and asked to rate how dishonest they perceived the behavior to be and the likelihood that they would report it. No main effects were found for institution size or type of honor code. Student–faculty ratio was not correlated with responses to the cheating scenarios. Students from modified honor code schools perceived more severe punishments for cheating and understood the reporting (...) process better than students from non–honor code schools. Implications for modified honor code systems are discussed. (shrink)

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, Sjöberg, (...) Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

The most common solutions to the problem of high pharmaceutical prices have taken the form of regulations, price negotiations, or changes in drug coverage by insurers. These measures for the most part transfer the burden of drug expenditures between pharmaceutical companies and payers or between payers. The aim of this study is to propose an alternative model for the relationship between the main stakeholders involved in the price setting and purchasing of pharmaceuticals, one that encourages a more cooperative approach. We (...) draw from principles of ethics and health economics and apply them to the context of the pharmaceutical industry. The model prioritises two objectives, to make drugs financially accessible to the patients who need them, and to keep pharmaceutical companies viable and profitable. It is centered around the sharing of financial risk between the main stakeholders, which we describe as ‘enlightened risk sharing’. After establishing the foundations of this model, we expand on the type of policies that can follow these principles with current day examples. (shrink)

»Weltanschauung« is an iridescent composite term that has made various careers – in intellectual discourses as well as in everyday language, in philosophy as well as in politics. Moreover, the word has become a specifically German-language and initially also specifically German legal term, which was and is used in the context of religious freedom. The fundamental right of individual »orientation towards meaning« (»Sinnorientierung«), formulated with the help of the worldview concept, puts religious and non-religious background beliefs in the same perspective. (...) In this perspective, which can be interpreted in terms of cultural philosophy, the ideological neutrality (»weltanschauliche Neutralität«) of the democratic constitutional state and tolerance as a civic virtue also become issues. (shrink)

It should come as no surprise that we will get three different answers to the same question since we have three lawyers on the panel. The law is a matter of policy, and there is usually no single “right” answer to these questions. Each lawyer will come to a question from a very different perspective and bring a different approach to the answer.

On oppose souvent politique constitutionnelle et politique normale, parce que la première implique des délibérations en matière de principes et débouche sur un consensus normatif, tandis que la seconde se caractérise par un marchandage intéressé et aboutit à un compromis. Nous critiquons cette position pour deux raisons. Nous soutenons d’abord que ce que Rawls a appelé les « fardeaux du jugement » signifie que, même sur les questions de principe, il peut exister quantité de points de vue raisonnables, tous n’étant (...) pas totalement compatibles avec les autres. Nous considérons ensuite que le marchandage et les compromis propres à la politique normale subissent bien des attirances normatives et sont souvent fort bien adaptés pour résoudre des désaccords de principe. Nous illustrons notre position par un examen détaillé de la Convention qui a élaboré la Charte européenne des droits fondamentaux. (shrink)

Ubiquitin is the most phylogenetically conserved protein known. This 8,500 Da polypeptide can be covalently attached to cellular proteins as a posttranslational modification. In most cases, the addition of multiple ubiquitin adducts to a protein targets it for rapid degradation by a multisubunit protease known as the 26S proteasome. While the ubiquitin/26S proteasome pathway is responsible for the degradation of the bulk of cellular proteins during homeostasis, it may also be responsible for the rapid loss of protein during the programmed (...) death of certain cells, such as skeletal muscle during insect metamorphosis. In addition, alterations in the expression and regulation of ubiquitin may play significant roles in pathological disorders. For example, dramatic increases in ubiquitin and ubiquitin‐protein conjugates are observed in a wide variety of neurodegenerative disorders, including Alzheimer's disease. Patients suffering from the autoimmune disease systemic lupus erythematosus generate antibodies reacting with ubiquitin and ubiquitinated histones. At present, it is not known whether these changes in ubiquitin expression and regulation initiate pathological changes in these diseases or if they are altered as a consequence of these disorders. (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)

Although we agree with the spirit of Knobe's competence model, our aim in this commentary is to argue that the default position should be made more precise. Our quibble with Knobe's model is that we find it hard to ascribe a coherent view to some experimental subjects if the default position is not clearly defined.

Ethical consumerism -- Caveat emptor -- The consumer as causal agent -- The consumer as complicit participant -- Toward a practical consumer ethic.

Der alle drei Jahre tagende Kongress der „Deutschen Gesellschaft für Philosophie“ (DGPhil) ist der größte Kongress für Philosophie in Deutschland. Vom 11.-15. September fand er diesmal an der Ludwig-Maximilians-Universität in München statt. Mit rund 1600 Teilnehmern und über 400 philosophischen Vorträgen fiel er, auch durch den Veranstaltungsort bedingt, wesentlich umfangreicher aus als der XXI. Kongress in Essen.

Examines the development of the philosophy, culture, and civilization of ancient China and discusses the history of Taoism and Confucianism.

Whether we're buying a pair of jeans, ordering a cup of coffee, selecting a long-distance carrier, applying to college, choosing a doctor, or setting up a 401(k), everyday decisions ; both big and small ; have become increasingly complex due to the overwhelming abundance of choice with which we are presented. As Americans, we assume that more choice means better options and greater satisfaction. But beware of excessive choice: choice overload can make you question the decisions you make before you (...) even make them, it can set you up for unrealistically high expectations, and it can make you blame yourself for any and all failures. In the long run, this can lead to decision-making paralysis, anxiety, and perpetual stress. And, in a culture that tells us that there is no excuse for falling short of perfection when your options are limitless, too much choice can lead to clinical depression. In The Paradox of Choice, Barry Schwartz explains at what point choice ; the hallmark of individual freedom and self-determination that we so cherish ; becomes detrimental to our psychological and emotional well-being. In accessible, engaging, and anecdotal prose, Schwartz shows how the dramatic explosion in choice ; from the mundane to the profound challenges of balancing career, family, and individual needs ; has paradoxically become a problem instead of a solution. Schwartz also shows how our obsession with choice encourages us to seek that which makes us feel worse. By synthesizing current research in the social sciences, Schwartz makes the counter intuitive case that eliminating choices can greatly reduce the stress, anxiety, and busyness of our lives. He offers eleven practical steps on how to limit choices to a manageable number, have the discipline to focus on those that are important and ignore the rest, and ultimately derive greater satisfaction from the choices you have to make."--provided by publisher. (shrink)

Ecology is indispensable to understanding the biological world and addressing the environmental problems humanity faces. Its philosophy has never been more important. In this book, James Justus introduces readers to the philosophically rich issues ecology poses. Besides its crucial role in biological science generally, climate change, biodiversity loss, and other looming environmental challenges make ecology's role in understanding such threats and identifying solutions to them all the more critical. When ecology is applied and its insights marshalled to address these (...) problems and guide policy formation, interesting philosophical issues emerge. Justus sets them out in detail, and explores the often ethically charged dimensions of applied ecological science, using accessible language and a wealth of scientifically-informed examples. (shrink)

The waning popularity of logical empiricism and the supposed discovery of insurmountable technical difficulties led most philosophers to abandon the project to formulate a formal criterion of empirical significance. Such a criterion would delineate claims that observation can confirm or disconfirm from those it cannot. Although early criteria were clearly inadequate, criticisms made of later, more sophisticated criteria were often indefensible or easily answered. Most importantly, Carnap’s last criterion was seriously misinterpreted and an amended version of it remains tenable.

As a discipline distinct from ecology, conservation biology emerged in the 1980s as a rigorous science focused on protecting biodiversity. Two algorithmic breakthroughs in information processing made this possible: place-prioritization algorithms and geographical information systems. They provided defensible, data-driven methods for designing reserves to conserve biodiversity that obviated the need for largely intuitive and highly problematic appeals to ecological theory at the time. But the scientific basis of these achievements and whether they constitute genuine scientific progress has been criticized. We (...) counter by pointing out important inaccuracies about the science and rejecting the apparent theory-first focus. More broadly, the case study reveals significant limitations of the predominant epistemic-semantic conceptions of scientific progress and the considerable merits of pragmatic, practically-oriented accounts. (shrink)

Perhaps no concept has been thought more important to ecological theorizing than the niche. Without it, technically sophisticated and well-regarded accounts of character displacement, ecological equivalence, limiting similarity, and others would seemingly never have been developed. The niche is also widely considered the centerpiece of the best candidate for a distinctively ecological law, the competitive exclusion principle. But the incongruous array and imprecise character of proposed definitions of the concept square poorly with its apparent scientific centrality. I argue this definitional (...) diversity and imprecision reflects a problematic conceptual indeterminacy that challenges its putative indispensability in ecology. (shrink)