Koonin argues that CRISPR-Cas systems present the best-known case in point for Lamarckian evolution because they satisfy his proposed criteria for the specific inheritance of acquired adaptive characteristics. We see two interrelated issues with Koonin’s characterization of CRISPR-Cas systems as Lamarckian. First, at times he appears to confuse an account of the CRISPR-Cas system with an account of the mechanism it employs. We argue there is no evidence for the CRISPR-Cas system being “Lamarckian” in any sense. Second, it is unclear (...) whether the mechanism is more “Lamarckian” than many other forms of genetic change already well-characterized in Darwinian terms. We present three conceptually distinct senses in which the mechanism of IAC may be considered Lamarckian and argue that only the strongest sense of goal-directed IAC would be difficult to accommodate in a Darwinian account. As the CRISPR-Cas mechanism does not qualify as “Lamarckian” in this strong sense, we argue there is no conceptual value in calling it “Lamarckian”. Finally, we suggest that CRISPR-Cas systems do hold the potential for genuinely non-Darwinian, directed evolution in a way that Koonin did not discuss, involving their potential use as a human gene-editing tool. (shrink)

There is increasing interest today in how the arts contribute to individual and community wellbeing. This scoping review identified and examined ways in which the arts have been used to address wellbeing in communities in the United States. The review examined 44 publications, with combined study populations representing a total of 5,080 research participants, including marginalized populations. It identified the types of artistic practices and interventions being conducted, research methods, and outcomes measured. It highlights positive associations found across a broad (...) spectrum of psychological, physical, and social outcomes, including improvements in self-esteem and identity formation, cognition, physical balance, and physical conditioning. It also reports negative outcomes of arts interventions that may be underreported. The study identifies the need for core outcomes sets and reporting guidelines for advancing evidence synthesis in this area. (shrink)

There is a compassion crisis in healthcare negatively impacting patient outcomes. Little is known about the relationship of love as a motivating factor in healthcare. Our research exploring physician and nurse perspectives on what it means to love their patients elucidated substantive themes. Here we report findings from an exploratory follow-up qualitative study exploring patient perspectives on what it means to be loved by the healthcare team. Through convenience sampling, we conducted 21 structured interviews of patients exiting a family medicine (...) clinic. Nineteen of 21 patients unreservedly thought healthcare professionals should love their patients. Common themes emerged, which included being caring, trustworthy, empathetic, compassionate, conscientious, and a concern for the patient’s well-being. The characteristics and actions that reflect love were remarkably consistent with physician and nurse descriptions in our prior study. The nature of love described by patients, physicians and nurses could serve as a basis for high quality, compassionate, ethically sound healthcare. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Vagaries and Vicissitudes of WarRichard W Sams III remember standing in the kitchen of our home on Camp Pendleton—a United States Marine Corps base in Southern California—listening to National Public Radio (NPR) and doing dishes in the fall of 2002. President Bush announced to the world that he was considering a pre-emptive invasion of Iraq on the pretext of Saddam Hussein harboring weapons of mass destruction (WMD). (...) Three months later, as a Navy Family Physician, I deployed with a surgical company in support of Operation Iraqi Freedom. Reflecting on the situation with a like-minded close friend, I was not sure— would this be a just war? A necessary war? In my mind, it did not rise to the level of conscientious objection, yet the rightness of invading another country with all the anticipated death and destruction was not clear.En route to Kuwait, we laid over in Spain. While fixed to a TV in a holding area, I watched the Secretary of State make a case to the United Nations (UN) and the world that removing Hussein from power would protect us from mobile anthrax labs that could kill tens of thousands. I thought to myself, Either he is absolutely right, and we are protecting our country and the rest of the free world, or he is terribly mistaken and we are embarking on a disaster.As we trained, prepared, and waited in our tents to invade, we listened to the news on “Voice of America” with a hand crank radio. Thousands of citizens from nations around the world protested. Pope John Paul II, a man well acquainted with the tragedy of war, even spoke out about the planned invasion. “War is not inevitable. It is always a defeat for humanity.” He admonished our leaders that war needed to be the very last option. As a man of faith, I was troubled by his resolute, thoughtful opposition to the crusade I was embarking on. As the day of the invasion approached, scud missiles flew over our camp and we scurried into bunkers, day and night, with our gas masks donned to protect us from possible WMD attacks. In March, with the announcement of a “shock and awe” missile attack on Hussein’s palace, the invasion commenced.Within a day of flying by helicopter into enemy territory to set up a surgical company, the fog of war set in. A series of mass casualties streamed in from nearby Nasiriya. We received dozens of injured enemy combatants and American soldiers. Most troubling were the civilians. An entire extended family fleeing for their lives stumbled into an Iraqi minefield meant for us: a mother dead, the men with shrapnel wounds, and an aunt lost both of her legs. Then there was the little boy. By doctrine, our leaders reassured us we would not care for children. Yet, out of instinct, the field corpsmen scooped up all injured, including children, and [End Page 170] brought them to us. The five-year-old’s legs were blown to bits. We had no pediatric supplies. The anesthesiologist heroically intubated the child’s tiny airway with a urinary catheter and placed an adult IV. The surgeons corrected the wounds the best they could. Hours later, in futility, we performed chest compressions on his tiny mangled body.A day later, the worst sandstorm in a decade struck the area. We struggled to keep the patient-filled tents erect. A Marine appeared on the scene out of the darkness (you could not see beyond your nose in the storm) exclaiming we were going to condition one—lock and load our weapons due to an imminent threat. As healthcare professionals, Geneva Conventions dictated we were to use weapons only in self-defense. We chambered our 9-millimeter pistols to defend our patients and ourselves while Marines formed a defensive perimeter. I thought to myself, Great I’m gonna be shot up and die during a freaking sandstorm in Iraq. Hours later, we were told to stand down. The threat was not from approaching enemy combatants but from shepherds running from the crossfire. I had a small nervous breakdown, sleep deprived and under duress... (shrink)

There is a compassion crisis in healthcare negatively impacting patient outcomes. Little is known about the relationship of love as a motivating factor in healthcare. Our research exploring physician and nurse perspectives on what it means to love their patients elucidated substantive themes. Here we report findings from an exploratory follow-up qualitative study exploring patient perspectives on what it means to be loved by the healthcare team. Through convenience sampling, we conducted 21 structured interviews of patients exiting a family medicine (...) clinic. Nineteen of 21 patients unreservedly thought healthcare professionals should love their patients. Common themes emerged, which included being caring, trustworthy, empathetic, compassionate, conscientious, and demonstrating concern for the patient's well-being. The characteristics and actions that reflect love were remarkably consistent with those mentioned by physicians and nurses in our prior study. The nature of love described by patients, physicians and nurses could serve as a basis for high quality, compassionate, ethically sound healthcare. (shrink)

Background Nurses experienced intense ethical and moral challenges during the COVID-19 pandemic. Our 2020 qualitative parent study of frontline nurses’ experiences during the COVID-19 pandemic identified ethics as a cross-cutting theme with six subthemes: moral dilemmas, moral uncertainty, moral distress, moral injury, moral outrage, and moral courage. We re-analyzed ethics-related findings in light of refined definitions of ethics concepts. Research aim To analyze frontline U.S. nurses’ experiences of ethics during the COVID-19 pandemic. Research design Qualitative analysis using a directed content (...) methodology. Participants and research context The study included 43 nurses from three major metropolitan academic medical centers and one community hospital in the northeastern, mid-Atlantic, midwestern, and western United States. Ethical considerations Participant privacy and data confidentiality were addressed. Findings Moral dilemmas arose from many situations, most frequently related to balancing safety and patient care. Moral uncertainty commonly arose from lacking health information or evidence about options. Moral distress occurred when nurses knew the right thing to do, but were prevented from doing so, including with end-of-life issues. Moral injury (accompanied by suffering, shame, or guilt) occurred after doing, seeing, or experiencing wrongdoing, often involving authority figures. Nurses expressed moral outrage at events and people within and outside healthcare. Despite difficult ethical situations, some nurses exemplified moral courage, sometimes by resisting policies they perceived as preventing compassionate care, guided by thinking about what was best for patients. Discussion This content analysis of ethics-related subthemes revealed conceptual characteristics and clarified distinctions with corresponding exemplars. Conceptual clarity may inform responses and interventions to address ethical quandaries in nursing practice. Conclusions Ethics education in nursing must address the moral dilemmas of pandemics, disasters, and other crises. Nurses need time and resources to heal from trying to provide the best care when no ideal option was available. (shrink)

Next SectionBiodefence, broadly understood as efforts to prevent or mitigate the damage of a bioterrorist attack, raises a number of ethical issues, from the allocation of scarce biomedical research and public health funds, to the use of coercion in quarantine and other containment measures in the event of an outbreak. In response to the US bioterrorist attacks following September 11, significant US policy decisions were made to spur scientific enquiry in the name of biodefence. These decisions led to a number (...) of critical institutional changes within the US federal government agencies governing scientific research. Subsequent science policy discussions have focused largely on ‘the dual use problem’: how to preserve the openness of scientific research while preventing research undertaken for the prevention or mitigation of biological threats from third parties. We join others in shifting the ethical debate over biodefence away from a simple framing of the problem as one of dual use, by demonstrating how a dual use framing distorts the debate about bioterrorism and truncates discussion of the moral issues. We offer an alternative framing rooted in social epistemology and institutional design theory, arguing that the ethical and policy debates regarding ‘dual use’ biomedical research ought to be reframed as a larger optimisation problem across a plurality of values including, among others: (1) the production of scientific knowledge; (2) the protection of human and animal subjects; (3) the promotion and protection of public health (national and global); (4) freedom of scientific enquiry; and (5) the constraint of government power. (shrink)

There is an extensive literature in social choice theory studying the consequences of weakening the assumptions of Arrow's Impossibility Theorem. Much of this literature suggests that there is no escape from Arrow-style impossibility theorems unless one drastically violates the Independence of Irrelevant Alternatives (IIA). In this paper, we present a more positive outlook. We propose a model of comparing candidates in elections, which we call the Advantage-Standard (AS) model. The requirement that a collective choice rule (CCR) be rationalizable by the (...) AS model is in the spirit of but weaker than IIA; yet it is stronger than what is known in the literature as weak IIA (two profiles alike on x, y cannot have opposite strict social preferences on x and y). In addition to motivating violations of IIA, the AS model makes intelligible violations of another Arrovian assumption: the negative transitivity of the strict social preference relation P. While previous literature shows that only weakening IIA to weak IIA or only weakening negative transitivity of P to acyclicity still leads to impossibility theorems, we show that jointly weakening IIA to AS rationalizability and weakening negative transitivity of P leads to no such impossibility theorems. Indeed, we show that several appealing CCRs are AS rationalizable, including even transitive CCRs. (shrink)

BackgroundCarefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/aids, without increasing burdens. Such studies, however, must navigate a ‘vulnerability paradox’, since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/aids (ALH) in Kenya, we develop an account of researchers’ responsibilities towards young people, incorporating concepts of vulnerability, resilience, and agency (...) as ‘interacting layers’.MethodsUsing a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders’ perspectives on vulnerability and resilience of young people living with HIV/aids, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna’s layered account of vulnerability.ResultsALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences.ConclusionsThe most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabilities, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interpersonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers’ responsibilities to work within multi-sectoral partnerships to plan and implement studies involving ALH, share findings in a timely way and contribute to policies addressing known causes of vulnerabilities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Full Collection of Personal NarrativesZohar Lederman, Ola Ziara, Rachel Coghlan, Oksana Sulaieva, Anna Shcherbakova, Oleksandr Dudin, Vladyslava Kachkovska, Iryna Dudchenko, Anna Kovchun, Lyudmyla Prystupa, Yuliya Nogovitsyna, Ghaiath Hussein, Kathryn Fausch, P. P. Kyaw, Ayesha Ahmad, Richard W Sams II, Handreen Mohammed Saeed, Artem Riga, Ryan C. Maves, Elizabeth Dotsenko, Irina Deyneka, Eva V. Regel, and Vita Voloshchuk• An Unsettling Affair• How We Keep Caring While Walking Through Our (...) Pain• Adjusting Laboratory Practices to the Challenges of Wartime• Why We Stay• A Semi-Personal Story from a Ukrainian NGO Professional (or a Semi-Professional Story from a Ukrainian Person) Living through the War• When Ethics Survives Where People Do Not: A Story From Darfur• Burma’s Healthcare Under Fire: My Experience as an Exiled Medical Professional• When a Conflict Collapses on a Child: An (Aborted) Medical Evacuation of a Hazara Toddler During the Kabul Airport Blast and the Taliban Takeover• The Vagaries and Vicissitudes of War• Providing Care to a Potential Aggressor: An Ethical Dilemma• One Surgeon’s Experience During Armed Conflict in Ukraine• The Limits of Our Obligations• A Liberating Breath• Soldiers of the Invisible Front: How Ukrainian Therapists Are Fighting for the Mental Health of the Nation Under Fire• Stories of Families with Chronically Ill Pediatric Patients during the War in UkraineCopyright © 2023 Johns Hopkins University Press... (shrink)

Beneficence and integrity comprise two of the five principles of the American Psychological Association (American Psychological Association [APA], 2017) code of ethics. The connection between ethic...

Examines how the modern city is portrayed in art and literature, discusses modernism, futurism, and expressionism, and looks at the work of Rilke, Eliot, Pound, Joyce, and Brecht.

The High Line – a public park on a repurposed railway track in New York City – first opened to the public in 2009, and has been increasingly celebrated as a model public space, and as a democratic project directed by community. Artistic and amateur photographic practices have significantly informed the High Line’s design, landscaping, publicity, urban policy, use and constellations of community. This photo-conceptual essay critically considers the constitutive function of the photographic image, as photography produces, interpellates and defines (...) the public and public sphere of the High Line. However, these imaging practices have also taken increasingly regulated form, and endorse conservative forms of community, personhood and publicness. The new park’s imaging practices may be understood as supplementary to neoliberal forms of property accumulation, in fact diminishing public space even as they purport to represent it. Drawing from the historical avant-garde, feminist critiques of representation and anti-capitalist urban theory, the following photographic series critiques the High Line’s photographic apparatus, from within a practice of photography, and from a position within the field of contemporary art. (shrink)

Volume 25, Issue 2, February 2025, Page 1-2.

Regulation theories focus primarily on the behavior of regulatory agencies. In this article, the authors elevate the level of analysis to study the disputes these agencies address. This change of analytic level has two advantages. First, it highlights the importance of other forms of dispute resolution. Second, it provides for specific dispute resolution strategies. The article uses systems and behavioral theories as the underpinnings of a broad model of societal regulation that offers strategies for avoiding and managing societal disputes.

Empathy is often split into an affective facet for embodied simulation or sometimes sensorial processing, and a cognitive facet for mentalizing and perspective-taking. However, a recent neurophenomenological framework proposes a graded view on empathy (i.e., “Graded Empathy”) that extends this dichotomy and considers multiple levels while integrating complex neural patterns and representations of subjective experience. In the current magnetoencephalography study, we conducted a multidimensional investigation of neural oscillatory modulations and their cortical sources in 44 subjects while observing stimuli that convey (...) vicarious pain (vs no-pain) in a broad time window and frequency range to explore rich neural representations of pain empathy. Furthermore, we collected participants’ subjective-experience of sensitivity to vicarious pain, as well as their self-reported trait levels of affective and cognitive empathy to examine the possible associations between neural mechanisms and subjective experiences and reports. While extending previous electrophysiological studies that mainly focused on alpha suppression, we found here four significant power modulation patterns corresponding to multiple facets of empathy: an early central (peaking in the paracentral sulcus) alpha (6–11 Hz) suppression pattern plausibly reflecting sensory processing, two early beta (15–23 Hz) suppression patterns in the mid-cingulate cortex (plausibly reflecting the affective component) and in the precuneus (plausibly reflecting the cognitive component), and a late anterior (peaking in the orbitofrontal cortex) alpha-beta (11–19 Hz) enhancement pattern (plausibly reflecting cognitive-control inhibitory response). Interestingly, the latter measure was negatively correlated with the subjective sensitivity to vicarious pain, thereby possibly revealing a novel inhibitory neural mechanism determining the subjective sensitivity to vicarious pain. Altogether, these multilevel findings cannot be accommodated by the dichotomous model of empathy (i.e., affective-cognitive), and provide empirical support to theGraded Empathyneurophenomenological framework. Furthermore, this work emphasizes the importance of examining multiple neural rhythms, their cortical generators, and reports of subjective-experience in the aim of elucidating the complex nature of empathy. (shrink)

Applications of Artificial Intelligence, particularly Expert Systems, are rapidly increasing. This science promises to give computer-based systems the capability of reasoning and decision making in near human-like fashion. Whether used for farm management or intelligent machine control, Expert Systems will find many agricultural applications. Much of the development and distribution of such systems will probably take place in the public sector, particularly the Cooperative Extension Service. A major nontechnical factor affecting the development and extensive use of Expert Systems is the (...) legal issue of products, liability, and negligence. The legal issues surrounding Expert Systems have not yet been fully tested and defined by the courts. Developers and users of Expert Systems must consider these factors for each particular application. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Full Collection of Personal NarrativesGianna O'Leary, Paul Hostovsky, Yilu Ma, Leo Almazan, Hilda Sanchez-Herrera, Marisa Rueda Will, Elaine Hsieh, Manuel Patiño, Felicity Ratway, Liliana Crane, Laisson DeSouza, Nilsa Ricci, Linda Pollack-Jackson, Kelley Cooper, Mateo Rutherford-Rojas, Rosa C. Moreno, Maja Milkowska-Shibata, Patricia Coronado, and Catalina Meyer• A Day in the Life of a Spanish Interpreter• Deaf Interpreter• "Call me Dr. XXX!"• Translating Care for the Voiceless Patient• Are We (...) There Yet? A Narrative of Firsthand Interpreter Experiences in the Medical Field and Insights to Aid Language Access Compliance• One Interpreter's Journey of Interpreting for Pregnancy Loss• More Than Words: Communicating for the Quality of Care• From Linguistic Bridge Builder to Aspiring Physician• Towards Language Justice: A Call to Identify and Overcome Structural Barriers• Voices in the Shadows: The Hidden Complexities of Being a Medical Interpreter• The Voice of Patients: The Exclusive Work of a Human Who Can Advocate• Don't Mute the Messenger• The Ramp and the Stop Sign• How Policies and Practices in Medical Settings Impact Communication Access with Deaf Patients and Caregivers• And When May I Cry? Juggling Emotions in Healthcare Interpreting• To Engage or Not to Engage: An Interpreter and a Mother's Need for Connection in the Cardiothoracic Unit• Witnessing Trauma: Emotional Challenges in Medical Interpretation• Being an Interpreter—Beyond Linguistics• 1-800-Quit-NowCopyright © 2024 Johns Hopkins University Press... (shrink)

Our goal is to analyze the distinction between factual statements and opinions from a philosophical—specifically an epistemological—perspective. Section 1 reviews the most common criteria for drawing the distinction, which while inadequate, as explained in Section 2, still plays an important cultural and political role. In Section 3, we argue that the difference between factual statements and opinions does not involve a single criterion. Instead, the conceptual structure of the terms ‘fact’ and ‘opinion’ is analogous to that of natural kinds—terms with (...) multiple dimensions. We expect that improved theory will lead to improvements in pedagogy, decision-making, and public discourse. But these consequences are not our chief focus. (shrink)

Background There is continued need for enhanced medical ethics education across the United States. In an effort to guide medical ethics education reform, we report the first interprofessional survey of a cohort of graduate medical, nursing and allied health professional students that examined perceived student need for more formalized medical ethics education and assessed preferences for teaching methods in a graduate level medical ethics curriculum. Methods In January 2018, following the successful implementation of a peer-led, grassroots medical ethics curriculum, student (...) leaders under faculty guidance conducted a cross-sectional survey with 562 of 1357 responses received among students enrolled in the School of Medicine, College of Nursing, Doctor of Physical Therapy and BS/ MD Professional Scholars programs at The Medical College of Georgia at Augusta University. An in person or web-based questionnaire was designed to measure perceived need for a more in-depth medical ethics curriculum. Results The majority of respondents were female, white and mid-20s in age. Almost half of respondents reported no prior medical ethics exposure or training in their previous educational experience, while 60% of students across all degree programs reported an interest in more medical ethics education and 92% noted that an understanding of medical ethics was important to their future career. Over a quarter of students were interested in pursuing graduate-level training in medical ethics, with case-based discussions, small group peer settings and ethics guest lectures being the most desired teaching methods. Conclusions The future physician, nursing and physical therapist workforce in our medical community demonstrated an unmet need and strong interest for more formal medical ethics education within their current coursework. Grassroots student-driven curricular development and leadership in medical ethics can positively impact medical education. Subsequent integration of interprofessional training in medical ethics may serve as a vital curricular approach to improving the training of ethically competent healthcare professionals and overcoming the current hierarchical clinical silos. (shrink)

Despite advances in theory, often driven by feminist ethicists, research ethics struggles in practice to adequately account for and respond to the agency and autonomy of people considered vulnerable in the research context. We argue that shifts within feminist research ethics scholarship to better characterise and respond to autonomy and agency can be bolstered by further grounding in discourses from the social sciences, in work that confirms the complex nature of human agency in contexts of structural and other sources of (...) vulnerability. We discuss some of the core concepts and critiques emerging from the literature on women and children's agency in under‐resourced settings, highlighting calls to move from individualistic to relational models of agency, and to recognise the ambiguous, value‐laden, and heterogeneous nature of the concept. We then draw out what these conceptual shifts might mean for research ethics obligations and guidance, illustrating our analysis using a case vignette based on research ethics work conducted in South Africa. We conclude that if research practices are to be supportive of agency, it will be crucial to scrutinise the moral judgements which underpin accounts of agency, derive more situated definitions of and responses to agency, and enable people and participants to influence these based on their own experiences and self‐perceptions. (shrink)