This article presents the Pilgrimage Model as a template for educators wishing to lead students on site-specific studies of engaged learning. During the 2015–2016 academic year, a group of Georgeto...

Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women 'choosing' to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of autonomy does not (...) seem adequate to capture concerns and intuitions that have a strong grip outside this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women's agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be 'for' or 'against' women's access to cesarean delivery in the absence of traditional medical indications – and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women's full inclusion in a safe and positive birth process. (shrink)

Setting out to understand the effects of positive moral emotions in leadership, this research examines the consequences of leaders’ expressions of gratitude and pride for their followers. In two experimental vignette studies and a field study, leaders’ gratitude expressions showed a positive effect and leaders’ pride expressions showed a negative effect on followers’ ascriptions of leader selfishness. Thereby, leaders’ gratitude expression indirectly led to higher follower satisfaction with and OCB towards the leader, while leaders’ pride expressions indirectly reduced satisfaction with (...) and OCB towards the leader. Furthermore, leaders’ expressions of gratitude indirectly reduced followers’ intentions to leave the leader, while leaders’ expressions of pride indirectly fuelled them. Although ascriptions of selfishness consistently influenced these leader outcomes more strongly than comparable organizational outcomes, results on organizational outcomes were mixed. While leaders’ expressions of gratitude led, as expected, to higher job satisfaction and lower turnover intentions, leaders’ expressions of pride showed positive relations with both OCB towards the organization and intentions to leave the organization. We discuss the theoretical implications of leaders’ expressions of positive moral emotions as signals of outcome attributions, as well as leaders’ selfishness and practical implications that help leaders build followers’ satisfaction and positive leader–follower relationships. (shrink)

Procrastination is a chronic and widespread problem; however, emerging work raises questions regarding the strength of the relationship between self-reported procrastination and behavioral measures of task engagement. This study assessed the internal reliability, concurrent validity, predictive validity, and psychometric properties of 10 self-report procrastination assessments using responses collected from 242 students. Participants’ scores on each self-report instrument were compared to each other using correlations and cluster analysis. Lasso estimation was used to test the self-report scores’ ability to predict two behavioral (...) measures of delay (days to study completion; pacing style). The self-report instruments exhibited strong internal reliability and moderate levels of concurrent validity. Some self-report measures were predictive of days to study completion. No self-report measures were predictive of deadline action pacing, the pacing style most commonly associated with procrastination. Many of the self-report measures of procrastination exhibited poor fit. These results suggest that researchers should exercise caution in selecting self-report measures and that further study is necessary to determine the factors that drive misalignment between self-reports and behavioral measures of delay. (shrink)

Singles are an understudied yet growing segment of the adult population. The current study aims to expand the lens of relationship science by examining the well-being of unpartnered, single adults using latent profile analysis. We recruited singles closely matched to the United States census for an exploratory cross-sectional survey using five variables that strongly predict well-being. All five variables significantly predicted life satisfaction for the full sample. Latent profile analyses detected 10 groups of singles. Half of the profiles were happy (...) and half of the profiles were unhappy. Each profile had its own unique patterns relating to personal relationships, self-esteem, and personality traits. The happiest profile had the best relationships, self-esteem, and personality, while the unhappiest profile had the worst relationships, self-esteem, and personality. The profiles in between these two extremes had more nuanced patterns. For example, one relatively happy profile in the middle had high friendship satisfaction but low family satisfaction, while an adjacent profile showed the opposite pattern. Overall, singles who had positive relationships—both with themselves and others—were happiest. (shrink)

BackgroundAustralian health and medical research funders support substantial research efforts, and incentives within grant funding schemes influence researcher behaviour. We aimed to determine to what extent Australian health and medical funders incentivise responsible research practices.MethodsWe conducted an audit of instructions from research grant and fellowship schemes. Eight national research grants and fellowships were purposively sampled to select schemes that awarded the largest amount of funds. The funding scheme instructions were assessed against 9 criteria to determine to what extent they incentivised (...) these responsible research and reporting practices: publicly register study protocols before starting data collection, register analysis protocols before starting data analysis, make study data openly available, make analysis code openly available, make research materials openly available, discourage use of publication metrics, conduct quality research, collaborate with a statistician, and adhere to other responsible research practices. Each criterion was answered using one of the following responses: “Instructed”, “Encouraged”, or “No mention”.ResultsAcross the 8 schemes from 5 funders, applicants were instructed or encouraged to address a median of 4 of the 9 criteria. Three criteria received no mention in any scheme. Importantly, most incentives did not seem strong as applicants were only instructed to register study protocols, discourage use of publication metrics and conduct quality research. Other criteria were encouraged but were not required.ConclusionsFunders could strengthen the incentives for responsible research practices by requiring grant and fellowship applicants to implement these practices in their proposals. Administering institutions could be required to implement these practices to be eligible for funding. Strongly rewarding researchers for implementing robust research practices could lead to sustained improvements in the quality of health and medical research. (shrink)

As thousands of healthy research participants are being included in small and large imaging studies, it is essential that dilemmas raised by the detection of incidental findings are adequately handled. Current ethical guidance indicates that pathways for dealing with incidental findings should be in place, but does not specify what such pathways should look like. Building on an interview study of researchers’ practices and perspectives, we identified key considerations for the set-up of pathways for the detection, management and communication of (...) incidental findings in imaging research. We conducted an interview study with a purposive sample of researchers at research facilities across the Netherlands. Based on a qualitative analysis of these interviews and on existing guidelines found in the literature, we developed a prototype ethical framework, which was critically assessed and fine-tuned during a two-day international expert meeting with bioethicists and representatives from large population-based imaging studies from the United Kingdom, Germany, Sweden and Belgium. Practices and policies for the handling of incidental findings vary strongly across the Netherlands, ranging from no review of research scans and limited feedback to research participants, to routine review of scans and the arrangement of clinical follow-up. Respondents felt that researchers do not have a duty to actively look for incidental findings, but they do have a duty to act on findings, when detected. The principle of reciprocity featured prominently in our interviews and expert meeting. We present an ethical framework that may guide researchers and research ethics committees in the design and/or evaluation of appropriate pathways for the handling of incidental findings in imaging studies. The framework consists of seven steps: anticipation of findings, information provision and informed consent, scan acquisition, review of scans, consultation on detected abnormalities, communication of the finding, and further clinical management and follow-up of the research participant. Each of these steps represents a key decision to be made by researchers, which should be justified not only with reference to costs and/or logistical considerations, but also with reference to researchers’ moral obligations and the principle of reciprocity. (shrink)

Aims: The experience of a compromised sense of ‘self’, termed ego-dissolution, is a key feature of the psychedelic experience and acute psychosis. This study aimed to validate the Ego-Dissolution Inventory (EDI), a new 8-item self-report scale designed to measure ego-dissolution. Additionally, we aimed to investigate the specificity of the relationship between psychedelics and ego-dissolution. Method: Sixteen items relating to altered ego-consciousness were included in an internet questionnaire; 8 relating to the experience of ego-dissolution (comprising the EDI), and 8 relating to (...) the antithetical experience of increased self-assuredness. Items were rated using a visual analogue scale. Participants answered the questionnaire for experiences with classical psychedelic drugs, cocaine or alcohol. They also answered the 7 questions from the Mystical Experiences Questionnaire (MEQ) relating to the experience of unity with one’s surroundings. Results: 691 participants completed the questionnaire, providing data for 1828 drug experiences (1043 psychedelics. 377 cocaine. 408 alcohol). Exploratory factor analysis demonstrated that the 8 EDI items loaded exclusively onto a single common factor, which was orthogonal to a second factor comprised of the items relating to increased self-assuredness (rho= -.110), demonstrating discriminant validity. The EDI correlated strongly with our measure of unitive experience (rho =.735), demonstrating convergent validity. EDI internal consistency was excellent (Cronbach’s alpha 0.93). Three analyses confirmed the specificity of ego-dissolution for experiences occasioned by psychedelic drugs. Firstly, EDI score correlated with drug-dose for psychedelic drugs (rho=.371), but not for cocaine (rho=.115) or alcohol (rho=-0.055). Secondly, the linear regression line relating the subjective intensity of the experience to EDI was significantly steeper for psychedelics (unstandardized B coefficient= 0.701) compared with cocaine (0.135) or alcohol (0.144). Finally, a binary support vector machine classifier identified experiences occasioned by psychedelic drugs vs. cocaine or alcohol with over 85% accuracy using ratings of ego-dissolution and ego-inflation alone. Conclusions: Our results demonstrate the psychometric structure, internal consistency and construct validity of the EDI. Moreover, we demonstrate the close relationship between ego-dissolution and the psychedelic experience. The EDI will facilitate the study of the neuronal correlates of ego-dissolution, which is relevant for psychedelic-assisted psychotherapy and our understanding of psychosis. (shrink)

The conduct of research in settings affected by disasters such as hurricanes, floods and earthquakes is challenging, particularly when infrastructures and resources were already limited pre-disaster. However, since post-disaster research is essential to the improvement of the humanitarian response, it is important that adequate research ethics oversight be available. We aim to answer the following questions: 1) what do research ethics committee members who have reviewed research protocols to be conducted following disasters in low- and middle-income countries perceive as the (...) key ethical concerns associated with disaster research?, and 2) in what ways do REC members understand these concerns to be distinct from those arising in research conducted in non-crisis situations? This qualitative study was developed using interpretative description methodology; 15 interviews were conducted with REC members. Four key ethical issues were identified as presenting distinctive considerations for disaster research to be implemented in LMICs, and were described by participants as familiar research ethics issues that were amplified in these contexts. First, REC members viewed disaster research as having strong social value due to its potential for improving disaster response, but also as requiring a higher level of justification compared to other research settings. Second, they identified vulnerability as an overarching concern for disaster research ethics, and a feature that required careful and critical appraisal when assessing protocols. They noted that research participants’ vulnerabilities frequently change in the aftermath of a disaster and often in unpredictable ways. Third, they identified concerns related to promoting and maintaining safety, confidentiality and data security in insecure or austere environments. Lastly, though REC members endorsed the need and usefulness of community engagement, they noted that there are significant challenges in a disaster setting over and above those typically encountered in global health research to achieve meaningful community engagement. Disaster research presents distinctive ethical considerations that require attention to ensure that participants are protected. As RECs review disaster research protocols, they should address these concerns and consider how justification, vulnerability, security and confidentially, and community engagement are shaped by the realities of conducting research in a disaster. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Proudly Jewish—and Averse to CircumcisionLisa Braver MossI've always had a strong sense of my Jewish identity—and I've always had grave misgivings about circumcision. It used to seem that these [End Page 86] statements were at odds with one another. Now I'm on a mission to integrate the two.I'm married to a man who's also Jewish. In the late 1980s, we had two sons, whose circumcisions I agreed to. (...) Brit milah (the covenant of circumcision) is intended as a spiritually meaningful act symbolizing the agreement between God and the Jewish people. But for me, the experience was so upsetting that I didn't feel God's presence. In spite of all the arguments in favor—the weight of tradition, wanting my boys to be accepted in the Jewish world, and so on—I came to regret my acquiescence.I began to explore reasons to question circumcision from a Jewish point of view, publishing articles in Jewish magazines and speaking at conferences. Rather than focusing on the medical pros and cons, I wrote about Jewish law and ethics, and spoke with many rabbis. I was hoping to deepen Jewish dialogue on this topic, which was oddly off-limits in a culture that values intellectual inquiry.Besides helping me understand more about Judaism, my research and writing was a way of living with my guilt. I had succumbed to—and put my boys through—a tradition that went completely against my maternal instincts. This schism had made me doubt myself as a new mother. What kind of parent was I if I couldn't be a fierce protector of my newborn baby? It was not a positive or welcoming way for me to enter into motherhood.I blamed myself. I hadn't done medical research before my boys were born, trusting instead in the longevity of the tradition and the claim that circumcision is more hygienic. I bought into the medical justifications for circumcision—all of which, I later learned, fail to acknowledge the erogenous nature of foreskin tissue and its physiological function. If I'd known more; if I'd thought more deeply about infant trauma; if I'd taken my own spirituality more seriously—I would have fought for a different outcome, despite the pressure I felt as a Jewish person.Years went by. I wrote a novel about Jewish circumcision, then co-wrote a book of alternative bris ceremonies for families opting out of circumcision. Slowly, I came to understand that blaming myself for agreeing to circumcise my sons was not only a waste of time, but also missed the larger point. I'm not alone in my objections to this ancient tradition. Indeed, many Jewish parents get through the event with white knuckles, emotional detachment, alcohol, or sedatives rather than with genuine religious feeling. Shouldn't their spiritual authenticity matter? Shouldn't mine have mattered?In Judaism, every commandment (of which circumcision is one) should be approached with kavanah, or spiritual intent. Thus, my non-spiritual feelings about the circumcision tradition are problematic from a Jewish point of view. I should have been able to tell the rabbi I didn't really believe circumcision was what God wanted me to do. I wish I'd been guided in coming to a decision that reflected my actual spirituality. Instead, all that seemed to matter to anyone was getting the deed done.Going against my instincts and spirituality was not just my failing—it also represented an institutional failing. Jewish leaders and rabbis aren't trained to respond compassionately to those averse to circumcision. Even parents merely questioning the practice may be subjected to judgment, lectures, and condescension. Parents deciding not to circumcise may face all that and more: in some synagogues in the U.S., boys that have not been circumcised are currently being denied bar mitzvah.________In the Jewish world, we tend to look upon circumcision as the one monolithic tradition: we assume that every Jewish male is circumcised and that no one talks about or questions this. The truth is that throughout our history, there have been males who, for various reasons, did not undergo the ritual... (shrink)

This paper presents an analysis of emotional and affectively toned discourse in biomedical engineering researchers’ accounts of their problem solving practices. Drawing from our interviews with scientists in two laboratories, we examine three classes of expression: explicit, figurative and metaphorical, and attributions of emotion to objects and artifacts important to laboratory practice. We consider the overall function of expressions in the particular problem solving contexts described. We argue that affective processes are engaged in problem solving, not as simply tacked onto (...) reasoning but as integral to it. The examples we present illustrate the close relation of emotion to problem solving and experimentation; they also implicate social and cultural dimensions of emotion expression. The analysis underscores a need to consider emotional expression to be intimately and importantly tied to the cognitive achievements and social negotiations of laboratory practices. (shrink)

We historically and conceptually situate distributed cognition by drawing attention to important similarities in assumptions and methods with those of American ?functional psychology? as it emerged in contrast and complement to controlled laboratory study of the structural components and primitive ?elements? of consciousness. Functional psychology foregrounded the adaptive features of cognitive processes in environments, and adopted as a unit of analysis the overall situation of organism and environment. A methodological implication of this emphasis was, to the extent possible, the study (...) of cognitive and other processes in the natural (real world) contexts in which they occur. We therefore emphasize commonalities and differences between functional psychology and D-Cog. One purpose of the comparison is to consider the extent to which criticisms directed at functional psychology are relevant to D-Cog. We also examine the relation between functional psychology and philosophical pragmatism and conclude that D-Cog's conceptual framework would be strengthened through more explicit adoption of philosophical pragmatism, consistent with the eventual trajectory of functional psychology. (shrink)

The rule of law is widely perceived to be a public law doctrine, concerned with the way governmental authority conforms to dictates of law. This book explores the idea that the rule of law instead concerns the conditions under which any relationship - that among citizens as well as that between citizens and the state - becomes subject to law.

The cognitive revolution in the 1950s and 1960s led researchers to view the human mind--like a computer--as an information-processing system that encodes, represents, and stores information and is constrained by limits on hardware and software. The emergence of new behavioral, computational, and neuroscience methodologies, has deeply expanded psychologists' understanding of the workings of the infant, child, and adult mind. One result is that research has focused on mechanisms of change, over developmental time, in the information-processing mind.In this book, Lisa (...) Oakes, Cara Cashon, Marianella Casasola, and David Rakison bring together the recent findings and theories about the origins and early development of the information-processing mind, and provide insight into the future directions in the study of infant perception and cognition. The contributors represent a wide-range of research areas in the study of infant perception and cognition, who emphasize the use of diverse methodological techniques to address key questions about development. Their chapters demonstrate how the combination of historical perspectives on the information-processing approach to cognition and recent advances in behavioral, computational, and neuroscience approaches to cognition has contributed to our understanding of how abilities ranging from visual attention to face processing to object categorization have developed during infancy. Across this broad range of topics, it is clear that much of our modern understanding of infant perceptual and cognitive development emerges from the foundation of classic information-processing models of development, such as that of Leslie B. Cohen. The recent advances illustrated in this book show how researchers have built on this foundation to uncover the mechanisms that drive developmental change. (shrink)

Teaching competency in bioethics has been a concern of the field since its start. In 1976, The Hastings Center published the first report on the teaching of contemporary bioethics. Graduate programs culminating in an MA or PhD were not needed at the time, concluded the report. “In the future, however,” the report speculated, “the development and/or changing social priorities may at some point allow, or even require, the creation of new academic structures for graduate education in bioethics.” Although that future (...) might be upon us, the creation of a terminal degree in bioethics has its detractors. Scholars have debated whether bioethics is a discipline with its own methods and theoretical grounding, a multidisciplinary field bringing various professional perspectives to bear on particular types of problems, a set of problem-solving skills to resolve moral disagreements, or something else entirely. Whether or not efforts to develop the methods and theory of bioethics have matured to the point that it is now a discipline in the strictest sense, new bioethics training programs have appeared at all postsecondary levels. In this essay, we examine the number and types of U.S. programs and degrees in this growing field. (shrink)

We describe our efforts to address theoretical opportunities and methodological challenges that arose in the context of our ethnographic investigation of research labs in four different fields of bioengineering science. The multiyear study compared the common and specific features of four sites of interdisciplinary practice and aimed to analyze personal and collective goals, problem formulations, methods, technologies, and social organization within each lab. In the second phase of the study we sought to inform curriculum development for biomedical engineering from the (...) ethnographic study, with the broader goal of positioning students to engage in the kind of thinking scientists actually do. Evaluating thinking in action posed considerable challenges, and required us to develop an approach to assessing the extent to which students enrolled in the new course were “thinking like a biomedical engineer.” Our principal point of emphasis for this chapter is that honest confrontation of the challenges of ethnographic study of science practice must lead to caution, yet that ethnographic study of science enables innovative adaptations of methods and can yield vital insights into psychological dimensions of science, including interdisciplinary science. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page W1-W3, August 2012.

Abram Brummett and Christopher Ostertag offer critiques of my argument that clinical ethics consultants have expertise but are not “ethics experts”. My argument begins within our less-than-ideal world and asks what a justification of a clinical ethics consultation recommendation might look like under those conditions. It is a challenge to what could be called an “inflationary” position on ethics expertise that requires agreement on or rational proof of metaethical facts about the values at stake in clinical ethics consultation. Brummett and (...) Ostertag critique three distinct steps in the argument. Two of those I have a brief answer for, and an assessment of the third demonstrates that Brummett and Ostertag do not consider the premise upon which I based my account. Instead, they assert a counter-premise without argument, which at best results in a stalemate between our two accounts. However, the reasons supporting my premise still seem to me to be stronger, so I am in the end unconvinced by their critiques. (shrink)

It is not clear whether breast cancer screening is a public health intervention or an individual clinical service. The question is important because the concepts best suited for ethical reasoning in public health might be different to the concepts commonly employed in biomedical ethics. We consider it likely that breast screening has elements of a public health intervention and used an empirical ethics approach to explore this further. If breast screening has public health characteristics, it is probable that policy and (...) practice experts will employ socially embedded concepts when reasoning about it. We gathered data on whether and how these concepts existed in the discussion and reasoning of Australian breast screening experts. We found that experts employed these concepts when talking about the purpose and practices of breast screening, and the behaviour of breast screening professionals and consumers. Experts gave varied judgements about breast screening based on reasoning with these concepts, considering it to be more or less successful in contributing to the public interest and in incorporating socially embedded concepts into its operational agenda. Our findings are compatible with breast screening having public health characteristics. We advocate for the incorporation of socially embedded concepts in breast screening policy and practice. (shrink)

The first Ethics Bowl competition was established in the 1990s by Dr. Robert Ladenson of the Illinois Institute of Technology to help students reason through ethical challenges they will face in their personal and professional lives, and help them develop responsibilities as citizens of a democracy. Since then, the Ethics Bowl format and its pedagogical goals have been adapted to many other academic disciplines and a variety of student and professional populations. Our aim was to quantify the growth of the (...) Ethics Bowl concept by enumerating and describing extant Ethics Bowl programs, outlining both pedagogical goals and operational aspects. Using respondent-driven sampling, we identified 20 Ethics Bowl programs across the globe, reaching tens of thousands of participants annually, and an additional two programs preparing to launch in the near future. We conclude by making recommendations for pedagogical and operational dimensions of the programs. (shrink)

Confronting any science studies or learning sciences researcher in the 21st century is the reality of interdisciplinary science. New hybrid fields1 collaboratively build new concepts, combine models from two or more disciplines and forge inter-reliant relationships among specialists with different skill sets to solve new problems. This paper emerges from our recognition that inescapable psychological factors, including identity dynamics, must be described and analyzed in order to better understand the social and cognitive practices specific to interdisciplinary science. In analysis of (...) the foundations and opportunities for an... (shrink)

The Office of Research Integrity found in 2011 that Vipul Bhrigu, a postdoctoral researcher who sabotaged a colleague’s research materials, was guilty of misconduct. However, I argue that this judgment is ill-considered and sets a problematic precedent for future cases. I first discuss the current federal definition of research misconduct and representative cases of research misconduct. Then, because this case recalls a debate from the 1990s over what the definition of “research misconduct” ought to be, I briefly recapitulate that history (...) and reconsider the Bhrigu case in light of that history and in comparison to other cases involving tampering. Finally, I consider what the aim of a definition of research misconduct ought to be, and argue that the precedent set by the reasoning in this case is problematic. (shrink)

We present a case for defining objectivity as responsibility. We do not attempt to offer new arguments on epistemological issues such as relativism or the fact-value distinction. Instead, we construct a conception of objectivity utilizing analyses from Deweyan pragmatism, feminist theory, and science studies, organizing them around the concept of responsibility. This conception of objectivity can serve as a tool to guide the process of inquiry; by suggesting that participants reflect on the question "how can this inquiry be made more (...) responsible?" it provides a guide for those struggling with the question of how to be more objective. (shrink)

Movement of leukocytes from peripheral blood into tissues, also called leukocyte extravasation, is absolutely essential for immunity in higher organisms. Over the past decade, our understanding of the molecular mechanisms involved in white blood cell extravasation during both normal immune surveillance and the generation of protective immune responses has taken a great leap forward with the discovery of the chemokine gene superfamily. Chemokines are low-molecular-weight cytokines whose major collective biological activity appears to be that of chemotaxis of both specific and (...) overlapping subsets of leukocytes. They are therefore likely to play a critical role in the directed movement of leukocytes from the bloodstream into tissue. These molecules are almost exclusively secreted and act as extracellular messengers for the immune system. However, emerging data also show that various members of the chemokine gene superfamily exert other biological effects outside the immune system. All nucleated cells and all tissues examined to date are capable of expressing at least some chemokines, and it seems likely therefore that by the time all the chemokines are identified, and all their biological functions elucidated, we will find that, as a family, these molecules perform an extracellular messenger role in all tissues and systems of the body. BioEssays 1999;21:17–28. © 1999 John Wiley & Sons, Inc. (shrink)

Reviews the role of intuition or an analogous concept within several divergent philosophical systems and argues that the salient feature common to various accounts of intuition is its non-inferential status. As such, it is argued to be highly relevant to contemporary theory. The paper offers several examples of points of compatibility with contemporary theory, including perception of social affordances, the apprehension linguistic rules and the construction of social norms. In claiming specific ways in which the concept of intuition is relevant (...) to contemporary theoretical psychology, the paper moves toward developing a more comprehensive and historically informed framework for intuition than is currently offered. It also underscores the historical underpinnings of contemporary debates. 2012 APA, all rights reserved). (shrink)

Clinical ethics consultation is on the horns of a dilemma. One horn skewers the field for its lack of standards, while the other horn skewers it for proposing arbitrary or deeply contested foundations. I articulate the dilemma by discussing several critiques of the field and the challenge of formulating standards and suggest that the solution lies, at least until a robust consensus emerges, with establishing a list of proscriptive standards to guide the field.

Contemporary biomedical ethics and environmental ethics share a common ancestry in Aldo Leopold's and Van Rensselaer Potter's initial broad visions of a connected biosphere. Over the past five decades, the two fields have become strangers. Public health ethics, a new subfield of bioethics, emerged from the belly of contemporary biomedical ethics and has evolved over the past 25 years. It has moved from its traditional concern with the tension between individual autonomy and community health to a wider focus on social (...) justice and solidarity. Public health has a broad focus that includes individual, community, and environmental health. Public health ethics attends to these broad commitments reflected in the increasing concern with the connectedness of health of individuals to the health of populations, to the health of animals, to the health of the environment; it is well situated to reconnect all three “fields” of ethics to promote a healthier planet. (shrink)

In their article “The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments,” Ray and Cooper (2024) invite us to prioritize environmental health...

Patients and surgeons participate in shared decision making when they make healthcare decisions together, taking into account the patient’s goals, values, and preferences. Surgical treatment is pursued when the potential benefits outweigh the risks, the burdens of treatment are acceptable, and no other alternatives are more appropriate for meeting the patient’s goals of care. Acute care surgical problems require shared decision making, often with constraining factors that include the time-sensitive and life-threatening nature of acute surgical disease, absence of a patient’s (...) decision-making capacity, and lack of a preexisting relationship between the patient and surgeon. These factors may create ethical challenges for acute care surgeons who care for these patients. (shrink)

As has become tradition, executive directors of United States’ presidential bioethics committees offer reflections about their experience shortly after the orderly shutdown of the commission staff. After the records are filed according to government records regulations; after all the staff members, who are hired into temporary positions that must be renewed every two years, have secured permanent employment; after preparations are made to ensure that the next commission staff (should there be one) has a budget and standard operating procedures in (...) order to begin its work in a timely manner; after the lights are turned out for the last time, the executive director makes the final climb up the stairs into the sunlight and reflects on the whirlwind. There is much about my work with the Presidential Commission for the Study of Bioethical Issues that deserves comment, but one aspect of the commission that has been especially valuable to me is its work to educate the nation on bioethical issues. This is, moreover, a contribution in which the commission staff was central, and it is one that, as an ethics educator myself, I will cherish deeply. (shrink)

Contemporary privacy debates regarding new technologies often define privacy in terms of control over personal information such that the privacy “problem” is a lack of control and the privacy “solution” is increased control. This article questions the control-paradigm by pointing to its parallels with earlier debates in the philosophy of technology regarding technology that was out-of-control. What first-generation philosophers of technology understood was that at the root of the questioning of technology lay a need to question the modern self itself. (...) Legal debates regarding privacy renew the importance of this question, for the control-paradigm perpetuates a view of the self as an individual with an inner core transparent to itself on solitary introspection and revealed to others through self-conscious acts of disclosure. Increasingly, this model fails to account for the challenges raised by new technologies and calls for rethinking. (shrink)

Before we commit significant resources of time and energy to clinical ethics consultation (CEC) certification, education, and the like, one of the questions we ought to be able to answer is how to...

This essay is a comparative analysis of results reported in this volume from studies in mainland China, the United States, Iran, and Hong Kong regarding organ donation incentives. They reveal widespread (but not unanimous) support for honorary incentives (such as notes or ceremonies of gratitude) and significant support for familist incentives (offering a donor’s family members priority should they need an organ transplant in the future). Opinions on financial incentives were much more mixed, with significant worries expressed regarding potential exploitation (...) and unfairness. These interviews also reinforce the importance of culturally appropriate constructions of any steps to increase organ donation rates. And, in addition to their comments on various types of incentive, interviewees in these chapters also offer insight into other measures that could be taken to increase organ donation. (shrink)

Volume 19, Issue 9, September 2019, Page 44-45.

The attempt to critique the profession of clinical ethics consultation by establishing the impossibility of ethics expertise has been a red herring. Decisions made in clinical ethics cases are almost never based purely on moral judgments. Instead, they are all-things-considered judgments that involve determining how to balance other values as well. A standard of justified decision-making in this context would enable us to identify experts who could achieve these standards more often than others, and thus provide a basis for expertise (...) in clinical ethics consultation. This expertise relies in part on what Richard Zaner calls the “expert knowledge of ethical phenomena”. (shrink)