The model of clinical ethics consultation (CEC) defended in the ASBH Core Competencies report has gained significant traction among scholars and healthcare providers. On this model, the aim of CEC is to facilitate deliberative reflection and thereby resolve conflicts and clarify value uncertainty by invoking and pursuing a process of consensus building. It is central to the model that the facilitated consensus falls within a range of allowable options, defined by societal values: prevailing legal requirements, widely endorsed organizational policies, and (...) professional standards of practice and codes of conduct. Moreover, the model stipulates that ethics consultants must refrain from giving substantive recommendations regarding how parties to a moral disagreement in the clinic should evaluate their options. We argue that this model of CEC is incomplete, because it wrongly assumes that what counts as the proper set of allowable options among which the parties are to deliberate will itself always be clearly discernible. We illustrate this problem with a recent case on which one of us consulted—a neonate born with trisomy 18 (T18). We try to show that law, policy, and standards of practice reveal no clear answer to the question posed by the case: namely, whether forgoing gastrostomy tube feedings for a baby with T18 is allowable. We suggest there may be other kinds of cases in which it may simply be unsettled whether a given choice falls within the set of allowable options within which consensus is to be facilitated. What should an ethicist do when confronting such unsettled cases? We agree with the facilitation model that an ethicist should remain neutral among the allowable options, when it is clear what the allowable options are. But, in unsettled cases, the role of a consultant should be expanded to include a process of moral inquiry into what the allowable options should be. We end by raising the issue of whether this means an ethicist should share his or her own conclusions or views about the allowability of a given clinical option. (shrink)

This paper offers some comments on bioethical debates about resource allocation in healthcare. It is stimulated by Rosalind McDougall’s argument that it is an affront to the human dignity of people with below “liberties-level” health to fund human reproductive cloning. McDougall is right to underline the relevance of resource prioritisation to the ethics of research and provision of new biomedical technologies. This paper argues that bioethicists should be careful when offering comments about such issues. In particular, it emphasises the need (...) to represent accurately the reality of the situation—especially when we are passing judgement on technologies that are in their infancy and whose practical application is yet to be confirmed. The paper also emphasises the importance of the actual context to bioethical debate, and note that it would be better to talk about resource expenditure rather than resource allocation when it comes to discussing the rights and wrongs of how money is spent. It also reiterates the claims made by other writers that social and political philosophy need to have a transparent and considered role in debates about resources. (shrink)

The behavioral sciences have come under attack for writings and speech that affront sensitivities. At such times, academic freedom and tenure are invoked to forestall efforts to censure and terminate jobs. We review the history and controversy surrounding academic freedom and tenure, and explore their meaning across different fields, at different institutions, and at different ranks. In a multifactoral experimental survey, 1,004 randomly selected faculty members from top-ranked institutions were asked how colleagues would typically respond when confronted with dilemmas concerning (...) teaching, research, and wrong-doing. Full professors were perceived as being more likely to insist on having the academic freedom to teach unpopular courses, research controversial topics, and whistle-blow wrong-doing than were lower-ranked professors (even associate professors with tenure). Everyone thought that others were more likely to exercise academic freedom than they themselves were, and that promotion to full professor was a better predictor of who would exercise academic freedom than was the awarding of tenure. Few differences emerged related either to gender or type of institution, and behavioral scientists' beliefs were similar to scholars from other fields. In addition, no support was found for glib celebrations of tenure's sanctification of broadly defined academic freedoms. These findings challenge the assumption that tenure can be justified on the basis of fostering academic freedom, suggesting the need for a re-examination of the philosophical foundation and practical implications of tenure in today's academy. (Published Online February 8 2007) Key Words: academia; academic freedom; ethical issues; faculty beliefs; professoriate; promotion; scientific misconduct; tenure; whistle-blowing. (shrink)

Current theories of breast cancer progression have been greatly influenced by the development and refinement of mouse transgenic and gene targeting technologies. Early transgenic mouse models confirmed the involvement of oncogenes, previously implicated in human breast cancer, by establishing a causal relationship between overexpression or activation of these genes and mammary tumorigenesis. More recently, the importance of genes located at sites of loss of heterozygosity in human breast cancer have been examined in mice by their targeted disruption via homologous recombination. (...) The union of these two approaches allows the generation of complex animal models that more accurately reflect the multistep nature of human breast cancer. This review will examine how the study of transgenic mice has increased our understanding of the molecular events responsible for oncogenic transformation of the mammary gland. BioEssays 22:554–563, 2000. © 2000 John Wiley & Sons, Inc. (shrink)

Narrative passages told from a character's perspective convey the character's thoughts and perceptions. We present a discourse process that recognizes characters'.

We argued in our joint article that the facilitated consensus model of clinical ethics consultation is incomplete because it does not address the problem of what we have called “unsettled cases.” Sabrina Derrington and April Dworetz, Mark Aulisio, and Al Jonsen have each usefully challenged our claims and conclusions. In this brief article we respond to some of their arguments.

Answering important public health questions often requires collection of sensitive information about individuals. For example, our understanding of how HIV is transmitted and how to prevent it only came about with people's willingness to share information about their sexual and drug-using behaviors. Given the scientific need for sensitive, personal information, researchers have a corresponding ethical and legal obligation to maintain the confidentiality of data they collect and typically promise in consent forms to restrict access to it and not to publish (...) identifying data.The interests of others, however, can threaten researchers' promises of confidentiality when legal demands are made to access research data. In some cases, the subject of the litigation is tightly connected to the research questions, and litigants' interest in the data is not surprising. Researchers conducting studies on tobacco or occupational or other chemical exposures, for example, are relatively frequent targets of subpoenas. (shrink)

Institutional review boards are almost universally considered to be overworked and understaffed. They also require substantial commitments of time and resources from their members. Although some surveys report average IRB memberships of 15 people or more, federal regulations require only five. We present data on IRB meetings at eight of the top 25 academic medical centers in the United States funded by the National Institutes of Health. These data indicate substantial contributions from primary reviewers and chairs during protocol discussions but (...) little from other members, which implies that it may be possible for smaller IRBs to accomplish the same tasks with no reduction in the quality of review. (shrink)

Nurses have moral obligations incurred by membership in the profession to participate knowingly in health policy advocacy. Many barriers have historically hindered nurses from realizing their potential to advance health policy. The contemporary political context sets additional challenges to policy work due to polarization and conflict. Nursing education can help nurses recognize their role in advancing health through political advocacy in a manner that is consistent with disciplinary knowledge and ethical responsibilities. In this paper, the authors describe an exemplar of (...) Elizabeth Barrett's “Power as Knowing Participation in Change” theory as a disciplinary lens within a doctoral nursing health policy course. Barrett (radically) emphasizes “power as freedom” instead of “power as control.” This approach is congruent with nursing disciplinary values and enhances awareness of personal freedom and building collaborative relationships in the policy process. The theory was used in concert with other traditional policy content and frameworks from nursing and other disciplines. We discuss the role of nursing ethics viewed as professional responsibility for policy action, an overview of Barrett's theory, and the design of the course. Four student reflections on how the course influenced their thinking about policy advocacy are included. While not specific to policymaking, Barrett's theory provides a disciplinary grounding to increase students' awareness of freedom and choices in political advocacy participation. Our experience suggests that Barrett's work can be fruitful for enhancing nurses' awareness of choices to participate in change across settings. (shrink)

Alan William Raitt, a Fellow of the British Academy, went up to Magdalen College at the University of Oxford from King Edward's Grammar School in Morpeth, in 1948. He progressed from being an undergraduate there to graduate student, Fellow by Examination, Fellow, Tutor, and Senior Tutor, as well as serving the college as a distinguished Vice-President from 1983 to 1985. Raitt had by then already been named in 1976 Special Lecturer in French Literature for the university and, three years later, (...) University Reader. In 1992 he received the accolade of an ad hominem Chair. Raitt had a gift for friendship; one of his greatest friends was Pierre Castex. His reputation as an international authority on nineteenth-century French literature is second to none. Unlike some British and American scholars, Raitt is widely read and admired by the French themselves, and his name figures prominently in all bibliographies devoted to Villiers de l'Isle-Adam and Gustave Flaubert. Despite his many commitments, both in Oxford and in the sphere of French studies generally, he remained a consistently prolific scholar. (shrink)

Narrative passages told from a character's perspective convey the character's thoughts and perceptions. We present a discourse process that recognizes characters' thoughts and perceptions in third-person narrative. An effect of perspective on reference In narrative is addressed: references in passages told from the perspective of a character reflect the character's beliefs. An algorithm that uses the results of our discourse process to understand references with respect to an appropriate set of beliefs is presented.

In an effort to further explore ostensible macroscopic psychokinesis (macro-PK) effects like those previously reported by Batcheldor (1966), Bourgeois (1994), Owen and Sparrow (1976), and Ullman (2001) in a sitter group setting, the first author designed and conducted a series of fifteen experimental sessions in which sitters claiming exceptional abilities attempted to generate a pseudo-spirit named "Daniel," to whom physical phenomena were attributed. To explore possible physical correlates of macro-PK, two approaches to measurement were utilized. In the first, sample data (...) from a local random number generator (RNG) continuously running as part of the Global Consciousness Project were extracted and examined for statistical deviations from randomness occurring in conjunction with the sitter group sessions. In the second, the Multi-Energy Sensor Array (MESA) was used to collect onsite environmental data during one of the sessions. While displays of ostensible macro-PK were observed during several of the sitter group sessions, the RNG data did not show a significant overall correlation with the sessions. The MESA data indicated notable drops in infrared and visual light, as well as changes in DC magnetic field strength, that are comparable to those observed in field studies of haunts. Keywords: sitter groups--macroscopic psychokinesis (macro-PK)--random number generator (RNG)--Multi-Energy Sensor Array (MESA). (shrink)

This collection of essays addresses some of the central issues in modern social and political thought, such as: the revival of Marxism and its relevance to the social sciences; the analysis of social and political structures and social movements; and the future of advanced capitalist societies.

The Geological Society of London was the first learned society to be devoted solely to geology, and its members were responsible for much of the spectacular progress of the science in the nineteenth century. Its distinctive character as a centre of geological discussion and research was established within the first five years from its foundation in 1807. During this period its activities were directed, and its policies largely shaped, by its President, George Bellas Greenough, on whose unpublished papers this account (...) is chiefly based.The Society began as a small scientific dining club in London, but it developed rapidly into a learned society with a nation-wide membership. It became so independent in outlook and so active in research that it was felt to threaten the esteem of the Royal Society; and little more than a year after its foundation it clashed with the Royal Society so violently that its continued existence was for a time uncertain.Its development into a large independent society was the outcome of its ‘Baconian’ view of the importance of collecting geological facts as a surer basis for geological theories. For this purpose it initiated an ambitious scheme for co-operative research, which would unite the efforts of ‘philosophers’ with those of ‘practical men’. Only personal reasons seem to have kept the most prominent of the practical men—William Smith—from co-operating with the Society. (shrink)

Until recently, retention of introns in mature mRNAs has been regarded as a consequence of mis‐splicing. Intron‐retaining transcripts are thought to be non‐functional because they are readily degraded by nonsense‐mediated decay. However, recent advances in next‐generation sequencing technologies have enabled the detection of numerous transcripts that retain introns. As we review herein, intron‐retaining mRNAs play an essential conserved role in normal physiology and an emergent role in diverse diseases. Intron retention should no longer be overlooked as a key mechanism that (...) independently reduces gene expression in normal biology. Exploring its contribution to the development and/or maintenance of diseases is of increasing importance. (shrink)

THE methodological principle known as Ockham’s Razor is usually formulated as “Entia non sunt multiplicanda praeter necessarium”. However, it is well known that neither this formulation of the principle nor the idea behind it come originally from William of Ockham. This particular formula is due to Leibniz, though Ockham’s works contain equivalent formulas: “Pluralitas non est ponenda sine necessitate”; “Si duae res sufficiunt ad eius veritatem, superfluum est ponere aliam rem”; “Frustra fit per plura, quod potest fieri per pauciora”. But (...) Duns Scotus had also used the same principle before Ockham and he refers it directly to Aristotle. If the Razor belongs to anyone then, it belongs to Aristotle, and the study of its exact meaning and value must begin with Aristotle’s views about it. It is interesting to note, in this respect, that the principle was recognized as Aristotle’s at least until the time of Galileo. Thus in his Dialogue concerning the Two chief World Systems Galileo supports his theory that “diurnal motion belongs to the earth alone rather than to the rest of the universe excepting the earth” by referring to “a very true maxim of Aristotle’s which teaches that ‘frustra fit per plura quod potest fieri per pauciora’.”. (shrink)

Experiments may contribute to understanding the basic processes of cultural evolution. We drew features from previous laboratory research with small groups in which traditions arose during several generations. Groups of four participants chose by consensus between solving anagrams printed on red cards and on blue cards. Payoffs for the choices differed. After 12 min, the participant who had been in the experiment the longest was removed and replaced with a naı¨ve person. These replacements, each of which marked the end of (...) a generation, continued for 10 – 15 generations, at which time the day’s session ended. Time-out duration, which determined whether the group earned more by choosing red or blue, and which was fixed for a day’s session, was varied across three conditions to equal 1, 2, or 3 min. The groups developed choice traditions that tended toward maximizing earnings. The stronger the dependence between choice and earnings, the stronger was the tradition. Once a choice tradition evolved, groups passed it on by instructing newcomers, using some combination of accurate information, mythology, and coercion. Among verbal traditions, frequency of mythology varied directly with strength of the choice tradition. These methods may be applied to a variety of research questions. D 2004 Elsevier Inc. All rights reserved. (shrink)