In her article “Shrinking Poor White Life Spans: Class, Race, and Health Justice," Erika Blacksher poses a provocative question: “How ought we ethically evaluate [the] life-span contraction in low-...

We hypothesize that black women experience accelerated biological aging in response to repeated or prolonged adaptation to subjective and objective stressors. Drawing on stress physiology and ethnographic, social science, and public health literature, we lay out the rationale for this hypothesis. We also perform a first population-based test of its plausibility, focusing on telomere length, a biomeasure of aging that may be shortened by stressors. Analyzing data from the Study of Women’s Health Across the Nation (SWAN), we estimate that at (...) ages 49–55, black women are 7.5 years biologically “older” than white women. Indicators of perceived stress and poverty account for 27% of this difference. Data limitations preclude assessing objective stressors and also result in imprecise estimates, limiting our ability to draw firm inferences. Further investigation of black-white differences in telomere length using large-population-based samples of broad age range and with detailed measures of environmental stressors is merited. (shrink)

Can one be fooled into believing that one intended an action that one in fact did not intend? Past experimental paradigms have demonstrated that participants, when provided with false perceptual feedback about their actions, can be fooled into misperceiving the nature of their intended motor act. However, because veridical proprioceptive/perceptual feedback limits the extent to which participants can be fooled, few studies have been able to answer our question and induce the illusion to intend. In a novel paradigm addressing this (...) question, participants were instructed to move a line on the computer screen by use of a phony brain–computer interface. Line movements were actually controlled by computer program. Demonstrating the illusion to intend, participants reported more intentions to move the line when it moved frequently than when it moved infrequently. Consistent with ideomotor theory, the finding illuminates the intimate liaisons among ideomotor processing, the sense of agency, and action production. (shrink)

This book is a rich blend of analyses by leading experts from various cultures and disciplines. A compact introduction to a complex field, it illustrates biotechnology's profound impact upon the environment and society. Moreover, it underscores the vital relevance of cultural values. This book empowers readers to more critically assess biotechnology's value and effectiveness within both specific cultural and global contexts.

A limiting factor in ethics education in medical training has been difficulty in assessing competence in ethics. This study was conducted to test the concept that content analysis of pediatric residents’ personal reflections about ethics experiences can identify changes in ethical sensitivity and reasoning over time. Analysis of written narratives focused on two of our ethics curriculum’s goals: 1) To raise sensitivity to ethical issues in everyday clinical practice and 2) to enhance critical reflection on personal and professional values as (...) they affect patient care. Content analysis of written reflections was guided by a tool developed to identify and assess the level of ethical reasoning in eight domains determined to be important aspects of ethical competence. Based on the assessment of narratives written at two times (12 to 16 months/apart) during their training, residents showed significant progress in two specific domains: use of professional values, and use of personal values. Residents did not show decline in ethical reasoning in any domain. This study demonstrates that content analysis of personal narratives may provide a useful method for assessment of developing ethical sensitivity and reasoning. (shrink)

We agree with Grossmann that fear often builds cooperative relationships. Yet he neglects much extant literature. Prior researchers have discussed how fear (and other emotions) build cooperative relationships, have questioned whether fear per se evolved to serve this purpose, and have emphasized that human cooperation takes many forms. Grossmann's theory would benefit from a wider consideration of this work.

For more than sixty years, surgeons have used bioethical strategies to promote patient self‐determination, many of these now collectively described as “informed consent.” Yet the core framework—understanding, risks, benefits, and alternatives—fails to support patients in deliberation about treatment. We find that surgeons translate this framework into an overly complicated technical explanation of disease and treatment and an overly simplified narrative that surgery will “fix” the problem. They omit critical information about the goals and downsides of surgery and present untenable options (...) as a matter of patient choice. We propose a novel framework called “better conversations.” Herein, surgeons provide context about clinical norms, establish the goals of surgery, and comprehensively delineate the downsides of surgery to generate a deliberative space for patients to consider whether surgery is right for them. This paradigm shift meets the standards for informed consent, supports deliberation, and allows patients to anticipate and prepare for the experience of treatment. (shrink)

Though assumptions about language underlie all bioethical work, the field has rarely partaken of theories of language. This article encourages a more linguistically engaged bioethics. We describe the tacit conception of language that is frequently upheld in bioethics—what we call the representational view, which sees language essentially as a means of description. We examine how this view has routed the field’s theories and interventions down certain paths. We present an alternative model of language—the pragmatic view—and explore how it expands and (...) clarifies traditional bioethical concerns. To lend concreteness, we apply the pragmatic view to a pervasive concept in bioethics and adjacent fields: decision making. We suggest that problems of the decision-making approach to bioethical issues are grounded in adherence to the representational view. Drawing on empirical work in surgery and critical care, we show how the pragmatic view productively reframes bioethical questions about how medical treatments are pursued. (shrink)

Heritable human genome editing has garnered significant attention in scholarly and lay media, yet questions remain about whether, when, and how heritable genome editing ought to proceed. Drawing on interviews with scientists who use genome editing in their research and professionals engaged in human genome editing governance efforts, we examine their views on the permissibility of heritable genome editing and the governance strategies they see as necessary and realistic. For both issues, we found divergent views from respondents. We place the (...) views of these scientists and governance professionals within the context of the larger bioethical discussion of heritable genome editing governance, along a continuum of hard to soft approaches. These respondents’ views highlight the challenges of various hard forms of governance and the potential virtues of soft governance approaches. (shrink)

This paper analyses the activities of five organizations shaping the debate over the global governance of genome editing in order to assess current approaches to public engagement (PE). We compare the recommendations of each group with its own practices. All recommend broad engagement with the general public, but their practices vary from expert-driven models dominated by scientists, experts, and civil society groups to citizen deliberation-driven models that feature bidirectional consultation with local citizens, as well as hybrid models that combine elements (...) of both approaches. Only one group practices PE that seeks community perspectives to advance equity. In most cases, PE does little more than record already well-known views held by the most vocal groups, and thus is unlikely to produce more just or equitable processes or policy outcomes. Our exploration of the strengths, weaknesses, and possibilities of current forms of PE suggests a need to rethink both “public” and “engagement.”. (shrink)

In this book philosophers, scholars of religion, and activists address the theme of responsibility. Barbara Darling-Smith brings together an enlightening collection of essays that analyze the ethics of responsibility, its relational nature, and its global struggle.

This paper raises two problems for plan-expressivism concerning normative judgments about non-corealizable actions: actions which cannot both be performed. First, plan-expressivists associate normative judgment with an attitude which satisfies a corealizability constraint, but this constraint is (in the interpersonal case) unwarranted, and (in the intrapersonal case) warranted only at the price of a contentious normative premise. Ayars (2022) holds that the pair of judgments ‘A should φ’ and ‘B should ψ’ is coherent only if one believes that A can φ (...) while B ψ’s. But this is false. Both Gibbard (2003) and Ayars hold that the pair of judgments ‘A should φ’ and ‘A should ψ’ is coherent only if one believes that A can φ and ψ. But this assumes possibilism. Second, the paper demonstrates, cases involving interpersonal non-corealizability prompt judgments about what multiple agents should do which – contra Gibbard – are not plausibly associated with any planning subject. (shrink)

The mantra of the Western philosopher is “know thyself.” However, many of us in the discipline of philosophy don’t seem to practice what we preach—or even preach this mantra. This is true in the conduct of our profession. The practices and norms of the members of an institution constitute that institution. If we are not rigorously self-examining ourselves, especially in the conduct of our professional lives, then the discipline of philosophy, the institution of philosophy as it exists in the West, (...) is not consistent with this defining imperative. (shrink)

Outpatient services are increasingly recognised as an important component of health care provision and may be improved through the application of modern management techniques. We have performed a time and role audit of consultation and waiting times in two medical clinics using different queuing systems: namely, a serial processing clinic where patients wait in a single queue and a quasi-parallel processing clinic where patients are directed to the shortest queue to maintain clinic flow. Data collected were used to construct a (...) computer simulation of patient flows in clinic. Assessment of patient satisfaction in the clinic process was determined using a self-administered questionnaire. Mean waiting time was shorter in the quasi-parallel processing clinic: 26 (SD 17) minutes compared with 36(24) minutes in the serial processing clinic. In the serial processing clinic 61% of patients waited more than 30 minutes compared with 41% in the quasi-parallel processing clinic. In the serial processing clinic 8% of 142 patients surveyed complained of the time spent waiting. The computer simulation we produced was able to determine waiting times with different clinic structures. The simulation showed that reductions in waiting time up to 30% might be achieved by changing our serial processing clinic to a quasi-parallel processing one. Performance of medical outpatient clinics can be improved by examining and changing clinic management. Computer simulation of outpatient clinics offers a means of assessing the impact of such changes on waiting time in clinic and on waiting lists. (shrink)

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

This article is the lead piece in a special report that presents the results of a bioethical investigation into chimeric research, which involves the insertion of human cells into nonhuman animals and nonhuman animal embryos, including into their brains. Rapid scientific developments in this field may advance knowledge and could lead to new therapies for humans. They also reveal the conceptual, ethical, and procedural limitations of existing ethics guidance for human‐nonhuman chimeric research. Led by bioethics researchers working closely with an (...) interdisciplinary work group, the investigation focused on generating conceptual clarity and identifying improvements to governance approaches, with the goal of helping scholars, funders, scientists, institutional leaders, and oversight bodies (embryonic stem cell research oversight [ESCRO] committees and institutional animal care and use committees [IACUCs]) deliver principled and trustworthy oversight of this area of science. The article, which focuses on human‐nonhuman animal chimeric research that is stem cell based, identifies key ethical issues in and offers ten recommendations regarding the ethics and oversight of this research. Turning from bioethics’ previous focus on human‐centered questions about the ethics of “humanization” and this research's potential impact on concepts like human dignity, this article emphasizes the importance of nonhuman animal welfare concerns in chimeric research and argues for less‐siloed governance and oversight and more‐comprehensive public communication. (shrink)

If you developed Alzheimer disease, would you want to go all the way to the end of what might be a decade‐long course? Some would; some wouldn't. Options open to those who choose to die sooner are often inadequate. Do‐not‐resuscitate orders and advance directives depend on others' cooperation. Preemptive suicide may mean giving up years of life one would count as good. Do‐it‐yourself methods can fail. What we now ask of family and clinicians caring for persons with dementia, and of (...) patients given no better option than to go on with lives they may not want, is unacceptable. To explore how one might better control one's own dying and avoid burdening others with overwhelming care and morally painful choices, we propose a thought experiment: an advance directive implant that would enable persons with early dementia, while competent, to arrange their own deaths without the subsequent intervention of anyone else. (shrink)

What is a crip politics of bodymind? Drawing upon Rosemarie Garland-Thomson's theory of the misfit, I explain my understanding of crip and bodymind within a feminist materialist framework, and argue that careful investigation of a crip politics of bodymind must involve accounting for two key, but under-explored, disability studies concepts: desire and pain. I trace the turn toward desire that has characterized DS theory for the last decade, and argue that while acknowledging disability desire, we must also attend to the (...) aspects of disability, including pain, that are sometimes bad. Although I don't argue that pain is always and only bad, I call for recognition of the ways pain complicates disability desire, as well as the possibilities it opens for specifically located, collective forms of care. (shrink)

The paper begins with a generic discussion of modelling, focusing on some of its practices and problems. I then move on to a philosophical discussion about emergence and multi-scale modelling; more specifically, the reasons why what looks like a promising strategy for dealing with emergence is sometimes incapable of delivering interesting results. This becomes especially evident when we look more closely at turbulence and what I take to be the main ontological feature of emergent behavior—universality. Finally, I conclude by showing (...) why, despite displaying multi-scale behaviour and some of the characteristics we identify with emergence, turbulence fails to fit neatly into the latter category and is not successfully captured using multi-scale modelling. The complex nature of turbulence illustrates the difficulties in characterizing emergence and why specific criteria are needed in order to prevent every complex behaviour we don’t understand being classified as emergent. (shrink)

Ruth Boeker’s Locke on Persons and Personal Identity is a tightly argued and illuminating account, containing much to ponder. The presence of both terms, ‘persons’ and ‘personal identity’, in the t...

The prelims comprise: Seeing Infectious Disease as Central The Birth of Bioethics Amid the Decline of Infectious Disease The Shifting Concerns of Public Health Bioethics and Public Health: How the Twain Didn't Meet The Case of HIV Bridging the Gap: Seeing Bioethics in Terms of the Patient as Victim and Vector An Ordinary Example Summing Up: Autonomous Agency in the Context of Infectious Disease Notes.

The paper examines philosophical issues that arise in contexts where one has many different models for treating the same system. I show why in some cases this appears relatively unproblematic (models of turbulence) while others represent genuine difficulties when attempting to interpret the information that models provide (nuclear models). What the examples show is that while complementary models needn’t be a hindrance to knowledge acquisition, the kind of inconsistency present in nuclear cases is, since it is indicative of a lack (...) of genuine theoretical understanding. It is important to note that the differences in modeling do not result directly from the status of our knowledge of turbulent flows as opposed to nuclear dynamics—both face fundamental theoretical problems in the construction and application of models. However, as we shall, the ‘problem context(s)’ in which the modeling takes plays a decisive role in evaluating the epistemic merit of the models themselves. Moreover, the theoretical difficulties that give rise to inconsistent as opposed to complementary models (in the cases I discuss) impose epistemic and methodological burdens that cannot be overcome by invoking philosophical strategies like perspectivism, paraconsistency or partial structures. (shrink)

During the coldest winter of my life, I breathe on my fingers to give them temporary relief from numbness. They come to life momentarily, and I lean down to puff on a cigarette again. The cold hurts my bones and has gotten inside of me in a way that I have never experienced before, even in my Midwestern childhood. I tilt my head back and blow the smoke out of an open window. There’s something thrilling about smoking indoors, and something (...) deeply uncomfortable that I don’t want to face about smoking inside of a hospital.I am standing in a hallway between wards of a Chinese hospital in the outskirts of Beijing. I’ve been here for weeks but have lost track of the days in a pleasantly disorienting way, almost like... (shrink)

Klagetraditionen: Form und Funktion der Klage in den Kulturen der Antike. Edited by Margaret Jaques. Orbis Biblicus et Orientalis, vol. 251. Fribourg, Switzerland: Academic Press, 2011. Pp. vii + 110, illus. SF35.

For the students, while the numbers are up,… the problem that minorities face – and it is persistent – is that there is still too much of a patronizing air in the professional schools. And there's still too much of the notion that if you're here it must be because someone gave you a break and you're different and you really don't belong here. And indeed when my son went off to school four years ago… I really wanted to warn (...) him about the atmosphere that you see on all too many campuses, diat if you're black and walking on campus, that all too many people look at you and say, “You must be an affirmative action product,” whatever that means to them. “You're here only at our good grace.” And no one's looking at the individual. Thinking about it in retrospect, I guess, in some ways I enjoyed an advantage in being [the only black in my law school class]. It was a terrible disadvantage in a lot of ways, but, because I was the only black, the one thing I never faced was anyone ever challenging my intellectual capability. The way they brought this off was to say, “Well, you're different. You're black but you're not really black.” I think it's a lot worse now…. Professional schools are hard enough as it is, and to constantly have the pressure of what others are thinking about you and wondering whether you really belong, that really is a difficult burden. (shrink)