If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

Background Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians’ decisions to honor or forgo previously established advance directives (ADs). In addition, physician views regarding legal risk, patients’ ability to comprehend (...) complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored. Methods Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents’ perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test. Results Three hundred eighty-eight of 951 surveys were completed (41% response rate). Eighty percent reported they were likely to honor a patient’s AD despite its 5 year age. Fewer than half (41%) would honor the AD of a patient in ventricular fibrillation who had expressed a desire to “pass away in peace.” Few (17%) would forgo an AD following a family’s request for continued resuscitative treatment. A majority (52%) considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage (74%) disagreed that patients could not appreciate complexities surrounding their care while 69% agreed that costs should never impact a physician’s decision as to whether to comply with a patient’s AD. Conclusions Our findings highlight the impact, albeit small, external factors have on physician AD compliance. Most respondents based their decision on the clinical situation at hand and interpretation of the patient’s initial wishes and preferences expressed by the AD. (shrink)

We report on the deliberations of an interdisciplinary group of experts in science, law, and philosophy who convened to discuss novel ethical and policy challenges in stem cell research. In this report we discuss the ethical and policy implications of safety concerns in the transition from basic laboratory research to clinical applications of cell-based therapies derived from stem cells. Although many features of this transition from lab to clinic are common to other therapies, three aspects of stem cell biology pose (...) unique challenges. First, tension regarding the use of human embryos may complicate the scientific development of safe and effective cell lines. Second, because human stem cells were not developed in the laboratory until 1998, few safety questions relating to human applications have been addressed in animal research. Third, preclinical and clinical testing of biologic agents, particularly those as inherently complex as mammalian cells, present formidable challenges, such as the need to develop suitable standardized assays and the difficulty of selecting appropriate patient populations for early phase trials. We recommend that scientists, policy makers, and the public discuss these issues responsibly, and further, that a national advisory committee to oversee human trials of cell therapies be established. **NB we did not reccommend a NAC, we think it might be appropriate**. (shrink)

The ability to process center‐embedded structures has been claimed to represent a core function of the language faculty. Recently, several studies have investigated the learning of center‐embedded dependencies in artificial grammar settings. Yet some of the results seem to question the learnability of these structures in artificial grammar tasks. Here, we tested under which exposure conditions learning of center‐embedded structures in an artificial grammar is possible. We used naturally spoken syllable sequences and varied the presence of prosodic cues. The results (...) suggest that mere distributional information does not suffice for successful learning. Prosodic cues marking the boundaries of the major relevant units, however, can lead to learning success. Thus, our data are consistent with the hypothesis that center‐embedded syntactic structures can be learned in artificial grammar tasks if language‐like acoustic cues are provided. (shrink)

Understanding how scientific activities use naming stories to achieve disciplinary status is important not only for insight into the past, but for evaluating current claims that new disciplines are emerging. In order to gain a historical understanding of how new disciplines develop in relation to these baptismal narratives, we compare two recently formed disciplines, systems biology and genomics, with two earlier related life sciences, genetics and molecular biology. These four disciplines span the twentieth century, a period in which the processes (...) of disciplinary demarcation fundamentally changed from those characteristic of the nineteenth century. We outline how the establishment of each discipline relies upon an interplay of factors that include paradigmatic achievements, technological innovation, and social formations. Our focus, however, is the baptism stories that give the new discipline a founding narrative and articulate core problems, general approaches and constitutive methods. The highly plastic process of achieving disciplinary identity is further marked by the openness of disciplinary definition, tension between technological possibilities and the ways in which scientific issues are conceived and approached, synthesis of reductive and integrative strategies, and complex social interactions. The importance – albeit highly variable – of naming stories in these four cases indicates the scope for future studies that focus on failed disciplines or competing names. Further attention to disciplinary histories could, we suggest, give us richer insight into scientific development. (shrink)

In “Stakes, Withholding, and Pragmatic Encroachment on Knowledge,” I used a variety of cases, including cases of forced choice, to illustrate my explanation of how and why some pragmatic factors, but not others, can affect whether an agent knows. In his recent contribution, Andy Mueller argues that cases of forced choice actually pose a dilemma for my account. In this paper I reply.

True ecotourism requires us to regain an understanding of the inextricable links between the habitats of a region, including its inhabitants, and their habits. With this systemic approach that integrates economic, ecological, and ethical dimensions, we define ecotourism as “an invitation to a journey (‘tour’) to appreciate and share the ‘homes’ (oikos) of diverse human and non-human inhabitants, their singular habits and habitats.” Today, mass nature tourism often denies theselinks and is generating biocultural homogenization, socio-ecological degradation, and marked distributive injustices (...) in iconic places, such as Costa Rica, the Galapagos and Cape Horn. In order to implement genuine ecotourism in Latin America and elsewhere, it is imperative to overcome marketing ambiguities, and pay close attention to local autonomy and biocultural diversity. (shrink)

This study investigates how dispute-mediators handle impasse in the re-negotiation of divorce decrees by divorced couples. Three sources of impasse and three strategies for handling impasse are identified based on analysis of mediation transcripts. The concern here lies not so much in the disputant's arguments but in the discussion procedures dispute-mediators use to craft the disputant's argumentation into a tool to solve conflict. Their moves are understood here as a practice of reconstructing argumentative discourse that is neither naïve nor critical (...) but reconstruction as design. Mediator's reconstruction reveals a type of communication work in contemporary societies involved in the crafting of forums and formats that mediate argumentative communication. This work is often invisible and strategic which makes its interpretation, judgment, and development a challenge for pragma-dialectical theory. How reconstruction as design can be understood is discussed by building on prior pragma-dialectical theory and research. (shrink)

This book . . . is an invitation to all Christians to begin constructing a food ethics; to the academic Christian ethicist, it presents an opportunity to join a discussion on a topic relevant in so many ways to the life of every American; to the Christian for whom the spark of the divine is detectable in the everyday life, it is a chance to begin making ethical sense out of something done every day for the entirety of one's natural (...) life-participating in agriculture. -from the Introduction In Sustainable Agriculture, Mark Graham joins the vibrant, substantive discussion about the moral issues in American agriculture by revealing what is going on in current agricultural practices and analyzing them in light of morality and sustainability. Graham's constructive proposal for change is based on a moral vision that identifies a group of core values around which our agricultural system should be developed, including: a) a consistent, safe food supply; b) vital, sustainable communities; and c) personal and environmental health. (shrink)

Most recent discussions of phenomenal consciousness are predicated on two deeply entrenched assumptions. The first is objectualism, the claim that what it is like to undergo an experience is something of which we are or can be aware in the having of that experience. The second is internalism, the claim that what it is like to undergo an experience is constituted by states, events and processes that are located inside the skins of experiencing subjects. This paper argues that both assumptions (...) should be rejected. What it is like to undergo an experience is not an object of consciousness but something that exists in the directing of consciousness towards objects. What it is like to undergo an experience is not something of which we are aware, but something in virtue of which we are aware. And there is little reason for supposing that the directing of consciousness towards its objects is something that occurs exclusively inside the skins of experiencing subjects. On the contrary, directing of consciousness towards its objects is often extended, involving acts of worldly probing and exploration. (shrink)

In his essay, “Affording our Culture: “Smart” Technology and the Prospects for Creative Democracy,” Tibor Solymosi addresses my challenge for neuropragmatism to counter what I have elsewhere called dopamine democracy. Although I believe that Solymosi has begun to provide an explanation for how neuropragmatism may counter dopamine democracy, especially with his conceptions Œ and cultural affordances, I respond with a helpful addition to his approach by returning to the theory of inquiry as put forth by John Dewey. In particular, I (...) focus on the phases of inquiry as colored by Dewey’s concept of humility. Solymosi does not pay adequate attention to the function of inquiry necessary for combatting dopamine democracy. His account of cultural affordances and education is strengthened by using Dewey’s concept of humility as a guiding disposition for neuropragmatic inquiry. Recognizing humility as an instrument of neuropragmatic inquiry provides us with a tool to better address the pitfalls of dopamine democracy, especially misinformation and incentive salience. My argument proceeds by first articulating dopamine democracy as a problem and Solymosi’s concept of cultural affordances and how he understands these as neuropragmatic tools to address the problem through education. I present humility as an instrumental concept derived from Dewey’s work on inquiry. I then suggest how humility may serve neuropragmatic inquiry to assist in combatting the problems of dopamine democracy. (shrink)

For forty years, Harvey Mansfield has been worth reading. Whether plumbing the depths of MachiavelliOs Discourses or explaining what was at stake in Bill ClintonOs impeachment, MansfieldOs work in political philosophy and political science has set the standard. In Educating the Prince, twenty-one of his students, themselves distinguished scholars, try to live up to that standard. Their essays offer penetrating analyses of Machiavellianism, liberalism, and America., all of them informed by MansfieldOs own work. The volume also includes a bibliography of (...) MansfieldOs writings. (shrink)

Dynamically transforming the elements of any performing artist’s craft, this practical guide is a must-have for musicians, dancers, and actors. The handbook shows how artistic performance is embodied in the unification of three critical elements—motion, emotion, and love—demonstrating how it offers experiences and opportunities distinct from the nonperforming arts. Step-by-step guidelines are provided for building intentional and inspirational practice time, thereby enhancing the relationships between the source, the performer, and the audience. Illustrating how intentional movement invokes emotions from both the (...) performer and the audience and how the concept of love gives a performance humanity and life, this eye-opening exploration creates pathways for achieving true artistry. (shrink)

I was interested to read Greg Pritchard’s articles ‘Civilised Lands’ in past issues of your magazine. In general, I think he gave a good overview of places of interest and tips for an overseas visitor on a climbing holiday to Australia. He failed, however, to warn visitors of the Australian pastime of sandbagging (which, I might add, Mr. Pritchard is a deft exponent of himself). I don’t know what state sandbagging has reached in your country but in Australia it has (...) become a refined art form. It is for this reason that I feel compelled to write this article, so as to warn otherwise unsuspecting English climbers of the possible pitfalls (or perhaps ground-falls would be more appropriate here) they may face on an Australian holiday. Firstly, an outline of what sandbagging is. The basic aim of the game is for the bagger to get an unsuspecting victim (also known as a baggee or sometimes a bunny) to do a climb (which, in the context of the game, is known as “the bag”) which they (the baggee) will not enjoy for one or a combination of three basic reasons. The first is that the climb may be positively dangerous, either loose and/or unprotected. Secondly, the climb may be much harder than either the grade or appearances indicate. Thirdly, the climb may be simply repulsive; for example, it might look like a nice diagonal layback flake and yet turn out to be a smooth flared overhanging off-width. The baggee, naturally enough, has a really miserable time and of course this gives the bagger great delight—in perfect accord with Toadie’s Law of the Conservation of Happiness (“happiness can be neither created nor destroyed”). Now, different baggers operate with different emphasis on each of the three basic bagging criteria, and have as their goal different levels of baggee misery. For example, there are those extremists, operating largely on criterion one, who are not completely happy unless they have witnessed a ground-fall from a reasonable height, in which case, if you are the baggee, your Australian holiday may consist of a few weeks in traction in Natimuk Bush Nursing Hospital.. (shrink)

In American Poetic Materialism from Whitman to Stevens, Mark Noble examines writers who rethink the human in material terms. Do our experiences correlate to our material elements? Do visions of a common physical ground imply a common purpose? Noble proposes new readings of Walt Whitman, Ralph Waldo Emerson, William James, George Santayana and Wallace Stevens that explore a literary history wrestling with the consequences of its own materialism. At a moment when several new models of the relationship between human (...) experience and its physical ground circulate among critical theorists and philosophers of science, this book turns to poets who have long asked what our shared materiality can tell us about our prospects for new models of our material selves. (shrink)

Every 4 years, for the past three decades, the world of argumentation research has gathered in Amsterdam at the International Society for the Study of Argumentation conferences to explore advances in understanding argumentation and how argumentation advances our understanding of the human condition. While comprehensive proceedings of selected papers are produced to document what has transpired in the world of argumentation over the preceding 4 years, there remains the important matter of taking the intellectual pulse of the world’s argumentation scholars, (...) to detect the beating heart of the community of scholars and the health and wellness of argumentation scholarship. One of the great services Frans van Eemeren, and his colleagues, have provided this community is a diagnosis that helps identify the assets upon which the health and wellness of the community can further build. This service has come in the form of several edited volumes, the most recent of which, Topical Themes in Argumen .. (shrink)