The phenomenon of contract cheating presents, potentially, a serious threat to the quality and standards of Higher Education around the world. There have been suggestions, cited below, to tackle the problem using legal means, but we find that current laws are not fit for this purpose. In this article we present a proposal for a specific new law to target contract cheating, which could be enacted in most jurisdictions.We test our proposed new law against a number of issues that would (...) need to be considered before any legal approach could be successful; would changing the legal status of contract cheating make it less likely to happen? Could this be achieved in a specific way? If so, who should actually be prosecuted and what offence are they committing? Would it actually address the causes of contract cheating? We suggest some answers to these questions, but then also identify a number of unintended potential consequences. We therefore additionally consider whether a legal approach is possible or even desirable.We conclude that a legal approach to contract cheating is possible, and, on balance, appropriate. Using UK law as an example, we offer a specific suggestion to lawmakers, around the world, for how this might be achieved, and conclude that the most successful approach would be to focus largely on a law targeting the providers of contract cheating, in particular commercial services. (shrink)

What characteristics or attributes of a healthcare decision qualify it as acceptable to those who are empowered to judge it as adequate and hence suitable to either proceed (or not) with a recommen...

Technological advances in veterinary medicine have produced considerable progress in the diagnosis and treatment of numerous diseases in animals. At the same time, veterinarians, veterinary technicians, and owners of animals face increasingly complex situations that raise questions about goals of care and correct or reasonable courses of action. These dilemmas are frequently controversial and can generate conflicts between clients and health care providers. In many ways they resemble the ethical challenges confronted by human medicine and that spawned the creation of (...) clinical ethics committees as a mechanism to analyze, discuss, and resolve disagreements. The staff of the North Carolina State University Veterinary Hospital, a specialty academic teaching institution, wanted to investigate whether similar success could be achieved in the tertiary care veterinary setting. We discuss the background and rationale for this method, as well as the approach that was taken to create a clinical ethics committee. (shrink)

Academic misconduct is a threat to the validity and reliability of online examinations, and media reports suggest that misconduct spiked dramatically in higher education during the emergency shift to online exams caused by the COVID-19 pandemic. This study reviewed survey research to determine how common it is for university students to admit cheating in online exams, and how and why they do it. We also assessed whether these self-reports of cheating increased during the COVID-19 pandemic, along with an evaluation of (...) the quality of the research evidence which addressed these questions. 25 samples were identified from 19 Studies, including 4672 participants, going back to 2012. Online exam cheating was self-reported by a substantial minority (44.7%) of students in total. Pre-COVID this was 29.9%, but during COVID cheating jumped to 54.7%, although these samples were more heterogenous. Individual cheating was more common than group cheating, and the most common reason students reported for cheating was simply that there was an opportunity to do so. Remote proctoring appeared to reduce the occurrence of cheating, although data were limited. However there were a number of methodological features which reduce confidence in the accuracy of all these findings. Most samples were collected using designs which makes it likely that online exam cheating is under-reported, for example using convenience sampling, a modest sample size and insufficient information to calculate response rate. No studies considered whether samples were representative of their population. Future approaches to online exams should consider how the basic validity of examinations can be maintained, considering the substantial numbers of students who appear to be willing to admit engaging in misconduct. Future research on academic misconduct would benefit from using large representative samples, guaranteeing participants anonymity. (shrink)

There should be no disagreement with the proposal for research into the role of applied social science in the formation of policy. The relation between social science and the formation of social policy and social action is, in fact, one of the more important areas of study in the general field of social control. The outline for research prepared by Mr. Merton constitutes a good framework for the investigation of important aspects of the relationship between social science and the world (...) of practical affairs. But there is room for vigorous disagreement with a fundamental assumption about the role of applied social science with which he starts, and there are various broad considerations of importance in framing the proposed study which merit mention or greater elaboration. It is to these matters that this essay is addressed. (shrink)

Since antiquity, doctors have employed case reports as an essential and ongoing part in communicating information about patients and their diseases to their colleagues and, at times, to the wider, nonmedical world. Given how useful case reports have been, a legitimate and persuasive argument could be made to retain them in modern medical literature. But there is an emerging problem with case reports. As the ability to publish and disseminate the information contained in them has become easier, the capacity for (...) individuals to maintain their privacy and restrict access to their personal information has become more strained, and it has become more difficult for doctors who tell clinical stories to respect the confidentiality of their patients while still communicating the pertinent details of their cases. Does the acknowledged educational and scientific value of (some) case reports justify the threat to personal privacy that may be entailed by the format itself? (shrink)

The current Ebola virus epidemic in Western Africa appears to be spiraling out of control. The worst-case projections suggested that the unchecked spread could result in almost 1.4 million cases by the end of January 2015 with a case fatality rate of at least 50%. The United States and European nations have begun to respond in earnest with promises of supplies, isolation beds, and trained health care personnel in an effort to contain the epidemic and care for the sick. However, (...) there is neither a vaccine nor specific treatment for Ebola infection, and therapy is ideally centered on supportive care. I have previously argued that the provision of palliative care is obligatory during an overwhelming health catastrophe, notably pandemic influenza. Since affected Ebola patients have best outcomes with technologically advanced intensive care—resources in scarce supply in the area—I suggest that the only acceptable approach to large numbers of very sick, dying, and suffering Ebola patients who overwhelm the resources available to successfully manage them is effective palliative care. However, this could hasten death in this vulnerable population and hence, while ethically and medically justifiable, is not without social risk. (shrink)

Rationing is an unavoidable mechanism for reining in healthcare costs. It entails establishing cutoff points that distinguish between what is and is not offered or available to patients. When the resource to be distributed is defined by vague and indeterminate terms such as “beneficial,” “effective,” or even “futile,” the ability to draw meaningful boundary lines that are both ethically and medically sound is problematic. In this article, I draw a parallel between the challenges posed by this problem and the ancient (...) Greek philosophical conundrum known as the “sorites paradox.” I argue, like the paradox, that the dilemma is unsolvable by conventional means of logical analysis. However, I propose another approach that may offer a practical solution that could be applicable to real-life situations in which cutoffs must be decided (such as rationing). (shrink)

In _Awakening the Dreamer: Clinical Journeys_, Philip Bromberg continues the illuminating explorations into dissociation and clinical process begun in _Standing in the Spaces_. Bromberg is among our most gifted clinical writers, especially in his unique ability to record peripheral variations in relatedness - those subtle, split-second changes that capture the powerful workings of dissociation and chart the changing self-states that analyst and patient bring to the moment. For Bromberg, a model of mind premised on the centrality of self-states and (...) dissociation not only offers the optimal lens for comprehending and interpreting clinical data; it also provides maximum leverage for achieving true intersubjective relatedness. And this manner of looking at clinical data offers the best vantage point for integrating psychoanalytic experience with the burgeoning findings of contemporary neuroscience, cognitive and developmental psychology, and attachment research. Dreams are approached not as texts in need of deciphering but as means of contacting genuine but not yet fully conscious self-states. From here, he explores how the patient's "dreamer" and the analyst's "dreamer" can come together to turn the "real" into the "really real" of mutative therapeutic dialogue. The "difficult," frequently traumatized patient is newly appraised in terms of tensions within the therapeutic dyad. And then there is the "haunted" patient who carries a sense of preordained doom through years of otherwise productive work - until the analyst can finally feel the patient's doom as his or her own. Laced with Bromberg's characteristic honesty, humor, and thoughtfulness, these essays elegantly attest to the mind's reliance on dissociation, in both normal and pathological variants, in the ongoing effort to maintain self-organization. _Awakening the Dreamer_, no less than _Standing in the Spaces_, is destined to become a permanent part of the literature on therapeutic process and change. (shrink)

Over the last century, and especially since the publication of the Belmont Report in 1978, respect for persons, as exemplified by respect for autonomous decision-making, has become a central tenet in the practice of medicine. The authority of cognitively competent adults to make their own healthcare decisions is enshrined in both law and practice in most advanced industrialized nations. The right to consent to or to refuse medical interventions is virtually absolute, but is contingent on the provision of materially relevant (...) information about the benefits and burdens or risks of the proposed treatment as well as the freedom from coercion by others, especially healthcare personnel. This power also extends to the kinds, amounts and details of the proposed intervention, including the option to decline to hear anything, if one so chooses, assuming that this is a rational choice. This respect transfers to other competent individuals who are authorized as surrogates to decide for those who have temporarily or permanently lost the capacity to make their own healthcare decisions. (shrink)

Most of us working in health care are concerned—perhaps even appalled—when patients make demands for doctors or nurses or other caregivers that accord with their bigoted sentiments. Even though there may be some reasons to believe that matching certain characteristics of doctors with those of their patients (whether the latter ask for them or not) may produce both more patient satisfaction and even some health benefits, how does one tease apart or distinguish requests that are potentially beneficial from those we (...) find abhorrent? What facts might make it acceptable for an African American patient to request an African American doctor or a Chinese Mandarin‐speaking patient to request a physician who is fluent in Mandarin and is also of Chinese ethnicity? At the same time, why do we recoil or find it objectionable that the father of the baby under Tonya Battle's care in Michigan might want a nurse caring for his child with whom he identifies ethnically, or racially or religiously, or based on any other superficial trait(s) that we use to characterize people? (shrink)

There are hundreds of indications leading us to conclude that at every moment there is in us an infinity of perceptions, unaccompanied by awareness or reflection; that is, of alterations in the soul itself, of which we are unaware because the impressions are either too minute or too numerous, or else too unvarying, so that they are not sufficiently distinctive on their own. But when they are combined with others they do nevertheless have their effect and make themselves felt, at (...) least confusedly, within the whole. (Leibniz, 1704/1981, p. 53). (shrink)

This thesis is concerned with Immanuel Kant's mature philosophy as a whole. My aim is to show the systematic relationship among Kant's three Critiques, and the continuity of these with the Inaugral Dissertation. I use recent interpretations of Kant's projects in the Critique of Pure Reason and I offer my own interpretation of the Critique of Judgment, in which I highlight the importance of the final Appendix in that work, to argue that the goal of these three works taken together (...) is to replace traditional metaphysics with a new approach entirely. In place of the traditional approach in which the principles of metaphysics are supposed to be principles of the objective order of things quite apart from the way they appear to us, Kant argues in favour of a system of subjective principles that he believes will nevertheless allow us to achieve the goals of metaphysics. The new metaphysics will not be knowledge-based, as traditional metaphysics had been. Rather Kant's system is primarily ethics-based. That is, the primary principles of Kant's metaphysical system are those of his rational ethics, which have the function of regulating our activity in, and organization of, the world. Instead of knowledge, ethics, and theology being uneasily coordinated parts of philosophy, as they are in traditional metaphysical systems, all three become integrated within an ethical, and essentially teleological, framework in Kant's system. Showing the role of the Critique of Judgment in bringing about this change, as well as showing the importance of teleology for Kant's philosophy, are both important goals of the thesis. (shrink)

The Institute of Medicine and the American Heart Association have issued a “call to action” to expand the performance of cardiopulmonary resuscitation in response to out-of-hospital cardiac arrest. Widespread advertising campaigns have been created to encourage more members of the lay public to undergo training in the technique of closed-chest compression-only CPR, based upon extolling the virtues of rapid initiation of resuscitation, untempered by information about the often distressing outcomes, and hailing the “improved” results when nonprofessional bystanders are involved. We (...) describe this misrepresentation of CPR as a highly effective treatment as the fetishization of this valuable, but often inappropriately used, therapy. We propose that the medical profession has an ethical duty to inform the public through education campaigns about the procedure's limitations in the out-of-hospital setting and the narrow clinical indications for which it has been demonstrated to have a reasonable probability of producing favorable outcomes. (shrink)

Patient and family demands for the initiation or continuation of life-sustaining medically non-beneficial treatments continues to be a major issue. This is especially relevant in intensive care units, but is also a challenge in other settings, most notably with cardiopulmonary resuscitation. Differences of opinion between physicians and patients/families about what are appropriate interventions in specific clinical situations are often fraught with highly strained emotions, and perhaps none more so when the family bases their desires on religious belief. In this essay, (...) I discuss non-beneficial treatments in light of these sorts of disputes, when there is a clash between the nominally secular world of fact- and evidence-based medicine and the faith-based world of hope for a miraculous cure. I ask the question whether religious belief can justify providing treatment that has either no or a vanishly small chance of restoring meaningful function. I conclude that non-beneficial therapy by its very definition cannot be helpful, and indeed is often harmful, to patients and hence cannot be justified no matter what the source or kind of reasons used to support its use. Therefore, doctors may legitimately refuse to provide such treatments, so long as they do so for acceptable clinical reasons. They must also offer alternatives, including second opinions, as well the option of transferring the care of the patient to a more accommodating physician or institution. (shrink)

The signal for sex determination in the nematode Caenorhabditis elegans is the ratio between the number of × chromosomes and the number of sets of autosomes (the X/A ratio). Animals with an X/A ratio of 0.67 (a triploid with two × chromosomes) or less are males. Animals with an X/A ratio of 0.75 or more are hermaphrodites. Thus, diploid males have one × chromosome and diploid hermaphrodites have two × chromosomes. However, the difference in X‐chromosome number between the sexes is (...) not reflected in general levels of X‐linked gene expression because of the phenomenon of dosage compensation. In dosage compensation, X‐linked gene expression appears to be ‘turned down’ in 2X animals to the 1X level of expression. An intriguing and unexplained finding is that mutations and X‐chromosome duplications that elevate X‐linked gene expression also feminize triploid males. One way that this relationship between sex determination and X‐linked gene expression may be operating is discussed. (shrink)

moment there is in us an infinity of perceptions, unaccompanied by awareness or reflection; that is, of alterations in the soul itself, of which we are unaware because the impressions are either too minute or too numerous, or else too unvarying, so that they are not sufficiently distinctive on their own.

Do studies of perception without awareness and studies of perception without attention address a similar underlying concept of awareness? To answer this question, we compared qualitative differences in performance across variations in stimulus quality with qualitative differences in performance across variations in the direction of attention . The qualitative differences were based on three different phenomena: Stroop priming, false recognition, and exclusion failure. In all cases, variations in stimulus quality and variations in the direction of attention led to parallel findings. (...) These results suggest that perception with and without awareness and perception with and without attention are equivalent ways of describing the same underlying process distinction. (shrink)

For many years a debate has raged over what constitutes futile medical care, if patients have a right to demand what doctors label as futile, and whether physicians should be obliged to provide treatments that they think are inappropriate. More recently, the argument has shifted away from the difficult project of definitions, to outlining institutional policies and procedures that take a measured and patient-by-patient approach to deciding if an existing or desired intervention is futile. The prototype is the Texas Advance (...) Directives Act, but similar procedures have been widely implemented both with and without the protection of the law. While this method has much to recommend it, there are inherent moral flaws that have not received as much discussion as warranted. Because these strategies adopt a semblance of procedural justice, it is assumed that the outcomes of such proceedings will be both correct and fair. In this paper, I argue that there are three main irremediable defects in the policy approach: there is the potential for arbitrary decision-making about futility in specific cases; there are structural, pre-ordained consequences for ethnic minorities who would be disproportionately affected by the use of these procedures; and the use of rationing justifications to support the use of these policies. These flaws detract so much from any benefit that could be derived that they make such strategies more harmful than helpful. (shrink)

The idea that cognitive processes can be meaningfully classified as conscious or unconscious has a long history in philosophy and psychology. However, even though many experimental reports during the past 100 years claim to demonstrate perception, Ieaming, or memory without conscious awareness, the distinction between conscious and unconscious ’ processes remains highly controversial. For example, the same empirical findings that Holender 1986 concludes provide little or no evidence for unconscious perception are considered by other reviewers as conclusive and overwhelming documentation (...) of the validity of perception without awareness. (shrink)

Periodic and unexpected shortages of drugs, biologics, and even medical devices have become commonplace in the United States. When shortages occur, hospitals and clinics need to decide how to ration their available stock. When such situations arise, institutions can choose from several different allocation schemes, such as first-come, first-served, a lottery, or a more rational and calculated approach. While the first two approaches sound reasonable at first glance, there are a number of problems associated with them, including the inability to (...) make fine, individual patient-centered decisions. They also do not discriminate between what kinds of patients and what types of uses may be more deserving or reasonable than others. In this article I outline an ethically acceptable procedure for rationing drugs during a shortage in which demand outstrips supply. (shrink)

Many studies directed at demonstrating perception without awareness have relied on the dissociation paradigm. Although the logic underlying this paradigm is relatively straightforward, definitive results have been elusive in the absence of any general consensus as to what constitutes an adequate measure of awareness. We propose an alternative approach that involves comparisons of the relative sensitivity of comparable direct and indirect indexes of perception. The only assumption required by the proposed approach is that the sensitivity of direct discriminations to relevant (...) conscious information is greater than or equal to the sensitivity of comparable indirect discriminations. The proposed approach is illustrated through an evaluation of Avant and Thieman’s recent claim that an indirect measure of perception based on judgments of apparent visual duration provides a more sensitive indicator of perception than does a direct measure based on forced-choice recognition. Contrary to this claim, when direct and indirect indexes are measured under comparable conditions, an indirect measure based on judgments of perceived duration provides a less sensitive index of perceptual processing than do comparable direct measures. The proposed approach provides a general conceptual/methodological framework for using the dissociation paradigm in studies directed at establishing unconscious processes. (shrink)

As an alternative to establishing awareness thresholds, stimulus contexts in which there were either greater conscious or greater unconscious influences were defined on the basis of performance on an exclusion task. Target words were presented for brief durations and each target word was followed immediately by its three-letter stem. Subjects were instructed to complete each stem with any word other than the target word. With this task, failures to exclude target words indicate greater unconscious influences, whereas successful exclusion indicates greater (...) conscious influences. Conscious influences were dominant at long durations , but unconscious influences were dominant at short durations . Performance on the exclusion task successfully predicated both qualitative differences in Stroop priming and qualitative differences in recognition memory previously associated with the different effects of conscious and unconscious influences. Taken together, these results demonstrate that an exclusion task allows both unconscious and conscious influences to be defined in terms of significant deviations from baseline performance. As such, exclusion tasks provide a method for distinguishing conscious from unconscious influences that does not require establishing thresholds for null awareness. (shrink)

Drug design methods have made significant new advances over the last ten years, mainly in the areas of molecular modelling. In more recent times important developments in theory have led to a different type of modelling becoming possible, the so‐called de novo or automated design algorithms. In this new method the programs perform much of the chemist's thinking, in finding appropriately sized chemical groups to fit into a target site. However this is a combinatoric problem which has no general analytical (...) solution; it is ripe for optimization. Other advances, such as combinatorial chemical synthesis and screening, will dramatically influence the search for new lead structures for target sites, which at present are poorly understood. Already these methods are being applied to peptide libraries. Peptides do not make good drug compounds because of their poor bioavailability; further, their flexibility reduces their affinity. In some cases peptide backbones can be removed and replaced with rigid non‐peptide scaffolds. (shrink)

This paper reviews the history of psychological investigations of unconscious perception and summarizes the current status of experimental research in this area of investigation. The research findings described in the paper illustrate how it is possible to distinguish experimentally between conscious and unconscious perception. The most successful experimental strategy has been to show that a stimulus can have qualitatively different consequences on cognitive and affective reactions depending on whether it was consciously or unconsciously perceived. In addition, recent studies of patients (...) undergoing general anaesthesia have shown that the effects of stimuli perceived unconsciously during surgery can last for approximately 24 hours. Taken together, the results of these recent psychological investigations provide empirical support for the importance of unconsciously perceived information in determining cognitive and affective reactions. (shrink)

Nel Noddings claims that there is an important normative element in happiness. For support, she points to the Aristotelian idea of the eudaimonic life, a concept that is often translated into English as ‘the happy life’. However, in light of the wide divergence between the Aristotelian view of eudaimonia as a life of virtuous activity and most contemporary psychologists’ and lay people’s view of happiness as subjective wellbeing, the authors of this article believe that Noddings’s merging of the two has (...) several shortcomings. Aside from ambiguity and confusion, it encourages us to deny that, given the human condition, we must sometimes choose between happiness as pursuit of positive emotion and personal satisfaction and happiness as pursuit of the common good and the virtuous life. (shrink)