Different types of consent are used to obtain human biospecimens for future research. This variation has resulted in confusion regarding what research is permitted, inadvertent constraints on future research, and research proceeding without consent. The National Institutes of Health Clinical Center's Department of Bioethics held a workshop to consider the ethical acceptability of addressing these concerns by using broad consent for future research on stored biospecimens. Multiple bioethics scholars, who have written on these issues, discussed the reasons for consent, the (...) range of consent strategies, and gaps in our understanding, and concluded with a proposal for broad initial consent coupled with oversight and, when feasible, ongoing provision of information to donors. This article describes areas of agreement and areas that need more research and dialogue. Given recent proposed changes to the Common Rule, and new guidance regarding storing and sharing data and samples, this is an important and tim.. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 16.4 (2006) 379-396MuseSearchJournalsThis JournalContents[Access article in PDF]Pharmacists and Conscientious Objection *In March 2005, a Wisconsin pharmacist's act of conscience garnered headlines across the United States. After a married woman with four children submitted a prescription for the morning-after pill, the pharmacist, Neil Noesen, not only refused to fill it, but also refused to transfer the prescription to another pharmacist or to return the prescription (...) to the customer. As more such incidents occurred, many states "... decided to consider and enact laws setting the bounds of pharmacists' and other health care workers' professional obligations" (III, Grady 2006, p. 327). Discussions of objector legislation, also referred to as "conscience clauses," "refusal clauses," and "abandonment laws" (III, Appel 2005, p. 279), are not limited to professional ethics, but also draw from philosophical, theological, and legal perspectives. The purpose of this Scope Note is to present a wide variety of viewpoints on the health provider's right to conscience.More than 40 years ago the development of "The Pill" as the first reliable method of birth control not only ushered in a feminist revolution, but also provided a new focus for concerns of conscience for those who were part of the anti-abortion movement based on religious belief in the sanctity of life. Similarly, in the past ten years, worldwide, and seven years (1999) since the emergency contraception "morning after" pill first became available as a prescription item, there has been an upsurge in the number of medical personnel who refuse to prescribe or dispense it on grounds of personal conscience, whether for religious reasons or not. Their actions bring into play issues of power and control for health care personnel and for patients—in this case women, which also raises women's rights issues. Ironically, studies in France, Sweden, and the United Kingdom have shown that emergency contraception does not reduce the abortion rate—it is too infrequently used (II, Glasier 2006).It is important to underline the difference between the "morning-after" pill or "Plan B," which is made up of two progestin pills containing levonorgestrel (a synthetic derivative of the female hormone progesterone), and RU-486 (Mifiprex [End Page 379] or mifipristone with misoprostol). Plan B, if taken within 72 hours post-coitus prevents implantation, and therefore pregnancy, by suppressing the output of luteinizing hormone, the hormone that triggers the ovulation process. Scientists have been unable to determine whether this action could destroy already fertilized eggs, but even if it does, it uses the same mechanism as occurs with the birth-control pill, that was developed some 45 years ago. By contrast, RU-486 acts up to 49 days after implantation by blocking the action of progesterone in order to terminate the pregnancy and as such is an abortifacient (II, US FDA 1).On 24 August 2006, the U.S. Food and Drug Administration announced approval of the Plan B pill for over-the-counter (OTC ) sales (II, US FDA 2). Although this action makes the drug more widely available, it remains to be seen whether pharmacists who are conscientious objectors and who refuse to dispense it also will refuse to provide it OTC.A survey article by Rebecca Dresser (II, 2005, p. 9) succinctly sums up the problem for conscientious objectors: "Because emergency contraception can act to block implantation of a fertilized egg, people who believe in protection of human life after conception find it morally objectionable."When conscientious objections are raised over abortion or birth control services performed, prescribed, or dispensed, they affect not only the health professionals—physicians, pharmacists, nurses, and health technicians—who may object, as well as their colleagues and/or managers, but also the consumers: the female patients who are then forced to reconsider or to seek an alternative supplier, as well as their spouses or partners. Alta Charo (II, 2005, p. 2473) makes the point that the patient needs to have access to a system of counseling and referral "so... (shrink)

Mass Hysteria examines the medical and cultural practices surrounding pregnancy, new motherhood, and infant feeding. Late eighteenth century transformations in these practices reshaped mothers' bodies, and contemporary norms and routines of prenatal care and early motherhood have inherited the legacy of that era. As a result, mothers are socially positioned in ways that can make it difficult for them to establish and maintain healthy and safe boundaries and appropriate divisions between public and private space.

Technology has played a central role in development programming since the inception of development assistance. Recent development organizations, like the Bill and Melinda Gates Foundation, believe technological innovation can improve development outcomes. Development ethics, a field of study focused on the ethical questions posed by development policies and practices, has yet to fully appreciate the ethical dimensions of the science and technology. Addressing this important research and policy gap, we contend that science and technology studies (STS) offers important insights that (...) can be used in combination with development ethics to influence development policies and practices. Utilizing a case study of a private development program in Uganda, we illustrate how STS offers important insights for understanding how a sociotechnical ensemble placed pressure on already scarce water resources. Two dimensions of STS scholarship, the power asymmetries of technological development and the incomplete or partial nature of technoscientific knowledge, are examined and help us to understand how sociotechnical ensembles in development increase the likelihood of the emergence of publics who are negatively impacted by sociotechnical ensembles in development programs. Leveraging STS insights, we argue for the importance of situated ethics—a pragmatic approach to ensuring responsiveness to the emergence of these publics. (shrink)

Organisations increasingly use digital nudges to influence their workforces’ behaviour without coercion or incentives. This can expose employees to arbitrary domination by infringing on their autonomy through manipulation and indoctrination. Nudges might furthermore give rise to the phenomenon of “organised immaturity.” Adopting a balanced approach between overly optimistic and dystopian standpoints, I propose a framework for determining the moral permissibility of digital nudging in the workplace. In this regard, I argue that not only should organisations provide pre-discursive justification of nudges (...) but they should also ensure that employees can challenge their implementation whenever necessary through legitimation procedures. Building on Rainer Forst’s concept of the right to justification, this article offers a way to combine contract- and deliberation-based theories for addressing questions in business ethics. I further introduce the concept of meta-autonomy as a capacity that employees can acquire to counter threats of arbitrary domination and to mitigate organised immaturity. (shrink)

Dr. Henry Beecher, a renowned Harvard Medical School anesthesiologist, sent shock waves through the medical research community and the lay press when he described 22 examples of “unethical or questionably ethical studies” by reputable researchers at major institutions in his now well-known 1966 New England Journal of Medicine article. Beecher concluded this exposé by noting: “The ethical approach to experimentation in man has several components: two are more important than the others, the first being informed consent.... Secondly, there is the (...) more reliable safeguard provided by the presence of an intelligent, informed, conscientious, compassionate, responsible investigator”. Beecher’s... (shrink)

An innovative examination of the ways in which dance and philosophy inform each other, Dance and Philosophy brings together authorities from a variety of disciplines to expand our understanding of dance and dance scholarship. Featuring an eclectic mix of materials from exposes to dance therapy sessions to demonstrations, Dance and Philosophy addresses centuries of scholarship, dance practice, the impacts of technological and social change, politics, cultural diversity and performance. Structured thematically to draw out the connection between different perspectives, this books (...) covers: - Philosophy practice and how it corresponds to dance - Movement, embodiment and temporality - Philosophy and dance traditions in everyday life - The intersection between dance and technology - Critical reflections on dance Offering important contributions to our understanding of dance as well as expanding the study of philosophy, this book is key to sparking new conversations concerning the philosophy of dance. (shrink)

Nursing policy and healthcare reform are focusing on two, interconnected areas: person‐centred care and fundamental care. Each initiative emphasises a positive nurse–patient relationship. For these initiatives to work, nurses require guidance for how they can best develop and maintain relationships with their patients in practice. Although empirical evidence on the nurse–patient relationship is increasing, findings derived from this research are not readily or easily transferable to the complexities and diversities of nursing practice. This study describes a novel methodological approach, called (...) holistic interpretive synthesis (HIS), for interpreting empirical research findings to create practice‐relevant recommendations for nurses. Using HIS, umbrella review findings on the nurse–patient relationship are interpreted through the lens of the Fundamentals of Care Framework. The recommendations for the nurse–patient relationship created through this approach can be used by nurses to establish, maintain and evaluate therapeutic relationships with patients to deliver person‐centred fundamental care. Future research should evaluate the validity and impact of these recommendations and test the feasibility of using HIS for other areas of nursing practice and further refine the approach. (shrink)

Volume 19, Issue 9, September 2019, Page 5-7.

Patients and family members (N = 671) were surveyed in five Mid-Atlantic U.S. hospitals to ascertain the number and kinds of ethical concerns they are presently experiencing or have previously experienced while being sick or receiving medical care. Seventy percent of participants had at least one (range 0–14) type of ethical concern or question. The most commonly experienced concerns pertained to being unsure how to plan ahead or complete an advance directive (29.4%), being unsure whether someone in the family was (...) able to make their own decisions (29.2%), deciding about limiting life-sustaining treatments (28.6%), wondering about disclosing personal medical information to others in the family (26.4%) and not being sure whether to undergo treatment because of cost (26.2%). Most were interested to some degree in getting help from ethics consultants in the future (76.6%). Given this prevalence, common concerns might usefully be addressed systematically, rather than exclusively on a case-by-case basis. (shrink)

In Christian books today readers can find dozens of spiritual practices. One resource of the Protestant tradition, however, that has largely been forgotten is the Puritan practice of conference. This article describes how for the English Puritans conference exemplified the importance of communal spiritual life, then considers applications for the contemporary church. Conference refers to intentional conversation among believers about spiritual matters. Conference particularly expresses the value of Christian community and the need for the body of Christ to function together (...) on the journey of faith. Understanding this practice not only illuminates the past but also offers valuable insights for the church today. (shrink)

In this set of contributions to the Kennedy Institute of Ethics Journal celebrating the significant work and contributions of LeRoy Walters, we aim to bring new perspectives to topics that Dr. Walters helped to pioneer and continue his tradition of bringing moral insights and arguments to bear on the development of practical public and professional policies. Dr. Walters is well known for his invaluable service as member and chair of the Recombinant DNA Advisory Committee at the National Institutes of Health. (...) He also made major contributions to a variety of other committees responsible for the oversight of research and science, and to the development and implementation of influential... (shrink)

Transformative experiences are epistemically and personally transformative: prior to having the experience, agents cannot predict the value of the experience and cannot anticipate how it will change their core values and preferences. Paul (2014, 2015) argues that these experiences pose a puzzle for standard decision-making procedures because values cannot be assigned to outcomes involving transformative experience. Responding philosophers are quick to point out that decision procedures are built to handle uncertainty, including the uncertainty generated by transformative experience. My paper enters (...) here and contributes two points. First, religious experiences are transformative experiences that are especially resistant to these responses. Second, a procedure that appeals to voluntarist reasons—reasons arising from an act of the will—can allow an agent to rationally decide to undergo or avoid an outcome involving transformative experience. Combining these two points results in some interesting implications with respect to practical aspects of religion. (shrink)

In 2015 the UK became the first country in the world to legalise mitochondrial donation, a controversial germ line reproductive technology to prevent the transmission of mitochondrial disease. Dimond and Stephens track the intense period of scientific and ethical review, public consultation and parliamentary debates preceeding the decision. They draw on stakeholder accounts and public documents to explore how patients, professionals, institutions and publics mobilised within ‘for’ and ‘against’ clusters, engaging in extensive promissory, emotional, bureaucratic, ethical, embodied and clinical labour (...) to justify competing visions of an ethical future. They describe how this decision is the latest iteration of a UK sociotechnical imaginary in which the further liberalization of human embryo research and use is rendered legitimate and ethical through modes of consultation and permissive but strictly regulated licensing. Overall, this book presents a timely, multi-dimensional, and sociological account of a globally significant landmark in the history of human genetics, and will be relevant to those with an interest in genetics, Science, Technology and Society, the sociology of medicine, reproductive technology, and public policy debate. (shrink)

The important roles of prediction and prior experience are well established in music research and fit well with Clark's concept of unified perception, cognition, and action arising from hierarchical, bidirectional predictive processing. However, in order to fully account for human musical intelligence, Clark needs to further consider the powerful and variable role of affect in relation to prediction error.

The empirical evidence for exploration underlying the appeal of imaginary worlds is mostly absent or contradictory. Openness, and the cognitive exploration it represents, provides a better account than the overall drive to explore predicted by evolutionary theory. Furthermore, exploration cannot explain why imaginary worlds foster frequent re-engagement.

This paper will examine intertextual references between the Dialogus of Tacitus and the letters of Pliny, in particular those regarding boar hunting. It will argue that there are clues in the letters of Pliny which can help us to understand the relationship between these two writers as well as the tone and purpose of the Dialogus. By studying Pliny's letters to Tacitus on hunting , one can see the specific reference to boars as an allusion to Marcus Aper, the chief (...) spokesperson for contemporary eloquence in the dialogue, indicating a degree of humor and irony in the Dialogus that is further displayed by the similarity of Pliny's opening exhortation in Epistle 1.6, ridebis et licet rideas, to the final words of the Dialogus, cum adrisissent, discessimus. Moreover, the dialogue between Pliny and Tacitus in Pliny's letters can be seen as an indication that the Dialogus itself may have been revised throughout the years, thus problematizing the debate about the “publication date” of the Dialogus. (shrink)

With growing awareness of a crisis in pollinator health, the practice of urban hobbyist beekeeping has grown in Canada with practitioners arguing that this activity can help to foster healthier honey bees and more mindful beekeeping practices. However, urban hobbyist beekeepers have been critiqued for encouraging improper beekeeping practices and over-saturation of honey bees in cities. Drawing on a multispecies ethnography based in London, Ontario and Toronto, including participant observation with the Toronto Beekeeping Collective and the London Urban Beekeeping Collective (...) and interviews with 26 urban beekeepers, I argue that urban hobbyist beekeepers develop a sensuous and embodied relationship with honey bees that typifies playful work. By integrating participant perspectives with social reproduction theory, I demonstrate that the playful work of urban hobbyist beekeeping allows practitioners to engage with non-human nature outside of the constraints of capitalist labour regimes, enabling the expression of delight, enchantment, and curiosity. This relationship between beekeepers and honey bees encourages the development of bee-centred practices in which the preferences and physiological needs of the bees are consciously put ahead of the needs of the beekeeper. The possibility for honey bee flourishing is increased significantly when bee-centred beekeeping is coupled with integrated pest management. (shrink)

The Fundamentals of Care Framework is an evidence‐based, theory‐informed framework that conceptualises high‐quality fundamental care. The Framework places the nurse–patient relationship at the centre of care provision and outlines the nurse behaviours required for relationship development. Numerous instruments exist to measure behavioural aspects of the nurse–patient relationship; however, the literature offers little guidance on which instruments are psychometrically sound and best measure the core relationship elements of the Fundamentals of Care Framework. This study evaluated the quality of nurse–patient relationship instruments (...) by (1) assessing their content development and measurement properties (e.g. dimensionality, targeting, reliability, validity) and (2) mapping instrument content to the Framework's core relationship elements: trust, focus, anticipate, know, and evaluate. Twenty‐seven instruments were evaluated. Findings demonstrated that patients and nurses were rarely involved in item development. Most instruments exhibited poor measurement properties, with only one instrument having complete information on all quality indicators. Instrument content focused primarily on nurses getting to know patients and earning their trust, with only 54, 18, and 1 item(s), respectively, measuring ‘focus’, ‘anticipate’ and ‘evaluate’. Hence, there does not appear to be a robust instrument measuring behavioural aspects of nurse–patient relationships, nor one capturing the relationship elements of the Fundamentals of Care Framework. (shrink)

This ground-breaking study conveys the thrill and moral power of the ancient Roman story-world and its ancestral tales of bloody heroism. Its account of 'exemplary ethics' explores how and what Romans learnt from these moral exempla, arguing that they disseminated widely not only core values such as courage and loyalty, but also key ethical debates and controversies which are still relevant for us today. Exemplary ethics encouraged controversial thinking, creative imitation, and a critical perspective on moral issues, and it plays (...) an important role in Western philosophical thought. The model of exemplary ethics developed here is based on a comprehensive survey of Latin literature, and its innovative approach also synthesizes methodologies from disciplines such as contemporary philosophy, educational theory, and cultural memory studies. It offers a new and robust framework for the study of Roman exempla that will also be valuable for the study of moral exempla in other settings. (shrink)

A discussion of the influence of Martin Buber is not easily limited to the philosophical anthropology he espoused. Nor is the political thinking of Hannah Arendt easily removed from criticism of the philosophies that informed her. Both Buber and Arendt attacked the beastly shoulders of a misapplied messianism as it emerged in modern Germany. Hegel, Heidegger, Marx and to some degree Nietzsche would affect this misplacement, and Arendt and Buber for their part would enter into a shared critique that is (...) often neglected, despite promising attempts in a comparative direction made by Ellis, Engel and Riker. In this essay, I make the case that the contributions of Buber and Arendt – their shared assessments of the viability of the public realm, the need for common responsibility and the recurrent decision to engage with otherness in practical terms – point to an innovative critique of the forcible abstraction of a more traditional messianic made by German views of history. In the midst of the crises identified as correlates of a misapplied messianic, the hope as Buber and Arendt see it lies in the capacity for reflective and courageous identification and education between human individuals as they live towards one another. (shrink)

By analyzing descriptions of illusory and nonillusory figures, Richer called into question the common assumption that illusory and nonillusory perceptions were experientially the same and differed only in terms of their accuracy. The present study attempted to replicate Richer's work with a focus on identifying within the subjects' descriptions any orienting attitudes corresponding to these two forms of perception. Nineteen student volunteers were asked to describe two illusory figures and a nonillusory control of similar complexity. The descriptions revealed consistent differences (...) between the two forms. However, the Hering and Zollner figures were not always described in illusory terms, and surprisingly, several subjects described the control as if it were illusory. Further, perceptual accuracy was not guaranteed by nonillusory experience. Subjects described the figures from within one of three different orienting attitudes-atomizing, representational, and geometrical-organizing. The latter attitude appeared necessary for the phenomena of illusory perception and experience. Though the present findings confirmed Richer's distinction between illusory and nonillusory experience, they also indicate the need for further differentiation- illusory perception versus illusory experience. Finally, the findings also supported Luria's and Segall, Campbell, and Herskovits's position on the importance of particular cultural and educational experiences and codes in relation to perceptual illusions. (shrink)

ArgumentThe Minnesota Multiphasic Personality Inventory (MMPI) was developed at the University of Minnesota, Minneapolis, in the 1930s and 1940s. It became a highly successful and highly controversial psychometric tool. In professional terms, psychometric tools such as the MMPI transformed psychology and psychiatry. Psychometric instruments thus readily fit into the developmental history of psychology, psychiatry, and neurology; they were a significant part of the narrative of those fields’ advances in understanding, intervening, and treating people with mental illnesses. At the same time, (...) the advent of such tools also fits into a history of those disciplines that records the rise of obsessional observational and evaluative techniques and technologies in order to facilitate patterns of social control that became typical during the Progressive Era in the United States and after. It was those patterns that also nurtured the resistance to psychometrics that emerged during the Vietnam War and after. (shrink)

The authors of the two main articles in this supplement recognize the enormous potential of learning health care systems. Their first article argues that the development of these systems calls into question existing guidelines and practices that treat clinical care and clinical research as distinct activities. Their second article proposes to replace this traditional approach with a new framework, one intended to promote two important goals: support the transformation to a learning health care system and help to ensure the ethical (...) appropriateness of the activities carried out within such a system. To promote these goals, the authors propose a framework consisting of seven obligations. The authors are aware that their framework does not provide much guidance for promoting their second goal. At first glance, the seven obligations also might appear to offer little in the way of promoting the first goal. In what way, then, is the proposed framework novel and transformative, as the authors claim? The answer appears to lie largely in how the authors interpret the sixth obligation in the framework—the obligation to conduct learning activities. (shrink)

In this essay, I offer some reflections on how the topics were identified and approached by the Presidential Commission for the Study of Bioethical Issues, on which I had the honor to serve, in the hope that the reflections may be useful to future national bioethics commissions. In the executive order that established the bioethics commission, President Obama explicitly recognized the ethical imperative to responsibly pursue science, innovation, and advances in biomedical research and health care, and the importance of national (...) attention to these issues. The bioethics commission prioritized practicable, actionable, targeted recommendations. Like most earlier U.S. national bioethics commissions, President Obama's commission did not undertake projects on significant and troublesome issues related to health and health care that were not associated with new science or technology. Issues such as health care access, health care delivery, opioid addiction, end‐of‐life care, and physician‐aid‐in‐dying are topical and ethically complex areas of significance to bioethics, and they are also being discussed and debated by the public, the media, and policy‐makers. In my view, there are good reasons to select and prioritize projects as well as a justification for confining commission efforts to issues related to novel science and emerging technologies, when there is only one national‐level bioethics commission that has been established by the Office of the President. (shrink)

Chaucer's best-known poem, The Canterbury Tales, is justly celebrated for its richness and variety, both literary - the Tales include fabliaux, romances, sermons, hagiographies, fantasies, satires, treatises, fables and exempla - and thematic, with its explorations of courtly love and scatology, piety and impiety, chivalry and pacifism, fidelity and adultery. Students new to Chaucer will find in this Companion a lively introduction to the poem's diversity, depth, and wonder. Readers returning to the Tales will appreciate the chapters' fresh engagement with (...) the individual tales and their often complicated critical histories, inflected in recent decades by critical approaches attentive to issues of gender, sexuality, class, and language. (shrink)