Melanie presented at twenty weeks of gestation to an obstetrics clinic in a critical access hospital in rural Vermont. She was excited to undergo routine fetal ultrasonography, but her obstetrician gave her grave news: the ultrasound revealed hypoplastic left heart syndrome, a devastating congenital heart defect. Initially, Melanie agreed in general to pursue surgical care for her fetus—a three‐stage process that has somewhat uncertain results and could only be done in tertiary care facilities far from her home in Vermont. A (...) week later, while the maternal fetal medicine and pediatric cardiology units made arrangements with colleagues in Boston, Melanie began having second thoughts. An ethics meeting was called to discuss conflicting clinician reactions to Melanie's dilemma. Most of the clinicians were stunned that the patient would change her mind. What advice should the ethics consultant offer the team about caring for Melanie? (shrink)

About 6,000 individuals participate in the U.S. transplant system as a living organ donor each year. Organ donation by living individuals is a unique procedure, where healthy patients undergo a major surgical operation without any direct functional benefit to themselves. In this article, the authors explore how the ideal of informed consent guides education and evaluation for living organ donation. The authors posit that informed consent for living organ donation is a process. Though the steps in this process are partially (...) standardized through national health policy, they can be improved through institutional structures at the local, transplant center-level. Effective structures and practices aimed at supporting and promoting comprehensive informed consent provide more opportunities for candidates to ask questions about the risks and benefits of living donation and to opt out voluntarily Additionally, these practices could enable new ways of measuring knowledge and improving the consent process. (shrink)

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert Advisory Group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since (...) the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs Programme. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating and integrating evidence to identify causes of human cancer. The advancements adopted include strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. (shrink)

Advances in our understanding of appraisal processes and emotion regulation have been two of the most important contributions of research on cognition and emotion in recent decades. Interestingly, however, progress in these two areas has been less mutually informative than one might expect or desire. To help remedy this situation, we provide an integration of appraisal theory and the process model of emotion regulation by describing parallel, interacting and iterative systems for emotion generation and emotion regulation. Outputs of the emotion (...) generation system are perceived by the emotion regulation system, and emotion regulation strategies then modulate emotion by intervening at specific stages of the emotion generation system, ultimately changing appraisal dimensions. We hope that our unified perspective will encourage and guide future research at the interface of cognition and emotion. (shrink)

Unlike most Western nations, Israel does not recognize full separation of church and state but seeks instead a gentle fusion of Jewish and democratic values. Inasmuch as important religious norms such as sanctity of life may clash with dignity, privacy, and self-determination, conflicts frequently arise as Israeli lawmakers, ethicists, and healthcare professionals attempt to give substance to the idea of a Jewish-democratic state. Emerging issues in Israeli bioethics—end-of-life treatment, fertility, genetic research, and medical ethics during armed conflict—highlight this conflict vividly.

Because the goal of military medicine is salvaging the wounded who can return to duty, military medical ethics cannot easily defend devoting scarce resources to those so badly injured that they cannot return to duty. Instead, arguments turn to morale and political obligation to justify care for the seriously wounded. Neither argument is satisfactory. Care for the wounded is not necessary to maintain an army's morale. Nor is there any moral or logical connection between the right to health care (a (...) universal human right) and the duty to defend one's nation (a local political duty). Once badly wounded, soldiers enjoy the same right to medical care as any similarly ill or injured individual. National health care systems grasp this point and offer few additional health care benefits to veterans. In the United States, however, lack of universal health coverage skews the debate to focus on special entitlements for veterans without considering the health care rights that other citizens enjoy. (shrink)

For all its popularity as a psychological construct, willpower is irremediably polysemous. A more helpful construct is self-control, defined as the self-regulation of conflicting impulses. We show how the process model of self-control provides a principled framework for examining how undesirable impulses may be weakened and desirable impulses may be strengthened.

In its American context the case of baby Messenger, a preterm infant disconnected from life-support by his father and allowed to die has generated debate about neonatal treatment protocols. Limited by the legal and ethical norms of the United States, this case did not consider treatment protocols that might be available in other countries such as Denmark and Israel: threshold protocols whereby certain classes of newborns are not treated, and preemptive abortion allowing one to choose late-term abortion rather than risk (...) delivery. Each offers a viable and ethically sound avenue for dealing with the economic and social expense of anomalous newborns by aborting or not treating those most likely to burden the health care system. Objections that these protocols are antithetical to American bioethical principles are considered but rejected as each policy answers to economic justice, utility and respect for autonomy. (shrink)

The Israeli Patient Rights Act attempts to accommodate personal autonomy within an avowedly paternalist communitarian state. Although Israel is still groping toward a solution, the legislation begins to show the different form a communitarian version of autonomy must take.

Medical rules of eligibility permit severely injured Iraqi and Afghan nationals to receive care in Coalition medical facilities only if bed space is available and their injuries result directly from Coalition fire. The first rule favors Coalition soldiers over host-nation nationals and contradicts the principle of impartial, needs-based medical care. To justify preferential care for compatriots, wartime medicine invokes associative obligations of care that favor friends, family, and comrades-in-arms. Associative obligations have little place in peacetime medical care but significantly affect (...) wartime medicine. The second rule suggests liability for collateral harm that is unsupported by international law and military ethics. Absent liability, there are pragmatic reasons to offer medical care to injured local civilians if it quells resentment and cements support for Coalition forces. In contrast to peacetime medicine, military necessity and associative obligations outweigh distributive principles based on medical need during war. (shrink)

ABSTRACTAre all forms of guerilla warfare apprehensible? Or can there be such a thing as just guerilla warfare? If so, what would be the reasonable requirements we would make of guerillas in order to consider them just? The remarks below, based on my new book The Ethics of Insurgency; A Critical Guide to Just Guerilla Warfare, summarize my attempts to answer those questions, discussing such issues as legitimate authority, just cause, and compliance with the laws of armed conflict, including the (...) use of human shields and ‘soft-war’ tactics such as cyber warfare. Three commentators thereafter delve into some of the most central critical questions and objections, to which I subsequently reply. (shrink)

“Medicalized” weapons—those that rely on advances in neuroscience, physiology, and pharmacology—offer the prospect of reducing casualties and protecting civilians. They could be especially useful in modern asymmetric wars in which conventional states are pitted against guerrilla or insurgent forces. But may physicians and other medical workers participate in their development?

Although the abortion debate continues to simmer in many places, the general issue of a woman's right to an abortion, at least in the Western democracies, is largely settled. In its place, the question of late-term abortion begins to assume a prominence only recently attributed to abortion itself. The advent of sophisticated fetal screening techniques makes possible detection of potentially severe fetal anomalies that in many cases are detected only late in the pregnancy, resulting in the need for late-term abortion.

Competent patients who refuse life saving medical treatment present a dilemma for healthcare professionals. On one hand, respect for autonomy and liberty demand that physicians respect a patient’s decision to refuse treatment. However, it is often apparent that such patients are not fully competent. They may not adequately comprehend the benefits of medical care, be overly anxious about pain, or discount the value of their future state of health. Although most bioethicists are convinced that partial autonomy or marginal competence of (...) this kind demands the same respect as full autonomy, Israeli legislators created a mechanism to allow ethics committees to override patients’ informed refusal and treat them against their will. To do so, three conditions must be satisfied: physicians must make every effort to ensure the patient understands the risks of non-treatment, the treatment physicians propose must offer a realistic chance of significant improvement, and there are reasonable expectations that the patient will consent retroactively. Although not all of these conditions are equally cogent, they offer a way forward to assure care for certain classes of competent patients without abandoning the principle of autonomy altogether. These concerns reach past Israel and should engage healthcare professionals wary that respect for autonomy may sometimes cause avoidable harm. (shrink)

Pregnant people experience moral judgment in healthcare settings that may be coded into clinical documentation. Stigmatizing language in medical records transmits bias between clinicians, potentially exacerbating disparities in maternal morbidity and mortality. We examined obstetrical records from 100 randomly selected patients who received prenatal and delivery care in an academic hospital system. Qualitative analysis sought to identify linguistic features conveying negative attitudes or moral judgment, revealing themes of epistemic injustice: (1) discrediting patient testimony as incompetent, unreliable, and hysterical; (2) unnecessary (...) details that are objectifying, stigmatizing, or unprofessional; and (3) judgments of maternal fitness, where women are labeled “bad mothers” by emphasizing neglectful, selfish, and debauched characteristics. We conclude by advocating for further validation of our findings, revisiting medical education paradigms, and supporting the development of natural language processing (NLP) technologies to detect and intercept stigma. (shrink)

Theories concerning love in the West tend to be bound by the problematic constraints of patriarchal conceptions of what counts ontologically as “true” or “universal” love. It seems that feminist love studies must choose between shining light on these constraints or bursting through them. In this article I give a feminist analysis of Augustine of Hippo's theory of love through a philosophical, psychological, and theological reading of his complicated relationships with women. I argue that, given the “embodied” nature of his (...) many loves throughout his life, there is room in Augustine's account of love for a gendered reading of love that is unconstrained by patriarchal notions concerning which gender is capable of which kind of love. Augustine's theory of love is one that is not coldly universal but bodied and personal; indeed, although it is founded inside patriarchal historical constructions, it is capable of bursting out of these constraints and suggesting an egalitarian, nongendered view of love. (shrink)

Military medical ethics is garnering growing attention today among medical personal in the American and other armies. Short courses or workshops in “battlefield ethics” for military physicians, nurses, medics, social workers, and psychologists address the nature of patient rights in the military, care for detainees, enemy soldiers and local civilians, problems posed by limited resources, ethical questions arising in humanitarian missions, as well as end-of-life issues, ethics consultations, care for veterans, advance directives, and assisted suicide. Although many of these issues (...) are the core subjects of any bioethics curriculum, military medical ethics presents unique challenges to bioethics educators. (shrink)

What psychological mechanisms enable people to reappraise a situation to change its emotional impact? We propose that reappraisal works by shifting appraisal outcomes—abstract representations of ho...

Communities are the chief source of philosophical sloppiness these days. Varying endlessly across the entire range of human experience, communities raise the specter of moral relativism that makes ethics sometimes seem a misguided and futile enterprise. Yet the language of communities and their multitude of norms, preferences, and principles present an opportunity, and challenge, to confront abiding moral problems in immeasurably richer and more novel ways. But neither the opportunities nor the challenges were always obvious. On the contrary, the origins (...) of the Enlightenment coincide with an assault on the disharmony posed by restless and unruly communities. (shrink)

From the first days of conscription, physicians have declared their opposition to unjust wars by using their good offices to aid draft evaders.

One of the most fundamental distinctions in the field of emotion is the distinction between emotion generation and emotion regulation. This distinction fits comfortably with folk theories, which view emotions as passions that arise unbidden and then must be controlled. But is it really helpful to distinguish between emotion generation and emotion regulation? In this article, we begin by offering working definitions of emotion generation and emotion regulation. We argue that in some circumstances, the distinction between emotion generation and emotion (...) regulation is indeed useful. We point both to citation patterns, which indicate that researchers from across a number of sub-areas within psychology are making this distinction, and to empirical studies, which indicate the utility of this distinction in many different research contexts. We then consider five ways in which the distinction between emotion generation and emotion regulation can be problematic. We suggest that it is time to move beyond debates about whether this distinction is useful to a more specific consideration of when and in what ways this distinction is useful, and in this spirit, we offer recommendations for future research. (shrink)

Responsible citizens are expected to combine ethical judgement with judiciously exercised social activism to preserve the moral foundation of democratic society and prevent political injustice. But do they? Utilizing a research model integrating insights from rational choice theory and cognitive developmental psychology this book carefully explores three exemplary cases of morally inspired activism: Jewish rescue in wartime Europe, abortion politics in the United States, and peace and settler activism in Israel. From all three analyses a single conclusion emerges: the most (...) politically competent individuals are, most often, the least morally competent. This is the central paradox of political morality. These findings cast doubt on strong models of political morality characterized by enlightened moral reasoning and concerted political action while affirming alternative weak models that fuse activism with sectarian moral interests. They provide empirical support to further upend the liberal vision of democratic character, education, and society. (shrink)

Medical ethics prohibits caregivers from discriminating and providing preferential care to their compatriots and comrades. In military medicine, particularly during war and when resources may be scarce, ethical principles may dictate priority care for compatriot soldiers. The principle of nondiscrimination is central to utilitarian and deontological theories of justice, but communitarianism and the ethics of care and friendship stipulate a different set of duties for community members, friends, and family. Similar duties exist among the small cohesive groups that typify many (...) military units. When members of these groups require medical care, there are sometimes moral grounds to treat compatriot soldiers ahead of enemy or allied soldiers regardless of the severity of their respective wounds. (shrink)

Medical ethics in times of war are fundamentally different from those in times of peace. War brings military and medical values into conflict, often overwhelming other moral obligations, such as a doctor's charge to relieve suffering, in the face of military necessity.

Theories concerning love in the West tend to be bound by the problematic constraints of patriarchal conceptions of what counts ontologically as “true” or “universal” love. It seems that feminist love studies must choose between shining light on these constraints or bursting through them. In this article I give a feminist analysis of Augustine of Hippo's theory of love through a philosophical, psychological, and theological reading of his complicated relationships with women. I argue that, given the “embodied” nature of his (...) many loves throughout his life, there is room in Augustine's account of love for a gendered reading of love that is unconstrained by patriarchal notions concerning which gender is capable of which kind of love. Augustine's theory of love is one that is not coldly universal but bodied and personal; indeed, although it is founded inside patriarchal historical constructions, it is capable of bursting out of these constraints and suggesting an egalitarian, nongendered view of love. (shrink)

ABSTRACT How should physicians act when faced with corporal punishment, such as amputation, or torture? In most cases, the answer is clear: international law, UN resolutions and universal codes of medical ethics absolutely forbid physicians from countenancing torture and corporal punishment in any form. An acute problem arises, however, in decent societies, but not necessarily liberal states, that are, nonetheless, welcome in the world community. The decent society is often governed, in whole or in part, by religious laws, and while (...) these states abridge various human rights they are peace loving, generally tolerant, and offer their citizens wide avenues for political participation. Under these circumstances the prohibition against corporal punishment and torture weakens, often compelling physicians to participate. This is true in two cases. In Rawls’ hypothetical nation of Kazanistan, Islamic law is the order of the day, and amputations and corporal punishment play an integral part in the execution of traditional Islamic justice. In Israel, torture is sometimes used to elicit the information needed to thwart impending terror attacks. In each case, a physician's participation is essential. In light of the near universal condemnation that accompanies torture and corporal punishment, physicians can only appeal to norms anchored in collective well‐being and concern for life that override respect for human dignity in these societies. Western societies have consistently rejected this reasoning, but it is part and parcel of life in the decent society. (shrink)

The speech-to-song illusion ( Deutsch et al., 2011 ) tracks the perceptual transformation from speech to song across repetitions of a brief spoken utterance. Because it involves no change in the stimulus itself, but a dramatic change in its perceived affiliation to speech or to music, it presents a unique opportunity to comparatively investigate the processing of language and music. In this study, native English-speaking participants were presented with brief spoken utterances that were subsequently repeated ten times. The utterances were (...) drawn either from languages that are relatively difficult for a native English speaker to pronounce, or languages that are relatively easy for a native English speaker to pronounce. Moreover, the repetition could occur at regular or irregular temporal intervals. Participants rated the utterances before and after the repetitions on a 5-point Likert-like scale ranging from “sounds exactly like speech” to “sounds exactly like singing.” The difference in ratings before and after was taken as a measure of the strength of the speech-to-song illusion in each case. The speech-to-song illusion occurred regardless of whether the repetitions were spaced at regular temporal intervals or not; however, it occurred more readily if the utterance was spoken in a language difficult for a native English speaker to pronounce. Speech circuitry seemed more liable to capture native and easy-to-pronounce languages, and more reluctant to relinquish them to perceived song across repetitions. (shrink)

abstract During the current round of fighting in the Middle East, Israel has provoked considerable controversy as it turned to targeted killings or assassination to battle militants. While assassination has met with disfavour among traditional observers, commentators have, more recently, sought to justify targeted killings with an appeal to both self‐defence and law enforcement. While each paradigm allows the use of lethal force, they are fundamentally incompatible, the former stipulating moral innocence and the latter demanding the presumption of criminal guilt. (...) Putting aside the paradigm of law enforcement which demands due process and forbids extra‐judicial execution, the only possible avenue for justifying named killings lies in self‐defence. While named killings might be defensible on the grounds that there are no other ways to disable combatants when they fight without uniforms, the costs, including the cost of targeted killing emerging as an acceptable convention in its own right, should be sufficient to view the practice with a good deal of caution. (shrink)

Asymmetric conflict is changing the way that we practise and think about war. Torture, rendition, assassination, blackmail, extortion, direct attacks on civilians, and chemical weapons are all finding their way to the battlefield despite longstanding international prohibitions. This book offers a practical guide for policy makers, military officers, students, and others who ask such questions as: do guerillas deserve respect or long jail sentences? Are there grounds to torture guerillas for information or assassinate them on the battlefield? Is there room (...) for nonlethal weapons to subdue militants and safeguard the lives of noncombatants? Who are noncombatants in asymmetric war? What is the status of civilians who shelter and aid guerillas? And, do guerillas have any right to attack civilians, particularly those who aid and shelter members of the stronger army? If one side can expand the scope of civilian vulnerability, then why can't the other? (shrink)

Just war theory focuses primarily on bodily harm, such as killing, maiming, and torture, while other harms are often largely overlooked. At the same time, contemporary international conflicts increasingly involve the use of unarmed tactics, employing 'softer' alternatives or supplements to kinetic power that have not been sufficiently addressed by the ethics of war or international law. Soft war tactics include cyber-warfare and economic sanctions, media warfare, and propaganda, as well as non-violent resistance as it plays out in civil disobedience, (...) boycotts, and 'lawfare.' While the just war tradition has much to say about 'hard' war - bullets, bombs, and bayonets - it is virtually silent on the subject of 'soft' war. Soft War: The Ethics of Unarmed Conflict illuminates this neglected aspect of international conflict. (shrink)

Draws upon Taoist wisdom and photographic artistry to provide insight into creativity, spirituality, and awareness training, with black-and-white photographs, passages from ancient Taoist writings, and practical exercises to explain the fundamentals of Taoist photography.

Abortion, particularly late‐term abortion, and neonaticide, selective non‐treatment of newborns, are feasible management strategies for fetuses or newborns diagnosed with severe abnormalities. However, policy varies considerably among developed nations. This article examines abortion and neonatal policy in four nations: Israel, the US, the UK and Denmark. In Israel, late‐term abortion is permitted while non‐treatment of newborns is prohibited. In the US, on the other hand, late‐term abortion is severely restricted, while treatment to newborns may be withdrawn. Policy in the UK (...) and Denmark bridges some of these gaps with liberal abortion and neonatal policy. Disparate policy within and between nations creates practical and ethical difficulties. Practice diverges from policy as many practitioners find it difficult to adhere to official policy. Ethically, it is difficult to entirely justify perinatal policy in these nations. In each nation, there are elements of ethically sound policy, while other aspects cannot be defended. Ethical policy hinges on two underlying normative issues: the question of fetal/newborn status and the morality of killing and letting die. While each issue has been the subject of extensive debate, there are firm ethical norms that should serve as the basis for coherent and consistent perinatal policy. These include 1) a grant of full moral and legal status to the newborn but only partial moral and legal status to the late‐term fetus 2) a general prohibition against feticide unless to save the life of the mother or prevent the birth of a fetus facing certain death or severe pain and suffering and 3) a general endorsement of neonaticide subject to a parent's assessment of the newborn's interest broadly defined to consider physical harm as well as social, psychological and or financial harm to related third parties. Policies in each of the nations surveyed diverging from these norms should be the subject of public discourse and, where possible, legislative reform. (shrink)