Next SectionReproductive medical tourism is by some accounts a multibillion dollar industry globally. The seeking by clients in high income nations of surrogate mothers in low income nations, particularly India, presents a set of largely unexamined ethical challenges. In this paper, eight such challenges are elucidated to spur discussion and eventual policy development towards protecting the rights and health of vulnerable women of the Global South.

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

Despite its relative infancy, ecological science plays a pre-eminent role in current environmental decision-making globally and has, over recent decades, permeated a broad range of academic disciplines. Developments in two areas of philosophical thought in particular, environmental aesthetics and the aesthetics of science, beg an exploration of their intersection with respect to the role of aesthetics in ecological science. Here, we provide a contemporary synthesis of both environmental aesthetics and aesthetics of science to explore aesthetic dimensions of contemporary ecological science, (...) highlighting three main areas of convergence: 1.) the influence of aesthetic experiences and judgements of nature by ecologists on ecological science and our contemporary understanding of nature; 2.) the development and role of ecological ‘taste’ amongst ecologists; and 3.) moral, cultural and political implications of the ecological imagination as underpinned by current ecological science. We identify a risk for feedback mechanisms to perpetuate a relatively homogeneous ecological aesthetic as a result of reciprocal influences between ecological science and society which may further promote inadvertent policy advocacy and stifle scientific innovation. We suggest ecological science would benefit from increased aesthetic literacy and reflection by broadening the ecological imagination and intentionally facilitating more diverse and equitable science to inform policy outcomes. Our argument should be of interest to philosophers of science, ecologists and those that draw on their outputs. (shrink)

Despite its relative infancy, ecological science plays a pre-eminent role in current environmental decision-making globally and has, over recent decades, permeated a broad range of academic disciplines. Developments in two areas of philosophical thought in particular, environmental aesthetics and the aesthetics of science, beg an exploration of their intersection with respect to the role of aesthetics in ecological science. Here, we provide a contemporary synthesis of both environmental aesthetics and aesthetics of science to explore aesthetic dimensions of contemporary ecological science, (...) highlighting three main areas of convergence: 1.) the influence of aesthetic experiences and judgements of nature by ecologists on ecological science and our contemporary understanding of nature; 2.) the development and role of ecological ‘taste’ amongst ecologists; and 3.) moral, cultural and political implications of the ecological imagination as underpinned by current ecological science. We identify a risk for feedback mechanisms to perpetuate a relatively homogeneous ecological aesthetic as a result of reciprocal influences between ecological science and society which may further promote inadvertent policy advocacy and stifle scientific innovation. We suggest ecological science would benefit from increased aesthetic literacy and reflection by broadening the ecological imagination and intentionally facilitating more diverse and equitable science to inform policy outcomes. Our argument should be of interest to philosophers of science, ecologists and those that draw on their outputs. (shrink)

Background: Improved techniques and life sustaining technology in the neonatal intensive care unit have resulted in an increased probability of survival for extremely premature babies. The by-product of the aggressive treatment is iatrogenic pain, and this infliction of pain can be a cause of suffering and distress for both baby and nurse. Research question: The research sought to explore the caregiving dilemmas of neonatal nurses when caring for extremely premature babies. This article aims to explore the issues arising for neonatal (...) nurses when they inflict iatrogenic pain on the most vulnerable of human beings – babies ≤24 weeks gestation. Participants: Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia. Ethical consideration: Ethical processes and procedures set out by the ethics committee have been adhered to by the researchers. Findings: A qualitative approach was used to analyse the data. The theme ‘inflicting pain’ comprised three sub-themes: ‘when caring and torture are the same thing’, ‘why are we doing this!’ and ‘comfort for baby and nurse’. The results show that the neonatal nurses were passionate about the need for appropriate pain relief for extremely premature babies. Conclusion: The neonatal nurses experienced a profound sense of distress manifested as existential suffering when they inflicted pain on extremely premature babies. Inflicting pain rather than relieving it can leave the nurses questioning their role as compassionate healthcare professionals. (shrink)

Lucid dreams are dreams in which a person becomes aware that they are dreaming. They are different from ordinary dreams, not just because of the dreamer's awareness that they are dreaming, but because lucid dreams are often strikingly realistic and may be emotionally charged to the point of elation. Celia Green and Charles McCreery have written a unique introduction to lucid dreams that will appeal to the specialist and general reader alike. The authors explore the experience of lucid dreaming, (...) relate it to other experiences such as out-of-the-body experiences and apparitions, and look at how lucid dreams can be induced and controlled. They explore their use for therapeutic purposes such as counteracting nightmares. Their study is illustrated throughout with many case histories. (shrink)

Mary Astell is a fascinating seventeenth‐century figure whose work admits of many interpretations. One feature of her work that has received little attention is her focus on bad custom. This is surprising; Astell clearly regards bad custom as exerting a kind of epistemic power over agents, particularly women, in a way that limits their intellectual capacities. This article aims to link two contemporary sociopolitical/social‐epistemological projects by showing how a seventeenth‐century thinker anticipated these projects. Astell's account of bad custom shows that (...) she was attuned to the kinds of institutional or structural explanations theorized by Sally Haslanger, and that she acknowledges that bad custom—as an institutional or structural explanation—is intimately linked with epistemic injustice, albeit a kind not yet captured by contemporary social epistemologists. I call this form of epistemic injustice found in Astell epistemic internalization injustice. I argue that the epistemic significance of Astell's notion of bad custom is that it enables us to understand how bad custom conditions human relations in such a way as to result in epistemic injustice. Through coming to understand her notion of bad custom, we can expand our understanding of social epistemic phenomena like epistemic injustice. (shrink)

This article answers questions about the consistency, coherence, and motivation of Hobbes's account of the right to punish. First, it develops a novel account of authorization that explains how Hobbes could have consistently held both that the subjects do not give the sovereign the right to punish and also that they authorize the sovereign to punish. Second, it shows that, despite appearances, the natural and artificial elements of Hobbes's account form a coherent whole. Finally, it explains why Hobbes thought it (...) was important to establish the sovereign's right to punish apart from the sovereign's power to punish. (shrink)

BackgroundThe public and healthcare workers have a high expectation of animal research which they perceive as necessary to predict the safety and efficacy of drugs before testing in clinical trials. However, the expectation is not always realised and there is evidence that the research often fails to stand up to scientific scrutiny and its 'predictive value' is either weak or absent.DiscussionProblems with the use of animals as models of humans arise from a variety of biases and systemic failures including: 1) (...) bias and poor practice in research methodology and data analysis ; 2) lack of transparency in scientific assessment and regulation of the research; 3) long-term denial of weaknesses in cross-species translation; 4) profit-driven motives overriding patient interests; 5) lack of accountability of expenditure on animal research; 6) reductionist-materialism in science which tends to dictate scientific inquiry and control the direction of funding in biomedical research.SummaryBias in animal research needs to be addressed before medical research and healthcare decision-making can be more evidence-based. Research funding may be misdirected on studying 'disease mechanisms' in animals that cannot be replicated outside tightly controlled laboratory conditions, and without sufficient critical evaluation animal research may divert attention away from avenues of research that hold promise for human health. The potential for harm to patients and trial volunteers from reliance on biased animal data1 requires measures to improve its conduct, regulation and analysis. This article draws attention to a few of the many forms of bias in animal research that have come to light in the last decade and offers a strategy incorporating ten recommendations stated at the end of each section on bias. The proposals need development through open debate and subsequent rigorous implementation so that reviewers may determine the value of animal research to human health. The 10Rs + are protected by a Creative Commons Attribution 3.0 Unported License and therefore may be 'shared, remixed or built on, even commercially, so long as attributed by giving appropriate credit with a link to the license, and indicate if changes were made.’. (shrink)

Although the first human embryonic stem cells were produced in 1998, the direction of U.S. policy on stem cell research was set nearly 20 years earlier when the recommendations of a congressionally established Ethics Advisory Board were ignored by the Reagan administration. Thus began an unprecedented and unparalleled 30-year-long history of political intrusions in an area of scientific and biomedical research that has measurable impacts on the health of Americans. Driving these intrusions were religiously informed public policy positions that have (...) usually escaped critical ethical analysis. Here I record my own encounters with this history of intrusions and the thinking behind them.My most abrupt encounter with the politics of stem cell research occurred on September 6, 2006, at a hearing of the Senate Subcommittee on Labor, Health and Human Services and Related Agencies, chaired by Senator Arlen Specter. Just a week before, scientists at Advanced Cell Technology, a small Massachusetts biotech company, had published a paper in the journal Nature in which they described a method for extracting stem cells from early human embryos while leaving the embryos intact and viable. As head of ACT’s Ethics Advisory Board, I had supported this research. (shrink)

This paper details a “metadisciplinary” applied ethics course jointly taught and pioneered by a biologist, psychologist, and ethicist on the subject of Assisted Reproduction. Contrasted with a transdisciplinary approach (whose content involves themes or issues that span traditional disciplinary lines) and a multidisciplinary approach (which involves experts from several disciplines working side by side), a metadisciplinary approach involves both of these former characteristics while incorporating a continuous, critical appreciation for the strengths and weaknesses of the contrasting methods and scopes of (...) each discipline’s methods of inquiry. This paper details the kinds of subjects that lend themselves to metadisciplinary approaches (e.g. applied ethics subjects which are real-world, complex, and studied by various disciplines), staffing guidelines for a smoothly functioning core team, how to plan and prepare the day-to-day of such a course to prevent a diffuse lesson structure, assignment and evaluation guidelines, and an appraisal of the value of such a class. The authors argue that while fundamental research may be conducted along traditional disciplinary lines, solutions to the complex problems of contemporary society require people who are equipped with problem-solving skills whose relevance spans disciplinary boundaries. (shrink)

The goal of the current study was to examine novice researchers’ views about online ethics education and to identify the instructional design components that may foster ethical practice. Applying the mixed methods approach, data were collected via a survey and semi-structured interviews among M.Sc. and Ph.D. students in science and engineering. The findings point to the need for rethinking the way conventional online ethics courses are developed and delivered; encouraging students to build confidence in learning from distance, engaging them in (...) online active and interactive experiences, and providing them with personalized support and adaptive guidance. The novice researchers identified the synergistic integration of collaborative, case-based, and contextual learning, as the instructional design components that may foster not only ethical knowledge but also ethical practice in a fully online course. (shrink)

Background: The ability to save the life of an extremely premature baby has increased substantially over the last decade. This survival, however, can be associated with unfavourable outcomes for both baby and family. Questions are now being asked about quality of life for survivors of extreme prematurity. Quality of life is rightly deemed to be an important consideration in high technology neonatal care; yet, it is notoriously difficult to determine or predict. How does one define and operationalise what is considered (...) to be in the best interest of a surviving extremely premature baby, especially when the full extent of the outcomes might not be known for several years? Research question: The research investigates the caregiving dilemmas often faced by neonatal nurses when caring for extremely premature babies. This article explores the issues arising for neonatal nurses when they considered the philosophical and ethical questions about quality of life in babies ≤24 weeks gestation. Participants: Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia. Ethical considerations: Ethical processes and procedures have been adhered to by the researchers. Findings: A qualitative approach was used to analyse the data. The theme ‘difficult choices’ was generated which comprised three sub-themes: ‘damaged through survival’, ‘the importance of the brain’ and ‘families are important’. The results show that neonatal nurses believed that quality of life was an important consideration; yet they experienced significant inner conflict and uncertainty when asked to define or suggest specific elements of quality of life, or to suggest how it might be determined. It was even more difficult for the nurses to say when an extremely premature baby’s life possessed quality. Their previous clinical and personal experiences led the nurses to believe that the quality of the family’s life was important, and possibly more so than the quality of life of the surviving baby. This finding contrasts markedly with much of the existing literature in this field. Conclusion: Quality of life for extremely premature babies was an important consideration for neonatal nurses; however, they experienced difficulty deciding how to operationalise such considerations in their everyday clinical practice. (shrink)

ABSTRACT In our current moment, there is considerable interest in networks, in how people and things are connected. This essay outlines one approach that brings together insights from actor-network theory, social network analysis, and digital history to interpret past scientific activity. Multispecies network analysis (MNA) is a means of understanding the historical interactions among scientists, institutions, and preferred experimental animals. A reexamination of studies of sexual behavior funded by the Committee for Research in Problems of Sex between the 1920s and (...) the 1940s demonstrates the applicability of MNA to clarifying the relations that sustained this area of psychology. The measures of weighted degree and betweenness can highlight which nodes (whether organisms or institutions) were particularly “central” to this network. Rats featured as the animals most widely studied during this period, but the analysis also reveals distinct institutional and disciplinary cultures where different species were favored as either surrogates for humans or representatives of more general biological groups. (shrink)

ABSTRACT Madeleine de Scudéry (1607–1701) is best remembered as a novelist rather than as a philosopher, but she is both a gifted literary figure and an overlooked philosopher. These roles are, at least in her case, inseparable. Through her dialogues, Scudéry offers an account of the conversation that is at once a rhetorical social art as well as a substantive philosophical phenomenon and socio-political practice with feminist effects. According to Scudéry, how one converses and what one converses about provides new (...) knowledge and ways of thinking as well as the potential to reshape our social and political relations. Scudérian conversation is not only a means to acquire and practice rhetoric – an art characterized by gendered hierarchy –but also a means of teaching women that equality in historically gendered domains is possible. Ultimately, Scudérian conversation is a kind of feminist praxis that flies under the radar in virtue of appearing to be merely a social art. (shrink)

John Stuart Mill's crisis of 1826 has received a great deal of attention from scholars. This attention results from reflection on the importance of the crisis to Mill's mature thought. Did the crisis signal rejection or revision of Benthamism? Or did it have little or no effect on Mill's view of his intellectual inheritance? Ultimately, an interpretation of the cause and resolution of the crisis is integral to an understanding of the nature of Mill's moral and social philosophy. Scholars, in (...) their zeal to understand Mill's crisis, have suggested various reasons for both the onset of the crisis and the recovery. Yet Mill's own perception of his crisis has often been overlooked or rejected. (shrink)

Animals in Disasters is a comprehensive book on animal rescue written by Dr. Dick Green who shares his experiences, best practices and lessons learned from well over 125 domestic and international disasters. It provides a step-by-step process for communities and states to more effectively address animal issues and enhance their animal response capabilities. Sections include an overview of the history of animal rescue, where we are today, and the steps needed to better prepare for tomorrow. This how-to book for (...) emergency managers who want to develop programs, craft policy, and build response capability/capacity is an ideal companion to their work. Clearly identifies the components of building a resilient community Introduces the Community Preparedness Checklist Helps readers develop and deliver effective animal response training. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Previous research demonstrates that consumers support firms’ CSR activities, and increasingly demand socially responsible products and services. However, an implicit assumption in the extant literature is that the purchaser and the consumer of the product are the same person. The current research focuses on a unique form of socially responsible consumption behavior: gift-giving. Through 30 depth consumer interviews, we develop a typology of consumers based on whether consumers integrate CSR-related information into purchases, and whether the purchases are for themselves or (...) for others. We find that in some instances, consumers actively avoid purchasing products from socially responsible organizations and do so with the intention of managing their impressions with the gift recipient. This is counter to previous research that suggests consumers often choose to make socially responsible consumption decisions in efforts to satisfy self-presentation concerns. In addition, the decision to engage in socially responsible consumption for oneself but not for others was motivated by a variety of factors including the role of the recipient and a concern over the credibility of socially responsible gifts. Finally, some participants who do not incorporate CSR into their own personal consumption chose gifts based on a variety of CSR activities in an effort to build awareness for socially responsible organizations. (shrink)

Improved life sustaining technology in the neonatal intensive care unit (NICU) has resulted in an increased probability of survival in extremely premature babies. Miracle baby stories in the popular press are a regular occurrence and these reports are often the first source from which the general public learn about extremely premature babies. The research from which this paper is drawn sought to explore the care‐giving and ethical dilemmas of neonatal nurses when caring for extremely premature babies 24 weeks gestation and (...) less. This current paper aims to outline the views of neonatal nurses on miracle baby stories in the media. Data were collected via a questionnaire to 760 Australian neonatal nurses with 414 returned, representing a response rate of 54.4%. Narrative was collected from semi‐structured interviews with 24 experienced neonatal nurses in NSW, Australia. A qualitative approach utilising thematic analysis was utilised to analyse the data. The theme the myth of the miracle baby is seen as generating myths and unrealistic expectations on the part of vulnerable families and the public. Neonatal nurses, as the primary caregivers for tiny babies and their families, viewed popular media publications with suspicion, believing published reports to be incomplete, inaccurate and biased towards the positive. (shrink)

In the 1970s feminist scholars rediscovered J. S. Mill's writings on sexual equality. The new feminist appraisal confronted traditional Mill scholarship which had tended either to neglect Mill's writings on women or to concentrate on Harriet Taylor's influence on Mill's views on sexual equality. But even the most cursory review of the writings of feminist scholars reveals a lack of consensus.

This title includes the following features: Presents a comprehensivediscussion of the central issues of psychiatric ethics, defining and exploringeach of these issues; Contains essential readings for each of these central issues, providing in onevolume readings that would otherwise be difficult to obtain; Includes introductory essays that provide a comprehensive overview of eachissue, efficiently and effectively organizing the reader's approach to theselected readings; Draws on the success of the well-known and respected 'PsychiatricEthics'.

Although we normally have no difficulty with holding individuals accountable for the effects of their actions, we are still confused about holding a health care team accountable. I argue that we can hold teams accountable in the same way that we hold individuals accountable. In constructing this argument, I first examine the nature of a team, then look at the consequences of team decision and action, in particular, the problem of synergistic decisionmaking. Finally I relate this philosophical discussion to patient (...) care decisions by teams. (shrink)

Libet's experiments, supported by a strict one-to-one identity thesis between brain events and mental events, have prompted the conclusion that physical events precede the mental events to which they correspond. We examine this claim and conclude that it is suspect for several reasons. First, there is a dual assumption that an intention is the kind of thing that causes an action and that can be accurately introspected. Second, there is a real problem with the method of timing the mental events (...) concerned given that Libet himself has found the reports of subjects to be unreliable in this regard. Third, there is a suspect assumption that there are such things as timable and locatable mental and brain events accompanying and causing human behaviour. For all these reasons we reject the claim that physical events are prior to and explain mental events. (shrink)