Parents who are facing decisions about life-sustaining treatment for their seriously ill or dying child are supported by their child's doctors and nurses. They also frequently seek other information sources to help them deal with the medical and ethical questions that arise. This might include written or web-based information. As part of a project involving the development of such a resource to support parents facing difficult decisions, some ethical questions emerged. Should this information be presented in a strictly neutral fashion? (...) Is it problematic if narratives, arguments or perspectives appear to favour stopping over continuing life-sustaining treatment? Similar questions might arise with written materials about decisions for adults, or for other ethically contentious decisions. This paper explores the meaning of ‘balance’ in information provision, focusing particularly on written information about life-sustaining treatment for children. We contrast the norm of non-directiveness in genetic counselling with the shared decision-making model often endorsed in end-of-life care. We review evidence that parents do not find neutrality from medical professionals helpful in discussions. We argue that balance in written information must be understood in the light of the aim of the document, the most common situation in which it will be used, and any existing biases. We conclude with four important strategies for ensuring that non-neutral information is nevertheless ethically appropriate. (shrink)

Minority female youth are significantly affected by the HIV epidemic. The purpose of this pilot study was to explore sexual behavior practices, disclosure of HIV status, attitudes about disclosure, and knowledge of HIV disclosure laws among female youth with HIV. Findings suggest that the majority of YWH studied have been sexually active since their HIV diagnosis, although the nature and extent of sexual activity varied. Rates of nondisclosure to sexual partners varied based on the type of question asked, but at (...) least some of the YWH in this sample reported sexual activity with a partner who was unaware of the participant’s HIV status. YWH appear to be more likely to disclose before, as opposed to after, sexual activity. Although most YWH believe disclosure to sexual partners is important for a variety of reasons, many reasons exist for nondisclosure, including fear of rejection and limited communication skills. The majority of YWH in this sample were aware of the potential legal ramifications of nondisclosure although fear of legal repercussions was not the most important factor related to disclosure. These findings favor the implementation of HIV disclosure interventions over the enactment of HIV criminalization laws as a strategy for reducing HIV transmission. (shrink)

Dealing with situations where parents’ views about treatment for their child are strongly opposed to doctors’ views is one major area of ethical challenge in paediatric health care. The traditional approach focuses on the child’s best interests, but this is problematic for a number of reasons. The Harm Principle test is regarded by many ethicists as more appropriate than the best interests test. Despite this, use of the best interests test for intervening in parental decisions is still very common in (...) clinical settings and can lead to confusion. In this paper, I propose the Zone of Parental Discretion as a means of putting into practice the key ideas of the Harm Principle, in a clear, step-by-step process. The Zone of Parental Discretion provides a tool for ethical deliberation by clinicians and ethicists about all situations in which parents and doctors disagree about treatment of a child, whether parents are refusing medically recommended treatment, or requesting non-recommended treatment. (shrink)

Holobionts are multicellular eukaryotes with multiple species of persistent symbionts. They are not individuals in the genetic sense— composed of and regulated by the same genome—but they are anatomical, physiological, developmental, immunological, and evolutionary units, evolved from a shared relationship between different species. We argue that many of the interactions between human and microbiota symbionts and the reproductive process of a new holobiont are best understood as instances of reciprocal scaffolding of developmental processes and mutual construction of developmental, ecological, and (...) evolutionary niches. Our examples show that mother, fetus, and different symbiotic microbial communities induce or constitute conditions for the development and reproduction of one another. These include the direct induction of maternal or fetus physiological changes, the restructuring of ecological relations between communities, and evolutionary selection against undesirable competitors. The mutual scaffolding and niche constructing processes start early—prior to amniotic rupture. We are evolutionarily, physiologically, and developmentally integrated holobiont systems, strung together through mutual reliance and mutual construction. Bringing the processes of niche construction and developmental scaffolding together to interpret holobiont birth conceptually scaffolds two new directions for research: in niche construction, identifying the evolutionary implications of organisms actively constructing multiple overlapping niches and scaffolds, and in Evolutionary Developmental Biology, characterizing evolutionary and ecological processes as developmental causes. (shrink)

The relationship between ethics and economics has never been easy. Opponents in a tug of war, friends in a warm embrace, ships passing in the night—the relationship has been highly variable. In recent years, the friendship model has been gaining credence, particularly among U.S. corporate executives. Increasingly, companies are launching ethics programs, values initiatives, and community involvement activities premised on management’s belief that “Ethics pays.”.

This book collects some of the most exciting pioneering work in perceptual and cognitive psychology. The authors' quantitative approach to the study of mental images and their representation is clearly depicted in this invaluable volume of research which presents, interprets, evaluates, and extends their work. The selections are preceded by a thorough review of the history of their experiments, and all of the articles have been updated with reviews of the current literature. The book's first part focuses on mental rotation; (...) the second includes other, more complex transformations and sequences of transformations. A third part describes work on rotational transformations in the context of the perceptual illusion of &"apparent motion.&" Roger N. Shepard is Professor of Psychology, Stanford University. Lynn A. Cooper is Professor of Psychology, University of Arizona. A Bradford Book. (shrink)

Introduction: working together on individuality / Lynn K. Nyhart and Scott Lidgard -- The work of biological individuality: concepts and contexts / Scott Lidgard and Lynn K. Nyhart -- Cells, colonies, and clones: individuality in the volvocine algae / Matthew D. Herron -- Individuality and the control of life cycles / Beckett Sterner -- Discovering the ties that bind: cell-cell communication and the development of cell sociology / Andrew S. Reynolds -- Alternation of generations and individuality, 1851 / (...) Lynn K. Nyhart and Scott Lidgard -- Spencer's evolutionary entanglement: from liminal individuals to implicit collectivities / Snait Gissis -- Biological individuality and enkapsis: from Martin Heidenhain's synthesiology to the völkisch national community / Olivier Rieppel -- Parasitology, zoology, and society in France, ca. 1880-1920 / Michael A. Osborne -- Metabolism, autonomy, and individuality / Hannah Landecker -- Bodily parts in the structure-function dialectic / Ingo Brigandt -- Commentaries: historical, biological, and philosophical perspectives -- Distrust that particular intuition: resilient essentialisms and empirical challenges in the history of biological individuality / James Elwick -- Biological individuality: a relational reading / Scott F. Gilbert -- Philosophical dimensions of individuality / Alan C. Love and Ingo Brigandt. (shrink)

The term “exploitation” has gained wide currency in recent discussions of biomedical and research ethics. This is due in no small measure to the influence of Alan Wertheimer’s path-breaking work on the topic (Wertheimer 1999, 2011). Wertheimer presented a clear and compelling non-Marxist account of the concept of exploitation—one that stressed the connection between exploitation and unfair distributive outcomes. On this account, when one party exploits another, she takes advantage of the other to gain unfairly. A number of contemporary bioethicists (...) have accepted Wertheimer’s account of exploitation and have proceeded to apply it to a range of issues in research ethics (Hawkins and Emanuel 2008; Miller and Brody .. (shrink)

This article critically analyzes the principle of beneficence and the principle of nonmaleficence in clinical medical ethics. It resists some recent skepticism about the principle of nonmaleficence, and then seeks to explain its role in medicine. The article proposes that the two principles are informed by different accounts of what is in the patient’s best interests. The principle of beneficence is tied to the patient’s best overall interests, whereas the principle of nonmaleficence is tied to the patient’s best medical interests (...) only. The article argues that the principle of nonmaleficence takes priority over the principle of beneficence in that it filters the treatment options that are appropriately subject to the principle of beneficence. Understanding how both principles can play an important role in medical practice, and how they relate when they come into conflict, can help clinicians to avoid certain mistakes in thinking about their duties to their patients. (shrink)

There is currently a great debate about whether the holobiont, i.e. a multicellular host and its residential microorganisms, constitutes a biological individual. We propose that resident microorganisms have a general and important role in the individuality of the host organism, not the holobiont. Drawing upon the Equilibrium Model of Immunity, we argue that microorganisms are scaffolds of immune capacities and processes that determine the constituency and persistence of the host organism. A scaffolding perspective accommodates the contingency and heterogeneity of resident (...) microorganisms while accounting for their necessity and unifying contributions to host individuality. In our symbiotic view of life, holobionts may not be organisms or units of selection, but macroorganisms cannot persist nor function as individuals without their scaffolding microorganisms. (shrink)

Ethical research on human subjects requires that subjects, if they have the capacity to do so, give free and informed consent to participate in the trials in which they are enrolled. This requirement, which is commonly referred to as the principle of informed consent, was prominently endorsed by the authors of the Belmont Report in 1978, and it remains widely accepted today. Yet while the principle of informed consent is by now almost universally accepted, the responsibilities that it imposes on (...) those who conduct research on human subjects is a more contentious matter. New challenges to securing informed consent have emerged since the publication of the Belmont Report, and responding to these challenges requires... (shrink)

The University of Pittsburgh Medical Center (UPMC) "Policy for the Management of Terminally Ill Patients Who May Become Organ Donors after Death" proposes to take organs from certain patients as soon as possible after expected cardiopulmonary death. This policy requires clear understanding of the descriptive state of the donor's critical cardiopulmonary and neurologic functional capacity at the time interventions to sustain or harvest organs are undertaken. It also requires strong consensus about the moral and legal status of the donor during (...) dying and confirmation of death. There has been no need for the clarity and precision that this policy relies upon, and thus the needed research and conceptual work has not previously been generated. The empiric base and societal consensus are both too frail to provide justification for this policy at this time. (shrink)

The juxtaposition encompassed in the phrase "feminist epistemology" strikes some feminist theorists and mainstream epistemologists as incongruous. To others, the phrase signals the view that epistemology and the philosophy of science are not what some of their practitioners and advocates have wanted or claimed them to be-but also are not "dead," as some of their critics proclaim. This essay explores the grounds for and implications of each view and recommends the second.

The author has previously shown that for a certain class of structures $\mathcal {I}$, $\mathcal {I}$-indexed indiscernible sets have the modeling property just in case the age of $\mathcal {I}$ is a Ramsey class. We expand this known class of structures from ordered structures in a finite relational language to ordered, locally finite structures which isolate quantifier-free types by way of quantifier-free formulas. This result is applied to give new proofs that certain classes of trees are Ramsey. To aid this (...) project we develop the logic of EM-types. (shrink)

Can one be fooled into believing that one intended an action that one in fact did not intend? Past experimental paradigms have demonstrated that participants, when provided with false perceptual feedback about their actions, can be fooled into misperceiving the nature of their intended motor act. However, because veridical proprioceptive/perceptual feedback limits the extent to which participants can be fooled, few studies have been able to answer our question and induce the illusion to intend. In a novel paradigm addressing this (...) question, participants were instructed to move a line on the computer screen by use of a phony brain–computer interface. Line movements were actually controlled by computer program. Demonstrating the illusion to intend, participants reported more intentions to move the line when it moved frequently than when it moved infrequently. Consistent with ideomotor theory, the finding illuminates the intimate liaisons among ideomotor processing, the sense of agency, and action production. (shrink)

The persistence, and international expansion, of food banks as a non-governmental response to households experiencing food insecurity has been decried as an indicator of unacceptable levels of poverty in the countries in which they operate. In 1998, Poppendieck published a book, Sweet charity: emergency food and the end of entitlement, which has endured as an influential critique of food banks. Sweet charity‘s food bank critique is succinctly synthesized as encompassing seven deadly “ins” (1) inaccessibility, (2) inadequacy, (3) inappropriateness, (4) indignity, (...) (5) inefficiency, (6) insufficiency, and (7) instability. The purpose of this paper is to examine if and how the contemporary food bank critique differs from Sweet charity’s “ins” as a strategy for the formulation of synthesizing arguments for policy advocacy. We used critical interpretive synthesis methodology to identify relationships within and/or between existing critiques in the peer-reviewed literature as a means to create “‘synthetic constructs’ (new constructs generated through synthesis)” of circulating critiques. We analyzed 33 articles on food banks published since Sweet charity, with the “ins” as a starting point for coding. We found that the list of original “ins” related primarily to food bank operations has been consolidated over time. We found additional “ins” that extend the food bank critique beyond operations (ineffectiveness, inequality, institutionalization, invalidation of entitlements, invisibility). No synthetic construct emerged linking the critique of operational challenges facing food banks with one that suggests that food banks may be perpetuating inequity, posing a challenge for mutually supportive policy advocacy. (shrink)

The Daily Spiritual Experience Scale is an instrument designed to provide researchers with a self-report measure of spiritual experiences as an important aspect of how religiousness/spirituality is expressed in daily life for many people. The sixteen-item scale includes constructs such as awe, gratitude, mercy, sense of connection with the transcendent, compassionate love, and desire for closeness to God. It also includes measures of awareness of discernment/inspiration and transcendent sense of self. This measure was originally developed for use in health studies, (...) but has been increasingly used more widely in the social sciences, for program evaluation, and for examining changes in religious/spiritual experiences over time. It has been included on the U. S. General Social Survey , and the items have shown high prevalence in that population. The challenge of identifying items that tap the underlying constructs was addressed through qualitative methods, both in the development and testing of the instrument. Translations have been made into Spanish, Korean, Hebrew, Vietnamese, and French, and the scale has been effectively used outside the United States. Detailed discussion of item construction based on qualitative work is given to assist in use, interpretation and translation development. Options for scoring and suggestions for exploring correlations with other variables using individual items and subgroups are also presented. (shrink)

What standard or principle should guide decisionmaking concerning the permissibility of allowing children to be organ donors? For a long time, it has been widely assumed that the best interest of the child is the appropriate standard. But recently, several critics have charged that this standard fails to give due weight to the interests of the family and the intimate relationships that the family makes possible.1,2 This article reviews and rejects both the best-interest standard and the alternative standard recommended by (...) the critics. I then propose a new standard to help parents, healthcare professionals, and judges decide when it is and is not permissible for children to serve as organ donors. This new standard modifies and broadens the best-interest standard to allow it to account adequately for the contribution that intimate relationships make to the well-being of children. (shrink)

When Andromache emerges from the inner chamber in Book 22, ascends the walls of Troy and looks out over the plain, she beholds a spectacle of ruthless brutality. She who has not been aware of the final combat, nor of the slaying of her husband, is suddenly confronted by the receding trail of utter defeat. Swift horses drag her husband's corpse into the distance, the cherished head disfigured as it is dragged, raking the dust of what was once their homeland. (...) The violence of the scene is forcefully conveyed by one word in particular. The swift horses drag Hektor κηδστως —without κδος without care, ‘sans soucier de, brutalement’. In itself the word κηδστως provides a definition of violence, one captured in Shakespeare's phrase ‘careless force’. Violence is, in its harsh brutality, specifically heedlessness, an absence of any form of care. When Achilles hurls the slain suppliant Lykaon into the river he utters the taunt, ‘the fish, κηδες, will lick clean your wound's blood’ . The discarded corpse is denied funeral rites: in place of the care that the relations of the dead traditionally bestow in tending, washing, enshrouding, lamenting, and burying the dead, here the heedless creatures of nature, fleeting visitors, will attend to the corpse, ‘clean’ it, but utterly without care, completely oblivious to the oblivion they create by destroying. In Book 24 Achilles will describe the gods themselves as κηδες. (shrink)

A distressing number of philosophers and classicists think that the deuteros plous or “second best” mentioned at Phaedo 99c9-dl is the hypothetical method. Many of them will even tell you that Plato says the hypothetical method is the deuteros plous, and that they are not merely interpreting his meaning. They usually back off, however, when challenged on this point, for there jus isn’t any such statement by Plato. Nor, I think, does Plato give us any justification at all for taking (...) the deuteros plous as the hypothetical method. I will argue in this paper that he is referring rather to the explanation of things in terms of their formal causes, and that this sort of explanation is “second best” when compared to a teleological explanation in terms of final causes. The hypothetical method of the dialectician is simply the logical device or apparatus by means of which the theory of ideas and the attendant notion of formal causation are introduced into the discussion; it is not a “second best” method and is not inferior to anything else. (shrink)

Purpose Recent research has found unrealistic optimism among patient-subjects in early-phase oncology trials. Our aim was to investigate the cognitive and motivational factors that evoke this bias in this context. We expected perceptions of control to be a strong correlate of unrealistic optimism. Methods A study of patient-subjects enrolled in early-phase oncology trials was conducted at two sites in the USA. Respondents completed questionnaires designed to assess unrealistic optimism and several risk attribute variables that have been found to evoke the (...) bias in other contexts. Results One hundred and seventy-one patient-subjects agreed to be interviewed for our study. Significant levels of perceived controllability were found with respect to all nine research-related questions. Perceptions of control were found to predict unrealistic optimism. Two other risk attribute variables, awareness of indicators and mental image, were correlated with unrealistic optimism. However, in multivariate regression analysis, awareness and mental image dropped out of the model and perceived controllability was the only factor independently associated with unrealistic optimism. Conclusion Patient-subjects reported that they can, at least partially, control the benefits they receive from participating in an early-phase oncology trial. This sense of control may underlie unrealistic optimism about benefiting personally from trial participation. Effective interventions to counteract unrealistic optimism may need to address the psychological factors that give rise to distorted risk/benefit processing. (shrink)

There is broad agreement among research ethicists that investigators have a duty to obtain the informed consent of all subjects who participate in their research trials. On a common view, the duty to obtain this informed consent follows from the need to respect persons and their autonomous decisions. However, the nature of informed consent and the demands it places on investigators are open to dispute and recently have been challenged. Respect for persons, it has been claimed, does not require investigators (...) to guarantee that the subjects enrolled in their trials comprehend the risk/benefit information disclosed to them or even that they appreciate the difference between research and therapy. According to this critique, the significance of defects in informed consent, like therapeutic misconception or unrealistic optimism, has been greatly exaggerated. This article reevaluates informed consent in clinical research in light of this critique. It not only rebuts the main points the critics raise, but also shows that other points they raise can be accepted by a doctrine of informed consent that resembles the common view in maintaining that autonomous authorization is central to informed consent. (shrink)

This essay critiques feminist treatments of maternal-fetal "relationality" that unwittingly replicate features of Western individualism (for example, the Cartesian division between the asocial body and the social-cognitive person, or the conflation of social and biological birth). I argue for a more reflexive perspective on relationality that would acknowledge how we produce persons through our actions and rhetoric. Personhood and relationality can be better analyzed as dynamic, negotiated qualities realized through social practice.

As destructive narcissists attain positions of power, unethical behavior ensues. Organizational identity shifts in response. As a result, unethical decisions become amplified in organizational structure and practices and embedded in technology. Little research related to how employees respond to organizational events, cost/benefit analysis of such, or the effects of negative treatment of employees by organizations is available. As persons become aware of the circumstances generated by destructive narcissistic behavior and informed about the consequences, some will resist. In this article, we (...) provide a model illustrating factors that may give rise to such organizational resistance to destructive arrogant narcissism. (shrink)

This paper examines socrates' method for determining whether virtue is taught, And discusses some of the opposing interpretations that have been offered (e.G., By robinson and hackforth). Some major conclusions are: that hypotheses that have been deduced from other hypotheses can still be called hypotheses; that it is false that there can be only one hypothesis per argument; and that the several hypotheses in a given argument need not all be hypothesized with the same degree of confidence.

Recent historical work on changing perceptions of the human body has been influenced by Michel Foucault’s contention that the self of western individualism was created by new regimes of disciplining the body. A different approach is taken here, one that focuses on how individual bodies came to be viewed as separate and inviolable, that is, as autonomous. The separateness and inviolability of bodies can be traced in the histories of bodily practices as different as portraiture and legal torture. After 1750, (...) regular public exhibitions, themselves a new feature of the social landscape, showed increasing numbers of portraits in London and Paris. The proliferation of individual likenesses encouraged the view that each person was an individual, that is, single, separate, distinctive and original. At the same time, the tide turned against judicially sanctioned torture and cruel punishment. Long-held notions of sacrificial punishment and truth through pain withered under the pressure of new experiences of the body that in turn facilitated the emergence of new conceptions of rights of individuals. (shrink)

One of the lessons we ought to have learned from the history of philosophy and science is that it is rarely, if ever, useful in dealing with challenges from a new movement or in distinguishing one’s position from a different school of thought, to “draw a line in the sand” and claim that everything on this side is legitimate and that everything on that side is not, and can therefore be dismissed without serious consideration or discussion. On some analyses, Plato (...) sought to dismiss all of natural science in this way, by claiming that since it dealt with change it can yield at best belief, not knowledge. The logical positivists, building on the work of Hume, tried to use the analytic/synthetic distinction and various forms of verificationism to dismiss as nonsense everything but science, logic, mathematics, and the philosophy of science. Neither of these moves succeeded in banishing what was placed on that side of the line to intellectual never-never land. More recently, critics of creationism have dismissed the views they are attacking as “not science at all” and therefore of neither concern nor interest to the scientific communities. These maneuvers tend to be unsuccessful not just because they rely on distinctions which cannot, in the end, be sustained—or can be drawn and maintained only after all the hard work which they are frequently claimed to make unnecessary has been done—but because they refuse to deal with the specific evidence and arguments advanced by the challengers, bad as those might be. (shrink)

The major aim of this research is to reopen the study of the subjective experience of upward mobility and to incorporate race and gender into our vision of the process. It examines evidence from a social science study of upward mobility among 200 Black and white professional-managerial women in the Memphis, Tennessee metropolitan area. The experiences of the women paint a different picture from the image of the mobility process that remains from scholarship conducted 20 to 30 years ago on (...) white males. Relationships with family of origin, partners, children, friends, and the wider community shaped the way these women envision and accomplish mobility and the way they sustain themselves as professionals and managers. (shrink)

In theory, HREC members should use the ethical guidelines in the National Statement on the Ethical Conduct of Research Involving Humans as the basis for their decisions, and researchers should design their research in accordance with these guidelines However, very little is known about what researchers and HREC members actually do in practice. In this paper, we report some of the key findings of the study “Human Research Ethics in Practice”, a qualitative interview-based study of health researchers and HREC members (...) in Victoria. The findings shed light on how researchers and HREC members conceptualise ethics, how they use the National Statement, and what deliberative strategies they employ to assess the ethical appropriateness of research studies. The findings also reveal differences and similarities between health researchers’ and HREC members’ perceptions of the roles of HRECs, and point to some sources of misunderstanding and tension. We examine the implications of some of these findings for the ways in which HRECs carry out their task, and research institutions support and promote ethical conduct in research amongst their staff and students. The focus of this study is on health research, but we suggest that the findings are highly relevant to all other research areas where human participants are involved. (shrink)