Patients should not always receive hard data about the risks and benefits of a medical intervention. That information should always be available to patients who expressly ask for it, but it should be part of standard disclosure only sometimes, and only for some patients. And even then, we need to think about how to offer it.

Some experts have argued that patients should routinely be told the specific magnitude and absolute probability of potential risks and benefits of screening tests. This position is motivated by the idea that framing risk information in ways that are less precise violates the ethical principle of respect for autonomy and its application in informed consent or shared decisionmaking. In this Perspective, we consider a number of problems with this view that have not been adequately addressed. The most important challenges stem (...) from the danger that patients will misunderstand the information or have irrational responses to it. Any initiative in this area should take such factors into account and should consider carefully how to apply the ethical principles of respect for autonomy and beneficence. (shrink)

Accounts of the concepts of function and dysfunction have not adequately explained what factors determine the line between low‐normal function and dysfunction. I call the challenge of doing so the line‐drawing problem. Previous approaches emphasize facts involving the action of natural selection (Wakefield 1992a, 1999a, 1999b) or the statistical distribution of levels of functioning in the current population (Boorse 1977, 1997). I point out limitations of these two approaches and present a solution to the line‐drawing problem that builds on the (...) second one. (shrink)

While several tests and strategies are recommended for colorectal cancer (CRC) screening, studies suggest that primary care providers often recommend colonoscopy without providing information about its risks or alternatives. These observations raise concerns about the quality of informed consent for screening colonoscopy.

A dilemma exists when a doctor is faced with a child or young person who refuses medically indicated treatment. The Gillick case has been interpreted by many to mean that a child of sufficient age and intelligence could validly consent or refuse consent to treatment. Recent decisions of the Court of Appeal on a child's refusal of medical treatment have clouded the issue and undermined the spirit of the Gillick decision and the Children Act 1989. It is now the case (...) that a child patient whose competence is in doubt will be found rational if he or she accepts the proposal to treat but may be found incompetent if he or she disagrees. Practitioners are alerted to the anomalies now exhibited by the law on the issue of children's consent and refusal. The impact of the decisions from the perspectives of medicine, ethics, and the law are examined. Practitioners should review each case of child care carefully and in cases of doubt seek legal advice. (shrink)

Some experts have argued that patients facing certain types of choices should not be told whether their risk is above or below average, because this information may trigger a bias (Fagerlin et al. 2007). But careful consideration shows that the comparative risk heuristic can usefully guide decisions and improve their quality or rationality. Building on an earlier paper of mine (Schwartz 2009), I will argue here that doctors and decision aids should provide comparative risk information to patients, even while (...) further research is conducted. (shrink)

Similarly to other accounts of disease, Christopher Boorse’s Biostatistical Theory (BST) is generally presented and considered as conceptual analysis, that is, as making claims about the meaning of currently used concepts. But conceptual analysis has been convincingly critiqued as relying on problematic assumptions about the existence, meaning, and use of concepts. Because of these problems, accounts of disease and health should be evaluated not as claims about current meaning, I argue, but instead as proposals about how to define and use (...) these terms in the future, a methodology suggested by Quine and Carnap. I begin this article by describing problems with conceptual analysis and advantages of “philosophical explication,” my favored approach. I then describe two attacks on the BST that also question the entire project of defining “disease.” Finally, I defend the BST as a philosophical explication by showing how it could define useful terms for medical science and ethics. (shrink)

"Modern History" versions of the etiological theory claim that in order for a trait X to have the proper function F, individuals with X must have been recently favored by natural selection for doing F (Godfrey-Smith 1994; Griffiths 1992, 1993). For many traits with prototypical proper functions, however, such recent selection may not have occurred: traits may have been maintained due to lack of variation or due to selection for other effects. I examine this flaw in Modern History accounts and (...) offer an alternative etiological theory, the Continuing Usefulness account, which appears to avoid such problems. (shrink)

Consider the following patient: a 40-year-old man who has had back pain that radiates down his left leg, on and off for 2 months. He performs his normal activities and does not have any “red flag”...

I argue that ductal carcinoma in situ (DCIS), the tumor most commonly diagnosed by breast mammography, cannot be confidently classified as cancer, that is, as pathological. This is because there may not be dysfunction present in DCIS—as I argue based on its high prevalence and the small amount of risk it conveys—and thus DCIS may not count as a disease by dysfunction-requiring approaches, such as Boorse’s biostatistical theory and Wakefield’s harmful dysfunction account. Patients should decide about treatment for DCIS based (...) on the risks it poses and the risks and benefits of treatment, not on its disease status. (shrink)

Ethics should guide the design of electronic health records (EHR), and recognized principles of bioethics can play an important role. This approach was adopted recently by a team of informaticists designing and testing a system where patients exert granular control over who views their personal health information. While this method of building ethics in from the start of the design process has significant benefits, questions remain about how useful the application of bioethics principles can be in this process, especially when (...) principles conflict. For instance, while the ethical principle of respect for autonomy supports a robust system of granular control, the principles of beneficence and non-maleficence counsel restraint due to the danger of patients being harmed by restrictions on provider access to data. Conflict between principles has long been recognized by ethicists and has even motivated attacks on approaches that state and apply principles. In this paper we show how using ethical principles can help in the design of EHRs by first, explaining how ethical principles can and should be used generally, and then by, discuss how attention to details in specific cases can show that the tension between principles is not as bad as it initially appeared. We conclude by suggesting further ways in which the application of these (and other) principles can add value to the ongoing discussion of patient involvement in their health care. This is a new approach to linking principles to informatics design that we expect will stimulate further interest. (shrink)

With the growing focus on prevention in medicine, studies of how to describe risk have become increasing important. Recently, some researchers have argued against giving patients “comparative risk information,” such as data about whether their baseline risk of developing a particular disease is above or below average. The concern is that giving patients this information will interfere with their consideration of more relevant data, such as the specific chance of getting the disease (the “personal risk”), the risk reduction the treatment (...) provides, and any possible side effects. I explore this view and the theories of rationality that ground it, and I argue instead that comparative risk information can play a positive role in decision-making. The criticism of disclosing this sort of information to patients, I conclude, rests on a mistakenly narrow account of the goals of prevention and the nature of rational choice in medicine. (shrink)

Imagine you fly home from vacation with your one-and-a-half-year-old son who is traveling for free as a “lap child.” In the airport parking lot, you put him into his forward-facing car seat, where he sits much more contentedly than he did in the rear-facing one that was mandatory until his first birthday. After he falls asleep on the way home, you transfer him to his crib without waking him, lowering the side rail so you can lift him in more easily. (...) -/- Many parts of this idyllic parenting picture are deemed unacceptably risky according to recent child safety proposals. While these proposals all aim to improve child safety, their possible impact is unclear because there has been little discussion of the absolute risk and risk reduction involved in each. And while precise figures are lacking, rough estimates indicate that the magnitudes are quite small. I will argue that this risk and benefit data raises important questions about the proposals, including whether parents might reasonably believe that the small absolute risk reduction offered by the proposed changes does not justify the attendant burdens. This possibility—termed the “prevention paradox” in other contexts—highlights ethical and theoretical challenges in this area of public health. (shrink)

Most people do not know there are different kinds of medical studies; some are conducted on people who already have a disease or medical condition, and others are performed on healthy volunteers who want to help science find answers. No matter what sort of research you are invited to participate in, or whether you are a patient when you are asked, it’s entirely up to you whether or not to do it. This decision is important and may have many implications (...) for your health and well-being, as well as those of other patients now and in the future. Making a good decision – the right one for you – requires you to become educated about topics you may not have thought about before, some of which may be quite complicated. This chapter explains the key issues to help you make a good decision. (shrink)

Although there is a growing recognition that older adults and those with extensive comorbid conditions undergo cancer screening too frequently, there is little information about patients’ perceptions regarding cessation of cancer screening. Information on older adults’ views of screening cessation would be helpful both for clinicians and for those designing interventions to reduce overscreening.

This article aims to read feminist new materialisms (Barad), together with ‘postulated’ linguistic or cultural primacy of Queer Theory (Butler), to show how both are engaged in similar critical-ethical endeavours. The central argument is that the criticism of Barad and new materialisms misses Butler’s materialistic insights due to a narrow interpretation of Butler's alleged social-constructivist position. There is, therefore, a specific focus on where they both make similar ethical appeals. Moreover, the article relies on Adorno's negative dialectic to highlight an (...) interpretation of Barad and Butler as being part of the same dialectical movement, in which materialism and idealism fluctuate in their mutual criticisms, thus continuing the procession towards 'new knowledge' and emancipation, or freedom, through their motions back and forth. (shrink)

This paper is about the similarity between the appreciation of a piece of art, such as a cherished music album, and the loving appreciation of a person whom one knows well. In philosophical discussion about the rationality of love, the Qualities View (QV) says that love can be justified by reference to the qualities of the beloved. I argue that the oft-rehearsed trading-up objection fails to undermine the QV. The problems typically identified by the objection arise from the idea that (...) love-worthy qualities could be coarse-grained, when in fact they must be fine-grained. The analogy with appreciation of aesthetic qualities helps to draw out this point. Once the fine-grained nature of love-worthy qualities is properly understood, it is clear that critics of the QV cannot rely on the trading-up objection to motivate its rejection. Moreover, the paper’s core argument helps to illuminate the persistently aesthetic nature of interpersonal affections. (shrink)

Some reasons are thought to depend on relations between people, such as that of a promiser to a promisee. It has sometimes been assumed that all reasons that are relational in this way are moral obligations. I argue, via a counter example, that there are non-obligatory relational reasons. If true, this has ramifications for relational theories of morality.

How does microbiota research impact our understanding of biological individuality? We summarize the interdisciplinary summer school on "Microbiota, Symbiosis and Individuality: Conceptual and Philosophical Issues" (July 2019), which was supported by a European Research Council starting grant project "Immunity, DEvelopment, and the Microbiota" (IDEM). The summer school centered around interdisciplinary group work on four facets of microbiota research: holobionts, individuality, causation, and human health. The conceptual discussion of cutting-edge empirical research provided new insights into microbiota and highlights the value of (...) incorporating into meetings experts from other disciplines, such as philosophy and history of science. (shrink)

Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)

Calls for compensation are heard in many countries all over the world. Spokespersons on behalf of formerly oppressed and dominated groups call for compensation for the deeply traumatic injustices their members have suffered in the past. Sometimes these injustices were suffered decades ago by members already deceased. How valid are such claims to compensation and should they be honoured as a matter of justice? The focus of this essay is on these issues of compensatory justice. I want to look at (...) the issue from the perspective of the eradication of systematic poverty affecting particular groups—where injustices of the distant past can reliably be identified as one of the major contributory factors to people’s current poverty. In the paper I will examine the following issues: (1) What kind of injustices qualify to be remedied by means of compensatory justice? (2) Should there be a limit to how far back in history one should go to compensate for injustice? (3) How can an injustice from the distant past be reliably identified as a cause of current problems? (4) Who should be compensated? (5) Who is responsible for compensation? (6) What form should compensation take? (7) Is the concept of compensatory justice backward looking or forward looking? I will argue for a moral obligation to the effect that serious injustices, perpetrated long ago against a group of people and caused them to be poor, ought to be compensated by society in a variety of ways to the original victims (if still alive) and their descendants. (shrink)

Rawls champions the cause of the poor because of his strong moral sentiments about the eradication of poverty. I present these sentiments, which he converts into normative elements of his theory of justice. However, the conceptual framework and intellectual resources that he uses to articulate these sentiments are inadequate. His sentiments against poverty cannot be accommodated neatly, simply, and coherently in his liberal theoretical framework. Also, I point out that his definition of the identification of poor people as the least (...) advantaged members of society is not adequate. Therefore, his theory is refashioned so that it can properly account for the fundamental interests of poor people. An alternative conception is presented, revising Rawlsian liberalism to enable it to adequately champion the cause of the poor. I provide an alternative definition of poverty and apply Mill’s analysis of the relation between justice and utility to Rawls’ theory of justice. (shrink)

If humans may indeed legitimately intervene in conservation areas to let nature be and to protect the lives of all the diverse individual animals under their care, then the management of elephants must be legitimate as part of the conservation of natural world diversities. If this is so, to what extent are current management options ethically acceptable? In this article I address the ethics of the management options available once the judgement has been made that there are too many elephants (...) in a conservation area. I evaluate the ethical acceptability of four options, i.e., the simulation of nature, translocation, contraception, and culling. I furthermore ask whether the harsh blow of culling under very specific conditions can be softened by the taming and training of African elephants. I then examine the ethics of decision making about these issues. Before I do so, two issues must be discussed that decisively influence the management of elephants. The one is whether it is ethically justifiable to fence in elephants. The second is the ethical requirements of the scientific practice that informs management decisions. In the article I come to the conclusion that all four options are ethically flawed. All four require some violation of the important injunction to let nature be and to treat individual animals with respect. However, to do nothing and allow a loss of other species violates the important goal of conserving natural world diversity. (shrink)

In this article I present an alternative philosophy of science based on ideas drawn from the study of complex adaptive systems. As a result of the spectacular expansion in scientific disciplines, the number of scientists and scientific institutions in the twentieth century, I believe science can be characterised as a complex system. I want to interpret the processes of science through which scientists themselves determine what counts as good science. This characterisation of science as a complex system can give an (...) answer to the question why the sciences are so successful in solving growing numbers of problems and correcting their own mistakes. I utilise components of complexity theory to explain and interpret science as a complex system. I first explain the concept of complexity in ordinary language. The explanation of science as a complex system starts with a definition of the basic rules that guide the behaviour of science as a complex system. Next, I show how various sciences result through the implementation of these rules in the study of a specific aspect of reality. The explanation of the growth of science through evolutionary adaptation and learning forms the core of the article. (shrink)

Culling seems to be a cruel method of human interference in the lives of elephants. The method of culling is generally used to control population numbers of highly developed mammals to protect vegetation and habitat for other less important species. Many people are against human interference in the lives of elephants. In this article aspects of this highly controversial issue are explored. Three fascinating characteristics of this ethical dilemma are discussed in the introductory part, and then the major arguments raised (...) against human interference in the lives of elephants are evaluated. These arguments are the following: First, that nature should be allowed to run its course and establish its own balance; nature will thus solve the problem of elephant overpopulation. The second argument raised by animal-rights activists as well as by animal-welfare groups either claim that animals have rights that humans must respect at all times, or that all sentient beings have interests that humans ought to respect, as those beings can experience pleasure or pain. The third argument often associates culling elephants as method for population control with the commercial use and exploitation of wilderness areas. Many people argue that it is unethical to use wildlife as a sustainable resource for fighting poverty. In conclusion it is stated that despite these arguments human intervention in the lives of elephants are ethically justified. (shrink)

Awareness of, and respect for differences of gender, race, religion, language, and culture have liberated many oppressed groups from the hegemony of white, Western males. However, respect for previously denigrated collective identities should not be allowed to confine individuals to identities constructed around one main component used for political mobilisation, or to identities that depend on a priority of properties that are not optional, like race, gender, and language. In this article I want to sketch an approach for accommodating different (...) kinds of identity within a multicultural constitutional democracy. From a vantage point provided by a definition and explanation of personal identity, I want to show how people define, construct and change their personal identities to make themselves into unique individuals. Next I show how democratic political institutions and the personal identities of individuals reciprocally influence one another. In the final section I sketch ways in which diverse personal identities ought to be accommodated in multicultural constitutional democracies. The conclusion is that a society which gives its members the liberty, space, and opportunity to freely construct their own identities might avoid the formation of closed groups committed exclusively to their own sectional interests. (shrink)

Can a man be a feminist? If so, what would it mean? I want to participate in a dialogue between women and men on how to accommodate women’s moral concerns. I propose that the fundamental values of justice embodied in the South African constitutional democracy require men to be feminist. These values provide the best safeguard of the important interests and values of both women and men. Men who accept these values can support the main concerns of feminism. The implications (...) of the argument in this article range from public issues to the most private aspects of marriage. (shrink)

It is common for people to be sensitive to aesthetic qualities in one another’s speech. We allow the loveliness or unloveliness of a person’s voice to make impressions on us. What is more, it is also common to allow those aesthetic impressions to affect how we are inclined to feel about the speaker. We form attitudes of liking, trusting, disliking or distrusting partly in virtue of the aesthetic qualities of a person’s speech. In this paper I ask whether such attitudes (...) could ever be legitimate. This is a microcosm of the broader issue of whether people’s aesthetic qualities in general can justify the interpersonal valuing-attitudes that they so often cause. I draw from recent discussions of body aesthetics to articulate a pair of challenges. One challenge says that aesthetic judgements of speech are reliant on unjustifiable prejudices. The other holds that a person’s aesthetic qualities are irrelevant to whether they should be liked. Against these challenges I argue that some speech can bear aesthetic qualities which are not reliant on prejudice and which are relevant to whether the speaker should be liked. I develop this argument through an analysis of the concept of lyricism. (shrink)

Being able to ask others to do things, and thereby giving them reasons to do those things, is a prominent feature of our interpersonal lives. In this paper, I discuss the distinctive normative status of requests – what makes them different from commands and demands. I argue for a theory of this normative phenomenon which explains the sense in which the reasons presented in requests are a matter of discretion. This discretionary quality, I argue, is something that other theories cannot (...) accommodate, though it is a significant aspect of the relations that people stand in to one another, and the kinds of practical reasons that flow from those relations. (shrink)

A lineage of prominent philosophers who have discussed the second-person relation can be regarded as advancing structural accounts. They posit that the second-person relation effects one transformative change to the structure of practical reasoning. In this paper, I criticise this orthodoxy and offer an alternative, substantive account. That is, I argue that entering into second-personal relations with others does indeed affect one's practical reasoning, but it does this not by altering the structure of one's agential thought, but by changing what (...) reasons can become available. The importance of second-personal thought for action is heterogenous. Second-person relations make possible the emergence of a wide variety of different kinds of practical reasons: creating some, revealing others. Recognising this diminishes the appeal of the traditional, structural accounts of the practical significance of such second-personal relations. Moving away from structural accounts facilitates a more thorough understanding of the intersubjective form of action. (shrink)

The ethical philosophy of Emmanuel Levinas is typically associated with a punishing conception of responsibility rather than freedom. In this chapter, our aim is to explore Levinas’s often overlooked theory of freedom. Specifically, we compare Levinas’s account of freedom to the Kantian (and Fichtean) idea of freedom as autonomy and the Hegelian idea of freedom as relational. Based on these comparisons, we suggest that Levinas offers a distinctive conception of freedom—“finite freedom.” In contrast to Kantian autonomy, finite freedom constitutively involves (...) standing in certain social relations with others. And in contrast to Hegelian relational freedom, the social relations involved in finite freedom are not defined by mutual recognition, but by feelings of separation and even antagonism. Along the way, we promote a reading Levinas’s Totality and Infinity as a Hegel-style story of Bildung (development), and show how, on Levinas’s view, freedom can develop or mature in the life of the individual. (shrink)

At the heart of Levinas’s work is the apparently simple idea that through the encounter with another person, we are forced to give up our self-concern and take heed of the ethical relation between us. But, while simple on the surface, when one tries to characterize it in more detail, it can be hard to fit together the various ways in which Levinas talks about this relation and to identify precisely what he took its normative structure to be, as this (...) is described in a number of apparently different ways, that are not obviously compatible or equivalent, such as “command,” “call,” “summons,” “demand,” and so on. In this chapter, we intend to focus on these different characterizations and show what makes them different while also endeavoring to find a way in which Levinas’s conception may nonetheless be fitted together into a coherent account of the face-to-face encounter that is at the heart of his ethics. We will begin by considering the different normative terms used to characterize the encounter in that text and show how they are conceptually distinct from one another; we will then offer a way to read Levinas’s position to nonetheless show how these different normative relations can be fitted together into a stable position. (shrink)

Some time ago, Joel Katzav and Brian Ellis debated the compatibility of dispositional essentialism with the principle of least action. Surprisingly, very little has been said on the matter since, even by the most naturalistically inclined metaphysicians. Here, we revisit the Katzav–Ellis arguments of 2004–05. We outline the two problems for the dispositionalist identified Katzav in his 2004 , and claim they are not as problematic for the dispositional essentialist at it first seems – but not for the reasons espoused (...) by Ellis. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

Both Philip and Andrew are philosophy students whose interests converge around the philosophy of technology broadly understood. Philip's interest is specifically aimed toward the ethics of Transhumanism and depictions of Transhumanism in works of fiction. On the other hand, Andrew finds himself more focused on religious behavior in the technological world. While the two perspectives might not seem that close, there is certain to be an overlap in Andrew and Philip's shared understanding of how technological phenomena play a crucial role (...) concerning religion and society. (shrink)

Objective: To examine the current ethical review process of ethics committees in a non-pharmacological trial from the perspective of a clinical investigator.Design: Prospective collection of data at the Study Centre of the German Surgical Society on the duration, costs and administrative effort of the ERP of a randomised controlled multicentre surgical INSECT Trial between November 2003 and May 2005.Setting: Germany.Participants: 18 ethics committees, including the ethics committee handling the primary approval, responsible overall for 32 clinical sites throughout Germany. 8 ethics (...) committees were located at university medical schools and 10 at medical chambers. Duration was measured as days between submission and receipt of final approval, costs in euros and administrative effort by calculation of the product of the total number of different types of documents and the mean number of copies required .Results: The duration of the ERP ranged from 1 to 176 days. The median duration was 26 days at MSUs compared with 34 days at medical chambers. The total cost was €2947. 1 of 8 ethics committees at universities and 8 of 10 at medical chambers charged a median fee of €162 . The administrative effort for primary approval was 30. Four ethics committees required a higher administrative effort for secondary approval .Conclusion: The ERP for non-pharmacological multicentre trials in Germany needs improvement. The administrative process has to be standardised: the application forms and the number and content of the documents required should be identical or at least similar. The fees charged vary considerably and are obviously too high for committees located at medical chambers. However, the duration of the ERP was, with some exceptions, excellent. A centralised ethics committee in Germany for multicentre trials such as the INSECT Trial can simplify the ERP for clinical investigators in and outside the country. (shrink)

Amidst the lively and often highly positive reception of this best-selling collection of six essays in feminist philosophy, some critics have complained that it does not seem to argue for very much...

Graduates' employability indicates the excellent education and relevant preparation they obtained from their respective degrees. Tracer studies have enabled higher education institutions to profile their graduates while also reflecting on the quality of education they provide. With the foregoing, a tracer study determined the demographic and academic profile of teacher education graduates from 2017 to 2020 in a state university in the West Philippines. It also ascertained the advanced studies they attended after college, their employment data, the relevance of college (...) preparation with their current employment, difficulties they encountered while securing employment and in their present job, and recommendations to strengthen the teacher education program. The study utilized a descriptive survey research design with 80 non-random samples chosen based on availability. The survey was based on the Philippine Commission on Higher Education with modifications elucidated from previous studies. Results showed that graduates took the teacher education program with a strong passion for the teaching profession. More graduates received honors and awards, passed the licensure examinations for teachers, attended advanced studies for professional development, and are employable. Besides, the graduates’ college preparation is relevant to their current employment. Further, difficulties and problems encountered and recommendations to strengthen the teacher education program were noted. These findings may serve as a baseline for curriculum review and give suggestions for future tracer studies. (shrink)

Initial responses to questionnaires used to assess participants' understanding of informed consent for malaria vaccine trials conducted in the United States and Mali were tallied. Total scores were analyzed by age, sex, literacy (if known), and location. Ninety-two percent (92%) of answers by United States participants and 85% of answers by Malian participants were correct. Questions more likely to be answered incorrectly in Mali related to risk, and to the type of vaccine. For adult participants, independent predictors of higher scores (...) were younger age and female sex in the United States, and male sex in Mali. Scores in the United States were higher than in Mali (P = 0.005). Despite this difference participants at both sites were well informed overall. Although interpretation must be qualified because questionnaires were not intended as research tools and were not standardized among sites, these results do not support concerns about systematic low understanding among research participants in developing versus developed countries. (shrink)

REMARKS ON EVOLUTION AND TIME-SCALES, Graham Cairns-Smith; HODGSON'S BLACK BOX, Thomas Clark; DO HODGSON'S PROPOSITIONS UNIQUELY CHARACTERIZE FREE WILL?, Ravi Gomatam; WHAT SHOULD WE RETAIN FROM A PLAIN PERSON'S CONCEPT OF FREE WILL?, Gilberto Gomes; ISOLATING DISPARATE CHALLENGES TO HODGSON'S ACCOUNT OF FREE WILL, Liberty Jaswal; FREE AGENCY AND LAWS OF NATURE, Robert Kane; SCIENCE VERSUS REALIZATION OF VALUE, NOT DETERMINISM VERSUS CHOICE, Nicholas Maxwell; COMMENTS ON HODGSON, J.J.C. Smart; THE VIEW FROM WITHIN, Sean Spence; COMMENTARY ON HODGSON, Henry Stapp.

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, Sjöberg, (...) Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

This chapter describes the potential far‐reaching consequences of contemplative higher education for the fields of science and medicine.

This paper is a study about Philadelphia’s comprehensive user engagement sites (CUESs) as the authors address and examine issues related to the upcoming implementation of a CUES while seeking solutions for its disputed questions and plans. Beginning with the federal drug schedules, the authors visit some of the medical and public health issues vis-à-vis safe injection facilities (SIFs). Insite, a successful Canadian SIF, has been thoroughly researched as it represents a paradigm for which a Philadelphia CUES can expand upon. Also, (...) the existing criticisms against SIFs are revisited while critically unpackaged and responded to in favor of the establishment. In the main section, the authors propose the layout and services of the upcoming CUES, much of which would be in congruent to Vancouver’s Insite. On the other hand, the CUES would be distinct from Insite, as the authors emphasize, in that it will offer an information center run by individuals in recovery and place additional emphasis on early education for young healthcare professionals by providing them a platform to work at the site. The paper will also briefly investigate the implementation of a CUES site under an ethical scope of the Harm Reduction Theory. Lastly, the authors recommend some strategic plans that the Philadelphia City government may consider employing at this crucial stage. (shrink)

The Twin Earth thought experiment invites us to consider a liquid that has all of the superficial properties associated with water (clear, potable, etc.) but has entirely different deeper causal properties (composed of “XYZ” rather than of H2O). Although this thought experiment was originally introduced to illuminate questions in the theory of reference, it has also played a crucial role in empirically informed debates within the philosophy of psychology about people’s ordinary natural kind concepts. Those debates have sought to accommodate (...) an apparent fact about ordinary people’s judgments: Intuitively, the Twin Earth liquid is not water. We present results from four experiments showing that people do not, in fact, have this intuition. Instead, people tend to have the intuition that there is a sense in which the liquid is not water but also a sense in which it is water. We explore the implications of this finding for debates about theories of natural kind concepts, arguing that it supports views positing two distinct criteria for membership in natural kind categories – one based on deeper causal properties, the other based on superficial, observable properties. (shrink)

Abstract: A novel quadric-dentate demi-macrocycle of the type [C14H30N2O2] (ClO4)2¯ was synthesized by 1:2 condensation reaction at high dilution process. The desired demi-macrocycle was characterized by spectral methods such as UV-visible, IR, 1HNMR and elemental analysis. The results obtained were in close conformity with properties and proposed structure.