Last year, the Joint Commission on Accreditation of Healthcare Organizations for the first time included provisions in its Hospital Accreditation Manual requiring institutions to have mechanisms in place to consider ethical issues arising in the care of patients and to educate care givers and patients on bioethical issues. This new requirement is notably vague. There is no indication of what type of mechanisms would be appropriate or how those involved in considering ethical issues should conduct themselves. This vagueness is by (...) no means accidental, but it reflects a recognition that clinical bioethics is still in its formative stages and that there are currently almost as many different mechanisms for dealing with bioethical issues in the healthcare setting as there are institutions that have such mechanisms. The Joint Commission's action, however, also implies that the time for experimentation will soon be over. (shrink)

Industry-sponsored biomedical research is under the microscope. In an attempt to achieve just results in extraordinary cases, critics are suggesting regulations that would pervert the U.S. clinical trial process. However, the arguments made to justify such regulation are weak at best. All the proposals to regulate industry sponsorship of clinical trials that we surveyed suffer from some form of fallacious reasoning. In the interest of advocating sound policy, this article points out some of the most common reasoning errors found in (...) the literature on financial conflicts of interest in clinical trials. (shrink)

There is no doubt that industry-sponsored biomedical research is under the microscope. Unfortunately, this new era of skepticism prematurely rushes in doubts of the ethos of science. Skepticism can lead to positive changes, but only when timely and supported by sound reasoning. Snapshot views and theories, especially those that result in costly new regulations and inefficient policies often do more harm than good. Many critics would have the reader doubt scientific integrity because they believe that the relationship between the pharmaceutical (...) industry and biomedical research poses an unavoidable and dangerous conflict of interest. However, these conflicts are neither unavoidable nor dangerous per se. (shrink)

Hospital ethics committees have become widespread over the last 25 years, stimulated by the Quinlan decision of the New Jersey Supreme Court, the report of a President's Commission, and most recently by the Joint Commission on Accreditation of Health Care Organizations , which now man dates that each hospital seeking accreditation have a functioning process for the consideration of ethical issues in patient care. Laws and regulations in several states require that hospitals establish ethics committees, and some states stipulate that (...) certain types of cases and disputes be taken to such committees. At least one state grants legal immunity to those who implement recommendations of an ethics committee. (shrink)

Hospital ethics committees have become widespread over the last 25 years, stimulated by the Quinlan decision of the New Jersey Supreme Court, the report of a President's Commission, and most recently by the Joint Commission on Accreditation of Health Care Organizations, which now man dates that each hospital seeking accreditation have a functioning process for the consideration of ethical issues in patient care. Laws and regulations in several states require that hospitals establish ethics committees, and some states stipulate that certain (...) types of cases and disputes be taken to such committees. At least one state grants legal immunity to those who implement recommendations of an ethics committee. (shrink)

Doping scandals can reveal unresolved tensions between the meritocratic values of equal opportunity + reward for effort and the “talentocratic” love of hereditary privilege. Whence this special reverence for talent? We analyze the following arguments: (1) talent is a unique indicator of greater potential, whereas doping enables only temporary boosts (the fluke critique); (2) developing a talent is an authentic endeavor of “becoming who you are,” whereas reforming the fundamentals of your birth suit via artifice is an act of alienation (...) (the phony critique); (3) your (lack of) talent informs you of your proper place and purpose in life, whereas doping frustrates such an amor fati self-understanding (the fateless critique). We conclude that these arguments fail to justify a categorical preference for natural talent over integrated artifice. Instead, they illustrate the extent to which unsavory beliefs about “nature’s aristocracy” may still be at play in the moral theatre of sports. (shrink)

Sigrid Fry-Revere’s The Kidney Sellers: A Journey of Discovery in Iran, an allegedly first-hand examination of the Iranian paid kidney donation model, has been criticized by Koplin in an essay formerly published in the Monash Bioethics Review. Koplin especially challenges Fry-Revere’s claim that financially compensating kidney vendors might facilitate altruistic kidney donation. The current situation in Iran, according to Koplin, suggests that the market model has undermined altruistic donation. On this point, this commentary tries to show that (...) healthcare policymakers in Iran no longer see the Iranian paid kidney donation model as a sustainable and ethically justifiable status quo. Briefly touching on the criticisms that have been made even by some positive commentators of the Iranian model, this commentary aims to call attention to the fact that the current dynamic within healthcare policymaking in Iran seeks primarily to decrease its reliance on the organ market instead of revising and modifying it. This complicates the plausibility of any kind of extrapolation, replication or extracting empirical support from the Iranian model to create organ markets in other countries, for example, as Fry-Revere suggests to conduct a trial of a financially incentivized kidney donation scheme in the US. The conclusion is that the Iranian healthcare system should tackle the organ shortage through increasing altruistic living and postmortem kidney donations. This might also provide, finally, a space for conducting extensive and long-term follow-up studies on well-being, satisfaction and social integration of Iranian kidney vendors. (shrink)

Assembled here for the first time in English translation, Sigrid Weigel and Georgina Paul offer illuminating new insights into Benjamin's theory, combining impulses from post-structuralism, feminism, cultural anthropology and psychoanalysis.

Wie müssen wir zurückschauen, um Was sehen zu können und darüber unseren Blick für das Gegenwärtige und Kommende zu schärfen?0Die Beiträge des Bandes, der zu Ehren von Sigrid Schade erscheint, beziehen sich auf vielschichtige Diskursgeschichten an den Schnittstellen von Kunst-, Kultur- und Medienwissenschaften. Sie beleuchten künstlerische, kulturelle und soziale Praktiken und Ordnungen als Aushandlungsort komplexer Bedeutungs- und Beziehungsgefüge.

An extensive body of research documents that women experience a motherhood penalty at work whereas men experience a fatherhood premium. Yet much of this work presupposes that employers are aware of a worker’s parental status. Given the different consequences that parenthood has on outcomes such as pay and promotions, it is conceivable that men and women may deploy their status as parents differently when interacting with employers. Drawing on in-depth interviews with a racially diverse sample, this article examines how mothers (...) and fathers working in the service sector use their parental status when negotiating work and child care responsibilities. Mothers, particularly black mothers, were less likely to openly discuss their children at work. In some cases, women purposefully concealed from their employers the fact that they were mothers or found other ways of signaling their commitment to their jobs. Fathers, on the other hand, were more likely to discuss their children with their employers and overwhelmingly characterized their managers as understanding of their parenting obligations. Together, these findings help us understand how mothers and fathers navigate the consequences of parenthood in the workplace and add nuance to previous studies of motherhood penalties and fatherhood premiums. (shrink)

We expand on Della Croce’s ambition to interpret “epistemic injustice” as a specification of non-maleficence in the use of the influential four-principle framework. This is an alluring line of thought for conceptual, moral, and heuristic reasons. Although it is commendable, Della Croce’s attempt remains tentative. So does our critique of it. Yet, we take on the challenge to critically address two interrelated points. First, we broaden the analysis to include deliberations about hermeneutical injustice. We argue that, if due consideration of (...) epistemic injustice is to require more than negative ethical obligations in medicine, dimensions of hermeneutical injustice should be explored as an avenue to arrive at such positive duties. Second, and relatedly, we argue that this may encompass moral responsibilities beyond the individual level, that is: positive obligations to take action on a structural level. Building on Dotson’s concept of “contributory injustice” and Scheman’s concept of “perceptual autonomy,” we suggest that the virtues of testimonial and hermeneutical justice may provide additional content not only to negative prohibitions of action (i.e. non-maleficence) but also to positive requirements of action, like respecting patient autonomy. (shrink)

A semantics for interrogatives is presented which is based on Karttunen's theory, but in a flexible manner incorporates both weak and strong exhaustivity. The paper starts out by considering degree questions, which often require an answer picking out the maximal degree from a certain set. However, in some cases, depending on the semantic properties of the question predicate, reference to the minimal degree is required, or neither specifying the maximum nor the minimum is sufficient. What is needed is an operation (...) which defines the maximally informative answer on the basis of the Karttunen question denotation. Shifting attention to non-degree questions, two notions of answerhood are adopted from work by Heim. The first of these is weakly exhaustive and the second strongly exhaustive. The second notion of answerhood is proven to be equivalent to Groenendijk and Stokhof's interrogative semantics. On the basis of a wide range of empirical data showing that questions often are not interpreted exhaustively, it is argued that a fairly rich system of semantic objects associated with questions is needed to account for the various ways in which questions contribute to the semantics and pragmatics of the utterances in which they appear. (shrink)

Management of the renewable natural resources in Madagascar is gradually being transferred to the local communities, particularly that of forest resources. However, these local communities are struggling to assess the consequences of management plans that they themselves must develop and implement on ecologically, economically and socially sustainable grounds. In order to highlight key aspects of different management options beforehand, we have developed MIRANA, a computer model to simulate various scenarios of management plan implementation. MIRANA differs from other simulation models by (...) not only taking into account individual practices and economic exchanges, but also by accounting for the applicable regulations. These regulations are taken into consideration by means of a multiplicity of normative structures within a spatial context. The objective of this paper is to describe the representations of institutions, norms and territories proposed by MIRANA and to discuss these representations in relation to the state of the art in the field of normative multi-agent systems. (shrink)

An effectiveness assessment on ASCT in locally advanced and metastatic breast cancer identified serious ethical issues associated with this intervention. Our objective was to systematically review these aspects by means of a literature analysis. We chose the reflexive Socratic approach as the review method using Hofmann's question list, conducted a comprehensive literature search in biomedical, psychological and ethics bibliographic databases and screened the resulting hits in a 2-step selection process. Relevant arguments were assembled from the included articles, and were assessed (...) and assigned to the question list. Hofmann's questions were addressed by synthesizing these arguments. Of the identified 879 documents 102 included arguments related to one or more questions from Hofmann's question list. The most important ethical issues were the implementation of ASCT in clinical practice on the basis of phase-II trials in the 1990s and the publication of falsified data in the first randomized controlled trials (Bezwoda fraud), which caused significant negative effects on recruiting patients for further clinical trials and the doctor-patient relationship. Recent meta-analyses report a marginal effect in prolonging disease-free survival, accompanied by severe harms, including death. ASCT in breast cancer remains a stigmatized technology. Reported health-related-quality-of-life data are often at high risk of bias in favor of the survivors. Furthermore little attention has been paid to those patients who were dying. The questions were addressed in different degrees of completeness. All arguments were assignable to the questions. The central ethical dimensions of ASCT could be discussed by reviewing the published literature. (shrink)

This article investigates a multiparty interaction in an accounting office by applying a multimodal approach to discourse. This approach allows the incorporation of all relevant communicative modes and is based on the following three notions: 1) the notion of mediated action; 2) the notion of modal density; and 3) the notion of a foreground– background continuum of attention/awareness. The article illustrates that a social actor in a multiparty interaction simultaneously co-constructs several higher-level actions with the various participants on different levels (...) of their attention/awareness. On a theoretical level, the article argues that traditional approaches to discourse analysis, with their unconditional focus on language as the primary mode, misconstrue the multiple higher-level actions that a social actor is engaged in simultaneously as dyadic or triadic interactions in quick succession. (shrink)

New-born screening programs for congenital disorders and chronic disease are expanding worldwide and children “at risk” are identified by nationwide tracking systems at the earliest possible stage. These practices are never neutral and raise important social and ethical questions. An emergent concern is that a reflexive professionalism should interrogate the ever earlier interference in children’s lives. The Flemish community of Belgium was among the first to generalize the screening for hearing loss in young children and is an interesting case to (...) study the public justification of early interventions for families with deaf children. This article uses a critical lens to study the archive of the government child healthcare organization in Flanders in order to uncover underlying constructions of childhood, deafness, and preventive health. We focus on two interrelated themes. The first is the notion of exclusion of the human factor through the mediation of technology. The second is the idea of deafness as endangering a healthy development, an impairment that can nevertheless be treated if detected early enough. It is argued that, since deafness cannot be viewed as a life-threatening condition, the public interest which is implicitly defended is not the rescue of deaf children rather the exclusion of otherness. (shrink)

The paper provides a semantic analysis of intervention effects in wh-questions. The interpretation component of the grammar derives uninterpretability, hence ungrammaticality, of the intervention data. In the system of compositional interpretation that I suggest, wh-phrases play the same role as focused phrases, introducing alternatives into the computation. Unlike focus, wh-phrases make no ordinary semantic contribution. An intervention effect occurs whenever a focus-sensitive operator other than the question operator tries to evaluate a constituent containing a wh-phrase. It is argued that this (...) approach can capture the universal as well as the crosslinguistically variable aspects of intervention effects, in a way that is superior to previous approaches. Further consequences concern other focus-related constructions: multiple focus data, NPI licensing, and alternative questions. (shrink)