Protection of human participants is a fundamental facet of biomedical research. We report the activities of a health service research study in which there were three institutional review boards (IRBs), three legal departments and one research administration department providing recommendations and mandating changes in the study methods. Complying with IRB requirements can be challenging, but can also adversely affect study outcomes. Multiple protocol changes mandated from multiple IRBs created a research method that was not reflective of how substance use screening (...) would be performed in a clinical setting. There was direct conflict between the IRBs' perceptions of participants' protection with the researchers' need to use research methodology that assures the clinical relevancy of results. (shrink)

This book provides practical and research-based chapters that offer greater clarity about the particular kinds of teacher reflection that matter and avoids talking about teacher reflection generically, which implies that all kinds of reflection are of equal value.

Sister (Sr.) Marie Simone Roach, of the Sisters of St. Martha of Antigonish, Nova Scotia, died at the Motherhouse on 2 July 2016 at the age of 93, leaving behind a rich legacy of theoretical and practical work in the areas of care, caring and nursing ethics. She was a humble soul whose deep and scholarly thinking thrust her onto the global nursing stage where she will forever be tied to a central concept in nursing, caring, through her Six (...) Cs of Caring model. In Canada, she was the lead architect of the Canadian Nurses Association's first code of ethics, and her influence on revisions to it is still profound more than 35 years later. In this paper, four global scholars in nursing and ethics are invited to reflect on Sr. Simone's contribution to nursing and health‐care, and we link her work to nursing and health‐care going forward. (shrink)

Information can be public among a group. Whether or not information is public matters, for example, for accounts of interdependent rational choice, of communication, and of joint intention. A standard analysis of public information identifies it with (some variant of) common belief. The latter notion is stipulatively defined as an infinite conjunction: for p to be commonly believed is for it to believed by all members of a group, for all members to believe that all members believe it, and so (...) forth. This analysis is often presupposed without much argument in philosophy. Theoretical entrenchment or intuitions about cases might give some traction on the question, but give little insight about why the identification holds, if it does. The strategy of this paper is to characterize a practical-normative role for information being public, and show that the only things that play that role are (variants of) common belief as stipulatively characterized. In more detail: a functional role for “taking a proposition for granted” in non-isolated decision making is characterized. I then present some minimal conditions under which such an attitude is correctly held. The key assumption links this attitude to beliefs about what is public. From minimal a priori principles, we can argue that a proposition being public among a group entails common commitment to believe among that group. Later sections explore partial converses to this result, the factivity of publicity and publicity from the perspective of outsiders to the group, and objections to the aprioricity of the result deriving from a posteriori existential presuppositions. (shrink)

Psychiatry uncomfortably spans biological and psychosocial perspectives on mental illness, an idea central to Engel's biopsychosocial paradigm. This paradigm was extremely ambitious, proposing new foundations for clinical practice as well as a non-reductive metaphysics for mental illness. Perhaps given this scope, the approach has failed to engender a clearly identifiable research programme. And yet the view remains influential. We reassess the relevance of the biopsychosocial paradigm for psychiatry, distinguishing a number of ways in which it could be (re)conceived.

Human enhancement has emerged in recent years as a blossoming topic in applied ethics. With continuing advances in science and technology, people are beginning to realize that some of the basic parameters of the human condition might be changed in the future. One important way in which the human condition could be changed is through the enhancement of basic human capacities. If this becomes feasible within the lifespan of many people alive today, then it is important now to consider the (...) normative questions raised by such prospects. The answers to these questions might not only help us be better prepared when technology catches up with imagination, but they may be relevant to many decisions we make today, such as decisions about how much funding to give to various kinds of research. Enhancement is typically contraposed to therapy. In broad terms, therapy aims to fix something that has gone wrong, by curing specific diseases or injuries, while enhancement interventions aim to improve the state of an organism beyond its normal healthy state. However, the distinction between therapy and enhancement is problematic, for several reasons. First, we may note that the therapy-enhancement dichotomy does not map onto any corresponding dichotomy between standard-contemporary-medicine and medicineas-it-could-be-practised-in-the-future. Standard contemporary medicine includes many practices that do not aim to cure diseases or injuries. It includes, for example, preventive medicine, palliative care, obstetrics, sports medicine, plastic surgery, contraceptive devices, fertility treatments, cosmetic dental procedures, and much else. At the same time, many enhancement interventions occur outside of the medical framework. Office workers enhance their performance by drinking coffee. Make-up and grooming are used to enhance appearance. Exercise, meditation, fish oil, and St John’s Wort are used to enhance mood. Second, it is unclear how to classify interventions that reduce the probability of disease and death.. (shrink)

S es un biólogo, un médico, un profesor, un gobierno, un periodista, un usuario de Twitter, Facebook, o YouTube, o una persona común y corriente. Supongamos también que P es el coronavirus SARS-CoVid-2, su origen, su potencial de infestación, patógeno y pandémico. S conoce P, es decir, que su creencia sobre P es verdadera y justificada. El objetivo de este artículo es argumentar que el reduccionismo epistemológico limita el reclamo de S, cuya superación marca los derroteros de la virología, la (...) epidemiologia, así como de la ética y la política para enfrentar la pandemia del COVID-19. (shrink)

Should we regard Jennifer Lackey’s ‘Creationist Teacher’ as understanding evolution, even though she does not, given her religious convictions, believe its central claims? We think this question raises a range of important and unexplored questions about the relationship between understanding, factivity and belief. Our aim will be to diagnose this case in a principled way, and in doing so, to make some progress toward appreciating what objectual understanding—i.e., understanding a subject matter or body of information—demands of us. Here is the (...) plan. After some ground clearing in §1, §2 outlines and motivates a plausible working model—moderate factivity—for characterising the sense in which objectual understanding should be regarded as factive. §3 shows how the datum that we can understand false theories can, despite initial suggestions to the contrary, be assimilated straightforwardly within the moderate factivity model. §4 highlights how the inverse kind of case to that explored in §3—viz., a variant of Lackey’s creationist teacher case—poses special problems for moderate factivity. With reference to recent work on moral understanding by Hills, §5 proposes a solution to the problem, and §6 attempts to diagnose why it is that we might originally have been led to draw the wrong conclusion. (shrink)

Three major strategies exist for the protection of endangered habitat and species: (1) land acquisition programs, (2) government legislation and regulatory agencies, and (3) "stewardship" programs that are voluntary and community-based. While all of these strategies have merit, we suggest that stewardship holds particular advantages and should be considered more often as a strategy of first choice. In this article, we examine the Municipal Wetland Stewardship program of Newfoundland, a popular and successful Canadian policy for the local protection of wetlands. (...) Important issues are at stake: competing philosophical foundations for managerial ecology, the value of "local ecological knowledge," principles of community-based conservation, the question of whether stewardship empowers local communities or controls them from afar, and ethical conflicts around American colonialism, hunting, and ecotourism. The results suggest that despite some potentially problematic ironies, the Newfoundland program provides a model for a public policy aimed both at the pragmatics of biophysical sustainability and at the ideals of environmental ethics, social justice, and democratic politics. (shrink)

There is a long tradition in philosophy of using a priori methods to draw conclusions about what is possible and what is necessary, and often in turn to draw conclusions about matters of substantive metaphysics. Arguments like this typically have three steps: first an epistemic claim , from there to a modal claim , and from there to a metaphysical claim.

Transformative technologies can radically alter human lives making us stronger, faster, more resistant to disease and so on. These include enhancement technologies as well as cloning and stem cell research. Such technologies are often approved of by many liberals who see them as offering us opportunities to lead better lives, but are often disapproved of by conservatives who worry about the many consequences of allowing these to be used. In this paper, we consider how a democratic government with mainly liberal (...) values that is governing a population divided between liberals and conservatives can introduce new transformative technologies and try to achieve consensus about the introduction of such technologies. To do so, we draw on recent work in moral psychology which enables us to better understand the intuitive and emotional responses that underpin conservative objections to such new technologies. We then show how a government may introduce incremental changes in our social practices that have the long-term effect of weakening conservative objections to transformative technologies and better enabling governments to achieve consensus about these. (shrink)

Living out of silence, out of a fully functioning, lovingly attentive mind, and not just out of thought, out of a partially functioning mind, is requisite for depth or profundity in living or relating. A fully attentive, truly silent or meditative mind sees that there is real dualism of time and the timeless and that time and the timeless each has its own unique value. The timeless, or real silence, that which alone can make for depth in one's living and (...) relating, can be there only when, in one's awareness, time and all that is related to time, have come to an end. An examination of a wide variety of statements made by writers, both past and present, shows that these understandings are seldom there in contemporary writings, just as they were not there in writings that have come down to us from the past. 'Living beyond the One and the Many' invites readers to consider the possibility that what is presented in it can bring deep meaning to one's way of living in the world"--Publisher's description, back cover. (shrink)

We consider the current debate between bioconservatives and their opponents—whom we dub bioliberals—about the moral acceptability of human enhancement and the policy implications of moral debates about enhancement. We argue that this debate has reached an impasse, largely because bioconservatives hold that we should honour intuitions about the special value of being human, even if we cannot identify reasons to ground those intuitions. We argue that although intuitions are often a reliable guide to belief and action, there are circumstances in (...) which they are not reliable. Intuitions—including intuitions about enhancement—are subject to various cognitive biases rendering them unreliable in some circumstances. We argue that many bioconservative intuitions about enhancement are examples of such unreliable intuitions. Given this, it is unrealistic of bioconservatives to expect others to rely on their unexamined intuitions. Furthermore, refusing to engage in debates about the reasons and values that underpin their intuitions about enhancement will have the effect of making bioconservative voices less relevant in policy debates about enhancement than they would otherwise be. (shrink)

Some writers claim that ethicists involved in assessing future technologies like nanotechnology and human enhancement devote too much time to debating issues that may or may not arise, at the expense of addressing more urgent, current issues. This practice has been claimed to squander the scarce and valuable resource of ethical concern. I assess this view, and consider some alternatives to ‘speculative ethics’ that have been put forward. I argue that attempting to restrict ethical debate so as to avoid considering (...) unacceptably speculative scenarios would not only leave scientific progress devoid of ethical guidance, but would also rule out some of our most important ethical projects. I conclude that the issue of speculation is a red herring: what is most important is not that ethicists concentrate on current issues or those that are most likely to arise; but that ethicists, scientists, and others focus on maximising what is most valuable. (shrink)

Stanley Klein and Shaun Nichols describe the case of patient R.B., whose memories lacked the sense of “mineness” usually conveyed by memory. Klein and Nichols take R.B.’s case to show that the sense of mineness is merely a contingent feature of memory, which they see as raising two problems for memory-based accounts of personal identity. First, they see it as potentially undermining the appeal of memory-based accounts. Second, they take it to show that the conception of quasi-memory that underpins many (...) memory-based accounts is inadequate. I argue that Klein and Nichols’ characterization of R.B.’s experience is implausible; as a result, the problems that they describe for memory-based accounts of personal identity do not arise. (shrink)

We consider the current debate between bioconservatives and their chief opponents — whom we dub bioliberals — about the moral acceptability of human enhancement and the policy implications of moral debates about enhancement. We argue that this debate has reached an impasse, largely because bioconservatives hold that we should honour intuitions about the special value of being human, even if we cannot identify reasons to ground those intuitions. We argue that although intuitions are often a reliable guide to belief and (...) action, there are circumstances in which they are not reliable. Intuitions — including intuitions about enhancement — are subject to various cognitive biases rendering them unreliable in some circumstances. We argue that many bioconservative intuitions about enhancement are examples of such unreliable intuitions. Given this, it is unrealistic of bioconservatives to expect others to rely on their unexamined intuitions. Furthermore, refusing to engage in debates about the reasons and values that underpin their intuitions about enhancement will have the effect of making bioconservative voices less relevant in policy debates about enhancement than they would otherwise be. (shrink)

Protagoras, of all the ancient philosophers, has perhaps attracted the most interest in modern times. His saying ‘Man is the measure of all things’ caused Schiller to adopt him as the patron of the Oxford pragmatists, and has generally earned him the title of the first humanist. Yet the exact delineation of his philosophcal position remains a baffling task. Neumann, writing on Die Problematik des ‘Homo-mensura’ Satzes in 1938,2 concludes that no certainty whatever can be reached on the meaning of (...) the dictum, since ‘man’, ‘measure’, and ‘things’ are all ambiguous, nor can we tell which of the three is the predicate. The time is past when it was believed that a man's philosophy could be understood apart from the events of his life and the circumstances of his age: yet in the case of Protagoras the historical method of approach has hardly been attempted, although the impact of environment was perhaps more decisive in the formation of philosophical concepts in the Greek world than anywhere else. The reality about which the Greek philosopher spoke had three aspects: it was either the one universe of physics, or the political unity, or God. For example, the book of Heracleitus Περ φσεως was divided into three chapters or logoi, About the Whole, a political, and a theological. Neither physics nor theology supplies from its own subject-matter the form in which this reality was described. (shrink)

With contributions from psychiatry, psychology, neuroscience, and philosophy, this book provides the most comprehensive account to date of the interplay between biological, psychological, and social factors in mental health and their ethical dimensions.

(No abstract is available for this citation).

This chapter concentrates mainly on biomedical cognitive enhancements, but many of the remarks apply equally to enhancements that work on non‐cognitive capacities, and to non‐biomedical means of enhancement. Proponents of a positive right to enhancements could argue their case on grounds of fairness or equality, or on grounds of a public interest in the promotion of the capacities required for autonomous agency. The societal benefits of effective cognitive enhancement may turn out to be so large and unequivocal that it would (...) be economically efficient to subsidize enhancement for the poor, just as the state now subsidizes education. The example on iodine deficiency illustrates that cognitive enhancement policy need not center on preparing the ground for sophisticated, yet‐to‐be‐realized technologies. “Smart policy” should, rather, take as its starting point the recognition that effective cognition is not only subjectively valuable to individuals, but also delivers significant social, cultural, financial, and scientific benefits. (shrink)

Is it conceptually possible for one person to ‘remember’ the experiences of another person? Many philosophical discussions of personal identity suppose that this is possible. For example, some philosophers believe that our personal identity through time consists in the continuation of our mental lives, including the holding of memories over time. However, since a person’s memories are necessarily memories of her own experiences, a definition of personal identity in terms of memory risks circularity. To avoid this, we must invoke the (...) concept of ‘quasi-memory’. From my quasi-memory of doing x, I cannot infer that I did x; but I can infer that somebody did x. It is then a further question as to whether the person who did x is me, the answer to which will depend upon what we believe personal identity to consist in. Quasi-memory, then, allows us to separate the concept of memory from the concept of personal identity. (shrink)

The achievements of the textile industry in Roman Britain are often underestimated as a result of the meagreness of our available evidence. The Edict on maximum prices issued by Diocletian in A.D. 301 shows that British capes commanded high prices on the markets of the Empire, and that in the late third century A.D. British rugs were the best in the world. In view of the competition from the traditional centres of rug manufacture in the East, this is an astonishing (...) achievement. (shrink)

The received translation and interpretation of many of the technical terms current in the textile industry of the Roman Empire are inaccurate, because lexicographers have either fought shy of being precise, or have thought that they recognized in the ancient world technical processes which originated at a much later date. The evidence is often equivocal or insufficient, but may still yield details that have been overlooked. The textile expression scutulatus, to take an example, deserves more attention than Blümner has devoted (...) to it. When it refers to the appearance of a garment, Lewis and Short, s.v. scutulatus, translate ‘diamond or lozenge-shaped, checkered’. It seems worth while to attempt a more precise translation, and, if possible, to estimate the significance in context of the goods so designated. (shrink)

Is it conceptually possible for an event, L, to be the cause of an earlier event, E? Some writers have employed the so-called bilking argument to attempt to show that the idea of such backwards causation is incoherent . According to this argument, if we are presented with what someone claims to be a case of backwards causation, it would be possible in principle to wait for E to occur, and then intervene to prevent the occurrence of L, thus demonstrating (...) that E could not have been caused by L after all. Moreover, if our attempts to bilk L-type events having observed E-type events always fail, we have grounds to argue that any causal relationship between the two is not one of backwards causation, but of ordinary, forwards, earlier-to-later causation.Does the bilking argument succeed in showing backwards causation to be incoherent? Before answering this question, let us deal with a far simpler reason for deeming backwards causation incoherent, whose elucidation now will be useful later. To those attracted to the view that temporal order is determined by causal order, 1 backwards causation may seem incoherent because on this view a cause is by definition earlier than its effect. I do not take issue with this view, and wish my conception of backwards causation to be compatible with it. 2 By ‘backwards causation’, I mean causation that runs in the opposite direction to some other causal processes, such that the temporal order entailed by such backwards causation is the reverse of that entailed by those other causal processes. In most philosophical discussions of backwards causation, we are at least implicitly given reasons to believe that these other causal processes dictate the …. (shrink)

There is an apparent epidemic of mental illness. At the end of 2011, untreated mental disorders accounted for 13% of the total global burden of disease, and for 25.3% and 33.5% of all years lived with a disability in low-and middle-income countries, respectively. Depression affects 350 million people globally and is the leading cause of disability. One in five U.S. adults takes psychiatric medication. One study found that by age 32, 50% of people surveyed qualified for an anxiety disorder, more (...) than 40% for a mood disorder, and more than 30% for substance dependence. Another study reported that... (shrink)

If the world itself is metaphysically indeterminate in a specified respect, what follows? In this paper, we develop a theory of metaphysical indeterminacy answering this question.

The dominant image of judicial authority is emotional detachment; however, judicial work involves emotion. This presents a challenge for researchers to investigate emotions where they are disavowed. Two projects, one in Australia and another in Sweden, use multiple sociological research methods to study judicial experience, expression, and management of emotion. In both projects, observational research examines judicial officers’ display of emotion in court, while interviews investigate judicial emotional experiences. Surveys in Australia identify emotions judicial officers generally find important in their (...) work; in Sweden, shadowing allows researchers to investigate individual judicial emotion experiences and expression. Evaluating the different methods used demonstrates the limitations and effectiveness of particular research designs, the value of multiple methods and the challenges for researching emotion. (shrink)

This brief but ambitious book explores our relationship with nature through the imagery we use when we talk about Mother Nature. Employing the critical tools of religious studies, psychology, and gender studies, Catherine M. Roach examines the various manifestations of nature as "mother" and what that idea implies for the way we approach the natural world. Part One, "Nature as Good Mother," discusses the notion that nature is, or is like, a beneficent and nurturing mother who provides and maintains (...) life. In studying the "green" slogan "Love Your Mother," Roach questions the effects—for women and for the environment—of imputing female gender to nature. She asks us to look at the associations that "motherhood" and "mothering" carry within a culture still shaped by patriarchy. She notes the danger of such an apparently pro-environmental slogan if "mother" evokes the bountiful, self-sacrificing provider who herself requires no care. Part Two, "Nature as Bad Mother," looks at the contrary notion of nature as a violent, threatening, and wrathful mother. This image arises most often when humans and technology are depicted as masters of unruly nature. Here Roach draws on theological reflection to analyze this ambivalence toward nature manifested in a fantasy that casts humans as gods. She explores the contributions of eco-theology and eco-psychology to a "heart of darkness" perspective. Finally, Part Three, "Nature as Hurt Mother," looks at possibilities and pitfalls of environmental healing inherent in the image of nature as a mother we have wounded and now seek to heal. (shrink)

The Yoga Sutra of Patanjali is a classic Sanskrit treatise consisting of 195 “threads,” or aphorisms, describing the process of liberation through yoga. Although little is known about Patanjali (most scholars estimate that he lived in India circa 200–300 b.c.), his writings have long been recognized as a vital contribution to the philosophy and practice of yoga. This new, expert translation of the original Sanskrit text of Patanjali’s best-known work presents his seminal ideas and methods in accessible, plain-language English. Patanjali (...) organized the sutra into four parts: Samadhi (absorption), Sadhana (practice), Vibhuti (supernatural powers), and Kaivalya (liberation). Each represents a step in breaking free of our limited definition of consciousness and training the mind to achieve oneness with the universe. Geshe Michael Roach, one of the most respected teachers of Tibetan Buddhism in America and a renowned scholar of Sanskrit, provides authoritative commentary on each of the sutras. His notes and clarification are straightforward and highly readable, untainted by obscure, academic terminology or New Age jargon. The first edition of the Yoga Sutra to present a Buddhist perspective, this paperback original will be welcomed by students and spiritual seekers alike. (shrink)

Yoga came to Tibet from India more than a thousand years ago, and it was quickly absorbed into the culture's rich traditions. In this small book readers will discover Heart Yoga, which developed over the centuries in the Gelukpa tradition of the Dalai Lamas. The program presented here combines popular yoga exercises wtih special Tibetan poses, and methods of working from the inside to give a healthy and a happy heart. Roach discovered a number of previously unknown Tibetan works (...) on yoga in the course of his ongoing efforts to find and preserve ancient Tibetan Buddhist texts. He discusses the ideas and insights presented in these texts and places them within the context of the Buddhist tradition. To help readers incorporate this ancient wisdom in their daily lives, he provides a specific regime of yoga postures and meditations. Combining instructive illustrations with the unique philosophical underpinnings of the Buddhist approach, Geshe Roach has created a unique program for yoga on a physical and spiritual level. (shrink)

This book offers the first comprehensive introduction to wave scattering in nonstationary materials. G. F. Roach's aim is to provide an accessible, self-contained resource for newcomers to this important field of research that has applications across a broad range of areas, including radar, sonar, diagnostics in engineering and manufacturing, geophysical prospecting, and ultrasonic medicine such as sonograms. New methods in recent years have been developed to assess the structure and properties of materials and surfaces. When light, sound, or some (...) other wave energy is directed at the material in question, "imperfections" in the resulting echo can reveal a tremendous amount of valuable diagnostic information. The mathematics behind such analysis is sophisticated and complex. However, while problems involving stationary materials are quite well understood, there is still much to learn about those in which the material is moving or changes over time. These so-called non-autonomous problems are the subject of this fascinating book. Roach develops practical strategies, techniques, and solutions for mathematicians and applied scientists working in or seeking entry into the field of modern scattering theory and its applications. Wave Scattering by Time-Dependent Perturbations is destined to become a classic in this rapidly evolving area of inquiry. (shrink)

Background Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design. Methods We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. (...) We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism. Results Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism. Conclusions Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism. (shrink)

Decency remains one of the most prevalent yet least understood terms in today's political discourse. In evoking respect, kindness, courage, integrity, reason, and tolerance, it has long expressed an unquestioned duty and belief in promoting and protecting the dignity of all persons. Today this unquestioned belief is in crisis. Tribalism and identity politics have both hindered and threatened its moral stability and efficacy. Still, many continue to undertheorize its political character by isolating it from the effects of identity politics. Decency (...) and Difference argues that decency is a primary source of the political tension that has long shaped the struggles for power, identity, and justice in the global arena. It distinguishes among basic, conservative, and liberal strands of decency to critically examine the many conflicting and competing applications of decency in global politics. Together these different stands reflect a long and uneven evolution from the British and American Empire to a global network of justice. By engaging the contradictions of the progressive and retrogressive qualities of decency and the role played by emotion and affect in driving these contradictions, the book exposes the propriety gaps of decency and the disparate ways that it is practiced in global politics. The book thus addresses the global challenge of reconciling different political proprieties and configuring a diverse political ethic of decency. (shrink)