Volume 39 of the Tanner Lectures on Human Values includes lectures initially scheduled during the academic year 2019-2020. Owing to the global coronavirus pandemic, some were delivered at a later date. The Tanner Lectures are published in an annual volume. In addition to permanent lectures at nine universities, the Tanner Lectures on Human Values funds special one-time lectures at selected higher educational institutions in the United States and around the world.

This paper explores ethical issues relating to the management of patients who are terminally ill and unable to maintain their own nutrition and hydration. A policy of sedation without hydration or nutrition is used in palliative medicine under certain circumstances. The author argues that this policy is dangerous, medically, ethically and legally, and can be disturbing for relatives. The role of the family in management is discussed. This issue requires wide debate by the public and the profession.

The author reviews and continues the debate initiated by her recent paper in this journal. The paper was critical of certain aspects of palliative medicine, and caused Ashby and Stoffell to modify the framework they proposed in 1991. It now takes account of the need for artificial hydration to satisfy thirst, or other symptoms due to lack of fluid intake in the terminally ill. There is also a more positive attitude to the emotional needs and ethical views of the patient's (...) family and care-givers. However, clinical concerns about the general reluctance to use artificial hydration in terminal care remain, and doubts persist about the ethical and legal arguments used by some palliative medicine specialists and others, to justify their approach. Published contributions to the debate to date, in professional journals, are reviewed. Key statements relating to the care of sedated terminally ill patients are discussed, and where necessary criticised. (shrink)

Background: Legislation on physician-assisted suicide is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians.Objective: To determine variables predictive of physicians’ opinions on PAS in a rural state, Vermont, USA.Design: Cross-sectional mailing survey.Participants: 1052 physicians licensed by the state of Vermont.Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should (...) not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation . Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness . 30% of the respondents had experienced a request for assistance with suicide.Conclusions: Vermont physicians’ opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. (shrink)

In the human quest for meaning, work occupies a central position. Most adults spend the majority of their waking hours at work, which often serves as a primary source of purpose, belongingness, and identity. In light of these benefits to employees and their organizations, organizational scholars are increasingly interested in understanding the factors that contribute to meaningful work, such as the design of jobs, interpersonal relationships, and organizational missions and cultures. In a separate line of inquiry, scholars of business ethics (...) have examined meaningful work as a moral issue concerning the management of others and ourselves, exploring whether there are definable characteristics of meaningful work to which we have moral rights, and whether there are moral duties to ourselves and others to fulfill those rights. In this article, we examine contemporary developments in both disciplines about the nature, causes, and consequences of meaningful work; we explore linkages between these disciplines; and we offer conclusions and research opportunities regarding the interface of ethical and organizational perspectives on performing and providing meaningful work. (shrink)

The authors conducted a baseline survey of baccalaureate and graduate degree health humanities programs in the United States and Canada. The object of the survey was to formally assess the current state of the field, to gauge what kind of resources individual programs are receiving, and to assess their self-identified needs to become or remain programmatically sustainable, including their views on the potential benefits of program accreditation. A 56-question baseline survey was sent to 111 institutions with baccalaureate programs and 20 (...) institutions with graduate programs. Respondents were asked about three areas: (1) program administration (managing unit, paid director, faculty lines, paid staff, funding sources); (2) educational program (curricular structure, CIP code usage, completion rates); and (3) views on accreditation for the field. A clear majority of respondents agreed that some form of accreditation or consultation service could address resource and sustainability issues. Overall, the survey responses to staffing, curricular structure, and support suggest the need for developing a sustainable infrastructure for health humanities. (shrink)

Communication and Conflict Management Training for Clinical Bioethics Committees Content Type Journal Article Pages 341-349 DOI 10.1007/s10730-009-9116-7 Authors Lauren M. Edelstein, Johns Hopkins Medicine’s Howard County General Hospital 5755 Cedar Lane Columbia MD 21044 USA Evan G. DeRenzo, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Elizabeth Waetzig, Change Matrix Inc. 485 Maylin St. Pasadena CA 91105 USA Craig Zelizer, Georgetown University Department of Government 3240 Prospect St. Washington, D.C. NW 20057 USA Nneka (...) O. Mokwunye, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

Introduction Future HIV vaccine efficacy trials with adolescents will need to ensure that participants comprehend study concepts in order to confer true informed assent. A Hepatitis B vaccine trial with adolescents offers valuable opportunity to test youth understanding of vaccine trial requirements in general. Methods Youth reviewed a simplified assent form with study investigators and then completed a comprehension questionnaire. Once enrolled, all youth were tested for HIV and confirmed to be HIV-negative. Results 123 youth completed the questionnaire (mean age=15 (...) years; 63% male; 70% Hispanic). Overall, only 69 (56%) youth answered all six questions correctly. Conclusions Youth enrolled in a Hepatitis B vaccine trial demonstrated variable comprehension of the study design and various methodological concepts, such as treatment group masking. (shrink)

This book updates and adds to the classic Social Movements of the Sixties and Seventies, showing how social movement theory has grown and changed.

The Aristotelian-Thomist claim is that external actions can be morally evaluated when they are voluntary (which includes being based on reasonably accurate knowledge of what an agent is doing), absent which, in effect, we evaluate outcomes, not acts. Also, in the Aristotelian-Thomist tradition the internal act of the will is paramount. These claims contrast with some current theorizing, e.g., by Judith Jarvis Thomson, that morally evaluates actions separately from agents, downplaying the internal act. Taking cases from current authors that revolve (...) around ignorance of key facts, I critique their theorizing on the basis of the nature of agency, the nature of abstraction, the moral language we use in describing acts, the need for reasonably complete descriptions of acts, and the tendency of act evaluations to “leak” into agent evaluations in objective theories. I then describe how Thomas Aquinas’s account of moral evaluation avoids these problems and provides a superior, multi-dimensional framework for moral evaluation. (shrink)

The Aristotelian-Thomist claim is that external actions can be morally evaluated when they are voluntary, absent which, in effect, we evaluate outcomes, not acts. Also, in the Aristotelian-Thomist tradition the internal act of the will is paramount. These claims contrast with some current theorizing, e.g., by Judith Jarvis Thomson, that morally evaluates actions separately from agents, downplaying the internal act. Taking cases from current authors that revolve around ignorance of key facts, I critique their theorizing on the basis of the (...) nature of agency, the nature of abstraction, the moral language we use in describing acts, the need for reasonably complete descriptions of acts, and the tendency of act evaluations to “leak” into agent evaluations in objective theories. I then describe how Thomas Aquinas’s account of moral evaluation avoids these problems and provides a superior, multi-dimensional framework for moral evaluation. (shrink)

We have synthesized a 582,970-base pair Mycoplasma genitalium genome. This synthetic genome, named M. genitalium JCVI-1.0, contains all the genes of wild-type M. genitalium G37 except MG408, which was disrupted by an antibiotic marker to block pathogenicity and to allow for selection. To identify the genome as synthetic, we inserted "watermarks" at intergenic sites known to tolerate transposon insertions. Overlapping "cassettes" of 5 to 7 kilobases (kb), assembled from chemically synthesized oligonucleotides, were joined by in vitro recombination to produce intermediate (...) assemblies of approximately 24 kb, 72 kb ("1/8 genome"), and 144 kb ("1/4 genome"), which were all cloned as bacterial artificial chromosomes in Escherichia coli. Most of these intermediate clones were sequenced, and clones of all four 1/4 genomes with the correct sequence were identified. The complete synthetic genome was assembled by transformation-associated recombination cloning in the yeast Saccharomyces cerevisiae, then isolated and sequenced. A clone with the correct sequence was identified. The methods described here will be generally useful for constructing large DNA molecules from chemically synthesized pieces and also from combinations of natural and synthetic DNA segments. 10.1126/science.1151721. (shrink)

Background: Little is known about what factors may contribute to the growth of a consultation service or how a practice may change or evolve across time. Methods: This study examines data collected from a busy ethics consultation service over a period of more than two decades. Results: We report a number of longitudinal findings that represent significant growth in the volume of ethics consultation requests from 19 in 1990 to 551 in 2013, as well as important changes in the patient (...) population for which ethics help is requested. The findings include (1) a steady growth in requests from primary care providers (e.g., physicians and nurses), as well as increases in ancillary services (e.g., social workers); (2) a decrease in length of stay (days) before ethics help is requested; (3) an increase in the reasons that individuals ask for help from ethics; (4) an upsurge in consults requests from areas outside the intensive care unit (ICU); (5) a decrease in patients that died during hospitalization (e.g., live discharges); and (6) growth in the numbers of patients lacking decision-making capacity. Conclusions: We believe the increases in consult requests reflect appropriate and necessary growth because recent consultations have also been associated with consultations requiring (7) additional interventions and (8) reasonably high time intensity scores. (shrink)

The mammalian chromosome is longitudinally heterogeneous in structure and function and this is the basis for the specific banding patterns produced by various chromosome staining techniques. The two most frequently used techniques are G, or Giemsa banding and R, or reverse banding. Each type of stained band is characterised by variations in gene density, time of replication, base composition, density of repeat sequences, and chromatin packaging. It is increasingly apparent that R and G bands, which are complementary to each other, (...) represent separate compartments of the euchromatic human genome, with R bands containing the vast majority of genes. R bands are also more GC‐rich, contain a higher density of Alu repeats, and replicate earlier in S phase, than G bands. These properties may be interdependent and may have coevolved. (shrink)

The mammalian chromosome is longitudinally heterogeneous in structure and function and this is the basis for the specific banding patterns produced by various chromosome staining techniques. The two most frequently used techniques are G, or Giemsa banding and R, or reverse banding. Each type of stained band is characterised by variations in gene density, time of replication, base composition, density of repeat sequences, and chromatin packaging. It is increasingly apparent that R and G bands, which are complementary to each other, (...) represent separate compartments of the euchromatic human genome, with R bands containing the vast majority of genes. R bands are also more GC‐rich, contain a higher density of Alu repeats, and replicate earlier in S phase, than G bands. These properties may be interdependent and may have coevolved. (shrink)

Psychologists and philosophers who pose moral dilemmas to understand moral judgment typically specify outcomes as certain to occur in them. This contrasts with real-life moral decision-making, which is almost always infused with probabilities (e.g., the probability of a given outcome if an action is or is not taken). Seven studies examine sensitivity to the size and location of shifts in probabilities of outcomes that would result from action in moral dilemmas. We find that moral judgments differ between actions that result (...) in an equal increase in probability of harm (equal size), but have different end-states (e.g., an increase in harm probability from 25% to 50% or from 50% to 75%). This deviation from expected value is robust under separate evaluation, and increases when the comparison between shifts is made explicit under simultaneous evaluation. Consistent with the centrality of perceived harm in some models of moral judgment, perceived harm partially mediates sensitivity to location of harm probability shift. Unlike for shifts in harm probabilities, participants are insensitive to the location of shifts in probability of beneficial outcomes. They are also insensitive to the location of shifts in probability of analogous monetary losses and gains, suggesting an asymmetry between harm and benefit in moral reasoning, as well as an asymmetry between moral and monetary decision-making more broadly. Implications for normative philosophical theory and moral psychological theory, as well as practical applications, are discussed. (shrink)

There are two fundamentally different approaches to innovation: incremental and radical. In Economics as Anatomy, G.M. Peter Swann argues that economics as a discipline needs both perspectives in order to create the maximum beneficial effect for the economy. Chapters explore how and why mainstream economics is very good at incremental innovation but seems uncomfortable with radical innovation. Swann argues that economics should follow the example of many other disciplines, transitioning from one field to a range of semi-autonomous sub-disciplines. In this (...) book, he compares the missing link in empirical economics to being the economic equivalent of anatomy, the basis of medical discourse. Working as a sequel to Swann's Putting Econometrics in its Place, this book will be a vital resource to those who are discontent with the state of mainstream economics, especially those actively seeking to promote change in the discipline. Students wishing to see progress in the teaching of economics will also benefit from this timely book. (shrink)

How scientific assumptions point to God -- How laws of nature point to God -- How physical constants points to God -- How a grand unified theorypoints to God -- How the big bang points to God -- How genetics points to God -- How evolution points to God -- How neuroscience points to God -- How behavioral science points to God -- How semantics points to God -- How logic and math point to God -- How Gödel's theorem points (...) to God. (shrink)

The classical Athenian philosopher Socrates was tried in 399 BCE on the basis of two notoriously ambiguous charges: corrupting the youth and impiety (in Greek, asebeia). A majority of the 501 dikasts (Athenian citizen-jurors) voted to convict him. Socrates was ultimately sentenced to death by drinking a hemlock-based liquid. This well-known account of the trial is by Plato, one of Socrates' students and a famous philosopher in his own right. Whether Socrates was punished unjustly is a contested issue which to (...) this day inspires discussions about the nature and meaning of justice. (shrink)

A few results generalizing well-known classical model theory ones have been obtained in institution theory these last two decades (e.g. Craig interpolation, ultraproduct, elementary diagrams). In this paper, we propose a generalized institution-independent version of the Beth definability theorem.

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)