Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the (...) circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (shrink)

Our objective is to understand how parents and children perceive their roles in decision making about research participation. Forty-five children (ages 4-15 years) with or without a chronic condition and 21 parents were the participants. A semistructured interview assessed perceptions of up to 4 hypothetical research scenarios with varying levels of risk, benefit, and complexity. Children were also administered the Peabody Picture Vocabulary Test, Third Edition, to assess verbal ability, as a proxy for the child's cognitive development. The audiotaped interviews (...) were transcribed and analyzed for themes related to parent and child decision-making roles. Both parents and children varied in their perceptions of decision-making roles. Child perceptions of parental influence on decision making as knowledge-based increased with cognitive development, whereas perceptions of parental influence as power-based decreased. Both children and parents commented that they would collaborate with each other when making decisions. Collaborative decision making appeared to increase with cognitive development. These findings suggest that approaches to child assent and parent permission should consider the parent-child relationship and how children and families typically make decisions. Future research is necessary to explain variation in the process of research decision making across children and families, explore the role of collaboration on children's decision-making skills, and understand developmental trajectories and mechanisms related to research decision making. (shrink)

This narrative review summarizes the empirical literature on children's competence for consent and assent in research and treatment settings. Studies varied widely regarding methodology, particularly in the areas of participant sampling, situational context studied (e.g., psychological versus medical settings), procedures used (e.g., lab-based vs. real-world approaches), and measurement of competence. This review also identified several fundamental dilemmas underlying approaches to children's informed consent. These dilemmas, including autonomy versus best interests approaches, legal versus psychological or ethical approaches, child- versus family-based approaches, (...) and approaches that emphasize consent versus those that emphasize assent, have implications for the measurement of children's competence and interpretation of findings. Recommendations for future research in the area of children's informed consent include the use of diverse samples and control groups, development of multidimensional and standardized measures of competence, utilization of observational methods and longitudinal designs, examination of noncognitive aspects of children's competence, and comparison of children's competence for treatment and research decisions. (shrink)

This study described parent participation in the informed consent conference for randomized clinical trials (RCTs) in childhood leukemia and documented the relationship of physician communication to parent participation. Parents of 140 children with newly diagnosed leukemia who were eligible for RCTs were studied at six sites using comprehensive methods involving direct observation and transcripts of parent-physician communication based on audiotapes. Parent participation during the informed consent conference reflected a wide range of content categories. Consistent with hypotheses, Physician Rapport and Partnership (...) Building related to parent participation in the informed consent conference but Information Giving did not. Higher parent socioeconomic status also was related to greater parent participation for two of three measures of parent participation. Findings suggest that physician behaviors that provide support and facilitate communication may enhance parental participation in the informed consent conference for RCTs in childhood leukemia. (shrink)

Importance Informed consent is essential to ethical, rigorous research and is important to recruitment and retention in cancer trials.Objective To examine cancer clinical trial (CCT) participants’ perceptions of informed consent processes and variations in perceptions by cancer type.Design and Setting and Participants Cross-sectional survey from mixed-methods study at National Cancer Institute–designated Northeast comprehensive cancer center. Open-ended and forced-choice items addressed: (1) enrollment and informed consent experiences and (2) decision-making processes, including risk-benefit assessment. Eligibility: CCT participant with gastro-intestinal or genitourinary, hematologic-lymphatic (...) malignancies, lung cancer, and breast or gynecological cancer (N = 334).Main Outcome Measures Percentages satisfied with consent process and information provided; and assessing participation’s perceptions of risks/benefits. Multivariable logistic or ordinal regression examined differences by cancer type.Results Most patient-participants felt well informed by the consent process (more than 90% overall and by cancer type) and. most (87.4%) reported that the consent form provided all the information they wanted, although nearly half (44.8%) reported that they read the form somewhat carefully or less. More than half (57.9%) said that talking to research staff (i.e., the consent process) had a greater impact on participation decisions than reading the consent form (2.1%). A third (31.1%) were very sure of joining in research studies before the informed consent process (almost half of lung cancer patients did—47.1%). Most patients personally assessed the risks and benefits before consenting. However, trust in physicians played an important role in the decision to enroll in CCT.Conclusions and Relevance Cancer patients rely less on written features of the informed consent process than on information obtained from the research staff and their own physicians. Research should focus on information and communication strategies that support informed consent from referring physicians, researchers, and others to improve patient risk-benefit assessment and decision-making. (shrink)

This review essay looks at Christopher Boyer’s Political landscapes: forests, conservation and community in Mexico,, Thomas Miller Klubock’s La Frontera: forests and ecological conflict in Chile’s Frontier Territory, Pablo Lapegna’s Soybeans and power: genetically modified crops, environmental politics and social movements in Argentina and Elspeth Probyn’s Eating the ocean as each provide a holistic study of how political ecology and marginalized peoples engage the issue of natural resources in Latin America. Through they deal with different regions and a wide (...) range of approaches to management, collectively they shine light on the social interactions that accompany changes in the land and how local communities engage issues surrounding nature’s use. On a larger level, they offer readers more insight into the field of the environmental humanities and what it means to live with the land. (shrink)

Payment for research participation has raised ethical concerns, especially with respect to its potential for coercion. We argue that characterising payment for research participation as coercive is misguided, because offers of benefit cannot constitute coercion. In this article we analyse the concept of coercion, refute mistaken conceptions of coercion and explain why the offer of payment for research participation is never coercive but in some cases may produce undue inducement.

This paper presents a new theory of modal reasoning, i.e. reasoning about what may or may not be the case, and what must or must not be the case. It postulates that individuals construct models of the premises in which they make explicit only what is true. A conclusion is possible if it holds in at least one model, whereas it is necessary if it holds in all the models. The theory makes three predictions, which are corroborated experimentally. First, conclusions (...) correspond to the true, but not the false, components of possibilities. Second, there is a key interaction: it is easier to infer that a situation is possible as opposed to impossible, whereas it is easier to infer that a situation is not necessary as opposed to necessary. Third, individuals make systematic errors of omission and of commission. We contrast the theory with theories based on formal rules. (shrink)

John McMillan's article raises numerous important points about the ethics of surgical castration of sex offenders.1 In this commentary, we focus solely on and argue against the claim that the offer of release from detention conditional upon surgical castration is a coercive offer that compromises the validity of the offender's consent. We take no view on the question as to whether castration for sex offenders is ethically permissible. But, we reject the claim that it is ethically permissible only if competing (...) ethical considerations outweigh worries about coercion. For in the situation described, the proposal is not coercive at all.McMillan states that if offenders agree to castration because they fear long-term detention, then ‘it seems, intuitively, as if agreeing to be castrated under these conditions makes the decision coerced in some way.’1 He adds that if castration is ‘the only way that they will be released back into the community, the status of this decision as a genuine expression of their autonomy is questionable.’1 In defence of his claim, he uses two analogies that he borrows from Joel Feinberg. First, if a governor offers to commute a death sentence if the prisoner agrees to participate in a medical experiment, then ‘it's clear that the governor is coercing the prisoner.’1 Second, if a millionaire offers to give a woman $1 000 000 …. (shrink)

Increasing public concern for the welfare of fish species that human beings use and exploit has highlighted the need for better understanding of the cognitive status of fish and of their ability to experience negative emotions such as pain and fear. Moreover, studying emotion and cognition in fish species broadens our scientific understanding of how emotion and cognition are represented in the central nervous system and what kind of role they play in the organization of behavior. For instance, on a (...) macro neuro-architecture level the brains of fish species look dramatically different from those of mammals, while such a dramatic difference does not (always) occur at the level of emotion- and cognition-related behavior. Here, therefore, we discuss the evidence of emotion and cognition in fish species related to underlying neuro-architecture and the role that emotion and cognition play in the organization of behavior. To do so we use a framework encompassing a number of steps allowing a systematic approach to these issues. Emotion and cognition confer on human and non-human animals the capacity to compliment and/or override immediate reflexes to stimuli and so allow a large degree of flexibility in behavior. Systematic research on behavior that in mammals is indicative of emotion and cognition has been conducted in only a few fish species. The data thus far indicate that in these species brain-behavior relationships are not fundamentally different from those observed in mammals. Furthermore, data from other studies show evidence that behavior patterns related to emotion and cognition vary between fish species as well within fish species, related to sex and life history stage for example. From a welfare perspective, knowledge of such variability will potentially help us to design optimal living conditions for fish species kept by humans. (shrink)

Increasing public concern for the welfare of fish species that human beings use and exploit has highlighted the need for better understanding of the cognitive status of fish and of their ability to experience negative emotions such as pain and fear. Moreover, studying emotion and cognition in fish species broadens our scientific understanding of how emotion and cognition are represented in the central nervous system and what kind of role they play in the organization of behavior. For instance, on a (...) macro neuro-architecture level the brains of fish species look dramatically different from those of mammals, while such a dramatic difference does not (always) occur at the level of emotion- and cognition-related behavior. Here, therefore, we discuss the evidence of emotion and cognition in fish species related to underlying neuro-architecture and the role that emotion and cognition play in the organization of behavior. To do so we use a framework encompassing a number of steps allowing a systematic approach to these issues. Emotion and cognition confer on human and non-human animals the capacity to compliment and/or override immediate reflexes to stimuli and so allow a large degree of flexibility in behavior. Systematic research on behavior that in mammals is indicative of emotion and cognition has been conducted in only a few fish species. The data thus far indicate that in these species brain-behavior relationships are not fundamentally different from those observed in mammals. Furthermore, data from other studies show evidence that behavior patterns related to emotion and cognition vary between fish species as well within fish species, related to sex and life history stage for example. From a welfare perspective, knowledge of such variability will potentially help us to design optimal living conditions for fish species kept by humans. (shrink)

The idea that our conscious decisions determine our actions has been challenged by a report suggesting that the brain starts to prepare for a movement before the person concerned has consciously decided to move . Libet et al. claimed that their results show that our actions are not consciously initiated. The current article describes two experiments in which we attempted to replicate Libet et al.'s comparison of participants' movement-related brain activity with the reported times of their decisions to move and (...) also the reported times of their decisions of which hand to move. We also looked at the distribution of participants' reports over time to evaluate an alternative explanation of Libet et al.'s results. Although the Readiness Potential was usually present before all of the decisions to move, consistent with the findings of Keller and Heckhausen and Libet et al. , we found that many reported decision times were before the onset of the Lateralized Readiness Potential, which measures hand-specific movement preparation. The latter finding is consistent with the conclusion that the LRP always started after the conscious decision to move. We conclude that even though activity related to movement anticipation may be present before a conscious decision to move, the cortical preparation necessary for the movement to happen immediately may not start until after the conscious decision to move. (shrink)

We argued last year in this journal that extensive integration of research and care is a worthy goal of health system design, and we second the call from Ruth Faden and colleagues to move toward learning health care systems. As they recognize, learning health care systems demand the coordination of research and medical ethics—two sets of normative commitments that have long been considered distinct. In offering a novel ethics framework for such systems, Faden et al. advance the scholarly debate about (...) how best to do this and challenge us to think more deeply about its practical implications. However, we believe that at least three issues they raise require additional attention. First, the research‐care distinction has more normative bite than they are willing to concede. Second, the role for independent oversight requires clarification. Finally, they neglect the concept of stewardship as a guiding obligation of learning health care systems. (shrink)

We argued last year in this journal that extensive integration of research and care is a worthy goal of health system design, and we second the call from Ruth Faden and colleagues to move toward learning health care systems. As they recognize, learning health care systems demand the coordination of research and medical ethics—two sets of normative commitments that have long been considered distinct. In offering a novel ethics framework for such systems, Faden et al. advance the scholarly debate about (...) how best to do this and challenge us to think more deeply about its practical implications. However, we believe that at least three issues they raise require additional attention. First, the research‐care distinction has more normative bite than they are willing to concede. Second, the role for independent oversight requires clarification. Finally, they neglect the concept of stewardship as a guiding obligation of learning health care systems. (shrink)

We seek to add to the Corporate Social Responsibility (CSR) and Sustainable Development (SD) literature through the empirical study of Latin American firm membership in the United Nations Global Compact (GC) and Global Report Initiative (GRI). Within an institutional-based framework, we explore through three filters – commercial, state-signaling, and distinguished peers – the impact of normative and mimetic pressures associated with GC/gri membership. Our sample includes 207 public firms from six Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico, and Peru). (...) Our results suggest Latin American firms from countries with a greater European influence (normative pressure) are twice as likely to be enrolled in the GC/gri. Additionally, we find that Latin American firms listed on the NYSE (mimetic pressure) are also twice as likely to sign up under the GC/gri. Hence, the normative and mimetic pillars of institutional theory are found to be significant factors for Latin American firms adopting sustainability initiatives. (shrink)

Purpose Prescription stimulant use as “cognitive enhancers” has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center. -/- Method Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was voluntary and (...) anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive. -/- Results Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/ energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%). -/- Conclusions Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., “cognitive enhancement”), educational quality, and patient safety or health care quality. (shrink)

Business and Society Review, Volume 127, Issue S1, Page 193-222, Spring 2022.

In the ancient world, precious stones (valuable stones and hard substances excluding gold, silver and copper) were distinguished in terms of appearance (beauty, colour), function (durability) and cost (rarity). As a result, there is considerable difficulty in determining how to correlate the inventory of lexical terms referring to precious stones in the ancient Near East with modern mineralogical identifications. In this article, the etymology and identification of precious stones in the Bible are revisited using editorial theory and complexity thinking. The (...) starting point for lexicographical identification is the breastpiece of the high priest (Ex 28:17–20; 39:10–14) with its 12 precious stones and the translation of the Hebrew terms in the Septuagint. In the light of the considerable writings in the Hellenistic world on precious stones, especially Pliny’s Naturalis Historia and Theophrastus’ On Stones, the Septuagint provides the key for the etymology and identification of the precious stones in both the Old Testament and the New Testament. Contribution: The Septuagint translation of the precious stones in the high priest’s breastpiece is the Rosetta Stone for the identification all of the precious stones in the Hebrew Bible and New Testament. The subsequent translations of the terms indicate changes or substitutions of referents and their meanings. (shrink)

Background Clinical ethics consultants are expected to “reduce disparities, discrimination, and inequities when providing consultations,” but few studies about inequities in ethics consultation exist.1 The objectives of this study were (1) to determine if there were racial or gender differences in the timing of requests for ethics consultations related to limiting treatment, and (2) if such differences were found, to identify factors associated with that difference and the role, if any, of ethics consultants in mitigating them. Methods The study was (...) a mixed methods retrospective study of consultation summaries and hospital and ethics center data on 56 age-and gender-matched Caucasian and African American Medicare patients who received ethics consultations related to issues around limiting medical treatment in the period 2011 to 2014. The average age of patients was 70.9. Results Consultation requests for females were made significantly earlier in their stays in the hospital (6.57 days) than were consultation requests made for males (16.07 days). For African American patients, the differences in admission-to-request intervals for female patients (5.93 days) and male patients (18.64 days) were greater than for Caucasian male and female patients. Differences in the timing of a consultation were not significantly correlated with the presence of an advance directive, the specialty of the attending physician, or the reasons for the consult request. Ethics consultants may have mitigated problems that developed during the lag in request times for African American males by spending more time, on average, on those consultations (316 minutes), especially more time, on average, than on consultations with Caucasian females (195 minutes). Most consultations (40 of 56) did result in movement toward limiting treatment, but no statistically significant differences were found among the groups studied in the movement toward limiting treatment. The average number of days from consult to discharge or death were strongly correlated with the intervals between admission to the hospital and request for an ethics consultation. Conclusion Our findings suggest race and gender disparities in the timing of ethics consultations that consultants may have partially mitigated. (shrink)

In this article we examine how Qumran Hebrew can contribute to our knowledge of historical Hebrew linguistics. The premise of this paper is that Qumran Hebrew reflects a distinct stage in the development of Hebrew which sets it apart from Biblical Hebrew. It is further assumed that these unique features are able to assist us to understand the nature of the development of Biblical Hebrew in a more precise way. Evidence from the syntax of participial negation at Qumran as opposed (...) to Biblical Hebrew provides evidence for this claim. (shrink)

In this essay, we demonstrate that in addition to the Revised Standard Version and its revisions as part of the linear emergence of the Tyndale–King James Version tradition in the 20th and 21st centuries, there are also alternative revisions and retranslations of the King James Version (KJV) of 1611 as literal or word-for-word translations, which emerge as divergent branches. The revisions of the American Standard Version (ASV) (1901) emerged in the following branches, namely the New American Standard Bible (NASB) and (...) its revisions, The Amplified Bible (AB) and its revisions, as well as The Living Bible, Paraphrased and its retranslation, the New Living Translation (NLT). Then there are revisions that emerged as alternatives to the Revised Standard Version (1946–1952/1971) by reverting to the King James Revised (Blayney) Edition (1769) as their incipient text rather than the ASV, namely The Modern King James Version (MKJV) (and similar revisions), The New King James Version (NKJV) and the New Cambridge Paragraph Bible. Finally, there are retranslations within the Tyndale–King James Version tradition, namely the Contemporary English Version (CEV), and the Common English Bible (CEB). The diversity reflects the search for individual identity to satisfy particular reader expectations in an age of digital-media interpretive culture featuring broad universal values.Contribution: Instead of viewing the revisions and retranslations within the Tyndale–King James Version tradition since the second half of the 20th century as new and independent, it is demonstrated that the various branches and their versions rather continue the emergence of the pre-20th century translation complex within this tradition to satisfy particular reader expectations. (shrink)

When listening to degraded speech, such as speech delivered by a cochlear implant, listeners make use of top-down linguistic knowledge to facilitate speech recognition. Lexical knowledge supports speech recognition and enhances the perceived clarity of speech. Yet, the extent to which lexical knowledge can be used to effectively compensate for degraded input may depend on the degree of degradation and the listener’s age. The current study investigated lexical effects in the compensation for speech that was degraded via noise-vocoding in younger (...) and older listeners. In an online experiment, younger and older normal-hearing listeners rated the clarity of noise-vocoded sentences on a scale from 1 to 7. Lexical information was provided by matching text primes and the lexical content of the target utterance. Half of the sentences were preceded by a matching text prime, while half were preceded by a non-matching prime. Each sentence also consisted of three key words of high or low lexical frequency and neighborhood density. Sentences were processed to simulate CI hearing, using an eight-channel noise vocoder with varying filter slopes. Results showed that lexical information impacted the perceived clarity of noise-vocoded speech. Noise-vocoded speech was perceived as clearer when preceded by a matching prime, and when sentences included key words with high lexical frequency and low neighborhood density. However, the strength of the lexical effects depended on the level of degradation. Matching text primes had a greater impact for speech with poorer spectral resolution, but lexical content had a smaller impact for speech with poorer spectral resolution. Finally, lexical information appeared to benefit both younger and older listeners. Findings demonstrate that lexical knowledge can be employed by younger and older listeners in cognitive compensation during the processing of noise-vocoded speech. However, lexical content may not be as reliable when the signal is highly degraded. Clinical implications are that for adult CI users, lexical knowledge might be used to compensate for the degraded speech signal, regardless of age, but some CI users may be hindered by a relatively poor signal. (shrink)