This book was inspired originally by the debates at the turn of the century about placebo controlled trials of antiretrovirals in HIV positive pregnant women in developing countries. Moving forward from this one limited example, the book includes several additional controversial cases of clinical research conducted in developing countries, and asks probing philosophical questions about the ethics of such trials. All clinical research by its very nature uses people to acquire generalizable knowledge to help future people. But what sorts of (...) "use" are morally permissible? What is it to exploit people? Suppose that a trial conducted in a developing country would not be ethically permissible in the developed world. Can we automatically conclude from this that the trial is unethical, that some sort of morally problematic double standard is in operation? Or might the differences in the two settings justify differences in trial design? This collection of philosophical essays examines these important questions about what exploitation is and when clinical research counts as exploitative. -/- "This is an outstanding contribution to the growing literature on the ethics of research with human subjects and a fine example of what bioethics can offer at its best. Anyone with a serious interest in these issues will need to read this book from start to finish." -Daniel Wikler, Harvard School of Public Health "This book contributes significantly to the literature on exploitation in clinical research conducted in the developing world."--Patricia Marshall, Case Western Reserve University . (shrink)

Theories of well-being are typically divided into subjective and objective. Subjective theories are those which make facts about a person’s welfare depend on facts about her actual or hypothetical mental states. I am interested in what motivates this approach to the theory of welfare. The contemporary view is that subjectivism is devoted to honoring the evaluative perspective of the individual, but this is both a misleading account of the motivations behind subjectivism, and a vision that dooms subjective theories to failure. (...) I suggest that we need to revisit and reinstate certain features of traditional hedonism, in particular the idea that felt experience plays a role that no theory of welfare can afford to ignore. I then offer a sketch of a theory that is subjective in my preferred sense and avoids the worst sins of hedonism as well as the problems generated by the contemporary constraints of subjective theorists. (shrink)

Desire satisfaction theorists and attitudinal-happiness theorists of well-being are committed to correcting the psychological attitudes upon which their theories are built. However, it is not often recognized that some of the attitudes in need of correction are evaluative attitudes. Moreover, it is hard to know how to correct for poor evaluative attitudes in ways that respect the traditional commitment to the authority of the individual subject's evaluative perspective. L. W. Sumner has proposed an autonomy-as-authenticity requirement to perform this task, but (...) this article argues that it cannot do the job. Sumner's proposal focuses on the social origins of our values and overlooks the deep psychological roots of other evaluative attitudes that are just as problematic for welfare. If subjective theories of welfare are to be at all plausible they may need to abandon or modify their traditional commitment to the authority of the individual subject. (shrink)

Decision-Making Capacity First published Tue Jan 15, 2008; substantive revision Fri Aug 14, 2020 In many Western jurisdictions the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own medical decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This question has to do with what (...) is commonly called “decisional capacity”, a central concept in health care law and ethics, and increasingly an independent topic of philosophical inquiry. -/- Decisional capacity can be defined as the ability of subjects to make their own medical decisions. Somewhat similar questions of capacity arise in other contexts, such as capacity to stand trial in a court of law and the ability to make decisions that relate to personal care and finances. However, the history behind the more general legal notions of capacity to stand trial and capacity to manage one’s life is different and operates somewhat differently in law (Roth, Meisel, & Litz 1977; Zapf & Roesch 2005). For the purposes of this discussion the notion of decisional capacity will be limited to medical contexts only; most notably, those where decisions to consent or to refuse treatment or participation in clinical research are concerned. (shrink)

In this article I explore various facets of Nozick’s famous thought experiment involving the experience machine. Nozick’s original target is hedonism—the view that the only intrinsic prudential value is pleasure. But the argument, if successful, undermines any experientialist theory, i.e. any theory that limits intrinsic prudential value to mental states. I first highlight problems arising from the way Nozick sets up the thought experiment. He asks us to imagine choosing whether or not to enter the machine and uses our choice (...) (or rather the choice he assumes most people will have) as evidence against experientialist theories. But for this strategy to succeed it must be possible to distinguish between self-interested and non-self-interested reasons for declining to enter the machine, and there is no obvious way to do this without begging the question against the hedonist. In successive sections I then (a) consider a common misconception of Nozick’s conclusion (that he thinks machine life is the worst life), (b) consider different intuitions about what is important to well-being but missing from machine life, and finally (c) explain what “the experience requirement” is, and describe its relationship to debates about experientialist theories. (shrink)

Philosophers concerned with what would be good for a person sometimes consider a person’s past desires. Indeed, some theorists have argued by appeal to past desires that it is in the best interests of certain dementia patients to die. I reject this conclusion. I consider three different ways one might appeal to a person’s past desires in arguing for conclusions about the good of such patients, finding flaws with each. Of the views I reject, the most interesting one is the (...) view that prudential value is, at least partly, concerned with the shape of a life as a whole. (shrink)

Desire is commonly spoken of as a state in which the desired object seems good, which apparently ascribes an evaluative element to desire. I offer a new defence of this old idea. As traditionally conceived, this view faces serious objections related to its way of characterizing desire's evaluative content. I develop an alternative conception of evaluative mental content which is plausible in its own right, allows the evaluative desire theorist to avoid the standard objections, and sheds interesting new light on (...) the idea of evaluative experience. (shrink)

In her impressive book, looking at the philosophy and science of well-being, Anna Alexandrova argues for the strong claim that we possess no stable, unified concept of well-being. Instead, she thinks the word “well-being” only comes to have a specific meaning in particular contexts, and has a quite different meaning in different contexts. I take issue with (1) her claim that we do not possess a unified, all-things-considered concept of well-being as well as with (2) her failure to consider why (...) we might want a unified concept. I grant that Alexandrova is probably correct that the word “well-being” is used differently in different contexts. But this only shows that one word can come to be used to express different concepts. Moreover, noting that several concepts exist that are picked out by “well-being” doesn’t establish that we lack altogether a notion of all-things-considered well-being. I believe we have such a concept, even though it is not always the concept in play. Moreover, I think we need such a concept. The conceptual muddles Alexandrova highlights—muddles that result from a single word being used to express multiple ideas—remind us how important it is to be able to distinguish different concepts from one another, as well as how important it is to periodically remind ourselves of how various forms of specialist dialogue relate back to the broader, more general notion of “well-being.”. (shrink)

Existence internalism claims that facts about human psychological responsiveness constrain the metaphysics of value in particular ways. Chapter 5 examines whether some form of existence internalism holds for prudential value. It emphasizes the importance of a modal distinction that has been traditionally overlooked. Some facts about personal good are facts about realized good. For example, right now it may be true that X is good for me. Other facts about goodness are facts about what would be good for me in (...) certain possible futures. These are facts about merely possible good. Philosophers should be internalists about realized good. The chapter defends a qualified version of the idea that a necessary constraint on something’s being good for a person at a time is that the thing in question elicits some kind of positive psychological response from the person at that time. However, philosophers should be motivational externalists about merely possible good. Facts about the superior future goodness of an option may ground reasons now to choose it. But we should not expect individuals to always recognize such facts, and so there is no reason to think such facts are always motivating. (shrink)

I consider the current best interests of patients who were once thought to be either completely unaware (to be in PVS) or only minimally aware (MCS), but who, because of advanced fMRI studies, we now suspect have much more “going on” inside their minds, despite no ability to communicate with the world. My goal in this chapter is twofold: (1) to set out and defend a framework that I think should always guide thinking about the best interests of highly cognitively (...) compromised patients, and then (2) to defend a particular conclusion that applies to this specific patient population. The framework requires us to ask two questions: Is the individual suffering? Is the individual gaining any benefit from life? There must be benefit of some sort for life to be worth preserving, and the benefit must outweigh any suffering (if there is suffering present). I then argue it would be best overall to allow these patients to die. Either these patients are not really very aware at all, in which case they are most likely not suffering, but not benefiting from life either, or they are mentally intact enough to make benefit a theoretical possibility, but in fact they are not benefiting because they cannot communicate with anyone. Such patients would most likely suffer. As there is no way currently to address their suffering, we should allow them to die. No matter the truth about their cognitive lives, death would either be a neutral event, or a blessing. (shrink)

The dominant approach to assessing decision-making capacity in medicine focuses on determining the extent to which individuals possess certain core cognitive abilities. Critics have argued that this model delivers the wrong verdict in certain cases where patient values that are the product of mental disorder or disordered affective states undermine decision-making without undermining cognition. I argue for a re-conceptualization of what it is to possess the capacity to make medical treatment decisions. It is, I argue, the ability to track one’s (...) own personal interests at least as well as most people can. Using this idea, I demonstrate that it is possible to craft a solution for the problem cases—one that neither alters existing criteria in dangerous ways (e.g. does not open the door to various kinds of abuse) nor violates the spirit of widely accepted ethical constraints on decision-making assessment. (shrink)

: Bioethicists have articulated an ideal of shared decision making between physician and patient, but in doing so the role of clinical uncertainty has not been adequately confronted. In the face of uncertainty about the patient's prognosis and the best course of treatment, many physicians revert to a model of nondisclosure and nondiscussion, thus closing off opportunities for shared decision making. Empirical studies suggest that physicians find it more difficult to adhere to norms of disclosure in situations where there is (...) substantial uncertainty. They may be concerned that acknowledging their own uncertainty will undermine patient trust and create additional confusion and anxiety for the patient. We argue, in contrast, that effective disclosure will protect patient trust in the long run and that patients can manage information about uncertainty. In situations where there is substantial uncertainty, extra vigilance is required to ensure that patients are given the tools and information they need to participate in cooperative decision making about their care. (shrink)

The dominant approach to assessing decision-making capacity in medicine focuses on determining the extent to which individuals possess certain core cognitive abilities. Critics have argued that this model delivers the wrong verdict in certain cases where patient values that are the product of mental disorder or disordered affective states undermine decision-making without undermining cognition. I argue for a re-conceptualization of what it is to possess the capacity to make medical treatment decisions. It is, I argue, the ability to track one’s (...) own personal interests at least as well as most people can. Using this idea, I demonstrate that it is possible to craft a solution for the problem cases—one that neither alters existing criteria in dangerous ways (e.g. does not open the door to various kinds of abuse) nor violates widely accepted ethical constraints on decision-making assessment. (shrink)

Mackenzie Graham has made an important contribution to the literature on decisionmaking for patients with disorders of consciousness. He argues, and I agree, that decisions for unresponsive patients who are known to retain some degree of covert awareness ought to focus on current interests, since such patients likely retain the kinds of mental capacities that in ordinary life command our current respect and attention. If he is right, then it is not appropriate to make decisions for such patients by appealing (...) to the values they had in the past, either the values expressed in an advance directive or the values recalled by a surrogate. There are two things I wish to add to the discussion. My first point is somewhat critical, for although I agree with his general conclusion about how, ideally, such decisions should be approached, I remain skeptical about whether his conclusion offers decisionmakers real practical help. The problem with these cases is that the evidence we have about the nature of the patient’s current interests is minimal or nonexistent. However—and this is important—Graham’s conclusion will be extremely relevant if in the future, our ability to communicate with such patients improves, as I hope it will. This leads to my second point. Graham’s conclusion illustrates a more general problem with our standard framework for decisionmaking for previously competent patients, a problem that has not been adequately recognized. So, in what follows, I explain the problem I see and offer some brief thoughts about solutions. (shrink)

Most theories of affective influences on judgement and choice take a valence-based approach, contrasting the effects of positive versus negative feeling states. These approaches have not specified if and when distinct emotions of the same valence have different effects on judgement. In this article, we propose a model of emotion-specific influences on judgement and choice. We posit that each emotion is defined by a tendency to perceive new events and objects in ways that are consistent with the original cognitive-appraisal dimensions (...) of the emotion. To pit the valence and appraisal-tendency approaches against one another, we present a study that addresses whether two emotions of the same valence but differing appraisals—anger and fear—relate in different ways to risk perception. Consistent with the appraisal-tendency hypothesis, fearful people made pessimistic judgements of future events whereas angry people made optimistic judgements. In the Discussion we expand the proposed model and review evidence supporting two social moderators of appraisal-tendency processes. (shrink)

Five-year-old children categorized as skilled versus unskilled counters were given verbal estimation and number word comprehension tasks with numerosities 20 – 120. Skilled counters showed a linear relation between number words and nonsymbolic numerosities. Unskilled counters showed the same linear relation for smaller numbers to which they could count, but not for larger number words. Further tasks indicated that unskilled counters failed even to correctly order large number words differing by a 2 : 1 ratio, whereas they performed well on (...) this task with smaller numbers, and performed well on a nonsymbolic ordering task with the same numerosities. These findings provide evidence that large, approximate numerosity representations become linked to number words around the time that children learn to count to those words reliably. (shrink)

Order of information plays a crucial role in the process of updating beliefs across time. In fact, the presence of order effects makes a classical or Bayesian approach to inference difficult. As a result, the existing models of inference, such as the belief-adjustment model, merely provide an ad hoc explanation for these effects. We postulate a quantum inference model for order effects based on the axiomatic principles of quantum probability theory. The quantum inference model explains order effects by transforming a (...) state vector with different sequences of operators for different orderings of information. We demonstrate this process by fitting the quantum model to data collected in a medical diagnostic task and a jury decision-making task. To further test the quantum inference model, a new jury decision-making experiment is developed. Using the results of this experiment, we compare the quantum inference model with two versions of the belief-adjustment model, the adding model and the averaging model. We show that both the quantum model and the adding model provide good fits to the data. To distinguish the quantum model from the adding model, we develop a new experiment involving extreme evidence. The results from this new experiment suggest that the adding model faces limitations when accounting for tasks involving extreme evidence, whereas the quantum inference model does not. Ultimately, we argue that the quantum model provides a more coherent account for order effects that was not possible before. (shrink)

Over the last decade, empirical research on compassion has burgeoned in the biomedical, clinical, translational, and foundational sciences. Increasingly sophisticated understandings and measures of compassion continue to emerge from the abundance of multi- and cross-disciplinary studies. Naturally, the diversity of research methods and theoretical frameworks employed presents a significant challenge to consensus and synthesis of this knowledge. To bring the empirical findings of separate and sometimes siloed disciplines into conversation with one another requires an examination of their disparate assumptions about (...) what compassion is and how it can be known. Here, we present an integrated theoretical review of methodologies used in the empirical study of compassion. Our goal is to highlight the distinguishing features of each of these ways of knowing compassion, as well as the strengths and limitations of applying them to specific research questions. We hope this will provide useful tools for selecting methods that are tailored to explicit objectives (methods matching), taking advantage of methodological complementarity across disciplines (methods-mixing), and incorporating the empirical study of compassion into fields in which it may be missing. (shrink)

The first years of life mark a time of rapid development and dietary change, as children transition from an exclusive milk diet to a modified adult diet. During these early years, children's learning about food and eating plays a central role in shaping subsequent food choices, diet quality, and weight status. Parents play a powerful role in children's eating behavior, providing both genes and environment for children. For example, they influence children's developing preferences and eating behaviors by making some foods (...) available rather than others, and by acting as models of eating behavior. In addition, parents use feeding practices, which have evolved over thousands of years, to promote patterns of food intake necessary for children's growth and health. However in current eating environments, characterized by too much inexpensive palatable, energy dense food, these traditional feeding practices can promote overeating and weight gain. To meet the challenge of promoting healthy weight in children in the current eating environment, parents need guidance regarding alternatives to traditional feeding practices. (shrink)

Neuroscience investigations of emotional influences on social cognition have been dominated by the somatic marker hypothesis and dual-process theories. Taken together, these lines of inquiry have not provided strong evidence that emotional influences on social cognition rely on neural systems which code for bodily signals of arousal nor distinguish emotional reasoning from other modes of reasoning. Recent findings raise the possibility that emotionally influenced social cognition relies on two stages of neural changes: once when emotion is elicited and a different (...) set of changes at the time of social cognitive judgment. These findings suggest that affect infusion models may be a fruitful framework for bridging neuroscience and psychological understanding of the role of emotion in social cognition. (shrink)

Eating behaviors evolve during the first years of life as biological and behavioral processes directed towards meeting requirements for health and growth. For the vast majority of human history, food scarcity has constituted a major threat to survival, and human eating behavior and child feeding practices have evolved in response to this threat. Because infants are born into a wide variety of cultures and cuisines, they come equipped as young omnivores with a set of behavioral predispositions that allow them to (...) learn to accept the foods made available to them. During historical conditions of scarcity, family life and resources were devoted to the procurement and preparation of foods, which are often low in energy, nutrients, and palatability. In sharp contrast, today in non-Third World countries children's eating habits develop under unprecedented conditions of dietary abundance, where palatable, inexpensive, ready-to-eat foods are readily available. (shrink)

This article provides empirical evidence of the social context and moral reasoning embedded within a parents’ decision to participate in autism genetics research. Based on in-depth interviews of parents who donated their family’s blood and medical information to an autism genetic database, three narratives of participation are analyzed, including the altruistic parent, the obligated parent, and the diagnostic parent. Although parents in this study were not generally concerned with bioethical principles such as autonomy and the issues of informed consent and/or (...) privacy and confidentiality of genetic information, a critical analysis reveals contextual bioethics embedded within these different narratives. These include the negotiations of responsibility that parents confront in biomedical research, the misguided hope and expectations parents place in genomic science, and the structural barriers of obtaining an autism diagnosis and educational services. Based on these findings, this article demonstrates the limits of a principle-based approach to bioethics and the emergent forms of biological citizenship that takes into account the social situations of people’s lives and the moral reasoning they negotiate when participating in autism genetic research. (shrink)

Philosophers sometimes claim that economics, and the idealizing strategies it employs, is ultimately unable to provide genuine laws of nature. Therefore, unlike physics, it does not qualify as an actual science. Careful consideration of thermodynamics, a well-developed physical theory, reveals substantial parallels with economic methodology. The corrective account of scientific understanding I offer appreciates these parallels: understanding in terms of efficient performance.

Only two articles in the past century have attempted reconstructions of this play: Gilbert Norwood in 1930 conjectured a basis in tragic burlesque, specifically a parody of Aeschylus’Edoni, due largely to the presence of Dionysus and a chorus of Babylonians. An entirely different plot was proposed in 1983 by David Welsh, who took as his starting point Herodotus’ account of the fall of Babylon; he thought that the chorus, envisioned as a group of refugees from the Persian empire, reflected the (...) recent arrival in Athens of the grandson of the Persian primarily credited with the capture of Babylon. Though commentators on Aristophanic comedy and politics often affect to be on firm footing about this play, the total dissimilarity of these two reconstructions actually highlights our ignorance. (shrink)

The Patient Protection and Affordable Care Act of 2010 (ACA) contains many provisions intended to increase access to and lower the cost of health care by adopting public health measures. One of these promotes the use of at-work wellness programs by both providing employers with grants to develop these programs and also increasing their ability to tie the price employees pay for health insurance for participating in these programs and meeting specific health goals. Yet despite ACA's specific alteration of three (...) different statues which had in the past shielded employees from having to contribute to the cost of their health insurance based on their achieving employer-designated health markers, it chose to leave alone recently enacted rules implementing the Genetic Non-Discrimination Act (GINA), which prohibits employers from asking employees about their family health history in any context, including assessing their risk for setting wellness targets. This article reviews how both the changes made by ACA and the restrictions recently put place by GINA will affect the way employers are likely to structure Wellness Programs. It also considers how these changes reflect the competing social goals of both ACA, which seeks to expand access to the population by lowering costs, and GINA, which seeks to protect individuals from discrimination. It does so by analyzing both positive theories about how these new laws will function and normative theories explaining the likelihood of future friction between the interests of the population of the United States as a whole who are in need of increased and affordable access to health care, and of the individuals living in this country who risk discrimination, as science and medicine continue to make advances in linking genetic make-up to risk of future illness. (shrink)

The passing of the Patient Protection and Affordable Care Act is a triumph for the field of public health. Its inclusion of many provisions intended to prevent illness and promote health endorses the core belief of public health as expressed by Dr. Georges Benjamin, the long-time executive director of the American Public Health Association, in a Washington Post opinion piece praising ACA for “provid[ing] care as far upstream as possible… [in order to] reduce costs by identifying problems early and then (...) managing them to reduce or eliminate the need for more costly care in the future.” In this article, I consider the conflict between ACA’s adoption of public health goals seeing population health and societal interests in protecting individuals from discrimination based on their health. The article focuses on one aspect of ACA which seeks to lower the costs to employers who provide health insurance for their employees by making it easier for them to offer their employees substantial incentives for participating in and meeting the goals of employer-sponsored Wellness Programs. (shrink)

Economists often consult multiple models in order to combat model uncertainty in the face of misspecification. By examining modeling practices at the Bank of England, this paper identifies an important, but underappreciated modeling procedure. Sometimes an idealized model is manipulated to reproduce the results from another distinct auxiliary model, ones which it could not produce on its own. However, this procedure does not involve making the original model “more realistic,” insofar as this means adding in additional causal factors. This suggests (...) that there are ways to make models more representationally adequate that do not involve de-idealization in the straightforward sense. (shrink)

A woman, perhaps a couple, learn they are pregnant. Perhaps she is elated for this desired news. Perhaps she is also overwhelmed or scared by the daunting task of parenthood ahead. Then, a prenatal screening reveals something worrisome about the fetus. A tumbling series of appointments and exams confirm the concerning findings. As Pope Francis notes, this news “changes the experience of pregnancy.” In place of optimistic wonderment for the future, parents now have new worries about whether their baby will (...) have a shortened life, experience suffering, or face many medical interventions in order to survive. I am a pediatric and perinatal palliative care doctor. I am often called to meet these wounded yet resilient... (shrink)

Martha A. Hall’s artists’ books documenting her experience of living with breast cancer offer future health professionals a unique opportunity to sit in the patient’s position of vulnerability and fear. Hall’s books have become a cornerstone of our medical humanities pedagogy at the Maine Women Writers Collection because of their emotional directness and their impact on readers. This essay examines the ways that Hall’s call for conversation with healthcare providers is enacted at the University of New England and provides a (...) model for how such works might be used at other educational institutions to encourage empathy between practitioners and patients by engaging in conversations about anger, fear, and other common reactions to life-threatening illness. We explore the unruly nature of Martha A. Hall’s narratives of illness and care, as well as how the form of the books themselves engages the reader in a deep relationship with Hall’s personal pain and her humanity itself. We explore, too, the cumulative effect of these powerful books on readers who handle them regularly, as we do in our roles as professor and archivist. (shrink)

Recent evidence suggests that experienced events are often mapped to too many episodic states, including those that are logically or experimentally incompatible with one another. For example, episodic over-distribution patterns show that the probability of accepting an item under different mutually exclusive conditions violates the disjunction rule. A related example, called subadditivity, occurs when the probability of accepting an item under mutually exclusive and exhaustive instruction conditions sums to a number >1. Both the over-distribution effect and subadditivity have been widely (...) observed in item and source-memory paradigms. These phenomena are difficult to explain using standard memory frameworks, such as signal-detection theory. A dual-trace model called the over-distribution model can explain the episodic over-distribution effect, but not subadditivity. Our goal is to develop a model that can explain both effects. In this paper, we propose the Generalized Quantum Episodic Memory model, which extends the Quantum Episodic Memory model developed by Brainerd, Wang, and Reyna. We test GQEM by comparing it to the OD model using data from a novel item-memory experiment and a previously published source-memory experiment examining the over-distribution effect. Using the best-fit parameters from the over-distribution experiments, we conclude by showing that the GQEM model can also account for subadditivity. Overall these results add to a growing body of evidence suggesting that quantum probability theory is a valuable tool in modeling recognition memory. (shrink)

In recent years, anthropologists have built a rich body of ethnography on the experience of addiction, including important cultural critiques of treatment systems. Yet little has been written from the perspective of those who work in the everyday to help others recover from substance abuse. In this article, I reflect on my labor as a clinical social worker providing therapy for homeless women and men who struggle with addiction. Building on the eloquence of those who seek to recover, recovery poets, (...) I demonstrate how the work of a team of frontline workers operates in a particular intersubjective realm that creates different conditions for understanding addiction and recovery than does anthropological fieldwork. By detailing the labor of recovery as I performed it using different evidence-based therapies to permit the emergence of a new consciousness, I aim to bring to center stage the complex labor of frontline workers so that their working conditions will be taken into account more often in anthropological work on addiction and treatment. (shrink)

Over the last decade, numerous interventions and techniques that aim to engender, strengthen, and expand compassion have been created, proliferating an evidence base for the benefits of compassion meditation training. However, to date, little research has been conducted to examine individual variation in the learning, beliefs, practices, and subjective experiences of compassion meditation. This mixed-method study examines changes in novice meditators’ knowledge and contemplative experiences before, during, and after taking an intensive course in CBCT®, a contemplative intervention that is increasingly (...) used for both inter- and intrapersonal flourishing. The participants in this study were Christian healthcare chaplains completing a 1-year residency in Clinical Pastoral Education who learned CBCT as part of their professional chaplaincy training curriculum. Prior to and upon completion of training, we surveyed participants to assess their beliefs about the malleability of compassion, types of engagement in compassion meditation, and perceptions of the impact of taking CBCT. We also conducted in-depth interviews with a subset of participants to gain a qualitative understanding of their subjective experiences of learning and practicing compassion meditation, a key component of CBCT. We found that participants reported increases in the extent to which they believed compassion to be malleable after studying CBCT. We also found high levels of variability of individual ways of practicing and considered the implications of this for the study of contemplative learning processes. This multi-methodological approach yielded novel insights into how compassion practice and compassion-related outcomes interrelate, insights that can inform the basic scientific understanding of the experience of learning and enacting compassion meditation as a means of strengthening compassion itself. (shrink)