Color conveys critical information about the flavor of food and drink by providing clues as to edibility, flavor identity, and flavor intensity. Despite the fact that more than 100 published papers have investigated the influence of color on flavor perception in humans, surprisingly little research has considered how cognitive and contextual constraints may mediate color–flavor interactions. In this review, we argue that the discrepancies demonstrated in previously-published color–flavor studies may, at least in part, reflect differences in the sensory expectations that (...) different people generate as a result of their prior associative experiences. We propose that color–flavor interactions in flavor perception cannot be understood solely in terms of the principles of multisensory integration but that the role of higher-level cognitive factors, such as expectations, must also be considered. (shrink)

Taking Australia as a case study that is relevant to all countries where public integrity is an issue, this collection reviews a variety of existing efforts to understand, 'map' and evaluate the effectiveness of integrity policies and institutions, not just in the government sector but across all the major institutions of modern society. It will be of interest to those in governance, politics, law and public policy.

An eye-opening tour of the political tricks that subvert scientific progress. The Butter-Up and Undercut. The Certain Uncertainty. The Straight-Up Fabrication. Dave Levitan dismantles all of these deceptive arguments, and many more, in this probing and hilarious examination of the ways our elected officials attack scientific findings that conflict with their political agendas. The next time you hear a politician say, "Well, I’m not a scientist, but…," you’ll be ready.

In this article, cluster analysis is used to explore the conflicting results reported when the Defining Issues Test is used to explain moral reasoning ability in business situations. Using a convenience sample, gender, age, work experience, and ethics training were examined to determine their impact on the level of moral reasoning ability as measured by the Defining Issues Test. Using the whole sample, a significant difference was found for average P scores reported for males and females, but no significant differences (...) were found based on age, work experience, and ethics training. However, the sample fell into distinct clusters that identified distinct male and female groupings. While females naturally fell into two distinct high- and low-moral reasoning ability clusters, male clusters were dominated more by work experience and ethics training. Clearly there are other factors mitigating the level of moral reasoning ability for males which require further exploration. The findings suggest that while the P score provides an initial point of comparison, the real benefit to the test is in exploring what is different for males and females in terms of training needs, and the impact of work experience on the moral reasoning ability, and most importantly, how to make ethics training enticing. Recommendations for future research are also discussed. (shrink)

A radical crítica à linguagem efetuada por Spinoza, que insiste em seu necessário potencial falsificador, parece equipará-lo aos seus contemporâneos. Mais do que isso, parece introduzir um problema insolúvel para a possibilidade de comunicação unívoca da verdade – incluindo a expressão dA radical crítica à linguagem efetuada por Spinoza, que insisteem seu necessário potencial falsificador, parece equipará-lo aos seus contemporâneos. Mais do que isso, parece introduzir um problema insolúvel para a possibilidade de comunicação unívoca da verdade — incluindo a expressão (...) de sua própria filosofia. Neste artigo, procuro refletir sobre esta crítica e propor uma alternativa ao caráter imaginativo das palavras, apostando na distinção entre linguagem e método. Esta propostainterpretativa permitirá reclassificar a posição spinozista e manter sua originalidade frente às demais concepções de seu período histórico.e sua própria filosofia. Neste artigo, procuro refletir sobre esta crítica e propor uma alternativa ao caráter imaginativo das palavras, apostando na distinção entre linguagem e método. Esta proposta interpretativa permitirá reclassificar a posição spinozista e manter sua originalidade frente às demais concepções de seu período histórico. (shrink)

Anthony Collins is known mostly as an eighteenth-century freethinker who contributed to ideas of rational religion and religious toleration, as a close friend of John Locke, and as a necessitarian and materialist who held a significant correspondence with Samuel Clarke. Yet, his political philosophy has rarely received serious attention, and he remains a neglected figure in the history of political thought. This article attempts to recover Collins as a philosopher who developed a complex political theory, by focusing on his conceptions (...) of liberty and authority. It shows that he conceptualised liberty, and liberty of thought in particular, both as non-interference and non-domination, namely, an absence of censorship as well as an absence of continuous tyranny over the minds of humankind. Then, it shows that Collins also developed a thorough idea of civil authority, according to which even religious liberties may depend in some cases on the discretion of the civil sovereign. Finally, this article suggests that Collins’s multi-layered theory continued to develop after his lifetime, and that he therefore had a prominent place in eighteenth-century debates of liberty and authority. (shrink)

In this Matters Arising article, we outline how the recent article “The impact on patients of objections by institutions to assisted dying: a qualitative study of family caregivers’ perceptions” (White et al., 2023 Mar 13;24(1):22) informed Voluntary Assisted Dying (VAD) implementation in our large Australian public health setting, where objections do not emanate from, but within, the institution. In reporting the harms to patients and caregivers created by institutional objection, White et al. provide an evidenced-based road map for potential potholes (...) or risks associated with VAD implementation. We discuss the complexities emerging from the diverse views of health professionals and the ethical tensions arising from such, especially within certain specialties, and how we developed systemic strategies that support patients, caregivers and staff alike. We highlighted the need to shift from “Do you support VAD?“ to “How can we support you as healthcare professionals to integrate VAD into your practice, in a way that complies with the legislation, meets the needs of patients and caregivers, and feels safe and does not compromise your moral stance?“. (shrink)

The SSIS SEL Brief Scales are multi-informant measures that were developed to efficiently assess the SEL competencies of school-age youth in the United States. Recently, the SSIS SELb was translated into multiple languages for use in a multi-site study across six European countries. The purpose of the current study was to examine concurrent and predictive evidence for the SEL Composite scores from the translated versions of the SSIS SELb Scales. Results indicated that SSIS SELb Composite scores demonstrated expected positive concurrent (...) and predictive relationships with scores from the Connor-Davidson Resilience Scale and negative relationships with scores from the problem behavior scales of the Strengths and Difficulties Questionnaire. Although there were a few exceptions, these patterns generally were consistent across informants and samples providing initial validity evidence for the Composite score from the translated versions of the SSIS SELb Scales. Limitations and future research directions are discussed. (shrink)

Human consciousness is one of the greatest mysteries in the universe. From one point of view this should be surprising, since we know a great deal about consciousness from our own experience. One could say that our own conscious experience is the thing in the world that we know best. Descartes wanted to build the entirety of natural science on the foundation of our understanding of our conscious thought. Yet despite our intimate relationship with our own consciousness experience, from another (...) point of view consciousness is a puzzling phenomenon. We have no idea what it is about us, as physical beings, that makes us conscious, why we have consciousness, or which creatures other than humans have consciousness. Not only is it hard to answer these questions, it is hard to know how to even start to find answers. (shrink)

O artigo pretende aproximar as ideias protofeministas desenvolvidas pelo filósofo e teólogo francês François Poulain de la Barre (1647-1723) das estratégias de escrita formuladas pelas autoras seiscentistas da assim chamada literatura preciosa, tais como Madeleine de Scudéry (1607-1701) e Madame de Lafayette (1634-1693). Critica, para tanto, a divisão proposta por Elsa Dorlin (1974-) entre o feminismo lógico e a préciosité duplamente: através de uma reflexão mais ampla sobre os limites da separação entre filosofia e literatura e, num segundo momento, a (...) partir da análise direta dos argumentos de Poulain. Procura, assim, demonstrar a associação possível entre a confecção de uma ordem fabulada como procedimento filosófico legítimo e o emprego da imaginação como modelo da produção literária. (shrink)

A Hobbesian utopia might sound paradoxical. Hobbes never prescribed a utopia per se, and he is well-known for his practical and pragmatic approach to human nature and to politics. Yet, this article identifies several utopian elements in Hobbes, starting with the ways in which his contemporaries thought of his work as utopian. Following Galileo and others, Hobbes might have been part of a utopian moment, or at least believed that he was, especially due to his novel and historic philosophy. Behind (...) his dystopian description of the state of nature there is a utopian vision of a civilized, peaceful, and industrious society, the result of true moral philosophy. Finally, the differences between Hobbes and Plato notwithstanding, there might be one overlooked similarity: if Plato designed a republic where Socrates would not have been persecuted, Hobbes might have designed a commonwealth that would produce and allow future Galileos to work without hindrance. (shrink)

This book presents recent advancements in positive psychology, specifically its application across broad areas of current interest. Chapters include submissions from various international authors in the field and cover discussion and presentation of relevant research, theories, and applications. The volume covers topics such as CBT, Student Resilience, Active Aging, Humour, Mindfulness, Character Strengths, Education, Health, Relationships, Workplaces, Performance, Technology, Design, and Communities. With the growing interest in the applications of positive psychology across diverse fields within psychology and beyond, this book (...) will make a worthwhile contribution to the field. It will also fill the current need for a volume that highlights specifically the various recent advancements in positive psychology into diverse fields and as such will be of benefit to a wide range of professionals, including psychologists, educators, clinicians, therapists, and many others. (shrink)

Artificial intelligence surveillance can be used to diagnose individual cases, track the spread of Covid‐19, and help provide care. The use of AI for surveillance purposes (such as detecting new Covid‐19 cases and gathering data from healthy and ill individuals) in a pandemic raises multiple concerns ranging from privacy to discrimination to access to care. Luckily, there exist several frameworks that can help guide stakeholders, especially physicians but also AI developers and public health officials, as they navigate these treacherous shoals. (...) While these frameworks were not explicitly designed for AI surveillance during a pandemic, they can be adapted to help address concerns regarding privacy, human rights, and due process and equality. In a time where the rapid implementation of all tools available is critical to ending a pandemic, physicians, public health officials, and technology companies should understand the criteria for the ethical implementation of AI surveillance. (shrink)

For the average person, genetic testing has two very different faces. The rise of genetic testing is often promoted as the democratization of genetics by enabling individuals to gain insights into their unique makeup. At the same time, many have raised concerns that genetic testing and sequencing reveal intensely personal and private information. As these technologies become increasingly available as consumer products, the ethical, legal, and regulatory challenges presented by genomics are ever looming. Assembling multidisciplinary experts, this volume evaluates the (...) different models used to deliver consumer genetics and considers a number of key questions: How should we mediate privacy and other ethical concerns around genetic databases? Does aggregating data from genetic testing turn people into products by commercializing their data? How might this data reduce or exacerbate existing healthcare disparities? Contributing authors also provide guidance on protecting consumer privacy and safety while promoting innovation. (shrink)

Traditionally, heated philosophical debates regarding the status of categories have turned on questions of "nominal" vs "real" existence, where the role and significance of rhetoric and politics is obscured. Feminists in the late 20th century acknowledge a variety of elements involved in the construction of categories such as "human," "nature," rhetoric and logic. I argue for a position which undercuts the traditional debates between nominalism and realism, and using "wo men" as a case study, demonstrate the intricacies of the relationship (...) of logic and rhetoric in category construction. (shrink)

This dissertation is comprised of three parts. The first part is an intellectual historical thesis, regarding the place of Jean Piaget in philosophic thought. In Chapter One I outline the differences between my thesis and Piaget's position on the development of spatial concepts. My second chapter places his theory within the context of congruent accounts from the philosophy of nature, neurophysiology, and philosophy of psychology. Chapter Three situates him in relation to a selection of philosophers in the history of western (...) philosophy, through a metapsychology. ;In Part II I provide a dynamic account of the order of conceptual development, and clarification of the concepts of topological space, projective space, and euclidean or metric space.$\sp1$ In three chapters I outline a systematic analysis of the genetic development of the concepts based on an analysis and critique of Piaget's observations. The emergence of each concept is shown to be a result of the experience of some incongruity between the concept immediately preceding, and experience. The order I outline differs in some specifics from that suggested by Piaget's broad outline, and I explain the differences as they occur. ;The third part of this dissertation is the most tentative. Chapter Nine discusses the kind of testing I will employ when I test the logical order of concepts. There are four kinds of modes which I use to test each concept. This is followed by Chapter Ten, which tests the dynamic development of concepts of space. In this I attempt to confirm those changes in the development of the concepts, as well as Piaget's overall framework, through the use of Piaget's pre-logical modes as well as others I have extracted from the dynamic development of concepts. ftn $\sp1$ I note here that Piaget means, by euclidean geometry, metric geometry. The distinction between geometry with a euclidean and a non-euclidean metric is not crucial for the purpose of this thesis. (shrink)

Robert Wallace (1697–1771) was a leading minister of the Church of Scotland, but he remains a largely overlooked figure in the literature. Nevertheless, his participation in philosophical and theological debates offers a glimpse of the complex positions of the Scottish clergy – and of Scottish moderation on its own terms. Wallace’s moderation was evident, for example, in his opposition both to radical deism and orthodox dogmatism. Yet what makes Wallace’s case particularly interesting is that he described himself as a ‘moderate (...) freethinker’ in a letter to David Hume, while distinguishing elsewhere the ‘moderate’ and ‘sober’ freethinkers from the dangerously sceptical ones. Exploring his consistent statements on this issue in various writings throughout his career, this article investigates the self-identified moderation of Wallace – in opposition, for example, to his rival freethinker William Dudgeon – and thus the clergy’s attempt to use this category in the shaping of their vision of the Scottish Enlightenment. (shrink)

In the latter half of the 20th century, Western medicine moved death from the home to the hospital. As a result, the process of dying seems to have lost its spiritual dimension, and become a matter of prolonging material life by means of medical technology. The novel quandaries that arose led in turn to medico-legal regulation. This paper describes the recent regulation of dying in Israel under its Dying Patient Law, 2005. The Law recognizes advance directives in principle, but limits (...) their effect and form through complex medico-legal artifices. It reflects a culture that places high value on both scientific medicine and the sanctity of life as such, and illustrates a medical culture that pitches battle against death. At the same time, the Law constructs the will of the individual in a medico-legal language that is alien to the lay person. The paper suggests an alternative approach to advance care planning that is patient-centred and addresses the psycho-social needs of the individual in terms of her relational autonomy. From this perspective, advance care planning becomes an opportunity to extract the patient from the medical context and allow her to speak about her approaching death with close ones in her own terms of reference. To this end, there is a need for facilitation of an intimate encounter where patients can speak about their concerns with their loved ones. The paper also presents a methodological approach of attentive listening, which can be applied across diverse cultures and circumstances. (shrink)

In this paper, I argue against any state intrusion and interference that amounts to scrutiny of parents based on their decision to separate. The state, to my mind, ought not to be involved in childrearing decisions in cases of divorce unless there is a sufficient reason, and, as I will argue, divorce per se does not present a level of risk to children that justifies state intervention. The claims I am about to make apply not only to parental capability tests (...) but also to the entire process of legal divorce, which allows the courts to decide who they believe is a better parent—a decision that, in my view, the state is not capable of (and should not be) making. I do not claim that states ought not to interfere at all but rather that, unless parents fail to do what they are morally required to do, state interference should not be permitted. To make this case, I present two claims: claim A, that only a risk reaching a certain level (which I will call level H) justifies state intervention; claim B, that the act of divorce does not meet level H; and therefore C, there is no justification for state intervention in divorce. (shrink)

Hobbes left a complicated legacy for the English Whigs. They thought that his Leviathan was all too powerful, but they found other elements in his thought more appealing – mostly his anticlericalism. Still, the precise relationship between Hobbes and the Whigs has remained underexplored, while some still argue that Hobbes was simply too much of an absolutist for the Whigs to rely on his political ideas. This article attempts to show that Hobbes was, in fact, recruited by proto- and early (...) Whigs for their causes. It shows how Hobbesian ideas were used in the toleration debates of the 1660s and 1670s, and even in debates on human reason and liberty of conscience. Then it demonstrates how similar Hobbesian principles, and even phrases, were used subsequently in the formative years of Whiggism from the 1680s to the 1720s, by thinkers who were worried, as Hobbes was, about the political aspirations of the Church. By collecting a series of prominent thinkers who are associated with Whiggism and who engaged with Hobbes in various ways – including Buckingham, Marvell, Cavendish, Warren, Blount, Tindal, Trenchard and Gordon – this article shows that Hobbes was employed systematically in the service of Whig causes, such as limited toleration, civil religion and an opposition to religious persecution. (shrink)

Qualitative research from a feminist perspective in the postmodern era: methodological, ethical and reflexive concerns Developing methodology is an ongoing process in certain types of qualitative research. This paper describes the process in a study of single midlife women, detailing reflexive concerns on the ethics of data collection and dissemination of research findings from a feminist postmodern perspective, as well as the way in which modification of techniques of analysis occurred as the study progressed. Beginning research questions were concerned with (...) identifying the impact of menopausal symptoms, and the debate surrounding HRT on the lives and decision‐making processes of single midlife women. Initial analysis of data, using grounded theory techniques, indicated a need to place greater emphasis on the way the women constructed or talked about the self, including the embodied self. This led to an exploration of the literature relating to reflexivity, identity construction and embodiment, including feminist poststructuralist interpretations of the discursive and embodied construction of self, and informed both the theoretical framework and the method. The way in which a type of analysis fitting under the broad rubric of discourse analysis, that is one that gave added emphasis to gendered subjectivity, directed further analysis is discussed, as well as the influence on the women of social and scientific discourses in circulation. (shrink)

This paper invites us to reimagine parents as history makers and parenthood as a political space where parents and adult educators collaborate in reading and acting on the world that is, with a view to achieving a world that is not. The pandemic provides a backdrop to a fundamental understanding that while the virus may claim to be entirely democratic, the pandemic has failed the equity test. The asymmetrical world that is calls for a reinvention of adult education as a (...) space in which the excesses of neoliberalism are resisted in preparation for a shift in consciousness that might promote collective action against today’s far-from-equitable reality. Parents as ‘Subjects’ is a cris de coeur for a liberatory parent-focused education that rehumanizes parents in a world that will be. (shrink)

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

The rapid development of assisted reproduction technologies for the treatment of infertility appears to empower women through expanding their individual choice, but it is also creating new forms of suffering for them and their collaborators, especially in the context of transnational third-party reproduction. This paper explores the possibility of framing the ethical discourse around third-party reproduction by bringing attention to concerns of altruistic empathy for women who collaborate in the reproductive process, in addition to those of individualistic choice. This would (...) entail moving beyond an ethic of liberty that is based on self-interest and the language of rights, to an alternative ethic of care that is based on self-restraint and the language of responsibilities. An ethic of care and responsibility would cultivate the empathetic self-reflection of the autonomous actor in relation to those others who are part of the enterprise of bringing a child into the world. (shrink)

The clinical application of the concept of patient autonomy has centered on the ability to deliberate and make treatment decisions (decisional autonomy) to the virtual exclusion of the capacity to execute the treatment plan (executive autonomy). However, the one-component concept of autonomy is problematic in the context of multiple chronic conditions. Adherence to complex treatments commonly breaks down when patients have functional, educational, and cognitive barriers that impair their capacity to plan, sequence, and carry out tasks associated with chronic care. (...) The purpose of this article is to call for a two-component re-conceptualization of autonomy and to argue that the clinical assessment of capacity for patients with chronic conditions should be expanded to include both autonomous decision-making and autonomous execution of the agreed-upon treatment plan. We explain how the concept of autonomy should be expanded to include both decisional and executive autonomy, describe the biopsychosocial correlates of the two-component concept of autonomy, and recommend diagnostic and treatment strategies to support patients with deficits in executive autonomy. (shrink)

Background Metaphors are central to the human understanding of complex issues; through the immediate associations they evoke and frame problems and suggest solutions. Our suggestion of Music in the Park as a metaphor for health systems reform brings to the forefront the environmentally diverse but bounded spaces of health services that offer a variety of attractors within their confines, while pushing into the background organizational and economic concerns.Reflections Parks, like health services, are embedded in their local landscape, serving their communities, (...) but most importantly parks are public spaces, publically funded, ideally offering universal access and equity and to be shared by all who want to go there.Music, like health, is tangible, technical and scientific, yet ultimately experiential and based on meaning. While it encompasses a wide range of styles and approaches, music making requires as its most important skill active listening which brings with it to be ‘in the moment’, to take personal risks and to draw energy and inspiration from the participants. Hence ‘audiences’ are equally active participants because music only has meaning if it internally resonates with the listener and only can exist in what is a co-constructed experience.Conclusions Music in the Park is a metaphor for primary health care systems based on shared values of experts and unique local communities. Health professionals are players in this arena, who develop and practise the full range of their skills in response to individual and community needs and preferences. Their leadership works through inspiration and empowerment, making patients ‘co-producers’ of their own health and ‘co-shapers’ of their health services. (shrink)

We demonstrate by use of a simple one-dimensional model of a square barrier imbedded in an infinite potential well that decoherence is enhanced by chaotic-like behavior. We, moreover, show that the transition h→0 is singular. Finally it is argued that the time scale on which decoherence occurs depends, on the degree of complexity of the underlying quantum mechanical system, i.e., more complex systems decohere relatively faster than less complex ones.

We are just beginning to understand the power of local history to enhance our understanding of ourselves, our cities, and our culture. It is, after all, that stratum of history that touches our lives most closely. Madison answers the basic questions of when, where, why, how, and by whom Madison, Wisconsin was developed. The book is richly detailed, fully documented, inclusive in coverage, and delightfully readable. More than 300 illustrations provide a vivid feeling for what life was like in Madison (...) during the formative years. David Mollenhoff's unique interpretive framework emphasizing public policies and community values, gives the book a consistent interpretive quality and reveals major themes that flow through time. This combination will allow you to see the city's growth and development with unusual clarity and coherence--almost as if you were watching time-lapse photography. When Mollenhoff began to study Madison's history, he was delighted by his early discoveries but frustrated because no one had written a book-length history of Madison since 1876. Finally, in 1972 he decided to write that book. His research required him to read five miles of microfilm, piles of theses and dissertations, shelves of reports, boxes of manuscripts and letters, and to study thousands of photographs. Soon after the first edition was published in 1982, readers declared it to be a classic. For this second edition Madison has been extensively revised and updated with new maps and photos. If you want to know the fascinating story of how Madison got to be the way it is, this book belongs on your bookshelf. It will change the way you see the city and your role in it. (shrink)

_ Source: _Volume 31, Issue 2, pp 166 - 187 The connection that Hobbes makes between reason, method, and science renders reason a faculty that is not only natural but also acquired and even somewhat exclusive. This idea might pose a serious problem to Hobbes’s political theory, as it relies heavily on the successful use of reason. This problem is demonstrated in Hobbes’s account of the laws of nature, for which some equality in human reason is clearly needed, but Hobbes (...) is not explicit about the relationship between that and the more advanced form of reason that eventually leads to science. This article suggests that Hobbes’s account of reason is developmental. The seed of natural reason is common to everyone, and is sufficient for the establishment of the commonwealth. Thereafter, peace and leisure provide the necessary conditions for developing the rational skill, that is, fulfilling the human potential for rationality. Consequently, under the right circumstances, knowledge and science are expected to progress dramatically for the benefit of society, an open-ended vision which Hobbes nevertheless leaves implicit. Following Hobbes’s account of reason and philosophy closely can therefore show that he might have had great hopes for humankind, and that in this sense he was a key member of an English Enlightenment. (shrink)

This is a retrospective of surrogacy in Israel in the context of medically assisted reproduction. The practice of surrogacy emerged in the 1980s, suggesting a radical view of women as autonomous reproductive agents free from double standards of patriarchy. In 1995 Israel enacted a law that regulated domestic surrogacy for the benefit of infertile married women in accord with orthodox views of halakha. In recent years we see the growth of inter-country practices catering to otherwise ineligible intended parents, and a (...) demand for posthumous male reproduction. Meanwhile, women become objects of intrusive medical procedures and commodities of a global market, more often than not for the benefit of others rather than themselves. Yet the essence of human reproduction remains relational, and calls for care and responsibility. (shrink)

The New Jersey Supreme Court has continually avoided making moral judgments about the value of life and emphasized that such decision making should be the province of the potential parents. Recently, in Acuna v. Turkish, the court elaborated on the limitations of the decision-making right of the potential parents, and its decision demonstrated that New Jersey courts were only willing to require physicians to disclose all relevant medical information, and not moral statements that had not been agreed upon by the (...) state's medical community, people, or legislature. Acuna might be read as a departure from the trend displayed by New Jersey courts in “wrongful birth” and “wrongful life” actions toward empowering potential parents to decide if they want to bring the pregnancy to term. However, the decision actually fits squarely within this trend in that the reluctance to expand the information to which potential parents are entitled from their physicians can be directly tied to the reluctance of the New Jersey Supreme Court to weigh in on the value of life in wrongful birth and wrongful life suits. (shrink)

“One man’s ceiling is another man’s floor”Paul SimonThe words of Paul Simon capture the essence of what the courts are called upon to deal with when adjudicating matters of health. Wealthier and healthier neighbors living in the upstairs apartment are, all things being equal, not overly interested in raising the floor of their apartment in order to create more space for those in the apartment below. The floor is tangible, measurable and movable, and thus a subject where science can contribute (...) much. However, where to locate the floor is a matter of values and thus largely in the realm of politics.Resorting to the courts in matters of public policy can be seen as the residual of the inability of the remaining two branches of government, the legislature and the executive, to succeed in allocating resources and regulating the system. When the combination of science and politics falters, enter the judiciary. (shrink)

“One man’s ceiling is another man’s floor”Paul SimonThe words of Paul Simon capture the essence of what the courts are called upon to deal with when adjudicating matters of health. Wealthier and healthier neighbors living in the upstairs apartment are, all things being equal, not overly interested in raising the floor of their apartment in order to create more space for those in the apartment below. The floor is tangible, measurable and movable, and thus a subject where science can contribute (...) much. However, where to locate the floor is a matter of values and thus largely in the realm of politics.Resorting to the courts in matters of public policy can be seen as the residual of the inability of the remaining two branches of government, the legislature and the executive, to succeed in allocating resources and regulating the system. When the combination of science and politics falters, enter the judiciary. (shrink)

In order for the Food and Drug Administration to receive the trust and deference it needs to accomplish its mission, it must be seen as relatively impervious to political manipulation. For most of the FDA’s history, it has been seen as an institution driven by scientific expertise, not by political maneuvering. However, the FDA was increasingly criticized during the Bush administration for politicizing decisions such as rejecting an application to grant the “morning after pill,” known as Plan B, over-the-counter status (...) for women of all ages. After an atypical approval process, the FDA approved OTC Plan B use only for women over the age of 18. Because some groups perceive the morning after pill as a form of abortion, the politically appointed leadership of the FDA was suspected of dramatically departing from normal FDA procedures in order to ensure that the application would not be approved. (shrink)

In order for the Food and Drug Administration to receive the trust and deference it needs to accomplish its mission, it must be seen as relatively impervious to political manipulation. For most of the FDA’s history, it has been seen as an institution driven by scientific expertise, not by political maneuvering. However, the FDA was increasingly criticized during the Bush administration for politicizing decisions such as rejecting an application to grant the “morning after pill,” known as Plan B, over-the-counter status (...) for women of all ages. After an atypical approval process, the FDA approved OTC Plan B use only for women over the age of 18. Because some groups perceive the morning after pill as a form of abortion, the politically appointed leadership of the FDA was suspected of dramatically departing from normal FDA procedures in order to ensure that the application would not be approved. (shrink)

In this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions. Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct (...) achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains – the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains. Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context. Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context-driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning. (shrink)

We are never illness or disease, but, rather, always their sum in the world of day-to-day experience. Disease and illness are not closed systems, but mutually constitutive and continuously interacting worlds. In the patient’s case it is always experience as well. Pain, sickness and death help make that particular experienced identity unavoidable, and at some level ultimately inaccessible to medicine’s changing understanding of disease and tools for managing it. Health—rather than cost containment, specific conditions, or technologies—should be the central focus (...) for health care and health-care reform. A compelling reason to focus on health comes from the observation that the prevalence of disease over the .. (shrink)