Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for thinking about vaccine-sensitive resource (...) allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics. (shrink)

Volume 19, Issue 10, October 2019, Page 88-90.

Background: Despite procedural innovations and increasing numbers of uterus transplant attempts worldwide, the perspectives of uterus transplant (UTx) trial participants are lacking. Methods: We conducted a mixed-methods study with women with absolute uterine factor infertility (AUFI). Participants included women who had previously contacted the Cleveland Clinic regarding the Uterine Transplant Trial and met the initial eligibility criteria for participation. In-depth interviews were conducted in conjunction with FertiQoL, a validated and widely used tool to measure the impact of infertility on the (...) quality of life of infertility patients. Results: All (n = 19) rated their overall health as good; some experienced grief and social isolation. AUFI is a life-framing experience that influences acceptance by family, partners, peers, and one’s self. UTx is a means to gain control of reproductive autonomy. UTx allows family-building and the ability to play an active role in prenatal health and well-being. Establishing and maintaining a supportive relationship is a key issue of AUFI and when considering UTx. Risks of UTx are perceived relative to risks to self/child/family posed by adoption/surrogacy. Participants had no overall preference regarding living or deceased donor. Conclusions: The ways in which women with AUFI conceptualize this condition in their lives and choices around UTx and participating in a study of the procedure are multifaceted and textured. These perspectives are critical to understanding its ethical, legal, and social implications. (shrink)

Philosophy has much to offer psychiatry, not least regarding ethical issues, but also issues regarding the mind, identity, values, and volition. This has become only more important as we have witnessed the growth and power of the pharmaceutical industry, accompanied by developments in the neurosciences. However, too few practising psychiatrists are familiar with the literature in this area. -/- The Oxford Handbook of Philosophy and Psychiatry offers the most comprehensive reference resource for this area ever published. It assembles challenging and (...) insightful contributions from key philosophers and others to the interactive fields of philosophy and psychiatry. Each contributions is original, stimulating, thorough, and clearly and engagingly written - with no potentially significant philosophical stone left unturned. Broad in scope, the book includes coverage of several areas of philosophy, including philosophy of mind, science, and ethics. For philosophers and psychiatrists, The Oxford Handbook of Philosophy and Psychiatry is a landmark publication in the field - one that will be of value to both students and researchers in this rapidly growing area. (shrink)

Relativism and contextualism are the most popular accounts of faultless disagreement, but Crispin Wright once argued for an account I call divergentism. According to divergentism, parties who possess all relevant information and use the same standards of assessment in the same context of utterance can disagree about the same proposition without either party being in epistemic fault, yet only one of them is right. This view is an alternative to relativism, indexical contextualism, and nonindexical contextualism, and has advantages over those (...) views. Wright eventually abandoned this view in favor of relativism for reasons related to a conciliationist view of disagreement between epistemic peers. I argue that he gave up on divergentism too soon. (shrink)

Does respect for autonomy imply respect for precedent autonomy? The principle of respect for autonomy requires us to respect a competent patient’s treatment preference, but not everyone agrees that it requires us to respect preferences formed earlier by a now‐incapacitated patient, such as those expressed in an advance directive. The concept of precedent autonomy, which concerns just such preferences, is problematic because it is not clear that we can still attribute to a now‐incapacitated patient a preference which that patient never (...) disaffirmed but can no longer understand. If we cannot make that attribution, then perhaps we should not respect precedent autonomy – after all, how can you respect patient autonomy by giving patients what they no longer want, even if they never disaffirmed those wants? I argue that whether an earlier preference can still be attributed to a now‐incapacitated patient depends on the reasons behind the preference, for a preference includes (and is not merely supported by) the reasons behind it. When the considerations that served as reasons no longer exist, neither does the preference which included those reasons. In particular, if the considerations that served as reasons for the patient exist only under conditions where the patient retains full mental capacity, then once that capacity is lost, so are those reasons and the preference based upon them. I use this analysis of precedent autonomy to ascertain the merits of various approaches to advance medical decisionmaking, including Nancy Rhoden’s approach, approaches based on a Parfitian personal identity analysis, approaches based on soft paternalism, and approaches based on the stability and longevity of preferences. Despite the apparent absurdity of respecting patient autonomy by giving patients what they no longer prefer but have never disaffirmed, I conclude with some programmatic remarks on when and why respect for (precedent) autonomy nonetheless requires us to respect former preferences. (shrink)

Most discussions of medical futility try to answer the Futility Question: when is a medical procedure futile? No answer enjoys universal support. Some futility policies say that the health care provider will answer this question when the provider and patient cannot agree. This raises the Decision Question: who has the moral authority to decide what to do in cases where futility is disputed? I look for a procedural answer to this question, an answer that does not turn on whether a (...) given party happens to answer the Futility Question correctly. I argue that these policies get it right; the provider should decide because providers have a right of conscientious refusal that extends to refusing procedures on grounds of futility. This is a procedural answer because providers have this right even if they are sincerely mistaken about whether a procedure is futile. (shrink)

Honoring a living will typically involves treating an incompetent patient in accord with preferences she once had, but whose objects she can no longer understand. How do we respect her precedent autonomy by giving her what she used to want? There is a similar problem with subsequent consent: How can we justify interfering with someone''s autonomy on the grounds that she will later consent to the interference, if she refuses now?Both problems arise on the assumption that, to respect someone''s autonomy, (...) any preferences we respect must be among that person''s current preferences. I argue that this is not always true. Just as we can celebrate an event long after it happens, so can we respect someone''s wishes long before or after she has that wish. In the contexts of precedent autonomy and subsequent consent, the wishes are often preferences about which of two other, conflicting preferences to satisfy. When someone has two conflicting preferences, and a third preference on how to resolve that conflict, to respect his autonomy we must respect that third preference. People with declining competence may have a resolution preference earlier, favoring the earlier conflicting preference (precedent autonomy), whereas those with rising competence may have it later, favoring the later conflicting preference (subsequent consent). To respect autonomy in such cases we must respect not a current, but a former or later preference. (shrink)

Patients sometimes request procedures their doctors find morally objectionable. Do doctors have a right of conscientious refusal? I argue that conscientious refusal is justified only if the doctor's refusal does not make the patient worse off than she would have been had she gone to another doctor in the first place. From this approach I derive conclusions about the duty to refer and facilitate transfer, whether doctors may provide 'moral counseling,' whether doctors are obligated to provide objectionable procedures when no (...) other doctor is available, why the moral consensus among doctors seems relevant even though it does not determine whether something is morally acceptable, and whether doctors should stay out of fields whose standard procedures they find morally unacceptable. (shrink)

University human research ethics application procedures can be complicated and daunting, especially for international students unfamiliar with the process and the language. We conducted focus groups and interviews with four research higher degree and 21 Master’s coursework international students at an Australian university to gain their views on the human ethics application process. We found the most important influences on their experience were: the time it took to do an application; support from supervisors, peers and others; their own language skills; (...) and their lack of familiarity with research ethics procedures. To improve the experience of international students undertaking research involving human research ethics applications, we recommend universities provide guidance on institutional ethics review processes, concepts and terminology, with translations in a range of languages, together with guidance on how to conduct research ethically within and outside the students’ own countries. We also recommend curricula be developed to further students’ understanding of the importance of ethical research practice, and that these curricula be embedded in undergraduate and postgraduate degree programs and reflected in course learning outcomes. (shrink)

This new edition of Baran and Davis's successful text provides a comprehensive, historically based, introduction to mass communication theory. Clearly written with examples, graphics, and other materials to illustrate key theories, this edition traces the emergence of two main bodies of mass communication theory: social, behavioral and critical, cultural. The authors emphasize that media theories are human creations that typically are intended to address specific problems or issues.

Moral and legal judgments sometimes depend on personal traits in this sense: the subject offers good reasons for her judgment, but if she had a different social or ideological background, her judgment would be different. If you would judge the constitutionality of restrictions on abortion differently if you were not a secular liberal, is your judgment really based on the arguments you find convincing, or do you find them so only because you are a secular liberal? I argue that a (...) judgment can be based on the considerations the subject claims as justification even when it depends on personal traits. (shrink)

Some moral disagreements are so persistent that we suspect they are deep : we would disagree even when we have all relevant information and no one makes any mistakes. The possibility of deep disagreement is thought to drive cognitivists toward relativism, but most cognitivists reject relativism. There is an alternative. According to divergentism, cognitivists can reject relativism while allowing for deep disagreement. This view has rarely been defended at length, but many philosophers have implicitly endorsed its elements. I will defend (...) it. (shrink)

The worst possible way to resolve this issue is to leave it up to individual choice. There is no known social good coming from the conquest of death (Bailey, 1999). - Daniel Callahan Dramatically extending the human lifespan seems increasingly possible. Many bioethicists object that life-extension will have Malthusian consequences as new Methuselahs accumulate, generation by generation. I argue for a Life-Years Response to the Malthusian Objection. If even a minority of each generation chooses life-extension, denying it to them deprives (...) them of many years of extra life, and their total extra life-years are likely to exceed the total life-years of a majority who do not want life-extension. This is a greater harm to those who want extended life than the Malthusian harms to those who refuse extended life, both because losing an extra year of life is worse than enduring a year of Malthusian conditions, and because the would-be Methuselahs have more life-years at stake. Therefore, even if life-extension seems likely to cause severe overcrowding and resource shortages, that threat is not sufficient to justify society in restricting the development or availability of life-extension. (shrink)

Many studies examine student self-concept during compulsory schooling but few have explored the self-concept of students in higher educational settings. The current study examined self-concept by faculty and gender among higher education students in New Zealand. Participants were 929 undergraduate students from a large New Zealand university. The results showed some differences in verbal and maths self-concept by faculty. Generally, students in faculties teaching subjects more reliant on maths skills had higher maths self-concept than those in faculties where facility in (...) verbal skills was important. The opposite results were found for verbal self-concept. No overall gender differences were found for general, academic, verbal and maths self-concept although a statistically significant difference was found for problem-solving self-concept. This finding suggests students? choice of faculty may be based on perceptions of their skills and capabilities in the various fields, irrespective of gender. (shrink)

Moral decision procedures such as principlism or casuistry require intuition at certain junctures, as when a principle seems indeterminate, or principles conflict, or we wonder which paradigm case is most relevantly similar to the instant case. However, intuitions are widely thought to lack epistemic justification, and many ethicists urge that such decision procedures dispense with intuition in favor of forms of reasoning that provide discursive justification. I argue that discursive justification does not eliminate or minimize the need for intuition, or (...) constrain our intuitions. However, this is not a problem, for intuitions can be justified in easy or obvious cases, and decision procedures should be understood as heuristic devices for reaching judgments about harder cases that approximate the justified intuitions we would have about cases under ideal conditions, where hard cases become easy. Similarly, the forms of reasoning which provide discursive justification help decision procedures perform this heuristic function not by avoiding intuition, but by making such heuristics more accurate. Nonetheless, it is possible to demand too much justification; many clinical ethicists lack the time and philosophical training to reach the more elaborate levels of discursive justification. We should keep moral decision procedures simple and user-friendly so that they will provide what justification can be achieved under clinical conditions, rather than trying to maximize our epistemic justification out of an overstated concern about intuition. (shrink)

Judith Thomson argues that a fetus may have a right to life yet lack the right to use its mother's body to stay alive. According to Kenneth Einar Himma, Thomson's argument applies only to cases where the parties meet two conditions. First, they must and, second, they must be Himma devises a case involving conjoined twins to show why the mother–fetus case does not meet these conditions.

On the face of things, the concept of 'profession' does not appear philosophically problematic: just survey the dozen or so occupations everyone calls professions and list their common attributes. Typically, it is said that law, medicine, teaching and other..

Sometimes the mentally ill have sufficient mental capacity to refuse treatment competently, and others have a moral duty to respect their refusal. However, those with episodic mental disorders may wish to precommit themselves to treatment, using Ulysses contracts known as “mental health advance directives.” How can health care providers justify enforcing such contracts over an agent’s current, competent refusal? I argue that providers respect an agent’s autonomy not retrospectively—by reference to his or her past wishes—and not merely synchronically—so that the (...) agent gets what he or she wants right now—but diachronically and prospectively, acting so that the agent can shape his or her circumstances as the agent wishes over time, for the agent will experience the consequences of providers’ actions over time. Mental health directives accomplish this, so they are a way of respecting the agent’s autonomy even when providers override the agent’s current competent refusal. (shrink)

Visual analogy is believed to be important in human problem solving. Yet, there are few computational models of visual analogy. In this paper, we present a preliminary computational model of visual analogy in problem solving. The model is instantiated in a computer program, called Galatea, which uses a language for representing and transferring visual information called Privlan. We describe how the computational model can account for a small slice of a cognitive-historical analysis of Maxwell’s reasoning about electromagnetism.

The Dispossessed has been described by political thinker Andre Gorz as 'The most striking description I know of the seductions—and snares—of self-managed communist or, in other words, anarchist society.' To date, however, the radical social, cultural, and political ramifications of Le Guin's multiple award-winning novel remain woefully under explored. Editors Laurence Davis and Peter Stillman right this state of affairs in the first ever collection of original essays devoted to Le Guin's novel. Among the topics covered in this wide-ranging, (...) international and interdisciplinary collection are the anarchist, ecological, post-consumerist, temporal, revolutionary, and open-ended utopian politics of The Dispossessed. The book concludes with an essay by Le Guin written specially for this volume, in which she reassesses the novel in light of the development of her own thinking over the past 30 years. (shrink)

Over one hundred genes have been isolated from the human genome and shown to be causally related to specific human genetic diseases. Studies with gene‐specific probes have demonstrated that the mutations resulting in a particular phenotype are highly heterogeneous as a group, ranging from alterations in transcription or RNA processing in the nucleus, through to errors in mRNA translation in the cytoplasm. Even where the gene‐specific probe is not available, defects have been localized to chromosomal regions by family studies. Recently (...) developed methods for moving along the chromosome from a linked marker to the mutation are resulting in rapid advances in the understanding of many monogenic disorders. (shrink)

Although in Drosophila pair‐rule genes play crucial roles in the genetic hierarchy that subdivides the embryo into segments, the extent to which pair‐rule patterning is utilized by different arthropods and other segmented phyla is unknown. Recent data of Dearden et al.1 and Henry et al.,2 however, hint that a pair‐rule mechanism might play a role in the segmentation process of basal arthropods and vertebrates. BioEssays 25:425–429, 2003. © 2003 Wiley Periodicals, Inc.