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)

The question concerning the meaning of life is important, but it immediately confronts the present authors with insurmountable obstacles from a philosophical standpoint, as it would require us to define not only what we hold to be life, but what we hold to be meaning in addition, requiring us to do both in a properly researched context. We unconditionally surrender to that challenge. Instead, we offer a vernacular, armchair approach to life’s origin and meaning, with some layman’s thoughts on the (...) meaning of origins as viewed from the biologist’s standpoint. One can observe that biologists generally approach the concept of biological meaning in the context of evolution. This is the basis for the broad resonance behind Dobzhansky’s appraisal that “Nothing in biology makes sense except in the light of evolution”. Biologists try to understand living things in the historical context of how they arose, without giving much thought to the definition of what life or living things are, which for a biologist is usually not an interesting question in the practical context of daily dealings with organisms. Do humans generally understand life’s meaning in the context of history? If we consider the problem of life’s origin, the question of what constitutes a living thing becomes somewhat more acute for the biologist, though not more answerable, because it is inescapable that there was a time when there were no organisms on Earth, followed by a time when there were, the latter time having persisted in continuity to the present. This raises the question of where, in that transition, chemicals on Earth became alive, requiring, in turn, a set of premises for how life arose in order to conceptualize the problem in relation to organisms we know today, including ourselves, which brings us to the point of this paper: In the same way that cultural narratives for origins always start with a setting, scientific narratives for origins also always start with a setting, a place on Earth or elsewhere where we can imagine what happened for the sake of structuring both the problem and the narrative for its solution. This raises the question of whether scientific origins settings convey meaning to humans in that they suggest to us from what kind of place and what kinds of chemicals we are descended, that is, to which inanimate things we are most closely related. (shrink)

This paper examines the relationship between university mission statements and sustainability practices by institutions of higher education. We examine mission statement constructs and the degree to which higher educational institutions meet specific sustainability criteria in line with the College Sustainability Report Card. Our sample consists of 347 universities from the Sustainable Endowment Institute's (2011) Green Report Card. Previous research suggests that mission statements are essential for superior organizational performance outcomes. We examine the relationship between university mission statement content and sustainability (...) practices. Findings indicate that the greater the number of specific terms used in the university mission statements, the higher the statistical likelihood that those universities had higher sustainability ratings. Findings also indicate that private institutions and nonreligious‐affiliated institutions are more likely to include sustainability constructs in their mission statements than colleges and universities with religious affiliation and public institutions. Several propositions to guide future research are discussed. (shrink)

In recent years, cognitive neuroscientists have began to explore the process of how sensory information gains access to awareness. To further probe this process, event-related functional magnetic resonance imaging was used while testing subjects with a paradigm known as the “attentional blink.” In this paradigm, visually presented information sporadically fails to reach awareness. It was found that the magnitude and time course of activation within the anterior cingulate , medial prefrontal cortex , and frontopolar cortex predicted whether or not information (...) was consciously perceived during the critical period for the attentional blink. These results are discussed in light of a neural framework for conscious processing. (shrink)

Reduced Environmental Stimulation Therapy (REST) alters the balance of sensory input to the nervous system by systematically attenuating sensory signals from visual, auditory, thermal, tactile, vestibular, and proprioceptive channels. Previous research from our group has shown that REST via floatation acutely reduces anxiety and blood pressure while simultaneously heightening interoceptive awareness in clinically anxious populations. Anorexia nervosa (AN) is an eating disorder characterized by elevated anxiety, distorted body representation, and abnormal interoception, raising the question of whether REST might positively impact (...) these symptoms. However, this approach has never been studied in eating disorders and it is unknown whether exposure to REST might worsen AN symptoms. To examine these possibilities we conducted an open-label study to investigate the safety and tolerability of REST in AN. We also explored the impact of REST on affective symptoms, body image disturbance, and interoception. Twenty-one partially weight-restored AN outpatients completed a protocol involving four sequential sessions of REST: reclining in a zero-gravity chair, floating in an open pool, and two sessions of floating in an enclosed pool. All sessions were 90 minutes, approximately one week apart. We measured orthostatic blood pressure before and immediately after each session (primary outcome), in addition to collecting blood pressure readings every 10 minutes during the session using a wireless waterproof system as a secondary outcome measure. Each participant's affective state, awareness of interoceptive sensations, and body image was assessed before and after every session (exploratory outcomes). There was no evidence of orthostatic hypotension following floating, and no adverse events (primary outcome). Secondary analyses revealed that REST induced statistically significant reductions in blood pressure, anxiety and negative affect, heightened awareness of cardiorespiratory but not gastrointestinal sensations, and reduced body image dissatisfaction. The findings from this initial trial suggest that individuals with AN can safely tolerate the physical effects of REST via floatation. Future randomized controlled trials will need to investigate whether these initial observations of improved anxiety, interoception, and body image disturbance can be effectively extended to acutely ill AN populations. (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)

Because of immigration in the West, increased cultural diversity poses a variety of problems for the criminal justice system. This paper examines whether a so‐called “cultural defense” ought to be allowed as a freestanding defense to a criminal charge. Such a defense would “negate or mitigate criminal responsibility where acts are committed under a reasonable good‐faith belief in their propriety, based on the actor's cultural heritage or tradition.” The cultural defense, as a formal defense, and the use of cultural evidence (...) in order to buttress one of the traditional defenses, are distinguished. Three cases are discussed to illustrate the issues. The possible similarity of the cultural defense to an ignorance or mistake of law defense is then considered. The latter is accepted by such theorists as Gunther Arzt and George P. Fletcher and also apparently in German law, but it is rejected by Jerome Hall on the ground that it undermines the objectivity of the criminal law. The similarity, however, is shown not to hold. It is concluded that a freestanding cultural defense should not be allowed. (shrink)

This book highlights some of the most pressing safety, ethical, legal and societal issues related to the diverse contexts in which robotic technologies apply. Focusing on the essential concept of well-being, it addresses topics that are fundamental not only for research, but also for industry and end-users, discussing the challenges in a wide variety of applications, including domestic robots, autonomous manufacturing, personal care robots and drones.

This chapter contains section titled: Questions About Responsibility The Holmesian Approach: Objective Liability Aristotle on Voluntary Action and Responsibility The Model Penal Code and Voluntariness Responsibility as a Defeasible Concept: H.L.A. Hart Individual Responsibility: Antony Duff Individual Responsibility: Norrie's Critique of Duff The Abandonment of Responsibility: Wootton The General Rationale of Excuses: H.L.A. Hart Conclusion References Further Reading.

Ever since Clifford Geertz urged the “blurring of genres” in the social sciences, many scholars have considered the crossing of disciplinary boundaries a healthy alternative to rigidly maintaining them. But what precisely does the metaphor of “blurring” imply? By unpacking the varieties of visual experiences that are normally grouped under this rubric, this essay seeks to provide some precision to our understanding of the implications of fuzziness. It extrapolates from the blurring caused by differential focal distances, velocities of objects in (...) the visual field, and competing perspectival vantage points to comparable effects in the intersection of different scholarly disciplines. Arguing against the holistic implications of Geertz's metaphor, as well as the even more totalizing concept of “consilience” introduced by E. O. Wilson, it suggests that blurring implies new types of complexity between or among those disciplines. (shrink)

(2008). The Framework of Essences in Spinoza's Ethics. British Journal for the History of Philosophy: Vol. 16, No. 3, pp. 489-509. doi: 10.1080/09608780802200489.

From the perspectives of Jewish tradition, particularly that of the Halakhah (Jewish law), this paper considers the policy problem of the balance in health care allocations between preventive and curative or crisis medicine. Since the value of human lives has a high degree of supremacy, and the duties to rescue imperiled life and to treat the sick are recognized, it might be argued that a basically curative policy should be favored. On the other hand, the duty of personal health maintenance (...) and safety would appear to argue in favor of a preventive policy. In balancing these considerations, it is suggested that the halakhic tradition can accommodate a preventive policy of health care because the duty to rescue is lessened or negatived by risk to the as-it-were rescuers. It is further suggested that Halakhah permits a non-divertable allocation of tax-generated funds to preventive health care. Keywords: Preventive medicine, curative medicine, value of human lives, duty to rescue, risk taking, Jewish law ( Halakhah ), charity tax CiteULike Connotea Del.icio.us What's this? (shrink)

This paper seeks to establish a connection between the existence of a legal system and the ideal of the rule of law. Its point of departure is the phenomenon of a transitional regime that is attempting to restore or institute the rule of law. Lon Fuller's formulation of the canons of the rule of law as an internal morality of law is expounded as well as his notion of legal pathology as symptomatic of departure from the canons' requirements. The existence (...) of a legal system, it is argued, is a matter of degree, covariant with the degree to which the rule of law is realized. Problems inherent to the implementation of the rule of law are examined, such as the effect of the passage of time on reasonable expectations. While legal pathology is always a matter of degree, police states are shown to suffer seriously from it. Among the examples discussed are Nazi Germany and Communist East Germany, though it is granted that there are moral differences between them. Finally, a response is made to some contemporary critiques of the rule of law. (shrink)

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

Pediatric oncology has a strong research culture. Most pediatric oncologists are investigators, involved in clinical care as well as research. As a result, a remarkable proportion of children with cancer enrolls in a trial during treatment. This paper discusses the ethical consequences of the unprecedented integration of research and care in pediatric oncology from the perspective of parents and physicians. An empirical ethical approach, combining (1) a narrative review of (primarily) qualitative studies on parents' and physicians' experiences of the pediatric (...) oncology research practice, and (2) comparison of these experiences with existing theoretical ethical concepts about (pediatric) research. The use of empirical evidence enriches these concepts by taking into account the peculiarities that ethical challenges pose in practice. Analysis of the 22 studies reviewed revealed that the integration of research and care has consequences for the informed consent process, the promotion of the child's best interests, and the role of the physician (doctor vs. scientist). True consent to research is difficult to achieve due to the complexity of research protocols, emotional stress and parents' dependency on their child's physician. Parents' role is to promote their child's best interests, also when they are asked to consider enrolling their child in a trial. Parents are almost never in equipoise on trial participation, which leaves them with the agonizing situation of wanting to do what is best for their child, while being fearful of making the wrong decision. Furthermore, a therapeutic misconception endangers correct assessment of participation, making parents inaccurately attribute therapeutic intent to research procedures. Physicians prefer the perspective of a therapist over a researcher. Consequently they may truly believe that in the research setting they promote the child's best interests, which maintains the existence of a therapeutic misconception between them and parents. Due to the integration of research and care, their different ethical perspectives become intertwined in the daily practice of pediatric oncology. Increasing awareness of what this means for the communication between parents and physicians is essential. Future research should focus on efforts that overcome the problems that the synchronicity of research and care evokes. (shrink)

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)