Background and PurposeMany critically ill patients in intensive care units (ICUs) are unable to communicate their wishes about goals of care, particularly about the use of life-sustaining treatments. Surrogates and clinicians struggle with medical decisions because of a lack of clarity regarding patients’ preferences, leading to prolonged hospitalizations and increased costs. This project focused on the development and implementation of a tool to facilitate a better communication process by (1) assuring the early identification of a surrogate if indicated on admission (...) and (2) clarifying the decision-making standards that the surrogate was to use when participating in decision making. Before introducing the tool into the admissions routine, the staff were educated about its use and value to the decision-making process.Project and MethodsThe study was to determine if early use of a simple method of identifying a patient’s surrogate and treatment preferences might impact length of stay (LOS) and total hospital charges. A pre- and post-intervention study design was used. Nurses completed the surrogacy information tool for all patients upon admission to the neuroscience ICU. Subjects (total N=203) were critically ill patients who had been on a mechanical ventilator for 96 hours or longer, or in the ICU for seven days or longer. The project included staff education on biomedical ethics, critical communication skills, early identification of families and staff in crisis, and use of a simple tool to document patients’ surrogates and previously expressed care wishes. Data on hospital LOS and hospital charges were collected through a retrospective review of medical records for similar four-month time frames pre- and post-implementation of the assessment tool.ResultsSignificant differences were found between pre- and post-groups in terms of hospital LOS (F=6.39, p=.01) and total hospital charges (F=7.03, p=.009).ConclusionsProject findings indicate that the use of a simple admission assessment tool, supported by staff education about its completion, use, and available resources, can decrease LOS and lower total hospital charges. The reasons for the difference between the pre- and post-intervention groups remain unclear. Further research is needed to evaluate if the quality of communications between patients, their legally authorized representatives, and clinicians—as suggested in the literature—may have played a role in decreasing LOS and total hospital charges. (shrink)

Social theory can sometimes seem as though it's speaking of a world that existed long ago, so why should we continue to study and discuss the theories of these dead white men? Can their work still inform us about the way we live today? Are they still relevant to our consumer-focused, celebrity-crazy, tattoo-friendly world? This book explains how the ideas of classical sociological theory can be understood, and applied to, everyday activities like listening to hip-hop, reading fashion magazines or watching (...) reality TV. Taking the reader through central sociological texts, Social Theory In Popular Culture explains why key theorists – from Marx to Saussure – are still considered to be the bedrock of sociology and sociological enquiry. Each chapter examines a different key thinker and applies their work to a recognisable aspect of popular cultural, showing how the central issues underpinning classic social thought - class, conflict, gender, power, ethnicity, and social status - can still be readily observed within the modern global world. Encouraging the reader to critique and reflect upon the ways in which classic social theory applies to their own worlds, this is the perfect antidote to dry social theory explanations. It is an eye-opening read for all students and scholars across the social sciences. (shrink)

Moral duties are regularly attributed to groups. Does this make conceptual sense or is this merely political rhetoric? And what are the implications for these individuals within groups? Collins outlines a Tripartite Model of group duties that can target political demands at the right entities, in the right way and for the right reasons.

Objectives: To explore opinions and attitudes regarding the current information-giving practices in research involving adults with intellectual disabilities.Design: Qualitative focus group study with a purposive sample.Setting: An intellectual disabilities service within the NHSParticipants: A sample of 26 individuals including adults with mild intellectual disability, carers, clinicians, care managers and the charitable sector.Results: Three main themes were identified: process, format, and content. There was agreement that there is a need for improvement in the process and quality of information giving. With regard (...) to the content of information, there was little discrepancy between the study findings and existing guidance.Conclusions: Information should be presented in different formats and prepared with input from appropriate professions. Additionally the roles of peers, carers and other professionals in the process of information giving should be considered. (shrink)

Argues that positive changes in perspective and deeper spiritual connections to things greater than oneself can influence the world for the better.

Se trata de un artículo que busca una relectura de los textos y problemas en la obra del filósofo francés Louis Althusser. Hay dos líneas argumentativa que sigue la relectura: 1) su materialismo aleatorio, y 2) su teoría del lenguaje.

The ethics of care has flourished in recent decades yet we remain without a succinct statement of its core theoretical commitment. This book uses the methods of analytic philosophy to argue for a simple care ethical slogan: dependency relationships generate responsibilities. It uses this slogan to unify, specify and justify the wide range of views found within the care ethical literature.

There is disagreement in the literature about the exact nature of the phenomenon of empathy. There are emotional, cognitive, and conditioning views, applying in varying degrees across species. An adequate description of the ultimate and proximate mechanism can integrate these views. Proximately, the perception of an object's state activates the subject's corresponding representations, which in turn activate somatic and autonomic responses. This mechanism supports basic behaviors that are crucial for the reproductive success of animals living in groups. The Perception-Action Model, (...) together with an understanding of how representations change with experience, can explain the major empirical effects in the literature. It can also predict a variety of empathy disorders. The interaction between the PAM and prefrontal functioning can also explain different levels of empathy across species and age groups. This view can advance our evolutionary understanding of empathy beyond inclusive fitness and reciprocal altruism and can explain different levels of empathy across individuals, species, stages of development, and situations. Key Words: altruism; cognitive empathy ; comparative; emotion; emotional contagion; empathy ; evolution; human; perception-action; perspective taking. (shrink)

The influence of surrealism and Philippe Soupault on William Carlos Williams' poetry.

Responding to calls for more substantive studies into ethical and responsible lobbying, we analyze data collected over a 5-year period in Brussels to explore how individual lobbyists understand the ethical dimensions of their work. Mobilizing insights from the sociology of the professions, we expose an emerging lobbying professionalism and unpack practitioners’ understandings of what being a professional lobbyist entails, focusing in particular on their espoused values of transparency and honesty. While expectations to lobby more transparently and honestly stem from political (...) institutions, we find individual lobbyists—acting as conduits—attempt to disseminate these expectations by setting limits that incite their clients to embrace what policymakers consider professional lobbying practice. Our study contributes to corporate political activity (CPA) scholarship by providing a professions-based understanding of ethical and responsible approaches to lobbying. We provide new insights into contextual and individual-level factors behind the emergence of such approaches, and elucidate implications of lobbying professionalism for business and European Union (EU) governance. (shrink)

Young children learn about the power of God's love and creation through simple text and illustrations.

The first Dr. Lerner -- Super doctor -- Illness hits home -- The second Dr. Lerner -- Forging my own path -- Treating the whole patient -- Family practitioner -- Growing disillusionment -- Slowing down -- Epilogue.

Many meta-ethicists are alethists: they claim that practical considerations can constitute normative reasons for action, but not for belief. But the alethist owes us an account of the relevant difference between action and belief, which thereby explains this normative difference. Here, I argue that two salient strategies for discharging this burden fail. According to the first strategy, the relevant difference between action and belief is that truth is the constitutive standard of correctness for belief, but not for action, while according (...) to the second strategy, it is that practical considerations can constitute motivating reasons for action, but not for belief. But the former claim only shifts the alethist's explanatory burden, and the latter claim is wrong—we can believe for practical reasons. Until the alethist can offer a better account, then, I argue that we should accept that there are practical reasons for belief. (shrink)

On a Humean account, a person's reasons for action are determined by her desires---in the broadest sense of 'desires', that is, noncognitive pro-attitudes. In four essays, I defend this account against several prominent objections. The first essay addresses the concern that the Humean cannot account for rationalizing reasons . The next three essays concern justifying reasons : reasons for action that are more fully normative than those that merely make action intelligible. Instrumental reasons, prudential reasons, and intrinsic reasons are three (...) different sorts of reasons to which an agent can appeal in justifying her action. ;Each essay focuses on a specific attack against the Humean account. In the second essay I argue that the normatively of instrumental reasons is brute ; and that, contrary to the received view, this is compatible with Humeanism. In the third essay I consider prudential reasons and defend the Humean claim that all and only present concerns provide normative reasons for action. In the final essay I address the fundamental question considerations of deliberative relevance: what makes certain desires and considerations relevant to a specific decision-making context, that is, what puts them among a person's present active reasons. ;In addition to defending a broadly Humean account of practical reasons, I am concerned to expand the components of a plausible form of Humeanism. Specifically, I argue that desires alone are not always sufficient to ground an agent's reasons, and that affective states are sometimes also necessary. I call this view "thick Humeanism". In essays one and four especially, I urge that a central place be given to affective states in determining practical reasons. I also invoke recent studies in cognitive psychology to support my claims about the role of the emotions in practical deliberation. (shrink)

Perhaps nothing symbolizes the current polarized political climate in the United States more than the world of public health. Public health schools and health departments are full of “true believers,” people willing to crusade for any program designed to reduce morbidity and mortality. But in the “real world,” proven programs and strategies—such as gun-control measures, universal vaccination, and improved traffic safety—are routinely thwarted. Why do critics oppose efforts to improve the public's health? History can provide some answers.

Organizations do moral wrong. States pursue unjust wars, businesses avoid tax, charities misdirect funds. Our social, political, and legal responses require guidance. We need to know what we’re responding to and how we should respond to it. We need a metaphysical and moral theory of wrongful organizations. This book provides a new such theory, paying particular attention to questions that have been underexplored in existing debates. These questions include: where are organizations located as material objects in the natural world? What’s (...) the metaphysical relation between organizations and their members? Can organizations be blameworthy for attitudes and character traits, as well as for actions? What about feelings of guilt, remorse, and shame—can organizations feel these emotions and why does this matter? How and why are members implicated in organizations’ wrongs? How should organizations’ reparative costs be apportioned among members? The book answers these questions. It argues that organizations are material objects with humans as material parts—much like how a pizza is a material object with slices as material parts. This picture helps us make sense of organizations’ blameworthiness, including blame for organization-level actions, attitudes, and character traits. The book argues that organizations can experience moral self-awareness—a crucial component of guilt, remorse, and shame. Members can be implicated in organizations’ actions in numerous ways—and, it is argued, members’ level of implication should determine their share of organizations’ reparative burdens. (shrink)

This article takes a speculative and design fiction approach to the critical analysis of the role of smart and autonomous vehicles (AVs) in the context of smart cities. The article explores arguments that these cars of the future will have decisive impacts on mobility, sustainability and road safety. The article examines the main parameters of smart city and smart car developments and then focuses on the visions of increasing AI-driven autonomy. The article demonstrates how these debates are linked to speculative (...) design as full autonomy does not currently exist but takes a speculative position as to what the critical issues are that face smart/autonomous city visions (enhanced surveillance and data mining) and considers the potentially hazardous ethical dilemmas that AVs may encounter once fully rolled out onto city roads. From a design fiction perspective, the article envisions the viability of AV prioritizing public rather than private transport as a means by which the ‘techno-utopic’ visions of smart city/AV integration can be realized and make positive impacts to enhance urban living in rendering future cities as more sustainable, efficiently mobile and safer urban spaces. (shrink)

Chalmers' (2018) meta-problem of consciousness emphasizes unexpected common ground between otherwise incompatible positions. We argue that the materialist should welcome discussion of the meta-problem. We suggest that the core of the metaproblem is the seeming arbitrariness of subjective experience. This has an unexpected resolution when one moves to an interventionist account of scientific explanation: the same interventions that resolve the hard problem should also resolve the meta-problem.

Trust is a critical component of research: trust in the work of co-workers and colleagues within the scientific community; trust in the work of research scientists by the non-research community. A wide range of factors, including internally and externally generated pressures and practical and personal limitations, affect the research process. The extent to which these factors are understood and appreciated influence the development of trust in scientific research findings.

With the growth of precision medicine research on health data and biospecimens, research institutions will need to build and maintain long-term, trusting relationships with patient-participants. While trust is important for all research relationships, the longitudinal nature of precision medicine research raises particular challenges for facilitating trust when the specifics of future studies are unknown. Based on focus groups with racially and ethnically diverse patients, we describe several factors that influence patient trust and potential institutional approaches to building trustworthiness. Drawing on (...) these findings, we suggest several considerations for research institutions seeking to cultivate long-term, trusting relationships with patients: Address the role of history and experience on trust, engage concerns about potential group harm, address cultural values and communication barriers, and integrate patient values and expectations into oversight and governance structures. (shrink)

While popular cultural representations portray the “new father” of the past two decades as more involved, more nurturing, and capable of coparenting, many argue that actual fathering conduct has not kept pace. Others, however, question the extent to which the culture of fatherhood does indeed support involved fathering and, if so, what this involvement entails. This study aims to contribute to the exploration of the culture of fatherhood through an analysis of a yearlong Canadian newspaper series dedicated to family issues. (...) Findings suggest that through representations of parental guilt, parental responsibility, work—family balance issues, and hegemonic masculinity, mothers continue to be positioned as primary parents. Support for father involvement, to the extent that it exists, occurs within the framework of fathers as part-time, secondary parents whose relationship with children remains less important than mothers'. (shrink)

This chapter argues that the best way for a non-naturalist to explain why the normative supervenes on the natural is to claim that, while there are some sui generis normative properties whose essences cannot be fully specified in non-normative terms and do not specify any non-normative sufficient conditions for their instantiation, there are certain hybrid normative properties whose essences specify both naturalistic sufficient conditions for their own instantiation and sufficient conditions for the instantiation of certain sui generis normative properties. This (...) is the only metaphysical explanation for supervenience on offer, the chapter argues, that can both clearly maintain the pre-theoretical commitments of non-naturalism, and provide a metaphysical explanation not just for supervenience, but for all metaphysical necessities involving natural and normative properties. (shrink)

Individuals sometimes pass their duties on to collectives, which is one way in which collectives can come to have duties. The collective discharges its duties by acting through its members, which involves distributing duties back out to individuals. Individuals put duties in and get (transformed) duties out. In this paper we consider whether (and if so, to what extent) this general account can make sense of states' duties. Do some of the duties we typically take states to have come from (...) individuals having passed on certain individual duties? There are complications: states can discharge their duties by contracting fulfilment out to non-members; states seem able to dissolve the duties of non-members; and some of states' duties are not derived in this way. We demonstrate that these complicate, but do not undermine, the general account and its application to states. And the application has an interesting upshot: by asking which individuals robustly participate in this process of duty transfer-and-transformation with a given state, we can begin to get a grip on who counts as a member of that state. (shrink)

A surfeit of research confirms that people activate personal, affective, and conceptual representations when perceiving the states of others. However, researchers continue to debate the role of self–other overlap in empathy due to a failure to dissociate neural overlap, subjective resonance, and personal distress. A perception–action view posits that neural-level overlap is necessary during early processing for all social understanding, but need not be conscious or aversive. This neural overlap can subsequently produce a variety of states depending on the context (...) and degree of common experience and emotionality. We outline a framework for understanding the interrelationship between neural and subjective overlap, and among empathic states, through a dynamic-systems view of how information is processed in the brain and body. (shrink)

Growing interest in embedded research approaches—where research is incorporated into clinical care—has spurred numerous studies to generate knowledge relevant to the real-world needs of patients and other stakeholders. However, it also has presented ethical challenges. An emerging challenge is how to understand the nature and extent of investigators’ obligations to patient-subjects. Prior scholarship on investigator duties has generally been grounded upon the premise that research and clinical care are distinct activities, bearing distinct duties. Yet this premise—and its corresponding implications—are challenged (...) when research and clinical care are deliberately integrated. After presenting three case studies from recent pragmatic clinical trials, we identify six differences between explanatory trials and embedded research that limit the application of existing scholarship for ascertaining investigator duties. We suggest that these limitations indicate a need to account for the implications of usual care and to move beyond a narrow focus on the investigator-subject dyad, one that better reflects the team- and institution-based nature of contemporary health systems. (shrink)

Business and Society Review, Volume 127, Issue S1, Page 283-298, Spring 2022.

The second International Knowledge and Discourse Conference, held at the University of Hong Kong in June 2002, was the forum for the long-awaited debate between Bruno Latour and Steve Fuller. Bruno Latour counts beyond two. He places the blame for the emphasis in academia on the subject-object distinction on Kant. Latour wants academics to acknowledge that things act, and suggests we look at other traditions, e.g. the Chinese, for alternatives to the subject-object dichotomy. Steve Fuller concentrated on the moral project (...) of science, which is to draw a distinction between the human and the non-human and, to highlight the fact that, as the culmination of the sciences, social science has a particular responsibility to make this distinction. He accused Bruno Latour of evading the moral issue. The debate can be read as a reiteration of the postions of Bruno Latour and Steve Fuller on the question of heterogeneity at the theoretical level, but it did not address the topic at the practical or research level. (shrink)

Noninvasive, prenatal whole genome sequencing may be a technological reality in the near future, making available a vast array of genetic information early in pregnancy at no risk to the fetus or mother. Many worry that the timing, safety, and ease of the test will lead to informational overload and reproductive consumerism. The prevailing response among commentators has been to restrict conditions eligible for testing based on medical severity, which imposes disputed value judgments and devalues those living with eligible conditions. (...) To avoid these difficulties, we propose an unrestricted testing policy, under which prospective parents could obtain information on any variant of known significance after a careful informed consent process that uses an interactive decision aid to deliver a mandatory presentation on the purposes, techniques, and limitations of genomic testing, as well as optional resources for reflection and consultation. This process would encourage thoughtful, informed deliberation... (shrink)

Classic statements of research ethics advise against permitting physician-investigators to obtain consent for research participation from patients with whom they have preexisting treatment relationships. Reluctance about “dual-role” consent reflects the view that distinct normative commitments govern physician–patient and investigator–participant relationships, and that blurring the research–care boundary could lead to ethical transgressions. However, several features of contemporary research demand reconsideration of the ethics of dual-role consent. Here, we examine three arguments advanced against dual-role consent: that it creates role conflict for the (...) physician-investigator; that it can compromise the voluntariness of the patient-participant’s consent; and that it promotes therapeutic misconceptions. Although these concerns have merit in some circumstances, they are not dispositive in all cases. Rather, their force—and the ethical acceptability of dual-role consent—varies with features of the particular study. As research participation more closely approximates usual care, it becomes increasingly acceptable, or even preferable, for physicians to seek consent for research from their own patients. It is time for a more nuanced approach to dual-role consent. (shrink)

Unconsented pelvic exams under anesthesia are assaults cloaked in defense of healthcare education. Preemptive linguistic qualifiers “presumed” or “implied” attempt to justify such violations with flippancy toward their oxymoronic implications: to suggest a priori that consent can be assumed undermines its otherwise standalone social, ethical, and medico-legal reverence. In this paper I conceptualize “medical sexual assault” and argue that presumed consent for intimate exams exemplifies its definition. By bluntly describing pelvic exams as “penetration,” this work aims to reify the intimate (...) reality of the clinical label “pelvic exam” and to call attention to cisheteronormative and androcentric assumptions involved in its practice. Additionally, this scholarship seeks to create a foundation toward broader work in conceptualizing clinical rape culture. Given recent national survey data indicating a surprising frequency of unconsented intimate exams, detailed language as to their problematics is necessary for ongoing legal and ethical efforts. Explicit consent for intimate exams must be the standard of care for conscious and unconscious patients. (shrink)

In the third Critique Kant details an aesthetic operation of judgment that is surprising considering how judgment functioned in the first Critique. In this book, I defend an understanding of Kant’s theory of Geschmacksurteil as detailing an operation of the faculties that does not violate the cognitive structure laid out in the first Critique. My orientation is primarily epistemological, elaborating the determinations that govern the activity of pure aesthetic judging that specify it as a "bestimmte" type of judgment without transforming (...) it into "ein bestimmendes Urteil". I focus on identifying how the logical functions from the table of judgments operate in the pure aesthetic judgment of taste to reveal "the moments to which this power of judgment attends in its reflection". In the course of doing so, a picture emerges of how the world is not just cognizable in a Kantian framework but also charged with human feeling, acquiring the inexhaustible, inchoate meaningfulness that incites "much thinking". The universal communicability of aesthetic pleasure serves as the foundation that grounds robust intersubjective relations, enabling genuine connection to others through a shared a priori feeling. (shrink)

There is currently little empirical information about attitudes towards cognitive enhancement - the use of pharmaceutical drugs to enhance normal brain functioning. It is claimed this behaviour most commonly occurs in students to aid studying. We undertook a qualitative assessment of attitudes towards cognitive enhancement by conducting 19 semi-structured interviews with Australian university students. Most students considered cognitive enhancement to be unacceptable, in part because they believed it to be unethical but there was a lack of consensus on whether it (...) was similar or different to steroid use in sport. There was support for awareness campaigns and monitoring of cognitive enhancement use of pharmaceutical drugs. An understanding of student attitudes towards cognitive enhancement is important in formulating future policy. (shrink)

Which kinds of responsibility can we attribute to which kinds of collective, and why? In contrast, which kinds of collective responsibility can we not attribute—which kinds are ‘gappy’? This study provides a framework for answering these questions. It begins by distinguishing between three kinds of collective and three kinds of responsibility. It then explains how gaps—i.e. cases where we cannot attribute the responsibility we might want to—appear to arise within each type of collective responsibility. It argues some of these gaps (...) do not exist on closer inspection, at least for some collectives and some of the time. (shrink)

In this article, we examine how regulators, prosecutors, and courts might support and encourage the efforts of organizations to not only reintegrate after misconduct but also to improve their conduct in a way that reduces their likelihood of re-offense (rehabilitation). We explore a novel experiment in creative sentencing in Alberta Canada that aimed to try to change the behaviour of an industry by publicly airing the root causes of a failure of one the industry’s leaders. Drawing on this case and (...) prior work, we articulate a model for a responsive and restorative approach to organizational misconduct that balances the punitive role of regulators and courts with new roles in supporting and overseeing rehabilitation. (shrink)

When a liberal-democratic state signs a treaty or wages a war, does its whole polity do those things? In this article, we approach this question via the recent social ontological literature on collective agency. We provide arguments that it does and that it does not. The arguments are presented via three considerations: the polity's control over what the state does; the polity's unity; and the influence of individual polity members. We suggest that the answer to our question differs for different (...) liberal-democratic states and depends on two underlying considerations: the amount of discretion held by the state's officeholders; the extent to which the democratic procedure is deliberative rather than aggregative. (shrink)