Despite enthusiasm for patient-centered care, the practice of patient-centered care is proving challenging. Further, it is curious that the literature about this subject does not explicitly address patient autonomy, since patients guide care in patient-centered care, and respect for patient autonomy is a prominent health-care value. We argue that by explicitly adopting a relational conception of autonomy as an essential component, patient-centered care becomes more coherent, is strengthened, and could help practitioners to make better use of a principle of respect (...) for autonomy. Hence, its use appears promising to narrow the theory–practice gap. (shrink)

Lisa A. Eckenwiler and Felicia G. Cohn, The ethics of bioethics: Mapping the moral landscape, Baltimore: The Johns Hopkins University Press, 2009, reviewed by Carolyn Ells.

The purpose of this paper is to show that the standard notion of informed choice is unacceptable and must be replaced. To do so, I examine Foucault's analysis of people in contemporary society, drawing attention to the ways power relations act upon us, and to the possibility of resistance. I show how feminist moral theory can be enriched by Foucault's analysis. Applying this new understanding of people and moral theory to an analysis of informed choice, I claim that the standard (...) notion of informed choice is unacceptable, in part because it relies on a false conception of people. Its “necessary” features—intention, understanding, and absence of controlling influences—are much more difficult, if not impossible, to obtain than proponents of the standard notion believe. I end by offering direction for creating a new, Foucault-inspired, feminist theory of informed choice. (shrink)

(2010). Levels of Intervention: Communicating with More Precision About Planned Use of Critical Interventions. The American Journal of Bioethics: Vol. 10, No. 1, pp. 78-79.

Some feminists have been critical about the dominant conception of autonomy, questioning, for example, its conception of persons and ideal of personhood. Tom Beauchamp and James Childress (BC), the major proponents of the dominant conception of autonomy, believe that these feminists have misunderstood their theory and, moreover, that their theory is immune to feminist attack. Their response to feminist critics, however, has been dismissive and does nothing to assuage these critics concerns. In this paper I briefly review the state of (...) play in this debate about autonomy, showing that BC are not without positive rejoinders to objections raised by feminist critics. These rejoinders rest on the notion that feminist concerns are a matter of what is logically entailed by BCs theory of autonomy and attempt to show that feminist commitments are logically consistent with that theory. However, these rejoinders are less than convincing for reasons illuminated by Cheshire Calhoun. Calhoun reminds us that feminists are sensitive to ways in which the shape of discourse is influenced by non-epistemic considerations. In particular, Calhoun draws our attention to the cumulative effect of a whole tradition of moral reasoning that focuses on too narrow a range of moral problems and too narrow an understanding of people and the human condition. BCs conception of autonomy relies on and reinforces ideologies of the moral life created in just this way. Following Calhoun, I show that criticism of their theory as ideology is not criticism of its logical implications, but something far more damaging, something without available rejoinders. (shrink)

The Ethics of Bioethics: Mapping the Moral Landscape is a compelling, thoughtful, sobering examination of the moral practice of bioethics. Jonathan D. Moreno sets the tone in the foreword by unsettling the reader with questions from critics about the intellectual legitimacy of bioethics (e.g., the frequent tensions of political ideology with normative expertise in the public debate) and the practices of some in bioethics (e.g., the controversial roles in for-profit industry or health care). Twenty-five essays follow, addressing issues and activities (...) that mark the relatively brief history and much of the scope of bioethics practice. Each essay turns bioethics practice inward to lay bare, explore, and possibly .. (shrink)

Numerous issues confront women's healthcare today, among them the medicalization of women's bodies, cosmetic genital surgery, violence against women, HIV, perinatal mental health disorders. This volume uniquely explores such difficult topics and others at the intersection of clinical practice, policy, and bioethics in women's health care through a feminist ethics lens. With in-depth discussions of issues in women's reproductive health, it also broadens scholarship by responding to a wider array of ethical challenges that many women experience in accessing health care. (...) Contributions touch on many themes previously tackled by feminist ethics, but in new, contemporary ways. Some chapters expand into new fields in the bioethics literature, such as the ethical issues related to the care of Indigenous women, uninsured refugees and immigrants, women engaged in sex work, and those with HIV at different life stages and perinatal mental health disorders. Authors seek to connect theory and practice with users of the health system by including women's voices in their research. Bringing to bear their experience in active clinical practice in medicine, nursing, and ethics, the authors contemplate new conceptual approaches to important issues in women's healthcare, and make ethical practice recommendations for those grappling with these issues. Topical and up-to-date, this book provides a valuable resource for physicians, nurses, clinical ethicists, and researchers working in some of the most critical areas of women's health and applied ethics today. (shrink)

The Declaration of Helsinki is recognised worldwide as a cornerstone of research ethics. Working in the wake of the Nazi doctors’ trials at Nuremberg, drafters of the Declaration set out to codify the obligations of physician-researchers to research participants. Its significance cannot be overstated. Indeed, it is cited in most major guidelines on research involving humans and in the regulations of over a dozen countries.Although it has undergone five revisions,1 and most recently incorporated language aimed at addressing concerns over research (...) carried out in resource-poor countries,2–5 the Declaration could go much farther in addressing the profoundly altered landscape of research with humans. Research involving humans is now a global enterprise and often involves participants from resource-poor countries. Rather than being carried out at single institutions by veteran researchers, many studies are now conducted at many locations—including sites that are not academic medical centres—by new and relatively inexperienced investigators. A growing number of projects involve novel agents, based on innovative work in genomics and proteomics. Increasingly, research is sponsored by the for-profit sector. National governments and professional organisations around the globe provide laws, regulations and standards for the conduct of research involving humans. Considerable scholarship also critiques and guides this endeavour.In light of the current effort of the World Medical Association to revise the Declaration, we offer ideas on how to re-conceive the concept of “vulnerability” and its links with the principle of justice and, in turn, redirect the attention of researchers towards those who might be so designated.In the research context, “vulnerability” is associated with an inability partly or totally to protect one’s own interests. Typically, conceptions of vulnerability centre upon characteristics associated with particular groups that …. (shrink)

This commentary was submitted to the World Medical Association on behalf of the International Network on Feminist Approaches to Bioethics. Our submission included a description of feminist research ethics, suggestions for specific revisions to the Declaration, and elements found in other international research ethics codes that are important from a feminist perspective. Our goals were to encourage the WMA to craft a declaration that: conceptualizes issues of vulnerability in richer and more nuanced ways, resists the influence of profit motives, and (...) extends the scope of responsibility for ethical research more broadly. (shrink)

Ethical review and analysis of health policy may help to ensure policies address the needs of society and align with relevant values and principles. Indeed, researchers and bioethicists have recognized the need for ethical frameworks specifically for public health applications. The objective of this research was to compile structured tools for ethical review of health policy and to analyze these tools for their scope and philosophical underpinnings. A systematic search and review of academic and grey literature was conducted to compile (...) existing tools designed for health policy ethics review. The search yielded 13 health policy ethical review tools. Qualitative content analysis revealed that all of the tools were influenced by multiple ethical values and that a majority were influenced by more than one ethical theory. The most common values were non-maleficence and beneficence. The most common influencing ethical theory was the Principles Approach. The structure of the tools demonstrates a heterogeneity of methodology designs to approach policy ethics review. This research offers a unique contribution to the bioethics field that provides a useful resource and understanding of the current ethical review tools for health policy. (shrink)

Immigration medicine and the work carried out by Panel Physicians within the Canadian immigration system give rise to ethically troublesome practices and consequences. In this analysis in three parts, we explore the context of the immigration medical examination, characterize the observed and potential burdens and harms for immigrant and refugee applicants with HIV, and critically assess the possibilities for transforming immigration medical practices and policy to reduce inequities. We use the Code of Ethics of the Canadian Medical Association and the (...) Medical Ethics Manual of the World Medical Association to analyse six practices that fail to meet ethical expectations. This analysis opens up new lines of inquiry into the medico-administrative practices regulating immigration to Canada. It also extends knowledge about the functioning of immigration medical policy and the collection and uses of HIV-related health information. We argue that to reduce burdens and harms to prospective immigrants and refugees to Canada with HIV, changes must occur in how Citizenship and Immigration Canada asks Panel Physicians to work with these applicants. This argument is empirically informed by institutional ethnographic research results of the Canadian immigration system and its treatment of applicants with HIV. (shrink)

Comme son titre l’indique, l’ouvrage, publié en 2012 et édité par Margaret Jolly, Christine Stewart et Carolyn Brewer, vise à réinvestir la question de la violence en Papouasie Nouvelle Guinée (PNG) à partir d’une lecture par le genre : il s’agit de « genrer » (engender) la violence, dans un pays où elle apparaît omniprésente. Les huit chapitres du livre, écrits en majorité par des anthropologues sur un terrain classique de l’anthropologie, s’inscrivent ainsi dans l’abondante littérature prod...

The Declaration of Helsinki is recognised worldwide as a cornerstone of research ethics. Working in the wake of the Nazi doctors’ trials at Nuremberg, drafters of the Declaration set out to codify the obligations of physician-researchers to research participants. Its significance cannot be overstated. Indeed, it is cited in most major guidelines on research involving humans and in the regulations of over a dozen countries.Although it has undergone five revisions,1 and most recently incorporated language aimed at addressing concerns over research (...) carried out in resource-poor countries,2–5 the Declaration could go much farther in addressing the profoundly altered landscape of research with humans. Research involving humans is now a global enterprise and often involves participants from resource-poor countries. Rather than being carried out at single institutions by veteran researchers, many studies are now conducted at many locations—including sites that are not academic medical centres—by new and relatively inexperienced investigators. A growing number of projects involve novel agents, based on innovative work in genomics and proteomics. Increasingly, research is sponsored by the for-profit sector. National governments and professional organisations around the globe provide laws, regulations and standards for the conduct of research involving humans. Considerable scholarship also critiques and guides this endeavour.In light of the current effort of the World Medical Association to revise the Declaration, we offer ideas on how to re-conceive the concept of “vulnerability” and its links with the principle of justice and, in turn, redirect the attention of researchers towards those who might be so designated.In the research context, “vulnerability” is associated with an inability partly or totally to protect one’s own interests. Typically, conceptions of vulnerability centre upon characteristics associated with particular groups that …. (shrink)

This article explores the relationship between terror, power and the rule of law. First, tracing Burke’s use of the term terror back to ancient Greek usage, I argue that being terrified is incommensurable with the experience of acting together with others. In this way, terror and power are distinct. However, most acts of terror aim to terrify some people while inoculating others from terror. Witnesses to the terror of others may feel empowered by the destruction of the power of others. (...) Second, the rule of law and terror seem incommensurable because causing terror often involves violating the law. However, modern political thought is founded on the idea that the law itself ought to be terrifying. That the terror of non-state actors appears random and the terror of the law has hardly been noticed in recent commentary on terrorism indicate that the rule of law produces an interesting audience effect. In order to sustain power and legitimacy while practising terror, governments use the rule of law to divide audiences up into terrified criminals and innocent witnesses. The practice of terror as an ‘open secret’ also produces similar audience effects. Finally, despite these connections between power, terror and the rule of law, I argue that terror is always technically out of power, even when practised by states. Terror is the true weapon of the weak because it always admits a failure to foster human connections with certain people and groups. Nonviolence is a weapon of the weak in the sense that it instantiates new, unencumbered power. (shrink)

Interoception can be broadly defined as the sense of signals originating within the body. As such, interoception is critical for our sense of embodiment, motivation, and well-being. And yet, despite its importance, interoception remains poorly understood within modern science. This paper reviews interdisciplinary perspectives on interoception, with the goal of presenting a unified perspective from diverse fields such as neuroscience, clinical practice, and contemplative studies. It is hoped that this integrative effort will advance our understanding of how interoception determines well-being, (...) and identify the central challenges to such understanding. To this end, we introduce an expanded taxonomy of interoceptive processes, arguing that many of these processes can be understood through an emerging predictive coding model for mind–body integration. The model, which describes the tension between expected and felt body sensation, parallels contemplative theories, and implicates interoception in a variety of affective and psychosomatic disorders. We conclude that maladaptive construal of bodily sensations may lie at the heart of many contemporary maladies, and that contemplative practices may attenuate these interpretative biases, restoring a person’s sense of presence and agency in the world. (shrink)

Since their inception, the Perspectives in Logic and Lecture Notes in Logic series have published seminal works by leading logicians. Many of the original books in the series have been unavailable for years, but they are now in print once again. This volume, the fifteenth publication in the Lecture Notes in Logic series, collects papers presented at the symposium 'Reflections on the Foundations of Mathematics' held in celebration of Solomon Feferman's 70th birthday (The 'Feferfest') at Stanford University, California in 1988. (...) Feferman has shaped the field of foundational research for nearly half a century. These papers reflect his broad interests as well as his approach to foundational research, which emphasizes the solution of mathematical and philosophical problems. There are four sections, covering proof theoretic analysis, logic and computation, applicative and self-applicative theories, and philosophy of modern mathematical and logic thought. (shrink)

Recent research indicates that compensation structure can be used by firms to discourage their employees from whistleblowing. We extend the ethics literature by examining how compensation structures and financial rewards work together to influence managers’ decisions to blow the whistle. Results from an experiment indicate that compensation with restricted stock, relative to stock payments that lack restrictions, can enhance the likelihood that managers will blow the whistle when large rewards are available. However, restricted stock can also threaten the effectiveness of (...) whistleblowing systems without the presence of large financial rewards for whistleblowing. Thus, the large potential rewards for whistleblowing enacted by the Dodd–Frank Act appear timely as firms are moving toward compensation agreements that include greater proportions of restricted stock. (shrink)

It is often assumed that engaging in a one‐on‐one dialogue with a tutor is more effective than listening to a lecture or reading a text. Although earlier experiments have not always supported this hypothesis, this may be due in part to allowing the tutors to cover different content than the noninteractive instruction. In 7 experiments, we tested the interaction hypothesis under the constraint that (a) all students covered the same content during instruction, (b) the task domain was qualitative physics, (c) (...) the instruction was in natural language as opposed to mathematical or other formal languages, and (d) the instruction conformed with a widely observed pattern in human tutoring: Graesser, Person, and Magliano's 5‐step frame. In the experiments, we compared 2 kinds of human tutoring (spoken and computer mediated) with 2 kinds of natural‐language‐based computer tutoring (Why2‐Atlas and Why2‐AutoTutor) and 3 control conditions that involved studying texts. The results depended on whether the students' preparation matched the content of the instruction. When novices (students who had not taken college physics) studied content that was written for intermediates (students who had taken college physics), then tutorial dialogue was reliably more beneficial than less interactive instruction, with large effect sizes. When novices studied material written for novices or intermediates studied material written for intermediates, then tutorial dialogue was not reliably more effective than the text‐based control conditions. (shrink)

Taste, perhaps the most intimate of the five senses, has traditionally been considered beneath the concern of philosophy, too bound to the body, too personal and idiosyncratic. Yet, in addition to providing physical pleasure, eating and drinking bear symbolic and aesthetic value in human experience, and they continually inspire writers and artists. In Making Sense of Taste, Carolyn Korsmeyer explains how taste came to occupy so low a place in the hierarchy of senses and why it is deserving of (...) greater philosophical respect and attention. Korsmeyer begins with the Greek thinkers who classified taste as an inferior, bodily sense; she then traces the parallels between notions of aesthetic and gustatory taste that were explored in the formation of modern aesthetic theories. She presents scientific views of how taste actually works and identifies multiple components of taste experiences. Turning to taste's objects—food and drink—she looks at the different meanings they convey in art and literature as well as in ordinary human life and proposes an approach to the aesthetic value of taste that recognizes the representational and expressive roles of food. Korsmeyer's consideration of art encompasses works that employ food in contexts sacred and profane, that seek to whet the appetite and to keep it at bay; her selection of literary vignettes ranges from narratives of macabre devouring to stories of communities forged by shared eating. (shrink)

A twenty‐person working group convened to discuss the ethical and policy considerations of the controversial intervention called “growth attenuation,” and if possible to develop practical guidance for health professionals. A consensus proved elusive, but most of the members did reach a compromise.

Feminism and Tradition in Aesthetics takes a fresh look at the history of aesthetics and at current debates within the philosophy of art by exploring the ways in which gender informs notions of art and creativity, evaluation and interpretation, and concepts of aesthetic value. Multiple intellectual traditions have formed this field, and the discussions herein range from consideration of eighteenth century legacies of ideas about taste, beauty, and sublimity to debates about the relevance of postmodern analyses for feminist aesthetics. Forward (...) by Arthur C. Danto, 20 authors include Paul Mattick, Jr., Caroline Korsmeyer, Timothy Gould, Christine Battersby, Mary Devereaux, bell hooks, REnee Lorraine, Trinh T. Minh-ha, Elizabeth Ann Dobie, Adrian Piper, Anita Silvers, Susan Feagin, Mary D. Garrard, Ellen Handler Spitz, Noel Carroll, Joanne Waugh, Joseph Margolis, Rita Felski, and Hilde Hein, as well as Peg Brand's essay, "Revising the Aesthetic-Nonaesthetic Distinction: The Aesthetic Value of Activist Art.". (shrink)

A twenty‐person working group convened to discuss the ethical and policy considerations of the controversial intervention called “growth attenuation,” and if possible to develop practical guidance for health professionals. A consensus proved elusive, but most of the members did reach a compromise.

It is often assumed that engaging in a one‐on‐one dialogue with a tutor is more effective than listening to a lecture or reading a text. Although earlier experiments have not always supported this hypothesis, this may be due in part to allowing the tutors to cover different content than the noninteractive instruction. In 7 experiments, we tested the interaction hypothesis under the constraint that (a) all students covered the same content during instruction, (b) the task domain was qualitative physics, (c) (...) the instruction was in natural language as opposed to mathematical or other formal languages, and (d) the instruction conformed with a widely observed pattern in human tutoring: Graesser, Person, and Magliano's 5‐step frame. In the experiments, we compared 2 kinds of human tutoring (spoken and computer mediated) with 2 kinds of natural‐language‐based computer tutoring (Why2‐Atlas and Why2‐AutoTutor) and 3 control conditions that involved studying texts. The results depended on whether the students' preparation matched the content of the instruction. When novices (students who had not taken college physics) studied content that was written for intermediates (students who had taken college physics), then tutorial dialogue was reliably more beneficial than less interactive instruction, with large effect sizes. When novices studied material written for novices or intermediates studied material written for intermediates, then tutorial dialogue was not reliably more effective than the text‐based control conditions. (shrink)

Research explored methods for “shortening the food links” or developing the “local foodshed” by connecting farmers with food service buyers (for restaurants and institutions) in Colorado. Telephone interviews were used to investigate marketing and purchasing practices. Findings include that price is not a significant factor in purchasing decisions; that food buyers prioritize quality as their top purchasing criterion but are not aware that local farmers can provide higher quality, that institutions are interested in buying locally; that small farms can offer (...) comparable or higher quality produce andservice; and that farmers need to show buyers what the quality of produce and service they can provide. (shrink)

This collection of newly published essays examines our relationship to physical objects that invoke, commemorate, and honor the past. The recent destruction of cultural heritage in war and controversies over Civil War monuments in the US have foregrounded the importance of artifacts that embody history. The book invites us to ask: How do memorials convey their meanings? What is our responsibility for the preservation or reconstruction of historically significant structures? How should we respond when the public display of a monument (...) divides a community? This anthology includes coverage of the destruction of Palmyra and the Bamiyan Buddhas, the loss of cultural heritage through war and natural disasters, the explosive controversies surrounding Confederate-era monuments, and the decay of industry in the U.S. Rust Belt. The authors consider issues of preservation and reconstruction, the nature of ruins, the aesthetic and ethical values of memorials, and the relationship of cultural memory to material artifacts that remain from the past. Written by a leading group of philosophers, art historians, and archeologists, the 23 chapters cover monuments and memorials from Dubai to Detroit, from the instant destruction of Hiroshima to the gradual sinking of Venice. (shrink)

Public attention on embryo research has never been greater. Modern reproductive medicine technology and the use of embryos to generate stem cells ensure that this will continue to be a topic of debate and research across many disciplines. This multidisciplinary book explores the concept of a 'healthy' embryo, its implications on the health of children and adults, and how perceptions of what constitutes child and adult health influence the concept of embryo 'health'. The concept of human embryo health is considered (...) from preconception to pre-implantation genetic diagnosis to recent foetal surgical approaches. Burgeoning capacities in both genetic and reproductive science and their clinical implications have catalysed the necessity to explore the concept of a 'healthy' embryo. The authors are from five countries and 13 disciplines in the social sciences, humanities, biological sciences and medicine, ensuring that the book has a broad coverage and approach. (shrink)

Did the September 11, 2001 terrorist attacks on the U.S. cause the values of teenagers in the U.S. to change? Did their previously important self-esteem and self-actualization values become less important and their survival and safety values become more important? Changes in the values of teenagers are important for practitioners, managers, marketers, and researchers to understand because high school students are our current and future employees, managers, and customers, and research has shown that values impact work and consumer-related attitudes and (...) behaviors. Further, studies that compared higher to lower performing for-profit and not-for-profit companies have found that higher performing organizations had strong values that permeated their organizations [Collins J. C., and J. I. Porras: 1994, Built to Last: Successful Habits of Visionary Companies (New York, Harper Business); O’Reilly, C. A. and J. A. Chatman: 1996, in B. M. Staw and L. L. Cummings (eds.), Research in Organizational Behavior, vol. 18 (JAI Press, Greenwhich, CT), pp. 157–200; O’Reilly, C. A.: 1989, California Management Review 31(4), 9–25; Posner, B. Z., and W. H. Schmidt: 1996, Public Personnel Management, 25(3), 277–298; Rousseau, D.: 1990, Group and Organization Studies 15(4), 448–460; Schein, E. H.: 2004, Organizational Culture and Leadership. San Francisco, Jossey Bass)]. While one study of adults found value changes, no known studies have explored if the values of teenagers also changed post-9/11. This study filled that research gap by exploring the values of a random sample of 1000 U.S. teenagers in grades 9 to 12 pre- and post-9/11, using a demographic questionnaire and the Rokeach Value Survey. The research results indicated that teenage survival, safety, and security values (a world at peace, freedom, national security, and salvation) increased in importance while their self-esteem and self-actualization values (a sense of accomplishment, inner harmony, pleasure, self-respect, and wisdom) decreased in importance, mirroring the changes for adults. The meaning of these findings for practitioners, managers, marketers and researchers was discussed. (shrink)

This interdisciplinary collection of essays highlights the relevance of Buddhist doctrine and practice to issues of globalization. From philosophical, religious, historical, and political perspectives, the authors show that Buddhism—arguably the world’s first transnational religion—is a rich resource for navigating todays interconnected world.

Due to COVID-19, university students continued their academic training remotely. To assess the effects of emergency remote teaching, we evaluated the expectations and, subsequently, the experiences of university students about online education. This study employed a simple prospective design as its method. We assessed the expectations of 1,904 students from different discipline areas during the beginning of the first semester, March 2020, and their experiences at the end of the same academic period, September 2020. We used convenience non-probability sampling. Participants (...) responded to the questionnaire on Expectations toward virtual education in higher education for students and the questionnaire on virtual education experiences in higher education. The results showed that students’ responses reflected low expectations regarding peer relationships and comparison with face-to-face education. This perception was maintained during the evaluation of experiences. Students reported positive experiences regarding online teaching and learning, online assessment, and their self-efficacy beliefs at T2. Statistically significant differences between measurements were found, with the expertise presenting higher averages than expectations. Furthermore, differences by gender were identified, reporting a positive change in the scores of women. In addition, results reflected differences according to the disciplinary area, showing Social Sciences and Medical and Health Sciences students a more significant size effect. Findings regarding the empirical evidence and the implications for future teaching scenarios in Higher Education are discussed. (shrink)

Our research examined understandings of individual student target setting processes through semi?structured interviews with staff and students from two schools in England: a special school for students with severe learning difficulties and a linked mainstream secondary school. This article details some of the tensions and issues arising from perceived ownership of targets and the communication and sharing of these between and within schools, specifically focusing on dimensions of power and agency.