Medicaid is uniquely equipped to serve low-income populations. We identify four features that form the “soul” of Medicaid, explain how the administration is testing them, and explore challenges in accountability contributing to this struggle. We highlight the work of watchdogs acting to protect Medicaid and conclude with considerations for future health reform.

When we conceptualized this symposium, Roe v. Wade1 was still the law of the land, albeit precariously. We aimed to commemorate its fiftieth anniversary by exploring historical, legal, medical, and related dimensions of access to abortion as well as the challenges ahead to secure reproductive justice. With the leak of the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization on May 2, 2022, we shifted to mark the dawn of a new era. In the nearly identical official (...) opinion announced on June 24, 2022,2 Justice Samuel Alito, writing for the majority (6-3), overturned Roe and Planned Parenthood of Southeastern Pennsylvania v. Casey.3. (shrink)

The next steps in health reform, like all such efforts before it, will have to engage the issue of American health care federalism – the relationship between the federal and state governments in the realm of health law and policy. Since its enactment in 2010, the Patient Protection and Affordable Care Act has offered a robust example of modern federalism and revealed new complexities. This article recounts the findings of our five-year study of the federalist and nationalist features of ACA (...) implementation. Contrary to the claims of ACA opponents that the law marked a federal “takeover,” the ACA's governance structures have advanced rather than suppressed state power. But we also found that the advances in state power occurred seemingly independently of the statute's structural arrangements; that is, the ACA's nationalist and federalist features both enhanced state power over health policy. These findings raise questions about whether cherished American federalism values are unique to federalist structures; they also raise the question of what exactly health care federalism is for, and why we continue to design health policy with federalism front and center. It is not clear that enhanced state power has brought better health policy. If it has not, is federalism for its own sake worth the trade-off? (shrink)

The Institute of Medicine has returned the problem of medical error to the top of the health-care agenda. Its report that 44,000 to 98,000 patients die each year as a result of medical errors in American hospitals has renewed scholarly interest in health system quality control. In To Err Is Human, the IOM provides a vivid picture of a health-care system riven with serious quality problems. It calls for systems-based error-reduction methods borrowed from other high-risk industries and forcefully argues against (...) the traditional tendency to assign accountability primarily to individual physicians. Most errors, the IOM argues, can be successfully addressed by engineering systemic fail-safe protections against the inevitable failings of human actors. (shrink)

The Institute of Medicine has returned the problem of medical error to the top of the health-care agenda. Its report that 44,000 to 98,000 patients die each year as a result of medical errors in American hospitals has renewed scholarly interest in health system quality control. In To Err Is Human, the IOM provides a vivid picture of a health-care system riven with serious quality problems. It calls for systems-based error-reduction methods borrowed from other high-risk industries and forcefully argues against (...) the traditional tendency to assign accountability primarily to individual physicians. Most errors, the IOM argues, can be successfully addressed by engineering systemic fail-safe protections against the inevitable failings of human actors. (shrink)

This paper offers a novel, qualitative approach to evaluating the outcomes of integrating humanities and ethics into a newly revised pre-clerkship medical education curriculum. The authors set out to evaluate medical students’ perceptions, learning outcomes, and growth in identity development. Led by a team of interdisciplinary scholars, this qualitative project examines multiple sources of student experience and perception data, including student essays, end-of-year surveys, and semi-structured interviews with students. Data were analyzed using deductive and inductive processes to identify key categories (...) and recurring themes. Results suggest that students not only engaged with the curricular content and met the stated learning objectives but also acknowledged their experience in the humanities and ethics curriculum as an opportunity to reflect, expand their perceptions of medicine (and what it means to be “in” medicine), connect with their classmates, and further cultivate their personal and professional identities. Results of this qualitative study show how and in what ways the ethics and humanities curriculum motivates students past surface-level memorization of factual knowledge and encourages thoughtful analysis and evaluation about how the course material relates to and influences their thinking and how they see themselves as future doctors. The comprehensive qualitative approach reflects a holistic model for evaluating the integration of humanities and ethics into the pre-clerkship medical education curriculum. Future research should examine if this approach provides a protective factor against the demonstrated ethical erosion and empathy decrease during clinical training. (shrink)

Human cooperation is highly unusual. We live in large groups composed mostly of non-relatives. Evolutionists have proposed a number of explanations for this pattern, including cultural group selection and extensions of more general processes such as reciprocity, kin selection, and multi-level selection acting on genes. Evolutionary processes are consilient; they affect several different empirical domains, such as patterns of behavior and the proximal drivers of that behavior. In this target article, we sketch the evidence from five domains that bear on (...) the explanatory adequacy of cultural group selection and competing hypotheses to explain human cooperation. Does cultural transmission constitute an inheritance system that can evolve in a Darwinian fashion? Are the norms that underpin institutions among the cultural traits so transmitted? Do we observe sufficient variation at the level of groups of considerable size for group selection to be a plausible process? Do human groups compete, and do success and failure in competition depend upon cultural variation? Do we observe adaptations for cooperation in humans that most plausibly arose by cultural group selection? If the answer to one of these questions is “no,” then we must look to other hypotheses. We present evidence, including quantitative evidence, that the answer to all of the questions is “yes” and argue that we must take the cultural group selection hypothesis seriously. If culturally transmitted systems of rules (institutions) that limit individual deviance organize cooperation in human societies, then it is not clear that any extant alternative to cultural group selection can be a complete explanation. (shrink)

Based on its prevalence, there is an urgent need to better understand the mechanisms, opportunities and risks of sexual interaction in digital contexts that are related with sexual arousal. While there is a growing body of literature on SIDC, there is also a lack of conceptual clarity and classification. Therefore, based on a conceptual analysis, we propose to distinguish between sexual interaction through, via, and with digital technologies. Sexual interactions through digital technologies are face-to-face sexual interactions that have been started (...) digitally or are accompanied by digital technology. Sexual interactions via digital technology are technology-mediated interpersonal sexual interactions. Sexual interactions with digital technology occur when the technology itself has the role of an interaction partner. The three types of SIDC and their respective subtypes are explained and backed up with empirical studies that are grouped according to two major mediators: consent and commerce. Regarding the causes and consequences of the three types of SIDC we suggest a classification that entails biological, psychological, social, economic, and technological factors. Regarding implications of SIDC we suggest to focus on both opportunities and risks for sexual health. The proposed conceptual framework of SIDC is meant to inform future research. (shrink)

Drawing from cross-cultural work on creativity undertaken within philosophical psychology, as well as contemporary commentaries on the philosophy of the Zhuangzi, this article motivates a conception of creativity that emphasizes spontaneity and adaptivity—rather than novelty or originality—engendered by embracing you 遊 (“wandering”). It argues that this approach to creativity can enable us to understand certain forms of religious experiences, especially those related to grief and bereavement, as creative in a sense that is compatible with both: i) views that emphasize the (...) capacity of religious experiences to connect us with something supernatural, immaterial, or non-physical and, ii) views that emphasize the capacity of religious experiences to connect us with something natural, material, or physical. Additionally, it elaborates how these reflections might pave the way for further cross-cultural inquiries—empirical and otherwise—into the nature and value of religious experience. (shrink)

L’utopie est nominalement un nulle part qui est aussi, comme nous le dit Thomas More, un “bon” endroit. Bien qu’il existe des notions concurrentes, la description grecque occupe une place importante dans la plupart des récits d’utopie. Les détails de cet idéal sont si précis que la littérature utopique consiste en un catalogue (et une critique) de ces caractéristiques. Cet essai attire l’attention sur le parfum attribué aux « Îles des bienheureux » de Lucien, ainsi que sur la description qu’en (...) fait Nietzsche, sur sa sensibilité à l’odorat et sur l’attention portée par Illich à l’« atmosphère » et au nez. On aborde également le scepticisme envers l’utopie et des parallèles sont établis, d’une part, avec les critiques pragmatiques de l’utopie comme étant intrinsèquement totalitaires, d’autre part, avec la « bonne vie » dans la théorie politique et le défaut programmatique de la fantaisie techno-utopique. L’article se termine par une discussion d’Illich sur la pax – c’est-à-dire la respiration. (shrink)

This intervention study explored the effects of a newly developed intergenerational encounter program on cross-generational age stereotyping. Based on a biographical-narrative approach, participants were invited to share ideas about existential questions of life. Therefore, the dyadic Life Story Interview had been translated into a group format, consisting of 10 90-min sessions. Analyses verified that LSEP participants of both generations showed more favorable CGAS immediately after, but also 3 months after the program end. Such change in CGAS was absent in a (...) control group. The LSEP-driven short- and long-term effects on CGAS could be partially explained by two program benefits, the feeling of comfort with and the experience of learning from the other generation. (shrink)

While previous research considering the emergence of strategic alliances has typically viewed their formation through a single theoretical lens, we suggest that multiple theoretical perspectives are needed to understand their complexity. This research conceptually integrates the resource-based view and institutional theory to assess variations in firm-level motivations to form strategic alliances. Applying these ideas to the context of complex environmental problems, we propose that strategic alliances typically are either competency- or legitimacy-oriented, and that four structural dimensions characterize both types of (...) alliances—organization learning, partner diversity, governance structure, and partner relations. We present research propositions that describe how alliances differ along these dimensions, and offer an important broader perspective on alliance formation that is applicable towards understanding their strategic and social outcomes. (shrink)

First, to what level of quality can medical ethics a spire, if it ignores callous discrimination in medrcal practice against large populations of the innocent poor? Second, how effective can such theories be in addressing the critical issues of medical and clinical ethics if they are unable to contribute to the closing of the gap of sociomedical disparity?Marcio Fabri dos Anjos, Medical Ethics in the Developing World: A Liberation Theology Perspective.

This paper makes a conceptual inquiry into the notion of ‘publics’, and forwards an understanding of this notion that allows more responsible forms of decision-making with regards to technologies that have localized impacts, such as wind parks, hydrogen stations or flood barriers. The outcome of this inquiry is that the acceptability of a decision is to be assessed by a plurality of ‘publics’, including that of a local community. Even though a plurality of ‘publics’ might create competing normative demands, its (...) acknowledgment is necessary to withstand the monopolization of the process of technology appraisal. The paper presents four ways in which such an appropriation of publicness takes place. The creation of dedicated ‘local publics’, in contrast, helps to overcome these problems and allows for more responsible forms of decision-making. We describe ‘local publics’ as those in which stakeholders from the different publics that are related to the process of technology implementation are brought together, and in which concerns and issues from these publics are deliberated upon. The paper will present eight conditions for increasing the effectiveness of such ‘local publics’. (shrink)

This article explores how aspects of traditional Chinese thought regarding creativity can influence and enrich contemporary thought about related topics: specifically, how creativity can be construed as an epistemic or intellectual virtue, and the benefits of considering it as such. It proceeds in three parts. First, I review a conception of creativity suggested by aspects of the Zhuangzi that centrally involves forms of spontaneity and adaptivity engendered by embracing you 遊, or “wandering”, contrasting it with more conventional conceptions of creativity (...) that emphasize novelty or originality. Second, I explain how this conception of creativity illuminates how creativity can be an epistemic virtue of a surprising sort: one that concerns a disposition to—borrowing an expression from Chris Fraser—“ride along with things”. This “riding along” is ironically engendered by letting go of what David Wong has characterized as “the obsession with being right”, about which the Zhuangzi expresses concern. I argue that, while this conception of creativity eschews fixed goals, including epistemically-oriented goals like apprehending truth or developing knowledge, there are nevertheless good reasons to count creativity (so understood) as an epistemic virtue. Third, I connect these explorations with current conversations (begun by Matthew Kieran and C. Thi Nguyen) that already treat creativity or, relatedly, play as an epistemic or intellectual virtue, and explore how engaging the Zhuangzi in the manner outlined promises to help extend them. (shrink)

A robust body of research supports the centrality of K-12 education to health and well-being. Critical perspectives, particularly Critical Race Theory (CRT) and Dis/ability Critical Race Studies (DisCrit), can deepen and widen health justice’s exploration of how and why a range of educational inequities drive health disparities. The CRT approaches of counternarrative storytelling, race consciousness, intersectionality, and praxis can help scholars, researchers, policymakers, and advocates understand the disparate negative health impacts of education law and policy on students of color, students (...) with disabilities, and those with intersecting identities. Critical perspectives focus upon and strengthen the necessary exploration of how structural racism, ableism, and other systemic barriers manifest in education and drive health disparities so that these barriers can be removed. (shrink)

Medicine and its allied health sciences have for too long been peripherally involved in work on human rights. Fifty years ago, the door to greater involvement was opened by Article 25 of the Universal Declaration of Human Rights, which underlined social and economic rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in (...) the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”. (shrink)

Bidirectional deep brain stimulation (DBS) platforms have enabled a surge in hours of recordings in naturalistic environments, allowing further insight into neurological and psychiatric disease states. However, high amplitude, high frequency stimulation generates artifacts that contaminate neural signals and hinder our ability to interpret the data. This is especially true in psychiatric disorders, for which high amplitude stimulation is commonly applied to deep brain structures where the native neural activity is miniscule in comparison. Here, we characterized artifact sources in recordings (...) from a bidirectional DBS platform, the Medtronic Summit RC + S, with the goal of optimizing recording configurations to improve signal to noise ratio (SNR). Data were collected from three subjects in a clinical trial of DBS for obsessive-compulsive disorder. Stimulation was provided bilaterally to the ventral capsule/ventral striatum (VC/VS) using two independent implantable neurostimulators. We first manipulated DBS amplitude within safe limits (2–5.3 mA) to characterize the impact of stimulation artifacts on neural recordings. We found that high amplitude stimulation produces slew overflow, defined as exceeding the rate of change that the analog to digital converter can accurately measure. Overflow led to expanded spectral distortion of the stimulation artifact, with a six fold increase in the bandwidth of the 150.6 Hz stimulation artifact from 147–153 to 140–180 Hz. By increasing sense blank values during high amplitude stimulation, we reduced overflow by as much as 30% and improved artifact distortion, reducing the bandwidth from 140–180 Hz artifact to 147–153 Hz. We also identified artifacts that shifted in frequency through modulation of telemetry parameters. We found that telemetry ratio changes led to predictable shifts in the center-frequencies of the associated artifacts, allowing us to proactively shift the artifacts outside of our frequency range of interest. Overall, the artifact characterization methods and results described here enable increased data interpretability and unconstrained biomarker exploration using data collected from bidirectional DBS devices. (shrink)

This article aims to contribute to the literature on conceptual change by engaging in direct theoretical and empirical comparison of contrasting views. We take up the question of whether naïve physical ideas are coherent or fragmented, building specifically on recent work supporting claims of coherence with respect to the concept of force by Ioannides and Vosniadou [Ioannides, C., & Vosniadou, C. (2002). The changing meanings of force. Cognitive Science Quarterly 2, 5–61]. We first engage in a theoretical inquiry on the (...) nature of coherence and fragmentation, concluding that these terms are not well‐defined, and proposing a set of issues that may be better specified. The issues have to do with contextuality, which concerns the range of contexts in which a concept (meaning, model, theory) applies, and relational structure, which is how elements of a concept (meaning, model, or theory) relate to one another. We further propose an enhanced theoretical and empirical accountability for what and how much one needs to say in order to have specified a concept. Vague specification of the meaning of a concept can lead to many kinds of difficulties.Empirically, we conducted two studies. A study patterned closely on Ioannides and Vosniadou's work (which we call a quasi‐replication) failed to confirm their operationalizations of “coherent.” An extension study, based on a more encompassing specification of the concept of force, showed three kinds of results: (1) Subjects attend to more features than mentioned by Ioannides and Vosniadou, and they changed answers systematically based on these features; (2)We found substantial differences in the way subjects thought about the new contexts we asked about, which undermined claims for homogeneity within even the category of subjects (having one particular meaning associated with “force”) that best survived our quasi‐replication; (3) We found much reasoning of subjects about forces that cannot be accounted for by the meanings specified by Ioannides and Vosniadou. All in all, we argue that, with a greater attention to contextuality and with an appropriately broad specification of the meaning of a concept like force, Ioannides and Vosniadou's claims to have demonstrated coherence seem strongly undermined. Students' ideas are not random and chaotic; but neither are they simply described and strongly systematic. (shrink)

The consequences of foreign direct investment (FDI) for human rights protection are poorly understood. We propose that the impact of FDI varies across industries. In particular, extractive firms in the oil and mining industries go where the resources are located and are bound to such investment, which creates a status quo bias among them when it comes to supporting repressive rulers (“location-bound effect”). The same is not true for nonextractive multinational corporations (MNCs) in manufacturing or services, which can, in comparison, (...) exit problematic countries more easily. We also propose that strong democratic institutions can alleviate negative impacts of extractive FDI on human rights (“democratic safeguard effect”). Using U.S. FDI broken up into extractive and nonextractive industries in 157 host countries (1999–2015), we find support for these propositions.1 Extractive FDI is associated with more human rights abuse, but nonextractive FDI is associated with less abuse, after controlling for other factors, including concerns about endogeneity. We find also that the negative human rights impact of extractive FDI vanishes in countries where democratic institutions are stronger. Our results are robust to a range of alternative estimation techniques. (shrink)

First, we explain the conception of trustworthiness that we employ. We model trustworthiness as a relation among a trustor, a trustee, and a field of trust defined and delimited by its scope. In addition, both potential trustors and potential trustees are modeled as being more or less reliable in signaling either their willingness to trust or their willingness to prove trustworthy in various fields in relation to various other agents. Second, following Alfano (forthcoming) we argue that the social scale of (...) a potential trust relationship partly determines both explanatory and normative aspects of the relation. Most of the philosophical literature focuses on dyadic trust between a pair of agents (Baier 1986, Jones 1996, Jones 2012, McGeer 2008, Pettit 1995), but there are also small communities of trust (Alfano forthcoming) and trust in large institutions (Potter 2002, Govier 1997, Townley & Garfield 2013, Hardin 2002). The mechanisms that induce people to extend their trust vary depending on the size of the community in question, and the ways in which trustworthiness can be established and trusting warranted vary with these mechanisms. Mechanisms that work in dyads and small communities are often unavailable in the context of trusting an institution or branch of government. Establishing trust on this larger social scale therefore requires new or modified mechanisms. In the third section of the paper, we recommend three policies that – we argue – tend to make institutions more trustworthy and to reliably signal that trustworthiness to the public. First, they should ensure that their decision-making processes are as open and transparent as possible. Second, they should make efforts to engage stakeholders in dialogue with decision-makers such as managers, members of the C-Suite, and highly-placed policy-makers. Third, they should foster diversity – gender, ethnicity, age, socioeconomic background, disability, etc. – in their workforce at all levels, but especially in management and positions of power. We conclude by discussing the warrant for distrust in institutions that do not adopt these policies, which we contend is especially pertinent for people who belong to groups that have historically faced (and in many cases still do face) oppression. (shrink)

The shortages of baby formula in the US resulting from the voluntary recall of contaminated products and shutdown of manufacturing facility in February led to increases in the national out-of-stock rate of the baby formula from 18 to 70% over the summer of 2022. This study utilizes social media listening and data analysis to examine how online media reactions to the physical shortage changed over time and how the reaction to the shortage differed from to the initial recall announcements. Improved (...) understanding of reactions to emergent issues in foods through this lens may improve communication efficiency to mitigate potential consequences. (shrink)

Robots are used in various social interactions that require them to be perceived as credible agents. To be rated credible a robot’s mentalizing abilities have shown to be beneficial because they allow a robot to infer users’ inner states, thus serving as a prerequisite for understanding their beliefs and attitudes. However, social robots are often deployed by private and thus profit-oriented companies. In such cases where an organization’s implied manipulative intent is salient, the effect of robots’ mentalizing abilities might be (...) reversed. The reason for this is that mentalizing abilities could pose a persuasive threat to users rather than a feature for better understanding, thereby decreasing credibility attributions. These assumptions were tested in a three by two between-subjects, pre-registered, laboratory experiment during which participants interacted with a social robot that recommended experience vouchers as potential gifts for participants’ target persons. Contrary to our assumptions, inferential statistical results revealed no significant differences in explicit or indirect credibility attributions caused by the experimental manipulation. The external manipulative intent of an organization using the robot caused no differences in participants’ behavioral intentions or evaluations of it. Furthermore, only participants’ attribution of empathic understanding to the robot varied significantly between the three mentalizing conditions. Our results suggest that people focus more on the robot than on the organization using it, causing potential opportunities for such organizations to hide their economic interests from the users. (shrink)

As emphasized in early cultural evolutionary theory, understanding heritability of human traits – especially, behavioural traits – is difficult. The target article describes important ways that culture can enhance, or obscure, signatures of heritability in genetic studies. Here, we discuss the utility of calculating heritability for behavioural traits influenced by cultural evolution and point to conceptual and technical complications to consider in future models.

Digital mental health technologies have been promoted with the promise of delivering wide-scale access to more efficient and effective mental health diagnosis and care. During the pandemic, the rap...

Previous discussions of the evolution of the self have diverged greatly in their estimates of the date at which the capacity for self-thought emerged, the factors that led self-reflection to evolve, and the nature of the evidence offered to support these disparate conclusions. Beginning with the assumption that human self-awareness involves a set of distinct cognitive abilities that evolved at different times to solve different adaptive problems, we trace the evolution of self-awareness from the common ancestor of humans and apes (...) to the beginnings of culture, drawing upon paleontological, anthropological, biological, and psychological evidence. These data converge to suggest that that modern self-thought appeared just prior to the Middle-Upper Paleolithic transition, approximately 60,000 years ago.Recto running head: Evolution of the Self. (shrink)

In this chapter, we focus on the simple sounding question: What is it to have sex? On the assumption that having sex is what you do with all and only your sexual part-ners, this offers a way of focusing the question: What would it take for a sex robot to be a sex partner? In order to understand the significance of the development of robots with whom (or which) we can have sex, we need to know what it is to (...) have sex with a robot. And in order to know this, we have to know what it is to have sex, period. In the bulk of the chapter, we develop an account of shared sexual agency we think is a plausible precondition of genuinely having sex. In the final section, we remark briefly on the issue of what it would take to form a sexual we (as we call it) with a robot. For if we can do this, we can probably have sex with robots; but if we can’t, we can’t. (shrink)

The “prescription” of humans' social learning bifocals is fine-tuned by cultural norms and, as a result, the readiness with which the instrumental or conventional lenses are used to view behavior differs across cultures. We present evidence for this possibility from cross-cultural work examining children's imitation and innovation.

Researchers in the area of children and advertising have been working for decades to determine exactly how children process commercial messages. While a great deal of work has focused on cognitive advertising literacy, research regarding the development of children’s moral advertising literacy is lacking. Given the popularity of social media platforms among youth today, this study examined age differences in children’s moral evaluations of product placement in a YouTube video displaying various forms of disclosures. Results revealed that more prominent disclosures (...) are associated with greater judgments of the appropriateness of the advertising tactic, which in turn is associated with more positive evaluations of the promoted brand. While the former relationship was particularly strong among younger children, older children were more likely to consider how others and society broadly are impacted by covert advertising, resulting in more negative evaluations of the promoted brand. (shrink)

Mientras Carole Pateman (1988) afirma que «para las feministas la democracia no ha existido jamás», Julieta Kirkwood (1986) sostiene que «no hay democracia sin feminismo». Ambas aluden a la deuda del ideal democrático con la emancipación de las mujeres, e incluso a la función estructural de la exclusión de las mujeres en la democracia liberal. A partir de los encuentros y desencuentros entre democracia y feminismo, el presente artículo pretende ofrecer una definición de la democracia feminista que vaya más allá (...) de la inclusión a través de la acción afirmativa, abordando las tensiones que esta genera en el debate feminista de las últimas décadas y los nuevos desafíos en torno a las políticas de redistribución y de reconocimiento. ¿Es posible superar la opresión y la dominación a partir de políticas centradas en el interés de grupo? ¿Cómo se define ese interés sin esencializar la diferencia? Responder a estas preguntas resulta clave para plantear un concepto eficaz de democracia feminista. (shrink)

The greater interconnectivity and interdependence unleashed by globalization are not creating a more harmonious, cosmopolitan humanity. On the contrary, the more global the world becomes, the more insistent particular differences, especially of the nationalist kind, are being articulated around the world, often leading to tension and conflict. This seeming paradox cannot be reconciled through simple mantras of ‘unity in diversity’. Rhetorical references to ‘a single humanity’ to overcome structurally entrenched divisions (as institutionalised in the world system of nation-states) are not (...) sufficient for the attainment of greater pan-human solidarity. In response to this predicament this paper argues for a cosmopolitan perspective, in which a humanistic universalism should not be seen as a static moral ideal, but as a social and political horizon that must be worked towards, but probably never achieved, through a painstaking and continuing process of cosmopolitanization against the grain of powerful modes of particularist closure. (shrink)

Patientenselbstbestimmung und Patientenverfügungen haben zunehmende Bedeutung und Beachtung erfahren. In der vorliegenden qualitativen Studie wurden 15 Patientinnen und Patienten mit amyotropher Lateralsklerose —einer unheilbaren, chronisch-degenerativen Erkrankung mit vorhersehbarer Symptomatik—interviewt, um zu erfahren, welche Werte und Kriterien sie bei prospektiven Entscheidungen am Lebensende und bei der Abfassung von PV zugrunde legen. Die Auswertung erfolgte nach der Methode der „grounded theory“. Die befragten Patientinnen und Patienten befürworteten einen Verzicht auf lebenserhaltende Behandlungen, wenn sie keine hinreichenden Lebensmöglichkeiten mehr sahen, d. h. wenn sie (...) die aktuelle Lebensqualität für unzureichend erachteten und die Chance auf Besserung als gering einschätzten. Dem Patientenwillen sprachen sie bei der Entscheidungsfindung ein Vetorecht zu. Patientenverfügungen fassten sie erst ab, als sie keine Hoffnung mehr auf Besserung ihrer Erkrankung hatten. Sie verstanden diese als Instrumente zur vorsorglichen Erklärung ihres Wunsches, auf lebensverlängernde Maßnahmen zu verzichten, wenn die LM inakzeptabel geworden sind. Damit wollten sie sich gegenüber dem Arzt absichern, den sie in der Rolle eines Anwalts des Lebens sahen und mit dem sie daher ihre Behandlungswünsche nicht besprochen haben. Trotz vorhersehbarer Symptomatik legten sie in ihren PV keine spezifischen Behandlungswünsche nieder, sondern verwendeten allgemeine Formularmuster ohne konkreten Bezug zu ihrer Erkrankung. Daher bestehen auch bei dieser Patientengruppe Zweifel, ob die PV in einer konkreten Behandlungssituation hilfreich sind. (shrink)

This paper offers a reconstruction of Descartes’s theory of the emotions, with special focus on the virtue “générosité” which he proposed as the master virtue to help humans manage and control their desires so that they can achieve the highest level of happiness which transcends the unpredictability and arbitrariness of fate. It first provides an analysis of Descartes’s notion of “divine providence,” “vain desires,” and “regret ;” then proceeds to offer an investigation of “générosité” both as an emotion and as (...) a virtue ; and concludes with an examination of “générosité” as a tool to master and control the emotions. (shrink)

When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics consultation. (...) In this paper, we aim to contribute to the sensitization of the problem of systematic reasoning biases by showing how exemplary individual and group biases can affect the quality of decision-making on an individual and group level. We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-making. (shrink)

To assess whether and how environmental values and sense of place relate to sustainable farming practices, we conducted a study in South Kona, Hawaii, addressing environmental values, sense of place, and farm sustainability in five categories: environmental health, community engagement and food security, culture and history, education and research, and economics. We found that the sense of place and environmental values indexes showed significant correlation to each category of sustainability in both independent linear regressions and multivariate regression. In total, sense (...) of place explained a larger share of the overall farm performance. However, each indicator showed relative strengths; environmental values showed significantly higher correlation to environmental and educational practices. Furthermore the scales were complimentary, and the use of both scales greatly improved prediction of good farming practices from a multiple-impact perspective. With implications for community and environmental impacts, results suggest that a more comprehensive view of farmers’ environmental values and place connections may help illuminate individual farmers’ decisions and sustainability-related practices. (shrink)

Ethical attitudes and behaviour are complex. This complexity extends to the influencers operating at different levels both outside and within the organisation, and in different combinations for different individuals. There is hence a growing need to understand the proximal and distal influencers of ethical attitudes, and how these operate in concert at the individual, organisational, and societal levels. Few studies have attempted to combine these main research streams and systematically examine their combined impact. The minority of studies that have taken (...) a combined approach have often done so using conventional statistical and analytical techniques which imply linearity between variables—a situation that rarely exists in business settings and is likely to lead to simplistic or even erroneous conclusions. Applying a fuzzy-set qualitative comparative analysis approach, this paper reports on the mutual and simultaneous influence of individual demographic factors, as well as proximal and distal factors stemming from within and outside the work environment to understand individuals’ ethical views within the workplace. The multiple configurations that emerged reveal the complex nature of influencers of ethical attitudes, and reinforce the view that “one size does not fit all”. We discuss these implications together with managerial recommendations and future research directions. (shrink)

Graphic and gut-wrenching images of death, violence, and pain fill our news media, despite debate about their effect on audiences and their potential to harm their subjects. This research uses in-d...

At first glance the three eukaryotic protein translocation machineries – the ER‐associated degradation (ERAD) transport apparatus of the endoplasmic reticulum, the peroxisomal importomer and SELMA, the pre‐protein translocator of complex plastids – appear quite different. However, mechanistic comparisons and phylogenetic analyses presented here suggest that all three translocation machineries share a common ancestral origin, which highlights the recycling of pre‐existing components as an effective evolutionary driving force.Editor's suggested further reading in BioEssays ERAD ubiquitin ligases Abstract.