As a gynecologic surgeon with a focus on infertility, I frequently hold complex discussions with patients, exploring with them the risks and benefits of surgical options. In the past, we physicians may have expected our patients to simply defer to our expertise and choose from the options we presented. In our contemporary era, however, patients frequently request options not favored by their physicians and even some they've found themselves online. In reproductive endocrinology and infertility, the range of options that may (...) be offered or that patients may themselves seek out is continuously widening. Physicians certainly seek to find the option that will result in the best outcome for their patients, but the information to guide us in achieving the best outcome can be vague or conflicting. Add to this the financial and emotional pressures bearing on patients seeking assisted reproduction. In this essay, I explore the extent to which clinicians in reproductive medicine should follow patient requests with which they disagree or instead try to persuade the patient to do something else or simply refuse outright to meet the request. And if persuasion is to be used, what would be legitimate methods? Clearly, coercion is unacceptable, but the line between persuasion and coercion can be elusive. At what point can or should clinicians resist such requests—and to what degree? (shrink)

Decision making during reproduction is complex for a variety of medical and social reasons. Anyone who has had a conversation with a family member about the “best time” to have a baby can attest to this — there is no “best time” or “best way.” Multiple pressures from any number of sources combine in a minefield of hazards made ever more complicated by restrictive laws in the US. Add to this a screening result of potential chromosomal aneuploidy and decision making (...) becomes ever more complex. Societal stigma and lack of adequate and accurate information during counseling certainly plays a role in the high number of terminations in the setting of diagnosed chromosomal aneuploidy, yet other factors also push families in this direction including medical considerations and the abysmal lack of social support programs. (shrink)

Respect for autonomy is a central value in reproductive ethics, but it can be a challenge to fulfill and is sometimes an outright puzzle to understand. If a woman requests the transfer of two, three, or four embryos during fertility treatment, is that request truly autonomous, and do clinicians disrespect her if they question that decision or refuse to carry it out? Add a commitment to justice to the mix, and the challenge can become more complex still. Is it unfair (...) for insurance policies to exclude from coverage the costs of giving fertility to those who lack it or restoring fertility in those who have lost it? What does “just reproduction” look like in the face of multifarious understandings of both justice and autonomy and in light of increasingly complex and costly reproductive technologies? In today's dialogue about reproduction, medicine, and ethics in the United States, old ethical issues—such as whether women ought to be allowed to access pregnancy termination—are more contested than they have been in decades, while new technologies—like those used to edit the genes of human embryos—suggest that our species could face unprecedented questions about who should exist. As we considered the discussions accompanying these issues and contemplated a special report responding to them, we found ourselves consistently circling back to two ethical commitments: respect for autonomy and the pursuit of justice. As one of the nine essays in this collection asks, why should certain women receive help to establish a pregnancy while others are thrown in jail when they miscarry or their child is stillborn? Respect for autonomy is required where individuals have the ability to make fully informed and voluntary choices. Yet does respecting autonomy require acceding to all the choices of patients or consumers of medical care? We consider these and related questions in this special report from the Hastings Center Report. (shrink)

The majority of obstetrician‐gynecologists in practice operate very infrequently. Most residents graduate with strong surgical skill sets, given residency requirements. Nonetheless, their practices become dominated by obstetrics, and their gynecologic surgical skills deteriorate. While cesarean sections are surgical in nature, the skill sets needed in these surgeries differ from the skills used in general gynecologic surgery. As gynecology has taken a back seat to obstetrics in our specialty, not only surgical skills but also diagnostic and management skills have deteriorated.

This book evaluates some of the most common ethical issues confronted by reproductive endocrinologists, embryologists, and their teams. The authors apply core ethical principles and approaches to problem solving to each of the cases raised. This work is a guide for both those on the front lines of patient care as well as for students in the field, whatever their background. By outlining sample cases, the book is an instigator for ethical discussions among ethicists, medical practitioners and students.

Reading Henry Greely's wonderful book, The End of Sex and the Future of Human Reproduction, while riding public transport sparked awkward looks and equally awkward discussions. I thought of removing the dust jacket, yet I was reminded that Greely's stated purpose in writing the book was to spark conversation. The title is, of course, intentionally provocative. Greely does not, in fact, believe that humans will stop having sex for the multitude of reasons that we do already. Quite the contrary; he (...) proposes that sex for reproduction will become a technical endeavor, while sex for pleasure or other purposes beyond reproduction will remain as it is. In a not-too-distant future, advances in genomics and assisted reproduction, especially preimplantation genetic diagnosis, will allow us to control the genetic makeup of embryos. To a limited degree, PGD already makes this possible, but what Greely proposes is slightly different. His vision of the future depends on the potential for further advances of today's already fairly complex biotechnology. Greely does an excellent job of making this cutting-edge science easy to understand. (shrink)

Research involving human participants has been conducted in the Philippines since the beginning of the Spanish colonial period. Such studies are expected to adhere to internationally accepted ethical guidelines. This paper discusses trends in clinical research ethics in the Philippines during the American colonial period (1898‐1946). Specifically, studies were assessed on: 1) their observance of ethical protocols, including review; 2) identification of inclusion and exclusion criteria in the selection of participants; 3) use of vulnerable subjects; and 4) practice of the (...) informed consent process. Only the informed consent process had a significant logistic correlation with progression of years. Recruitment of vulnerable groups was common during this period; children and prisoners were the most common participants. Trends in medical ethics in the Philippines reflected those in the United States prior to the publication of the Nuremberg Code, which served as a milestone in the protection of human welfare in clinical research. (shrink)

The particle internal clock conjectured by de Broglie in 1924 was investigated in a channeling experiment using a beam of ∼80 MeV electrons aligned along the 〈110〉 direction of a 1 μm thick silicon crystal. Some of the electrons undergo a rosette motion, in which they interact with a single atomic row. When the electron energy is finely varied, the rate of electron transmission at 0° shows a 8% dip within 0.5% of the resonance energy, 80.874 MeV, for which the (...) frequency of atomic collisions matches the electron’s internal clock frequency. A model is presented to show the compatibility of our data with the de Broglie hypothesis. (shrink)

ABSTRACT There is limited guidance about whether and how to provide psychological assessment results to research participants. This paper considers several ethical challenges associated with offering individual research results in psychological assessment research. Additionally, the process used to return individual results within a study examining neurodevelopmental effects of anesthesia exposure in children and adolescents is described. Almost all participants requested to know if results were concerning; however, only around a third of those with concerning findings sought additional feedback. Ongoing research (...) and guidance are necessary to establish evidence-based practices and manage challenges that may emerge when disclosing such results. (shrink)

Background Speech understanding may rely not only on auditory, but also on visual information. Non-invasive functional neuroimaging techniques can expose the neural processes underlying the integration of multisensory processes required for speech understanding in humans. Nevertheless, noise (from fMRI) limits the usefulness in auditory experiments, and electromagnetic artefacts caused by electronic implants worn by subjects can severely distort the scans (EEG, fMRI). Therefore, we assessed audio-visual activation of temporal cortex with a silent, optical neuroimaging technique: functional near-infrared spectroscopy (fNIRS). Methods (...) We studied temporal cortical activation as represented by concentration changes of oxy- and deoxy-hemoglobin in four, easy-to-apply fNIRS optical channels of 33 normal-hearing adult subjects and 5 post-lingually deaf cochlear implant (CI) users in response to supra-threshold unisensory auditory and visual, as well as to congruent auditory-visual speech stimuli. Results Activation effects were not visible from single fNIRS channels. However, by discounting physiological noise through reference channel subtraction, auditory, visual and audiovisual speech stimuli evoked concentration changes for all sensory modalities in both cohorts (p<0.001). Auditory stimulation evoked larger concentration changes than visual stimuli (p<0.001). A saturation effect was observed for the audiovisual condition. Conclusions Physiological, systemic noise can be removed from fNIRS signals by reference channel subtraction. The observed multisensory enhancement of an auditory cortical channel can be plausibly described by a simple addition of the auditory and visual signals with saturation. (shrink)

What is Japanese philosophy? This paper will address this question, not by giving a survey of the works of Japanese philosophers or a definition of the subject matter of Japanese philosophy, but by attempting to present how it emerged as a distinct philosophical tradition—by sketching the controversies that gave rise to its formation; the social, intellectual, and historical factors that paved the way to its development; and the revolution of thought which finally gave it the title “Japanese philosophy.” I will (...) argue that Japanese philosophy was born not because Japanese thinkers desperately wanted a philosophy that they could call their own, but because, first and foremost, they were thinking of ways to articulate the ever changing and paradoxical nature of reality. Formed by their religion and informed by the Chinese and Japanese classics, they used the language learned from the West and tried to answer the most fundamental questions of existence. A unique way of philosophizing thus emerged and became a true locus of dialogue between Eastern and Western thought.An Inquiry into the Historical Development of Philosophy in Japan. (shrink)

Mastery imagery has been shown to be associated with more positive cognitive and emotional responses to stress, but research is yet to investigate the influence of mastery imagery ability on imagery’s effectiveness in regulating responses to acute stress, such as competition. Furthermore, little research has examined imagery’s effectiveness in response to actual competition. This study examined (a), whether mastery imagery ability was associated with stress response changes to a competitive stress task, a car racing computer game, following an imagery intervention, (...) and (b), the effects of different guided imagery content on pre-task cognitive and emotional responses. In Session 1, 78 participants (M age = 20.03 years, SD = 1.28) completed ratings of pre-task anxiety intensity and direction, confidence, and perceived control. Imagery ability was also assessed before completing the task. In Session 2, participants were randomly allocated to an imagery condition (positive mastery, negative mastery, relaxation) or control group (no imagery) before completing the task and outcome measures again. For the negative mastery group, greater positive mastery imagery ability was associated with greater perceived control and perceiving anxiety as more facilitative. Furthermore, mastery imagery ability moderated the relationship between anxiety intensity and direction. Altogether, results suggest that positive mastery imagery ability may act as a potential buffer against the effects of negative images. (shrink)

This study focuses on the managerial issue of should social enterprises become more marketing oriented. It adapts the Kohli et al. MARKOR marketing orientation scale to measure the adoption of marketing by SEs. The items capture Vincentian-based values to leverage business in service to the poor as a measure of a Vincentian marketing orientation. A VMO is an organisational wide value-driven philosophy of management that focuses a SE on meeting its objectives by adopting a more marketing orientated approach to serve (...) the needy and poor in a just and sustainable manner. SEs that exhibit a VMO seek to understand and respond to both the needs of their beneficiaries and stakeholders. They are constantly generating, disseminating, and responding to environmental, beneficiary, and stakeholder information and develop their business propositions to more effectively and efficiently meet the needs of the poor, while guided by a philosophy of leveraging business for social good. This study of SEs in Australia found that a VMO is strongly and positively correlated with social, economic, and environmental performance. These findings suggest that SEs may benefit by leveraging marketing capabilities to better serve their beneficiaries and stakeholders. (shrink)

As an alternative to universalism and particularism, Intermedialities: Philosophy, Arts, Politics proposes "intermedialities" as a new model of social relations and intercultural dialogue. The concept of "intermedialities" stresses the necessity of situating debates concerning social relations in the divergent contexts of new media and avant-garde artistic practices as well as feminist, political, and philosophical analyses.

Objective: Illness perceptions are important predictors of emotional and behavioral responses in many diseases. The current study aims to investigate the COVID-19-related IP throughout Europe. The specific goals are to understand the temporal development, identify predictors and examine the impacts of IP on perceived stress and preventive behaviors.Methods: This was a time-series-cross-section study of 7,032 participants from 16 European countries using multilevel modeling from April to June 2020. IP were measured with the Brief Illness Perception Questionnaire. Temporal patterns were observed (...) considering the date of participation and the date recoded to account the epidemiological evolution of each country. The outcomes considered were perceived stress and COVID-19 preventive behaviors.Results: There were significant trends, over time, for several IP, suggesting a small decrease in negativity in the perception of COVID-19 in the community. Age, gender, and education level related to some, but not all, IP. Considering the self-regulation model, perceptions consistently predicted general stress and were less consistently related to preventive behaviors. Country showed no effect in the predictive model, suggesting that national differences may have little relevance for IP, in this context.Conclusion: The present study provides a comprehensive picture of COVID-19 IP in Europe in an early stage of the pandemic. The results shed light on the process of IP formation with implications for health-related outcomes and their evolution. (shrink)

Background Victoria was the first Australian state to legalize voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). Some institutions indicated they would not participate in voluntary assisted dying. The Victorian government issued policy approaches for institutions to consider Objective To describe and analyse publicly available policy documents articulating an institutional objection to voluntary assisted dying in Victoria. Methods Policies were identified using a range of strategies, and those disclosing and discussing the nature of an institutional objection were thematically (...) analysed using the framework method. Results The study identified fifteen policies from nine policymakers and developed four themes: (1) extent of refusal to participate in VAD, (2) justification for refusal to provide VAD, (3) responding to requests for VAD, and (4) appeals to state-sanctioned regulatory mechanisms. While institutional objections were stated clearly, there was very little practical detail in most documents to enable patients to effectively navigate objections in practice. Conclusion This study demonstrates that despite having clear governance pathways developed by centralized bodies (namely, the Victorian government and Catholic Health Australia), many institutions’ public-facing policies do not reflect this guidance. Since VAD is contentious, laws governing institutional objection could provide greater clarity and regulatory force than policies alone to better balance the interests of patients and non-participating institutions. (shrink)

In jurisdictions where voluntary assisted dying is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this (...) protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture. There are no data in this work. (shrink)

The coronavirus disease pandemic fundamentally disrupted humans’ social life and behavior. Public health measures may have inadvertently impacted how people care for each other. This study investigated prosocial behavior, its association well-being, and predictors of prosocial behavior during the first COVID-19 pandemic lockdown and sought to understand whether region-specific differences exist. Participants from eight regions clustering multiple countries around the world responded to a cross-sectional online-survey investigating the psychological consequences of the first upsurge of lockdowns in spring 2020. Prosocial behavior (...) was reported to occur frequently. Multiple regression analyses showed that prosocial behavior was associated with better well-being consistently across regions. With regard to predictors of prosocial behavior, high levels of perceived social support were most strongly associated with prosocial behavior, followed by high levels of perceived stress, positive affect and psychological flexibility. Sociodemographic and psychosocial predictors of prosocial behavior were similar across regions. (shrink)

ABSTRACT. The author looks at two themes in the writings of four African scholars: E. Bolaji Idowu, John Mbiti, Okot p’Bitek and Kwame Appiah. She surveys their ideas about the existence of truth and of a High God. For each theme, she outlines the significance of each author’s work. In the conclusion the coherence between both themes is shown with the help of two varieties of philosophical positions and aesthetic styles, notably: modern-ism and postmodernism She shows why Idowu and Mbiti (...) should be categorized as mod-ernist. She argues that Okot p’Bitek’s view of God-as-dead shows him to be a modernist and why his deconstruction of the work of previous scholars also makes him a postmod-ernist avant la lettre. Finally, she argues that Appiah’s postmodern vision on the non-existence of one single truth has been conducive to his vision on identity as a bricolage of traditional and modern elements of culture. KEY WORDS. African religion, Appiah (Kwame), discourse, High God, Idowu (Bolaji), Mbiti (John), modernism, Okot p’Bitek, postmodernism, truth. (shrink)

With this issue we initiate the policy of expanding the scope of Tulane Studies in Philosophy to include, in addition to the work of members of the department, contributions from philosophers who have earned advanced degrees from Tulane and who are now teaching in other colleges and universities. The Editor THE LOGIC OF OUR LANGUAGE ROBERT L. ARRINGTON Wittgenstein wrote in the Tractatus that "logic is not a body of doctrine, but a mirror-image of the world. " 1 In line (...) with his suggestion that a proposition is a 'picture', Wittgenstein argued that propositions 'show' the logical structure of the real. He was insistent, however, that "the apparent logical form of a proposition need not be its real one. " 2 As a result of this we can misunderstand the structure of fact. Philosophical problems arise just when "the logic of our language is mis understood. " 3 It is common knowledge that much of this view of logic was rejected by Wittgenstein himself in the Philosophical Investi gations. There we are told that language has no ideal or sublime 4 logic which mirrors the structure of the extra-linguistic world. Consequently, inferences from the structure of language to the structure of that extra-linguistic world are invalid. Reality can be 'cut up' in any of a number of ways by language. Wittgenstein adopted a view of philosophy which would render that discipline a non-explanatory, non-critical study of the multiple ways in which language can be used. (shrink)

In cognitive science, there is a tacit norm that phenomena such as cultural variation or synaesthesia are worthy examples of cognitive diversity that contribute to a better understanding of cognition, but that other forms of cognitive diversity (e.g., autism, attention deficit hyperactivity disorder/ADHD, and dyslexia) are primarily interesting only as examples of deficit, dysfunction, or impairment. This status quo is dehumanizing and holds back much-needed research. In contrast, the neurodiversity paradigm argues that such experiences are not necessarily deficits but rather (...) are natural reflections of biodiversity. Here, we propose that neurodiversity is an important topic for future research in cognitive science. We discuss why cognitive science has thus far failed to engage with neurodiversity, why this gap presents both ethical and scientific challenges for the field, and, crucially, why cognitive science will produce better theories of human cognition if the field engages with neurodiversity in the same way that it values other forms of cognitive diversity. Doing so will not only empower marginalized researchers but will also present an opportunity for cognitive science to benefit from the unique contributions of neurodivergent researchers and communities. (shrink)

The progress of electronic health technologies and biobanks holds enormous promise for efficient research. Evidence shows that studies based on sharing and secondary use of data/samples have the potential to significantly advance medical knowledge. However, sharing of such resources for international collaboration is hampered by the lack of clarity about ethical and legal requirements for transfer of data and samples across international borders. Here, the International Clinical Trial Center Network reports the legal and ethical requirements governing data and sample exchange (...) across four continents. The most recurring requirement is ethical approval, whereas only in specific conditions approval of national health authorities is required. Informed consent is not required in all sharing situations. However, waiver of informed consent is only allowed in certain countries/regions and under certain circumstances. The current legal and ethical landscape appears to be very complex and under constant evolution. Regulations differ between countries/regions and are often incomplete, leading to uncertainty. With this work, ICN illuminates the unmet need for a single international collaborative framework to facilitate DSE. Harmonising requirements for global DSE will reduce inefficiency and waste in research. There are many challenges to realising this ambitious vision, including inconsistent terminology and definitions, and heterogeneous and dynamic legal constraints. Here, we identify areas of agreement and significant difference as a necessary first step towards facilitating international collaboration. We propose the establishment of a working group to continue the comparison across jurisdictions, create a standardised glossary and define a set of basic principles and fundamental requirements for DSE. (shrink)

This paper is as much about a particular depiction of the tribune P. Sulpicius Rufus as it is about Cicero's De Oratore, a dialogue regularly called upon by historians to give evidence on the 90s b.c. and the characters who take part in the conversation it depicts. My main focus is literary: I will argue that, given what we know about the historical Sulpicius, Cicero's choice of Sulpicius for a prominent minor role in De Oratore drives the tragic historical framework (...) that undercuts the optimism expressed within the dialogue by the main protagonist L. Licinius Crassus for the civic value of oratory. The Rhetorica ad Herennium illustrates a certain type of allegory with the statement ‘as if one should call Drusus a “faded reflection of the Gracchi”’. In De Oratore, Drusus’ friend and successor Sulpicius functions as a reflection of the Gracchi and his eloquence reinforces the problem posed by such orators as the notoriously eloquent Gaius Gracchus for any such grand claims about the civic value of oratory. By examining Cicero's use of relatively recent history, we therefore discover that De Oratore is significantly more pessimistic than it may at first seem. This pessimism, however, has important implications for historians, since expanding our understanding of De Oratore as a literary construct should encourage historians to be significantly more cautious about using the text as a historical source. As Görler points out with regard to Crassus’ swansong at De or. 3.4–5, although ‘a naive reader of Oratorum Romanorum Fragmenta could be left with the impression that some sentences are quite well attested’, most of the fragments of Crassus’ speech can actually be traced back to De Oratore. Likewise, a significant proportion of the standard elements in Sulpicius’ backstory go back to De Oratore and become a great deal less convincing once we accept De Oratore as a sustained fictional account featuring people who were neither as politically ‘safe’ nor as intellectually united as Cicero would have them be. My secondary focus in this paper is therefore on the broader lessons to be drawn from Sulpicius’ role in De Oratore. I will begin by outlining the historical context of the dialogue, which was written in the mid 50s but is set in 91, a few weeks before the natural death of Crassus, one of its two protagonists. Next, I will discuss the dialogue's literary context, specifically the Platonic allusions Cicero embeds within the text. These allusions encourage us to treat De Oratore’s historical framework carefully, if not sceptically, and I will outline the ‘off notes’ struck by references to the Gracchi and by the presentation of Crassus and Antonius before examining the problem Sulpicius poses for a straightforwardly optimistic reading of De Oratore. I will conclude by considering first the literary implications for De Oratore of accepting that Sulpicius is a deliberately problematic character and then the historical implications of taking a sceptical approach towards De Oratore as an historical source for our picture of Sulpicius. (shrink)

RACINE L and PETRUCKA P. Nursing Inquiry 2011; 18: 12–20 Enhancing decolonization and knowledge transfer in nursing research with non-western populations: examining the congruence between primary healthcare and postcolonial feminist approachesThis article is a call for reflection from two distinct programs of research which converge on common interests pertaining to issues of health, social justice, and globalization. One of the authors has developed a research program related to the health and well-being of non-western populations, while the other author has expanded (...) the field of Aboriginal and international research in Canada and abroad. Based on examples drawn from our respective programs of research, we suggest conciliating the philosophy of primary healthcare to postcolonial feminism for decolonizing research and enhancing knowledge transfer with non-western populations. We contend that applying the theoretical and methodological strengths of these two approaches is a means to decolonize nursing research and to avoid western neocolonization. In conciliating primary health care and postcolonial feminism, the goal is to enhance the pragmatic relevance of postcolonial feminism to generate resistance through transformative research for achieving social justice. In tapping into the synergistic and complementary epistemological assumptions of the philosophy of primary health care and postcolonial ‘feminisms’, nurse researchers reinforce the anti-oppresive goals of postcolonial feminist research. Consequently, this approach may enhance both decolonization and knowledge transfer through strategies like photovoice. (shrink)

Public health communication makes extensive use of a linguistic formulation that will be called the “no evidence” statement. This is a written or spoken statement of the form “There is no evidence that P” where P stands for a proposition that typically describes a human health risk. Danger lurks in these expressions for the hearer or reader who is not logically perspicacious, as arguments that use them are only warranted under certain conditions. The extent to which members of the public (...) are able to determine what those conditions are will be considered by examining data obtained from 879 subjects. The role of “no evidence” statements as cognitive heuristics in public health reasoning is considered. (shrink)

Dialogue d'amitié, ce livre à deux voix témoigne d'un long travail commun. Les deux chapitres, « Ulysse en personne » et « Au miroir de Pénélope » qui ouvrent et ferment le livre, sont rédigés par Jean-Pierre Vernant qui écrit là quelques unes de ses pages les plus abouties, récit et analyse mêlés, au service du questionnement toujours neuf d'un texte cent fois relu. Le but de ce questionnement, c'est aussi celui des chapitres rédigés par Françoise Frontisi-Leroux sous le titre (...) « L'... (shrink)

Dialogue d'amitié, ce livre à deux voix témoigne d'un long travail commun. Les deux chapitres, « Ulysse en personne » et « Au miroir de Pénélope » qui ouvrent et ferment le livre, sont rédigés par Jean-Pierre Vernant qui écrit là quelques unes de ses pages les plus abouties, récit et analyse mêlés, au service du questionnement toujours neuf d'un texte cent fois relu. Le but de ce questionnement, c'est aussi celui des chapitres rédigés par Françoise Frontisi-Leroux sous le titre (...) « L'.. (shrink)