When a patient lacks decision-making capacity, then according to standard clinical ethics practice in the United States, the health care team should seek guidance from a surrogate decision-maker, either previously selected by the patient or appointed by the courts. If there are no surrogates willing or able to exercise substituted judgment, then the team is to choose interventions that promote a patient’s best interests. We argue that, even when there is input from a surrogate, patient preferences should be an additional (...) source of guidance for decisions about patients who lack decision-making capacity. (shrink)

This article reports results of a survey about employment and compensation models for clinical ethics consultants working in the United States and discusses the relevance of these results for the professionalization of clinical ethics. This project uses self-reported data from healthcare ethics consultants to estimate compensation across different employment models. The average full-time annualized salary of respondents with a clinical doctorate is $188,310.08 (SD=$88,556.67), $146,134.85 (SD=$55,485.63) for those with a non-clinical doctorate, and $113,625.00 (SD=$35,872.96) for those with a masters as (...) their highest degree. Pay differences across degree level and type were statistically significant (F = 3.43; p. (shrink)

Nocebo effects occur when an adverse effect on the patient arises from the patient's own negative expectations. In accordance with informed consent, providers often disclose information that results in unintended adverse outcomes for the patient. While this may adhere to the principle of autonomy, it violates the doctrine of “primum non nocere,” given that side-effect disclosure may cause those side effects. In this article we build off previous work, particularly by Wells and Kaptchuk and by Cohen :3–11.[Taylor & Francis Online], (...) [Web of Science ®] [Google Scholar]), to suggest ethical guidelines that permit nondisclosure in the case when a nocebo effect is likely to occur on of the basis of nonmaleficence. We accept that that autonomy vis-à-vis informed consent must be forestalled, but salvage much of its role by elaborating a practical clinical approach to postencounter follow-up. In doing so, we reconcile a clinically practicable process of determining conditions of disclosure with long-standing ethical commitments to patients. (shrink)

We agree with Emily Walsh (2020) that the current preferences of patients with dementia should sometimes supersede those patients’ advance directives. We also agree that consensus clinical ethics guidance does a poor job of explaining the moral value of such patients’ preferences. Furthermore, Walsh correctly notes that clinicians are often averse to treating patients with dementia over their objections, and that this aversion reflects clinical wisdom that can inform revisions to clinical ethics guidance. But Walsh’s account of the moral value (...) of the preferences of patients with dementia suffers from three major problems: (1) it does not engage the actual practices of clinical ethics; (2) it provides an inadequate account of why these patients’ preferences matter; and (3) it offers a poor explanation of clinicians’ intuitions in these cases. Her arguments engage a philosophical debate that is largely irrelevant to clinical practice and she therefore leaves pressing real-world clinical ethics questions unaddressed. After underscoring some of Walsh’s main points, we will discuss each of these shortcomings. (shrink)

Some physicians refuse to perform life-sustaining interventions, such as tracheostomy, on patients who are very likely to remain permanently unconscious. To explain their refusal, these clinicians often invoke the language of “futility”, but this can be inaccurate and can mask problematic forms of clinical power. This paper explores whether such refusals should instead be framed as conscientious objections. We contend that the refusal to provide interventions for patients very likely to remain permanently unconscious meets widely recognized ethical standards for the (...) exercise of conscience. We conclude that conscientious objection to tracheostomy and other life-sustaining interventions on such patients can be ethical because it does not necessarily constitute a form of invidious discrimination. Furthermore, when a physician frames their refusal as conscientious objection, it makes transparent the value-laden nature of their objection and can better facilitate patient access to the requested treatment. (shrink)

Our purpose in this article is to identify and suggest resolution for two core problematics of grounded theory. First, while grounded theory provides transparency to one part of the conceptualization process, where codes emerge directly from the data, it provides no such systematic or transparent way for gaining insight into the conceptual relationships between discovered codes. Producing a grounded theory depends not only on the definition of conceptual pieces, but the delineation of a relationship between at least two of those (...) pieces. Second, the conceptualization process of grounded theory is done in hierarchical fashion, where individual codes emerge from the data but then are used to generate insight into more general concepts and thematic statements. But various works on grounded theory have failed to provide any systematic way of using data specific levels of scale (the codes) to gain insight into more macro levels of scale (concepts and themes). We offer fractal concept analysis as a means of resolving both of these issues. By using a logic structure generator, fractal concept analysis delineates self-similar conceptual frameworks at various levels of abstraction, yielding a method for linking concepts together within and between levels of scale encountered in the grounded theory coding and categorization process. We conclude that this fractal analytic technique can bolster the aims of grounded theory as a formalized and systematic process for generating theory from empirical data. (shrink)

Calls for incorporating social science into patient care typically have accounted for neither the logistic constraints of medical training nor the methodological fallacies of utilizing aggregate “social facts” in clinical practice. By elucidating the different epistemic approaches of artistic and scientific practices, this paper illustrates an integrative artistic pedagogy that allows clinical practitioners to generate social scientific insights from actual patient encounters. Although there is no shortage of calls to bring social science into medicine, the more fundamental processes of thinking (...) by which art and science proceed have not been addressed to this end. As such, the art of medical practice is conceptualized as an innate gift, and thus little is done to cultivate it. Yet doing so is more important than ever because uncertainty in diagnosing and treating chronic illnesses, the most significant contemporary mortality risks, suggests a re-expanding role for clinical judgment. (shrink)

The capacity to designate a surrogate is not simply another kind of medical decision-making capacity. A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients who lack DMC (...) for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases. That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions. (shrink)

In this commentary, I explore the usefulness of the framework Abram Brummett and Erica K. Salter present in their article “Mapping the Moral Terrain of Clinical Deception.” Deception cases are divisive because they nearly always evoke the metadilemma of clinical ethics: a clash between duties (in these cases, truth telling) and consequences (whatever good might come of the lie). Here, I describe a patient case in which the clinical team considered deceiving a patient about his pain‐medicine dosage in exchange for (...) his allowing the clinicians to properly care for his percutaneous endoscopic gastrostomy tube stoma, so as to prevent infection. Applying the framework that Brummett and Salter have developed helped our clinical team parse the numerous complex issues involved. The nuances of our case also illustrated additional ways in which the ethics of deception needs to be further refined. (shrink)

There is a perpetrator historiography of the Holocaust and a Jewish historiography of the Holocaust. The former has received the lion’s share of attention in bioethics, particularly in the form of warnings about medicine’s potential for complicity in human atrocity. However, stories of Jewish physicians during the Holocaust are instructive for positive bioethics, one that moves beyond warnings about what not to do. In exercising both explicit and introspective forms of resistance, the heroic work of Jewish physicians in the ghettos (...) and concentration camps tells us a great deal about the virtues and values of medicine. In this article, we frame the stories of four of these Jewish physicians in ways that are instructive for contemporary medicine. By far, the most widely recognized and discussed figure is Viktor Frankl, whose work on hope and the meaning of suffering remains essential insofar as medicine inherently confronts disease and death. Less discussed in bioethics and medical humanities are the cases of Mark Dworzecki, Karel Fleischmann, and Gisella Perl. Dworzecki’s efforts to encourage others in the Vilna Ghetto to document their experiences illustrates the power of narrative for the human experience and the notion of ethics as narrative in the face of suffering. Fleischmann’s art underscores not only the importance of reflective practices for professionals as a form of simultaneous introspection and testimonial, but illuminates hope amid sheer hopelessness. This hope, which was comparatively implicit in much of Fleishmann’s art, is explicated as a method by Frankl, becoming a form of therapy for both physicians wrestling with their professional work, and patients wrestling with their illnesses and diseases. Finally, Perl’s resistance to Mengele’s orders highlights the importance of moral action, not just reflective reaction. The experiences of each of these figures, while certainly located in the unique horrors of Holocaust Germany, portends lessons for today’s physicians faced with moral distress and ethical dilemma in the face of suffering, interpersonal relationships, and socio-political conflicts that increasingly test the professed ideals of medicine. In this article we briefly tell the story of each of these physicians and connect the lessons therein to contemporary medical practice. (shrink)

More than 20 years ago, the pioneering pediatric ethicist William Bartholome wrote a fiery letter to the editor of this journal because he thought a recently published statement on pediatric assent, from the Committee on Bioethics of the American Academy of Pediatrics (AAP), showed insufficient respect for children. That AAP statement, like its 2016 update, asserts that pediatric assent should be solicited only when a child’s dissent will be honored. Bartholome objected that pediatricians should always solicit children’s assent and that (...) they should acknowledge and apologize when they treat children over their objections even when they must do so to promote children’s best interests. We think Bartholome was right. In this brief commentary, we elaborate on his perspective about the moral value of pediatric assent, and we suggest improvements to the corresponding clinical guidance. (shrink)

The field of clinical bioethics strongly advocates for the use of advance directives to promote patient autonomy, particularly at the end of life. This paper reports a study of clinical bioethicists’ perceptions of the professional consensus about advance directives, as well as their personal advance care planning practices. We find that clinical bioethicists are often sceptical about the value of advance directives, and their personal choices about advance directives often deviate from what clinical ethicists acknowledge to be their profession’s recommendations. (...) Moreover, our respondents identified a pluralistic set of justifications for completing treatment directives and designating surrogates, even while the consensus view focuses on patient autonomy. Our results suggest important revisions to academic discussion and public-facing advocacy about advance care planning. (shrink)

Background: Previous research shows that pediatricians inconsistently utilize the ethics consultation service (ECS). Methods: Pediatricians in two suburban, Midwestern academic hospitals were asked to reflect on their ethics training and utilization of ECS via an anonymous, electronic survey distributed in 2017 and 2018, and analyzed in 2018. Participants reported their clinical experience, exposure to formal and informal ethics training, use of formal and informal ethics consultations, and potential barriers to formal consultation. Results: Less experienced pediatricians were more likely to utilize (...) formal ethics consultation and more likely to have formal ethics training. The most commonly reported reasons not to pursue formal ECS consultation were inconvenience and self-reported expertise in pediatric ethics. Conclusions: These results inform ongoing discussions about ethics consultation among pediatricians and the role of formal ethics training in both undergraduate and graduate medical education. (shrink)

Two new documents from the Committee on Bioethics of the American Academy of Pediatrics expand the terrain for parental decision making, suggesting that pediatricians may override only those parental requests that cross a harm threshold. These new documents introduce a broader set of considerations in favor of parental authority in pediatric care than previous AAP documents have embraced. While we find this to be a positive move, we argue that the 2016 AAP positions actually understate the importance of informed and (...) voluntary parental involvement in pediatric decision making. This article provides a more expansive account of the value of parental permission. In particular, we suggest that an expansive role for parental permission may reveal facts and values relevant to their child's treatment, encourage resistance to suboptimal default practices, improve adherence to treatment, nurture children's autonomy, and promote the interests of other family members. (shrink)

The birth of our daughter nearly 5 years ago went very well. But in a new city, with some experience on our side and access to a homelike natural birth center connected to a major area hospital, we thought it would be all the better when our son was born. We hadn’t dreamed that the detection of a benign arrhythmia in the baby’s heart would cascade into a situation that would not only undermine our entire birth plan, but force unwanted (...) treatment and threats of abandonment. In this commentary, our intention is to illustrate the way in which narratives, and the commonalities between the stories shared by other authors in this issue and our own, can give profound depth and new insights into the things that happen to us. (shrink)

Pediatric intervention principles help clinicians and health-care institutions determine appropriate responses when parents’ medical decisions place children at risk. Several intervention principles have been proposed and defended in the pediatric ethics literature. These principles may appear to provide conflicting guidance, but much of that conflict is superficial. First, seemingly different pediatric intervention principles sometimes converge on the same guidance. Second, these principles often aim to solve different problems in pediatrics or to operate in different background conditions. The potential for convergence (...) between intervention principles—or at least an absence of conflict between them—matters for both the theory and practice of pediatric ethics. This article builds on the recent work of a diverse group of pediatric ethicists tasked with identifying consensus guidelines for pediatric decision-making. (shrink)

Children’s preferences about medical treatment—like the preferences of other patients—hold moral weight in decision-making that is independent of considerations of autonomy or best interests. In light of this understanding of the moral value of patient preferences, the American Academy of Pediatrics could strengthen the ethical foundation for its formal guidance on pediatric assent.

Two core questions in pediatric ethics concern when and how physicians are ethically permitted to intervene in parental treatment decisions (intervention principles), and the goals or values that should direct physicians’ and parents’ decisions about the care of children (guidance principles). Lainie Friedman Ross argues in this issue of The Journal of Clinical Ethics that constrained parental autonomy (CPA) simultaneously answers both questions: physicians should intervene when parental treatment preferences fail to protect a child’s basic needs or primary goods, and (...) both physicians and parents should be guided by a commitment to protect a child’s basic needs and primary goods. In contrast, we argue that no principle—neither Ross’s CPA, nor the best interest standard or the harm threshold—can serve as both an intervention principle and a guidance principle. First, there are as many correct intervention principles as there are different kinds of interventions, since different kinds of interventions can be justified under different conditions. Second, physicians and parents have different guidance principles, because the decisions physicians and parents make for a child should be informed by different values and balanced by different (potentially) conflicting commitments. (shrink)

Vaccine refusal forces us to confront tensions between many values, including scientific expertise, parental rights, children’s best interests, social responsibility, public trust, and community health. Recent outbreaks of vaccine-preventable and emerging infectious diseases have amplified these issues. The prospect of a coronavirus disease 2019 vaccine signals even more friction on the horizon. In this contentious sociopolitical landscape, it is therefore more important than ever for clinicians to identify ethically justified responses to vaccine refusal.

According to a standard account of patient decision-making capacity, patients can provide ethically valid consent or refusal only if they are able to understand and appreciate their medical c...

The three of us work as academics and clinical ethicists. In our clinical ethics work, we often encounter patients who lack decision-making capacity, but who nonetheless have strong preferences abo...

In light of the ongoing development and implementation of core competencies in bioethics, it is important to proceed with a clear sense of how bioethics knowledge is utilized in the functioning of hospital ethics committees (HECs). Without such an understanding, we risk building a costly edifice on a foundation that is ambiguous at best. This article examines the empirical relationship between traditional paradigms of bioethics theory and actual decision making by HEC members using survey data from HEC members. The assumption (...) underlying the standardization of qualifications and corresponding call for increased education of HEC members is that they will base imminent case decisions on inculcated knowledge. Our data suggest, however, that HEC members first decide intuitively and then look for justification, thereby highlighting the need to re-examine the pedagogical processes of ethics education in the process of standardizing and improving competencies. (shrink)

In this issue of the Hastings Center Report, Jason Wasserman and Mark Navin argue that patients without decisional capacity can still have relatively stable wishes or inclinations toward one treatment option over another and that these preferences are “not devoid of moral weight and might therefore guide or at least influence treatment decisions when they cannot be defeated by other considerations.” This position is not controversial among most bioethicists. The hard work comes in sussing out the details of (...) this position. How much moral weight do these preferences have? When should preferences be defeated by other considerations? How should we identify actual preferences, and how should preferences be differentiated and weighed against one another? (shrink)

People who lack decision‐making capacity may be able to communicate preferences, which can and should inform surrogate decision‐making on their behalf. It is unclear whether making a further distinction about “capacity for preferences,” as Jason Wasserman and Mark Navin propose in this issue of the Hastings Center Report, would improve the process of surrogate decision‐making. Anyone who is regularly involved in surrogate decision‐making or who has worked to articulate decision‐making standards and processes can think of cases in which (...) a patient's voice was ignored or his or her preferences and ability to communicate them overlooked. However, we can also think of cases in which it was unclear whether information provided by a patient, recently or in the past, should have been characterized as a preference relevant to a medical decision that the patient lacked the capacity to make. We should also recognize that clear preferences of a patient who lacks decision‐making capacity may conflict with the limits of another person or of a family's resources such that these preferences cannot guide a surrogate's decision. This patient will not get what he wants. A situation in which preferences are known and make sense but cannot be applied in a feasible way demonstrates the limits of the medical decision‐making framework concerning care that is not covered by medical insurance. (shrink)

Hobbits and hooligans -- Ignorant, irrational, misinformed nationalists -- Political participation corrupts -- Politics doesn't empower you or me -- Politics is not a poem -- The right to competent government -- Is democracy competent? -- The rule of the knowers -- Civic enemies.

In the philosophy of perception, olfaction is the perennial problem child, presenting a range of difficulties to those seeking to define its proper referents, and its phenomenological content. Here, we argue that many of these difficulties can be resolved by recognizing the object-like representation of odors in the brain, and by postulating that the basic objects of olfaction are best defined by their biological value to the organism, rather than physico-chemical dimensions of stimuli. Building on this organism-centered account, we speculate (...) that the phenomenological space of olfaction is organized into a number of coarse affective dimensions that apply categorically. This organization may be especially useful for coupling sensation to decision-making and instrumental action in a sensory modality where the stimulus space is especially complex and high-dimensional. (shrink)

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

Recently, debate over whether health care providers should have a protected right to conscientiously refuse to offer legal health care services—such as abortion, elective sterilization, aid in dying, or treatments for transgender patients—has grown exponentially. I advance a modified compromise view that bases respect for claims of conscientious refusal to provide specific health care services on a publicly defensible rationale. This view requires health care providers who refuse such services to disclose their availability by other providers, as well as to (...) arrange for referrals or facilitate transfers of care. This requirement raises the question of whether providers are being forced to be complicit in the provision of services they deem to be morally objectionable. I conclude by showing how this modified compromise view answers the most significant objections mounted by critics of the right to conscientious refusal and safeguards providers from having to offer services that most directly threaten their moral integrity. (shrink)

The “participatory turn” cutting across technical approaches for appraising environment, risk, science, and technology has been accompanied by intense debates over the desired nature, extent, and quality of public engagement in science. Burgeoning work evaluating the effectiveness of such processes and the social study of science in society more generally is notable, however, for lacking systematic understanding of the very actors shaping these new forms science-society interaction. This paper addresses this lacuna by drawing on United Kingdom based in-depth empirical research (...) that made space for participatory appraisal experts to reflect on effective practice and novel questions of competence, expertise, and citizen-specialist relations within analytic-deliberative processes. Emerging practitioner principles warn that existing participatory models have not sufficiently considered constructivist perspectives on knowledge, analysis, and deliberation. Effective participatory appraisal under uncertainty needs to guard against the “technocracy of participation” by opening up to diversity, difference, antagonism, and uncertainties/indeterminacies. (shrink)

Although Eugen Fink often reflected upon the role religion, these reflections are yet to be addressed in secondary literature in any substantive sense. For Fink, religion is to be understood in relation to “play,” which is a metaphor for how the world presents itself. Religion is a non-repetitive, and entirely creative endeavor or “symbol” that is not achieved through work and toil, or through evaluation or power, but rather, through his idea of play and “cult” as the imaginative distanciation from (...) a predictable lifeworld. This paper describes Fink’s understanding of religion and its most relevant aspects found in Spiel als Weltsymbol. The paper is organized into five sections—1: An introduction to his phenomenological approach in general, and description of the role of “play”; 2: investigations into the relation between play and world; 3: a description of his phenomenology of religion; 4: engagements in the idea of cult-play and the sacred sphere, and 5: reflection on his idea of the play of God. (shrink)

Recent debate among bioethicists concerns the potential to enhance human beings’ physical or cognitive capacities by means of genetic, pharmacological, cybernetic, or surgical interventions. Between “transhumanists,” who argue for unreserved enhancement of human capabilities, and “bioconservatives,” who warn against any non-therapeutic manipulation of humanity’s natural condition, lie those who support limited forms of enhancement for the sake of individual and collective human flourishing. Many scholars representing these views also share a concern over the status and interests of human beings with (...) various types of cognitive and physical disabilities, some of which may be ameliorable by enhancement interventions. The question addressed in this paper is whether valuing the enhancement of human capabilities may be reconciled with valuing the existence and phenomenological experiences of human beings with various disabilities. Can we value enhanced capabilities without disvaluing those whose capabilities fall below a defined threshold of “normal function”? Furthermore, if certain forms of disability, particularly cognitive disabilities, negatively impact one’s flourishing, could the enhancement of one’s cognitive capacities through biotechnological means enhance one’s flourishing. (shrink)

Transhumanism is an ideology that embraces the use of various forms of biotechnology to enhance human beings toward the emergence of a “posthuman” kind. In this article, I contrast some of the foundational tenets of Transhumanism with those of Christianity, primarily focusing on their respective anthropologies—that is, their diverse understandings of whether there is an essential nature shared by all human persons and, if so, whether certain features of human nature may be intentionally altered in ways that contribute toward how (...) each views human flourishing. A central point of difference concerns Transhumanists’ aim of attaining “substrate independence” for the human mind, such that one’s consciousness could be uploaded into a cybernetic environment. Christian anthropology, on the other hand, considers embodiment, with its characteristics of vulnerability and finitude, to be an essential feature of human nature—hence, Christians’ belief in bodily resurrection. Despite Christianity and Transhumanism having fundamental differences, I contend that Christians may support moderate forms of enhancement oriented toward supporting our flourishing as living, sentient, social, and rational animals. (shrink)

Abstract Theories of personal well-being are typically developed so that they render verdicts on (a) how well-off a person is at a moment, (b) how well-off a person is over an interval of time, and (c) how good a whole life is for the person who lives it. Conative theories of welfare posit welfare-atoms that consist, e.g., in episodes of desire-satisfaction, aim-achievement, or values-realisation. Most extant conative theories are additive: they compute well-being over time - up to and including the (...) value of a whole life - by adding up the values of these welfare atoms. Here, it is shown that such atomistic, additive conative theories do not always generate plausible verdicts on (b) and (c) above. They imply that lives featuring incoherent plans and rapidly changing projects go surprisingly well for those who lived them. Holistic theories of well-being are often thought to provide a solution to problems like these. However, one of the best-known versions of welfare holism within the conative family, Rawls? rational life-preferentism, is based on the problematic assumption that there is one ideal life plan for each person. This paper presents a new form of paradigm-resemblance based conative holism that does not make this assumption and that explains the limits of additivity. (shrink)

Debate over whether health care institutions or individual providers should have a legally protected right to conscientiously refuse to offer legal services to patients who request them has grown exponentially due to the increasing legalization of morally contested services. This debate is particularly acute for Catholic health care providers. We elucidate Catholic teaching regarding the nature of conscience and the intrinsic value of being free to act in accord with one’s conscience. We then outline the primary positions defended in this (...) debate and respond to critics of Catholic teaching. In so doing, we show how Catholic health care providers’ claims to conscientiously refuse to offer specific health care services are not essentially faith-based, but are founded upon publicly defensible reasons. We also address the question of whether conscientiously refusing health care providers may become complicit in moral wrongdoing or potentially cause scandal by means of disclosure or referral to another provider. (shrink)

One of the chief aims of Donald Davidson's later work was to show that participation in a certain causal nexus involving two creatures and a shared environment–Davidson calls this nexus “triangulation”–is a metaphysically necessary condition for the acquisition of thought. This doctrine, I suggest, is aptly regarded as a form of what I call transcendental externalism. I extract two arguments for the transcendental‐externalist doctrine from Davidson's writings, and argue that neither succeeds. A central interpretive claim is that the arguments are (...) primarily funded by a particular conception of the nature of non‐human animal life. This conception turns out to be insupportable. The failure of Davidson's arguments presses the question of whether we could ever hope to arrive at far‐reaching claims about the conditions for thought if we deny, as does Davidson, the legitimacy of the naturalistic project in the philosophy of mind. (shrink)

The question of how to handle incidental findings has sparked a heated debate among neuroimaging researchers and medical ethicists, a debate whose urgency stems largely from the recent explosion in the number of imaging studies being conducted and in the sheer volume of scans being acquired. Perhaps the point of greatest controversy within this debate is whether the magnetic resonance imaging scans of all research participants should be reviewed in an active search for pathology and, moreover, whether this search should (...) be performed by a radiologist. Resistance to routine readings performed by radiologists, as opposed to selective review of those scans on which investigators have spotted a possible IF, has been fueled in part by the obvious and enormous cost — financial and logistical — of engaging radiologists to read massive numbers of scans. This cost would be especially burdensome, even prohibitive, to investigators who are not affiliated with a medical center, because of their limited access to radiologists and other medical expertise. (shrink)

The “participatory turn” cutting across technical approaches for appraising environment, risk, science, and technology has been accompanied by intense debates over the desired nature, extent, and quality of public engagement in science. Burgeoning work evaluating the effectiveness of such processes and the social study of science in society more generally is notable, however, for lacking systematic understanding of the very actors shaping these new forms science-society interaction. This paper addresses this lacuna by drawing on United Kingdom based in-depth empirical research (...) that made space for participatory appraisal experts to reflect on effective practice and novel questions of competence, expertise, and citizen-specialist relations within analytic-deliberative processes. Emerging practitioner principles warn that existing participatory models have not sufficiently considered constructivist perspectives on knowledge, analysis, and deliberation. Effective participatory appraisal under uncertainty needs to guard against the “technocracy of participation” by opening up to diversity, difference, antagonism, and uncertainties/indeterminacies. (shrink)

This study provides a comparative analysis of students' self-reported beliefs and behaviors related to six analogous pairs of conventional and digital forms of academic cheating. Results from an online survey of undergraduates at two universities (N = 1,305) suggest that students use conventional means more often than digital means to copy homework, collaborate when it is not permitted, and copy from others during an exam. However, engagement in digital plagiarism (cutting and pasting from the Internet) has surpassed conventional plagiarism. Students (...) also reported using digital "cheat sheets" (i.e., notes stored in a digital device) to cheat on tests more often than conventional "cheat sheets." Overall, 32% of students reported no cheating of any kind, 18.2% reported using only conventional methods, 4.2% reported using only digital methods, and 45.6% reported using both conventional and digital methods to cheat. "Digital only" cheaters were less likely than "conventional only" cheaters to report assignment cheating, but the former was more likely than the latter to report engagement in plagiarism. Students who cheated both conventionally and digitally were significantly different from the other three groups in terms of their self-reported engagement in all three types of cheating behavior. Students in this "both" group also had the lowest sense of moral responsibility to refrain from cheating and the greatest tendency to neutralize that responsibility. The scientific and educational implications of these findings are discussed in this study. (shrink)

According to Pierre Bourdieu, practices and habits are out the realm of rationality; this claim about their nature explains their peculiar resistance to rational revision. I argue that one can explain the fact that practices and habits are difficult to revise, without abandoning the view that they are within the space of reasons.