Discussions surrounding patient engagement and empowerment often use the terms “patient” and “consumer” interchangeably. But do the two terms hold the same meaning, or is a “patient” a passive actor in the health care arena and a “consumer” an informed, rational decision-maker? Has there been a shift in our usage of the two terms that aligns with the increasing commercialization of health care in the U.S. or has the patient/consumer dynamic always been a part of the buying and selling of (...) health care in the American system? Recent discussions of the issue exist in the popular press and in social media forums such as TEDMED, but few direct analyses of the ethical, legal, and policy ramifications of this possible shift in terminology are available in the academic literature. This paper analyzes our usage of the terms and any recent changes in the dynamic and discusses the ethical, legal, and policy implications of this simple terminology for the physicianpatient relationship. (shrink)

As we move toward the creation of a networked health information environment, the potential of privacy intrusions increases, with potentially devastating impact on quality and access to healthcare. This paper describes the risks we face and proposes a framework to minimize those risks. In particular, it proposes nine principles to protect privacy in an information age.

During this early stage of HIT adoption, it is critical that we engage in discussions regarding informed consent's proper role in a health care environment in which electronic information sharing holds primary importance. This article discusses current implementation of the doctrine within health information exchange networks; the relationship between informed consent and privacy; the variety of ways that the concept is referenced in discussions of information sharing; and challenges that surround incorporation of the doctrine into the evolving HIT environment. The (...) article concludes by reviewing the purpose behind the traditional obligation to obtain informed consent and the possibility of maintaining its relevance in the new environment. (shrink)

As policy makers place great hope in health information technology as a means to lower costs and achieve improvements in health care quality, safety, and efficiency, organizations at the forefront of building health information exchange networks attempt to weave the concept and function of informed consent into an evolving information-driven health care system. The vast amount of information that will become available to both health professionals and patients in the new HIT-driven environment can reasonably be expected to affect the relationship (...) between them in many ways, particularly in the area of informed consent. During this early stage of HIT adoption, it is critical that we engage in discussions regarding informed consent’s proper role in a heretofore unknown health care environment — one in which electronic information sharing holds primary importance. The central and largely unexamined question of whether and how the legal and ethical underpinnings of informed consent will fit into the context of HITenabled treatment is critical to both public policy and clinical practice. (shrink)

The widespread adoption of health information technology has been recognized as both a necessary element of health reform and a required building block of a modern, high performing health care system.

Information technology is considered a potentially transformative element in the field of health care by payers, providers, vendors, and consumers alike. Because of this transformative potential, health information technology adoption is viewed by many as a key component of health system reform. HIT is in its earliest stages, with diffusion of the technology still relatively limited; at the same time, there is growing awareness of its potential to affect the operation of the entire health care system as a result of (...) the vast amount of information that will become available to both health professionals and patients. (shrink)

Patients and family members (N = 671) were surveyed in five Mid-Atlantic U.S. hospitals to ascertain the number and kinds of ethical concerns they are presently experiencing or have previously experienced while being sick or receiving medical care. Seventy percent of participants had at least one (range 0–14) type of ethical concern or question. The most commonly experienced concerns pertained to being unsure how to plan ahead or complete an advance directive (29.4%), being unsure whether someone in the family was (...) able to make their own decisions (29.2%), deciding about limiting life-sustaining treatments (28.6%), wondering about disclosing personal medical information to others in the family (26.4%) and not being sure whether to undergo treatment because of cost (26.2%). Most were interested to some degree in getting help from ethics consultants in the future (76.6%). Given this prevalence, common concerns might usefully be addressed systematically, rather than exclusively on a case-by-case basis. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

Recent literature on Stalnaker's Thesis, which seeks to vindicate it from Lewis (1976)'s triviality results, has featured linguistic data that is prima facie incompatible with Conditionalization in iterated cases (McGee 1989, 2000; Kaufmann 2015; Khoo & Santorio, 2018). In a recent paper (2021), Goldstein & Santorio make a bold claim: they hold that these departures light the way to a new, non‐conditionalizing theory of rational update.Here, I consider whether this new form of update is subject to a Dutch book. (...) On the official, invariantist version of the theory, I show that the answer is “yes”. On a competing, contextualist theory of indicative conditionals (Bacon, 2015), the answer is “no”, for reasons that have familiar connections to the limits of textbook Bayesianism. After presenting a concrete case, I explore the dialectical ramifications. The upshot is some hard choices for theories that seek to save the linguistic phenomena. (shrink)

Laurence Goldstein gives a straightforward and lively account of some of the central themes of Wittgenstein's writings on meaning, mind, and mathematics.

On a version of consent theory that tempts many, predatory sexual relations involving significant power imbalances (e.g. between professors and students, adults and teenagers, or employers and employees) are wrong because they violate consent-centric norms. In particular, the wronged party is said to have been _incapable_ of consenting to the predation, and the sexual wrong is located in the encounter’s nonconsensuality. Although we agree that these are sexual wrongs, we resist the idea that they are always nonconsensual. We argue instead (...) that it is possible for students, teenagers, employees, etc. to fully consent to sexually predatory encounters; denying as much renders survivors of predation vulnerable to compounding harms. Survivors face a dilemma: give up either their understanding of their experience as wrong, or their self-conception as an agent capable of consenting. We call the latter phenomenon _agential demotion_. (shrink)

Many extant theories of placebo focus on their causal structure wherein placebo effects are those that originate from select features of the therapy (e.g., client expectations or “incidental” features like size and shape). Although such accounts can distinguish placebos from standard medical treatments, they cannot distinguish placebos from everyday occurrences, for example, when positive feedback improves our performance on a task. Providing a social-epistemological account of a treatment context can rule out such occurrences, and furthermore reveal a new way to (...) distinguish clinical placebos from standard medical treatments. (shrink)

Competition among scientists for funding, positions and prestige, among other things, is often seen as a salutary driving force in U.S. science. Its effects on scientists, their work and their relationships are seldom considered. Focus-group discussions with 51 mid- and early-career scientists, on which this study is based, reveal a dark side of competition in science. According to these scientists, competition contributes to strategic game-playing in science, a decline in free and open sharing of information and methods, sabotage of others’ (...) ability to use one’s work, interference with peer-review processes, deformation of relationships, and careless or questionable research conduct. When competition is pervasive, such effects may jeopardize the progress, efficiency and integrity of science. (shrink)

Where do our ideas about politics come from? What can we learn from the Greeks and Romans? How should we exercise power? Melissa Lane teaches politics at Princeton University, and previously taught political thought at the University of Cambridge, where she was a Fellow of King's College. She has received a Guggenheim Fellowship in the field of classics, and the historian Richard Tuck called her book Eco-Republic 'a virtuoso performance by one of our best scholars of ancient philosophy.'.

I respond to a dilemma for Causal Decision Theory (CDT) under determinism, posed in Adam Elga's paper “Confessions of a Causal Decision Theorist”. The treatment I present highlights (i) the status of laws as predictors, and (ii) the consequences of decision dependence, which arises natively out of Jeffrey Conditioning and CDT's characteristic equation.My argument leverages decision dependence to work around a key assumption of Elga's proof: to wit, that in the two problems he presents, the CDTer must employ subjunctive-suppositional (rather (...) than evidential) transformations of a shared prior. (shrink)

Here we examine the hypothesis that symbolic understanding across domains is mediated by a fundamental ‘symbolizing’ ability in young children. We tested 30 children aged 2–4 years on symbolic tasks assessing iconic and non-iconic word-referent and picture-referent understanding and administered standardised tests of symbolic play and receptive language. Children showed understanding of the symbol-referent relation earlier for pictures than written words, and performance within domains was correlated and, importantly, predicted by a marker of general symbolic ability. Performance on picture and (...) written word tasks was also unrelated to language comprehension. Thus, symbolic abilities in specific domains are underpinned by a general symbolizing ability which arises early in development. (shrink)

Ethics researchers advise managers of organizations to link rewards and punishments to ethical and unethical behavior, respectively. We build on prior research maintaining that organizations operate at Kohlbergs stages of moral reasoning, and explain how the over-reliance on rewards and punishments encourages employees to operate at Kohlbergs lowest stages of moral reasoning. We advocate designing organizations as ethical communities and relying on different assumptions about employees in order to foster ethical reasoning at higher levels. Characteristics associated with ethical communities are (...) identified and AES Corporation and Semco S/A serve as examples of corporations exhibiting the design characteristics and assumptions of ethical organizations. (shrink)

With candid, witty, and compelling experiences of yoga from renowned memoirists, including Cheryl Strayed (author of the number-one New York Times bestseller Wild), Claire Dederer (author of national bestseller Poser: My Life in 23 Yoga Poses), Dinty W. Moore (author of The Accidental Buddhist), Neal Pollack (author of Stretch: The Making of a Yoga Dude) and many others, Going Om shares a range of observations about this popular practice. Unlike books on yoga that provide instruction on technique, Going Om is (...) a unique collection of personal narratives from celebrated authors. This anthology of original material values the quality of writing over the authors' flexibility. Ira Sukrungruang shares his heartbreaking struggle as a 375 pound yoga student discovering self-worth on his mat; Gloria Munoz explores the practice of stillness with lyrical elegance in the midst of her busy mind; Neal Pollack's signature sarcasm leads to surprising turns at yoga class with his dad; Elizabeth Kadetsky uses yogic wisdom while coping with her mother's devastating Alzheimer's. (shrink)

Many prescriptions offered in the literature for enhancing creativity and innovation in organizations raise ethical concerns, yet creativity researchers rarely discuss ethics. We identify four categories of behavior proffered as a means for fostering creativity that raise serious ethical issues: (1) breaking rules and standard operating procedures; (2) challenging authority and avoiding tradition; (3) creating conflict, competition and stress; and (4) taking risks. We discuss each category, briefly identifying research supporting these prescriptions for fostering creativity and then we delve into (...) ethical issues associated with engaging in the prescribed behavior. These four rubrics illustrate ethical issues that need to be incorporated into the creativity and innovation literature. Recommendations for how organizations can respond to the ethical issues are offered based on practices of exemplary organizations and theories of organizational ethics. A research agenda for empirically investigating the ethical impact these four categories of behavior have on organizations concludes the article. (shrink)

Discrimination and inequalities in healthcare can be experienced by many patients due to many characteristics ranging from the obviously visible to the more subtly noticeable, such as race and ethnicity, legal status, social class, linguistic fluency, health literacy, age, gender and weight. Discrimination can take a number of forms including overt racist statement, stereotyping or explicit and implicit attitudes and biases. This paper presents the case study of a complex transcultural clinical encounter between the mother of a young infant in (...) a highly vulnerable social situation and a hospital healthcare team. In this clinical setting, both parties experienced difficulties, generating explicit and implicit negative attitudes that heightened into reciprocal mistrust, conflict and distress. The different factors influencing their conscious and unconscious biases will be analysed and discussed to offer understanding of the complicated nature of human interactions when faced with vulnerability in clinical practice. This case vignette also illustrates how, even in institutions with long-standing experience and many internal resources to address diversity and vulnerability, cultural competence remains a constant challenge. (shrink)

This paper presents a direction for narrative ethics based on ethical ideas found in the works of Michel Foucault. Narrative ethics is understood here at the meta-level of cultural discourse to see how the moral subject is constituted by the discursive practices that structure the contemporary debate on reproductive technologies. At this level it becomes meta-narrative-ethics. After a theoretical discussion, this paper uses two literary narratives representing the polarized views in the debate to show how the moral subject may be (...) compelled to relate to its self. Ethics is redefined as Foucauldian rapport à soi, and ethical analysis, at this meta-level, shows how the moral self is intimately connected to cultural discourse. (shrink)

The idea of 'holiness' is central to religion, but it is also one of the hardest concepts to define. Is 'holiness' a synonym for Godliness, one of God's attributes, or does it have independent existence? What does it mean to say that both God and man are holy? What is the proper understanding of 'Be holy, because I the Lord your God am holy'? A Theology of Holiness analyzes the meaning of the Hebrew root k-d-sh from ancient sources, throughout Tanakh, (...) the Talmud, Rashi, Maimonides, Nachmanides, Rabbi Samson Raphael Hirsch, and Rabbi Joseph B. Soloveitchik. Ultimately, it is a work of theology, and helps the reader achieve a deeper understanding of holiness"--Page 4 of cover. (shrink)

Chapter One The Karaite Community of Jerusalem in the Tenth and Eleventh Centuries: Background and Development A time of intellectual change The eighth and ninth centuries were a time of great political and intellectual change for Jews ...

Journal of Philosophy of Education, EarlyView.

Programs, policies, and technologies — particularly those concerned with health equity — are often designed with justice envisioned as the end goal. These policies or interventions, however, frequently fail to recognize how the beneficiaries have historically embodied the cumulative effects of marginalization, which undermines the effectiveness of the intended justice. These well-meaning attempts at justice are bounded by greater socio-historical constraints. Bounded justice suggests that it is impossible to attend to fairness, entitlement, and equity when the basic social and physical (...) infrastructures underlying them have been eroded by racism and other historically entrenched isms. Using the case of Brazil’s National Health Policy for the Black Population, this paper proposes that bounded justice can contribute to justice discourses by serving as a concept, a proffering to a multi-disciplinary conceptual framework, and a potential analytic for those interested in the design of policy, technology, and programmatic interventions towards health equity. (shrink)

The Great Divide in metaphysical debates about laws of nature is between Humeans, who think that laws merely describe the distribution of matter, and non-Humeans, who think that laws govern it. The metaphysics can place demands on the proper formulations of physical theories. It is sometimes assumed that the governing view requires a fundamental / intrinsic direction of time: to govern, laws must be dynamical, producing later states of the world from earlier ones, in accord with the fundamental direction of (...) time in the universe. In this paper, we propose a minimal primitivism about laws of nature (MinP) according to which there is no such requirement. On our view, laws govern by constraining the physical possibilities. Our view captures the essence of the governing view without taking on extraneous commitments about the direction of time or dynamic production. Moreover, as a version of primitivism, our view requires no reduction / analysis of laws in terms of universals, powers, or dispositions. Our view accommodates several potential candidates for fundamental laws, including the principle of least action, the Past Hypothesis, the Einstein equation of general relativity, and even controversial examples found in the Wheeler-Feynman theory of electrodynamics and retrocausal theories of quantum mechanics. By understanding governing as constraining, non-Humeans who accept MinP have the same freedom to contemplate a wide variety of candidate fundamental laws as Humeans do. (shrink)

I propose a unified solution to two puzzles: Ross's puzzle and free choice permission. I begin with a pair of cases from the decision theory literature illustrating the phenomenon of act dependence, where what an agent ought to do depends on what she does. The notion of permissibility distilled from these cases forms the basis for my analysis of 'may' and 'ought'. This framework is then combined with a generalization of the classical semantics for disjunction — equivalent to Boolean disjunction (...) on the diagonal, but with a different two-dimensional character — that explains the puzzling facts in terms of semantic consequence. (shrink)

Within the growing developmental literature on children's testimonial learning, the emphasis placed on children's evaluations of testimonial evidence has shielded from view some of the more collaborative dimensions of testimonial learning. Drawing on recent philosophical work on testimony and interpersonal trust, we argue for an alternative way of conceptualizing the social nature of testimonial learning. On this alternative, some testimonial learning is the result of a jointly collaborative epistemic activity, an activity that aims at the epistemic goal of true belief, (...) but that does so by means of an irreducibly social process. (shrink)

Disclosure in clinical practice is aimed at promoting patient autonomy, usually culminating in patient choice (e.g., to consent to an operation or not, or between different medications). In medical ethics, there is an implicit background assumption that knowing more about (X) automatically translates to greater, or more genuine, autonomy with respect to one's choices involving (X). I challenge this assumption by arguing that in rare cases, withholding information can promote a patient's autonomy (understood as the capacity for rational choice in (...) alignment with one's values and goals). (shrink)

In recent essays, Jürgen Habermas endorses an account of political liberalism much like John Rawls'. Like Rawls, he argues that laws and public policies should be justified only in neutral terms, i.e. in terms of reasons that people holding conflicting world-views could accept. Habermas also, much like Rawls, distinguishes reasonable religious citizens, whose views should be included in public discourse, from unreasonable citizens in his expectation that religious citizens self-modernize. But in sharing these Rawlsian features, Habermas is vulnerable to some (...) of the same objections posed to Rawls. In this article I assess Habermas' ability to overcome two objections frequently posed to Rawls: (1) that religious citizens are unfairly expected to split their identities in public discourse, and (2) that the burdens of citizenship are asymmetrically distributed. I conclude that while he may be able to overcome the second, the first remains a problem for him. (shrink)