In the rapidly evolving healthcare environment, perhaps no role is in greater flux and redefinition than that of the clinical bioethicist. The discussion of ethics consultation in the bioethics literature has moved from an ambiguous concern regarding its proper place in the clinical milieu to the more provocative question of which methods and theories should best characterize the intellectual and practical work it claims to do. The American Society for Bioethics and Humanities addressed these concerns in its 1998 report, CoreCompetenciesforHealthCareEthicsConsultation. (...) The report tries to answer the question as to what disciplinary training, background experience, and levels of knowledge in ethics the clinical ethics consultant should have, and what specific skills and character traits the clinical ethics consultant should cultivate. In addition to acquiring knowledge of common bioethical issues, theoretical concepts in ethical theory and moral reasoning, and health-related law and policy, the report also recommends that ethics consultants demonstrate knowledge of the health beliefs and perspectives of patients and healthcare providers. In our opinion, this recommendation underscores a crucial aspect of the practice of ethics consultation in the increasingly multicultural settings of healthcare institutions. Clearly, the dynamic of American life and culture is permeated with diversity and variety as new groups suffuse their own beliefs and faith perspectives into the health sector. New immigrant groups force society to question traditional healthcare practices and to accommodate changing medical needs. (shrink)

This paper offers a narrative approach to understanding the process of clinical reasoning in complex cases involving medical uncertainty, moral ambiguity, and futility. We describe a clinical encounter in which the pediatric health care team experienced a great deal of conflict and distrust as a result of an ineffective process of interpretation and communication. We propose a systematic method for analyzing the technical, ethical, behavioral, and existential dimensions of the clinical reasoning process, and introduce the Clinical Reasoning Discussion Tool—a dialogical (...) and interpretive device aimed at improving communication, understanding, empathy, and moral deliberation in the clinical setting. (shrink)

This paper attempts to sort out some of the current tensions and ambiguities inherent in the field of bioethics as it continues to mature. In particular it focuses on the question of the methodological relevance of theory or ethical principles to the domain of clinical ethics. I offer an approach to reasoning about moral conflict that combines the insights of contemporary moral theorists, the philosophy of American pragmatism, and the skills of rhetorical deliberation. This synthetic approach locates a proper role (...) for moral theory in the practice of clinical ethics, thus linking abstract philosophical ideas about morality, humanity, suffering, and health to specific deeds, actions, and decisions in the concrete lives of particular individuals. The aim of this synthetic approach of bioethical inquiry is a rapprochement between theoretical knowledge in moral philosophy and the contextualized, relational, and practical understanding of what morality demands of us in our daily lives. I argue for a conception of bioethical inquiry that takes morality to be a study of certain practical, socially embedded concerns about matters of right and wrong, good and evil, as well as a study of the moral theories by which these actual concerns can be explored and critically evaluated. (shrink)

The National Institutes of Health is the largest biomedical research institution in the world. It has become one of the world's most highly respected research centers in part because of its efforts over the years to provide the research community with leadership in both the ethical and scientific parameters of research involving humans. As its 113th birthday approaches at the turn of the century, its great legacy is providing an environment to stimulate and nourish the diversity and creativity of ideas, (...) and thereby enable science to progress. This research must continue to be guided and tempered by consistent and critical federally-supported ethical analyses. (shrink)

As a way of contributing to bioethics' understanding of itself, and, more particularly, to invigorate conversation about how we can best educate future colleagues, we present here a sketch of the quarter-century-old graduate concentration in medical ethics housed in the Department of Philosophy at the University of Tennessee, Knoxville. Our hope is to incite other programs to share their histories, strategies, problems, and aspirations, so as to help the field as a whole get a clearer sense of how we are (...) putting together our future, and of how we might best go about this important job. (shrink)

IntroductionEnabling education programs, otherwise known as Foundation Studies or Preparatory programs, provide pathways for students typically under-represented in higher education. Students in Enabling programs often face distinct challenges in their induction to academic culture which can implicate them in cases of misconduct. This case study addresses a gap in the enabling literature reporting on how a culture of academic integrity can be developed for students and staff in these programs through an educative approach.Case descriptionThis paper outlines how an educative approach (...) to academic integrity is implemented within the Enabling programs of two Australian universities.Discussion and reflectionThis case study reflects upon an approach which makes specific reference to the key elements of ‘support’, ‘approach’ and ‘responsibility’ as highlighted in Bretag and Mahmud’s seminal paper. The paper reports a reduction in misconduct cases at the two institutions suggesting a positive correlation between the interventions and students’ understanding of ethical academic practice. This study reflects upon practitioner experiences with academic integrity investigations to evaluate the effectiveness of this approach.ConclusionsThe authors show that it is possible to ensure academic integrity practices and values are upheld within a supportive learning environment appropriate to a students’ level of study. (shrink)

The planetary boundaries concept has profoundly changed the vocabulary and representation of global environmental issues. The article starts by highlighting the strengths and weaknesses of planetary boundaries from a social science perspective. It is argued that the growth imperative of capitalist economies, as well as other particular characteristics detailed below, are the main drivers of the ecological crisis and exacerbated trends already underway. Further, the planetary boundaries framework can support interpretations that do not solely emphasize technocratic operational approaches and costs, (...) but also assume that these alone can be the solution. (shrink)

The notion of societal boundaries aims to enhance the debate on planetary boundaries. The focus is on capitalist societies as a heuristic for discussing the expansionary dynamics, power relations, and lock-ins of modern societies that impel highly unsustainable societal relations with nature. While formulating societal boundaries implies a controversial process – based on normative judgments, ethical concerns, and socio-political struggles – it has the potential to offer guidelines for a just, social-ecological transformation.

In recent work, J. Adam Carter argues that truth-relativism should be compatible with the so-called conformist response to peer disagreement about taste to the effect that subjects should revise their opinions. However, Carter claims that truth-relativism cannot make sense of this response since it cannot make sense of the idea that when two subjects are recognised as epistemic peers, they should acknowledge that they are equally likely to be right about the targeted issue. The main aim of this (...) paper is a modest one: to argue that truth-relativists should not be worried about their alleged incompatibility with conformism for they should be non-conformists. (shrink)

To what extent do we pay attention to the text and images that cover our hospital walls and do we offer any critique either as professionals or service users? In the past we might have expected to see functional or helpful instructions about where to go (or not to go) and in more well‐endowed buildings, perhaps we would see some works of art, sculpture, stained glass even, with the intention to encourage, distract or even forewarn us. However, it is now (...) common in UK hospitals, for wall space to be used as a portal for a range of institutional political messages, that convey information about everything from its own values, behaviours to advertisements for products and services to requirements for rule following. Michel Foucault's ideas about Heterotopic space can help us to see that hospitals tend to fall (awkwardly) between being a public and personal health care space, and this is a possible explanation for the confused material culture and messages that are shared there. This paper draws on ethnographic methods to reflect on personal experience in order to offer a critique of the contemporary political discourse which has become 'literally' written onto our hospital walls. (shrink)

Much existing literature in anthropology suggests that teaching is rare in non-Western societies, and that cultural transmission is mostly vertical (parent-to-offspring). However, applications of evolutionary theory to humans predict both teaching and non-vertical transmission of culturally learned skills, behaviors, and knowledge should be common cross-culturally. Here, we review this body of theory to derive predictions about when teaching and non-vertical transmission should be adaptive, and thus more likely to be observed empirically. Using three interviews conducted with rural Fijian populations, we (...) find that parents are more likely to teach than are other kin types, high-skill and highly valued domains are more likely to be taught, and oblique transmission is associated with high-skill domains, which are learned later in life. Finally, we conclude that the apparent conflict between theory and empirical evidence is due to a mismatch of theoretical hypotheses and empirical claims across disciplines, and we reconcile theory with the existing literature in light of our results. (shrink)

Much human adaptation depends on the gradual accumulation of culturally transmitted knowledge and technology. Recent models of this process predict that large, well-connected populations will have more diverse and complex tool kits than small, isolated populations. While several examples of the loss of technology in small populations are consistent with this prediction, it found no support in two systematic quantitative tests. Both studies were based on data from continental populations in which contact rates were not available, and therefore these studies (...) do not provide a test of the models. Here, we show that in Oceania, around the time of early European contact, islands with small populations had less complicated marine foraging technology. This finding suggests that explanations of existing cultural variation based on optimality models alone are incomplete because demography plays an important role in generating cumulative cultural adaptation. It also indicates that hominin populations with similar cognitive abilities may leave very different archaeological records, a conclusion that has important implications for our understanding of the origin of anatomically modern humans and their evolved psychology. (shrink)

We assessed the attitudes, perceptions, and stereotypes toward Latino immigrants among 247 mental health professionals across 32 U.S. states. We also randomly presented two versions of an attitude measure that varied in their references to immigrants. Participants reported that they did not agree with the anti-immigration law Arizona SB 1070 and other similar bills. Also, greater multicultural awareness was related to positive attitudes and fewer stereotypes toward immigrants. Furthermore, participants who were asked to think about “undocumented immigrants” viewed Latino immigrants (...) more positively than those who were asked think about “illegal aliens.” Findings show the continued need for multicultural awareness and competence training for mental health professionals, which align with the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct. Limitations and future directions for research are discussed. (shrink)

ABSTRACTJoseph E. Uscinski and Ryden W. Butler argue that fact-checking should be condemned to the dustbin of history because the methods fact-checkers use to select statements, consider evidence, and render judgment fail to stand up to the rigors of scientific inquiry and threaten to stifle political debate. However, the premises upon which they build their arguments are flawed. By sampling from multiple “fact-checking agencies” that do not practice fact-checking on a regular basis in a consistent manner, they perpetuate the selection (...) effects they criticize and thus undermine their own position. Furthermore, not only do their arguments suffer from overgeneralization, they fail to offer empirical quantification to support some of their anecdotal criticisms. This rejoinder offers a study demonstrating a high level of consistency in fact-checking and argues that as long as unambiguous practices of deception continue, fact-checking has an important role to play in the United States and around the world. (shrink)

White evangelical habits of mind and idolatrous allegiances propped up a devastatingly irresponsible political administration; I argue that the COVID-19 pandemic should be viewed as an apocalypse: “a catastrophic revelation”—in this case, of Christian responsibility refused. I engage the works of Christian historians Mark Noll and Kristin Kobes Du Mez to interrogate how evangelical habits of mind and heart have nurtured anti-intellectualism, credulousness, and the uncritical adoption of neoliberal economic individualism before turning to a constructive Christian realist call for “nasty” (...) (honest, embodied) thinking and genuine repentance which draws from Andrew DeCort’s Bonhoeffer scholarship. (shrink)

This paper explores the theological work of Ada María Isasi-Díaz’s Mujerista Theology, with an emphasis on the role of hybridity, daily life, and autobiography in her corpus. It also offers suggestions for future developments in this theology.

The use of aborted fetal tissues in research and therapy has raised exciting possibilities and a host of social, legal and ethical issues. Perhaps the most difficult issue is whether the use of materials from elective abortion can be viewed and weighed separately from the abortion itself, or if in using these tissues there is inherent complicity with the abortion act. Those who oppose FTT claim that there is complicity with the abortion act and liken the use of fetal tissue (...) from abortions to the use of data from the Nazi experiments. Within this lobby are those who claim that the option to donate fetal tissues will make abortion a more attractive alternative for pregnant women, and that there are doctors who will offer fetal tissue donation as a positive incentive to abortion-with the net effect that more abortions will take place. (shrink)

The use of aborted fetal tissues in research and therapy has raised exciting possibilities and a host of social, legal and ethical issues. Perhaps the most difficult issue is whether the use of materials from elective abortion can be viewed and weighed separately from the abortion itself, or if in using these tissues there is inherent complicity with the abortion act. Those who oppose FTT claim that there is complicity with the abortion act and liken the use of fetal tissue (...) from abortions to the use of data from the Nazi experiments. Within this lobby are those who claim that the option to donate fetal tissues will make abortion a more attractive alternative for pregnant women, and that there are doctors who will offer fetal tissue donation as a positive incentive to abortion-with the net effect that more abortions will take place. (shrink)

Contemporary psychiatry maintains the myth that it is value neutral by appeal to modern medical science for both its diagnostic categories and its therapeutic interventions, leaving the impression that it relies on reason—that is to say, reason divorced from tradition—to master human nature. Such a practice has a certain way of characterizing and defining humanity's lapses from acceptable human behavior—a lapse from human being. The modern practice of psychiatry applies a particular notion (largely influenced by Enlightenment ideals) of scientific instrumentation (...) to the human person in order to diagnose the ailment and manufacture a corresponding treatment in keeping with a hidden conception of human biological flourishing. This covert vision is an impoverished (and possibly dangerous) one. As much as the practice of psychiatry is constrained by the goals of the dominant moral tradition of our day, it becomes a tool (or technique) for achieving the transient and partial ends of modern individualism. Given this truncated view of human nature and human end, modern psychiatry fails to attend comprehensively to the unity of a life, missing altogether the essential relevance of character formation, and thereby forfeiting excellence in human flourishing. (shrink)

An apparently simple answer to this question is 'diversity': there is a diversity of women readers, diversity of interests, diversity of methods and diversity of results of women reading the Bible. In this article I will discuss the complex reality of the diversity of contemporary women's reading of the Bible. I will discuss women readers under two headings, namely the everyday, non-academic reader on the one hand, and the professional, academically trained biblical exegete on the other. I will first suggest (...) a general comparison of these two groups before I treat each one in greater detail. Finally, I will offer a reading of a story about a woman from the Gospel of Mark that draws on feminist hermeneutics to read for a meaning that liberates women from a burdensome, conventional reading. (shrink)

I explore the impact of memory altering technologies in the science fiction drama (2016–2020) in order to show that unreconciled altered traumatic memory may lead to a dystopian breakdown of society. I bring Miroslav Volf's theological perspectives on memory into conversation with the plot of Westworld in order to reveal connections between memory altering technologies and humanity's responsibility to remember rightly. Using Volf's theology of remembering as an interpretive lens, I analyze characters’ inability to remember rightly while recalling partial memories (...) of their trauma. In virtue of this examination, I contend that memory altering technologies may inhibit individuals from relational processes of healing, such as forgiveness. Consequently, I argue that this study leads to a richer understanding of the potential that memory altering technologies have for undermining humanity's ability to interact in a relational capacity, specifically in terms of forgiveness. (shrink)

Molecular interactions are at the origin of life. How molecules get at different locations in the cell and how they locate their partners is a major and partially unresolved question in biology that is paramount to signaling. Spatio‐temporal correlations of fluctuating fluorescently tagged molecules reveal how they move, interact, and bind in the different cellular compartments. Methods based on fluctuations represent a remarkable technical advancement in biological imaging. Here we discuss image analysis methods based on spatial and temporal correlation of (...) fluctuations, raster image correlation spectroscopy, number and brightness, and spatial cross‐correlations that give us information about how individual molecules move in cells and interact with partners at the single molecule level. These methods can be implemented with a standard laser scanning microscope and produce a cellular level spatio‐temporal map of molecular interactions. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)