Ten qualitative research articles published from July 2013 through June 2014 on ethical topics in healthcare and health research are examined here. Full reference information is given for each article. A brief summary of the background, objectives, methods, results and conclusions is offered. These articles were chosen based on the quality of the work done and how well the work fits the interests of Narrative Inquiry in Bioethics readers.

Academic health centres have historically treated patients with the most complex of diseases, served as training grounds to teach the next generations of physicians and fostered an innovative environment for research and discovery. The physicians who hold faculty positions at these institutions have long understood how these key academic goals are critical to serve their patient community effectively. Recent healthcare reforms, however, have led many academic health centres to recruit physicians without these same academic expectations and to partner with non-faculty (...) physicians at other health systems. There has been limited transparency in regard to the expertise among the physicians and the academic faculty within these larger entities. Such lack of transparency may lead to confusion among patients regarding the qualifications of who is actually treating them. This could threaten the ethical principles of patient autonomy, benevolence and non-maleficence as patients risk making uninformed decisions that might lead to poorer outcomes. Furthermore, this lack of transparency unjustly devalues the achievements of physician faculty members as well as potentially the university they represent. In this paper, it is suggested that academic health centres have an obligation to foster total transparency regarding what if any role a physician has at a university or medical school when university or other academic monikers are used at a hospital. (shrink)

The study reports on the results of an empirical investigation of the education and recruitment processes used in HIV vaccine trials conducted in South Africa. Interviews were conducted with 21 key informants involved in HIV vaccine research in South Africa and three focus groups of community advisory board members. Data analysis identified seven major themes on the relationship between education and recruitment: the process of recruitment, the combined dual role of educators and recruiters, conflicts perceived by field staff, pressure to (...) achieve recruitment targets, problems in achieving comprehension, accountability and education as capacity building. The results raise ethical concerns about the adequacy of current informed consent processes in these settings. The study findings bear directly on current debates about issues of exploitation and the scope of moral responsibilities of researchers and funding agencies to assure that HIV clinical prevention research is conducted ethically. (shrink)

The observational-theoretical distinction has played a central role in the philosophy of science from logical empiricism onwards. Developments within the discipline have shown that such a distinction hides two non-identical distinctions: observational vs. non-observational and theoretical vs. non-theoretical. Likewise, metatheoretical structuralism proposed a more sophisticated treatment of theoricity in terms of the operational dependence or independence of concepts from the theories in which they appear. Despite this remarkable sophistication, it is still generally accepted that the distinction between theoretical and non-theoretical (...) concepts coincides with the explanatory vs. non-explanatory and testing vs. non-testing distinctions. Ginnobili and Carman argued for the independence between theoricity and explanation. In this paper we will focus on testing and argue for its independence from both theoricity and explanation. To do so, we propose an account of theory testing based on the framework of metatheoretical structuralism and apply it to natural selection theory and cladistics. (shrink)

Think theory is thoroughly removed from explaining international crises such as Bosnia, Rwanda, and Korea? Think again! James Rosenau and Mary Durfee have teamed up to show how the same events take on different coloration depending on the theory used to explain them. In order to better understand world politics, the authors maintain, theory does make a difference. Thinking Theory Thoroughly is a primer for all kinds of readers who want to begin theorizing about international relations (IR). In this (...) second edition, realism (the dominant theoretical perspective in IR), postinternationalism (Rosenau’s famed turbulence paradigm), and liberalism are treated together in a chapter that compares them along various analytic dimensions, which makes the book even more useful.In this new edition, the order and content of case chapters have been changed to better reflect the ways theory can be used to organize empirical material. The chapter on crises, which is now at the beginning, shows how systemic theories might cope with problems and evidence of a more local and temporally constrained nature. A chapter on the U.N. illustrates how systemic theories can cope with institutions, and the last chapter, on Antarctica, delineates how systemic theories can be used to generate hypotheses that then demand different kinds of evidence. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Taber and Lodge offer a powerful case for the prevalence of directional reasoning that aims not at truth, but at the vindication of prior opinions. Taber and Lodge's results have far-reaching implications for empirical scholarship and normative theory; indeed, the very citizens often seen as performing “best” on tests of political knowledge, sophistication, and ideological constraint appear to be the ones who are the most susceptible to directional reasoning. However, Taber and Lodge's study, while internally beyond reproach, may substantially overstate (...) the presence of motivated reasoning in political settings. That said, focusing on the accuracy motivation has the potential to bring together two models of opinion formation that many treat as competitors, and to offer a basis for assessing citizen competence. (shrink)

It is said there are only two things in life that are certain: death and taxes … maybe only taxes.

In this paper we offer a new argument for the existence of God. We contend that the laws of logic are metaphysically dependent on the existence of God, understood as a necessarily existent, personal, spiritual being; thus anyone who grants that there are laws of logic should also accept that there is a God. We argue that if our most natural intuitions about them are correct, and if they are to play the role in our intellectual activities that we take (...) them to play, then the laws of logic are best construed as necessarily existent thoughts -- more specifically, as divine thoughts about divine thoughts. We conclude by highlighting some implications for both theistic arguments and antitheistic arguments. (shrink)

The sounds that make up spoken words are heard in a series and must be mapped rapidly onto words in memory because their elements, unlike those of visual words, cannot simultaneously exist or persist in time. Although theories agree that the dynamics of spoken word recognition are important, they differ in how they treat the nature of the competitor set—precisely which words are activated as an auditory word form unfolds in real time. This study used eye tracking to measure the (...) impact over time of word frequency and 2 partially overlapping competitor set definitions: onset density and neighborhood density. Time course measures revealed early and continuous effects of frequency (facilitatory) and on set based similarity (inhibitory). Neighborhood density appears to have early facilitatory effects and late inhibitory effects. The late inhibitory effects are due to differences in the temporal distribution of similarity within neighborhoods. The early facilitatory effects are due to subphonemic cues that inform the listener about word length before the entire word is heard. The results support a new conception of lexical competition neighborhoods in which recognition occurs against a background of activated competitors that changes over time based on fine-grained goodness-of-fit and competition dynamics. (shrink)

The sounds that make up spoken words are heard in a series and must be mapped rapidly onto words in memory because their elements, unlike those of visual words, cannot simultaneously exist or persist in time. Although theories agree that the dynamics of spoken word recognition are important, they differ in how they treat the nature of the competitor set—precisely which words are activated as an auditory word form unfolds in real time. This study used eye tracking to measure the (...) impact over time of word frequency and 2 partially overlapping competitor set definitions: onset density and neighborhood density. Time course measures revealed early and continuous effects of frequency (facilitatory) and on set based similarity (inhibitory). Neighborhood density appears to have early facilitatory effects and late inhibitory effects. The late inhibitory effects are due to differences in the temporal distribution of similarity within neighborhoods. The early facilitatory effects are due to subphonemic cues that inform the listener about word length before the entire word is heard. The results support a new conception of lexical competition neighborhoods in which recognition occurs against a background of activated competitors that changes over time based on fine‐grained goodness‐of‐fit and competition dynamics. (shrink)

In Paradox in Christian Theology I argued that the Christian doctrines of the Trinity and the Incarnation are paradoxical—that is, they appear to involve implicit contradictions—yet Christians can still be rational in affirming and believing those doctrines. Dale Tuggy has characterized my theory of theological paradox as a form of “positive mysterianism” and argues that the theory “faces steep epistemic problems, and is at best a temporarily reasonable but ultimately unsustainable stance.” After summarizing my proposed model for the rational affirmation (...) of theological paradox and considering whether my proposal is indeed a form of “positive mysterianism” as Tuggy defines the term, I address the two main criticisms raised in Tuggy’s paper: first, that the doctrine of divine incomprehensibility cannot bear the weight required by my defense of paradox; and second, that my proposed model is afflicted with epistemic instability. I conclude that Tuggy has failed to show that a mysterian stance with respect to paradoxical Christian doctrines is in principle unreasonable, unnatural, or unsustainable. (shrink)

Here I propose to undertake a brief survey of the statements of the argument given by these proponents, formulating and qualifying as I go what seems to me a sound version of it, capable of withstanding both Ayer's criticism and others that I have developed. There must be additional ways in which the same or similar points can be expressed. Another review of Kant, Paton, Taylor, and Kenner would no doubt produce a somewhat different result. All that is claimed here (...) is that the argument advanced in this paper is sound and that it was suggested by certain statements of theirs. (shrink)

The question of when and how bottom‐up input is integrated with top‐down knowledge has been debated extensively within cognition and perception, and particularly within language processing. A long running debate about the architecture of the spoken‐word recognition system has centered on the locus of lexical effects on phonemic processing: does lexical knowledge influence phoneme perception through feedback, or post‐perceptually in a purely feedforward system? Elman and McClelland (1988) reported that lexically restored ambiguous phonemes influenced the perception of the following phoneme, (...) supporting models with feedback from lexical to phonemic representations. Subsequently, several authors have argued that these results can be fully accounted for by diphone transitional probabilities in a feedforward system (Cairns et al., 1995; Pitt & McQueen, 1998). We report results strongly favoring the original lexical feedback explanation: lexical effects were present even when transitional probability biases were opposite to those of lexical biases. (shrink)

The effectiveness of case-based learning in ethics education varies widely regarding how cases are presented. Case process instruction may impact case-based ethics education to promote sensemaking processes, ethical sensemaking strategy use, and ethical decision making (EDM) quality. This study examined two teaching techniques, notes and review, and participants completed note-taking and review activities examining a case-based scenario during an ethics education course. Results suggest that providing case notes in outline form improves sensemaking processes, strategy use, and EDM quality. In addition, (...) combining processes of provided notes and passive review results in incremental, additive performance via certain ethical sensemaking strategies and EDM quality. (shrink)

Wind turbines generate low-frequency sounds that affect the ear. The ear is superficially similar to a microphone, converting mechanical sound waves into electrical signals, but does this by complex physiologic processes. Serious misconceptions about low-frequency sound and the ear have resulted from a failure to consider in detail how the ear works. Although the cells that provide hearing are insensitive to infrasound, other sensory cells in the ear are much more sensitive, which can be demonstrated by electrical recordings. Responses to (...) infrasound reach the brain through pathways that do not involve conscious hearing but instead may produce sensations of fullness, pressure or tinnitus, or have no sensation. Activation of subconscious pathways by infrasound could disturb sleep. Based on our current knowledge of how the ear works, it is quite possible that low-frequency sounds at the levels generated by wind turbines could affect those living nearby. (shrink)

Subsequent to the end of the Cold War, analysts groped for an understanding of the overall structures of world politics that marked the emergence of a new epoch. As a result, the concept of empire became a major preoccupation, with the economic and military power of the United States considered sufficient for regarding it as an empire. Due to the proliferation of new microelectronic technologies and for a variety of other specified reasons, however, the constraints inherent in the new epoch (...) make it seem highly unlikely that the U.S. or any other country can ever achieve the status of an empire. In effect, the substantial shrinkage of time and distance in the current period has led to the replacement of the age of the nation-state that originated with the Treaty of Westphalia in 1648 with the age of the networked individual. It is an age that has developed on a global scale and that has brought an end to the history of empires. (shrink)

Natural ecosystems perform fundamental life-support services upon which human civilization depends. However, many people believe that nature provides these services for free and therefore, they are of little or no value. One nearly forgotten ecosystem service is ecotherapy – the ability of interaction with nature to enhance healing and growth. While we do not pay for this service, we pay significantly for its loss resulting in slower recovery times, greater distress, reduced well-being and losses in those images of nature that (...) contribute to our basic happiness. Little is understood about the ecotherapy benefits of the natural environment and its ecosystem services. The complex and interactive relationship of ecosystems, their services and human well-being is poorly acknowledged in the broad social, philosophical and economic well-being literature. In this article, we examine the role of nature and its ecosystem services in ecotherapy and its associated enhancement of recovery from physical and mental illness. (shrink)

Rosenau writes that the history of the nineteenth and twentieth centuries is the story of convergence around political entities in order to preserve individual values in the context of collective needs and wants; but today the process of community building has been reversed.

Taber and Lodge offer a powerful case for the prevalence of directional reasoning that aims not at truth, but at the vindication of prior opinions. Taber and Lodge's results have far-reaching implications for empirical scholarship and normative theory; indeed, the very citizens often seen as performing “best” on tests of political knowledge, sophistication, and ideological constraint appear to be the ones who are the most susceptible to directional reasoning. However, Taber and Lodge's study, while internally beyond reproach, may substantially overstate (...) the presence of motivated reasoning in political settings. That said, focusing on the accuracy motivation has the potential to bring together two models of opinion formation that many treat as competitors, and to offer a basis for assessing citizen competence. (shrink)

No overarching hypotheses tie the basic mechanisms of mitochondrial reactive oxygen species (ROS) production to activity dependent synapse pruning—a fundamental biological process in health and disease. Neuronal activity divergently regulates mitochondrial ROS: activity decreases whereas inactivity increases their production, respectively. Placing mitochondrial ROS as innate synaptic activity sentinels informs the novel hypothesis that: (1) at an inactive synapse, increased mitochondrial ROS production initiates intrinsic apoptosis dependent pruning; and (2) at an active synapse, decreased mitochondrial ROS production masks intrinsic apoptosis dependent (...) pruning. Immature antioxidant defense may enable the developing brain to harness mitochondrial ROS to prune weak synapses. Beyond development, endogenous antioxidant defense constrains mitochondrial (ROS) to mask pruning. Unwanted age‐related synapse loss may arise when mitochondrial ROS aberrantly recapitulate developmental pruning. Placing mitochondrial ROS with their hands on the shears is beneficial in early but deleterious in later life. (shrink)

The possibility of achieving ectogenesis, or the growing of a human fetus to term in an artificial womb, is approaching reality as a result of advances in treatment of premature newborns and in in vitro fertilization techniques. In their 1984 book, The Reproductive Revolution, issued in North America as Making Babies, Peter Singer and Deane Wells offered several arguments for ectogenesis. James examines their arguments and rejects two of them, that ectogenesis offers a less problematic alternative to surrogate motherhood, (...) and that ectogenesis could make it possible to reconcile fetal rights with the right to abortion on demand. He grants Singer and Wells' argument that the childless have a claim to state support of their desire to nurture, but contends that government-supported ectogenesis should still be rejected because the adoption of unwanted children is a preferable alternative to the use of an exotic, expensive, and still unproven technology. (shrink)