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)

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)

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)

This article discusses the representation of AIDS in Guibert's posthumously published novel Le Paradis. The novel is situated in relation to Guibert's better known previous AIDS writings. The article proposes that Guibert's AIDS works fall in to three related categories: writings about other peoples' AIDS; autobiographical writings about AIDS, and, in the third, terminal stage in which Le Paradis fits, writing AIDS. As such the article suggests that Le Paradis manages to reflect and communicate some of the trauma of living (...) with AIDS by specifically trying not to write about it. The article raises issues related to constructions of sexualized and AIDS identities in fiction, and presents the novel as a form which represents a loss of self. The novel, it is argued, becomes a self-mourning for a healthy past which is memorialized in a fictional present, itself always-already haunted by the nostalgia for a lost future. (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 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 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)

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)

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)

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

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)

This copiously illustrated volume is the first systematic general work to do justice to the fruits of recent scholarship in the history of natural history. Public interest in this lively field has been stimulated by environmental concerns and through links with the histories of art, collecting and gardening. The centrality of the development of natural history for other branches of history - medical, colonial, gender, economic, ecological - is increasingly recognized. Twenty-four specially commissioned essays cover the period from the sixteenth (...) century, when the first institutions of natural history were created, to its late nineteenth-century transformation by practitioners of the new biological sciences. An introduction discusses novel approaches that have made this a major focus for research in cultural history. The essays, which include suggestions for further reading, offer a coherent and accessible overview of a fascinating subject. An epilogue highlights the relevance of this wide-ranging survey for current debates on museum practice, the display of ecological diversity and concerns about the environment. (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)

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)

In another tumultuous term of the United States Supreme Court in 2022-2023 a series of critical cases implicate instant and forthcoming changes in multiple fronts that collectively shift the national public health law and policy environment.

Among the morass of critical issues impacting the results of the midterm elections in 2022 were core public health issues related to health care access, justice, and reforms. Collectively, voters’ communal health and safety concerns dominated outcomes in key races which may shape national, state, and local legal approaches to protecting the public’s health in the modern era.