The world’s first living donor liver transplant from an HIV-positive mother to her HIV-negative child, performed by our team in Johannesburg, South Africa in 2017, was necessitated by disease profile and health system challenges. In our country, we have a major shortage of donor organs, which compels us to consider innovative solutions to save lives. Simultaneously, the transition of the HIV pandemic, from a death sentence to a chronic illness with excellent survival on treatment required us to rethink our policies (...) regarding HIV infection and living donor liver transplantation. Although HIV infection in the donor is internationally considered an absolute contraindication for transplant to an HIV-negative recipient, there have been a very small number of unintentional transplants from HIV-positive deceased donors to HIV-negative recipients. These transplant recipients do well on antiretroviral medication and their graft survival is not compromised. We have had a number of HIV-positive parents in our setting express a desire to be living liver donors for their critically ill children. Declining these parents as living donors has become increasingly unjustifiable given the very small deceased donor pool in SA; and because many of these parents are virally suppressed and would otherwise fulfil our eligibility criteria as living donors. This paper discusses the evolution of HIV and transplantation in SA, highlights some of the primary ethical considerations for us when embarking on this case and considers the new ethical issues that have arisen since we undertook this transplant. (shrink)

BackgroundThe phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice.Research aimTo explore the concept of moral (...) distress in nursing both empirically and conceptually.MethodologyFeminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis.Ethical considerationsThe study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom.FindingsThe empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas.DiscussionWe suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress.ConclusionThe empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’. (shrink)

There has been increasing debate in recent years about the conceptualization of moral distress. Broadly speaking, two groups of scholars have emerged: those who agree with Jameton’s ‘narrow definition’ that focuses on constraint and those who argue that Jameton’s definition is insufficient and needs to be broadened. Using feminist empirical bioethics, we interviewed critical care nurses in the United Kingdom about their experiences and conceptualizations of moral distress. We provide our broader definition of moral distress and examples of data that (...) both challenge and support our conceptualization. We pre‐empt and overcome three key challenges that could be levelled at our account and argue that there are good reasons to adopt our broader definition of moral distress when exploring prevalence of, and management strategies for, moral distress. (shrink)

The aim of this paper is to explain why, while Charles Darwin was well recognized as a scientific leader of his time, Claude Bernard never really regarded Darwinism as a scientific theory. The lukewarm reception of Darwin at the Académie des Sciences of Paris and his nomination to a chair only after 8 years contrasts with his prominence, and Bernard’s attitude towards Darwin’s theory of species evolution belongs to this French context. Yet we argue that Bernard rejects the scientific value (...) of Darwinian principles mainly for epistemological reasons. Like Darwin, Bernard was interested in hereditary processes, and planned to conduct experiments on these processes that could lead to species transformation. But the potential creation of new forms of life would not vindicate Darwinism since biologists can only explain the origin of morphotypes and morphological laws by the means of untestable analogies. Because it can be the object neither of experiments nor of any empirical observation, phylogeny remains out of science’s scope. Around 1878 Bernard foresaw a new general physiology based on the study of protoplasm, which he saw as the agent of all basic living phenomena. We will analyze why Bernard regarded Darwinism as part of metaphysics, yet still referred to Darwinians in his latter works in 1878. Basically, the absence of a scientific reception of Darwinism in Bernard's work should not obscure its philosophical reception, which highlights the main principles of Bernard’s epistemology. (shrink)

In recent years, several countries have enacted guidelines and/or mandatory laws to increase the presence of women on the boards of companies. Through these regulatory interventions, the aim is to eradicate the social and labor grievances that women have traditionally experienced and which has relegated them to smaller-scale jobs. Nevertheless, and despite the advances achieved, the female representation in the boardroom remains far from the desired levels. In this context, it is now necessary to enhance the advantages of board gender (...) diversity from both ethical and economic points of view. This article examines the relation between board gender diversity and economic results in Spain: the second country in the world to legally require gender quotas in boardrooms and historically characterized by a minimal female participation in the workforce. Based on a sample of 125 non-financial firms listed on the Madrid Stock Exchange from 2005 to 2009, our findings show that in the period analyzed the increase of the number of women on boards was over 98 %. This suggests that compulsory legislation offers an efficient framework to execute the recommendation of Spanish codes of good governance by means of the increase in the number of women in the boards of firms. Furthermore, we find that the increase in the number of women on the boards is positively related to higher economic results. Therefore, both results suggest that gender diversity in boardrooms should be incremented, mandatory laws being a key factor to do so. (shrink)

With the COVID-19 pandemic, governments implemented successive lockdowns that forced employees to work from home to contain the spread of the coronavirus. This crisis raises the question of the effects of mandatory work from home on employees’ well-being and performance, and whether these effects are the same for all employees. In the present study, we examined whether working at home may be related to intensity, familiarity with WFH, employees’ well-being and creativity. We also examined whether the psychological profile of employees, (...) combining preference for solitude and associated personality variables from the Big Five, may influence the effects of WFH. The data were collected via an online survey from November 13th to December 15th 2020 among 946 employees from various organizations during the second lockdown in France. In addition to identifying two distinctive psychological profiles for employees having to WFH, results revealed that those with a “Solitary” profile reported higher loneliness at work, higher levels of stress, and lower levels of job satisfaction and work engagement than those with an “Affiliative” profile. It was also found that employees with a “Solitary” profile perceived themselves as less creative and produced objectively fewer ideas than individuals with an “Affiliative” profile. The present study suggests the necessity to distinguish the profiles of teleworkers and to offer a stronger support for the less affiliative employees when working from home. (shrink)

Research using the intermodal preferential looking paradigm (IPLP) has consistently shown that English‐learning children aged 2 can associate transitive argument structure with causal events. However, studies using the same methodology investigating 2‐year‐old children’s knowledge of the conjoined agent intransitive and semantic role assignment have reported inconsistent findings. The aim of the present study was to establish at what age English‐learning children have verb‐general knowledge of both transitive and intransitive argument structure using a new method: the forced‐choice pointing paradigm. The results (...) suggest that young 2‐year‐olds can associate transitive structures with causal (or externally caused) events and can use transitive structure to assign agent and patient roles correctly. However, the children were unable to associate the conjoined agent intransitive with noncausal events until aged 3;4. The results confirm the pattern from previous IPLP studies and indicate that children may develop the ability to comprehend different aspects of argument structure at different ages. The implications for theories of language acquisition and the nature of the language acquisition mechanism are discussed. (shrink)

We address how listeners perceive temporal regularity in music performances, which are rich in temporal irregularities. A computational model is described in which a small system of internal self‐sustained oscillations, operating at different periods with specific phase and period relations, entrains to the rhythms of music performances. Based on temporal expectancies embodied by the oscillations, the model predicts the categorization of temporally changing event intervals into discrete metrical categories, as well as the perceptual salience of deviations from these categories. The (...) model's predictions are tested in two experiments using piano performances of the same music with different phrase structure interpretations (Experiment 1) or different melodic interpretations (Experiment 2). The model successfully tracked temporal regularity amidst the temporal fluctuations found in the performances. The model's sensitivity to performed deviations from its temporal expectations compared favorably with the performers' structural (phrasal and melodic) intentions. Furthermore, the model tracked normal performances (with increased temporal variability) better than performances in which temporal fluctuations associated with individual voices were removed (with decreased variability). The small, systematic temporal irregularities characteristic of human performances (chord asynchronies) improved tracking, but randomly generated temporal irregularities did not. These findings suggest that perception of temporal regularity in complex musical sequences is based on temporal expectancies that adapt in response to temporally fluctuating input. (shrink)

A growing body of research reveals that abusive supervision may have negative impacts in organizations. The purpose of the present study is to expand the knowledge regarding the impacts of this dysfunctional leadership behavior by examining its relationship with innovation in work teams. Specifically, we investigate the process through which abusive supervision may undermine team innovation by taking into account the mediating role of team proactive behavior. Moreover, we propose a boundary condition of the negative effect of abusive supervision by (...) considering leader–members interdependence as a moderator. Using a multisource approach, data were gathered from 394 members and 82 immediate supervisors in a public safety organization. Results of path analyses reveal that the relationship between abusive supervision and team innovation is mediated by team proactive behavior. Furthermore, we found that the relationship between abusive supervision and team proactive behavior is moderated by leader–members interdependence, such that this relationship is stronger when the level of interdependence is high. Taken together, the findings of this study improve the understanding of why and under what circumstances abusive supervision may impair team innovation. (shrink)

As donor trust legitimises research, trust is vital for research in the fields of biomedicine, genetics, translational medicine and personalised medicine. For parts of the donor community, the consent signature is a sign of trust in research. Many consent processes in biomedical research ask donors to provide their data for an unspecified future use, which introduces uncertainty of the unknown. This uncertainty can jeopardise donor trust or demand blind trust. But which donor wants to trust blindly? To reduce this uncertainty, (...) we explore first, which future-proof actors donors could trust when signing a consent form. Second, we discuss the question Can we know if donor trust expires? and what prevents donor trust from expiring. Finally, we present possible measures that can help to nurture trust in the far future. In this article, we draw on our previous research on trust in biomedical research, on trust in the broader healthcare system and Niklas Luhmann’s and Anthony Giddens’ trust theories. Our findings suggest that, in the far future, researchers will need to consider donor autonomy, as well as societal norms and values of the time period in which the data were donated. They will need to find mechanisms where possible to publicly announce the use of old data sets. However, foremost researchers will need to treat the data respectfully. It remains vital that professionals and the society continue to elaborate on the norms and values that shape the common understanding of what is morally right and wrong when researching data. (shrink)

Mounting ambitions and capabilities for public and private, non-government sector crewed space exploration bring with them an increasingly diverse set of space travelers, raising new and nontrivial ethical, legal, and medical policy and practice concerns which are still relatively underexplored. In this piece, we lay out several pressing issues related to ethical considerations for selecting space travelers and conducting human subject research on them, especially in the context of non-governmental and commercial/private space operations.

Circadian rhythm abnormalities in bipolar disorder have led to a search for genetic abnormalities in circadian "clock genes" associated with BD. However, no significant clock gene findings have emerged from genome-wide association studies. At least three factors could account for this discrepancy: complex traits are polygenic, the organization of the clock is more complex than previously recognized, and/or genetic risk for BD may be shared across multiple illnesses. To investigate these issues, we considered the clock gene network at three levels: (...) essential "core" clock genes, upstream circadian clock modulators, and downstream clock controlled genes. Using relaxed thresholds for GWAS statistical significance, we determined the rates of clock vs. control genetic associations with BD, and four additional illnesses that share clinical features and/or genetic risk with BD. Then we compared the results to a set of lithium-responsive genes. Associations with BD-spectrum illnesses and lithium-responsiveness were both enriched among core clock genes but not among upstream clock modulators. Associations with BD-spectrum illnesses and lithium-responsiveness were also enriched among pervasively rhythmic clock-controlled genes but not among genes that were less pervasively rhythmic or non-rhythmic. Our analysis reveals previously unrecognized associations between clock genes and BD-spectrum illnesses, partly reconciling previously discordant results from past GWAS and candidate gene studies. (shrink)

Can we build endogenous expectations about the locus of occurrence of a target without being able to describe them? Participants performed cue–target detection tasks with different proportions of valid and invalid trials, without being informed of these proportions, and demonstrated typical endogenous effects. About half were subsequently able to correctly describe the cue–target relationships . However, even non-verbalizer participants showed endogenous orienting with peripheral cues , not depending solely on practice . Explicit instructions did not bring about dramatic advantages in (...) performance .With central symbolic cues, only verbalizers showed reliable endogenous effects . We concluded that endogenous orienting with peripheral cues can occur independently of participants developing explicit hypotheses about the cue–target relationships. (shrink)

Wijdicks and colleagues1 recently presented the Full Outline of UnResponsiveness (FOUR) scale as an alternative to the Glasgow Coma Scale (GCS)2 in the evaluation of consciousness in severely brain-damaged patients. They studied 120 patients in an intensive care setting (mainly neuro-intensive care) and claimed that “the FOUR score detects a locked-in syndrome, as well as the presence of a vegetative state.”1 We fully agree that the FOUR is advantageous in identifying locked-in patients given that it specifically tests for eye movements (...) or blinking on command. This is welcomed given that misdiagnosis of the locked-in syndrome has been shown to occur in more than half of the cases (see Laureys and colleagues3 for review). As for the diagnosis of the vegetative state, the scale explicitly tests for visual pursuit, and hence can disentangle the vegetative state from the minimally conscious state (MCS). The diagnostic criteria for MCS have been proposed4 only recently, but Wijdicks and colleagues1 do not mention the existence of this clinical entity in their article. As for the vegetative state, MCS can be encountered in the acute or subacute setting as a transitional state on the way to further recovery, or it can be a more chronic or even permanent condition. The MCS refers to patients showing inconsistent, albeit clearly discernible, minimal behavioral evidence of consciousness (eg, localization of noxious stimuli, eye fixation or tracking, reproducible movement to command, or nonfunctional verbalization).4 The FOUR scale does not test for all of the behavioral criteria required to diagnose MCS.4 It is known from the literature (see Majerus and colleagues5 for review) that about a third of patients diagnosed with vegetative state are actually in MCS, and this misdiagnosis can lead to major clinical, therapeutic, and ethical consequences. We tested the ability of the newly proposed FOUR scale to correctly diagnose the vegetative state in an acute (intensive care and neurology ward) and chronic (neurorehabilitation) setting.. (shrink)

ABSTRACTAdults perceive emotional expressions categorically, with discrimination being faster and more accurate between expressions from different emotion categories than between two stimuli from the same category. The current study sought to test whether facial expressions of happiness and fear are perceived categorically by pre-verbal infants, using a new stimulus set that was shown to yield categorical perception in adult observers. These stimuli were then used with 7-month-old infants using a habituation and visual preference paradigm. Infants were first habituated to an (...) expression of one emotion, then presented with the same expression paired with a novel expression either from the same emotion category or from a different emotion category. After habituation to fear, infants displayed a novelty preference for pairs of between-category expressions, but n... (shrink)

Liberals agree that free speech should be protected, where speech is understood broadly to include all forms of intentional communication, including actions and pictures, not merely the spoken or written word. A surprising view about free speech in some liberal and legal circles is that communications should be protected on free-speech grounds only if the communications are mentally mediated. By “mentally mediated communication” we mean speech which communicates its message in such a way that the message can be rationally evaluated (...) by hearers, and causes the hearers to believe it, when it does, through the mechanism of those hearers employing their rational capacity to judge that it is correct. The mental-mediation or persuasion principle, as it is sometimes called, has some important legal and public policy implications. It has been applied to argue that certain forms of expression, despite being forms of speech or expression, lack even a prima facie claim to protection on free speech grounds. -/- Our central aim is to show why the mental mediation principle is mistaken. Liberals should think that some speech which is not mentally mediated deserves protection for the very same reasons that speech which is mentally mediated is often thought to deserve protection. (shrink)

At one time, specialized health privacy laws represented the bulk of the rules regulating genetic privacy, Today, however, as both the field of genomics and the content of privacy law change rapidly, a new generation of general-purpose privacy laws may impose new restrictions on collection, storage, and disclosure of genetic data. This article surveys these laws and considers implications.

People with neurodevelopmental disorders are often considered unsuitable or incapable of working in open employment. When employment is available, tasks are often limited, and opportunities for career development are restricted. Policy and funding constraints leave people with disabilities without an opportunity to develop skills due to the additional time and costs for employers. To overcome these barriers, virtual environments have been proposed as a safe and reliable solution for training. An important prerequisite for a wider uptake of training in virtual (...) environments are demonstrations that the training leads to improved performance in the real world. This is particularly true for people with neurodevelopmental disorders, as transferring learnings from one context to another can be challenging. A systematic review was conducted to assess whether training in virtual environments can be used to improve real-world vocational skills in people with neurodevelopmental disorders. After a systematic search in six databases, eight out of the initially identified 1,806 articles met the inclusion criteria. The findings from these eight studies demonstrate that people with neurodevelopmental disorders can transfer vocational skills from virtual environments to real-world settings. With substantial technological improvements, a surge in accessibility, and improved affordability, there is a need to build upon the promising results identified in this review. (shrink)

Fix an integer $r \ge 3$. We consider metric spaces on n points such that the distance between any two points lies in $\left\{ {1, \ldots,r} \right\}$. Our main result describes their approximate structure for large n. As a consequence, we show that the number of these metric spaces is $\left\lceil {{{r + 1} \over 2}} \right\rceil ^{\left + o\left}.$Related results in the continuous setting have recently been proved by Kozma, Meyerovitch, Peled, and Samotij [34]. When r is even, our (...) structural characterization is more precise and implies that almost all such metric spaces have all distances at least $r/2$. As an easy consequence, when r is even, we improve the error term above from $o\left$ to $o\left$, and also show a labeled first-order 0-1 law in the language ${\cal L}_r $, consisting of r binary relations, one for each element of $[r]$. In particular, we show the almost sure theory T is the theory of the Fraïssé limit of the class of all finite simple complete edge-colored graphs with edge colors in $\left\{ {r/2, \ldots,r} \right\}$.Our work can be viewed as an extension of a long line of research in extremal combinatorics to the colored setting, as well as an addition to the collection of known structures that admit logical 0-1 laws. (shrink)

Résumé Le principe de précaution engage les rapports entre la connaissance, les risques et l’action ; appréhendé d’un point de vue simultanément éthique et politique, il pose également un défi aux institutions et au public pour ce qui est de sa mobilisation dans le débat et de sa mise en œuvre dans l’action, en tant que principe possédant une portée générale. L’article propose une description des problèmes spécifiques que comporte, à cet égard, le choix des interprétations. Cette description conduit à (...) une appréciation positive du nouveau rôle dévolu aux démarches participatives dans la discussion des enjeux éthiques et des risques acceptables. (shrink)

We address the problem of musical variation (identification of different musical sequences as variations) and its implications for mental representations of music. According to reductionist theories, listeners judge the structural importance of musical events while forming mental representations. These judgments may result from the production of reduced memory representations that retain only the musical gist. In a study of improvised music performance, pianists produced variations on melodies. Analyses of the musical events retained across variations provided support for the reductionist account (...) of structural importance. A neural network trained to produce reduced memory representations for the same melodies represented structurally important events more efficiently than others. Agreement among the musicians' improvisations, the network model, and music‐theoretic predictions suggest that perceived constancy across musical variation is a natural result of a reductionist mechanism for producing memory representations. (shrink)

We can think about the use of controlled substances in the treatment of anxiety disorders in two simple but diametrically opposed ways. First, we can say that anxiety disorders are trivial and require only acts of willpower, or, if anxiety disorders do require treatment, they are better treated without the use of benzodiazepines. When BZs are used to treat anxiety, they pose grave risks of addiction to the patients to whom these medicines are prescribed; they relieve patients’ symptoms, but are (...) the equivalent of a pharmacological “roach motel,” a haven into which many unsuspecting patients enter, but from which few emerge without becoming addicted. Patients must then face terrible struggles to free themselves of dependence on BZs, and this compounds the problem for which they sought treatment. Furthermore, the large number of prescriptions for BZs are a threat to the public health because these drugs are widely abused by alcoholics and drug addicts. (shrink)

There seems to be a proliferation of prizes and rankings for ethical business over the past decade. Our principal aims in this article are twofold: to initiate an academic discussion of the epistemic and normative stakes in business-ethics competitions; and to help organizers of such competitions to think through some of these issues and the design options for dealing with them. We have been able to find no substantive literature — academic or otherwise — that addresses either of these two (...) broad topics and audiences. Our modest aim, therefore, is to suggest an agenda of issues, and to begin to explore and analyse some of the possible arguments for and against various philosophical or practical solutions. Part I explores the challenges facing a prize-organizing committee, including problems derived from what Rawls calls the "fact of pluralism" in democratic societies (reasonable people will always disagree over some basic values, including those relevant to evaluating business practices), and epistemic issues about how we can justify qualitative judgments on the basis of incomplete quantitative data. We also try to identify risks and opportunity costs for ethics-prize granters. In Part II we spell out (a) a range of design options and (b) some advice about how any particular prize-awarding committee might select among these options to best achieve its goals (which typically involve highlighting and publicizing best practices for ethical business). (shrink)

Despite general agreement within philosophy that peer review is indispensable, its fairness and reliability is often questioned. This article suggests that such worries can to a large extent be met by adopting the practice that reviews as well as earlier versions of papers are made publicly available when the final version of a paper is published. This suggestion combines the advantages of transparency with the merits of anonymity of reviewers. While there are obstacles to this suggestion, the article argues that (...) it would be worthwhile to implement it because it can help map patterns of conduct and secure confidence in the fairness and reliability of review procedures and journal editing within philosophy. (shrink)

Este artigo aborda as motivações para a docência e os desafios enfrentados por licenciandos em psicologia. A metodologia utilizada foi a abordagem qualitativa, e o instrumento de coleta de dados questionário online com questões abertas e fechadas. Participaram do estudo, onze estudantes de cursos de licenciatura em psicologia de quatro instituições universitárias das regiões sul e sudeste do Brasil. Os resultados demonstraram que a escolha pela licenciatura se deu, sobretudo, pelo interesse e curiosidade na área da educação, apropriação dos saberes (...) pedagógicos, ampliação do mercado de trabalho, bem como as possibilidades de atuação profissional. As dificuldades apontadas revelaram: a falta de informações sobre as especificidades do curso de licenciatura e da atuação do professor de psicologia e a ausência de docentes com saberes pedagógicos para atuar na licenciatura em psicologia. Embora seja considerada formação complementar entre os estudantes, observou-se possibilidades de um ensino-aprendizagem de psicologia engajada e inventiva. (shrink)

In this paper we suggest that there is a need to examine what is meant by “context” in Social Psychology and present an example of how to place identity in its social and institutional context. Taking the case of British naturalisation, the process whereby migrants become citizens, we show that the identity of naturalised citizens is defined by common-sense ideas about Britishness and by immigration policies. An analysis of policy documents on “earned citizenship” and interviews with naturalised citizens shows that (...) the distinction between “elite” and “non-elite” migrants is evident in both the “reified” sphere of policy and the “common sense” sphere of everyday identity construction. While social representations embedded in lay experience construct ethno-cultural similarity and difference, immigration policies engage in an institutionalised positioning process by determining migrants' rights of mobility. These spheres of knowledge and practice are not disconnected as these two levels of “managing otherness” overlap—it is the poorer, less skilled migrants, originating outside the West who epitomise difference (within a consensual sphere) and have less freedom of mobility (within a reified sphere). We show that the context of identity should be understood as simultaneously psychological and political. (shrink)

The production of complex sequences like music or speech requires the rapid and temporally precise production of events (e.g., notes and chords), often at fast rates. Memory retrieval in these circumstances may rely on the simultaneous activation of both the current event and the surrounding context (Lashley, 1951). We describe an extension to a model of incremental retrieval in sequence production (Palmer & Pfordresher, 2003) that incorporates this logic to predict overall error rates and speed—accuracy trade-offs, as well as types (...) of serial ordering errors. The model—assumes that retrieval of the current event is influenced by activations of surrounding events. Activations of surrounding events increase over time, such that both the accessibility of distant events and overall accuracy increases at slower production rates. The model's predictions were tested in an experiment in which pianists performed unfamiliar music at 8 different tempi. Model fits to speed—accuracy data and to serial ordering errors support model predictions. Parameter fits to individual data further suggest that working memory contributes to the retrieval of serial order and overall accuracy is influenced in addition by motor dexterity and domain-specific skill. (shrink)

As more young people feel safe to outwardly identify as transgender or gender expansive (TGE), meaning that their gender identity does not align with the sex they were assigned at birth, an increasing number of youth who identify as TGE seek gender-affirming medical care (GAMC). GAMC raises a number of ethical questions, such as the capacity of a minor to assent or consent, the role of parents or legal guardians in decisions about treatment, and implications for equitable access to care (...) when differing parental or custodial viewpoints are present. These questions are further complicated by the difficulties in explaining the limits of long-term research in GAMC, with regard to the preservation of fertility, for example. We present two de-identified composite case studies to highlight dilemmas that may arise and offer recommendations to better support patient- and family-centered decision making for GAMC. These include employing a multidisciplinUniverary shared decision-making approach, disentangling informed consent and assent from chronological age, developing a consistent approach to the assessment of decisional capacity, and developing age-appropriate informational materials. (shrink)

Jacques Derrida returns relentlessly to the question of literature which is already a prominent concern in early texts such as Writing and Difference. The focus of this article is the conception of literature in ‘Literature in Secret: An Impossible Filiation’, in which Derrida discusses filiation with reference to Abraham and Isaac, the fundamental necessity of secrecy and the notion of the pardon. Above all, it is Kafka's Letter to His Father which perhaps provides a paradigm for defining literature. In this (...) specular address, the promise of a heritage is in the balance. Writing incessantly on Kafka, Maurice Blanchot also reflects on literature. The notion of literature put forward by Derrida in ‘Literature in Secret: An Impossible Filiation’ is considered in this article, as well as reflections by Blanchot, to show what might be at stake in Kafka's Letter to His Father. (shrink)

Numismatique François de Callatay et Caroline Mattheeuws, À propos d'une série exceptionnelle de grands bronzes thasiens (fin ive- début me siècle) p. 481-490 L'acquisition par le Cabinet des Médailles de Bruxelles d'un lot de trente-cinq grands bronzes thasiens aux types «Tête de Déméter/Bustes des Dioscures» permet d'affiner la connaissance de cette émission exceptionnelle. Tous les exemplaires sont contremarques et beaucoup présentent des traces de surfrappe. L'étude du style combinée à celle des poids permet de déceler une manipulation monétaire qui (...) avait échappé jusqu'à présent. Avant de réaliser cette émission en surfrappant une émission existante au type de l'Héraclès imberbe, on s'était d'abord servi de nouveaux flans d'un poids lourd (ca 13 g). L'étude du contexte archéologique confirme d'autre part pour ces bronzes, sans toutefois qu'il soit permis de les situer à l'année près, une datation à l'extrême fin du ive s. av. J.-C. (shrink)

Spatial Turns brings together essays that apply a spatial analysis to German literature and other media and engages with specifically German theorizations of ...

During the last few years, several maternity departments in Paris hospitals have registered an increasing number of parental refusals to terminate pregnancies on the basis of foetal abnormality. These refusals have provoked disagreement and tension between parents and medical staff within the departments in question. The present contribution will endeavour to advance a number of ethical arguments and an analysis of these moral dilemmas with a view to justifying the need to fully account for the moral preferences of the parents (...) who refuse to have their pregnancy interrupted. (shrink)

In this paper anorexia nervosa is examined through three lenses to determine its possible causes. This paper contains a clinical analysis of the anorexic personality, a psychoanalytic/religious interpretation of the demands of society, and· a feminist reinterpretationof the effects of those demands on the female body. The societal demands to renounce instincts, when examined through a feminist lens, reveals that these demands, in concert with the detrimental effects of feminine socialization and characteristics of the anorexic personality, may lead some women (...) to view their needs as not important, and cause a detachment from and turning against the body in the form of anorexia nervosa. It is concluded that anorexia is not just women taking a diet “too far.” There are other psychological, philosophical, and social factors leading to a prevalence of anorexia nervosa in Western culture. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Vagaries of Exemplarity: Distortion or Dismissal?Michel JeanneretExample is an uncertain looking-glass, all embracing, turning all ways.Montaigne 1Ancients and Moderns: Negotiating CoexistenceDo the Ancients provide the Renaissance with a repertoire of infallible examples? Do they have such absolute authority that their models, whether ethical or aesthetic, retain their relevance in every circumstance? The question is part and parcel of that thinking, which is fundamental to the sixteenth century, on (...) the status of Greco-Roman paradigms in the management of public and private life, or in the methods of science and the arts. Before analyzing two particular responses to classical exemplarity—by Erasmus and Montaigne—we shall set the problem in its general context.Whether lobbying for intense faithfulness to the models or recognizing the need for divergence, whether insisting on continuity or the need for change, on the possibility or impossibility of equaling the masters, everyone in the sixteenth century measured art, knowledge, and moral reflection according to the Greek and Roman norm. Scholars and artists together entered into this exchange on a daily basis and everybody, whatever the extent of their dependence, knew that their work could not be conceived or perceived as anything other than the more or less free modification of a particular vestige of classical heritage. To escape tradition was unthinkable, but to accept it resignedly was absurd. All room for maneuver was therefore in the shifting difference between [End Page 565] old and new, and in the extent of its transformation. 2 It is then predictable, given these conditions, that the transmission of classical examples should be subject to turbulence without, however, undergoing any violent break.The question was even more relevant given that the sense of history, the consciousness of time past being irrevocably lost took on a new resonance now. Recognizing and acknowledging the phenomenon of irreversible development—whether good or bad—counts as one of the most important intellectual acquisitions of the Renaissance. 3 The Middle Ages had been able to maintain the illusion of continuity and, by dressing Antiquity up in the manners and colors of feudal chivalry, had seen itself reflected in it as in a mirror. With the influx of new documents and the perfecting of more rigorous methods of interpretation—the techniques of philology—intellectuals had to acknowledge evident change. The past could no longer be modeled on the present; all imitation would henceforth be witness to the impossibility of any perfect match. At the same time as the classical world was coming to light, it was also getting further away, getting lost. This bereavement sometimes sparked off enough regressive nostalgia to provide matter for many an antiquarian project. In reaction to this loss, most humanists were motivated into salvaging the salvageable by injecting a dose of novelty into the rift created by their awareness of history. The intellectuals of the Renaissance would often have felt as if they were reenacting the famous encounter of the Romans and the Greeks; like the Romans they wanted to be both conquering and conquered, free and faithful, differing and deferring. For them also the antique model will be an ideal simultaneously present and lost, necessary and foreign.Two opposing solutions to this dilemma seemed to offer themselves: on the one hand an unconditional return to the sources minimizing the effects of history, and on the other an exploitation of the eclipses of the past, giving the present a chance to fight it out with the Ancients. We shall sketch out each of these two strategies: both the methods of respectful transmission and those of transformative intervention.Fine-tuned by the humanists, philology was closely linked to the advent of historical consciousness. Since classical civilization had definitively come to an end, the philologist devoted himself to reconstituting and preserving it, in all its original specificity. He removed the layers of interference accumulated over the centuries, reestablished the texts in their authentic versions, maybe even providing commentary on the meaning of the work within its context. Theoretically his intervention stopped there. Acknowledging the difference and [End Page 566] superiority of past authors, he did not touch their works except to restore them to their pristine selves. Soon... (shrink)

Some patients awaken from their coma but only show reflex motor activity. This condition of wakeful (eyes open) unawareness is called the vegetative state. In 2002, a new clinical entity coined ‘‘minimally conscious state’’ defined patients who show more than reflex responsiveness but remain unable to communicate their thoughts and feelings. Emergence from the minimally conscious state is defined by functional recovery of verbal or nonverbal communication.1 Our empirical medical definitions aim to propose clearcut borders separating disorders of consciousness such (...) as coma, vegetative state and minimally conscious state but clinical reality shows that these boundaries can often be fuzzy (fig 1). Recent clinical, electrophysiological and neuroimaging studies are shedding light on these challenging limits of consciousness encountered following severe acute brain damage. At the patient’s bedside, it is very challenging to differentiate reflex or automatic motor behaviour from movements indicating signs of consciousness, and hence some minimally conscious patients might be misdiagnosed as being vegetative. For some motor responses (eg, blinking to visual threat, brief fixation, normal flexion response to pain, etc) it remains unclear whether they truly are voluntary or willed because we lack convincing scientific evidence. We also lack consensus on how to practically assess some of these behavioural responses. For example, there is no agreement on what stimulus to employ in the assessment of visual pursuit movements— often one of the first clinical signs heralding the transition from the vegetative to the minimally conscious state. Vanhaudenhuyse and colleagues2 recently studied visual pursuit in 51 post-comatose patients comparing eye tracking of a moving object, person or mirror. It was shown that more.. (shrink)

In order to implement cost-benefit analysis of protective actions to reduce radiological exposures, one needs to attribute a monetary value to the avoided exposure. Recently, the International Commission on Radiological Protection has stressed the need to take into consideration not only the collective exposure to ionising radiation but also its dispersion in the population. In this paper, by using some well known and some recent results in the economics of uncertainty, we discuss how to integrate these recommendations in the valuation (...) of the benefit of protection. (shrink)

While professional philosophers are often reluctant to address the issue of the aims of philosophy, the field of philosophy with children is abundant with articulated aims which tend to be more concrete and ambitious than those of academic philosophy. Is this asymmetry a problem? And how are we to think about the aims of philosophy with children? This article argues that not much will be gained from looking to academic philosophy because discussions here are surprisingly meager and have provided little (...) agreement. Nevertheless, it is also argued that the aims of philosophy with children must be constrained by what can be achieved by academic philosophy. (shrink)

In contemporary society, childhood is characterized as mediatized and commercialized. Media consumption worlds (MCWs) are a phenomenon that mirrors both aspects. They are narratives that are presented through various media platforms, games, and merchandising products. In this paper, the concept of children’s MCWs is developed theoretically and investigated empirically using the case of primary school children’s appropriation of MCWs as well as parental mediation and attitude in Austria and Germany. A mixed-methods design was applied, starting with qualitative interviews with children (...) and their parents and followed by an online survey for parents (N=327). The study revealed that children find individual ways to deal with MCWs, some of which foster creativity and self-expression but also consumerism. The parents’ attitude is ambivalent. They view MCWs as beneficial in terms of creativity, positive values, and as peer group experience. However, parents observe critically that MCWs lure children to the media and to consumption. (shrink)