There are competing ethical concerns when it comes to designing any clinical research study. Clinical trials of possible treatments for Ebola virus are no exception. If anything, the competing ethical concerns are exacerbated in trying to find answers to a deadly, rapidly spreading, infectious disease. The primary goal of current research is to identify experimental therapies that can cure Ebola or cure it with reasonable probability in infected individuals. Pursuit of that goal must be methodologically sound, practical and consistent with (...) prevailing norms governing human subjects research. Some maintain that only randomized controlled trials with a placebo or standard-of-care arm can meet these conditions. We maintain that there are alternative trial designs that can do so as well and that sometimes these are preferable to RCTs. (shrink)

Some bioethicists argue that conscientious objectors in health care should have to justify themselves, just as objectors in the military do. They should have to provide reasons that explain why they should be exempt from offering the services that they find offensive. There are two versions of this view in the literature, each giving different standards of justification. We show these views are each either too permissive (i.e. would result in problematic exemptions based on conscience) or too restrictive (i.e. would (...) produce problematic denials of exemption). We then develop a middle ground position that we believe better combines respect for the conscience of healthcare professionals with concern for the duties that they owe to patients. Our claim, in short, is that insofar as objectors should have to justify themselves, they should have to do it according to the standard that we defend rather than according to the standards that others have developed. (shrink)

How diverse is philosophy? In this paper we explore recent data on the racial, ethnic, and gender diversity of philosophy students and faculty in the United States. We have found that women are underrepresented in philosophy at all levels from first-year intention to major through senior faculty. The past four years have seen an increase in the percentage of women philosophy majors at the undergraduate level, but it remains to be seen if this recent increase in the percentage of women (...) will eventually also show at more advanced stages. Temporal trends since 2000 also show substantial increases in the racial and ethnic diversity of philosophy majors at all levels of education from first-year undergraduate through PhD, with substantial declines in the percentage of non-Hispanic White philosophy majors and substantial increases in all other commonly measured racial/ethnic groups except for Native American / Alaska Native. Despite generally increasing diversity, people who identify as Hispanic (any race), or non-Hispanic Native American, Alaska Native, or Black remain substantially underrepresented in philosophy at all levels compared to their presence in the U.S. population, and in some cases also as compared to other majors. (shrink)

In “Obligations of the Gift,” Lee argues that ethical thinking regarding return of genetic research results has been too narrowly focused on individual consent and participants’ “right to kn...

The Hague Conference on Private International Law currently has a Parentage/Surrogacy Project, which evaluates the legal status of children in cross-border situations, including situations involving international contract pregnancy. Should a convention focusing on international contract pregnancy emerge from this project, it will need to be consistent with the Hague convention on Intercountry Adoption. The latter convention prohibits adoptions unless, among other things, ‘the competent authorities of the receiving State have determined that the prospective adoptive parents are eligible and suited to (...) adopt’. Included in it, therefore, is a parental vetting or licensing requirement. In our view, a similar requirement must also appear in any Hague Convention on international contract pregnancy if the two conventions are to be ethically consistent with one another. In particular, there should be a licensing requirement in such a convention for at least some of the prospective parents in contract pregnancy arrangements. We consider several arguments against this conclusion, and argue that none of them is successful. (shrink)

:In a recent paper in Cambridge Quarterly of Healthcare Ethics on the necessary conditions for morally responsible animal research David DeGrazia and Jeff Sebo claim that the key requirements for morally responsible animal research are an assertion of sufficient net benefit, a worthwhile-life condition, and a no-unnecessary-harm condition. With regards to the assertion of sufficient net benefit, the authors claim that morally responsible research offers unique benefits to humans that outweigh the costs and harms to humans and animals. In this (...) commentary we will raise epistemic, practical, and ethical challenges to DeGrazia and Sebo’s emphasis on benefits in the prospective assessment of research studies involving animals. We do not disagree with DeGrazia and Sebo that, at the theoretical level, the benefits of research justify our using animals. Our contribution intends to clarify, at the practical level, how we should understand benefits in the prospective assessment and moral justification of animal research. We argue that ASNB should be understood as an assessment of Expectation of Knowledge Production in the prospective assessment and justification of animal research. EKP breaks down into two further claims: that morally responsible research generates knowledge worth having and that morally responsible research is designed and executed to produce generalizable knowledge. We understand the condition called knowledge worth having as scientists’ testing a hypothesis that, whether verified or falsified, advances an important interest, and production of generalizable knowledge in terms of scientific integrity. Generalizable knowledge refers to experimental results that generalize to a larger population beyond the animals studied. Generalizable scientific knowledge is reliable, replicable, and accurately descriptive. In sum, morally responsible research will be designed and carefully executed to successfully test a hypothesis that, whether verified or falsified, advances important interests. Our formulation of EKP, crucially, does not require further showing that an experiment involving animals will produce societal benefits. (shrink)

Antimicrobial resistance (AMR) describes the evolution of treatment‐resistant pathogens, with potentially catastrophic consequences for human medicine. AMR is driven by the over‐prescription of antibiotics, and could be reduced through consideration of the ethical dimensions of the dilemma faced by doctors. This dilemma involves balancing apparently opposed interests of current and future patients, and unique contextual factors in different countries, which may modify the core dilemma. We describe three example countries with different economic backgrounds and cultures—South Africa, Sri Lanka and the (...) United Kingdom. Then we discuss how country‐specific factors impact on the prominence of various ethical dimensions of the dilemma (visibility and moral equality of future generations; Rule of Rescue; prescribing autonomy and conflicts of interest; consensus on collective action). We conclude that a nuanced understanding of national prescribing dilemmas is critical to inform the design of effective stewardship approaches. (shrink)

A model policy for conscientious objection in medicine.

Psychologists, as well as other mental health professionals, face unique demands in the workplace that create increased risk for burnout. This article discusses burnout prevalence and detection, including issues of complexity regarding diagnosis and assessment. An ethical lens is utilized to explore problems that may arise due to burnout, and the ethical responsibility of practicing self-care. Recommendations for graduate clinical training programs as well as practicing professionals are suggested, including strategies for monitoring self and others for warning signs of burnout (...) and implementing self-care. (shrink)

The Patient Protection and Affordable Care Act, passed in 2010, is considered by many to be the most significant healthcare overhaul since the 1960s, but part of its promise — improvement of population health through requirements for non-profit hospitals to provide “community benefit” — has not been met. This paper examines the history of community benefit legislation, how community benefit dollars are allocated, and innovative practices by a few hospitals and communities that are addressing primarily non-medical factors that influence health (...) such as social disadvantage, attitudes, beliefs, risk exposure, and social inequalities. (shrink)

Peak human performance—whether of Olympic athletes, Nobel prize winners, or you cooking the best dish you’ve ever made—depends on skill. Skill is at the heart of what it means to excel. Yet, the fixity of skilled behavior can sometimes make it seem a lower-level activity, more akin to the movements of an invertebrate or a machine. Peak performance in elite athletes is often described, for example, as “automatic” by those athletes: “The most frequent response from participants when describing the execution (...) of a peak performance was the automatic execution of performance”. While the automaticity of skilled behavior is widely acknowledged, some worry that too much automaticity in skill would challenge its ability to exhibit human excellence. And so two camps have developed: those who focus on the automaticity of skilled behavior, the “habitualists,” and those who focus on the higher-level cognition behind peak performance, the “intellectualists.” We take a different tack. We argue that skilled behavior weaves together automaticity and higher-level cognition, which we call “pluralism.” That is, we argue that automaticity and higher-level cognition are both normal features of skilled behavior that benefit skilled behavior. This view is hinted at in other quotes about automaticity in skill—while expert gamers describe themselves as “playing with” automaticity, expert musicians are said to balance automaticity with creativity through performance cues: “Performance cues allow the musician to attend to some aspects of the performance while allowing others to be executed automatically”. We describe in this paper three ways that higher-level cognition and automaticity are woven together. The first two, level pluralism and synchronic pluralism, are described in other papers, albeit under different cover. We take our contribution to be both distinguishing the three forms and contributing the third, diachronic pluralism. In fact, we find that diachronic pluralism presents the strongest case against habitualism and intellectualism, especially when considered through the example of strategic automaticity. In each case of pluralism, we use research on the presence or absence of attention to explore the presence or absence of higher-level cognition in skilled behavior. (shrink)

The Declaration of Helsinki is recognised worldwide as a cornerstone of research ethics. Working in the wake of the Nazi doctors’ trials at Nuremberg, drafters of the Declaration set out to codify the obligations of physician-researchers to research participants. Its significance cannot be overstated. Indeed, it is cited in most major guidelines on research involving humans and in the regulations of over a dozen countries.Although it has undergone five revisions,1 and most recently incorporated language aimed at addressing concerns over research (...) carried out in resource-poor countries,2–5 the Declaration could go much farther in addressing the profoundly altered landscape of research with humans. Research involving humans is now a global enterprise and often involves participants from resource-poor countries. Rather than being carried out at single institutions by veteran researchers, many studies are now conducted at many locations—including sites that are not academic medical centres—by new and relatively inexperienced investigators. A growing number of projects involve novel agents, based on innovative work in genomics and proteomics. Increasingly, research is sponsored by the for-profit sector. National governments and professional organisations around the globe provide laws, regulations and standards for the conduct of research involving humans. Considerable scholarship also critiques and guides this endeavour.In light of the current effort of the World Medical Association to revise the Declaration, we offer ideas on how to re-conceive the concept of “vulnerability” and its links with the principle of justice and, in turn, redirect the attention of researchers towards those who might be so designated.In the research context, “vulnerability” is associated with an inability partly or totally to protect one’s own interests. Typically, conceptions of vulnerability centre upon characteristics associated with particular groups that …. (shrink)

Over the past decade, feminist philosophers have gone a long way toward identifying and explaining the phenomenon that has come to be known as epistemic injustice. Epistemic injustice is injustice occurring within the domain of knowledge (e.g., knowledge production and transmission), which typically impacts structurally marginalized social groups. In this paper, we argue that, as they currently work, algorithms on social media exacerbate the problem of epistemic injustice and related problems of social distrust. In other words, we argue that algorithms (...) on social media recreate and reify the conditions that lead to some groups being systematically denied the full status of knowers, thereby corrupting the epistemic terrain and, with it, systems of social trust and cooperation. We argue that algorithms do this in two ways—namely, via what we are calling algorithmic targeting and algorithmic sorting. (shrink)

Emotional intelligence (EI) stands at the nexus between intelligence and emotion disciplines, and we outline how EI research might be better integrated within both theoretical frameworks. From the former discipline, empirical research focused upon whether EI is an intelligence and what type of intelligence it constitutes. It is clear that ability-based tests of EI form a group factor of cognitive abilities that may be integrated into the Cattell–Horn–Carroll framework; less clear is the lower order factor structure of EI. From the (...) latter discipline, research linking EI with theoretical frameworks from emotion research remain relatively sparse. Emotion regulation and appraisal theory may be key to explain how EI may reflect different processes. We propose a research agenda to advance the EI study. (shrink)

Rigorous attention has been paid to moral distress among healthcare professionals, largely in high-income settings. More obscure is the presence and impact of moral distress in contexts of chronic poverty and structural violence. Intercultural ethics research and dialogue can help reveal how the long-term presence of morally distressing conditions might influence the moral experience and agency of healthcare providers. This article discusses mixed-methods research at one nongovernmental social support agency and clinic in Rio de Janeiro, Brazil. Chronic levels of moral (...) distress and perceptions of moral harm among clinicians in this setting were both violent, following Nancy Scheper-Hughes’ use of that term, and a source of exceptional and innovative care. Rather than glossing over the moral variables of work in such desperate extremes, ethnography in these settings reveals novel skills and strategies for managing moral distress. (shrink)

Since their inception, the Perspectives in Logic and Lecture Notes in Logic series have published seminal works by leading logicians. Many of the original books in the series have been unavailable for years, but they are now in print once again. This volume, the fifteenth publication in the Lecture Notes in Logic series, collects papers presented at the symposium 'Reflections on the Foundations of Mathematics' held in celebration of Solomon Feferman's 70th birthday (The 'Feferfest') at Stanford University, California in 1988. (...) Feferman has shaped the field of foundational research for nearly half a century. These papers reflect his broad interests as well as his approach to foundational research, which emphasizes the solution of mathematical and philosophical problems. There are four sections, covering proof theoretic analysis, logic and computation, applicative and self-applicative theories, and philosophy of modern mathematical and logic thought. (shrink)

The term "false memories" has been used to refer to suggestibility experiments in which whole events are apparently confabulated and in media accounts of contested memories of childhood abuse. Since 1992 psychologists have increasingly used the term "false memory" when discussing memory errors for details, such as specific words within word lists. Use of the term to refer to errors in details is a shift in language away from other terms used historically (e.g., "memory intrusions"). We empirically examine this shift (...) in language and discuss implications of the new use of the term "false memories." Use of the term presents serious ethical challenges to the data-interpretation process by encouraging over-generalization and misapplication of research findings on word memory to social issues. (shrink)

The digital humanities represent, for many researchers, the potential for extending their research in terms of audience, scope, methods, and opportunity for interdisciplinary collaboration. Ideally, this potential should also extend access to cultural engagement and preservation for marginalized groups. In practice, the reality may be quite different for projects that focus on diverse racial, gender, ethnic, and cultural heritage. In this short article we discuss preliminary findings from a study of patterns in U.S. federal funding for digital humanities projects, with (...) particular focus on cultural heritage and archival projects. Through the lens of funding and access, we raise some questions about whether the digital humanities can represent a shift from old hegemonies or run the risk of expressing them in a new technological paradigm. (shrink)

Singh's cultural evolutionary theory posits that methods of inducing shamanic altered states of consciousness differ, resulting in profoundly different cognitive states. We argue that, despite different methods of induction, altered states of consciousness share neurophysiological features and cause shared cognitive and behavioral effects. This common foundation enables further cross-cultural comparison of shamanic activities that is currently left out of Singh's theory.

The wisdom of meditation requires the movement of energy. This energy is the mount or steed of consciousness and experientially all but indistinguishable from knowing itself. These energies must be part of what we consider when we look into the living practices of Buddhist communities. Using this bodily dynamism or energy as an organizing principle, the author points out three things. First, this often overlooked or under‐analyzed category is important for a fuller picture of Buddhist religious life. Second, its importance (...) by no means undermines, and in fact extends, the significance of the philosophical import of Buddhist literature. Third, the significance of “energy” is not limited to esoteric Buddhism. To aid this discussion, the author introduces and explores the new term “energetic sensibility” as a way of referring to the cluster of important Buddhist terms associated with the viscerally energetic or dynamic dimension of persons and their practices. (shrink)

Previous work has shown that concerns of breast cancer patients after finishing radiotherapy are responsive to conversations with radiographers during the treatment period. This study seeks to further understand radiographer and patient experiences, determine shared priorities for improvement in clinical interaction and develop communication guidelines and training to help radiographers support patients.Methods: Using the principles of Experience-Based Co-Design, semi-structured interviews were held with N = 4 patients and N = 4 radiographers, followed by feedback events to validate findings. Patients and (...) radiographers exchanged experiences in a joint co-design session, agreed with shared priorities and generated ideas for further support. A survey was conducted for process evaluation. To scale up findings, UK-wide representatives from patient networks and radiographers and managerial staff provided consultative input utilizing an iterative, adaptive procedure.Results: Radiographers expressed a need for support with “difficult conversations,” especially those on Fear of Cancer Recurrence, and their appropriate management. Important pointers for reassuring communication were identified, including: being treated like a person, knowing what to expect, and space to ask questions. The co-design process was rated positively by both staff and patients. Thematic collation of findings and mapping these on literature evidence resulted in the “KEW” communication guidelines for radiographers: Know, Encourage, Warmth. National stakeholder consultations validated and helped fine-tune the training model. The resulting training package, included: trigger videos, a simulated patient scenario and interactive handouts on fears of cancer recurrence and the patient pathway.Conclusions: The co-design process captured good practice to help standardize quality in empathic communication in the radiotherapy service. The resulting KEW: Know, Encourage, Warmth guidelines, and training package are user-centered as well as evidence-based. Supplementing single-site co-design with national consultative feedback allows for the development of interventions that are relevant to the clinical practice, even in detail, and helps to generate appropriate buy-in for roll out on a wider scale after evaluation.Trial Registration:www.ClinicalTrials.gov ID: NCT03468881. (shrink)

Research explored methods for “shortening the food links” or developing the “local foodshed” by connecting farmers with food service buyers (for restaurants and institutions) in Colorado. Telephone interviews were used to investigate marketing and purchasing practices. Findings include that price is not a significant factor in purchasing decisions; that food buyers prioritize quality as their top purchasing criterion but are not aware that local farmers can provide higher quality, that institutions are interested in buying locally; that small farms can offer (...) comparable or higher quality produce andservice; and that farmers need to show buyers what the quality of produce and service they can provide. (shrink)

A Correction to this paper has been published: 10.1007/13164.1878-5166.