When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

Evidence‐based interventions have been developed and used to prevent HIV infections among black men who have sex with men (MSM) in Canada and the United States; however, the degree to which interventions address racism and other interlocking oppressions that influence HIV vulnerability is not well known. We utilize integrative antiracism to guide a review of HIV prevention intervention studies with black MSM and to determine how racism and religious oppression are addressed in the current intervention evidence base. We searched CINAHL, (...) PsychInfo, MEDLINE and the CDC compendium of evidence‐based HIV prevention interventions and identified seventeen interventions. Three interventions targeted black MSM, yet only one intervention addressed racism, religious oppression, cultural assets and religious assets. Most interventions' samples included low numbers of black MSM. More research is needed on interventions that address racism and religious oppression on HIV vulnerability among black MSM. Future research should focus on explicating mechanisms by which multiple oppressions impact HIV vulnerability. We recommend the development and integration of social justice tools for nursing practice that aid in addressing the impacts of racism and other oppressions on HIV vulnerability of black MSM. (shrink)

Natural science enables us, it is supposed, first to know what science properly is. Other sciences—which purport to exhibit a radically divergent type—are either of doubtful authenticity and highly disputable value, or else humbug, which has long since become transparent. If now the humanists are to be compelled to practise science, they will have perforce, nolentes volentes, to take the natural sciences for their model and adopt their methods. Extra ecclesiam nulla salus. Under no circumstances is recognition extended to a (...) distinctive humanistic type of science side by side with the type of natural science. The distinctions between scientific forms and methods of procedure, which are forthcoming, accordingly all turn out to constitute merely variations within natural science itself. (shrink)

Delusion is one of the most intriguing psychopathological phenomena and its conceptualization remains the subject of genuine debate. Claims that it is ill-defined, however, are typically grounded on essentialist expectations that a given definition should capture the core of every instance acknowledged as delusion in the clinical setting.

In 2018-2019, at the Keck School of Medicine of the University of Southern California, we developed and piloted a narrative-based health systems science intervention for patients living with HIV and medical students in which medical students co-wrote patients’ life narratives for inclusion in the electronic health record. The pilot study aimed to assess the acceptability of the “life narrative protocol” from multiple stakeholder positions and characterize participants’ experiences of the clinical and pedagogical implications of the LNP. Students were recruited from (...) KSOM. Patients and staff were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology at Los Angeles County+USC Medical Center. Ten patients, seventeen students, and ten MCA staff participated in the pilot study. Qualitative methods were used to gather data from students’, patients’, and staff’s perspectives. Three themes emerged from the thematic analysis: patients’ life narratives conveyed their unique life experiences and voices; the protocol could result in wide-ranging effects on HIV care; the LNP enabled students to contribute value to patients’ healthcare. Across groups, participants considered the LNP an acceptable intervention. The LNP, its limitations, and implications for HIV care, narrative medicine, and health information technology are presented. (shrink)

– The paper explores first the postulational basis and significance of‘measures of information’in current information theory and their possible relations to physical entropy and Brillouin's‘negentropy’regarded as the negative of entropy. For some purposes, the same pattern or formal structure may be abstracted from both‘entropy’and‘information’. The paper analyzes, in the second place, the mathematical analogies which have been traced between information theory and quantum mechanics and argues that the analogies have but a limited value when we come to grips with the (...) deeper, and yet unsolved, problems of quantum theory. Lastly it is urged that the indiscriminate extensions of statistical and information‐theoretic methods, and of quantum‐mechanical analogies, e.g.‘linguistic duality’, to psycholinguistics, literary and aesthetic Gestalten, can result only in crude exaggerations. Dialectical methodology requires the continual reformulation of all scientific descriptions which have to reckon perpetually with the richness of human materials. (shrink)

The quantitative problem of old evidence is the problem of how to measure the degree to which e confirms h for agent A at time t when A regards e as justified at t. Existing attempts to solve this problem have applied the e-difference approach, which compares A's probability for h at t with what probability A would assign h if A did not regard e as justified at t. The quantitative problem has been widely regarded as unsolvable primarily on (...) the grounds that the e-difference approach suffers from intractable problems. Various philosophers have proposed that 'Bayesianism' should be rejected as a research strategy in confirmation theory in part because of the unsolvability of this problem. I develop a version of the e-difference approach which overcomes these problems and possesses various advantages (but also certain limitations). I develop an alternative 'theistic' approach which handles many cases that my development of the e-difference approach does not handle. I conclude with an assessment of the significance of the quantitative problem for Bayesianism and argue that this problem is misunderstood in so far as it is regarded as unsolvable, and in so far as it is regarded as a problem only for Bayesians. (shrink)

This chapter describes the potential far‐reaching consequences of contemplative higher education for the fields of science and medicine.

The effectiveness of complaint handling and service recovery policies in customer retention has been the focus of both scholars and service organizations. In the past decade, Justice Theory has provided the basis of the dominant theoretical framework for complaint management and service recovery. However, it does not explicitly address unfair trade practices, which constitute an ethical issue. Favorable outcomes in complaint handling may not be able to restore the reputation of a company and the potential harm perceived by consumers. Using (...) face-to-face interviews, this study applies Fairness Theory to explore the psychological responses of consumers in the post-complaint phase, particularly in ethical judgment. The findings suggest that an unfavorable outcome in the post-complaint stage leads to counterfactual thinking by the consumer about the consumer's state of well-being. The complaint must be due to the discretionary actions of the service provider whose accountability is assessed. Those harmful actions are then judged against an ethical standard. Explanations can reduce blame, and their effectiveness is moderated by outcome favorability but not ethical judgment. Favorable outcome, captured by "Would Perception," has only limited influence on Perceived Potential Harm (PPH), which is an important determinant of ethical judgment. This study makes both theoretical and practical contributions. It is the first study to validate Fairness Theory empirically and apply it to complaint handling as a complement of Justice Theory in the information and communication technology (ICT) service context. The study indicates that customers may condemn a service provider because of PPH even though the outcome is favorable. Unfair trade practices are what make customers hate ICT service providers. (shrink)

The internet is widely used for health information and support, often by vulnerable people. Internet-based research raises both familiar and new ethical problems for researchers and ethics committees. While guidelines for internet-based research are available, it is unclear to what extent ethics committees use these. Experience of gaining research ethics approval for a UK study (SharpTalk), involving internet-based discussion groups with young people who self-harm and health professionals is described. During ethical review, unsurprisingly, concerns were raised about the vulnerability of (...) potential participants. These were dominated by the issue of anonymity, which also affected participant safety and consent. These ethical problems are discussed, and our solutions, which included: participant usernames specific to the study, a closed website, private messaging facilities, a direct contact email to researchers, information about forum rules displayed on the website, a ‘report’ button for participants, links to online support, and a discussion room for forum moderators. This experience with SharpTalk suggests that an approach to ethics, which recognises the relational aspects of research with vulnerable people, is particularly useful for internet-based health research. The solutions presented here can act as guidance for researchers developing proposals and for ethics committees reviewing them. (shrink)

Next SectionIn an online study conducted separately in the UK and the US, participants rated the acceptability and fairness of four interventions: two types of financial incentives and two types of medical interventions. These were stated to be equally effective in improving outcomes in five contexts: weight loss and smoking cessation programmes, and adherence in treatment programmes for drug addiction, serious mental illness and physiotherapy after surgery. Financial incentives were judged less acceptable and to be less fair than medical interventions (...) across all five contexts. Context moderated the relative preference between rewards and penalties: participants from both countries favoured rewards over penalties in weight loss and treatment for serious mental illness. Only among US participants was this relative preference moderated by perceived responsibility of the target group. Overall, participants supported funding more strongly for interventions when they judged members of the target group to be less responsible for their condition, and vice versa. These results reveal a striking similarity in negative attitudes towards the use of financial incentives, rewards as well as penalties, in improving outcomes across a range of contexts, in the UK and the USA. The basis for such negative attitudes awaits further study. (shrink)

This report describes the rationale, approaches, organization, and resource development leading to a large-scale deletion bin map of the hexaploid wheat genome. Accompanying reports in this issue detail results from chromosome bin-mapping of expressed sequence tags representing genes onto the seven homoeologous chromosome groups and a global analysis of the entire mapped wheat EST data set. Among the resources developed were the first extensive public wheat EST collection. Described are protocols for sequencing, sequence processing, EST nomenclature, and the assembly of (...) ESTs into contigs. These contigs plus singletons were used for selection of distinct sequence motif unigenes. Selected ESTs were rearrayed, validated by 5′ and 3′ sequencing, and amplified for probing a series of wheat aneuploid and deletion stocks. Images and data for all Southern hybridizations were deposited in databases and were used by the coordinators for each of the seven homoeologous chromosome groups to validate the mapping results. Results from this project have established the foundation for future developments in wheat genomics. (shrink)

ABSTRACT Global biodiversity declines are increasingly recognized as profound ecological and social crises. In areas subject to colonialization, these declines have advanced in lockstep with settler colonialism and imposition of centralized resource management by settler states. Many have suggested that resurgent Indigenous-led governance systems could help arrest these trends while advancing effective and socially just approaches to environmental interactions that benefit people and places alike. However, how dominant management and conservation approaches might be decolonized (i.e., how their underlying colonial structure (...) might be addressed, transformed, and replaced) is not always clear. Here, we describe a ‘Decolonial Model of Environmental Management and Conservation’ as an alternative paradigm to dominant approaches of conservation and management. The tenets of the model describe characteristics that might be expected of decolonized management, contrasted with those of dominant state-led approaches such as those embedded in the North American Model of Wildlife Conservation. The model does not prescribe how Indigenous governments or communities ought to govern their own territories, but instead offers insights into how external management and conservation agencies and practitioners might support (or stop impeding) Indigenous-led governance. We illustrate the model with a conservation ‘bright spot’: grizzly bear stewardship in the area now referred to as the Great Bear Rainforest in British Columbia, Canada, with a focus on work led by or in collaboration with, and within the territories of, the Haíɫzaqv, Kitasoo/xai’xais, Nuxalk, and Wuikinuxv First Nations. While acknowledging the important context-specific variability among place-based management and conservation applications, we also discuss the model’s broader applicability. (shrink)

We study the minimal enumeration degree problem in models of fragments of Peano arithmetic () and prove the following results: in any model M of Σ2 induction, there is a minimal enumeration degree if and only if M is a nonstandard model. Furthermore, any cut in such a model has minimal e-degree. By contrast, this phenomenon fails in the absence of Σ2 induction. In fact, whether every Σ2 cut has minimal e-degree is independent of the Σ2 bounding principle.