Competition among scientists for funding, positions and prestige, among other things, is often seen as a salutary driving force in U.S. science. Its effects on scientists, their work and their relationships are seldom considered. Focus-group discussions with 51 mid- and early-career scientists, on which this study is based, reveal a dark side of competition in science. According to these scientists, competition contributes to strategic game-playing in science, a decline in free and open sharing of information and methods, sabotage of others’ (...) ability to use one’s work, interference with peer-review processes, deformation of relationships, and careless or questionable research conduct. When competition is pervasive, such effects may jeopardize the progress, efficiency and integrity of science. (shrink)

We argued last year in this journal that extensive integration of research and care is a worthy goal of health system design, and we second the call from Ruth Faden and colleagues to move toward learning health care systems. As they recognize, learning health care systems demand the coordination of research and medical ethics—two sets of normative commitments that have long been considered distinct. In offering a novel ethics framework for such systems, Faden et al. advance the scholarly debate about (...) how best to do this and challenge us to think more deeply about its practical implications. However, we believe that at least three issues they raise require additional attention. First, the research‐care distinction has more normative bite than they are willing to concede. Second, the role for independent oversight requires clarification. Finally, they neglect the concept of stewardship as a guiding obligation of learning health care systems. (shrink)

We argued last year in this journal that extensive integration of research and care is a worthy goal of health system design, and we second the call from Ruth Faden and colleagues to move toward learning health care systems. As they recognize, learning health care systems demand the coordination of research and medical ethics—two sets of normative commitments that have long been considered distinct. In offering a novel ethics framework for such systems, Faden et al. advance the scholarly debate about (...) how best to do this and challenge us to think more deeply about its practical implications. However, we believe that at least three issues they raise require additional attention. First, the research‐care distinction has more normative bite than they are willing to concede. Second, the role for independent oversight requires clarification. Finally, they neglect the concept of stewardship as a guiding obligation of learning health care systems. (shrink)

The rule of rescue describes the moral impulse to save identifiable lives in immediate danger at any expense. Think of the extremes taken to rescue a small child who has fallen down a well, a woman pinned beneath the rubble of an earthquake, or a submarine crew trapped on the ocean floor. No effort is deemed too great. Yet should this same moral instinct to rescue, regardless of cost, be applied in the emergency room, the hospital, or the community clinic? (...) -/- In health care, the desire to save lives at any cost must be reconciled with the reality of resource scarcity. As one example, the estimated cost for prophylactic Factor VIII to treat one patient with hemophilia for one year is $300,000. Costs of this magnitude have been accepted by public and private insurers in the developed world, even though, in principle, these sums could provide greater overall health benefit if allocated to pay for the unmet health care needs of many other patients. Looking forward, however, broad application of the rule of rescue will be increasingly untenable. But the moral instinct will remain: the desire to help those weakest among us, especially when their small numbers allow us to see them as unique individuals. What, then, is the ethical framework that can guide coverage and reimbursement decisions for orphan drugs into the future? (shrink)

Medical ethics assumes a clear boundary between clinical research and clinical medicine: one produces knowledge for the benefit of future patients, while the other provides optimal care to individuals right now. It also assumes that the two cannot be integrated without sacrificing the needs of the current patient to those of future patients. But integration could allow us to provide better care to everyone, now and in the future.

Coregulation refers to the process by which relationship partners form a dyadic emotional system involving an oscillating pattern of affective arousal and dampening that dynamically maintains an optimal emotional state. Coregulation may represent an important form of interpersonal emotion regulation, but confusion exists in the literature due to a lack of precision in the usage of the term. We propose an operational definition for coregulation as a bidirectional linkage of oscillating emotional channels between partners, which contributes to emotional stability for (...) both partners. We propose several distinctions and raise unanswered questions that will need to be addressed in order to understand the relevance of coregulation for well-being in adulthood. (shrink)

People in an emotional exchange form a temporal interpersonal emotion system (TIES), in which their emotions are interconnected over time (Butler, 2011). These systems can be in various states, defined by the pattern of emotional interconnections. We have defined coregulation as one such state involving coupled dampened oscillations between partners’ emotions that converge on a stable level. Coregulation could be distinguished from other states, such as stress buffering, by comparing statistical models that represent the theoretical distinctions between states. Optimal data (...) for such modeling includes assessments of both partners’ emotions over time and a contrast between securely attached partners, strangers, and being alone. Research of this sort is needed to uncover the mechanisms by which emotional interdependence promotes well-being. (shrink)

Name der Zeitschrift: Archiv für Geschichte der Philosophie Jahrgang: 98 Heft: 8 Seiten: 1-20.

A decade after the ‘‘Sokal Hoax,’’ Alan Sokal and Paul Boghossian still claim that postmodern arguments are incoherent attacks on reason and truth. However, both also continue to mischaracterize ‘‘constructivist’’ epistemology, to engage in highly problematic logical gymnastics to defend their own views, and to ignore changes in philosophy of science and science studies since 1996. I offer a brief description of my own, rather different understanding of postmodern science criticism in order to contextualize my dissatisfaction with Sokal and Boghossian’s (...) arguments, and to highlight the value of cross-subfield anthropological collaboration based on the constructivist perspective articulated by Barbara Herrnstein Smith. Downloaded by [New York University] at 03:33 19 July 2011.. (shrink)

Everything is constantly changing. Our emotions are one of the primary ways we track, evaluate, organize, and motivate responsive action to those changes. Furthermore, emotions are inherently interpersonal. We learn what to feel from others, especially when we are children. We “catch” other people’s emotions just by being around them. We get caught in escalating response–counterresponse emotional sequences. This all takes place in time, generating complex patterns of interpersonal emotional dynamics. This review summarizes theory, empirical findings, and key challenges for (...) future research regarding three processes that contribute to interpersonal affective dynamics: Convergence of social partners’ emotional responses to the external world, emotional reactivity of social partners to each other, and interpersonal emotion regulation. (shrink)

To ensure that the information resulting from research is relevant to patients, the Patient‐Centered Outcomes Research Institute eschews the “traditional health research” paradigm, in which investigators drive all aspects of research, in favor of one in which patients assume the role of research partner. If we accept the premise that patient engagement can offer fresh perspectives that shape research in valuable ways, then at least two important sets of questions present themselves. First, how are patients being engaged—and how should they (...) be engaged? Second, which patients are being engaged—and which patients should be? This set has received relatively less attention, and the neglect is surprising, given that the “who” question is conceptually prior to the question of “how.”This article focuses attention on the “who” of patient engagement in research. First, we provide background on the rationale for patient engagement, underscoring the importance of ensuring the representativeness of engaged patients. Second, we present what little is known about patients engaged in PCORI‐funded research. Third, we identify and discuss the ethical implications of ways in which current practices of patient identification and recruitment may lead to a lack of representativeness. These practices include reliance on the well‐connected and well‐informed, reliance on patients who are not well trained or well‐informed, and reliance on patient advocacy organizations. Finally, we consider several strategies for addressing these pitfalls in order to maximize the positive goals of patient engagement. Patient engagement is intended to address the inability of researchers, funders, and others to fully represent patient views and priorities, but without sufficient attention, the patients selected for this role may still leave important gaps. (shrink)

Interest in the use of medical data for health research is increasing. Yet, as Elizabeth Ford and colleagues rightly note, there are open questions about the suitability of existing ethical and regulatory oversight frameworks for these research approaches. In their feature article, ‘Should free text data in electronic medical records be shared for research? A citizen’s jury study in the United Kingdom’, Ford et al report the results of a deliberative engagement study in which 18 members of the public were (...) asked whether and under what conditions free text data from medical records should be shared for research purposes. The authors’ explicit aim was to inform national policy on sharing medical text. Public attitudes—stated otherwise, the attitudes of patients whose medical information will ultimately be used under any data sharing policy—are a necessary input into ethical and regulatory decision-making about use of medical data for health research. Though public attitudes will rarely be determinative, they must be weighed in order to uphold the ethical principle of respect for persons.1 Ford et al ’s article is, therefore, an important contribution to …. (shrink)

In Living for Pleasure, philosopher Emily Austin offers a lively, jargon-free tour of Epicurean strategies for diminishing anxiety, achieving satisfaction, and relishing joys.

In this issue of the Hastings Center Report, James Sabin and his colleagues ask what responsibility investigators in a learning health organization have to patients when research—particularly research of which patients might be unaware—illuminates problematic aspects of the patients' care. Sabin and his colleagues were confronted by this question in the midst of designing a randomized controlled trial that sought to determine if an educational intervention targeted at patients with atrial fibrillation and their clinicians reduces underuse of oral anticoagulants. Worried (...) about harm that might befall patients in the control group and fearing that they would be negligent bystanders if they knew these patients were at risk and did nothing, the investigators adopted a “workaround.” But the “workaround,” I suggest, was not a solution to the negligent bystander problem. Nor was it a solution to the problem as I would alternatively frame it—how to address instances of suboptimal patient care identified through research within learning health organizations. (shrink)

Topics related to ethical issues in agricultural production, particularly farm animal welfare, are increasingly featured in mainstream news media. Media representations of farm animal welfare issues are important because the media is a significant source of information, but also because the way that the issues are represented, or framed, defines these issues in particular ways, suggests causes or solutions, and provides moral evaluations. As such, analysis of media frames can reveal how issues are being made public and identify the cues (...) that audiences are given to help them make sense of complex ethical issues. Previous research on media frames and animal welfare has tended to focus on single issues or events; however we sought to identify whether media frames extended across different farm animal welfare-related issues to investigate whether there is any commonality between issues. We analysed articles published in the mainstream press in Australia between 2014 and 2016 related to farm animal welfare, and identified two dominant frames: that governments and the farm animal production industries cannot be trusted to ensure good farm animal welfare; and that consumers can act to improve animal welfare through ethical consumption. These frames have implications for how the Australian public interpret and understand the roles and responsibilities of different actors in the food production system. This research also contributes to discussion about the role of the media in shaping public opinion about ethical issues in agriculture and how, in turn, the media landscape itself is being shaped by consumer attitudes. (shrink)

This groundbreaking interactive book contains the tools that you will need in order to clean your emotional house from top to bottom. It includes a journal as well as access to audio meditations for you to listen along to as you read. The meditations will help you dig deep into past trauma and discover when and how trauma took root, learn to get in touch with various parts of the physical and energy body, and how to use them to let (...) go of stored traumas. From this, you will learn to live from a new mindful and powerful space. (shrink)

Rimé makes the important observation that the literature on adult emotion and emotion regulation has largely focused on the individual level of analysis. He argues, we believe correctly, that emotion research would benefit by addressing the fact that emotional events provoke not only individual responses, but systematic social responses as well. We present examples of our own research that are in accord with Rimé's central claims, and that demonstrate the benefits of considering the goals that are provoked and satisfied by (...) emotions, as well as the social context of emotional responding. We conclude by advocating a dynamic systems approach that would allow an integration of individual and social levels of analysis in the study of adult emotion and emotion regulation. (shrink)

At the time I wrote my original review (Schultz 2010) of the books by Sokal (2008), Boghossian (2006), and Smith (2006), I did not know that I would have the opportunity to reply to their responses to my review. Nevertheless, I value the occasion this offers to correct errors and respond to their commentary. Let me say, first of all, that Alan Sokal is quite correct in pointing out that the citation from Donna Haraway which I attribute to him is (...) incorrect. I realize now that I copied that version of the citation from an earlier working notes file for the review. I should have verified that the copied version was identical to the citation in the Beyond the Hoax text (Sokal 2008) before I sent off the review. That I did not do so is an error that I deeply regret, and for which I apologize. In line with this, I also apologize for, and retract, my observations in the review about the omitted passages in the citation, for which Sokal obviously was not responsible. So, does consideration of the full quotation by Donna Haraway in any way affect the rest of my critique? Not at all, as it happens, because the focus of the rest of my remarks is on the way Sokal treats this passage by Haraway. That is, he presents the excerpt to readers in isolation, and makes no effort to.. (shrink)

California has focused on health equity in the state’s COVID-19 reopening plan. The Blueprint for a Safer Economy assigns each of California’s 58 counties into 1 of 4 tiers based on 2 metrics: test positivity rate and adjusted case rate. To advance to the next less-restrictive tier, counties must meet that tier’s test positivity and adjusted case rate thresholds. In addition, counties must have a plan for targeted investments within disadvantaged communities, and counties with more than 106 000 residents must (...) meet an equity metric. California's explicit incorporation of health equity into its reopening plan underscores the interrelated fate of its residents during the COVID-19 pandemic and creates incentives for action. This article evaluates the benefits and challenges of this novel health equity focus, and outlines recommendations for other US states to address disparities in their reopening plans. (shrink)

During spring of 2020, environmental ethics students at a medium sized metropolitan university in the Southeastern United States were asked to read and comment on classic essays from Robert Heilbroner and Garrett Hardin, essays regarding our responsibilities towards future generations. In general, students seemed to hold more with Heilbroner’s stance, which left room for compassion, while condemning Hardin’s harshness. Students were then asked to provide written responses stating whether they would personally sacrifice their eventual retirement in order to stop COVID-19 (...) and the reasons for their views. Responses were analyzed and categorized to detect inconsistencies between students’ described views and their willingness to personally sacrifice for the sake of others. Almost 72% of respondents asserted that they would be willing to intervene to stop the novel coronavirus by sacrificing their retirement. A fair number of respondents that stated they would sacrifice said that they would do so because they would benefit personally from the avoidance of guilt and/or from the opportunity to feel good about themselves, suggesting that even seemingly selfless behaviors are sometimes driven by egoistic motivations. Forty percent of all respondents held inconsistent views. Most notably, a number of students condemned Hardin for his lack of compassion, yet were not willing to act compassionately themselves. (shrink)

Supported decision making is a model of decision making in which an adult with impaired capacity enters freely into an agreement with a closely trusted person or persons (the “s...

This article examines five different Medical-Legal Partnerships associated with Yale Law School in New Haven, Connecticut to illustrate how MLP addresses the social determinants of poor health. These MLPs address varied and distinct health and legal needs of unique patient populations, including: 1) children; 2) immigrants; 3) formerly incarcerated individuals; 4) patients with cancer in palliative care; and 5) veterans. The article charts a research agenda to create the evidence base for quality and evaluation metrics, capacity building, sustainability, and best (...) practices; it also focuses specifically on a research agenda that identifies the value of the lawyers in MLP. Such a focus on the “L” has been lacking and is overdue. (shrink)

Over the course of human life, health care decision‐making is often interdependent. In this article, we use “interdependence” to refer to patients’ engagement of nonclinicians—for example, family members or trusted friends—to reach health care decisions. Interdependence, we suggest, is common for patients in all stages of life, from early childhood to late adulthood. This view contrasts with the common bioethical assumption that medical decisions are either wholly independent or dependent and that independence or dependence is tightly coupled with a person's (...) decision‐making capacity. In this article, we array various approaches to decision‐making along a continuum of interdependence. An appreciation of this continuum can empower patients and elucidate ethical challenges that arise when people transition between different kinds of interdependence across the life span. (shrink)