Whole genome sequencing is quickly becoming more affordable and accessible, with the prospect of personal genome sequencing for under $1,000 now widely said to be in sight. The ethical issues raised by the use of this technology in the research context have received some significant attention, but little has been written on its use in the clinical context, and most of this analysis has been futuristic forecasting. This is problematic, given the speed with which whole genome sequencing technology is likely (...) to be incorporated into clinical care. This paper explores one particular subset of these issues: the implications of adopting this technology in the prenatal context without a good understanding of when and how it is useful. Prenatal whole genome sequencing differs from current prenatal genetic testing practice in a number of ethically relevant ways. Most notably, whole genome sequencing would radically increase the volume and scope of available prenatal genetic data. The wealth of new data could enhance reproductive decision‐making, promoting parents' freedom to make well‐informed reproductive decisions. We argue, however, that there is potential for prenatal whole genome sequencing to alter clinical practice in undesirable ways, especially in the short term. We are concerned that the technology could (1) change the norms and expectations of pregnancy in ways that complicate parental autonomy and informed decision‐making, (2) exacerbate the deleterious role that genetic determinism plays in child rearing, and (3) undermine children's future autonomy by removing the option of not knowing their genetic information without appropriate justification. (shrink)

Teaching children to ask and answer questions is critically important if they are to learn to talk and reason effectively together, particularly during inquiry-based science where they are required to investigate topics, consider alternative propositions and hypotheses, and problem-solve together to propose answers, explanations, and prediction to problems at hand. This study involved 108 students (53 boys and 55 girls) from seven, Year 7 teachers’ classrooms in five primary schools in Brisbane, Australia. Teachers were randomly allocated by school to one (...) of two conditions: the metacognitive questioning condition (Trained condition) or the prescriptive questioning condition (Untrained condition). Data on students’ discourse and reasoning and problem-solving (RP-S) were collected across Times 1 and 2. The results showed that while there were significant differences in the discourse categories of the students in the two conditions at Time 1, the only significant difference was in questioning behaviour at Time 2 with the students in the trained condition continuing to ask more questions than their untrained peers. Given that these students had been taught to specifically ask ‘thinking’ questions that probed and interrogated information, these results are not surprising. A follow-up examination of students’ discourse during their small group discussions illustrated how these students interacted with each other to probe and interrogate information by providing explanations and reasons to make their thinking explicit and by using analogies to verbally represent concepts they were trying to express. Results on the follow-up reasoning and problem-solving (RP-S) tasks indicated that students in the Trained and Untrained conditions improved their scores from Time 1 to Time 2 although the change was not significantly different between conditions. (shrink)

Go to John Cantwell’s response to the original paper from here › Go to Grazia Ietto-Gillies’ original paper from here ›.

The creation of poetry can be an intensely healing process, as therapeutic as the other arts and talking therapies. This paper examines three areas. First, it sets out some opinions about the specific qualities of poetry that make it particularly valuable as part of a therapeutic process. It goes on to give exemplified information about how poetry is used within healthcare in Britain. Finally, it indicates the current growth of interest in this area, with brief descriptions of pilot research studies (...) where poetry has been offered by a writing therapist, or by nursing or medical practitioners. (shrink)

Evidence-based medicine (EBM) makes use of explicit procedures for grading evidence for causal claims. Normally, these procedures categorise evidence of correlation produced by statistical trials as better evidence for a causal claim than evidence of mechanisms produced by other methods. We argue, in contrast, that evidence of mechanisms needs to be viewed as complementary to, rather than inferior to, evidence of correlation. In this paper we first set out the case for treating evidence of mechanisms alongside evidence of correlation in (...) explicit protocols for evaluating evidence. Next we provide case studies which exemplify the ways in which evidence of mechanisms complements evidence of correlation in practice. Finally, we put forward some general considerations as to how the two sorts of evidence can be more closely integrated by EBM. (shrink)

Commentator: Mark Purvis Commentator: Sheena McMain Commentator: Clare Connolly Commentator: Maggie Eisner Commentator: Shirley Brierley Commentator: Becky Ship.

Understanding Animal Abuse and How to Intervene with Children and Young People offers a positive, compassion-based and trauma-informed approach to understanding and intervening in animal abuse. It provides an accessible cross-disciplinary synthesis of current international evidence on animal abuse, and a toolkit for professionals working with people and/or animals to help them understand, prevent, and intervene in cases of animal abuse. With contributions from experts in the field, this essential text offers ten user-friendly chapters with questions for reflection and key (...) summary points. It offers a definition of animal abuse, synthesises the latest research on children, young people and animal abuse, and explores the link between animal abuse and other forms of abuse, and legal perspectives on animal abuse. The second half of the book presents a practical toolkit for professionals, offering guidance and strategies for prevention of and intervention in cases of animal abuse. It provides multidisciplinary perspectives on interventions; from teachers' and social workers roles in detection and intervention of childhood animal abuse, to the roles of enforcement agencies and veterinarians in legal cases of adult animal abuse. Together with a final chapter proposing new directions for research, policy, and practice, this guide is for all who work with children, young people and/or animals, including psychologists, social workers, veterinarians, education professionals, and animal welfare educators. It is also key reading for those involved in legal and policy issues relating to animal welfare. (shrink)

According to current hierarchies of evidence for EBM, evidence of correlation is always more important than evidence of mechanisms when evaluating and establishing causal claims. We argue that evidence of mechanisms needs to be treated alongside evidence of correlation. This is for three reasons. First, correlation is always a fallible indicator of causation, subject in particular to the problem of confounding; evidence of mechanisms can in some cases be more important than evidence of correlation when assessing a causal claim. Second, (...) evidence of mechanisms is often required in order to obtain evidence of correlation. Third, evidence of mechanisms is often required in order to generalise and apply causal claims. While the EBM movement has been enormously successful in making explicit and critically examining one aspect of our evidential practice, i.e., evidence of correlation, we wish to extend this line of work to make explicit and critically examine a second aspect of our evidential practices: evidence of mechanisms. (shrink)

The last couple of decades has brought a renewed interest in American conservatism among historians. Yet most recent studies have focused on the emergence of neoconservatism after World War II and virtually no recent scholarly work has pursued the history of conservatism before the 1920s. Both Richard Hofstadter and Clinton Rossiter agreed that the late nineteenth century was an important watershed in the evolution of American conservative thought. Hofstadter argued that the new laissez-faire conservatism that became dominant during the Gilded (...) Age was remarkable in that “it lacked many of the signal characteristics of conservatism as it is usually found.” Yet some conservatives refused to accept key features of what Clinton Rossiter once branded this new “contradictory conservatism.” This essay focuses mostly on Protestant clerical intellectuals who dissented from the new orthodoxy and attempted to preserve older conservative principles. Against the laissez-faire conservatives' hyperindividualism, these dissenting conservatives stressed an organic view of the social order and the importance of mediating institutions such as family and church. To the others' secularism, they offered a social theory suffused with evangelical Protestantism. This analysis highlights where these dissidents differed from their fellow conservatives and seeks also to elucidate their alternative conservative vision of the American republic. Such a study serves to clarify just how profound an ideological shift occurred among conservatives during the Gilded Age and illuminates some of the persistent tensions within American conservatism still evident today. (shrink)

The ideal moral standard for surgical informed‐consent calls upon surgeons to carry out a disclosure dialogue with patients so they have as full as possible an understanding of the procedure before they sign the informed‐consent form. This study is the first to empirically explore patient preferences regarding disclosure dialogue. Twelve Israelis who underwent life‐saving surgeries participated in a narrative study. Three themes emerged from the analysis: objectification of patients, anxiety provoking processes and information, and lack of information that was essential (...) for patients. Findings contribute to existing debates among surgeons regarding the scope and importance of some disclosure components. Analysis led to our formulation of an augmented subjective model of information disclosure that participants prefer, which extends beyond the immediate present of the surgery to the period after discharge, and until return to routine. Surgeons should be aware of patient preferences in disclosure, and gaps between perceptions of surgeons, and preferences and needs of patients. (shrink)

Costs at the end of life disproportionately contribute to health care costs in the United States. Addressing these costs will therefore be an important component in making the U.S. health care system more financially sustainable. In this paper, we explore the moral justifications for having discussions of end-of-life costs in the doctor-patient encounter as part of an effort to control costs. As health care costs are partly shared through pooled resources, such as insurance and taxation, and partly borne by individuals (...) through out-of-pocket expenses, we separate our defense for, and approach to, discussing both pooled and individual aspects of cost. We argue that there needs to be a shift away from formulating the options as a dichotomous choice of paying attention to end-of-life costs versus ignoring such costs. The question should be how personal costs will be managed and how societal expenditures should be allocated. These are issues that we believe patients care about and need to have addressed in a manner with which they are comfortable. Conversations about how money will be spent at the end of life should begin before the end is near. We propose discussing costs from the onset of chronic illness and incorporating financial issues in advance care planning. Through these approaches one can avoid abruptly and insensitively introducing financial issues at the very conclusion of a person's life when one would prefer to address the painful and important issues of spiritual and existential loss that are appropriately the focus when a person is dying. (shrink)

The cost of health care at the end of life accounts for a high proportion of total health care costs in the United States. The percentage of Medicare payments attributable to patients in their last year of life was 28.3% in 1978 and has remained substantially the same at 25.1% in 2006. This indicates how little progress has been made in containing these costs, though doing so will be important to promote a financially sustainable health care system. These expenditures also (...) highlight the prospect that efforts to reduce health care costs overall are likely to disproportionately affect the care patients receive at the end of life. (shrink)

The paper briefly summarises the historical evolution of transnational corporations and their activities. It then introduces the major theories developed to explain the TNC. There is an attempt to place the theories historically, within the context of the socio-economic … More ›.

Background There is little dispute that the ideal moral standard for surgical informed consent calls for surgeons to carry out a disclosure dialogue with patients before they sign the informed consent form. This narrative study is the first to link patient experiences regarding the disclosure dialogue with patient-surgeon trust, central to effective recuperation and higher adherence. Methods Informants were 12 Israelis, aged 29–81, who underwent life-saving surgeries. A snowball sampling was used to locate participants in their initial recovery process upon (...) discharge. Results Our empirical evidence indicates an infringement of patients’ right to receive an adequate disclosure dialogue that respects their autonomy. More than half of the participants signed the informed consent form with no disclosure dialogue, and thus felt anxious, deceived and lost their trust in surgeons. Surgeons nullified the meaning of informed consent rather than promoted participants’ moral agency and dignity. Discussion Similarity among jarring experiences of participants led us to contend that the conduct of nullifying surgical informed consent does not stem solely from constraints of time and resources, but may reflect an underlying paradox preserving this conduct and leading to objectification of patients and persisting in paternalism. We propose a multi-phase data-driven model for informed consent that attends to patients needs and facilitates patient trust in surgeons. Conclusions Patient experiences attest to the infringement of a patient’s right to respect for autonomy. In order to meet the prima facie right of respect for autonomy, moral agency and dignity, physicians ought to respect patient’s needs. It is now time to renew efforts to avoid negligent disclosure and implement a patient-centered model of informed consent. (shrink)

Recently, there have been a number of lawsuits in the United States in which families objected to performance of apnoea testing for determination of brain death. The courts reached conflicting determinations in these cases. We discuss the medicolegal complications associated with apnoea testing that are highlighted by these cases and our position that the decision to perform apnoea testing should be made by clinicians, not families, judges, or juries.

Epistemic modals are standardly taken to be context-dependent quantifiers over possibilities. Thus sentences containing them get truth-values with respect to both a context and an index. But some insist that this relativization is not relative enough: `might'-claims, they say, only get truth-values with respect to contexts, indices, and—the new wrinkle—points of assessment (hence, CIA). Here we argue against such "relativist" semantics. We begin with a sketch of the motivation for such theories and a generic formulation of them. Then we catalogue (...) central problems that any such theory faces. We end by outlining an alternative story. (shrink)

It is a recurring mantra that epistemic must creates a statement that is weaker than the corresponding flat-footed assertion: It must be raining vs. It’s raining. Contrary to classic discussions of the phenomenon such as by Karttunen, Kratzer, and Veltman, we argue that instead of having a weak semantics, must presupposes the presence of an indirect inference or deduction rather than of a direct observation. This is independent of the strength of the claim being made. Epistemic must is therefore quite (...) similar to evidential markers of indirect evidence known from languages with rich evidential systems. We work towards a formalization of the evidential component, relying on a structured model of information states (analogous to some models used in the belief dynamics literature). We explain why in many contexts, one can perceive a lack of confidence on the part of the speaker who uses must. (shrink)

1. Modes of art -- 2. Ways of art -- 3. Illustrations.

The simplest story about modals—might, must, possibly, necessary, have to, can, ought to, presumably, likelier, and the rest—is also the canon: modals are context-dependent quantifiers over a domain of possibilities. Different flavors of modality correspond to quantification over different domains of possibilities. Logical modalities quantify over all the possibilities there are, physical modalities over possibilities compatible with the..