Traditional, positivist assessment approaches generally fail to capture the nuances of learners’ clinical competence in medical programmes. This has led to the implementation of an alternate assessment approach known as ‘programmatic assessment’, which embraces subjectivity of human judgement in holistic decision making in clinical settings. Faculty and staff have found the introduction of programmatic assessment to be challenging because it is a major, complex change to the traditional way of carrying out assessment. Extending our previous work, where we used critical (...) realism to explore students’ experiences of programmatic assessment, we here unpack the underlying conditions and mechanisms triggered by programmatic assessment’s implementation. We applied Bhaskar’s concept of ontological stratification, retroduction and Archer’s theoretical accounts of morphogenesis/stasis to theorize the interplay between the socio-cultural entities that constrain and enable desired changes in assessment practices, and those that condition students and staff to accept or reject the new ‘non-traditional’ assessment processes. (shrink)

Many firms are striving to improve their environmental positions by presenting their environmental efforts to the public. To do so, they are applying green marketing strategies to help gain competitive advantage and appeal to ecologically conscious consumers. However, not all green marketing claims accurately reflect firms’ environmental conduct, and can be viewed as ‘greenwashing’. Greenwashing may not only affect a company’s profitability, but more importantly, result in ethical harm. Therefore, this research extends past greenwashing studies by examining additional influences on (...) and outcomes of perceived greenwashing. To do so, we conducted two studies, an interview study with consumer product and consulting firms, as well as an experiment examining consumers interacting with a company website. For these studies, we used multiple methods, including interviews, questionnaires, and neurophysiological techniques. We found that perceived greenwashing relates not only to environmental and product perceptions, but also to consumers’ happiness while interacting with the website. We also found that website interactivity relates to perceived greenwashing, environmental and product perceptions, and to the amount of interaction with the website. We conclude by discussing managerial and ethical implications for research and practice. (shrink)

Some individuals facing dementia contemplate hastening their own death: weighing the possibility of living longer with dementia against the alternative of dying sooner but avoiding the later stages of cognitive and functional impairment. This weighing resonates with an ethical and legal consensus in the United States that individuals can voluntarily choose to forgo life‐sustaining interventions and also that medical professionals can support these choices even when they will result in an earlier death. For these reasons, whether and how a terminally (...) ill individual can choose to control the timing of their death is a topic that cannot be avoided when considering the dementia trajectory. With a focus on the U.S. context, this landscape review considers the status of provisions that would legally permit people facing dementia to hasten death with appropriate support from medical professionals. This review can be used to plan and guide clinical and legal practitioner discussion and policy development concerning evolving questions not fully covered by existing medical decision‐making provisions. (shrink)

In the past decade, numerous ethical frameworks have been developed to support public health decision‐making in challenging areas. Before the COVID‐19 pandemic began, members of the authorship team were involved in research programmes, in which the development of ethical frameworks was planned, to guide (a) the use of new technologies for emerging infectious disease surveillance; and (b) the allocation of scarce supplies of pandemic influenza vaccine. However, as the pandemic evolved, significant practical challenges emerged that led to our questioning the (...) value of these frameworks. We now believe that a normative instrument, such as a framework, cannot adequately or reliably provide the ethical guidance that needs to be incorporated into public health decision‐making during natural disasters or infectious disease emergencies. Recently it has been suggested that there are potentially more dynamic, flexible, and effective ways to navigate decisions involving complex considerations entailed in policies and practices during a public health emergency. In this paper, we first outline the key functions of a public health ethics framework, before describing why we believe it would not be fit for purpose during a crisis. We end by considering whether proposed alternative methods to promote ethical public health decision‐making goals have the potential to meet these objectives. (shrink)

Informed by Critical Race Theory, this quantitative study supports civic educators in understanding the role of classroom climate and racial identity in students’ civic engagement during a statewide middle school civics mandate (n = 4707). Findings reveal that students of color experience higher civic engagement and lower civic attitude scores than white-identifying peers, after controlling for school, classroom, and affluence indicators. Students’ perception of whiteness (or perhaps majority status) appeared to correlate with positive civic knowledge and civic attitude, but relative (...) civic inaction. These findings suggest differences in civic outcomes as early as middle school between white-identifying students and students of color. Such differences offer implications for civic education interventions that address not only effective instruction, but civic inequities, students’ perceived agency, and curricular content. (shrink)

The abortion debate rages on. Yet the two most popular positions seem to be clearly mistaken. Conservatives maintain that a human life begins at conception and that therefore abortion must be wrong because it is murder. But not all killings of humans are murders. Most notably, self defense may justify even the killing of an innocent person.Liberals, on the other hand, are just as mistaken in their argument that since a fetus does not become a person until birth, a woman (...) may do whatever she pleases in and to her own body. First, you cannot do as you please with your own body if it affects other people adversely. Second, if a fetus is not a person, that does not imply that you can do to it anything you wish. Animals, for example, are not persons, yet to kill or torture them for no reason at all is wrong. (shrink)

Calls for the “translation” of research from bench to bedside are increasingly demanding. What is translation, and why does it matter? We sketch the recent history of outcome-oriented translational research in the United States, with a particular focus on the Roadmap Initiative of the National Institutes of Health (Bethesda, MD). Our main example of contemporary translational research is stem cell research, which has superseded genomics as the translational object of choice. We explore the nature of and obstacles to translational research (...) and assess the ethical and biomedical challenges of embracing a translational ethos. (shrink)

The use of genome-wide association studies in medical research and the increased ability to share data give a new twist to some of the perennial ethical issues associated with genomic research. GWAS create particular challenges because they produce fine, detailed, genotype information at high resolution, and the results of more focused studies can potentially be used to determine genetic variation for a wide range of conditions and traits. The information from a GWA scan is derived from DNA that is a (...) powerful personal identifier, and can provide information not just on the individual, but also on the individual's relatives, related groups, and populations. Furthermore, it creates large amounts of individual-specific digital information that is easy to share across international borders. This paper provides an overview of some of the key ethical issues around GWAS: consent, feedback of results, privacy, and the governance of research. Many of the questions that lie ahead of us in terms of the next generation sequencing methods will have been foreshadowed by GWAS and the debates around ethical and policy issues that these have created. (shrink)

The concept of vulnerability is deployed in bioethics to, amongst other things, identify and remedy harms to participants in research, yet although nonhuman animals in experimentation seem intuitively to be vulnerable, this concept and its attendant protections are rarely applied to research animals. I want to argue, however, that this concept is applicable to nonhuman animals and that a new taxonomy of vulnerability developed in the context of human bioethics can be applied to research animals. This taxonomy does useful explanatory (...) work, helping to pinpoint the limitations of the 3Rs/welfare approach currently adopted in the context of animal experimentation. On this account, the 3Rs/welfare approach fails to deliver for nonhuman animals in experimentation because it effectively addresses only one element of their vulnerability (inherent) and paradoxically through the institution of Animal Ethics Committees intended to protect experimental animals in fact generates new vulnerabilities that exacerbate their already precarious situation. (shrink)

The ArgumentThis paper argues that different epistemic styles exist in science, and that these make up an important unit of analysis for studying science. On occasion these different sets of commitments to ways of doing and knowing about the world may fall along national boundaries. The case presented here examines German and American embryology around 1900 and shows that differences in goals and approaches make up different epistemic styles.In particular, the Germans sought causal mechanical explanations of as many phenomena as (...) possible, guided by strong theories which achieved confirmation when they fit with as much of the available data as possible. The Americans, in contrast, sought definitive facts, as many as possible, which might be quite specific or narrowly based. These facts could lead to empirical generalizations which, in turn, could guide the generation of new knowledge in the form of new facts. Thus, the two epistemic styles emphasized different goals, processes of investigation, and standards of evidence. (shrink)

Using an approach developed in the context of human bioethics, we argue that chimpanzees in research can be regarded as vulnerable subjects. This vulnerability is primarily due to communication barriers and situational factors—confinement and dependency—that make chimpanzees particularly susceptible to risks of harm and exploitation in experimental settings. In human research, individuals who are deemed vulnerable are accorded special protections. Using conceptual and moral resources developed in the context of research with vulnerable humans, we show how chimpanzees warrant additional safeguards (...) against harm and exploitation paralleling those for human subjects. These safeguards should include empowering third parties to act as surrogate decision makers for chimpanzees, ensuring participant “assent,” and avoiding recruitment of animal subjects based merely on convenience. (shrink)

One of the most basic understandings of nursing is that a nurse is a caregiver for a patient who helps to prevent illness, treat health conditions, and manage the physical needs of patients. Nursing is often presented as a caring profession, which provides patient care driven by ideals of empathy, compassion and kindness. These ideals of care have further been foregrounded through the development and implementation of stress on patient centred care (PCC) and/or person‐centred practice (PCP). Although the idealisation of (...) nursing as a caring profession is common, and one certainly seen as integral by nurses and written into the heart of regulatory documentation, we contend that the actual delivery of care is being undercut by the very regulatory climate that strives to professionalise care. As we outline, with specific reference to the context of Australian Nursing, this transformation delivers a commodified, even McDonaldized, model of patient management rather than care. It seems that even with its explicit stress on PCC and PCP, Australian Nursing cannot live up to its own care ideals. Having outlined this problem, the paper then demonstrates the ways in which PCC is thwarted at the coal face of nursing practice and that there must be an institutionalised change to be able to provide genuine patient‐centred care. (shrink)

Innovative surgery raises four kinds of ethical challenges: potential harms to patients; compromised informed consent; unfair allocation of healthcare resources; and conflicts of interest. Lack of adequate data on innovations and lack of regulatory oversight contribute to these ethical challenges. In this paper these issues and the extent to which problems may be resolved by better evidence-gathering and more comprehensive regulation are explored. It is suggested that some ethical issues will be more resistant to resolution than others, owing to special (...) features of both surgery and innovation. (shrink)

There has been much attention devoted in recent years to the question of whether our moral principles can be related to our biological nature. This collection of new essays focuses on the connection between biology, in particular evolutionary biology, and foundational questions in ethics. The book asks such questions as whether humans are innately selfish, and whether there are particular facets of human nature that bear directly on social practices. The volume is organised historically beginning with Aristotle and covering such (...) major figures as Hume and Darwin down to the present and the work of Harvard sociobiologist, E. O. Wilson. This is the first book to offer this historical perspective on the relation of biology and ethics, and has been written by some of the leading figures in the history and philosophy of science, whose work stands very much at the cutting edge of these disciplines. (shrink)

Diagrams make it possible to present scientific facts in more abstract and generalized form. While some detail is lost, simplified and accessible knowledge is gained. E. B. Wilson's work in cytology provides a case study of changing uses of diagrams and accompanying abstraction. In his early work, Wilson presented his data in photographs, which he saw as coming closest to “fact.” As he gained confidence in his interpretations, and as he sought to provide a generalized textbook account of cell development, (...) he relied on increasingly abstract diagrams. In addition, he came to see that highly abstract and even schematic drawings could provide more than pictures directly from life. (shrink)

This chapter contains section titled: Introduction Background Central Philosophical Issues in Works on the Passions The Weakness of Reason “Reason Directs and the Affections Execute”19 Hume's Connection to the Earlier Literature Central Philosophical Issues regarding the Passions: Hume's Alternative Analyses Conclusion Notes References and further reading.

Prompted by the ever-increasing cesarean rate, this paper considers the interpretive disjunct between two significant strands of feminist analysis that have arisen in the last four decades as a consequence of the phenomenon of medicalized birth. In contrast to the dominant paradigm of bioethical “Principalism,” both modes of analysis, understood as “the critique of industrialized labor” and “the critique of idealized labor,” are attentive to the way in which social discourses inform bioethical deliberation and practice, but significantly diverge in the (...) nature of their accounts. The “industrialization critique” understands the culture of medical intervention to be impelled by an “obstetric desire” to appropriate women's reproductive potency, whereas the “idealization critique” relates new mothers’ “low childbirth satisfaction” to a pernicious normative ideal propagated by the natural childbirth movement. This paper will explore the anatomy of both critiques and interrogate their fidelity to the phenomenological insight of the body as chiasm between material and ideal. I will argue that while the insights of the idealization critique are well grounded, we must exercise caution about the critique's tendency to reductively understand the embodied experience of labor as entirely discursively produced, a gesture that risks re-performing the dematerialization of women often effected through obstetric intervention itself. (shrink)

Historians have emphasized the appearance of a productive research program in genetics after 1910, and philosophers and biologists have considered endorsement of genetics as a progressive move, indeed as a starting point for modern experimental biology. These efforts focus on what biology had changed to. This paper examines the condition from which biology moved, stressing the way in which Americans held heredity and development as a natural, intimately intertwined couple. Heredity accounts for likenesses, development for variation, and the two act (...) together throughout an individual's life. This discussion establishes the antecedent conditions necessary to explain the split of genetics and embryology and addresses the reasons for the split. (shrink)

In this paper we propose a new way of conceptualizing animals in experimentation – the animal-as-patient. Construing and treating animals as patients offers a way of successfully addressing some of the entrenched epistemological and ethical problems within a practice of animal experimentation directed to human clinical benefit. This approach is grounded in an epistemological insight and builds on work with so-called ‘pet models’. It relies upon the occurrence and characterization of analogous human and nonhuman animal diseases, where, if certain criteria (...) of homology and mechanism are met, the animal simultaneously becomes a patient and a spontaneous model of the human disease. (shrink)

The phrase “regenerative medicine” is used so often and for so many different things, with such enthusiasm or worry, and often with a sense that this is something radically new. This paper places studies of regeneration and applications in regenerative medicine into historical perspective. In fact, the first stem cell experiment was carried out in 1907, and many important lines of research have contributed since. This paper explores both what we can learn about the history and what we can learn (...) from the history of regenerative medicine research. (shrink)

Anton Dohrn rejected the popular Amphioxus-ascidian theory of vertebrate origin, which saw Amphioxus as the most primitive vertebrate and ascidians as vertebrate ancestors. Instead he argued for the segmented annelids as the more likely candidate. Attacked for being 'unscientific' by such popular morphologists as Carl Gegenbaur and Ernst Haeckel, Dohrn countered with similar accusations. Since the debate peaked as Dohrn was establishing his Stazione Zoologica in Naples at the end of the nineteenth century, it gained him valuable attention and may (...) have encouraged him to retain his view even in the face of new and problematic evidence. This paper explores Dohrn's contributions and the underlying commitments revealing what he regarded as important in science. (shrink)

The purpose of this article is to elaborate the many literary allusions that Simone Weil used in her ultimate work: L' Enracinement, translated as The Need for Roots, to achieve her goal of encouraging her fellow countrymen to create a new postwar society. Understanding how she used the riches of the French and Western Literary Cannon, less easily grasped by those not educated in the French Education system, enriches the understanding of Weil's purpose and skill in writing on many levels, (...) simultaneously for different target audiences. Underlying her stress on the need for truth and honesty about a county's past and present, with discernable respect for every person, is her foundational belief in the spiritual destiny of every human being. Examining her literary allusions in detail to show her clever subversion of traditionally accepted interpretations brings a new dimension to Simone Weil studies, while underlining the relevance of this essay to contemporary dilemmas. (shrink)

Responsible Research and Innovation (‘RRI’) is a cross-cutting priority for scientific research in the European Union and beyond. This paper considers whether the way such research is organised and delivered lends itself to the aims of RRI. We focus particularly on international consortia, which have emerged as a common model to organise large-scale, multi-disciplinary research in contemporary biomedical science. Typically, these consortia operate through fixed-term contracts, and employ governance frameworks consisting of reasonably standard, modular components such as management committees, advisory (...) boards, and data access committees, to co-ordinate the activities of partner institutions and align them with funding agency priorities. These have advantages for organisation and management of the research, but can actively inhibit researchers seeking to implement RRI activities. Conventional consortia governance structures pose specific problems for meaningful public and participant involvement, data sharing, transparency, and ‘legacy’ planning to deal with societal commitments that persist beyond the duration of the original project. In particular, the ‘upstream’ negotiation of contractual terms between funders and the institutions employing researchers can undermine the ability for those researchers to subsequently make decisions about data, or participant remuneration, or indeed what happens to consortia outputs after the project is finished, and can inhibit attempts to make project activities and goals responsive to input from ongoing dialogue with various stakeholders. Having explored these challenges, we make some recommendations for alternative consortia governance structures to better support RRI in future. (shrink)

The United Kingdom is a leader in genomics research, and the presence of numerous types of biobanks and the linking of health data and research within the UK evidences the importance of biobank-based research in the UK. There is no biobank-specific law in the UK and research on biobank materials is governed by a confusing set of statutory law, common law, regulations, and guidance documents. Several layers of applicable law, from European to local, further complicate an understanding of privacy protections. (...) Finally, biobanks frequently contain data in addition to the samples; the legal framework in the UK generally differentiates between data and samples and the form of the data affects the applicability of legal provisions. Biobanks must be licensed by the Human Tissue Authority; certain projects must be reviewed by Research Ethics Committees, and all projects are encouraged to be reviewed by them. Data Access Committees in biobanks are also common in the UK. While this confusing array of legal provisions leaves privacy protections in biobanking somewhat unclear, changes at the EU level may contribute to harmonization of approaches to privacy. (shrink)

Abstract“Development” suggests that there is something that is developing, or changing over time. We can ask about temporal boundaries of that developmental process, asking when development begins or ends and whether it has defined stages along the way, for example. We can ask about spatial boundaries as well: where does the developing object start and end? For this article, I ask about the boundary definition of the developing organism in particular. What is an individual organism, and what defines it as (...) the same organism as it changes over time? In particular, how has this been answered historically: how have researchers described and explained what an individual developing organism is? This article explores ideas and approaches especially starting in the late 19th century, and in particular looks at the role of “organization.”. (shrink)