A commentary on “What's Not Being Shared in Shared Decision‐Making?” from the July‐August 2013 issue.

Medical decision making when a patient cannot participate is complicated by the question of whose voice should be heard. The most common answer to this question is that “autonomy” is paramount, and therefore it is the voice of the unwell person that should be given priority. Advance care planning processes and practices seek to capture this sentiment and to allow treatment preferences to be documented and decision makers to be nominated. Despite good intentions, advance care planning is often deficient because (...) it is unable to facilitate a relational approach to decision making in cases when the patient’s competence is reduced. In this article we present findings from a study of the ways in which older people and their significant others understand decision making in such circumstances. Critical to the participants’ understanding was the emergent concept of “relational knowing,” a concept that is poorly articulated in the advance care planning literature. Our findings suggest that the dominant understanding of decision making in conditions of impaired competence is incomplete and obscures much of what matters to people. We conclude that, having recognized a broader set of ethical concerns, it is necessary to develop a relational and narrative based approach that applies in appropriate settings. (shrink)

The capacity to perceive internal bodily states is linked to emotional awareness and effective emotional regulation. We explore individual differences in emotional awareness in relation to the fading affect bias, which refers to the greater dwindling of unpleasant compared to pleasant emotions in autobiographical memory. We consider interoceptive awareness and alexithymia in relation to the FAB, and private event rehearsal as a mediating process. With increasing interoceptive awareness, there was an enhanced FAB, but with increasing alexithymia, there was a decreased (...) FAB. Further, the effects of interoceptive awareness were partially mediated by private rehearsal of pleasant events. We provide novel evidence that capacity for emotional awareness and thus effective processing is an important factor predictive of the FAB. Moreover, our results imply an important role for maintaining positive affect in the FAB. Our findings offer new insights into the effects of interoception and alexithymia on autobiographical memory, and support concepts of the FAB emerging as a result of adaptive emotional regulation processes. (shrink)

Establishing interdisciplinary academic departments has been a common response to the challenge of addressing complex problems. However, the assumptions that guide the formation of such departments are rarely questioned. Additionally, the designers and managers of interdisciplinary academic departments in any field of endeavour struggle to set an organisational climate appropriate to the diversity of their members. This article presents a preliminary analysis of collaborative dynamics within two interdisciplinary university departments in Australia focused on sustainability. Social network diagrams and metrics of (...) coauthorship and cosupervision are analysed qualitatively. A "vicarious interdisciplinarity" was identified among key academics working narrowly in order to earn the resources that allow them to support others working interdisciplinarily. Those supported in this way appear to benefit from the esteem and nonredundant collaborative connections their mentors provide via this strategy, but they experience uncertainty about their own career opportunities in similar settings. This article thus unearths a conundrum of succession for interdisciplinary academic environments, and suggests that simple colocation of diverse academic stars is an inadequate strategy to achieve effective intradepartmental collaboration. (shrink)

Calls for increasing integration of ethical considerations into business education are well documented. Business graduates are perceived to be ethically naive at best, and at worst, constrained in their moral development by the lack of ethical content in their courses. The pedagogic concern is to find effective methods of incorporating ethics into the fabric of business education. The purpose of this paper is to suggest and illustrate role play as an appropriate method for integrating ethical concerns.

One implication of Laland, Odling-Smee & Feldman's niche construction model concerns the significance of the role of behavioural or cultural traits in comparative analysis. In this commentary it is suggested that cladistic methods already recognise this importance, and that behavioural characters may play a key role in hominid speciation and the definition of species.

"The doctrine of materialism is one of the perennial and most controversial ideas in the arts and sciences. Throughout history it has aroused strong passions, and in the Sixteenth and Twentieth centuries was a doctrine over which people were persecuted and killed. Yet it has been equally aligned with empirical, enlightened and tolerant thinking. This book explores the fascinating and important philosophy of materialism in an engaging and thought-provoking way. Opening with an overview of the ideas of some of the (...) most important materialists, including Lucretius, Epicurus, Hobbes and Hume up to Darwin and Marx, Brown and Ladyman show how materialism's origins were twofold: it was an early form of scientific explanation but also an intellectual outlook, or belief-system, about the world in general. They then explain how materialism's beginnings as imaginative vision of the true nature of things faced a major challenge from modern physics, in the form of quantum theory and the general theory of relativity. This posed major questions for materialism: how could it be reconciled with unobservable entities and new discoveries about the nature of space and time? As the authors show, out of this challenge materialism did not die but re-emerged - as the new doctrine of physicalism. Drawing on colourful examples throughout - from modern physics, the nature of the mind, and atheism - the authors argue that whilst materialism may not have all the answers, its humanism and staunch belief in observation, evidence and experiment remains our best hope in a fragmented and hyper-specialised world"--. (shrink)

As the structure of healthcare delivery undergoes a breathtaking transformation, many ethics committees are wondering how and if they will be affected. Although the impact has not yet been widely felt, hospital-based ethics committees cannot avoid the pressures and upheaval caused by the reorganization of healthcare. This article will briefly review some of the factors contributing to the transformation of medicine, and suggest a number of ways in which ethics committees can respond proactively.

We provide a formulation of physicalism, and show that this is to be favoured over alternative formulations. Much of the literature on physicalism assumes without argument that there is a fundamental level to reality, and we show that a consideration of the levels problem and its implications for physicalism tells in favour of the form of physicalism proposed here. Its hey elements are, fast, that the empirical and substantive part of physicalism amounts to a prediction that physics will not posit (...) new entities solely for the purpose of accounting for mental phenomena, nor new entities with essentially mental characteristics such as propositioned attitudes or intentions; secondly, that physicalism can safely make do with no more than a weak global formulation of supervenience. (shrink)

This paper reports on the experiences of creative practice graduate researchers and academic staff as they seek to comply with the requirements of the Australian National Statement on the Ethical Conduct of Research Involving Humans. The research was conducted over a two-year period as part of a wider project ‘iDARE – Developing New Approaches to Ethics and Research Integrity Training through Challenges Presented by Creative Practice Research’. The research identified the appreciation of ethics that the participants acquired through their experience (...) of institutional research ethics procedures at their university. It also revealed a disjunction between the concepts of ethics acquired through meeting institutional research ethics requirements, the notion of ethics that many researchers adopt in their own professional creative practice and the contents of professional codes of conduct. A key finding of the research was that to prepare creative practice graduates for ethical decision-making in their professional lives, research ethics training in universities should be broadened to encompass a variety of contexts and enable researchers to develop skills in ethical know-how. (shrink)

It should surprise no one familiar with the problems in rural healthcare that 87% of a randomly selected sample of Nebraskans recently called for either fundamental or complete change of the healthcare system. Rural communities in the United, States have been hard hit by the rising cost of healthcare at a time of economic and demographic decline. Unable to sustain operating costs and personnel needs, rural hospitals and medical, practices have been forced to close their doors at an, alarming rate.Furthermore, (...) rural patients are decreasingly able to afford what services are available to them. Most must purchase insurance privately because they are unlikely to be insured through employment. Therefore, they pay dearly because they are not eligible for corporate rates and because insurance companies use experience instead of community rating to assess risk. (shrink)

This paper reviews the literature concerning the neural correlates of the self, the relationship between self and memory and the profile of memory impairments in Alzheimer’s disease and explores the relationship between the preservation of the self and anosognosia in this condition. It concludes that a potential explanation for anosognosia in AD is a lack of updating of personal information due to the memory impairments characteristic of this disease. We put forward the hypothesis that anosognosia is due in part to (...) the “petrified self.”. (shrink)

?Vulnerability? is now a popular term in the lexicon of every-day life and a notion frequently drawn upon by policy-makers, academics, journalists, welfare workers and local authorities. This essay explores some of the ethical and practical implications of ?vulnerability? as a concept in social welfare. It highlights how ideas about vulnerability shape the ways in which we manage and classify people, justify state intervention in citizens? lives, allocate resources in society and define our social obligations. The lack of clarity and (...) limited analysis of the concept of ?vulnerability? in welfare arenas is highlighted as concerning, particularly given that those seen as most in need of support seem to be implicated in commonly held views about ?the vulnerable?. I argue that far from being innocuous, ?vulnerability? is so loaded with political, moral and practical implications that it is potentially damaging to the pursuit of social justice. Two opposing presentations of the notion are set out in order to illustrate that ?vulnerability? is a concept that should be handled with more care. (shrink)

The doctrine of materialism is one of the most controversial in the history of ideas. For much of its history it has been aligned with toleration and englightened thinking, but it has also aroused strong, often violent, passions among both its opponents and proponents. This book explores the deelopment of materialism in an engaging and thought-provoking way and defends the form it takes in the twenty-first century.

With reference to the intergenerational theorizing of trauma, this article considersthe role of transcendence in the substance of our theoretical ideas about psycho-sis. Arguing against an emphasis on notions of developmental de fi cit, the author considers the recent work of Davoine and Gaudilliere as a means of questioningsome of the paradigmatic assumptions of clinical psychology. It is suggested that the relationship between psychosis and spirituality has often been conceived insuch a way as to depreciate both, and that a shift (...) in mainstream theorizingrequires that a more fundamental place be made for the question of transcen-dence in the theorizing of madness. (shrink)

The shortage of organs for transplantation by its nature prompts ethical dilemmas. For example, although there is an imperative to save human life and reduce suffering by maximising the supply of vital organs, there is an equally important obligation to ensure that the process by which we increase the supply respects the rights of all stakeholders. In a relatively unexamined practice in the USA, organs are procured from unrepresented decedents without their express consent. Unrepresented decedents have no known healthcare wishes (...) or advance care planning document; they also lack a surrogate. The Revised Uniform Anatomical Gift Act of 2006 sends a mixed message about the procurement of organs from this patient population and there are hospitals that authorise donation. In addition, in adopting the RUAGA, some states included provisions that clearly allow organ procurement from unrepresented decedents. An important unanswered question is whether this practice meets the canons of ethical permissibility. The current Brief Report presents two principled approaches to the topic as a way of highlighting some of the complexities involved. Concluding remarks offer suggestions for future research and discussion. (shrink)

_Psychoanalysis Beyond the End of Metaphysics_ offers a new paradigm approach which advocates reengaging the importance of metaphysics in psychoanalytic theorizing. The emergence of the relational trend has witnessed a revitalizing influx of new ideas, reflecting a fundamental commitment to the principle of dialogue. However, the transition towards a more pluralistic discourse remains a work in progress, and those schools of thought not directly associated with the relational shift continue to play only a marginal role. In this book, Robin S. (...) Brown argues that for contemporary psychoanalysis to more adequately reflect a clinical ethos of pluralism, the field must examine the extent to which a theoretical commitment to the notion of relationship can grow restrictive. Suggesting that in the very effort to negotiate theoretical biases, psychoanalytic practice may occlude a more adequate recognition of its own evolving assumptions, Brown proposes that the profession’s advance requires a return to first principles. Arguing for the fundamental role played by faith in supporting the emergence of consciousness, this work situates itself at the crossroads of relational, Jungian, and transpersonal approaches to the psyche. Psychoanalysis Beyond the End of Metaphysics will be of significant interest to all psychodynamically oriented clinicians, alongside scholars of depth psychology and the philosophy of mind. It will also be helpful to advanced and postgraduate students of psychoanalysis seeking to orient themselves in the field at present. (shrink)

In seeking to move beyond causal-reductivism, this book explores a variety of perspectives on the question of finding inherent meaning in madness and extreme states.

The introductory section discusses supervenience and the role it plays in formulating contemporary physicalism. The section concludes with the definition of local supervenience used by Kim in the causal-exclusion argument. The second section outlines an abstract model for the analysis of supervenience, associating total mental states with total states of the nervous system. It is argued that Kim’s formulation confuses two orders of necessity: a metaphysical necessity attaching to the supervenience of the total mental state, and a nomological necessity attaching (...) to the correlation of particular elements of the concurrent physical and mental states. A central idea is the degree of resolution of the description of the state of the nervous system. This serves as a metaphor for the idea of multiplelevels of physical description, and in the third section it is argued that any formulation of supervenience that was attached to a particular level of description would risk error if changes at a more fundamental level of the subvening base proved to be significant for supervenience. In the fourth section it is argued that the problem of levels of properties and description cannot be avoided by a retreat from local to global supervenience. Loewer’s notion of a duplicate world may help, but an alternative weaker formulation is proposed that does avoid the difficulty. (shrink)

Alternative education often seeks to promote creativity. In so far as this tendency might come to suggest something ideological, then the intent thus indicated is liable to become self-defeating. This article considers C.G. Jung's conservative ideas about education, and explores how these notions might relate to his wider psychology. Contrasting Jung's position with Alfonso Montuori's notion of Creative Inquiry, the author argues for the importance of a more conscious relationship to the role of conflict in the development of a relationally (...) focused pedagogy. (shrink)

We are less optimistic than Madole & Harden that family-based genome-wide association studies (GWASs) will lead to significant second-generation causal knowledge. Despite bearing some similarities, family-based GWASs and randomised controlled trials (RCTs) are not identical. Most RCTs assess a relatively homogenous causal stimulus as a treatment, whereas GWASs assess highly heterogeneous causal stimuli. Thus, GWAS results will not translate so easily into second-generation causal knowledge.

From a secular perspective, emphasizing the theme of spirituality can seem antithetical to the needs of a pluralistically nuanced clinical attitude. This article suggests that, on the contrary, the reticence of the clinical mainstream to more directly embrace spiritual concerns betrays an underlying dogmatism. The theme of spirituality is thus argued to have paradigmatic importance in demonstrating the pluralistic failings of Western psychology. Drawing on recent developments in American psychoanalysis, consideration is given to the theoretical challenges associated with maintaining a (...) pluralistic sensibility in clinical practice. Contemporary psychoanalysis is argued to offer spiritually oriented clinicians an important basis in which to ground practice, yet it is also argued that contemporary psychoanalysis can only hope to more adequately reflect its ostensible commitment to inclusivity by revising its implicit reliance on a secular worldview. Such an undertaking might be achieved by drawing from the recent “participatory turn” in transpersonal psychology to offer a reading of Jung’s work demonstrating the enduring importance of an archetypal approach. (shrink)

This is a unique, groundbreaking study in the history of philosophy, combining leading men and women philosophers across 2600 years of Western philosophy, covering key foundational topics, including epistemology, metaphysics, and ethics. Introductory essays, primary source readings, and commentaries comprise each chapter to offer a rich and accessible introduction to and evaluation of these vital philosophical contributions. A helpful appendix canvasses an extraordinary number of women philosophers throughout history for further discovery and study.

Emerging parallel to long-standing, academic and policy inquiries on personal responsibility for health is the empirical assessment of lay persons’ views. Yet, previous studies rarely explored personal responsibility for health among lay persons as dynamic societal values. We sought to explore lay persons’ views on personal responsibility for health using the Fairness Dialogues, a method for lay persons to deliberate equity issues in health and health care through a small group dialogue using a hypothetical scenario. We conducted two 2-h Fairness (...) Dialogues sessions (n = 15 in total) in Nova Scotia, Canada. We analyzed data using thematic analysis. Our analysis showed that personal choice played an important role in participants’ thinking about health. Underlying the concept of personal choice was considerations of freedom and societal debt. In participants’ minds, personal and social responsibilities co-existed and they were unwilling to determine health care priority based on personal responsibility. The Fairness Dialogues is a promising deliberative method to explore lay persons’ views as dynamic values to be developed through group dialogues as opposed to static, already-formed values waiting to be elicited. (shrink)

Snake venoms are recognized here as a grossly under‐explored resource in pharmacological prospecting. Discoveries in snake systematics demonstrate that former taxonomic bias in research has led to the neglect of thousands of species of potential medical use. Recent discoveries reveal an unexpectedly vast degree of variation in venom composition among snakes, from different species down to litter mates. The molecular mechanisms underlying this diversity are only beginning to be understood. However, the enormous potential that this resource represents for pharmacological prospecting (...) is clear. New high‐throughput screening systems offer greatly increased speed and efficiency in identifying and extracting therapeutically useful molecules. At the same time a global biodiversity crisis is threatening the very snake populations on which hopes for new venom‐derived medications depend. Biomedical researchers, pharmacologists, clinicians, herpetologists, and conservation biologists must combine their efforts if the full potential of snake venom‐derived medications is to be realized. (shrink)

We develop a formal semantic analysis of the alarm calls used by Campbell’s monkeys in the Tai forest and on Tiwai island —two sites that differ in the main predators that the monkeys are exposed to. Building on data discussed in Ouattara et al. :e7808, 2009a; PNAS 106: 22026–22031, 2009b and Arnold et al., we argue that on both sites alarm calls include the roots krak and hok, which can optionally be affixed with -oo, a kind of attenuating suffix; in (...) addition, sentences can start with boom boom, which indicates that the context is not one of predation. In line with Arnold et al., we show that the meaning of the roots is not quite the same in Tai and on Tiwai: krak often functions as a leopard alarm call in Tai, but as a general alarm call on Tiwai. We develop models based on a compositional semantics in which concatenation is interpreted as conjunction, roots have lexical meanings, -oo is an attenuating suffix, and an all-purpose alarm parameter is raised with each individual call. The first model accounts for the difference between Tai and Tiwai by way of different lexical entries for krak. The second model gives the same underspecified entry to krak in both locations, but it makes use of a competition mechanism akin to scalar implicatures. In Tai, strengthening yields a meaning equivalent to non-aerial dangerous predator and turns out to single out leopards. On Tiwai, strengthening yields a nearly contradictory meaning due to the absence of ground predators, and only the unstrengthened meaning is used. (shrink)

I. EXECUTIVE SUMMARY The MRCT Center Post-trial Responsibilities: Continued Access to an Investigational Medicine Framework outlines a case-based, principled, stakeholder approach to evaluate and guide ethical responsibilities to provide continued access to an investigational medicine at the conclusion of a patient’s participation in a clinical trial. The Post-trial Responsibilities (PTR) Framework includes this Guidance Document as well as the accompanying Toolkit. A 41-member international multi-stakeholder Workgroup convened by the Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard University (...) (MRCT Center) developed this Guidance and Toolkit. Project Motivation A number of international organizations have discussed the responsibilities stakeholders have to provide continued access to investigational medicines. The World Medical Association, for example, addressed post-trial access to medicines in Paragraph 34 of the Declaration of Helsinki (WMA, 2013): “In advance of a clinical trial, sponsors, researchers and host country governments should make provisions for post-trial access for all participants who still need an intervention identified as beneficial in the trial. This information must also be disclosed to participants during the informed consent process.” This paragraph and other international guidance documents converge on several consensus points: • Post-trial access (hereafter referred to as “continued access” in this Framework [for terminology clarification – see definitions]) is the responsibility of sponsors, researchers, and host country governments; • The plan for continued access should be determined before the trial begins, and before any individual gives their informed consent; • The protocol should delineate continued access plans; and • The plan should be transparent to potential participants and explained during the informed consent process. -/- However, there is no guidance on how to fulfill these responsibilities (i.e., linking specific responsibilities with specific stakeholders, conditions, and duration). To fill this gap, the MRCT Center convened a working group in September of 2014 to develop a framework to guide stakeholders with identified responsibilities. This resultant Framework sets forth applicable principles, approaches, recommendations and ethical rationales for PTR regarding continued access to investigational medicines for research participants. (shrink)

The powerful combination of genetic, developmental and molecular approaches possible with the fruit fly, Drosophila melanogaster, has led to a profound understanding of the genetic control of early developmental events. However, Drosophila is a highly specialized long germ insect, and the mechanisms controlling its early development may not be typical of insects or Arthropods in general. The beetle, Tribolium castaneum, offers a similar opportunity to integrate high resolution genetic analysis with the developmental/molecular approaches currently used in other organisms. Early results (...) document significant differences between insect orders in the functions of genes responsible for establishing developmental commitments. (shrink)