While various definitions of moral distress have been proposed, some agreement exists that it results from illegitimate constraints in clinical practice affecting healthcare professionals’ moral agency. If we are to reduce moral distress, instruments measuring it should provide relevant information about such illegitimate constraints. Unfortunately, existing instruments fail to do so. We discuss here several shortcomings of major instruments in use: their inability to determine whether reports of moral distress involve an accurate assessment of the requisite clinical and logistical facts (...) in play, whether the distress in question is aptly characterized as moral, and whether the moral distress reported is an appropriate target of elimination. Such failures seriously limit the ability of empirical work on moral distress to foster appropriate change. (shrink)

This book explores how the immediate experience of musical sound relates to processes of meaning construction and discursive mediation. A unique multi-authored work that both draws on and contributes to current debates in ethnomusicology, musicology, psychology, and cognitive science, it presents a novel and productive view of how cultural practice relates to the experience and meaning of musical performance.

To most laypersons and scientists, science and progress appear to go hand in hand, yet philosophers and historians of science have long questioned the inevitability of this pairing. As we take leave of a century acclaimed for scientific advances and progress, Science at Century's End, the eighth volume of the Pittsburgh-Konstanz Series in the Philosophy and History of Science, takes the reader to the heart of this important matter. Subtitled Philosophical Questions on the Progress and Limits of Science, this timely (...) volume contains twenty penetrating essays by prominent philosophers and historians who explore and debate the limits of scientific inquiry and their presumed consequences for science in the 21st century. (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

This study examined the role of temporal orientation and affective frame in the execution of ethical decision-making strategies. In reflecting on a past experience or imagining a future experience, participants thought about experiences that they considered either positive or negative. The participants recorded their thinking about that experience by responding to several questions, and their responses were content-analyzed for the use of ethical decision-making strategies. The findings indicated that a future temporal orientation was associated with greater strategy use. Likewise, a (...) positive affective frame was associated with greater strategy use. Future orientation may permit better strategy execution than a past orientation because it facilitates more objective, balanced contemplation of the reflected-upon situation and minimizes potential self-threat associated with past behavior. A positive affective frame likely improves strategy execution because it facilitates active analysis of the experience. Future directions and implications of these findings are discussed. (shrink)

Clinical ethics support for health care professionals and patients is increasingly seen as part of good health care. However, there is a key drawback to the way CES services are currently offered. They are often performed as isolated and one-off services whose ownership and impact are unclear. This paper describes the development of an integrative approach to CES at the Center of Expertise and Care for Gender Dysphoria at Amsterdam University Medical Center. We specifically aimed to integrate CES into daily (...) work processes at the CEGD. In this paper, we describe the CES services offered there in detail and elaborate on the 16 lessons we learned from the process of developing an integrative approach to CES. These learning points can inform and inspire CES professionals, who wish to bring about greater integration of CES services into clinical practice. (shrink)

Background The use of tissue collected at a forensic post-mortem for forensic genetics research purposes remains of ethical concern as the process involves obtaining informed consent from grieving family members. Two forensic genetics research studies using tissue collected from a forensic post-mortem were recently initiated at our institution and were the first of their kind to be conducted in Cape Town, South Africa. Main body This article discusses some of the ethical challenges that were encountered in these research projects. Among (...) these challenges was the adaptation of research workflows to fit in with an exceptionally busy service delivery that is operating with limited resources. Whilst seeking guidance from the literature regarding research on deceased populations, it was noted that next of kin of decedents are not formally recognised as a vulnerable group in the existing ethical and legal frameworks in South Africa. The authors recommend that research in the forensic mortuary setting is approached using guidance for vulnerable groups, and the benefit to risk standard needs to be strongly justified. Lastly, when planning forensic genetics research, consideration must be given to the potential of uncovering incidental findings, funding to validate these findings and the feedback of results to family members; the latter of which is recommended to occur through a genetic counsellor. Conclusion It is hoped that these experiences will contribute towards a formal framework for conducting forensic genetic research in medico-legal mortuaries in South Africa. (shrink)

These few pages will attempt to analyze the relationships created in the chronically delirious person between himself and his own biography, such as he knows and has experienced it, to which he attaches himself and which dominates him without his knowing it. A few remarks to clarify our vocabulary before getting into the development of this question. We prefer the expression “chronic deliria“, in the plural, to the word “psychosis”, used in the singular. The former term is clinical, and therefore (...) empirical, whereas the second derives from theories; and, especially, the former does not immediately imply a unity of process as opposed to the effective diversity of semiotic appearances. Moreover, the nominal adjective “psychotic“ runs the risk of both clandestinely bringing in hidden presuppositions and of re-establishing the old presumed unity with mental alienation, which had, indeed, been exorcised by J. P. Falret by the middle of the nineteenth century. (shrink)

The use of tissue collected at a forensic post-mortem for forensic genetics research purposes remains of ethical concern as the process involves obtaining informed consent from grieving family members. Two forensic genetics research studies using tissue collected from a forensic post-mortem were recently initiated at our institution and were the first of their kind to be conducted in Cape Town, South Africa. This article discusses some of the ethical challenges that were encountered in these research projects. Among these challenges was (...) the adaptation of research workflows to fit in with an exceptionally busy service delivery that is operating with limited resources. Whilst seeking guidance from the literature regarding research on deceased populations, it was noted that next of kin of decedents are not formally recognised as a vulnerable group in the existing ethical and legal frameworks in South Africa. The authors recommend that research in the forensic mortuary setting is approached using guidance for vulnerable groups, and the benefit to risk standard needs to be strongly justified. Lastly, when planning forensic genetics research, consideration must be given to the potential of uncovering incidental findings, funding to validate these findings and the feedback of results to family members; the latter of which is recommended to occur through a genetic counsellor. It is hoped that these experiences will contribute towards a formal framework for conducting forensic genetic research in medico-legal mortuaries in South Africa. (shrink)

Feminists debate whether women can autonomously embrace their own subordination. Some argue that it is the process of identifying with desires and values that matters; others, that it is the content of the desires and values that matters. In this paper, I introduce a novel class of cases of ‘thwarted autonomy,’ in which women pursue autonomy but in ways that reinforce gendered subordination, and draw on these cases to develop an expressivist view of women’s autonomy. On this view, agents must (...) embody desires and values in the social world if they are to achieve self-understanding, such that the social world mediates the relation-to-self. Oppressive meanings and norms can channel this expressive activity in ways that violate women’s physical integrity and involve self-abnegation that is incompatible with autonomy. (shrink)

Artificial intelligence (AI) based clinical decision support systems (CDSS) are becoming ever more widespread in healthcare and could play an important role in diagnostic and treatment processes. For this reason, AI‐based CDSS has an impact on the doctor–patient relationship, shaping their decisions with its suggestions. We may be on the verge of a paradigm shift, where the doctor–patient relationship is no longer a dual relationship, but a triad. This paper analyses the role of AI‐based CDSS for shared decision‐making to better (...) comprehend its promises and associated ethical issues. Moreover, it investigates how certain AI implementations may instead foster the inappropriate paradigm of paternalism. Understanding how AI relates to doctors and influences doctor–patient communication is essential to promote more ethical medical practice. Both doctors' and patients' autonomy need to be considered in the light of AI. (shrink)

PurposeInformation and communications technologies (ICTs) have transformed the lives of many people around the world, yet billions remain unconnected. While many initiatives attempt to “connect the unconnected,” initiatives focused on access and skills-development alone will still fall short. Based on the authors’ experience with the SolarSPELL initiative, this study aims to propose using the concept of socio-technical awareness as a step forward in conceptualizing a more accurate picture of capabilities necessary to enable people to make meaningful use of the internet.Design/methodology/approachThis (...) paper uses an integrative literature review for the ideas related to the digital divide, digital inclusion and digital literacies, as well as the applied work of the authors in the SolarSPELL initiative, to develop the concept of socio-technical awareness, which is presented as a method for understanding empowered, meaningful internet use.FindingsThe argument is made that access, skills- and literacy-development are necessary but insufficient conditions for meaningful ICTs use. Accordingly, a third concept, socio-technical awareness, is introduced, and the case is made for including this concept in both application and measurement of meaningful use of ICTs.Practical implicationsThe design of digital inclusion initiatives should focus on increasing socio-technical awareness to empower users to make meaningful use of digital technologies.Originality/valueTaking a step further than most assessments of the digital divide or digital inclusion, this study proposes that to achieve meaningful internet use, people need access, requisite skills development and socio-technical awareness, to be able to make informed, empowered decisions about ICT use. (shrink)

Jecker and colleagues open (2024) a critical and needed dialogue about the ethics of international conferencing. In particular, they focus on proposing a set of principles in selecting the location...

Informed consent is at the core of the clinical relationship. With the introduction of machine learning in healthcare, the role of informed consent is challenged. This paper addresses the issue of whether patients must be informed about medical ML applications and asked for consent. It aims to expose the discrepancy between ethical and practical considerations, while arguing that this polarization is a false dichotomy: in reality, ethics is applied to specific contexts and situations. Bridging this gap and considering the whole (...) picture is essential for advancing the debate. In the light of the possible future developments of the situation and the technologies, as well as the benefits that informed consent for ML can bring to shared decision-making, the present analysis concludes that it is necessary to prepare the ground for a possible future requirement of informed consent for medical ML. (shrink)

This study examined the role of temporal orientation and affective frame in the execution of ethical decision-making strategies. In reflecting on a past experience or imagining a future experience, participants thought about experiences that they considered either positive or negative. The participants recorded their thinking about that experience by responding to several questions, and their responses were content-analyzed for the use of ethical decision-making strategies. The findings indicated that a future temporal orientation was associated with greater strategy use. Likewise, a (...) positive affective frame was associated with greater strategy use. Future orientation may permit better strategy execution than a past orientation because it facilitates more objective, balanced contemplation of the reflected-upon situation and minimizes potential self-threat associated with past behavior. A positive affective frame likely improves strategy execution because it facilitates active analysis of the experience. Future directions and implications of these findings are discussed. (shrink)

Corporations significantly influence the public and political spheres. In light of this corporate power in society, academics have criticized the lack of legitimization (i.e., the legitimacy gap) and highlighted a potential divergence between corporate resource allocation and the needs and preferences of the public (i.e., the social issues gap). To address these problems, democratizing organizations has been proposed as a potential solution. In line with this, the authors argue that an increase in corporate power outside the economic realm should be (...) counterbalanced by more democratic corporate governance (i.e., an internalization of democracy). While important groundwork exists, academic attention to these topics remains limited. The authors provide an overview of the literature linking corporate power and the claim for democratizing organizations, advocate for legitimization, identify research gaps, and develop a research agenda to inspire and guide future research efforts. The paper's findings suggest the importance of conceptual and empirical research on the micro-, meso-, and macro-levels and the cross-level effects, which is needed to advance this incipient research area. Future research must (1) clearly define corporate power and discuss how democratizing organizations can contribute to more legitimate organizational decisions, (2) unveil novel approaches for more democratic corporate governance, and (3) understand the organizational- and individual-level factors necessary for the successful realization of democratic organizations. (shrink)

In this commentary, we support a complex, mosaic, and multimodal approach to the evolution of intelligence. Using the arcuate fasciculus as an example of discontinuity in the evolution of neurobiological architectures, we argue that the strict dichotomy of modules versus G, adopted by Burkart et al. in the target article, is insufficient to interpret the available statistical and experimental evidence.

Beginning in the nineteenth century, scientists speculated that the Pleistocene megafauna—species such as the giant ground sloth, wooly mammoth, and saber-tooth cat—perished because of rapid climate change accompanying the end of the most recent Ice Age. In the 1950s, a small network of ecologists challenged this view in collaboration with archeologists who used the new tool of radiocarbon dating. The Pleistocene overkill hypothesis imagined human hunting, not climate change, to be the primary cause of megafaunal extinction. This article situates the (...) Pleistocene overkill hypothesis in a broader history of the emergence of historical ecology as a distinct sub-discipline of paleoecology. Tracing the work of the Yale Geochronometric Laboratory and an interdisciplinary research network that included Paul Sears, Richard Foster Flint, Edward Deevey, Kathryn Clisby, and Paul S. Martin, it reveals how both the methods and the meaning of studying fossil pollen shifted between the 1910s and 1960s. First used as a tool for fossil fuel extraction, fossil pollen became a means of envisioning climatic history, and ultimately, a means of reimagining global ecological history. First through pollen stratigraphy and then through radiocarbon dating, ecologists reconstructed past biotic communities and rethought the role of humans in these communities. By the 1980s, the discipline of historical ecology would reshape physical environments through the practice of ecological restoration. (shrink)

This study shows how Goethe's Die pilgernde Torin, Kleist's Die Marquise von O..., Hawthorne's The Scarlet Letter, and James' Daisy Miller can appeal to the reader who identifies a message friendly towards woman and her plight, whether the message was the author's intention or not.

Ciertos rasgos de la filosofía de Popper y Gadamer hacen pensar en dos concepciones irreconciliables. Sin embargo, bajo muchos aspectos, ambos filósofos acuerdan de modo notable, más allá del hecho histórico de que ninguno dé ellos haya destacado el valor de esos acuerdos, subrayando, en cambio, las discrepancias. La intención fenomenológica que guía la hermenéutica de Gadamer difiere en algunos rasgos fundamentales del racionalismo crítico popperiano. En cambio, Popper y Gadamer coinciden en la visión humanística de la filosofía y se (...) apartan del ideal de certeza de la ilustración. Con distintos argumentos, ambos se oponen al relativismo subjetivista y defienden el carácter objetivo del conocimiento. Bajo el supuesto de que es posible señalar coincidencias sustantivas entre estos dos filósofos, me propongo confrontar algunas de sus afirmaciones, en especial en lo referido a: 1) La valoración positiva del prejuicio en la formación del conocimiento; 2) el carácter abierto de la experiencia; 3) El papel del lenguaje en la argumentación en favor del carácter objetivo del conocimiento. (shrink)

I. En el presente trabajo me propongo examinar criticamente la fundamentación popperiana de la libertad, que a mi juicio, puede esquematizarse de la siguiente manera- 2. - Nuestra conducta está influida por el conocimiento, o sea, por las teorías que aceptamos. 3. - Somos libres frente a nuestras teorías, es decir, su aceptación o rechazo depende de nuestras decisiones. Por lo tanto, 4. - Nuestra conducta no está determinada sino que, por el contrario, es libre. Lo que intentaré discutir es, (...) no la corrección del argumento precedente, sino la segunda de sus premisas Después de mostrar que Popper efectivamente sostiene la tesis que le he atribuido, trataré de sugerir que la relación que postula entre libertad y racionalidad tropieza con dificultades graves. Más específicamente, procuraré defender la idea de que, en la aceptación o el rechazo de teorías somos racionales justamente en la medida en que nuestras decisiones" no son libres. (shrink)

The private letter, one of the most representative expressions of mass literacy, was the product of improved postal services and epistolary manuals. In the nineteenth century, which also witnessed the new phenomenon of mass emigration, letter writing became one of the most common practices. This article discusses the correspondence of José Moldes, an Asturian who left Spain for Puerto Rico at the age of fourteen and settled shortly afterwards in Chile. He died in his native Asturias at the age of (...) sixty-one. Throughout these fifty or so years, José wrote letters to keep in contact with members of his family, to control them when he became head of the household or to manage his businesses and investments. About 120 of his letters survived in the Moldes-Barreras family archive, through which we can reconstruct his experiences. The essential characteristics of this epistolary corpus emerge from an analysis of its material and graphic aspects, suggesting the profound influence of immigration on personal writing. (shrink)

What is the nature of agency under oppressive social conditions? Oppressive structures inhibit our agency in ways to which we are often blind, yet social movements show that as agents we can enact emancipatory change. My dissertation articulates a social ontology to account for this conflict between structure and agency. I analyze structures in terms of practices built around implicit values, which require agents to occupy valued or denigrated statuses. Agents can participate in practices without being aware of their oppressive (...) frames, thereby unwittingly perpetuating oppression. Making these frameworks explicit can lead to social change but, as oppressive practices shape agents’ senses of value and status, practices themselves must also change. (shrink)

Background Much like academic-industry partnerships, industry financial support of patient advocacy organizations has become very common in recent years. While financial conflicts of interest between PAOs and industry have received more attention in recent years, robust efforts to mitigate these conflicts are still limited. Main body The authors outline the possible benefits and ethical concerns that can result from financial interactions between biomedical companies and PAOs. They argue that the use of novel strategies, such as the creation of a standing (...) ethics committee, could be helpful in managing FCOIs and ensuring the warranted trust of PAO’s constituents. Although ethics committees to address FCOIs are common in the academic context, its use by PAOs is still limited. The authors conclude by describing the process of development and implementation of such an ethics committee at the Crohn’s & Colitis Foundation. Conclusions While collaborations with industry can result in conflicts of interest, PAOs can develop strategies to address those conflicts. One such strategy is the creation of a standing independent ethics committee to guide PAOs on new and/or existing programs and protocols as they pertain to their industry relationships. (shrink)

El presente trabajo es un estudio descriptivo y con un enfoque sincrónico que da muestra de las deficiencias de los profesores universitarios al redactar textos científicos. Este estudio tiene como objetivo proponer varias acciones de superación para perfeccionar el manejo del lenguaje y el arte de redactar de los docentes de la Universidad de Ciencias Médicas "Dr. Faustino Pérez Hernández" de la provincia Sancti Spíritus que cursan la octava edición de la Maestría en Ciencias de la Educación de la Universidad (...) de Sancti Spíritus "José Martí Pérez". Para darle cumplimiento a este propósito, se aplicaron varios métodos y técnicas de recolección de datos a una muestra seleccionada al azar de informantes y de sus publicaciones, lo que permitió fundamentar la existencia de varias problemáticas en la redacción científica de dichos profesores y la necesidad de implementar formas organizativas básicas del proceso de educación de posgrado para su inmediata y eficaz aplicación. The present work is a descriptive study grounded in a synchronic approach that identifies the deficiencies of university professors when writing scientific texts. This study aims to propose several measures to improve the use of language and the art of writing of teachers of the " Dr. Faustino Pérez Hernández" University of Medical Sciences in Sancti Spíritus, Cuba who are participating in the eighth edition of the Master's Degree in Educational Sciences program at the "José Martí Pérez" University, also located in Sancti Spiritus. Several methods and techniques of data collection were applied to a random sample of informants and their scientific articles. This allowed for the detection of several problems in scientific writing and the need to implement basic organizational forms of postgraduate education for immediate and effective application. (shrink)

Human individuals often exhibit important differences in their sensitivity to ionising radiation. Extensive literature links radiation sensitivity with impaired DNA repair which is due to a lack of correct functioning in many proteins involved in DNA‐repair pathways and/or in DNA‐damage checkpoint responses. Given that ionising radiation is an important and widespread diagnostic and therapeutic tool, it is important to investigate further those factors and mechanisms that underlie individual radiosensitivity. Recently, evidence is accumulating that telomere function may well be involved in (...) cellular and organism responses to ionising radiation, broadening still further the currently complex and challenging scenario. BioEssays. BioEssays 28: 1172–1180, 2006. © 2006 Wiley Periodicals, Inc. (shrink)

Cognitive scientists distinguish between automatic and controlled mental processes. Automatic processes are either innately involuntary or become automatized through extensive practice. For example, reading words is a purportedly automatic process for proficient readers and the Stroop effect is consequently considered the “gold standard” of automated performance. Although the question of whether it is possible to regain control over an automatic process is mostly unasked, we provide compelling data showing that posthypnotic suggestion reduced and even removed Stroop interference in highly hypnotizable (...) individuals. Drawing on a large sample of highly hypnotizable participants, we examined the effects of suggestion on Stroop performance both with and without a posthypnotic suggestion to perceive the input stream as meaningless symbols. We show that suggestion administered to highly hypnotizable persons significantly reduced Stroop interference and derailed a seemingly automatic process. (shrink)

This study examined the role of reflection on personal cases for making ethical decisions with regard to new ethical problems. Participants assumed the position of a business manager in a hypothetical organization and solved ethical problems that might be encountered. Prior to making a decision for the business problems, participants reflected on a relevant ethical experience. The findings revealed that application of material garnered from reflection on a personal experience was associated with decisions of higher ethicality. However, whether the case (...) was viewed as positive or negative, and whether the outcomes, processes, or outcomes and processes embedded in the experience were examined, influenced the application of case material to the new problem. As expected, examining positive experiences and the processes involved in those positive experiences resulted in greater application of case material to new problems. Future directions and implications for understanding ethical decision making are discussed. (shrink)

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

Peer review is a widely accepted instrument for raising the quality of science. Peer review limits the enormous unstructured influx of information and the sheer amount of dubious data, which in its absence would plunge science into chaos. In particular, peer review offers the benefit of eliminating papers that suffer from poor craftsmanship or methodological shortcomings, especially in the experimental sciences. However, we believe that peer review is not always appropriate for the evaluation of controversial hypothetical science. We argue that (...) the process of peer review can be prone to bias towards ideas that affirm the prior convictions of reviewers and against innovation and radical new ideas. Innovative hypotheses are thus highly vulnerable to being “filtered out” or made to accord with conventional wisdom by the peer review process. Consequently, having introduced peer review, the Elsevier journal Medical Hypotheses may be unable to continue its tradition as a radical journal allowing discussion of improbable or unconventional ideas. Hence we conclude by asking the publisher to consider re-introducing the system of editorial review to Medical Hypotheses. (shrink)