During public health crises including the COVID-19 pandemic, resource scarcity and contagion risks may require health systems to shift—to some degree—from a usual clinical ethic, focused on the well-being of individual patients, to a public health ethic, focused on population health. Many triage policies exist that fall under the legal protections afforded by “crisis standards of care,” but they have key differences. We critically appraise one of the most fundamental differences among policies, namely the use of criteria to categorically exclude (...) certain patients from eligibility for otherwise standard medical services. We examine these categorical exclusion criteria from ethical, legal, disability, and implementation perspectives. Focusing our analysis on the most common type of exclusion criteria, which are disease-specific, we conclude that optimal policies for critical care resource allocation and the use of cardiopulmonary resuscitation (CPR) should not use categorical exclusions. We argue that the avoidance of categorical exclusions is often practically feasible, consistent with public health norms, and mitigates discrimination against persons with disabilities. (shrink)

The success of deep brain stimulation (DBS) for movement disorders and the improved understanding of the neurobiologic and neuroanatomic bases of psychiatric diseases have led to proposals to expand current DBS applications. Recent preclinical and clinical work with Alzheimer's disease and obsessive-compulsive disorder, for example, supports the safety of stimulating regions in the hypothalamus and nucleus accumbens in humans. These regions are known to be involved in addiction and overeating associated with obesity. However, the use of DBS targeting these areas (...) as a treatment modality raises common ethical considerations, which include informed consent, coercion, enhancement, threat to personhood, and manipulation of the reward center. Pilot studies for both of these conditions are currently investigational. If these studies show promise, then there is a need to address the ethical concerns related to the initiation of clinical trials including the reliability of preclinical evidence, patient selection, study design, compensation for participation and injury, cost-effectiveness, and the need for long-term follow-up. Multidisciplinary teams are necessary for the ethical execution of such studies. In addition to establishing safety and efficacy, the consideration of these ethical issues is vital to the adoption of DBS as a treatment for these conditions. We offer suggestions about the pursuit of future clinical trials of DBS for the treatment of addiction and overeating associated with obesity and provide a framework for addressing ethical concerns related to treatment. (shrink)

This article describes the spiritual formation training program for counseling students at Richmont Graduate University, an evangelical institution providing Master’s-level instruction for counselors and ministers. This model of spiritual formation has a dual foundation which includes the centrality of love to the Christian life and the importance of attachment to the development of persons. The training is intentionally designed to invite students to pursue a more secure attachment to God, healthier relationships with others, and a more grace-based self-awareness. Integrative and (...) clinical instruction, and experiences that foster establishment of secure attachment are described. Co-curricular efforts in research and student advisement focus on grace and wellness, as well as opportunities for service, and these serve to further contribute to a supportive environment for spiritual formation. (shrink)

The sudden emergence of the COVID-19 pandemic brought global disruption to every aspect of society including healthcare, supply chain, the economy, and social interaction. Among the many emergent considerations were the safety and public health of the public, patients, essential workers, and healthcare professionals. In certain locations, clinical research was halted—or terminated—in deference to the immediate needs of patient care, and clinical trials focusing on the treatment and prevention of coronavirus infection were prioritized over studies focusing on other diseases. Difficult (...) decisions were made rapidly; flexibility and reconsideration were necessary not only because the intensity and severity of infection varied over time and by locale but also because knowledge of the disease and understanding of its treatment grew. Here we discuss the ethical challenges in decision-making and competing ethical tensions during the pandemic in an effort to advance future preparedness. (shrink)

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert Advisory Group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since (...) the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs Programme. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating and integrating evidence to identify causes of human cancer. The advancements adopted include strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. (shrink)

In many research studies, tumor biopsies are an unavoidable requirement for achieving key scientific aims. Yet some commentators view mandatory research biopsies as coercive and suggest they should be optional, or at least optional until further data are obtained regarding their scientific usefulness. Further complicating the ethical picture is the fact that some research biopsies offer a potential for clinical benefit to trial participants. We interviewed and surveyed a convenience sample of participants in phase I clinical trials at a single (...) institution. Our primary aim was to describe phase I participants’ understanding of whether a research biopsy offered them the prospect of medical benefit. We also endeavored to describe participants’ views about biopsies—specifically, the benefits of biopsies, if any, and whether biopsies were acceptable, risky, or discouraged trial participation. Finally, we collected data on demographics and attitudes to see if any strong correlations with misunderstanding, acceptability, or riskiness existed. Overall, the respondents tended to view research biopsies as acceptable, though they did not succeed in identifying the lack of benefit of a research biopsy. These findings call for renewed efforts in consent conversations and documents to carefully describe the benefits, or lack thereof, of research biopsies. (shrink)

Hume discusses the distinction of reason to explain how we distinguish things inseparable, and so identical, e.g., the color and figure of a white globe. He says we note the respect in which the globe is similar to a white cube and dissimilar to a black sphere, and the respect in which it is dissimilar to the first and similar to the second. Unfortunately, Hume takes these differing respects of resemblance to be identical with the white globe (...) itself. Contradiction results, undermining his theory of abstraction. The way out is apparently to admit an intrinsic complexity in even simple things. (shrink)

A longitudinal study of 308 white -collar U.S. employees revealed that feelings of hope and gratitude increase concern for corporate social responsibility. In particular, employees with stronger hope and gratitude were found to have a greater sense of responsibility toward employee and societal issues; interestingly, employee hope and gratitude did not affect sense of responsibility toward economic and safety/quality issues. These findings offer an extension of research by Giacalone, Paul, and Jurkiewicz.

Recent large-scale personal data loss incidents highlighted the need for public bodies to more securely handle confidential data. We surveyed trainees from all specialties in the Welsh Deanery for their knowledge and practice. All registered trainees were invited to participate in an online anonymised survey. There were 880 completed and non-duplicated responses (52.9% response rate). Responses were analysed using Microsoft Access. Over 40% (388/880 (44.1%)) did not use formal guidelines on storage or disposal of confidential data. The majority appeared to (...) dispose of confidential paper documents securely, that is, using shredders and white shredder bags. However, there were significant numbers of unmarked responses. Clinical documents, such as theatre lists, were taken home by 281/880 (31.9%) of trainees. The majority secured their computers (569/871 (65.3%)) by either not keeping patient identifiable data on them or using encryption. However, 302/871 (34.7%) did not adequately secure their computers. The surgical and anaesthetic specialties were least aware of formal confidentiality guidelines (95/178 (53.4%)) and 52/102 (51.0%) respectively) and least secured their computers (106/178 (59.6%) and 63/102 (61.8%) respectively). Education is needed to improve knowledge and practice of confidential data handling. This may be delivered through workshops during induction programmes or as part of European Computer Driving Licence (ECDL) modules. Training is especially indicated for the surgical and anaesthetic specialties. (shrink)

This book is about what makes law possible. A stranger to contemporary legal practice might think such a book unnecessary, but the eight authors of this book share the view that what makes law possible is under siege today. The authors also share the hope that by exploring how law is a humanistic practice that involves whole persons, the siege will be reversed. The pathbreaking work of University of Michigan Law professor Joseph Vining provides the authors' focus for their varied (...) analyses of how law works not through force but, instead, through affinity.Vining's four books and other writings, spanning four decades, reveal the hidden connections by which men and women freely create and sustain a world of meaning through the phenomena we associate with law. Drawing on legal philosophy, theology, musicology, and other humanistic disciplines, the authors join Vining in discovering how law is, as Vining has written, “evidence of view and belief far stronger than academic statement or introspection can provide.” Law as Vining and the other authors reveal it is evidence of our better selves, not of the totalizing and brutalizing selves humans are capable of becoming, sometimes even under cover of law.In addition to the three editors, the book's authors are Joseph Vining, Rev. John McCausland, Hon. John T. Noonan, Jr., Steven Smith, and James Boyd White.Lawyers and all who care about law, the human future, and what human freedom can do to connect person to person as valued will find much to ponder in the chapters of this book. By avoiding jargon and the cliché, the authors follow Vining's lead in illuminating the deep springs of law's vitality and authority. (shrink)

The authors illuminate the process of preservice teacher learning about race through a narrativized case study of Michelle, a White elementary teacher. Michelle displayed elements of White resistance to race but also a desire to engage in teaching about race. When race is viewed as a threshold concept ( Meyer & Land, 2006 ), Michelle's struggles with race highlight important considerations for teacher education.

White begins his inaugural lecture by explaining that philosophy is about explanations. He distinguishes between types of explanation and factors in explanation; he finds "reason," "cause," and, most controversially, "motive" to be examples of the former; and "feelings," "dispositions," "desires," and also "intentions" to be instances of the latter. Unfortunately he has no opportunity to elaborate on exactly what type of explanation a motive is.--W. L. M.

Recent magnetic resonance imaging and pathological studies have indicated that axonal loss is a major contributor to disease progression in multiple sclerosis. 1 H magnetic resonance spectroscopy, through measurement of N -acetyl aspartate, a neuronal marker, provides a unique tool to investigate this. Patients with primary progressive multiple sclerosis have few lesions on conventional MRI, suggesting that changes in normal appearing white matter, such as axonal loss, may be particularly relevant to disease progression in this group. To test this (...) hypothesis NAWM was studied with MRS, measuring the concentration of N -acetyl derived groups. Single-voxel MRS using a water-suppressed PRESS sequence was carried out in 24 patients with primary progressive multiple sclerosis and in 16 age-matched controls. Ratios of metabolite to creatine concentration were calculated in all subjects, and absolute concentrations were measured in 18 patients and all controls. NA/Cr was significantly lower in NAWM in patients than in controls, as was the absolute concentration of NA. There was no significant difference in the absolute concentration of creatine between the groups. This study supports the hypothesis that axonal loss occurs in NAWM in primary progressive multiple sclerosis and may well be a mechanism for disease progression in this group. (shrink)

Recent research suggests holding a structural, rather than interpersonal, understanding of racism is associated with greater impetus to address racial disparities. We believe greater acknowledgment of structural racism also functions to mitigate against empathic failures in response to structural injustices. Given South Africa’s situatedness as a country characterized by historical racialized oppression and continuing unjust legacies, it is appropriate to examine these ideas there. Across three studies, we tested the hypotheses that members of advantaged groups’ perspective taking and empathic concern (...) may be compromised in response to people challenging the unequal status quo, and that a priori perceptions about the impact of structural racism may mitigate or exacerbate such empathic failures. In Study 1, a national sample of White South Africans endorsed perceptions of interpersonal racism more readily than perceptions of structural racism, and expressed high levels of competitive victimhood for perceived anti-White structural racism. Studies 2 and 3 showed that White participants at a historically White university responded with impaired perspective taking and intergroup empathy bias in response to people challenging structural disparities. Finally, reduced recognition of continuing structural racism predicted greater intergroup empathy bias, which, in turn, was associated with reduced willingness to engage in intergroup discussions about past harm. We propose that greater acknowledgment of structural racism is necessary not only to surmount intergroup empathic failures, but also to transcend the socioeconomically unequal legacies of apartheid and beyond. (shrink)

A high percent of oxidative energy metabolism is needed to support brain growth during infancy. Unhealthy diets and limited nutrition, as well as other environmental insults, can compromise these essential developmental processes. In particular, iron deficiency anemia has been found to undermine both normal brain growth and neurobehavioral development. Even moderate ID may affect neural maturation because when iron is limited, it is prioritized first to red blood cells over the brain. A primate model was used to investigate the neural (...) effects of a transient ID and if deficits would persist after iron treatment. The large size and postnatal growth of the monkey brain makes the findings relevant to the metabolic and iron needs of human infants, and initiating treatment upon diagnosis of anemia reflects clinical practice. Specifically, this analysis determined whether brain maturation would still be compromised at 1 year of age if an anemic infant was treated promptly once diagnosed. The hematology and iron status of 41 infant rhesus monkeys was screened at 2-month intervals. Fifteen became ID; 12 met clinical criteria for anemia and were administered iron dextran and B vitamins for 1–2 months. MRI scans were acquired at 1 year. The volumetric and diffusion tensor imaging measures from the ID infants were compared with monkeys who remained continuously iron sufficient. A prior history of ID was associated with smaller total brain volumes, driven primarily by significantly less total gray matter and smaller GM volumes in several cortical regions. At the macrostructual level, the effect on white matter volumes was not as overt. However, DTI analyses of WM microstructure indicated two later-maturating anterior tracts were negatively affected. The findings reaffirm the importance of iron for normal brain development. Given that brain differences were still evident even after iron treatment and following recovery of iron-dependent hematological indices, the results highlight the importance of early detection and preemptive supplementation to limit the neural consequences of ID. (shrink)

Numerous studies have shown almost uniformly positive opinions among patients and physicians regarding theconceptof advance directives (either a healthcare proxy or living will). Several of these studies have also shown that the actual use of advance directives is significantly lower than this enthusiasm would suggest, but they have not explained the apparent discordance. Nor have researchers explained why members of minority groups are much less likely to complete advance directives than are white patients. In this study, we used a (...) focus group methodology to examine the ways in which diverse populations of patients view the medical, philosophical, and practical issues surrounding advance directives. We were motivated by the significantly lower prevalence of advance directives among African-American and Hispanic patients at one urban teaching hospital (18% for Caucasians, 4% for African-Americans, and 2% for Hispanics). Our premise was that African-American and Hispanic populations, who have had higher rates of morbidity and mortality across numerous disease categories, and historically have had limited access to care and opportunities to discuss health concerns, may be more suspicious about the right of autonomy that an advance directive is designed to ensure. (shrink)

Numerous studies have shown almost uniformly positive opinions among patients and physicians regarding theconceptof advance directives (either a healthcare proxy or living will). Several of these studies have also shown that the actual use of advance directives is significantly lower than this enthusiasm would suggest, but they have not explained the apparent discordance. Nor have researchers explained why members of minority groups are much less likely to complete advance directives than are white patients. In this study, we used a (...) focus group methodology to examine the ways in which diverse populations of patients view the medical, philosophical, and practical issues surrounding advance directives. We were motivated by the significantly lower prevalence of advance directives among African-American and Hispanic patients at one urban teaching hospital (18% for Caucasians, 4% for African-Americans, and 2% for Hispanics). Our premise was that African-American and Hispanic populations, who have had higher rates of morbidity and mortality across numerous disease categories, and historically have had limited access to care and opportunities to discuss health concerns, may be more suspicious about the right of autonomy that an advance directive is designed to ensure. (shrink)

Recent attempts by American theorists to produce a radical politics, characterized by the effort to translate the insights of Continental philosophy into a political register, remain trapped in that which they purport to transcend: the metaphysics of subjectivity. In their essential determinations, the works of William Connolly, Stephen White, Richard Ashley, etc. remain firmly anchored in a traditional liberal schema. The reason for this is that while these efforts have sought to de-center political identity by exposing its relational character (...) they have not re-thought 'rela tionality' itself. Our attempt to develop the more profound political impli cations of 'relationality' unfolds through a synthetic explication of Martin Heidegger's analysis of language, Jacques Derrida's logic of the gift, and Emmanuel Levinas' consideration of the Other. The emergent thematic of asymmetrical relationality reconfigures liberalism and provides for a rethinking of the structure of welfare. (shrink)

In Greek mythology, the Chimera is a fire-breathing monster with three heads: one of a lion, one of a horned goat, and one of a powerful dragon. Of similar construction is the presence of three structures in US society, whiteness, patriarchy, and capitalism, which are overwhelmingly represented, valued, and espoused when examining areas of progress, i.e., family income, poverty rates, high school and college graduation rates, and home ownership. This modern American three-headed beast controls, manipulates, and permeates all aspects of (...) US society irrespective of class, culture, or gender. Using critical race theory and critical whiteness studies, this critically interpretive parable draws from the ways in which whiteness, patriarchy, and capitalism function in social, cultural, economic, and educational spheres. The parable tells the story of Sue Libertad and analyzes how this metaphorical Chimera, despite its ubiquity, silently permeates all aspects of her life. Not until a tragic outbreak occurs, does the hegemony of this chimera erodes and Sue. (shrink)

This study aims to reveal patterns of e-petition co-signing behavior that are indicative of the political mobilization of online “communities”. We discuss the case of We the People, a US national experiment in the use of social media technology to enable users to propose and solicit support for policy suggestions to the White House. We apply Baumgartner and Jones's work on agenda setting and punctuated equilibrium, which suggests that policy issues may lie dormant for periods of time until some (...) event triggers attention from the media, interest groups, and elected representatives. In the case study presented, we focus on 21 petitions initiated during the week after the Sandy Hook shooting in opposition to gun control or in support of policy proposals that are alternatives to gun control, which we view as mobilized efforts to maintain stability and equilibrium in a policy system threatening to change. Using market basket analysis and social network analysis we found a core group of petitions in the “support law-abiding gun owners” theme that were highly connected and four “communities” of e-petitioners mobilizing in opposition to change in gun control policies and in favor of alternative proposals. (shrink)

Professional workplaces that embody an “ideal worker” image that is implicitly white and male set-up persistent biases against the competence and suitability for authority of those who are not white men, forcing them to work harder to prove their competence and fit in. The added labor of coping with these burdens is largely invisible to dominant actors in the workplace who do not experience them. To facilitate change by making such burdens visible for all, we present data from (...) a survey of 1,349 architects, including white, Asian, Black, Latinx, and mixed race/other underrepresented men and women, about their specific behavioral experiences of prove-it-again bias, tightrope bias, problems of fit, exclusion, emotion work, and interruptions. Across all measures, white men architects report significantly lower levels of these burdens than do women of any race and almost all non-white men. Consistent with status expectations and stereotype prototypicality theories, we find intersectional patterns in the relative burdens experienced by women and men of different racial groups. Gender differences in bias experiences are greatest among white, less among Asian, and least among Black architects. Women of color report the highest levels of bias overall. (shrink)

Conscience is often referred to yet not understood. This text develops a theory of cognition around a model of conscience, the ACTWith model. It represents a synthesis of results from contemporary neuroscience with traditional philosophy, building from Jamesian insights into the emergence of the self to narrative identity, all the while motivated by a single mechanism as represented in the ACTWith model. Emphasis is placed on clarifying historical expressions and demonstrations of conscience - Socrates, Heidegger, Kant, M.L. King - in (...) light of the ACTWith model, while at once turning these resources to developing the basic architecture. In the end, this text aims to enrich moral theory by improving our understanding of moral cognition, while at once providing a useful tool in everyday moral practice and self-development. (shrink)

I am impressed by how angry Jonathan Crewe is, but I found his remarks confused and unclear and so I’m uncertain how to reply. Whatever the matter it, he wants “to forestall a sense of academic obligation on anyone’s part to work back to Cavell through Bruns” . God knows this might be a good idea, judging from what James Conant says.Conant’s criticisms are directed at the section of my paper called “The Moral of Skepticism,” which he cannot help wanting (...) to rewrite, since he has a much more intimate grasp of Cavell’s thinking than I have. I imagined myself on the outside of Cavell’s texts, trying to characterize them in a certain way, not on the inside, giving an account of their genesis. Obviously my paper is neither philosophy nor literary criticism but a crossdressing of the two that is bound to make someone like Crewe bite his teeth. I appreciate Conant’s forbearance. Gerald L. Bruns is William and Hazel White Professor of English and Comparative Literature at the University of Notre Dame. His most recent book is Heidegger’s Estrangements: Language, Truth, and Poetry in the Later Writings. (shrink)