climate are both linked to an organization's ability to retain healthcare professionals and increase their level of job satisfaction, leaders have a corollary responsibility to address moral distress. We recommend that leaders should provide access to ethics education and resources, offer interventions such as ethics debriefings, establish ethics committees, and/or hire a bioethicist to develop ethics capacity and to assist with addressing healthcare provider moral distress....

Background There are numerous ethical challenges that can impact patients and families in the health care setting. This paper reports on the results of a study conducted with a panel of clinical bioethicists in Toronto, Ontario, Canada, the purpose of which was to identify the top ethical challenges facing patients and their families in health care. A modified Delphi study was conducted with twelve clinical bioethicist members of the Clinical Ethics Group of the University of Toronto Joint Centre for Bioethics. (...) The panel was asked the question, what do you think are the top ten ethical challenges that Canadians may face in health care? The panel was asked to rank the top ten ethical challenges throughout the Delphi process and consensus was reached after three rounds. Discussion The top challenge ranked by the group was disagreement between patients/families and health care professionals about treatment decisions. The second highest ranked challenge was waiting lists. The third ranked challenge was access to needed resources for the aged, chronically ill, and mentally ill. Summary Although many of the challenges listed by the panel have received significant public attention, there has been very little attention paid to the top ranked challenge. We propose several steps that can be taken to help address this key challenge. (shrink)

One hypothesis concerning the human dorsal anterior cingulate cortex (ACC) is that it functions, in part, to signal the occurrence of conflicts in information processing, thereby triggering compensatory adjustments in cognitive control. Since this idea was first proposed, a great deal of relevant empirical evidence has accrued. This evidence has largely corroborated the conflict-monitoring hypothesis, and some very recent work has provided striking new support for the theory. At the same time, other findings have posed specific challenges, especially concerning the (...) way the theory addresses the processing of errors. Recent research has also begun to shed light on the larger function of the ACC, suggesting some new possibilities concerning how conflict monitoring might fit into the cingulate's overall role in cognition and action. (shrink)

[T. M. Scanlon] It is clearly impermissible to kill one person because his organs can be used to save five others who are in need of transplants. It has seemed to many that the explanation for this lies in the fact that in such cases we would be intending the death of the person whom we killed, or failed to save. What makes these actions impermissible, however, is not the agent's intention but rather the fact that the benefit envisaged does (...) not justify an exception to the prohibition against killing or the requirement to give aid. The difference between this explanation and one appealing to intention is easily overlooked if one fails to distinguish between the prospective use of a moral principle to guide action and its retrospective use to appraise the way an agent governed him or herself. Even if this explanation is accepted, however, it remains an open question whether and how an agent's intention may be relevant to the permissibility of actions in other cases. \\\ [Jonathan Dancy] My first four sections concentrate on the second section of Professor Scanlon's contribution, where he lays out his conception of moral principles and of the role they play in theory and practice. I will raise questions on the following issues: 1. Scanlon's initial introduction of the notion of a principle. 2. His rejection of the standard view that principles are concerned with the forbidding, permitting and requiring of actions. 3. His rejection of pro tanto conceptions of principles in favour of a conception of them as conclusive. 4. The resulting account of what it is for a principle to face and survive exceptions. Scanlon's discussion of these matters here both appeals to and is in some respects more detailed than the relevant section of his recent What We Owe to Each Other. The topic is interesting both for the role played by principles in Scanlon's present discussion of intention and permissibility, and more generally because of his account of wrongness: an act is wrong iff it is ruled out by principles that nobody could reasonably reject. The remainder of my contribution is concerned with the ostensible focus of IP, namely the relevance of agent-intentions to the permissibility of what is done. (shrink)

It is clearly impermissible to kill one person because his organs can be used to save five others who are in need of transplants. It has seemed to many that the explanation for this lies in the fact that in such cases we would be intending the death of the person whom we killed, or failed to save. What makes these actions impermissible, however, is not the agent's intention but rather the fact that the benefit envisaged does not justify an (...) exception to the prohibition against killing or the requirement to give aid. The difference between this explanation and one appealing to intention is easily overlooked if one fails to distinguish between the prospective use of a moral principle to guide action and its retrospective use to appraise the way an agent governed him or herself. Even if this explanation is accepted, however, it remains an open question whether and how an agent's intention may be relevant to the permissibility of actions in other cases. \\\ [Jonathan Dancy] My first four sections concentrate on the second section of Professor Scanlon's contribution, where he lays out his conception of moral principles and of the role they play in theory and practice. I will raise questions on the following issues: 1. Scanlon's initial introduction of the notion of a principle. 2. His rejection of the standard view that principles are concerned with the forbidding, permitting and requiring of actions. 3. His rejection of pro tanto conceptions of principles in favour of a conception of them as conclusive. 4. The resulting account of what it is for a principle to face and survive exceptions. Scanlon's discussion of these matters here both appeals to and is in some respects more detailed than the relevant section of his recent What We Owe to Each Other. The topic is interesting both for the role played by principles in Scanlon's present discussion of intention and permissibility, and more generally because of his account of wrongness: an act is wrong iff it is ruled out by principles that nobody could reasonably reject. The remainder of my contribution is concerned with the ostensible focus of IP, namely the relevance of agent-intentions to the permissibility of what is done. (shrink)

We argue that heritability estimates cannot be used to make informed judgments about the populations from which they are drawn. Furthermore, predicting changes in heritability from population changes is likely impossible, and of limited value. We add that the attempt to separate human environments into cultural and non-cultural components does not advance our understanding of the environmental multiplier effect.

The growing popularization of stakeholder theory among management scholars has offered a useful framework for understanding the multiple and interdependent roles of government and business in an increasingly challenging political and regulatory environment. Despite this trend, attention to the role and responsibility of government to protect citizen rights has been limited. To the two traditional stakeholder theory views of government where the focal organization remains the firm, we propose to add two views by pivoting the government’s place and making it (...) the focal organization. We thus describe governments as serving four roles in the business–government–society nexus. For each role, we analyze typical governmental activities/behaviors, relationships with firms’ stakeholders, as well as the challenges and limits to these roles. We also focus on the central notion of salience amplification, as a means of checks and balances across stakeholders in order to safeguard citizen rights and reveal the greater good. (shrink)

The ability to learn the direction of causal relations is critical for understanding and acting in the world. We investigated how children learn causal directionality in situations in which the states of variables are temporally dependent (i.e., autocorrelated). In Experiment 1, children learned about causal direction by comparing the states of one variable before versus after an intervention on another variable. In Experiment 2, children reliably inferred causal directionality merely from observing how two variables change over time; they interpreted Y (...) changing without a change in X as evidence that Y does not influence X. Both of these strategies make sense if one believes the variables to be temporally dependent. We discuss the implications of these results for interpreting previous findings. More broadly, given that many real-world environments are characterized by temporal dependency, these results suggest strategies that children may use to learn the causal structure of their environments. (shrink)

Advocates for the professionalization of clinical bioethics argue that bioethics professionals play an important role in contemporary medicine and patient care, especially when addressing complex ethical questions that arise in the delivery of reproductive medicine. For bioethics consultants to serve effectively, they need adequate training in the medical and ethical issues that patients and clinicians will face, and they need skills to facilitate effective dialog among all parties. Because clinical ethics consultation is a “high‐stakes endeavor” that can acutely affect patient (...) care, efforts are under way to ensure that bioethics consultants have the competence to provide such guidance. Yet to date, no studies have examined whether the training of bioethics consultants meets the needs of health care professionals who are on the front lines of such issues. In fact, limited information is available on the reproductive health issues that bioethics training programs address or the degree to which these programs meet the needs of patients confronting reproductive health decisions and their clinicians. It is therefore important to answer this key question: What are the primary ethical issues encountered in reproductive medicine that currently affect patient care? Equally important, are bioethics training programs prepared to address those issues?To begin to answer these questions, we conducted parallel surveys of directors of graduate bioethics training programs and obstetrician‐gynecologists. The goal of this project is to lay the groundwork to establish a working partnership between bioethics educators and reproductive medicine practitioners to address the often troubling and frequently complex ethical issues in reproductive medicine. (shrink)

Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

In his writings, Pope Francis describes a culture of interfaith and intercultural encounter as the foundation of lasting peace, friendship, and reconciliation among peoples. Far from superficial, a culture of encounter is built upon the slow work of honoring differences and forming social bonds across differences. In the first part of this paper, the authors investigate correspondences between the theology of encounter in the teaching and witness of Martin Buber and Pope Francis, in which the sacred, the ground of reality, (...) and the potential for redemption are revealed in the engaged space “between” self and other. In the second part of the paper, they explore how these ideas are actualized in practices of nonviolence, such as dialogue. In conclusion, they identify how these ideas and role models suggest a road map to build a culture of nonviolence and just peace through encounter within fractured societies throughout the world today. (shrink)

As part of a review symposium on DARWIN'S ARGUMENT BY ANALOGY: FROM ARTIFICIAL TO NATURAL SELECTION (2021), the journal METASCIENCE invited Roger White, Jon Hodge and me to submit a response to the thoughtful commentaries on our book by Andrea Sullivan-Clarke, David Depew and Andrew Inkpen.

This study examined the link between employees’ adult attachment orientations and perceptions of line managers’ interpersonal justice behaviors, and the moderating effect of national culture. Participants from countries categorized as low collectivistic and high collectivistic completed an online survey. Attachment anxiety and avoidance were negatively related to interpersonal justice perceptions. Cultural differences did not moderate the effects of avoidance. However, the relationship between attachment anxiety and interpersonal justice was non-significant in the Southern Asia cultural cluster. Our findings indicate the importance (...) of ‘fit’ between cultural relational values and individual attachment orientations in shaping interpersonal justice perceptions, and highlight the need for more non-western organizational justice research. (shrink)

Software application ontologies have the potential to become the keystone in state-of-the-art information management techniques. It is expected that these ontologies will support the sort of reasoning power required to navigate large and complex terminologies correctly and efficiently. Yet, there is one problem in particular that continues to stand in our way. As these terminological structures increase in size and complexity, and the drive to integrate them inevitably swells, it is clear that the level of consistency required for such navigation (...) will become correspondingly difficult to maintain. While descriptive semantic representations are certainly a necessary component to any adequate ontology-based system, so long as ontology engineers rely solely on semantic information, without a sound ontological theory informing their modeling decisions, this goal will surely remain out of reach. In this paper we describe how Language and Computing nv (L&C), along with The Institute for Formal Ontology and Medical Information Sciences (IFOMIS), are working towards developing and implementing just such a theory, combining the open software architecture of L&C’s LinkSuiteTM with the philosophical rigor of IFOMIS’s Basic Formal Ontology. In this way we aim to move beyond the more or less simple controlled vocabularies that have dominated the industry to date. (shrink)

The law of informed consent to medical treatment has recently been extensively overhauled in England. The 2015 Montgomery judgment has done away with the long-held position that the information to be disclosed by doctors when obtaining valid consent from patients should be determined on the basis of what a reasonable body of medical opinion agree ought to be disclosed in the circumstances. The UK Supreme Court concluded that the information that is material to a patient’s decision should instead be judged (...) by reference to a new two-limbed test founded on the notions of the ‘reasonable person’ and the ‘particular patient’. The rationale outlined in Montgomery for this new test of materiality, and academic comment on the ruling’s significance, has focused on the central ethical importance that the law now accords to respect for patient autonomy in the process of obtaining consent from patients. In this paper, we dispute the claim that the new test of materiality articulated in Montgomery equates with respect for autonomy being given primacy in re-shaping the development of the law in this area. We also defend this position, arguing that our revised interpretation of Montgomery’s significance does not equate with a failure by the courts to give due legal consideration to what is owed to patients as autonomous decision-makers in the consent process. Instead, Montgomery correctly implies that doctors are ethically obliged to attend to a number of relevant ethical considerations in framing decisions about consent to treatment, which include subtle interpretations of the values of autonomy and well-being. Doctors should give appropriate consideration to how these values are fleshed out and balanced in context in order to specify precisely what information ought to be disclosed to a patient as a requirement of obtaining consent, and as a core component of shared decision-making within medical encounters more generally. (shrink)

Aristotle considered moral beauty to be the telos of the human virtues. Displays of moral beauty have been shown to elicit the moral emotion of elevation and cause a desire to become a better person and to engage in prosocial behavior. Study 1 (N = 5380) shows engagement with moral beauty is related to several psychological constructs relevant to moral education, and structural models reveal that the story of engagement with moral beauty may be considered a story of love and (...) connectedness; it is uniquely predictive of caring for, being empathic of, loving, and valuing benevolence toward others. Study 2 (N = 542) demonstrates that the personality trait of engaging with moral beauty moderates susceptibility to elevation. These studies suggest that encouraging students to engage with moral beauty might increase their desire to become better persons and to do good. Convergent with other research showing that moral emotions motivate moral behavior, we suggest that moral education programs increase their focus on developing engagement with moral beauty. (shrink)

Levelt et al. attempt to “model their theory” with WEAVER ++. Modeling theories requires a model theory. The time is ripe for a methodology for building, testing, and evaluating computational models. We propose a tentative, five-step framework for tackling this problem, within which we discuss the potential strengths and weaknesses of Levelt et al.'s modeling approach.

This study examines the relative effects of three policy levers on health coverage and costs in plans aimed at covering all Americans. Specifically, using microsimulation analysis and hypothetical proposals, it assesses how the generosity of financial assistance, an employer mandate, and an individual mandate affect the level of uninsurance, distribution of coverage, and federal costs, holding delivery system and benefits constant. The results suggest that only an individual mandate would cover all the uninsured; neither an employer mandate nor generous subsidies (...) alone would be sufficient. The distribution of coverage would be least disrupted by an employer mandate, while 7.3% of people could lose employer coverage with generous subsidies and a voluntary purchasing pool. Federal costs would be highest under a combined individual and employer mandate since there would be costs to minimize disruption. Although less generous subsidies coupled with an individual mandate could yield universal coverage at a low federal cost, doing so would require large, new payments by individuals. Other key trade-offs are discussed. (shrink)

This article reflects on context effects in the study of behavioral ethics and organizational justice. After a general overview, we review three key challenges confronting research in these two domains. First, we consider social scientific versus normative approaches to inquiry. The former aims for a scientific description, while the latter aims to provide prescriptive advice for moral conduct. We argue that the social scientific view can be enriched by considering normative paradigms. The next challenge we consider, involves the duality of (...) morally upright versus morally inappropriate behavior. We observe that there is a long tradition of categorizing behavior dichotomously rather than continuously. We conclude by observing that more research is needed to compare the dichotomous versus continuous perspectives. Third, we examine the role of “cold” cognitions and “hot” affect in making judgments of ethicality. Historically speaking, research has empathized cognition, though recent work has begun to add greater balance to affective reactions. We argue that both cognition and affect are important, but more research is needed to determine how they work together. After considering these three challenges, we then turn to our special issue, providing short reviews of each contribution and how they help in better addressing the three challenges we have identified. (shrink)

Disordered sleep is strongly linked to future depression, but the reasons for this link are not well understood. This study tested one possibility – that poorer sleep impairs emotion regulation, which over time leads to increased depressive symptoms. Our sample contained individuals with a wide range of depression symptoms, who were followed clinically over six months and reassessed for changes in depressive symptom levels. As predicted, maladaptive ER mediated both cross-sectional and prospective relationships between poor sleep quality and depression symptoms. (...) In contrast, an alternative mediator, physical activity levels, did not mediate the link between sleep quality and depression symptoms. Maladaptive ER may help explain why sleep difficulties contribute to depression symptoms; implications for interventions are discussed. (shrink)

We sought to gain more insight into the effects of attention focus and time constraints on skill learning and performance in novices and experts by means of two complementary experiments using a table tennis paradigm. Experiment 1 showed that skill-focus conditions and slowed ball frequency disrupted the accuracy of experts, but dual-task conditions and speeded ball frequency did not. For novices, only speeded ball frequency disrupted accuracy. In Experiment 2, we extended these findings by instructing novices either explicitly or by (...) analogy . Explicitly instructed novices were less accurate in skill-focused and dual-task conditions than in single-task conditions. Following analogy instruction novices were less accurate in the skill-focused condition, but maintained accuracy under dual-task conditions. Participants in both conditions retained accuracy when ball frequency was slowed, but lost accuracy when ball frequency was speeded, suggesting that not attention, but motor dexterity, was inadequate under high temporal constraints. (shrink)

Spirituality is a universal human experience. Within the process of development, the role of spirituality as a developmental asset is understudied in general and especially within majority world contexts. In this article, we frame advances in spirituality research and practice with youth around three pillars: (a) theory, (b) measurement, and (c) research about and evaluations of positive youth development (PYD) programs in low- and middle-income countries. We place PYD programs as associated with dynamic, relational developmental systems (RDS)-based models of human (...) development, describe spirituality and the “Big Three” features of effective PYD programs as aligning to promote thriving, and discuss spirituality as a strength, as a key asset, in the lives of youth. We discuss advances in developmental methods and measures for describing, explaining, and promoting spirituality and PYD and offer a case study that responds to a United States Agency for International Development call for action and evaluations of spirituality within the context of a PYD program in the majority world. Considerations for future research about spirituality and youth development are discussed. (shrink)

Cognitive Science, Volume 46, Issue 2, February 2022.

The attitudes of patients' to consent have changed over the years, but there has been little systematic study of the attitudes of anaesthetists and surgeons in this process. We aimed to describe observations made on the attitudes of medical professionals working in the UK to issues surrounding informed consent.

Research on multiple relationships by practicing psychologists has typically presumed the presence of a professional relationship and focused on the ethicality of subsequent, nonprofessional relationships. Instead, this study focused on the question of what, exactly, constitutes the professional relationship in the first place. Practicing psychologists and undergraduates responded to vignettes portraying various early stages of interaction between a therapist and a prospective client. Participants' responses indicated that determinations of professional relationship establishment, and the ethicality of subsequent nonprofessional relationships, depended upon (...) the degree of engagement. Some differences emerged between perceptions by professionals and nonprofessionals. Ethical and professional implications are discussed. (shrink)

There is societal consensus that cancer clinical trial participation is unjust because some sociodemographic groups have been systematically underrepresented. Despite this, neither a definition nor an ethical explication for the justice norm of equity has been clearly articulated in this setting, leading to confusion over its application and goals. Herein we define equity as acknowledging sociodemographic circumstances and apportioning resource and opportunity allocation to eliminate disparities in outcomes, and we explore the issues and tensions this norm generates through practical examples. (...) We assess how equality-based enrollment structures in clinical cancer research have perpetuated historical disparities and what equity-based alternatives are necessary to achieve representativeness and an expansive conception of participatory justice in clinical cancer research. This framework addresses the breadth from normative to applied by defining the justice norm of equity and translating it into practical strategies for addressing participation disparities in clinical cancer research. (shrink)

Applying machine learning algorithms to automatically infer relationships between concepts from large-scale collections of documents presents a unique opportunity to investigate at scale how human semantic knowledge is organized, how people use it to make fundamental judgments (“How similar are cats and bears?”), and how these judgments depend on the features that describe concepts (e.g., size, furriness). However, efforts to date have exhibited a substantial discrepancy between algorithm predictions and human empirical judgments. Here, we introduce a novel approach to generating (...) embeddings for this purpose motivated by the idea that semantic context plays a critical role in human judgment. We leverage this idea by constraining the topic or domain from which documents used for generating embeddings are drawn (e.g., referring to the natural world vs. transportation apparatus). Specifically, we trained state-of-the-art machine learning algorithms using contextually-constrained text corpora (domain-specific subsets of Wikipedia articles, 50+ million words each) and showed that this procedure greatly improved predictions of empirical similarity judgments and feature ratings of contextually relevant concepts. Furthermore, we describe a novel, computationally tractable method for improving predictions of contextually-unconstrained embedding models based on dimensionality reduction of their internal representation to a small number of contextually relevant semantic features. By improving the correspondence between predictions derived automatically by machine learning methods using vast amounts of data and more limited, but direct empirical measurements of human judgments, our approach may help leverage the availability of online corpora to better understand the structure of human semantic representations and how people make judgments based on those. (shrink)