This “Legal Briefing” column covers recent legal developments involving patient decision aids. This topic has been the subject of recent articles in JCE. It is included in the 2010 Patient Protection and Affordable Care Act. And it has received significant attention in the biomedical literature, including a new book, a thematic issue of Health Affairs, and a recent article in the New England Journal of Medicine. Moreover, physicians and health systems across the United States are increasingly integrating decision aids into (...) their clinical practice. Both federal and state laws play a significant role in promoting this expanded use. On the other hand, concerns about liability could stymie development and implementation. We categorize legal developments concerning patient decision aids into the following five sections:1. Development of decision aids2. Effectiveness of decision aids3. Federal regulation of decision aids4. State regulation of decision aids5. Legal concerns regarding decision aids. (shrink)

Darwin's phrase “place in natural economy”, andSpencer's term “correspondence” can be regarded as first attempts to express the organism-environment relationships. The same concept has more recently been approached from the point of view of life-form, external activities, and habitat. Though all these points are interlocking, they have been stressed differently in the writings of American and European ecologists. It is proposed that the term “niche” would be most useful and rational if applied to the total of relationships between a living (...) organism and its complete environment, both biotic and abiotic. (shrink)

The ability to improve diagnosis and refine prognosis in children with acute leukaemia is improving steadily. A growing number of tests can and are being performed on leukaemic cells. These include surface-marker analysis, DNA content, cytogenetics and studies of gene rearrangements. Increasingly large bone-marrow samples, now usually obtained under general anaesthesia, are required to make secure diagnoses. Ethical issues arise from three major areas. 1) Current research on leukaemia cells requested by the Medical Research Council is considered by local research (...) ethics committees, but parents are not regularly given detailed information about or asked specifically to consent to such research; 2) substantial quantities of excess cells are stored indefinitely. This archive of stored material is a valuable resource for research but there has been little consideration of the ethical issues which arise from this practice, and 3) there is a potential for pressure to obtain increasingly large samples. 'Creeping growth' in sample size is likely to continue unless ethics committees consider future research proposals in more detail. These issues deserve attention in order that worthwhile research and its publication are not impeded for want of ethical consideration. The implications extend beyond the field of childhood leukaemia. (shrink)

Medea killed her children to take away the smile from her husband's face, according to Euripides, an offence against nature and morality. What if Medea had still been carrying her two children, perhaps due to give birth within a week or so, and had done the same? If this would also have been morally reprehensible, would that be a judgment based on her motives or on her action? We argue that the act has multiple and holistic moral features and that, (...) in fact, there is no absolute principle, such as the right of the fetus to life, which governs our moral judgments about fetal-maternal conflicts. We suggest that they illustrate a pervasive feature of human moral discourse and can only be addressed by attending to a range of negotiable moral considerations which depend on particular features of each situation. (shrink)

Lying is an important moral phenomenon that most people are affected by on a daily basis—be it in personal relationships, in political debates, or in the form of fake news. Nevertheless, surprisingly little is known about what actually constitutes a lie. According to the traditional definition of lying, a person lies if they explicitly express something they believe to be false. Consequently, it is often assumed that people cannot lie by more indirectly communicating believed‐false claims, for instance by merely conversationally (...) implicating them. In this paper, we subject this claim to an empirical test. In a preregistered study of 300 participants, we investigate how people judge cases of implicit deceptions that would usually be excluded by the traditional definition of lying (i.e., conversational implicatures, presuppositions, and nonverbal actions). Our results show that people do in fact consider it possible to lie by indirect means, suggesting that people have a broader concept of lying than is usually assumed. Moreover, our findings indicate that lie judgments are closely tied to the extent to which agents are perceived as having committed themselves to the believed‐false claims they have communicated. We discuss the implications of our results for the traditional definition of lying and propose a new commitment‐based definition of lying that can account for the findings of our experiment. (shrink)

The Ethics of War is an indispensable collection of essays addressing issues both timely and age-old about the nature and ethics of war. Features essays by great thinkers from ancient times through to the present day, among them Plato, Augustine, Aquinas, Machiavelli, Grotius, Kant, Russell, and Walzer Examines timely questions such as: When is recourse to arms morally justifiable? What moral constraints should apply to military conduct? How can a lasting peace be achieved? Will appeal to a broad range of (...) readers interested in morality and ethics in war time Includes informative introductions and helpful marginal notes by editors. (shrink)

Ethics and the Clinical Encounter explores the moral dimensions of clinical medicine and the phenomenon of illness, to determine what ethics must be in order to be fully responsive to clinical encounters. Written in a lively and conversational style with minimal technical terminology, and enhanced by actual experience or real clinical situations, this volume lays out a clinical ethics methodology both in practical and theoretical terms. Here's what the experts had to say: Professor Zaner has provided us with a remarkably (...) lucid and trenchant discussion of the interface of philosophy and the field of medicine. He brings into play an extraordinary range of historial knowledge, extensive observations based on firsthand experience with medical practices, and an acute sense of philosophical argumentation. This is a work that will be an exemplary and indispensable text in the philosophy of medicine for years to come. -- Calvin Schrag... it is a highly original contribution usable in a number of fields.... It really has no competition.... The genius of Zaner's approach is to ground ethics from the 'bottom up' and to direct us to the concrete particulars of therapeutic encounters wherein lie moral and ethical matters... meaty, challenging, and ultimately rewarding.... -- Paul R. Dokecki Richard M. Zaner founded the Center for Clinical and Research Ethics at Vanderbilt University Medical Center. Having established Vanderbilt's first Hospital Ethics Committee (1985), he served as co-chair of VUMC's Ethics Committee since its inception in 1990. Zaner has published five original books, edited ten, and translated four more, and has published more than 100 sections of books and professional journals. (shrink)

Much has been published about the ethical issues encountered by clinicians in genetics/genomics, but those experienced by clinical laboratory scientists are less well described. Clinical laboratory scientists now frequently face navigating ethical problems in their work, but how they should be best supported to do this is underexplored. This lack of attention is also reflected in the ethics tools available to clinical laboratory scientists such as guidance and deliberative ethics forums, developed primarily to manage issues arising within the clinic.We explore (...) what ethical issues are being experienced by clinical scientists, how they think such issues could be best analysed and managed, and whether their practice might be enhanced by more situated approaches to ethics deliberation and practice such as ethical preparedness. From thematic analysis of cases presented by clinical scientists at a specially convened meeting of the UK Genethics Forum, we derived three main ethical themes: (1) the redistribution of labour and responsibilities resulting from the practice of genomic medicine; (2) the interpretation and certainty of results and (3) the proposal that better standardisation and consistency of ethical approaches (for example, more guidelines and policy) could resolve some of the challenges arising.We argue that although standardisation is important for promoting shared understandings of good (including ethical) practice, supplementary approaches to enhance and sustain ethical preparedness will be important to help clinical scientists and others in the recently expanded genetic/genomic medicine environment foster quality ethical thinking. (shrink)

Contrary to what has been alleged, the moral equivalence of combatants (MEC) is not a doctrine that was expressly developed by the traditional theorists of just war. Working from the axiom that just cause is unilateral, they did not embrace a conception of public war that included MEC. Indeed, MEC was introduced in the early fifteenth century as a challenge to the then reigning just war paradigm. It does not follow, however, that the distinction between private and public war had (...) no place in the traditional teaching. Thomas Aquinas and his successors did not analyse just war by extrapolation from the related idea of self-defense. Rather, they likened just war to a legal proceeding that could solely be undertaken by persons possessed of legitimate authority. For this reason, just war was first and foremost public war. Private war was deemed ?war? only in a secondary and reduced sense of the term. It was accordingly understood that public war should be waged and its morality judged by reference to a set of norms that are not directly reducible to those governing private self (and other)-defense. (shrink)

The present study examines cross-cultural differences in people’s concept of lying with regard to the question of whether lying requires an agent to _say_ something they believe to be false. While prominent philosophical views maintain that lying entails that a person explicitly expresses a believed-false claim, recent research suggests that people’s concept of lying might also include certain kinds of deception that are communicated more indirectly. An important drawback of previous empirical work on this topic is that only few studies (...) have investigated people’s concept of lying in non-Western samples. In the present study, we compare people’s intuitions about lying with indirect deceptions (i.e., presuppositions, conversational implicatures, and non-verbal actions) in a sample of _N_ = 255 participants from Russia and _N_ = 300 participants from the United Kingdom. Our findings show a strong degree of similarity between lie ratings of participants from Russia and the United Kingdom, with both samples holding it possible for agents to lie with deceptive statements and actions that do not involve the agent _saying_ something they believe to be false. (shrink)

Virtually all historical treatments of just war recognize the importance of the account given by Thomas Aquinas in Summa theologiae II-II, q. 40, ?De bello?, where he outlines three conditions ? legitimate authority, just cause, and right intention ? for a justifiable use of armed force. It is, however, less well known that within the same section of the work (q. 50, a. 4) Aquinas extended his reflection on just war into a theory of military prudence. By placing generalship under (...) the category of ?prudence?, rather than ?art? or ?science?, he held that military command involves more than a morally neutral skill with victory as its sole aim. Building on the premise that service to the common good constitutes the overarching purpose of the military profession, Aquinas showed how the virtue of prudence provides an inner compass for decision-making amid the uncertainty and confusion of the battlefield. (shrink)

Although radical forms of relativism are perhaps beyond the epistemological pale, I argue here that a more moderate form may be plausible, and articulate the conditions under which moderate epistemic relativism could well serve our epistemic goals. In particular, as a result of our limitations as human cognizers, we find ourselves needing to investigate the dappled and difficult world by means of competing communities of highly specialized researchers. We would do well, I argue, to admit of the existence of unresolvable (...) disputes between such communities, but only so long as there is a sufficient amount of fruitful exchange between them as well. I close with some speculation about when it is or is not legitimate to make an “appeal to discipline”: responding to another’s argument by saying something like, “we should do it this way, because we are philosophers (/linguists/psychologists/…), and that’s just what we do”. (shrink)

(2013). Malebranche and Chinese Philosophy: A Reconsideration. British Journal for the History of Philosophy: Vol. 21, No. 2, pp. 262-280. doi: 10.1080/09608788.2012.718869.

Inquiring 'whether any war can be just', Thomas Aquinas famously responded that this may hold true, provided the war is conducted by a legitimate authority, for a just cause, and with an upright intention. Virtually all accounts of just war, from the Middle Ages to the current day, make reference to this threefold formula. But due in large measure to its very succinctness, Aquinas's theory has prompted contrasting interpretations. This book sets the record straight by surveying the wide range of (...) texts in his literary corpus that have bearing on peace and the ethics of war. Thereby emerges a coherent and nuanced picture of just war as set within his systematic moral theory. It is shown how Aquinas deftly combined elements from earlier authors, and how his teaching has fruitfully propelled inquiry on this important topic by his fellow scholastics, later legal theorists such as Grotius, and contemporary philosophers of just war. (shrink)

Some recent authors have argued that Aquinas deliberately integrated a pacifist outlook into his just war theory. Others, by contrast, have maintained that his rejection of pacifism was unequivocal. The present article attempts to set the historical record straight by an examination of Aquinas's writings on this topic. In addition to Q. 40, A. 1 of Summa theologiae II–II, the text usually cited in this connection, this article considers the biblical commentaries where Aquinas explains how the Gospel “precepts of patience,” (...) especially Matthew 5:39, “Do not resist evil,” should be interpreted in light of the doctrine of just war. The article concludes that Aquinas formulated a two-stage theory whereby pacifism was rejected as a suitable form of agency for the state (respublica), while it was affirmed as the appropriate response to evil for the agency of the church (ecclesia). (shrink)

With disparate rates of morbidity and mortality among minoritized communities, COVID-19 illuminated the need for equity-informed practices in public health. Pacia et al posit FQHCs as entities that addressed inequity when others failed. This commentary further situates how FQHCs address the public health crisis of institutional racism and related health inequities every day and presents a FQHC-led Ethics and Equity Framework and Workflow Checklist to guide ethical and equitable engagement with FQHCs.

Despite its uniform appearance, the cerebellar cortex is highly heterogeneous in terms of structure, genetics and physiology. Purkinje cells (PCs), the principal and sole output neurons of the cerebellar cortex, can be categorized into multiple populations that differentially express molecular markers and display distinctive physiological features. Such features include action potential rate, but also their propensity for synaptic and intrinsic plasticity. However, the precise molecular and genetic factors that correlate with the differential physiological properties of PCs remain elusive. In this (...) article, we provide a detailed overview of the cellular mechanisms that regulate PC activity and plasticity. We further perform a pathway analysis to highlight how molecular characteristics of specific PC populations may influence their physiology and plasticity mechanisms. (shrink)

Richard Waller, Fellow and Secretary of the Royal Society, is probably best remembered for editing Robert Hooke’s posthumously published works. Yet, Waller also created numerous drawings, paintings, and engravings for his own work and the Society’s publications. From precisely observed grasses to allegorical frontispieces, Waller’s images not only contained a diverse range of content, they are some of the most beautiful, colorful, and striking from the Society’s early years. This article argues that Waller played a distinctly important role in shaping (...) the visual program of the Royal Society by virtue of his multiple functions as reliable administrator and translator, competent natural philosopher, and skilled image-maker. It analyzes Waller’s visual works in the context of his graphic training—in part influenced by his mother Mary More—and situates them within the context of English image-making traditions and Waller’s own natural philosophical interests. Examined as a functional whole, Waller’s career as a Fellow of the Royal Society emerges as an important case study in the fusion of visual and scientific practices in early-modern England. (shrink)

Reingold and MerikleÕs (1988, 1990) critique of the classic dissociation paradigm identified several issues as inherent problems that severely undermine the utility of this paradigm. Erdelyi (2004) extending his prior analysis (Erdelyi, 1985, 1986) points out several additional factors that may complicate the interpretation of empirically obtained dissociations. The goal of the present manuscript is to further discuss some of these commonly neglected interpretive difficulties. Ó 2003 Elsevier Inc. All rights reserved.

BackgroundMoral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes.MethodsA regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level (...) of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice.ResultsThe mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9).ConclusionsFemale, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals. (shrink)

It has been argued that organizational structures (the way tasks are defined, allocated, and coordinated) can influence moral agency in organizations. In particular, low values on different structural parameters (functional concentration, specialization, separation, and formalization) are said to foster an organizational context (allowing for relating to the goals and output of the organization, moral deliberation, and social connectedness) that is conducive to moral agency. In this paper, we investigate the relation between the organizational structure and moral agency in the case (...) of a.s.r. (a large Dutch insurance company). While our empirical results fit the thesis that low values on structural parameters positively relate to moral agency, they also refine our understanding of the influence of structural parameters. In particular, our data suggest that the influence of functional concentration not only depends on whether it is low, but also on the type of criterion used for identifying business units; they suggest that the specific organizational context may put a limit to lowering design parameters and points at several non-structural factors that have an influence on the relation between structure and moral agency. In all, the paper contributes to a more detailed understanding of the conditions conducive to moral agency in organizations. (shrink)