Research involving recently deceased humans that are physiologically maintained following declaration of death by neurologic criteria—or ‘research involving the recently deceased’—can fill a translational research gap while reducing harm to animals and living human subjects. It also creates new challenges for honouring the donor’s legacy, respecting the rights of donor loved ones, resource allocation and public health. As this research model gains traction, new empirical ethics questions must be answered to preserve public trust in all forms of tissue donation and (...) in the practice of medicine while respecting the legacy of the deceased and the rights of donor loved ones. This article suggests several topics for immediate investigation to understand the attitudes and experiences of researchers, clinical collaborators, donor loved ones and the public to ensure research involving the recently deceased advances ethically. (shrink)

The training relationship between sport psychology professionals (SPPs) and their students is a critical aspect of graduate training. Maintaining ethical, appropriate boundaries within training relationships is imperative, as boundary crossings can have deleterious effects on students. SPPs (N = 152) and Sport Psychology graduate students (N = 165) completed The Survey of Applied Sport Psychologists to explore their experiences and perceptions of sexual attractions and boundary crossings within training relationships. Nearly 30% of SPPs acknowledged sexual attractions toward their students, yet (...) few students (8.5%) perceived such attractions. Compared to the SPPs, the students reported higher levels of anxiety regarding the SPP’s attraction toward them; both groups reported infrequent use of supervision for this attraction. Nine students and 13 SPPs reported engaging in sexual behaviors (e.g., kissing, dating, intercourse) with the other. Within the larger sample, the three most common nonsexual boundary crossings were becoming social friends, attending social gatherings, and the SPP initiating nonsexual touching. Both groups are advised to engage in ongoing monitor their behaviors, receive training specific to ethics within training relationships, and seek consultation/supervision to ensure appropriate boundaries remain intact. (shrink)

About 6,000 individuals participate in the U.S. transplant system as a living organ donor each year. Organ donation by living individuals is a unique procedure, where healthy patients undergo a major surgical operation without any direct functional benefit to themselves. In this article, the authors explore how the ideal of informed consent guides education and evaluation for living organ donation. The authors posit that informed consent for living organ donation is a process. Though the steps in this process are partially (...) standardized through national health policy, they can be improved through institutional structures at the local, transplant center-level. Effective structures and practices aimed at supporting and promoting comprehensive informed consent provide more opportunities for candidates to ask questions about the risks and benefits of living donation and to opt out voluntarily Additionally, these practices could enable new ways of measuring knowledge and improving the consent process. (shrink)

Volume 19, Issue 11, November 2019, Page 42-44.

BackgroundPeople with upper extremity amputations report receiving insufficient information about treatment options. Furthermore, patients commonly report not knowing what questions to ask providers. A question prompt sheet, or list of questions, can support patient-centered care by empowering patients to ask questions important to them, promoting patient-provider communication, and increasing patient knowledge. This study assessed information needs among people with UE amputations about UE vascularized composite allotransplantation and developed a UE VCA-QPS.MethodsThis multi-site, cross-sectional, mixed-methods study involved in-depth and semi-structured interviews with (...) people with UE amputations to assess information needs and develop a UE VCA-QPS. Qualitative data were analyzed by thematic analysis; quantitative data were analyzed by descriptive statistics. The initial UE VCA-QPS included 130 items across 18 topics.ResultsEighty-nine people with UE amputations participated. Most were male, had a mean age of 46 years, and had a unilateral and below-elbow amputation. Participants desired information about UE VCA eligibility, evaluation process, surgery, risks, rehabilitation, and functional outcomes. After refinement, the final UE VCA-QPS included 35 items, across 9 topics. All items were written at a ≤ 6th grade reading level. Most semi-structured interview participants reported being ‘completely’ or ‘very’ likely to use a UE VCA-QPS.ConclusionPeople with UE amputations have extensive information needs about UE VCA. The UE VCA-QPS aims to address patients’ information needs and foster patient-centered care. Future research should assess whether the UE VCA-QPS facilitates patient-provider discussion and informed decision-making for UE VCA. (shrink)

In this letter to the editor, the author responds to articles by G. Testa and colleagues, "Living Donation and Cosmetic Surgery: A Double Standard in Medical Ethics?" and by L. Friedman Ross and colleagues, "Different Standards Are Not Double Standards: All Elective Surgery Patients Are Not Alike," which were published in the Summer 2012 issue of The Journal of Clinical Ethics.

Les professeurs Macey et Miller analysent la relation entre l’assurance des dépôts et l’ inadé quation dans la structure des échéances des actifs et passifs des banques commerciales. Après avoir critiqué l’hypothèse traditionnelle concernant la réglementation, d’après laquelle les banques sont incitées à financer les actifs à long terme par des passifs à court terme parce que l’assurance des dépôts garantie par l’Etat stimule le crédit des banques et subventionne les passifs à court terme, ils utilisent l’analyse économique des (...) décisions publiques pour soutenir qu’une version modifiée de l’hypothèse de la réglementation est la meilleure explication de la déstructuration des échéances des actifs et passifs bancaires.Finalement, ils considèrent que soutenir l’hypothèse de la réglementation n’entraîne pas l’ acceptation du modèle d’assurance des dépôts garantie par l’Etat tel qu’il existe aux Etats-Unis aujourd’hui.Professors Macey and Miller explore the relationship between deposit insurance and the mismatch in the term structure of commercial banks’ assets and liabilities. After criticizing the traditional regulatory hypothesis, which posits that banks have incentives to fund long-term assets with short-term liabilities because government-sponsored deposit insurance enhances bank credit and subsidizes short-term liabilities, they use public choice theory to argue that a modified version of the regulatory hypothesis is the best explanation for the mismatch in the term structure of banks’ assets and liabilities. Finally, they argue that embracing the regulatory hypothesis does not imply acceptance of the government-sponsored deposit insurance scheme as it exists in the U.S. today. (shrink)

Abstract:This symposium includes thirteen personal narratives from people who have received at least one organ transplant from a living or deceased donor. These narratives foster better understanding of the experiences of life-saving organ recipients and their families, including post-transplant difficulties experienced—sometimes requiring multiple transplants. This issue also includes three commentaries by Macey L. Levan, Heather Lannon, and Vidya Fleetwood, Roslyn B. Mannon & Krista L. Lentine. Dr. Levan is a living kidney donor and associate professor of surgery (...) and population health. She writes and teaches on organ transplant and has expertise and experience in governance at the federal level as a member of the board of directors for the U.S. Organ Procurement and Transplantation Network. Dr. Lannon is a social worker and transplant advocate. Her work and interest in the topic were inspired by her husband who needed a heart transplant. Dr. Fleetwood is a surgeon specializing in liver transplantation, pancreas transplantation, kidney transplantation, as well as living donor nephrectomy. Dr. Mannon is a nephrologist and professor of medicine, pathology and microbiology. Her work focuses on understanding and improving long-term kidney transplant outcomes for patients, donors, and caregivers. Dr. Lentine is a nephrologist specializing in treatment of adult patients with kidney disease. She is a researcher and co-chaired the international work group that developed guidelines for living donor kidney transplantation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors’ NoteJames M. DuBois, Ana S. Iltis, and Heidi A. WalshFrom childhood, David Slakter had undergone tests and invasive procedures to monitor his nephritis. It was not a surprise when in 2015, doctors told him he needed a kidney transplant. The wife of a childhood friend was a close match and gave him one of her kidneys. Before his transplant, aerobic exercise was difficult; a few months after transplant, (...) Slakter could ride his bike, hike, and work out with a personal trainer. He no longer had to weigh food or gauge his potassium consumption, a concern for people with kidney failure. For Slakter, “life post-transplant has been a significant improvement.”Individuals or family members of those who have received an organ transplant from a living or deceased donor share their stories in this issue of Narrative Inquiry in Bioethics. The symposium is titled “Receiving the Gift of Life: Stories from Organ Transplant Recipients.” Organ transplantation can extend an individual’s life by decades. It can also greatly improve an individual’s quality of life, as was Slakter’s experience. At the same time, organ transplantation is expensive and stressful. Recipients can experience complications, including organ rejection, and there are few appealing alternatives.After her heart transplant, author Leilani R. Graham required four open-heart surgeries, ECMO, and an intra-aortic balloon pump. She experienced delirium, necrotizing pneumonia, and severe muscular atrophy that required her to re-learn how to walk. She struggled with weight gain, explosive mood swings, hair loss, and was terrified that her body would reject the new heart. For Graham, “[Transplant] was not the miracle [she] was hoping for.” Graham says she felt unprepared for and inadequately informed about what to expect after her transplant, which left her “battered, beaten, and bruised” with a 12-inch line from neck to navel and “bullet holes” up and down her torso from the chest tubes. When reflecting on her experience post-transplant, Graham says, “It wasn’t the physical trauma that hurt the most. It was that no one seemed surprised [by the aftereffects of transplant].” Seemingly no one, that is except Graham, who calls on transplant providers to “prioritize empathy.”The symposium editors are Jason T. Eberl and Tristan McIntosh. Three commentary articles, written by Macey Leigh Levan, Heather Lannon, and Vidya A. Fleetwood, Roslyn B. Mannon & Krista L. Lentine, offer important insights into the authors’ stories. The editors thank Mid-America Transplant, the UCSF Lung Transplant Program, Donor Connect, William L. Freeman, MD, MPH, MJIL, CIP, Janet Monk, and the individuals who gave anonymous donations to support the publication of this issue, an open-access VOICES edition of the symposium, and accompanying teaching guides.The research article in this issue, “‘A Shell of My Former Self’: Using Figurative Language to Promote Communication about Patient Suffering,” was written by Tyler Tate, Elizabeth Stein, and Robert A. Pearlman. The relief of suffering is a primary goal of medicine. However, the authors note that clinicians often miss or ignore suffering because they focus on the causes rather than the experience of suffering, or the subjective nature of suffering makes it difficult to discuss. The authors believe that “the key to communicating about suffering lies in finding [End Page vii] the right kind of words to describe the experience” and say that figurative language offers a promising approach. In their research, the authors performed qualitative analysis on 52 works of literature and identified 254 excerpts of figurative language with themes of non-physical or psychological suffering. The authors found 13 salient themes: brokenness, diminishment, disorientation, drowning, emptiness, imprisonment, battle, darkness, isolation, invisibility, lifelessness, punishment, and torture. The authors reiterate that developing a shared language of suffering could foster a therapeutic patient-clinician relationship and improve clinicians’ ability to recognize and address a patient’s experience of suffering.María Susana Ciruzzi wrote the first of two case studies included in this issue. “The Sword of King Solomon” addresses a tragic and difficult subject—how to navigate the situation posed by conjoined twins when “any decision will produce damage and suffering.” The case involves two infant male patients born at 37 weeks gestation as omphalo-ischiopagus conjoined twins... (shrink)

Hennepin County is the largest metropolitan area in Minnesota and includes the city of Minneapolis and surrounding suburbs. On Tuesday, March 24, 2020, the weekly local shelter count identified 1,494 individuals accessing homeless shelters within Minneapolis—205 children with adults, 112 adults with children, 56 youth without an adult, 971 individual adults, and 115 adults accessing emergency hotel placement in response to COVID-19 pandemic. Beyond the shelter system, a recent local point-in-time count logged 732 individuals sleeping on transit, in encampments, in (...) abandoned buildings, or otherwise outdoors. This total of 2,226 Hennepin County residents identified who lacked residence in the late winter of 2020 is... (shrink)

The one -- The first limit and the first infinity -- The henads -- Intellect -- Soul -- Time and eternity.

The Industrial Revolution caused an expansion of our ideas of property to include other forms of wealth, such as innovations and productive techniques. And the modern age has caused a further expansion of our ideas of property to include inchoate items, particularly information. The Framers of the U.S. Constitution presumed that government not only took an expansive view of the nature of property rights, they also believed that such rights should be protected. To James Madison and the other Framers, property (...) was a “broad and majestic term” that “embraces everything which may have a value to which man may attach a right.”. (shrink)

The existence of a meaningful distinction between economic rights and “other rights” has been a cornerstone of constitutional law for the past sixty years. During this period, the federal courts consistently have taken the position that Congress is free to abuse citizens’ economic liberties, but is not permitted to interfere with such other, noneconomic “rights” as freedom of expression, freedom of assembly, and freedom of religion.

In this essay, I identify the reasons that libertarian principles have failed to capture the popular imagination as an acceptable form of civil society. By the term “libertarian” I mean a belief in and commitment to a set of methods and policies that have as their common aim greater freedom under law for individuals. The term “freedom” in this context means not only a commitment to civil liberties, such as freedom of expression, but also to economic liberties, including a commitment (...) to a laissez-faire policy of free enterprise and free trade between countries. Libertarians, therefore, are committed to the absolute minimum state intervention in the economy as well as in people's private lives. In a world constrained by these libertarian principles, people should be permitted to do as they please, constrained only by rules that prevent them from encroaching on the liberty of others. (shrink)

The paper provides a preliminary study of algebraic semantics for modal and superintuitionistic non-monotonic logics. The main question answered is: how can non-monotonic inference be understood algebraically?

Moral philosophers agree that welfare matters. But they disagree about what it is, or how much it matters. In this vital new work, Wayne Sumner presents an original theory of welfare, investigating its nature and discussing its importance. He considers and rejects all notable theories of welfare, both objective and subjective, including hedonism and theories founded on desire or preference. His own theory connects welfare closely with happiness or life satisfaction. Reacting against the value pluralism that currently dominates moral philosophy, (...) he advances welfare as the only basic ethical value. He concludes by discussing the implications of this thesis for ethical and political theory. Written in clear, non-technical language, and including a definitive survey of other work in this area, Sumner's book is essential reading for moral philosophers, political theorists, and welfare economists. (shrink)

The most comprehensive study of the controversial French thinker--and of his place in the history of philosophy. As public as Foucault was in his militant campaigns on behalf of prisoners, dissidents, and homosexuals, his private life was mysterious: he tried to destroy all documents that might offer clues to his personality.

Critics of contemporary metaphysics argue that it attempts to do the hard work of science from the ease of the armchair. Physics, not metaphysics, tells us about the fundamental facts of the world, and empirical psychology is best placed to reveal the content of our concepts about the world. Exploring and understanding the world through metaphysical reflection is obsolete. In this paper, I will show why this critique of metaphysics fails, arguing that metaphysical methods used to make claims about the (...) world are similar to scientific methods used to make claims about the world, but that the subjects of metaphysics are not the subjects of science. Those who argue that metaphysics uses a problematic methodology to make claims about subjects better covered by natural science get the situation exactly the wrong way around: metaphysics has a distinctive subject matter, not a distinctive methodology. The questions metaphysicians address are different from those of scientists, but the methods employed to develop and select theories are similar. In the first section of the paper, I will describe the sort of subject matter that metaphysics tends to engage with. In the second section of the paper, I will show how metaphysical theories are classes of models and discuss the roles of experience, common sense and thought experiments in the construction and evaluation of such models. Finally, in the last section I will discuss the way these methodological points help us to understand the metaphysical project. Getting the right account of the metaphysical method allows us to better understand the relationship between science and metaphysics, to explain why doing metaphysics successfully involves having a range of different theories, to understand the role of thought experiments involving fictional worlds, and to situate metaphysical realism in a scientifically realist context. (shrink)

Can philosophy offer reasonable grounds for the existence of a God possessing genuine religious significance and not proposed simply as the solution to a purely intellectual philosophical problem? Certainly many contemporary thinkers have insisted that no genuine religion could be based upon metaphysics. In this book, however, T. L. S. Sprigge examines sympathetically the most notable metaphysical systems of the last four centuries which purport to put religion on a rational footing and, after a thorough examination of their claims, considers (...) what kind of religious outlook they might support and how they actually affected the lives of their proponents. The thinkers studied include Spinoza, Hegel, T. H. Green, Bernard Bosanquet, Josiah Royce, A. N. Whitehead, and Charles Hartshorne, concluding with an exposition of the author's own viewpoint and a general discussion on the relation between metaphysics and religion. There is also a chapter on Kierkegaard as the most important critic of metaphysical religion. (shrink)

The paradox of knowability, derived from a proof by Frederic Fitch in 1963, is one of the deepest paradoxes concerning the nature of truth. Jonathan Kvanvig argues that the depth of the paradox has not been adequately appreciated. It has long been known that the paradox threatens antirealist conceptions of truth according to which truth is epistemic. If truth is epistemic, what better way to express that idea than to maintain that all truths are knowable? In the face of the (...) paradox, however, such a characterization threatens to undermine antirealism. If Fitch's proof is valid, then one can be an antirealist of this sort only by endorsing the conclusion of the proof that all truths are known.Realists about truth have tended to stand on the sidelines and cheer the difficulties faced by their opponents from Fitch's proof. Kvanvig argues that this perspective is wholly unwarranted. He argues that there are two problems raised by the paradox, one that threatens antirealism about truth and the other that threatens everybody's view about truth, realist or antirealist. The problem facing antirealism has had a number of proposed solutions over the past 40 years, and the results have not been especially promising with regard to the first problem. The second problem has not even been acknowledged, however, and the proposals regarding the first problem are irrelevant to the second problem. This book thus provides a thorough investigation of the literature on the paradox, and also proposes a solution to the deeper of the two problems raised by Fitch's proof. It provides a complete picture of the paradoxicality that results from Fitch's proof, and presents a solution to the paradox that claims to address both problems raised by the original proof. (shrink)

I defend a one category ontology: an ontology that denies that we need more than one fundamental category to support the ontological structure of the world. Categorical fundamentality is understood in terms of the metaphysically prior, as that in which everything else in the world consists. One category ontologies are deeply appealing, because their ontological simplicity gives them an unmatched elegance and spareness. I’m a fan of a one category ontology that collapses the distinction between particular and property, replacing it (...) with a single fundamental category of intrinsic characters or qualities. We may describe the qualities as qualitative charactersor as modes, perhaps on the model of Aristotelian qualitative (nonsubstantial) kinds, and I will use the term “properties” interchangeably with “qualities”. The qualities are repeatable and reasonably sparse, although, as I discuss in section 2.6, there are empirical reasons that may suggest, depending on one’s preferred fundamental physical theory, that they include irreducibly intensive qualities. There are no uninstantiated qualities. I also assume that the fundamental qualitative natures are intrinsic, although physics may ultimately suggest that some of them are extrinsic. On my view, matter, concrete objects, abstract objects, and perhaps even spacetime are constructed from mereological fusions of qualities, so the world is simply a vast mixture of qualities, including polyadic properties (i.e., relations). This means that everything there is, including concrete objects like persons or stars, is a quality, a qualitative fusion, or a portion of the extended qualitative fusion that is the worldwhole. I call my view mereological bundle theory. (shrink)

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

What does it mean for someone to have a moral right to something? What kinds of creatures can have rights, and which rights can they have? While rights are indispensable to our moral and political thinking, they are also mysterious and controversial; as long as these controversies remain unsolved, rights will remain vulnerable to skepticism. Here, Sumner constructs both a coherent concept of a moral right and a workable substantive theory of rights to provide the moral foundation necessary to dispel (...) such doubts. (shrink)