Miller synthesizes Karen Horney's model of submission, aggression and withdrawal, Jean Baker Miller's concept of relational being, Julia Kristeva's idea of psychic space, and Kelly Oliver's notions on social support to advance a penetrating analysis of the fiction of Paule Constant.

In early 2020, the COVID-19 pandemic forced a large portion of the world into quarantine, leading to an extensive period of stress making it necessary to explore regulatory techniques that are effective at stimulating long-lasting positive emotion. Previous research has demonstrated that anticipating positive events produces increases in positive emotion during discrete stressors. We hypothesized that state and trait positive anticipation during the COVID-19 pandemic would be associated with increased positive emotions. We assessed how often participants thought about a future (...) positive/negative/neutral event, activity, or goal through a daily reconstruction method that represented a “day in the life” of people in the United States during the early stages of the COVID-19 pandemic. The results of multi-level modeling and mediational analyses demonstrated that higher optimism, one form of trait positive anticipation, was related to higher state positive anticipation, which was in turn related to higher positive emotions during the current episode, which persisted to the next episode. In addition, both optimism and state positive anticipation were related to adaptive responses to the pandemic. These findings suggest that anticipation of future emotional experiences and hopefulness for the future can be a powerful predictor of positive emotions during global pandemics and perhaps other similar chronic stressors. (shrink)

We present an experiment designed to investigate three different mechanisms to achieve impartiality in distributive justice. We consider a first-person procedure, inspired by the Rawlsian veil of ignorance, and two third-party procedures, an involved spectator and a detached observer. First-person veiled stakeholders and involved spectators are affected by an initially unfair distribution that, in the stakeholders’ case, is to be redressed. We find substantial differences in the redressing task. Detached observers propose significantly fairer redistributions than veiled stakeholders or involved spectators. (...) Risk preferences partly explain why veiled stakeholders propose less egalitarian redistributions. Surprisingly, involved spectators, who are informed about their position in society, tend to favour stakeholders holding the same position as they do after the initial distribution. (shrink)

I explain the notion of contributory injustice, a kind of epistemic injustice, and argue that it occurs within psychiatric services, affecting those who hear voices. I argue that individual effort on the part of clinicians to avoid perpetrating this injustice is an insufficient response to the problem; mitigating the injustice will require open and meaningful dialogue between clinicians and service user organisations, as well as individuals. I suggest that clinicians must become familiar with and take seriously concepts and frameworks for (...) understanding mental distress developed in service user communities, such as Hearing Voices Network, and by individual service users. This is especially necessary when these concepts and frameworks explicitly conflict with medical or technical understandings of users’ experiences. I defend this proposal against three objections. (shrink)

Everyone knows that a tiny acorn grows into a mighty oak and a caterpillar becomes a butterfly. But in this clever, visually enchanting volume, it's also true that a cow can result in both a bottle of milk and a painting of a cow, and an ape in a jungle may become an urban King Kong. Just as day turns into night and back again, a many-tiered cake is both created and eaten down to a single piece. With simple, graphic (...) illustrations sure to appeal to even the youngest of children, this beautiful rumination on the passage of time will please the most discerning adult readers, too. (shrink)

Dual-track assessment directs research ethics committees to assess the risks of research interventions based on the unclear distinction between therapeutic and non-therapeutic interventions. The net risks test, in contrast, relies on the clinically familiar method of assessing the risks and benefits of interventions in comparison to the available alternatives and also focuses attention of the RECs on the central challenge of protecting research participants.Research guidelines around the world recognise that clinical research is ethical only when the risks to participants are (...) reasonable.1 Appropriate implementation of this requirement is vital to protecting research participants and allowing research to proceed when it poses acceptable risks. Unfortunately, as the US National Bioethics Advisory Commission notes: “current regulations do not further elaborate how risks and potential benefits are to be assessed, and little additional guidance is available to IRBs.”1The NBAC, as well as numerous commentators, recommend that research ethics committees , ethics review committees and institutional review boards should adopt what may be called dual-track risk assessment.2–5 Yet, dual-track assessment unnecessarily divides research interventions into two different categories before assessing their risks and relies on the unclear distinction between therapeutic and non-therapeutic interventions. As a result, dual-track assessment provides RECs with confusing guidance and has the potential to block valuable research that poses acceptable risks. This paper describes one alternative, the net risks test, and argues that this approach offers a better method for assessing research risks, one that puts RECs in a position to protect participants without blocking appropriate research studies.BACKGROUNDClinical research exposes participants to interventions and procedures to gather systematic data that may be used to improve overall health and well-being. To ensure that research is ethical, RECs must ensure that the risks and burdens to participants are not excessive and that …. (shrink)

Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Ins...

Senior service colleges provide professional education to prepare military and government civilians for public service at the senior levels of strategy and policy. Inclusive in the program of study...

This paper focuses on the _ethics of how_ to approach the introduction of MAiD as an organizational ethics challenge, a focus that diverges from the traditional focus in healthcare ethics on the _ethics of why_ MAiD is right or wrong. It describes a method co-designed and implemented by ethics and medical leadership at a tertiary hospital to develop a values-based, grassroots response to the decriminalization of assisted dying in Canada. This organizational ethics engagement method embodied core tenants that drew inspiration (...) from a variety of sources, including poetic ones. These tenants are: make the problem bigger; focus on values; cultivate open moral spaces; and trust emergence. The paper describes how these tenants were put into practice in order to create a rigorous and sustainable MAiD program that delivers high-quality care to patients and families while honoring the moral diversity of the hospital workforce. One of the goals in sharing this method is to provide a roadmap for healthcare organizations in Canada and other jurisdictions around the world that are facing the challenge of responding to patient requests for MAiD following the decriminalization of this care option. (shrink)

Accounting ethics failures have seized headlines and cost investors billions of dollars. Improvement of the ethical reasoning and behavior of accountants has become a key concern for the accounting profession and for higher education in accounting. Researchers have asked a number of questions, including what type of accounting ethics education intervention would be most effective for accounting students. Some researchers have proposed virtue ethics as an appropriate moral framework for accounting. This research tested whether Smithian virtue ethics training, based on (...) Adam Smith’s “The Theory of Moral Sentiments”, is effective in improving accounting student’s cognitive moral development. This research used a pre-test, treatment, post-test, quasi-experimental design utilizing the Defining Issues Test 2 instrument to measure students’ CMD. Analysis of DIT-2 gain scores did show a significant improvement in subjects’ personal interest scores and a significant improvement in an overall measure of CMD, the DIT N2 index, whereas their DIT-2 post-conventional scores did not improve significantly. This research supports the proposition that the concepts contained in Smithian virtue ethics can contribute to an effective accounting ethics education intervention. However, further research is required to determine what concepts should be included to improve accounting students’ post-conventional moral reasoning. (shrink)

The concept of minimal risk has been used to regulate and limit participation by adolescents in clinical trials. It can be understood as setting an absolute standard of what risks are considered minimal or it can be interpreted as relative to the actual risks faced by members of the host community for the trial. While commentators have almost universally opposed a relative interpretation of the environmental risks faced by potential adolescent trial participants, we argue that the ethical concerns against the (...) relative standard may not be as convincing as these commentators believe. Our aim is to present the case for a relative standard of environmental risk in order to open a debate on this subject. We conclude by discussing how a relative standard of environmental risk could be defended in the specific case of an HIV vaccine trial among adolescents in South Africa. (shrink)

Researchers are developing a fertility preservation technique?testicular tissue cryopreservation (TTCP)?for prepubescent boys who may become infertile as a result of their cancer treatment. Although this technique is still in development, some researchers are calling for its widespread use. They argue that if boys do not bank their tissue now, they will be unable to benefit from any therapies that might be developed in the future. There are, however, risks involved with increasing access to an investigational procedure. This article examines four (...) methods of expanding access to TTCP: (1) expansion of institutional review board (IRB)-approved research trials; (2) offering TTCP as an innovative procedure in hospitals; (3) offering TTCP as a standard practice in hospitals; and (4) commercialization of TTCP. The ethical and practical implications of each are evaluated through a comparison with umbilical cord blood banking (UCBB), a technology that has achieved widespread use based on similar claims of future benefit. (shrink)

Volume 20, Issue 7, July 2020, Page 112-114.

A special report of The Hastings Center and the Association of American Medical Colleges addressed the ethical oversight of learning health systems, which seek to combine high‐quality patient care with routine data collection aimed at improving patient outcomes. The report contained two position papers, authored by a number of distinguished bioethicists, and several commentaries. The position papers urged two changes. First, they urged a rethinking of our approach to the regulation of human subjects research, so as to make it easier (...) in the future for learning health systems to function well. Second, they argued that the rethinking required dispensing with a strict distinction between research and therapy, which has been a major tenet of bioethics since the Belmont Report, which explicated basic ethical principles governing human subjects research. We fully support the objectives of the authors, and we agree that the learning health system is an important advance that serves patients well. Unnecessary regulatory burden ought not impede this progress. We disagree, however, that the best way to bring about these needed changes in the regulatory environment is to reject the basic distinction between research and treatment. Unfortunately, we find the arguments in favor of that strategy to be, in places, reminiscent of what we take to be basic conceptual errors that hampered the ethical understanding of human subjects research prior to adoption of the Belmont Report. To see why one need not reject the research‐treatment distinction in order to promote learning health systems, we first investigate in some detail the arguments offered for eliminating the distinction. We next turn to an issue not addressed by those authors, namely, the relationship between the physician or investigator and the patient or subject, to illustrate why the distinction is important and what is lost if it is jettisoned. (shrink)

The rotating spot method of timing subjective events involves the subject’s watching a rotating spot on a computer and reporting the position of the spot at the instant when the subjective event of interest occurs. We conducted an experiment to investigate factors that may impact on the results produced by this method, using the subject’s perception of when they made a simple finger movement as the subjective event to be timed. Seven aspects of the rotating spot method were investigated, using (...) a factorial experiment. Four of these aspects altered the physical characteristics of the computer generated spot or clock face and the remaining three altered the instructions given to the participant. We found compelling evidence that one factor, whether the subject was instructed to report the instant when the finger movement was initiated or the instant when it was completed, resulted in a systematic shift in the response. Evidence that three other factors affect the observed variability in the response was also found. In addition, we observed that there are substantial systematic differences in the responses made by different subjects. We discuss the implications of our findings and make recommendations about the optimal way of conducting future experiments using the rotating spot method. Our overall conclusion is that our results strongly validate the rotating spot method of timing at least the studied variety of subjective event. (shrink)

Seeing a red hat can (i) increase my credence in the hat is red, and (ii) introduce a negative dependence between that proposition and po- tential undermining defeaters such as the light is red. The rigidity of Jeffrey Conditionalization makes this awkward, as rigidity preserves inde- pendence. The picture is less awkward given ‘Holistic Conditionalization’, or so it is claimed. I defend Jeffrey Conditionalization’s consistency with underminable perceptual learning and its superiority to Holistic Conditionalization, arguing that the latter is merely (...) a special case of the former, is itself rigid, and is committed to implausible accounts of perceptual con- firmation and of undermining defeat. (shrink)

In recent decades, psychological research on the effects of mindfulness-based interventions has greatly developed and demonstrated a range of beneficial outcomes in a variety of populations and contexts. Yet, the question of how to foster subjective well-being and happiness remains open. Here, we assessed the effectiveness of an integrated mental training program The Art of Happiness on psychological well-being in a general population. The mental training program was designed to help practitioners develop new ways to nurture their own happiness. This (...) was achieved by seven modules aimed at cultivating positive cognition strategies and behaviors using both formal and informal practices. The program was conducted over a period of 9 months, also comprising two retreats, one in the middle and one at the end of the course. By using a set of established psychometric tools, we assessed the effects of such a mental training program on several psychological well-being dimensions, taking into account both the longitudinal effects of the course and the short-term effects arising from the intensive retreat experiences. The results showed that several psychological well-being measures gradually increased within participants from the beginning to the end of the course. This was especially true for life satisfaction, self-awareness, and emotional regulation, highlighting both short-term and longitudinal effects of the program. In conclusion, these findings suggest the potential of the mental training program, such as The Art of Happiness, for psychological well-being. (shrink)

Contributors to this volume demonstrate how the ethics of care factors into a variety of social policies and institutions, and can indeed be useful in thinking about a number of different social problems. Divided into two sections, the first looks at care as a model for an evaluative framework that rethinks social institutions, liberal society, and citizenship at a basic conceptual level. The second explores care values in the context of specific social practices or settings, as a framework that should (...) guide thinking. (shrink)

We are very grateful to the commentators for taking the time to respond to our little article, ‘What Makes Killing Wrong?’ They raise many points, so we cannot respond to them all, but we do want to head off a few misinterpretations.Our critics in this journal avoid one careless misinterpretation, but less informed readers have pressed this misinterpretation in popular venues, so we need to start by renouncing it. We do not deny that killing humans is morally wrong. To the (...) contrary, we argue that killing humans is almost always morally wrong, because killing humans is almost always disabling, and disabling is morally wrong. Here we do not disagree with common sense. We also do not deny that killing partially or even profoundly disabled humans is morally wrong. People who are disabled in some ways still retain many other valuable abilities. This should be obvious. To kill a person with some disabilities but many other valuable abilities is to disable that person, so that is morally wrong. Here again we do not disagree with common sense. The one and only surprising application of our theory is to humans who are alive but totally disabled. We argue that, apart from special circumstances, it is not morally wrong to kill live humans who are totally disabled, whereas many people think that it would be morally wrong to kill even in these extreme and unusual cases, because they assume that killing is morally wrong for reasons apart from disabling.What could those reasons be? DeGrazia mentions three possibilities. First, ‘the harm of killing —in those ordinary cases in …. (shrink)

Mood disorders, including major depressive disorder and bipolar disorder, are highly prevalent, frequently disabling, and sometimes deadly. Additional research and more effective medications are desperately needed, but clinical trials research in mood disorders is fraught with ethical issues. Although many authors have discussed these issues, most do so from a theoretical viewpoint. This manuscript uses available empirical data to inform a discussion of the primary ethical issues raised in mood disorders research. These include issues of consent and decision-making capacity, including (...) patients’ motivations for participating in research. We also address drug withdrawals, placebo controls, and the overall safety of research. Finally, we examine the extant literature for studies discussing potential indirect benefits of clinical trials research to participants. Taken together, the evidence suggests that clinical trials research incorporating drug withdrawals and placebo controls can be conducted safely and ethically, even in patients with severe or treatment-resistant mood disorders. In fact, given the dearth of effective treatment options for this population, it is our opinion that a moral imperative exists to extend the offer of research participation to severely ill or treatment-resistant groups. (shrink)

Over the past 5 years, a series of articles in leading American newspapers has revealed the extent to which the conduct of clinical trials may be affected by inducements offered by corporate research sponsors and accepted by some unscrupulous physicians. The cases described were disturbing. They involved physicians engaged in excessive “enrollment activities” in exchange for money. Some of these physicians perpetrated fraud, falsifying their recruitment records in order to increase their profits. Others ignored exclusion criteria designed to ensure the (...) safety of subjects and the validity of research results, referring their patients to research investigating treatments for conditions from which they did not suffer. One of the articles reports that physicians focusing exclusively on commercial research regularly divulge annual incomes upwards of $1,000,000 with profits in excess of $300,000. Two physicians accumulated well over $10,000,000 through clinical trials activities in less than a decade. (shrink)

Neurofilaments are one of the major components of the neuronal cytoskeleton and are responsible for maintaining the calibre of axons. They are modified by post‐translational changes that are regulated in complex fashions including by the interaction with neighbouring glial cells. Neurofilament accumulations are seen in several neurological diseases and neurofilament mutations have now been associated with Charcot‐Marie‐Tooth disease, Parkinson's disease and amyotrophic lateral sclerosis. In this review, we discuss the structure, normal function and molecular pathology of neurofilaments. BioEssays 25:346–355, 2003. (...) © 2003 Wiley Periodicals, Inc. (shrink)

Book reviewed in this article: Perspectives on the Unity and Integration of Knowledge Garth Benson, Ronald Glasberg & Bryant Griffith Intercultural Communication: pragmatics, genealogy, deconstruction Robert Young.

In the ancient world, precious stones (valuable stones and hard substances excluding gold, silver and copper) were distinguished in terms of appearance (beauty, colour), function (durability) and cost (rarity). As a result, there is considerable difficulty in determining how to correlate the inventory of lexical terms referring to precious stones in the ancient Near East with modern mineralogical identifications. In this article, the etymology and identification of precious stones in the Bible are revisited using editorial theory and complexity thinking. The (...) starting point for lexicographical identification is the breastpiece of the high priest (Ex 28:17–20; 39:10–14) with its 12 precious stones and the translation of the Hebrew terms in the Septuagint. In the light of the considerable writings in the Hellenistic world on precious stones, especially Pliny’s Naturalis Historia and Theophrastus’ On Stones, the Septuagint provides the key for the etymology and identification of the precious stones in both the Old Testament and the New Testament. Contribution: The Septuagint translation of the precious stones in the high priest’s breastpiece is the Rosetta Stone for the identification all of the precious stones in the Hebrew Bible and New Testament. The subsequent translations of the terms indicate changes or substitutions of referents and their meanings. (shrink)

:In this article, we present an educational intervention that embeds ethics education within research laboratories. This structure is designed to assist students in addressing ethical challenges in a more informed way, and to improve the overall ethical culture of research environments. The project seeks to identify factors that students and researchers consider relevant to ethical conduct in science, technology, engineering, and math and to promote the cultivation of an ethical culture in experimental laboratories by integrating research stakeholders in a bottom-up (...) approach to developing context-specific, ethics-based guidelines. An important assumption behind this approach is that direct involvement in the process of developing laboratory specific ethical guidelines will positively influence researchers’ understanding of ethical research and practice issues, their handling of these issues, and the promotion of an ethical culture in the respective laboratory. The active involvement may increase the sense of ownership and integration of further discussion on these important topics. Based on the project experiences, the project team seeks to develop a module involving the bottom-up building of codes-of-ethics-based guidelines that can be used by a broad range of institutions and that will be distributed widely. (shrink)

The 'Art of Life' is John Stuart Mill's name for his account of practical reason. In this volume, eleven leading scholars elucidate this fundamental, but widely neglected, element of Mill's thought. Mill divides the Art of Life into three 'departments': 'Morality, Prudence or Policy, and Æsthetics'. In the volume's first section, Rex Martin, David Weinstein, Ben Eggleston, and Dale E. Miller investigate the relation between the departments of morality and prudence. Their papers ask whether Mill is a rule utilitarian (...) and, if so, whether his practical philosophy must be incoherent. The second section contains papers by Jonathan Riley and Wendy Donner, who explore the relation between the departments of morality and aesthetics. They discuss issues ranging from supererogation to aesthetic pleasure and humanity's relationship with nature. -/- The papers in the third section consider the Art of Life's axiological first principle, the principle of utility. Elijah Millgram contends that Mill's own life refutes his claim that the Art of Life has a single axiological first principle. Philip Kitcher maintains that Mill has a dynamic axiology requiring us to continually refine our conception of the good. In the final section, three papers address what it means to put the Art of Life into practice. Robert Haraldsson locates an 'Art of Ethics' in On Liberty that is in tension with the Art of Life. Nadia Urbinati plumbs the classical roots of Mill's view of the good life. Finally, Colin Heydt develops Mill's suggestion that we regard our own lives as works of art. (shrink)

To speak of human rights in the twenty-first century is to speak of proportionality. Proportionality has been received into the constitutional doctrine of courts in continental Europe, the United Kingdom, Canada, New Zealand, Israel, South Africa, and the United States, as well as the jurisprudence of treaty-based legal systems such as the European Convention on Human Rights. Proportionality provides a common analytical framework for resolving the great moral and political questions confronting political communities. But behind the singular appeal to proportionality (...) lurks a range of different understandings. This volume brings together many of the world's leading constitutional theorists - proponents and critics of proportionality - to debate the merits of proportionality, the nature of rights, the practice of judicial review, and moral and legal reasoning. Their essays provide important new perspectives on this leading doctrine in human rights law. (shrink)

The development of photodynamic therapy and anti-vascular endothelial growth factor agents have revolutionized the treatment of retinal diseases, transforming the retina subspecialty by ushering in an age of pharmacological treatments for a wide range of diseases, including age-related macular degeneration.

In this paper we describe the objectives of teaching medical ethics to undergraduates and the teaching methods used. We describe a workshop used in the University of Liverpool Department of Psychiatry, designed to enhance ethical sensitivity in psychiatry. The workshop reviews significant historical and current errors in the ethical practice of psychiatry and doctors' defence mechanisms against accepting responsibility for deficiencies in ethical practice. The workshop explores the student doctors' own group ethos in response to ethical dilemmas, and demonstrates how (...) the individual contributes to and is responsible for the group ethos through participation and also through nonparticipation. The student feedback about the workshop is reviewed. The Toronto Ethical Sensitivity Instrument was used to assess whether or not the workshop altered sensitivity. Compared to a control group the attenders' sensitivity was significantly increased (on Student's t-test p equals or is less than 0.002). (shrink)