This article focuses on two possible missions for a national bioethics commission. The first is handling differences of worldview, political orientation, and discipline. Recent work in political philosophy emphasizes regard for the dignity of difference manifested in "conversation" that seeks understanding rather than agreement. The President's Council on Bioethics gets a mixed review in this area. The second is experimenting with prophetic bioethics. "Prophetic bioethics" is a term coined by Daniel Callahan to describe an alternative to compromise-seeking "regulatory bioethics." It (...) involves a critique of modern medicine. In the contemporary context, the areas of biotechnology and access to health care cry out for prophetic attention. The Council has addressed biotechnology; unfortunately, that experience suggests that the kind of prophecy that it practices poses risks to conversation. With regard to access issues, the article proposes an effort that unites themes of human dignity, solidarity, and limits in support of reform, while highlighting, rather than papering over, differences. (shrink)

Pressure is mounting to hold researchers and research institutions accountable for the protection of human subjects. When subjects or their family members believe they have been injured, they are increasingly willing to file lawsuits. Recent cases indicate that institutional review boards and their members may be pulled more and more into the legal fray.On September 17, 1999, 18-year-old Jesse Gelsinger died while participating in research conducted by the University of Pennsylvania's Institute for Gene Therapy. Gelsinger was involved in a Phase (...) I clinical trial testing a new approach to treatment of ornithine transcarbamylase deficiency, a rare metabolic disorder. Although infants affected by the severe form of OTC die shortly after birth, Gelsinger suffered from a relatively mild form. It appears undisputed that the cause of Gelsinger's death was not the disorder itself, but multiple organ system failure triggered by the virus used to carry new genetic material into his system. (shrink)

In the surviving plays of Aeschylus and Sophocles the gods appear to men only rarely. In the Eumenides Apollo and Athena intervene to bring acquittal to Orestes. In Sophocles' Philoctetes Heracles appears ex machina to ensure that the hero returns to Troy, and we learn from a messenger how the gods have summoned the aged Oedipus to a hero's tomb. In Sophocles' Ajax Athena drives Ajax mad and taunts him cruelly. Prometheus Bound might seem to be an exception, since all (...) but one of its characters are gods. But nonetheless the intervention of the gods in the life of the one human character, Io, brings pain and trouble as well as promise of benefit. Io has been driven mad because she has refused to obey the dreams that tell her to go to the meadow where Zeus wants to have intercourse with her. The god does not make his request in person, and it is only in the course of her wanderings that Io learns how Zeus will bring a gentle end to her sufferings. Her informant is another god, Zeus' adversary Prometheus, who answers her questions, at times grudgingly , and in ways that are not immediately clear to her. (shrink)

The old proverb can still more accurately be applied to their biographers.‘ Even the more plausible and psycho logically tempting details in the lives of literary figures derive from these authors’ fictional works, poems, and dramas, and not from the kind of source material biographers use today, letters, documents, eyewitness testimony. Critics and readers eager to establish some historical correlation between any ancient poet's life and his work should expect to be disappointed. But even if the ancient lives are useless (...) to the historian or critic trying to explain what in Euripides’ experience compelled him to write about Medea, these stories are of interest to mythologists. If we stop being angry at the Lives for failing to be historical, and look at them rather as myths or fairy tales, some informative patterns begin to emerge. (shrink)

Pindar, perhaps more than any other ancient poet, seems to demand from his interpreters declarations of their critical premises. In recent years scholars customarily have made initial acknowledgment to the work of E. R. Bundy, as psychoanalysts must to Freud, before they begin to offer their own modifications to and expansions of his fundamental work. Much contemporary scholarship has concentrated on the identification and classification in the odes of the elements whose function Bundy labelled and explained. But useful as this (...) type of analysis has been for exorcising the demon of biographical interpretation, it has, like all orthodoxies, prevented perception of other equally important truths. It constitutes no radical heterodoxy to try to account for the fact that each individual ode, for all its dependence on common conventions of structure and of content, makes a different impression. Nor is it unreasonable to try to explain what makes Pindar's style and approach distinctive.In my own work I have argued, though perhaps not always convincingly, that language as well as structure contributes to an ode's coherence. Scholars trained in America are more willing to assume that repetition of phrase or theme within a poem has significance, and that metaphors can simultaneously bear more than one connotation. The issues at stake have most recently been delineated by Michael Silk, in his discussion of the effect of metaphor in archaic poetry: ‘By “patent”, I mean effects whose existence is not in doubt, though their character may be disputed; by “latent”, those whose effective significance is so tenuous or marginal that one resents the impression of solidity that even mentioning them produces. Such insensitivity is more common than it should be among American classicists, many of whom have also been influenced by the “New Criticism”…’ As illustration of the erroneous American approach Silk cites Cedric Whitman's description of the thematic relation of fires in theIliad.Silk himself avoids the trap Whitman falls into by considering only ‘patent’ metaphors, and these consistentlyout of context, so that there is no necessity to comment on the existence or non-existence of thematic connections among them. But it is possible—at least logically—to frame the question differently, and to ask whether a metaphor cannot have patent and latent associations at the same time. (shrink)

Although authorship policies exist, researchers understand little about their impact on perceptions of authorship scenarios. Graduate students (N = 277) at a large university read 1 of 3 vignettes about a graduate student-faculty collaboration. One half of the surveys included the American Psychological Association's statement on authorship. Participants rated (a) the ethics of the professor as first author and (b) the likelihood of a dissatisfied student reporting the authorship result, as well as the effectiveness and negative consequences of reporting. Work (...) arrangements on the project had a consistent main effect. Also, an authorship policy impacted women's ratings of first authorship when the student contributed the idea for a project. For men, a policy impacted only ratings of the likelihood of reporting when a professor was first author on a student's dissertation. Apart from sex, no other demographic variables on participants were predictive. Discussion focuses on the policy's potential for making only some specific issues salient. (shrink)

In cognitive science, there is a tacit norm that phenomena such as cultural variation or synaesthesia are worthy examples of cognitive diversity that contribute to a better understanding of cognition, but that other forms of cognitive diversity (e.g., autism, attention deficit hyperactivity disorder/ADHD, and dyslexia) are primarily interesting only as examples of deficit, dysfunction, or impairment. This status quo is dehumanizing and holds back much-needed research. In contrast, the neurodiversity paradigm argues that such experiences are not necessarily deficits but rather (...) are natural reflections of biodiversity. Here, we propose that neurodiversity is an important topic for future research in cognitive science. We discuss why cognitive science has thus far failed to engage with neurodiversity, why this gap presents both ethical and scientific challenges for the field, and, crucially, why cognitive science will produce better theories of human cognition if the field engages with neurodiversity in the same way that it values other forms of cognitive diversity. Doing so will not only empower marginalized researchers but will also present an opportunity for cognitive science to benefit from the unique contributions of neurodivergent researchers and communities. (shrink)

This volume contains thirteen papers that were presented at the 2017 Annual Meeting of the Canadian Society for History and Philosophy of Mathematics/Société canadienne d’histoire et de philosophie des mathématiques, which was held at Ryerson University in Toronto. It showcases rigorously reviewed modern scholarship on an interesting variety of topics in the history and philosophy of mathematics from Ancient Greece to the twentieth century. A series of chapters all set in the eighteenth century consider topics such as John Marsh’s techniques (...) for the computation of decimal fractions, Euler’s efforts to compute the surface area of scalene cones, a little-known work by John Playfair on the practical aspects of mathematics, and Monge’s use of descriptive geometry. After a brief stop in the nineteenth century to consider the culture of research mathematics in 1860s Prussia, the book moves into the twentieth century with an examination of the historical context within which the Axiom of Choice was developed and a paper discussing Anatoly Vlasov’s adaptation of the Boltzmann equation to ionized gases. The remaining chapters deal with the philosophy of twentieth-century mathematics through topics such as an historically informed discussion of finitism and its limits; a reexamination of Mary Leng’s defenses of mathematical fictionalism through an alternative, anti-realist approach to mathematics; and a look at the reasons that mathematicians select specific problems to pursue. Written by leading scholars in the field, these papers are accessible to not only mathematicians and students of the history and philosophy of mathematics, but also anyone with a general interest in mathematics. (shrink)

BackgroundThe proper and ethical inclusion of PWLHIV and their young children in research is paramount to ensure valid evidence is generated to optimize treatment and care. Little empirical data exists to inform ethical considerations deemed most critical to these populations. Our study aimed to systematically review the empiric literature regarding ethical considerations for research participation of PWLHIV and their young children.MethodsWe conducted this systematic review in partnership with a medical librarian. A search strategy was designed and performed within the following (...) electronic databases: Ovid MEDLINE, Embase and CINAHL. We screened titles and abstracts using the following inclusion criteria: (1) a study population of PWLHIV or children under 5 years of age; and (2) collection of qualitative or quantitative data regarding ethics of research participation. Excluded were reviews, commentaries, policy statements, clinical care-related ethics concerns, abstracts, case studies, or studies unrelated to HIV research. Studies were appraised for quality, data were extracted, and studies were qualitatively analyzed using a principle-based ethical framework within the Belmont Report.ResultsOf the 7470 titles identified, 538 full-text articles were reviewed for eligibility and only three articles met full criteria for inclusion within this review. While we allowed for inclusion of studies involving young children born to mothers with HIV, only articles focused on PWLHIV were identified. Within the results of these studies, four themes emerged: (1) adequacy of informed consent; (2) consideration of paternal involvement; (3) balancing risks; and (4) access to research and treatment. A strength of this review is that it included perspectives of international research investigators, community leaders, and male partners. However, only two studies collected empiric data from PWLHIV regarding their experiences participating in researchConclusionResearchers and funding agencies should be aware of these considerations and appreciate the value of and critical need for formative research to ensure clinical trials involving PWLHIV promote ethical, well-informed research participation and, ultimately, improve care outcomes. More research is needed to create a comprehensive ethical framework for researchers when conducting studies with PWLHIV. (shrink)

Recent data breaches underscore the importance of organizational cybersecurity. However, the high costs of such security can force chief financial officers (CFOs) to make difficult financial and ethical trade-offs that have both business and societal implications. We employ a 2 × 2 randomized experiment that varies both an observed scenario CFO’s investment decision (invest/not invest in security) and organizational outcomes (positive/negative) to investigate these trade-offs. Participant managers assess the observed CFO’s investment behavior and indicate their own intentions to invest. Results (...) indicate that when the observed scenario CFO invests in security, managers primarily follow their peers when making investment decisions. However, when the observed CFO does not invest in security, managers make their own decisions by engaging in more in-depth reasoning that includes assessment of the seriousness of consequences, as well as the ethical and societal considerations. Moderated mediation findings further deconstruct and corroborate these relationships. (shrink)

Firearm violence in the United States produces over 36,000 deaths and 74,000 sustained firearm-related injuries yearly. The paper describes the burden of firearm violence with emphasis on the disproportionate burden on children, racial/ethnic minorities, women and the healthcare system. Second, this paper identifies factors that could mitigate the burden of firearm violence by applying a blend of key ethical theories to support population level interventions and recommendations that may restrict individual rights. Such recommendations can further support targeted research to inform (...) and implement interventions, policies and laws related to firearm access and use, in order to significantly reduce the burden of firearm violence on individuals, health care systems, vulnerable populations and society-at-large. By incorporating a blended public health ethics to address firearm violence, we propose a balance between societal obligations and individual rights and privileges. (shrink)

ObjectiveMost young adults diagnosed with breast or gynecologic cancers experience adverse reproductive or sexual health outcomes due to cancer and its treatment. However, evidence-based interventions that specifically address the RSH concerns of young adult and/or LGBTQ+ survivor couples are lacking. Our goal is to develop a feasible and acceptable couple-based intervention to reduce reproductive and sexual distress experience by young adult breast and gynecologic cancer survivor couples with diverse backgrounds.MethodsWe systematically adapted an empirically supported, theoretically grounded couple-based intervention to address (...) the RSH concerns of young couples coping with breast or gynecologic cancer through integration of stakeholder perspectives. We interviewed 11 couples with a history of breast or gynecologic cancer to review and pretest intervention materials. Three of these couples were invited to review and comment on intervention modifications. Content experts in RSH and dyadic coping, clinicians, and community advisors participated throughout the adaptation process.ResultsFindings confirmed the need for an online, couple-based intervention to support young couples experiencing RSH concerns after breast or gynecologic cancer. Qualitative themes suggested intervention preferences for: A highly flexible intervention that can be tailored to couples’ specific RSH concerns; Active steps to help members of a dyad “get on the same page” in their relationship and family building plans; A specific focus on raising partners’ awareness about how cancer can affect body image and physical intimacy; and Accessible, evidence-based information about RSH for both partners. These results, along with feedback from stakeholders, informed adaptation and finalization of the intervention content and format. The resulting virtual intervention, Opening the Conversation, includes five weekly sessions offering training to couples in communication and dyadic coping skills for addressing RSH concerns.ConclusionThe systematic adaptation process yielded a theory-informed intervention for young adult couples facing breast and gynecological cancers, which will be evaluated in a randomized controlled trial. The long-term goal is to implement and disseminate Opening the Conversation broadly to reach young adult couples with diverse backgrounds who are experiencing RSH concerns in cancer survivorship. (shrink)

Background:Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives, setting, and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether research nurses experience unique ethical challenges distinct from those experienced (...) by nurses in traditional patient-care settings.Research objectives:The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice.Research design:The study utilized a qualitative descriptive design with individual interviews.Participants and research context:Participating nurses self-identified as having experienced ethical challenges during screening. The majority were Caucasian, female, and worked in outpatient settings. Approximately 50% had > 10 years of research experience.Ethical considerations:The human subjects review board approved the study. Written informed consent was obtained.Findings:Predominant themes were revealed: the inability to provide a probable good, or/do no harm, and dual obligations. The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship.Discussion:Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science.Conclusion:Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

Apoptosis is now widely recognized as a common form of cell death and represents a mechanism of cell clearance in many physiological situations where deletion of cells is required. Peptide growth factors, initially characterised as stimulators of cell proliferation, have now been shown to inhibit death in many cell types. Deprivation of growth factors leads to the induction of apoptosis, i.e. condensation of chromatin and degradation in oligonucleosomesized fragments, formation of plasma and nuclear membrane blebs and cell fragmentation into apoptotic (...) bodies which can be taken up by neighbouring cells. Here we discuss the mechanism(;s) by which growth factors may inhibit apoptosis. (shrink)

The existence of free will has been both an enduring presumption of Western culture and a subject for debate across disciplines for millennia. However, little empirical evidence exists to support the almost unquestioned assumption that, in general, Westerners endorse the existence of free will. The few studies that measure belief in free will have methodological problems that likely resulted in underestimating the true extent of belief. Recently, Rakos et al. (Behavior and Social Issues 17:20–39, 2008 ) found a stronger endorsement (...) of free will when demand characteristics were eliminated. The current study builds on this work by sampling incarcerated adolescents and adults, whose freedom to act is externally constrained. Belief in free will as well as attitudes toward punishment, self-esteem, and locus of control were measured. The results indicate that free will is strongly endorsed in Western society even when freedom to act is severely restricted. However, incarcerated adolescents endorsed free will to a slightly lesser extent than their nonincarcerated counterparts from Rakos et al. (Behavior and Social Issues 17:20–39, 2008 ), while incarcerated and nonincarcerated adults offered equally strong endorsements. The comparable endorsement by adults is consistent with the hypothesis that the belief in agency is an evolutionary adaptation. The small decrease found for incarcerated adolescents may reflect the interaction between developmental factors and the expression of an evolutionary adaptation. Additionally, incarcerated adolescents and adults associated beliefs in free will with viewing punishment as a means of deterrence, rehabilitation, and retribution. Incarcerated adults, but not incarcerated adolescents, associated beliefs in free will with greater self-esteem and with an external locus of control. Finally, though both incarcerated adults and adolescents endorsed free will strongly, the former manifested the belief by emphasizing free agentic choice whereas the latter focused on the personal responsibility that is interwoven with free choice. The implications of these findings are discussed in the context of evolutionary, cultural, and developmental factors. (shrink)

According to Aquinas, the love of God and neighbor can be either based on Christian revelation or natural knowledge. If the former, the love precepts are the primary precepts of Christian morality; if the latter, the love precepts are the primary precepts of natural law.

Aquinas argues that love of others depends on whether the other is seen as a person like oneself or as a tool of gratification. The former grounds love-of-friendship (altruistic love), the latter love-of-concupiscence. Seeing the other as a person like oneself enables one to love the other as another self, thereby, basing altruism ultimately on self-love.

In her recent paper ‘The Epistemology of Propaganda’ Rachel McKinnon discusses what she refers to as ‘TERF propaganda’. We take issue with three points in her paper. The first is her rejection of the claim that ‘TERF’ is a misogynistic slur. The second is the examples she presents as commitments of so-called ‘TERFs’, in order to establish that radical (and gender critical) feminists rely on a flawed ideology. The third is her claim that standpoint epistemology can be used to establish (...) that such feminists are wrong to worry about a threat of male violence in relation to trans women. In Section 1 we argue that ‘TERF’ is not a merely descriptive term; that to the extent that McKinnon offers considerations in support of the claim that ‘TERF’ is not a slur, these considerations fail; and that ‘TERF’ is a slur according to several prominent accounts in the contemporary literature. In Section 2, we argue that McKinnon misrepresents the position of gender critical feminists, and in doing so fails to establish the claim that the ideology behind these positions is flawed. In Section 3 we argue that McKinnon’s criticism of Stanley fails, and one implication of this is that those she characterizes as ‘positively privileged’ cannot rely on the standpoint-relative knowledge of those she characterizes as ‘negatively privileged’. We also emphasize in this section McKinnon’s failure to understand and account for multiple axes of oppression, of which the cis/trans axis is only one. (shrink)

This dissertation argues that neither inconsistency nor a theological treatment of natural law was involved when Aquinas wrote that the prescriptions to love God above all and to love neighbors as self are the first principles of natural law, self-evident to human reason through nature. The argument is extended through two volumes. ;Volume one: Foundations of natural law. This volume accomplishes four tasks. First, it uses Aquinas' generic definition of law and his specific definition of natural law to determine the (...) essential characteristics of a natural law principle's obligatory power, self-evidence, promulgation, and reliance upon natural inclinations. Second, it explicates how the Bonum precept, "Good is to be done and pursued, and evil avoided," functions within natural law; this explication shows that the status of first principle can be assigned to more than one precept. Third, it explains the relationship between natural law principles and derived precepts, particularly those of the Decalogue. Fourth, it shows that the essential characteristics of natural law principles preclude those principles from being dependent upon faith and Christian revelation. ;Volume two: Love and the natural law. This exegetical argument involves explicating the nature of loving God above all and loving neighbor as self in order to show that the prescriptions of these loves possess the essential characteristics of natural law principles. Accordingly, this volume uses the findings of Volume One to show that natural law prescribes a love of God above all and a love of neighbors as self which cannot be identified as prescriptions of charity, that these prescriptions are self-evident principles of natural law, and that they are natural law's first and primary principles. (shrink)

This paper seeks to counter the argument that since Aquinas’s natural law obligations necessarily presuppose the ability of practical reason to prescribeand proscribe for the sake of eudaimonia, it is irrational in cases of inescapable suffering to characterize any natural law obligation as indefeasible. Four possiblerebuttals of this argument from suffering are examined; but only three are judged successful. Their key premises are that, as Aristotle and Aquinas pointed out, this life’s eudaimonia is defined in terms of human nature and (...) not in terms of individual psychological conditions, e.g., suffering; that suffering does not negate the rationality of hoping for attaining eudaimonia in the future; and that suffering necessarily precludes neither the virtuous acts that per se constitute this life’s eudaimonia nor the love that enables one to experience eudaimonic joy. (shrink)

This paper seeks to counter the argument that since Aquinas’s natural law obligations necessarily presuppose the ability of practical reason to prescribeand proscribe for the sake of eudaimonia, it is irrational in cases of inescapable suffering to characterize any natural law obligation as indefeasible. Four possiblerebuttals of this argument from suffering are examined; but only three are judged successful. Their key premises are that, as Aristotle and Aquinas pointed out, this life’s eudaimonia is defined in terms of human nature and (...) not in terms of individual psychological conditions, e.g., suffering; that suffering does not negate the rationality of hoping for attaining eudaimonia in the future; and that suffering necessarily precludes neither the virtuous acts that per se constitute this life’s eudaimonia nor the love that enables one to experience eudaimonic joy. (shrink)

This paper argues against the indeterminacy thesis that attempts to defeat traditional natural law by asserting that specific moral norms cannot be based on human nature. As put by Jean Porter (Nature as Reason 2005, 338): “the intelligibilities of human nature underdetermine their forms of expression, and that is why this theory does not yield a comprehensive set of determinate moral norms, compelling to all rational persons.” However, if this were so, one could adopt any morality with impunity from nature’s (...) sanctions. But I argue that nature punishes violators of the natural law in various ways. In addition, I argue that the indeterminacy thesis cannot be supported by appealing to the diversity of moral norms across the globe. Such diversity is required, for instance, both by the reliance of Thomistic natural law on the practical syllogism and by its reliance on practical reason’s ability to prescribe for the sake of the person in highly unique situations as required by Wojtyla’s Personalistic Norm and Aquinas’s norm of neighborly love. (shrink)

This paper argues against the indeterminacy thesis that attempts to defeat traditional natural law by asserting that specific moral norms cannot be based on human nature. As put by Jean Porter (Nature as Reason 2005, 338): “the intelligibilities of human nature underdetermine their forms of expression, and that is why this theory does not yield a comprehensive set of determinate moral norms, compelling to all rational persons.” However, if this were so, one could adopt any morality with impunity from nature’s (...) sanctions. But I argue that nature punishes violators of the natural law in various ways. In addition, I argue that the indeterminacy thesis cannot be supported by appealing to the diversity of moral norms across the globe. Such diversity is required, for instance, both by the reliance of Thomistic natural law on the practical syllogism and by its reliance on practical reason’s ability to prescribe for the sake of the person in highly unique situations as required by Wojtyla’s Personalistic Norm and Aquinas’s norm of neighborly love. (shrink)

Navigating to goal locations in a known environment (wayfinding) can be accomplished by different strategies, notably by taking habitual, well-learned routes (response strategy) or by inferring novel paths, such as shortcuts, from spatial knowledge of the environment's layout (place strategy). Human and animal neuroscience studies reveal that these strategies reflect different brain systems, with response strategies relying more on activation of the striatum and place strategies associated with activation of the hippocampus. In addition to individual differences in strategy, recent behavioral (...) studies show sex differences such that men use place strategies more than women, and age differences such that older adults use more response strategies than younger adults. This paper takes a comprehensive multilevel approach to understanding these differences, characterizing wayfinding as a complex information processing task. This analysis reveals factors that affect navigation strategy, including availability of the relevant type of environmental knowledge, momentary access to this knowledge, trade-offs between physical and mental effort in different navigation contexts, and risk taking. We consider how strategies are influenced by the computational demands of a navigation task and by factors that affect the neural circuits underlying navigation. We also discuss limitations of laboratory studies to date and outline priorities for future research, including relating wayfinding strategies to independent measures of spatial knowledge, and studying wayfinding strategies in naturalistic environments. (shrink)

Navigating to goal locations in a known environment (wayfinding) can be accomplished by different strategies, notably by taking habitual, well-learned routes (response strategy) or by inferring novel paths, such as shortcuts, from spatial knowledge of the environment's layout (place strategy). Human and animal neuroscience studies reveal that these strategies reflect different brain systems, with response strategies relying more on activation of the striatum and place strategies associated with activation of the hippocampus. In addition to individual differences in strategy, recent behavioral (...) studies show sex differences such that men use place strategies more than women, and age differences such that older adults use more response strategies than younger adults. This paper takes a comprehensive multilevel approach to understanding these differences, characterizing wayfinding as a complex information processing task. This analysis reveals factors that affect navigation strategy, including availability of the relevant type of environmental knowledge, momentary access to this knowledge, trade-offs between physical and mental effort in different navigation contexts, and risk taking. We consider how strategies are influenced by the computational demands of a navigation task and by factors that affect the neural circuits underlying navigation. We also discuss limitations of laboratory studies to date and outline priorities for future research, including relating wayfinding strategies to independent measures of spatial knowledge, and studying wayfinding strategies in naturalistic environments. (shrink)

BackgroundThe emergence of artificial intelligence (AI) in medicine has prompted the development of numerous ethical guidelines, while the involvement of patients in the creation of these documents lags behind. As part of the European PROFID project we explore patient perspectives on the ethical implications of AI in care for patients at increased risk of sudden cardiac death (SCD).AimExplore perspectives of patients on the ethical use of AI, particularly in clinical decision-making regarding the implantation of an implantable cardioverter-defibrillator (ICD).MethodsSemi-structured, future scenario-based (...) interviews were conducted among patients who had either an ICD and/or a heart condition with increased risk of SCD in Germany (n = 9) and the Netherlands (n = 15). We used the principles of the European Commission’s Ethics Guidelines for Trustworthy AI to structure the interviews.ResultsSix themes arose from the interviews: the ability of AI to rectify human doctors’ limitations; the objectivity of data; whether AI can serve as second opinion; AI explainability and patient trust; the importance of the ‘human touch’; and the personalization of care. Overall, our results reveal a strong desire among patients for more personalized and patient-centered care in the context of ICD implantation. Participants in our study express significant concerns about the further loss of the ‘human touch’ in healthcare when AI is introduced in clinical settings. They believe that this aspect of care is currently inadequately recognized in clinical practice. Participants attribute to doctors the responsibility of evaluating AI recommendations for clinical relevance and aligning them with patients’ individual contexts and values, in consultation with the patient.ConclusionThe ‘human touch’ patients exclusively ascribe to human medical practitioners extends beyond sympathy and kindness, and has clinical relevance in medical decision-making. Because this cannot be replaced by AI, we suggest that normative research into the ‘right to a human doctor’ is needed. Furthermore, policies on patient-centered AI integration in clinical practice should encompass the ethics of everyday practice rather than only principle-based ethics. We suggest that an empirical ethics approach grounded in ethnographic research is exceptionally well-suited to pave the way forward. (shrink)

Pandemics first and foremost hit those who are most vulnerable, and the COVID-19 pandemic is not different. Although the infection rate in the nation’s poorest neighborhoods is twice as it is in th...

While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in (...) implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: train-the-trainer, local capacity-building, circuit-riding, and consolidated accountability. We note each model’s benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations. (shrink)

In November 2018, the practice of health care ethics consultation crossed a major threshold when 138 candidates took the inaugural Healthcare Ethics Consultant Certification Examination. This accomplishment, long in the making, has had and continues to have both advocates and critics. The Healthcare Ethics Consultant Certification Commission, a functionally autonomous body created and funded by the American Society for Bioethics and Humanities, was charged with overseeing creation of the certification process, developing the exam, and formulating certification standards and policies to (...) assess candidates’ qualifications. In this essay, as members of the commission, we describe the process of developing, administering, and scoring the certification examination as well as the historical context and the outlook for certification. By detailing the decisions and actions of the commission, we aim to provide a transparent account of the commission's efforts to develop a psychometrically sound, reliable, and secure examination through a deliberative, fair, and data‐driven process. (shrink)