This essay aims to elucidate how multiple voices and traditions should interact with one another in the practice of ethics. First, it explores some of the major ways in which questions of bodily autonomy function in secular feminist and Jewish bioethical discourses. It then uses case studies to illuminate ways each discourse's concepts of bodily autonomy can be deeply problematic, and argues that the strengths in each discourse can serve as important correctives for the weaknesses in the other. It suggests (...) that some formal features of rabbinic texts can serve as a model for a discourse of constant and animated mutual correction. Finally, it examines two case studies in light of this model. (shrink)

What can the Jewish tradition contribute to the current public debate about vaccination? Much of the rhetoric surrounding vaccine refusal appeals to concepts of individual autonomy and fears of political and intellectual authority, claiming that the individual is the best expert on his or her own health and on whether to actively deny accepted medical consensus. Unlike many other health decisions, vaccine refusal has direct and measurable consequences for one's community. The Jewish tradition's emphasis on community and the well-being of (...) the collective, as well as its tradition of respect for intellectual authority, can be a critical support to the medical community in encouraging wide-spread vaccination. (shrink)

Journal of Religious Ethics, Volume 49, Issue 2, Page 226-244, June 2021.

Regnant public accounts of Jewish sexual ethics—both external and internal—fall short of what they could accomplish. Using a Twitter thread on sexual ethics which falls into some key errors as a case study, I argue that Jewish ethicists are poised to address the thread's errors by offering sources for alternative moral frameworks. I examine how thinking with this Twitter thread can help us clarify what we mean by public scholarship more generally, what is wrong with some common public deployments of (...) specifically Jewish sources, and some implications of this for both Jewish and non‐Jewish publics. I conclude with some reflections about the role of traditional academic venues, such as the Journal of Religious Ethics, within this. (shrink)

When We Collide is a landmark reassessment of the significance of sex in contemporary Jewish ethics. Rebecca Epstein-Levi offers a fresh and vital exploration of sexual ethics and virtue ethics in conversation with rabbinic texts and feminist and queer theory. Epstein-Levi explores how sex is not a special or particular form of social interaction but one that is entangled with all other forms of social interaction. The activities of sex-doing it, talking about it, thinking about it, regulating (...) it-are sites of ongoing moral formation on individual, interpersonal, and communal levels. When We Collide explores the development of Jewish sexual ethics, and represents an opportunity to move beyond the usual heteronormative accounts that are presented as though they were neutral representations of what "Judaism teaches about sex.". (shrink)

Background Encounters of moral distress have long-term consequences on healthcare workers’ physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. Research Objective The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic (...) medical center. Participants & Research Context Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. Research Design Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine’s National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. Ethical Considerations Ethics approval was obtained from the university and medical center institutional review boards. Findings Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. Conclusion Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being. (shrink)

Objective Gather information from physicians about factors contributing to unnecessary noninvasive imaging and impact of possible solutions. Methods Qualitative study of 14 physicians using a phenomenological approach and the Theoretical Domains Framework. Results Most participants self-reported that >10% of the imaging tests they order are unnecessary. External sources of pressure included: peer-review, patient demands, nursing expectations, specialist requests, as well as prior experience with patient advocates, and the compensation and pension system. Internal sources of pressure included reliance on anecdote, self-doubt (...) about diagnoses, and fear of missing a diagnosis and of professional liability. Participants expressed both optimism and concern about potential solutions, such as adopting decision support software. Conclusion Physicians are under pressure from multiple sources to order unnecessary imaging. Peer review, nursing expectations, and perceptions about Veteran compensation and pension are newly reported contributing factors. (shrink)

Marine interstitial environments are teeming with an extraordinary diversity of coexisting microeukaryotic lineages collectively called “meiofauna.” Interstitial habitats are broadly distributed across the planet, and the complex physical features of these environments have persisted, much like they exist today, throughout the history of eukaryotes, if not longer. Although our general understanding of the biological diversity in these environments is relatively poor, compelling examples of developmental heterochrony (e.g., pedomorphosis) and convergent evolution appear to be widespread among meiofauna. Therefore, an improved understanding (...) of meiofaunal biodiversity is expected to provide some of the deepest insights into the following themes in evolutionary biology: (i) the origins of novel body plans, (ii) macroevolutionary patterns of miniaturization, and (iii) the intersection of evolution and community assembly – e.g., “community convergence” involving distantly related lineages that span the tree of eukaryotes. (shrink)

Leibniz's widely influential account of time provides a significant puzzle for those seeking to locate this account within his hierarchical ontology. Leibniz follows his scholastic predecessors in supposing that there are different grades of being, with substances being the most real and all other things possessing their reality via their relationships to substance. Following this picture, Leibniz suggests that phenomenal bodies only possess the being that they derive from the substances (i.e., monads) that ground them. Some would argue that time (...) likewise only possesses its being based on the bodies that it relates. Contrary to this suggestion (i.e., that time is twice removed from substances), I will argue that time is derived directly from rational souls. Thus, I will argue that time is on an ontological par with the phenomenal world of bodies. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

Biological ontologies are used to organize, curate, and interpret the vast quantities of data arising from biological experiments. While this works well when using a single ontology, integrating multiple ontologies can be problematic, as they are developed independently, which can lead to incompatibilities. The Open Biological and Biomedical Ontologies Foundry was created to address this by facilitating the development, harmonization, application, and sharing of ontologies, guided by a set of overarching principles. One challenge in reaching these goals was that the (...) OBO principles were not originally encoded in a precise fashion, and interpretation was subjective. Here we show how we have addressed this by formally encoding the OBO principles as operational rules and implementing a suite of automated validation checks and a dashboard for objectively evaluating each ontology’s compliance with each principle. This entailed a substantial effort to curate metadata across all ontologies and to coordinate with individual stakeholders. We have applied these checks across the full OBO suite of ontologies, revealing areas where individual ontologies require changes to conform to our principles. Our work demonstrates how a sizable federated community can be organized and evaluated on objective criteria that help improve overall quality and interoperability, which is vital for the sustenance of the OBO project and towards the overall goals of making data FAIR. Competing Interest StatementThe authors have declared no competing interest. (shrink)

Mr. Galanas, an eighty‐six‐year‐old man, intentionally shot himself in the chest and abdomen. Surprisingly, the bullet damaged only his distal pancreas and part of his colon, requiring a diverting colostomy to prevent leakage of bowel fluids into his abdomen. After being admitted, he lies intubated in the intensive care unit awaiting surgery to repair his colon. He is responsive but does not demonstrate clear decision‐making capacity. He grudgingly accepts pain medications but refuses antibiotics and antidepressants. He has a living will (...) that gives his wife durable power of attorney and also explicitly states a desire to refuse all medical interventions if he is permanently unconscious or in an end‐stage condition. Mrs. Galanas reports frequent conversations in which her husband said he would not want to be sustained on life support. She also says that he often mentioned he would not want an ostomy bag—a likely, albeit temporary, outcome of the proposed surgery. His physicians are nervous about withholding medical interventions when Mr. Galanas's injury is the result of a suicide attempt and his prognosis is good. Should the care team surgically repair his injured colon, regardless of the patient's capacity, his advance directive, and his wife's statement that he would not want surgery or other life‐sustaining treatment? (shrink)

The adage “an ounce of prevention is worth a pound of cure” is widely used in healthcare settings and can be applied to the work of institutional clinical ethics committees. The model of clinical ethics consultation, however, is inherently reactive: a crisis or question emerges, and ethics experts are called to help. In an effort to employ a proactive component to the model of clinical ethics consultation (as well as to standardize our educational interventions), we developed ethics pocket cards. The (...) purpose of this article is to: (1) describe the rationale for using ethics pocket cards, (2) provide examples of our cards, and (3) begin a dialogue about the potential uses of ethics pocket cards. In doing so, we hope to explore how such portable, economical devices can advance the goals of ethics consultation as well as the educational aims of ethics committees. (shrink)

In this review, we discuss the application of mouse models to the identification and pre‐clinical validation of novel therapeutic targets in colorectal cancer, and to the search for early disease biomarkers. Large‐scale genomic, transcriptomic and epigenomic profiling of colorectal carcinomas has led to the identification of many candidate genes whose direct contribution to tumourigenesis is yet to be defined; we discuss the utility of cross‐species comparative ‘omics‐based approaches to this problem. We highlight recent progress in modelling late‐stage disease using mice, (...) and discuss ways in which mouse models could better recapitulate the complexity of human cancers to tackle the problem of therapeutic resistance and recurrence after surgical resection. (shrink)

We report an experiment investigating the “special-process” theory of insight problem solving, which claims that insight arises from non-conscious, non-reportable processes that enable problem re-structuring. We predicted that reducing opportunities for speech-based processing during insight problem solving should permit special processes to function more effectively and gain conscious awareness, thereby facilitating insight. We distracted speech-based processing by using either articulatory suppression or irrelevant speech, with findings for these conditions supporting the predicted insight facilitation effect relative to silent working or thinking (...) aloud. The latter condition was included to investigate the currently contested effect of “verbal overshadowing” on insight, whereby thinking aloud is claimed to hinder the operation of special, non-reportable processes. Whilst verbal overshadowing was not evident in final solution rates, there was nevertheless support for verbal overshadowing up to and beyond.. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:When We Collide: Sex, Social Risk, and Jewish Ethics by Rebecca J. Epstein-LeviJoshua Stein (bio)When We Collide: Sex, Social Risk, and Jewish Ethics by Rebecca J. Epstein-Levi. Bloomington: Indiana University Press, 2023Sex is messy:Ethicists have an unfortunate habit of speaking of sex—or "good" sex, anyway—in lofty, aspirational terms: the physical and spiritual union of committed partners, the human sharing in divine creativity, the two becoming (...) one, and so on. This image of choreographed perfection is reproduced in popular culture. … But the actual practice of sex, by ordinary people, is not so lofty, so beautifully synchronous. Real sex, even "good" sex, is carnivalesque, even grotesque. Real sex involves fluids, farts, jiggling, grunting, adjustments of position, arms falling asleep, and accidental pinching or pulling of hair … and the making of a vast number of frankly ridiculous faces (83).Rebecca J. Epstein-Levi's When We Collide (2023) challenges us to think about sex as it is, rather than as we are conditioned to talk about it (or as we might sometimes like to imagine it). This is foundational to the book. There is a familiar tradition of sanitizing sex, reducing it to teleology, idealized bodies, heteronormativity, and venerated social institutions. In dispensing with this sanitized illusion, the book adopts a healthier and more honest relationship with sex; in order to have a productive discussion about the ethics of any human activity, that discussion should represent the human activity faithfully. Part of the reason that Epstein-Levi takes this approach is to distinguish Jewish ethics' discussion of sex, which regards sex, and therefore sexual ethics, "as an empirical, lived, and granular phenomenon" (3).Discussions in Jewish sexual ethics should treat sex as a lived social experience and be responsive to the messiness of that experience. Epstein-Levi argues that sanitizing sex through appeal to a nebulous notion of how historical [End Page 99] religious traditions must have been puritanical is ahistorical, chauvinistic, and inconsistent with scholarship on rabbinic texts.This is a striking and perhaps subversive view in our present context. Centrally, many associate "religious views" (especially in sexual ethics) with politically Conservative and purity-driven views characteristic of some Christian traditions. The term "Judeo-Christian" in American political discourse is often used evocatively of the heteronormative, sanitized, idealized posture toward sex that Levi explicitly rejects. Epstein-Levi's book recognizes that rabbinic scholarship underrepresents marginalized communities, including women, LGBTQ+ people, and disabled people. This is the major moral and practical focus of Epstein-Levi's analysis; historical traditions in which dominant moral views are shaped by a particular group often have glaring blind spots. When we recognize those blind spots, as members of that tradition, need to be updated simply to address sex as it exists, not as we idealize it.The book centers Jewish texts and methods of thought, but (in my view) readers who will benefit most from reading Epstein-Levi's book are non-Jewish readers thinking about sex. Epstein-Levi's book illustrates methodological differences in Jewish ethics from other approaches. The ethics of sex should change as our knowledge of sex changes; as we learn about sexual activity and about the social lives of people, we should apply that knowledge to our understanding. For Jewish thought, ethics is discursive, not fixed; our understanding of ethics requires constant consideration and discussion as our understanding of the world changes and improves.One central focus of the book is risk; our knowledge of sex changes as we understand and mediate against the risks involved in sexual activity and as we learn more about how risk works itself. Risk is tied up in all social activity, including sex. The ethics of sex requires discussion of risk but often does so in a way not congruous with the discussion of risk in other areas of social life. "Sex is dangerous. … Sexual intercourse opens us up to risks of infections, violence, and, if we are in possession of functional ovaries and a uterus, pregnancy" (98). All social activity is risky; we are all acutely aware given the prospects of exposure to strains of a novel coronavirus and the way we have changed our... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:When We Collide: Sex, Social Risk, and Jewish Ethics by Rebecca J. Epstein-LeviJoshua Stein (bio)When We Collide: Sex, Social Risk, and Jewish Ethics by Rebecca J. Epstein-Levi. Bloomington: Indiana University Press, 2023Sex is messy:Ethicists have an unfortunate habit of speaking of sex—or "good" sex, anyway—in lofty, aspirational terms: the physical and spiritual union of committed partners, the human sharing in divine creativity, the two becoming (...) one, and so on. This image of choreographed perfection is reproduced in popular culture. … But the actual practice of sex, by ordinary people, is not so lofty, so beautifully synchronous. Real sex, even "good" sex, is carnivalesque, even grotesque. Real sex involves fluids, farts, jiggling, grunting, adjustments of position, arms falling asleep, and accidental pinching or pulling of hair … and the making of a vast number of frankly ridiculous faces (83).Rebecca J. Epstein-Levi's When We Collide (2023) challenges us to think about sex as it is, rather than as we are conditioned to talk about it (or as we might sometimes like to imagine it). This is foundational to the book. There is a familiar tradition of sanitizing sex, reducing it to teleology, idealized bodies, heteronormativity, and venerated social institutions. In dispensing with this sanitized illusion, the book adopts a healthier and more honest relationship with sex; in order to have a productive discussion about the ethics of any human activity, that discussion should represent the human activity faithfully. Part of the reason that Epstein-Levi takes this approach is to distinguish Jewish ethics' discussion of sex, which regards sex, and therefore sexual ethics, "as an empirical, lived, and granular phenomenon" (3).Discussions in Jewish sexual ethics should treat sex as a lived social experience and be responsive to the messiness of that experience. Epstein-Levi argues that sanitizing sex through appeal to a nebulous notion of how historical [End Page 99] religious traditions must have been puritanical is ahistorical, chauvinistic, and inconsistent with scholarship on rabbinic texts.This is a striking and perhaps subversive view in our present context. Centrally, many associate "religious views" (especially in sexual ethics) with politically Conservative and purity-driven views characteristic of some Christian traditions. The term "Judeo-Christian" in American political discourse is often used evocatively of the heteronormative, sanitized, idealized posture toward sex that Levi explicitly rejects. Epstein-Levi's book recognizes that rabbinic scholarship underrepresents marginalized communities, including women, LGBTQ+ people, and disabled people. This is the major moral and practical focus of Epstein-Levi's analysis; historical traditions in which dominant moral views are shaped by a particular group often have glaring blind spots. When we recognize those blind spots, as members of that tradition, need to be updated simply to address sex as it exists, not as we idealize it.The book centers Jewish texts and methods of thought, but (in my view) readers who will benefit most from reading Epstein-Levi's book are non-Jewish readers thinking about sex. Epstein-Levi's book illustrates methodological differences in Jewish ethics from other approaches. The ethics of sex should change as our knowledge of sex changes; as we learn about sexual activity and about the social lives of people, we should apply that knowledge to our understanding. For Jewish thought, ethics is discursive, not fixed; our understanding of ethics requires constant consideration and discussion as our understanding of the world changes and improves.One central focus of the book is risk; our knowledge of sex changes as we understand and mediate against the risks involved in sexual activity and as we learn more about how risk works itself. Risk is tied up in all social activity, including sex. The ethics of sex requires discussion of risk but often does so in a way not congruous with the discussion of risk in other areas of social life. "Sex is dangerous. … Sexual intercourse opens us up to risks of infections, violence, and, if we are in possession of functional ovaries and a uterus, pregnancy" (98). All social activity is risky; we are all acutely aware given the prospects of exposure to strains of a novel coronavirus and the way we have changed our... (shrink)

Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothesize that 1) lack of equipoise at enrolment among parents may reduce recruitment; 2) lack of equipoise during participation may reduce retention in patients assigned to a less favoured treatment-strategy. Methods We compared preferences of (...) parents/patients at enrolment, documented by a questionnaire, with preferences developed during follow-up by an interview-study to investigate equipoise of child-participants and parents in the BeSt-for-Kids-study. This trial in new-onset Juvenile Idiopathic Arthritis-patients consists of three strategies. One strategy comprises initial treatment with a biological disease-modifying-antirheumatic-drug, currently not standard-of-care. Semi-structured interviews were conducted with 23 parents and 7 patients, median 11 months after enrolment. Results Initially most parents and children were not in equipoise. Parents/patients who refused participation, regularly declined due to specific preferences. Many participating families preferred the biological-first-strategy. They participated to have a chance for this initial treatment, and would even consider stopping trial-participation when not randomized for it. Their conviction of superiority of the biological-first strategy was based on knowledge from internet and close relations. According to four parents, the physician-investigator preferred the biological-first-strategy, but the majority stated that she had no preferred strategy. In phase 2, preferences tended to change to the treatment actually received. Conclusions Lack of equipoise during enrolment did not reduce study recruitment, mainly due to the fact that preferred treatment was only available within the study. Still, when developing a trial it is important to evaluate whether the physicians’ research question is in line with preferences of the patient-group. By exploring so-called ‘informed patient-group’-equipoise, successful recruitment may be enhanced and bias avoided. In our study, lack of equipoise during trial-participation did not reduce retention in those assigned to a less favoured option. We observed a change for preference towards treatment actually received, possibly explained by comparable outcomes in all three arms. (shrink)

ExcerptI have apologized privately to Prof. Perry—and do so again publicly—for my incorrect notation about her speech and my lack of precise citation. I was unaware of the published article, but had heard the speech at a regional AAS conference. I made assumptions about its nature (not its content) that I should not have done. I do not wish to elaborate here on our different ways of framing historical arguments and questions. Over many years, I have been an admiring reader (...) of Prof. Perry's impressive corpus of work, even as I have disagreed with elements of it (as is normal…. (shrink)

© 2017. The American Astronomical Society. All rights reserved.We present new observations of the low-mass companion to HD 984 taken with the Gemini Planet Imager as a part of the GPI Exoplanet Survey campaign. Images of HD 984 B were obtained in the J and H bands. Combined with archival epochs from 2012 and 2014, we fit the first orbit to the companion to find an 18 au orbit with a 68% confidence interval between 14 and 28 au, an eccentricity (...) of 0.18 with a 68% confidence interval between 0.05 and 0.47, and an inclination of 119°with a 68% confidence interval between 114°and 125°. To address the considerable spectral covariance in both spectra, we present a method of splitting the spectra into low and high frequencies to analyze the spectral structure at different spatial frequencies with the proper spectral noise correlation. Using the split spectra, we compare them to known spectral types using field brown dwarf and low-mass star spectra and find a best-fit match of a field gravity M6.5 ±1.5 spectral type with a corresponding temperature of K. Photometry of the companion yields a luminosity of log=2.88 ± 0.07 dex with DUSTY models. Mass estimates, again from DUSTY models, find an age-dependent mass of 34 ±1 to 95 ±4 M Jup. These results are consistent with previous measurements of the object. (shrink)

During the past decade, patient participation became an important issue in the medical field, and patient participation in biomedical research processes is increasingly called for. One of the arguments for this refers to the specific kind of knowledge, called experiential knowledge, patients could contribute. Until now, participation of patients in biomedical research has been rare, and integration of patients’ experiential knowledge with scientific knowledge—in the few cases it takes place—occurs implicitly and on an ad hoc basis. This is illustrated by (...) describing and analyzing the activities of the German patient group on retinitis pigmentosa. The authors argue that to be able to optimize the use of experiential knowledge of patients in biomedical research, a systematic approach is required. Transdisciplinary research provides such an approach, systematically, explicitly, and deliberately integrating knowledge from different scientific and nonscientific sources. In this article, the concept of transdisciplinarity is elaborated upon. The authors propose a possible procedure, identify necessary conditions and skills, and evaluate the feasibility of its implementation and institutionalization. Finally, the authors introduce a recent research project to further investigate and implement transdisciplinary research in the biomedical field. (shrink)

Using a sample of 652 college students, we examined several implications of the hypothesis that the shape of the human penis evolved to enable males to substitute their semen for those of their rivals. The incidence of double mating by females appears sufficient to make semen displacement adaptive (e.g., one in four females acknowledge infidelity, one in eight admit having sex with two or more males in a 24-hour period, and one in 12 report involvement in one or more sexual (...) threesomes with two males). We also document several changes in post-ejaculatory behavior (e.g., reduced thrusting, penis withdrawal, loss of an erection) which may have evolved to minimize displacement of the male’s own semen. Consistent with predictions derived from a theoretical model (Gallup and Burch 2006), we discovered that most females report waiting at least 48 hours following an instance of infidelity before resuming sex with their in-pair partners. (shrink)

In this paper I take Hempel’s raven paradox as the claim that statements of the form ‘∼Ru v Bu’, ‘u is not a raven or u is black,’ confirm the hypothesis h ‘(x)(Rx → Bx)’, ‘All ravens are black.’ Although Hempel discusses this using a criterion of confirmation expressed wholly in terms of deductive logic (see 1965, pp. 35-9), it has become more common to articulate criteria of confirmation using concepts of probability and, in particular, to employ the positive relevance (...) criterion of confirmation which says that, given background knowledge k, (i) e confirms h if and only if P(h/e.k)>P(h/k); (ii) e disconfirms h if and only if P(h/e.k)shrink)