In my professional role as anatomy administrator and bequeathal secretary at a large surgical training centre, I am the first point of contact both for people wishing to donate their body, and for newly bereaved relatives telling us that their registered loved-one has died. I am involved in every stage of the process from that first phone call, through to eventual funeral service, cremation of the body and return of the ashes to the family. I am also a registered body (...) donor myself, as I strongly believe in the value of cadaveric training having seen it first hand. When prospective donors and relatives find out that I am also a registered body donor they find this to be very reassuring to know that having ‘behind the scenes’ access has not put me off, and is a good endorsement for the process, …. (shrink)

Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centred outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively remediated (...) patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centred TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centred TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centred outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarised, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilisation of multivariate prediction models to inform individually-tailored interventions targeting a range of health conditions. (shrink)

Smajdor invites welcome interrogation of the distance between our philosophical justifications of how we engage people in decisions about healthcare or research, and the ways we do so.1 She notes the implicit elision made between autonomy and informed consent, and argues the latter alone cannot secure the former, proposing a more flexible approach. As researchers working with people with dementia (PwD), we share Smajdor’s reservations. We argue that an autonomy worthy of respect requires not just decision-making capacity, but also authenticity; (...) the ability to determine for oneself what is good for oneself.2 Furthermore, our relationships support or undermine both capacity and authenticity, and autonomous expression manifests throughout evolving relationships. This invites us to view respect differently—as an ongoing conversation with another person, capable of holding values that may move us. In Smajdor’s terminology, it requires that we recognise them. We describe how we operationalise this in our research. Three broad arguments usually support respect for autonomy.2 One—owed to JS Mill—holds that permitting individuals free choice promotes utility of all, by helping them fulfil ideas of the good, demonstrating ‘experiments in living’. Another draws from Kant’s categorical imperative; its Formula of Humanity holds that the capacity to determine our own values gives us reason to act, and we ought, therefore, to treat others’ values with the respect we show our own. Lastly, many simply assume ‘liberal neutrality’—an intrinsic value in people being permitted to pursue the …. (shrink)

In this paper an economics approach to assessing community values in health care priority setting is examined. The approach is based on the concept of ‘willingness to pay’ (WTP). Eighty two parents were interviewed with regard to three aspects of provision of child health services. For each aspect a choice of two courses of action was presented. Parents were asked which course of action they preferred and what was the maximum amount of money they would be prepared to pay for (...) this rather than their less preferred option. WTP responses are acceptable to the majority of respondents and appear to ‘behave’ in accordance witha priori expectations. A method of assessing the influence of ability to pay on preferences and WTP is outlined. Preferences and WTP do not appear to have been unduly distorted by ability to pay. Use of WTP data does have the potential to provide health care purchasers and providers with information on intensity as well as direction of the preferences of members of the community. (shrink)

United Nations (UN) leaders suggest that the world is not on track to meet the Sustainable Development Goals (SDGs) by 2030. The purpose of this paper is to explore whether the SDGs provide a valuable platform to call for a basic income (BI) globally. Adopting a critical historical studies approach, the article traces the evolution of ‘development’, including the UN decades of development, the Millennium Development Goals, and the SDGs. It subsequently describes the structural adjustment and poverty reduction efforts by (...) the World Bank and International Monetary Fund, and then outlines why the SDG framework may be helpful in advancing a BI. We argue that as climate-related disasters increase, a BI will be vital in providing a modicum of security in an increasingly unstable world. Calls for BI must be anchored to a broader change agenda that recognizes the causes of poverty and income inequality, and seeks their dismantling and redress. (shrink)

A basic model of hierarchical structure, expressed by simple, linear differential equations, shows that the pattern of population growth is essentially determined by conditions of redundancy in the sub-structure of individuals. There does not exist any possible combination between growth rate and accident rate that could balance population numbers and/or the level of redundancy within the population; all possible combinations either lead to extinction or to positive population growth with a decline of the fraction of individuals with redundant substructure. Declining (...) populations, however, can be held fluctuating between certain limits by periodic phases of sub-unit repair. These results are particularly pertinent to the population dynamics of diploid (polyploid) organisms. (shrink)

Electronic technologies, in general, and computer-oriented technologies specifically have had a tremendous impact on all aspects of business. One area of increased concern is the protection of intellectual properties -- notably copyrights -- within the boundaries of the broadly defined technology industry. While the ability to share copyrighted information has always existed at the most basic levels, the advent of the information age has allowed the sharing of this information to take place in potentially greater quantities and without a loss (...) of quality. As such, copying creates a major threat to industries dealing in the production and distribution of copyrightable creations. The focus of this paper is to better understand how the ethical judgments of employees regarding the opportunities to recreate copyrighted works via traditional and newer technologies impact assessments of copying behavior in the workplace. (shrink)

Drawing from both theoretical and empirical research, the literature on basic income (BI) is now voluminous, pronouncing both its merits and its limitations. Burgeoning research documents the impacts of un/conditional cash transfers and negative income tax programs, with many studies highlighting the effectiveness of these programs in reducing poverty, and improving a host of social, economic and health outcomes. We consider possible avenues for BI architecture to be adopted within Canada’s existing constellation of income security programs, to the benefit of (...) disadvantaged groups in society. Identifying key federal and provincial (i.e., Ontario) transfer and tax benefit programs, we highlight which programs might best be maintained or converted to a BI. While opponents decry the (alleged) exorbitant costs of BI schemes, we suggest that the existing approach not only produces an ineffective system—which actually engenders poverty and the health and social problems that accompany it—but an excessively costly one. (shrink)

Biological dysfunction is regarded, in many accounts, as necessary and perhaps sufficient for disease. But although disease is conceptualized as all-or-nothing, biological functions often differ by degree. A tension is created by attempting to use a continuous variable as the basis for a categorical definition, raising questions about how we are to pinpoint the boundary between health and disease. This is the line-drawing problem. In this paper, we show how the line-drawing problem arises within “dysfunction-requiring” accounts of disease, such as (...) those of Christopher Boorse and Jerome Wakefield. We then provide several detailed examples to establish that biological dysfunction cannot provide a boundary. We examine potential ways of resolving the line-drawing problem, either by dropping one of the claims that generates it, or by appealing to additional criteria. We argue that two of these options are plausible, and that each of these can be applied with regard to different diseases. (shrink)

“The world of life which is comprised of the lithosphere, the hydrosphere and the atmosphere”: this definition of the biosphere is not complete since it does not express the determining influence of living organisms on its composition, on its structure and on the processes of its continuing evolution. The part of living matter in the biosphere is relatively small (about 0.25%), but this part has a considerable influence on its structure.The biosphere should be considered as the universal source of all (...) food products without exception. Mankind's ability to feed itself depends on the productivity of this biosphere in the first place. Moreover, its condition determines not only the quantity but also the quality of nourishment. The problem is a critical one today because of the increasing pollution of the biosphere by products poured into it by various human activities. (shrink)

Background The ethical use both of human and non-human animals in research is predicated on the assumption that it is of a high quality and its projected benefits are more significant than the risks and harms imposed on subjects. Yet questions remain about whether and how IRBs and IACUCs should consider the scientific value of proposed research studies.Methods We draw upon 45 interviews with IRB and IACUC members and researchers with oversight experience about their perceptions of their own roles in (...) reviewing the quality and value of scientific protocols. Interview transcripts were memoed to highlight specific findings, which were then used to identify key themes through an iterative process.Results IRB and IACUC members expressed broad trust in the need for and value of research, and they often assumed that protocols had social value or that prior review, especially when associated with funding, affirmed both the rigor and merit of those protocols. Some oversight members also took an explicit stance against scientific review by stating that such review is not within the regulatory mandates governing their parts in the oversight system. Yet other interviewees expressed uneasiness about the current paradigm for evaluating the quality and overall value of science, suggesting that IRB and IACUC members perceive gaps in the oversight systems.Conclusions These findings reveal many similarities in how IRB and IACUC members understand the roles and limitations of their respective oversight committees. We conclude with a discussion of how the lack of a clear mandate regarding scientific review within US federal regulations may undermine ethical engagement of whether human and animal research is scientifically justified, resulting in a “mission lapse” wherein no organizational body is clearly responsible for ensuring that the research being conducted has the potential to advance science and benefit society. (shrink)

_Manual of Regulation-Focused Psychotherapy for Children with Externalizing Behaviors: A Psychodynamic Approach_ offers a new, short term psychotherapeutic approach to working dynamically with children who suffer from irritability, oppositional defiance and disruptiveness. _RFP-C_ enables clinicians to help by addressing and detailing how the child’s externalizing behaviors have meaning which they can convey to the child. Using clinical examples throughout, Hoffman, Rice and Prout demonstrate that in many dysregulated children, _RFP-C_ can: Achieve symptomatic improvement and developmental maturation as a result of (...) gains in the ability to tolerate and metabolize painful emotions, by addressing the crucial underlying emotional component. Diminish the child’s use of aggression as the main coping device by allowing painful emotions to be mastered more effectively. Help to systematically address avoidance mechanisms, talking to the child about how their disruptive behavior helps them avoid painful emotions. Facilitate development of an awareness that painful emotions do not have to be so vigorously warded off, allowing the child to reach this implicit awareness within the relationship with the clinician, which can then be expanded to life situations at home and at school. This handbook is the first to provide a manualized, short-term dynamic approach to the externalizing behaviors of childhood, offering organizing framework and detailed descriptions of the processes involved in _RFP-C_. Supplying clinicians with a systematic individual psychotherapy as an alternative or complement to PMT, CBT and psychotropic medication, it also shifts focus away from simply helping parents manage their children’s misbehaviors. Significantly, the approach shows that clinical work with these children is compatible with understanding the children’s brain functioning, and posits that contemporary affect-oriented conceptualizations of defense mechanisms are theoretically similar to the neuroscience construct of implicit emotion regulation, promoting an interface between psychodynamics and contemporary academic psychiatry and psychology. Manual of Regulation-Focused Psychotherapy for Children with Externalizing Behaviors: A Psychodynamic Approach is a comprehensive tool capable of application at all levels of professional training, offering a new approach for psychoanalysts, child and adolescent counselors, psychotherapists and mental health clinicians in fields including social work, psychology and psychiatry. (shrink)

Over the last 20 years, sex offender policies, specifically in terms of community corrections, have increased in scope. One of the most controversial and pervasive sex offender policies is that of registration. In response to the consumption of already limited resources, jurisdictions have imposed increasingly higher community supervision fees onto the offenders, requiring them to pay for their own re-entry. However, to date no research study has examined the statutory language associated with registration fees collected post release from formal community (...) sanctions. Using a statutory analysis within the United States, this research finds and quantifies the imposition of a registration fee on offenders who are legally compelled to pay these registration costs, regardless of whether they are still currently under community supervision. Results show that more than half of U.S. states (n = 28) incorporate statutory language authorizing registration fees, ranging anywhere from $5 per registration to up to $250 per year. These findings, as well as suggestions for future research and policy recommendations, are discussed. (shrink)

This article is an amendment to Drengson (2011) that offers examples from fieldwork and reporting of practices influenced by the technocratic paradigm. Specifically (1) Krippner's work with Brazilian shamans and the theft of their tribal knowledge by the biotechnology industry that Krippner refers to as ecopiratism. (2) Hitchcock's field research with indigenous populations in the northwestern Kalahari Desert region of southern Africa and his documented assault of these indigenous peoples by private companies that Hitchcock refers to as developmental genocide. And (...) (3) Walker's summary of Monsanto's patenting of seeds, and her warning of the health and environmental problems associated with genetically modified organisms. These examples offer support for the hypothesis that the eco-crisis is born of conscious agency. Beyond documenting and diagnosing these symptoms of the eco-crisis, this article puts forth the thesis that a transformation of consciousness would change the conditions of our present situation by providing the opportunity for different solutions to be found through the creation of a new mind set to make the necessary decisions for change. Many refer to the emerging field concerned with developing approaches to this transformation of consciousness as ecopsychology that Schroll prefers to call transpersonal ecosophy. (shrink)

Counterfactual verbal irony, an evaluative form of figurative language wherein a speaker’s intended meaning is opposite to the literal meaning of his or her words, is used to serve many social goals. Despite recent calls for theoretical accounts to include the factors that influence irony interpretation, few studies have examined the individual differences that may impact verbal irony interpretation. The present study examined whether adults with elevated shyness would generate more negative interpretations of ironic statements. University students with varying degrees (...) of shyness listened to stories wherein one character made literal or ironic criticisms or compliments to another character. Participants then appraised each speaker’s belief and attitude. Self-reported shyness did not predict comprehension of the counterfactual nature of ironic statements. However, shyer adults rated speakers who made ironic compliments as being meaner than did adults low in shyness. Thus, while understanding that ironic speakers intended to communicate their true beliefs, shyer individuals construed the social meaning of irony more negatively. Such interpretive biases may lead shy individuals to more frequently take offense at ironic compliments and experience more negativity in social interactions. (shrink)

En la Biblia de Ávila se encuentra el ciclo pictórico de la vida y la pasión de Cristo más completo del Románico español. Cada escena viene acompañada por una inscripción en latín añadida poco después de que se completaran las imágenes. Sin embargo, no todas las inscripciones identifican los personajes o las escenas correctamente. Uno de los errores se encuentra en el último folio del ciclo que, habiendo sido identificado como Pentecostés o la bajada del Espíritu Santo, no presenta ninguna (...) de las características iconográficas típicas de este tema. Este artículo investiga otras alternativas iconográficas que puedan explicar la peculiaridad de la imagen y la posición final del folio. (shrink)

Medicine seeks to overcome one of the most fundamental fragilities of being human, the fragility of good health. No matter how robust our current state of health, we are inevitably susceptible to future illness and disease, while current disease serves to remind us of various frailties inherent in the human condition. This article examines the relationship between fragility and uncertainty with regard to health, and argues that there are reasons to accept rather than deny at least some forms of uncertainty. (...) In situations of current ill health, both patients and doctors seek to manage this fragility through diagnoses that explain suffering and provide some certainty about prognosis as well as treatment. However, both diagnosis and prognosis are inevitably uncertain to some degree, leading to questions about how much uncertainty health professionals should disclose, and how to manage when diagnosis is elusive, leaving patients in uncertainty. We argue that patients can benefit when they are able to acknowledge, and appropriately accept, some uncertainty. Healthy people may seek to protect the fragility of their good health by undertaking preventative measures including various tests and screenings. However, these attempts to secure oneself against the onset of biological fragility can cause harm by creating rather than eliminating uncertainty. Finally, we argue that there are good reasons for accepting the fragility of health, along with the associated uncertainties. (shrink)

MPZL3 is a nuclear‐encoded, mitochondrially localized, immunoglobulin‐like V‐type protein that functions as a key regulator of epithelial cell differentiation, lipid metabolism, ROS production, glycemic control, and energy expenditure. Recently, MPZL3 has surfaced as an important modulator of sebaceous gland function and of hair follicle cycling, an organ transformation process that is also governed by peripheral clock gene activity and PPARγ. Given the phenotype similarities and differences between Mpzl3 and Pparγ knockout mice, we propose that MPZL3 serves as a signaling hub (...) that is regulated by core clock gene products and/or PPARγ to translate signals from these nuclear transcription factors to the mitochondria to modulate circadian and metabolic regulation. Conservation between murine and human MPZL3 suggests that human MPZL3 may have similarly complex functions in health and disease. We summarize current knowledge and discuss future directions to elucidate the full spectrum of MPZL3 functions in mammalian physiology. (shrink)

Consumers are bombarded with labels and claims that are intended to address their concerns about how food products are produced, processed, and regulated. Among those are the natural or all-natural claims and the certified organic label. In this study, two focus groups were conducted to explore consumers’ attitudes toward all-natural and organic pork and to gather their reactions to the USDA organic standards for meat, and the policy for natural claims. Results indicated that participants had positive associations with the terms (...) “organic” and “all-natural” with exceptions regarding the trustworthiness of all-natural claims. Participants perceived the “no” labeling theme (no antibiotics, no hormones, no chemicals, etc.) often coupled with the all-natural label on pork products as identifying potential health and animal welfare risks. In response to the USDA standards and policies for labeling pork products as organic or all-natural, participants expressed confusion and had many unanswered questions. (shrink)

Advances in DNA sequencing technology open new possibilities for public health genomics, especially in the form of general population preventive genomic sequencing. Such screening programs would sit at the intersection of public health and preventive health care, and thereby at once invite and resist the use of clinical ethics and public health ethics frameworks. Despite their differences, these ethics frameworks traditionally share a central concern for individual rights. We examine two putative individual rights—the right not to know, and the child’s (...) right to an open future—frequently invoked in discussions of predictive genetic testing, in order to explore their potential contribution to evaluating this new practice. Ultimately, we conclude that traditional clinical and public health ethics frameworks, and these two rights in particular, should be complemented by a social justice perspective in order adequately to characterize the ethical dimensions of general population PGS programs. (shrink)

Due to their consolidated nature, corporate sustainability reports often mask the evolution of organizations’ sustainability initiatives. Thus, to more fully understand the environmental performance of an organization, it is essential to examine the experiences of specific projects and how they relate to corporate sustainability. Based on case studies of green projects in four different organizations, we find that it is difficult to determine the environmental impact of a project a priori, even in cases where environmental considerations are included as part (...) of the initial project scope. Instead, the decision to integrate environmentally favorable elements into projects is a dynamically occurring interaction between competing institutional logics and organizational identities, which create windows of opportunity for individual agency. During these windows, individuals may engage in reinforcing microprocesses that support traditional practices, or invoke enabling microprocesses to facilitate green decision-making, consistent with ecosystem logics. The process model developed in this paper provides a new perspective on the temporal and contextual dimensions of environmental championship behaviors, and sheds light on otherwise puzzling results such as why organizations with strong environmental orientations continue to struggle with delivering projects with strong positive environmental impacts. (shrink)

ABSTRACT:Clinical ethics consultants bear witness to the direct harms of intersecting axes of oppression—such as racism and classism—as they impinge on elucidating and resolving ethical dilemmas in health care. Health Care Ethics Consultation (HCEC) professional guidance supports recognizing and analyzing power dynamics and social-structural obstacles to good care. However, the most relied upon bioethical principles in clinical ethics have been criticized for insufficiency in this regard. While individual ethics consultants have found ways to expand their approaches, they do so in (...) an ad hoc way without frameworks to guide consistency. Motivated by the practical expertise of clinical ethicists, this essay offers a new framework to support openness to analyzing power imbalances and respecting marginalized voices and values. This framework is grounded in transformative justice, where the aim is to take responsibility for oppression by centering and responding to moral perspectives and value systems that are all too often silenced. (shrink)

Background Our objective was to evaluate whether the description of a machine learning (ML) app or brain imaging technology to predict the onset of schizophrenia or alcohol use disorder (AUD) influences healthcare professionals’ judgments of stigma, empathy, and compassion. Methods We randomized healthcare professionals (N = 310) to one vignette about a person whose clinician seeks to predict schizophrenia or an AUD, using a ML app, brain imaging, or a psychosocial assessment. Participants used scales to measure their judgments of stigma, (...) empathy, and compassion. Results Participants randomized to the ML vignette endorsed less anger and more fear relative to the psychosocial vignette, and the brain imaging vignette elicited higher pity ratings. The brain imaging and ML vignettes evoked lower personal responsibility judgments compared to the psychosocial vignette. Physicians and nurses reported less empathy than clinical psychologists. Conclusions The use of predictive technologies may reinforce essentialist views about mental health and substance use that may increase specific aspects of stigma and reduce others. (shrink)

This article is concerned with the ways in which bodies and subjects are enacted and negotiated in the encounter between client and practitioner within specialized kinesiology – a specific complementary and alternative medical practice. In the article we trace the ideas of connections and disconnections, which are conceptualized and practised within kinesiology. We attempt to come to grips with these specific notions of relatedness through the introduction of the concept ‘energetic kinship’ and to relate them to more general discussions about (...) the nature of subjects, bodies and social identity in late modern society. We argue that through the particular approach to the body as a prime locus of knowledge on which kinesiological treatment practices are based, kinesiology offers clients an alternative understanding of being-in-the-world. The understanding of the body as the locus of knowledge might, on the one hand, potentially alleviate the individual from the weight of a late modern focus on self-responsible, rational and autonomous individuality, while, on the other hand, it simultaneously supports this understanding. Hence, we argue that kinesiology operates with a subject which is both inherently related and individual at the same time, and that these particular understandings may be appealing in a world in which health and illness are increasingly seen as a question of individual responsibility. The article was written on the basis of interviews and participant observation among kinesiological teachers and practitioners in Denmark. (shrink)

This paper offers a novel, qualitative approach to evaluating the outcomes of integrating humanities and ethics into a newly revised pre-clerkship medical education curriculum. The authors set out to evaluate medical students’ perceptions, learning outcomes, and growth in identity development. Led by a team of interdisciplinary scholars, this qualitative project examines multiple sources of student experience and perception data, including student essays, end-of-year surveys, and semi-structured interviews with students. Data were analyzed using deductive and inductive processes to identify key categories (...) and recurring themes. Results suggest that students not only engaged with the curricular content and met the stated learning objectives but also acknowledged their experience in the humanities and ethics curriculum as an opportunity to reflect, expand their perceptions of medicine (and what it means to be “in” medicine), connect with their classmates, and further cultivate their personal and professional identities. Results of this qualitative study show how and in what ways the ethics and humanities curriculum motivates students past surface-level memorization of factual knowledge and encourages thoughtful analysis and evaluation about how the course material relates to and influences their thinking and how they see themselves as future doctors. The comprehensive qualitative approach reflects a holistic model for evaluating the integration of humanities and ethics into the pre-clerkship medical education curriculum. Future research should examine if this approach provides a protective factor against the demonstrated ethical erosion and empathy decrease during clinical training. (shrink)

In this case report, we describe a woman with advancing dementia who still retained decisional capacity and was able to clearly articulate her request for deactivation of her implanted cardiac pacemaker—a scenario that would result in her death. In this case, the patient had the autonomy to make her decision, but clinicians at an outside hospital refused to deactivate her pacemaker even though they were in unanimous agreement that the patient had capacity to make this decision, citing personal discomfort and (...) a belief that her decision seemed out of proportion to her suffering. We evaluated her at our hospital, found her to have decision-making capacity, and deactivated her pacer resulting in her death about 9 days later. While some clinicians may be comfortable discussing patient preferences for device deactivation in patients who are imminently dying, we can find no reports in the literature of requests for device deactivation from patients with terminal diagnoses who are not imminently dying. (shrink)

This article argues that hope is of value in clinical ethics and that it can be important for clinicians to be sensitive to both the risks of false hope and the importance of retaining hope. However, this sensitivity requires an understanding of the complexity of hope and how it bears on different aspects of a well-functioning doctor-patient relationship. We discuss hopefulness and distinguish it from three different kinds of hope, or ‘hopes for’, and then relate these distinctions back to differing (...) accounts of autonomy. This analysis matters because it shows how an overly narrow view of the ethical obligations of a clinician to their patient, and autonomy, might lead to scenarios where patients regret the choices they make. (shrink)

The paper examines a single, apparently simple argument for the existence of incompatibilities between the virtues as traits of character. This argument appeals not to empirical truths about human psychology or human nature but to the possibility of conflict between the exercise of different virtues in action. There are, for example, situations in which we can exercise the virtue of truthfulness only at the expense of not exercising the virtue of tact, as when we are asked a question to which (...) the straightforward answer will pain our questioner. The person who in these situations would give a straightforward answer possesses the virtue of truthfulness to a higher degree than the person who would respond more evasively, whereas the latter person possesses the virtue of tact to a higher degree than the former. But since the two responses are mutually exclusive, it follows that the degree to which we possess the virtue of truthfulness must, at least in some measure, correlate inversely with the degree to which we possess the virtue of tact. And similarly for many other pairs of virtues. My paper focusses on the two cardinal assumptions of this argument, viz., (i) that sometimes the exercise of one virtue can conflict with the exercise of another, and (ii) that the degree to which a person possesses a virtue correlates directly with the extent of its exercise, and defends both assumptions against a variety of objections which allege that, in different ways, they are insensitive to the complexity of the virtues. (shrink)

In this paper, we examine recent critiques of the debate about defining disease, which claim that its use of conceptual analysis embeds the problematic assumption that the concept is classically structured. These critiques suggest, instead, developing plural stipulative definitions. Although we substantially agree with these critiques, we resist their implication that no general definition of “disease” is possible. We offer an alternative, inductive argument that disease cannot be classically defined and that the best explanation for this is that the concept (...) is structured as a cluster. We further argue that we do not need to reject the possibility of defining the general concept “disease” to legitimate developing stipulative definitions of disease that are relative to particular purposes. A cluster definition of disease is compatible with contextually motivated definitions, which may be considered précisifications of the more general cluster concept. (shrink)

Empirical research is largely supportive of the assertion of instrumental stakeholder theory that a positive relationship exists between “managing for stakeholders” and firm performance. However, despite considerable debate on the subject, the amount of variation across firm investments in stakeholders (stakeholder management performance) has not been adequately investigated. We address this gap using a sample of more than eighteen thousand firm-level observations over ten years. We find evidence to support an inverted U–shaped relationship between variation in stakeholder management performance and (...) Tobin’sq, suggesting that firms that have some imbalance in their stakeholder management, but not too much, perform best. We discuss the implications of our study for instrumental stakeholder theory and managerial practice. (shrink)

A. D. M. Walker; III*—Gratefulness and Gratitude, Proceedings of the Aristotelian Society, Volume 81, Issue 1, 1 June 1981, Pages 39–56, https://doi.org/10.1093.

BackgroundUse of modified texture diets—thickening of liquids and modifying the texture of foods—in the hope of preventing aspiration, pneumonia and choking, has become central to the current management of dysphagia. The effectiveness of this intervention has been questioned. We examine requirements for a valid informed consent process for this approach and whether the need for informed consent for this treatment is always understood or applied by practitioners.Main textValid informed consent requires provision of accurate and balanced information, and that agreement is (...) given freely by someone who knows they have a choice. Current evidence, including surveys of practitioners and patients in different settings, suggests that practice in this area is often inadequate. This may be due to patients’ communication difficulties but also poor communication—and no real attempt to obtain consent—by practitioners before people are ‘put on’ modified texture diets. Even where discussion occurs, recommendations may be influenced by professional misconceptions about the efficacy of this treatment, which in turn may poison the well for the informed consent process. Patients cannot make appropriate decisions for themselves if the information provided is flawed and unbalanced. The voluntariness of patients’ decisions is also questionable if they are told ‘you must’, when ‘you might consider’ is more appropriate. Where the decision-making capacity of patients is in question, inappropriate judgements and recommendations may be made by substitute decision makers and courts unless based on accurate information.ConclusionResearch is required to examine the informed consent processes in different settings, but there is ample reason to suggest that current practice in this area is suboptimal. Staff need to reflect on their current practice regarding use of modified texture diets with an awareness of the current evidence and through the ‘lens’ of informed consent. Education is required for staff to clarify the importance of, and requirements for, valid informed consent and for decision making that reflects people’s preferences and values. (shrink)

The distribution of cultural variants in a population is shaped by both neutral evolutionary dynamics and by selection pressures. The temporal dynamics of social network connectivity, that is, the order in which individuals in a population interact with each other, has been largely unexplored. In this paper, we investigate how, in a fully connected social network, connectivity dynamics, alone and in interaction with different cognitive biases, affect the evolution of cultural variants. Using agent‐based computer simulations, we manipulate population connectivity dynamics (...) (early, mid, and late full‐population connectivity); content bias, or a preference for high‐quality variants; coordination bias, or whether agents tend to use self‐produced variants (egocentric bias), or to switch to variants observed in others (allocentric bias); and memory size, or the number of items that agents can store in their memory. We show that connectivity dynamics affect the time‐course of variant spread, with lower connectivity slowing down convergence of the population onto a single cultural variant. We also show that, compared to a neutral evolutionary model, content bias accelerates convergence and amplifies the effects of connectivity dynamics, while larger memory size and coordination bias, especially egocentric bias, slow down convergence. Furthermore, connectivity dynamics affect the frequency of high‐quality variants (adaptiveness), with late connectivity populations showing bursts of rapid change in adaptiveness followed by periods of relatively slower change, and early connectivity populations following a single‐peak evolutionary dynamic. We evaluate our simulations against existing data collected from previous experiments and show how our model reproduces the empirical patterns of convergence. (shrink)