Communication and Conflict Management Training for Clinical Bioethics Committees Content Type Journal Article Pages 341-349 DOI 10.1007/s10730-009-9116-7 Authors Lauren M. Edelstein, Johns Hopkins Medicine’s Howard County General Hospital 5755 Cedar Lane Columbia MD 21044 USA Evan G. DeRenzo, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Elizabeth Waetzig, Change Matrix Inc. 485 Maylin St. Pasadena CA 91105 USA Craig Zelizer, Georgetown University Department of Government 3240 Prospect St. Washington, D.C. NW 20057 USA Nneka (...) O. Mokwunye, Washington Hospital Center Center for Ethics 110 Irving St Washington, D.C. NW 20010 USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal Issue Volume 21, Number 4. (shrink)

Background The opioid epidemic has enabled rapid and unsurpassed use of big data on people with opioid use disorder to design initiatives to battle the public health crisis, generally without adequate input from impacted communities. Efforts informed by big data are saving lives, yielding significant benefits. Uses of big data may also undermine public trust in government and cause other unintended harms. Objectives We aimed to identify concerns and recommendations regarding how to use big data on opioid use in ethical (...) ways. Methods We conducted focus groups and interviews in 2019 with 39 big data stakeholders who had interest in or knowledge of the Public Health Data Warehouse maintained by the Massachusetts Department of Public Health. Results Concerns regarding big data on opioid use are rooted in potential privacy infringements due to linkage of previously distinct data systems, increased profiling and surveillance capabilities, limitless lifespan, and lack of explicit informed consent. Also problematic is the inability of affected groups to control how big data are used, the potential of big data to increase stigmatization and discrimination of those affected despite data anonymization, and uses that ignore or perpetuate biases. Participants support big data processes that protect and respect patients and society, ensure justice, and foster patient and public trust in public institutions. Recommendations for ethical big data governance offer ways to narrow the big data divide, enact shared data governance, cultivate public trust and earn social license for big data uses, and refocus ethical approaches. Conclusions Using big data to address the opioid epidemic poses ethical concerns which, if unaddressed, may undermine its benefits. Findings can inform guidelines on how to conduct ethical big data governance and in ways that protect and respect patients and society, ensure justice, and foster patient and public trust in public institutions. (shrink)

Involuntary civil commitment to treatment for opioid use disorder prevents imminent overdose, but also restricts autonomy and raises other ethical concerns. Using the Kass Public Health Ethics Framework, we identified ICC benefits and harms. Benefits include: protection of vulnerable, underserved patients; reduced legal consequences; resources for families; and “on-demand” treatment access. Harms include: stigmatizing and punitive experiences; heightened family conflict and social isolation; eroded patient self-determination; limited or no provision of OUD medications; and long-term overdose risk. To use ICC ethically, (...) it should be recognized as comprising vulnerable patients worthy of added protections; be a last resort option; utilize consensual, humanizing processes; provide medications and other evidence-based-treatment; integrate with existing healthcare systems; and demonstrate effective outcomes before diffusion. ICC to OUD treatment carries significant potential harms that, if unaddressed, may outweigh its benefits. Findings can inform innovations for ensuring that ICC is used in an ethically responsible way. (shrink)

Due to constraints on institutional capacity and financial resources, the road to universal health coverage (UHC) involves difficult policy choices. To assist with these choices, scholars and policy makers have done extensive work on criteria to assess the substantive fairness of health financing policies: their impact on the distribution of rights, duties, benefits and burdens on the path towards UHC. However, less attention has been paid to the procedural fairness of health financing decisions. The Accountability for Reasonableness Framework (A4R), which (...) is widely applied to assess procedural fairness, has primarily been used in priority-setting for purchasing decisions, with revenue mobilization and pooling receiving limited attention. Furthermore, the sufficiency of the A4R framework’s four criteria (publicity, relevance, revisions and appeals, and enforcement) has been questioned. Moreover, research in political theory and public administration (including deliberative democracy), public finance, environmental management, psychology, and health financing has examined the key features of procedural fairness, but these insights have not been synthesized into a comprehensive set of criteria for fair decision-making processes in health financing. A systematic study of how these criteria have been applied in decision-making situations related to health financing and in other areas is also lacking. This paper addresses these gaps through a scoping review. It argues that the literature across many disciplines can be synthesized into 10 core criteria with common philosophical foundations. These go beyond A4R and encompass equality, impartiality, consistency over time, reason-giving, transparency, accuracy of information, participation, inclusiveness, revisability and enforcement. These criteria can be used to evaluate and guide decision-making processes for financing UHC across different country income levels and health financing arrangements. The review also presents examples of how these criteria have been applied to decisions in health financing and other sectors. (shrink)

Contemporary feminisms are ineluctably drawn into comparisons with historic discourses, forms of praxis and tactical repertoires. While this can underscore points of continuity and commonality in ongoing struggles, it can also result in nostalgia for a more unified and purposeful feminist politics. Kate Eichhorn argues that our interest in nostalgia should be to understand feminist temporalities, and in particular the specific context in which we experience such nostalgia. Accordingly, this article takes up the idea that neoliberalism and populism, which have (...) given rise to both neoliberal feminism and femonationalism, have produced a series of contestations regarding the purpose and nature of feminist politics, as expressed by white popular feminism in the United Kingdom. This article examines two dimensions of feminist nostalgia: first, nostalgia for a more radical form of feminist politics – one not co-opted by neoliberal forces, not individualistic and not centred around online activism; and second, a nostalgia for the idea of ‘sisterhood’ – a time before white feminists were called upon to engage with intersectionality or be inclusive of trans-women. We analyse these themes through analysis of white popular feminism produced in the United Kingdom between 2010 and 2020, cautioning against a feminist nostalgia which neglects to engage with the radical politics of intersectionality. (shrink)

Within any organization (e.g. a hospital or clinic) the perception of the way things operate may vary dramatically as a function of one’s location in the organizational hierarchy as well as one’s professional discipline. Interorganizational variability depends on organizational coherence, safety, and stability. In this four-nation (Canada, Ireland, Australia, and Korea) qualitative study of 42 nurses, we explored their perception of how ethical decisions are made, the nurses’ hospital role, and the extent to which their voices were heard. These nurses (...) suggested that their voices were silenced (often voluntarily) or were not expressed in terms of ethical decision making. Finally, they perceived that their approach to ethical decision making differed from physicians. (shrink)

Fundamental problems of environmental sustainability, including climate change and fisheries management, require collective action on a scale that transcends the political and cultural boundaries of the nation-state. Rational, self-interested neoclassical economic theories of human behavior predict tragedy in the absence of third party enforcement of agreements and practical difficulties that prevent privatization. Evolutionary biology offers a theory of cooperation, but more often than not in a context of discrimination against other groups. That is, in-group boundaries are necessarily defined by those (...) excluded as members of out-groups. However, in some settings human’s exhibit behavior that is inconsistent with both rational economic and group driven cooperation of evolutionary biological theory. This paper reports the results of a non-cooperative game-theoretic exercise that models a tragedy of the commons problem in which groups of players may advance their own positions only at the expense of other groups. Students enrolled from multiple universities and assigned to different multi-university identity groups participated in experiments that repeatedly resulted in cooperative outcomes despite intergroup conflicts and expressions of group identity. We offer three possible explanations: students were cooperative because they were in an academic setting; students may have viewed their instructors as the out-group; or the emergence of a small number of influential, ethical leaders is sufficient to ensure cooperation amongst the larger groups. From our data and analysis, we draw out lessons that may help to inform approaches for institutional design and policy negotiations, particularly in climate change management. (shrink)

In this paper I argue that Gareth Evans’ famous proof of the impossibility of de re indeterminate identity fails on a counterpart-theoretic interpretation of the determinacy operators. I attempt to motivate a counterpart-theoretic reading of the determinacy operators and then show that, understood counterpart-theoretically, Evans’ argument is straightforwardly invalid.

We discuss arguments against the thesis that the world itself can be vague. The first section of the paper distinguishes dialectically effective from ineffective arguments against metaphysical vagueness. The second section constructs an argument against metaphysical vagueness that promises to be of the dialectically effective sort: an argument against objects with vague parts. Firstly, cases of vague parthood commit one to cases of vague identity. But we argue that Evans' famous argument against will not on its own enable one (...) to complete the reductio in the present context. We provide a metaphysical premise that would complete the reductio, but note that it seems deniable. We conclude by drawing general morals from our case study. (shrink)

This text of Elizabeth Fox-Genovese's is published posthumously in the context of pieces dedicated to her memory. It is unclear whether she intended it for eventual publication or whether she had intended it as a lecture; nor is there decisive evidence for a date of composition. In it, she reviews the stance of feminist literary criticism toward religion and finds it to be generally negative. She regrets that feminist critics see in religion mostly a means of subordinating women to (...) men, given that most of the writers whose work they explicate were themselves fervently religious. She then examines the feminization of religion in nineteenth-century America and the growing idea at the time of female moral stewardship. After examining the contrasting approaches taken to the process of feminization by Harriet Beecher Stowe and Elizabeth Cady Stanton, Fox-Genovese then takes as her main case Augusta Jane Evans's novels Beulah and St. Elmo. She argues that feminist critics, in concentrating on questions about the marriage or independence of Evans's characters miss Evans's central concern, which was the loss and recovery of her characters' faith. The feminist critics (given their hostility to religion) misunderstand that Evans's stance was not one against female individualism, but rather (given her commitment as a Christian) a stance against the unbridled individualism of modern American society. (shrink)

This set reprints a wide range of key articles exploring the role of feminists in the development of post-Enlightenment thought. Including groundbreaking work from the 1970s, 1980s and 1990s, with pieces by Sandra Harding, Julia Kristeva, Gayatri Chakravorty Spivak, Elizabeth Spelman, and other internationally-esteemed scholars, the collection features an original introduction and comprehensive index, making this an invaluable resource for women's studies students in a wide range of subject areas. For a full listing of contents, visit www.routledge-ny.com and type (...) the isbn into the search engine. (shrink)

‘Virtue signaling’ is the practice of using moral talk in order to enhance one’s moral reputation. Many find this kind of behavior irritating. However, some philosophers have gone further, arguing that virtue signaling actively undermines the proper functioning of public moral discourse and impedes moral progress. Against this view, I argue that widespread virtue signaling is not a social ill, and that it can actually serve as an invaluable instrument for moral change, especially in cases where moral argument alone does (...) not suffice. Specifically, virtue signaling can change the broader public’s social expectations, which can in turn motivate the adoption of new, positive social norms. I also argue that the reputation-seeking motives underlying virtue signaling impose important constraints on virtue signalers’ behavior, which serve to keep the worst excesses of virtue signaling in check. (shrink)

If the world itself is metaphysically indeterminate in a specified respect, what follows? In this paper, we develop a theory of metaphysical indeterminacy answering this question.

How is human social intelligence engaged in the course of ordinary conversation? Standard models of conversation hold that language production and comprehension are guided by constant, rapid inferences about what other agents have in mind. However, the idea that mindreading is a pervasive feature of conversation is challenged by a large body of evidence suggesting that mental state attribution is slow and taxing, at least when it deals with propositional attitudes such as beliefs. Belief attributions involve contents that are decoupled (...) from our own primary representation of reality; handling these contents has come to be seen as the signature of full-blown human mindreading. However, mindreading in cooperative communication does not necessarily demand decoupling. We argue for a theoretical and empirical turn towards “factive” forms of mentalizing here. In factive mentalizing, we monitor what others do or do not know, without generating decoupled representations. We propose a model of the representational, cognitive, and interactive components of factive mentalizing, a model that aims to explain efficient real-time monitoring of epistemic states in conversation. After laying out this account, we articulate a more limited set of conversational functions for nonfactive forms of mentalizing, including contexts of meta-linguistic repair, deception, and argumentation. We conclude with suggestions for further research into the roles played by factive versus nonfactive forms of mentalizing in conversation. (shrink)

Character judgments play an important role in our everyday lives. However, decades of empirical research on trait attribution suggest that the cognitive processes that generate these judgments are prone to a number of biases and cognitive distortions. This gives rise to a skeptical worry about the epistemic foundations of everyday characterological beliefs that has deeply disturbing and alienating consequences. In this paper, I argue that this skeptical worry is misplaced: under the appropriate informational conditions, our everyday character-trait judgments are in (...) fact quite trustworthy. I then propose a mindreading-based model of the socio-cognitive processes underlying trait attribution that explains both why these judgments are initially unreliable, and how they eventually become more accurate. (shrink)

In recent years, there has been a heated debate about how to interpret findings that seem to show that humans rapidly and automatically calculate the visual perspectives of others. In the current study, we investigated the question of whether automatic interference effects found in the dot-perspective task (Samson, Apperly, Braithwaite, Andrews, & Bodley Scott, 2010) are the product of domain-specific perspective-taking processes or of domain-general “submentalizing” processes (Heyes, 2014). Previous attempts to address this question have done so by implementing inanimate (...) controls, such as arrows, as stimuli. The rationale for this is that submentalizing processes that respond to directionality should be engaged by such stimuli, whereas domain-specific perspective-taking mechanisms, if they exist, should not. These previous attempts have been limited, however, by the implied intentionality of the stimuli they have used (e.g. arrows), which may have invited participants to imbue them with perspectival agency. Drawing inspiration from “novel entity” paradigms from infant gaze-following research, we designed a version of the dot-perspective task that allowed us to precisely control whether a central stimulus was viewed as animate or inanimate. Across four experiments, we found no evidence that automatic “perspective-taking” effects in the dot-perspective task are modulated by beliefs about the animacy of the central stimulus. Our results also suggest that these effects may be due to the task-switching elements of the dot-perspective paradigm, rather than automatic directional orienting. Together, these results indicate that neither the perspective-taking nor the standard submentalizing interpretations of the dot-perspective task are fully correct. (shrink)

Introduction: human rights in healthcare -- A right to treatment? the allocation of resouces in the National Health Service -- Ensuring quality healthcare: an issue of rights or duties? -- Autonomy and consent in medical treatment -- Treating incompetent patients: beneficence, welfare and rights -- Medical confidentiality and the right to privacy -- Property right in the body -- Medically assisted conception and a right to reproduce? -- Termination of pregnancy: a conflict of rights -- Pregnancy and freedom of choice (...) -- The right to life at the end of life -- The law and ethics of assisted dying: is there a right to die? (shrink)

Focuses on the encounters of feminist and queer theories, on the ways in which basic terms such as - sex, gender, and sexuality change meaning as they move from one body of theory to another. This book includes essays by Judith Butler, Evelynn Hammonds, Biddy Martin, Kim Michasiw, Carole-Anne Tyler, and Elizabeth Weed.

Phillips and colleagues convincingly argue that knowledge attribution is a faster, more automatic form of mindreading than belief attribution. However, they do not explain what it is about knowledge attribution that lends it this cognitive advantage. I suggest an explanation of the knowledge-attribution advantage that would also help to distinguish it from belief-based and minimalist alternatives.

Gorgias’ On Not-Being survives only in two divergent summaries. Diels–Kranz's classic edition prints the better-preserved version that appears in Sextus’ Aduersus Mathematicos. Yet, in recent years there has been rising interest in a second summary that survives as part of the anonymous De Melisso, Xenophane, Gorgia. The text of MXG is more difficult; it contains substantial lacunae that often make it much harder to make grammatical let alone philosophical sense of. As Alexander Mourelatos reports, one manuscript has a scribal note (...) that reads: "The original contains many errors; no one should blame me; I just copy what I see.". The treatise's state of preservation has aptly prompted Michael Gagarin to liken it to a black hole: "something we cannot see directly but know must exist because of certain effects it has on other objects.". (shrink)

The current industrial revolution is said to be driven by the digitization that exploits connected information across all aspects of manufacturing. Standards have been recognized as an important enabler. Ontology-based information standard may provide benefits not offered by current information standards. Although there have been ontologies developed in the industrial manufacturing domain, they have been fragmented and inconsistent, and little has received a standard status. With successes in developing coherent ontologies in the biological, biomedical, and financial domains, an effort called (...) Industrial Ontologies Foundry (IOF) has been formed to pursue the same goal for the industrial manufacturing domain. However, developing a coherent ontology covering the entire industrial manufacturing domain has been known to be a mountainous challenge because of the multidisciplinary nature of manufacturing. To manage the scope and expectations, the IOF community kicked-off its effort with a proof-of-concept (POC) project. This paper describes the developments within the project. It also provides a brief update on the IOF organizational set up. (shrink)

The question has long confounded philosophers and scientists, and it is this so-called explanatory gap between biological life and consciousness that Evan ...

It is time to bring the rich resources of these traditions into the contemporary debate about the nature of self. This volume is the first of its kind.

These are central to the accounts of lexical representation and meaning construction developed, giving rise to the Theory of Lexical Concepts and Cognitive ...

The experience of a reward appears to enhance memory for recent prior events, adaptively making that information more available to guide future decision-making. Here, we tested whether reward enhances memory for associative item-location information and also whether the effect of reward spreads to other categorically-related but unrewarded items. Participants earned either points (Experiment 1) or money (Experiment 2) through a time-estimation reward task, during which stimuli-location pairings around a 2D-ring were shown followed by either high-value or low-value rewards. All stimuli (...) were then tested for location memory or recognition (yes/no), immediately and after a 24-hour delay. Across both experiments (combined analysis), there was a robust improvement in location memory following high-value rewards, even though evidence supporting this effect was reliable in Experiment 2 but not in Experiment 1. The memory-enhancing effect of reward was observed on both the immediate and delayed location-memory tests. Reward-enhanced memory for both directly rewarded stimuli and categorically related stimuli that were not directly rewarded. No reliable effect of reward value on yes/no recognition-memory performance was observed in either experiment. We hypothesise that reward enhances the consolidation of recent experience and conceptually related memories to make these more available for future decisions. (shrink)

The highly structured mechanisms of cancers, their tendency to occur as a response to environmental stress, and the existence of oncogenes, suggest that neoplasticity may represent more than a biological disfunction. It is proposed that cancer exists as a phylogenetic mechanism serving to promote hyperevolution, albeit at the expense of the ontogeny, that is similar to a process recently discovered in bacterial mutations. Cell-surface-associated nucleic acid in tumorigenic cells and sperm cell vectorization of foreign DNA indicate the existence of essential (...) mechanisms necessary to the occurrence of cancer mediated hyperevolution. An analysis of the proposed mechanism indicates that for mutagenesis of chemical cytology, stress induced neoplasticity confers an evolutionary advantage of more than two orders of magnitude. (shrink)

In the small but growing literature on the philosophy of country music, the question of how we ought to understand the genre’s notion of authenticity has emerged as one of the central questions. Many country music scholars argue that authenticity claims track attributions of cultural standing or artistic self-expression. However, careful attention to the history of the genre reveals that these claims are simply factually wrong. On the basis of this, we have grounds for dismissing these attributions. Here, I argue (...) for an alternative model of authenticity in which we take claims about the relative authenticity of country music to be evidence of ‘country’ being a dual character concept in the same way that it has been suggested of punk rock and hip-hop. Authentic country music is country music that embodies the core value commitments of the genre. These values form the basis of country artists’ and audiences’ practical identities. Part of country music’s aesthetic practice is that audiences reconnect with, reify, and revise this common practical identity through identification with artists and works that manifest these values. We should then think of authenticity discourse within country music as a kind of game within the genre’s practice of shaping and maintaining this practical identity. (shrink)

Both mindreading and stereotyping are forms of social cognition that play a pervasive role in our everyday lives, yet too little attention has been paid to the question of how these two processes are related. This paper offers a theory of the influence of stereotyping on mental-state attribution that draws on hierarchical predictive coding accounts of action prediction. It is argued that the key to understanding the relation between stereotyping and mindreading lies in the fact that stereotypes centrally involve character-trait (...) attributions, which play a systematic role in the action–prediction hierarchy. On this view, when we apply a stereotype to an individual, we rapidly attribute to her a cluster of generic character traits on the basis of her perceived social group membership. These traits are then used to make inferences about that individual’s likely beliefs and desires, which in turn inform inferences about her behavior. (shrink)