Advance care planning allows patients to articulate preferences for their medical treatment, lifestyle, and surrogate decision-makers in order to anticipate and mitigate their potential loss of decision-making capacity. Written advance directives are often emphasized in this regard. While these directives contain important information, there are several barriers to consider: veracity and accuracy of surrogate decision-makers in making choices consistent with the substituted judgement standard, state-to-state variability in regulations, literacy issues, lack of access to legal resources, lack of understanding of medical (...) options, and cultural disparities. Given these issues, it is vital to increase the use of patient and healthcare provider conversations as an advance care planning tool and to increase integration of such discourse into advance care planning policy as adjuncts and complements to written advance directives. This paper reviews current legislation about written advance directives and dissects how documentation of spoken interactions might be integrated and considered. We discuss specific institutional policy changes required to facilitate implementation. Finally, we explore the ethical issues surrounding the increased usage and recognition of clinician–patient conversations in advance care planning. (shrink)

As library collections and services have increasingly moved from print to digital, much of the work that used to be done by libraries themselves with regard to creating, maintaining, and managing the systems that hold collections and facilitate user access to them is now done primarily by vendors. This change to the information services landscape for academic libraries is the occasion not only of technical and procedural challenges, but also some internal conflicts concerning the ethical demands of the library profession. (...) This essay examines the ways in which these conflicts become acute and obvious when attention is paid to the way in which attempts to promote equity, diversity, and inclusion (EDI) are undermined by the handover of library services to vendors, even when—or perhaps especially when—those vendors use their control of content and platforms to commodify diverse content instead of making the necessary systemic changes required by truly effective EDI efforts. (shrink)

Data documenting poor understanding among research participants and real-time efforts to assess comprehension in large-scale studies are focusing new attention on informed consent comprehension. Within the context of biobanking consent, we previously convened a multidisciplinary panel to reach consensus about what information must be understood for a prospective participant’s consent to be considered valid. Subsequently, we presented them with data from another study showing that many U.S. adults would fail to comprehend the information the panel had deemed essential. When asked (...) to evaluate the importance of the information again, panelists’ opinions shifted dramatically in the direction of requiring that less information be understood. Follow-up interviews indicated significant uncertainty about defining a threshold of understanding and what should happen when prospective participants are unable to grasp key information. These findings have important implications for urgently needed discussion of whether... (shrink)

Book reviewed in this article: Feminist Ethics. Ed. Claudia Card.

An audiovisual correspondence (AVC) refers to an observer’s seemingly arbitrary yet consistent matching of sensory features across the two modalities; for example, between an auditory pitch and visual size. Research on AVCs has frequently used a speeded classification procedure in which participants are asked to rapidly classify an image when it is either accompanied by a congruent or an incongruent sound (or vice versa). When, as is typically the case, classification is faster in the presence of a congruent stimulus, researchers (...) have inferred that the AVC is automatic and bottom-up. Such an inference is incomplete because the procedure does not show that the AVC is not subject to top-down influences. To remedy this problem, we devised a procedure that allows us to assess the degree of “bottom-up-ness” and “top-down-ness” in the processing of an AVC. We did this in studies of AVCs between pitch and five visual features: size, height, spatial frequency, brightness, and angularity. We find that all the AVCs we studied involve both bottom-up and top-down processing, thus undermining the prevalent generalization that AVCs are automatic. (shrink)

Aristotle's Topics is a handbook for dialectic, which can be understood as a philosophical debate between a questioner and a respondent. In book 2, Aristotle mainly develops strategies for making deductions about 'accidents', which are properties that might or might not belong to a subject (for instance, Socrates has five fingers, but might have had six), and about properties that simply belong to a subject without further specification. In the present commentary, here translated into English for the first time, Alexander (...) develops a careful study of Aristotle's text. He preserves objections and replies from other philosophers whose work is now lost, such as the Stoics. He also offers an invaluable picture of the tradition of Aristotelian logic down to his time, including innovative attempts to unify Aristotle's guidance for dialectic with his general theory of deductive argument (the syllogism), found in the Analytics. The work will be of interest not only for its perspective on ancient logic, rhetoric, and debate, but also for its continuing influence on argument in the Middle Ages and later. (shrink)

We investigated how two cues to contrast—beat gesture and contrastive pitch accenting—affect comprehenders' cognitive load during processing of spoken referring expressions. In two visual‐world experiments, we orthogonally manipulated the presence of these cues and their felicity, or fit, with the local (sentence‐level) referential context in critical referring expressions while comprehenders' task‐evoked pupillary responses (TEPRs) were examined. In Experiment 1, beat gesture and contrastive accenting always matched the referential context of filler referring expressions and were therefore relatively felicitous on the global (...) (experiment) level, whereas in Experiment 2, beat gesture and contrastive accenting never fit the referential context of filler referring expressions and were therefore infelicitous on the global level. The results revealed that both beat gesture and contrastive accenting increased comprehenders' cognitive load. For beat gesture, this increase in cognitive load was driven by both local and global infelicity. For contrastive accenting, this increase in cognitive load was unaffected when cues were globally felicitous but exacerbated when cues were globally infelicitous. Together, these results suggest that comprehenders' cognitive resources are taxed by processing infelicitous use of beat gesture and contrastive accenting to convey contrast on both the local and global levels. (shrink)

We surveyed IRB chairs' perspectives on offering individual genetic research results to participants and families, including family members of deceased participants, and the IRB's role in addressing these issues. Given a particular hypothetical scenario, respondents favored offering results to participants but not family members, giving choices at the time of initial consent, and honoring elicited choices. They felt IRBs should have authority regarding the process issues, but a more limited role in medical and scientific issues.

In qualitative interviews with a diverse group of experts, the vast majority believed unregulated researchers should seek out independent oversight. Reasons included the need for objectivity, protecting app users from research risks, and consistency in standards for the ethical conduct of research. Concerns included burdening minimal risk research and limitations in current systems of oversight. Literature and analysis supports the use of IRBs even when not required by regulations, and the need for evidence-based improvements in IRB processes.

A worldwidemental health crisis is expected, as millions worldwide fear death and disease while being forced into repeated isolation. Thus, there is a need for new proactive approaches to improve mental resilience and prevent mental health conditions. Since the 1990s, art has emerged as an alternative mental health therapy in the United States and Europe, becoming part of the social care agenda. This article focuses on how visual esthetic experiences can create similar patterns of neuronal activity as those observed when (...) the reward system is activated. The activation of the reward structures could have a stress buffering effect, given the interdependence observed between the reward and stress systems. Therefore, could visual esthetic experiences stimulate mental resilience? And if this were the case, could art-based interventions be offered for mental health in the context of COVID-19 and beyond? (shrink)

Consumption--the flow of physical materials in human lives--is an important ethical issue. Be it fair trade coffee or foreign oil, North Americans' consumption choices affect the well-being of humans around the globe, in addition to impacting the natural world and consumers themselves. In this book, Laura Hartman seeks to formulate a coherent Christian ethic of consumption.

Ecological restoration and native landscaping are increasing, particularly in the American Midwest, where they form part of the area's history and culture of conservation. But practitioners rarely pause to ask philosophical questions related to categories of native and invasive or human control and harmony with nature. This article brings philosophy into conversation with practice, using members of Wild Ones Native Landscaping, a non-profit headquartered in Neenah, WI, as a case study. Philosophers and ethicists who are studying Ecological Restoration and Native (...) Landscaping can learn valuable lessons - in practicality, aesthetics and flexibility - from practitioners such as the Wild Ones. (shrink)

Climate engineering is subject to the “playing God” critique, which charges that humans should not undertake to control nature in ways that seem to overstep the proper scope of human agency. This argument is easily discredited, and in fact the opposite—that we should “play God”—may be equally valid in some circumstances. To revive the playing God critique, I argue that it functions not on a logical but on a symbolic and emotional level to highlight nostalgia for functional dualisms in the (...) face of the bewildering problem of climate change. It also raises significant questions about the virtue of those who might engineer the climate. These two concerns point to questions about the proper role of human agency. I use the scholarship of Aldo Leopold and H. Richard Niebuhr to argue for a model of human agency based on contextual awareness and responsive, communal responsibility. I conclude with some implications of this view for decision-makers engaging the topic of climate engineering. (shrink)

Health policymakers employ utility measures to inform resource allocation decisions. They often rely on a conceptual tool called the quality-adjusted life year that discounts the value of years lived in a state of disability relative to years lived in full health. A representative sample of the general public is asked to place values on hypothetical health states as part of a standard gamble or time trade-off task. Policymakers use the resulting values to calculate the number of QALYs gained through particular (...) interventions. Utilitarian reasoning mandates that policymakers maximize QALYs gained per unit cost.Although many scholars have explored the problems of distributive justice that arise from this system... (shrink)

Feminist criticism of health care and ofbioethics has become increasingly rich andsophisticated in the last years of thetwentieth century. Nonetheless, this body ofwork remains quite marginalized. I believe thatthere are (at least) two reasons for this.First, many people are still confused aboutfeminism. Second, many people are unconvincedthat significant sexism still exists and aretherefore unreceptive to arguments that itshould be remedied if there is no largerbenefit. In this essay I argue for a thin,``core'' conception of feminism that is easy tounderstand and (...) difficult to reject. Corefeminism would render debate within feminismmore fruitful, clear the way for appropriaterecognition of differences among women andtheir circumstances, provide intellectuallycompelling reasons for current non-feminists toadopt a feminist outlook, and facilitatemutually beneficial cooperation betweenfeminism and other progressive socialmovements. This conception of feminism alsomakes it clear that feminism is part of alarger egalitarian moral and political agenda,and adopting it would help bioethics focus onthe most urgent moral priorities. In addition,integrating core feminism into bioethics wouldopen a gateway to the more speculative parts offeminist work where a wealth of creativethinking is occurring. Engaging with thisfeminist work would challenge and strengthenmainstream approaches; it should also motivatemainstream bioethicists to explore othercurrently marginalized parts of bioethics. (shrink)

This chapter contains sections titled: General Assessments of Assisted Reproduction Pre‐birth Testing Conclusion References Further reading.

The woman at the heart of Pearl Jam’s “Better Man” (Vitalogy, 1994) is trapped. She has committed herself to a relationship that makes her miserable, but she sees no viable alternative to staying in it. She mourns a past self who might have been able to leave and dreams of a dierent way things might be, but remains unable to move on. It is tempting to view her with a mixture of pity and frustration (reecting some of the personal circumstances (...) -- Eddie Vedder’s mother’s second marriage -- informing its composition). As a moral being, she appears to be hopelessly compromised by her situation, even as she is also doing her best to survive under conditions designed to undermine her autonomy and keep her trapped (as abusive relationships do). The song is not so much critical of her choice to stay as it is confused by and resigned to it. -/- What keeps a person where she so clearly does not want to be? -/- The song itself was, at least early in its recorded life for Pearl Jam, similarly compromised. Vedder appears to have thought of it as too “accessible”, too much of a pop hit for the kind of musical vision he had in mind either for Vs. (for which it had originally been intended) or for Vitalogy; by this point in the band’s career, he was ever more actively resisting success, accessibility, and everything that went with the version of rock star life imposed collectively on the band and on him as an individual. The form that resistance took was an exercise of artistic and other forms of control, sometimes exercised in ways that were destructive or damaging (to the band and its internal relationships, its fame or success, its image, its artistic identity, etc.). -/- What keeps an artist or a band where they so clearly do not want to be? In this chapter, I oer a loose exploration of some possible philosophical approaches to answering the question of what keeps us where we are, like it or not, worked out in parallel through the lyrics of “Better Man” and the circumstances of the song’s eventual arrival Vitalogy. My main interest is in examining the ethical dimensions of the question itself -- what, if anything, are we morally required or expected to do under compromised or compromising conditions? My main suggestion is that answering the question might require of us a messier, more ambivalent, and perhaps more compassionate notion of moral agency, inspired by Simone Weil’s work on affliction. (shrink)

: In APo II 3-7 Aristotle discusses a series of difficulties concerning definition, deduction, and demonstration. In this paper I focus on two interrelated but distinct questions: firstly, what are exactly the difficulties emerging from or alluded to in the discussion in II 3-7; secondly, whether and in what sense the discussion in II 3-7 can be considered an aporetic discussion with a specific role to play in the development of the argument in APo II.

The informed consent process for genetic testing does not commonly address preferences regarding disclosure of results in the event of the patient's death. Adults being tested for familial colorectal cancer were asked whether they want their exome sequencing results disclosed to another person in the event of their death prior to receiving the results. Of 78 participants, 92% designated an individual and 8% declined to. Further research will help refine practices for informed consent.

The vice of acedia deserves—and rewards—a closer reading than is implied in the old rendering ‘sloth’, or even in contemporary readings of ‘spiritual sloth’. Such is at least true in Aquinas’s Summa Theologiae, the subject of the following close reading of this enigmatic vice. Investigating the question on acedia and its grounding in portions of I-II, I first establish acedia’s basis not in a sovereign spiritual ‘choice’ but in the sensitive appetite and the passion of sorrow. This turns the portrait (...) of acedia’s ‘patients’ from those who avoid to those who embrace the labors of love, those who experience acedia’s sorrow in the very midst of pursuing divine joy. A third section steps back to show the entire problem of acedia, including its ‘slothful’ effects, in terms of this one fundamental sorrow that suppresses joy—real rest—in the Lord. I end with Thomas’s remedy, the hope-charged possibility of rising up in defense of the divine joy, turning back acedia’s sorrow at every point of its attack and reclaiming the pleasure of sharing in God’s life. (shrink)

Science is revolutionizing human reproduction. New techniques are already with us, such as artificial insemination, the freezing of sperm, in vitro fertilization and the use of surrogate mothers. Artificial wombs are clearly on the horizon.

For the last eighteen months, I have worked with a group of disability and health policy researchers. I began this interview-based project trying to learn how these researchers’ disability identities shaped their work. How did their disability standpoint contribute to the liberatory nature of their research? I found that the disability standpoint of these researchers was in fact hard-won and grew not just out of their own disability experiences but out of their connections with the larger disability community. These connections, (...) for the most part, helped researchers come to “claim crip,” and that later influenced their research. (shrink)

Volume 20, Issue 5, June 2020, Page 26-28.

Recruiting research participants based on genetic information generated about them in a prior study is a potentially powerful way to study the functional significance of human genetic variation, but it also presents ethical challenges. To inform policy development on this issue, we conducted a survey of U.S. institutional review board chairs concerning the acceptability of recontacting genetic research participants about additional research and their views on the disclosure of individual genetic results as part of recruitment. Our findings suggest there is (...) unlikely to be a “one-size-fits-all” solution, but rather several ethically acceptable approaches to genotype-driven recruitment, depending on context. Disclosures made during the consent process for the original study and the clinical validity of the results are key considerations. Researchers must be prepared to communicate and answer questions in clear lay language about what is known and not known regarding the role of genetics in their proposed area of research. (shrink)

Despite this virtue's history as an instrument of women's oppression, modesty, at its most basic, means voluntary restraint of one's power, undertaken for the sake of others. It is a mechanism that modifies unequal power relationships and encourages greater compassion and fairness. I use a Christian perspective with influences from Jewish and Muslim sources to examine modesty. The modest person, I argue, must be in relationship with others, must be honestly aware of her impacts on others, must be sensitive to (...) those impacts, compassionate toward others, and willing to hold back for others' sakes. Moreover, modesty is not only a virtue that pertains to sexuality and clothing, but it also can promote virtuous environmental behavior, particularly as it leads to awareness of, and sensitivity to, the effects of everyday behaviors on vulnerable others. (shrink)

Shulamith Firestone argues that for women to embrace equal rights without recognizing them for children is unjust. Protection of children is merely repressive control: they are infantilized by our treatment of them. I maintain that many children no longer get much protection, but neither are they being provided with an environment conducive to learning prudence or morality. Recognizing equal rights for children is likely to worsen this situation, not make it better.

The field of ethics is enjoying a much-needed renaissance. Traditional theories and approaches are appropriately coming under fire, although not every new idea will stand time's test. Feminist thinking suggests that we at least emphasize the importance of women and their interests, focus on issues specially affecting women, rethink fundamental assumptions, incorporate feminist insights and conclusions from other areas, and be consistent with respect to our concerns about equality by paying attention to race and class.

Book reviewed in this article: Feminist Ethics. Ed. Claudia Card.

This article draws on in-depth case studies of 61 women and men of diverse sexual identities to show how gender, while apparently diminishing in significance, continues to shape interpretations and experiences of virginity loss in complex ways. Although women and men tended to assign different meanings to virginity, those who shared an interpretation reported similar virginity-loss encounters. Each interpretation of virginity—as a gift, stigma, or process—featured unequal roles for virgin and partner, which interacted with gender differences in power to produce (...) interpretation-specific patterns of gender subordination, only one of which consistently gave men power over women. (shrink)