BackgroundThe COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic.MethodTo inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a (...) literature review to summarize the ethical issues.ResultsThis literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates.ConclusionThis literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve. (shrink)

We use the format of a hypothetical case study to review issues related to pharmaceutical product approval and physician prescribing practices. In this case, a new FDA-approved drug is recommended for a patient who subsequently experiences an adverse event that may or may not be related to the prescription. This case raises a number of ethical and legal considerations physicians routinely face when deciding whether to recommend such drugs for their patients. Despite the need for ongoing observation by the regulatory (...) apparatus, physicians should be cognizant of the limitations of the drug approval system and the post-approval prescription drug surveillance system. We discuss physicians’ ethical obligations when faced with a newly approved drug, including seeking out independent sources of learning, reporting adverse effects, and notifying patients about limitations in available knowledge about therapeutic recommendations. (shrink)

This paper examines the identity of Asian swamp buffalo (Bubalus bubalis) from different value orientations. Buffalo were introduced into Northern (Top End) Australia in the early nineteenth century. A team of transdisciplinary researchers, including an ethicist, has been engaged in field research on feral buffalo in Arnhem Land over the past three years. Using historical documents, literature review, field observations, interviews with key informants, and interaction with the Indigenous land owners, an understanding of the diverse views on the scientific, cultural, (...) and economic significance of buffalo was obtained. While the diverse stakeholders in buffalo exploitation and management have historically delivered divergent value orientations on the nature of the human–buffalo relationship, we argue that over time there is the possibility of values and ethical convergence. Such convergence is possible via transdisciplinary and transcultural agreement on the value stances that constitute the construction of the being or identity of buffalo in the face of the overwhelming need to manage population density and gross numbers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Phenomenology and Modern Behavioral PsychologyLindsay B. Fletcher (bio) and Steven C. Hayes (bio)Keywordsacceptance, contextualism, defusion, relational-frame-theoryPérez-Álvarez and Sass (2008) deserve praise for examining the philosophical roots of clinical psychological science. Modern psychology has moved away from the development of philosophy and theory that is needed to ground scientific investigation within a coherent system. The result is increasingly ill-defined constructs and research programs that each operate within their own divergent (...) paradigm. B.F. Skinner is one of the few modern experimental behavioral psychologists who attempted to build a coherent science of behavior based on observable events with testable hypotheses. Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, and Wilson 1999) and its associated basic science of cognition, Relational Frame Theory (RFT; Hayes, Barnes-Holmes, and Roche 2001), build on Skinner’s work to produce a more progressive science.Psychology and philosophy are different disciplines and how they are approached is defined by the objective. The purpose of philosophy from a scientific point of view is not the same as from a philosophical point of view. It is fine to compare radical behaviorism and phenomenology, but it seems important to ask whether and how this will lead to a more progressive science of behavior.In this commentary, we discuss the philosophy and theory that underlie ACT/RFT and show how they reflect on the relevant points made by the authors regarding the shared features of phenomenology and radical behaviorism. We make two adjustments to the explanation of radical behavioral concepts presented in the current paper to create a more coherent analysis. Finally, we show here how the development of a theory based on applied goals directly informs the methods used in clinical settings.Philosophical AssumptionsThe field of behavior analysis that originated with Skinner has different strands. Some are holistic and pragmatic, whereas others are elementalistic and mechanistic (Hayes, Hayes, and Reese 1988). ACT is based on an a-ontological philosophy termed functional contextualism (Hayes 1993), which views behavior analysis from a holistic and pragmatic perspective. Functional contextualism (AKA radical behaviorism) shares some of the assumptions of phenomenology, as has long been noted (Day 1969). For example, Pérez-Álvarez and Sass (2008) identify a-dualism, or monism, as a common feature. In functional contextualism, the whole is divided into functional units for the purpose of prediction and influence. A three-term contingency (antecedent–behavior–consequence) in behavior analysis is viewed as a [End Page 255] whole event with pragmatically distinguishable aspects, not an assemblage. As the authors point out, this results in a dialectic tension between stimulus control, action, and reinforcer because none are distinct units, and each is defined with reference to the others much as the front of a coin cannot exist without the back. These are not ontological entities, but functional units that are abstracted from the whole for pragmatic purposes. What is “radical” about radical behaviorism is that the philosopher, psychologist, or researcher participates in the event they are observing, and their own acts of scientific observation are identified based on their own functional properties.Behavioral ThinkingIn the service of further developing this philosophical and theoretical foundation and considering it along side phenomenology, we need to examine two aspects of the target article. The first regards the role of the environment in shaping behavior that is central to behavioral and contextual theories. The authors object to behaviorism’s notion of environment and suggest replacing it with the concept of the world, stating that “animals have environment, but man has world.” What is missing is an account of that shift. We believe that modern behavior analysis provides that account.Similarly, the paper argues that “reinforcers are not just things that follow behavior, but also, and above all, values that guide our life.” Again what is missing is an account of the precise behavioral basis for the distinction.In an attempt to do this, the authors incorrectly analyze operant behavior as future oriented, even appealing to final causality. In the three-term contingency, the discriminative stimulus sets the occasion for reinforcement of a particular behavior. The behavior of interest has been reinforced in similar contexts in the past, which gives... (shrink)

The ACA shifted U.S. health policy from centering on principles of actuarial fairness toward social solidarity. Yet four legal fixtures of the health care system have prevented the achievement of social solidarity: federalism, fiscal pluralism, privatization, and individualism. Future reforms must confront these fixtures to realize social solidarity in health care, American-style.

Two types of variables impact face recognition: estimator variables that cannot be controlled and system variables that are under direct control by the criminal justice system. This article addresses some of the reasons that eyewitnesses are prone to making errors, particularly false identifications. It provides a discussion of the differences between typical facial memory and eyewitness studies and shows that the two areas generally find similar results. It reviews estimator variable effects and focuses on system variables. Traditional facial recognition researchers (...) rarely study system variables but reveal important factors that police and policy makers should consider with regard to eyewitness identification and the courts. It concludes that there is still room for considerable improvement in identification procedures and wants to encourage more system variable research as a means of reducing wrongful convictions. (shrink)

This research focuses on how children negotiate gender boundaries in middle childhood play. Over a nine-week period, children were observed creating, defining, and altering gender codes in a summer day camp. When girls and boys disregarded pre-described boundaries, they entered an area we refer to as the gender transgression zone. This area of activity, where boys and girls conduct heterosocial relations in hopes of either maintaining or expanding gender boundaries in child culture, is where gender transgression takes place. The study (...) revealed that high-status boys used hegemonic masculinity to regulate both girls' and boys' boundaries by reserving the authority to sanction all gender transgressions. While race and class were salient for girls' homosocial organization and behavior, within this age group they did not appear to influence the boys' status system. (shrink)

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

Since 2000, research within positive psychology has exploded, as reflected in dozens of meta-analyses of different interventions and targeted processes, including strength spotting, positive affect, meaning in life, mindfulness, gratitude, hope, and passion. Frequently, researchers treat positive psychology processes of change as distinct from each other and unrelated to processes in clinical psychology. This paper presents a comprehensive framework for positive psychology processes that crosses theoretical orientation, links coherently to clinical psychology and its more dominantly “negative” processes, and supports practitioners (...) in their efforts to personalize positive psychological interventions. We argue that a multi-dimensional and multi-level extended evolutionary approach can organize effective processes of change in psychosocial interventions, by focusing interventions on context-appropriate variation, selection, and retention of processes, arranged in terms of key biopsychosocial dimensions across psychological, biophysiological, and sociocultural levels of analysis. We review widely studied positive psychology constructs and programs and show how this evolutionary approach can readily accommodate them and provide a common language and framework for improving human and community flourishing. We conclude that Interventions should start with the person, not the protocol. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Gonzales v. Oregon and the Politics of MedicineRonald A. Lindsay (bio)Throughout 2005, the morbid joke on Capitol Hill was that the twin inevitabilities of "death and taxes" had been replaced by "death politics and taxes." There seemed to be some truth in this observation given the highly publicized intervention by some members of Congress in the Schiavo case and the continuing controversy over government regulation of end-of-life care. (...) The Supreme Court's recent decision in Gonzales v. Oregon (74 U.S.L.W. 4068 (17 January 2006)) has resolved one of the critical issues relating to this controversy by holding that a physician may prescribe controlled substances to provide assistance in dying if such a practice is authorized by state law and not expressly prohibited by federal law. However, other issues remain. In fact, the Court's decision has underscored some of the reasons why there is not only continuing controversy over end-of-life care, but also over other aspects of the practice of medicine. First, it is apparent there is no consensus among health care professionals about the precise boundaries of the legitimate practice of medicine. Second, the regulation of the practice of medicine traverses ill-defined legal territory. In particular, there is significant uncertainty concerning the implications of some regulations as well as the allocation of regulatory authority between and within state and federal governments. This uncertainty leaves substantial room for political maneuvers.Before discussing the politics of medicine, it is worth looking at the regulation of controlled substances in some detail both because this review will provide the necessary background for understanding the ruling in Gonzales v. Oregon and because it will illustrate the uncertainty resulting from multiple sources of regulatory authority.Federal and State Regulation of Controlled SubstancesSince the Pure Food and Drug Act of 1906, the federal government has regulated certain aspects of the distribution and administration of drugs deemed susceptible to abuse. The current primary vehicle for federal regulation is the Comprehensive Drug Abuse Prevention and Control Act, enacted in 1970, of which Title II is known as the Controlled Substances Act (CSA) (21 U.S.C. § 801 et seq.). A [End Page 99] "controlled" substance is just that, a substance that is regulated under the CSA. The CSA classifies controlled substances in five categories or schedules based on their potential for abuse, their accepted medical use, and the risks associated with their use under medical supervision. Schedule I substances have a high potential for abuse and have no currently accepted use in medical treatment. Schedule II-V substances are approved for medical use but are subject to a descending hierarchy of restrictions on their use. To give a lawful prescription for a controlled substance, a physician must be registered with the appropriate federal agency, currently the Drug Enforcement Administration (DEA). Moreover, to be valid, such a prescription must be issued for "a legitimate medical purpose" (21 U.S.C. § 830(b)(3)(A)(ii)).There is little dispute that the primary purposes of the CSA are to control drug abuse and to eliminate illicit trafficking in drugs. In accomplishing these objectives, there is a division of responsibility among various federal agencies, in particular the Department of Health and Human Services and the Department of Justice. Of particular relevance to the controversy in Gonzales v. Oregon is the Attorney General's authority to revoke a physician's registration for prescribing controlled substances if the physician's registration would be inconsistent with the public interest.All 50 states have their own statutes and regulations that address various aspects of the distribution and administration of controlled substances. Most states have adopted versions of the model Uniform Controlled Substances Act, which largely mimics federal law, but several states have placed additional restrictions on a physician's ability to prescribe controlled substances, including time limits on the validity of a prescription and limits on the quantity of a drug that can be prescribed. States are the primary, but by no means the exclusive, source of regulation of medical practice in general. States license physicians, establish boards and agencies to regulate the actions of physicians, and promulgate rules and guidelines to which physicians... (shrink)

An ideal vision model accounts for behavior and neurophysiology in both naturalistic conditions and designed lab experiments. Unlike psychological theories, artificial neural networks (ANNs) actually perform visual tasks and generate testable predictions for arbitrary inputs. These advantages enable ANNs to engage the entire spectrum of the evidence. Failures of particular models drive progress in a vibrant ANN research program of human vision.

Lindsay Judson and Vassilis Karasmanis present a selection of philosophical papers by an outstanding international team of scholars, assessing the legacy and continuing relevance of Socrates's thought 2,400 years after his death. The topics of the papers include Socratic method; the notion of definition; Socrates's intellectualist conception of ethics; famous arguments in the Euthyphro and Crito; and aspects of the later portrayal and reception of Socrates as a philosophical and ethical exemplar, by Plato, the Sceptics, and in the early (...) Christian era. Contributors include Lesley Brown, David Charles, John Cooper, Michael Frede, Terence Irwin, Charles Kahn, Vassilis Karasmanis, Carlo Natali, Vasilis Politis, Dory Scaltsas, Gerhard Seel, and C. C. W. Taylor. (shrink)

Caesar left off writing de Bello Gallico at the end of the Alesia campaign in 51 B.C., and his account of the civil war begins in January 49. There was therefore a gap ofa year and more between the narratives in the two collections of Caesar's own Commentaries. Some time soon after Caesar's death, his officer A. Hirtius decided toknit together these unlinked narratives, supplying a preface to account for hisprocedure. It is usually assumed, and it is assumed here, that (...) this Preface, whichappears at the start of B.G. 8 in the MSS, should be taken to mean that its author wasthe author too of the book immediately following, which connects de Bello Gallico with de Bello Civili by narrating, essentially, the transactions of the year 50. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Christian’s Appreciation of the BuddhaBonnie ThurstonEs gibt, so glaube ich, in der Tat jenes Ding nicht, das wir >Lernen< nennen.—Hermann Hesse, SiddharthaI must warn you at the beginning that what follows is an embarrassingly personal reflection—a confession even—and not a scholarly essay. I cannot be dispassionate about the Buddha, to whom in a roundabout way I owe both my status as an ordained Christian minister and perhaps the (...) greatest joy of my life, the study and practice of the Christian scripture. How? In February 1970 I was given a copy of Hesse’s novel Siddhartha, a fictionalized account of the Buddha’s life. Already an active Christian, it was this gift, received my senior year in high school, that introduced me to Buddhism and to the reality of spiritual journey and the possibility of enlightenment. While I know the Buddhist meaning of that term, it serves for Christians as well, because our God could not leave us in darkness but made light the first creature (Gen. 1:1–5) and came among us as light (John 1:1–5). 1 When in the fall of 1970 my brother traveled to Japan, the memento I requested was a small statue of the Buddha. It is beside me as I write. In 1983 when we moved to Germany, the second book I bought in German was Siddhartha; the first was the New Testament.Over the years I have had the opportunity to continue to study the life of the Buddha and the spread and development of his teachings. By the Buddha, of course, I mean Sakyamuni (“sage of the Sakyas”) Buddha (“enlightened one”), son of Suddhodana and Maya, whom they called Siddhartha (“wish fulfilled” or “goal realized”) and whom we also know as Gotama or Gautama (literally “superior cow”), whose dates are given variously as 560–480 B.C. or 460–380 B.C. 2 I am appreciative of what I have learned—applying the root meaning of that word, appretiare: “to see” or “to appraise.” The Buddha has helped me to see and to appraise or evaluate many aspects of life. The appreciation that follows, then, is both a grateful recognition as of benefits received and a sensitive awareness or an estimate. I have tried both to view the Buddha clearly and to appraise what he has meant in my life. In essence, Buddhism and the Buddha have been for me the means of establishing a personal, internal religious clarity about what I do believe, passionately. In a deeply Buddhist sense, the Buddha has been my raft. But he has not been my Savior.There is, as Tillich noted in Christianity and the Encounter with World Religions, a point “in the depth of every living religion... at which the religion itself loses its importance, and that to which it points breaks through its particularity.” 3 It has [End Page 121] helped me to understand religions as fingers and the Divine Reality as the moon to which they point. And I am convinced that Tillich’s breakthrough point is usually reached by means of deep penetration into one religious tradition. Jacques-Albert Cuttat was exactly correct: “The more deeply a person probes into his own religious faith, the more he is able to understand the religious faith of others from the inside; conversely, the more a person explores religious connections other than his own, the more he deepens his understanding of his own religion.” 4 This has been my experience. Dialogue with the Buddha has given me great clarity about the Christ. And the study and practice of Christianity has afforded me my glimpses of the moon.What, then, do I appreciate about the Buddha? What have I learned from him? To help focus my answer, I read or reread a number of different accounts of his life 5 and noted six specific aspects of his life and teaching (his quest itself; his powers of analysis; his pragmatism; his moral vision; his compassion; and the outcome of living, his ‘way’) that have attracted and taught me.First, I am appreciative of the Buddha’s quest itself. To put it simply, according to the accounts... (shrink)

Phillip Hansen’s Reconsidering C. B. Macpherson:From Possessive Individualism to Democratic Theory and Beyond has many virtues, principal among them the fact that it casts Macpherson’s thought in what to many will be the unfamiliar light of Continental critical theory. Doing so could broaden Macpherson’s audience to include those working within this tradition. What is less clear is whether casting Macpherson’s thought in this light will yield any new insights into his historical interpretations or his democratic theory. I argue that there (...) may be reasons to doubt that it will. (shrink)

The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of hepatitis C (...) transmission, and lower rates of re-incarceration. Despite evidence of improved outcomes, many jails and prisons do not offer MAT to individuals with opioid use disorder. This seems partly due to a scientifically unjustified preference for an abstinence-only treatment approach. The absence of MAT in prisons and jails results in poor outcomes for individuals and poses a public health threat to communities. Furthermore, it disproportionately harms poor communities and communities of color. Health care providers in prisons and jails have an ethical obligation to offer MAT to individuals with opioid use disorder to mitigate risk of infectious diseases, opioid overdose and health disparities associated with incarceration. (shrink)

The result is a vision of creative individualism for the post-communist world that combines Macpherson's insistence on social justice with the lessons learned ...

Mrs. Dall, in her article A Seventh-Century English Edition of Virgil , shows that Virgil glosses taken from marginalia in the same MS. of the poems often preserve something of their original coherence in the two kindred glossaries, Affatim and the Second Amplonian, in spite of all the reshuffling of these two collections. Thus a small group of Virgil items appears in Affatim on p. 491 of Goetz's apograph : Carecta, Crateras, etc. The second last of this ‘Virgil cluster’ is (...) Cada: vasa vinaria. It appears also in Ampl. II. Ca[t]da: vas vinaria, and in Ampl. I. Cada: vasa vinaria, and is apparently taken , ultimately or immediately, from a marginal annotation on Aen. 1, 195 ‘uina bonus quae deinde cadis onerarat Acestes’ for in the Virgil Glossary printed by Goetz in C.G.L. IV. 427–470 we find Cadis: vasis vinariis. (shrink)

Terence was studied, though not so much as Virgil, in monastery-schools. Their magistri bestirred themselves to get aid for pupils. Some famous magister— we know not who—had written, between the lines or in the margins, interpretations of difficult words in at least the three opening plays of the MS. which he used—Andr., Ad., Eun.—if not in all. These interpretations were collected from his MS. and found their way into many monastery-libraries. Goetz has published these glossae collectae of Terence from a (...) tenth century MS. in Vol. V. of his Corpus Glossariorum Latinorum, pp. 529–539; Mr. Austin has added more from a Leyden MS. , written apparently in Belgium or Holland, c. 800–815 A.D. . Probably Dr. Theander will add a further batch from a Paris MS. (shrink)

The communitarian critique of liberal agency is reminiscent of two earlier critiques: C. B. Macpherson's theory of possessive individualism and Marx's theory of alienation. As with the communitarian critique, Macpherson and Marx saw the liberal individual as being in some way 'disembodied'. Where they differed from communitarians was in the attention they paid to the actual social relations that gave rise to such an image. The comparison is thus fruitful because the emphasis Macpherson and Marx give to the concrete circumstances (...) of disempowerment highlights the overly abstract nature of the communitarian critique, demonstrating how it, and other similarly abstract normative theories, might maintain a focus on actual social relations. Key Words: alienation • communitarism • disembodiment • labor • liberalism • Macpherson • Marx • self. (shrink)

OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining (...) Treatment. PARTICIPANTS: The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public. CONCLUSIONS: This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment. (shrink)