In vitro fertilisation (IVF) daily practice reveals that couples are willing to take greater risks than doctors if there is a higher chance of pregnancy. Arising from this is a frequently addressed issue regarding the embryo transfer strategy: single or double embryo transfer? The dilemma is faced by patients, as well as physicians, who are caught between the possibility of no pregnancies at all and facing the prospect of iatrogenic twin gestation. How could the couple's preferences concerning how many children (...) they would like be taken into account in determining the number of embryos transferred? How should the physician exercise his medical responsibility towards his patients and the unborn child? An effective approach could be to enhance a couple’s autonomy by advocating a medical beneficence that incorporates patients’ values. This can be achieved through a case-by-case approach in a deliberative process of decision-making which includes real patient-centred communication. (shrink)

According to current opinion in western psychopathology, depression is regarded as a disorder of mood and affect on the one hand, and as a distortion of cognition on the other. Disturbances of bodily experience and of social relations are regarded as secondary to the primarily 'inner'and individual disorder. However, quite different concepts can be found in cultures whose members do not experience themselves as much as separate individuals but rather as parts of social communities. Disorders of mood or well-being are (...) then conceived less as intra-psychic, but rather as bodily, interpersonal, or atmospheric processes. On this background, the paper describes depression as a disorder of intercorporeality and interaffectivity. After developing these phenomenological concepts, it analyses depression as a 'detunement' of the resonant body that mediates our participation in a shared affective space. Instead of expressing the self, the body is turned into a barrier to all impulses directed to the environment. This impairs particularly the patient's interaction with others, resulting in a general sense of detachment, separation, or even segregation. Moreover, the restriction of the lived body also corresponds to the triggering situations of depression, namely experiences of a disruption of social bonds. Thus, intercorporeality and interaffectivity are presented as crucial dimensions for an ecological and non-reductionist view of depression. (shrink)

Would compulsory treatment or vaccination for Covid-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints—such as quarantine, isolation and ‘lockdown’—that have already been authorised to control the pandemic. We argue that, if the permissive English approach to external constraints for Covid-19 has been justified, then there is a case for a similarly permissive approach (...) to compulsory medical interventions. (shrink)

Kelly Sorensen defends a model of the relationship between effort and moral worth in which the effort exerted in performing a morally desirable action contributes positively to the action’s moral worth, but the effort required to perform the action detracts from its moral worth. I argue that Sorensen’s model, though on the right track, is mistaken in three ways. First, it fails to capture the relevance of counterfactual effort to moral worth. Second, it wrongly implies that exerting unnecessary effort confers (...) moral worth on an action. Third, it fails to adequately distinguish between cases in which effort is required because of defects of moral character and those in which effort is required because of barriers external to moral character, such as social pressures or non-moral cognitive deficits. I suggest three amendments to Sorensen’s model that correct these three defects. (shrink)

Tragedy is a founding theme in disability studies. Critical disability studies have, since their inception, argued that understandings of disability as tragedy obscure the political dimensions of disability and are a barrier facing disabled persons in society. In this paper, we propose an affirmative understanding of tragedy, employing the philosophical works of Nietzsche, Spinoza and Hasana Sharp. Tragedy is not, we argue, something to be opposed by disability politics; we can affirm life within it. To make our case, we (...) look to an ongoing ethnography of two Canadian children’s rehabilitation clinics. Looking to the clinical experience of Canadian boys and young men diagnosed with Duchenne Muscular Dystrophy and those of their families, we show how this affirmative understanding of tragedy allows us to pursue the themes of disability politics within tragedy. Contrary to an optimism that would eschew tragedy at all costs or a pessimistic approach that declines to act in the face of tragic circumstance, we argue that a revised understanding of tragedy allows us to situate the occasionally-tragic clinical experience of disability in a philosophy of life. Both disability and tragedy point us to the shared entanglements that make life what it is. (shrink)

As engineering applications require management of ever larger volumes of data, ontologies offer the potential to capture, manage, and augment data with the capability for automated reasoning and semantic querying. Unfortunately, considerable barriers hinder wider deployment of ontologies in engineering. Key among these is lack of a shared top-level ontology to unify and organise disparate aspects of the field and coordinate co-development of orthogonal ontologies. As a result, many engineering ontologies are limited to their scope, and functionally difficult to extend (...) or interoperate with other engineering ontologies. This paper demonstrates how the use of a top-level ontology, specifically the Basic Formal Ontology (BFO), greatly facilitates interoperability of multiple engineering-related ontologies. We constructed a system of formal linked ontologies by re-engineering legacy ontologies to be conformant with BFO and developing new BFO-conformant ontologies to capture knowledge in the engineering design, enterprise, human factors, manufacturing, and application domain of additive manufacturing. The resulting Integrated Framework for Additively Manufactured Products (IFAMP), including the body knowledge instantiated on its basis, serve as the basis for a proposed Design with Additive Manufacturing Method (DWAM), which we believe can support the design of innovative products with semantically enhanced ideation tools and enhanced access to application domain knowledge. The method and its facilitation through the ontological framework are demonstrated using a case study in medicine. (shrink)

Fair trade has been researched extensively. However, our understanding of why consumers might be reluctant to purchase fair trade goods, and the associated potential barriers to the wider adoption of fair trade products, is incomplete. Based on data from 409 USA participants, our study demonstrates some of the psychological processes that underlie the rejection of fair trade products by conservatives. Our findings show that political conservatism affects fair trade perspective-taking and fair trade identity, and these latter two subsequently affect fair (...) trade purchase intention. The decrease in fair trade perspective-taking and fair trade identity are two psychological features that potentially shield conservatives from the appeals of fair trade products. We extend prior research on the effects of political ideology on consumption not only by demonstrating the predisposition of highly conservative consumers towards prosocial consumption, but also by showing the internal functioning of the conservative decision-making process. We further demonstrate that the effect of conservatism on fair trade purchase deliberation is moderated by age and income. Age reduces the negative effect of conservatism on fair trade perspective-taking, whereas income heightens the negative effect of conservatism on fair trade perspective-taking. Our results suggest that fair trade initiatives can target the conservative consumer segment in high-income countries with a greater chance of success when applying marketing strategies that make perspective-taking redundant and that aim at younger consumers with lower incomes. (shrink)

This critique of nine service learning projects within schools of business is designed to encourage other educational institutions to add service learning requirements into business ethics and leadership courses. It champions the role of the faculty member teaching these courses while at the same time offering constructive analysis on pedagogy, a review of curriculum issues, identification of barriers to service learning, and guidelines for teaching service learning ventures. Challenges to all faculty involved in business ethics courses are made to better (...) manage their courses and careers from a broader context outside of university settings. (shrink)

The paper discusses examples of integrative metatheoretical and theoretical work undertaken in the spirit of unification. Unification is defined as a recursive process in which the outcome of any one integrative episode provides ideas that may enter into further such episodes. The conceptual materials entering into integration exist at different levels and in distinct contexts. At the metatheoretical level, the examples relate to a number of contexts and issues, including methodological individualism versus holism. At the theoretical level, two examples of (...) the idea of a unification episode are described. In each instance, the ideas entering into the integrative episode are drawn from distinct research programs. It is argued that the spirit of unification, as embodied in theoretical practice along the lines suggested by the examples, can create bridges between disparate theory enterprises so as to help break down particularistic barriers within sociological theory. (shrink)

Young men who have sex with men younger than 18 years are often excluded from HIV prevention research in Thailand due to cultural attitudes toward youth sexuality, social stigma, and difficulties obtaining guardian permission. Culturally sensitive focus group discussions conducted with parents and YMSM in Bangkok, Thailand, identified barriers and facilitators related to minors’ participation in HIV prevention research. Although gender and class differences emerged, mothers and fathers were generally accepting of research to reduce HIV risk but not in favor (...) of waiver. Youth’s positive attitude toward parental permission was tempered by concerns about harms posed by disclosing same-sex attraction through permission forms. (shrink)

The debate about the Sustainable Development Goals, which are to replace the Millennium Development Goals when they expire in 2015, is moving very quickly. Weighing in on this debate, we argue that if the SDGs are to be as effective as they can realistically be, concrete responsibilities must be assigned to specific competent actors, measurement methods involved in development targets must not be allowed to be changed midway, and the tracking of progress must be left to independent experts. New development (...) goals should aim for inequality reduction, a more comprehensive view of poverty, and, most importantly, systemic reforms of global institutions. The world will not make decent progress against poverty until the most powerful agents accept real action commitments, not only in the marginal area of development assistance, but in all their policy and institutional design decisions, at both the domestic and especially the supranational level. We end with eight examples of institutional reform goals – ranging from deterring trade barriers to mitigating the effects of lost corporate tax revenues on poor populations – that should be included in the new list. (shrink)

The debate about the Sustainable Development Goals, which are to replace the Millennium Development Goals when they expire in 2015, is moving very quickly. Weighing in on this debate, we argue that if the SDGs are to be as effective as they can realistically be, concrete responsibilities must be assigned to specific competent actors, measurement methods involved in development targets must not be allowed to be changed midway, and the tracking of progress must be left to independent experts. New development (...) goals should aim for inequality reduction, a more comprehensive view of poverty, and, most importantly, systemic reforms of global institutions. The world will not make decent progress against poverty until the most powerful agents accept real action commitments, not only in the marginal area of development assistance, but in all their policy and institutional design decisions, at both the domestic and especially the supranational level. We end with eight examples of institutional reform goals – ranging from deterring trade barriers to mitigating the effects of lost corporate tax revenues on poor populations – that should be included in the new list. (shrink)

The debate about the Sustainable Development Goals, which are to replace the Millennium Development Goals when they expire in 2015, is moving very quickly. Weighing in on this debate, we argue that if the SDGs are to be as effective as they can realistically be, concrete responsibilities must be assigned to specific competent actors, measurement methods involved in development targets must not be allowed to be changed midway, and the tracking of progress must be left to independent experts. New development (...) goals should aim for inequality reduction, a more comprehensive view of poverty, and, most importantly, systemic reforms of global institutions. The world will not make decent progress against poverty until the most powerful agents accept real action commitments, not only in the marginal area of development assistance, but in all their policy and institutional design decisions, at both the domestic and especially the supranational level. We end with eight examples of institutional reform goals – ranging from deterring trade barriers to mitigating the effects of lost corporate tax revenues on poor populations – that should be included in the new list. (shrink)

Social constructionism is a broad position that emphasizes the importance of human social processes in psychology. These processes are generally associated with language and the ability to construct stories that conform to the emergent rules of "language games". This view allows one to espouse a variety of critical postures with regard to realist commitments within the social and behavioural sciences, ranging from outright relativism to a more moderate respect for the "barrier" that linguistic descriptions can place between us and (...) reality. This paper first outlines some possible social construction-ist viewpoints and then goes on to show how each of them conforms to the basic principles of information theory. After establishing this relation the paper then argues that this leads to a great deal of commonality between social construction-ist positions and the baseline aims of cognitive science. Finally, the paper argues that, if information theory is held in common, this both suggests future research collaborations and helps to "mop up" some of the arguments surrounding realist commitments. (shrink)

The policy adopted by housing authorities of denying prospective tenants with a criminal record access to housing is an important barrier to ex-offenders seeking somewhere to live. The policy is legal, but are there any good reasons in favor of it when we know that having no, or limited, access to secure and affordable housing increases the probability of recidivism? The primary aim of this article is to critically discuss two central reasons that have been given for denying people (...) with criminal records access to housing: that doing so will prevent crime, and that the policy reduces fear of crime. We also try to evaluate an argument for the conclusion that current law, and the policies that follows wrongfully discriminate against people with criminal records. The general thrust of the article is that arguments for this practice turning on its crime preventive effect, and its role in reducing or preventing fear of crime, are unpersuasive. We then explained why, in our view, excluding ex-offenders from housing amounts to wrongful discrimination against them. Our analysis suggests that ex-offenders, apart from a few excemptions, ought to be allowed access to housing to the same extent as other people. (shrink)

Despite similar health problems, older persons show different care seeking behaviours for a variety of reasons. The aim of this study was to identify motives underlying the attitudes of older persons to seek nursing care and to develop a theoretical rationale which allows viewing their mutual interaction. Theory development according to Walker and Avant was used as a method to derive a model from the reviewed literature. Six categories were identified that may influence seeking of nursing care: perceived threat, disposition, (...) external options & barriers, current coping abilities, influence of significant others, and outcome value. Findings do not allow determination of factors that may predict care seeking attitude but provide a loosely structured conceptual model for culture specific investigations. Qualitative studies guided by the model should be conducted in order to develop testable theories of care seeking for different cultures and settings. (shrink)

Examine the first-year student experience as so rarely seen from the community college perspective and increase the odds of the new-to-college students’ success. For three decades, U.S. higher education has paid increasing attention to the beginning college experience—to ensure that entering students make a successful transition to college. Yet, much of the extant research and practice literature focuses on the experience of first-year students entering four-year colleges and universities. Fulfilling the Promise of the Community College is an insightful publication that (...) provides a thought-provoking, idea-inspiring look at the unique characteristics of the community college and its students. In addition, it explores the barriers to success these students face as well as strategies for ensuring that their higher education goals can be achieved. Authors describe successful adaptations of faculty development initiatives, first-year seminars, common reading programs, academic and career advising, learning communities, and STEM initiatives in the community college setting. (shrink)

In The Brothers Karamazov, Ivan is said to have held the view, at least at one time, that there is no God, and that, as a result, morality as it existed before this knowledge was achieved no longer has any force or authority. Ivan believed that God or the belief in God was the source of authority for the “old morality” and that the man who recognizes that there is no God “may lightheartedly overstep all the barriers” of that morality (...) and construct a new one. The question in which I am interested is concerned with the sense or senses in which God might be considered to be the source of the authority of morality. In considering this question, I will consider three related views: the view that God is the criterion of moral goodness and makes certain character traits and qualities good by being himself the exemplar of goodness and by esteeming certain character traits and qualities; and that God is the criterion of moral rightness and makes certain actions right by commanding or desiring us to do them, and others wrong by commanding us not to do them; or, alternatively, that the criterion of moral rightness is what God would command or desire us to do; the view that God’s existence is necessary for moral utterances to make proper sense; and the view that the assumption of God’s existence is necessary for moral arguments to have any power to move those to whom they are addressed. I will argue that each of these is incorrect. (shrink)

This narrative symposium examines the relationship of bioethics practice to personal experiences of illness. A call for stories was developed by Tod Chambers, the symposium editor, and editorial staff and was sent to several commonly used bioethics listservs and posted on the Narrative Inquiry in Bioethics website. The call asked authors to relate a personal story of being ill or caring for a person who is ill, and to describe how this affected how they think about bioethical questions and the (...) practice of medicine. Eighteen individuals were invited to submit full stories based on review of their proposals. Twelve stories are published in this symposium, and six supplemental stories are published online only through Project MUSE. Authors explore themes of vulnerability, suffering, communication, voluntariness, cultural barriers, and flaws in local healthcare systems through stories about their own illnesses or about caring for children, partners, parents and grandparents. Commentary articles by Arthur Frank, Bradley Lewis, and Carol Taylor follow the collection of personal narratives. (shrink)

Background Community advisory boards have expanded beyond high-income countries and play an increasing role in low- and middle-income country research. Much research has examined CABs in HICs, but less is known about CABs in LMICs. The purposes of this scoping review are to examine the creation and implementation of CABs in LMICs, including identifying frequently reported challenges, and to discuss implications for research ethics. Methods We searched five databases for publications describing or evaluating CABs in LMICs. Two researchers independently reviewed (...) articles for inclusion. Data related to the following aspects of CABs were extracted from included publications: time, country, financial support, research focus, responsibilities, and challenges. Thematic analyses were used to summarize textual data describing challenges. Results Our search yielded 2005 citations, 83 of which were deemed eligible for inclusion. Most studies were published between 2010 and 2017. Upper-middle-income countries were more likely to have studies describing CABs, with South Africa, China, and Thailand having the greatest numbers. The United States National Institutes of Health was the main source of financial support for CABs. Many CABs focused on HIV research. Thirty-four studies reported how CABs influenced the informed consent process for clinical trials or other aspects of research ethics. CAB responsibilities were related to clinical trials, including reviewing study protocols, educating local communities about research activities, and promoting the ethical conduct of research. Challenges faced by CABs included the following: incomplete ethical regulations and guidance; limited knowledge of science among members of communities and CABs; unstable and unbalanced power relationships between researchers and local communities; poor CAB management, including lack of formal participation structures and absence of CAB leadership; competing demands for time that limited participation in CAB activities; and language barriers between research staff and community members. Several challenges reflected shortcomings within the research team. Conclusions Our findings examine the formation and implementation of CABs in LMICs and identify several ethical challenges. These findings suggest the need for further ethics training among CAB members and researchers in LMICs. (shrink)

In management theory and business practice, the dealing with diversity, especially a diverse workforce, has played a prominent role in recent years. In a globalizing economy companies recognized potential benefits of a multicultural workforce and tried to create more inclusive work environments. However, many organizations have been disappointed with the results they have achieved in their efforts to meet the diversity challenge [Cox: 2001, Creating the Multicultural Organization (Jossey-Bass, San Francisco)]. We see the reason for this in the fact that (...) while much attention has been paid to the strategic dimension of diversity policies, systems, and processes, much less thought has been given to the normative dimension, the norms and values involved. Given the fact that diversity is essentially about cultural norms and values, appropriate reflection work becomes a fundamental task to create a truly inclusive work environment where people from diverse backgrounds feel respected and recognized. Therefore, we focus in this article on the challenge of building an inclusive diversity culture showing that such a culture of inclusion has to be built on solid moral grounds. We present a conceptual framework of inclusion based on a moral theory of recognition and introduce the founding principles of reciprocal understanding, standpoint plurality and mutual enabling, trust and integrity. After revealing barriers that hinder a culture of inclusion from emerging we shed light on the process of developing such a culture which involves four essential transformational stages: The first phase focuses on raising awareness, building understanding and encouraging reflection. The second phase deals with the development of a vision of inclusion as an important step to define the change direction. In a third phase key management concepts and principles should be re-thought. This leads to the fourth, action-oriented phase, that focuses on an integrated Human Relations Management (HRM)1 system that helps implement change by doing both, translating the founding principles via competencies into observable and measurable behavior and fostering the development, reinforcement and recognition of inclusive behavior. (shrink)

ObjectiveInformed consent is a prerequisite for caesarean section, the commonest surgical procedure in low- and middle-income settings, but not always acquired to an appropriate extent. Exploring perceptions of health care workers may aid in improving clinical practice around informed consent. We aim to explore health workers’ beliefs and experiences related to principles and practice of informed consent.MethodsQualitative study conducted between January and June 2018 in a rural 150-bed mission hospital in Southern Malawi. Clinical observations, semi-structured interviews and a focus group (...) discussion were used to collect data. Participants were 22 clinical officers, nurse-midwives and midwifery students involved in maternity care. Data were analysed to identify themes and construct an analytical framework.ResultsDefinition and purpose of informed consent revolved around providing information, respecting women’s autonomy and achieving legal protection. Due to fear of blame and litigation, health workers preferred written consent. Written consent requires active participation by the consenting individual and was perceived to transfer liability to that person. A woman’s refusal to provide written informed consent may pose a dilemma for the health worker between doing good and respecting autonomy. To prevent such refusal, health workers said to only partially disclose surgical risks in order to minimize women's anxiety. Commonly perceived barriers to obtain a fully informed consent were labour pains, language barriers, women’s lack of education and their dependency on others to make decisions.ConclusionsHealth workers are familiar with the principles around informed consent and aware of its advantages, but fear of blame and litigation, partial disclosure of risks and barriers to communication hamper the process of obtaining informed consent. Findings can be used to develop interventions to improve the informed consent process. (shrink)

We expand Chater & Loewenstein's discussion of barriers to s-frames by highlighting moral psychological mechanisms. Systemic aspects of moralized social issues can be neglected because of (a) the individualistic frame through which we perceive moral transgressions; (b) the desire to punish elicited by moral emotions; and (c) the motivation to attribute agency and moral responsibility to transgressors.

Studies suggest that medical students and physicians have higher rates of anxiety, depression, and suicidal ideation than their peers in the general population. Some authors have suggested that medical culture perpetuates these problems by erecting “barriers to treatment,” preventing students and physicians from getting the help they need. Here, the author begins a broader examination of the potential role of culture by examining the myths and symbols that form the basis for medical culture and the medical self-image. The author argues (...) that a medical self-image based on a de-contextualized medical mythology, the Asclepius myth, results in a sense of professional identity that is unbalanced, dehumanized, and characterized by unattainable expectations. The outward expression of this medical self-image, the medical culture, is often a-relational, unhealthy, stressed, or even toxic. The author suggests some ways of re-modeling medical culture, including its rituals and symbols, and medical education in ways that incorporate what is currently kept in its shadow. (shrink)

There is a well-established relationship between isolation and both morbidity and mortality in the context of addiction recovery, yet the protective effects of intimate and familial relationships have not been adequately assessed. The current paper uses the European Life In Recovery database to assess the association between relationship status and living with dependent children on recovery capital of people in recovery from drug addiction, operationalised by the Strengths And Barriers Recovery Scale. The study participants were drawn from the REC-PATH study (...) and supplemented by a second sample recruited by the Recovered Users Network across various European countries, resulting in a combined sample of 1,313 individuals completing the survey, primarily online. The results show that, in recovery, those who are married or co-habiting reported significantly greater recovery strengths and fewer barriers to recovery, and reported greater gains in recovery capital across their recovery journeys. Similar associations are found for participants who have dependent children living with them. There is also some indication that this association is stronger for female than for male participants. Finally, having more people that one can rely on and a greater proportion of people in recovery in the social network are both linked to greater recovery capital and greater self-reported growth in recovery capital. We conclude that this study provides further evidence in favour of a “social cure” in recovery, in which close familial ties are associated with stronger recovery resources. (shrink)

Background Rapid Ethical Assessment is a form of rapid ethnographic assessment conducted at the beginning of research project to guide the consent process with the objective of reconciling universal ethical guidance with specific research contexts. The current study is conducted to assess the perceived relevance of introducing REA as a mainstream tool in Ethiopia. Methods Mixed methods research using a sequential explanatory approach was conducted from July to September 2012, including 241 cross-sectional, self-administered and 19 qualitative, in-depth interviews among health (...) researchers and regulators including ethics committee members in Ethiopian health research institutions and universities. Results In their evaluation of the consent process, only 40.2% thought that the consent process and information given were adequately understood by study participants; 84.6% claimed they were not satisfied with the current consent process and 85.5% thought the best interests of study participants were not adequately considered. Commonly mentioned consent-related problems included lack of clarity, inadequate information, language barriers, cultural differences, undue expectations and power imbalances. About 95.4% believed that consent should be contextualized to the study setting and 39.4% thought REA would be an appropriate approach to improve the perceived problems. Qualitative findings helped to further explore the gaps identified in the quantitative findings and to map-out concerns related to the current research consent process in Ethiopia. Suggestions included, conducting REA during the pre-test phase of studies when applicable. The need for clear guidance for researchers on issues such as when and how to apply the REA tools was stressed. Conclusion The study findings clearly indicated that there are perceived to be correctable gaps in the consent process of medical research in Ethiopia. REA is considered relevant by researchers and stakeholders to address these gaps. Exploring further the feasibility and applicability of REA is recommended. (shrink)

Many parents are hesitant about, or face motivational barriers to, vaccinating their children. In this paper, we propose a type of vaccination policy that could be implemented either in addition to coercive vaccination or as an alternative to it in order to increase paediatric vaccination uptake in a non-coercive way. We propose the use of vaccination nudges that exploit the very same decision biases that often undermine vaccination uptake. In particular, we propose a policy under which children would be vaccinated (...) at school or day-care by default, without requiring parental authorization, but with parents retaining the right to opt their children out of vaccination. We show that such a policy is likely to be effective, at least in cases in which non-vaccination is due to practical obstacles, rather than to strong beliefs about vaccines, ethically acceptable and less controversial than some alternatives because it is not coercive and affects individual autonomy only in a morally unproblematic way, and likely to receive support from the UK public, on the basis of original empirical research we have conducted on the lay public. (shrink)

Autonomous vehicles (AV) offer promising benefits to society in terms of safety, environmental impact and increased mobility. However, acute challenges persist with any novel technology, inlcuding the perceived risks and trust underlying public acceptance. While research examining the current state of AV public perceptions and future challenges related to both societal and individual barriers to trust and risk perceptions is emerging, it is highly fragmented across disciplines. To address this research gap, by using the Web of Science database, our study (...) undertakes a bibliometric and performance analysis to identify the conceptual and intellectual structures of trust and risk narratives within the AV research field by investigating engineering, social sciences, marketing, and business and infrastructure domains to offer an interdisciplinary approach. Our analysis provides an overview of the key research area across the search categories of ‘trust’ and ‘risk’. Our results show three main clusters with regard to trust and risk, namely, behavioural aspects of AV interaction; uptake and acceptance; and modelling human–automation interaction. The synthesis of the literature allows a better understanding of the public perception of AV and its historical conception and development. It further offers a robust model of public perception in AV, outlining the key themes found in the literature and, in turn, offers critical directions for future research. (shrink)

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Heidegger’s two modes of thinking, calculative and meditative, were used as the thematic basis for this qualitative study of physicians from seven countries . Focus groups were conducted in each country with 69 physicians who cared for the elderly. Results suggest that physicians perceived ethical issues primarily through the lens of calculative thinking with emphasis on economic concerns. Meditative responses represented 24% of the statements and were mostly generated by Canadian physicians whose patients typically were not faced with economic barriers (...) to treatment due to Canada’s universal health care system. (shrink)

At the 2022 Clinical Ethics Unconference, the authors perceived a significant lack of racial and ethnic diversity, which was consistent with their experiences in other clinical ethics settings. As a result, they convened a working group to address the pervasive lack of diversity present in the field of clinical ethics and to propose strategies to increase the representation of people from racial and ethnic minority populations. This article identifies the harms associated with the lack of diversity in the healthcare setting (...) and translates these to the field of clinical ethics. The article then proposes a framework that may be used to help diversify the field of clinical ethics. Specifically, the authors identify existing barriers to appropriate diversity, actionable steps to increase diversity, and tools the field can utilize to systematically assess its progress with respect to achieving diversity. (shrink)

Cognitive science-informed approaches have gained considerable influence in education in the UK and internationally, but not much is known about how teachers perceive cognitive science-informed strategies or enact them within the contexts of their everyday classrooms. In this paper, we discuss the perceptions and experiences of cognitive science-informed strategies of 13 teachers in England. The paper critically explores how the teachers understood and used cognitive science-informed strategies in their teaching, their views of the benefits and challenges for different subjects and (...) groups of learners, and their reflections on supporting factors and barriers for adopting the strategies in their schools. The teachers’ accounts illustrate some of the many complexities of adopting cognitive science-informed approaches in real-life educational settings. Drawing on their narratives, the paper emphasises the importance of acknowledging different contextual dimensions and the dynamic interactions between them to understand when and how teachers enact cognitive science-informed approaches in their classrooms. (shrink)

Driving is central to adult independence and autonomy; yet most autistic young adults do not acquire driver’s licenses. It is important to understand barriers to achieving this milestone for autistic adults. Differences in negative affect and emotion dysregulation associated with autism may interfere with managing difficult driving situations. The current study compared perceived driving difficulty, emotion dysregulation, and negative affect in emerging drivers with and without autistic traits, and investigated how emotion dysregulation and negative affect relate to perceived DD. We (...) expected greater perceived DD, emotion dysregulation, and negative affect in participants with AT and a positive correlation of perceived DD with both emotion dysregulation and negative affect in the whole sample. Thirty-seven adolescents and young adults self-reported perceived DD in 15 scenarios and completed the Difficulty in Emotion Dysregulation Scale and the Depression, Anxiety, and Stress Scale. Autistic participants scored significantly higher on mean perceived DD, DERS Impulse subscale, DASS total and DASS Stress subscale scores. Perceived DD positively correlated with the DERS and DASS total scores, all DASS subscales, and DERS Nonacceptance, Goals, and Impulse subscales across the whole sample. The findings highlight the roles of emotion dysregulation and negative affect in perceived DD in emerging drivers with AT. In particular, emotional stress and impulsivity may map onto mechanisms of over-reactivity to negative affect and explain why autistic people perceive particular situations as difficult when driving. Implications and directions for future research are discussed. (shrink)

The focus on translational research in clinical trials has the potential to generate clinically relevant genetic data that could have importance to patients. This raises challenging questions about communicating relevant genetic research results to individual patients. An exploratory pharmacogenetic analysis was conducted in the international ovarian cancer phase III trial, AGO-OVAR 16, which found that patients with clinically important germ-line BRCA1/2 mutations had improved progression-free survival prognosis. Mechanisms to communicate BRCA results were evaluated, because these findings may be beneficial to (...) patients and their families. Communicating individual BRCA results was not anticipated during clinical trial design. Consequently, options were not available for patients to indicate their preference for receiving their individual results when they signed pharmacogenetic informed consent. Differences in local requirements, clinical practice, and opinion regarding the ethical aspects of how to convey genetic results to patients are all potential barriers to returning individual BRCA results to patients. Communicating the aggregate BRCA result from this study provided clinical investigators with a mechanism to disseminate the overall study finding to patients while taking individual circumstances, local guidelines and clinical practice into account. This study illustrates the importance of increasing the clarity and scope of informed consent and the need for patient engagement to ensure clinical trial participants can indicate their preference regarding receipt of potentially important individual pharmacogenetic results. This study was registered in the NCT Clinical Trial Registry under NCT00866697 on March 19, 2009, following approval from participating ethics committees. (shrink)

A barrier to the development and refinement of ethics education in and across health professional schools is that there is not an agreed upon instrument or method for assessment in ethics education. The most widely used ethics education assessment instrument is the Defining Issues Test (DIT) I & II. This instrument is not specific to the health professions. But it has been modified for use in, and influenced the development of other instruments in, the health professions. The DIT contains (...) certain philosophical assumptions (“Kohlbergian” or “neo-Kohlbergian”) that have been criticized in recent years. It is also expensive for large institutions to use. The purpose of this article is to offer a rubric—which the authors have named the Health Professional Ethics Rubric—for the assessment of several learning outcomes related to ethics education in health science centers. This rubric is not open to the same philosophical critiques as the DIT and other such instruments. This rubric is also practical to use. This article includes the rubric being advocated, which was developed by faculty and administrators at a large academic health science center as a part of a campus-wide ethics education initiative. The process of developing the rubric is described, as well as certain limitations and plans for revision. (shrink)

The application of machine learning and artificial intelligence in healthcare domains has received much attention in recent years, yet significant questions remain about how these new tools integrate into frontline user workflow, and how their design will impact implementation. Lack of acceptance among clinicians is a major barrier to the translation of healthcare innovations into clinical practice. In this systematic review, we examine when and how clinicians are consulted about their needs and desires for clinical AI tools. Forty-five articles (...) met criteria for inclusion, of which 24 were considered design studies. The design studies used a variety of methods to solicit and gather user feedback, with interviews, surveys, and user evaluations. Our findings show that tool designers consult clinicians at various but inconsistent points during the design process, and most typically at later stages in the design cycle. We also observed a smaller amount of studies adopting a human-centered approach and where clinician input was solicited throughout the design process. A third of all studies reported on clinician trust in clinical AI algorithms and tools. The surveyed articles did not universally report validation against the “gold standard” of clinical expertise or provide detailed descriptions of the algorithms or computational methods used in their work. To realize the full potential of AI tools within healthcare settings, our review suggests there are opportunities to more thoroughly integrate frontline users’ needs and feedback in the design process. (shrink)

In Paradigms and Barriers Howard Margolis offers an innovative interpretation of Thomas S. Kuhn's landmark idea of "paradigm shifts," applying insights from cognitive psychology to the history and philosophy of science. Building upon the arguments in his acclaimed Patterns, Thinking, and Cognition, Margolis suggests that the breaking down of particular habits of mind—of critical "barriers"—is key to understanding the processes through which one model or concept is supplanted by another. Margolis focuses on those revolutionary paradigm shifts— such as the (...) switch from a Ptolemaic to a Copernican worldview—where challenges to entrenched habits of mind are marked by incomprehension or indifference to a new paradigm. Margolis argues that the critical problem for a revolutionary shift in thinking lies in the robustness of the habits of mind that reject the new ideas, relative to the habits of mind that accept the new ideas. Margolis applies his theory to famous cases in the history of science, offering detailed explanations for the transition from Ptolemaic to cosmological astronomy, the emergence of probability, the overthrow of phlogiston, and the emergence of the central role of experiment in the seventeenth century. He in turn uses these historical examples to address larger issues, especially the nature of belief formation and contemporary debates about the nature of science and the evolution of scientific ideas. Howard Margolis is a professor in the Harris Graduate School of Public Policy Studies and in the College at the University of Chicago. He is the author of Selfishness, Altruism, and Rationality and Patterns, Thinking, and Cognition, both published by the University of Chicago Press. (shrink)

The newly updated Right and Wrong 2nd Edition is an accessible introduction to the major traditions in western philosophical ethics, written in a lively and engaging style. It is designed for entry-level ethics courses and includes real-life ethical scenarios chosen to appeal directly to students. Greatly expanded and improved, this successful text introduces students to the major ethical traditions, and provides a simple methodology for resolving ethical dilemmas Treats teleological and deontological approaches to ethics as the two most important traditions, (...) but now includes chapters on virtue ethics and the ethics of care The very accessible writing style speaks directly to students’ own experience Draws examples from three types of real-life ethical scenarios submitted by students: academic dishonesty, partying, and personal relationships Provides a concise treatment of this notoriously complex subject, perfect for entry-level ethics and applied ethics courses. (shrink)

When making decisions, humans can observe many kinds of information about others' activities, but their effects on performance are not well understood. We investigated social learning strategies using a simple problem-solving task in which participants search a complex space, and each can view and imitate others' solutions. Results showed that participants combined multiple sources of information to guide learning, including payoffs of peers' solutions, popularity of solution elements among peers, similarity of peers' solutions to their own, and relative payoffs from (...) individual exploration. Furthermore, performance was positively associated with imitation rates at both the individual and group levels. When peers' payoffs were hidden, popularity and similarity biases reversed, participants searched more broadly and randomly, and both quality and equity of exploration suffered. We conclude that when peers' solutions can be effectively compared, imitation does not simply permit scrounging, but it can also facilitate propagation of good solutions for further cumulative exploration. (shrink)

Big Ideas for Little Kids includes everything a teacher, a parent, or a college student needs to teach philosophy to elementary school children from picture books. Written in a clear and accessible style, the book explains why it is important to allow young children access to philosophy during primary-school education. Wartenberg also gives advice on how to construct a "learner-centered" classroom, in which children discuss philosophical issues with one another as they respond to open-ended questions by saying whether they agree (...) or disagree with what others have said. (shrink)

Some theories of goodness are descriptively rich: they have much to say about what makes things good. Neo-Aristotelian accounts, for instance, detail the various features that make a human being, a dog, a bee good relative to facts about those forms of life. Famously, such theories of relative goodness tend to be comparatively poor: they have little or nothing to say about what makes one kind of being better than another kind. Other theories of goodness—those that take there to be (...) absolute goodness—are comparatively rich: they offer grounds for judging some types of things better than others because they have more absolute goodness. Moorean accounts, for example, can tell us that humans and human experiences are superior to bees and blades of grass. But such theories tend to be descriptively poor: they struggle to tell us in virtue of what this is so. In this essay we motivate and flesh out a view that splits the difference between accounts of goodness as relative and accounts of goodness as absolute. Such a view holds promise only if the mechanics of this kind of metaphysics of goodness can be worked out. Here we present a view on which the paradigm for absolute goodness is God and the paradigm for each kind of relative goodness is a divine idea. (shrink)

Proceedings of a conference held in Apr. 2008 in Washington, D.C.