Hospice is the premiere end of life program in the United States, but its requirement that patients forgo disease-directed therapies and that they have a prognosis of 6 months or less means that it serves less than half of dying patients and often for very short periods of time. Palliative care offers careful attention to pain and symptom management, added support for patients and families, and assistance with difficult medical decision making alongside any and all desired medical treatments, but it (...) does not include a comprehensive system of care as is provided by hospice. The practice of palliative care and hospice is filled with sometimes overt (requests for hastened death in an environment where such acts are legally prohibited) and other times covert (the delay in palliative care referral because the health care team believes it will undermine disease directed treatment) ethical issues. The contributors to this volume use a series of case presentations within each chapter to illustrate some of the palliative care and hospice challenges with significant ethical dimensions across the three overarching domains: 1) care delivery systems; 2) addressing the many dimensions of suffering; and 3) difficult decisions near the end of life. The contributors are among the most experienced palliative care, hospice and ethics scholars in North America and Western Europe. Each has been given relatively free reign to address what they feel are the most pressing ethical challenges within their domain, so a wide range of positions and vantage points are represented. As a result, the volume provides a very diverse ethical exploration of this relatively young field that can deepen, stretch, and at times confront any simple notion of the challenges facing patients, their families, professional caregivers, and policy makers. (shrink)

Completely revised and updated, this classic introduction to moral theology in the Roman Catholic tradition speak clearly to anyone interested in understanding what it means to live the Christian life. Beginning with a concise definition of the roles of revelation and interpretation in the formation of moral theology, O'Connell explores the concept of a moral person, the shape and dynamics of a moral world, and the implications not only for the individual Christian but for the community as a whole.

Palliative care and hospice should be the standards of care for all terminally ill patients. The first place for clinicians to go when responding to a request for assisted death is to ensure the adequacy of palliative interventions. Although such interventions are generally effective, a small percentage of patients will suffer intolerably despite receiving state-of-the-art palliative care, and a few of these patients will request a physician-assisted death. Five potential “last resort” interventions are available under these circumstances: (1) accelerating opioids (...) for pain or dyspnea; (2) stopping potentially life-prolonging therapies; (3) voluntarily stopping eating and drinking; (4) palliative sedation (potentially to unconsciousness); and (5) physician-assisted death. Patient, family, and clinicians should search for the least harmful way to respond to intolerable end-of-life suffering in ways that are effective and also respect the values of the major participants. A system that allows an open response to such cases ultimately protects patients by ensuring a full clinical evaluation and search for alternative responses, while reinforcing the need to be responsive and to not abandon. (shrink)

In my career as a primary care physician and as a palliative care consultant, I have assisted many patients to die with their full consent. None of them wanted to die, and all would have chosen other paths had their disease not been so severe and irreversible. To a person, none of these patients thought of themselves as “suicidal,” and they would have found that label preposterous and demeaning. In fact, the kind of personal disintegration that the label implies is (...) just what is trying to be prevented by those choosing this possibility. So on behalf of patients who have chosen this option, I reject the title of this debate as it unnecessarily tars the discussion with the suggestion of mental illness. In my primary care practice, I have also met many patients who were “suicidal” in the mental health sense of the word, and rest assured I have assisted none of them to die. In fact, I have at times had them involuntarily hospitalized to prevent them from carrying out their wishes. (shrink)

Academic integrity violations on college campuses continue to be a significant concern that draws public attention. Even though AI has been the subject of numerous studies offering explanations and recommendations, academic dishonesty persists. Consequently, this has rekindled interest in understanding AI behavior and its influencers. This paper focuses on the AI violations of plagiarism and sharing homework for freshman business students, examining the factors that influence a student’s intention to plagiarize or share homework with others. Using a sample of more (...) than 1300 freshman business students over 2 years, we modeled intent to plagiarize and intent to share homework using factors in the Theory of Planned Behavior in addition to past violation behavior and moral obligation. Based on the results of this study, attitude, perceived behavioral control, subjective norm, and in addition past behavior and moral obligation, were found to significantly influence an individual’s intention to violate academic integrity, explaining 33 and 35 % of the variance in intention to commit an AI violation for sharing homework and plagiarism, respectively. These results contribute to a better understanding of individuals’ motivations for plagiarizing and sharing homework, which is a necessary step toward reducing academic integrity violations. (shrink)

We report the results of an experiment designed to determine the effects of psychological proximity—proxied by awareness of pain and friendship—on moral reasoning. Our study tests the hypotheses that a moral agent’s emphasis on justice decreases with proximity, while his/her emphasis on care increases. Our study further examines how personality, gender, and managerial status affect the importance of care and justice in moral reasoning. We find support for the main hypotheses. We also find that care should be split into two (...) components, one related to protection and the other to the preservation of relationships. Although gender does not affect moral reasoning directly, we find that it does so indirectly via personality, controlling for age, professional status, and professional background. We do not find a significant effect of managerial status on ethics of justice, but do find that holding a managerial position has a negative impact on ethics of care. Regarding personality, we detect significant positive effects of conscientiousness on ethics of justice and of neuroticism on ethics of care. (shrink)

Black Panther, even with the deep problems in how it represents Black American men, grapples with messy histories directly, in plain sight of white audiences. The motivations and struggles of the characters Shuri and Erik "Killmonger" Stevens, in particular, show us how Black Panther's blend of Africanfuturism and Afrofuturism is meant to teach us how our memories of the past must connect with our visions of the future. Black Panther presents a vision of a distinctly African future that not only (...) affirms that there are in fact Black people in the future, but also gives us a glimpse of how Black people make it to the future and what kind of home we make there. Ruha Benjamin describes how our technologies coalesce to support anti‐Blackness and white supremacy – sometimes inadvertently, oftentimes explicitly. African/Afrofuturist works like Black Panther help us calibrate our walking canes, in a way. (shrink)

Voluntary active euthanasia (VAE) and physician-assisted suicide (PAS) remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical (...) climate. In this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries. (shrink)

Food images are useful stimuli for the study of cognitive processes as well as eating behavior. To enhance rigor and reproducibility in task-based research, it is advantageous to have stimulus sets that are publicly available and well characterized. Food Folio by Columbia Center for Eating Disorders is a publicly available set of 138 images of Western food items. The set was developed for the study of eating disorders, particularly for use in tasks that capture eating behavior characteristic of these illnesses. (...) It contains foods that are typically eaten, as well as those typically avoided, by individuals with eating disorders. Each image has now been rated across 17 different attributes by a large general United States population sample via Amazon’s Mechanical Turk. Ratings included subjective attributes as well as estimates of nutrient content. Each participant rated a subset of stimulus set food items on all 17 dimensions. Additional description of the image set is provided in terms of physical image information and accurate nutritional information. Correlations between subjective ratings were calculated and an exploratory factor analysis and exploratory cluster analysis completed. Outcomes of the factor analysis suggested foods may be described along three latent factors of healthiness, tastiness, and umami taste; the cluster analysis highlighted five distinct clusters of foods varying on these same dimensions. Descriptive outcomes indicated that the stimulus set includes a range of foods that vary along multiple dimensions and thus is likely to be useful in addressing various research questions surrounding eating behavior and cognition in healthy populations, as well as in those with eating disorders. The provision of comprehensive descriptive information allows for stimulus selection that is optimized for a given research question and promotes strong inference. (shrink)

Making recognition decisions often requires us to reference the contents of working memory, the information available for ongoing cognitive processing. As such, understanding how recognition decisions are made when based on the contents of working memory is of critical importance. In this work we examine whether recognition decisions based on the contents of visual working memory follow a continuous decision process of graded information about the correct choice or a discrete decision process reflecting only knowing and guessing. We find a (...) clear pattern in favor of a continuous latent strength model of visual working memory–based decision making, supporting the notion that visual recognition decision processes are impacted by the degree of matching between the contents of working memory and the choices given. Relation to relevant findings and the implications for human information processing more generally are discussed. (shrink)

Reviews evidence which suggests that there may be little or no direct introspective access to higher order cognitive processes. Ss are sometimes unaware of the existence of a stimulus that importantly influenced a response, unaware of the existence of the response, and unaware that the stimulus has affected the response. It is proposed that when people attempt to report on their cognitive processes, that is, on the processes mediating the effects of a stimulus on a response, they do not do (...) so on the basis of any true introspection. Instead, their reports are based on a priori, implicit causal theories, or judgments about the extent to which a particular stimulus is a plausible cause of a given response. This suggests that though people may not be able to observe directly their cognitive processes, they will sometimes be able to report accurately about them. Accurate reports will occur when influential stimuli are salient and are plausible causes of the responses they produce, and will not occur when stimuli are not salient or are not plausible causes. (shrink)

To date, research into socially responsible investment (SRI), and in particular the socially responsible investment funds industry, has focused on whether investing in SRI assets has any differential impact on investor returns. Prior findings generally suggest that, on a risk-adjusted basis, there is no difference in performance between SRI and conventional funds. This result has led to questions about whether SRI funds are really any different from conventional funds. This paper examines whether the portfolio allocation across industry sectors and the (...) stock-picking ability of SRI managers are different when compared to conventional fund managers. The study finds that SRI funds exhibit different industry betas consistent with different portfolio positions, but that these differences vary from year to year. It is also found that there is little difference in stock-picking ability between the two groups of fund managers. (shrink)

Cultural narratives shape how we think about the world, including how we decide when the end of life begins. Hospice care has become an integral part of the end‐of‐life care in the United States, but as it has grown, its policies and practices have also imposed cultural narratives, like those associated with the “six‐month rule” that the majority of the end of life takes place in the final six months of life. This idea is embedded in policies for a range (...) of care practices and reimbursement processes, even though six months is not always a meaningful marker. In the case of people living with advanced dementia, six months is both too early in the trajectory to facilitate conversations and too late in the trajectory to ensure decision‐making capacity. This essay encourages scholars and policy‐makers to consider how cultural narratives may limit what they think is possible in care for people living with dementia. (shrink)

Community supported agriculture programs are transforming the way people relate to food and agriculture. Many researchers have considered the transformative potential of CSAs on economic, social, and environmental relations. They illustrate how participants are embedded in broader political economic transformations. The same focus, however, has not been given to CSAs’ transformative impact on individual shareholders—especially in terms of their relationship to food and health. We draw together literatures from behavioral economics, econometrics, and political ecology to evaluate the potential impacts of (...) CSA participation on food lifestyle behaviors. Using primary data drawn from a survey of four groups with distinct food acquisition environments, we compare respondents’ self-assessed food-related behaviors along three different categories: produce versus processed food consumption, food away from home consumption, and food acquisition and interest in nutrition. By documenting between-group differences, we confirm that shareholders display significant absolute differences to other groups along numerous indicators related to the above-stated categories and in general assessments of health. These differences correspond directionally to behaviors public health officials identify as correlated to beneficial health outcomes. We conclude by theorizing how the food environments delineated by a CSA exchange relationship provide unique reflexive opportunities for participants to develop diverse food-related skills and behaviors. (shrink)

The de‐repression of transposable elements (TEs) in mammalian genomes is thought to contribute to genome instability, inflammation, and ageing, yet is viewed as a cell‐autonomous event. In contrast to mammalian cells, prokaryotes constantly exchange genetic material through TEs, crossing both cell and species barriers, contributing to rapid microbial evolution and diversity in complex communities such as the mammalian gut. Here, it is proposed that TEs released from prokaryotes in the microbiome or from pathogenic infections regularly cross the kingdom barrier to (...) the somatic cells of their eukaryotic hosts. It is proposed this horizontal transfer of TEs from microbe to host is a stochastic, ongoing catalyst of genome destabilization, resulting in structural and epigenetic variations, and activation of well‐evolved host defense mechanisms contributing to inflammation, senescence, and biological ageing. It is proposed that innate immunity pathways defend against the horizontal acquisition of microbial TEs, and that activation of this pathway during horizontal transposon transfer promotes chronic inflammation during ageing. Finally, it is suggested that horizontal acquisition of prokaryotic TEs into mammalian genomes has been masked and subsequently under‐reported due to flaws in current sequencing pipelines, and new strategies to uncover these events are proposed. (shrink)

Untying the Gordian Knot shows how the fundamental notions of process, logic and relations, woven with triads of input-output-context, can be combined with quantum distinctions associated with actuality and potentiality, enabling the leveraging of many advances in philosophy and physics to unravel several long-standing philosophical problems.

Voluntary active euthanasia and physician-assisted suicide remain technically illegal in the Netherlands, but the practices are openly tolerated provided that physicians adhere to carefully constructed guidelines. Harsh criticism of the Dutch practice by authors in the United States and Great Britain has made achieving a balanced understanding of its clinical, moral, and policy implications very difficult. Similar practice patterns probably exist in the United States, but they are conducted in secret because of a more uncertain legal and ethical climate. In (...) this manuscript, we plan to compare end-of-life care in the United States and the Netherlands with regard to underlying values, justifications, and practices. We will explore the risks and benefits of each system for a real patient who was faced with a common end-of-life clinical dilemma, and close with challenges for public policies in both countries. (shrink)

This paper examines Plutarch's treatment of education in the Parallel Lives. Beginning with a close reading of Them. 2, it identifies two distinct ways in which Plutarch exploits the education of his subjects: in the first, a subject's attitude to education is used to illustrate a character presented as basically static (a 'static/illustrative' model); in the second, a subject's education is looked at in order to explain his adult character, and education is assumed to affect character (a 'developmental' model). These (...) two models are often associated with two different forms of discourse: anecdotal for the static/illustrative model and analytical for the developmental. The developmental model, furthermore, is closer to Plutarch's thinking in theoretical discussions of character in the Moralia; the static/illustrative model to Plutarch's treatment of character in the Lives more generally, where anecdotal treatments predominate. The coexistence of these two models is probably to be seen as the result of a tension between Plutarch's philosophical thinking and his biographical practice: those few passages in the Lives which assume a developmental model occur in contexts where either Platonic texts or the activity of philosophers are being discussed. (shrink)

Through both an historical and philosophical analysis of the concept of possibility, we show how including both potentiality and actuality as part of the real is both compatible with experience and contributes to solving key problems of fundamental process and emergence. The book is organized into four main sections that incorporate our routes to potentiality: potentiality in modern science [history and philosophy; quantum physics and complexity]; Relational Realism [ontological interpretation of quantum physics; philosophy and logic]; Process Physics [ontological interpretation of (...) relativity theory; physics and philosophy]; on speculative philosophy and physics [limitations and approximations; process philosophy]. We conclude that certain fundamental problems in modern physics require complementary analyses of certain philosophical and metaphysical issues, and that such scholarship reveals intrinsic features and limits of determinism, potentiality and emergence that enable, among others, important progress on the quantum theory of measurement problem and new understandings of emergence. (shrink)