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Patient consent has been formulated in terms of radical individualism rather than shared benefits. Medical education relies on the provision of patient consent to provide medical students with the training and experience to become competent doctors. Pelvic examination represents an extreme case in which patients may legitimately seek to avoid contact with inexperienced medical students particularly where these are male. However, using this extreme case, this paper will examine practices of framing and obtaining consent as perceived by medical students. This (...) paper reports findings of an exploratory qualitative study of medical students and junior doctors. Participants described a number of barriers to obtaining informed consent. These related to misunderstandings concerning student roles and experiences and insufficient information on the nature of the examination. Participants reported perceptions of the negative framing of decisions on consent by nursing staff where the student was male. Potentially coercive practices of framing of the decision by senior doctors were also reported. Participants outlined strategies they adopted to circumvent patients’ reasons for refusal. Practices of framing the information used by students, nurses and senior doctors to enable patients to decide about consent are discussed in the context of good ethical practice. In the absence of a clear ethical model, coercion appears likely. We argue for an expanded model of autonomy in which the potential tension between respecting patients’ autonomy and ensuring the societal benefit of well-trained doctors is recognised. Practical recommendations are made concerning information provision and clear delineations of student and patient roles and expectations. (shrink)

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Obtaining informed consent, an ethical obligation of nurses and other health care providers, occurs routinely when patients make health care decisions. The values underlying informed consent (promotion of patients’ well-being and respect for their self-determination) are embedded in the dominant American culture. Nurses who apply the USA’s cultural values of informed consent when caring for patients who come from other cultures encounter some ethical dilemmas. This descriptive study, conducted with Latino, Chinese and Anglo-American cancer patients in a large, public, west-coast (...) clinic, describes constraints on the informed consent process in a multicultural setting, including language barriers, the clinical environment, control in decision making, and conflicting desired health outcomes for health care providers and patients, and suggests some implications for nursing practice. (shrink)

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Modified Theistic Activism is the view that abstract objects not essentially possessed by God fall under God’s creative activity in one way or another. Michelle Panchuk has argued that this position succumbs to the bootstrapping problem such that God is and is not logically prior to his properties—an incoherent and necessarily false state of affairs. In this essay we respond to Panchuk by arguing that our neo-Aristotelian account of substance and property possession successfully avoids the bootstrapping problem. Moreover, her own (...) neo-Augustinian account of universals contains many conceptual deficiencies and ultimately succumbs to an epistemic iteration of the bootstrapping problem. Finally, we argue that the reasons provided for thinking only created beings need universals to ground character is unmotivated. In clarifying and defending our position, our hope is to bury once and for all the familiar claim that traditional theists cannot be realists with respect to abstract objects because of divine bootstrapping. (shrink)

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In this introduction to Part 1 of the Common Knowledge symposium, “Fuzzy Studies,” the journal's editor discusses four essays from the 1980s by Richard Rorty, in which Rorty chose to associate himself with various neopragmatists, Continental thinkers, and “left-wing Kuhnians” under the rubric of the “new fuzziness.” The term had been introduced as an insult by a philosopher of science with positivist leanings, but Rorty took it up as an “endearing” compliment, arguing that “to be less fuzzy” was also to (...) be “less genial, tolerant, open-minded, and fallibilist.” He defined the “new fuzziness” as “an attempt to blur just those distinctions between the objective and subjective and between fact and value which the critical conception of rationality has developed.” This introduction also examines W. V. Quine's essay “Speaking of Objects”, which describes objects as fuzzy “half-entities”; Clifford Geertz's essay “Blurred Genres”, which advises social scientists that being “taxonomically upstanding” is futile; and Lofti Zadeh's article “The Concept of a Linguistic Variable and Its Application to Approximate Reasoning”, which abandons “Aristotelian, bivalent logic” in favor of a “fuzzy logic” based on Zadeh's “fuzzy set theory.” This introductory piece relates these theoretical works of the past half-century to the sorites paradox and to classical issues of vagueness raised and still unresolved in Western philosophy. Returning then to Rorty, the author questions how Rorty expected his endorsement of the “new fuzziness” to be applied, as proposed, to theology and politics. Suggesting that such applications are the natural work of historians, the author, having asked the historian Natalie Zemon Davis for comment, then quotes her response—which associates fuzzy studies, “common knowledge,” and peacemaking—at length. (shrink)

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Although women are severely under-represented in national politics in Europe, in the European Parliament they are better represented than they are in the national parliaments of the EEC member states. This book examines why this is so. Based largely on their detailed interviews with women MEPs, the authors describe the latter's backgrounds, attitudes and political experience. They also explain the history, structure and organisation of the European Parliament and outline the complexities of the European legal system. A particular concern of (...) the book is the contribution that women MEPs have made to legislation and policy, expecially in the context of recent Community legislation on sex equality, and what impact their presence has had on issues relating to women's interests. (shrink)

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Recent public hearings on misconduct charges belie the conjecture that due process will perforce defeat informed scientific reasoning. One notable case that reviewed an obtuse description of experimental methods displays some of the subtleties of differentiating carelessness from intent to deceive. There the decision of a studious nonscientist panel managed to reach sensible conclusions despite conflicting expert testimony. The significance of such a result may be to suggest that to curtail due process would be both objectionable and unproductive.

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Recent magnetic resonance imaging and pathological studies have indicated that axonal loss is a major contributor to disease progression in multiple sclerosis. 1 H magnetic resonance spectroscopy, through measurement of N -acetyl aspartate, a neuronal marker, provides a unique tool to investigate this. Patients with primary progressive multiple sclerosis have few lesions on conventional MRI, suggesting that changes in normal appearing white matter, such as axonal loss, may be particularly relevant to disease progression in this group. To test this hypothesis (...) NAWM was studied with MRS, measuring the concentration of N -acetyl derived groups. Single-voxel MRS using a water-suppressed PRESS sequence was carried out in 24 patients with primary progressive multiple sclerosis and in 16 age-matched controls. Ratios of metabolite to creatine concentration were calculated in all subjects, and absolute concentrations were measured in 18 patients and all controls. NA/Cr was significantly lower in NAWM in patients than in controls, as was the absolute concentration of NA. There was no significant difference in the absolute concentration of creatine between the groups. This study supports the hypothesis that axonal loss occurs in NAWM in primary progressive multiple sclerosis and may well be a mechanism for disease progression in this group. (shrink)

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Advances in genomics have led to calls for developing population-based preventive genomic sequencing programs with the goal of identifying genetic health risks in adults without known risk factors. One critical issue for minimizing the harms and maximizing the benefits of PGS is determining the kind and degree of control individuals should have over the generation, use, and handling of their genomic information. In this article we examine whether PGS programs should offer individuals the opportunity to selectively opt out of the (...) sequencing or analysis of specific genomic conditions or whether PGS should be implemented using an all-or-nothing panel approach. We conclude that any responsible scale-up of PGS will require a menu approach that may seem impractical to some, but that draws its justification from a rich mix of normative, legal, and practical considerations. (shrink)

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After introducing the new field of cultural evolution, we review a growing body of empirical evidence suggesting that culture shapes what people attend to, perceive and remember as well as how they think, feel and reason. Focusing on perception, spatial navigation, mentalizing, thinking styles, reasoning (epistemic norms) and language, we discuss not only important variation in these domains, but emphasize that most researchers (including philosophers) and research participants are psychologically peculiar within a global and historical context. This rising tide of (...) evidence recommends caution in relying on one’s intuitions or even in generalizing from reliable psychological findings to the species, Homo sapiens. Our evolutionary approach suggests that humans have evolved a suite of reliably developing cognitive abilities that adapt our minds, information-processing abilities and emotions ontogenetically to the diverse culturally-constructed worlds we confront. (shrink)

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The typical Cartesian collection contains papers which treat the problems arising out of Descartes's philosophy as though they and it appeared for the first time in a recent journal. The approach of this collection is quite different. The eight contributors concentrate on problems faced by Cartesianism which are of historical significance. Without denigrating the importance of the technique of exploiting the texts in a manner that appeals to contemporary philosophical interests, the contributors show how Cartesianism was shaped over time by (...) the criticism it received. This criticism took place in many areas - politics, theology, natural science, and metaphysics - and its scope is reflected in this collection of papers. The efforts of advocates of Cartesianism to produce a biography of Descartes, and the political difficulties they faced, are no less a part of the problems of Cartesianism than are the difficulties alleged against the Cartesian ontology of thought and extension in accounting for transubstatiation. Seventeenth- and eighteenth-century theories of the formation of the earth, for example, were historically part of the same set of problems as the difficulties in Bible criticism. These significant issues and many others are discussed in this volume. (shrink)

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The growing practice of returning individual results to research participants has revealed a variety of interpretations of the multiple and sometimes conflicting duties that researchers may owe to participants. One particularly difficult question is the nature and extent of a researcher’s duty to facilitate a participant’s follow-up clinical care by placing research results in the participant’s medical record. The question is especially difficult in the context of genomic research. Some recent genomic research studies — enrolling patients as participants — boldly (...) address the question with protocols dictating that researchers place research results directly into study participants’ existing medical records, without participant consent. Such privileging of researcher judgment over participant choice may be motivated by a desire to discharge a duty that researchers perceive themselves as owing to participants. However, the underlying ethical, professional, legal, and regulatory duties that would compel or justify this action have not been fully explored. (shrink)

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Although medical providers rely on similar tools to “treat” intersex and trans individuals, their enactment of medicalization practices varies. To deconstruct these complexities, we employ a comparative analysis of providers who specialize in intersex and trans medicine. While both sets of providers tend to hold essentialist ideologies about sex, gender, and sexuality, we argue they medicalize intersex and trans embodiments in different ways. Providers for intersex people are inclined to approach intersex as an emergency that necessitates medical attention, whereas providers (...) for trans people attempt to slow down their patients’ urgent requests for transitioning services. Building on conceptualizations of “giving gender,” we contend both sets of providers “give gender” by “giving sex.” In both cases too, providers shift their own responsibility for their medicalization practices onto others: parents in the case of intersex, or adult recipients of care in the case of trans. According to the accounts of most providers, successful medical interventions are achieved when a person adheres to heteronormative gender practices. (shrink)

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The generalized second law of thermodynamics states that entropy always increases when all event horizons are attributed with an entropy proportional to their area. We test the generalized second law by investigating the change in entropy when dust, radiation and black holes cross a cosmological event horizon. We generalize for flat, open and closed Friedmann–Robertson–Walker universes by using numerical calculations to determine the cosmological horizon evolution. In most cases, the loss of entropy from within the cosmological horizon is more than (...) balanced by an increase in cosmological event horizon entropy, maintaining the validity of the generalized second law of thermodynamics. However, an intriguing set of open universe models shows an apparent entropy decrease when black holes disappear over the cosmological event horizon. We anticipate that this apparent violation of the generalized second law will disappear when solutions are available for black holes embedded in arbitrary backgrounds. (shrink)

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A simple experimental paradigm creates the powerful illusion that one is touching one’s own hand even when the two hands are separated by 15 cm. The participant uses her right hand to administer stimulation to a prosthetic hand while the Examiner provides identical stimulation to the participant’s receptive left hand. Change in felt position of the receptive hand toward the prosthetic hand has previously led to the interpretation that the participant experiences self-touch at the location of the prosthetic hand, and (...) experiences a sense of ownership of the prosthetic hand. Our results argue against this interpretation. We assessed change in felt position of the participant’s receptive hand but we also assessed change in felt position of the participant’s administering hand. Change in felt position of the administering hand was significantly greater than change in felt position of the receptive hand. Implications for theories of ownership are discussed. (shrink)

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Philosophy and Christianity make truth claims about many of the same things. They both claim to provide answers to the deep questions of life. But how are they related to one another? Four Views on Christianity and Philosophy introduces readers to four predominant views on the relationship between philosophy and the Christian faith and their implications for life. Each author identifies the propositional relation between philosophy and Christianity along with a section devoted to the implications for living a life devoted (...) to the pursuit of wisdom. -/- The contributors and views include: -/- Graham Oppy—Conflict: Philosophy Trumps Christianity K. Scott Oliphint—Covenant: Christianity Trumps Philosophy Timothy McGrew—Convergence: Philosophy Confirms Christianity Paul Moser—Conformation: Philosophy Reconceived Under Christianity. (shrink)

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While somatic cell editing to treat disease is widely accepted, the use of human genome editing for “enhancement” remains contested. Scientists and policy-makers routinely cite the prospect of enhancement as a salient ethical challenge for human genome editing research. If preventive genome editing projects are perceived as pursuing human enhancement, they could face heightened barriers to scientific, public, and regulatory approval. This article outlines what we call “preventive strengthening research” (or “PSR”) to explore, through this example, how working to strengthen (...) individuals’ resistance to disease beyond what biomedicine considers to be the human functional range may be interpreted as pursuing human enhancement. Those involved in developing guidance for PSR will need to navigate the interface between preventive goals and enhancement implications. This article identifies and critiques three of these ideas in the interest of anticipating the wider emergence of PSR and the need for a normative approach for its pursuit. All three “candidate criteria” merit attention, but each also faces challenges that will need to be addressed as further research policy is developed. (shrink)

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Background: The Declaration of Helsinki, the World Medical Association’s statement of ethical guidelines regarding medical research, is published in the three official languages of the WMA: English, French and Spanish.Methods: A detailed comparison of the three official language versions was carried out to determine ways in which they differed and ways in which the wording of the three versions might illuminate the interpretation of the document.Results: There were many minor linguistic differences between the three versions. However, in paragraphs 1, 6, (...) 29, 30 and in the note of clarification to paragraph 29, there were differences that could be considered potentially significant in their ethical relevance.Interpretation: Given the global status of the Declaration of Helsinki and the fact that it is translated from its official versions into many other languages for application to the ethical conduct of research, the differences identified are of concern. It would be best if such differences could be eliminated but, at the very least, a commentary to explain any differences that are unavoidable on the basis of language or culture should accompany the Declaration of Helsinki. This evidence further strengthens the case for international surveillance of medical research ethics as has been proposed by the WMA. (shrink)

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Hookups are uncommitted sexual encounters that range from kissing to intercourse and occur between individuals in whom there is no current dating relationship and no expressed or acknowledged expectations of a relationship following the hookup. Research over the last decade has begun to focus on hooking up among adolescents and young adults with significant research demonstrating how alcohol is often involved in hooking up. Given alcohol’s involvement with hooking up behavior, the array of health consequences associated with this relationship, as (...) well as its increasing prevalence from adolescence to young adulthood, it is important to determine the predictors and consequences associated with alcohol-related hooking up. The current review extends prior reviews by adding more recent research, including both qualitative and experimental studies (i.e. expanding to review more diverse methods), research that focuses on the use of technology in alcohol-related hookups (i.e. emerging issues), further develops prevention and intervention potentials and directions, and also offers a broader discussion of hooking up outside of college student populations (i.e., expanding generalization). This article will review the operationalization and ambiguity of the phrase hooking up, the relationship between hooking up and alcohol use at both the global and event levels, predictors of alcohol-related hooking up, and both positive and negative consequences, including sexual victimization, associated with alcohol-related hookups. Throughout, commentary is provided on the methodological issues present in the field, as well as limitations of the existing research. Future directions for research that could significantly advance our understanding of hookups and alcohol use are provided. (shrink)

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Inattentional blindness studies have shown that an unexpected object may go unnoticed if it does not share the property specified in the task instructions. Our aim was to demonstrate that observers develop an attentional set for a property not specified in the task instructions if it allows easier performance of the primary task. Three experiments were conducted using a dynamic selective-looking paradigm. Stimuli comprised four black squares and four white diamonds, so that shape and colour varied together. Task instructions specified (...) shape but observers developed an attentional set for colour, because we made the black–white discrimination easier than the square–diamond discrimination. None of the observers instructed to count bounces by squares reported an unexpected white square, whereas two-thirds of observers instructed to count bounces by diamonds did report the white square. When attentional set departs from task instructions, you may fail to see what you were told to look for. (shrink)

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Promoting patient autonomy has become a key imperative in health service encounters. We will examine the potential negative effects of over-promoting patient autonomy and consider the impact on patient access, their experience and the provision of equitable services by focusing on an extreme manifestation of this trend, i.e. calls for patient involvement in health care decision making to be mandatory. Advocates of mandatory autonomy hold that patients have a duty to themselves, to society and to the medical system to make (...) decisions on their health care independently. Models of mandatory autonomy may be contrasted to those of optional autonomy that seek to ascertain patients’ decisional preferences and to understand wider limitations on their freedom to choose. Where choice as decisional responsibility becomes mandatory it ceases to promote agency and where autonomous choice is understood as an individualistic practice it will contribute to the cultural dominance of Western values. Moreover, taking a view that principlist ethics needs to take account of the social and cultural contexts of individual lives, we argue that if mandatory autonomy were to be over-emphasised as part of an ongoing move towards patient choice in UK National Health Service (NHS), educated and affluent people would be more able to exercise choices at the expense of people who are experienced in asserting preferences and who have the resources to make use of choices. We will argue that the promotion of autonomy needs to be tempered by steps to enable less powerful social, cultural and economic groups to contribute to decision making and to support individuals who may feel abandoned by having decisional responsibility transferred to them. Until constraints on individual choice can be understood and addressed, we advocate the model of optional autonomy used in shared decision making and make recommendations for practice, policy, education and research. (shrink)

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The nonvisual self-touch rubber hand paradigm elicits the compelling illusion that one is touching one’s own hand even though the two hands are not in contact. In four experiments, we investigated spatial limits of distance and alignment on the nonvisual self-touch illusion and the well-known visual rubber hand illusion. Common procedures and common assessment methods were used. Subjective experience of the illusion was assessed by agreement ratings for statements on a questionnaire and time of illusion onset. The nonvisual self-touch illusion (...) was diminished though never abolished by distance and alignment manipulations, whereas the visual rubber hand illusion was more robust against these manipulations. We assessed proprioceptive drift, and implications of a double dissociation between subjective experience of the illusion and proprioceptive drift are discussed. (shrink)

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This study statistically analyzes two-year college students' attitudes toward cheating via a survey containing academic and business situations that the students evaluated on a seven point scale from unethical to ethical. When both the general questions concerning attitudes about cheating and the opinions on the ethical statements are considered, the business students were generally more unethical in their behavior and attitudes than non-business majors. These results indicate a need for more ethical exposure in business courses to help students distinguish ethical (...) from unethical decisions. (shrink)

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Thematically organized around the major concerns of Basil Bernstein's work as a sociologist, this book includes chapters from some of the leading sociologists and educational scholars. Each section attempts to provide a critical evaluation of Bernstein's work, framed within four interrelated contexts: his sociological theory, sociology of language and code theory, sociology of education and social reproduction, and the influence of his sociology on educational research. In a separate section, Bernstein himself responds to the earlier chapters. The book examines Bernstein's (...) sociology of schools in relation to his general sociological theory and in doing so demonstrates that sociology is an essential lens for understanding the structure and processes of schooling. It also provides a critical evaluation of the strengths and weaknesses of Bernstein's work, as well as a correction to current work in education, which eschews theory in favor of practicality. (shrink)

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