Merrill, Booker and Fivush examine the social functions associated with transmitting intergenerational narratives to adolescents and emerging adults and how these family stories affect identity formation in early adulthood. Merrill et al. observed that the intergenerational stories of parents’ transgression and proud moments told by adolescents and emerging adults operate as a way to transmit life lessons, strengthen relationships with the parent and give insights into their parents and their self.

Barbara Jordan (1936–1996), a formidable politician, won election to the Texas Senate (1966) and to the US Congress (1972). She became one of the most celebrated African‐American politicians of the twentieth century, acclaimed both by white and black. Jordan was a voluntarist, viewing individuals as able to change the world through their own actions. She was committed to the American dream of inclusion, and also to the importance of positive ties to elites; to coping with the ‘world as (...) it is’, to the futility of confrontation, and also to changing and influencing the attitudes of men at the top. Jordan opposed civil disobedience, nonviolent or not. Yet she admired symbols of defiance like Malcolm X and Mohammed Ali. A highly public figure, she was also exceptionally self‐repressed. Critics likened her to the conservative Booker Washington, yet she was a staunch defender of voting rights and a radical integrationist. (shrink)

The shift towards "empirical bioethics" was largely triggered by a recognition that stakeholders' views and experiences are vital in ethical analysis where one hopes to produce practicable recommendations. Such perspectives can provide a rich resource in bioethics scholarship, perhaps challenging the researcher's perspective. However, overreliance on a picture painted by a group of research participants—or on pre‐existing literature in that field—can lead to a biased view of a given context, as the subjectivity of data generated in these ways cannot (and (...) should not wholly) be escaped. In response, we propose the implementation of a complementary approach of ethno‐immersion in bioethics research. By positioning oneself in the context being researched, the researcher can better understand the realities of that context. The researcher's understanding will, naturally, be subjective too. However, it will act as a better developed and more informed outsider view, when considering the picture painted by participants and previous studies, thus enabling the researcher to introduce more nuance when analysing data. We introduce this approach after examining what we call the context detachment problem, whereby some bioethics scholarship—empirical or otherwise—fails to reflect the reality of the healthcare setting it concerns. Our proposed ethno‐immersion (which differs from formal ethnography) is then explored as a response, highlighting its benefits, and answering the question of timing within a research project. Finally, we reflect on the applicability of our proposal to non‐empirical bioethics scholarship, concluding that it remains important but may require some adjustments. (shrink)

Bioethics, Volume 36, Issue 4, Page 423-433, May 2022.

The COVID-19 pandemic is putting the NHS under unprecedented pressure, requiring clinicians to make uncomfortable decisions they would not ordinarily face. These decisions revolve primarily around intensive care and whether a patient should undergo invasive ventilation. Certain vulnerable populations have featured in the media as falling victim to an increasingly utilitarian response to the pandemic—primarily those of advanced years or with serious existing health conditions. Another vulnerable population potentially at risk is those who lack the capacity to make their own (...) care decisions. Owing to the pandemic, there are increased practical and normative challenges to following the requirements of the Mental Capacity Act 2005. Both capacity assessments and best interests decisions may prove more difficult in the current situation. This may create a more paternalistic situation in decisions about the care of the cognitively impaired which is at risk of taking on a utilitarian focus. We look to these issues and consider whether there is a risk of patients who lack capacity to make their own care decisions being short-changed. (shrink)

Access to abortion care has been hugely affected by the COVID-19 pandemic. This has prompted several governments to permit the use of telemedicine for fully remote care pathways, thereby ensuring pregnant people are still able to access services. One such government is that of England, where these new care pathways have been publicly scrutinised. Those opposed to telemedical early medical abortion care have raised myriad concerns, though they largely centre on matters of patient safeguarding. It is argued that healthcare professionals (...) cannot adequately carry out their safeguarding duties if the patient is not in the room with them. These concerns lack empirical support. Emerging evidence suggests that safeguarding processes may, in fact, be more effective within telemedical abortion care pathways. In this article, we address two specific safeguarding concerns: (1) that a remote consultation prevents a healthcare professional from identifying instances of abuse, and (2) that healthcare professionals cannot reliably confirm the absence of coercion during a remote consultation. We demonstrate that such concerns are misplaced, and that safeguarding may actually be improved in telemedical care pathways as victims of abuse may find it easier to engage with services. It is inevitable that some individuals will fall through the net, but this is unavoidable even with in-person care and thus does not constitute a strong critique of the use of telemedicine in abortion care. These safeguarding concerns set aside, then, we argue that the current approval that enables telemedical early medical abortion should be afforded permanence. (shrink)

Technology presents a means of improving health outcomes for vast numbers of individuals. It has historically been deployed to streamline healthcare delivery and reach those who would previously have faced obstacles to accessing services. It has also enabled improved health education and management. Telemedicine can be employed in everything from primary care consultations to the monitoring of chronic diseases. Despite recommendation by the World Health Organization, countries have been slow to embrace such technology in the health sector. Nonetheless, it is (...) expected to become more prevalent with increased digitization. Further, amidst the COVID‐19 pandemic, there was a rush to implement forms of telemedicine where possible to prevent patients breaking social distancing rules. In this paper, I present and defend what I term the ‘telemedical imperative’. The telemedical imperative represents a duty for healthcare systems to implement remote access to services where possible, thereby furthering the mission of equity in access to healthcare. It is intended as an addition to in‐person services rather than a replacement. After highlighting the benefits of telemedicine, I provide four criteria that must be met for the telemedical imperative to arise. The first three—safety, effectiveness, and acceptability—are consistent and essential. The fourth adapts to the service in question and requires that there be no other obstacles specific to that service that cannot reasonably be overcome. Finally, I address several potential objections to the telemedical imperative based on more general concerns around the implementation of telemedicine. (shrink)

The thesis that humanity progresses in a lawlike manner from inferior states (of wellbeing, cognitive skills, culture, etc.) to superior ones dominated eighteenth- and nineteenth- century thought, including authors otherwise as diverse as Kant and Ernst Haeckel. Positioning himself against this philosophically and scientifically popular view, Nietzsche suggests that humanity is in a prolonged state of decline. I argue that Nietzsche’s rejection of the thesis that progress is inevitable is a product of his acceptance of Lamarck’s use-and-disuse theory of evolution (...) and his belief that society selects for traits beneficial to society and negatively selects for traits that promote individual flourishing. This explains Nietzsche’s emphasis on self-development as cultivating traits that Nietzsche views as valuable and that would, by Lamarck’s theory of evolution, become heritable and so help steer our evolutionary trajectory, correcting our decline. (shrink)

In Great Britain, abortion has long proven to be contentious in the context of policy making, with it remaining a criminal offence. Despite progress over the last decade to permit home use of abortion medications and remote consultation, we have seen prosecutions in recent years. Regulatory frameworks such as this have been framed as ‘abortion exceptionalism’, such that termination of pregnancy is far more tightly regulated than comparable healthcare. One example of this exceptionalism is the strict abortion reporting requirements found (...) in Great Britain. Per these requirements, any doctor providing abortion care must notify the relevant Chief Medical Officer or Public Health Scotland of each and every termination, including a startling amount of information about the patient. The extent of these requirements raises serious questions in relation to patient confidentiality and is, I suggest, an outlier in these terms. Further, it is questionable whether such reporting can be in any way said to be in the public interest. I begin by outlining the Abortion Regulations 1991, which apply in England and Wales, before considering the updated Scottish approach brought about by the Abortion (Scotland) Amendment Regulations 2021. I then move to examine the abortion reporting requirements against our general conception of patient confidentiality, highlighting the discordance. I ultimately argue that the requirements are not adequately justified and represent yet another, often forgotten, example of abortion exceptionalism in Great Britain. Thus, I suggest that all three nations that comprise Great Britain ought to further revise their approach to abortion data. (shrink)

Direct-to-consumer genetic testing is a growing phenomenon, fuelled by the notion that knowledge equals control. One ethical question that arises concerns the proband’s duty to share information indicating genetic risks in their relatives. However, such duties are unenforceable and may result in the realisation of anticipated harm to relatives. We argue for a shift in responsibility from proband to provider, placing a duty on test providers in the event of identified actionable risks to relatives. Starting from Parker and Lucassen’s 'joint (...) account model', we adapt Kilbride’s application of the rule of rescue and balance it against the relative’s right not to know, placing responsibility on the providers of direct-to-consumer genetic testing. Where the risk of disease to a relative is actionable, we argue providers ought to share results even in the face of the proband’s objections. Confidentiality issues are navigated by a pre-emptive consent model, whereby consumers agree to the sharing of certain information with their relatives ahead of testing and as a condition of testing. When a relative is informed, the proband’s privacy is protected by maximal deidentification, and the rights of the relative are met by a stepwise approach to informing that allows them to decide how much information they receive. (shrink)

All four UK nations have, in recent years, introduced “opt out” organ donation systems. Whilst these systems are largely similar, they operate independently. A key feature of each policy is a residency requirement, stipulating that opt out may only apply where the deceased had been ordinarily resident in that nation for at least 12 months. A resident of Scotland who dies in England, for example, would not fall under opt out. Public awareness is the underlying reasoning for such stipulations. A (...) residency requirement was appropriate when Wales was the only UK nation with an opt out system, but, I suggest, the continued imposition of intra-UK borders on organ donation is unjustified now that all four nations operate the same policy. Further, it has the potential to limit organ donation. There is a need for all four systems to be amended to allow for UK-wide applicability, such that providing the deceased was ordinarily resident in the UK, they can fall under opt out in any of the four nations. I argue that such an amendment is ethically justified – continuing to satisfy the public awareness criterion – and practically straightforward. In doing so, I emphasise that my proposed amendment should extend only to the four UK nations, stopping short of the Crown Dependencies even though they also operate opt out systems for organ donation. (shrink)

The freedom to choose for oneself is a part of what it means to be a human being.Jackson J In England and Wales, the Mental Capacity Act 20...

Volume 20, Issue 7, July 2020, Page 199-201.

Joint attention (JA) is hypothesized to have a close relationship with developing theory of mind (ToM) capabilities. We tested the co-occurrence of ToM and JA in social interactions between adults with no reported history of psychiatric illness or neurodevelopmental disorders. Participants engaged in an experimental task that encouraged nonverbal communication, including JA, and also ToM activity. We adapted an in-lab variant of experience sampling methods (Bryant, Coffey, Povinelli, & Pruett, 2013) to measure ToM during JA based on participants’ subjective reports (...) of their thoughts while performing the task. This experiment successfully elicited instances of JA in 17/20 dyads. We compared participants’ thought contents during episodes of JA and non-JA. Our results suggest that, in adults, JA and ToM may occur independently. (shrink)

Histories of psychiatry in the United States can shed light on current areas of need in mental health research and treatment. Often, however, these histories fail to represent accurately the distinct trajectories of psychiatric care among black and white populations, not only homogenizing the historical narrative but failing to account for current disparities in mental health care among these populations. The current paper explores two parallel histories of psychiatry in the United States and the way that these have come to (...) influence current mental health practices. Juxtaposing the development of psychiatric care and understanding as it was provided for, and applied to, black and white populations, a picture of the theoretic foundations of mental health emerges, revealing the separate history that led to the current uneven state of psychiatric care. (shrink)

The last decade has seen significant developments in UK health policy, with are largely claimed to be evidence based. However, such a characterisation ought, in many cases, to be questioned. Policies can be broadly understood as based primarily on either a logical or empirical case. In the absence of relevant empirical evidence, policymakers understandably appeal to logical cases. Once such evidence is available, however, it can inform policy and enable the logical case to be set aside. Such a linear policy (...) process is not always the reality, and logical cases often continue to guide policy decisions in direct opposition to empirical evidence. In this paper, I discuss two recent examples of this disconnect between logical and empirical cases in UK health policy. The first—organ donation—illustrates an example of a significant policy change being made in opposition to the evidence. I refer to this as the improvidence approach. The second—abortion—provides an example of policymakers not making a change that has extensive supporting data. I refer to this using the more recognisable language of the precautionary approach. Ultimately, I argue that both the improvidence and precautionary approaches are examples of problematic public policy where policymakers provide no explicit justification for going against the evidence. (shrink)

Wakefield’s harmful dysfunction analysis asserts that the concept of medical disorder includes a naturalistic component of dysfunction and a value component, both of which are required for disorder attributions. Muckler and Taylor, defending a purely naturalist, value-free understanding of disorder, argue that harm is not necessary for disorder. They provide three examples of dysfunctions that, they claim, are considered disorders but are entirely harmless: mild mononucleosis, cowpox that prevents smallpox, and minor perceptual deficits. They also reject the proposal that dysfunctions (...) need only be typically harmful to qualify as disorders. We argue that the proposed counterexamples are, in fact, considered harmful; thus, they fail to disconfirm the harm requirement: incapacity for exertion is inherently harmful, whether or not exertion occurs, cowpox is directly harmful irrespective of indirect benefits, and colorblindness and anosmia are considered harmful by those who consider them disorders. We also defend the typicality qualifier as viably addressing some apparently harmless disorders and argue that a dysfunction’s harmfulness is best understood in dispositional terms. (shrink)

In ‘Rethinking Disease’, Powell and Scarffe1 propose what in effect is a modification of Jerome Wakefield’s2 3 harmful dysfunction analysis (HDA) of medical (including mental) disorder. The HDA maintains that ‘disorder’ (or ‘disease’ in Powell and Scarffe’s terminology) is a hybrid factual and value concept requiring that a biological dysfunction, understood as a failure of some feature to perform a naturally selected function, causes harm to the individual as evaluated by social values. Powell and Scarffe accept both the HDA’s evolutionary (...) biological function component and its incorporation of a value component. Their proposed ‘new twist’ is to revise the value component: ‘Our proposed definition of disease is as follows: a biomedical state is a disease only if it implicates a biological dysfunction that is, or would be, properly disvalued’. So, they propose that a disorder is a ‘properly disvalued dysfunction’ rather than a ‘harmful dysfunction’, an approach they term ‘thickly normative’ in contrast to the thin normative approach of the HDA. There has been a surge of interest recently in better understanding the ‘harm’ component of the HDA. Powell and Scarffe’s analysis is a helpful contribution to this discussion. We focus here exclusively on their proposal regarding the analysis of the concept of disorder and ignore many important related issues that the authors address, ranging from prioritising resource allocation between disorders and non-disorders to whether the concept of disorder should be replaced by a generic welfarist concept. The resolution of these additional issues depends on first understanding ‘disorder’. The authors’ proposed changes to the HDA also deserve evaluation because the HDA, which has been endorsed by leading nosologists,4 plays an influential role in nosological debate across categories of disorder ranging, for example, from sexual paraphilias5 to psychopathy.6 A basic problem is that Powell and Scarffe misinterpret …. (shrink)

BackgroundChronic kidney disease is a significant cause of global deaths. Those who progress to end-stage kidney disease often commence dialysis as a life-extending treatment. For cognitively impaired patients, the decision as to whether they commence dialysis will fall to someone else. This scoping review was conducted to map existing literature pertaining to how decisions about dialysis are and should be made with, for, and on behalf of adult patients who lack decision-making capacity. In doing so, it forms the basis of (...) a larger body of work that is exploring how these decisions ought to be made.MethodsTo identify relevant papers, searches were conducted on Ovid MEDLINE(R), Embase, PsychINFO, The Cochrane Library, and Web of Science. Inclusion criteria were then applied, requiring that papers: report on empirical studies about how decisions about dialysis are made and/or discuss how decisions about dialysis should be made with, for, and on behalf of adult patients who lack decision-making capacity; be published from 1961 onwards; and be published in English. This resulted in 27 papers eligible for inclusion.ResultsOf note, the majority of papers originated in the United States. There was wide variation across the included papers. Extracted data were grouped under the following themes: involving various parties (patient involvement, family dominance, and wider communication); objectivity about care options (including difficulties with family detachment); cultural sensitivity; medical versus non-medical factors; managing nonadherent patients; and the role and prevalence of substituted judgement. The literature shows that there is inconsistency in the principles and processes surrounding decisions made about dialysis with, for, and on behalf of adult patients who lack decision-making capacity.ConclusionsThis scoping review demonstrates that there is significant variation in both the practice and theory of dialysis decision making with, for, and on behalf of cognitively impaired adult patients. Complexity arises in considering who should get a say, how influential their say should be in a decision, and what factors are most relevant to the decision. A lack of up-to-date literature exploring this issue is highlighted, with this scoping review providing a useful groundwork from which further research can be undertaken. (shrink)

There is a global mental health crisis. Although several barriers to mental health treatments exist, one that almost certainly contributes to this problem is the insufficient number of mental health professionals available to meet the demand. To combat this, several companies have set to work creating digital mental health interventions (DMHI) that may relieve the pressure on the already overburdened mental health professional population. Although its promise to reach patients otherwise unable to receive treatment represents a revolution in mental health (...) care, several ethical concerns accompany DMHI that are sometimes obscured by their great promise. This article explores eleven ethical challenges to DMHI that arise across the “lifecycle” of DMHI’s development, deployment, and regulation, seeking to foreground how these technologies might influence the practice of psychotherapy. (shrink)

Uterus transplantation (UTx) is highly anticipated for the benefits that it might bring to individuals wanting to carry a pregnancy in order to reproduce who do not have a functioning uterus. The surgery—now having been performed successfully in several countries around the world—remains experimental. However, UTx is at some point expected to become a routine treatment for people without a uterus and considering themselves in need of one: women with absolute uterine factor infertility; transgender women; and even cisgender men who (...) wish to gestate. Given the unique benefits UTx offers, uteri are likely to be ‘in demand’, and such demand, we suggest, will feasibly outstrip supply. Therefore, allocation of those uteri available for transplant may become a pressing issue. In this paper, we consider one aspect of organ allocation—the preferences of donors in making a directed or conditional donation of their uterus. To what extent, in the context of uterus donation, would such donations be ethically permissible? (shrink)

The discipline of psychology has been under-represented in the critical realist account of the relationship between structure and agency. In this paper a critical realist perspective of educational...

Abstractabstract:Paolo Bacigalupi’s The Windup Girl (2009) is set in twenty-third-century Thailand, in a world in which climate change and the depletion of the oil supply have led to a collapse of the global economic system. Disease and famine are rampant. And yet, in this seemingly postapocalyptic world, there are numerous signs of hope. This text, in fact, contains strong utopian energies, driven partly by the motif of genetic engineering, which suggest the possibility of rebuilding the world in a way that (...) overcomes many of the limitations of the past in terms of the politics of race, gender, and class, but also in terms of more enlightened attitudes toward the relationship between humans and the natural world. (shrink)

ὃσον κατ’ ⋯ρχ⋯ς το⋯ πολ⋯μου οἱ μ⋯ν ⋯νιαυτ⋯ν, οἱ δ⋯ δ⋯ο,οἱ δ⋯ τρι⋯ν γε ⋯τ⋯ν οὐδε⋯ς πλε⋯ω χρ⋯μιζον περο⋯σειν αὐτοὺς, εἰ οἱ Πελοπονν⋯σιοι ⋯σβ⋯λοιεν ⋯ς τ⋯ν χώραν.

Medical assistance in dying (MAiD) and palliative sedation (PS) are both legal options in Canada that may be considered by patients experiencing intolerable and unmanageable suffering. A contentious, lively debate has been ongoing in the literature regarding the similarities and differences between MAiD and PS. The aim of this paper is to explore the propositions that MAiD and PS are essentially similar and conversely that MAiD and PS are distinctly different. The relevance of such a debate is apparent for clinicians (...) and patients alike. Understanding the complex and multi‐faceted nuances between PS and MAiD allows patients and caregivers to make more informed decisions pertaining to end‐of‐life care. It is hoped that this paper will also serve to foster further debate and consideration of the issues associated with PS and MAiD with a view to improve patient care and the quality of both living and dying in Canada. (shrink)

As a classical liberal, or libertarian, I am concerned to advance liberty and minimize coercion. Indeed on this view liberty just is the absence of coercion or costs imposed on others. In order to better understand the notion of coercion I discuss Robert Nozick's classic essay on the subject as well as more recent contributions. I then address the question of whether law is coercive, and respond to Edmundson and others who think that it isn't. Assuming that the law is (...) in fact coercive, there is still a question,as with all coercive acts, as to whether that coercion is justified. Edmundson thinks that this places a special burden on the state of justifying its existence, whereas it simply places the same burden on the state as anyone else. What I reject is the longstanding doctrine of Staatsrason, namely that the state is not subject to the same moral rules as its subjects. With respect to the relation of morality to law, Edmundson thought that another of the fallacies of which philosophical anarchists were guilty was that of assuming that there was a sphere of morality where law had no business. On the contrary, our concern is with spheres of law which appear to have little to do with morality, which is to say laws against wrongs of the malum prohibitum variety, as opposed to wrongs which are malum in se. I then turn to a matter with which Edmundson begins his study, namely how it is that states acquire the authority to do what they do, namely coerce their subjects. While the fact that the philosopher's stone of political obligation has proved rather elusive may mean that a legitimate state lacks the authority to demand obedience pure and simple, Edmundson contends that it can at the very least demand that we do not interfere in the administration of justice. I argue that this attempt to sidestep the justification of the authority of the state fails and that we seem in the end to be having to take the state's word for it that we must do X on pain of penalty P. Nor, as I go on to argue, is it any help to appeal to democracy to remedy a failed justification of the authority of the state. There either is a moral justification of state coercion in order to prevent harm to innocent subjects, or there isn't, and this holds,if it does, not only at the level of individuals, but also at the level of the state, regardless of its constitutional form. After concluding that the attempts of Edmundson and others to refute the anarchic turn in recent political philosophy have failed, it would seem that the withering away of the state foreseen in Marx's eschatology is not as improbable as maybe it once appeared. (shrink)

This book is a collection of essays exploring adaptive systems from many perspectives, ranging from computational applications to models of adaptation in living and social systems. The essays on computation discuss history, theory, applications, and possible threats of adaptive and evolving computations systems. The modeling chapters cover topics such as evolution in microbial populations, the evolution of cooperation, and how ideas about evolution relate to economics. The title Perspectives on Adaptation in Natural and Artificial Systems honors John Holland, whose 1975 (...) Book, Adaptation in Natural and Artificial Systems has become a classic text for many disciplines in which adaptation play a central role. The essays brought together here were originally written to honor John Holland, and span most of the different areas touched by his wide-ranging and influential research career. The authors include some of the most prominent scientists in the fields of artificial intelligence evolutionary computation, and complex adaptive systems. Taken together, these essays present a broad modern picture of current research on adaptation as it relates to computers, living systems, society, and their complex interactions. (shrink)

An earlier version of this paper was presented at the 2011 IEEE International Symposium on Technology and Society at Saint Xavier University in Chicago, Illinois. This paper examines factors in college student confidence in using electronic books as learning tools between 2007 and 2009. The study was done in response to the growing concern over the cost of textbooks and the increase in the use of e-textbooks to counteract that cost. This study shows that despite a lack of a gap (...) between comfort of use of computers, students whose parents income is above the national median income are more confident in learning from electronic books than students whose parents income is not. Not only is this gap existent but it widened between 2007 and 2009 despite the growing confidence in the use of electronic books by both groups. The results of this study suggests that this gap, and its concomitant widening, could be associated with exposure to computer classes in high school and the choice of major. (shrink)

Cases of sexual harassment have become increasingly common in the courts, but there is at present no coherent definition of just what sexual harassment is supposed to consist. The Equal Employment Opportunity Commission guidelines ultimately focus on issues of subjective victimization, a standard which is overly broad and prescriptively empty. In order to salvage the concept of sexual harassment, it is argued here that the element of unwelcomeness must be removed from it. Instead of considering welcomeness, it is argued that (...) sexual harassment can be given proscriptive clarity if it is delineated as gender harassment, coercive sexual harassment, and presumptive sexual harassment. (shrink)

The televised Charlie Brown Christmas tale and its bawdy Peanuts characters taught me important lessons while growing up as the awkwardly drawn, “blockhead” sibling. This essay explores the down and dirty deities that reside in each of us, including Brown and Pig Pen, at once seen as contemporary symbols of the globally inter challenged-being and surprising instruments of sacred expression. Ruminations on the Bhagavad Gita, Immanuel Kant, Jessye Norman, bell hooks, and Thich Nhat Hahn encourage us to reimagine contexts for (...) power and authority, racial mistrust and injustice, and restoring our slumping spirits. (shrink)