Friesen et al. (2023) describe barriers to research in patient populations that have been historically labeled as vulnerable and, as a result, are under-represented in research due to the Instituti...

BackgroundCommentators believe that the ethical decision-making climate is instrumental in enhancing interprofessional collaboration in intensive care units (ICUs). Our aim was twofold: (1) to determine the perception of the ethical climate, levels of moral distress, and intention to leave one's job among nurses and physicians, and between the different ICU types and (2) determine the association between the ethical climate, moral distress, and intention to leave.MethodsWe performed a cross-sectional questionnaire study between May 2021 and August 2021 involving 206 nurses and (...) physicians in a large urban academic hospital. We used the validated Ethical Decision-Making Climate Questionnaire (EDMCQ) and the Measure of Moral Distress for Healthcare Professionals (MMD-HP) tools and asked respondents their intention to leave their jobs. We also made comparisons between the different ICU types. We used Pearson's correlation coefficient to identify statistically significant associations between the Ethical Climate, Moral Distress, and Intention to Leave.ResultsNurses perceived the ethical climate for decision-making as less favorable than physicians (p < 0.05). They also had significantly greater levels of moral distress and higher intention to leave their job rates than physicians. Regarding the ICU types, the Neonatal/pediatric unit had a significantly higher overall ethical climate score than the Medical and Surgical units (3.54 ± 0.66 vs. 3.43 ± 0.81 vs. 3.30 ± 0.69; respectively; both p ≤ 0.05) and also demonstrated lower moral distress scores (both p < 0.05) and lower “intention to leave” scores compared with both the Medical and Surgical units. The ethical climate and moral distress scores were negatively correlated (r = −0.58, p < 0.001); moral distress and "intention to leave" was positively correlated (r = 0.52, p < 0.001); and ethical climate and “intention to leave” were negatively correlated (r = −0.50, p < 0.001).ConclusionsSignificant differences exist in the perception of the ethical climate, levels of moral distress, and intention to leave between nurses and physicians and between the different ICU types. Inspecting the individual factors of the ethical climate and moral distress tools can help hospital leadership target organizational factors that improve interprofessional collaboration, lessening moral distress, decreasing turnover, and improved patient care. (shrink)

The rationing problem—the challenge of squaring finite resources with unlimited demand for services—is common to all health systems. In most low- and middle-income countries, rationing occurs as an ad hoc series of nontransparent choices, reflecting the competing interests of governments, donors, and other stakeholders. Yet in a growing number of countries, more explicit processes are under development; these merit better support. This chapter reflects the findings of a Center for Global Development working group on priority-setting in health. The authors briefly (...) review global and national efforts to strengthen priority-setting and describe a “7 + 7 framework”—seven principles and seven processes—to guide priority-setting, applying that framework to a real-world example from the United Kingdom. The authors consider common obstacles to health technology assessment within low- and middle-income countries and discuss mitigating strategies. The chapter concludes with recommendations for how countries can improve their priority-setting processes and how the global community can best support those efforts. (shrink)

This chapter will summarise the insights gained from our analysis so far, incorporating the examples and case studies presented in Part III. We will examine the advances derived from these models, and their impact on the field of demography and its approach to modelling and simulation. Having taken stock of the state of model-based demography, we will discuss how this methodological paradigm might influence efforts to establish simulation as a powerful tool for the broader social science community.

In this chapter we examine an agent-based model of social care costs in the context of an ageing population. The model brings together statistical demographic modelling with a spatial agent-based model including a rudimentary economic model. Agents undergo the core demographic processes of fertility, mortality, and migration, and as they age they may develop varying levels of social care need. Building on the example presented in the previous chapter, this model increases the complexity of agent behaviours to allow for a (...) more nuanced examination of the drivers of care demand and supply amongst an ageing populace. The results demonstrate that alongside the expected outcomes of social care cost rising as the population ages, the age of retirement has an unexpected impact on cost due to the size of the care burden being shouldered by healthy spouses of ill agents. (shrink)

ABSTRACT The specific form of holocaust humor that I will address—as developed by comedians Larry David, Sarah Silverman, Rachel Bloom, Ilana Glazer, and Abbi Jacobson—is neither trivial nor trivializes the suffering of the Jews but rather can expose the complicity of our narratives about the holocaust with our own white indifference to the pervasive ruthlessness of American genocide against black communities and our failure to bear witness to the survival of certain genocidal logics from the past in the (...) American present. (shrink)

The Dialectic of Essence offers a systematic new account of Plato's metaphysics. Allan Silverman argues that the best way to make sense of the metaphysics as a whole is to examine carefully what Plato says about ousia (essence) from the Meno through the middle period dialogues, the Phaedo and the Republic, and into several late dialogues including the Parmenides, the Sophist, the Philebus, and the Timaeus. This book focuses on three fundamental facets of the metaphysics: the theory of Forms; (...) the nature of particulars; and Plato's understanding of the nature of metaphysical inquiry. Silverman seeks to show how Plato conceives of "Being" as a unique way in which an essence is related to a Form. Conversely, partaking ("having") is the way in which a material particular is related to its properties: Particulars, thus, in an important sense lack essence. Additionally, the author closely analyzes Plato's idea that the relation between Forms and particulars is mediated by form-copies. Even when some late dialogues provide a richer account of particulars, Silverman maintains that particulars are still denied essence. Indeed, with the Timaeus's introduction of the receptacle, there are no particulars of the traditional variety. This book cogently demonstrates that when we understand that Plato's concern with essence lies at the root of his metaphysics, we are better equipped to find our way through the labyrinth of his dialogues and to better appreciate how they form a coherent theory. (shrink)

Background: Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic. Objective: To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency. Research design: A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses (...) caring for Covid-19 patients in the acute care units within large academic medical systems in Maryland and New York City during April to June 2020. Ethical considerations: We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore. Results: We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies. Discussion/Conclusion: Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences. (shrink)

The Threshold of the Visible World advances a revolutionary new political aesthetic--Kaja Silverman explores the possibilities for looking beyond the restrictive mandates of the self, and the normative aspects of the cultural image-repertoire. She provides a detailed account of the social and psychic forces which constrain us to look and identify in normative ways, and the violence which that normativity implies. Accounting for these phenomena on both a conscious and an unconcious level, Silverman analyzes the psychic and textual (...) conditions under which our "field of vision" can be expanded. The title of this book is taken from Lacan's essay on the mirror stage. In that text, Lacan writes that "the mirror-image would seem to be the threshold of the visible world." He thereby suggests that the visible world has no existence as such until the infant subject has access to an image of self. Lacan intimates that the mirror provides the frame through which one relates to others within the domain of vision, stressing the priority of narcissism and the ego over all other libidinal transactions. The Threshold of the Visible World provides a psychic, social and political specification of Lacan's claim, and most particularly of its implications for the subject's relations to the social other. This is accomplished through examination of the ego, as well as two other categories at the center of Lacan's account of the mirror stage: ideality and identification. This book is an ethical-political project which leads to the re-elaboration of a number of crucial theoretical categories--Silverman offers an account of the bodily ego, of identification, of idealization, of the gaze, of the look, and of the "photographic." The Threshold of the Visible World leads as well to the formulation of a fresh model for conceptualizing sexual, racial and class "difference," and the terms under which it might be dismantled. This book thus seeks to apprehend the field of vision through the frame of a different kind of bodily ego, and discover the pleasures to be derived from corporeal transport. (shrink)

The sensorimotor theory of perceptual experience claims that perception is constituted by bodily interaction with the environment, drawing on practical knowledge of the systematic ways that sensory inputs are disposed to change as a result of movement. Despite the theory’s associations with enactivism, it is sometimes claimed that the appeal to ‘knowledge’ means that the theory is committed to giving an essential theoretical role to internal representation, and therefore to a form of orthodox cognitive science. This paper defends the role (...) ascribed to knowledge by the theory, but argues that this knowledge can and should be identified with bodily skill rather than representation. Making the further argument that the notion of ‘representation hunger’ can be replaced with ‘prima facie representation hunger’, it concludes that although the theory could optionally be developed scientifically in part by reference to internal representation, it makes a strong and natural fit with anti-representationalist embodied or enactive cognitive science. (shrink)

BackgroundBiobanks have recently been established in several low- and middle-income countries (LMICs) in the Arab region of the Middle East. We aimed to explore the views of biobank managers regarding the challenges, ethical issues, and governance arrangements of their biobanks.MethodsIn-depth semi-structured qualitative interviews were conducted with a purposive sample of eight biobank managers from Egypt (6), Jordan (1), and Sudan (1). Interviews were performed either face-to-face, by phone, or via Zoom and lasted approximately 45–75 min. After verbal consent, interviews were (...) recorded and then transcribed. The authors performed a thematic analysis of the transcripts independently and then integrated the themes via a consensus process.ResultsBiobank managers discussed the main challenges in establishing their biobanks. These included the staff’s lack of experience and training, limited funds, deficit awareness of biobanks, obtaining funding from different sources. Only four reported they were active in distributing biospecimens and health data to researchers. Six biobanks used a broad consent model, one used tiered consent, and another allowed participants to opt-out of being recontacted. Five managers avoided partnerships with pharmaceutical companies due to concerns with unfavorable reactions from the community. Five managers did not have clear policies for returning research results to the donors. Five expressed challenges with sample and data sharing with international collaborators; all five used material transfer agreements. The biobank managers revealed variable governance arrangements and activities with community involving awareness and educational efforts rather than active engagement. Several expressed the importance of transparency with the operations of their biobanks and gaining the trust of their stakeholders.ConclusionManagers of biobanks in LMICs in the Arab Middle East encounter financial, operational, and social challenges toward their sustainability efforts. Discussions with key stakeholders are warranted to manage ethical issues involving informed consent, privacy, data sharing, and the return of results. We recommend that biobank managers in the Arab Middle East form collaborative networks within the region and internationally, develop trusting governance relationships with their stakeholders, and pursue engagement activities with their communities to enhance trust. (shrink)

Population-based genomics studies have proven successful in identifying genetic variants associated with diseases. High-quality biospecimens linked with informative health data from diverse segments of the population have made such research possible. However, the success of biobank research depends on the willingness of the public to participate in this type of research. We aimed to explore the factors associated with the willingness of the public to participate in biobank research from four low- and middle-income countries in the Arab region (Egypt, Jordan, (...) Morocco, and Sudan). We used a previously validated questionnaire to assess several constructs that included the public’s perceptions, attitudes, and willingness to participate in biobank research. We recruited 967 participants. More than half did not have prior awareness of biobanks. Participants’ willingness to donate biospecimens and health data was less than 10%. Our results also showed that participants harbored concerns with trust, privacy, and with data-sharing involving international researchers. Predictors of willingness to participate in biobank research included no previous involvement in research and positive attitudes toward biobanks. Finally, our study showed several differences between the four countries regarding several of the investigated constructs. We conclude there should be additional efforts to raise public awareness and enhance perceptions of the public in biobanking research to enhance trust. We further recommend qualitative research to explore the underlying factors that contribute to the public’s concerns with international data sharing that would enhance global health. (shrink)

The Prudence of Love focuses upon the intersection of philosophical, theological, and psychological issues related to love. Eric Silverman defends an account of love derived from the views of Thomas Aquinas and argues that love provides numerous psychological and relational benefits that increase the lover's happiness. Furthermore, he argues that love is beneficial according to all major contemporary accounts of happiness.

In a series of three experiments, we explored the nature of implicit representations in change blindness . Using 3 × 3 letter arrays, we asked subjects to locate changes in paired arrays separated by 80 ms ISIs, in which one, two or three letters of a row in the second array changed. In one testing version, a tone followed the second array, signaling a row for partial report . In the other version, no PR was required. After Ss reported whether (...) a change had been detected and the PR had been completed , they were asked to identify a degraded letter trigram that was either novel, or from a previously shown row . Our findings indicate that when CB occurs, both the pre-change and post-change stimulus information primes despite its unavailability to consciousness. Surprisingly, findings also indicate that when change detection occurs only the post-change information primes. (shrink)

Hastings Center Report, Volume 52, Issue 5, Page 32-42, September–October 2022.

Until about thirty years ago, the extent of disclosure about and consent-seeking for medical interventions was influenced by a beneficence model of professional behaviour. Informed consent shifted attention to a duty to respect the autonomy of patients. The new requirement arrived on the American scene in two separate contexts: for daily practice in 1957, and for clinical study in 1966. A confusing double standard has been established. 'Daily consent' is reviewed, if at all, only in retrospect. Doctors are merely exhorted (...) to obtain informed consent; they often minimise uncertainties about 'best' treatment and they feel duty-bound to provide patients with an unequivocal recommendation for action. 'Study consent' in a clinical trial is reviewed prospectively, and doctors are compelled by regulation to point out that there is insufficient evidence to make a rational choice between two compared treatments. It has been impossible to devise informed consent practices that satisfy, in full, the competing moral imperatives of respect for autonomy, concern for beneficence with emphasis on the value of health, and a vigil for justice. A way must be found to experiment with various discretionary approaches that would strike a realistic balance among competing interests. (shrink)

Background Studies have shown that medical students and residents believe that their ethics preparation has been inadequate for handling ethical conflicts. The objective of this study was to determine the self-perceived comfort level of medical students and residents in confronting clinical ethics issues. Methods Clinical medical students and residents at the University of Maryland School of Medicine completed a web-based survey between September 2009 and February 2010. The survey consisted of a demographic section, questions regarding the respondents’ sense of comfort (...) in handling a variety of clinical ethics issues, and a set of knowledge-type questions in ethics. Results Survey respondents included 129 medical students (response rate of 40.7%) and 207 residents (response rate of 52.7%). There were only a few clinical ethics issues with which more than 70% of the respondents felt comfortable in addressing. Only a slight majority (60.8%) felt prepared, in general, to handle clinical situations involving ethics issues, and only 44.1% and 53.2% agreed that medical school and residency training, respectively, helped prepare them to handle such issues. Prior ethics training was not associated with these responses, but there was an association between the level of training (medical students vs residents) and the comfort level with many of the clinical ethics issues. Conclusions Medical educators should include ethics educational methods within the context of real-time exposure to medical ethics dilemmas experienced by physicians-in-training. (shrink)

Spectacular treatment disasters in recent years have made it clear that informal "let's-try-it-and-see" methods of testing new proposals are more risky now than ever before, and have led many to call for a halt to experimentation in clinical medicine. In this easy-tp-read, philosophical guide to human experimentation, William Silverman pleads for wider use of randomized clinical trials, citing many examples that show how careful trials can overturn preconceived or ill-conceived notions of a therapy's effectiveness and lead to a clearer (...) understanding of clinical anomalies. Because it gives careful guidance on setting up trials and avoiding conceptual pitfalls, this book will be of great interest to all epidemiologists and clinical statisticians, and to a wide varitey of clinicians, pharmacologists, and nurses. Since it requires no medical or statistical knowledge, it will also appeal to ethicists, lawyers, and the general public. (shrink)

The purpose of this paper is to re-examine the nature of “meaning” and “meaningfulness” in the context of instrumental music education. By doing so, I propose to expand the ways in which instrumental music educators conceive their mission and the ways in which we may instill meaning in people’s lives. Traditionally, pursuits of philosophical deliberation have claimed that meaningfulness comes from either personal happiness (e.g., Jeremy Bentham and John Stuart Mill) or an impersonal sense of duty (e.g., St. Augustine, St. (...) Thomas Aquinas, and Immanuel Kant). However, philosopher Susan Wolf (2010) criticizes these positions in favor of a broader perspective, one that arises from understanding that there is a third sort of value, namely “meaningfulness.” Rightly understanding meaningfulness may help us engage more fully with a greater sense and understanding of the full potentials of eudaimonia: a life of significance and value for oneself and one’s community. Therefore, this paper links meaningfulness to a 4-E (embodied, embedded, enacted, and extended) account of “sense-making” in/for instrumental music education. In doing so, I discuss the aims of public-school music education; aims that engage teachers and students in meaningfulness—a meaningfulness that is ethical, embodied, enacted, and extended—in, with, and through musics and, more directly, “instrumental” music making. (shrink)

Context Physicians are regularly confronted with research that is funded or presented by industry. Objective To assess whether physicians discount for conflicts of interest when weighing evidence for prescribing a new drug. Design and setting Participants were presented with an abstract from a single clinical trial finding positive results for a fictitious new drug. Physicians were randomly assigned one version of a hypothetical scenario, which varied on conflict of interest: ‘presenter conflict’, ‘researcher conflict’ and ‘no conflict’. Participants 515 randomly selected (...) Fellows in the American College of Obstetricians and Gynecologists' Collaborative Ambulatory Research Network; 253 surveys (49%) were returned. Main object measures The self-reported likelihood that physicians would prescribe the new drug as a first-line therapy. Results Physicians do not significantly discount for conflicts of interest in their self-reported likelihood of prescribing the new drug after reading the single abstract and scenario. However, when asked explicitly to compare conflict and no conflict, 69% report that they would discount for researcher conflict and 57% report that they would discount for presenter conflict. When asked to guess how favourable the results of this study were towards the new drug, compared with the other trials published so far, their perceptions were not significantly influenced by conflict of interest information. Conclusion While physicians believe that they should discount the value of information from conflicted sources, they did not do so in the absence of a direct comparison between two studies. This brings into question the effectiveness of merely disclosing the funding sources of published studies. (shrink)

O’Regan and Noë’s sensorimotor approach rejects the old-fashioned view that perceptual experience in humans depends solely on the activation of internal representations. Reflecting a wealth of empirical work, for example active vision, the approach suggests that perceiving is, instead, a matter of bodily exploration of the outside environment. To this end, the approach says the perceiver must deploy knowledge of sensorimotor contingencies, the ways sense input changes with movement by the perceiver or object perceived. Clark has observed that the approach (...) faces a challenge accounting for the experience of temporal duration, since event-like properties cannot be characterised by reference to the sensory consequences of possible movements. This paper argues that the account can best be shored up by emphasising, more than Noë does, the dependence of perceptual experience, in general, on temporally extended, organismic interaction with the outside environment. The paper argues, moreover, that an ‘extensionalist’ account of temporal experience could help make sense of object experience, which is itself, plausibly, an experience of temporal duration. (shrink)

At 47e–53c of the Timaeus Plato presents his most detailed metaphysical analysis of particulars. We are told about the construction of the physical universe, the ways we can and cannot talk about the phenomena produced, and about the two causes – Necessity and Intelligence – which govern the processes and results of production. It seems to me that we are told too much and too little: too much, because we have two accounts of the generation of phenomenal particulars – one, (...) the ‘formal account’, which makes use of the receptacle, Forms and form-copies, and a second, the ‘geometrical account’, which appeals to geometrical shapes, the Demiurge and, apparently, matter; too little, because there is insufficient guidance as to how to relate the two accounts. (shrink)

On the face of it, Plato's treatment of aisthesis is decidedly ambiguous. Sometimes he treats aisthesis as a faculty which, though distinct from all rational capacities, is nonetheless capable of forming judgments such as ‘This stick is bent’ or ‘The same thing is hard and soft’. In the Theaetetus, however, he appears to separate aisthesis from judgment, isolating the former from all prepositional, identificatory and recognitional capacities. The dilemma is easily expressed: Is perception a judgmental or cognitive capacity, or is (...) it a non-judgmental, non-cognitive capacity? If the former, how does perception differ from belief? If the latter, is perception a faculty of the rational or irrational soul? Not surprisingly, the topic has received much scrutiny over the years. And equally unsurprisingly, the debate has turned as much on what it means for a capacity to be judgmental, cognitive, non-judgmental or non-cognitive, as on whether Plato says that it is of either kind. (shrink)

I argue that we should rethink the nature and scope of Spinoza’s “one and the same” relation. Contrary to the standard reading, the nature of this relation is not identity but a union, and its scope includes all idea-object pairs, even God and the idea of God. A crucial reason we should adopt this dual picture is that the idea of God must be one and the same as something found when Nature is conceived under each of the other attributes. (...) If “one and the same” is interpreted as a relation of identity, this requirement cannot be met. However, maintaining that God and the idea of God are one and the same not only fulfills this requirement, but also is independently motivated. I also briefly consider how the thesis that God and the idea of God are one and the same affords us with positive insights concerning the nature of this relation. (shrink)

Through a wide-ranging discussion, that extends from Ovid and Leonardo da Vinci to Gerhard Richter, and from philosophy and literature to time-based art, Kaja ...

Upshot: Paul Silverman is Professor in the Psychology Department of the University of Montana. He completed his doctorate at the University of Georgia in 1977 with Ernst von Glasersfeld as mentor. His essay focuses on his personal encounters with him during that period.

The ASBH Core Competencies Update Task Force (Tarzian and ASBH Core Competencies Update Task Force 2013) provides useful information for individual consultants performing case consultations. A grow...

In _Philosophy and Non-Philosophy since Merleau-Ponty,_ editor Hugh J. Silverman has collected essays from the leading scholars in Continental philosophy, creating a forum for the discussion of contemporary writings and differing perspectives on the role of philosophy since the death of Merleau-Ponty: Sartre, Barthes, Heidegger, Lacan, Levinas, Deleuze, Foucault, Lyotard, Habermas, and Derrida. Included in this volume is Silverman's translation of Merleau-Ponty's last course at the Collège de France in 1960-61 and an extensive research bibliography. Originally published in (...) 1988, _Philosophy and Non-Philosophy since Merleau-Ponty_ is a fascinating inquiry into the developments, directions, and ruptures in Continental philosophy since Merleau-Ponty's death in 1961. (shrink)

A new preface by the author updates this classic text.

Through qualitative surveys, a team of law students, law professors, physicians, and residents explored the perceptions of neurology residents towards referral to appropriate legal resources in an academic training program. Respondents reported feeling uncomfortable screening their patients for health-harming legal needs, which many attributed to a lack of training in this area. These findings indicate that neurology residents would benefit from training on screening for social factors that may be impacting their patients’ health.

The Dialectic of Essence offers a systematic new account of Plato's metaphysics. Allan Silverman argues that the best way to make sense of the metaphysics as a whole is to examine carefully what Plato says about ousia (essence) from the Meno through the middle period dialogues, the Phaedo and the Republic, and into several late dialogues including the Parmenides, the Sophist, the Philebus, and the Timaeus. This book focuses on three fundamental facets of the metaphysics: the theory of Forms; (...) the nature of particulars; and Plato's understanding of the nature of metaphysical inquiry.Silverman seeks to show how Plato conceives of "Being" as a unique way in which an essence is related to a Form. Conversely, partaking ("having") is the way in which a material particular is related to its properties: Particulars, thus, in an important sense lack essence. Additionally, the author closely analyzes Plato's idea that the relation between Forms and particulars is mediated by form-copies. Even when some late dialogues provide a richer account of particulars, Silverman maintains that particulars are still denied essence. Indeed, with the Timaeus's introduction of the receptacle, there are no particulars of the traditional variety. This book cogently demonstrates that when we understand that Plato's concern with essence lies at the root of his metaphysics, we are better equipped to find our way through the labyrinth of his dialogues and to better appreciate how they form a coherent theory. (shrink)

In philosophy of religion, there are few more frequently visited topics than the problem of evil, which has attracted considerable interest since the time of Epicurus. It is well known that the problem of evil involves responding to the apparent tension between 1) belief in the existence of a good, all powerful, all knowing God and 2) the existence of evil—such as personal suffering embodied in the experience of cancer. While a great deal has been written concerning abstract philosophical theories (...) that academics use to explain the existence of evil, much less has been written about how religious lay people make sense of evil and suffering. What explanations, meanings, and perceptions do they hold concerning the religious significance of evil? What can theologians and philosophers learn from these lay experiences? Our interdisciplinary team designed an experiment to identify the religious significance that personal suffering held for a group of religious cancer sufferers. We interviewed twenty-nine self-identified evangelical Christians who had received a cancer diagnosis at some point in their lives for our experiment. Since all interviewees identified as Christians, it was expected that they would assent to belief in a theistic God. It was also expected that each interviewee would assent the existence of evil and see their cancer experience as a dramatic and personal instance of an evil event. The explicit existential threat of cancer guarantees that the individual has much at stake in the experience. Furthermore, the pain and suffering that typically accompanies either the cancer itself or cancer treatments make it a compelling example of evil experienced in a very personal way. Finally, even when successfully treated, the ongoing threat of potentially fatal recurrence looms over the sufferer for years to come. We asked 17 questions related to the religious significance of their cancer experience in each interview and coded these interviews looking for five distinct types of explanations for/meaning of evil: trusting God in mystery, free will, moral development, spiritual growth, and growth in human relationships/community. These categories were meant to correspond loosely to five philosophical responses to the existence of evil.Our interviews included several important results. First, 79% of interviewees had at least one answer that fit into the ‘trust God in mystery’ category of responses with 48% using this category of responses as their most frequently cited theme. This result could be interpreted as a kind of generic theodical response: God has a good, but unknown reason for allowing evil/suffering. Alternatively, another possible interpretation is that at least some of these interviewees intuited something similar to skeptical theism, since it claims that if one understands the type of God proposed by theism and possesses an accurate view of human cognitive capacities, it is apparent that there is no real tension to be resolved between theism and the existence of evil. Some of our interviewees seemed to believe not only that the answer to why evil exists is mysterious, but that they simply could not have the necessary perspective to judge what kinds of purposes God might have for allowing this painful episode in their lives.While it was unsurprising that religious sufferers would find it important to trust God in ambiguous difficult circumstances, more surprisingly, we found that 52% of our respondents did not judge that their cancer experience was at all in tension with their religious beliefs. Whereas a broad range of philosophers and theologians acknowledge that there is at least an apparent conflict between the existence of a good, all-powerful God and the existence of evil, most of our interviewees did not even perceive an apparent tension between theistic beliefs and their painful cancer experiences that would be in need of additional reconciliation.There are at least two ways this result might be interpreted. First, our interviewees might hold additional beliefs that make the existence of evil easier for them to accept. After all, these interviewees were not ‘bare theists’ who held only to the existence of God, but presumably held a broad range of religious beliefs which may already serve to reconcile the existence of evil: that growing closer to God is more important than earthly life itself, that in evil in this life allows us a greater appreciation of a blessed eternity, or simply that ‘God works for our good in mysterious ways.’ Thus, a fully developed Christian worldview may already accommodate the existence of evil in a way not fully appreciated by philosophers.Another possible interpretation is that at least some of our interviewees were not adequately reflective to perceive the tension between their religious beliefs and their experience of suffering. There is at least some reason to doubt this explanation as an overarching interpretation of this result since our interviewees were generally well educated with the median participant holding at least a Bachelor’s degree, and most were ongoing participants in a cancer support group ensuring long-term ongoing engagement with their cancer experience.A final significant finding is that a high portion of our interviewees, 83% reported specific examples of beneficial personal growth—moral, spiritual, or relational— that resulted from their cancer experience. When asked about their cancer experience’s broad effect upon their lives in these areas they volunteered at least one example of a benefit they received in these areas. Depending on one’s accompanying value theory and whether such benefits might have been otherwise achieved, they might provide a morally sufficient reason for the existence of suffering. Our interviewees frequently described experiencing the kind of benefits at the heart of John Hick’s soul making theodicy and Eleonore Stump’s ‘spiritual growth’ theodicy, providing at least some corroborating evidence for such views. Experiences common to our interviewees were similar to what such theodicies would predict. (shrink)