Psychiatric disorders present distinct clinical challenges which are partly attributable to their multifactorial aetiology and the absence of laboratory tests that can be used to confirm diagnosis or predict risk. Psychiatric disorders are highly heritable, but also polygenic, with genetic risk conferred by interactions between thousands of variants of small effect that can be summarized in a polygenic risk score. We discuss four areas in which the use of polygenic risk scores in psychiatric research and clinical contexts could have ethical (...) implications. First, there is concern that clinical use of polygenic risk scores may exacerbate existing health inequities. Second, research findings regarding polygenic risk could be misinterpreted in stigmatising or discriminatory ways. Third, there are concerns associated with testing minors as well as eugenics concerns elicited by prenatal polygenic risk testing. Fourth, potential challenges that could arise with the feedback and interpretation of high polygenic risk for a psychiatric disorder would require consideration. While there would be extensive overlap with the challenges of feeding back genetic findings in general, the potential clinical use of polygenic risk scoring warrants discussion in its own right, given the recency of this possibility. To this end, we discuss how lay interpretations of risk and genetic information could intersect. Consideration of these factors would be necessary for ensuring effective and constructive communication and interpretation of polygenic risk information which, in turn, could have implications for the uptake of any therapeutic recommendations. Recent advances in polygenic risk scoring have major implications for its clinical potential, however, care should be taken to ensure that communication of polygenic risk does not feed into problematic assumptions regarding mental disorders or support reductive interpretations. (shrink)

The transmission of cholera, a highly infectious disease, is closely linked to inadequate access to clean water and sanitation facilities, with resource-poor communities, including refugees, rural communities and temporary displacement camps particularly vulnerable to outbreaks. Any disruption in water and sanitation systems or a sudden surge in community size owing to displacement can spark a humanitarian and health crisis, elevating the risk of cholera transmission and possibly triggering a regional epidemic. Recently, Hammanskraal in Gauteng, South Africa, experienced such an epidemic. (...) A multifaceted approach is essential to minimise fatalities and effectively manage healthcare services in such health emergencies. This approach includes early detection, rapid response to contain outbreaks, and the effective deployment of technical support, advocacy, resource mobilisation and partnerships at local, national, and international levels. This paper explores the responsibilities of individuals, healthcare workers, communities and governments in addressing epidemics. It also delves into the concept of collective responsibility with regard to climate change and cholera, as part of the multifaceted approach for cholera prevention and control. While economic development, equal access to safe drinking water, and adequate sanitation are necessary for cholera control, major challenges persist in achieving the fundamental right to a healthy environment in the long term. We also discuss these obstacles and conclude with practical suggestions and recommendations for future cholera prevention. (shrink)

Psychiatric genetic research investigates the genetic basis of psychiatric disorders with the aim of more effectively understanding, treating, or, ultimately, preventing such disorders. Given the challenges of recruiting research participants into such studies, the potential for long‐term benefits of such research, and seemingly minimal risk, a strong claim could be made that all non‐acute psychiatric inpatients, including forensic and involuntary patients, should be included in such research, provided they have capacity to consent. There are tensions, however, regarding the ethics of (...) recruiting psychiatric inpatients into such studies. In this paper our intention is to elucidate the source of these tensions from the perspective of research ethics committee interests and decision‐making. We begin by defining inpatient status and outline some of the assumptions surrounding the structures of inpatient care. We then introduce contemporary conceptions of vulnerability, including Florencia Luna’s account of vulnerability which we use as a framework for our analysis. While psychiatric inpatients could be subject to consent‐related vulnerabilities, we suggest that a particular kind of exploitation‐related vulnerability comes to the fore in the context of our case study. Moreover, a subset of these ethical concerns takes on particular weight in the context of genetic research in low‐ and middle‐income countries. At the same time, the automatic exclusion of inpatients from research elicits justice‐related vulnerabilities. (shrink)

In a world with limited resources, allocation of resources to certain individuals and conditions inevitably means fewer resources allocated to other individuals and conditions. Should a patient's personal responsibility be relevant to decisions regarding allocation? In this project we combine the normative and the descriptive, conducting an empirical bioethical examination of how both Norwegian and British doctors think about principles of responsibility in allocating scarce healthcare resources. A large proportion of doctors in both countries supported including responsibility for illness in (...) prioritization decisions. This finding was more prominent in zero‐sum scenarios where allocation to one patient means that another patient is denied treatment. There was most support for incorporating prospective responsibility (through patient contracts), and low support for integrating responsibility into co‐payments (i.e. through requiring responsible patients to pay part of the costs of treatment). Finally, some behaviours were considered more appropriate grounds for deprioritization (smoking, alcohol, drug use)—potentially because of the certainty of impact and direct link to ill health. In zero‐sum situations, prognosis also influenced prioritization (but did not outweigh responsibility). Ethical implications are discussed. We argue that the role that responsibility constructs appear to play in doctors' decisions indicates a needs for more nuanced—and clear—policy. Such policy should account for the distinctions we draw between responsibility‐sensitive and prognostic justifications for deprioritization. (shrink)

A. C. Lloyd; XIV—Non-Discursive Thought—An Enigma of Greek Philosophy, Proceedings of the Aristotelian Society, Volume 70, Issue 1, 1 June 1970, Pages 261–274.

A. C. Grayling; III*—Epistemology and Realism, Proceedings of the Aristotelian Society, Volume 92, Issue 1, 1 June 1992, Pages 47–66, https://doi.org/10.1093/ar.

AC Grayling is Britain’s leading popular philosopher. A professor at Birkbeck College, University of London, he has written over 20 books, ranging from academic monographs such as Truth, Meaning and Realism to more accessible works such as What is Good? and The Mystery of Things. His most recent books are Towards The Light and The Choice of Hercules.

A little while ago I thought the ontological argument dead and buried beyond any possible hope of resurrection and no philosophical event has caused me much greater surprise than its revival by a member of the very linguistic school to whose line of thinking it seemed most alien and who were held to have given it its quietus once for all. I am tempted to welcome any relapse into metaphysics by a member of this school as being some sign of (...) grace, but on this issue I must for once take sides with the prevailing tradition against at least this kind of metaphysics. Let me make clear, however, what it is I am combating. The term ‘ontological argument’ has been used for arguments which its original supporters would certainly not have recognised as theirs. It has been used for instance to stand for the claim that it is an essential presupposition of thought that what we must think is true of the real, a claim which could not be used to prove the existence of God unless we had available another proof that we really must think that God exists. It has been used for kinds of ‘idealist’ arguments which I do not want to discuss here. It has been used for the argument that the idea of a perfect being cannot be explained as derived from any other idea and must therefore be explained as produced in us by a being who really is perfect, an argument which appears in Descartes side by side with the ontological argument but which he carefully distinguishes from it. (shrink)

Ludwig Wittgenstein (1889-1951) was an extraordinarily original thinker, whose influence on twentieth-century thinking far outside the bounds of philosophy alone. In this engaging Introduction, A.C. Grayling makes Wittgenstein's thought accessible to the general reader by explaining the nature and impact of Wittgenstein's views. He describes both his early and later philosophy, the differences and connections between them, and gives a fresh assessment of Wittgenstein's continuing influence on contemporary thought.

In this benchmark five-volume study, originally published between 1922 and 1955, Surendranath Dasgupta examines the principal schools of thought that define Indian philosophy. A unifying force greater than art, literature, religion, or science, Professor Dasgupta describes philosophy as the most important achievement of Indian thought, arguing that an understanding of its history is necessary to appreciate the significance and potentialities of India's complex culture. Volume I offers an examination of the Vedas and the Brahmanas, the earlier Upanisads, and the six (...) systems of Indian philosophy. (shrink)

In contrast with the different views of some recent scholars, Ch. 7 constitutes an important attempt to point out the importance played by non‐discursive thought in Plotinus and Proclus in several ways. Firstly, the differences between the doctrines of Plotinus and Proclus are investigated. Secondly, it is considered the role of the ‘Loving Intellect’ in both Plotinus’ and Proclus’ philosophy. Thirdly, it is indicated how the One plays a crucial role in the mystical experience and how this kind of experience (...) may be an evidence of the activity of the One. Finally, it is shown how some problems and difficulties of Plotinus’ philosophy may be explained through reference to the mystical experience. (shrink)

Focuses on Porphyry's semantic and more specifically on his theory of ‘imposition of names’, i.e. how names are related to things. Examines Porphyry's treatment of genus and species and also of individual, singular, and general terms to emphasize his peculiarity in Neoplatonic philosophy. Infers that Porphyry's attitude is not to develop a metaphysical and a logical semantics, but only a metaphysical one. Finally, considers how Porphyry's metaphysical approach towards semantics was maintained by eleventh and twelfth century Byzantine Neoplatonists.

In the light of increasing public mistrust, there is an urgent need to clarify the moral status of the medical profession and of the relationship of the clinician to his/her patients. In addressing this question, I first establish the coherence, within moral philosophy generally, of the concept of supererogation . I adopt the notion of an act of “unqualified” supererogation as one that is non-derivatively good, praiseworthy, and freely undertaken for others' benefit at the risk of some cost to the (...) agent. I then argue that committing oneself to the profession of clinical medicine is an act of this kind. This is the case, not because the aim of medicine is to help patients, but because of the open ended commitment of time and the vulnerability to the consequences of failure that the clinician must accept. (shrink)

Number theory abounds with conjectures asserting that every natural number has some arithmetic property. An example is Goldbach’s Conjecture, which states that every even number greater than 2 is the sum of two primes. Enumerative inductive evidence for such conjectures usually consists of small cases. In the absence of supporting reasons, mathematicians mistrust such evidence for arithmetical generalisations, more so than most other forms of non-deductive evidence. Some philosophers have also expressed scepticism about the value of enumerative inductive evidence in (...) arithmetic. But why? Perhaps the best argument is that known instances of an arithmetical conjecture are almost always small: they appear at the start of the natural number sequence. Evidence of this kind consequently suffers from size bias. My essay shows that this sort of scepticism comes in many different flavours, raises some challenges for them all, and explores their respective responses. (shrink)

The larval arms of echinoid plutei are used for locomotion and feeding. They are composed of internal calcite skeletal rods covered by an ectoderm layer bearing a ciliary band. Skeletogenesis includes an autonomous molecular differentiation program in primary mesenchyme cells (PMCs), initiated when PMCs leave the vegetal plate for the blastocoel, and a patterning of the differentiated skeletal units that requires molecular cues from the overlaying ectoderm. The arms represent a larval feature that arose in the echinoid lineage during the (...) Paleozoic and offers a subject for the study of gene co-option in the evolution of novel larval features. We isolated new molecular markers in two closely related but differently developing species, Heliocidaris tuberculata and Heliocidaris erythrogramma. We report the expression of a larval arm-associated ectoderm gene tetraspanin, as well as two new PMC markers, advillin and carbonic anhydrase. Tetraspanin localizes to the animal half of blastula stage H. tuberculata and then undergoes a restriction into the putative oral ectoderm and future location of the postoral arms, where it continues to be expressed at the leading edge of both the postoral and anterolateral arms. In H. erythrogramma, its expression initiates in the animal half of blastulae and expands over the entire ectoderm from gastrulation onward. Advillin and carbonic anhydrase are upregulated in the PMCs postgastrulation and localized to the leading edge of the growing larval arms of H. tuberculata but do not exhibit coordinated expression in H. erythrogramma larvae. The tight spatiotemporal regulation of these genes in H. tuberculata along with other ontogenetic and phylogenetic evidence suggest that pluteus arms are novel larval organs, distinguishable from the processes of skeletogenesis per se. The dissociation of expression control in H. erythrogramma suggest that coordinate gene expression in H. tuberculata evolved as part of the evolution of pluteus arms, and is not required for larval or adult development. (shrink)