Introduction Future HIV vaccine efficacy trials with adolescents will need to ensure that participants comprehend study concepts in order to confer true informed assent. A Hepatitis B vaccine trial with adolescents offers valuable opportunity to test youth understanding of vaccine trial requirements in general. Methods Youth reviewed a simplified assent form with study investigators and then completed a comprehension questionnaire. Once enrolled, all youth were tested for HIV and confirmed to be HIV-negative. Results 123 youth completed the questionnaire (mean age=15 (...) years; 63% male; 70% Hispanic). Overall, only 69 (56%) youth answered all six questions correctly. Conclusions Youth enrolled in a Hepatitis B vaccine trial demonstrated variable comprehension of the study design and various methodological concepts, such as treatment group masking. (shrink)

The thesis that all learning has the character of enquiry is advanced and its implications are explored. R. G. Collingwood's account of ‘the logical priority of the question’ is explained and Hans-Georg Gadamer's hermeneutical justification and development, particularly the rejection of the re-enactment thesis, is discussed. Educators are encouraged to consider the following implications of the character of the question implied in all learning: (i) that it is a question that is constituted in the event rather than prepared or given (...) in advance, and that this leads to a necessary tension between learning and the curriculum or scheme, (ii) that it is a question that concerns some subject matter or issue that is at stake for both the student and the object of study, which draws our attention to the ‘intentionality’ of learning, and (iii) that it is a question that operates on the level of being—students are ‘called into question’, and thus transformed, by the object of study. (shrink)

In many regions around the world, those at highest risk for acquiring HIV are young adults and adolescents. Young men who have sex with men in the USA are the group at greatest risk for HIV acquisition, particularly if they are part of a racial or ethnic minority group.1 Adolescent girls and young women have the highest incidence rates of any demographic subgroup in sub-Saharan Africa.2 To reverse the global AIDS pandemic’s toll on these high-risk groups, it is important to (...) deploy the most effective HIV prevention tools to young MSM in the USA, to adolescent girls and young women in sub-Saharan Africa, and to any other adolescents and young adults at high risk for HIV as products are proven to be safe and efficacious. Although prevention interventions with proven efficacy, such as oral pre-exposure prophylaxis, are available,3–8 they have not been sufficient to stem the tide and an expanded prevention toolkit is urgently needed to serve these populations. The field of HIV prevention continues to identify promising leads in the development of new biomedical prevention products, either delivering antiviral drug topically or systemically. The dapivirine ring has been shown to provide modest protection and is currently being tested in open label studies while injectable cabotegravir is being tested in a large efficacy trial for preventing HIV acquisition. Advances in the field of HIV prevention mean that scientists and regulators must plan for how they will bring prevention tools to populations at high risk for HIV as they conduct efficacy and effectiveness trials. For instance, safety data from younger age groups can also be used in combination with efficacy data from adult studies, where appropriate, as bridging studies to expand labelling to younger ages. If these …. (shrink)

Current computational models predict reward based solely on learning. Real motivation involves that but also more. Brain reward systems can dynamically generate incentive salience, by integrating prior learned values with even novel physiological states (e.g., natural appetites; drug-induced mesolimbic sensitization) to cause intense desires that were themselves never learned. We hope future computational models may capture this too.

In The Varieties of Reference (1982), Gareth Evans claims that considerations having to do with certain basic ways we have of gaining knowledge of our own physical states and properties provide "the most powerful antidote to a Cartesian conception of the self" (220). In this chapter, I start with a discussion and evaluation of Evans' own argument, which is, I think, in the end unconvincing. Then I raise the possibility of a more direct application of similar considerations in defence of (...) common sense anti-Cartesianism. Progress in this direction depends upon a far more psychologically informed understanding of normal and abnormal bodily awareness than is generally found in philosophical discussions of these issues. In the context of my attempt at some such understanding, I go on to assess the potential of this more direct line of argument. (shrink)

The number of wars in which modern countries, primarily the United States and Great Britain, have been involved in the past one hundred years might leave the impression that peace movements there are ineffectual. Virtually every war in recent US and UK history has had its corresponding anti-war protests, and there is no record of a peace movement actively stopping an impending significant military action at inception, although evidence exists that peace movements have affected martial policy after the initial stages (...) of a military action. Instead, peace movements seem to elicit ill will and accusations of self-preservation and treason. This paper will show that peace movements are thus censored through a sense of patriotism constructed by those in positions of influence, including government entities and the press. More important, this paper will argue that the reasoning of these pacifist movements and of their detractors can be more clearly understood through application of the work of philosopher G.E.M. Anscombe, particularly her essay “Modern Moral Philosophy,” than through other philosophers such as Richard M. Weaver. (shrink)

This paper examines the role of metalinguistic negotiation in lawyers’ and judges’ speech about the law. A speaker engages in metalinguistic negotiation when the speaker uses a term to advocate for what that term should mean or how it should be used relative to context. While I doubt that legal practitioners employ metalinguistic negotiation in the ways that David Plunkett and Tim Sundell have proposed, it is plausible that practitioners do so in another way. Specifically, I contend that lawyers and (...) judges sometimes use key terms in legal interpretation – e.g., ‘plain’, ‘meaning’, or ‘holding’ – to advocate for what those terms should mean or how courts should use them in adjudication. This suggests an intriguing role for metalinguistic negotiation in legal argumentation, one that could shed light on practitioners’ disputes in a range of cases dealing with constitutional, statutory, or common-law interpretation. (shrink)

“Bads” e.g. poverty, deprivation, constraint, ill-treatment, misery The traditional concern of theories of punishment (“retributive justice”).

In ‘Fregean Reference Defended’ (1995), Sosa presents a sophisticated descriptive theory of reference, which he calls ‘fregean’, and which he argues avoids standard counterexamples to more basic variants of this approach. What is characteristic of a fregean theory, in his sense, is the idea that what makes a person’s thought about some object, a, a thought about that particular thing, is the fact that a uniquely satisfies an appropriate individuator which is suitably operative in her thinking.1 On his version, (FT), (...) any individuating concept, or definite description, is an appropriate individuator, whether it picks out its referent entirely independently of context, and is therefore absolute (e.g. ), or it picks out its referent only with the aid of a context of use, and is therefore perspectival (e.g. ); and such an individuator, α, may be suitably operative in a person’s thinking in one of two ways. First, she may be thinking, de dicto, a proposition predicating some property φ with respect to α. Second, she may be thinking, de dicto, a proposition predicating φ with respect to another individuator, β, which is a member of a referential conception for her at that time, whose epistemic basis contains α as one of its great preponderance of individually co-referential members. The second possibility is designed to avoid standard counterexamples, in which, insofar as a person is thinking, de dicto, a proposition predicating φ with respect to some individuator, β, she is nevertheless intuitively thinking about something other than the unique satisfier of β, either because there is no such thing, just a near miss, or because, although there is, she is really thinking about something else, which may generally be believed to be the β (e.g. Donnellan, 1966; and Kripke, 1980). For Sosa argues that, in such cases, the intuitive object of thought uniquely satisfies an appropriately related α.. (shrink)

This paper examines the role that population vulnerabilities play in insurance coverage for a representative sample of Latinos and Asians in the United States. Using data from the National Latino and Asian American Study (NLAAS), these analyses compare coverage differences among and within ethnic subgroups, across states and regions, among types of occupations, and among those with or without English language proficiency. Extensive differences exist in coverage between Latinos and Asians, with Latinos more likely to be uninsured. Potential explanations include (...) the type of occupations available to Latinos and Asians, reforms in immigration laws, length of time in the United States, and regional differences in safety-net coverage. Policy implications are discussed. (shrink)

A sentence containing disjunction in the scope of a possibility modal, such as _Angie is allowed to buy the boat or the car_, gives rise to the free choice inference that Angie can freely choose between the two. This inference poses a well-known puzzle, in that it is not predicted by a standard treatment of modals and disjunction (e.g., Kamp (Proceedings of the Aristotelian Society 74:57–74, 1974 )). To complicate things further, free choice tends to disappear under negation: _Angie is (...) not allowed to buy the boat or the car_ doesn’t merely convey the negation of free choice, but rather the stronger double prohibition reading that Angie cannot buy either one. There are two main approaches to the free choice - double prohibition pattern in the literature. While they both capture the relevant data points, they make a testable, divergent prediction regarding the status of positive and negative sentences in a context in which Angie can only buy one of the two objects, e.g., the boat. In particular, the implicature-based approach (e.g., Fox (Presupposition and implicature in compositional semantics, pp. 71–120, 2007 ); Klinedinst (Plurality and possibility, PhD diss., UCLA, 2007 ); Bar-Lev and Fox (Proceedings of SALT 27, pp. 95–115, 2017 ); Bar-Lev and Fox (Natural Language Semantics 28:175–223, 2020 )) predicts that the positive sentence is true in such a context, but associated with a false implicature, while it predicts the negative sentence to be straightforwardly false. The homogeneity-based approach in Goldstein (Semantics & Pragmatics 12:1–53, 2019 ) predicts both the positive and negative sentences to be equally undefined (see also Aloni (Semantics & Pragmatics 15:5, 2022 ); Willer (Proceedings of the 21st Amsterdam Colloquium, pp. 511–520, 2017 )) for similar predictions). Investigating the contrast between these sentences in such a context therefore provides a clear way to address the debate between implicature and non-implicature accounts of free choice. We present a set of four experiments aiming to do just this, by comparing free choice inferences to regular implicatures, using a ternary judgment task. The results overall present a challenge for the implicature approach. We discuss how the implicature approach could be amended to account for our results, based on a recent proposal by Enguehard and Chemla (Linguistics & Philosophy 44:79–112, 2021 ) on the distribution of implicatures. (shrink)

In 2019, several US states passed “heartbeat” bills. Should such bills go into effect, they would outlaw abortion once an embryonic heartbeat can be detected, thereby severely limiting an individual’s access to abortion. Many states allow health care professionals to refuse to provide an abortion for reasons of conscience. Yet heartbeat bills do not include a positive conscience clause that would allow health care professionals to provide an abortion for reasons of conscience. I argue that this asymmetry is unjustified. The (...) same criteria that justify protecting conscientious refusals to provide abortion also justify protecting positive conscientious appeals regarding abortion. Thus, if the law provides legal exemptions for health care professionals who, as a matter of conscience, refuse to provide abortions where it is legal, it should also provide exemptions for health care professionals who, as a matter of conscience, feel obligated to provide abortions where it is illegal. (shrink)

Students in two classes in the fall of 2004 making extensive use of online courseware were logged as they visited over 500 different “learning pages” which varied in length and in difficulty. We computed the time spent on each page by each student during each session they were logged in. We then modeled the time spent for a particular visit as a function of the page itself, the session, and the student. Surprisingly, the average time a student spent on learning (...) pages was of almost no value in predicting how long they would spend on a given page, even controlling for the session and page difficulty. The page itself was highly predictive, but so was the average time spent on learning pages in a given session. This indicates that local considerations, e.g., mood, deadline proximity, etc., play a much greater role in determining student pace and attention than do intrinsic student traits. We also consider the average time spent on learning pages as a function of the time of semester. Students spent less time on pages later in the semester, even for more demanding material. (shrink)

The authors are members of the British Association Committee on Social Concern and Biological Advances. Following earlier discussions of legal and social problems arising from certain medical advances, they undertook, independently, to examine the Law Commission's study.

The fiftieth anniversary of the death of President Franklin Delano Roosevelt arrived only months after the 1994 U.S. elections brought to power conservative Republican congressional majorities determined to reverse key legacies of Roosevelt's New Deal. At this juncture of special poignancy for many of those assembled at the “Little White House” in Warm Springs, Georgia on April 12, 1995, President Bill Clinton offered remarks on “Remembering Franklin D. Roosevelt.” “Like our greatest presidents,” Clinton eulogized, Roosevelt “showed us how to (...) be a nation in time of great stress” and “taught us again and again that our government could be an instrument of democratic destiny.”. (shrink)

Objectives: To analyse legislation and medical professional positions concerning the doctor’s role in assisted dying in western Europe, and to discuss their implications for doctors.Method: This paper is based on country-specific reports by experts from European countries where assisted dying is legalised , or openly practiced , or where it is illegal .Results: Laws on assisted dying in The Netherlands and Belgium are restricted to doctors. In principle, assisted suicide is not illegal in either Germany or Switzerland, but a doctor’s (...) participation in Germany would violate the code of professional medical conduct and might contravene of a doctor’s legal duty to save life. The Assisted Dying for the Terminally Ill Bill proposed in the UK in 2005 focused on doctors, whereas the Proposal on Assisted Dying of the Norwegian Penal Code Commission minority in 2002 did not.Professional medical organisations in all these countries except The Netherlands maintain the position that medical assistance in dying conflicts with the basic role of doctors. However, in Belgium and Switzerland, and for a time in the UK, these organisations dropped their opposition to new legislation. Today, they regard the issue as primarily a matter for society and politics. This “neutral” stance differs from the official position of the Royal Dutch Medical Association which has played a key role in developing the Dutch practice of euthanasia as a “medical end-of-life decision” since the 1970s.Conclusion: A society moving towards an open approach to assisted dying should carefully identify tasks to assign exclusively to medical doctors, and distinguish those possibly better performed by other professions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinicians’ “Folk” Taxonomies and the DSM: Pick Your PoisonG. Scott Waterman (bio)Keywordsnosology, classification, diagnosis, psychopathologyWith attention turning to the process of formulating the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V; e.g., Kendler et al. 2008), the study by Flanagan and Blashfield (2007) of the similarities and differences between clinicians’ “folk” taxonomies and psychiatry’s official one is timely, and its lessons are in need of (...) analysis. In this commentary I first address questions raised by the existence of multiple de facto taxonomies, and by the characteristics of those taxonomies themselves, before focusing attention on the DSM diagnostic system and its attributes that make acceptance by its constituencies far less than complete. Although the aim of Flanagan’s and Blashfield’s study is explicitly descriptive rather than normative, it provides an important opportunity to examine the extent to which our taxonomies serve the purposes for which they were constructed—whether by experts or by clinicians.There are certainly reasons to expect significant deviations between clinicians’ everyday taxonomies and the official one. Perhaps the most glaring reason is the fact that—even if it were desirable—no one can be familiar with the enormous number of categories codified by the DSM. On the other hand, the remarkable hegemony of the DSM—in the education and training of physicians and clinical psychologists, in clinical communication, and in the ubiquitous administrative functions of billing and coding—makes such deviations at least somewhat surprising and in need of scrutiny and explanation. The first question, however, is whether one should be concerned by the existence (surprising or otherwise) of multiple taxonomies. Flanagan and Blashfield make the compelling case that, given the high rate at which Americans seek clinical attention for psychiatric problems, the stakes are commensurately high for our efforts at categorizing those problems in valid and useful ways. And the extent to which a gulf exists between the way psychiatry and clinical psychology are written about and taught on the one hand, and conceptualized and practiced by clinicians on the other, invites a multitude of problems—among which cynicism about our disciplines may be one of the most pernicious.At least as important as their finding of only moderate correlations between clinicians’ taxonomies [End Page 271] and that of the DSM are the characteristics of clinicians’ diagnostic systems themselves. One potentially major artifact of their methodology, however, must be borne in mind: the instruction to the clinicians in their study to “[p]ut together the diagnoses that have similar treatments…” (emphasis mine). Although they cite previous work (Flanagan and Blashfield 2006) in defense of the proposition that such instruction did not unduly influence their findings, it was certainly an avoidable potential problem, which itself likely reflects the history of our clinical disciplines in which the treatment cart frequently pulled the diagnosis horse. It is, therefore, not unlikely that clinicians’ taxonomies might emphasize treatment considerations even if they had not been directed to do so. The fallacious reasoning behind such intuitively appealing practice, however, must be exposed. The implicit assumption that treatment response is a proxy for other important characteristics of illnesses is predicated on the false proposition that our treatments exert their effects via similar mechanisms across the various indications for their uses, thus allowing us to infer from such responses that what was awry in the first place among the conditions for which a given treatment is effective must be closely related. Categorizing mania and trigeminal neuralgia together by virtue of their shared responses to anticonvulsant therapy, or considering autoimmune platelet deficiencies to be closely related to abdominal trauma due to the fact that each sometimes requires splenectomy, are examples of the potential results of acting on that false premise.Another parameter on which the clinicians in the current study based their nosologies—most explicitly by the “dimensional experts”—is the “environmental” versus “biological” one. Given that a coherent dichotomy would either distinguish environmental from genetic etiological factors, or would contrast psychological (i.e., subjective or first-person) from biological (i.e., objective or third-person) manifestations of illness, a taxonomy one of whose axes purports to represent an environmental/biological continuum cannot... (shrink)

Could a Nazi soldier or terrorist be courageous? The Courage Problem asks us to answer this sort of question, and then to explain why people are reluctant to give this answer. The present paper sheds new light on the Courage Problem by examining a controversy sparked by Bill Maher, who claimed that the 9/11 terrorists’ acts were ‘not cowardly.’ It is shown that Maher's controversy is fundamentally related to the Courage Problem. Then, a unified solution to both problems is (...) provided. This solution entails that gutsy people who lack good ends are not courageous. (shrink)

Originally published in 1999, this classic textbook includes twenty-six cases with commentary and bibliographic resources designed especially for medical students and the training of ethics consultants. The majority of the cases reflect the day-to-day moral struggles within the walls of hospitals typically described as community hospitals; as a result, the cases do not focus on esoteric, high-tech dilemmas--viz., genetic engineering or experimental protocols--but rather on fundamental problems that are pervasive in basic healthcare delivery in the United States: where to send (...) a frail, elderly patient who refuses to go to a nursing home; what role the family should play in making a treatment decision; what a hospital should do when it is getting stuck with too many unpaid bills. This thoroughly revised and updated second edition includes thirteen new cases, five of which are designated as "skill builder" cases aimed specifically for those participants in the Neiswanger Institute for Bioethics' web-based instructional program. This edition has also been restructured for teachability, and will feature reformatted and revised commentaries. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume 29, Number 1, April 2003, pp. 89-98 Another "Curious Legend" about Hume's An Abstract of a Treatise of Human Nature MARK G. SPENCER I In 1938, J. M. Keynes and P. Sraffa edited and introduced for Cambridge University Press a reprinting of An Abstract of A Treatise of Human Nature.1 The Abstract they claimed in their subtitle was "A Pamphlet hitherto unknown by DAVID HUME." Arguing (...) against a number of nineteenth and early-twentieth -century scholars who attributed authorship of an abstract of the Treatise to Adam Smith, Keynes and Sraffa convincingly documented in their introductory essay many solid reasons for thinking that the pamphlet being reprinted was Hume's.2 Sixty years on, their account dispelling this "curious legend" of Smith's authorship has now become the received opinion. T.E. Jessop accepted Keynes and Sraffa's argument (having seen it in proof before the edition was published) in his bibliography of 1938, and Norman Kemp Smith gave their version an early supportive review.3 E.C. Mossner, in his well-known biography of Hume, accepted wholeheartedly Keynes and Sraffa's findings.4 When in 1978 the Selby-Bigge's edition of Hume's Treatise saw its second edition the text of the Abstract was appended and a note gave P.H. Nidditch's opinion that "Hume's authorship is overwhelmingly likely."5 More recently Mark G. Spencer is Social Sciences and Humanities Research Council of Canada Postdoctoral Research Fellow, Department of History, University of Toronto. Sidney Smith Hall, 100 St. George St., Toronto, Ontario MSS 3GS, Canada. [email protected] 90 Mark G. Spencer in the pages of this journal, Jeff Broome, David Raynor, and David Fate Norton have all helped buttress the case for Hume's authorship, as did R. W. Connon and M. Pollard elsewhere.6 Despite an occasional dissenting voice,7 the Abstract is now widely, and rightly (or so it seems to this author), thought to have been Hume's. But with all of this scholarly attention focused on confirming Hume's authorship, another much more contentious aspect of Keynes and Sraffa's interpretation has gone largely unnoticed. Keynes and Sraffa's billing of the Abstract as "A Pamphlet hitherto unknown by DAVID HUME," suggested that before 1938 the Abstract had not been attributed publicly to Hume and that the contents of the pamphlet also had been completely unknown. "Students of Hume have known that an abstract of the Treatise was made and intended for publication," wrote a reviewer of Keynes and Sraffa, "[b]ut no copy of this abstract was known to exist: indeed it was usually supposed that the abstract had never been printed at all."8 Relying on Keynes and Sraffa it would be easy to suppose that the Abstract was never publicly ascribed to Hume and even that the contents of the pamphlet had been overlooked entirely until Keynes and Sraffa came along. One of the purposes of the present short essay is to dispel, once and for all, that misunderstanding about the Abstract. Norman Kemp Smith went part of the way toward that end in 1938 when he reviewed Keynes and Sraffa's edition. But in the process Kemp Smith introduced another "curious legend" that has slipped into scholarly acceptance with little comment and no debate. We will see that it is a mistake to argue, as Kemp Smith did, that Hume's authorship of a sixpenny pamphlet was known to readers of An universal biographical and historical dictionary, published in 1800. There is no discussion of Hume's Abstract in that book. However, the Abstract was discussed in print in at least three different publications between 1818 and 1827, long after its initial publication in 1740 and long before Keynes and Sraffa brought it to the attention of their audience in 1938. While pre-1938 Hume scholars had overlooked the Abstract, at least one of Hume's early nineteenth-century critics knew of the Abstract's existence, attributed the work to Hume, and even quoted extensively from Hume's "Preface." Most interesting of all, Hume's authorship of the Abstract was interpreted in ways that are telling of the historical reception of... (shrink)