It is argued here that the practice of medical students performing pelvic exams on women who are under anesthetic and have not consented is immoral and indefensible. This argument begins by laying out the ethical justification for the practice of informed consent, which can be found in autonomy and basic rights. Foregoing the process of consent within medicine can result in violations of both autonomy and basic rights, as well as trust, forming the basis of the wrong of unauthorized pelvic (...) examinations. Several objections to this argument are considered, all of which stem from the idea that this practice constitutes an exception to the general requirement of informed consent. These objections suggest that nonconsensual pelvic examinations on women under anesthetic are ethically acceptable on utilitarian grounds, in that they offer benefits either to the patient or to society, or on the grounds of triviality, in that consent is already presumed, or the practice is insignificant. Each of these objections is rejected and the practice is deemed indefensible. (shrink)

This article reflects on the relevance and applicability of the Belmont Report nearly four decades after its original publication. In an exploration of criticisms that have been raised in response to the report and of significant changes that have occurred within the context of biomedical research, five primary themes arise. These themes include the increasingly vague boundary between research and practice, unique harms to communities that are not addressed by the principle of respect for persons, and how growing complexity and (...) commodification in research have shed light on the importance of transparency. The repercussions of Belmont's emphasis on the protection of vulnerable populations is also explored, as is the relationship between the report's ethical principles and their applications. It is concluded that while the Belmont Report was an impressive response to the ethical issues of its day, the field of research ethics involving human subjects may have outgrown it. (shrink)

Drawing on data from interviews with 65 masculine-to-feminine transgenderists, the authors examine the coming-out experiences of transgendered individuals. Drawing on the literature that shows gender to be an inherent component of the social infrastructure that at an individual level is accomplished in interaction with others, they demonstrate that interactional challenges to gender are insufficient to challenge the system of gender. Whereas many transgenderists believe that their actions and identities are radical challenges to the binary system of gender, in fact, the (...) majority of such individuals reinforce and reify the system they hope to change. (shrink)

Institutional review boards, tasked with facilitating ethical research, are often pulled in competing directions. In what we call the protection-inclusion dilemma, we acknowledge the tensions IRBs face in aiming to both protect potential research participants from harm and include under-represented populations in research. In this manuscript, we examine the history of protectionism that has dominated research ethics oversight in the United States, as well as two responses to such protectionism: inclusion initiatives and critiques of the term vulnerability. We look at (...) what we know about IRB decision-making in relation to protecting and including “vulnerable” groups in research and examine the lack of regulatory guidance related to this dilemma, which encourages protection over inclusion within IRB practice. Finally, we offer recommendations related to how IRBs might strike a better balance between inclusion and protection in research ethics oversight. (shrink)

This paper argues against incorporating assessments of individual responsibility into healthcare policies by expanding an existing argument and offering a rebuttal to an argument in favour of such policies. First, it is argued that what primarily underlies discussions surrounding personal responsibility and healthcare is not causal responsibility, moral responsibility or culpability, as one might expect, but biases towards particular highly stigmatised behaviours. A challenge is posed for proponents of taking personal responsibility into account within health policy to either expand the (...) debate to also include socially accepted behaviours or to provide an alternative explanation of the narrowly focused discussion. Second, a critical response is offered to arguments that claim that policies based on personal responsibility would lead to several positive outcomes including healthy behaviour change, better health outcomes and decreases in healthcare spending. It is argued that using individual responsibility as a basis for resource allocation in healthcare is unlikely to motivate positive behaviour changes, and is likely to increase inequality which may lead to worse health outcomes overall. Finally, the case of West Virginia's Medicaid reform is examined, which raises a worry that policies focused on personal responsibility have the potential to lead to increases in medical spending overall. (shrink)

As we rapidly approach the 50th year of the much‐celebrated ‘cognitive revolution’, it is worth reflecting on its widespread impact on individual disciplines and areas of multidisciplinary endeavour. Of specific concern in this paper is the example of the influence of cognitivism's equation of mind and computer in education. Within education, this paper focuses on a particular area of concern to which both mind and computer are simultaneously central: educational technology. It examines the profound and lasting effect of cognitive science (...) on our understandings of the educational potential of information and communication technologies, and further argues that recent and multiple ‘signs of discontent’, ‘crises’ and even ‘failures’ in cognitive science and psychology should result in changes in these understandings. It concludes by suggesting new directions that educational technology research might take in the light of this crisis of cognitivsm. (shrink)

Phillips & Silverstein argue that a range of cognitive disturbances in schizophrenia result from a deficit in cognitive coordination attributable to NMDA receptor dysfunction. We suggest that the viability of this hypothesis would be further supported by explicit implementation in a computational framework that can produce quantitative estimates of the behavior of both healthy individuals and individuals with schizophrenia.

In the reality of the modern world, the positivist or scientifically-believing scientists or technicians often ignore philosophy, because it does not bring them any immediately usable results and, in this respect, no progress. Because philosophical thinking does not have the character of an objective process of progress like scientific thinking does. It is not the thinking that deals with the investigation of what is still unthought in thinking itself, but rather the thinking that creates an economic competitive advantage by acquiring (...) performance knowledge that is relevant for society. But can't philosophical thinking be progressive? The authors of this book answer this question extremely differently. (shrink)

It warrants examining how well people can come to argue under supportive conditions, not only what they do under ordinary conditions. Sustained engagement of young people in dialogic argumentation yields more than the temporary that Mercier & Sperber (M&S) identify in the target article. If such engagement were to become the norm, who can say what the argumentive potential of future generations is?

As participatory research practices are increasingly taken up in health research, claims related to experiential authority and expertise are frequently made. Here, in an exploration of what grounds such claims, we consider how feminist standpoint theory might apply to the psy sciences (psychiatry, psychology, psychotherapy, psychoanalysis, and so on). Standpoint theory claims that experiences of marginalization and critical engagement can lead to a standpoint that offers an epistemic advantage within a domain of knowledge. We examine experiences of marginalization and critical (...) engagement in the mental health system, as well as evidence for epistemic advantages resulting from these experiences. This evidence, found in the identification of problematic assumptions and the development of new tools and theories in the field, grounds our argument that standpoint theory is indeed relevant to the psy sciences and that many of those who have experienced marginalization and have engaged critically have an epistemic advantage when it comes to knowledge-production. The implications of this argument are significant: those who have attained a standpoint within the psy sciences ought to be included in research and given both tools and funding to develop research programs. However, we must be wary of the risks of tokenization, cooptation, and essentialization that are likely to accompany such a transformation. (shrink)

This paper offers a critical analysis of several accounts of the placebo effect that have been put forward. While the placebo effect is most often thought of as a control in research and as a deceptive tool in practice, a growing body of research suggests that it ought to be thought of as a powerful phenomenon in its own right. Several accounts that aim to draw boundaries around the placebo effect are evaluated in relation to current evidence and it is (...) argued that none of them adequately capture the variability and potency of the phenomenon. Two accounts, however, that point towards the underlying mechanisms of the placebo effect, are shown to offer promise in terms of developing a more comprehensive account of the placebo effect. (shrink)

Many are calling for concrete mechanisms of oversight for health research involving artificial intelligence (AI). In response, institutional review boards (IRBs) are being turned to as a familiar model of governance. Here, we examine the IRB model as a form of ethics oversight for health research that uses AI. We consider the model's origins, analyze the challenges IRBs are facing in the contexts of both industry and academia, and offer concrete recommendations for how these committees might be adapted in order (...) to provide an effective mechanism of oversight for health‐related AI research. (shrink)

In the introduction to a recent anthology of contemporary issues in philosophy of psychiatry, editors Jeffrey Poland and Şerife Tekin declare this to be a moment of crisis within the field. They suggest that the state of psychiatry today reflects Thomas Kuhn's conception of a period of extraordinary science, which occurs when anomalies begin to build up, confidence in the dominant paradigm is shook, competing theories arise, and philosophical questions come to the fore. Although perhaps not all would agree that (...) the field is in crisis, there is certainly an abundance of pessimism. Within the realm of research, a mood of explanatory pessimism has been growing, characterized by a... (shrink)

The increasing use of online simulations as replacements for animal dissection in the classroom or lab raises important questions about the nature of simulation itself and its relationship to embodied educational experience. This paper addresses these questions first by presenting a comparative hermeneutic-phenomenological investigation of online and offline dissection. It then interprets the results of this study in terms of Borgmann’s (1992) notion of the intentional “transparency” and “pliability” of simulated hyperreality. It makes the case that it is precisely encumbrance (...) and disruption—elements that are by definition excluded from simulations and interfaces—which give dissection its educational value. (shrink)

We note the development of the widely employed but loosely defined construct of critical thinking from its earliest instantiations as a measure of individual ability to its current status, marked by efforts to better connect the construct to the socially-situated thinking demands of real life. Inquiry and argument are identified as key dimensions in a process-based account of critical thinking. Argument is identified as a social practice, rather than a strictly individual competency. Yet, new empirical evidence is presented documenting a (...) role for individual reasoning competencies in supporting the effectiveness of argumentive discourse. A successful curriculum is described for employing extended engagement in dialogic argumentation as a pathway to development of individual argumentive skill. (shrink)

Why does discourse so often seem shallow, with people arguing past one another more than with one another? Might contributing causes be individual and logical rather than only dialogical? We consider here whether there exist errors in reasoning that could be particularly damaging in their effects on argumentive discourse. In particular, we examine implications for discourse of two such errors – explanation as a replacement for evidence and neglecting the likelihood of multiple causes contributing to an outcome. In Studies 1 (...) and 2, we show these errors to be prevalent in a cross section of adults, as well as samples of community college students and young adolescents, with minimal age-related improvement. They also occur, although less frequently, among a sample of highly educated adults, and in Study 3, we examine their role in the discourse of college-educated adults. We point finally to evidence that these individual reasoning errors are potentially addressable through education. (shrink)

This research engages with the problem of company–community conflict in mining. The inequitable distributions of risks, impacts, and benefits are key drivers of resource conflicts and are likely to remain at the forefront of mining-related research and advocacy. Procedural and interactional forms of justice therefore lie at the very heart of some of the real and ongoing challenges in mining, including: intractable local-level conflict; emerging global norms and performance standards; and ever-increasing expectations for the industry to translate high-level corporate social (...) responsibility policy into on-the-ground practice. This research focuses on the “process” aspects of resource conflicts through an examination of existing grievance-handling procedures at six mining operations where company–community conflict was present. In their current form, and on their own, the six mechanisms were found to be insufficient in their capacity to advance justice. The authors argue that if the overall objective of global norms is that companies construct and perform grievance handling in ways that strongly preference just practices, then “mechanisms-in-practice” must be better understood and constructively critiqued along all justice dimensions. (shrink)

What does it take to argue well? The goal of this series of studies was to better understand the cognitive skills entailed in argument, and their course of development, isolated from the verbal and social demands that argumentive discourse also entails. Findings indicated that young adolescents are less able than adults to coordinate attention to both positions in an argument, an age-related pattern that parallels one found in discourse. Contributing to this weakness was inattention to the opposing position (in both (...) constrained and unconstrained formats), but not ability to address the opposing position when explicitly asked to do so. In addition to implementing the necessary dual focus, results point to the importance of developing epistemological understanding of the relevance of the opposing position to argument, as well as of the goals of argument more generally. The results also reflect the close parallels between dialogic and non-dialogic argument. (shrink)

There is compelling evidence that pain experience is influenced by cognitive states. We explore one specific form of such influence, namely placebo analgesia, and examine its relevance for the cognitive penetration debate in philosophy of mind. We single out as important a form of influence on experience that we termradical cognitive penetration,and argue that some cases of placebo analgesia constitute compelling instances of this phenomenon. Still, we urge caution in extrapolating from this to broader conclusions about cognitive penetration in perceptual (...) experience. Instead, we suggest that the cognitive penetration of pain raises distinctive psychological, epistemological, and ethical issues. (shrink)

Building on decades of rich discussions of why 'nothing about us without us' matters in the field of psychiatry, this paper aims to illuminate the justifications underlying participatory research in psychiatry, and how these justifications might shape participatory methodologies. This is accomplished through the examination of several epistemic and ethical features of psychiatry that underlie the importance of engaging in participatory research in the field, unpacking their connection to participatory research, and offering suggestions related to their implications for research methodologies. (...) The epistemic features include: the irreducible value of patient experience, the extent of disagreement and uncertainty in the field, and the value-laden nature of knowledge in psychiatry. The ethical features include: the preponderance of harm, denials of agency and epistemic injustice, and the constant struggle for power. These features offer useful touchpoints for thinking through why participation matters in mental health research. (shrink)

Simple explanations are very often inadequate and can encourage faulty inferences. We examined college students’ explanations regarding illegal immigration to determine the prevalence of single-factor explanations. The form of students’ explanations was predicted by their responses on a simple three-item forced-choice multivariable causal reasoning task in which they selected the strongest evidence against a causal claim. In a further qualitative investigation of explanations by a sample of community adults, we identified positive features among those who scored high on this multivariable (...) causal reasoning task. We consider limitations of single-factor reasoning and means of encouraging more comprehensive explanations to support claims. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Democratizing Psychiatric ResearchRecognizing the Potential and the Limits of Experiential ExpertiseThe author reports no conflict of interests.First, I want to express my gratitude for such thoughtful and generative responses to the manuscript "Why Democratize Psychiatric Research?," which has been in development for several years and is the product of much reflection that has taken place in academic, advocacy, and interpersonal contexts. I am delighted to see such insightful engagement (...) with the piece and to have a chance to respond to both Drs. David Crepaz-Keay and Sam Fellowes here. Given that the authors raise such different questions within their commentaries, I consider each in turn.In his illuminating commentary, Crepaz-Keay makes three important points in response to the epistemic and ethical reasons I lay out as justifications for democratizing efforts in mental health research. First of all, Crepaz-Keay warns that there is "more subjectivity across much of medicine" than in the picture I've painted, and that we might do better to focus on this shared territory, taking up the goal of democratization across all of medicine, rather than risk "othering" psychiatry as uniquely subjective. In this way, Crepaz-Keay emphasizes, mental health service user researchers might "become leaders in progressive medical thinking."I appreciate this call to emphasize the ways in which the importance of subjective experiences cuts across all of medicine and to learn broad lessons from the pioneering participatory work that has been accomplished in the domain of mental health. I agree that much of medicine suffers from a focus on the objective to the neglect of the subjective, and wonder if this focus can sometimes create a distinct kind of worry in territories in which objective measures are widely available. Consider the focus on reducing the size of a tumor at all costs that can sometimes obscure important considerations related to what a good end of life might look like (Gawande, 2014). Particularly [End Page 143] within the process of determining what is worth measuring within research (and what is worth treating within clinical contexts), patient voices are essential to making an informed and beneficial decision. I agree with Crepaz-Keay here—this point applies to all realms of medicine.In contrast, I think other kinds of risks arise in domains in which objective measures are not widely available and therefore subjective reports of patients make up an essential part of any diagnosis or assessment. Another area I often think about is placebo studies, and in this space, stereotypes related to 'real' suffering and 'real' healing circulate widely (Friesen, 2019b). Largely, these stereotypes tend to support the importance and reality of that which occurs at the level of the physical or biological and take much less seriously suffering or healing which is thought to be located 'all in the head' (Friesen & Dionne, 2022). These biases also cut across medicine, influencing which patients are seen as trustworthy, dramatic, or worthy of one's compassion. I would argue that they show up especially in the setting of mental health care and research, in part because of the lack of objective measures and physiological explanations. A psychiatrized patient often has nothing physical or objective to point to with regard to their suffering, and so may be at the whim of a provider in relation to whether they are likely to be believed or discredited. As such, we must be especially alert to the unique risks that arise when evidence for suffering comes in a subjective form, and how efforts toward democratization might help reduce such risks.Second, Crepaz-Keay offers an essential intervention in relation to the importance of anti-racism within participatory practices in psychiatry. Although I do make mention of the lack of representation of racialized communities in participatory psychiatric research in discussing the important role that values play in the development of psychiatric knowledge, Crepaz-Keay accurately points out that this point related to representation is cross-cutting, and highly relevant to several of the other reasons I offer for why psychiatry research ought to be democratized. I am grateful for this invitation to look more broadly at how the exclusion of some voices from participatory efforts might apply across... (shrink)

In a recent paper, a “distance” function, $\cal D$ , was defined which measures the distance between pure classical and quantum systems. In this work, we present a new definition of a “distance”, D, which measures the distance between either pure or impure classical and quantum states. We also compare the new distance formula with the previous formula, when the latter is applicable. To illustrate these distances, we have used 2 × 2 matrix examples and two-dimensional vectors for simplicity and (...) clarity. Several specific examples are calculated. (shrink)

Die Unterscheidung von <I>theoretischer Ethik und <I>angewandter Ethik ist als Antwort auf vollig neue Handlungsoptionen und Entscheidungsdilemmata zu betrachten, die im Zuge des wissenschaftlich-technischen Fortschritts seit der zweiten Halfte des 20. Jahrhunderts entstanden. Die im Zusammenhang mit dieser Entwicklung auftretenden ethischen Fragen bzw. Probleme erfordern neuartige Losungsstrategien. Diese konnen nicht mehr ohne weiteres aus den uberlieferten moralischen Prinzipien der traditionellen Moralphilosophie abgeleitet werden. Aus diesem Grunde entstehen neue Herausforderungen fur die Philosophie, denen sich die Autoren dieses Sammelbandes gestellt haben. In (...) den Aufsatzen wird zum einen gezeigt, dass sich dem berechtigten <I>Praktischwerden der Ethik als praktischer Philosophie auch andere Formen <I>Praktizierender Philosophie zuordnen, wie etwa der Bereich der <I>Lebenskunst oder der einer <I>Philosophischen Praxis, zum anderen zeigen die verschiedenen Arbeiten aber auch, dass bei all dem nicht ubersehen werden darf, dass angewandte Ethik keine <I>Sonderethik ist, die unabhangig von der allgemeinen philosophischen Ethik betrieben werden kann.". (shrink)

Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can (...) meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance. (shrink)

Historians of Reformational philosophy often claim that Abraham Kuyper obtained the idea of sovereignty in its own sphere from Guillaume Groen van Prinsterer. But very little historical research has been done on Groen’s sources for and development of this idea. The first use of the Dutch phrase souvereiniteit in eigen sfeer is much earlier than previously thought; it was used in 1853 by J.I. Doedes, an associate of the “ethical theologian” Daniël Chantepie de la Saussaye. Groen became aware of the (...) ideas of Franz von Baader through journals founded by them, and by reading and corresponding with them and others, such as J.H. Gunning Jr. and Friedrich Fabri. Groen himself owned some of Baader’s books. He also relied strongly on the work of the jurist Friedrich Julius Stahl, who was 37 years younger than Baader but taught for a while at the same Munich university and shared Baader’s anti-revolutionary ideas. (shrink)

Why are the fundamentals of education apparently so little changed in our era of digital technology? Is their obstinate persistence evidence of resilience or obsolescence? Such questions can best be answered not by imagining an uncertain high-tech future, but by examining a well-documented past--a history of instruction and media that extends from Gilgamesh to Google. Norm Friesen looks to the combination and reconfiguration of oral, textual, and more recent media forms to understand the longevity of so many educational arrangements (...) and practices. Friesen examines the interrelationship of reading, writing, and pedagogy in the case of the lecture and the textbook--from their premodern to their postmodern incarnations. Over hundreds of years, these two forms have integrated textual, oral, and (more recently) digital media and connected them with changing pedagogical and cultural priorities. The Textbook and the Lecture opens new possibilities for understanding not only mediated pedagogical practices and their reform but also gradual changes in our conceptions of the knowing subject and of knowledge itself. Drawing on wide-ranging scholarship in fields as diverse as media ecology and German-language media studies, Foucauldian historiography, and even archaeological research, The Textbook and the Lecture is a fascinating investigation of educational media. (shrink)