After the Provisional Basic Law (Provisional Constitution) had been adopted on 11 March 1990, it soon became clear that it did not meet the new needs of the society and the state. It became clear that the new Constitution had to be drafted promptly. Its drafting was taking place at the time of heated discussions about various things, but especially about the structure of branches of state power, the empowerment thereof and their interrelations. The author of the article was a (...) member of the working group drafting the new Constitution. In his article, the author presents passages from the notes made by him about the sittings of the Provisional Commission for Drafting the Constitution and those of its working group. The notes disclose the variety of the views of the deputies and legal specialists and show the difficult way of emergence of the draft Constitution. This is confirmed by the time-line of drafting the Constitution. In 1990 and at the beginning of 1991, the first draft Constitutions were published, which had been drafted by the members of the societies of Lithuanian philosophers and lawyers, by the Lithuanian Democratic Labour Party, etc. Prior to the resolution of the Supreme Council of the Republic of Lithuania of 7 November 1990, a group of deputies was formed for drafting an outline of the concept of the Constitution. On 22 October 1991, the Council of the Seimas of the Lithuanian Sąjūdis Movement made a statement “On the Restoration of the Institution of the President of the Republic”. On 5 November 1991, the Supreme Council of the Republic of Lithuania adopted a Resolution “On the Development of the Lithuanian Constitutionalism”, whereas by its resolution of 10 December 1991 it formed the Provisional Commission for Drafting the Constitution. On 3 March 1992, the said Provisional Commission approved the draft Constitution that it prepared; it was submitted to the Supreme Council. Three members of the Provisional Commission had submitted alternatives to a number of articles of the Constitution. On 21 April 1992, the Supreme Council assented to the work done by the Provisional Commission and decided to publish the draft Constitution so that it could be discussed by the public. On 6 May 1992, the Lithuanian Sąjūdis Movement, the Democratic Party, the Christian Democratic Party, and the Lithuanian Nationalist Union formed a coalition for drafting an alternative draft Constitution; soon the press published the alternative draft Constitution prepared by the Sąjūdis Movement Coalition “For the Democratic Lithuania”. On 23 May 1992, the referendum on the restoration of the institution of the President of the Republic took place—that referendum did not approve the proposal. Thus, two alternative draft Constitutions appeared. The essential difference between those drafts was a different approach to the system of branches of state powers, their empowerment and their interrelation. The draft Constitution prepared by the Provisional Commission was based on the parliamentary republic form of governance, whereas in the draft prepared by the Sąjūdis Movement Coalition “For Democratic Lithuania” the model of half-presidential republic was dominant. In order to prepare a single draft Constitution, which could then be proposed for the referendum of the Nation, political and legal compromises were sought. For this purpose, the Group for the Adjustment of Constitutional Issues was formed. At the end of September and at the beginning of October 1992, one single (the so-called “compromise”) draft Constitution was prepared from the existing two alternative drafts. The Constitution of the Republic of Lithuania was adopted by the Nation in the referendum of 25 October 1992 and came into force on 2 November 1992. (shrink)

The Metropolitan Museum of Art (Met) recently hosted the blockbuster exhibition, Africa & Byzantium, which ran from November 19, 2023, to March 3, 2024. This long-anticipated show and accompanying catalogue1 represent one of the first major exhibitions to place the contemporaneous arts of Byzantine, Coptic, Nubian, Ethiopian, and Islamic traditions in Africa side by side. Showcasing medieval Africa’s rich cultural heritage, complexity, power, and transcontinental influence, Africa & Byzantium will become a standard resource for scholars reevaluating Africa’s role (...) in medieval art and culture. Head curator of the exhibition, Dr. Andrea Myers Achi, has kindly agreed to an interview as a supplement to the current Convivium issue on The Arts of Medieval Northern Africa. Dr. Achi is Mary and Michael Jaharis Associate Curator of Byzantine Art at the Met. She specializes in Late Antique and Byzantine art and archaeology in Northern Africa, particularly in Egypt. She previously worked on the Met’s exhibitions for Art and Peoples of the Kharga Oasis (October 11, 2017 – April 11, 2021), Crossroads: Power and Piety (March 6, 2020 – July 24, 2022), The Good Life: Collecting Late Antique Art at The Met (May 24, 2021 – January 7, 2024), and Afterlives: Contemporary Art in the Byzantine Crypt (2024), which recently opened and will be on display through January 25, 2026. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume 32, Number 1, April 2006, pp. 113-117 How Wide Is Hume's Circle? (A question raised by the exchange between Erin I. Kelly and Louis E. Loeb, Hume Studies, November 2004) ANNETTE C. BAIER Hume's version, in An Enquiry concerning the Principles of Morals, section 9,2 of the viewpoint from which moral assessments are made, and from which traits are recognized as virtues or vices, (...) is that it is one which activates a "universal principle of the human frame," the "principle of humanity." It displays "the force of many sympathies," and depends upon our possession of "some propensity to the good of mankind" (EPM 5.39; SBN 226). Does this represent a revision, on Hume's part, of his Treatise claim that sympathy with a person's "narrow circle" is what enables us to judge that person's moral goodness? A humanity-wide circle is scarcely "narrow," even if it is not wide enough for those who see our treatment of animals as relevant to our moral merit or demerit. The claim about sympathy with the narrow circle is made in the Treatise section "Of goodness and benevolence."3 It has recently been assuming the status of a definition of the Humean moral point of view, in some commentators' writings.4 If it had been so intended, then there would indeed be a revision in EPM, where there is no mention of narrow circles, merely two footnotes, 22 and 25, to the section "Why utility pleases," concerning the wisdom of confining our efforts to do good to those close to us, lest our efforts be "dissipated or lost for want of a properly limited object." But in fact Hume never claimed that sympathy with a Annette Baier formerly taught in the Department of Philosophy at the University of Pittsburgh, and is now retired. Email: ann.kurt@xtra.co.nz. 114 Annette C. Baier person's narrow circle was enough to enable us to recognize her bravery, her proper pride, her prudence, her good judgement, her wit, her integrity, her "justice" or her allegiance to lawful magistrates. It is needed only to judge her "goodness and benevolence. " (I take it that the title, "Of goodness and benevolence," is pleonastic, that the varieties of benevolence exhaust "goodness.") Just as benevolence is not the whole of virtue, for Hume, nor is "goodness." The section in which he uses the phrase, "narrow circle," begins with an explicit limitation of what is there to be discussed: "Having thus explained that praise and approbation for everything we call great in human affections, we now proceed to give an account of their goodness..." (T 3.3.3.1; SBN 602). "Good" is not, for Hume, the most general term of moral approbation. Just as we can judge some to be "too intrepid" (an ingredient in "greatness of mind"), so we can judge some to be "too good" (EPM 7.22; SBN 259). Hume's most general terms of approbation are "meritorious" and "estimable." He uses "good" in a restricted sense, for a person's possession of the group of virtues that come under "benevolence." In the Treatise 3.3.3.15 (SBN 581-82), he speaks not of one moral point of view, but of "steady and generalpoinrs of view" (my emphasis), and it is possible, indeed plausible, that sympathy with circles of different widths will be needed to recognize different virtues and groups of virtues. For some, such as justice, "extensive sympathy" (T 3.3.1.23; SBN 586) is needed. For others, such as affability, and other aspects of "goodness," we sympathize with the effects of the person's character on a less extensive circle. A good person is affable, generous, and kind, does well as friend, as parent, as neighbor, as colleague, as employer. She does considerate and helpful things to those she encounters, both those close to her, friends, family, and work-mates, and also to those to whom she is not so close, such as the needy in her own community, to whom she may give employment, or charity. Hume uses other phrases in Treatise 3.3 which are sometimes taken to refer to the same... (shrink)

Photo ID 71252867© Stepan Popov| Dreamstime.com Abstract While Medical Assistance in Dying (MAiD) has been legalized in Canada since 2016, it still excludes eligibility for persons who have mental illness as a sole underlying medical condition. This temporary exclusion was set to expire on March 17th, 2024, but was set 3 years further back by the Government of Canada to March 17th, 2027. This paper presents a critical appraisal of the case of MAiD for individuals with mental illness as the (...) sole underlying medical condition through the analysis of three ethical theories: principlism, deontology, and utilitarianism. Through evidence and discussion, it will be demonstrated that MAiD, in this context, may be ethically justifiable on the grounds of upholding human rights, protecting dignity, and minimizing suffering. Introduction In June of 2016, Medical Assistance in Dying (MAiD) was legalized in Canada.[1] Throughout the first six years, a temporary exclusion of eligibility for persons suffering solely from mental illness was extended.[2] The exclusion of mental illness as a sole underlying medical condition was set to expire on March 17, 2024.[3] However, on February 1, 2024, just over a month before the set expiration, the Government of Canada once again extended the exclusion, this time setting it back three years to March 17, 2027. There are currently several countries that allow MAiD for mental illness, including Belgium, the Netherlands, and Luxembourg.[4] Some countries, like Spain,[5] do not give specific guidance, leaving the matter under discussion by ethicists and courts. In these countries, there are specific (although different) requirements for the process; overall, for mental illness, the illness must be verifiable and not simply related to a perception of satisfaction with the length of life. This extension ignited discussion on whether MAiD for persons who have mental illness as a sole underlying medical condition in Canada is ethically acceptable. As a complex, multi-faceted, and interdisciplinary issue, ethicists assessing MAiD must take into account various moral obligations and considerations. This paper analyses MAiD in this context through the application of three ethical theories: principlism, deontology, and utilitarianism. This paper concludes that, based on the current evidence and knowledge of this developing situation, MAiD for persons with mental illness in Canada may be ethically justified on the grounds of upholding human rights, labour obligations, and dignity. Through the exploration of research and discussions, it will be demonstrated that society at large ought to protect liberty and act towards relieving suffering, thereby supporting the potential eligibility of MAiD for persons who have mental illness. Principlism: The Capacity and Ability to Assess and Decide for One’s Own Life Principlism is the application of four principles: autonomy, beneficence, non-maleficence, and justice. Principlism supports permitting MAiD for mental illness due to the importance of autonomy in decision-making, equitable and just practices for MAiD assessors, and reducing suffering for patients and their family member(s) and/or friend(s). Carter v. Canada, the Canadian Supreme Court ruling of 2015—which changed Canadian law to allow for MAiD—held that the prohibition of MAiD infringed on Canadians’ right to “life, liberty, and the security of the person.” In a unanimous decision, the Supreme Court of Canada decided that the criminal prohibition of MAiD violates the Canadian Charter of Rights and Freedoms.[6] The Court concluded that the criminal law prohibiting MAiD interfered with people’s autonomy and dignity, which are protected by the rights of liberty and security of the person.[7] The ruling emphasized that Canada’s constitution reflects the fundamental importance of individual autonomy in personal decision-making. Research provides evidence that MAiD improves autonomy: A study among psychiatric patients found that 8 of 48 psychiatric patients said the mere option of accessing MAiD was enough to assess their future options for living wholly.[8] These findings complement a study entailing interviews with 30 adults who have mental illness, which emphasized that the ability to access MAiD allows individuals to analyze their quality of life, envision their desired future, and make decisions accordingly.[9] Although not all participants agreed that mental illness as the only underlying medical condition was appropriate for MAiD eligibility, many participants agreed that patient autonomy in decision-making was paramount and should be respected. However, autonomy as an ethical principle does not immediately grant all persons with mental illness the option to access MAiD. There are multiple eligibility criteria for those who wish to receive MAiD, which still must be approved and assessed. Currently, eligibility criteria for MAiD states that individuals must “give informed consent to receive MAiD, meaning that the person has consented to receiving MAiD after they have received all information needed to make this decision.”[10] Consent requires capability or capacity, which is the ability to understand relevant information, appreciate its potential consequences, and make an informed decision for oneself.[11] Like for many other diseases, disabilities, and conditions, patient capability is determined on a case-by-case basis.[12] Given the stigma surrounding those struggling with mental health, this thorough case-by-case examination of an individual patient’s capability and capacity without prejudice or partiality should lead to equitable and fair treatment. Without appropriate testing, those with mental illness could be wrongly stripped of their decision-making power. Arguments against MAiD for those with mental illness have raised concerns about the potential for individuals to harm themselves and others. A survey of MAiD providers demonstrated that physicians believed that the bereavement experience following MAiD is challenging and profoundly distinct and that bereavement support for all members involved should be required.[13] However, while watching one die (of MAiD) may cause harm to their families, friends, and support system at large, it is also important to recognize that watching someone suffer and struggle through their mental health journey also poses significant harm. Qualitative studies in Ontario, Canada, have interviewed family members of persons with mental illness as a sole medical condition, and interviewees shared that witnessing the illness and its impacts on their close one's lives was a very difficult experience.[14] As it relates to MAiD, participants emphasized that those living with mental illness are in the best position to understand their own pain and suffering and, in turn, make their own decisions about relief.[15] In an interview, a MAiD provider stated that MAiD may provide less suffering and more peace, and that, although it “depends on the family,... usually the family is more prepared and at peace.”[16] On the contrary, a person who has mental illness may perceive choosing MAiD as beneficial to their family member(s) and/or friend(s). Among those who died by MAiD in 2021, 35.7 percent reported that they perceived themselves as a burden on their family and friends.[17] While some authors report their concerns regarding such social burden as a potential driving factor for MAiD requests, others report that there are other additional burdens associated with requesting MAiD that may be financial, societal, and personal.[18] As such, the extension of MAiD eligibility to those with mental illness will likely only allow a small number of people to be granted MAiD.[19] Many others will be diverted to appropriate services and treatments. Patients’ decision to choose MAID noted their ability to make choices about their own care, reflecting the value of autonomy.[20] Although it is difficult to determine what is good for families in individual cases, MAiD presents an option that is both beneficent and non-maleficent. Therefore, these arguments satisfy the principles which do not necessarily conflict with MAiD. Deontology: The Duty to Recognize Vulnerability and Relieve Suffering The argument here begins with the fundamental focus of deontology—that moral duty lies in an action rather than in its consequences. Further discussion is required to analyze the impact of MAiD on healthcare workers. The Canadian Medical Association (CMA) Code of Ethics and Professionalism requires physicians to abide by virtues, commitments, and responsibilities in delivering health care and service.[21] The code states that “a compassionate physician recognizes suffering and vulnerability, … and alleviate[s] the patient’s suffering.”[22] In the context of MAiD for persons with mental illness as a sole underlying medical condition, vulnerabilities could be wide in range. Many Canadians are concerned with the interaction between mental health and other social determinants of health, such as the lack of medical, disability, financial, housing, and social support and resources.[23] As a result, another layer to the ethical issue arises: Does permitting MAiD for mental illness treat the symptoms of the issue rather than the root problem itself (social, economic, and systemic inequities)? Some argue against MAiD, stating that the nation should first focus on developing better quality care and service.[24] Others support MAiD as a potential harm reduction approach, given that most of these unjust conditions require a higher level of long-term structural and public policy overhaul.[25] The CMA Code also calls upon physicians to recognize and alleviate patients’ suffering. Some argue that while physicians and medical professionals do work to relieve suffering, they are trained to do so through a primary care-based diagnose-and-treat approach.[26] Studies that have captured Canadian physicians’ experiences providing MAiD report that, although physicians stated that the work was rewarding, it came with many challenges, including strained relationships with coworkers, increased workload, and inadequate compensation.[27] Physicians report that a part of the problem is that MAiD rules are written by lawyers and experts who are removed from its reality in medical practice. As a result, there is a lack of clarity surrounding practice norms and a lack of support for physicians.[28] Thus, while healthcare practitioners have a duty to relieve patients’ suffering, they should feel adequately trained and supported in doing so. If physicians and healthcare professionals recognize vulnerability and relieve suffering, then they should act accordingly, regardless of potential associations or outcomes. Making persons with mental illness eligible for MAiD ensures that treatment to relieve their suffering is available. However, it is imperative that there are sufficient resources and support available to healthcare professionals to ensure that they feel prepared and supported to provide MAiD, should they wish to do so. Utilitarianism: Minimizing Intolerable Suffering and Dying with Dignity Overall, utilitarianism is largely concerned with the greatest happiness principle—to increase the amount of happiness for the greatest number of people. So far, this paper has analyzed individual, family, and practitioner-based ethical considerations. But if MAiD were to be extended to those with mental illness as a singular underlying medical condition, what implications would this have for the world and society at large? There is a global drive toward authorizing organized ending of life, with an increasing number of countries legalizing MAiD.[29] The medical system is generally seen as a safe and appropriate system to carry out MAiD, especially when suicide and self-harm are regarded as “alternatives.” Yet despite these worldwide efforts, many argue through the theory of utilitarianism that the inability to see long-term consequences renders MAiD a premature solution, particularly for those who are unable or unwilling to seek other forms of potentially healing treatment or for those who may undergo MAiD only for a technological innovation or biomedical advancement to later come along as a potential cure.[30] While it is true that MAiD does not prevent these “premature deaths,” it is also true that it does not claim to.[31] MAiD provides an option to alleviate intolerable suffering. Some individuals with severe mental illness do describe their condition as intolerable suffering. MAiD is seen as an option to minimize suffering. It can also be seen as a way to die with dignity and relief.[32] While predicting outcomes is difficult, extending MAiD eligibility for persons experiencing mental illness does not undermine its ability to end suffering. It allows eligible individuals to take charge of their health, their life, and their future. Conclusion Based on the current evidence, allowing MAiD for persons with mental illness as their sole underlying medical condition presents as an ethically justifiable action. The right to self-determination and fair accessibility demonstrates that there is more harm done by prohibiting MAiD for mental illness than allowing it. Such liberty is a right, and in the context of relieving suffering, it is a duty that healthcare workers must uphold, although the ability to opt out of providing MAiD is well established. Thus, to recognize vulnerability and relieve suffering means to provide methods, such as MAiD, for those deeply impacted by mental illness. These justifications stand at both the individual level and for society at large. Nevertheless, it remains imperative to take an upstream approach that addresses the social determinants of health and aims to prevent mental illness and promote long-term, beneficial social change for those suffering, struggling, and vulnerable in our communities. - [1] Jaro Kotalik and David W. Shannon, Medical Assistance in Dying (MAID) in Canada Key Multidisciplinary Perspectives, 1st ed. 2023., The International Library of Bioethics, 104 (Cham: Springer International Publishing, 2023), https://doi.org/10.1007/978-3-031-30002-8. [2] Department of Justice Government of Canada, “Canada’s Medical Assistance in Dying (MAID) Law,” February 21, 2024, https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html. [3] Health Canada, “Final Report of the Expert Panel on MAiD and Mental Illness,” transparency - other, May 13, 2022, https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advi sory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html. [4] Federal Public Service (FPS) Health Belgium, “Federal Commission for the Control and Evaluation of Euthanasia,” n.d., https://consultativebodies.health.belgium.be/en/advisory-and-consultative-bodies/federal-commission- control-and-evaluation-euthanasia.; Government of Netherlands, “Is Euthanasia Allowed in the Netherlands?,” n.d., https://www.government.nl/topics/euthanasia/is-euthanasia-allowed.; “Information on Requesting Euthanasia or Assisted Suicide,” n.d., https://guichet.public.lu/en/citoyens/sante/fin-vie/euthanasie/euthanasie-assistance-suicide.html. [5] Luis Espericueta, First official report on euthanasia in Spain: A comparison with the Canadian and New Zealand experiences, Medicina Clínica (English Edition), Volume 161, Issue 10, 2023, Pages 445-447, ISSN 2387-0206, https://doi.org/10.1016/j.medcle.2023.06.021. [6] Government of Canada, “The Canadian Charter of Rights and Freedoms,” March 15, 2021, https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/. [7] Supreme Court of Canada, “Carter v. Canada,” Constitutional Law, 2015, https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do.; Kotalik and Shannon, Medical Assistance in Dying (MAID) in Canada Key Multidisciplinary Perspectives. [8] Karandeep Sonu Gaind, “What Does ‘Irremediability’ in Mental Illness Mean?,” Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 65, no. 9 (September 2020): 604–6, https://doi.org/10.1177/0706743720928656; Lieve Thienpont et al., “Euthanasia Requests, Procedures and Outcomes for 100 Belgian Patients Suffering from Psychiatric Disorders: A Retrospective, Descriptive Study,” BMJ Open 5, no. 7 (July 27, 2015): e007454, https://doi.org/10.1136/bmjopen-2014-007454. [9] Hamer Bastidas-Bilbao et al., “Walking Alongside: Views of Family Members on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition,” Qualitative Health Research 33 (September 29, 2023), https://doi.org/10.1177/10497323231197365. [10] Government of Canada, “Canada’s Medical Assistance in Dying (MAID) Law.” [11] Commission sur les soins de fin de vie, “Les conditions de l’admissibilité à l’aide médicale à mourir au Québec: la constance dans l’évolution de la loi concernant les soins de fin de vie,” June 9, 2023, https://csfv.gouv.qc.ca/ fileadmin/docs/autres_rapports/csfv_lcsfv_conditions_ amm_2023-06-29.pdf.; Trudo Lemmens, “When Death Becomes Therapy: Canada’s Troubling Normalization of Health Care Provider Ending of Life,” The American Journal of Bioethics 23, no. 11 (November 2, 2023): 79–84, https://doi.org/10.1080/15265161.2023.2265265. [12] Justine Dembo, Udo Schuklenk, and Jonathan Reggler, “‘For Their Own Good’: A Response to Popular Arguments Against Permitting Medical Assistance in Dying (MAID) Where Mental Illness Is the Sole Underlying Condition,” Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie 63, no. 7 (July 2018): 451–56, https://doi.org/10.1177/0706743718766055. [13] Konia Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” British Columbia Medical Journal 62, no. 1 (2020). [14] Bastidas-Bilbao et al., “Walking Alongside.” [15] Bastidas-Bilbao et al. [16] Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” 2020. [17] Ramona Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” Palliative & Supportive Care 21, no. 5 (October 2023): 871–78, https://doi.org/10.1017/S1478951523001025; Health Canada, “Third Annual Report on Medical Assistance in Dying in Canada 2021,” report on plans and priorities;transparency - other, July 26, 2022, https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-me dical-assistance-dying-2021.html; Lemmens, “When Death Becomes Therapy.” [18] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023.; Bastidas-Bilbao et al., “Walking Alongside.” [19] Olivia Stefanovich, “Opposition Parties Call for Indefinite Pause to MAID Expansion for Mental Illness | CBC News,” Canadian Broadcasting Corporation, January 28, 2024, https://www.cbc.ca/news/politics/special-joint-committee-maid-mental-illness-report-1.7095679; Benjamin Lopez Steven, “Number of Assisted Deaths Jumped More than 30 per Cent in 2022, Report Says | CBC News,” Canadian Broadcasting Corporation, October 27, 2023, https://www.cbc.ca/news/politics/maid-canada-report-2022-1.7009704. [20] Hamer Bastidas-Bilbao et al., “Searching for Relief from Suffering: A Patient-Oriented Qualitative Study on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition,” Social Science & Medicine 331 (August 1, 2023): 116075, https://doi.org/10.1016/j.socscimed.2023.116075. [21] Canadian Medical Association, “Canadian Medical Association Code of Ethics and Professionalism” (Canada: Canadian Medical Association, December 8, 2018), https://policybase.cma.ca/link/policy13937. [22] Canadian Medical Association. [23] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023; Stefanovich, “Opposition Parties Call for Indefinite Pause to MAID Expansion for Mental Illness | CBC News.” [24] John Paul Tasker, “Liberal Government Promoting a ‘culture of Death’ with Medical Assistance in Dying Law, Conservative MP Says | CBC News,” Canadian Broadcasting Corporation, March 6, 2023, https://www.cbc.ca/news/politics/culture-of-death-medical-assistance-in-dying-mental-illness-1.67695 04. [25] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023; Kayla Wiebe and Amy Mullin, “Choosing Death in Unjust Conditions: Hope, Autonomy and Harm Reduction,” Journal of Medical Ethics, April 26, 2023, https://doi.org/10.1136/jme-2022-108871. [26] Ramona Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” Palliative & Supportive Care 21, no. 5 (October 2023): 871–78, https://doi.org/10.1017/S1478951523001025. [27] Konia Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” British Columbia Medical Journal 62, no. 1 (2020), https://bcmj.org/articles/attitudes-and-expectations-regarding-bereavement-support-patients-family-m embers-and.; William Robert Nielsen, “MAiD in Canada: Ethical Considerations in Medical Assistance in Dying,” Canadian Journal of Bioethics 4, no. 2 (December 9, 2021): 93–98, https://doi.org/10.7202/1084456ar. [28] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023. [29] Lemmens, “When Death Becomes Therapy.” [30] William Robert Nielsen, “MAiD in Canada: Ethical Considerations in Medical Assistance in Dying,” Canadian Journal of Bioethics 4, no. 2 (December 1, 2021): 93–98, https://doi.org/10.7202/1084456ar. [31] Steven, “Number of Assisted Deaths Jumped More than 30 per Cent in 2022, Report Says | CBC News.” [32] A. Plaisance et al., “Quebec Population Highly Supportive of Extending Medical Aid in Dying to Incapacitated Persons and People Suffering Only from a Mental Illness: Content Analysis of Attitudes and Representations,” Ethics, Medicine and Public Health 21 (April 1, 2022): 100759, https://doi.org/10.1016/j.jemep.2022.100759. (shrink)

In the course of its 53 Stephanus pages Plato's Protagoras uses the verb διαλέγεσθαι 32 times: a frequency considerably greater than that of any other dialogue. The next largest total is 21 occurrences in the Theaetetus. In the vast bulk of the Republic διαλέγεσθαι occurs just 20 times over 294 Stephanus pages. The ratios are striking. In the Protagoras the verb turns up on average once every 1.65 Stephanus pages; in the Theaetetus once every 3.25 pages; in the Republic only (...) once every 14.7. The statistics reflect a fact evident to any reader of the Protagoras and Theaetetus, that the first of these dialogues is Plato's most sustained treatment of the comparative merits of the many different forms of διαλέγεσθαι, the second his most ambitious exhibition of the type of dialectic with which Socrates there wins his contest against Protagoras. It is the former dialogue that interests me here. (shrink)

The texts in this collection are revised versions of presentations given at the Coimbra International Conference on the Semantics of Culture, held on November 24-25, 2011. Their common theme is the idea that the phenomenon of culture cannot be reduced to a substantialist vision of the diversity of manifestations of society and human beings. However, if one were to accept the concept of culture as a starting point for observing these manifestations, then it should also be adopted as (...) a starting point for critical questioning, that is, for problematizing. The texts in this volume contribute to this philosophical problematization by pointing out - each with its own perspective of analysis - articulations of the phenomenon of culture as a theoretical object and as a thematic object. (shrink)

Belief revision theory concerns methods for reformulating an agent's epistemic state when the agent's beliefs are refuted by new information. The usual guiding principle in the design of such methods is to preserve as much of the agent's epistemic state as possible when the state is revised. Learning theoretic research focuses, instead, on a learning method's reliability or ability to converge to true, informative beliefs over a wide range of possible environments. This paper bridges the two perspectives by assessing the (...) reliability of several proposed belief revision operators. Stringent conceptions of “minimal change” are shown to occasion a limitation called inductive amnesia: they can predict the future only if they cannot remember the past. Avoidance of inductive amnesia can therefore function as a plausible and hitherto unrecognized constraint on the design of belief revision operators. (shrink)

The volume starts with the paper of Lynn Maurice Ferguson Arnold, former Premier of South Australia and former Minister of Education of Australia, concerning the Exposition Internationale des Arts et Techniques dans la Vie Moderne (International Exposition of Art and Technology in Modern Life) that was held from 25 May to 25 November 1937 in Paris, France. The organization of the world exhibition had placed the Nazi German and the Soviet pavilions directly across from each other. Many (...) papers are devoted to the interpretation of this opposition. Arnold’s paper considers the differences in the two totalitarian states’ architectural and design discourse styles. Although each of them communicated a totalitarian language of purposes, permissions, and boundaries, they essentially differed in the styles of discourse represented by the architecture and design of their respective pavilions. They were opposites of each other and the liberal ideals they contested. The internationalist viewpoint reflecting the multi-ethnic mix of the USSR is contrasted to the ein Volk homogeneity represented in the German pavilion. The Soviet pavilion opted for a utopian future to be arrived at by “benign” leadership, whereas the German pavilion anchored itself in the myth of Teutonic history with the nostalgic pride protected by the swastika-bearing eagle. Jean-Yves Béziau is best known as a logician and founder of Universal Logic. However, in this paper, he poses a new philosophical question: why philosophical discourse does not use images? The paper begins with a general analysis of different types of philosophical discourses. Then, he focuses on why images have been and are still rejected in philosophical discourse. He explains various ways to use images in a fruitful way to develop philosophical thinking and discourse and illustrates his view by providing several examples. He concludes with a promising programmatic declaration about founding a new journal entitled World Journal of Pictorial Philosophy to stimulate the usage of images for developing philosophical thinking. Although complaints about the obscurity of many philosophers’ discourse are widespread, Tatiana Denisova, ex-professor of the Surgut University and a research associate of the University of the Aegean undertakes a positive attitude to this problem. She explains that the reasons for the obscurity of philosophical texts, the subsequent complexity in communicating philosophers’ meanings and their eventual incomplete understanding is not a sign of their inferiority. On the contrary, it is a sign of the fruitfulness of philosophical discourse, which can generate new meanings. Thus, the darkness of philosophical discourse is like the life-giving chaos, and the obscurity that it inevitably contains can be the keeper of implicit meanings and even their generator. Katarzyna Gan-Krzywoszyńska and Piotr Leśniewski, authors of a monograph on Polish philosopher Kazimierz Ajdukiewicz (1890 – 1963), make a comparative analysis of his educational style with that of Paulo Reglus Neves Freire (1921 – 1997). The authors highlight that these scholars have distinctly different backgrounds. The former was an educator, philosopher and a leading advocate of critical pedagogy connected with the dialogical Latin-American tradition. The latter was a philosopher and logician, a notable representative of the Lwów–Warsaw school of logic with significant contributions to semantics, model theory and the philosophy of science. Despite their apparent difference, the authors identify some striking similarities regarding their attitudes towards education; notably, their approaches are essentially dialogical. Gilah Yelin Hirsch is a multidisciplinary artist who works as a painter, writer, curator, educator, and filmmaker. In her experiential paper, he explains how and why she uses four channels of communication in her creative expression: writing, painting, filmmaking, and teaching, as dialogic inquiry. She considers that these channels compose a continuum of discourse styles, each reaching a different facet of kaleidoscopic consciousness. She claims that her choice of medium is prompted by a need to communicate her insights profoundly. Thus, for instance, she created painted allegories to express narratives based on dreams and visions emerging from her subconscious. Art and healing is another Tibetan-rooted type of discourse practised by the author. Creating and observing a healing image produces a positive psychophysiological change in both the artist and the viewer. The discourse here is tripartite between creator, image, and viewer. Filmmaking is another type of discourse she practices between the filmmaker/artist as shaman or healer and the viewer as respondent or participant. These films are meant to be experienced frame by frame, physically and emotionally in both the body and mind. Jocelyn Ireson-Paine is a cartoonist and programmer. His paper offers an original attempt to use category theory in cartooning. Category theory is a branch of mathematics that provides concepts and methods to describe general abstract structures in terms of a labelled directed graph called category, whose nodes are called objects, and whose labelled directed edges are called arrows (or morphisms or transformations or mappings). The author explores different ways to define “style” in art using category theory and a relational view of art. Moreover, he examines how “translation” (transformation) between styles could be defined and reveals the difficulties of how it could be implemented in a computer using special software. Jens Lemanski is a philosopher who has revived research in Arthur Schopenhauer’s legacy by exploring his work on mathematical evidence, logic diagrams, and problems of semantics. In this paper, he advances a new approach to eristic as an art of protecting oneself from the one who deliberately violates norms of discourse ethics to win an argument. The author attributes the origins of this view to Schopenhauer, suggesting a new reading of his work. According to the author, eristic is a prohibitive technique that takes effect when the norms of discourse ethics are transgressed and violated. Thus, eristic is viewed as a discipline of Enlightenment philosophy and a correlate of discourse ethics. Roshdi Rashed is an authority on the history of Arabic mathematical sciences. Proceeding from Gilles-Gaston Granger’s definition of mathematical style, he studies the question of whether a mathematical work can be characterized by a single style or by a multitude of styles. This question is explored within the style of a single work, namely Menelaus’s Sphaerica, and through the study of the development of a single problem over time, namely the isoperimetric problem. He indicates Menelaus’s divergence from the Euclidean style of (plane and stereometric) geometry caused by the drop of the Parallel Postulate, which associated it with hyperbolic geometry. Hence, the author concludes that Menelaus’s Sphaerica incorporates the well-known Euclidean style with a variation of the non-Euclidean one. On the other hand, examining the isoperimetric problem reveals another interesting historical picture. A succession of different styles (cosmological, geometric, infinitesimalistic, style of the calculus of variations, of synthetic geometry) can be observed due to the transformation of the research object over time. Boris Shalyutin, a Russian social philosopher, and Ombudsman for Human Rights in the Kurgan Region, explores the origins of discourse in combination with the birth of society and law. He claims that legal discourse marks the historical emergence of discourse in general. Homo Juridicus generated Homo Sapiens, which have created new spheres of discourse, notably moral discourse and further philosophical, political, and scientific discourse. Petros Stefaneas, a logician, computer scientist and novelist, suggests an alternative to the traditional narratology approach for studying (interactive) social media discourse. He claims that style describes how the parts of a narrative are blended into a whole. The author relies upon Goguen’s and Harrel’s concept of style as a choice of blending principles and transfers to the study of the social media narratives elements from the methodology of studying Web-based collaborative search for mathematical proofs like those implemented within the Polymath project. The last paper belongs to Ghil‘ad Zuckermann, a linguist, language revivalist, and proponent of a model of the emergence of Israeli Hebrew, according to which Hebrew and Yiddish were the primary sources of Modern Hebrew. This paper explores the fascinating and multifaceted Yiddish language and its survival in Israeli. Yiddish is characterized by a unique style that embeds psycho-ostensive expressions throughout its discourse. The author highlights the cross-fertilization between Hebrew and Yiddish as it manifests itself in any aspect of the Israeli language. He claims that Yiddish survives beneath Israeli phonetics, phonology, discourse, syntax, semantics, lexis, and even morphology, although traditional and institutional linguists have been most reluctant to admit it. (shrink)

Summary Many people were involved in producing the seven volumes that make up the fourth series of the Royal Society catalogue of scientific papers. Included were about two hundred volunteers and about one hundred people working either on short-term contracts or carrying out piece work. At the Royal Society there was a small, largely female, secretariat working full-time. It included both clerical and bibliographic staff. Coordinating all the work was the chemist Herbert McLeod, appointed director of the catalogue in 1901. (...) As is discussed, the position of director was created especially for him after his forced retirement from the Royal Indian Engineering College. The paper shows the complexity of the work involved in producing the catalogue, as well as something of the office culture at the Royal Society in the early twentieth century. The working conditions of the women employees, and prevailing attitudes toward the largely female clerical and bibliographic staff, are briefly discussed. (shrink)

Texas festivals are given credit for providing benefits for both the festival's community and for the people who visit the community. As a result of these perceived benefits, communities across Texas stage a broad range of festivals and events. These events require substantial planning and skilled management to be successful. Those involved in the planning are often volunteers and have little or no background in event planning and management. Regardless of their experience level however, most event coordinators have ongoing needs (...) for information that will help them produce successful events. To produce a successful event, coordinators seek information from a variety of sources. These sources may include their personal network of friends and colleagues to professional consultants or formal workshops, conferences, and seminars. The primary purpose of this project is to provide information that will help the Texas Agricultural Extension Service Recreation, Park & Tourism Program evaluate its future role in responding to the needs of Texas festival coordinators. To accomplish this end, this study seeks to identify information needs of Texas festival coordinators and to describe how current sources of information are utilized by festival coordinators. This paper outlines the development and implementation of an information needs assessment of Texas festival coordinators and a description of current information sources being used by them. The project seeks to identify gaps in the provision of information and the access Texas festival coordinators perceive they have to information. The "importance"/"access" scale of this survey clearly identifies a range of important information topics which organizations could address. The following are the top 10 information needs of Texas festival coordinators as indicated by mail survey respondents: 1. Writing press releases 2. How to measure advertising success 3. Regulations for food, fire, safety, etc. 4. How to find regional talent 5. Insurance issues 6. Americans with Disabilities Act (ADA) 7. How to find and contract for professional entertainment 8. How to determine space requirements for event activities 9. How to create a layout for people/vehicle flow and activities 10. Estimating amount and type of security need It is indicated that most coordinators are aware of the six organizations and agencies that serve the needs of the festival industry. 1. International Festivals & Events Association (IFEA) 2. Texas Agricultural Extension Service (TAEX) - Department of Recreation, Park & Tourism at Texas A&M University 3. Texas Travel Industry Association (TTIA) 4. Texas Festivals & Events Association (TFEA) 5. Texas Department of Economic Development (TDED) 6. Texas Department of Transportation (TxDOT) Of respondents to the needs assessment mail survey, 82.8% to 72.6% of Texas festival coordinators are aware of the programs and services of these organizations and agencies. While coordinators show a high level of awareness of conferences, seminars, and workshops, only 13% to 24.7% have attended. Coordinator networks and the internet are viable sources of information. The majority (88%) of festival coordinators (n=216) indicated they have access to the internet and 81.9% of respondents (n=215) said they use the internet. Organizations can use this study and its results to focus on information needs that coordinators indicate are important and have low accessibility. January and February followed by June and July would be the best months for conferences, seminars, and workshops. Seminars may be held during the "off peak" months of January and February while brochures about how to better market an event can be distributed during the peak festival times of September and April. Coordinators' responses as to the best months they would be able to attend Certified Festival Manager (CFM) training also corresponded with event seasonality patterns. Using multiple distribution methods can improve access to festival planning information. Workshops, internet sites, brochures, and publications are just a few of the ways organizations may vary their distribution of information resources. Coordinators indicted their main source of information comes from coordinator networks (48.9%). This finding should be used to note the importance of networking at coordinator informational events. The internet is a viable source of information. Of the respondent coordinators, 98% indicted they have access to the internet. It is reasonable to suggest that more information can be provided via the internet. There are clearly overlapping functions among these organizations', however, many programs are carried out as partners in serving the festival industry. While this study did not examine these overlapping roles, it would be appropriate that areas of overlap should be examined more closely. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Beyond the Ethics of Wealth and a World of Economic InequalityMark D. WoodAnalyzing the ethics of wealth and the relationship between the dominant ethics of wealth and economic inequality is vital to creating a humane mode of global life. We are living during a period in which the unequal concentration of wealth—which is to say, the unequal concentration of the resources that make human existence, development, and fulfillment possible—has (...) never been greater.1 The World Bank reports that almost “1.3 billion people remain below the extreme poverty line with an income of US $1.25 or less a day. Close to 2.5 billion—more than one-third of the world’s population—live on less than US $2 a day, another common measurement of deep deprivation,”2 and a staggering 80 percent of the world’s population struggles to survive on less than US $10 dollars a day.3 Credit Suisse’s 2012 Global Wealth Report indicates “the bottom half of the global population [or more than 3.5 billion persons] possess barely 1 percent of total wealth... In sharp contrast, the richest 10 percent own 86 percent of the world’s wealth, with the top 1 percent alone accounting for 46 percent of global assets.”4 Given the history of international colonial and neocolonial relations, it comes as no surprise that wealth is highly concentrated in Western Europe and North America, while the overwhelming majority of individuals living in poverty are concentrated in Africa, India, Asia, and Central and South America.5The wealth gap between the top 10 percent and the bottom 90 percent is, however, also reaching record levels in developed nations. While in 2012, the United States had the seventh highest average wealth holdings per adult in the world, “among nations with at least a quarter-million adults, only Russia, Ukraine, and Lebanon are more unequal” than the United States.6 A Reuters investigative report published in 2012 reveals that “inequality has risen not just in plutocratic hubs such as Wall Street and Silicon Valley, but also in virtually every corner of the world’s richest nation: Inequality has increased in 49 of 50 states since 1989,” with Mississippi being the only exception, even as it still “ranks worst in the nation on both counts.”7 In 2010, “the top 1 percent of households (the upper class) owned 35.4 percent of all privately held wealth, and the next 19 percent (the managerial, professional, and small business stratum) had 53.5 percent, which means that just 20 percent of the people owned a remarkable 89 percent, leaving only 11 percent of the wealth for the bottom 80 percent [End Page 125] (wage and salary workers).”8 In The Price of Inequality (2012), Nobel Prize–winning economist Joseph E. Stiglitz indicates that the “six heirs to the Walmart empire command wealth of $69.7 billion dollars, which is equivalent to the entire wealth of the bottom 30 percent of U.S. society.”9 In short, six individuals possess more wealth than do ninety-six million individuals—though this figure is misleading inasmuch as most of the ninety-six million own almost nothing but mounting debt. Most significantly, the top 10 percent own between 81 percent and 94 percent of all stocks, bonds, trust funds, and business equity, and almost 80 percent of non-home real estate.10 G. William Domhoff makes the vital point that inasmuch as “financial wealth is what counts as far as the control of income-producing assets,” that is, control of the means of producing wealth, “we can say that just 10 percent of the people own the United States of America.”11 Meanwhile, according to the latest census, fifty million Americans qualify as poor and another 100 million qualify as low income.12The concentration of the lion’s share of wealth in the hands of a tiny fraction of humanity is devastating for the majority of people living on the planet and ultimately for everyone. On the ground, capitalism’s champagne glass–shaped distribution of wealth means that hundreds of millions of persons have barely enough of the basics necessary to exist. Between 24,000... (shrink)

The first National Bioethics Conference in India was held from 25 to 27 November 2005 at the YMCA and Rail Nikunj, in Mumbai, India, under the aegis of the Indian Journal of Medical Ethics. Twenty institutions from all over the country participated in organising the conference, including All India Institute of Medical Sciences from Delhi, King Edward Memorial Hospital, Forum for Medical Ethics Society and Jaslok Hospital from Mumbai, National AIDS Research Institute from Pune, Institute of Legal Medicine (...) from Chennai, and Christian Medical College from Vellore among others. More than 400 delegates from all over the world attended the conference. It was interesting to see that the participants were from different areas of healthcare delivery, …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume XXV, Numbers 1 and 2, April/November 1999, pp. 139-153 Hume on Monkish Virtues WILLIAM DAVIE In the second Enquiry1 Hume denounces the "monkish virtues," saying that men of sense will regard them as vices because they "cross all... desirable ends; stupify the understanding and harden the heart, obscure the fancy and sour the temper" (EPM 270). He includes under this heading, "Celibacy, fasting, penance, (...) mortification, self-denial, humility, silence, solitude." No doubt Hume's stance regarding the "monkish virtues" does fit into a particular vision of the desirable life, but it may be questioned whether it fits his philosophy with full consistency. In this paper, I will argue that Hume's explicit formula for identifying virtues fails to justify his rejection of the monkish virtues if it is followed without prejudice. I. Identifying Virtues Our whole comprehension of virtue, and our competence to identify it in any community, ultimately derives from our perception of virtue in particular instances. The edifice of morality reaches into the thin air of abstractions and general rules, but it does not begin there and it is always grounded in the concrete experience of human individuals. In the most basic case, what we perceive is not (say) the trait of kindness as embodied in George.2 We rather perceive the whole phenomenon of George in his particular situation. We pick up information about the person and the surroundings, including bits about motivation, moods, temptations, complications of all sorts, plus the general William Davie is an associate professor at the Department of Philosophy, 1295 University of Oregon, Eugene, OR 97403-1295, USA. e-mail: wdavie@darkwing.uoregon.edu 140 William Davie background understanding we have of human nature. We ascertain whether the man's character is useful or agreeable, for himself or others. All this is needed to "pave the way" for the activation of moral sentiment. Then we get an impression (not an idea) of the man's virtue; we feel the warm glow of George's kindness on this particular occasion. How does language figure in our experience of moral differences? We know that as any individual's time on earth mounts up, and as one gains a few years of experience, he or she will gradually acquire abstract ideas and the words which signify them. Here in brief is Hume's account of the formation process (T 17-25). The first order of business is to notice a resemblance among certain objects of experience; we apply the same word to all of them. Thus, we would gather indefinitely many instances in which the word 'kind' is applied to something, or where somebody speaks of 'kindness.' The word becomes associated with a certain custom, or habit of mind, which custom is evoked whenever we hear or speak that word, or at least whenever the word is used wrongly. In that event, the custom fires up some relevant counterexamples for our attention. If somebody asserts, "True kindness is always well-planned and fully reflective," our mind instantly lights upon cases of spontaneous or impulsive kindness. If we should overhear, "She is a very kind person, so people don't like her," we know that something is amiss. Our competence in handling abstract ideas clearly underwrites the catalog that Hume confidently envisions at the start of his second Enquiry. We can make two lists, one for virtues and one for vices. In this process, Hume thinks, "The very nature of language guides us almost infallibly" (EPM 174). We can easily appreciate why it should be so. Our moral epithets are mounted on items of direct perception. Our understanding of a particular word is really a custom of associating certain elements of our own experience. He offers some concrete guides, each of which can be used from one's armchair : 1. A philosopher can "enter into his own breast" for a moment, and consider whether or not he should desire to have this or that quality ascribed to him. 2. He can consider whether the attribution of a particular quality to him would come from a friend or an enemy. 3. He can consider whether a quality, if ascribed to any person, "implies... (shrink)

In this article Roberto Balzani, the mayor of Forlì, remembers Roberto Ruffilli, 25 years after his murder. The remembrance reconstructs the steps of his academic career and of his political commitment. Ruffilli graduated at the Catholic University of Milan; his researches in contemporary history placed him in an original position if compared with the Italian studies of the time. The constant attention towards the history of administration and the transformations of the state is the basis on which Ruffilli built his (...) proposals concerning the reform of the insitutional and political system. Balzani concludes the article by affirming that the problems of today aren't any different, that is why Ruffilli's proposals still demonstrate their modernity. (shrink)

Algorithmic probability and friends: Proceedings of the Ray Solomonoff 85th memorial conference is a collection of original work and surveys. The Solomonoff 85th memorial conference was held at Monash University's Clayton campus in Melbourne, Australia as a tribute to pioneer, Ray Solomonoff, honouring his various pioneering works - most particularly, his revolutionary insight in the early 1960s that the universality of Universal Turing Machines could be used for universal Bayesian prediction and artificial intelligence. This work continues to increasingly influence (...) and under-pin statistics, econometrics, machine learning, data mining, inductive inference, search algorithms, data compression, theories of intelligence and philosophy of science - and applications of these areas. Ray not only envisioned this as the path to genuine artificial intelligence, but also, still in the 1960s, anticipated stages of progress in machine intelligence which would ultimately lead to machines surpassing human intelligence. Ray warned of the need to anticipate and discuss the potential consequences - and dangers - sooner rather than later. Possibly foremostly, Ray Solomonoff was a fine, happy, frugal and adventurous human being of gentle resolve who managed to fund himself while electing to conduct so much of his paradigm-changing research outside of the university system. The volume contains 35 papers pertaining to the abovementioned topics in tribute to Ray Solomonoff and his legacy. (shrink)

Exhibition catalogue for the exhibition of drawings and paintings held as part of the Wilderness and Inner Space conference at the University of Kent, Canterbury 2008. The concept of Territorialization from Deleuze and Guattari is linked to ideas of wilderness to both describe the psychotherapeutic relationship and to critique the proposed state regulation of the psychotherapies. The transference and counter transference relation between client and psychotherapist is described as a process of territorialization and deterritorialization in which a (...) dream of the client led to the production of art works by the psychotherapist. This at work led to the production of imagery based around the therapeutic relationship involving key images of wild animals. The animal imagery is linked to Deleuze and Guattari's re-interpretation of Freud’s interpretation of the Wolfman dream, emphasizing the social and historical determinants of dream imagery. The interrelationships between Wilderness, Territorialization and the personal and the political in dream imagery suggest the psychotherapeutic space as located on the borders between the social and a wild or wilderness space. The need to recognise the wild dimension of psychotherapy highlights the necessity to resist the imposition of monocultures of therapeutic practice through possible state regulation. (shrink)

In Book 8 of his Geographike Hyphegesis Ptolemy gives coordinates for ca. 360 so-called noteworthy cities. These coordinates are the time difference to Alexandria, the length of the longest day, and partly the ecliptic distance from the summer solstice. The supposable original conversions between the coordinates in Book 8 and the geographical coordinates in the location catalogue of Books 2–7 including the underlying parameters and tabulations are here reconstructed. The results document the differences between the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} (...) \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\Omega}$$\end{document} - and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\Xi}$$\end{document} -recension. The known difference in the longitude of Alexandria underlying the conversion of the longitudes is examined more closely. For the ecliptic distances from the summer solstice of the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\Omega}$$\end{document} -recension, it is revealed that they were originally computed by means of a so far undiscovered approximate, linear conversion. Further it is shown that the lengths of the longest day could be based on a linear interpolation of the data in the Mathematike Syntaxis 2.6. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:ArtistsJennifer and Kevin McCoy are Brooklyn-based artists who make projects about how our thoughts, experiences, and memories are structured through genre and repetition. In order to focus attention on these structures, they often reexamine classic works of science fiction or television narrative, creating sculptural objects, video projections, or live events from what they find.Their work has been exhibited at The Museum of Modern Art, The Metropolitan Museum of Art, (...) The New Museum (all in New York), and The Renaissance Society (Chicago). International exhibitions include projects at ZKM (Karlsruhe, Germany) and Kunst Werke (Berlin), and a solo exhibition at The British Film Institute (London, UK). Articles about their work have appeared in Art News, Art in America, Artforum, Flash Art, The Wire, dArt International, Spin Magazine, Feed, and The Independent. Installation view and detail images of Double Fantasy 2 (Sex) were shown in the solo exhibition "Directed Dreaming" at Postmasters, New York, March–April 2006. The Double Fantasy image was part of the exhibition "Night Sites" at the Hannover Kunstverein in Hannover Germany, November 2005. Each side of the sculpture has a model of a childhood sex fantasy for each of us. Cameras project large-scale images of it onto the wall, accompanied by a soundtrack. Click for larger view View full resolutionFigure 1.Jennifer and Kevin McCoy, Double Fantasy 2 (Sex). "Directed Dreaming," installation view. March–April 2006 at Postmasters Gallery, New York(Cover) Click for larger view View full resolutionFigure 2.Jennifer and Kevin McCoy, Double Fantasy 2 (Sex). "Directed Dreaming," installation view. March–April 2006 at Postmasters Gallery, New York(Page 2) Click for larger view View full resolutionFigure 3.Jennifer and Kevin McCoy, Double Fantasy 2 (Sex). "Directed Dreaming," detail. March–April 2006 at Postmasters Gallery, New York(Page 16) Click for larger view View full resolutionFigure 4.Jennifer and Kevin McCoy, Double Fantasy 2 (Sex). "Directed Dreaming," detail. March–April 2006 at Postmasters Gallery, New York(Page 32) Click for larger view View full resolutionFigure 5.Jennifer and Kevin McCoy, Double Fantasy 2 (Sex). "Directed Dreaming," installation view. March–April 2006 at Postmasters Gallery, New York(Page 47) Click for larger view View full resolutionFigure 6.Jennifer and Kevin McCoy, Double Fantasy 2 (Sex). "Directed Dreaming," installation view. March–April 2006 at Postmasters Gallery, New York(Page 63) Click for larger view View full resolutionFigure 7.Jennifer and Kevin McCoy, Double Fantasy 2 (Sex). "Directed Dreaming," installation view. March–April 2006 at Postmasters Gallery, New York(Page 77) Click for larger view View full resolutionFigure 8.Jennifer and Kevin McCoy, Double Fantasy 2 (Sex). "Directed Dreaming," detail. March–April 2006 at Postmasters Gallery, New York(Page 92) Click for larger view View full resolutionFigure 9.Jennifer and Kevin McCoy, Double Fantasy. "Night Sites," installation view. November 2005 at Hannover Kunstverein, Hannover, Germany(Page 107)Copyright © 2007 The Johns Hopkins University Press... (shrink)

ABSTRACT I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments. INTRODUCTION In contrast to the classic model of randomized-control trials, often with a large number of (...) subjects enrolled, precision medicine attempts to optimize therapeutic outcomes by focusing on the individual.[i] A recent publication highlights the strengths and weakness of both traditional evidence-based medicine and precision medicine.[ii] Plus, it outlines a tension in the shift from evidence-based medicine’s inductive reasoning style (the collection of data to postulate general theories) to precision medicine’s abductive reasoning style (the generation of an idea from the limited data available).[iii] The paper’s main example is the application of precision medicine for the treatment of cancer.[iv] I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. As the name suggests, brain-computer interfaces are a significant advancement in neurotechnology that directly connects someone’s brain to external or implanted devices.[v] Among the various kinds of brain-computer interfaces, adaptive deep brain stimulation devices require numerous personalized adjustments to their settings during the implantation and computation stages in order to provide adequate relief to patients with treatment-resistant disorders. What makes these devices unique is how adaptive deep brain stimulation integrates a sensory component to initiate the stimulation. While not commonly at the level of sophistication as self-supervising or generative large language models,[vi] they currently allow for a semi-autonomous form of neuromodulation. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments.[vii] ANALYSIS I. The State of Precision Medicine in Oncology and the Epistemological Shift While a thorough overview of precision medicine for the treatment of cancer is beyond the scope of this article, its practice can be roughly summarized as identifying clinically significant characteristics a patient possesses (e.g., genetic traits) to land on a specialized treatment option that, theoretically, should benefit the patient the most.[viii] However, in such a practice of stratification patients fall into smaller and smaller populations and the quality of evidence that can be applied to anyone outside these decreases in turn.[ix] As inductive logic helps to articulate, the greater the number of patients that respond to a particular therapy the higher the probability of its efficacy. By straying from this logical framework, precision medicine opens the treatment of cancer to more uncertainty about the validity of these approaches to the resulting disease subcategories.[x] Thus, while contemporary medical practices explicitly describe some treatments as “personalized”, they ought not be viewed as inherently better founded than other therapies.[xi] A relevant contemporary case of precision medicine out of Norway focuses on the care of a patient with cancer between the ventricles of the heart and esophagus, which had failed to respond to the standard regimen of therapies over four years.[xii] In a last-ditch effort, the patient elected to pay out-of-pocket for an experimental immunotherapy (nivolumab) at a private hospital. He experienced marked improvements and a reduction in the size of the tumor. Understandably, the patient tried to pursue further rounds of nivolumab at a public hospital. However, the hospital initially declined to pay for it given the “lack of evidence from randomised clinical trials for this drug relating to this [patient’s] condition.”[xiii] In rebuttal to this claim, the patient countered that he was actually similar to a subpopulation of patients who responded in “open‐label, single arm, phase 2 studies on another immune therapy drug” (pembrolizumab).[xiv] Given this interpretation of the prior studies and the patient’s response, further rounds of nivolumab were approved. Had the patient not had improvements in the tumor’s size following a round of nivolumab, then pembrolizumab’s prior empirical evidence in isolation would have been insufficient, inductively speaking, to justify his continued use of nivolumab.[xv] The case demonstrates a shift in reasoning from the traditional induction to abduction. The phenomenon of ‘cancer improvement’ is considered causally linked to nivolumab and its underlying physiological mechanisms.[xvi] However, “the weakness of abductions is that there may always be some other better, unknown explanation for an effect. The patient may for example belong to a special subgroup that spontaneously improves, or the change may be a placebo effect. This does not mean, however, that abductive inferences cannot be strong or reasonable, in the sense that they can make a conclusion probable.”[xvii] To demonstrate the limitations of relying on the abductive standard in isolation, commentators have pointed out that side effects in precision medicine are hard to rule out as being related to the initial intervention itself unless trends from a group of patients are taken into consideration.[xviii] As artificial intelligence (AI) assists the development of precision medicine for oncology, this uncertainty ought to be taken into consideration. The implementation of AI has been crucial to the development of precision medicine by providing a way to combine large patient datasets or a single patient with a large number of unique variables with machine learning to recommend matches based on statistics and probability of success upon which practitioners can base medical recommendations.[xix] The AI is usually not establishing a causal relationship[xx] – it is predicting. So, as AI bleeds into medical devices, like brain-computer interfaces, the same cautions about using abductive reasoning alone should be carried over. II. Responsive Neurostimulation, AI, and Personalized Medicine Like precision medicine in cancer treatment, computer-brain interface technology similarly focuses on the individual patient through personalized settings. In order to properly expose the intersection of AI, precision medicine, abductive reasoning, and implantable neurotechnologies, the descriptions of adaptive deep brain stimulation systems need to deepen.[xxi] As a broad summary of adaptive deep brain stimulation, to provide a patient with the therapeutic stimulation, a neural signal, typically referred to as a local field potential,[xxii] must first be detected and then interpreted by the device. The main adaptive deep brain stimulation device with premarket approval, the NeuroPace Responsive Neurostimulation system, is used to treat epilepsy by detecting and storing “programmer-defined phenomena.”[xxiii] Providers can optimize the detection settings of the device to align with the patient’s unique electrographic seizures as well as personalize the reacting stimulation’s parameters.[xxiv] The provider adjusts the technology based on trial and error. One day machine learning algorithms will be able to regularly aid this process in myriad ways, such as by identifying the specific stimulation settings a patient may respond to ahead of time based on their electrophysiological signatures.[xxv] Either way, with AI or programmers, adaptive neurostimulation technologies are individualized and therefore operate in line with precision medicine rather than standard treatments based on large clinical trials. Contemporary neurostimulation devices are not usually sophisticated enough to be prominent in AI discussions where the topics of neural networks, deep learning, generative models, and self-attention dominate the conversation. However, implantable high-density electrocorticography arrays (a much more sensitive version than adaptive deep brain stimulation systems use) have been used in combination with neural networks to help patients with neurologic deficits from a prior stroke “speak” through a virtual avatar.[xxvi] In some experimental situations, algorithms are optimizing stimulation parameters with increasing levels of independence.[xxvii] An example of neurostimulation that is analogous to the use of nivolumab in Norway surrounds a patient in the United States who was experiencing both treatment-resistant OCD and temporal lobe epilepsy.[xxviii]Given the refractory nature of her epilepsy, implantation of an adaptive deep brain stimulation system was indicated. As a form of experimental therapy, her treatment-resistant OCD was also indicated for the off-label use of an adaptive deep brain stimulation set-up. Another deep brain stimulation lead, other than the one implanted for epilepsy, was placed in the patient’s right nucleus accumbens and ventral pallidum region given the correlation these nuclei had with OCD symptoms in prior research. Following this, the patient underwent “1) ambulatory, patient-initiated magnet-swipe storage of data during moments of obsessive thoughts; (2) lab-based, naturalistic provocation of OCD-related distress (naturalistic provocation task); and (3) lab-based, VR [virtual reality] provocation of OCD-related distress (VR provocation task).”[xxix] Such signals were used to identify when to deliver the therapeutic stimulation in order to counter the OCD symptoms. Thankfully, following the procedure and calibration the patient exhibited marked improvements in their OCD symptoms and recently shared her results publicly.[xxx] In both cases, there is a similar level of abductive justification for the efficacy of the delivered therapy. In the case study in which the patient was treated with adaptive deep brain stimulation, they at least had their neural activity tested in various settings to determine the optimum parameters for treatment to avoid them being based on guesswork. Additionally, the adaptive deep brain stimulation lead was already placed before the calibration trials were conducted, meaning that the patient had already taken on the bulk of the procedural risk before the efficacy could be determined. Such an efficacy test could have been replicated in the first patient’s cancer treatment, had it been biopsied and tested against the remaining immunotherapies in vitro. Yet, in the case of cancer with few options, one previous dose of a drug that appeared to work on the patient may justify further doses. However, as the Norwegian case presents, corroboration with known responses to a similar drug (from a clinical trial) could be helpful to validate the treatment strategy. (It should be noted that both patients were resigned to these last resort options regardless of the efficacy of treatment.) There are some elements of inductive logic seen with adaptive deep brain stimulation research in general. For example, abductively the focus could be that patient X’s stimulation parameters are different from patient Y’s and patient Z’s. In contrast, when grouped as subjects who obtained personalized stimulation, patients X, Y, and Z demonstrate an inductive aspect to this approach’s safety and/or efficacy. The OCD case holds plenty of abductive characteristics in line with precision medicine’s approach to treating cancer and as more individuals try the method, there will be additional data. With the gradual integration of AI into brain-computer interfaces in the name of efficacy, this reliance on abduction will continue, if not grow, over time. Moving forward, if a responsive deep brain stimulation treatment is novel and individualized (like the dose of nivolumab) and there is some other suggestion of efficacy (like clinical similarities to other patients in the literature), then it may justify insurance coverage for the investigative intervention, absent other unrelated reasons to deny it. III. Ethical Implications and Next Steps While AI’s use in oncology and neurology is not yet as prominent as its use in other fields (e.g., radiology), it appears to be on the horizon for both.[xxxi] AI can be found in both the functioning of the neurotechnologies as well as the implementation of precision medicine. The increasing use of AI may serve to further individualize both oncologic and neurological therapies. Given these implications and the handful of publications cited in this article, it is important to have a nuanced evaluation of how these treatments, which heavily rely on abductive justification, ought to be managed. The just use an abductive approach may be difficult as AI infused precision medicine is further pursued. At baseline, such technology relies on a level of advanced technology literacy among the general public and could exclude populations who lack access to basic technological infrastructure or know-how from participation.[xxxii] Even among nations with adequate infrastructure, as more patients seek out implantable neurotechnologies, which require robust healthcare resources, the market will favor patient populations that can afford this complex care.[xxxiii] If patients already have the means to pay for an initial dose/use of a precision medicine product out of pocket, should insurance providers be required to cover subsequent treatments?[xxxiv] That is, if a first dose of a cancer drug or a deep brain stimulator over its initial battery life is successful, patients may feel justified in having the costs of further treatments covered. The Norwegian patient’s experience implies there is a precedent for the idea that some public insurance companies ought to cover successful cancer therapies, however, insurance companies may not all see themselves as obligated to cover neurotechnologies that rely on personalized settings or that are based on precision/abductive research more than on clinical trials. CONCLUSION The fact that the cases outlined above rely on abductive style of reasoning implies that there may not be as strong a justification for coverage by insurance, as they are both experimental and individualized, when compared to the more traditional large clinical trials in which groups have the same or a standardized protocol (settings/doses). If a study is examining the efficacy of a treatment with a large cohort of patients or with different experimental groups/phases, insurance companies may conclude that the resulting symptom improvements are more likely to be coming from the devices themselves. A preference for inductive justification may take priority when ruling in favor of funding someone’s continued use of an implantable neurostimulator. There are further nuances to this discussion surrounding the classifications of these interventions as research versus clinical care that warrant future exploration, since such a distinction is more of a scale[xxxv] than binary and could have significant impacts on the “right-to-try” approach to experimental therapies in the United States.[xxxvi] Namely, given the inherent limitations of conducting large cohort trials for deep brain stimulation interventions on patients with neuropsychiatric disorders, surgically innovative frameworks that blend abductive and inductive methodologies, like with sham stimulation phases, have traditionally been used.[xxxvii] Similarly, for adaptive brain-computer interface systems, if there are no large clinical trials and instead only publications that demonstrate that something similar worked for someone else, then, in addition to the evidence that the first treatment/dose worked for the patient in question, the balance of reasoning would be valid and arguably justify insurance coverage. As precision approaches to neurotechnology become more common, frameworks for evaluating efficacy will be crucial both for insurance coverage and for clinical decision making. ACKNOWLEDGEMENT This article was originally written as an assignment for Dr. Francis Shen’s “Bioethics & AI” course at Harvard’s Center for Bioethics. I would like to thank Dr. Shen for his comments as well as my colleagues in the Lázaro-Muñoz Lab for their feedback. - [i] Jonathan Kimmelman and Ian Tannock, “The Paradox of Precision Medicine,” Nature Reviews. Clinical Oncology 15, no. 6 (June 2018): 341–42, https://doi.org/10.1038/s41571-018-0016-0. [ii] Henrik Vogt and Bjørn Hofmann, “How Precision Medicine Changes Medical Epistemology: A Formative Case from Norway,” Journal of Evaluation in Clinical Practice 28, no. 6 (December 2022): 1205–12, https://doi.org/10.1111/jep.13649. [iii] David Barrett and Ahtisham Younas, “Induction, Deduction and Abduction,” Evidence-Based Nursing 27, no. 1 (January 1, 2024): 6–7, https://doi.org/10.1136/ebnurs-2023-103873. [iv] Vogt and Hofmann, “How Precision Medicine Changes Medical Epistemology,” 1208. [v] Wireko Andrew Awuah et al., “Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications,” World Neurosurgery, May 22, 2024, S1878-8750(24)00867-2, https://doi.org/10.1016/j.wneu.2024.05.104. [vi] Mark Riedl, “A Very Gentle Introduction to Large Language Models without the Hype,” Medium (blog), May 25, 2023, https://mark-riedl.medium.com/a-very-gentle-introduction-to-large-language-models-without-the-hype-5 f67941fa59e. [vii] David E. Burdette and Barbara E. Swartz, “Chapter 4 - Responsive Neurostimulation,” in Neurostimulation for Epilepsy, ed. Vikram R. Rao (Academic Press, 2023), 97–132, https://doi.org/10.1016/B978-0-323-91702-5.00002-5. [viii] Kimmelman and Tannock, 2018. [ix] Kimmelman and Tannock, 2018. [x] Simon Lohse, “Mapping Uncertainty in Precision Medicine: A Systematic Scoping Review,” Journal of Evaluation in Clinical Practice 29, no. 3 (April 2023): 554–64, https://doi.org/10.1111/jep.13789. [xi] Kimmelman and Tannock, “The Paradox of Precision Medicine.” [xii] Vogt and Hofmann, 1206. [xiii] Vogt and Hofmann, 1206. [xiv] Vogt and Hofmann, 1206. [xv] Vogt and Hofmann, 1207. [xvi] Vogt and Hofmann, 1207. [xvii] Vogt and Hofmann, 1207. [xviii] Vogt and Hofmann, 1210. [xix] Mehar Sahu et al., “Chapter Three - Artificial Intelligence and Machine Learning in Precision Medicine: A Paradigm Shift in Big Data Analysis,” in Progress in Molecular Biology and Translational Science, ed. David B. Teplow, vol. 190, 1 vols., Precision Medicine (Academic Press, 2022), 57–100, https://doi.org/10.1016/bs.pmbts.2022.03.002. [xx] Stefan Feuerriegel et al., “Causal Machine Learning for Predicting Treatment Outcomes,” Nature Medicine 30, no. 4 (April 2024): 958–68, https://doi.org/10.1038/s41591-024-02902-1. [xxi] Sunderland Baker et al., “Ethical Considerations in Closed Loop Deep Brain Stimulation,” Deep Brain Stimulation 3 (October 1, 2023): 8–15, https://doi.org/10.1016/j.jdbs.2023.11.001. [xxii] David Haslacher et al., “AI for Brain-Computer Interfaces,” 2024, 7, https://doi.org/10.1016/bs.dnb.2024.02.003. [xxiii] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 103–4; “Premarket Approval (PMA),” https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P100026. [xxiv] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 104. [xxv] Burdette and Swartz, 126. [xxvi] Sean L. Metzger et al., “A High-Performance Neuroprosthesis for Speech Decoding and Avatar Control,” Nature 620, no. 7976 (August 2023): 1037–46, https://doi.org/10.1038/s41586-023-06443-4. [xxvii] Hao Fang and Yuxiao Yang, “Predictive Neuromodulation of Cingulo-Frontal Neural Dynamics in Major Depressive Disorder Using a Brain-Computer Interface System: A Simulation Study,” Frontiers in Computational Neuroscience 17 (March 6, 2023), https://doi.org/10.3389/fncom.2023.1119685; Mahsa Malekmohammadi et al., “Kinematic Adaptive Deep Brain Stimulation for Resting Tremor in Parkinson’s Disease,” Movement Disorders 31, no. 3 (2016): 426–28, https://doi.org/10.1002/mds.26482. [xxviii] Young-Hoon Nho et al., “Responsive Deep Brain Stimulation Guided by Ventral Striatal Electrophysiology of Obsession Durably Ameliorates Compulsion,” Neuron 0, no. 0 (October 20, 2023), https://doi.org/10.1016/j.neuron.2023.09.034. [xxix] Nho et al. [xxx] Nho et al.; Erik Robinson, “Brain Implant at OHSU Successfully Controls Both Seizures and OCD,” OHSU News, accessed March 3, 2024, https://news.ohsu.edu/2023/10/25/brain-implant-at-ohsu-successfully-controls-both-seizures-and-ocd. [xxxi] Awuah et al., “Bridging Minds and Machines”; Haslacher et al., “AI for Brain-Computer Interfaces.” [xxxii] Awuah et al., “Bridging Minds and Machines.” [xxxiii] Sara Green, Barbara Prainsack, and Maya Sabatello, “The Roots of (in)Equity in Precision Medicine: Gaps in the Discourse,” Personalized Medicine 21, no. 1 (January 2024): 5–9, https://doi.org/10.2217/pme-2023-0097. [xxxiv] Green, Prainsack, and Sabatello, 7. [xxxv] Robyn Bluhm and Kirstin Borgerson, “An Epistemic Argument for Research-Practice Integration in Medicine,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 43, no. 4 (July 9, 2018): 469–84, https://doi.org/10.1093/jmp/jhy009. [xxxvi] Vijay Mahant, “‘Right-to-Try’ Experimental Drugs: An Overview,” Journal of Translational Medicine 18 (June 23, 2020): 253, https://doi.org/10.1186/s12967-020-02427-4. [xxxvii] Michael S. Okun et al., “Deep Brain Stimulation in the Internal Capsule and Nucleus Accumbens Region: Responses Observed during Active and Sham Programming,” Journal of Neurology, Neurosurgery & Psychiatry 78, no. 3 (March 1, 2007): 310–14, https://doi.org/10.1136/jnnp.2006.095315. (shrink)

Increasing attention and efforts are being put towards engaging patients in health research, and some have even argued that patient engagement in research is an ethical imperative. Yet there is relatively little empirical data on ethical issues associated with PER. A three-round Delphi survey was conducted with a panel of early-career researchers involved in PER. One of the objectives was to examine the ethical dimensions of PER as well as ECRs’ self-perceived level of preparedness to conduct PER ethically. The study (...) was conducted among awardees of the Québec SPOR-SUPPORT Unit in Canada, who represent the next generation of researchers involved in PER. Many themes were addressed throughout the study, such as definition, values, patients’ roles, expected characteristics of patients, and anticipated challenges. Open-ended questions were used, and all quantitative data were collected through statements using 7-point Likert scales. Between April and November 2016, 25 ECRs were invited to participate; 18 completed both the first and second rounds, and 16 completed the third round. Panelists consisted of nine women and seven men with various backgrounds. The majority were between 25 and 44 years old. Panelists’ responses showed PER raises important ethical issues: 1) professionalization of patients involved in research ; 2) adequate remuneration of patients; 3) fair recognition of patients’ experiential knowledge; and 4) tokenism. While the panelists felt moderately prepared to confront these ethical issues, they reported being uncomfortable applying for an ethics certificate for a PER project. If PER is an ethical imperative, it is vital to establish clear ethical standards and to train and support the PER community to identify and resolve ethical issues. Despite their overall readiness to conduct PER, panelists did not feel adequately prepared to address many of these issues. It is not easy for ECRs to reconcile ethical desiderata and logistical imperatives. Additional research should focus on supporting the responsible conduct of PER, which, if not done, can undermine the credibility and feasibility of the entire PER enterprise. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:New Periodical Articles by Russell (II)Kenneth BlackwellThere are 51 new C entries since the twenty-year update in Russell 34 (2014) to the first edition of A Bibliography of Bertrand Russell (3 vols., 1994). Too many to list here are the new speech reports, interviews, blurbs, and multiple-signatory letters to the editor in other parts of Volume ii and new books and contributions to them in Volume i. A sub-division (...) is made between those articles published by Russell during his lifetime and those posthumously by his editors. In the Collected Papers there are many further articles now published, whose appearance could not be traced during his lifetime. Thanks in advance to readers for any corrections and further discoveries for Russell's vast corpus. For some Chinese publications cited in C20.21′, I am indebted to Lianghua Zhou, "A Critical Bibliography of Russell's Lectures and Addresses in China" (36 [2016]) in this journal. Files for the new entries are not available in the Russell Archives.For assistance with this update I wish to thank David Blitz, William Bruneau, Ruth Derham, Carl Spadoni, Michael Stevenson, Sheila Turcon, the two Editors, and (for conversion of the first edition files) Arlene Duncan.C20.21′ [RESPONSE TO SPEECH OF WELCOME TO CHINA]. Shibao [世報], Shanghai, 14 Oct. 1920, p. 5.In "Huanyan da zhexuejia Luosu ji 歡宴大哲學家羅素紀 [Notes from the Welcome Banquet for the Great Philosopher Russell]".—Russell's speech was translated by his official translator, Zhao Yuanren [Y. R. Chao].—Reprinted in Chen Bao [Morning Post], 16 Oct. 1920, p. 3 (cited in Papers 15: li); Luosu Yuekan [Russell Monthly], Beijing, no. 1 (Jan. 1921): App., pp. 6–7; and Yuan Gang, Sun Jiaxiang, and Ren Bingqiang, eds., Zhongguo Dao Ziyou Zhi Lu: Luosu Zaihua Jiangyanji [China's Road to Freedom: a Collection of Russell's Lectures in China] (Beijing: Beijing Daxue [End Page 71] Chubanshe [Peking University Press], 2004).—Translated into English in "Welcome Banquet for the Great Philosopher Russell", in Jan Vrhovski and Jana S. Rošker, eds., Bertrand Russell's Visit to China: Selected Texts on the Centenary of Intercultural Dialogues in Logic and Epistemology (Ljubljana, Slovenia: Ljubljana U. P., 2021), pp. 61–3 (which is the source of the Chinese characters below). Click for larger view View full resolution"Bertrand Russell" in simplified Chinese charactersC23.24a BERTRAND RUSSELL ON "HELL". Haldeman-Julius Weekly, Girard, ks, no. 1,446 (18 Aug. 1923): 4.Letter to Upton Sinclair on his play Hell, dated 20 June 1923.—Photocopy of holograph letter is at ra Rec. Acq. 40.—Reprinted in Collected Papers 16 (forth.).C24.12a CHILDREN AND YOUNG PERSONS BILL. The Manchester Guardian, 7 March 1924, p. 10.Signed also by Clifford Allen and sent from his address in Battersea.—"We must beware lest in our zeal to maintain the existing moral code we inflict further suffering upon the very children and women whom the promoters of the bill wish to protect."—Re abortion and underage sex.—Reprinted in Collected Papers 16 (forth.).C24.20a MACDONALD'S POLICY WILL ALTER SPIRIT OF WORLD. The Winnipeg Evening Tribune, Winnipeg, mb, 5 April 1924, theatre sec., p. 7.Subtitled "English Philosopher States Rumors of Split in Labor Ranks Exaggerated".—An editorial note states that the article was "prepared exclusively" for the Tribune.—Reprinted in Collected Papers 16 (forth.).C24.50a "WHAT'S WRONG WITH U.S.?["] BERTRAND RUSSELL FORESEES RADICALISM MUCH OPPRESSED.The Daily Notes, Canonsburg, pa, 22 Nov. 1924, p. 6.Datelined London, 21 November.—International News Service (ins) had invited Russell's views on "What Is Wrong with America" in a letter of 14 October 1924 (ra1 410).—Also as "Toleration Now Greatest Need of This Nation; Noted British Writer Sees Most of America's Troubles Migratory; Believes Negro Question, with Persecution, Will Lead to Difficulty", Defiance Crescent-News, Defiance, oh, 24 Nov. 1924, p. 1; " 'What's Wrong with U.S.?' Bertrand Russell Sees Radicalism Much Oppressed", The Evening News, Wilkes-Barre, pa, 25 Nov. 1924, p. 13; op. cit., St. Petersburg Times, St. Petersburg, fl, 25 Nov. 1924, sec. 3, p. 7; op. cit., The Huntington Herald, Huntington, il, 26 Nov. 1924, p. 10; op. cit... (shrink)

On September 27, 2016 people across the world looked down at their buzzing phones to see the AP Alert: “Baby born with DNA from 3 people, first from new technique.” It was an announcement met with confusion by many, but one that polarized the scientific community almost instantly. Some celebrated the birth as an advancement that could help women with a family history of mitochondrial diseases prevent the transmission of the disease to future generations; others held it unethical, citing (...) medical tourism and consequences for the future of the therapy. The child in question was actually born a few months earlier on April 6, 2016, but the research was published a few months later in the October edition of Fertility and Sterility. The mother carries DNA that could have given the baby Leigh Syndrome, a severe neurological disorder characterized by psychomotor regression that typically results in death between ages two and three.[1] Also known as subacute necrotizing encephalomyelopathy, Leigh Syndrome is caused by genetic mutations in mitochondrial DNA, which causes defective oxidative phosphorylation. Because people with this condition cannot re-form ATP, “demyleniation, gliosis, necrosis, spongiosis, or capillary proliferation”[2] can occur, thereby producing bilateral lesions across the central nervous system. The 36-year-old mother previously had four miscarriages and successfully birthed two children, both of whom survived less than six years due to the syndrome. For religious reasons, the mother opted for Spindle Nuclear Transfer instead of Pronuclear Transfer,[3] which many religious organizations oppose because it entails the destruction of fertilized eggs.[4] In Pronuclear Transfer, both the parent and donor egg are fertilized. The parent’s nuclear material is then removed from the egg containing mutated mitochondria and inserted into the fertilized donor egg—from which the original nuclear material has been removed and destroyed. Spindle Nuclear Transfer, on the other hand, removes the mother’s nuclear material from the egg with unhealthy mitochondria, then implants it into a donor’s egg. The newly created egg is then fertilized with the father’s sperm. This Spindle Nuclear Transfer was performed in Mexico by a team of doctors led by Dr. John Zhang, the founder of the New Hope Fertility Center in New York City. In their report, the doctors outline that five oocytes were successfully reconstituted, four of which developed into blastocysts. Only one was euploid: containing 46 XY chromosomes. Researchers then biopsied that blastocyst and found that the transmission rate of maternal mtDNA was, “5.10 ± 1.11% and the heteroplasmy level for 8993T>G was 5.73%.”[5] This indicates that at the blastocyst stage, around five percent of the mitochondria are from the original maternal egg with the mutation for Leigh Syndrome. After birth, they biopsied different tissues and found that they had an average of less than 1.60 ± 0.92% of transmitted mtDNA from the original maternal egg. The baby is reportedly doing well and the team of doctors concluded that “[h]uman oocytes reconstituted by SNT are capable of producing a healthy live birth. SNT may provide a novel treatment option in minimizing pathogenic mtDNA transmission from mothers to their babies."[6] Even when considered theoretically, Spindle Nuclear Transfer is controversial. Many doctors believe that the risks at this stage of research are too great. Dr. Trevor Stammers, a bioethicist at St. Mary’s University in London, points out: “We do not yet have a clear picture of the interaction between nuclear DNA and mitochondria.”[7] Others hold that faulty mitochondrial DNA can still be transferred during the procedure. Still more argue this technology could create problems because of germline modification.[8] Dr. Paul Knoepfler, a cell biologist at the UC Davis School of Medicine, explains: “Since this is uncharted territory and the children born from this technology would have heritable genetic changes, there are also significant unknown risks to future generations.”[9] However, proponents counter these arguments. They say the benefits outweigh the risks, as “mitochondrial replacement techniques [like Spindle Nuclear Transfer] would eliminate maternal transmission of mitochondrial disease… allowing a woman with a family history of mitochondrial diseases to ensure her children would not be affected.”[10] Additionally, experts say that no symptoms will occur if less than 20% of the transferred mitochondrial DNA is faulty.[11] And while opponents see potential germline modification as a problem, advocates answer that this could stop a family history of mitochondrial disease, which they deem a more serious concern. In this case specifically, however, there are more issues at hand. While the team of doctors did eliminate the possibility of germline modification by selecting a male embryo, there are other ethical concerns. Some argue that this case could be described as “medical tourism.” While New Hope Medical Clinic does maintain a branch in Mexico, Dr. Zhang stated that Mexico has “no rules.”[12] It is a country with underdeveloped regulations, making it difficult to confirm that doctors adhere to widely-held medical and ethical standards. Furthermore, while it is highly unlikely that the child will develop Leigh’s Syndrome, Dr. Dietrich Egli of the New York Stem Cell Foundation says the 5% mitochondrial transfer rate indicates that the technique “was not carried out well.”[13] He points to studies of embryos where the rate of mtDNA transfer was almost ten times lower. Spindle Nuclear Transfer is currently legal in the UK,[14] and many are hoping to see it legalized in the US, although Congress currently prohibits the FDA from considering applications that would entail trials in people.[15] While Dr. Zhang’s work is arguably revolutionary, many wonder if the manner in which this study was performed—in Mexico and with a high mitochondrial transfer rate—will impact the technology’s future in the US. Last week, Dr. Zhang presented the report to scientists gathered in Salt Lake City, saying that while science isn’t a race, it is “in a sense, a race for the family to find a cure, to find hope.”[16] Only time will tell if this study set back other families racing and hoping for a cure. References 1. "Leigh Syndrome." Genetics Home Reference, US National Library of Medicine, 25 Oct. 2016. Accessed 26 Oct. 2016. 2. McKusick, Victor A., and Ada Hamosh. "LEIGH SYNDROME; LS." Online Mendelian Inheritance in Man, Johns Hopkins University, 20 Jan. 2016. Accessed 30 Oct. 2016. 3. Zhang, J, H Liu, S Luo, A Chavez-Badiola, and Z Liu. "First live birth using human oocytes reconstituted by spindle nuclear transfer for mitochondrial DNA mutation causing Leigh syndrome." Fertility and Sterility, vol. 106, no. 3, 2016, pp. e375-76. Accessed 30 Oct. 2016. 4. Sample, Ian. "‘Three-parent’ babies explained: what are the concerns and are they justified?" The Guardian, 2 Feb. 2015. Accessed 30 Oct. 2016. 5. Zhang, et al. 6. Ibid. 7. Knapton, Sarah. "Three-parent babies: the arguments for and against." The Telegraph, 3 Feb. 2015. 8. Ibid. 9. Ibid. 10. "Mitochondrial Replacement Therapy FAQs." New York Stem Cell Foundation Research Institute, New York Stem Cell Foundation. Accessed 30 Oct. 2016. 11. Reardon, Sara. "‘Three-parent baby’ claim raises hopes — and ethical concerns." Nature, 28 Sept. 2016. Accessed 30 Oct. 2016. 12. Hamzelou, Jessica. "Exclusive: World’s first baby born with new “3 parent” technique." New Scientist, 27 Sept. 2016. Accessed 30 Oct. 2016. 13. Reardon, Sara. "‘Three-parent baby’ claim raises hopes — and ethical concerns." Nature, 28 Sept. 2016. Accessed 30 Oct. 2016. 14. "3-Person IVF: A Resource Page." Center for Genetics and Society, 24 Oct. 2016. Accessed 30 Oct. 2016. 15. Ritter, Malcolm. "Baby born with DNA from 3 people, first from new technique." Associated Press, 27 Sept. 2016. Accessed 30 Oct. 2016. 16. Chen, Daphne. "Controversy swirls around first three-parent baby." Deseret News, 19 Oct. 2016. Accessed 30 Oct. 2016. Works consulted Swetlitz, Ike. "FDA urged to approve ‘three-parent embryos,’ a new frontier in reproduction." STAT, 3 Feb. 2016. Accessed 30 Oct. 2016. (shrink)

This article draws from cultural studies, political theory, international relations, art history and museum studies in order to consider `China Design Now' — the blockbuster exhibition, recently held at the V&A. It argues that, despite the inclusion of a number of interesting exhibits, the attempt to frame contemporary Chinese design independently of political contextualization has led to an exhibition which is largely unsatisfying. The approach taken by the V&A is further shown to have produced several ironic outcomes. (...) First, by attempting to avoid `contentious' political issues, the museum has, in fact, forced the `political' to the fore. Second, by taking such an approach, the V&A demonstrates that it has failed to understand the essentially political nature of the design problem. Third, it has produced an exhibition which appears to advocate a (highly political) neoliberal agenda — one which insists on an inexorable drive towards greater global economic integration. Finally, it has failed to mention its own embeddedness within larger strategies of `cultural diplomacy' and the significance of such strategies for international relations and for cultural production. As well as drawing on a range of relevant literature, the article makes direct reference to exhibition wall texts, exhibit labels and quotations from the catalogue in order to support its argument. (shrink)

The first meeting of the Global Forum for Bioethics in Research was initiated by the Fogarty International Centre of the National Institutes of Health and sponsored by the World Health Organisation, the Pan American Health Organisation and the NIH. Held in Bethesda on November 7-10,1999, the intent was to bring together individuals involved in medical research in low- and middle-income nations to share views with each other and with organisations that support clinical research. Approximately 120 persons from 34 (...) countries participated, including individuals from developing countries, pharmaceutical organisations, and communities where medical research is under way.The participants addressed the partnerships required between research sponsors and investigators involved in clinical trials in developing countries and the long-term needs for international multicentred training programs. (shrink)

Both in his time, and still now, the name of Descartes has been linked with Pelagianism. Upon close investigation, however, the allegations of Pelagianism and the evidence for them offer very slim pickings. Whether Descartes was a Pelagian is a theological question; the argument here will be that a consideration of Descartes’s claims cited as Pelagian nonetheless promises a better philosophical understanding of his views on the will and other, related matters.After an introduction to Pelagianism (sec.1), the most prominent source (...) nowadays for its connection with Descartes is seen to be Arnauld, the master critic of the period, who as a Jansenist was especially sensitive to any sign of Pelagianism (sec.2). Historically, however, the more important source was the Dutch theologian Revius, whose allegation of it against Descartes ignited a long and widespread controversy (sec.3). Just as Pelagianism might be seen as a “topos in which the Dutch anti-Cartesian literature was concentrated,”1 so a topos for the Pelagian controversy itself might be the biblical text alluded to by Descartes in the fourth Meditation, according to which man is created in the image and likeness of God, most so, according to Descartes, with respect to the will (sec.4). Another way to frame the issue, of particular philosophical interest, then, is the infinity of the Cartesian will, explored more recently by Grimaldi (sec.5). Another recent publication, by Scribano, sets out its origins in a way that shows how complex the Dutch debate really was both in terms of partisanship and philosophical relevance (sec.6). The issues raised by the connection of Descartes to Pelagianism tend to be orthogonal, breeding confusion; so, at the end below, a brief catalogue of the theological views relevant to Descartes’s claims will be given, based on the results of this investigation (sec.7). (shrink)

This study focus is how burnout felt by nurse in social caring institution for multiple disability child. Nurse as supported profession often feel burnout as caused by excessive workload. Such case that felt by nurse which cares multiple disability child. Workload and work demand often become problem which appear burnout. Such case is added by less balance between workload and nurse income that relative small and inadequate facilities. Result of study shows that burnout which felt subject because there is low (...) control to job. Subject less control their task which they must done. Such case is caused by limited in their education and knowledge background about nursing for multiple disability child. This study using interview technique. This study is conducted from November 2007 until April 2008. Subject of this study amount five persons. Such fifth of subjects felt burnout during work as nurse for multiple disability child. (shrink)

In this paper I will examine a difficulty (aporia), which Aristotle raises in Physics B 5.197a20-25: whether fortuitous things can be held as causes of luck. I will show the meaning of the passage and its relevance within the context of Aristotelian extended analysis of the notions of ``luck'' and ``chance''. I will claim that, in facing the problem, Aristotle has a twofold aim. Firstly, he wants to explain why luck is, after having enquired whether it exists and what (...) it is. Secondly, he wants to prevent his pupils, among others, from denying causal efficacy to luck, by reducing fortuitous events, that are the result of accidental causes, to the action of per se causes, such as nature and human deliberation. (shrink)