Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period (...) of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. Results: These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering “culture” in the presentation and expression of mental distress. The narratives reveal an overall “culture of understanding cultural issues” and specific “cultures of care”. These emerged as necessary foci of intervention to improve service user outcomes. Conclusion: Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery. (shrink)

Biologists frequently draw on ideas and terminology from engineering. Evolutionary systems biology—with its circuits, switches, and signal processing—is no exception. In parallel with the frequent links drawn between biology and engineering, there is ongoing criticism against this cross-fertilization, using the argument that over-simplistic metaphors from engineering are likely to mislead us as engineering is fundamentally different from biology. In this article, we clarify and reconfigure the link between biology and engineering, presenting it in a more favorable light. We do so (...) by, first, arguing that critics operate with a narrow and incorrect notion of how engineering actually works, and of what the reliance on ideas from engineering entails. Second, we diagnose and diffuse one significant source of concern about appeals to engineering, namely that they are inherently and problematically metaphorical. We suggest that there is plenty of fertile ground left for a continued, healthy relationship between engineering and biology. (shrink)

Intellectual knowledge is omnipresent in human lives and decisions. We are constantly trying to make good and correct decisions. However, responsible decision-making is characterised by rather difficult epistemic conditions. It applies all the more during the pandemic when decisions require not only specialised knowledge in a number of disciplines, scientific consensus, and participants from different fields, but also responsibility and respect for moral principles in order to ensure that the human rights of all groups are observed. Pandemic measures are created (...) by politicians, healthcare policy-makers, and epidemiologists. However, what is the role of ethics as a moral philosophy and experts in ethics? Experts in ethics and philosophy are carefully scrutinising political decisions. Levy and Savulescu have claimed that Ethicists and philosophers are not epistemically arrogant if they question policy responses. They played an important role in the creation of a reliable consensus. This study analyses epistemic and moral responsibility, their similarities, analogies, and differences. Are they interconnected? What is their relationship and how can they be filled with actual content during the pandemic? (shrink)

En el siguiente estudio se evalúa un panorama con respecto al comportamiento sociológico en un preámbulo tanto antes durante y después de esta crisis social que se está viviendo debido a la pandemia de hoy en día. Por ello para sustentar dicha investigación se realizó un censo en el cuál, mediante el uso de herramientas estadísticas, se pudo realizar una comparación entre un antes y un durante de la pandemia, lo cual facilitaría intrínsicamente a la predicción de una denominada post (...) pandemia. En este texto se pretende detallar el proceso y forma de la encuesta, al igual que los resultados obtenidos de la misma. Se proveen, además, posibles explicaciones para estos resultados, guiándose por las restricciones de salud nacionales como posibles razones para el cambio de comportamiento actual. Palabras Clave: coronavirus, pandemia, frecuencia de salida. Referencias [1]P. Byass, «Eco-epidemiological assessment of the COVID-19 epidemic in China, January-February 2020,» Web Of Science, vol. 13, nº 1, 2020. [2]P. Stefanoni, «Brasil: pandemia, guerra cultural y precariedad,» Nueva Sociedad, pp. 49-59, 2020. [3]M. J. Báguena Cervellera, «La pandemia de COVID-19 a la luz de la historia de la medicina,» Investigación y Ciencia, 2020. [4]A. Levy, «La pandemia de COVID-19 podr{ia ayudar a resolver una gran incógnita climática,» Investigación y Ciencia, 2020. [5]T. Marcel Ariel, «Relaciones en tiempos de pandemia: COVID-19 y bienestar animal, ambiental y humano,» Revista Facultad Nacional De Agronomia Medellin, vol. 2, 2020. [6]F. Manrique-Abril, «Modelo SIR de la pandemia de Covid-19 en Colombia/SIR model of the COVID-19 pandemic in Colombia,» Revista De Salúd Publica, vol. 22, pp. 1-6, 2020. [7]D. Arango-Londoño, «Predicciones de un modelo SEIR para casos de COVID-19 en Cali, Colombia/Predictions of a SEIR model for COVID-19 cases in Cali-Colombia,» Revista De Salúd Publica, vol. 22, nº 2, pp. 1-9, 2020. [8]J. Gonzales-Castillo, «Pandemia de la COVID-19 y las Políticas de Salud Pública en el Perú: marzo-mayo 2020/COVID-19 pandemic and Public Health Policies in Peru: March-May 2020,» Revista De Salúd Publica, vol. 22, nº2, pp. 1-9, 2020. [9]A. Valenzuela-Cazés y L. Becerra-Ostos, «Práctica clínica, ámbito laboral y riesgos de la fisioterapia ante el COVID-19/Clinical practice, work and risks of physical therapy in the face of COVID-19,» Revista De Salúd Publica, vol. 22, nº 2, pp. 1-4, 2020. [10]P. Montes-Alarcón y A. Campo-Arias, «Los médicos generales y la salud mental en la pandemia por COVID-19,» Duazary, vol. 17, nº 3, pp. 4-6, 2020. (shrink)

Generalisations of theory change involving operations on arbitrary sets ofwffs instead of on belief sets (i.e., sets closed under a consequencerelation), have become known as base change. In one view, a base should bethought of as providing more structure to its generated belief set, whichmeans that it can be employed to determine the theory contraction operationassociated with a base contraction operation. In this paper we follow suchan approach as the first step in defining infobase change. We think of an infobase (...) as a finite set of wffs consisting of independently obtainedbits of information. Taking AGM theory change (Alchourrón et al. 1985) as the general framework, we present a method that uses the structure of aninfobase B to obtain an AGM theory contraction operation for contractingthe belief set Cn(B). Both the infobase and the obtained theory contraction operation then play a role in constructing a unique infobasecontraction operation. Infobase revision is defined in terms of an analogueof the Levi Identity, and it is shown that the associated theory revisionoperation satisfies the AGM postulates for revision. Because every infobaseis associated with a unique infobase contraction and revision operation, the method also allows for iterated base change. (shrink)

This introduction to the Common Knowledge symposium titled “Comparative Relativism” outlines a variety of intellectual contexts where placing the unlikely companion terms comparison and relativism in conjunction offers analytical purchase. If comparison, in the most general sense, involves the investigation of discrete contexts in order to elucidate their similarities and differences, then relativism, as a tendency, stance, or working method, usually involves the assumption that contexts exhibit, or may exhibit, radically different, incomparable, or incommensurable traits. Comparative studies are required to (...) treat their objects as alike, at least in some crucial respects; relativism indicates the limits of this practice. Jensen argues that this seeming paradox is productive, as he moves across contexts, from Lévi-Strauss's analysis of comparison as an anthropological method to Peter Galison's history of physics, and on to the anthropological, philosophical, and historical examples offered in symposium contributions by Barbara Herrnstein Smith, Eduardo Viveiros de Castro, Marilyn Strathern, and Isabelle Stengers. Comparative relativism is understood by some to imply that relativism comes in various kinds and that these have multiple uses, functions, and effects, varying widely in different personal, historical, and institutional contexts that can be compared and contrasted. Comparative relativism is taken by others to encourage a “comparison of comparisons,” in order to relativize what different peoples—say, Western academics and Amerindian shamans—compare things “for.” Jensen concludes that what is compared and relativized in this symposium are the methods of comparison and relativization themselves. He ventures that the contributors all hope that treating these terms in juxtaposition may allow for new configurations of inquiry. (shrink)

Die in diesem Band versammelten Arbeiten des französischen Phänomenologen Maurice Merleau-Ponty (1908-1961) führen nicht nur auf vorzügliche Weise in dessen Philosophie ein, sie dokumentieren darüber hinaus auch die Entwicklung neu einsetzender Reflexionen in den Jahren nach der Publikation der Phänomenologie der Wahrnehmung (1945). Kunsttheoretische, sprachphilosophische und auch soziologische Untersuchungen erschließen dem Leser eine Philosophie, die im Rahmen einer kulturphilosophischen Selbstverständigung das 20. Jahrhundert hinsichtlich seiner großen Themen und seiner radikalen Fragestellungen umgreift. Inhalt: Der Zweifel Cézannes (1945), Das Kino und die (...) neue Psychologie (1947), Das Metaphysische im Menschen (1947), Der Mensch und die Widersetzlichkeit der Dinge (1952), Schrift für die Kandidatur am Collège de France (1951/52), Das mittelbare Sprechen und die Stimmen des Schweigens (1952); Lob der Philosophie (1953), Von Mauss zu Claude Lévi-Strauss (1959), Der Philosoph und sein Schatten (1959), Das Auge und der Geist (1961). (shrink)

Andreas Schmidt and Neil Levy have recently defended nudging against the objection that nudges fail to treat nudgees as rational agents. Schmidt rejects two theses that have been taken to support the objection: that nudges harness irrational processes in the nudgee, and that they subvert the nudgee’s rationality. Levy rejects a third thesis that may support the objection: that nudges fail to give reasons. I argue that these defences can be extrapolated from nudges to some nonconsensual neurointerventions; if Schmidt’s and (...) Levy’s defences succeed, then some nonconsensual neurointerventions neither harness irrationality, nor subvert rationality, nor fail to give reasons. This, I claim, poses a challenge both to opponents of nonconsensual neurointerventions, and to defenders of nudging. (shrink)

Giorgio Levi Della Vida (1886-1967) was not only an eminent Islamologist, he was also a man with solid roots in his own time. He taught in Naples and Rome, then for the ten years 1939-1948 at the University of Pennsylvania. He was one of the few university teachers who, when the oath of loyalty to the Italian fascist regime was introduced in October 1931, opted not to accept that act of submission. His memoirs, Fantasmi ritrovati, were published in 1966; (...) the book, now out of print, conjures up a tableau vivant of half a century of intellectual encounters in Italy and Europe between the wars. Among the portraits he paints there is the astounding story of those crucial days in June 1924 when the fascist government became a full-blown regime. This article presents extended extracts from that story. (shrink)

This article has a dual purpose: on the one hand, it aims to add to the study of text production from a formulation-centered perspective ; on the other, since the analysis and discussion of linguistic problems presented here focus on a specific discourse type within scientific communication, this article is intended as a contribution to scientific communication studies. As I am particularly interested in text production as a process, the corpus I examine consists of oral interviews. In particular, I explore (...) the oral interaction between scientists and specialized journalists that precedes the writing of science popularization texts targeted for the lay reader. I analyze and assess, from a structural and functional point of view, two types of recurrent formulation procedures usually deployed by experts: `illustration' and `reformulation', and claim they constitute resources for the construction of the interlocutors' discursive identities. (shrink)

A partir de los trabajos fundacionales de Lakoff y Johnson (1991, 1999) existe un consenso generalizado entre lingüistas y filósofos respecto de la omnipresencia de las metáforas en la comunicación cotidiana. Sin embargo, es sabido que su ocurrencia y sus efectos en los textos de la ciencia han sido por largo tiempo temas controvertidos y polémicos; sólo recientemente se ha comenzado a trabajar de manera intensiva en la descripción y explicación de la naturaleza y las funciones que cumplen las metáforas (...) en la comunicación de ciencia. En este artículo, intento aportar argumentos para fundamentar la pertinencia y la relevancia del enfoque lingüistico en este campo de investigación. El trabajo, que se basa en muestras de textos provenientes de distintas disciplinas y géneros discursivos, examina y explica el carácter asiduo y multifuncional del instrumento metafórico en los distintos escenarios considerados, y su valor como recurso de recontextualización. (shrink)

BackgroundThis pilot study aims to test the usability of the iACTwithPain platform, an online ACT-based intervention for people with chronic pain, to obtain information on which intervention and usability aspects need improvement and on expected retention rates.MethodsSeventy-three Portuguese women with chronic pain were invited to complete the first three sessions of the iACTwithPain intervention assess their quality, usefulness and the platform’s usability. Twenty-one accepted the invitation. Additionally, eight healthcare professionals working with chronic medical conditions assessed the platform and the intervention (...) from a practitioner’s point of view.ResultsThis study presented a considerable attrition rate (71.43%) among chronic pain participants, with six completers. There were no significant differences in demographic or clinical variables between dropouts and completers except for completed education (participants who dropped out presented less education than completers). Reasons for dropout were related to difficult personal events occurring during the time of the intervention, lack of time, or having forgotten. There seemed to be an overall satisfaction with both the intervention, its contents and form of presentation of information, and the platform, concerning its design, appearance, and usability. Real image videos were preferred over animations or audio by chronic pain participants. Healthcare professionals emphasized the appealing and dynamic aspects of the animation format.ConclusionThis study informs the ongoing improvement of the iACTwithPain platform and provides valuable information on aspects researchers should consider while developing online psychological interventions for chronic pain. Further implications are discussed. (shrink)

La véritable esthétique de la Mort n'est pas d'en répartir le domaine en catégories, mais d'examiner le fait de l'Art tut entier sous l'hypothèse de sa présence prépondérante au sein même des démarches créatrices (...). Une esthétique de la Mort. Dans une nouvelle dialectique, Mort ne recouvre pas une idée vague, mais si le mot Vie me sollicite à la reconnaissance de tous les éléments fondamentaux d'une présence intérieure à moi-même, devenant Moi par la pensée que je lui accorde, Mort (...) implique une prise de conscience analogue et antagoniste (...). L'art dit s'examiner préférentiellement dans ses liens avec la Mort, et non dans l'arbitraire liaison avec la vie, dont toute prépondérance dans l'œuvre est la véritable perturbation affectant les rapports pré-établis, valorisants, de l'œuvre et de la Mort. Michel Guiomar. (shrink)

La véritable esthétique de la Mort n'est pas d'en répartir le domaine en catégories, mais d'examiner le fait de l'Art tut entier sous l'hypothèse de sa présence prépondérante au sein même des démarches créatrices (...). Une esthétique de la Mort. Dans une nouvelle dialectique, Mort ne recouvre pas une idée vague, mais si le mot Vie me sollicite à la reconnaissance de tous les éléments fondamentaux d'une présence intérieure à moi-même, devenant Moi par la pensée que je lui accorde, Mort (...) implique une prise de conscience analogue et antagoniste (...). L'art dit s'examiner préférentiellement dans ses liens avec la Mort, et non dans l'arbitraire liaison avec la vie, dont toute prépondérance dans l'œuvre est la véritable perturbation affectant les rapports pré-établis, valorisants, de l'œuvre et de la Mort. Michel Guiomar. (shrink)

"Every word, like a sacred object, has its place. No _précis_ is possible. This extraordinary book must be read."—Edmund Carpenter, _New York Times Book Review _ "No outline is possible; I can only say that reading this book is a most exciting intellectual exercise in which dialectic, wit, and imagination combine to stimulate and provoke at every page."—Edmund Leach, _Man _ "Lévi-Strauss's books are tough: very scholarly, very dense, very rapid in argument. But once you have mastered him, human history (...) can never be the same, nor indeed can one's view of contemporary society. And his latest book, _The Savage Mind_, is his most comprehensive and certainly his most profound. Everyone interested in the history of ideas _must_ read it; everyone interested in human institutions _should _read it."—J. H. Plumb, _Saturday Review_ "A constantly stimulating, informative and suggestive intellectual challenge."—Geoffrey Gorer, _The Observer_, London. (shrink)

Citizen science models of public participation in scientific research represent a growing area of opportunity for health and biomedical research, as well as new impetus for more collaborative forms of engagement in large-scale research. However, this also surfaces a variety of ethical issues that both fall outside of and build upon the standard human subjects concerns in bioethics. This article provides background on citizen science, examples of current projects in the field, and discussion of established and emerging ethical issues for (...) citizen science in health and biomedical research. (shrink)

An influential tradition holds that thoughts are public: different thinkers share many of their thoughts, and the same applies to a single subject at different times. This ‘publicity principle’ has recently come under attack. Arguments by Mark Crimmins, Richard Heck and Brian Loar seem to show that publicity is inconsistent with the widely accepted principle that someone who is ignorant or mistaken about certain identity facts will have distinct thoughts about the relevant object—for instance, the astronomer who does not know (...) that Hesperus is Phosphorus will have two distinct thoughts Hesperus is bright and Phosphorus is bright. In this paper, I argue that publicity can be defended if we adopt a relational account on which thoughts are individuated by their mutual relations. I then go on to develop a specific relational theory—the ‘linking account’—and contrast it with other relational views. (shrink)

The sense of agency is the experience of being the origin of a sensory consequence. This study investigates whether contextual beliefs modulate low-level sensorimotor processes which contribute to the emergence of the sense of agency. We looked at the influence of causal beliefs on ‘intentional binding’, a phenomenon which accompanies self-agency. Participants judged the onset-time of either an action or a sound which followed the action. They were induced to believe that the tone was either triggered by themselves or by (...) somebody else, although, in reality, the sound was always triggered by the participants. We found that intentional binding was stronger when participants believed that they triggered the tone, compared to when they believed that another person triggered the tone. These results suggest that high-level contextual information influences sensorimotor processes responsible for generating intentional binding. (shrink)

Abstract: According to the Veridicality Thesis, information requires truth. On this view, smoke carries information about there being a fire only if there is a fire, the proposition that the earth has two moons carries information about the earth having two moons only if the earth has two moons, and so on. We reject this Veridicality Thesis. We argue that the main notions of information used in cognitive science and computer science allow A to have information about the obtaining of (...) p even when p is false. (shrink)

In recent works, Kind has argued that imagination is a skill, since it possesses the two hallmarks of skill: improvability by practice, and control. I agree with Kind that and are indeed hallmarks of skill, and I also endorse her claim that imagination is a skill in virtue of possessing these two features. However, in this paper, I argue that Kind’s case for imagination’s being a skill is unsatisfactory, since it lacks robust empirical evidence. Here, I will provide evidence for (...) by considering data from mental rotation experiments and for by considering data from developmental experiments. I conclude that imagination is a skill, but there is a further pressing question of how the cognitive architecture of imagination has to be structured to make this possible. I begin by considering how can be implemented sub-personally. I argue that this can be accounted for by positing a selection mechanism which selects content from memory representations to be recombined into imaginings, using Bayesian generation. I then show that such an account can also explain. On this basis, I hold that not only is imagination a skill, but that it is also plausibly implemented sub-personally by a Bayesian selection mechanism. (shrink)

This paper reviews the uneven history of the relationship between Anthropology and Cognitive Science over the past 30 years, from its promising beginnings, followed by a period of disaffection, on up to the current context, which may lay the groundwork for reconsidering what Anthropology and (the rest of) Cognitive Science have to offer each other. We think that this history has important lessons to teach and has implications for contemporary efforts to restore Anthropology to its proper place within Cognitive Science. (...) The recent upsurge of interest in the ways that thought may shape and be shaped by action, gesture, cultural experience, and language sets the stage for, but so far has not fully accomplished, the inclusion of Anthropology as an equal partner. (shrink)

The ontology of recipes is by and large unexplored. In this paper, I offer a three-steps account. After introducing some key terminology, I distinguish four main options for a theory of recipes: realism, constructivism, existentialism, and the naïve approach. Hence, I first argue that recipes are social entities whose identity depends on a process of identification, typically performed by means of a performative utterance on the part of a cook ; thus, the best theoretical framework for a theory of recipes (...) is a constructivist. Secondly, I argue that the identity of recipes can be grasped only by being suitably acquainted with the dishes that instantiate them, because of the impossibility to spell out recipes in details that would match a full-fledged dish; hence, the authority to establish the identity of a recipe rests on a process of apprenticeship. Finally, I argue that the identity of recipes and—vicariously—of the dishes that instantiate them, rest on three factors: the expertise required on the part of the cook; authenticity ; and the open-ended character of recipes. (shrink)

Several authors have recently contended that modern statistical theory provides a powerful argument in favor of the view that if scientists accept or reject hypotheses at all they do so only in a behavioral sense--i.e., in a sense which reduces "accepting P" to "acting on the basis of P relative to an objective O". In this paper, the argument from statistics in favor of a behavioral view is outlined; an interpretation of two statistical procedures (Bayes method and signifigance testing) is (...) offered which does not entail a behavioral analysis of "accepting a hypothesis"; and the conclusion that non-behavioral analyses of belief are compatible with the application of current statistical theory in the sciences is tentatively advanced. (shrink)

Our aim in this paper is to employ conceptual negotiation to inform a method of rethinking defective food concepts, that is concepts that fail to suitably represent a certain food-related domain or that offer representations that run counter to the interests of their users. We begin by sorting out four dimensions of a food concept: the data upon which it rests and the methodology by which those data are gathered; the ontology that sustains it; the social acts that serve to (...) negotiate and establish the concept; and the aims and values that it fosters. We then discuss the conditions that make a food concept defective, pointing out four types of defects—fragility, polarization, incoherence, and schizophrenia—which we illustrate by means of two specific examples: local food and healthy food. (shrink)

This paper investigates the logic of Ockhamism, a view according to which future contingents are either true or false. Several attempts have been made to give rigorous shape to this view by defining a suitable formal semantics, but arguably none of them is fully satisfactory. The paper draws attention to some problems that beset such attempts, and suggests that these problems are different symptoms of the same initial confusion, in that they stem from the unjustified assumption that the actual course (...) of events must be represented in the semantics as a distinguished history, the Thin Red Line. (shrink)

There seems to be a minimal core that every theory wishing to accommodate the intuition that the future is open must contain: a denial of physical determinism (i.e. the thesis that what future states the universe will be in is implied by what states it has been in), and a denial of strong fatalism (i.e. the thesis that, at every time, what will subsequently be the case is metaphysically necessary).1 Those two requirements are often associated with the idea of an (...) objective temporal flow and the non-reality of the future. However, at least certain ways to frame the “openness” intuition do not rely on any of these. Branching Time Theory (BTT) is one such: it is compatible with the denial that time flow is objective and it is couched in a language with a (prima facie) commitment to an eternalist ontology. BTT, though, urges us to resist certain intuitions about the determinacy of future claims, which arguably do not lead either to physical determinism or to fatalism. Against BTT, supporters of the Thin Red Line Theory (TRL) argue that their position avoids determinism and fatalism, while also representing the fact that there is a future which is “special” because it is the one that will be the case. But starting with Belnap and Green 1994, some have objected to the tenability of TRL, mainly on metaphysical grounds. In particular, those argue that “positing a thin red line amounts to giving up objective indeterminism,”2 and that “has unacceptable consequences, ranging from a mistreatment of actuality to an inability to talk coherently about what would have happened had what is going to happen not taken place.”3 In this paper, we wish to reframe the.. (shrink)

Increasing evidence from psychology and neuroscience suggests that emotion plays an important and sometimes critical role in moral judgment and moral behavior. At the same time, there is increasing psychological and neuroscientific evidence that brain regions critical in emotional and moral capacity are impaired in psychopaths. We ask how the criminal law should accommodate these two streams of research, in light of a new normative and legal account of the criminal responsibility of psychopaths.

A study of a group of elementary school students learning to control a computer‐implemented Newtonian object reveals a surprisingly uniform and detailed collection of strategies, at the core of which is a robust “Aristotelian” expectation that things should move in the direction they are last pushed. A protocol of an undergraduate dealing with the same situation shows a large overlap with the set of strategies used by the elementary school children and thus a marked lack of influence of classroom physics (...) training on this student's naive physics. The data from these two studies are pooled and elaborated into a “genetic task analysis” of how one might come to understand Newtonian dynamics as a more or less natural evolution from the naive state. (shrink)

This paper focuses on the _ethics of how_ to approach the introduction of MAiD as an organizational ethics challenge, a focus that diverges from the traditional focus in healthcare ethics on the _ethics of why_ MAiD is right or wrong. It describes a method co-designed and implemented by ethics and medical leadership at a tertiary hospital to develop a values-based, grassroots response to the decriminalization of assisted dying in Canada. This organizational ethics engagement method embodied core tenants that drew inspiration (...) from a variety of sources, including poetic ones. These tenants are: make the problem bigger; focus on values; cultivate open moral spaces; and trust emergence. The paper describes how these tenants were put into practice in order to create a rigorous and sustainable MAiD program that delivers high-quality care to patients and families while honoring the moral diversity of the hospital workforce. One of the goals in sharing this method is to provide a roadmap for healthcare organizations in Canada and other jurisdictions around the world that are facing the challenge of responding to patient requests for MAiD following the decriminalization of this care option. (shrink)

Large language models (LLMs) have now entered the realm of medical ethics. In a recent study, Balaset alexamined the performance of GPT-4, a commercially available LLM, assessing its performance in generating responses to diverse medical ethics cases. Their findings reveal that GPT-4 demonstrates an ability to identify and articulate complex medical ethical issues, although its proficiency in encoding the depth of real-world ethical dilemmas remains an avenue for improvement. Investigating the integration of LLMs into medical ethics decision-making appears to be (...) an interesting avenue of research. However, despite the promising trajectory of LLM technology in medicine, it is crucial to exercise caution and refrain from attributing their expertise to medical ethics. Our thesis follows an examination of the nature of expertise and the epistemic limitations that affect LLM technology. As a result, we propose two more fitting applications of LLMs in medical ethics: first, as tools for mining electronic health records or scientific literature, thereby supplementing evidence for resolving medical ethics cases, and second, as educational platforms to foster ethical reflection and critical thinking skills among students and residents. The integration of LLMs in medical ethics, while promising, requires careful consideration of their epistemic limitations. Consequently, a well-considered definition of their role in ethically sensitive decision-making is crucial. (shrink)

Following an initial study of the needs of healthcare providers (HCP) regarding the introduction of Medical Assistance in Dying (MAiD), and the subsequent development of an assisted dying program, this study sought to determine the efficacy and impact of MAiD services following the first two years of implementation. The first of three aims of this research was to understand if the needs, concerns and hopes of stakeholders related to patient requests for MAiD were addressed appropriately. Assessing how HCPs and families (...) perceived the quality of MAiD services, and determining if the program successfully accommodated the diverse needs and perspectives of HCPs, rounded out this quality evaluation. This research implemented a mixed-methods design incorporative of an online survey with Likert scale and open-ended questions, as well as focus groups and interviews with staff and physicians, and interviews with MAiD-involved family members. There were 356 online surveys, as well as 39 participants in six focus groups with HCP, as well as fourteen interviews with MAiD-involved family members. Participants indicated that high-quality MAiD care could only be provided with enabling resources such as policies and guidelines to ensure safe, evidence-based, standardized care, as well as a specialized, trained MAiD team. Both focus group and survey data from HCPs suggest the infrastructure developed by the hospital was effective in delivering high-quality MAiD care that supports the diverse needs of various stakeholders. This study may serve as a model for evaluating the impact and quality of services when novel and ethically-contentious clinical practices are introduced to healthcare organizations. (shrink)

This study assessed the attitudes and needs of physicians and health professional staff at a tertiary care hospital in Canada regarding the introduction of physician assisted dying (PAD) during 2015–16. This research aimed to develop an understanding of the wishes, concerns and hopes of stakeholders related to handling requests for PAD; to determine what supports/structures/resources health care professionals (HCP) require in order to ensure high quality and compassionate care for patients requesting PAD, and a supportive environment for all healthcare providers (...) across the moral spectrum. This study constituted a mixed methods design with a qualitative descriptive approach for the study’s qualitative component. A total of 303 HCPs working in a tertiary care hospital completed an online survey and 64 HCPs working in hospital units with high mortality rates participated in 8 focus group discussions. Both focus group and survey data coalesced around several themes to support the implementation of PAD following the decriminalization of this practice: the importance of high quality care; honoring moral diversity; supporting values (such as autonomy, privacy, beneficence); and developing resources, including collaboration with palliative care, education, policies and a specialized team. This study provided the foundational evidence to support the development of the PAD program described in other papers in this collection, and can be a model for gathering evidence from stakeholders to inform the implementation of PAD in any healthcare organization. (shrink)

First published in 1990. Routledge is an imprint of Taylor & Francis, an informa company.

In this paper, I critically discuss Riggle’s definition of street art. I argue that his definition has important limitations, and is therefore unsuccessful. I show that his view obscures a defining feature of street art, that is, its subversive power. As a significant consequence of ignoring that essential aspect, Riggle is incapable of fully understanding how street art transforms public space by turning one corner of the city at the time into contested ground. I also suggest that, when appreciating street (...) art's subversiveness, its challenge against the Modern separation of art and life appears more radical than Riggle foresees. (shrink)

We address an open problem in the philosophy of artificial intelligence (AI): how to justify the epistemic attitudes we have towards the trustworthiness of AI systems. The problem is important, as providing reasons to believe that AI systems are worthy of trust is key to appropriately rely on these systems in human-AI interactions. In our approach, we consider the trustworthiness of an AI as a time-relative, composite property of the system with two distinct facets. One is the actual trustworthiness of (...) the AI and the other is the perceived trustworthiness of the system as assessed by its users while interacting with it. We show that credences, namely, beliefs we hold with a degree of confidence, are the appropriate attitude for capturing the facets of the trustworthiness of an AI over time. Then, we introduce a reliabilistic account providing justification to the credences in the trustworthiness of AI, which we derive from Tang’s probabilistic theory of justified credence. Our account stipulates that a credence in the trustworthiness of an AI system is justified if and only if it is caused by an assessment process that tends to result in a high proportion of credences for which the actual and perceived trustworthiness of the AI are calibrated. This approach informs research on the ethics of AI and human-AI interactions by providing actionable recommendations on how to measure the reliability of the process through which users perceive the trustworthiness of the system, investigating its calibration to the actual levels of trustworthiness of the AI as well as users’ appropriate reliance on the system. (shrink)

Among the various motivations that may lead to the idea that truth is relative in some non-conventional sense, one is that the idea helps explain how there can be ‘‘ faultless disagreements’’, that is, situations in which a person A judges that p, a person B judges that not-p, but neither A nor B is at fault. The line of argument goes as follows. It seems that there are faultless disagreements. For example, A and B may disagree on culinary matters (...) without either A or B being at fault. But standard semantics has no room for such a case, so there is something wrong with standard semantics. The best way to amend it is to add a new parameter that is relevant to the truth or falsity of what A and B judge, presumably, something related to personal taste. The aim of the paper is to show that this line of argument is flawed. It is true that standard semantics has no room for faultless disagreements. But there is nothing wrong with this, for it should not be assumed that such disagreements exist. (shrink)