In lieu of an abstract, here is a brief excerpt of the content:Global Health Careers:Serving the Navajo CommunityMaricruz Merino, Jonathan Iralu, and Sonya ShinGallup Indian Medical Center (GIMC) sits on a hilltop in Gallup, New Mexico, a town of 20,000 in the four corners region of the Southwestern United States. From its third story windows one can see the red cliffs of the nearby Navajo Nation, a 27,000 square mile reservation that reaches into Arizona, northern New Mexico, and (...) the southern edges of Utah. It is a vast, rural landscape that houses more than 350,000 Navajos. For many on the reservation, healthcare is provided by Indian Health Service hospitals such as GIMC."Are you going to stay?" is a common question for new doctors at GIMC. The Navajo know that their geographic location, while beautiful and attractive to many young providers, will also be the reason they leave. It is hard for doctors to be away from their own homelands. Aging parents get sick, [End Page 86] educational opportunities arise, and children who need to be near extended family are born. But to the Navajo, the story of an individual provider is not so important or memorable. All they know is that providers come and go."Are you here to experiment on us?" is yet another question. Years of exploitation and efforts to destroy traditional ways and language have made many Navajo wary of healthcare providers, no matter how genuine their intentions. Many are so fearful of the hospital—they regard it as "the place to go die."Yet despite this initial suspicion, the Navajo are welcoming people at heart, and tend to develop relationships of trust with their providers. Parents will begin to talk about their grief over a son that has committed suicide or a daughter who died from alcoholic cirrhosis. The elderly will tell you how they care for their five orphaned grandchildren while they can barely take care of their own diabetes. A carpenter tells you he has not worked in a year and feels worthless. An HIV-positive woman will tell you she has been sleeping in a dry river bed because she has no place to go. It quickly becomes apparent that as a physician you will be treating patients with enormous social challenges in addition to complex medical conditions.The origins of the Federal Government's involvement in the healthcare of American Indians and Alaskan Natives (AI/ANs) in the 19th century arose out of both legal obligation and concern for self- preservation. Health services were promised to AI/ ANs in exchange for land, settlements, and agreements. In addition, infectious diseases endemic on reservations as a consequence of crowding and abject poverty, including smallpox and tuberculosis, were seen as a major public health concern. The responsibility of Native American health was first granted to the War Department, then to the Bureau of Indian Affairs, and finally to the Public Health Service in 1955 under the heading of the IHS, or Indian Health Service (U.S. Commission on Civil Rights, 2004; National Library of Medicine, 1994).Since then, the IHS has had many successes. Vaccination rates have gone up, and rates of pneumonia and tuberculosis have gone down significantly. Maternal and infant mortality have declined, and life expectancy has increased (Indian Health Services, 1999). Nonetheless, these improvements remain overshadowed by glaring health disparities among AI/ANs across a broad spectrum of diseases, both communicable and non-communicable, acute and chronic. Native Americans experience higher rates of obesity, diabetes, and cardiovascular disease than the general United States population. They are also more likely to die from alcohol-related causes and in accidents. Life expectancy remains more than five years less than that of the general U.S. population (U.S. Commission on Civil Rights, 2004; U.S. Department of Health and Human Services, 2000).Underlying these health indicators is the continued impoverished status of most AI/ANs. In Navajo, almost half of the population lives below the poverty line. According to the Navajo Nation, the current unemployment rate is 42% (Navajo Nation Department of Economic Development, 2011). Many Navajo on the reservation do not have running water or electricity. They heat with wood, which they chop and haul themselves—regardless... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Striving To Do Good:Well-Springs, Realities, and Paradoxes of Medical Humanitarian WorkRenée C. FoxThe voices that speak from the pages of these testimonial narratives are those of physicians who are engaged in medical humanitarian work. The preponderance of them are based in U.S. academic medical centers where they have clinical, teaching, and research responsibilities from which they regularly "commute" to care for patients in what the euphemistic language of "global (...) health" terms "resource-limited," rather than "poor" countries." This "hybrid life," as one of the physicians (Robert Riviello) refers to it, has transported them periodically to numerous African societies (to Algeria, Ethiopia, Gabon, Morocco, Rwanda, Sudan, Tanzania, and Uganda), to Haiti, to India and Nepal, and to Guatemala and Mexico. Three of the "stories" are written by physicians at work in the countries where they were born (Prasanta Tripathy in Eastern India, Sridevi Seetharam and colleagues in Southern India, and Paul Pierre, in Haiti).Only one group of physician-coauthors (Maricruz Merino, Jonathan Iralu, and Sonya Shin) write about their experiences in practicing medicine among poor and socially disadvantaged patients on the American mainland—in the setting of the Navajo Indian reservation in Gallup, New Mexico.All these physicians describe their involvement in humanitarian medicine as emanating from their commitment to "social justice," to "saving lives," and to "caring for the poor"; to their universalistic convictions about "human solidarity," and the non- otherness of others; to their indignation about the inequities and injustices of the world, particularly with regard to access to health care (in the words of Jeffrey Deal, "[They] deserve better. They all do"); and to their "passionate" desire, not just their "sense of duty," to help rectify these wrongs (Richard Keiden). I was struck by the fact that none of them uses the word "suffering" to describe the plight of the persons whom they feel they have been called to medically assist.Three of the physicians express the wellsprings of their motivation in religious terms. Richard Keiden refers to a "guiding principle of Judaism" on which his medical humanitarian work has been founded—"tzedakah"—which "translates as charity but actually means righteousness," is based on a "concept of social justice," and is "an obligation, not a choice." Robert Riveillo says that at the time of his graduation from high school he envisioned his "life's work as a long-term missionary surgeon"; he invokes "loving mercy," as well as justice, "in this work of solidarity" that he has undertaken; and he poignantly admits that "most days I still long to pack my things, my family, and our efforts and move to Africa for a life of direct service." What Jeffrey Deal writes is the most explicitly and ardently religious of all. He identifies his work as a physician in Sudan with Jesus's "desire for us to care [End Page 115] for the poor and downtrodden in His stead." He is haunted by his "failure" to deliver alive a "partially born" baby girl who for him incarnated "the least of the least" of whom Jesus "spoke passionately." And in touching "ever so briefly... [that] one, tiny being [he] encountered... [on ] that hot morning in Sudan," he attests, he "touched Jesus."Jeffrey Deal is not the only one who was so stricken by the death of a baby or a child. For a number of these physicians (Sadath Sayeed, Maneesh Batra, and for Sridevi Seetharam, Lisa Adams and their colleagues), it was a tragedy that they found hard to bear with "detached enlightenment" (Sayeed), or to accept. The most demonstrably heartbroken and morally outraged among them is Sadath Sayeed, who "wept uncontrollably" over the death of a baby boy, born "at home" in Haiti, "probably in one of the hundreds of make-shift tent cities." The baby was not breathing continuously, and was "handed" to him to care for. At the close of the "story " about this experience that he recounts, Sayeed lashes out with fury and angst at those who were likely to ask him, "How was it in Haiti?" Do you want to hear "my real answer?" he replies:... [L]et me summarize my last patient for you: Good luck Dad... (shrink)

While aging research and policy aim to promote ‘health’ at all ages, there remains no convincing explanation of what this ‘health’ is. In this paper, I investigate whether we can find, implicit within the sciences of aging, a way to know what health is and how to measure it, i.e. a theory of health. To answer this, I start from scientific descriptions of aging and its modulators and then try to develop some generalizations about ‘health’ implicit within this research. After (...) discussing some of the core aspects of aging and the ways in which certain models describe spatial and temporal features specific to both aging and healthy phenotypes, I then extract, explicate, and evaluate one potential construct of health in these models. This suggests a theory of health based on the landscape of optimized phenotypic trajectories. I conclude by considering why it matters for more candidate theories to be proposed and evaluated by philosophers and scientists alike. (shrink)

Philosophers have recently argued that traditional discussions of virtue and character presuppose an account of behaviour that experimental psychology has shown to be false. Behaviour does not issue from global traits such as prudence, temperance, courage or fairness, they claim, but from local traits such as sailing-in-rough-weather-with-friends-courage and office-party-temperance. The data employed provides evidence for this view only if we understand it in the light of a behaviourist construal of traits in terms of stimulus and response, rather than in the (...) light of the more traditional construal in terms of inner events such as inclinations. More recent experiments have shown this traditional conception to have greater explanatory and predictive power than its behaviourist rival. So we should retain the traditional conception, and hence reject the proposed alteration to our understanding of behaviour. This discussion has further implications for future philosophical investigations of character and virtue. Key Words: character traits • situationism • social psychology • virtue ethics. (shrink)

Various influential ethical theories propose that we should strive to develop morally sound character traits, either because good actions are those that issue from good character traits, or because good traits are those that generally incline us toward actions that are good for some independent reason such as the intentions with which they are performed or the consequences of performing them. This proposal obviously raises questions about the nature and origins of character traits, and our degree of control over them. (...) For if we cannot develop our traits then this proposal should be abandoned, and if we can then we need to know how this is best achieved. (shrink)

I begin by expressing my sincere thanks to my critics for taking time from their own impressive projects in epistemology to consider mine. Often, in reading their criticisms, I had the feeling of having received more help than I really wanted! But the truth of the matter is that we learn best by making mistakes, and I appreciate the conscientious attention to my work that my critics have shown.

The discovery of the engram, the physical substrate of memory, is a central challenge for the sciences of memory. Following the application of optogenetics to the neurobiological study of memory, scientists and philosophers claim that the engram has been found. In this paper, I evaluate the implications of applying optogenetic tools to the localization of the engram. I argue that conceptions of engram localization need to be revised to be made consistent with optogenetic studies of the engram. I distinguish between (...) challenges to vehicle and content localization. First, I consider the silent engram hypothesis. According to this hypothesis, optogenetic studies indicate that synaptic efficacy, the traditional engram-bearing vehicle, is important merely for retrieval. I argue that this interpretation rests upon a misunderstanding of accessibility. Second, I argue that optogenetic-based strategies and findings conflict with preservationist and constructivist views on memory storage. There is an enduring trace, but stored content may change over time and experience, resulting in doubt about what constitutes a single engram. (shrink)

O artigo tem por objeto o estudo dos limites do sigilo bancário e empresarial na concessão de empréstimos pelo Banco Nacional de Desenvolvimento Econômico e Social (BNDES), a partir da contraposição entre o dever de transparência da Administração Pública e os direitos fundamentais à intimidade e livre iniciativa. Através do método dedutivo e revisão bibliográfica, analisou-se as normas constitucionais envolvidas, a evolução da transparência nas operações de empréstimos do referido banco público, além de importante julgado do Supremo Tribunal Federal (STF) (...) sobre o tema, traçando-se ao fim, alguns limites aos direitos fundamentais em confronto. (shrink)

It’s generally assumed that, if an agent x acts by ϕ-ing, then there occurs an event which is x’s ϕ-ing. But what about when an agent tries to do something? Are there such things as attempts? The standard answer is ‘Yes’. But in a series of articles, and now a book, David-Hillel Ruben has argued that the answer is ‘No’: what happens when x tries to ϕ isn’t that an attempt occurs; rather, what happens is simply that a certain subjunctive (...) conditional fact obtains; x tries to ϕ just in case, had all the necessary conditions for success obtained, x would have intentionally ϕ-ed. I defend the existence of attempts. Following Ruben, I frame the issue in terms of the logical form of trying sentences. Against Ruben’s view that such sentences express subjunctive conditionals, I argue that they express existential quantifications over attempts qua events. Thus, trying sentences are true only if attempts qua events exist. (shrink)

Third-party punishment (TPP) occurs when the perpetrator of a transgression is punished by an individual who is not the victim of the transgression and, therefore, not directly affected by it. As F...

This article examines the philosophical methodology of intuitions beginning with an argument developed by Max Deutsch and Herman Cappelen over the descriptive adequacy of what Cappelen calls “methodological rationalism”, and their own preferred view, “intuition nihilism”. Based on inadequacies in both accounts, it offers a descriptive take on intuition-deploying philosophical practice today via what it calls “Protean Crypto-Rationalism”. It then describes the epistemic profile of the appeal to intuition, listing four key aspects of the basic shape of intuition-deploying philosophical practice: (...) primacy of cases, flexibility of report format, freedom of stipulation, and interpretation-hungry. It also considers several sources of error for intuitions featured in at least the informal methodological lore of philosophy, namely: misconstruals, modal confusions, pragmatics/semantics confusion, and “tin ear”. Finally, it explores the problem of methodological ignorance and inferential demand, particularly the typical practices of philosophical inference that operate on the premises delivered by appeal to intuitions. (shrink)

The principle of exchange seems to be limited in its application, and it cannot serve as a link between utilitarianism and the idea of a market for interpersonal relations. Our preferences concern the inner states of other people as well as their overt behavior. The neglect of this aspect of our preferences is a result of the coupling of utilitarianism with behaviorism. The problem is thus behaviorism, not consequentialism. It might be argued that commensurability is wrong because it sanctions impure (...) practices - aside from any principle of exchange. In reply, it may be argued that the principle of purity is an intuitive one, which must be justified at a higher level. At the intuitive level, the purity principle competes with the view that practices are in some cases too pure already, and that blind purity cannot be maintained without educational deception. The apparent difficulty of making tradeoffs among different kinds of consequences is a problem in practice, not a problem in principle. The difficulty may indeed justify certain prescriptive rules, but a blanket prohibition against impure practices would seem to require considerable defense. (shrink)

This article explains Hume's conception of the imagination and its relations to our other faculties of thought, highlighting the continuities and discontinuities between his views and those of his Early Modern predecessors. It then presents some of the basic functions that Hume thinks the imagination performs, and surveys some highlights of his science of man, showing how he uses the imagination’s basic functions to explain several important mental phenomena; examines “fictions of the imagination,” which have an important place in his (...) science of man; examines his view that whatever we can clearly imagine is possible; and discusses the relationship between Hume’s theory of the imagination and his skepticism. (shrink)

What contribution can political philosophers make to policy questions, such as the best configuration of the welfare state? On one view, political philosophers set out abstract theories of justice that can guide policy makers in their attempt to transform existing institutions. Yet it rarely seems the case that such a model is used in practice, and it therefore becomes unclear how political philosophy can contribute to policy debates. Following a suggestion from Margaret MacDonald, I consider the view that political philosophers (...) can contribute by drawing attention to relatively neglected values. I develop this view to add the possibility that political philosophers can try to correct a situation in which a particular value, though important, can come to be too highly emphasised. I illustrate the account by considering the rise of the value of ‘responsibility’ in the welfare state, and ultimately the damage that has been done to society to disadvantaged groups by the over-insistence on the importance of responsibility. (shrink)

Johnson-Laird and Byrne present a theory of conditional inference based upon the manipulation of mental models. In the present paper, the theory is critically examined with regard to its ability to account for psychological data, principally with respect to the rate at which people draw the four basic inferences of modus ponens, denial of the antecedent, affirmation of the consequent and modus tollens. It is argued first that the theory is unclear in its definition and in particular with regard to (...) predictions of problem difficulty. Clarification and specification of principles are consequently provided here. Next, it is argued that there are a number of phenomena in the conditional reasoning literature for which the theory cannot account in its present form. Specifically, the relatively frequency of DA and AC inferences on affirmative conditionals is not as predicted by the theory, differences occur between inferences on if then and only if rules beyond the capacity of the theory to explain and there is no account of the “negative conclusion bias” observed when negated components are introduced into the rules. A number of revisions to the mental model theory of conditional reasoning are proposed in order to account for these findings. (shrink)

Presenting a new political and historical theory of the mixed economy, this book is a convincing argument for a challenging social ideal - democratic communitarianism. Individualistic notions of liberty, equality and prosperity are too central to modern life and they need to be balanced by values of `community' and co-operation. Arguing that such a transformation is possible and practical, the author argues that long-term changes must be achieved before economic success can take place in a more fraternal, participative, and democratic (...) society. (shrink)

How can one Jewish thinker's natural law theory explain morality, divine commandments, and human ordinances; and how do we assess the consistency of that theory when it is mentioned in connection with such diverse areas? The answer lies in the changing meaning of reason in Novak's writings.

Many healthcare agencies are producing evidence-based guidance and policy that may determine the availability of particular healthcare products and procedures, effectively rationing aspects of healthcare. They claim legitimacy for their decisions through reference to evidence-based scientific method and the implementation of just decision-making procedures, often citing the criteria of ‘accountability for reasonableness’; publicity, relevance, challenge and revision, and regulation. Central to most decision methods are estimates of gains in quality-adjusted life-years, a measure that combines the length and quality of survival. (...) However, all agree that the QALY alone is not a sufficient measure of all relevant aspects of potential healthcare benefits, and a number of value assessment frameworks have been suggested. I argue that the practical implementation of these procedures has the potential to lead to a distorted assessment of value. Undue weight may be ascribed to certain attributes, particularly those that favour commercial or political interests, while other attributes that are highly valued by society, particularly those related to care processes, may be omitted or undervalued. This may be compounded by a lack of transparency to relevant stakeholders, resulting in an inability for them to participate in, or challenge, the decisions. The makes it likely that costly new technologies, for which inflated prices can be justified by the current value frameworks, are displacing aspects of healthcare that are highly valued by society. (shrink)

Matching bias in conditional reasoning consists of a tendency to select as relevant cases whose lexical content matches that referred to in the conditional statement, regardless of the presence of negatives. Evans demonstrated that use of explicit rather than implicit negative cases markedly reduced the matching bias effect on the conditional truth table task. In apparent contrast, recent studies of explicit negation on the Wason selection task have failed to find evidence of logical facilitation. Experiment 1 of the present study (...) strongly replicated the Evans findings and extended them to three forms of conditional statement. Experiments 2 and 3 showed further that the use of explicit negatives removed completely the matching bias effect on the Wason selection task. However, consistent with other recent studies, this elimination of bias didnotlead to facilitation of correct responding. The findings are interpreted as providing evidence that matching bias reflects a linguistically cued relevance effect. (shrink)