In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all (...) further questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Sociobiological explanation requires both a reliable and a valid definition of the sociopathy phenotype. Mealey assumes that such reliable and valid definition of sociopathy exists in her A review of psychiatric literature on the diagnosis of antisocial personality disorder clearly demonstrates that this assumption is faulty. There is substantial disagreement among diagnostic systems (e.g., RDC, DSM-III) over what constitutes the antisocial phenotype, different systems identify different individuals as sociopathic. Without a valid definition of sociopathy, sociobiological theories like Mealey's should be (...) viewed as entirely speculative. (shrink)

introduction to the model of human agency -- Human agency -- Circle within a circle -- Communication over intervention -- Objective function -- Economic resources -- Resource allocation -- Risk, returns & rewards -- Risk aversion -- Individual investment -- Organization investment -- The law of proportion -- Heart capital -- Heart labor -- Territory -- Information asymmetry -- Monitoring and bonding -- Testing.

Intelligent humanoid robots (IHRs) are becoming likely to be integrated into nursing practice. However, a proper integration of IHRs requires a detailed description and explanation of their essential capabilities, particularly regarding their competencies in replicating and portraying emotive functions such as empathy. Existing humanoid robots can exhibit rudimentary forms of empathy; as these machines slowly become commonplace in healthcare settings, they will be expected to express empathy as a natural function, rather than merely to portray artificial empathy as a replication (...) of human empathy. This article works with a twofold purpose: firstly, to consider the impact of artificial empathy in nursing and, secondly, to describe the influence of Affective Developmental Robotics (ADR) in anticipation of the empathic behaviour presented by artificial humanoid robots. The ADR has demonstrated that it can be one means by which humanoid nurse robots can achieve expressions of more relatable artificial empathy. This will be one of the vital models for intelligent humanoid robots currently in nurse robot development for the healthcare industry. A discussion of IHRs demonstrating artificial empathy is critical to nursing practice today, particularly in healthcare settings dense with technology. (shrink)

This book provides a collection of essays representing the state of the art in the research into argumentation in classical antiquity. It contains essays from leading and up and coming scholars on figures as diverse as Parmenides, Gorgias, Seneca, and Classical Chinese "wandering persuaders." The book includes contributions from specialists in the history of philosophy as well as specialists in contemporary argumentation theory, and stimulates the dialogue between scholars studying issues relating to argumentation theory in ancient philosophy and contemporary argumentation (...) theorists. Furthermore, the book sets the direction for research into argumentation in antiquity by encouraging an engagement with a broader range of historical figures, and closer collaboration between contemporary concerns and the history of philosophy. (shrink)

The discussion on ethical issues, it is said, should not be confined to experts but should be extended to patients and local communities, because of the real need to engage stakeholders and non‐stakeholders alike not only in carrying out any biomedical research project, but also in the drafting and legislation of bioethics instruments. Several local and inter‐country consultations have already been conducted in furtherance of this goal, but there is much left to be desired in them. The consultations may have (...) helped in articulating local principles, but not in making the instruments embody these principles. As such, instruments turn incompossible, i.e. the principles and actions they legitimate are not performable. In an ethnographic study conducted in the Philippines, for example, paragraphs 29 and 30 of the Declaration of Helsinki and CIOMS guidelines 8 and 15 are construed as not only contradictory to one another but also to local principles. This problem can be solved by taking deliberate steps to ensure that consultations are grounded in ethnographic data about local principles, which the instruments would embody. A steering committee can be of help in gathering ethnographic data, in conducting consultations at the local level, and in providing a venue for discourse on various bioethical issues. (shrink)

Matteo Ricci (1552-1610) was an Italian Jesuit and one of the first Christian missionaries to China in the modern era. He was a genuine polymath—a translator, cartographer, mathematician, astronomer, and musician. Above all, Ricci was a missionary for the gospel. As we briefly examine his 1603 seminal work, The True Meaning of the Lord of Heaven, our hope is that we, as evangelical educators, will perceive some of the deeper principles necessary for our own missionary work among unreached people.

As human beings age, they become weak, fragile, and feeble. It is a slowly progressing yet complex syndrome in which old age or some disabilities are not prerequisites; neither does loss of human parts lead to frailty among the physically fit older persons. This paper aims to describe the influences of transhumanist perspectives on human‐technology enhancements and replacements in the transcendence of human frailties, including those of older persons, in which technology is projected to deliver solutions toward transcending these frailties. (...) Through technologies including genetic screening and other technological manipulations, intelligent machines and augmented humans improve, maintain, and remedy human‐linked susceptibilities. Furthermore, other technologies replace parts fabricated through inorganic‐mechanical processes such as 3D‐printing. Advancing technologies are reaching the summit of technological sophistication contributing to the transhumanist views of being human in a technological world. Technologies enhance the transcendence of human frailties as essential expressions of the symbiosis between human beings and technology in a transcendental world. (shrink)

In this paper we look at the manual analysis of arguments and how this compares to the current state of automatic argument analysis. These considerations are used to develop a new approach combining a machine learning algorithm to extract propositions from text, with a topic model to determine argument structure. The results of this method are compared to a manual analysis.

While more species are being identified as cultural on a regular basis, stark differences between human and animal cultures remain. Humans are more richly cultural, with group-specific practices and social norms guiding almost every element of our lives. Furthermore, human culture is seen as cumulative, cooperative, and normative, in contrast to animal cultures. One hypothesis to explain these differences is grounded in the observation that human children across cultures appear to spontaneously over-imitate silly or causally irrelevant behaviors that they observe. (...) The few studies on over-imitation in other species are largely taken as evidence that spontaneous over-imitation is not present in other species. This leads to the over-imitation hypothesis – that the differences between human culture and animal cultures can be traced to the human unique tendency to over-imitate. In this paper, we analyze the current state of the literature on animal over-imitation and challenge the adequacy of the over-imitation hypothesis for the differences between humans and animal cultures. To make this argument, we first argue that the function of human over-imitation is norm-learning and that over-imitation, like skill-learning, should be subject to selective social learning effects. Then we review the empirical evidence against animal over-imitation and argue that these studies do not take into account the relevant variables given the normative and selective nature of over-imitation. We then analyze positive empirical evidence of over-imitation in great apes and canids from the experimental literature and conclude that the current body of evidence suggests that some canids and primates may have the capacity for over-imitation. This paper offers a methodological suggestion for how to study animal over-imitation, and a theoretical suggestion that over-imitation might be much more widely found among species. The larger implication for claims about human uniqueness suggests that if we do find widespread evidence of over-imitation across species, many of the current theories of human uniqueness that focus on human hyper-cooperation or social norms may have only identified a difference of degree, not of kind, between humans and other animals. (shrink)

Rational justification of claims with empirical content calls for empirical and not only normative philosophical investigation. Empirical approaches to bioethics are epistemically valuable, i.e., such methods may be necessary in providing and verifying basic knowledge about cultural values and norms. Our assumptions in moral reasoning can be verified or corrected using these methods. Moral arguments can be initiated or adjudicated by data drawn from empirical investigation. One may argue that individualistic informed consent, for example, is not compatible with the Asian (...) communitarian orientation. But this normative claim uses an empirical assumption that may be contrary to the fact that some Asians do value and argue for informed consent. Is it necessary and factual to neatly characterize some cultures as individualistic and some as communitarian? Empirical investigation can provide a reasonable way to inform such generalizations. In a multi‐cultural context, such as in the Philippines, there is a need to investigate the nature of the local ethos before making any appeal to authenticity. Otherwise we may succumb to the same ethical imperialism we are trying hard to resist. Normative claims that involve empirical premises cannot be reasonably verified or evaluated without utilizing empirical methods along with philosophical reflection. The integration of empirical methods to the standard normative approach to moral reasoning should be reasonably guided by the epistemic demands of claims arising from cross‐cultural discourse in bioethics. (shrink)

Application of egalitarian and prioritarian accounts of health resource allocation in low‐income countries have both been criticized for implying distribution outcomes that allow decreasing/undermining health gains and for tolerating unacceptable standards of health care and health status that result from such allocation schemes. Insufficient health care and severe deprivation of health resources are difficult to accept even when justified by aggregative efficiency or legitimized by fair deliberative process in pursuing equality and priority oriented outcomes. I affirm the sufficientarian argument that, (...) given extreme scarcity of public health resources in low‐income countries, neither health status equality between populations nor priority for the worse off is normatively adequate. Nevertheless, the threshold norm alone need not be the sole consideration when a country's total health budget is extremely scarce. Threshold considerations are necessary in developing a theory of fair distribution of health resources that is sensitive to the lexically prior norm of sufficiency. Based on the intuition that shares must not be taken away from those who barely achieve a minimal level of health, I argue that assessments based on standards of minimal physical/mental health must be developed to evaluate the sufficiency of the total resources of health systems in low‐income countries prior to pursuing equality, priority, and efficiency based resource allocation. I also begin to examine how threshold sensitive health resource assessment could be used in the Philippines. (shrink)

One of the earliest issues in cognitive ethology concerned the meaning of animal signals. In the 1970s and 1980s this debate was most active with respect to the question of whether animal alarm calls convey information about the emotional states of animals or whether they “refer” directly to predators in the environment (Seyfarth, Cheney, & Marler 1980; see Radick 2007 for a historical account), but other areas, such as vocalizations about food and social contact, were also widely discussed. In the (...) 1990s, ethologists largely came to a consensus that such calls were “functionally referential” (Evans & Marler 1995) even if they did not satisfy all the semantic requirements imposed by philosophers of language. More recently, though, it has been argued that ethologists should eschew the concept of reference and return to a focus on the affective aspects of animal communication (Rendall & Owren 2002). We propose to take a new look at this debate in the light of recent developments in the philosophy of language under the heading of “Neo-Expressivism” (Bar-On 2004). This view provides two different senses.. (shrink)

BackgroundInvolvement of adolescent girls in biomedical HIV research is essential to better understand efficacy and safety of new prevention interventions in this key population at high risk of HIV infection. However, there are many ethical issues to consider prior to engaging them in pivotal biomedical research. In Uganda, 16–17-year-old adolescents can access sexual and reproductive health services including for HIV or other sexually transmitted infections, contraception, and antenatal care without parental consent. In contrast, participation in HIV prevention research involving investigational (...) new drugs requires adolescents to have parental or guardian consent. Thus, privacy and confidentiality concerns may deter adolescent participation. We describe community perspectives on ethical considerations for involving adolescent girls in the MTN 034 study in Uganda.MethodsFrom August 2017 to March 2018, we held five stakeholder engagement meetings in preparation for the MTN 034 study in Kampala, Uganda (NCT03593655): two with 140 community representatives, two with 125 adolescents, and one with 50 adolescents and parents. Discussions were moderated by the study team. Proceedings were documented by notetakers. Summary notes described community perspectives of adolescent participation in HIV research including convergent, divergent or minority views, challenges, and proposed solutions.ResultsMost community members perceived parental or guardian consent as a principal barrier to study participation due to concerns about adolescent disclosure of pre-marital sex, which is a cultural taboo. Of 125 adolescent participants, 119 (95%) feared inadvertent disclosure of sexual activity to their parents. Community stakeholders identified the following critical considerations for ethical involvement of adolescents in HIV biomedical research: (1) involving key stakeholders in recruitment, (2) ensuring confidentiality of sensitive information about adolescent sexual activity, (3) informing adolescents about information to be disclosed to parents or guardians, (4) offering youth friendly services by appropriately trained staff, and (5) partnering with community youth organizations to maximize recruitment and retention.ConclusionsStakeholder engagement with diverse community representatives prior to conducting adolescent HIV prevention research is critical to collectively shaping the research agenda, successfully recruiting and retaining adolescents in HIV clinical trials and identifying practical strategies to ensure high ethical standards during trial implementation. (shrink)

War: A Primer for Christians provides a concise introduction to the main approaches that Christians have taken toward war and examines each approach critically. Some Christians have supported their country's wars as crusades of good against evil. Others, as pacifists, have rejected participation in or support for any war. Still others have followed the just-war tradition in holding that it can be justifiable under some conditions to resort to war, but that then Christian love must limit the conduct of war. (...) In an updated preface and new afterword, Allen explores aspects of current international relations that have a special bearing on the context of war. “Joseph Allen’s War: A Primer for Christians is just that: a succinct, fair-minded, wonderfully reasoned, and accessible account of the major Christian traditions on war—Just War, Holy War, and the Pacifist renunciation of violence. His book is also a primer in the further sense, that it will prime the pump for further discussion and debate as to when wars are just and how a nation might keep the means employed under restraints.”—William F. May. (shrink)

Mounting ambitions and capabilities for public and private, non-government sector crewed space exploration bring with them an increasingly diverse set of space travelers, raising new and nontrivial ethical, legal, and medical policy and practice concerns which are still relatively underexplored. In this piece, we lay out several pressing issues related to ethical considerations for selecting space travelers and conducting human subject research on them, especially in the context of non-governmental and commercial/private space operations.

Ethical beliefs may vary across cultures but there are things that must be valued as preconditions to any cultural practice. Physical and mental abilities vital to believing, valuing and practising a culture are such preconditions and it is always important to protect them. If one is to practise a distinct culture, she must at least have these basic abilities. Access to basic healthcare is one way to ensure that vital abilities are protected. John Rawls argued that access to all-purpose primary (...) goods must be ensured. Amartya Sen and Martha Nussbaum claim that universal capabilities are what resources are meant to enable. Len Doyal and Ian Gough identify physical health and autonomy as basic needs of every person in every culture. When we disagree on what to prioritize, when resources to satisfy competing demands are scarce, our common needs can provide a point of normative convergence. Need-based rationing, however, has been criticized for being too indeterminate to give guidance for deciding which healthcare services to prioritize and for tending to create a bottomless-pit problem. But there is a difference between needing something (first-order need) and needing to have the ability to need (second-order need). Even if we disagree about which first-order need to prioritize, we must accept the importance of satisfying our second-order need to have the ability to value things. We all have a second-order need for basic healthcare as a means to protect our vital abilities even if we differ in what our cultures consider to be particular first-order needs. (shrink)

In seeking to determine what place, if any, the concept of moral rights can and/or should have in theological ethics, it is first necessary to clarify the nature of the concept. On this task contemporary moral philosophy is found to be especially helpful. It is then suggested that from a theological standpoint an appeal to moral rights might be justified by reference to (1) the moral fabric of persons under God, (2) the worth of persons as ends, and (3) the (...) inclusiveness of the moral community. The author claims that the concept of moral rights is compatible with belief in a sovereign God who promises his steadfast love, and that it need not imply any "natural" ethic in competition with theological ethics. Finally, the affirmation of moral rights is found to be highly appropriate to an emphasis upon love toward other persons. (shrink)

Main Response Topics ? Introduction ? Open display and public evaluation ? Publicity versus patient privacy ? Facial tissue donation ? Validity of Louisville Instrument for Risk Acceptance ? Patients' understanding of risk ? Face versus hand transplantation ? Rejection rates/risks ? Patient compliance ? Exit strategy ? Functional recovery ? Societietal implications ? Psychological implications ? Conclusion: Uncertainty likely to persist.

The goal of this study was to assess the relationships between computational approaches to analyzing constructed responses made during reading and individual differences in the foundational skills of reading in college readers. We also explored if these relationships were consistent across texts and samples collected at different institutions and texts. The study made use of archival data that involved college participants who produced typed constructed responses under thinking aloud instructions reading history and science texts. They also took assessments of vocabulary (...) knowledge and proficiency in comprehension. The protocols were analyzed to assess two different ways to determine their cohesion. One approach involved assessing how readers established connections with themselves. The other approach involved assessing connections between the constructed responses and the texts that were read. Additionally, the comparisons were made by assessing both lexical and semantic comparisons. The result showed that both approaches for analyzing cohesion and making the comparisons were correlated with vocabulary knowledge and comprehension proficiency. The implications of the results for theory and practice are discussed. (shrink)

We describe the results of an experiment testing for the presence of strong altruism among Christians in New Zealand. The study examined anonymous participant generosity to cohort. We found that in modified dictator games, anonymous Christians in New Zealand gave significantly more to Canadian Christians than anonymous New Zealand citizens gave to their fellow citizens. The gifting opportunities occurred after anonymous benefactors observed recipients willingly undertake costly acts of group commitment. We found that mean gifting after witnessing a fellow group (...) member metaphorically "fall on a hand grenade" to punish a member of an out-group was almost four times greater in the Christian group than it was in the New Zealand control. Our data support the hypothesis that religious altruism exists and is especially strong among Christians in New Zealand. The data also weakly support a multi-level selection hypothesis for the evolution of religious altruism. (shrink)