Objectives—While clinical practice is complicated by many ethical dilemmas, clinicians do not often request ethics consultations. We therefore investigated what triggers clinicians' requests for ethics consultation. Design—Cross-sectional telephone survey.Setting—Internal medicine practices throughout the United States.Participants—Randomly selected physicians practising in internal medicine, oncology and critical care.Main measurements—Socio-demographic characteristics, training in medicine and ethics, and practice characteristics; types of ethical problems that prompt requests for consultation, and factors triggering consultation requests. Results—One hundred and ninety of 344 responding physicians (55%) reported requesting ethics (...) consultations. Physicians most commonly reported requesting ethics consultations for ethical dilemmas related to end-of-life decision making, patient autonomy issues, and conflict. The most common triggers that led to consultation requests were: 1) wanting help resolving a conflict; 2) wanting assistance interacting with a difficult family, patient, or surrogate; 3) wanting help making a decision or planning care, and 4) emotional triggers. Physicians who were ethnically in the minority, practised in communities under 500,000 population, or who were trained in the US were more likely to request consultations prompted by conflict. Conclusions—Conflicts and other emotionally charged concerns trigger consultation requests more commonly than other cognitively based concerns. Ethicists need to be prepared to mediate conflicts and handle sometimes difficult emotional situations when consulting. The data suggest that ethics consultants might serve clinicians well by consulting on a more proactive basis to avoid conflicts and by educating clinicians to develop mediation skills. (shrink)

There are two main approaches within classical cognitive science to explaining how humans can entertain mental states that integrate contents across domains. The language-based framework states that this ability arises from higher cognitive domain-specific systems that combine their outputs through the language faculty, whereas the language-independent framework holds that it comes from non-language-involving connections between such systems. This article turns on its head the most influential empirical argument for the language-based framework, an argument that originates from research on spatial reorientation. (...) I make the case that neuroscientific findings about spatial reorientation in rodents and humans bolster the language-independent framework instead. (shrink)

Many species rely on the three-dimensional surface layout of an environment to find a desired goal following disorientation. They generally do so to the exclusion of other important spatial cues. Two influential frameworks for explaining that phenomenon are provided by geometric-module theories and view-matching theories of reorientation respectively. The former posit a module that operates only on representations of the global geo- metry of three-dimensional surfaces to guide behavior. The latter place snapshots, stored representations of the subject’s two-dimensional retinal stimulation (...) at specific locations, at the heart of their accounts. In this paper, I take a fresh look at the debate between them. I begin by making a case that the empirical evidence we currently have does not clearly favor one framework over the other, and that the debate has reached something of an impasse. Then, I present a new explanatory problem—the representation selection problem—that offers the pro- spect of breaking the impasse by introducing a new type of explanatory consideration that both frameworks must address. The representation selection problem requires explaining how subjects can reliably select the relevant representation with which they initiate the reorientation process. I argue that the view-matching framework does not have the resources to address this problem, while a certain type of theory within the geometric-module framework can provide a natural response to it. In showing this, I develop a new geometric-module theory. (shrink)

The effects of aging on the cognitive and affective dimensions of theory of mind , and on the latter’s links with other cognitive processes, such as information processing speed, executive functions and episodic memory, are still unclear. We therefore investigated these effects in young , middle-aged and older adults , using separate subjective and objective assessment tasks. Furthermore, a novel composite task probed participants’ abilities to infer both cognitive and affective mental states in an interpersonal context. Although age affected the (...) objective ToM tests, results revealed a direct aging effect on the second-order ToM, but an indirect one on the first-order cognitive ToM, mediated mainly by age-related declines in executive functions. This study supports the notion of an age-related distinction between subjective and objective assessments of ToM, and confirms that ToM is a complex mental ability with several characteristics reliant to some extent on executive processes. (shrink)

Spelke convincingly argues that we should posit six innate modular systems beyond the periphery (i.e., beyond low-level perception and motor control). I focus on the case of spatial navigation (Ch. 3) to claim that there remain powerful considerations in favor of positing additional innate, nonperipheral modules. This opens the door to stronger forms of nativism and nonperipheral modularism than Spelke's.

Clinical Study Agreements can have profound effects both on the protection of human subjects and on the independence of investigators to conduct research with scientific integrity. Sponsors, institutions, and even investigators may fail to give adequate attention to these issues in the negotiation of CSAs. Despite the key role of CSAs in structuring ethically important aspects of research, they remain largely unregulated and unreviewed for adherence to ethical norms. Academic institutions routinely enter into research contracts that fail to meet adequate (...) ethical standards. This is a failing that can have serious consequences.Accordingly, it is necessary that some independent body have the authority both to review research contracts for compliance with norms of subject protection and ethical integrity, and to reject studies that fail to meet ethical standards. Such review should take place prior to the start of research, not later. Because of its expertise and authority, the institutional ethics review board is the appropriate body to undertake such review. Much recent commentary has focused on contractual restrictions on the investigator’s freedom to publish research findings. The Olivieri experience, and that of other investigators, has brought freedom of publication issues into sharp focus. Clinical study agreements also raise a number of other ethical issues relating to human subjects and research integrity, however, including disclosures relating to patient safety, data analysis and reporting, budget, confidentiality, and premature termination of the study. This paper describes the ethical issues at stake in structuring such agreements and suggests ethical standards to guide institutional ethics review. (shrink)

Many philosophers have adopted epistemic expressivism in recent years. The core commitment of epistemic expressivism is that epistemic claims express conative states. This paper assesses the plausibility of this commitment. First, we raise a new type of problem for epistemic expressivism, the epistemic motivation problem. The problem arises because epistemic expressivists must provide an account of the motivational force of epistemic judgment (the mental state expressed by an epistemic claim), yet various features of our mental economy seem to show that (...) they can’t do so. Second, we develop what we take to be the most promising response to that problem for expressivists. We end by noting that this response faces an important challenge pertaining to the psychology of epistemic criticism and praise. (shrink)

If clinical trials become a commercial venture in which self-interest overrules public interest and desire overrules science, then the social contract which allows research on human subjects in return for medical advances is broken.BackgroundIn the past two decades, the involvement of non-academic sponsors of biomedical research, particularly clinical trial research, has increased exponentially. The value of such sponsored research is difficult to ascertain. However, it is estimated that, between 1980 and 2003, overall research and development expenditures by US pharmaceutical companies (...) increased from $2 billion to $33 billion and that, in 2001, clinical trial research expenditures in Canada totaled $800 million to $1 billion.The source of funding for biomedical research has shifted significantly from predominantly government and private foundations to industry. By 2002,70% of funding for clinical trials came from industry. These factors have affected the conduct of research, particularly clinical trial research, in a variety of ways. (shrink)

The practice of nonphysician ethicist-consultants giving ethics advice concerning the appropriate medical treatment of patients in hospitals is a relatively recent development. Although only a minority of hospitals make substantial use of any formal ethics consulting service, the number is growing and apparently will continue to do so. Indeed, at least among urban teaching hospitals, some sort of ethics consulting service is increasingly commonplace.

Les premiers travaux réalisés sur les effets du confinement du printemps 2020 sur les enfants ont établi que ceux qui étaient en résidence alternée l’avaient mieux vécu que les autres. L’objectif de cet article est de comprendre pourquoi. À partir de l’enquête Sapris et plus particulièrement du sous-échantillon des enfants âgés de 8-9 ans des cohortes Elfe et Epipage2, nous comparons les conséquences du confinement sur les enfants selon la structure familiale dans laquelle ils vivaient. Continu dans les familles nucléaires, (...) le temps familial est habituellement beaucoup plus fractionné entre les résidences des parents pour les enfants de familles séparées. Le confinement est venu transformer les expériences habituelles du temps familial pour les enfants, aussi bien dans son organisation que dans sa texture. Il a modifié leur cadre de vie ordinaire, en réorganisant leurs occupations au quotidien et en modifiant leurs relations avec leurs parents. En observant particulièrement les différences apparues entre les résidences alternées qui ont continué et celles qui ont été interrompues, nous montrons que si les mouvements réguliers des enfants ont pu constituer une respiration bienvenue pour les différents acteurs concernés, les alternances interrompues ont ouvert des espaces exceptionnels dans lesquels il a été possible de renouer avec des formes passées de continuité familiale. (shrink)

In the past twelve to eighteen months, another perceived threat to the safety of America's blood supply has arisen. The fear is that Creutzfeldt-Jakob disease will join hepatitis, HW and AIDS in the public and medical consciousness as the 1990s next infectious disease epidemic. A particular kind of ethical dilemma has arisen causing much debate and consternation for hospitals, regulators, and blood suppliers, and has elicited a remarkably varied response.CJD is a rare but uniformly fatal neurological disease: it affects the (...) brain and the rest of the central nervous system. Its incidence in the population of the developed world is about one per million per year, although some geographic anomalies exist. CJD manifests itself in two broad ways. First, the disease is associated with symptoms of mental deterioration and dementia, including memory loss, anxiety, and cognitive impairment. Second, CJD is also associated with a range of neurological symptoms, including muscle rigidity, seizures, tremors, muscle twitching, and spasticity, as well as problems with muscle coordination and unsteady gait, sometimes resulting in total disability. (shrink)

Deduction systems and graph transformation systems are compared within a common categorical framework. This comparison results in a proposal for a new deduction method in diagrammatic logics, allowing the deletion of intermediate lemmas.

Résumé L’étude porte sur la représentation d’un enfer chinois. Les espaces plastiques et l’équivoque domaine du textuel y sont interrogés. Fruit d’une imagination complexe, liée aux syncrétismes religieux et païens, l’image engendre des formes vivantes inattendues, notamment grâce à la facture de l’imagier. Condamné par les sages chinois comme la source du mal, l’esprit de démesure semble gagner, jusque dans les moindres détails, ces enfers aux châtiments hallucinants.

My dissertation is a study of the relationships among aesthetics, ethics and politics in the philosophy of Ludwig Wittgenstein. In this project I use primary texts, records of conversations, and correspondence to describe Wittgenstein's "moral perfectionism." I then consider what place there might be for political action within his conception of the good life. The aim of the dissertation is twofold. First, it is an analysis of Wittgenstein's ethical thought and the continuity it provides between his early and later work. (...) I begin with Wittgenstein's claim that "Ethics and aesthetics are one," and then I trace the development of his views on ethics through the middle and later periods of his work. Second, the study of Wittgenstein's ethical views is an occasion for the study of the relationships among aesthetics, ethics, and politics. I argue that Wittgenstein's views on ethics and ethical language suggests a "politics of health". I read Wittgenstein as a critic of modernity whose work suggests both that our future political endeavors should be detached from questions of certainty, and that we should return to the Aristotelian model of allowing the good person to stand as a moral and political exemplar without epistemic or scientific justification. (shrink)

Résumé Le formalisme relève d’une vision unilatérale et dualiste qui lutte contre les formes. La forme est vivante comme désir conscient et inconscient, matière, couleur, rythme, métamorphose, Gestaltung énergétique et érotique au sens de Klee. Ces perspectives semblent échapper à nombre de théoriciens qui la figent dans ses oppositions traditionnelles avec le contenu et la matière. Refoulant l’événement sensible et corporel qu’elle constitue, les uns l’assimilent au formalisme, les autres élaborent un concept d’informe, tous s’avérant incapables de distinguer la forme (...) du formalisme. (shrink)

Le problème du fondement de la raison ne peut se résoudre que par le principe de transcendance. Les principes rationnels ne sont pas constitutifs d’un esprit pur, qui imposerait, du dehors, ses formes aux objets de sa pensée ; ils naissent dans le progrès et l’effort de l’esprit, pour se dépasser lui-même.

In this short paper, using category theory, we argue that logical rules can be seen as fractions and logics as limit sketches.