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)

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)

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)

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)

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.

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)

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.

This letter replies to the letter “Colonial and Neocolonial Barriers to Companion Digital Humans in Africa,” by Luís Cordeiro‐Rodrigues, in the same, May‐June 2024, issue of the Hastings Center Report.

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)

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)

Retells the Old Testament story of how the baby Moses was saved from death by the Pharoah's daughter.

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.

_The Scarlet Empire_ (1906) by David Maclean Parry, a former president of the National Association of Manufacturers (NAM), offers an anti-utopian romance set in an authoritarian socialist Atlantis. Supplementing the efforts of NAM to limit the power of unions and diminish the appeal of socialism through political and editorial suasion, the novel promised a new and powerful way of proselytizing middle-class readers by competing with prominent literary utopians and socialists, especially Edward Bellamy and Upton Sinclair. The novel's protagonist is converted (...) to individualism and capitalism and comes to see socialism as emasculating. _Empire_ bundles capitalism and masculinity together through a redemptive adventure romance narrative that serves capitalist ideological purposes and has the protagonist combining tremendous wealth, a powerful faith in individualism, and a recovered masculine subjectivity to become a captain of industry and paragon of a hegemonic masculinity at the turn of the twentieth century. (shrink)

It is often supposed that the spectacular successes of our modern mathematical sciences support a lofty vision of a world completely ordered by one single elegant theory. In this book Nancy Cartwright argues to the contrary. When we draw our image of the world from the way modern science works - as empiricism teaches us we should - we end up with a world where some features are precisely ordered, others are given to rough regularity and still others behave (...) in their own diverse ways. This patchwork makes sense when we realise that laws are very special productions of nature, requiring very special arrangements for their generation. Combining classic and newly written essays on physics and economics, The Dappled World carries important philosophical consequences and offers serious lessons for both the natural and the social sciences. (shrink)

Il s’agira ici de faire apparaître la régressivité — possibilité perpétuelle d’adjoindre un degré supplémentaire à l’énoncé — comme le principe même de l’ironie, ce qui conduit à la concevoir non comme une grille sémiotique et axiologique, mais comme une dynamique.La réflexion part de la cellule de base qu’est le signe ironique en tant que structure hiérarchisée à deux degrés, selon la conception traditionnelle. Cette dualité est d’abord analysée du point de vue sémantique, dans le cadre tropologique, puis sur les (...) plans axiologique, actantiel et énonciatif, ce qui aboutit à l’hypothèse de l’ironie comme trope métadiscursif, cumulant l’usage et la mention . Dans ce cadre, l’ironie se conçoit comme une représentation de représentation, comme un processus d’auto-duplication agissant par réflexivité critique et comique, et donc capable de se perpétuer virtuellement à l’infini puisque, s’appliquant à lui-même, il peut toujours ajouter un degré au précédent, sans pour autant l’annuler : le signe à deux niveaux ne constitue que la réalisation minimale de l’ironie, dont le second degré peut lui-même être réfléchi par un troisième, etc. Le « pouvoir réfléchissant » de l’ironie fait ainsi sa « force ascensionnelle » régressive, selon deux expressions empruntées à Proust.Interne au signe, ce dynamisme permet aussi, à l’échelle d’une oeuvre, de greffer différentes sortes d’ironie les unes sur les autres : la puissance créatrice du processus régressif conduit à envisager son rôle dans l’oeuvre d’art, en l’occurrence À la recherche du temps perdu, dont le texte multiplie de façon exemplaire et retorse les strates d’ironie. La Recherche, qui aura préalablement servi de support à toutes les analyses, permettra, par l’intermédiaire de Bergotte — écrivain ironiste dont le génie consiste dans le « pouvoir réfléchissant » et l’énergie créatrice dans la « force ascensionnelle » —, de poser la question de l’actualisation de la régressivité ironique dans l’oeuvre littéraire.Regressivity, as the perpetual possibility of adding a further degree to an utterance is the very principle of irony, which is thus conceived not under a semiotic and axiological grid, but as a dynamics.Reflection starts from the ironic sign as the basic cell and as a two tiered hierarchical structure, according to the traditional conception. This duality is first analysed from a semantical point of view, within the tropological framework, then on the axiological, actancial and utterance theoretic levels. This leads us to the hypothesis that irony is a metadiscursive trope, bringing together use and mention . Within this framework, irony is a representation of representation, an auto-duplicative process which acts through critical and comical reflectivity, and which is liable to perpetuate itself indefinitely, since, being auto-applicative, a new degree can always be added to the previous one, without cancelling itself : the two tiered sign being only the minimal realisation of irony, whose second degree can itself be reflected through a third, and so on. The “reflective power” of irony thus produces its “ascending force”.This mechanism internal to the sign allows also, at the level of the work, to plug different kinds of ironies onto each other : the creative power of the regressive process allows us to envisage its role in the work of art, in the case at hand in Remembrance of Things Past, whose text multiplies the various layers of irony. Proust’s work, which is here the basis of all our analyses, allows Bergotte — the ironist writer whose genius consists in the “reflective power” and in the “ascending force” — to raise the question of the actualisation of the ironical regressivity of the literary work. (shrink)

(1997). Are we postinterruption? Postmodernism, resistance, and practice. The European Legacy: Vol. 2, Fourth International Conference of the International Society for the Study of European Ideas, pp. 690-696.

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.

How do novel scientific concepts arise? In Creating Scientific Concepts, Nancy Nersessian seeks to answer this central but virtually unasked question in the problem of conceptual change. She argues that the popular image of novel concepts and profound insight bursting forth in a blinding flash of inspiration is mistaken. Instead, novel concepts are shown to arise out of the interplay of three factors: an attempt to solve specific problems; the use of conceptual, analytical, and material resources provided by the (...) cognitive-social-cultural context of the problem; and dynamic processes of reasoning that extend ordinary cognition. Focusing on the third factor, Nersessian draws on cognitive science research and historical accounts of scientific practices to show how scientific and ordinary cognition lie on a continuum, and how problem-solving practices in one illuminate practices in the other. (shrink)

Unruly Practices brings together a series of widely discussed essays in feminism and social theory. Read together, they constitute a sustained critical encounter with leading European and American approaches to social theory. In addition, Nancy Fraser develops a new and original socialist-feminist critical theory that overcomes many of the limitations of current alternatives. First, in a series of critical essays, she deploys philosophical and literary techniques to assess the work of Michael Foucault, the French deconstructionists, Richard Rorty, and Jürgen (...) Habermas. Then, in a group of constructive essays, she incorporates their respective strengths in a new critical theory of late-capitalist political culture. Fraser breaks new ground methodologically by integrating the previously divergent insights of poststructuralism, critical social theory, feminist theory, and pragmatism. Thematically, she deals with varied forms of dominance and subordination in modern, industrial, late-capitalist societies. These themes are integrated in an original theory of 'the politics of need interpretation.' This concept becomes the linchpin of the socialist-feminist critical theory. (shrink)

Hunting Causes and Using Them argues that causation is not one thing, as commonly assumed, but many. There is a huge variety of causal relations, each with different characterizing features, different methods for discovery and different uses to which it can be put. In this collection of new and previously published essays, Nancy Cartwright provides a critical survey of philosophical and economic literature on causality, with a special focus on the currently fashionable Bayes-nets and invariance methods - and it (...) exposes a huge gap in that literature. Almost every account treats either exclusively how to hunt causes or how to use them. But where is the bridge between? It's no good knowing how to warrant a causal claim if we don't know what we can do with that claim once we have it. This book will interest philosophers, economists and social scientists. (shrink)

How the new conspiracists are undermining democracy—and what can be done about it Conspiracy theories are as old as politics. But conspiracists today have introduced something new—conspiracy without theory. And the new conspiracism has moved from the fringes to the heart of government with the election of Donald Trump. In A Lot of People Are Saying, Russell Muirhead and Nancy Rosenblum show how the new conspiracism differs from classic conspiracy theory, why so few officials speak truth to conspiracy, and (...) what needs to be done to resist it. Classic conspiracy theory insists that things are not what they seem and gathers evidence—especially facts ominously withheld by official sources—to tease out secret machinations. The new conspiracism is different. There is no demand for evidence, no dots revealed to form a pattern, no close examination of shadowy plotters. Dispensing with the burden of explanation, the new conspiracism imposes its own reality through repetition and bare assertion. The new conspiracism targets democratic foundations—political parties and knowledge-producing institutions. It makes it more difficult to argue, persuade, negotiate, compromise, and even to disagree. Ultimately, it delegitimates democracy. Filled with vivid examples, A Lot of People Are Saying diagnoses a defining and disorienting feature of today's politics and offers a guide to responding to the threat. (shrink)

A deeply informed exploration of what Stoic ideas have to offer us today Stoicism is the ideal philosophy of life for those seeking calm in times of stress and uncertainty. For many, it has become the new Zen, with meditation techniques that help us face whatever life throws our way. Indeed, the Stoics address a key question of our time: how can we be masters of our fate when the outside world threatens to unmoor our well-being? In Stoic Wisdom, Georgetown (...) philosophy professor Nancy Sherman, an expert in ancient and modern ethics, shows what a practical modern Stoicism really looks like. Drawing on the wisdom of Stoic thinkers Epictetus, Marcus Aurelius, Seneca and others, Sherman paints a portrait that uncovers the true subtlety and power of Stoic ideas. That portrait reveals a truth often ignored: that the Stoics never thought self-sufficiency was only about rugged self-reliance and mental discipline. We are at home in the world, they taught, when we are connected to each other in cooperative efforts. While mastery of one's self is essential, we also must draw on our deepest relationships for true strength and resilience. Bringing these ancient ideas to bear on 21st century environments-from Silicon Valley to first responders in a pandemic, to soldiers on the battlefield-Sherman shows how Stoicism can both prepare us for an uncertain future and help us cope with traumatic events. Stoic Wisdom will appeal to anyone feeling helpless or looking for deeper, meaningful strength and goodness in addressing life's biggest and smallest challenges. (shrink)

(No abstract is available for this citation).