Do studies of perception without awareness and studies of perception without attention address a similar underlying concept of awareness? To answer this question, we compared qualitative differences in performance across variations in stimulus quality with qualitative differences in performance across variations in the direction of attention . The qualitative differences were based on three different phenomena: Stroop priming, false recognition, and exclusion failure. In all cases, variations in stimulus quality and variations in the direction of attention led to parallel findings. (...) These results suggest that perception with and without awareness and perception with and without attention are equivalent ways of describing the same underlying process distinction. (shrink)

Academic misconduct is a threat to the validity and reliability of online examinations, and media reports suggest that misconduct spiked dramatically in higher education during the emergency shift to online exams caused by the COVID-19 pandemic. This study reviewed survey research to determine how common it is for university students to admit cheating in online exams, and how and why they do it. We also assessed whether these self-reports of cheating increased during the COVID-19 pandemic, along with an evaluation of (...) the quality of the research evidence which addressed these questions. 25 samples were identified from 19 Studies, including 4672 participants, going back to 2012. Online exam cheating was self-reported by a substantial minority (44.7%) of students in total. Pre-COVID this was 29.9%, but during COVID cheating jumped to 54.7%, although these samples were more heterogenous. Individual cheating was more common than group cheating, and the most common reason students reported for cheating was simply that there was an opportunity to do so. Remote proctoring appeared to reduce the occurrence of cheating, although data were limited. However there were a number of methodological features which reduce confidence in the accuracy of all these findings. Most samples were collected using designs which makes it likely that online exam cheating is under-reported, for example using convenience sampling, a modest sample size and insufficient information to calculate response rate. No studies considered whether samples were representative of their population. Future approaches to online exams should consider how the basic validity of examinations can be maintained, considering the substantial numbers of students who appear to be willing to admit engaging in misconduct. Future research on academic misconduct would benefit from using large representative samples, guaranteeing participants anonymity. (shrink)

Studies investigating memory for events during anesthesia show a confusing pattern of positive and negative results. To establish whether there are any consistent patterns of findings across studies, we conducted a meta-analysis of the data from 2517 patients in 44 studies. The meta-analysis included two measures of the effects of positive suggestions on postoperative recovery: the duration of postoperative hospitalization and the amount of morphine administered via patient-controlled anesthesia, as well as two measures of memory for specific information presented during (...) anesthesia: direct tests and indirect tests. The meta-analysis indicated that positive suggestions presented during anesthesia have little or no effect on postoperative recovery. On the other hand, the meta-analysis showed that specific information is remembered following surgery, as long as testing is not delayed longer than 36 h. Studies of memory for events during anesthesia provide a useful avenue for exploring unconscious cognition. (shrink)

The current Ebola virus epidemic in Western Africa appears to be spiraling out of control. The worst-case projections suggested that the unchecked spread could result in almost 1.4 million cases by the end of January 2015 with a case fatality rate of at least 50%. The United States and European nations have begun to respond in earnest with promises of supplies, isolation beds, and trained health care personnel in an effort to contain the epidemic and care for the sick. However, (...) there is neither a vaccine nor specific treatment for Ebola infection, and therapy is ideally centered on supportive care. I have previously argued that the provision of palliative care is obligatory during an overwhelming health catastrophe, notably pandemic influenza. Since affected Ebola patients have best outcomes with technologically advanced intensive care—resources in scarce supply in the area—I suggest that the only acceptable approach to large numbers of very sick, dying, and suffering Ebola patients who overwhelm the reso.. (shrink)

The current outbreak of Ebola virus infection in West Africa continues to spread. Several patients have now been treated in the United States and preparations are being made for more. Because of the strict isolation required for their care, questions have been raised about what diagnostic and therapeutic interventions should be available. I discuss the ethical challenges associated with caring for patients in strict isolation and personnel wearing bulky protective gear with reduced dexterity and flexibility, the limitations this may place (...) on available treatments and the permissibility of consequent departures from the standards of care. Restricting access to some interventions such as surgery requiring an operating room, advanced imaging, etc. is reasonable due to concern for protecting other patients, visitors and staff. Cardiopulmonary resuscitation is a special case and the implications for withholding this intervention in situations where it may be desired is discussed, especially with respect to those patients who have suspected, but not proven, infection. These same restrictions are also considered under conditions where there are scarce resources and thus limited numbers of patients may receive care. While it is to be hoped that there is only limited and sporadic infection with Ebola virus in the US, careful thought must be given to the care of these patients under the unusual circumstances demanded by their isolation. I argue that an altered standard of care is reasonable and ethically acceptable under certain conditions. (shrink)

The ongoing revolution in molecular genetics has led many to speculate that one day we will be able to change the expression or phenotype of numerous complex traits to improve ourselves in many different ways. The prospect of genetic enhancements has generated heated controversy, with proponents advocating research and implementation, with caution advised for concerns about justice, and critics tending to see the prospect of genetic enhancements as an assault on human freedom and human nature. Both camps base their arguments (...) on the unquestioned assumption that the science will realize either their dreams or nightmares. In this paper, I show that their beliefs are based upon two fundamental mistakes. First, they are based upon an unwarranted reliance in a genetic determinism that takes for granted that the traits that we might most want to enhance, like intelligence, aggression, shyness, and even athletic ability, can be causally directed by specific genes. In so doing, character descriptions are reified to be concrete and discrete entities, in this case, genes. Second, they have accepted on faith that there is, or will be, a science to translate their hopes or worries into reality when, in fact, that is unlikely to occur because of the irreducible complexity of phenotypic expression. (shrink)

The Institute of Medicine and the American Heart Association have issued a “call to action” to expand the performance of cardiopulmonary resuscitation in response to out-of-hospital cardiac arrest. Widespread advertising campaigns have been created to encourage more members of the lay public to undergo training in the technique of closed-chest compression-only CPR, based upon extolling the virtues of rapid initiation of resuscitation, untempered by information about the often distressing outcomes, and hailing the “improved” results when nonprofessional bystanders are involved. We (...) describe this misrepresentation of CPR as a highly effective treatment as the fetishization of this valuable, but often inappropriately used, therapy. We propose that the medical profession has an ethical duty to inform the public through education campaigns about the procedure's limitations in the out-of-hospital setting and the narrow clinical indications for which it has been demonstrated to have a reasonable probability of producing favorable outcomes. (shrink)

Patient and family demands for the initiation or continuation of life-sustaining medically non-beneficial treatments continues to be a major issue. This is especially relevant in intensive care units, but is also a challenge in other settings, most notably with cardiopulmonary resuscitation. Differences of opinion between physicians and patients/families about what are appropriate interventions in specific clinical situations are often fraught with highly strained emotions, and perhaps none more so when the family bases their desires on religious belief. In this essay, (...) I discuss non-beneficial treatments in light of these sorts of disputes, when there is a clash between the nominally secular world of fact- and evidence-based medicine and the faith-based world of hope for a miraculous cure. I ask the question whether religious belief can justify providing treatment that has either no or a vanishly small chance of restoring meaningful function. I conclude that non-beneficial therapy by its very definition cannot be helpful, and indeed is often harmful, to patients and hence cannot be justified no matter what the source or kind of reasons used to support its use. Therefore, doctors may legitimately refuse to provide such treatments, so long as they do so for acceptable clinical reasons. They must also offer alternatives, including second opinions, as well the option of transferring the care of the patient to a more accommodating physician or institution. (shrink)

Drug design methods have made significant new advances over the last ten years, mainly in the areas of molecular modelling. In more recent times important developments in theory have led to a different type of modelling becoming possible, the so‐called de novo or automated design algorithms. In this new method the programs perform much of the chemist's thinking, in finding appropriately sized chemical groups to fit into a target site. However this is a combinatoric problem which has no general analytical (...) solution; it is ripe for optimization. Other advances, such as combinatorial chemical synthesis and screening, will dramatically influence the search for new lead structures for target sites, which at present are poorly understood. Already these methods are being applied to peptide libraries. Peptides do not make good drug compounds because of their poor bioavailability; further, their flexibility reduces their affinity. In some cases peptide backbones can be removed and replaced with rigid non‐peptide scaffolds. (shrink)

Behavioral genetics has as its goal the discovery of genes that play a significant causal role in complex phenotypes that are socially relevant such a parenting, aggression, psychiatric disorders, intelligence, and even race. In this article, I present the stories of the discoveries of three such important phenotypes: maternal nurturing behavior and the c-fosB gene; intelligence and phenylketonuria ; and pair-bonding and monogamy and show that the reality is considerably more complex than often portrayed. These accounts also lay bare some (...) fundamental misconceptions of this field in which genes hold a privileged place and inherently subjective phenomena are mistakenly objectified. (shrink)

There are hundreds of indications leading us to conclude that at every moment there is in us an infinity of perceptions, unaccompanied by awareness or reflection; that is, of alterations in the soul itself, of which we are unaware because the impressions are either too minute or too numerous, or else too unvarying, so that they are not sufficiently distinctive on their own. But when they are combined with others they do nevertheless have their effect and make themselves felt, at (...) least confusedly, within the whole. (Leibniz, 1704/1981, p. 53). (shrink)

Periodic and unexpected shortages of drugs, biologics, and even medical devices have become commonplace in the United States. When shortages occur, hospitals and clinics need to decide how to ration their available stock. When such situations arise, institutions can choose from several different allocation schemes, such as first-come, first-served, a lottery, or a more rational and calculated approach. While the first two approaches sound reasonable at first glance, there are a number of problems associated with them, including the inability to (...) make fine, individual patient-centered decisions. They also do not discriminate between what kinds of patients and what types of uses may be more deserving or reasonable than others. In this article I outline an ethically acceptable procedure for rationing drugs during a shortage in which demand outstrips supply. (shrink)

In _Awakening the Dreamer: Clinical Journeys_, Philip Bromberg continues the illuminating explorations into dissociation and clinical process begun in _Standing in the Spaces_. Bromberg is among our most gifted clinical writers, especially in his unique ability to record peripheral variations in relatedness - those subtle, split-second changes that capture the powerful workings of dissociation and chart the changing self-states that analyst and patient bring to the moment. For Bromberg, a model of mind premised on the centrality of self-states and (...) dissociation not only offers the optimal lens for comprehending and interpreting clinical data; it also provides maximum leverage for achieving true intersubjective relatedness. And this manner of looking at clinical data offers the best vantage point for integrating psychoanalytic experience with the burgeoning findings of contemporary neuroscience, cognitive and developmental psychology, and attachment research. Dreams are approached not as texts in need of deciphering but as means of contacting genuine but not yet fully conscious self-states. From here, he explores how the patient's "dreamer" and the analyst's "dreamer" can come together to turn the "real" into the "really real" of mutative therapeutic dialogue. The "difficult," frequently traumatized patient is newly appraised in terms of tensions within the therapeutic dyad. And then there is the "haunted" patient who carries a sense of preordained doom through years of otherwise productive work - until the analyst can finally feel the patient's doom as his or her own. Laced with Bromberg's characteristic honesty, humor, and thoughtfulness, these essays elegantly attest to the mind's reliance on dissociation, in both normal and pathological variants, in the ongoing effort to maintain self-organization. _Awakening the Dreamer_, no less than _Standing in the Spaces_, is destined to become a permanent part of the literature on therapeutic process and change. (shrink)

Abstract:The number of patients with organ failure who could potentially benefit from transplantation continues to exceed the available supply of organs. Despite numerous efforts to increase the number of donors, there remains an enormous mismatch between demand and supply. Large numbers of people still die with potentially transplantable organs remaining in situ, most frequently as a result of family objections. I argue that there are no persuasive moral arguments against mandated organ retrieval from all dead individuals who meet clinical criteria. (...) However, because of continuing endemic prejudice in United States society and its healthcare system and the distrust this engenders, I conclude that proceeding with a policy of compulsory organ retrieval, even if morally unobjectionable, would not be warranted. (shrink)

The signal for sex determination in the nematode Caenorhabditis elegans is the ratio between the number of × chromosomes and the number of sets of autosomes (the X/A ratio). Animals with an X/A ratio of 0.67 (a triploid with two × chromosomes) or less are males. Animals with an X/A ratio of 0.75 or more are hermaphrodites. Thus, diploid males have one × chromosome and diploid hermaphrodites have two × chromosomes. However, the difference in X‐chromosome number between the sexes is (...) not reflected in general levels of X‐linked gene expression because of the phenomenon of dosage compensation. In dosage compensation, X‐linked gene expression appears to be ‘turned down’ in 2X animals to the 1X level of expression. An intriguing and unexplained finding is that mutations and X‐chromosome duplications that elevate X‐linked gene expression also feminize triploid males. One way that this relationship between sex determination and X‐linked gene expression may be operating is discussed. (shrink)

For many years a debate has raged over what constitutes futile medical care, if patients have a right to demand what doctors label as futile, and whether physicians should be obliged to provide treatments that they think are inappropriate. More recently, the argument has shifted away from the difficult project of definitions, to outlining institutional policies and procedures that take a measured and patient-by-patient approach to deciding if an existing or desired intervention is futile. The prototype is the Texas Advance (...) Directives Act, but similar procedures have been widely implemented both with and without the protection of the law. While this method has much to recommend it, there are inherent moral flaws that have not received as much discussion as warranted. Because these strategies adopt a semblance of procedural justice, it is assumed that the outcomes of such proceedings will be both correct and fair. In this paper, I argue that there are three main irremediable defects in the policy approach: there is the potential for arbitrary decision-making about futility in specific cases; there are structural, pre-ordained consequences for ethnic minorities who would be disproportionately affected by the use of these procedures; and the use of rationing justifications to support the use of these policies. These flaws detract so much from any benefit that could be derived that they make such strategies more harmful than helpful. (shrink)

Since antiquity, doctors have employed case reports as an essential and ongoing part in communicating information about patients and their diseases to their colleagues and, at times, to the wider, nonmedical world. Given how useful case reports have been, a legitimate and persuasive argument could be made to retain them in modern medical literature. But there is an emerging problem with case reports. As the ability to publish and disseminate the information contained in them has become easier, the capacity for (...) individuals to maintain their privacy and restrict access to their personal information has become more strained, and it has become more difficult for doctors who tell clinical stories to respect the confidentiality of their patients while still communicating the pertinent details of their cases. Does the acknowledged educational and scientific value of (some) case reports justify the threat to personal privacy that may be entailed by the format itself? (shrink)

This thesis is concerned with Immanuel Kant's mature philosophy as a whole. My aim is to show the systematic relationship among Kant's three Critiques, and the continuity of these with the Inaugral Dissertation. I use recent interpretations of Kant's projects in the Critique of Pure Reason and I offer my own interpretation of the Critique of Judgment, in which I highlight the importance of the final Appendix in that work, to argue that the goal of these three works taken together (...) is to replace traditional metaphysics with a new approach entirely. In place of the traditional approach in which the principles of metaphysics are supposed to be principles of the objective order of things quite apart from the way they appear to us, Kant argues in favour of a system of subjective principles that he believes will nevertheless allow us to achieve the goals of metaphysics. The new metaphysics will not be knowledge-based, as traditional metaphysics had been. Rather Kant's system is primarily ethics-based. That is, the primary principles of Kant's metaphysical system are those of his rational ethics, which have the function of regulating our activity in, and organization of, the world. Instead of knowledge, ethics, and theology being uneasily coordinated parts of philosophy, as they are in traditional metaphysical systems, all three become integrated within an ethical, and essentially teleological, framework in Kant's system. Showing the role of the Critique of Judgment in bringing about this change, as well as showing the importance of teleology for Kant's philosophy, are both important goals of the thesis. (shrink)

There should be no disagreement with the proposal for research into the role of applied social science in the formation of policy. The relation between social science and the formation of social policy and social action is, in fact, one of the more important areas of study in the general field of social control. The outline for research prepared by Mr. Merton constitutes a good framework for the investigation of important aspects of the relationship between social science and the world (...) of practical affairs. But there is room for vigorous disagreement with a fundamental assumption about the role of applied social science with which he starts, and there are various broad considerations of importance in framing the proposed study which merit mention or greater elaboration. It is to these matters that this essay is addressed. (shrink)

As medical technology continues to improve, more people will live longer lives with multiple chronic illnesses with increasing cumulative debilitation, including cognitive dysfunction. Combined with the aging of society in most developed countries, an ever-growing number of patients will require surrogate decision-makers. While advance care planning by patients still capable of expressing their preferences about medical interventions and end-of-life care can improve the quality and accuracy of surrogate decisions, this is often not the case, not infrequently leading to demands for (...) ineffective, inappropriate and prolonged interventions. In 1980 LaFollette called for the licensing of prospective parents, basing his argument on the harm they can do to vulnerable people. In this paper, I apply his arguments to surrogate decision-makers for cognitively incapacitated patients, rhetorically suggesting that we require potential surrogates to qualify for this position by demonstrating their ability to make reasonable and rational decisions for others. I employ this theoretical approach to argue that the loose criteria by which we authorize surrogates’ generally unchallenged power should be reconsidered. (shrink)

The phenomenon of contract cheating presents, potentially, a serious threat to the quality and standards of Higher Education around the world. There have been suggestions, cited below, to tackle the problem using legal means, but we find that current laws are not fit for this purpose. In this article we present a proposal for a specific new law to target contract cheating, which could be enacted in most jurisdictions.We test our proposed new law against a number of issues that would (...) need to be considered before any legal approach could be successful; would changing the legal status of contract cheating make it less likely to happen? Could this be achieved in a specific way? If so, who should actually be prosecuted and what offence are they committing? Would it actually address the causes of contract cheating? We suggest some answers to these questions, but then also identify a number of unintended potential consequences. We therefore additionally consider whether a legal approach is possible or even desirable.We conclude that a legal approach to contract cheating is possible, and, on balance, appropriate. Using UK law as an example, we offer a specific suggestion to lawmakers, around the world, for how this might be achieved, and conclude that the most successful approach would be to focus largely on a law targeting the providers of contract cheating, in particular commercial services. (shrink)