Though it enjoys widespread support, the claim that perceptual experiences possess nonconceptual content has been vigorously disputed in the recent literature by those who argue that the content of perceptual experience must be conceptual content. Nonconceptualism and conceptualism are often assumed to be well-defined theoretical approaches that each constitute unitary claims about the contents of experience. In this paper I try to show that this implicit assumption is mistaken, and what consequences this has for the debate about perceptual experience. I (...) distinguish between two different ways that nonconceptualist (and conceptualist) proposals about perceptual content can be understood: as claims about the constituents that compose perceptual contents or as claims about whether a subject. (shrink)

Gametes, tissue, and organs can be taken from the dying or dead for reproduction, transplantation, and research. Whole bodies as well as parts can be used for teaching anatomy. While these uses are diverse, they have an ethical consideration in common: the claims of the people whose bodies are used. Is some use permissible only when people have consented to the use, actually wanted the use, would have wanted the use, not opposed the use, or what? The aim of this (...) article is to make progress in answering these questions. Initially I assume knowledge of people’s desires in order to test whether consent is directly required by their rights without worrying about mistaken uses against their wishes. I claim consent is not directly required by people’s rights. If we know people wanted or would want a use, their rights permit the use, but if we know they wanted or would want not to be used, their rights do not permit the use. The knowledge assumption is then dropped and the question becomes how to decide what to do when the wishes of rightholders are not known. I suggest working out what to do when wishes are known and then adjusting, on the basis of whatever evidence there is, for probability and strength of desire. There are other considerations too, for instance about default rules. The key general comment here is that, in setting rules, the costs to rightholders in not getting what they want needs to be taken into account. The final section tries to show that, in setting these rules, mistaken uses are not to be taken as worse than mistaken failure to use. (shrink)

Paternalist policies in public health often aim to improve people’s well-being by reducing their options, regulating smoking offering a prime example. The well-being challenge is to show that people really are better off for having their options reduced. The distribution challenge is to show how the policies are justified since they produce losers as well as winners. If we start from these challenges, we can understand the importance of the empirical evidence that a very high proportion of smokers regret smoking. (...) In short, it is important that they regret it and important that the proportion is so high. This paper explains how, philosophically, regret can relate to well-being and it considers some of the strengths and weakness in the empirical research that the explanation brings out. The regret case for regulating smoking is indeed strong, although not as strong as the empirical researchers think. It is much weaker for paternalistic intervention in other public health problems, such as obesity and binge drinking. (shrink)

In a well known British case, the relatives of a dead man consented to the use of his organs for transplant on the condition that they were transplanted only into white people. The British government condemned the acceptance of racist offers and the panel they set up to report on the case condemned all conditional offers of donation. The panel appealed to a principle of altruism and meeting the greatest need. This paper criticises their reasoning. The panel’s argument does not (...) show that conditional donation is always wrong and anyway overlooks a crucial distinction between making an offer and accepting it. But even the most charitable reinterpretation of the panel’s argument does not reject selective acceptance of conditional offers. The panel’s reasoning has no merit. (shrink)

This volume explores how Catholicism began and continues to open its doors to the wider world and to other confessions in embracing ecumenism, thanks to the vision and legacy of the Second Vatican Council. It explores such themes as the twentieth century context preceding the council; parallels between Vatican II and previous councils; its distinctively pastoral character; the legacy of the council in relation to issues such as church-world dynamics, as well as to ethics, social justice, economic activity. Several chapters (...) discuss the role of women in the church before, during, and since the council. Others discern inculturation in relation to Vatican II. The book also contains a wide and original range of ecumenical considerations of the council, including by and in relation to Free Church, Reformed, Orthodox, and Anglican perspectives. Finally, it considers the Council’s ongoing promise and remaining challenges with regard to ecumenical issues, including a groundbreaking essay on the future of ecumenical dialogue by Cardinal Walter Kasper. (shrink)

Ronald Dworkin argues on the basis of a theory of well-being that critical paternalism is self-defeating. People must endorse their lives if they are to benefit. This is the endorsement constraint and this paper rejects it. For certain kinds of important mistakes that people can make in their lives, the endorsement constraint is either incredible or too narrow to rule out as much paternalism as Dworkin wants. The endorsement constraint cannot be interpreted to give sensible judgements when people change their (...) minds about the value of their lives. And the main argument for the endorsement constraint, which is based on the value of integrity, does not support Dworkin's anti-paternalism. (shrink)

In response to a collection of essays in Jonathan Kvanvig's (1996) Warrant in Contemporary Epistemology: Essays in Honor of Plantinga's Theory of Knowledge, Alvin Plantinga notices that certain Gettier-style examples undermine his (1993b) canonical account of epistemic warrant as delineated in Warrant and Proper Function. In hopes to clarify how his account survives Gettier's purchase, he (1996; 2000) argues that a belief has warrant sufficient for knowledge only when produced in a favorable cognitive mini-environment. In Warranted Christian Belief Plantinga (2000) (...) specifies a condition required for a cognitive mini-environment's favorability. I argue that this condition falls prey to counterexample. Then I investigate a possible solution, which I reason fails as well. (shrink)

This book assesses how Vatican II opened up the Catholic Church to encounter, dialogue, and engagement with other world religions. Opening with a contribution from the President of the Pontifical Council for Interreligious Dialogue, Cardinal Jean-Louis Tauran, it next explores the impact, relevance, and promise of the Declaration Nostra Aetate before turning to consider how Vatican II in general has influenced interfaith dialogue and the intellectual and comparative study of world religions in the postconciliar decades, as well as the contribution (...) of particular past and present thinkers to the formation of current interreligious and comparative theological methods. Additionally, chapters consider interreligious dialogue vis-à-vis theological anthropology in conciliar documents; openness to the spiritual practices of other faith traditions as a way of encouraging positive interreligious encounter; the role of lay and new ecclesial movements in interreligious dialogue; and the development of Monastic Interreligious Dialogue. Finally, it includes a range of perspectives on the fruits and future of Vatican’s II’s opening to particular faiths such as Judaism, Islam, Hinduism, and Buddhism. (shrink)

Beginning with a review of Michael Pollan's latest book about the renaissance of research into the use of psychedelics to treat addiction, depression, and end-of-life anxiety, this essay considers wisdom and insight that might be gained by examining the psychedelic practices of primitive people. Pollan finds that almost all who begin using psychedelics to treat the ill eventually come to the conclusion that they should be made available for the broader purpose of 'the betterment of well people'. By considering both (...) scientific and spiritual perspectives on these compounds, the book offers insight into the toxicity not only of our mental environment, but at the same time our relationship to fellow humanity and Mother Nature. However, Pollan does not consider what is perhaps the greatest source of wisdom regarding the pharmacological potential of psychedelics: primitive societies who have long incorporated these compounds into their ways of being. By casting anthropological accounts of primitive psychedelic practices against those of contemporary research, this essay seeks to deepen enquiry into the pathologies of modern personhood as they bear upon the ecological crisis, together with the potential value of entheogens for understanding and responding to these problems. (shrink)

The great philosophers have generally held that there was some kind of interdependence between philosophy and practice. An unexamined life, they have maintained, is not worth living; and if there is to be anything to examine, life must first be lived, i.e. a practical experience is a propaedeutic to philosophy. But although Plato, for instance, thought that the task of government could be well performed only by the philosopher, he does not seem to have thought that fifteen years’ practical experience (...) had any beneficial influence on the philosopher’s subsequent work of philosophic contemplation. Aristotle explicitly prefers the theoretical to the practical life, and the resultant divorce of theory and practice leads to quietism and so to ethical scepticism. (shrink)

H.B. Acton, professor successively in South Wales, London, and Edinburgh, died in June 1974 when he was just sixty-six. His loss is deeply lamented by his friends, not least by students of Hegel; and they extend their profound sympathy to his widow. He was much interested in political, economic and social questions, and his publications on these matters are expressive of a humane and liberal outlook. His remarkable short book on Kant’s moral philosophy shed fresh light on a well-worn topic, (...) and his posthumously printed Comte lecture on The Idea of A Spiritual Power must have many readers wish that he could have seen his idea translated into reality. It is sad that his notes for a book on Hegel in Perspective did not reach a stage at which they could be worked up for publication, but his long preface to a translation of Hegel’s essay on Natural Law is to appear in 1975 from the University of Pennsylvania Press. Not even the shortest notice could exclude mention of his effectiveness as a teacher, his untiring devotion to his students, or the respect and admiration which in them and others he inspired. (shrink)

The great philosophers have generally held that there was some kind of interdependence between philosophy and practice. An unexamined life, they have maintained, is not worth living; and if there is to be anything to examine, life must first be lived, i.e. a practical experience is a propaedeutic to philosophy. But although Plato, for instance, thought that the task of government could be well performed only by the philosopher, he does not seem to have thought that fifteen years’ practical experience (...) had any beneficial influence on the philosopher’s subsequent work of philosophic contemplation. Aristotle explicitly prefers the theoretical to the practical life, and the resultant divorce of theory and practice leads to quietism and so to ethical scepticism. (shrink)

This chapter contains sections titled: Introduction The Nature of Virtue Morality Virtue and the mean: Aristotle and Torah contrasted Saintliness, Asceticism, and the Mean: Is the Hasid a Sinner? On Knowing the Good and Doing the Good Morality and Law: The Purpose of the Commandments Maimonides' Moral Theory: Universalist or Particularist? Conclusion further reading.

An anthology of philosophical essays and abstracts ranging from Plato to C. D. Broad. The work includes specific discussions of the philosophy of science, religion, politics, and value, as well as discussions concerned with the more general issues of epistemology and metaphysics.--T. M. G.

A brief summary of ancient thinkers who contribute to a theory of the physical universe, ranging from Anaximander to Proclus, with a major emphasis on pre-Aristotelian thought. Included in the work are many well-chosen abstracts of primary sources, such as Hippocrates' "On the Sacred Disease" and Parmenides' "On Nature." De Santillana presents a lively account of his materials, together with helpful illustrations. There is a rather insensitive portrayal of Aristotle as a mere synopticist of earlier theories and as primarily concerned (...) with "a tidiness of words."--T. M. G. (shrink)

This powerful, original, and tendentious book was written in 1940, published in Russia in 1965, and is now available in English. It suffers from many shortcomings--repetitiousness, oversimplification, the exclusion of material which fails to fit the author's thesis. It also inevitably reflects ignorance of scholarship since the thirties, which has tended to deny Rabelais' alleged agnosticism and nudged him closer to orthodoxy. But it represents nonetheless an important advance in the understanding of Rabelais' book, and defends provocatively an unfashionable theory (...) of the Renaissance. Bakhtin lays heaviest stress on his author's freedom to play with authorized symbols and solemn institutions in the spirit of the carnival, a spirit deriving from folk humor. The common folk of town and country delighted in improprieties, turned all serious values and structures upside down, dwelt subversively and coarsely on the "bodily lower stratum." Just as food enters the body and is eliminated, so all authorized solemnity enters Pantagruel and is turned into fun. This peasant laughter remains unafraid before age and death because it recognizes the simultaneous destruction and creation in all experience. The medieval hierarchical conception of the universe is replaced in Rabelais and in the entire Renaissance by a new horizontal perspective upon the individual in history. This new perspective fastens particularly upon the body and renders it good-humoredly grotesque. Bakhtin seriously underestimates the breadth of both Renaissance religious feeling and neo-Platonic speculation as well as the strength of medieval survivals. But specific readings of Rabelais' text are genuinely enlightening even when they distort or simplify his meaning.--T. M. G. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Objective Reality of Ideas in Descartes, Caterus, and Su irez NORMAN j. WELLS IT HAS LONG BEEN ACKNOWLEDGEDthat Francisco Sufirez's distinction between a formal and an objective concept exercised some influence upon Descartes's teaching on 'idea'.' It would appear, however, that not enough attention has been given to that distinction of Sufirez (and especially to another to be mentioned shordy) to aid in dispelling what I take to (...) be a widespread confusion and misunderstanding with regard to 'idea' in Descartes, especially with respect to 'idea' taken 'objectively'. Much, if not all, of the confusion in question has to do with Descartes's admittedly equivocal use of the term 'idea'. For he had allowed that 'idea' could be taken 'materially' (materialiter), on the one hand, for the knowing activity of the intellect. On the other hand, it could be taken 'objectively' (objective) for the thing (res) represented by that knowing activity.' At this point, the contemporary reader can only be brought up short, See E. Gilson, Index scolastico-cart~sien (New York: Burt Franklin Reprint, 1912), 48-49; Discours de la m~thode: Texte et commentazre (Paris: J. Vrin, 1947), 321; G. Rodis-Lewisin her edition of Meditationes de Prima PhRosoph.m (Paris: J. Vrin, 1953), 41 n. 1; L'oeuure de Descartes (Paris: J. Vrin, 1971), 53~ n. 8; J. Collins, Modern European Philosophy (Milwaukee: Bruce, 1954), 165;T.J. Cronin, S.J., Objecttve Being m Descartes and SuArez (Rome: Gregorian University Press, 1966); "Objective Reality of Ideas in Human Thought: Descartes and Su~rez," Wisdom in Depth: Essays in Honor of Henri Renard, SJ., eds. V. F. Daues, S.J., M. R. Holloway, S.J., L. Sweeney, S.J. (Milwaukee : Bruce, 1966), 68-79; L. Gilen, S.J., "Uber die Beziehungen Descartes zur zeitgenossischen Scholastik," Scholastik 32 (1957): 41-66; R. Dalbiez, "Les sources scolastiques de la th~orie cart6sienne de l'&re objectif," Revue d'histoire de la philosophic 3 (1929): 464-72;J. Owens, C.S.S.R., in The Cambridge HtstoU of Later Medu,val Philosophy, eds. N. Kretzmann, A. Kenny, J. Pinborg (Cambridge University Press, 1982), 459; G. Nuchelmans,Judgment and Propositwnfrom Descartesto Kant (Amsterdam: North Holland Publishing Co., 1983), 36-54. " Oeuvres de Descartes, ed. C. Adam et P. Tannery, 11 vols. (Paris: J. Vrin, 1897-19o9; hereafter cited according to volume, page and line), Praefatio ad Lectorem, 7: 8. 19-251 "Sed respondeo hic subesse aequivocationem in voce ideae: sumi enim potest vel materialiter, pro operatione intellectus, quo sensu me perfectior dici nequit, vel objective, pro re per istam operationem repraesentata, quae res, etsi non supponatur extra intellectum existere, potest tamen me esse perfectior ratione suae essentiae." It is clear that two realities are to be causally accounted for. The [33] 34 JOURNAL OF THE HISTORY OF PHILOSOPHY 28"1 JANUARY 1990 conditioned as we are by an appreciation of 'objectivity' altogether extramental! It makes for a considerable wrench of perspective to do justice to Descartes's acknowledged doctrine of intramental objectivity and an intramental 'thing represented' (resrepraesentata). 'Idea', then, in traditional Cartesian fashion, designates the act of representing as well as the 'thing represented '. S Yet, for all this, and despite repeated expressions of the same doctrine, there is a persistent tendency in the history of Cartesianism and its scholarship to interpret 'idea' taken 'objectively' as in some way representative. Contrary to what I take to be Descartes's constant position, such a rendering unwittingly transfers that function which is proper to the cognitive activity, mind is the efficient cause of its cognitive activity. With respect to ideas taken 'objectively', such as the ideas of God and the triangle on the levels of metaphysical and mathematical intelligibility, an efficient cause, extrinsic to the mind, is certainly at issue. For here we are in the presence of what is independent of the mind, however intramental it may be. On the triangle, see Medit. 5; 7: 64. ]4s7 : "...est tamen profecto determinata quaedam ejus natura, sire essentia, sive forma, immutabUis et aeterna, quae a me non efficta est, nec a mente mea dependet." For the idea of God, see Medit. 5; 7: 68. l o-12: "Nam sane multis modis inteUigo illam [ideam... (shrink)

Recurrent, unvarying, and seemingly purposeless patterns of action and cognition are part of normal development, but also feature prominently in several neuropsychiatric conditions. Repetitive stereotyped behaviors can be viewed as exaggerated forms of learned habits and frequently correlate with alterations in motor, limbic, and associative basal ganglia circuits. However, it is still unclear how altered basal ganglia feedback signals actually relate to the phenomenological variability of RSBs. Why do behaviorally overlapping phenomena sometimes require different treatment approaches−for example, sensory shielding strategies (...) versus exposure therapy for autism and obsessive-compulsive disorder, respectively? Certain clues may be found in recent models of basal ganglia function that extend well beyond action selection and motivational control, and have implications for sensorimotor integration, prediction, learning under uncertainty, as well as aesthetic learning. In this paper, we systematically compare three exemplary conditions with basal ganglia involvement, obsessive-compulsive disorder, Parkinson’s disease, and autism spectrum conditions, to gain a new understanding of RSBs. We integrate clinical observations and neuroanatomical and neurophysiological alterations with accounts employing the predictive processing framework. Based on this review, we suggest that basal ganglia feedback plays a central role in preconditioning cortical networks to anticipate self-generated, movement-related perception. In this way, basal ganglia feedback appears ideally situated to adjust the salience of sensory signals through precision weighting of new sensory information, relative to the precision of predictions based on prior generated models. Accordingly, behavioral policies may preferentially rely on new data versus existing knowledge, in a spectrum spanning between novelty and stability. RSBs may then represent compensatory or reactive responses, respectively, at the opposite ends of this spectrum. This view places an important role of aesthetic learning on basal ganglia feedback, may account for observed changes in creativity and aesthetic experience in basal ganglia disorders, is empirically testable, and may inform creative art therapies in conditions characterized by stereotyped behaviors. (shrink)

Metaphysics has had a long history of debate over its viability, and substantivity. This thesis explores issues connected to the realism question within the domain of metaphysics, ultimately aiming to defend a realist, substantive metaphysics by responding to so-called deflationary approaches, which have become prominent, and well supported within the recent metametaphysical and metaontological literature. To this end, I begin by examining the changing nature of the realism question. I argue that characterising realism and anti-realism through theories of truth unduly (...) places epistemology prior to ontology, and is unwarranted in assuming a non-neutrality between theories of truth and positions within the realism debate. I therefore propose a characterisation of realism and anti-realism understood through truthmaking. This produces a suitable working characterisation of realism that will be used within the remainder of this project. In the second section, I trace the historical influences upon current deflationary approaches to metaphysics, most prominently those of Carnap, and Putnam. I argue that Quine’s supposed attack on Carnap’s anti-metaphysical thought fails, and show how current deflationary thought, most prominently exhibited by Hirsch, came to focus on linguistically derived concerns over the substantivity of metaphysics. In the third section, I outline a number of issues for the deflationist, and defend the coherency and legitimacy of the unrestricted existential quantifier. Focusing on the linguistic aspect of deflationism, I argue that the conception of language that the deflationist relies upon lacks suitable empirical and theoretical support within linguistics and other related domains. Furthermore, I suggest that linguistic analysis in fact supports the claim that the quantifier carries no inherent restrictions. This restores our ability to suitably posit the unrestricted existential quantifier, as a quantifier wherein the domain is only restricted by metaphysically substantive restrictions. Through this, I argue that metaphysics is a substantive domain of discourse. Lastly, I sketch a positive account of how, under an empirically and theoretically justified conception of language, metaphysics can be coherently held to be a realist, substantive enterprise, contra claims that hold that the nature of language inherently prevents metaphysics being considered to be a substantive domain of discourse. (shrink)

A paradigm shift in public health and medicine has broadened the field from a singular focus on the ill effects of negative states and psychopathology to an expanded view that examines protective psychological assets that may promote improved physical health and longevity. We summarize recent evidence of the link between psychological well-being and physical health, with particular attention to outcomes of mortality and chronic disease incidence and progression. Within this evolving discipline there remain controversies and lessons to be learned. We (...) discuss measurement-related challenges, concerns about the quality of the evidence, and other shortcomings in the field, along with a brief discussion of hypothesized biobehavioral mechanisms involved. Finally, we suggest next steps to move the field forward. (shrink)

While outcomes for children with T-cell acute lymphoblastic leukemia have improved dramatically, survival rates for patients with relapsed/refractory disease remain dismal. Prior studies indicate that glucocorticoid resistance is more common than resistance to other chemotherapies at relapse. In addition, failure to clear peripheral blasts during a prednisone prophase correlates with an elevated risk of relapse in newly diagnosed patients. Here we show that intrinsic GC resistance is present at diagnosis in early thymic precursor T-ALLs as well as in a subset (...) of non-ETP T-ALLs. GC-resistant non-ETP T-ALLs are characterized by strong induction of JAK/STAT signaling in response to interleukin-7 stimulation. Removing IL7 or inhibiting JAK/STAT signaling sensitizes these T-ALLs, and a subset of ETP T-ALLs, to GCs. The combination of the GC dexamethasone and the JAK1/2 inhibitor ruxolitinib altered the balance between pro- and anti-apoptotic factors in samples with IL7-dependent GC resistance, but not in samples with IL7-independent GC resistance. Together, these data suggest that the addition of ruxolitinib or other inhibitors of IL7 receptor/JAK/STAT signaling may enhance the efficacy of GCs in a biologically defined subset of T-ALL.Leukemia advance online publication, 30 May 2017; doi:10.1038/leu.2017.136. (shrink)

Language is more than a source of information for accessing higher-order conceptual knowledge. Indeed, language may determine how people perceive and interpret visual stimuli. Visual processing in linguistic contexts, for instance, mirrors language processing and happens incrementally, rather than through variously-oriented fixations over a particular scene. The consequences of this atypical visual processing are yet to be determined. Here, we investigated the integration of visual and linguistic input during a reasoning task. Participants listened to sentences containing conjunctions or disjunctions and (...) looked at visual scenes containing two pictures that either matched or mismatched the nouns. Degree of match between nouns and pictures and between their expected and actual spatial positions affected fixations as well as judgments. We conclude that language induces incremental processing of visual scenes, which in turn becomes susceptible to reasoning errors during the language-meaning verification process. (shrink)

The avocado (Persea americana) is a major crop commodity worldwide. Moreover, avocado, a paleopolyploid, is an evolutionary “outpost” among flowering plants, representing a basal lineage (the magnoliid clade) near the origin of the flowering plants themselves. Following centuries of selective breeding, avocado germplasm has been characterized at the level of microsatellite and RFLP markers. Nonetheless, little is known beyond these general diversity estimates, and much work remains to be done to develop avocado as a major subtropical‐zone crop. Among the goals (...) of avocado improvement are to develop varieties with fruit that will “store” better on the tree, show uniform ripening and have better post‐harvest storage. Avocado transcriptome sequencing, genome mapping and partial genomic sequencing will represent a major step toward the goal of sequencing the entire avocado genome, which is expected to aid in improving avocado varieties and production, as well as understanding the evolution of flowers from non‐flowering seed plants (gymnosperms). Additionally, continued evolutionary and other comparative studies of flower and fruit development in different avocado strains can be accomplished at the gene expression level, including in comparison with avocado relatives, and these should provide important insights into the genetic regulation of fruit development in basal angiosperms. BioEssays 30:386–396, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

Next SectionIn an online study conducted separately in the UK and the US, participants rated the acceptability and fairness of four interventions: two types of financial incentives and two types of medical interventions. These were stated to be equally effective in improving outcomes in five contexts: weight loss and smoking cessation programmes, and adherence in treatment programmes for drug addiction, serious mental illness and physiotherapy after surgery. Financial incentives were judged less acceptable and to be less fair than medical interventions (...) across all five contexts. Context moderated the relative preference between rewards and penalties: participants from both countries favoured rewards over penalties in weight loss and treatment for serious mental illness. Only among US participants was this relative preference moderated by perceived responsibility of the target group. Overall, participants supported funding more strongly for interventions when they judged members of the target group to be less responsible for their condition, and vice versa. These results reveal a striking similarity in negative attitudes towards the use of financial incentives, rewards as well as penalties, in improving outcomes across a range of contexts, in the UK and the USA. The basis for such negative attitudes awaits further study. (shrink)

Background Biobank participants often do not understand much of the information they are provided as part of the informed consent process, despite numerous attempts at simplifying consent forms and improving their readability. We report the first assessment of biobank enrollees’ comprehension under an "integrated consent” process, where patients were asked to enroll in a research biobank as part of their normal healthcare experience. A number of healthcare systems have implemented similar integrated consent processes for biobanking, but it is unknown how (...) much patients understand after enrolling under these conditions. Methods: We recruited patients who enrolled in a biobank while in a healthcare setting when receiving ordinary care. We assessed knowledge of consent materials using 11 true/false questions drawn from a well-known biobank knowledge test. After reviewing the results from 114 participants, we revised the consent form and repeated the knowledge assessment with 144 different participants. Results: Participants scored poorly on the knowledge test in both rounds, with no significant differences in overall scores or individual items between the rounds. In Phase 1, participants answered 53% of the questions correctly, 25% incorrectly, and 22% “I don’t know.” In Phase 2, participants answered 53% of questions correctly, 24% incorrectly, and 23% “I don’t know.” Participants scored particularly poorly on questions about data sharing and accessing medical records. Conclusions: Enrollees under an integrated consent model had significant misunderstandings that persisted despite an attempt to improve information specifically about those topics in a consent form. These results raise challenges for current approaches that attribute misunderstanding to overly complex consent forms. They also suggest that the pressures of the clinic may compound other problems with patient understanding of biobank consent. As health systems increasingly blend research and care, they may need to rethink their approach to educating patients about participation in a biobank. (shrink)

BackgroundSystems medicine is the name for an assemblage of scientific strategies and practices that include bioinformatics approaches to human biology ; “big data” statistical analysis; and medical informatics tools. Whereas personalized and precision medicine involve similar analytical methods applied to genomic and medical record data, systems medicine draws on these as well as other sources of data. Given this distinction, the clinical translation of systems medicine poses a number of important ethical and epistemological challenges for researchers working to generate systems (...) medicine knowledge and clinicians working to apply it.DiscussionThis article focuses on three key challenges: First, we will discuss the conflicts in decision-making that can arise when healthcare providers committed to principles of experimental medicine or evidence-based medicine encounter individualized recommendations derived from computer algorithms. We will explore in particular whether controlled experiments, such as comparative effectiveness trials, should mediate the translation of systems medicine, or if instead individualized findings generated through “big data” approaches can be applied directly in clinical decision-making. Second, we will examine the case of the Riyadh Intensive Care Program Mortality Prediction Algorithm, pejoratively referred to as the “death computer,” to demonstrate the ethical challenges that can arise when big-data-driven scoring systems are applied in clinical contexts. We argue that the uncritical use of predictive clinical algorithms, including those envisioned for systems medicine, challenge basic understandings of the doctor-patient relationship. Third, we will build on the recent discourse on secondary findings in genomics and imaging to draw attention to the important implications of secondary findings derived from the joint analysis of data from diverse sources, including data recorded by patients in an attempt to realize their “quantified self.”SummaryThis paper examines possible ethical challenges that are likely to be raised as systems medicine to be translated into clinical medicine. These include the epistemological challenges for clinical decision-making, the use of scoring systems optimized by big data techniques and the risk that incidental and secondary findings will significantly increase. While some ethical implications remain still hypothetical we should use the opportunity to prospectively identify challenges to avoid making foreseeable mistakes when systems medicine inevitably arrives in routine care. (shrink)

What if human joy went on endlessly? Suppose, for example, that each human generation were followed by another, or that the Western religions are right when they teach that each human being lives eternally after death. If any such possibility is true in the actual world, then an agent might sometimes be so situated that more than one course of action would produce an infinite amount of utility. Deciding whether to have a child born this year rather than next is (...) a situation wherein an agent may face several alternatives whose effects could well ramify endlessly on such suppositions, for the child born this year would be a different person—one who preferred different things, performed different actions, and had different descendants—from a child born next year. It has recently been suggested that traditional utilitarianism stumbles on such cases of infinite utility. Specifically, utilitarianism seems to require, for its application, that all experience of pleasure and pain cease at some time in the future or asymptotically approach zero.2 If neither of these conditions holds, then the utility produced by each of two alternative actions may turn out to be infinite, and utilitarianism thus loses its ability to discriminate morally between them. (shrink)

The purpose of this study was to develop a Physician's Spiritual Well-Being Scale (PSpWBS). The significance of a physician's spiritual well-being was explored through in-depth interviews with and qualitative data collection from focus groups. Based on the results of qualitative analysis and related literature, the PSpWBS consisting of 25 questions was established. Reliability and validity tests were performed on 177 subjects. Four domains of the PSpWBS were devised: physician's characteristics; medical practice challenges; response to changes; and overall well-being. The explainable (...) total variance was 65.65%. Cronbach α was 0.864 when the internal consistency of the whole scale was calculated. Factor analysis showed that the internal consistency Cronbach α value for each factor was between 0.625 and 0.794 and the split-half reliability was 0.865. The scale has satisfactory reliability and validity and could serve as the basis for assessment of the spiritual well-being of a physician. (shrink)

This paper analyses the activities of five organizations shaping the debate over the global governance of genome editing in order to assess current approaches to public engagement (PE). We compare the recommendations of each group with its own practices. All recommend broad engagement with the general public, but their practices vary from expert-driven models dominated by scientists, experts, and civil society groups to citizen deliberation-driven models that feature bidirectional consultation with local citizens, as well as hybrid models that combine elements (...) of both approaches. Only one group practices PE that seeks community perspectives to advance equity. In most cases, PE does little more than record already well-known views held by the most vocal groups, and thus is unlikely to produce more just or equitable processes or policy outcomes. Our exploration of the strengths, weaknesses, and possibilities of current forms of PE suggests a need to rethink both “public” and “engagement.”. (shrink)

A longstanding issue in attempts to understand the Everett (Many-Worlds) approach to quantum mechanics is the origin of the Born rule: why is the probability given by the square of the amplitude? Following Vaidman, we note that observers are in a position of self-locating uncertainty during the period between the branches of the wave function splitting via decoherence and the observer registering the outcome of the measurement. In this period it is tempting to regard each branch as equiprobable, but we (...) argue that the temptation should be resisted. Applying lessons from this analysis, we demonstrate (using methods similar to those of Zurek's envariance-based derivation) that the Born rule is the uniquely rational way of apportioning credence in Everettian quantum mechanics. In doing so, we rely on a single key principle: changes purely to the environment do not affect the probabilities one ought to assign to measurement outcomes in a local subsystem. We arrive at a method for assigning probabilities in cases that involve both classical and quantum self-locating uncertainty. This method provides unique answers to quantum Sleeping Beauty problems, as well as a well-defined procedure for calculating probabilities in quantum cosmological multiverses with multiple similar observers. (shrink)

Several commentators have noted that “justice has not fared well in the revival of virtue ethics”; it “has become damagingly marginalized” and “no longer has a starring role.” Given its traditional place among the four cardinal virtues this is a remarkable state of affairs and yet exactly this has occurred has not been adequately explored or explained. In this paper, I argue that the particular moral virtue of justice has been largely disregarded by the contemporary virtue theorists primarily because their (...) conception of justice is so different from Aristotle’s. Accordingly, they do not need the virtue of justice to do the kind of explanatory work in their systems that it does in Aristotle’s. (shrink)

The coronavirus disease pandemic fundamentally disrupted humans’ social life and behavior. Public health measures may have inadvertently impacted how people care for each other. This study investigated prosocial behavior, its association well-being, and predictors of prosocial behavior during the first COVID-19 pandemic lockdown and sought to understand whether region-specific differences exist. Participants from eight regions clustering multiple countries around the world responded to a cross-sectional online-survey investigating the psychological consequences of the first upsurge of lockdowns in spring 2020. Prosocial behavior (...) was reported to occur frequently. Multiple regression analyses showed that prosocial behavior was associated with better well-being consistently across regions. With regard to predictors of prosocial behavior, high levels of perceived social support were most strongly associated with prosocial behavior, followed by high levels of perceived stress, positive affect and psychological flexibility. Sociodemographic and psychosocial predictors of prosocial behavior were similar across regions. (shrink)

Background: Black, Asian and minority ethnic groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks. Objective: To identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent. Methods: Three-phase programme comprising community-based research (...) involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; hospital-based research examining staff practices and influences on family consent through ethics discussion groups with staff, a study on intensive care units and interviews with bereaved ethnic minority families; and development and evaluation of a training package to enhance cultural competence among ICU staff. Setting: Community focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts. Participants: Community studies: 228 focus group participants; hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and evaluation: 66 health professionals. Data sources: Focus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation. Review methods: Systematic review and narrative synthesis. Results: Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. Evaluation: professional development package – a digital versatile disk-based training package was developed to promote confidence and skills in cross-cultural communication. Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation. Limitations: Participants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families. Conclusions: The research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS. Future work: Greater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families. Funding: The National Institute for Health Research Programme Grants for Applied Research programme. (shrink)

This paper discusses the possibility of creating a digital platform based on Mojo v3 for monitoring the operation of a dual-circuit solar collector. In the proposed system, measurements are made from 6 digital sensors, 16 wires are used. Using Dallas sensors and the appropriate software, you can monitor the temperature level and the amount of heat. The use of 6 digital sensors significantly increases the efficiency of control over the system and increases the speed of data processing. The possibilities of (...) configuring sensors for the platform Mojo v3, as well as the control circuit of the solar collector are considered. (shrink)

BackgroundThe potential contribution of community engagement to addressing ethical challenges for international biomedical research is well described, but there is relatively little documented experience of community engagement to inform its development in practice. This paper draws on experiences around community engagement and informed consent during a genetic cohort study in Kenya to contribute to understanding the strengths and challenges of community engagement in supporting ethical research practice, focusing on issues of communication, the role of field workers in 'doing ethics' on (...) the ground and the challenges of community consultation.MethodsThe findings are based on action research methods, including analysis of community engagement documentation and the observations of the authors closely involved in their development and implementation. Qualitative and quantitative content analysis has been used for documentation of staff meetings and trainings, a meeting with 24 community leaders, and 40 large public and 70 small community group meetings. Meeting minutes from a purposive sample of six community representative groups have been analysed using a thematic framework approach.ResultsField workers described challenges around misunderstandings about research, perceived pressure for recruitment and challenges in explaining the study. During consultation, leaders expressed support for the study and screening for sickle cell disease. In community meetings, there was a common interpretation of research as medical care. Concerns centred on unfamiliar procedures. After explanations of study procedures to leaders and community members, few questions were asked about export of samples or the archiving of samples for future research.ConclusionsCommunity engagement enabled researchers to take account of staff and community opinions and issues during the study and adapt messages and methods to address emerging ethical challenges. Field workers conducting informed consent faced complex issues and their understanding, attitudes and communication skills were key influences on ethical practice. Community consultation was a challenging concept to put into practice, illustrating the complexity of assessing information needs and levels of deliberation that are appropriate to a given study. (shrink)

In this paper we open up the topic of ethical corporate identity: what we believe to be a new, as well as highly salient, field of inquiry for scholarship in ethics and corporate social responsibility. Taking as our starting point Balmer’s (in Balmer and Greyser, 2002) AC2ID test model of corporate identity – a pragmatic tool of identity management – we explore the specificities of an ethical form of corporate identity. We draw key insights from conceptualizations of corporate social responsibility (...) and stakeholder theory. We argue ethical identity potentially takes us beyond the personification of the corporation. Instead, ethical identity is seen to be formed relationally, between parties, within a community of business and social exchange. Extending the AC2ID test model, we suggest the management of ethical identity requires a more socially, dialogically embedded kind of corporate practice and greater levels of critical reflexivity. (shrink)

In recent times, daily, ordinary medical practices have incontrovertibly been developing under the condition of complexity. Complexity jeopardizes the moral core of practicing medicine: helping people, with their illnesses and suffering, in a medically competent way. Practical wisdom (a modification of the Aristotelian phronèsis) has been proposed as part of the solution to navigate complexity, aiming at the provision of morally good care. Practical wisdom should help practitioners to maneuver in complexity, where the presupposed linear ways of operating prove to (...) be insufficient. However, this solution is unsatisfactory, because the proposed versions of practical wisdom are too individualistic of nature, while physicians are continuously operating in varying teams, and dealing with complicated technologies and pressing structures. A second point of critique is, that these versions are theory based, and thus insufficiently attuned to the actual context of everyday medical practices. Now, our proposal is to use an approach of practical wisdom that enables medical practices to counter the complexity issue and to re-invent the moral core of medical practicing as well. This implies a practice oriented approach, as thematized by practice theory, qualitative empirical research from the inside, and abduction from actual performed practical wisdom towards an apt understanding of phronèsis. (shrink)

This paper discusses some engineering considerations that should be taken into account when building a knowledge based system, and recommends isomorphism, the well defined correspondence of the knowledge base to the source texts, as a basic principle of system construction in the legal domain. Isomorphism, as it has been used in the field of legal knowledge based systems, is characterised and the benefits which stem from its use are described. Some objections to and limitations of the approach are discussed. The (...) paper concludes with a case study giving a detailed example of the use of the isomorphic approach in a particular application. (shrink)

When searching for concepts in memory—as in the verbal fluency task of naming all the animals one can think of—people appear to explore internal mental representations in much the same way that animals forage in physical space: searching locally within patches of information before transitioning globally between patches. However, the definition of the patches being searched in mental space is not well specified. Do we search by activating explicit predefined categories and recall items from within that category, or do we (...) activate and recall a connected sequence of individual items without using categorical information, with each item recalled leading to the retrieval of an associated item in a stream, or both? Using semantic representations in a search of associative memory framework and data from the animal fluency task, we tested competing hypotheses based on associative and categorical search models. Associative, but not categorical, patch transitions took longer to make than position-matched productions, suggesting that categorical transitions were not true transitions. There was also clear evidence of associative search even within categorical patch boundaries. Furthermore, most individuals' behavior was best explained by an associative search model without the addition of categorical information. Thus, our results support a search process that does not use categorical information, but for which patch boundaries shift with each recall and local search is well described by a random walk in semantic space, with switches to new regions of the semantic space when the current region is depleted. (shrink)

As scientific and engineering efforts become increasingly global in nature, the need to understand differences in perceptions of research ethics issues across countries and cultures is imperative. However, investigations into the connection between nationality and ethical decision-making in the sciences have largely generated mixed results. In Study 1 of this paper, a measure of biases and compensatory strategies that could influence ethical decisions was administered. Results from this study indicated that graduate students from the United States and international graduate students (...) studying in the US are prone to different biases. Based on these findings, recommendations are made for developing ethics education interventions to target these decision-making biases. In Study 2, we employed an ethics training intervention based on ethical sensemaking and used a well-established measure of ethical decision-making that more fully captures the content of ethical judgment. Similar to Study 1, the results obtained in this study suggest differences do exist between graduate students from the US and international graduate students in ethical decision-making prior to taking the research ethics training. However, similar effects were observed for both groups following the completion of the ethics training intervention. (shrink)