Book reviewed in this article: The Insanity Defense and the Trial of John W. Hinckley, Jr. By Lincoln Caplan.

Abstract:Facial transplantation is emerging as a therapeutic option for self-inflicted gunshot wounds. The self-inflicted nature of this injury raises questions about the appropriate role of self-harm in determining patient eligibility. Potential candidates for facial transplantation undergo extensive psychosocial screening. The presence of a self-inflicted gunshot wound warrants special attention to ensure that a patient is prepared to undergo a demanding procedure that poses significant risk, as well as stringent lifelong management. Herein, we explore the ethics of considering mechanism of injury (...) in the patient selection process, referring to the precedent set forth in solid organ transplantation. We also consider the available evidence regarding outcomes of individuals transplanted for self-inflicted mechanisms of injury in both solid organ and facial transplantation. We conclude that while the presence of a self-inflicted gunshot wound is significant in the overall evaluation of the candidate, it does not on its own warrant exclusion from consideration for a facial transplantation. (shrink)

Research involving recently deceased humans that are physiologically maintained following declaration of death by neurologic criteria—or ‘research involving the recently deceased’—can fill a translational research gap while reducing harm to animals and living human subjects. It also creates new challenges for honouring the donor’s legacy, respecting the rights of donor loved ones, resource allocation and public health. As this research model gains traction, new empirical ethics questions must be answered to preserve public trust in all forms of tissue donation and (...) in the practice of medicine while respecting the legacy of the deceased and the rights of donor loved ones. This article suggests several topics for immediate investigation to understand the attitudes and experiences of researchers, clinical collaborators, donor loved ones and the public to ensure research involving the recently deceased advances ethically. (shrink)

It is sometimes suggested that the logic of religious language differs from other kinds of language. Or it is said that each ‘language-game’ has its own ‘logic’ and that, whatever usual language-games are played in the context of religion, there is something that could be called the ‘religious language-game’ which does not correspond to any other and, therefore, has its own peculiar logic. In either case, religious people are urged to make clear what this logic is, so that their utterances (...) may be understood and evaluated. (shrink)

I want to put forward a certain view of the logical foundation of religious belief. It is, in a sentence, the view that religious belief is constituted by the concept of god. This view will be discussed under three headings. First, I shall explain as clearly as I can what I mean by it. Secondly, I shall indicate what seem to me to be interesting parallels, both with regard to universes of discourse in general and to religious belief in particular, (...) between my idea of a constitutive concept and Wittgenstein's ideas of a fundamental proposition and a religious ‘picture’. Thirdly, I shall try to substantiate the view I take of the logical foundation of religious belief by rebutting three conceivable objections to it: namely, that it rests on an illegitimate craving for generality, that it is at variance with common usage, and that it consigns religious belief to an intellectual ghetto. (shrink)

Das »Richtige und das Gute« (1930), das ethische Hauptwerk W. D. Ross’, enthält eine Vielzahl wichtiger moralphilosophischer Thesen und Argumente, die bis in die Gegenwart kontrovers diskutiert werden. Im Mittelpunkt steht seine pluralistische Deontologie, der zufolge sich die richtige Handlung aus einer Abwägung der in der jeweiligen Situation relevanten und unableitbaren Prima-facie-Pflichten ergibt, von denen nur ein Teil auf die Optimierung der Handlungsfolgen bezogen ist. Diese Deontologie wurde zu einem modernen Klassiker unter den normativen ethischen Theorien. Darüber hinaus stellt Ross’ (...) These, dass moralische Intuitionen eine Quelle selbstevidenten Wissens sein können, einen wichtigen Referenzpunkt in Debatten um den erkenntnistheoretischen Fundamentalismus dar. Auch für die Handlungstheorie liefert Ross einflussreiche Argumente, wenn er die Ansicht vertritt, dass Pflichten nie ein bestimmtes Motiv des Handelnden zum Gegenstand haben können. Eine zentrale Stellung nimmt für Ross die Güterlehre ein, in welcher er von vier Grundgütern, Tugend, Wissen, Lust und Gerechtigkeit, ausgeht. Wurde Ross in den ersten Jahrzehnten des 20. Jahrhunderts im damaligen Großbritannien als ein herausragender Ethiker – einer der bedeutendsten des Jahrhunderts, auf Augenhöhe mit G.E. Moore – angesehen, wandelte sich das Meinungsbild in den folgenden Jahrzehnten unter dem Einfluss besonders des Logischen Positivismus und der Philosophie Wittgensteins. In den letzten Jahrzehnten ist jedoch wieder ein wachsendes Interesse an Ross’ Ethik festzustellen. Dabei wird »Das Richtige und das Gute« bisweilen sogar mit der »Nikomachischen Ethik«, Kants »Grundlegung« und Humes »Untersuchung über die Prinzipien der Moral« verglichen. (shrink)

The genetically-modified-organism (GMO) experience has been prominent in motivating science, industry, and regulatory communities to address the social and ethical dimensions of nanotechnology. However, there are some significant problems with the GMO-nanotech analogy. First, it overstates the likelihood of a GMO-like backlash against nanotechnology. Second, it invites misconceptions about the reasons for public engagement and social and ethical issues research as well as their appropriate roles in nanotech research, development, application, commercialization, and regulatory processes. After an explication of the standard (...) GMO-Nanotech analogy, these two problems are discussed in turn. (shrink)

Successfully explaining and replicating the complexity and generality of human and animal learning will require the integration of a variety of learning mechanisms. Here, we introduce a computational model which integrates associative learning (AL) and reinforcement learning (RL). We contrast the integrated model with standalone AL and RL models in three simulation studies. First, a synthetic grid‐navigation task is employed to highlight performance advantages for the integrated model in an environment where the reward structure is both diverse and dynamic. The (...) second and third simulations contrast the performances of the three models in behavioral experiments, demonstrating advantages for the integrated model in accounting for behavioral data. (shrink)

Philosophy is very largely concerned with speculation upon problems of a highly abstract character, but some of the questions with which it deals have important practical aspects; and I think that social philosophy occupies—and rightly occupies—a dominant place in contemporary thought. If post-war policies are to render more secure the lives, the liberties and the happiness of mankind, they must be based upon sound principles; and it is with the intention of throwing certain of these principles into bold relief that (...) I have ventured to choose the realm of politics and culture as the subject of these reflections. (shrink)

The existing model for ethical review of medical research consists primarily of regulations designed to prevent exploitation of participants. This model may fail when reviewing other ethical obligations, particularly the responsibility to provide valuable knowledge to society. Such failure is most apparent in developing countries, in which many stakeholders lack incentives or power to uphold society’s interests. An alternative ethical model is that of partnership, which actively involves all partners during ethical review and aims to secure partners’ best interests through (...) compromise. Unlike the existing “regulatory” model, the partnership model effectively addresses ethical obligations to provide positive benefits to society. For the partnership model to be effective, power must be shared among partners; thus, the partnership model can be harmonised with the “regulatory” model through explicit consideration of power structures. One opportunity for crafting power balance in developing countries is apparent in “implementation trials”—randomised trials motivated by and integrated into the implementation of long term public health interventions. Given the failings of the existing ethical review model, alternative models—for example, partnership—and means to balance power—for example, implementation trials—must be explored to ensure that medical research provides knowledge of value to societies in the developing world. (shrink)

The empiricism of eighteenth-century experimental science meant that the development of scientific instruments influenced the formulation of new concepts; a two-way process for new theory also affected instrument design. This relationship between concept and instrumentation will be examined by tracing the development of electrical instruments and theory during this period. The different functions fulfilled by these devices will also be discussed. Empiricism was especially important in such a new field of research as electricity, for it gave rise to phenomena that (...) could not have been predicted by theory alone. However, the interpretation of these phenomena, and what the natural philosopher thought he observed, were often unconsciously determined by current ideas and attitudes; the interaction between instrumentally induced phenomena and observation was more complex than was realized at the time. The shortcomings of this empirical approach will be discussed. In the case of electricity this became increasingly apparent during the latter part of the century. The many discoveries had to be placed in a unifying framework before new advances could be made. Instruments, however, continued to play an important role in scientific progress, for they made visible what was hidden in nature. (shrink)

Unlike old soldiers, the rhetoric of the great neither dies nor fades away. And so Hume's celebrated ‘is-ought’ passage still provokes debate.Hume was worried about the relation between ought statements and those supporting them: between ‘tolerence brings peace’ or ‘is God's will’, and ‘so one ought to be tolerant’. He denies the deducibility of the latter from the former, as the ‘ought’ expresses ‘a new relation or affirmation’, ‘entirely different from the others’. And this is commonly taken as saying that (...) the ought statement is ‘different’ and non-deducible, because it is no longer a ‘purely factual statement’, to wit one that makes another ordinarily testable truth claim.However, recent criticism, by W. D. Hudson and others, points out that Hume says other things seemingly inconsistent with this. In the passage, he mentions ‘ought’ and ‘virtue’ interchangeably, and ‘tolerance is virtuous’ as in the same boat as ‘one ought to be tolerant’. But, also, he treats the virtue of an action as sensibly discernible by the approbation which it evokes, and takes us to mean by a virtuous action that we will approve of it on contemplation. (shrink)

Purpose: Physicians are often reluctant to discuss “Do Not Resuscitate” orders with patients. Although perceived self-efficacy is a known prerequisite for behavioural change, little is understood about the confidence of physicians regarding DNR discussions.Subjects and methods: A survey of 217 internal medicine attendings and 132 housestaff at two teaching hospitals about their attitudes and confidence regarding DNR discussions.Results: Participants were significantly less confident about their ability to discuss DNR orders than to discuss consent for medical procedures , and this was (...) true for both attendings and housestaff . In a multivariate logistic model of confidence regarding DNR discussions, women were less confident than men ; house officers were less confident than attendings , those who were less confident of their ability to discuss medical procedures were less confident discussing DNR , and those who found talking to patients about DNR orders very difficult reported less confidence than those who did not .Conclusion: We conclude that physicians’ confidence regarding DNR discussions is low compared with their confidence regarding other medical discussions and that confidence varies by sex and perceived difficulty of the task. Efforts to improve DNR discussions should explore the need to tailor educational interventions to fit these characteristics. (shrink)