Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. Voluntary medical male circumcision (VMMC) programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of males who, for whatever reason, remain uncircumcised. This paper discusses the ethics of stigma (...) with regard to uncircumcised adolescent males in global VMMC programs, particularly in certain recruitment, demand creation and social norm interventions. Grounded in our own experiences gained while conducting HIV-related ethics research with adolescents in Kenya, we argue that use of explicit or implicit stigma to increase the number of VMMC volunteers is unethical from a public health ethics perspective, particularly in campaigns that leverage social norms of masculinity. Ongoing global efforts to circumcise adolescent and adult males to reduce their risk of acquiring HIV constitute the largest public health prevention initiative, using surgical means, in human history. VMMC programs in Africa have significantly altered social norms related to male circumcision among previously non-circumcising groups and groups that have practiced traditional (non-medical) circumcision. One consequence of this change is the stigmatization of males who, for whatever reason, remain uncircumcised. This paper discusses the ethics of stigma with regard to uncircumcised adolescent males in global VMMC programs, particularly in certain recruitment, demand creation and social norm interventions. Grounded in our own experiences gained while conducting HIV-related ethics research with adolescents in Kenya, we argue that use of explicit or implicit stigma to increase the number of VMMC volunteers is unethical from a public health ethics perspective, particularly in campaigns that leverage social norms of masculinity. (shrink)

The use of targets to direct public health programmes, particularly in global initiatives, has become widely accepted and commonplace. This paper is an ethical analysis of the utilisation of targets in global public health using our fieldwork on and experiences with voluntary medical male circumcision initiatives in Kenya. Among the many countries involved in VMMC for HIV prevention, Kenya is considered a success story, its programmes having medically circumcised nearly 2 million men since 2007. We describe ethically problematic practices in (...) Kenyan VMMC programmes revealed by our fieldwork, how the problems are related to the pursuit of targets and discuss possible approaches to their management. Although the establishment and pursuit of targets in public health can have many benefits, assessments of target-driven programmes tend to focus on quantifiable outcomes rather than the processes by which the outcomes are obtained. However, in order to speak more robustly about programmatic ‘success’, and to maintain community trust, it is vital to ethically evaluate how a public health initiative is actually implemented in the pursuit of its targets. (shrink)

Dynamic consent is increasingly recommended for longitudinal and biobanking research; however, the value of investing in such systems is unclear. We undertook a rapid review of the benefits and challenges of implementing dynamic consent by searching five databases (Ovid Medline, Ovid Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature – CINAHL) for articles published up to May 2023 that report on participants’ or researchers’ experience of dynamic consent. From 1611 papers screened, 12 met inclusion criteria. (...) Guided by thematic analysis with an inductive approach, we synthesised 31 benefits and 8 challenges. Benefits included: enhanced participant experience through improved consent management and tailoring; greater participant engagement and retention through increased autonomy, trust and communication; reduced costs and burden and increased accessibility and inclusivity. Participants and researchers also valued additional features that dynamic consent platforms facilitate such as two-way communication and return of research updates. The main challenges included the digital divide and consent fatigue. The papers gave recommendations to mitigate these challenges, for example by supplementing with other communication tools and allowing a broad consent approach, respectively. Overall, dynamic consent was described as a valuable consent approach with many benefits and some surmountable challenges. Most included literature was qualitative, so further research is needed to quantify the impact of dynamic consent on recruitment, retention, and participant experience. Further long-term investigations are necessary to explore whether participants want to and do change their consent over time, as well as the impact of dynamic consent on participant privacy. (shrink)

Mathematical modelling has played an increasingly prominent role in public health responses, for example by offering estimates of how infectious disease incidence over time may be affected by the adoption of certain policies and interventions. In this paper, we call for greater research and reflection into the ethics of mathematical modeling in public health. First, we present some promising ways of framing the ethics of mathematical modeling that have been offered in the very few publications specifically devoted to this subject. (...) Second, to draw out some issues that have not yet been sufficiently considered, we bring in the case of mathematical modeling in voluntary medical male circumcision (VMMC) initiatives for HIV prevention in Africa. We argue that greater attention should be paid to ethical considerations in mathematical modeling, particularly as its use is becoming more widespread and its potential impacts are becoming greater in the ‘big data’ era, as witnessed during the COVID-19 pandemic. (shrink)

Today there are multiple implantable medical devices on the market. The type of implants that interface the body’s tissues has been considered to have particular strong ethical implications. This article describes a development of a novel practice for ethical assessment and reflection within medical device research and development of non-CE marked medical devices, taking the perspective of both the ethicist and the researcher. The research case was an EU funded project where the aim was to develop and compare the efficiency (...) of invasive and non-invasive technological medical devices to create meaningful sensations as a novel therapy for phantom limb pain. An Independent Ethical Advisor with a regulatory and advisory role was assigned to the project, allowing us to investigate the projects deliberate incorporation of ethics. In the article we suggest and applied a novel framework based on action research for combining ethical assessment with building ethical reflection. The case analyse five different activities / elements: 1) the use of informed consent; 2) a survey amongst the research partners; 3) a workshop session; 4) observation of consortium meetings; and 5) an interview with a participating patient. (shrink)

Clinical mental health researchers may understandably struggle with how to incorporate biological assessments in clinical research. The options are numerous and are described in a vast and complex body of literature. Here we provide guidelines to assist mental health researchers seeking to include biological measures in their studies. Apart from a focus on behavioral outcomes as measured via interviews or questionnaires, we advocate for a focus on biological pathways in clinical trials and epidemiological studies that may help clarify pathophysiology and (...) mechanisms of action, delineate biological subgroups of participants, mediate treatment effects, and inform personalized treatment strategies. With this paper we aim to bridge the gap between clinical and biological mental health research by (1) discussing the clinical relevance, measurement reliability, and feasibility of relevant peripheral biomarkers; (2) addressing five types of biological tissues, namely blood, saliva, urine, stool and hair; and (3) providing information on how to control sources of measurement variability. (shrink)

Hand function improvement in stroke survivors in the chronic stage usually plateaus by 6 months. Brain-computer interface (BCI)-guided robot-assisted training has been shown to be effective for facilitating upper-limb motor function recovery in chronic stroke. However, the underlying neuroplasticity change is not well understood. This study aimed to investigate the whole-brain neuroplasticity changes after 20-session BCI-guided robot hand training, and whether the changes could be maintained at the 6-month follow-up. Therefore, the clinical improvement and the neurological changes before, immediately after, (...) and 6 months after training were explored in 14 chronic stroke subjects. The upper-limb motor function was assessed by Action Research Arm Test (ARAT) and Fugl-Meyer Assessment for Upper-Limb (FMA), and the neurological changes were assessed using resting-state functional magnetic resonance imaging. Repeated-measure ANOVAs indicated that long-term motor improvement was found by both FMA (F[2,26]= 6.367,p= 0.006) and ARAT (F[2,26]= 7.230,p= 0.003). Seed-based functional connectivity analysis exhibited that significantly modulated FC was observed between ipsilesional motor regions (primary motor cortex and supplementary motor area) and contralesional areas (supplementary motor area, premotor cortex, and superior parietal lobule), and the effects were sustained after 6 months. The fALFF analysis showed that local neuronal activities significantly increased in central, frontal and parietal regions, and the effects were also sustained after 6 months. Consistent results in FC and fALFF analyses demonstrated the increase of neural activities in sensorimotor and fronto-parietal regions, which were highly involved in the BCI-guided training.Clinical Trial Registration:This study has been registered atClinicalTrials.govwith clinical trial registration number NCT02323061. (shrink)

"Homage to Rudolph Carnap."--Hempel, C. G. Rudolf Carnap, logical empiricist.--Wedberg, A. How Carnap built the world in 1928.--Eberle, R. A construction of quality classes improved upon the Aufbau.--Carnap, R. Observation language and theoretical language.--Kaplan, D. Significance and analyticity: a comment of some recent proposals of Carnap.--Wójcicki, R. The factual content of empirical theories.--Williams, P. M. On the conservative extensions of semantical systems: a contribution to the problem of analyticity.--Winnie, J. A. Theoretical analyticity.--Wedberg, A. Decision and belief in science.--Bohnert, H. (...) G. Carnap's logicism.--Hintikka, J. Carnap's heritage in logical semantics.--Partee, B. H. The semantics of belief-sentences.--Kasher, A. Pragmatic representations and language-games.--Carnap, R. Notes on probability and induction.--Jeffrey, R. C. Carnap's inductive logic.--Hilpinen, R. Carnap's new system of inductive logic.--Kuipers, T. A. F. A generalization of Carnap's inductive logic. Essler, W. K. Hintikka versus Carnap.--Hintikka, J. Carnap and Essler versus inductive generalization.--Shimony, A. Carnap on entropy, introduction to "Two essays on entropy" by Rudolf Carnap. (shrink)

Realists and anti-realists disagree about whether contemporary scientists are epistemically privileged. Because the issue of epistemic privilege figures in arguments in support of and against theoretical knowledge in science, it is worth examining whether or not there is any basis for assuming such privilege. I show that arguments that try to explain the success of science by appeal to some sort of epistemic privilege have, so far, failed. They have failed to give us reason to believe (i) that scientists are (...) prone to develop theories that are true, (ii) that our current theories are not apt to be replaced in the future, and (iii) that science is nearing its completion. (shrink)

I examine the influence of James B. Conant on the writing of Kuhn’s Structure of Scientific Revolutions. By clarifying Conant’s influence on Kuhn, I also clarify the influence that others had on Kuhn’s thinking. And by identifying the various influences that Conant had on Kuhn’s view of science, I identify Kuhn’s most original contributions in Structure. On the one hand, I argue that much of the framework and many of the concepts that figure in Structure were part of Conant’s picture (...) of science, a picture that figured prominently in the general education natural science courses that Conant taught at Harvard. On the other hand, I show that Kuhn’s Structure contains important contributions that do not figure in Conant’s picture of science. I argue that the following three themes in Structure do not originate with Conant: (1) the concept of “normal science”; (2) “the problem of scientific revolutions,” that is, the apparent threat posed by radical changes of theory in science; and (3) Kuhn’s emphasis on the social dimensions of science, specifically the social structure of research communities. (shrink)

I evaluate the extent to which we could learn something about how we should be conducting collaborative research in science from the research on groupthink. I argue that Solomon has set us in the wrong direction, failing to recognize that the consensus in scientific specialties is not the result of deliberation. But the attention to the structure of problem-solving that has emerged in the groupthink research conducted by psychologists can help us see when deliberation could lead to problems for a (...) research team. I argue that whenever we need to generate alternative solutions or proposals, groupthink is a genuine threat, and research teams would be wise to allow individuals opportunities to work alone. But the benefits of team work emerge when scientists seek to evaluate the various proposals generated, and determine a course of action. Then the group is less prone is groupthink, and the interaction of group members can be an epistemic asset. (shrink)

I revisit an older defense of scientific realism, the methodological defense, a defense developed by both Popper and Feyerabend. The methodological defense of realism concerns the attitude of scientists, not philosophers of science. The methodological defense is as follows: a commitment to realism leads scientists to pursue the truth, which in turn is apt to put them in a better position to get at the truth. In contrast, anti-realists lack the tenacity required to develop a theory to its fullest. As (...) a consequence, they are less likely to get at the truth. -/- My aim is to show that the methodological defense is flawed. I argue that a commitment to realism does not always benefit science, and that there is reason to believe that a research community with both realists and anti-realists in it may be better suited to advancing science. A case study of the Copernican Revolution in astronomy supports this claim. (shrink)

Phenomenological analyses of ageing and old age have examined themes such as alterity, finitude, and time, not seldom from the perspective of “healthy” aging. Phenomenologists have also offered detailed analyses of lived experiences of illness including lived experiences of dementia. This article offers a phenomenological account of what we label as entering the grey zone of aging between “healthy” aging and aging with a disease. This account is developed through a qualitative phenomenological philosophy analysis of elderly persons’ lived experiences of (...) being tested for dementia through primary care in Sweden, i.e., within a cultural context where dementia commonly is understood as a frightening a loss of self even though this understanding also is questioned. To enter this grey zone of aging, we argue, does not dissolve dynamic self-becoming but can involve an experience of oneself as being old. Further, in the grey zone, the self experiences itself as neither fully healthy nor as having a disease, and as needing to negotiate and live this ambiguity. To enter this grey zone is to enter an affectively charged, sociocultural and medicalized zone, and while the self can still act in different ways within it, staying in the grey zone can result in a re-orientation in the self’s mode of being, in ways that are thoroughly beyond its control. To stay in the grey zone can have detrimental effects on the self, even though the self does not have a disease: the self can become “stuck” in a reflective mode of attending to embodiment, aging, health, and disease. (shrink)

A partir de son apparemment étrange observation d'une influence cachée des étoiles sur l'action humaine une attentive reconsidération du concept de l'actus humanus de Saint Thomas dans la Prima Secundae révèle une vue plus ample des processus internes à l'agent humain qui contribuent à la spécification individuelle de l'action humaine et, donc, de la liberté humaine. Il semble que parmi les adeptes de la théorie thomiste de l'action, l'influence importante que l'appétit sensible peut exercer en cette direction, tout en restant (...) entièrement caché aux actes conscients de l'intellect et de la volonté de la personne, n'a pas été reconnue jusqu'aujourd'hui. Dans sa théorie de l'action Saint Thomas fournit un cadre solide pour une réflexion ultérieure sur l'influence de l'inconscient dynamique sur la liberté et pour une intégration critique interdisciplinaire des intuitions valides de la psychologie des profondeurs. En plus, il semble que la redécouverte de son concept plus large de l'actus humunus rende possible de repenser à profit certains éléments classique de son éthique. (shrink)

Jon Elster and Daniel Little have criticized social scientists for appealing to a mechanism of social selection in functional explanations of social practices. Both believe that there is no such mechanism operative in the social world. I develop and defend an account of functional explanation in which a mechanism of social selection figures centrally. In addition to developing an account of social selection, I clarify what functional hypotheses purport to claim, and re-examine the role of agents’ intentions in functional explanations (...) in an effort to show why a mechanism of social selection is indispensable to adequate functional explanations. (shrink)

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Purpose: This paper is a brief introduction to enactive cognitive science: a description of some of the main research concerns; some examples of how such concerns have been realized in actual research; some of its research methods and proposed explanatory mechanisms and models; some of the potential as both a theoretical and applied science; and several of the major open research questions. Findings: Enactive cognitive science is an approach to the study of mind that seeks to explain how the structures (...) and mechanisms of autonomous cognitive systems can arise and participate in the generation and maintenance of viable perceiver-dependent worlds -- rather than more conventional cognitivist efforts, such as the attempt to explain cognition in terms of the ``recovery'' of (pre-given, timeless) features of The (objectively-existing and accessible) World. As such, enactive cognitive science is resonant with radical constructivism. Research implications: As with other scientific efforts conducted within a constructivist orientation, enactive cognitive science is broadly ``conventional'' in its scientific methodology. That is, there is a strong emphasis on testable hypotheses, empirical observation, supportable mechanisms and models, rigorous experimental methods, acceptable criteria of validation, and the like. Nonetheless, this approach to cognitive science does also raise a number of specific questions about the scope of amenable phenomena (e.g., meaning, consciousness, etc.) -- and it also raises questions of whether such a perspective requires an expansion of what is typically considered within the purview of scientific method (e.g., the role of the observer/scientist). (shrink)

This anthology focuses on three areas in the theory of knowledge: epistemic justification; analyses of knowledge and scepticism; and recent development in epistemology. Each of the three sections includes a brief introduction to the readings, a series of study questions, and a list of suggested readings. Section 1 deals with coherentism, foundationalism, reliabilism, and includes articles by Chisholm, BonJour, Audi, Goldman, and Fumerton. Section 2 deals with the analysis of knowledge and Gettier problems, and a variety of forms and responses (...) to scepticism; it includes articles by Gettier, Conee, Feldman, Putnam, Nagel, and Stroud. Section 3 introduces the reader to recent developments in naturalized, feminist, and social epistemology, and includes articles by Quine, Almeder, Putnam, Anderson, Harding, Longino, Hardwig, Rorty, and Kitcher. (shrink)

In ''''A Defense of Evolutionary Ethics'''' (1986), Robert J. Richardsendeavors to explain how moral ''oughts'' can be derived from thescience of evolutionary biology without committing the dreadednaturalistic fallacy. First, Richards assumes that ''ought'' as usedin ethical discourse bears the same meaning as ''ought'' used anywherein science, indicating merely that certain results or behaviors arepredicted based on prior structured contexts. To this extent, themoral behavior of animals, what they ''ought'' to do, could arguablybe predicted by evolutionary biology as effectively as, say,molecular (...) behavior may be predicted by chemistry. But afteracknowledging that biological inferences to this limited senseof ''ought'' were never contested by Moore''s naturalistic fallacy,Richard proposes to add to evolutionary ethics a decision procedureto determine which members of a set of predicted behaviors arethose which truly ought to occur – in the genuinelyprescriptive sense intended by ethical discourse. But theprocedure which Richards fabricates for this purpose appealsto such alleged ''facts'' as cultural conventions and moral opinionpolling, hardly a secure foundation for the sort of scientific ethics promised by Richards at the outset. (shrink)