Within bioethics as well as in broader clinical practice, support for transgender and gender‐questioning adolescent access to pubertal suppression has often relied heavily on the desire to prevent risky, self‐destructive, and suicidal behavior. We argue that framing justifications for access to puberty suppression in this way can actually be harmful to both individual patients as well as to the broader trans population. This justification for access to care makes such access precarious, limits its scope, and introduces perverse incentives to (...) the patient population that is being served. We go on to offer an alternative, positive defense of access to puberty‐blocking treatment for transgender youth grounded in the child's right to an open future. We argue that decisions related to pubertal suppression are both importantly weighty and potentially irreversible, and show why this justification is preferable to so‐called “informed consent” approaches. (shrink)

The decision of the High Court in Bell v Tavistock has excited considerable discussion about lawful consent for puberty-blocking drug treatment for children with gender dysphoria. The present paper draws attention to a wider question that surfaces through this case: is informed decision-making an adequate practical tool for seeking and obtaining patients’ consent for medical treatment? Informed decision-making engages the premises of the rational choice theory: that people will have well-crystallised health goals; and, if they are (...) provided with sufficient information about medical treatments, then they will be able to choose the treatment that satisfies their goals. Whilst appealing, the informed decision-making paradigm is assailed by various fallacies, which apply not only to children but also to adults. In Bell v Tavistock, the High Court seems to have recognised such fallacies, and it rejected informed decision-making as an adequate tool for consent from children with gender dysphoria. Similar considerations apply to adults in various situations. Thus, Bell v Tavistock can be seen as an attempt to refine the views on the consent that were expressed by the Supreme Court in Montgomery. It can be inferred that the Supreme Court did recognise the limitations of informed decision-making, but it did not develop this point. Further work is required to formulate an adequate model of decision-making, and Bell v Tavistock serves as a useful reminder to rethink informed decision-making as the device for consent. (shrink)

In ‘The Complex Case of Ellie Anderson’, Joona Rasanen and Anna Smajdor raise several ethical questions about the case. One question asks, but does not answer, whether Ellie faced discrimination for being transgender when her mother was not allowed access to Ellie’s sperm following her death. In raising the question, the authors imply anti-trans bias may have influenced this determination. However, this inference is not supported by current ethical and legal guidance for posthumous use of gametes, with which Ellie’s case (...) is consistent. We consider the authors’ responses to their other ethical queries, and how their suggestions for what options might have been available to Ellie and her family are instructive for addressing attempts in the USA and UK to restrict minors’ access to gender-affirming medical treatment, including puberty-blocking therapy. (shrink)

Lord Scarman’s judgment about when someone under the age of 16 years should have the right to make their own medical decisions emphasised the decision-making abilities of the particular child. He said: > …the parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when the child achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed.1 That created a duty (...) on healthcare practitioners to assess whether a particular minor has decision-making abilities at a degree that would enable them to understand the decision to a high extent, sufficient hopefully that they would ‘own’ the decision. In December of 2020, the High Court considered whether young people with gender dysphoria and seeking access to puberty blocking therapy, were likely to pass Scarman’s mature minor test and cast doubt on their ability to fully understand that decision, thereby making it less likely that a healthcare practitioner would decide they are a mature minor for that therapy. The High Court said: > It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers. It is doubtful that a child …. (shrink)

Volume 19, Issue 7, July 2019, Page 68-69.

This study shows that double thymidine block treatment efficiently arrests the EO771 cells in the S‐phase without altering cell growth or survival. A long‐term analysis of cell behavior, using 5(6)‐carboxyfluorescein diacetate N‐succinimidyl ester (CFSE) staining, show synchronization to be stable and consistent over time. The EO771 cell line is a medullary breast‐adenocarcinoma cell line isolated from a spontaneous murine mammary tumor, and can be used to generate murine tumor implantation models. Different biological (serum or amino acid deprivation), physical (elutriation, (...) mitotic shake‐off), or chemical (colchicine, nocodazole, thymidine) treatments are widely used for cell synchronization. Of the different methods tested, the double thymidine block is the most efficient for synchronization of murine EO771 cells if a large quantity of highly synchronized cells is recommended to study functional and biochemical events occurring in specific points of cell cycle progression. (shrink)

BackgroundHealthcare professionals and surrogate decision-makers often face the difficult decision of whether to initiate or withhold antibiotics from people with dementia who have developed a life-threatening infection after losing decisional capacity.MethodsWe conducted a vignette-based survey among 1050 Quebec stakeholders (senior citizens, family caregivers, nurses and physicians; response rate 49.4%) to (1) assess their attitudes toward withholding antibiotics from people with dementia lacking decisional capacity; (2) compare attitudes between dementia stages and stakeholder groups; and (3) investigate other correlates of attitudes, including (...) support for continuous deep sedation (CDS) and medical assistance in dying (MAID). The vignettes feature a woman moving along the dementia trajectory, who has refused in writing all life-prolonging interventions and explicitly requested that a doctor end her life when she no longer recognizes her loved ones. Two stages were considered after she had lost capacity: the advanced stage, where she likely has several more years to live, and the terminal stage, where she is close to death.ResultsSupport for withholding antibiotics ranged from 75% among seniors and caregivers at the advanced stage, to 98% among physicians at the terminal stage. Using the generalized estimating equation approach, we found stakeholder group, religiosity, and support for CDS and MAID, to be associated with attitudes toward antibiotics.ConclusionsFindings underscore the importance for healthcare professionals of discussing underlying values and treatment goals with people at an early stage of dementia and their relatives, to help them anticipate future care decisions and better prepare surrogates for their role. Findings also have implications for the scope of MAID laws, in particular in Canada where the extension of MAID to persons lacking decisional capacity is currently being considered. (shrink)

In the context of transgender health, most people are not comfortable with allowing a twelve‐year‐old child with gender dysphoria to elect to undergo gender reassignment surgery. The likelihood is too high that the child would be unable to fully comprehend the scope of a decision that carries significant, permanent consequences, particularly because the decision to surgically change gender is based upon a conception of gender that can fluctuate during adolescent years. Conversely, however, most people would not contend that this fluidity (...) is reason to wholly deny certain medical care such as hormonal treatments to transgender youth, a demographic with extremely high rates of violent behavior, self‐harm, and suicide. This paper will explore ethical considerations to this emerging debate of what therapeutic options should be offered to transgender children and adolescents.Pediatric endocrinologists have been treating gender dysphoric adolescents with puberty‐suppressing drugs and, to a lesser extent, with cross‐sex hormone therapies for more than twenty years. Clinicians and thought leaders have mentioned ethical components of this emerging practice in the few cohort studies and clinical review articles about the subject. However, ethics have generally been a secondary consideration in the medical academic literature. In this paper, I will provide a brief overview of the practice, summarize the current research on hormone treatment for transgender minors, and provide an ethical analysis of the practice. (shrink)

In the past few years, the introduction and rapid acceptance of puberty suppression has transformed the clinical treatment of children diagnosed with Gender Identity Disorder. This essay analyzes the narratives used by some advocates of this treatment, particularly the elements of saving children from the looming disaster of puberty and from future abject lives of violence and suicide as transgender adults. It briefly addresses the potential implications of this account for the well being of the children (...) brought under clinical purview. (shrink)

We thank the commentators for their thoughtful responses to our article.1 Due to space constraints, we will confine our discussion to just three key issues. The first issue relates to the central ethical conundrum for clinicians working with young people like Phoenix: namely, how to respect, value and defer to a person’s own account of their identity and what is needed for their well-being, while staying open to the possibility that such an account may reflect a work in progress. This (...) conundrum thus relates both to what will be beneficial for that person and what constitutes respecting their autonomy, and clinicians must dwell on these questions when deciding what forms of medical intervention to offer. D’Angelo,2 Lemma3 and Wren4 highlight the importance of considering Phoenix (or, indeed, any person pursuing gender-affirming interventions) as a ‘whole person in context’ (p5)2 prior to initiating treatment or care. In this way, they advocate for a process of ‘therapeutic exploration’ (p1),4 which includes taking sufficient time to explore Phoenix’s personhood with them so as to support them in achieving an ‘authentic self-discovery’ (p5).2 We agree with these authors that identity (including gender identity) development is a complex, life-long process that is influenced by biological, psychosocial and relational aspects, all of which may contribute to an individual’s desire to pursue gender-affirming interventions. To explore the various factors—both conscious and unconscious—that might be motivating Phoenix’s decision to pursue ongoing puberty suppression (OPS), D’Angelo,2 Lemma3 and Wren4 describe a comprehensive psychological approach to working with transgender (trans) and gender diverse (TGD) individuals and propose questions to guide such discussions. Consistent with this approach, we stipulated that Phoenix had undergone regular psychological counselling and that the psychologist had judged that ‘Phoenix’s distress is significant and enduring…not a symptom …. (shrink)

Paradigms that combine synthetic (one-word) and periphrastic forms in complementary distribution have loomed large in discussions of morphological blocking (McCloskey and Hale 1983, Poser 1986, Andrews 1990). Such composite paradigms potentially challenge the lexicalist claim that words and sentences are organized by distinct subsystems of grammar. They are of course grist for the mill of Distributed Morphology, a theory which revels in every kind of interpenetration of morphology and syntax. But they have prompted even Paradigm Function Morphologists to introduce (...) syntactic constructions into their morphology. I shall argue, instead, for a lexicalist treatment, which is based on the idea that blocking is a filtering device that applies to the output of the generative system, rather than operating directly on its derivations (Wunderlich 1996). I present this approach to blocking in section 1, and show in section 2 how it deals with the intricate composite verb paradigm of Latin, where the periphrastic perfect passive supplies the missing pieces of an otherwise synthetic inflectional system. This part of Latin verb morphology has recently been treated from the perspective of Distributed Morphology and Paradigm Function Morphology. I compare my solution to these treatments and argue that it is superior in two respects: it predicts the complementarity of the synthetic and periphrastic formations and yet allows their respective morphological and syntactic properties to be captured, and it readily covers some basic data that the other analyses get wrong. (shrink)

Transgender children who are not treated for their condition are at high risk of violence and suicide. As a matter of survival, many are willing to take whatever help is available, even if this is offered by illegal sources, and this often traps them into the juvenile criminal system and exposes them to various threats. Endocrinology offers a revolutionary instrument to help children /adolescents with gender identity disorder: suspension of puberty. Suspension of puberty raises many ethical issues, and (...) experts dissent as to when treatment should be commenced and how children should be followed up. This paper argues that suspension of puberty is not only not unethical: if it is likely to improve the child’s quality of life and even save his or her life, then it is indeed unethical to defer treatment. (shrink)

Aims. Currently, methylphenidate (MPH, trade name Ritalin) is the most widely prescribed medication for attention deficit/hyperactivity disorder (ADHD). We examined the ability of repeated MPH administration to produce a sensitized appetitive eagerness type response in laboratory rats, as indexed by 50-kHz ultrasonic vocalizations (50-kHz USVs). We also examined the ability of MPH to reduce play behavior in rats which may be partially implicated in the clinical efficacy of MPH in ADHD. Design. 56 adolescent rats received injections of either 5.0 mg/kg (...) MPH, or vehicle each day for 8 consecutive days, and a week later received a challenge injection of either MPH or vehicle. Measurements. Both play behavior (pins) and 50-kHz USVs were recorded after each drug or vehicle administration. Results. MPH challenge produced a substantial 73% reduction in play behavior during the initial treatment phase, and during the last test (1 week post drug), 50-kHz USVs were elevated approximately threefold only in animals with previous MPH experience. Conclusions. These data suggest that MPH treatment may lead to psychostimulant sensitization in young animals, perhaps by increasing future drug-seeking tendencies due to an elevated eagerness for positive incentives. Further, we hypothesize that MPH may be reducing ADHD symptoms, in part, by blocking playful tendencies, whose neuro-maturational and psychological functions remain to be adequately characterized. (shrink)

Recent evidence from studies on DNA repair systems that are implicated in accelerated aging syndromes, have revealed a mechanism through which low levels of persistent damage might exert beneficial effects for both cancer prevention and longevity assurance. Beneficial effects of adaptive responses to low doses of insults that in higher concentrations show adverse effects are generally referred to as hormesis. There are numerous examples of hormetic effects ranging from mild stresses of irradiation to heat stress, hypergravity, pro‐oxidants, or food restriction. (...) Although the notion of hormesis is supported by many observations in various organisms, at least two major caveats have thus far prevented the application of hormesis for disease prevention in humans. First, the very nature of hormesis using toxins as a treatment regimen harbors the inherent danger of detrimental consequences. Second, the molecular mechanisms through which insults might exert beneficial effects have thus far remained elusive. Here, I discuss a mechanistic basis for hormesis and its implications for cancer prevention and healthy aging. (shrink)

The question of which is the logic that underlies quantum physics does not have an absolute answer, but only in relation to a conventional choice of interpretation . Most of the interpretations that have been offered work within the framework of classical logic. In contrast to these, we examine the corpuscular interpretation which is assumed in the application of non-distributive logic . The experiment in which single photons pass through a Mach-Zehnder interferometer is examined, indicating the difficulty of employing a (...) realist corpuscular interpretation in this context. One way to save this interpretation would be to use non-distributive logic to analyze the experiment, but this is not satisfactory . However, the use of an alethic modal logic solves the problem, blocking the argument that put the aforementioned corpuscular interpretation into difficulty. In the discussion of the conceptual problems involved, we suggest that a stochastic corpuscular interpretation is well adapted to this logical description. The project of extending this modal logical approach to other experiments in quantum physics, and of providing a rigorous logical treatment, is left open. (shrink)

This article considers the claim that gender diverse minors and their families should not be able to consent to hormonal treatment for gender dysphoria. The claim refers particularly to hormonal treatment with so-called ‘blockers’, analogues that suspend temporarily pubertal development. We discuss particularly four reasons why consent may be deemed invalid in these cases: the decision is too complex; the decision-makers are too emotionally involved; the decision-makers are on a ‘conveyor belt’; the possibility of detransitioning. We examine each (...) of these reasons and we show that none of these stand up to scrutiny, and that some are based on a misunderstanding of the nature and purposes of this stage of treatment and of the circumstances in which it is usually prescribed. Moreover, accepting these claims at face value could have serious negative implications, not just for gender diverse youth, but for many other minors and families and in a much broader range of healthcare settings. (shrink)

Jacobson finds two distinct meanings of “dignity” in the literature on dignity and health: intrinsic human dignity and social dignity constituted through interactions with caregivers. Especially the latter has been central in empirical health research and warrants further exploration. This article focuses on the social dignity of people marginalized by mental illness, substance abuse and comparable conditions in extramural settings. 35 studies published between 2007 and 2017 have addressed this issue, most of them identifying norms for social dignity: civilized interactions, (...) non-stigmatizing treatment, treatment as unique individuals, being taken seriously, maintaining a positive identity, experiencing independence, relating to others, and participating in daily life. We argue that these norms belong to ideal theory, whereas we agree with Robeyns and others that improving practice is better served by non-ideal theory. Towards this end, we derive from the literature four building blocks for a non-ideal theory of dignity: avoid violations of dignity rather than seeking to promote it; dignity is not a goal to be reached; it requires ongoing effort; promoting dignity is a balancing act; contradictory norms can make it impossible to realize; and dignity can be undermined by organizational and discursive constraints. (shrink)

Fabrice Correia and Sven Rosenkranz’s book Nothing to Come: a Defence of the Growing Block Theory of Time offers an incredibly rich and skillful defense of the growing block theory (GBT), a view of time that arguably has much intuitive appeal, and which has been under attack from many sides. Nonetheless, I have to report that the book’s tense-logical course of treatment has not worked for me; I still struggle with making sense of the GBT. This article begins by (...) drawing out some implications of the book’s set up. First, the notion of existence in play here is not interpretable on the basis of ordinary usage. Second, it would be a mistake to take the tense-logical framework to have any metaphysical significance. I then articulate two main worries about their version of the GBT. The first worry takes a familiar shape: it is just hard to see how their view is dynamic in the relevant sense. The second worry is that the topic seems to have been changed. C&R’s logical system helps itself to key notions whose intended interpretation includes a solution to every metaphysical puzzle about the GBT, so that these puzzles are not so much addressed as enshrined in a formal system. That is, their view seems to answer the question of how language should behave, if the GBT were (somehow) true. (shrink)

In this moment of rising nationalism worldwide, governments, civil society groups, transnational companies, and web users all complain of increasing regional fragmentation online. While prior work in this area has primarily focused on issues of government censorship and regulatory compliance, we use an inductive and qualitative approach to examine targeted blocking by corporate entities of entire regions motivated by concerns about fraud, abuse, and theft. Through participant-observation at relevant events and intensive interviews with experts, we document the quest by (...) professionals tasked with preserving online security to use new machine-learning based techniques to develop a “fairer” system to determine patterns of “good” and “bad” usage. However, we argue that without understanding the systematic social and political conditions that produce differential behaviors online, these systems may continue to embed unequal treatments, and troublingly may further disguise such discrimination behind more complex and less transparent automated assessment. In order to support this claim, we analyze how current forms of regional blocking incentivize users in blocked regions to behave in ways that are commonly flagged as problematic by dominant security and identification systems. To realize truly global, non-Eurocentric cybersecurity techniques would mean incorporating the ecosystems of service utilization developed by marginalized users rather than reasserting norms of an imagined user that casts aberrations as suspect. (shrink)

I present a ‘stage-theoretical’ interpretation of the supervaluationist semantics for the growing-block theory of time according to which the ‘nodes’ on the branching tree of historical possibilities are taken to be possible stages of the growth of the growing-block. As I will argue, the resulting interpretation (i) is very intuitive, (ii) can easily ward off an objection to supervaluationist treatments of the growing-block theory presented by Fabrice Correia and Sven Rosenkranz, and (iii) is also not saddled by the problems affecting (...) the supervaluationist version of the growing-block theory defended by R. A. Briggs and Graeme A. Forbes. (shrink)

In Max Black’s Objection to Mind–Body Identity, Ned Block seeks to offer a definitive treatment of property dualism arguments that exploit modes of presentation. I will argue that Block’s central response to property dualism is confused. The property dualist can happily grant that mental modes of presentation have a hidden physical nature. What matters for the property dualist is not the hidden physical side of the property, but the apparent mental side. Once that ‘thin’ side is granted, the property (...) dualist has won. I conclude that although Block is wrong to think that the property dualist must argue for so-called thin mental properties, Block, and the physicalist, are able to resist property dualism. But any attempt to bolster this resistance and do more than dogmatically assert the crucial identity runs a serious risk of undermining the physicalism it is meant to save. (shrink)

Gender dysphoria (GD) is marked by an incongruence between a person’s biological sex at birth, and their felt gender (or gender identity). There is continuing debate regarding the benefits and drawbacks of physiological treatment of GD in children, a pathway, beginning with endocrine treatment to suppress puberty. Currently, the main alternative to physiological treatment consists of the so-called “wait-and-see” approach, which often includes counseling or other psychotherapeutic treatment. In this paper, we argue in favor of (...) a “third pathway” for the diagnosis and treatment of GD in youths. To make our case, we draw on a recent development in bioethics: the phenomenological approach. Scholars such as Slatman and Svenaeus have argued that the extent to which the body can (or should be) manipulated or reconstructed through medical intervention is not only determined by consideration of ethical frameworks and social and legal norms. Rather, we must also take account of patients’ personal experience of their body, the personal and social values associated with it, and their understanding of its situation in their life: their narrative identities. We apply this phenomenological approach to medicine and nursing to the diagnosis and treatment of GD in youth. In particular, we discuss Zahavi and Martiny’s conception of the phenomenological interview, in order to show that narrative techniques can assist in the process of gender identification and in the treatment of youth presenting with GD. We focus on two case studies that highlight the relevance of a narrative-based interview in relations between patients, HCPs, and family, to expose the influence of social ideologies on how young people presenting with GD experience their bodies and gender. (shrink)

Depression is the principal cause of illness and disability in the world. Studies charting the prevalence of depression among children and adolescents report high percentages of youngsters in both groups with depressive symptoms. This review analyzes the construct and explanatory theories of depression and offers a succinct overview of the main evaluation instruments used to measure this disorder in children and adolescents, as well as the prevention programs developed for the school environment and the different types of clinical treatment (...) provided. The analysis reveals that in mental classifications, the child depression construct is no different from the adult one, and that multiple explanatory theories must be taken into account in order to arrive at a full understanding of depression. Consequently, both treatment and prevention should also be multifactorial in nature. Although universal programs may be more appropriate due to their broad scope of application, the results are inconclusive and fail to demonstrate any solid long-term efficacy. In conclusion, we can state that: (1) There are biological factors (such as tryptophan—a building block for serotonin-depletion, for example) which strongly influence the appearance of depressive disorders; (2) Currently, negative interpersonal relations and relations with one's environment, coupled with social-cultural changes, may explain the increase observed in the prevalence of depression; (3) Many instruments can be used to evaluate depression, but it is necessary to continue to adapt tests for diagnosing the condition at an early age; (4) Prevention programs should be developed for and implemented at an early age; and (5) The majority of treatments are becoming increasingly rigorous and effective. Given that initial manifestations of depression may occur from a very early age, further and more in-depth research is required into the biological, psychological and social factors that, in an interrelated manner, may explain the appearance, development and treatment of depression. (shrink)

Medical research saves lives--yet all too often, it is thwarted by a review system supposed to safeguard patients that instead creates needless delays and expense. Institutional Review Boards, which exist at every hospital and medical school that conducts medical research, have ended up imposing such complex, draconian conditions that research is frequently damaged, delayed, and distorted. This is why medical miracles like the COVID-19 vaccines, which were developed at warp speed, are far too rare. Instead, medical research in countless areas (...) is kept at a horse-and-buggy pace. The result: unnecessary suffering and avoidable deaths. From Oversight to Overkill vividly recounts the story behind this crisis, one that remains unknown to the general public. Family physician and ethicist Simon Whitney shows how the IRB system was launched in response to scandals like the notorious Tuskegee syphilis study--and how, in recent decades, this well-intentioned program has become increasingly bureaucratic, convoluted, and stifling. Readers will learn how vital breakthroughs in treating conditions from kidney stones to heart attacks and premature birth have been delayed by IRB red tape, forcing doctors and patients to settle for less-effective treatments. They'll see how ill-informed demands from Congressional leaders that regulators "get tough" on scientists have caused respected research institutions to be shut down-with no benefit to the public. And they'll learn about a balanced, common-sense approach to reforming the system that can free scientists from pointless wheel-spinning while still protecting the public from the risks of unethical or careless experimentation. Until now, the debate about the IRB system's failures has been confined to specialty journals in medicine, law, and ethics. From Oversight to Overkill will finally alert citizens about this little-known crisis with America's medical research system-and what can be done about it. (shrink)

In §93 of The Principles of Mathematics, Bertrand Russell observes that “the variable is a very complicated logical entity, by no means easy to analyze correctly”. This assessment is borne out by the fact that even now we have no fully satisfactory understanding of the role of variables in a compositional semantics for first-order logic. In standard Tarskian semantics, variables are treated as meaning-bearing entities; moreover, they serve as the basic building blocks of all meanings, which are constructed out of (...) variable assignments. But this has disquieting consequences, including Fine’s antinomy of the variable and an undue dependence of meanings on language. Here I develop an alternative, Fregean version of predicate logic that uses the traditional quantifier–variable apparatus for the expression of generality, possesses a fully compositional, non-representational semantics, and is not subject to the antinomy of the variable. The advantages of Fregean over Tarskian predicate logic are due to the former’s treating variables not as meaningful lexical items, but as mere marks of punctuation, similar to parentheses. I submit that this is indeed how the variables of predicate logic should be construed. (shrink)

Growing evidence suggests that pathological overactivation of the endocannabinoid system (ECS) is associated with dyslipidemia, obesity and diabetes. Indeed, this signalling system acting through cannabinoid receptors has been shown to function both centrally and peripherally to regulate feeding behaviour as well as energy expenditure and metabolism. Consequently, modulation of these receptors can promote significant alterations in body weight and associated metabolic profile. Importantly, blocking cannabinoid receptor type 1 function has been found to prevent obesity and metabolic dysfunction in various (...) murine models and in humans. Here we provide a detailed account of the known physiological role of the ECS in energy balance, and explore how recent studies have delivered novel insights into the potential targeting of this system as a therapeutic means for treating obesity and related metabolic disorders. (shrink)

The Inverted Earth case has seen fierce debate between Ned Block, who says it defeats the causal-covariational brand of wide representationalism about qualia, and Michael Tye and Bill Lycan, who say it does not. The debate has generated more heat than light because of a failure to get clear on who is supposed to be proving what, and what premises can be deployed in doing so. I argue that a correct understanding of the case makes it clear that the causal (...) covariation theory is in deeper trouble over Inverted Earth than is generally supposed even by the theory's detractors. (shrink)

Sometimes, offering someone beneficial care is likely to thwart the similar or more serious medical needs of more people. For example, when acute shortage is strongly predicted to persist, providing the long period on scarce intensive care that a certain COVID‐19 patient needs is sometimes projected to block several future COVID‐19 patients from receiving the shorter periods on intensive care that they will need. Expected utility is typically higher if the former is denied intensive care. A tempting initial account of (...) such cases is that consequentialism supports denying care to that patient and nonconsequentialism supports providing that care. This paper argues that the consequentialist case is more complicated than it may initially seem and that nonconsequentialism sides more readily with denial of the beneficial treatment. It also shows that when denying it would directly enhance public health by a lot, either ethical approach would normally recommend denying it. Practical implications are discussed, including how to address conscientious objection to this shared recommendation. (shrink)

Minimalism concerning truth is the view that that all there is to be said concerning truth is exhausted by a set of basic platitudes. In the first part of this thesis, I apply this methodology to the concept of knowledge. In so doing, I develop a model of inexact knowledge grounded in what I call minimal margin for error principles. From these basic principles, I derive the controversial result that epistemological internalism and internalism with respect to self-knowledge are untenable doctrines. (...) In the second part of this thesis, I develop a minimal theory of vagueness in which a rigorous but neutral definition of vagueness is shown to be possible. Three dimensions of vagueness are distinguished and a proof is given showing how two of these dimensions are equivalent facets of the same phenomenon. From the axioms of this minimal theory one can also show that there must be higher-order vagueness, contrary to what some have argued. In the final part of this thesis, I return to issues concerning the credentials of truth-minimalism. Is truth-minimalism compatible with the possibility of truth-value gaps? Is it right to say that truth-minimalism is crippled by the liar paradox? With respect to the former question, I develop a novel three-valued logical system which is both proof-theoretically and truth-theoretic ally well-motivated and compatible with at least one form of minimalism. With respect to the second question, a new solution to the liar paradox is developed based on the claim that while the liar sentence is meaningful, it is improper to even suppose that this sentence has a truth-status. On that basis, one can block the paradox by restricting the Rule of Assumptions in Gentzen-style presentations of the sentential sequent calculus. The first lesson of the liar paradox is that not all assumptions are for free. The second lesson of the liar is that, contrary to what has been alleged by many, minimalism concerning truth is far better placed than its rival theories to solve the paradox. (shrink)

The original “Dutch Protocol”—the treatment model comprised of puberty blockers, cross‐sex hormones, and surgery—was intended to improve the mental and physical health of pediatric patients experiencing distress over their sexed bodies. Consequently, both researchers and clinicians have couched eligibility for treatment and measures of treatment efficacy in terms of the interventions’ effects on outcomes such as gender dysphoria, depression, anxiety, and suicide. However, recent systematic reviews have concluded that the scientific evidence supporting these interventions is uncertain, (...) leading to significant international differences in what treatments are offered to youth. Against this backdrop, a different argumentative approach has emerged in support of gender‐affirming care. This approach appeals not to reductions in patient morbidity or mortality but to patient autonomy, where medical intervention is pursued as a means to the satisfaction of a patient's “embodiment goals.” In this article, I raise objections to autonomy‐based justifications for pediatric gender‐affirming care, concluding that these arguments misunderstand the place of autonomy in clinical decision‐making and, consequently, put patients at risk of medical harm. (shrink)

In the USA, one child in 285 children is diagnosed with cancer every year, but thanks to improvements in medicine, the survival rate has reached 80%. However, cancer treatments, such as chemotherapy and radiation, are likely to affect their fertility later in life, limiting their ability to conceive. To reduce this risk, ovarian tissue cryopreservation is a surgical procedure that allows the ovarian tissue to be retrieved and cryopreserved in order to be reimplanted back into the abdomen and restore ovarian (...) function in children who become infertile due to gonadotoxic treatments. A case study published in 2014 offered recommendations to help assess whether such a procedure should be offered to female patients who have not yet entered puberty. This paper will investigate whether, in light of more recent and updated literature, their recommendations may need to be revised. (shrink)

This paper addresses a family of issues surrounding the biological phenomenon of resistance and its representation in realist ontologies. The treatments of resistance terms in various existing ontologies are examined and found to be either overly narrow, internally inconsistent, or otherwise problematic. We propose a more coherent characterization of resistance in terms of what we shall call blocking dispositions, which are collections of mutually coordinated dispositions which are of such a sort that they cannot undergo simultaneous realization within a (...) single bearer. A definition of ‘protective resistance’ is proposed for use in the Infectious Disease Ontology (IDO) and we show how this definition can be used to characterize the antibiotic resistance in Methicillin-Resistant Staphylococcus aureus (MRSA). The ontological relations between entities in our MRSA case study are used alongside a series of logical inference rules to illustrate logical reasoning about resistance. A description logic representation of blocking dispositions is also provided. We demonstrate that our characterization of resistance is sufficiently general to cover two other cases of resistance in the infectious disease domain involving HIV and malaria. (shrink)

The algorithm, a building block of computer science, is defined from an intuitive and pragmatic point of view, through a methodological lens of philosophy rather than that of formal computation. The treatment extracts properties of abstraction, control, structure, finiteness, effective mechanism, and imperativity, and intentional aspects of goal and preconditions. The focus on the algorithm as a robust conceptual object obviates issues of correctness and minimality. Neither the articulation of an algorithm nor the dynamic process constitute the algorithm itself. (...) Analysis for implications in computer science and philosophy reveals unexpected results, new questions, and new perspectives on current questions, including the relationship between our informally construed algorithms and Turing machines. Exploration in terms of current computational and philosophical thinking invites further developments. (shrink)

Despite advances in treatments over the last decades, a uniformly reliable and free of side effects therapy of human cancers remains to be achieved. During chromosome replication, a premature halt of two converging DNA replication forks would cause incomplete replication and a cytotoxic chromosome nondisjunction during mitosis. In contrast to normal cells, most cancer cells bear numerous DNA deletions. A homozygous deletion permanently marks a cell and its descendants. Here, we propose an approach to cancer therapy in which a pair (...) of sequence‐specific roadblocks is placed solely at two cancer‐confined deletion sites that are located ahead of two converging replication forks. We describe this method, termed “replication blocks specific for deletions” (RBSD), and another deletions‐based approach as well. RBSD can be expanded by placing pairs of replication roadblocks on several different chromosomes. The resulting simultaneous nondisjunctions of these chromosomes in cancer cells would further increase the cancer‐specific toxicity of RBSD. (shrink)

We applaud Notini and colleagues for highlighting the clinical and ethical complexities of a case in which a non-binary individual desires indefinite treatment with puberty blockers.1 While we agree discontinuing treatment may cause psychological distress, we believe there are potential physical and neurocognitive harms caused by prolonged treatment that have been underestimated given the limited research conducted to date. Specifically, the impact of permanent pubertal suppression on the brain and decision-making capacity should be considered. In this (...) context, we outline the potential risks of ongoing pubertal suppression on bone and cardiovascular health, sexual and reproductive function, and brain development—all noted in the article but perhaps in an overly simplistic manner.1 First, the authors’ note OPS will almost certainly result in reduced bone density.1 Although we agree the absolute fracture risk is low in studies among older adults, there is less clarity about implications during adolescence and young adulthood when peak bone accrual occurs.2 Further, the authors propose ongoing monitoring with bone density scans, but no clear guidelines for clinicians if bone density becomes critically low—so we ask, at what point would a potential fracture risk outweigh the proposed benefits …. (shrink)

Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference (...) of opinion about whether it is ethical to offer such ‘experimental’ procedures. The question addressed in this paper is: when, if ever, is it ethically justifiable to offer fertility preservation surgery to prepubertal children? We present the ethical concerns about prepubertal fertility preservation, drawing both on existing literature and our experience discussing this issue with clinicians in clinical ethics case consultations. We argue that offering the procedure is ethically justifiable in certain circumstances. For many children, the balance of benefits and burdens is such that the procedure is ethically permissible but not ethically required; when the procedure is medically safe, it is the parents’ decision to make, with appropriate information and guidance from the treating clinicians. We suggest that clinical ethics support processes are necessary to assist clinicians to engage with the ethical complexity of prepubertal fertility preservation and describe the framework that has been integrated into the pathway of care for patients and families attending the Royal Children’s Hospital in Melbourne, Australia. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Removing the Mask: Hopeless Isolation to Intersex AdvocacyAlexandra von KlanStrangers undoubtedly perceive me as female, but I identify as an intersex woman. My karyotype is 46,XY, a typically defined marker of male biological sex, and I was born with undeveloped, non–functioning gonads. As an intersex person, I know firsthand the negative consequences of pathologizing intersex people’s lived experience by categorizing otherwise healthy, functioning organs and bodies as abnormal. The (...) following narrative recounts conversations and interactions with medical providers during my diagnosis and subsequent treatment of pure XY gonadal dys-genesis, sometimes referred to as Swyer Syndrome. I hope to elaborate upon emotionally significant actions and inactions of medical care providers to expose consequential effects on my emotional processing, physical health, and self–actualization.In December 1988, I was born with “typical” female genitalia. No one knew I was an intersex woman with 46,XY karyotype. Thus, there was no hesitation in the announcement of the birth of a girl in the delivery room or later, on my birth certificate. My parents raised me as a girl and dressed their firstborn in culturally normative feminine garments and accessories: lace frilly frocks, oversized bows, white stockings, and black patent leather Mary Jane’s. I embraced femininity and expressed this gender identity throughout my childhood and adolescence. I’m the eldest of six children split between two households.In January 2005, a month after my sixteenth birthday, delayed puberty and absent menstruation prompted an appointment to a local women’s health center. Nurses collected blood samples and administered an MRI scan on my pelvic region. A week later, my father received a perplexing phone call. An inexperienced doctor told him “there must be something wrong” with me, because lab results revealed I was “chromosomally male.” My father recalls the information presented like, based on the evidence, “your daughter may not be completely female,” and that is that. His impression was that she knew little about the subject and was a bit clueless. She did not mention Swyer Syndrome, or any diagnosis for that matter.Up to this point, I was unaware that a member of my extended family also had Swyer Syndrome. Born in the 1950s, secrecy engulfed her medical treatment and doctors warned her parents against revealing her true chromosomal sex in order to prevent the hysterical panic and depression they [End Page E14] thought the truth would bring. Years later, she sought her medical records and unearthed the truth. Shortly after my father received that dubious phone call, my relative’s endocrinologist provided a referral to his mentor, “Doctor A,” a clinical reproductive endocrinologist.Under Doctor A’s care, I experienced the first of many pelvic exams. Much to my discomfort, Doctor A inspected my semi–clothed body with a male resident in the room. As a people–pleasing teen, I granted permission for his presence; I didn’t voice my preference for a female alternative. Doctor A’s cold hands pressed around each undeveloped breast, pulled a gown away from my hips to inspect a sparse patch of pubic hair, and conducted an examination of my vaginal canal.Shortly after the examination, Doctor A charted Swyer Syndrome as the official diagnosis. Speaking to my father and me, he described my condition as an extremely rare genetic mutation. He told us that Swyer Syndrome was an intersex condition, a group of congenital disorders impacting a person’s internal or external reproductive systems, including endocrine function and genitalia. He explained I had atypical streak gonads instead of ovaries and that, despite having typical male sex chromosomes, I was still very much a girl. He disclosed that my vaginal canal was moderate in length, perhaps further evidence—or consolation—that my body possessed normative female reproductive attributes after all.Next, Doctor A identified a pressing medical concern—golf–ball–sized benign tumors had developed on each streak gonad; if allowed to remain, they would pose an increasing risk of malignancy. We scheduled an appointment for laparoscopic gonadectomy six months later. I left his office with a 3–month prescription for estrogen and progesterone oral tablets. On the way home, we drove to an electronics store where my father... (shrink)

In many countries grappling with the politics of equal recognition, the experiences, beliefs and reasons for action of people who identify as non-binary are starting to be seen as valid and intelligible.1 And, despite some gender clinics still responding cautiously to requests for non-standard medical interventions, their treatment needs are now recognised in major clinical guidelines. This is the current social context in which Notini and colleagues outline the case of ‘Phoenix’, an 18-year-old birth-assigned woman, who has requested the (...) indefinite continuation of puberty suppression, a treatment that was initiated when the client was 11 years old to mitigate their intense distress at the onset of puberty. Drawing on a conception of health as overall well-being, the authors conclude that OPS is ‘consistent with the proper goals of medicine’, and that there are ‘equity-based reasons’ for offering OPS to adults as a group. They concede that the physical risks are greater for OPS than for hormonal interventions generally provided to people with a binary gender identity. They also acknowledge the need for ‘a fine-grained ethical evaluation of Phoenix’s particular situation’ to assess whether the potential benefits of OPS outweigh the potential harms for this individual. Here I respectfully raise three points to amplify the authors’ discussion. First, there seem to be significant ethical issues of a general, not a particular, kind arising from the type of individual evaluation they call for. Following initial screening for significant mental distress and other major vulnerabilities, the key undertaking …. (shrink)

The medical profession and medical ethics currently place a greater emphasis on physician responsibility than patient responsibility. This imbalance is not due to accident or a mistake but, rather is motivated by strong moral reasons. As we debate the nature and extent of patient responsibility it is important to keep in mind the reasons for giving a relatively minimal role to patient responsibility in medical ethics. It is argued that the medical profession ought to be characterized by two moral asymmetries: (...) (1) Even if some degree of responsible behavior from patients is called for, placing the dominant emphasis on professional responsibility over patient responsibility is largely correct. The value of protecting the right to refuse treatment and arguments against paternalism block a more expansive account of patient responsibility and support a strong notion of professional responsibility. (2) Insofar as we do want to encourage an increase in patient responsibility, we have good reasons to emphasize prospective rather than retrospective notions of responsibility in clinical practice. Concerns about patient vulnerability along with the determined factors in disease leave little room for blame at the bedside. These two asymmetries generate normative limits on any positive account of patient responsibility. (shrink)

One goal of this paper is to argue that autobiographical memories are extended and distributed across embodied brains and environmental resources. This is important because such distributed memories play a constitutive role in our narrative identity. So, some of the building blocks of our narrative identity are not brain-bound but extended and distributed. Recognising the distributed nature of memory and narrative identity, invites us to find treatments and strategies focusing on the environment in which dementia patients are situated. A second (...) goal of this paper is to suggest various of such strategies, including lifelogging technologies such as SenseCams, life story books, multimedia biographies, memory boxes, ambient intelligence systems, and virtual reality applications. Such technologies allow dementia patients to remember their personal past in a way that wouldn’t be possible by merely relying on their biological memory, in that way aiding in preserving their narrative identity and positively contributing to their sense of well-being. (shrink)

In the early 18th Century, Daniel Defoe found it natural to write a novel whose heroine was a sexually adventurous, socially marginal property offender. Only half a century later, this would have been next to unthinkable. In this paper, the disappearance of Moll Flanders, and her supercession in the annals of literary female offenders by heroines like Tess of the d'Urbervilles, serves as a metaphor for fundamental changes in ideas of selfhood, gender and social order in 18th and 19th Century (...) England. Drawing on law, literature, philosophy and social history, I argue that these broad changes underpinned a radical shift in mechanisms of responsibility-attribution, with decisive implications for the criminalisation of women. I focus in particular on the question of how the treatment and understanding of female criminality was changing during the era which saw the construction of the main building blocks of the modern criminal process, and of how these understandings related in turn to broader ideas about gender, social order and individual agency. (shrink)

Ordinary disposition ascriptions appear to form a semantically heterogeneous class of clauses some of which can be straightforwardly analyzed as possibility claims, and some of which resist a simple quantificational treatment. For example, while “The block is breakable” is true if the block breaks at a relevant possible world, for “The block is fragile” to be true it doesn’t suffice that the block breaks at one of the worlds that matter to the evaluation of the ascription, since the block (...) could break accidentally and yet be sturdy. The contrast has been taken to indicate that sentences like “The block is fragile” don’t introduce mere existential quantification over sets of worlds, and should be represented as claims about sufficient ratios or proportions of worlds. However, recent work has suggested that by pairing the recalcitrant DAs with modified manifestation phrases, we can generalize the standard analysis of existential DAs to the problematic examples, and state a uniform characterization of DAs as claims of possibility. The paper discusses some counterexamples to the view that allegedly non-existential DAs are covert claims of fine-grained possibility, and sketches a hybrid account combining proportional quantification with fine-grained manifestations. (shrink)

Ekphrasis, a part of the ancient Greek and Roman rhetorical practices, is, in its most basic sense, the verbal expression of a visual object. Since the description of Achilles’ shield in Homer’s Iliad, ekphrasis has been a literary practice used for the portrayal of visual artworks through fiction and poetry, as well as in prose written in history, art criticism and travelogues. Ekphrasis is a convenient literary tool for analysing the author’s treatment of the object depicted. Ekphrastic studies enable (...) the identification of the author’s relationship with objectivity and subjectivity, and the building blocks of the said subjectivity, through literary elements. What kind of fictional language does ekphrasis, which is essentially the act of making the mute object speak, point to, in Evliya Çelebi’s representation? This article will aim to examine the subjective factors, personal taste and cultural positioning that emerge in Evliyâ Çelebi’s writing practice, mainly in his “ekphrastic” narration of the Western paintings that he saw in the Balkans and Vienna, which he describes in great detail in his Seyahatnâme. It is of the author’s opinion that, although Evliyâ Çelebi’s cultural positioning imposed limitations on his aesthetic perception and ekphrastic narration, he had an admiration for the Western art; and his “actual” cultural position manifests itself in an “in-betweenness” in the East-West spiral, which also reflects his unique literary mode. (shrink)

In the section of the Antinomy of pure Reason Kant presents three notions of infinity. By investigating these concepts of infinity, this paper highlights important ‘building blocks’ of the structure of the mathematical antinomies, such as the ability of reason of producing ascending and descending series, as well as the notions of given and givable series. These structural features are discussed in order to clarify Ernst Zermelo’s reading of Kant’s antinomy, according to which the latter is deeply rooted in the (...) tendency of the mind of producing “creative progress” and “inclusive closure”. The aim of this paper is to explain in which sense and why Kant’s treatment of the antinomies attracts the attention of Zermelo in the early 1900s and which aspects of his second axiomatic system have been inspired by Kant’s philosophy. Thus, by reading Kant’s antinomy ‘through Zermelo’s eyes’—with emphasis on the concept of regressive series in indefinitum and on that of regressive series ad infinitum – this paper identifies the echoes of Kant’s work in the making of the ZFC set theory. (shrink)

Weeds are a bigger problem in direct seeding rice systems compared to conventional ones, because weeds germinate and grow at the same time as the rice. so it's more competitive. Chemical weed control with herbicides, if done with one active ingredient repeatedly, will cause resistance which threatens biodiversity. This research aims to determine the appropriate dose of the Florpyrauxifen-Benzyl and Cyhalofop mixture in controlling weeds in direct seeding lowland rice plants. The research was conducted in Sambi Village, Sambirejo District, Sragen (...) Regency, Central Java in July - November 2023. The experiment used a complete randomized block design, the treatments were: (1) Florpyrauxifen-Benzyl dose 1000 ml/ha. (2) Florpyrauxifen-Benzyl dose 1250 ml/ha, (3) Florpyrauxifen-Benzyl + chyalofop dose 750 ml/ha + 1000 ml/ha, (4) Florpyrauxifen-Benzyl + chyalofop dose 800 ml/ha + 1000 ml/ha (5) Manual control and (6) no weed control. The experiment was repeated in 4 repetitions with an area of 100 m in each experimental unit2. Research result: Herbicide application Florpyrauxifen-benzyl alone and Florpyrauxifen-benzyl at a dose of 1000 ml/ha b.a. + cyhalofop-butyl dose 750 ml/ha b.a. does not cause poisoning in rice plants. Florpyrauxifen-Benzyl + chyalofop dose 800 ml/ha + 1000 ml/ha showed very mild poisoning and symptoms of poisoning were not visible 14 days after application. Herbicide application Florpyrauxifen-benzyl alone against E. cruis-galli and L. chinensis Some control is not satisfactory, while broadleaf weeds are controlled. The mixed herbicide Florpyrauxifen-Benzyl+chyalofop provides perfect control for all target weeds. The rice yield saved by the single application of the herbicide Florpyrauxifen is between 47.44% - 50.57%, while with the use of the mixed herbicide Florpyrauxifen-benzyl+ cyhalofop-butyl it is 52% -53, 28%. (shrink)

The question of the influence of commercialism in medicine is often put in terms of how the money factor influences the actions and the judgments of the individual physician—just as in the culture at large there is and has always been the question of sacrificing personal moral values for financial gain. But it is necessary now, perhaps especially for physicians and others who are presumably operating in the “market-free zone,” to put the question in an even more intimate way. The (...) question becomes to what extent does the pressure of financial gain influence perception itself in the clinical setting. To what extent do the pressures of commercialism block or interfere with perceptions of fact and truth in establishing diagnosis, in projecting methods and strategies of treatment, and in assessing the medical, psychological, and moral needs of the individual patient? To this extent, it is not so much a question of physicians making intentional, self-serving decisions. It is a question of physicians unconsciously making such decisions based on perceptions and processes of judgment subconsciously or semiconsciously governed by the monetary considerations that have permeated nearly every corner and pocket of the contemporary culture. (shrink)

Spasticity and muscle weakness is common in children with cerebral palsy (CP). Spasticity can be treated with Botulinum Neurotoxin-A (BoNT-A), but this drug has also been reported to induce muscle weakness. Our purpose was to describe the effect on muscle strength in the lower extremities after BoNT-A injections in children with cerebral palsy. A secondary aim was to relate the effect of BoNT-A to gait pattern and range of motion. Twenty children with spastic cerebral palsy were included in the study, (...) eight girls and 12 boys (mean age 7.7 years). All were able to walk without support, but with increased muscle tone interfering with motor function and gait pattern. Sixteen children had unilateral spastic CP and four bilateral spastic CP. Twenty-four legs received injections with BoNT-A in the plantar flexor muscles. The children were tested before treatment, around six weeks after at the peak effect of BoNT-A, and at six months after treatment, with measurement of muscle strength, gait analysis and range of motion. There were no differences in muscle strength in plantar flexors of treated legs at peak effect compared to baseline. Six months after treatment, there was still no change in untreated plantar flexor muscles, but an increasing trend in plantar flexor strength in legs treated with BoNT-A. Parents reported positive effects in all children, graded as: small in three children, moderate in eight, and large in nine children. The gait analysis showed a small improvement in knee extension at initial contact, and there was a small increase in passive range of motion for ankle dorsiflexion. Two children had a period with transient weakness and pain. We found that voluntary force production in plantar flexor muscles did not decrease after BoNT-A, instead there was a trend to increased muscle strength at follow-up. The increase may be explained as an effect of the blocking of involuntary nerve impulses, leading to an opportunity to using and training the muscles with voluntary control. Adequate muscle strength is important for maintaining the ability to walk and knowledge of how a treatment affects muscle strength is useful when selecting interventions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Shame is Not an Effective Diet PlanJudith BrukThe stigma of being obese is so strong that it is assumed that anyone with the condition is (or should be) deeply ashamed. After all, it’s really easy to lose weight, right? Just cut out dessert and walk around the block three times a week. If you can’t even do that, then you are definitely a moral failure, have succumbed to Gluttony (...) and Sloth, and deserve to be shunned by society.The problem is that shame is not a very effective diet plan; quite the opposite. It’s no surprise that recent research shows that shame leads to depression that leads to isolation, which, in the morbidly obese, leads to a suicide rate twelve times that of healthy–weight people.Unfortunately, it is indeed true that many obese people feel a great deal of shame, even if we occasionally put on a façade of bravado or seeming shamelessness, e.g., the “large and in charge” sitcom staple trope. The bottom line is that our shame about our weight does keep us from engaging with other people, limits our willingness to participate in physical activities, and generally makes us reluctant to simply exist out in public. None of these are behaviors conducive to positive lifestyle changes.For years I engineered my life so I would only go out of my house when absolutely necessary: grocery shopping and the occasional meeting at work were pretty much it (I usually work from home). I went for years without going to a movie, shopping for clothes in a store, eating in a restaurant, gardening, or any of the other activities I once enjoyed. I was ashamed to be seen. And since I had tried and tried and tried and tried to lose weight for three decades and only ended up more overweight as the years went by, I finally, truly gave up. I convinced myself my psychological makeup was so flawed (or was missing whatever ingredient it was that made someone succeed at sustained weight loss) that I just hoped my inevitable heart attack would be instantaneously fatal. This thinking is irrational, or at least unhealthy. (I am an otherwise fairly smart person with an advanced degree and am professionally employed.) Yet, it is basically the path that both societal attitudes and medical treatment lead us down at this point in time.Here are a few examples that illustrate how the path to irrationality evolved for me.About twelve years ago, I decided to see a psychotherapist to get to the bottom of my subconscious psychological issue that was keeping me overweight. This therapist suggested I see a nutritionist who gave me a list of detailed thyroid tests to take to my doctor so she could order the labs and we could get a full profile of how my thyroid was functioning. Upon presenting the list to my doctor’s PA (my doctor was not available that day), she rolled her eyes, gave a very deep sigh and said to me, “Every fat woman wants to believe it’s because of her thyroid and it never, ever is.” I was so embarrassed for having even brought the subject up that in an effort to save face, I reacted to my shame by replying, “Yeah, I just assume my extreme lack of energy and excess weight is simply because I eat too much.” She said, “Right, so let’s not even bother running these tests.” It was at least ten years later that I finally had the thyroid panel run and found out it was very low functioning.After about a year of seeing that shrink, she declared me “cured” and sent me on my way, though I had not lost any weight. It was about this time I first began thinking that throwing in the towel [End Page 91] was a good option. That didn’t mean that I went out and ate pizza and ice cream every day. Not at all. In fact, given the fact that I had been vegetarian and general health–food freak beginning in my mid–twenties, I rarely had anything in the house that contained sugar... (shrink)