Evaluating clinical ethics support services has been hailed as important research task. At the same time, there is considerable debate about how to evaluate CESS appropriately. The criticism, which has been aired, refers to normative as well as empirical aspects of evaluating CESS. In this paper, we argue that a first necessary step for progress is to better understand the intervention in CESS. Tools of complex intervention research methodology may provide relevant means in this respect. In a first step, (...) we introduce principles of “complex intervention research” and show how CESS fulfil the criteria of “complex interventions”. In a second step, we develop a generic “conceptual framework” for “ethics consultation on request” as standard for many forms of ethics consultation in clinical ethics practice. We apply this conceptual framework to the model of “bioethics mediation” to make explicit the specific structural and procedural elements of this form of ethics consultation on request. In a final step we conduct a comparative analysis of two different types of CESS, which have been subject to evaluation research: “proactive ethics consultation” and “moral case deliberation” and discuss implications for evaluating both types of CESS. To make explicit different premises of implemented CESS interventions by means of conceptual frameworks can inform the search for sound empirical evaluation of CESS. In addition, such work provides a starting point for further reflection about what it means to offer “good” CESS. (shrink)

A Boltzmann Brain, haphazardly formed through the unlikely but still possible random assembly of physical particles, is a conscious brain having experiences just like an ordinary person. The skeptical possibility of being a Boltzmann Brain is an especially gripping one: scientific evidence suggests our actual universe’s full history may ultimately contain countless short-lived Boltzmann Brains with experiences just like yours or mine. I propose a solution to the skeptical challenge posed by these countless actual Boltzmann Brains. My key idea is (...) roughly this: the skeptical argument that you’re one of the Boltzmann Brains requires you to make a statistical inference, but the Principle of Total Evidence blocks us from making the inference. I discuss how my solution contrasts with a recent suggestion, made by Sean Carroll and David Chalmers, for how to address the skeptical challenge posed by Boltzmann Brains. And I discuss how my solution handles certain relevant concerns about what to do when we have higher-order evidence indicating that our first-order evidence is misleading. (shrink)

Discrepancies between the Uniform Determination of Death Act (UDDA) and the adult and pediatric diagnostic guidelines for brain death (BD) (the “Guidelines”) have motivated proposals to revise the UDDA. A revision proposed by Lewis, Bonnie and Pope (the RUDDA), has received particular attention, the three novelties of which would be: (1) to specify the Guidelines as the legally recognized “medical standard,” (2) to exclude hypothalamic function from the category of “brain function,” and (3) to authorize physicians to conduct an apnea (...) test without consent and even over a proxy’s objection. One hundred seven experts in medicine, bioethics, philosophy, and law, spanning a wide variety of perspectives, have come together in agreement that while the UDDA needs revision, the RUDDA is not the way to do it. Specifically, (1) the Guidelines have a non-negligible risk of false-positive error, (2) hypothalamic function is more relevant to the organism as a whole than any brainstem reflex, and (3) the apnea test carries a risk of precipitating BD in a non-BD patient, provides no benefit to the patient, does not reliably accomplish its intended purpose, and is not even absolutely necessary for diagnosing BD according to the internal logic of the Guidelines; it should at the very least require informed consent, as do many procedures that are much more beneficial and less risky. Finally, objections to a neurologic criterion of death are not based only on religious belief or ignorance. People have a right to not have a concept of death that experts vigorously debate imposed upon them against their judgment and conscience; any revision of the UDDA should therefore contain an opt-out clause for those who accept only a circulatory-respiratory criterion. (shrink)

This paper explores the level of obligation called for by Milton Friedman’s classic essay “The Social Responsibility of Business is to Increase Profits.” Several scholars have argued that Friedman asserts that businesses have no or minimal social duties beyond compliance with the law. This paper argues that this reading of Friedman does not give adequate weight to some claims that he makes and to their logical extensions. Throughout his article, Friedman emphasizes the values of freedom, respect for law, and duty. (...) The principle that a business professional should not infringe upon the liberty of other members of society can be used by business ethicists to ground a vigorous line of ethical analysis. Any practice, which has a negative externality that requires another party to take a significant loss without consent or compensation, can be seen as unethical. With Friedman’s framework, we can see how ethics can be seen as arising from the nature of business practice itself. Business involves an ethics in which we consider, work with, and respect strangers who are outside of traditional in-groups. (shrink)

Radical ontic structural realism (ROSR) asserts an ontological commitment to ‘free-standing’ physical structures understood solely in terms of fundamental relations, without any recourse to relata that stand in these relations. Bain ([2013], pp.1621–35) has recently defended ROSR against the common charge of incoherence by arguing that a reformulation of fundamental physical theories in category-theoretic terms (rather than the usual set-theoretic ones) offers a coherent and precise articulation of the commitments accepted by ROSR. In this essay, we argue that category theory (...) does not offer a more hospitable environment to ROSR than set theory. We also show that the application of category-theoretic tools to topological quantum field theory and to algebraic generalizations of general relativity do not warrant the claim that these theories describe ‘object-free’ structures. We conclude that category theory offers little if any comfort to ROSR. 1 Introduction: Ridding Structures of Objects2 The Set-theoretic Peril for Radical Ontic Structural Realism3 Bain’s Categorial Strategy to Save Radical Ontic Structural Realism4 Throwing out the Relations with the Relata5 Categorial and Set-theoretical Structures6 Radical Suggestions from Topological Quantum Field Theory?7 Sheaves of Einstein Algebras as Radical Structures?8 Conclusions. (shrink)

According to so-called epistemic theories of conditionals, the assertability/acceptability/acceptance of a conditional requires the existence of an epistemically significant relation between the conditional’s antecedent and its consequent. This paper points to some linguistic data that our current best theories of the foregoing type appear unable to explain. Further, it presents a new theory of the same type that does not have that shortcoming. The theory is then defended against some seemingly obvious objections.

This paper aims to explain why the laws of nature are held fixed in counterfactual reasoning. I begin by highlighting three salient features of counterfactual reasoning: it is conservative, nomically guided, and it uses hindsight. I then present a rationale for our engagement in counterfactual reasoning that aims to make sense of these features. In particular, I argue that counterfactual reasoning helps us evaluate the evidential relations between unanticipated pieces of evidence and various hypotheses of interest about the history of (...) the actual world. Given this goal, it makes a great deal of sense that counterfactual reasoning would have the aforementioned features. Additionally, it turns out that this account of counterfactual reasoning is nicely congruent with Humean views of laws. Specifically, it can explain, in a Humean-friendly way, both why the laws are counterfactually resilient, and why we may be inclined to have anti-Humean intuitions in the first place, even if some form of Humeanism is correct. (shrink)

BackgroundExisting clinical ethics support (CES) instruments are considered useful. However, users report obstacles in using them in daily practice. Including end users and other stakeholders in developing CES instruments might help to overcome these limitations. This study describes the development process of a new ethics support instrument called CURA, a low-threshold four-step instrument focused on nurses and nurse assistants working in palliative care. MethodWe used a participatory development design. We worked together with stakeholders in a Community of Practice (...) throughout the study. Potential end users (nurses and nurse assistants in palliative care) used CURA in several pilots and provided us with feedback which we used to improve CURA.ResultsWe distinguished three phases in the development process. Phase one, Identifying Needs, focused on identifying stakeholder and end user needs and preferences, learning from existing CES instruments, their development and evaluation, and identify gaps. Phase two, Development, focused on designing, developing, refining and tailoring the instrument on the basis of iterative co-creation. Phase three, Dissemination, focused on implementation and dissemination. The instrument, CURA, is a four-step low-threshold instrument that fosters ethical reflection.ConclusionsParticipatory development is a valuable approach for developing clinical ethics support instruments. Collaborating with end users and other stakeholders in our development study has helped to meet the needs and preferences of end users, to come up with strategies to refine the instrument in order to enhance its feasibility, and to overcome reported limitations of existing clinical ethics instruments. (shrink)

Background Non-adherence to medication is associated with increased risk of relapse in patients with bipolar disorder. Objectives To validate patient-evaluated adherence to medication measured via smartphones against validated adherence questionnaire; and investigate characteristics for adherence to medication measured via smartphones. Methods Patients with BD evaluated adherence to medication daily for 6–9 months via smartphones. The Medication Adherence Rating Scale and the Rogers’ Empowerment questionnaires were filled out. The 17-item Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Functional (...) Assessment Short Test were clinically rated. Data were collected multiple times per patient. The present study represents exploratory pooled reanalyses of data collected as part of two randomised controlled trials. Findings During the study 90.50% of the days were evaluated as ‘medication taken’, 6.91% as ‘medication taken with changes’ and 2.59% as ‘medication not taken’. Adherence to medication measured via smartphones was valid compared with the MARS. Younger age and longer illness duration were significant predictors for non-adherence to medication. Decreased affective symptoms measured with smartphone-based patient-reported mood and clinical ratings as well as decreased empowerment were associated with non-adherence. Conclusions Smartphone-based monitoring of adherence to medication was valid compared with validated adherence questionnaire. Younger age and longer illness duration were predictors for non-adherence. Increased empowerment was associated with adherence. Clinical implications Using smartphones for empowerment of adherence using patient-reported measures may be helpful in everyday clinical settings. Trial registration number NCT01446406 and NCT02221336. (shrink)

Objectivism about evidential support is the thesis that facts about the degree to which a body of evidence supports a hypothesis are objective rather than depending on subjective factors like one’s own language or epistemic values. Objectivism about evidential support is key to defending a synchronic, time-slice-centric conception of epistemic rationality, on which what you ought to believe at a time depends only on what evidence you have at that time, and not on how you were at previous (...) times. Here, I defend a version of objectivism about evidential support on which facts about evidential support are grounded in facts about explanatoriness. (shrink)

Eliminative reasoning is a method that has been employed in many significant episodes in the history of science. It has also been advocated by some philosophers as an important means for justifying well-established scientific theories. Arguments for how eliminative reasoning is able to do so, however, have generally relied on a too narrow conception of evidence, and have therefore tended to lapse into merely heuristic or pragmatic justifications for their conclusions. This paper shows how a broader conception of evidence not (...) only can supply the needed justification but also illuminates the methodological significance of eliminative reasoning in a variety of contexts. (shrink)

Initiating clinical ethics support in psychiatry and maintaining its continuity appear to be easy. This is contradicted by the observed delay or lack of CESiP, e.g. ethics consultation. On the basis of a published literature search and the discussion of practical experiences over 2.5 years 10 tasks and relating challenges of initiating and maintaining CESiP are formulated and illustrated by examples. Referral to experiences is grounded on the systematic documentation of ca. 100 CESiP activities. The tasks and challenges illustrate (...) how CESiP was initiated and maintained in child and adolescent, adult and forensic psychiatry. Each example is followed by a “rule of thumb” that was found useful in our centre. Discussion: Suggestions I–III are of organisational nature, IV–X have explicit ethical content concerning the ethos or professionalism of the ethics consultant and CES practice. Their realisation requires a minimum of stability of CESiP and considerable consultancy experience. (shrink)

People are motivated by shared social values that, when held with moral conviction, can serve as compelling mandates capable of facilitating support for ideological violence. The current study examined this dark side of morality by identifying specific cognitive and neural mechanisms associated with beliefs about the appropriateness of sociopolitical violence, and determining the extent to which the engagement of these mechanisms was predicted by moral convictions. Participants reported their moral convictions about a variety of sociopolitical issues prior to undergoing (...) functional MRI scanning. During scanning, they were asked to evaluate the appropriateness of violent protests that were ostensibly congruent or incongruent with their views about sociopolitical issues. Complementary univariate and multivariate analytical strategies comparing neural responses to congruent and incongruent violence identified neural mechanisms implicated in processing salience and in the encoding of subjective value. As predicted, neuro-hemodynamic response was modulated parametrically by individuals’ beliefs about the appropriateness of congruent relative to incongruent sociopolitical violence in ventromedial prefrontal cortex, and by moral conviction in ventral striatum. Overall moral conviction was predicted by neural response to congruent relative to incongruent violence in amygdala. Together, these findings indicate that moral conviction about sociopolitical issues serves to increase their subjective value, overriding natural aversion to interpersonal harm. (shrink)

This paper sheds light on the role of digital platform labour in the development of today’s artificial intelligence, predicated on data-intensive machine learning algorithms. Focus is on the specific ways in which outsourcing of data tasks to myriad ‘micro-workers’, recruited and managed through specialized platforms, powers virtual assistants, self-driving vehicles and connected objects. Using qualitative data from multiple sources, we show that micro-work performs a variety of functions, between three poles that we label, respectively, ‘artificial intelligence preparation’, ‘artificial intelligence verification’ (...) and ‘artificial intelligence impersonation’. Because of the wide scope of application of micro-work, it is a structural component of contemporary artificial intelligence production processes – not an ephemeral form of support that may vanish once the technology reaches maturity stage. Through the lens of micro-work, we prefigure the policy implications of a future in which data technologies do not replace human workforce but imply its marginalization and precariousness. (shrink)

1. The last 25 years have seen an increasing interest in the area of formal argumentation. The ultimate goal of the field is to come up with computational models of how we make decisions, based on...

Crispin Wright’s discussion of the notion of ‘transmission-failure’ promises to have important philosophical ramifications, both in epistemology and beyond. This paper offers a precise, formal characterisation of the concept within a Bayesian framework. The interpretation given avoids the serious shortcomings of a recent alternative proposal due to Samir Okasha.

The origin, character, and reception of the Development Act of 1909 are described. Extant evaluations of its historical significance are presented and criticized. It is claimed that the significance of the Act for the promotion of scientific research in agriculture, horticulture, and forestry has been largely overlooked. The way in which the Commissioners of the Act interpreted their brief by establishing scholarships, new research institutes, and developing existing institutes is described.

Volume 20, Issue 6, June 2020, Page 75-77.

Re-analysis of the data provided in the target article reveals a lack of evidence for a strong, universal relationship between parasite stress and the variables relating to sociality. Furthermore, even if associations between these variables do exist, the analyses presented here do not provide evidence for Fincher & Thornhill's (F&T's) proposed causal mechanism.

Much recent work in philosophy of memory discusses the question whether episodic remembering is continuous with imagining. This paper contributes to the debate between continuists and discontinuists by considering a previously neglected source of evidence for continuism: the linguistic properties of overt memory and imagination reports (e.g. sentences of the form 'x remembers/imagines p'). I argue that the distribution and truth-conditional contribution of episodic uses of the English verb 'remember' is surprisingly similar to that of the verb 'imagine' – even (...) when compared to the distribution of other experiential attitude verbs like 'see', 'hallucinate', or 'dream'. This holds despite the presence of some remarkable truth-conditional differences between 'remember' and 'imagine'. I show how these differences can be explained by a continuist account of remembering on which remembering is past-directed, referential, and accurate experiential imagining. (shrink)

BackgroundInternationally, clinical ethics support has yet to be implemented systematically in community health and care services. A large-scale Norwegian project attempted to increase ethical competence in community services through facilitating the implementation of ethics support activities in 241 Norwegian municipalities. The article describes the ethics project and the ethics activities that ensued.MethodsThe article first gives an account of the Norwegian ethics project. Then the results of two online questionnaires are reported, characterizing the scope, activities and organization of the (...) ethics activities in the Norwegian municipalities and the ethical topics addressed.ResultsOne hundred and thirty-seven municipal contact persons answered the first survey, whereas 217 ethics facilitators from 48 municipalities responded to the second. The Norwegian ethics project is vast in scope, yet has focused on some institutions and professions whilst seldom reaching others. Patients and next of kin were very seldom involved. Through the ethics project employees discussed many important ethical challenges, in particular related to patient autonomy, competence to consent, and cooperation with next of kin. The “ethics reflection group” was the most common venue for ethics deliberation.ConclusionsThe Norwegian project is the first of its kind and scope, and other countries may learn from the Norwegian experiences. Professionals have discussed central ethical dilemmas, the handling of which arguably makes a difference for patients/users and service quality. The study indicates that large scale implementation of CES structures for the municipal health and care services is complex, yet feasible. (shrink)

Unfortunately, there is broad confusion regarding the justification for healthcare professionals unilaterally limiting or withdrawing life-prolonging interventions. Many mistakenly believe that suc...

This paper aims to pay tribute to Figal’s comprehensive and innovative analysis of the artwork and beauty, while challenging both his realist position on the immediacy of meaning and his monist stance that reduces sublimity to beauty. To enquire into the origin of aesthetic feelings and sense, and thus, to break the hermeneutic circle, we first trace the origin of this reduction to the reception of Burke’s concept of the sublime by Mendelssohn and Kant. We then recur to Husserl and (...) Dufrenne to trace the origin of the sense of the feeling of sublimity in the realm of affectivity or sensuousness. This genesis takes place in passive experience, where we identify an excess of sensuous sense over categorial meaning that is constitutive of the affective sense that our bodily sensations give to hyletic material. It is argued that this sensuous excess evokes a sublime experience in the phenomenological sense, involving an affective and disruptive bodily experience and an endless process of sense formation. Affective or sensuous sense is thus an event that irreversibly affects the bodily surface. To elucidate this phenomenon, we draw on the theoretical framework of Breton and Bataille, positing it as a form-transgressive ‘convulsive’ sublime, which we then illustrate in the architectural works of Tschumi and Eisenman. In short, we have retrieved the origin of aesthetic experience and redefined the feeling of the sublime as a phenomenological ‘convulsive’ sublimity. (shrink)

The study of biodiversity spans many disciplines and includes data pertaining to species distributions and abundances, genetic sequences, trait measurements, and ecological niches, complemented by information on collection and measurement protocols. A review of the current landscape of metadata standards and ontologies in biodiversity science suggests that existing standards such as the Darwin Core terminology are inadequate for describing biodiversity data in a semantically meaningful and computationally useful way. Existing ontologies, such as the Gene Ontology and others in the Open (...) Biological and Biomedical Ontologies (OBO) Foundry library, provide a semantic structure but lack many of the necessary terms to describe biodiversity data in all its dimensions. In this paper, we describe the motivation for and ongoing development of a new Biological Collections Ontology, the Environment Ontology, and the Population and Community Ontology. These ontologies share the aim of improving data aggregation and integration across the biodiversity domain and can be used to describe physical samples and sampling processes (for example, collection, extraction, and preservation techniques), as well as biodiversity observations that involve no physical sampling. Together they encompass studies of: 1) individual organisms, including voucher specimens from ecological studies and museum specimens, 2) bulk or environmental samples (e.g., gut contents, soil, water) that include DNA, other molecules, and potentially many organisms, especially microbes, and 3) survey-based ecological observations. We discuss how these ontologies can be applied to biodiversity use cases that span genetic, organismal, and ecosystem levels of organization. We argue that if adopted as a standard and rigorously applied and enriched by the biodiversity community, these ontologies would significantly reduce barriers to data discovery, integration, and exchange among biodiversity resources and researchers. (shrink)

In their target article, Childress et al provide a detailed analysis of dilemmas arising from disagreement between an ICU team and a competent patient (Mr J) about dis/continuation of extra-corpore...

ABSTRACTIn this paper, I critique one way of arguing for global democracy on grounds of affected interests and defend another. A famous argument for global democracy, which I call the Demos-Based Argument, attempts to justify global democracy based on the claim that affected interests vindicate individual claims to democratic participation or representation. I analyze and evaluate the Demos-Based Argument and consider different ways of interpreting and justifying its crucial premise: the Principle of Affected Interests. The result is that the argument (...) fails. One lesson of the discussion of the Demos-Based Argument is that the most promising, though eventually unsuccessful, justification of the Principle of Affected Interests is utilitarian. Given the failure of the Demos-Based Argument, the question suggests itself if there is another way to argue for global democracy on utilitarian grounds. I will outline a promising alternative argument for global democracy, which I call the Direct Argument. Like the De... (shrink)

When information is transformed from what has traditionally been a paper-based format into digitized elements with meaning associated to them, new and intriguing discussions begin surrounding proper and improper uses of this codified and easily transmittable information. As these discussions continue, some health care providers, insurers, laboratories, pharmacies, and other healthcare stakeholders are creating and retroactively digitizing our medical information with the unambiguous endorsement of the federal government.Some argue that these enormous databases of medical information offer improved access to timely (...) information, evidence-based treatments, and complete records from which to provide care. To the extent that these claims are true, it would seem that this is a valuable asset that offers immeasurable benefit to all. Others believe this digitization to be an egregious invasion of privacy. In this article, I investigate the broad research questions of whether the public good aspect of capturing private health information outweighs individual interests and whether it is ethical to mandate participation in health information exchanges by all individuals who use the U.S. health system. (shrink)

In pluralist societies, stakeholders in healthcare may have different experiences of and moral perspectives on health, well-being, and good care. Increasing cultural, religious, sexual, and gender diversity among both patients and healthcare professionals requires healthcare organizations to address these differences. Addressing diversity, however, comes with inherent moral challenges; for example, regarding how to deal with healthcare disparities between minoritized and majoritized patients or how to accommodate different healthcare needs and values. Diversity statements are an important strategy for healthcare organizations to (...) define their normative ideas with respect to diversity and to establish a point of departure for concrete diversity approaches. We argue that healthcare organizations ought to develop diversity statements in a participatory and inclusive way in order to promote social justice. Furthermore, we maintain that clinical ethicists can support healthcare organizations in developing diversity statements in a more participatory way by fostering reflective dialogues through clinical ethics support. We will use a case example from our own practice to explore what such a developmental process may look like. We will critically reflect on the procedural strengths and challenges as well as on the role of the clinical ethicist in this example. (shrink)

Many clinical ethics support services do not involve patients. This is surprising because of the broad commitment to provide patient-centered healthcare. Clinical ethics support services are a component of the healthcare system and have an influence on patient care, and should therefore align with the regulatory and ethical requirements of patient-centered care, just process and cultural competence. First, in order to achieve good patient care, it is essential to involve patients in making their own healthcare decisions. Second, just (...) ethical deliberation requires that the deliberating parties have access to complete, accurate and unbiased information – this is best achieved through direct patient input. These arguments are especially compelling in the case of non-dominant cultural and ethnic groups. Here, we argue that when a clinician refers a case to a clinical ethics support services for consideration, and that case involves a conflict between the views or values of the clinician and the patient, the patient is entitled to, at a minimum: (a) be informed of the referral; (b) have the opportunity to speak directly to the clinical ethics support services prior to deliberation; (c) be provided with any opinion directly from the clinical ethics support services; and (d) have the opportunity to speak to a clinical ethics support services member after the deliberation. We use New Zealand as a case study to support and extrapolate the ethical principles and the minimum patient involvement requirements. We draw on our empirical research with senior doctors at a tertiary New Zealand hospital. Clinicians in our study indicated that they would feel bound by clinical ethics support service advice and that the clinical ethics support service has a significant impact on patient care in the case it reviews. (shrink)

Personhood theism is the view that God exists and is a person. It is often claimed that, whatever conclusions might be reached abstractly by philosophers and theologians, Christianity as lived out practically embodies belief in personhood theism. In this article, I critically examine this claim and argue that Christian prayer and liturgical practice does not in fact embody this belief and that the claim that it does begs the questions against the non-personhood theist.

Recent research illustrates substantial gaps between entrepreneurial intentions and behavior. This is a challenge for entrepreneurship promotion interventions that have primarily focused on stimulating entrepreneurial intentions. However, extant literature suggests that implementation intentions enhance the likelihood of acting congruently to the behavioral intention. Furthermore, theory also suggests the condition effects of situations and the perceived control over them. We therefore hypothesized that implementation intentions mediate the relationship between entrepreneurial intention and action, while perceived family support moderates the movement from (...) implementation intention to entrepreneurial action. Using two-wave survey data from a sample of students at an African university, we measured two psychological attributes as important precursors of entrepreneurship and entrepreneurial intentions present before undertaking an innovations and entrepreneurship course. Implementation intentions regarding entrepreneurship, entrepreneurial actions, and perceived parental support for entrepreneurial activities were also measured 2 weeks after completion of the course. Our results demonstrate support for the proposed moderated double mediation model in which the effects of the two psychological attributes on entrepreneurial actions are explained via entrepreneurial intentions and implementation intentions. We further find moderation effects of perceived family support indicating that implementation intentions more likely predicted entrepreneurial actions in cases of higher family support. (shrink)