Objective: To examine the role of explainability in machine learning for healthcare (MLHC), and its necessity and significance with respect to effective and ethical MLHC application. Study Design and Setting: This commentary engages with the growing and dynamic corpus of literature on the use of MLHC and artificial intelligence (AI) in medicine, which provide the context for a focused narrative review of arguments presented in favour of and opposition to explainability in MLHC. Results: We find that concerns regarding explainability are (...) not limited to MLHC, but rather extend to numerous well-validated treatment interventions as well as to human clinical judgment itself. We examine the role of evidence-based medicine in evaluating unexplainable treatments and technologies, and highlight the analogy between the concept of explainability in MLHC and the related concept of mechanistic reasoning in evidence-based medicine. Conclusion: Ultimately, we conclude that the value of explainability in MLHC is not intrinsic, but is instead instrumental to achieving greater imperatives such as performance and trust. We caution against the uncompromising pursuit of explainability, and advocate instead for the development of robust empirical methods to successfully evaluate increasingly inexplicable algorithmic systems. (shrink)

There exists in academic medicine a core ethical issue that is seldom pursued: trainees are frequently not the best person in the operating room at a given intervention being performed, and yet as a profession we understand a fundamental need to afford them opportunities to perform. Academic centres are traditionally associated with a higher quality of care than non-academic centres, suggesting that practical measures exist within teaching hospitals that effectively mask the clinical discrepancies between trainees and their preceptors. Nonetheless, we (...) are bound by our ethical commitments as physicians to balance the obligations of care with the duty to teach. In order to ethically validate the model of ‘surgeon as teacher’, we propose that there must be a reconciliation of the tensions between traditional professional values in medicine with the constraints inherent in a time-bound utilitarian medical system. Ultimately, we must consciously accept that ensuring the longitudinal availability of skilled surgeons in society aligns more closely with our core ethical obligations as outlined in the social contract that medical professionals maintain with the general public than does the ethical demand to provide unreservedly individual-focused patient care. It is the duty of individual practitioners, as a necessity of lineage to maintain and fulfil our greater duties to society, to foster deontological relationships where possible within this utilitarian system while accepting short-term imperfection in our practice. There are no data in this manuscript. (shrink)

Volume 20, Issue 8, August 2020, Page 51-53.

In many jurisdictions, legal frameworks afford patients the opportunity to make prospective medical decisions or to create directives that contain a special provision forfeiting their own ability to object to those decisions at a future time point, should they lose decision‐making capacity. These agreements have been described with widely varying nomenclatures, including Ulysses Contracts, Odysseus Transfers, Psychiatric Advance Directives with Ulysses Clauses, and Powers of Attorney with Special Provisions. As a consequence of this terminological heterogeneity, it is challenging for healthcare (...) providers to understand the terms and uses of these agreements and for ethicists to engage with the nuances of clinical decision‐making with such unique provisions surrounding patient autonomy. In theory, prospective self‐binding agreements may safeguard patient's “authentic” wishes from future “inauthentic” changes of mind. In practice, it is unclear what may be comprised within these agreements or how—and to what effect—they are used. The primary focus of this integrative review is to curate the existing literature describing Ulysses Contracts (and analogous decisions) used in the clinical arena, in order to empirically synthesize their shared essence and provide insights into the traditional components of these agreements when used in practice, the requirements of their consent processes, and the outcomes of their utilization. (shrink)

Emerging technologies such as artificial intelligence are actively revolutionizing the healthcare industry. While there is widespread concern that these advances will displace human practitioners within the healthcare sector, there are several tasks – including original and nuanced ethical decision making – that they cannot replace. Further, the implementation of artificial intelligence in clinical practice can be anticipated to drive the production of novel ethical tensions surrounding its use, even while eliminating some of the technical tasks which currently compete with ethical (...) deliberation for clinicians’ limited time. A new argument therefore arises to suggest that although these disruptive technologies will change the face of medicine, they may also foster a revival of several fundamental components inherent to the role of healthcare professionals, chiefly, the principal activities of moral philosophy. Accordingly, “machine medicine” presents a vital opportunity to reinvigorate the field of bioethics, rather than withdraw from it. (shrink)

As Alfandre and colleagues describe in “Between Usual and Crisis Phases of a Public Health Emergency: The Mediating Role of Contingency Measures”, efforts to maintain standards of care durin...

Analgesia and amnesia represent two complimentary pillars of anesthesia directed, respectively, at mitigating the experience of pain and the processes of encoding that experience into memory. These elements are typically combined in modern anesthetic techniques, but some circumstances exist – such as conscious sedation – in which the conditions of amnesia are satisfied while analgesia plays an auxiliary and often incomplete role. These activities reflect a widely held yet underrecognized belief in clinical practice that although pain experiences may be short-lived, (...) their representation in memory and its subsequent effects on thought and emotion can have enduring consequences for patients. In this exploratory article, we delineate phenomenal and abstract ontological categories of pain experience; advance a claim that they are treated by analgesic and amnestic agents, respectively; and describe how each class of experience is uniquely able to bring about individual harm. Beginning with the question of how it can be permissible to allow any preventable experiences or memories of pain, we identify that both phenomenal and abstract pain manifest on a spectrum of severity, each with an enigmatic threshold – unique to circumstance and individual – that determines whether or not pain will translate into harm, and what permissions therefore surround its treatment. Ultimately, we find that there are compelling physiological reasons for the concurrent use of analgesics and amnestics when pain experience exceeds these thresholds, while the treatment of “sub-threshold” experience in either class is a purely ethical imperative to be balanced with considerations of the potential harms posed by the treatments themselves. (shrink)

In their forthcoming article, ‘What makes a medical intervention invasive?’ De Marco, Simons, and colleagues explore the meaning and usage of the term ‘invasive’ in medical contexts. They describe a ‘Standard Account’, drawn from dictionary definitions, which defines invasiveness as ‘incision of the skin or insertion of an object into the body’. They then highlight cases wherein invasiveness is employed in a manner that is inconsistent with this account (eg, in describing psychotherapy) to argue that the term invasiveness is often (...) used to explicitly or implicitly reference interventions that do not fall under the standard account. The authors offer an alternative ‘schematic’ definition of invasiveness, whereby medical interventions entail an underlying context-independent property of ‘basic invasiveness’ and may be understood both relative to each other and to a context-specific threshold of what is ‘invasive’.1 We propose that the meaning of terms such as ‘invasiveness’ is necessarily heterogeneous, and that what is implied by its usage will certainly depend on context, particularly in medical settings. Hence, the creation of a unifying definition is less critical than clarification of the implied and intended meanings of each instance of the term’s use. We further argue that interpreting the use of terms like ‘invasiveness’ in medical practice is complicated by the embedding of each use of this term in a different ‘language game’, whereby words and their meanings are understood by an in-group familiar with …. (shrink)

In their forthcoming article, Shavelson and colleagues (2023) identify a key ethical concern associated with medical aid-in-dying (MAiD) laws in the eleven US jurisdictions where the practice is le...

BackgroundThe expectation of pandemic-induced severe resource shortages has prompted authorities to draft and update frameworks to guide clinical decision-making and patient triage. While these documents differ in scope, they share a utilitarian focus on the maximization of benefit. This utilitarian view necessarily marginalizes certain groups, in particular individuals with increased medical needs.Main bodyHere, we posit that engagement with the disability critique demands that we broaden our understandings of justice and fairness in clinical decision-making and patient triage. We propose the capabilities (...) theory, which recognizes that justice requires a range of positive capabilities/freedoms conducive to the achievement of meaningful life goals, as a means to do so. Informed by a disability rights critique of the clinical response to the pandemic, we offer direction for the construction of future clinical triage protocols which will avoid ableist biases by incorporating a broader apprehension of what it means to be human.ConclusionThe clinical pandemic response, codified across triage protocols, should embrace a form of justice which incorporates a vision of pluralistic human capabilities and a valuing of positive freedoms. (shrink)

A good deal of attention has been given in recent philosophy of religion to the question of whether we can sensibly attribute to God a form of knowledge which the 16th-century Jesuit theologian Luis de Molina termed "middle knowledge". Interest in the doctrine has been spurred by a recognition of its intimate connection to certain conceptions of providence, prophecy, and response to petitionary prayer. According to defenders of the doctrine, which I will call "Molinism", the objects of middle knowledge are (...) all the true counterfactuals of the form, 'If C were to occur, then S would freely do A', where C specifies a particular set of circumstances. (Such propositions are usually referred to as "counterfactuals of freedom" - hereafter "CFs".)' I will try to assess the current status of two distinct questions: (1) Are there true CFs? and (2) Could God know true CFs if there are any? Obviously, Molinism must answer both questions affirmatively. Most of the discussion has focused on the first question. I hope to show that this approach has been a dialectical mistake on the part of critics of Molinism, for the difficulties of giving an affirmative answer to question (2) are, I believe, far easier to state clearly and convincingly. (shrink)

This article argues that Habermas’s formal-pragmatics are better understood as a set of weak-universal dispositions susceptible to erosion over the course of a lifetime, if exposed to continual “disappointing” communicative experiences. Habermas’s rational-reconstructive project to explicate the intuitive rule-consciousness held by competent speakers retains immense theoretical value for analyzing both partisan and mass political discourse, if his emphasis on isolated speech situations is supplemented with a logic of communicative memory better accounting for how disagreement antecedes discourse on the formal-pragmatic register. (...) I argue that Habermas’s concept of the “lifeworld” contains untapped theoretical resources for thinking about the formal-pragmatic consequences of accumulated partisan experiences; namely, how such experiences lead inter-partisan actors to jettison mutual imputations of communicative accountability. I conclude by offering revisions to Habermas’s discourse ethics. Rapport-building intended to alleviate the negative effects of prior accumulated partisan experiences is first necessary if a norm is to enjoy real justification. (shrink)

Available in paperback for the first time, this landmark volume examines the course of Western philosophy over the past 2,500 years. A Critical History of Western Philosophy focuses on the most significant thinkers and philosophical movements while emphasizing key ideas of permanent interest and relevance. Arranged chronologically from early Greece to the twentieth century, this comprehensive work includes expert histories of all major figures from Socrates and Plato to G.E. Moore and Bertrand Russell, and of every important school from the (...) Epicureans to the Existentialists. (shrink)

In this important new book, David O'Connor discusses both logical and empirical forms of the problem of inscrutable evil, perennially the most difficult ...

Mild signs of postpartum depression or anxiety are present in up to half of all new mothers. However, the impact of having the “baby blues” on infant development remains largely unknown. The current study explores a potential relation between mother’s self-reported depression or anxiety symptoms and infant’s motor development in a longitudinal sample of 50 mother-infant dyads. Further, we examine whether engaging in fetal kick counting during pregnancy may reduce maternal psychopathology symptoms and thereby positively influence infant motor development and (...) parent-child engagement during the first months of life. We hypothesized that subclinical maternal psychopathology would negatively impact infant motor development, and that completing a fetal kick count activity during the third trimester would reduce overall signs of maternal psychopathology. Results only partially support these hypotheses. Postpartum maternal anxiety seems to negatively affect the emergence of infants’ fine motor skills. However, engaging in fetal kick counting during pregnancy did not reduce maternal depression or anxiety symptoms. Nevertheless, preliminary evidence suggests that engaging in fetal kick counting may impact early child development by altering the mother’s attitudes toward the child. Future research is needed to examine the value of this low-cost intervention strategy more closely. (shrink)

"Why should we care about having true beliefs? And why do demonstrably false beliefs persist and spread despite consequences for the people who hold them? Philosophers of science Cailin O’Connor and James Weatherall argue that social factors, rather than individual psychology, are what’s essential to understanding the spread and persistence of false belief. It might seem that there’s an obvious reason that true beliefs matter: false beliefs will hurt you. But if that’s right, then why is it irrelevant to (...) many people whether they believe true things or not? In an age riven by "fake news," "alternative facts," and disputes over the validity of everything from climate change to the size of inauguration crowds, the authors argue that social factors, not individual psychology, are what’s essential to understanding the persistence of false belief and that we must know how those social forces work in order to fight misinformation effectively."–Publisher’s description. (shrink)

In this paper, I examine some main threads of the identification stage of Scotus's project in the fourth chapter of De Primo, where he tries to show that a first efficient cause must have the attributes of simplicity, intellect, will, and infinity. Many philosophers are favorably disposed towards one or another argument such as Scotus's (e.g., the cosmological argument from contingency) purporting to show that there is an absolutely first efficient cause. How far can Scotus take us from this starting (...) point towards the ultimate aim of establishing the existence of a being more recognizably identifiable as God? (shrink)

In Cajetan's Biblical Commentaries, Michael O'Connor argues that Cajetan's motive was more 'Catholic Reform' than 'Counter-Reformation', and that his method was a bold hybrid of scholasticism and Renaissance humanism, correcting the Vulgate's errors and expounding the text according to the literal sense.

The shortages of baby formula in the US resulting from the voluntary recall of contaminated products and shutdown of manufacturing facility in February led to increases in the national out-of-stock rate of the baby formula from 18 to 70% over the summer of 2022. This study utilizes social media listening and data analysis to examine how online media reactions to the physical shortage changed over time and how the reaction to the shortage differed from to the initial recall announcements. Improved (...) understanding of reactions to emergent issues in foods through this lens may improve communication efficiency to mitigate potential consequences. (shrink)

ArgumentBy the mid-eighteenth century, governors of the major European states promoted the study of nature as part of natural-resource based schemes for improvement and economic self-sufficiency. Procuring beneficial knowledge about nature, however, required observers, collectors, and compilers who could produce usable and useful descriptions of nature. The ways governments promoted scientific explorations varied according to the form of government, the makeup of the civil society, the state's economic ideologies and practices, and the geographical situation. This article argues that the roots (...) of a major natural history initiative in Denmark-Norway were firmly planted in the state-church organization. Through the clergymen and their activities, a bishop, supported by the government in Copenhagen, could gather an impressive collection of natural objects, receive observations and descriptions of natural phenomena, and produce natural historical publications that described for the first time many of the species of the north. Devout naturalists were a common species in the eighteenth century, when clergymen and missionaries involved themselves in the investigation of nature in Europe and far beyond. The specific interest here is in how natural history was supported and enforced as part of clerical practice, how specimen exchange was grafted on to pre-existing institutions of gift exchange, and how this influenced the character of the knowledge produced. (shrink)

Most non-human animals live in the wild and it is probable that suffering predominates in their lives due to natural events. Humans may at some point be able to engage in paradise engineering, or the modification of nature and animal organisms themselves, to improve the well-being of wild animals. We may, in other words, make nature 'red in tooth and claw' no more. We argue that this creates a tension between environmental ethics and animal ethics which is likely insurmountable. First, (...) we argue that concern for the environment can be compatible with helping individual wild animals but should see redesigning nature as morally impermissible. Second, we argue that if we are concerned with animal well-being, we may reject that we have a duty to help wild animals even to the point of redesigning nature, but we must nevertheless concede that it is permissible to do so under certain circumstances. We show how this permissibility can be derived from three animal rights views: Tom Regan's, a novel account inspired by Thomas Pogge and a libertarian approach to animal rights. (shrink)

In her Pharmaceutical Freedom, Jessica Flanigan argues that antibiotics can be regulated consistent with her otherwise largely deregulatory view with respect to pharmaceuticals and recreational drugs. I contend in this essay that the reasons for justifying antibiotic regulation are reasons that can be offered to justify the regulation of many other drugs, both pharmaceutical and recreational. After laying out the specifics of Flanigan’s view, I suggest that it is amenable to the regulation of drugs like varenicline. Though such drugs can (...) legitimately improve the quality of a patient’s life by helping them quit smoking, they could be permissibly regulated if they expose others to impermissible risks. I then argue that recreational drugs like alcohol could be regulated using the same reasoning. In the penultimate section of this essay, I anticipate objections that one might have to my extension of arguments favoring antibiotic regulation to drugs correlated with aggression. Flanigan might find my extrapolation of her view as entirely plausible and accept that her view is relatively friendly to these regulations, or she might reconsider her antibiotic caveat if these regulations are overly paternalistic on her understanding. I conclude by briefly considering the benefits and drawbacks of adopting each view. (shrink)

In this article the author examines Fitzpatrick’s foundational critique of liberal legality and racism, a theme which remained central to his decades-long excavation of modern law’s self-identity. After considering Fitzpatrick’s ‘separation thesis’, the author then turns to consider the ways in which neoliberal legality is parasitic upon liberal legal racial formations while at the same time, obscuring the foundational place of race in contemporary capitalism by subsuming material life within its modes of value extraction.

The “scarred villain” trope, where facial differences like scars signify moral corruption, is ubiquitous in film (e.g., Batman’s The Joker). Strides by advocacy groups to undermine the trope, however, suggest cinematic representations of facial differences could be improving with time. This preregistered study characterized facial differences in film across cultures (US vs. India) and time (US: 1980-2019, India: 2000-2019). Top-grossing films by country and decade were screened for characters with facial differences. We found that the scarred villain trope has actually (...) worsened with time, although in tandem with progress in also representing non-villainous characters with facial anomalies. Country of origin did not predict the presence of facial differences in villains or heroes. “Action” and “fantasy” movies were the most likely genres to depict villains with facial differences. Finally, villains’ facial differences crossed more facial subunits and were more likely to involve lips, chin, and mandible than when present in heroes. Our findings underscore the need for critical reflection on the role of cultural practices—even when seemingly innocuous—in shaping and maintaining negative biases against already stigmatized groups. (shrink)

The defection thesis holds that members of marginalized social groups are obligated not to express views important to others in the group that are regarded by the others as substantively wrong. In this essay, I evaluate arguments that seek to vindicate the defection thesis and conclude they all fail. Then, I argue that we have reason to believe sanctioning defectors in certain ways is wrongful and that the expression of their contentious ideas is good for members of marginalized groups. We (...) are left to conclude both that members of marginalized groups have no obligation to suppress certain heterodox views and that it is likely wrong to sanction them for expressing these views even if it were wrong for them to do so. (shrink)

In this classic, exciting, and thoughtful text, Metaphysics , Peter van Inwagen examines three profound questions: What are the most general features of the world? Why is there a world? and What is the place of human beings in the world? Metaphysics introduces to readers the curious notion that is metaphysics, how it is conceived both historically and currently. The author's work can serve either as a textbook in a university course on metaphysics or as an introduction to metaphysical thinking (...) for the interested reader. This second edition, revised though not fundamentally changed, includes the basis of the first edition with a new chapter on the nature of time. (shrink)

In this new book, Alessandra Tanesini demonstrates that feminist thought has a lot to offer to the study of Wittgenstein's philosophical work, and that -at the same time-that work can inspire feminist reflection in new directions. In Wittgenstein, Tanesini offers a highly original interpretation of several themes in Wittgenstein's philosophy. She argues that when we look at his work through feminist eyes we discover that he is not primarily concerned with providing solutions to technical problems in the philosophy of mind, (...) mathematics, and language. Instead, his remarks on these topics are intended to offer insights about human finitude, the loneliness of the modern autonomous self, and our relations to other human beings. Thus, the modern conception of the individual emerges as the critical target of Wittgenstein's philosophical work, both early and late. This conception has also been one of the dominant concerns of contemporary feminist philosophy. In this book, Wittgenstein's insights are deployed to further feminist debates on issues such as identity, difference, the masculine character of the modern self. (shrink)

The Netherne Hospital in Surrey is perhaps the most prestigious site in the history of British art therapy, associated with the key figures Edward Adamson and Eric Cunningham Dax, whose pioneering work involved the setting-up of a large studio for psychiatric patients to create expressive paintings. What is little-known, however, is the work of the designated scientist for psychiatric research, Hungarian Jewish émigré Francis Reitman, who was charged with an overall scientific analysis of the artistic products of the studio. Schooled (...) in the biological psychiatric tradition of Ladislas J. Meduna in Budapest prior to his exile to the Maudsley Hospital in 1938 – and committed to treatments such as leucotomy and electro-convulsive therapy (ECT) – Reitman was an unusual candidate for research into the unconscious processes behind art and psychosis. Yet he authored two highly popular and widely reviewed books on his analyses of the abundant artistic output created by patients with schizophrenic diagnoses at the Netherne. In his Psychotic Art (1950) and Insanity, Art and Culture (1954), Reitman compared such schizophrenic images with those produced by artists under the influence of mescaline and examined the artistic output of patients having undergone leucotomy. This article draws on archival materials and Reitman’s original research publications in order to reconstruct his theory of schizophrenic art within the complex context of postwar British psychiatry, negotiating as he did between biologically reductive understandings of Freudian and Jungian psychoanalytic categories, and ultimately synthesizing concepts from both. It also analyses Reitman’s implicit theory of the therapeutic mechanism of art in the treatment of psychiatric patients. (shrink)

The last decade has seen an explosion of research on the gut microbiota—the trillions of microorganisms that colonize the human gut. It is now clear that interindividual diversity in microbiota composition plays an important role in determining susceptibility to a wide variety of diseases. However, identifying the precise changes in microbiota composition that play causal roles has remained a largely unrealized goal. Here, we propose that functional classifications of microbes based on their interactions with and effects on the host—particularly the (...) host immune system—will illuminate the role of the microbiota in shaping human physiology. We outline the benefits of “functional” classification compared to phylogenetic classifications, and review current efforts at functional classification of the microbiota. Finally, we outline a theoretical framework for classifying host-microbiota interactions. Future advances enabling broader functional classifications of the microbiota promise to revolutionize our understanding of the role of gut microbes in health and disease. Functional classifications of the human microbiota reveal previously hidden patterns and will be key to cracking the microbiota composition code. This figure shows a theoretical comparison between phylogenetic classification and functional classification of a host-associated microbial community. (shrink)

Catherine Malabou's concept of plasticity has influenced and inspired scholars from across disciplines. The contributors to _Plastic Materialities_—whose fields include political philosophy, critical legal studies, social theory, literature, and philosophy—use Malabou's innovative combination of post-structuralism and neuroscience to evaluate the political implications of her work. They address, among other things, subjectivity, science, war, the malleability of sexuality, neoliberalism and economic theory, indigenous and racial politics, and the relationship between the human and non-human. _Plastic Materialities_ also includes three essays by Malabou (...) and an interview with her, all of which bring her work into conversation with issues of sovereignty, justice, and social order for the first time. Contributors. Brenna Bhandar, Silvana Carotenuto, Jonathan Goldberg-Hiller, Jairus Victor Grove, Catherine Kellogg, Catherine Malabou, Renisa Mawani, Fred Moten, Alain Pottage, Michael J. Shapiro, Alberto Toscano. (shrink)

This article discusses the representation of law in Toni Morrison’s Beloved in the context of legal philosophy. Beloved’s contribution to the legal humanities has been described in terms of the contrast Morrison dramatizes between two visions of law: the violence of human chattel slavery embodied by the titular ghost, Beloved, and the communal act of solidarity that exorcizes her from her mother’s house. Yet this characterization neglects the associations Morrison draws in Beloved and in her metacommentary between the ghost and (...) other juridical forms, including personality and property. This article proposes an interpretation of Beloved that reads the ghost as a metaphor for the modern, metaphysicalized sense of the legal person for whom self-possession has become a prerequisite for action. Through a reading of Beloved that considers the final version of the novel against an unpublished earlier ending revealed by Morrison’s papers, I argue that Beloved challenges the reducibility of modern personhood to reflexive ownership. (shrink)