It is generally agreed that physicians should not provide futile interventions, for the obvious reason that an intervention without utility causes harm without benefit. However, despite efforts to standardize a definition, there is a lack of universal consensus as to what constitutes “futility.” Two recent policy statements object to the terminology of futility based on the lack of a universal definition. Schneiderman, Jecker, and Jonsen object to the proposed alternative terminology of “inappropriate.” These differing opinions about the most apt terminology (...) raise the question of whether definitions are helpful or counterproductive in addressing disputes that... (shrink)

A forty-year-old man is brought to the emergency room by his wife at five in the morning, two hours after he fell down the stairs at home, hitting his head and injuring his arm. He tells the ER physician that he got up to get a drink of water and tripped in the dark. His speech is slurred, and he smells strongly of alcohol. Lab results reveal elevated liver enzymes, and his blood alcohol level is 0.1. His medical history is (...) unremarkable. When asked about his alcohol consumption, he says he usually has one or two drinks a night with dinner but that he drinks more on holidays and special occasions. He admits he had more to drink than usual last night because it had been a stressful day at work, but he is vague about how much he drank. His wife takes the ER physician aside and describes a very different situation. She says that her husband regularly has three or four drinks a night. She always goes to bed before he does and thinks he stays up later so he can continue to drink. She says that he often has no memory of conversations they had the night before and is concerned because he makes work-related calls at night. When asked what he does for a living, she hesitates, and then answers that he is an internist. He does not work at this hospital but works at one of its affiliated clinics. The ER doctor is concerned that his patient is an impaired physician. Yet when the admitting hospitalist, to whom he explains the situation, asks if he really wants to “go there,” he shrugs his shoulders. “I suppose,” she replies, “you might as well call an ethics consult.”. (shrink)

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

Despite the salient experience of encoding threatening events, these memories are prone to distortions and often non-veridical from encoding to recall. Further, threat has been shown to preferentially disrupt the binding of event details and enhance goal-relevant information. While extensive work has characterised distinctive features of emotional memory, research has not fully explored the influence threat has on temporal memory, a process putatively supported by the binding of event details into a temporal context. Two primary competing hypotheses have been proposed; (...) that threat can impair or enhance temporal memory. We analysed two datasets to assess temporal memory for an in-person haunted house experience. In study 1, we examined the temporal structure of memory by characterising memory contiguity in free recall as a function of individual levels of heart rate as a proxy of threat. In study 2, we replicated marginal findings of threat-related increases in memory contiguity found in study 1. We extended these findings by showing threat-related increases in recency discriminations, an explicit test of temporal memory. Together, these findings demonstrate that threat enhances temporal memory regarding free recall structure and during explicit memory judgments. (shrink)

Both unipolar and bipolar depression have been linked with impairments in executive functioning. In particular, mood symptom severity is associated with differences in common EF, a latent measure of general EF abilities. The relationship between mood disorders and EF is particularly salient in adolescence and young adulthood when the ongoing development of EF intersects with a higher risk of mood disorder onset. However, it remains unclear if common EF impairments have associations with specific symptom dimensions of mood pathology such as (...) blunted positive affect, mood instability, or physiological arousal, or if differences in common EF more broadly relate to what is shared across various symptom domains, such as general negative affect or distress. To address this question, bifactor models can be applied to simultaneously examine the shared and unique contributions of particular mood symptom dimensions. However, no studies to our knowledge have examined bifactor models of mood symptoms in relation to measures of common EF. This study examined associations between common EF and general vs. specific symptom dimensions using structural equation modeling in adolescents and young adults with varying severity of mood symptoms. A General Depression factor capturing shared variance across symptoms statistically predicted lower Common EF. Additionally, a factor specific to physiological arousal was associated with lower Common EF. Anhedonia-specific and Mania-specific factors were not significantly related to Common EF. Altogether, these results indicate that deficits in common EF are driven by, or reflect, general features of mood pathology that are shared across symptom dimensions but are also specifically associated with physiological arousal. (shrink)

Quantificational determiners are often said to be devices for expressing relations. For example, the meaning of _every_ is standardly described as the inclusion relation, with a sentence like _every frog is green_ meaning roughly that the green things include the frogs. Here, we consider an older, non-relational alternative: determiners are tools for creating restricted quantifiers. On this view, determiners specify how many elements of a restricted domain (e.g., the frogs) satisfy a given condition (e.g., being green). One important difference concerns (...) how the determiner treats its two grammatical arguments. On the relational view, the arguments are on a logical par as independent terms that specify the two relata. But on the restricted view, the arguments play distinct logical roles: specifying the limited domain versus supplying an additional condition on domain entities. We present psycholinguistic evidence suggesting that the restricted view better describes what speakers know when they know the meaning of a determiner. In particular, we find that when asked to evaluate sentences of the form _every F is G_, participants mentally group the Fs but not the Gs. Moreover, participants forego representing the group defined by the intersection of F and G. This tells against the idea that speakers understand _every F is G_ as implying that the Fs bear relation (e.g., inclusion) to a second group. (shrink)

This paper describes a study conducted in collaboration with a marketing agency and a nonprofit organization providing regional sexual health services, which included advice on, and testing f...

Pure mathematics can play an indispensable role explaining empirical phenomena if recent accounts of insect evolution are correct. In particular, the prime life cycles of cicadas and the geometric structure of honeycombs are taken to undergird an inference to the best explanation about mathematical entities. Neither example supports this inference or the mathematical realism it is intended to establish. Both incorrectly assume that facts about mathematical optimality drove selection for the respective traits and explain why they exist. We show how (...) this problem can be avoided, identify limitations of explanatory indispensability arguments, and attempt to clarify the nature of mathematical explanation. (shrink)

Lloyd analyzes every proposed evolutionary explanation of female orgasm and argues that all but one suffers from serious evidential errors. Lloyd attributes these errors to two main biases: androcentrism and adaptationism. This paper begins by arguing that the explanation Lloyd favors—the by-product account—is guilty of the androcentrism which supposedly implicates the other explanations of female orgasm with numerous evidential discrepancies. This suggests that there is another error afflicting orgasm research in addition to the biases Lloyd identities. I attempt to diagnose (...) and characterize this additional error. In short, I think the error is using an imprecise definition of the trait in question. Further, Lloyd takes her analysis to support Longino’s contextual empiricist model of scientific objectivity. I consider what implications this analysis has for contextual empiricism. Finally, I argue that theorizing about female orgasm should be done from a conceptual engineering approach. (shrink)

This paper argues for two conclusions: (1) evaluating the success of engineered concepts necessarily involves empirical work; and (2) the Carnapian Explication criterion precision ought to be a methodological standard in conceptual engineering. These two conclusions provide a new analysis of the race and gender debate between Sally Haslanger and Jennifer Saul. Specifically, the argument identifies the resources Haslanger needs to respond to Saul’s main objections. Lastly, I contrast the methodology advocated here with the so-called “method of cases” and draw (...) out some general implications for how we should think about concepts. (shrink)

This paper argues for two conclusions: (1) evaluating the success of engineered concepts necessarily involves empirical work; and (2) the Carnapian Explication criterion precision ought to be a methodological standard in conceptual engineering. These two conclusions provide a new analysis of the race and gender debate between Sally Haslanger and Jennifer Saul. Specifically, the argument identifies the resources Haslanger needs to respond to Saul’s main objections. Lastly, I contrast the methodology advocated here with the so-called “method of cases” and draw (...) out some general implications for how we should think about concepts. (shrink)

The niche is allegedly the conceptual bedrock underpinning the most prominent, and some would say most important, theorizing in ecology. We argue this point of view is more aspirational than veridical. Rather than critically dissect existing definitions of the concept, the supposedly significant work it is thought to have done in ecology is our evaluative target. There is no denying the impressive mathematical sophistication and theoretical ingenuity of the ecological modeling that invokes ‘niche’ terminology. But despite the pervasive labeling, we (...) demonstrate that niche talk is nothing more than a gloss on theory developed without it, that doesn’t need it, and that doesn’t benefit from it. (shrink)

This article surveys recent feminist contributions to moral philosophy with an emphasis on those works which engage with debates within mainstream ethics. The article begins by examining a tension said to arise from the two criteria a theory must meet if it is to count as feminist moral theory: the women's experience requirement and the feminist conclusion requirement. Subsequent sections deal with feminist relational theories of rights, feminist work on responsibility and feminist contractarian approaches to ethics. A final section looks (...) at the application of some feminist moral theories to the problem of abortion. (shrink)

The concept of medical necessity is often used to explain or justify certain decisions—for example, which treatments should be allowed under certain conditions—as though it had an obvious, agreed-upon meaning as well as an inherent normative force. In introducing this special issue of Clinical Ethics on medical necessity, we argue that the term, as used in various discourses, generally lacks a definition that is clear, non-circular, conceptually plausible, and fit for purpose. We propose that future work on this concept should (...) address three main questions: what medical necessity is (i.e., what makes something medically necessary, as opposed to something else); what the concept does (what ‘work’ is it doing when invoked in different settings); and what should follow, normatively, from the fact that something is indeed medically necessary (on some plausible conception). (shrink)

In _Biocultural Creatures_, Samantha Frost brings feminist and political theory together with findings in the life sciences to recuperate the category of the human for politics. Challenging the idea of human exceptionalism as well as other theories of subjectivity that rest on a distinction between biology and culture, Frost proposes that humans are biocultural creatures who quite literally are cultured within the material, social, and symbolic worlds they inhabit. Through discussions about carbon, the functions of cell membranes, the activity (...) of genes and proteins, the work of oxygen, and the passage of time, Frost recasts questions about the nature of matter, identity, and embodiment. In doing so, she elucidates the imbrication of the biological and cultural within the corporeal self. In remapping the relation of humans to their habitats and arriving at the idea that humans are biocultural creatures, Frost provides new theoretical resources for responding to political and environmental crises and for thinking about how to transform the ways we live. (shrink)

Foucault contra Habermas is an incisive examination of, and a comprehensive introduction to, the debate between Foucault and Habermas over the meaning of enlightenment and modernity. It reprises the key issues in the argument between critical theory and genealogy and is organised around three complementary themes: defining the context of the debate; examining the theoretical and conceptual tools used; and discussing the implications for politics and criticism. In a detailed reply to Habermas' Philosophical Discourse of Modernity, this volume explains the (...) difference between Habermas' philosophical practice and Foucault's between the analytics of truth and the politics of truth. Many of the most difficult arguments in the exchange are subject to a detailed critical analysis. This examination also includes discussion of the ethics of dialogue; the practice of criticism; the politics of recognition, and the function of civil society and democracy. (shrink)

Paternalism is widely viewed as presumptively justifiable for children but morally problematic for adults. The standard explanation for this distinction is that children lack capacities relevant to the justifiability of paternalism. I argue that this explanation is more difficult to defend than typically assumed. If paternalism is often justified when needed to keep children safe from the negative consequences of their poor choices, then when adults make choices leading to the same negative consequences, what makes paternalism less justified? It seems (...) true that ordinary adults have capacities enabling them to promote their interests in ways most children lack. This can explain why paternalism is more often justified towards children than adults. What is not explained, however, is why paternalism would be justifiable for children, but not adults, when neither possess the relevant interest-promoting capacities—exactly the cases when paternalism towards adults might be considered. I argue that this dilemma undercuts capacities-based explanations for the belief that childhood is distinctively relevant for the permissibility of paternalism. I then address defenses of both consequentialist and deontological versions of the capacities-based explanation. Absent this capacities-based explanation, I argue that the intuition that less demanding justificatory standards apply to paternalism when directed at children than when directed towards adults presents unresolved problems for egalitarians. (shrink)

Background The review of human participant research by Research Ethics Committees or Institutional Review Boards is a complex multi-faceted process that cannot be reduced to an algorithm. However, this does not give RECs/ IRBs permission to be inconsistent in their specific requirements to researchers or in their final opinions. In England the Health Research Authority coordinates 67 committees, and has adopted a consistency improvement plan including a process called “Shared Ethical Debate” where multiple committees review the same project. Committee reviews (...) are compared for consistency by analysing the resulting minutes. Methods We present a description of the ShED process. We report an analysis of minutes created by research ethics committees participating in two ShED exercises, and compare them to minutes produced in a published “mystery shopper” exercise. We propose a consistency score by defining top themes for each exercise, and calculating the ratio between top themes and total themes identified by each committee for each ShED exercise. Results Our analysis highlights qualitative differences between the ShED 19, ShED 20 and “mystery shopper” exercises. The quantitative measure of consistency showed only one committee across the three exercises with more than half its total themes as top themes. The average consistency scores for the three exercises were 0.23, 0.35 and 0.32. There is a statistically significant difference between the ShED 19 exercise, and the ShED 20 and mystery shopper exercises. Conclusions ShED exercises are effective in identifying inconsistency between ethics committees and we describe a scoring method that could be used to quantify this. However, whilst a level of inconsistency is probably inevitable in research ethics committee reviews, studies must move beyond the ShED methodology to understand why inconsistency occurs, and what an acceptable level of inconsistency might be. (shrink)

The review of human participant research by Research Ethics Committees or Institutional Review Boards is a complex multi-faceted process that cannot be reduced to an algorithm. However, this does not give RECs/ IRBs permission to be inconsistent in their specific requirements to researchers or in their final opinions. In England the Health Research Authority coordinates 67 committees, and has adopted a consistency improvement plan including a process called “Shared Ethical Debate” where multiple committees review the same project. Committee reviews are (...) compared for consistency by analysing the resulting minutes. We present a description of the ShED process. We report an analysis of minutes created by research ethics committees participating in two ShED exercises, and compare them to minutes produced in a published “mystery shopper” exercise. We propose a consistency score by defining top themes for each exercise, and calculating the ratio between top themes and total themes identified by each committee for each ShED exercise. Our analysis highlights qualitative differences between the ShED 19, ShED 20 and “mystery shopper” exercises. The quantitative measure of consistency showed only one committee across the three exercises with more than half its total themes as top themes. The average consistency scores for the three exercises were 0.23, 0.35 and 0.32. There is a statistically significant difference between the ShED 19 exercise, and the ShED 20 and mystery shopper exercises. ShED exercises are effective in identifying inconsistency between ethics committees and we describe a scoring method that could be used to quantify this. However, whilst a level of inconsistency is probably inevitable in research ethics committee reviews, studies must move beyond the ShED methodology to understand why inconsistency occurs, and what an acceptable level of inconsistency might be. (shrink)

The essays in this book clarify the technical, legal, ethical, and social aspects of the interaction between eHealth technologies and surveillance practices. The book starts out by presenting a theoretical framework on eHealth and surveillance, followed by an introduction to the various ideas on eHealth and surveillance explored in the subsequent chapters. Issues addressed in the chapters include privacy and data protection, social acceptance of eHealth, cost-effective and innovative healthcare, as well as the privacy aspects of employee wellness programs using (...) eHealth, the use of mobile health app data by insurance companies, advertising industry and law enforcement, and the ethics of Big Data use in healthcare. A closing chapter draws on the previous content to explore the notion that people are 'under observation', bringing together two hitherto unrelated streams of scholarship interested in observation: eHealth and surveillance studies. In short, the book represents a first essential step towards cross-fertilization and offers new insights into the legal, ethical and social significance of being 'under observation'. (shrink)

Abstract‘Serendipity’ is a category used to describe discoveries in science that occur at the intersection of chance and wisdom. In this paper, I argue for understanding serendipity in science as an emergent property of scientific discovery, describing an oblique relationship between the outcome of a discovery process and the intentions that drove it forward. The recognition of serendipity is correlated with an acknowledgment of the limits of expectations about potential sources of knowledge. I provide an analysis of serendipity in science (...) as a defense of this definition and its implications, drawing from theoretical and empirical research on experiences of serendipity as they occur in science and elsewhere. I focus on three interrelated features of serendipity in science. First, there are variations of serendipity. The process of serendipitous discovery can be complex. Second, a valuable outcome must be obtained before reflection upon the significance of the unexpected observation or event in respect to that outcome can take place. Therefore, serendipity is retrospectively categorized. Third, the primacy of epistemic expectations is elucidated. Finally, I place this analysis within discussions in philosophy of science regarding the impact of interpersonal competition upon the number and significance of scientific discoveries. Thus, the analysis of serendipity offered in this paper contributes to discussions about the social-epistemological aspects of scientific discovery and has normative implications for the structure of epistemically effective scientific communities. (shrink)

Thomas Hobbes is an iconic figure who serves as an easy reference for pundits commenting on the brutality of war as well as for critics of a distinctly modern individualism in which calculating and rapacious self-interest is the cause of the violence, destruction, and exploitation endemic to the contemporary world. Frost's reading of Hobbes's philosophy shows us that underlying such visions of self and politics is another iconic figure: that of the Cartesian subject. What gives the iconic Hobbes his hardcore (...) individualism and its corollary accounts of instrumentalism, conflict, and absolutism is a Cartesian rendering of the self as split into mind and body. Carefully elaborating Hobbes's materialist ontology, _Lessons from a Materialist Thinker_ challenges both our implicit Cartesian assumptions about the self and the commonplace Hobbes that so readily figures violence in our political imagination. Through his materialism, Hobbes presents an alternative modern account of self-consciousness, reason, agency, power, freedom, and responsibility. In doing so, he shows that our fundamental intersubjectivity and interdependence require that we pursue peace above all else. (shrink)

Déjà vu and involuntary autobiographical memories (IAMs) are differentiated by a number of factors including metacognition. In contrast to IAMs, déjà vu activates regions associated with self-awareness including the right dorsolateral prefrontal cortex.

‘Serendipity’ is a category used to describe discoveries in science that occur at the intersection of chance and wisdom. In this paper, I argue for understanding serendipity in science as an emergent property of scientific discovery, describing an oblique relationship between the outcome of a discovery process and the intentions that drove it forward. The recognition of serendipity is correlated with an acknowledgment of the limits of expectations about potential sources of knowledge. I provide an analysis of serendipity in science (...) as a defense of this definition and its implications, drawing from theoretical and empirical research on experiences of serendipity as they occur in science and elsewhere. I focus on three interrelated features of serendipity in science. First, there are variations of serendipity. The process of serendipitous discovery can be complex. Second, a valuable outcome must be obtained before reflection upon the significance of the unexpected observation or event in respect to that outcome can take place. Therefore, serendipity is retrospectively categorized. Third, the primacy of epistemic expectations is elucidated. Finally, I place this analysis within discussions in philosophy of science regarding the impact of interpersonal competition upon the number and significance of scientific discoveries. Thus, the analysis of serendipity offered in this paper contributes to discussions about the social-epistemological aspects of scientific discovery and has normative implications for the structure of epistemically effective scientific communities. (shrink)

This study identified and compared the attitudes of visitors toward zoo-housed little penguins, their enclosure and visitor experience that may influence the way visitors behave toward little penguins at two Australian zoos. Visitor attitudes were assessed using an anonymous questionnaire, targeting visitor beliefs, and experiences, where visitors were randomly approached at the penguin exhibit after they had finished viewing the penguins. Visitors were given two options to complete the questionnaire, on an iPad during their zoo visit or online (URL sent (...) via email) after their zoo visit. A total of 638 participants (495 at Melbourne Zoo and 143 at Taronga Zoo) completed the questionnaire, 42% were completed onsite during their zoo visit and 58% were completed online after their zoo visit. Most participants were living in Australia, non-zoo members, female, previously or currently owned a pet, aged between 26 and 35 years and had a University degree. Results showed that the attitude dimensions of visitors were consistent between the two zoos which indicates that these measures of attitudes were stable over time and location. Overall, visitors at both zoos had positive attitudes toward little penguins, penguin welfare, the enclosure, and visitor experience. However, whether these positive attitudes and positive visitor experience influenced the way visitors behaved toward the penguins remains unclear. There were some differences in visitor attitudes toward the perceived “aggressiveness” and “timidness” of little penguins, “negative penguin welfare”, “experience with the penguins”, “learning”, “visual barriers” and the way visitors rated their overall experience at the penguin enclosure. While the reasons for the differences in visitor attitudes and visitor experience between the zoos were not clear, some factors such as penguin behavior and enclosure design, may have been attributable to these differences. Also, a relationship was found between visitor attitudes and how visitors rated the welfare of penguins, the enclosure and visitor experience at the enclosure; more positive visitor attitudes were associated with higher ratings of penguin welfare, the enclosure and visitor experience. The practical implications of these results for zoos is unclear because the differences in visitor attitudes were numerically small. This requires further comparisons between zoos or enclosures that are more markedly different than the penguin enclosures in the present study and further research on how visitors assess zoo animals, enclosures and visitor experience. (shrink)

This article focuses on practical, ethical and political issues that arise in the context of cetacean conservation. Our point of departure is the controversy surrounding plans to assist J50, an ailing member of the southern resident orca population, during the summer of 2018. A brief history of cetacean captivity provides context for the current backlash against captivity. We then argue that, in many cases, interventions aimed at capture, rehabilitation and release are practically feasible and that such interventions are ethically justifiable. (...) Moreover, the political context highlights the importance of engaging a broad range of stakeholders in conservation decision making. (shrink)

A sentence like every circle is blue might be understood in terms of individuals and their properties or in terms of a relation between groups. Relatedly, theorists can specify the contents of universally quantified sentences in first-order or second-order terms. We offer new evidence that this logical first-order vs. second-order distinction corresponds to a psychologically robust individual vs. group distinction that has behavioral repercussions. Participants were shown displays of dots and asked to evaluate sentences with each, every, or all combined (...) with a predicate. We find that participants are better at estimating how many things the predicate applied to after evaluating sentences in which universal quantification is indicated with every or all, as opposed to each. We argue that every and all are understood in second-order terms that encourage group representation, while each is understood in first-order terms that encourage individual representation. Since the sentences that participants evaluate are truth-conditionally equivalent, our results also bear on questions concerning how meanings are related to truth-conditions. (shrink)