In 1976, The Hastings Center convened a conference to examine the validity of proposed parallels between Nazi and contemporary biomedical practices in moral argument. Charges that current medical and social practices and policies are analogous to or are the moral equivalent of Nazi programs are again in the air, and in this new feature of the Report, four commentators display and critique the use of this analogy.

In some cases people judge it morally acceptable to sacrifice one person’s life in order to save several other lives, while in other similar cases they make the opposite judgment. Researchers have identified two general factors that may explain this phenomenon at the stimulus level: (1) the agent’s intention (i.e. whether the harmful event is intended as a means or merely foreseen as a side-effect) and (2) whether the agent harms the victim in a manner that is relatively “direct” or (...) “personal”. Here we integrate these two classes of findings. Two experiments examine a novel personalness/directness factor that we call personal force, present when the force that directly impacts the victim is generated by the agent’s muscles (e.g., in pushing). Experiments 1a and b demonstrate the influence of personal force on moral judgment, distinguishing it from physical contact and spatial proximity. Experiments 2a and b demonstrate an interaction between personal force and intention, whereby the effect of personal force depends entirely on intention. These studies also introduce a method for controlling for people’s real-world expectations in decisions involving potentially unrealistic hypothetical dilemmas. (shrink)

Scientists seeking hard evidence of prayer's curative powers misunderstand the nature of prayer in the Western theistic traditions. Yet theistically consonant ways in which religious belief may influence health do not figure as they should in current professional practice.

Although universal schooling has been adopted as a goal by international organizations, bilateral aid agencies, national governments, and non-profit organizations, little sustained international attention has been devoted to the purposes or goals of universal education. What is universal primary and secondary education intended to accomplish? This book, which grew out of a project of the American Academy of Arts & Sciences, offers views from Asia, Africa, Europe, North America and South America on the purposes of universal education while considering diverse (...) cultures, religions, and professions. It is the first book in which renowned authors from around the world have proposed, considered, and debated goals of basic and secondary education, engaging in a constructive dialogue on one of the most pressing issues facing education today. (shrink)

Modern physicians are taught that they should not involve themselves in their patients’ religious concerns. Many worry that doing so would be intrusive, manipulative, difficult, and embarrassing. Patients, however, often want their physicians to explore questions of religion and faith with them. If these questions are broached in a sensitive and flexible way, they can be a natural and appropriate part of the physician‐patient relationship.

Neokantismes: la marque du pluriel indique d'emblee que le mot d'ordre des annees 1865 Retour a Kant! regroupe differentes ecoles. Les auteurs dont les textes inedits en francais se trouvent ici rassembles et traduits, appartiennent en effet soit a l'ecole de Marbourg (H. Cohen, P. Natorp et E. Cassirer) soit a l'ecole de Bade (W. Windelband, H. Rickert, E. Lask, J. Cohn). Le point commun du neokantisme logique des premiers et du neokantisme axiologique des seconds consiste en une volonte (...) d'asseoir le positivisme sur un fondement philosophique respectueux de l'attitude phenomenologique. Kant apparut donc a tous ces penseurs comme science rigoureuse a condition toutefois de ne considerer le sujet transcendantal que comme une fonction logique de la pensee qui elabore la forme et le contenu de la connaissance. A condition egalement de ne pas limiter l'entreprise critique a la physique, mais de l'etendre au fondement de toutes les sciences de l'esprit. (shrink)

Purpose: Explore public attitudes towards the trade-offs between justice and medical outcome inherent in organ allocation decisions.Background: The US Task Force on Organ Transplantation recommended that considerations of justice, autonomy and medical outcome be part of all organ allocation decisions. Justice in this context may be modeled as a function of three types of need, related to age, clinical urgency, and quality of life.Methods: A web-based survey was conducted in which respondents were asked to choose between two hypothetical patients who (...) differed in clinical urgency , age, pretransplant and post-transplant quality of life, and life expectancy.Results: A pool of 1600 people were notified via email about the survey; 623 responded. Respondents preferred giving organs to younger people up to an age difference of <15.4 years and more clinically urgent people up to a difference in urgency of <2.54 months . Priority varied with the quality of life of the worst-off patient and the relative status of the patients. If both had worse than average quality of life, respondents preferred the better-off patient. When both had better than average quality of life, they preferred the worse-off patient. In analysis according to age versus clinical urgency, the older the patient, the more urgency needed to receive priority. In quality of life versus clinical urgency, the better the control’s quality of life, the more urgency the competing patient required. The worse the patient’s post-transplant outcome, the more urgency needed to receive priority.Conclusions: It appears that clinical urgency is only one of many factors influencing attitudes about allocation decisions and that respondents may invoke different principles of fairness depending the relative clinical status of patients. (shrink)

Purpose: Explore public attitudes towards the trade-offs between justice and medical outcome inherent in organ allocation decisions.Background: The US Task Force on Organ Transplantation recommended that considerations of justice, autonomy and medical outcome be part of all organ allocation decisions. Justice in this context may be modeled as a function of three types of need, related to age, clinical urgency, and quality of life.Methods: A web-based survey was conducted in which respondents were asked to choose between two hypothetical patients who (...) differed in clinical urgency , age, pretransplant and post-transplant quality of life, and life expectancy.Results: A pool of 1600 people were notified via email about the survey; 623 responded. Respondents preferred giving organs to younger people up to an age difference of <15.4 years and more clinically urgent people up to a difference in urgency of <2.54 months . Priority varied with the quality of life of the worst-off patient and the relative status of the patients. If both had worse than average quality of life, respondents preferred the better-off patient. When both had better than average quality of life, they preferred the worse-off patient. In analysis according to age versus clinical urgency, the older the patient, the more urgency needed to receive priority. In quality of life versus clinical urgency, the better the control’s quality of life, the more urgency the competing patient required. The worse the patient’s post-transplant outcome, the more urgency needed to receive priority.Conclusions: It appears that clinical urgency is only one of many factors influencing attitudes about allocation decisions and that respondents may invoke different principles of fairness depending the relative clinical status of patients. (shrink)

When ethics committees are consulted about patients who have or need court-appointed guardians, they lack empirical evidence about several common issues, including the relationship between guardianship and prolonged, potentially medically unnecessary hospitalizations for patients. To provide information about this issue, we conducted quantitative and qualitative analyses using a retrospective cohort from Veterans Healthcare Administration. To examine the relationship between guardianship appointment and hospital length of stay, we first compared 116 persons hospitalized prior to guardianship appointment to a comparison group (n (...) = 348) 3:1 matched for age, diagnosis, date of admission, and comorbidity. We then compared 91 persons hospitalized in the year following guardianship appointment to a second matched comparison group (n = 273). Mean length of stay was 30.75 days (SD = 46.70) amongst those admitted prior to guardianship, which was higher than the comparison group (M = 7.74, SD = 9.71, F = 20.75, p. (shrink)

This paper is intended to stimulate debate amongst stakeholders in the international research community on the topic of returning individual genetic research results to study participants. Pharmacogenetics and disease genetics studies are becoming increasingly prevalent, leading to a growing body of information on genetic associations for drug responsiveness and disease susceptibility with the potential to improve health care. Much of these data are presently characterized as exploratory (non‐validated or hypothesis‐generating). There is, however, a trend for research participants to be permitted (...) access to their personal data if they so choose. Researchers, sponsors, patient advocacy groups, ethics committees and regulatory authorities are consequently confronting the issue of whether, and how, study participants might receive their individual results. Noted international ethico‐legal guidelines and public policy positions in Europe and the United States are reviewed for background. The authors offer ‘Points‐to‐Consider’ regarding returning research results in the context of drug development trials based on their knowledge and experience. These considerations include: the clinical relevance of data, laboratory qualifications, informed consent procedures, confidentiality of medical information and the competency of persons providing results to participants. The discussion is framed as a benefit‐to‐risk assessment to balance the potential positive versus negative consequences to participants, while maintaining the integrity and feasibility of conducting genetic research studies. (shrink)

ABSTRACT This paper is intended to stimulate debate amongst stakeholders in the international research community on the topic of returning individual genetic research results to study participants. Pharmacogenetics and disease genetics studies are becoming increasingly prevalent, leading to a growing body of information on genetic associations for drug responsiveness and disease susceptibility with the potential to improve health care. Much of these data are presently characterized as exploratory (non‐validated or hypothesis‐generating). There is, however, a trend for research participants to be (...) permitted access to their personal data if they so choose. Researchers, sponsors, patient advocacy groups, ethics committees and regulatory authorities are consequently confronting the issue of whether, and how, study participants might receive their individual results. Noted international ethico‐legal guidelines and public policy positions in Europe and the United States are reviewed for background. The authors offer ‘Points‐to‐Consider’ regarding returning research results in the context of drug development trials based on their knowledge and experience. These considerations include: the clinical relevance of data, laboratory qualifications, informed consent procedures, confidentiality of medical information and the competency of persons providing results to participants. The discussion is framed as a benefit‐to‐risk assessment to balance the potential positive versus negative consequences to participants, while maintaining the integrity and feasibility of conducting genetic research studies. (shrink)

BackgroundAlthough the number of reporting guidelines has grown rapidly, few have gone through an updating process. The STARD statement (Standards for Reporting Diagnostic Accuracy), published in 2003 to help improve the transparency and completeness of reporting of diagnostic accuracy studies, was recently updated in a systematic way. Here, we describe the steps taken and a justification for the changes made.ResultsA 4-member Project Team coordinated the updating process; a 14-member Steering Committee was regularly solicited by the Project Team when making critical (...) decisions. First, a review of the literature was performed to identify topics and items potentially relevant to the STARD updating process. After this, the 85 members of the STARD Group were invited to participate in two online surveys to identify items that needed to be modified, removed from, or added to the STARD checklist. Based on the results of the literature review process, 33 items were presented to the STARD Group in the online survey: 25 original items and 8 new items; 73 STARD Group members (86 %) completed the first survey, and 79 STARD Group members (93 %) completed the second survey.Then, an in-person consensus meeting was organized among the members of the Project Team and Steering Committee to develop a consensual draft version of STARD 2015. This version was piloted in three rounds among a total of 32 expert and non-expert users. Piloting mostly led to rewording of items. After this, the update was finalized. The updated STARD 2015 list now consists of 30 items. Compared to the previous version of STARD, three original items were each converted into two new items, four original items were incorporated into other items, and seven new items were added.ConclusionsAfter a systematic updating process, STARD 2015 provides an updated list of 30 essential items for reporting diagnostic accuracy studies. (shrink)

European animal disease policy seems to find its justification in a “harm to other” principle. Limiting the freedom of animal keepers—e.g., by culling their animals—is justified by the aim to prevent harm, i.e., the spreading of the disease. The picture, however, is more complicated. Both during the control of outbreaks and in the prevention of notifiable, animal diseases the government is confronted with conflicting claims of stakeholders who anticipate running a risk to be harmed by each other, and who ask (...) for government intervention. In this paper, we first argue that in a policy that aims to prevent animal diseases, the focus shifts from limiting “harm” to weighing conflicting claims with respect to “risks of harm.” Therefore, we claim that the harm principle is no longer a sufficient justification for governmental intervention in animal disease prevention. A policy that has to deal with and distribute conflicting risks of harm needs additional value assumptions that guide this process of assessment and distribution. We show that currently, policies are based on assumptions that are mainly economic considerations. In order to show the limitations of these considerations, we use the interests and position of keepers of backyard animals as an example. Based on the problems they faced during and after the recent outbreaks, we defend the thesis that in order to develop a sustainable animal disease policy other than economic assumptions need to be taken into account. (shrink)

Book reviewed in this article: Deciding for Others: The Ethics of Surrogate Decision Making. By Allen E. Buchanan and Dan W. Brock Abating Treatment with Critically Ill Patients. By Robert F. Weir.

“de-extinction” refers to the process of resurrecting extinct species by genetic methods. This science-fiction-sounding idea is in fact already in early processes of scientific implementation. Although this recent “revival of the dead” raises deep ethical questions, the ethics of de-extinction has barely received philosophical treatment. Rather than seeking a verdict for or against de-extinction, this paper attempts an overview and some novel analyses of the main ethical considerations. Five dimensions of the ethics of de-extinction are explored: (a) the possible contribution (...) of de-extinction to promoting ecological values, (b) the deontological argument that we owe de-extinction to species we rendered extinct, (c) the question of “playing God” through de-extinction, (d) the utilitarian perspective, and (e) the role of aesthetic considerations in the ethics of de-extinction. A general feature arising from the paper’s discussion is that, due to de-extinction’s special character, it repeatedly tests the limits of our ethical notions. (shrink)

The New Evil Demon problem has been hotly debated since the case was introduced in the early 1980’s (e.g. Lehrer and Cohen 1983; Cohen 1984), and there seems to be recent increased interest in the topic. In a forthcoming collection of papers on the New Evil Demon problem (Dutant and Dorsch, forthcoming), at least two of the papers, both by prominent epistemologists, attempt to resist the problem by appealing to the distinction between justification and excuses. My primary aim (...) here is to critically evaluate this new excuse maneuver as a response to the New Evil Demon problem. -/- Their response attempts to give us reason to reject the idea that victims of the New Evil Demon have justification for believing as they do. I shall argue that this approach is ultimately unsuccessful, however much of value can be learned from these attempts. In particular, progress in the debate can be made by following those who advance the excuse maneuver and make explicit the connection between epistemic justification and epistemic norms. By doing so, the questions being debated are clarified, as is the methodology being used to attempt to answer them. (shrink)

Representations of the fingers are embodied in our cognition and influence performance in enumeration tasks. Among deaf signers, the fingers also serve as a tool for communication in sign language. Previous studies in normal hearing (NH) participants showed effects of embodiment (i.e., embodied numerosity) on tactile enumeration using the fingers of one hand. In this research, we examined the influence of extensive visuo‐manual use on tactile enumeration among the deaf. We carried out four enumeration task experiments, using 1–5 stimuli, on (...) a profoundly deaf group (n = 16) and a matching NH group (n = 15): (a) tactile enumeration using one hand, (b) tactile enumeration using two hands, (c) visual enumeration of finger signs, and (d) visual enumeration of dots. In the tactile tasks, we found salient embodied effects in the deaf group compared to the NH group. In the visual enumeration of finger signs task, we controlled the meanings of the stimuli presentation type (e.g., finger‐counting habit, fingerspelled letters, both or neither). Interestingly, when comparing fingerspelled letters to neutrals (i.e., not letters or numerical finger‐counting signs), an inhibition pattern was observed among the deaf. The findings uncover the influence of rich visuo‐manual experiences and language on embodied representations. In addition, we propose that these influences can partially account for the lag in mathematical competencies in the deaf compared to NH peers. Lastly, we further discuss how our findings support a contemporary model for mental numerical representations and finger‐counting habits. (shrink)

Many feminists (e.g. T. Bettcher and B. R. George) argue for a principle of first person authority (FPA) about gender, i.e. that we should (at least) not disavow people's gender self-categorisations. However, there is a feminist tradition resistant to FPA about gender, which I call "radical feminism”. Feminists in this tradition define gender-categories via biological sex, thus denying non-binary and trans self-identifications. Using a taxonomy by B. R. George, I begin to demystify the concept of gender. We are also able (...) to use the taxonomy to model various feminist approaches. It becomes easier to see how conceptualisations ofgender which allow for FPA often do not allow for understanding female subjugation as being rooted in reproductive biology. I put forward a conceptual scheme: radical FPA feminism. If we accept FPA, but also radical feminist concerns, radical FPA feminism is an attractive way of conceptualising gender. (shrink)

Most solutions to the sorites reject its major premise, i.e. the quantified conditional . This rejection appears to imply a discrimination between two elements that are supposed to be indiscriminable. Thus, the puzzle of the sorites involves in a fundamental way the notion of indiscriminability. This paper analyzes this relation and formalizes it, in a way that makes the rejection of the major premise more palatable. The intuitive idea is that we consider two elements indiscriminable by default, i.e. unless we (...) know some information that discriminates between them. Specifically, following Rough Set Theory, two elements are defined to be indiscernible if they agree on the vague property in question. Then, a is defined to be indiscriminable from b if a is indiscernible by default from b . That is to say, a is indiscriminable from b if it is consistent to assume that a and b agree on the relevant vague property. (shrink)

A is for Alice and astronomers arguing about acceleration -- B is for Bernard's body-exchange machine -- C is for the Catholic cannibal -- D is for Maxwell's demon -- E is for evolution (and an embarrassing problem with it) -- F is for the forms lost forever to the prisoners of the cave -- G is for Galileo's gravitational balls -- H is for Hume's shades -- I is for the identity of indiscernibles -- J is for Henri Poincaré (...) and alternative geometries -- K is for the Kritik and Kant's kind of thought experiments -- L is for Lucretius' spear -- M is for Mach's motionless chain -- N is for Newton's bucket -- O is for Olbers' paradox -- P is for Parfit's person -- Q is for the questions raised by thought experiments quotidiennes -- R is for the rule-ruled room -- S is for Salvatius' ship, sailing along its own space-time line -- T is for the time-travelling twins -- U is for the universe, and Einstein's attempts to understand it -- V is for the vexed case of the violinist -- W is for Wittgenstein's beetle -- X is for xenophanes and thinking by examples -- Y is for counterfactuals and a backwards approach to history -- Z is for Zeno and the mysteries of infinity. (shrink)

No two individuals with the autism diagnosis are ever the same—yet many practitioners and parents can recognize signs of ASD very rapidly with the naked eye. What, then, is this phenotype of autism that shows itself across such distinct clinical presentations and heterogeneous developments? The “signs” seem notoriously slippery and resistant to the behavioral threshold categories that make up current assessment tools. Part of the problem is that cognitive and behavioral “abilities” typically are theorized as high-level disembodied and modular functions—that (...) are assessed discretely (impaired, normal, enhanced) to define a spectral syndrome. Even as biology reminds us that organic developing bodies are not made up of independent switches, we remain often seduced by the simplicity of mechanistic and cognitive models. Developmental disorders such as autism have accordingly been theorized as due to different modular dysfunctions—typically of cortical origin, i.e., failures of “theory of mind” (Baron-Cohen et al., 1985), of the “mirror neuron system” (Ramachandran and Oberman, 2006), of “weak central coherence” (Happe and Frith, 2006) or of the balance of “empathizing” and “systemizing” (Baron-Cohen, 2009), just to list a few. -/- The broad array of autonomic (Ming et al., 2005; Cheshire, 2012) and sensorimotor (Damasio and Maurer, 1978; Maurer and Damasio, 1982; Donnellan and Leary, 1995; Leary and Hill, 1996; Donnellan and Leary, 2012; Donnellan et al., 2012) differences experienced and reported by people with autism have by such theories typically been sidelined as “co-morbidities,” possibly sharing genetic causes, but rendered as incidental and decisively behaviorally irrelevant symptoms—surely disconnected from cognition. But what if the development of cortically based mental processes and autonomous control relies on the complexities and proper function of the peripheral nervous systems? Through such an “embodied” lens the heterogeneous symptoms of autism invites new interpretations. We propose here that many behavioral-level findings can be re-defined as downstream effects of how developing nervous systems attempt to cope and adapt to the challenges of having various noisy, unpredictable, and unreliable peripheral inputs. (shrink)

We perceive relevance by virtue of inference habits, which may be expressed as Pierce's leading principles or as Toulmin's warrants. Hence relevance in a descriptive sense is a ternary relation between two statements and a set of inference rules. For a normative sense, the warrants must be properly backed. Different types of warrant to empirical generalizations, we introduce L.J. Cohen's notion of inductive support. A to empirical generalizations, we introduce L.J. Cohen's notion of inductive support. A generalization H (...) is supported by evidence E to degree i/in iff E indicates that H passes canonical test i, where there are n canonical tests. In a canonical test, one or more relevant variables, factors which may falsify H, are varied. H passes a test if it is not falsified. The tests are cumulative. Degree of support is relative to the canonical test, and may be modeled as relative to a point in a dialectical situation. A value of a variable at which H is falsified is a rebutting value. A is normatively relevant to B with respect to W iff sup[associated generalization(W), E] = i/n and for j > i, there is a presumption that the values of j are non-rebuting. (shrink)

Even after multiple cycles of ABET accreditation, many engineering programs are unsure of how much curriculum content is needed to meet the requirements of ABET’s Criterion 3.f (an understanding of professional and ethical responsibility). This study represents the first scholarly attempt to assess the impact of curriculum reform following the introduction of ABET Criterion 3.f. This study sought to determine how much professional and ethical responsibility curriculum content was used between 1995 and 2005, as well as how, when, why, and (...) to what effect changes in the amount of content occurred. Subsequently, the study sought to evaluate if different amounts of curriculum content generated differing student outcomes. The amount of curriculum content used by each of the participating programs was identified during semi-structured interviews with program administrators and a review of ABET Self-Study documents. Quantitative methods were applied to determine if a relationship existed between the curriculum content and performance on a nationally administered, engineering-specific standardized examination. The findings indicate a statistical relationship, but a lack of structure between the amount of required content in the curriculum and performance on the examination. Additional findings were also generated regarding the way that programs interpret the Criterion 3.f feedback generated during accreditation visits. The primary impact of this study is that it dispels the myth that more courses or course time on professionalism and ethics will necessarily lead to positive engineering education outcomes. Much of the impetus to add more curriculum content results from a lack of conclusive feedback during ABET accreditation visits. (shrink)