The division of cognitive labor is fundamental to all cultures. Adults have a strong sense of how knowledge is clustered in the world around them and use that sense to access additional information, defer to relevant experts, and ground their own incomplete understandings. One prominent way of clustering knowledge is by disciplines similar to those that comprise the natural and social sciences. Seven studies explored an emerging sense of these discipline‐based ways of clustering of knowledge. Even 5‐year‐olds could cluster knowledge (...) in a manner roughly corresponding to the departments of natural and social sciences in a university, doing so without any explicit awareness of those academic disciplines. But this awareness is fragile early on and competes with other ways of clustering knowledge. Over the next few years, children come to see discipline‐based clusters as having a privileged status, one that may be linked to increasingly sophisticated assumptions about essences for natural kinds. Possible mechanisms for this developmental shift are examined. (shrink)

Epistemic theories of truth, such as those presumed to be typical for anti-realism, can be characterised as saying that what is true can be known in principle: p → ◊Kp. However, with statements of the form “p & ¬Kp”, a contradiction arises if they are both true and known. Analysis of the nature of the paradox shows that such statements refute epistemic theories of truth only if the the anti-realist motivation for epistemic theories of truth is not taken into account. (...) The motivation in a link of understandability ans meaningful- ness suggests to change the above principle and to restrict the theory to logically simple sentences, in which case the paradox does not arise. This suggestion also allows to see the deep philosophical problems for anti-realism those counterexamples are pointing at. (shrink)

Abstract“Comprehensive Healthcare for America” is a largely single-payer reform proposal that, by applying the insights of behavioral economics, may be able to rally patients and clinicians sufficiently to overcome the opposition of politicians and vested interests to providing all Americans with less complicated and less costly access to needed healthcare.

The question—what is a political constitution?—might seem, at first blush, fairly innocuous. At one level, the idea of a political constitution seems fairly well settled, at least insofar as most political constitutionalists subscribe to a similar set of commitments, arguments and assumptions. At a second, more reflective level, however, there remains some doubt whether a political constitution purports to be a descriptive or normative account of a real world constitution, such as Britain’s. By exploring the idea of a political constitution (...) as differently articulated by J.A.G. Griffith, Adam Tomkins and Richard Bellamy, this essay explores why the normativity of a political constitution may be indistinct and ill-defined, and how compelling reasons for this indistinctness and ill-definition are to be found in the very idea of a political constitution itself. A political constitution is here conceived as a ‘model’ which supplies an explanatory framework within which to make sense of our constitutional self-understandings. The discipline of thinking in terms of a model opens up a critical space wherein there need not be some stark, all-encompassing choice between constitutional models, which, in turn, allows for more subtle understandings of Britain’s constitution as neither exclusively ‘political’ nor ‘legal’. (shrink)

Psychiatric disorders present distinct clinical challenges which are partly attributable to their multifactorial aetiology and the absence of laboratory tests that can be used to confirm diagnosis or predict risk. Psychiatric disorders are highly heritable, but also polygenic, with genetic risk conferred by interactions between thousands of variants of small effect that can be summarized in a polygenic risk score. We discuss four areas in which the use of polygenic risk scores in psychiatric research and clinical contexts could have ethical (...) implications. First, there is concern that clinical use of polygenic risk scores may exacerbate existing health inequities. Second, research findings regarding polygenic risk could be misinterpreted in stigmatising or discriminatory ways. Third, there are concerns associated with testing minors as well as eugenics concerns elicited by prenatal polygenic risk testing. Fourth, potential challenges that could arise with the feedback and interpretation of high polygenic risk for a psychiatric disorder would require consideration. While there would be extensive overlap with the challenges of feeding back genetic findings in general, the potential clinical use of polygenic risk scoring warrants discussion in its own right, given the recency of this possibility. To this end, we discuss how lay interpretations of risk and genetic information could intersect. Consideration of these factors would be necessary for ensuring effective and constructive communication and interpretation of polygenic risk information which, in turn, could have implications for the uptake of any therapeutic recommendations. Recent advances in polygenic risk scoring have major implications for its clinical potential, however, care should be taken to ensure that communication of polygenic risk does not feed into problematic assumptions regarding mental disorders or support reductive interpretations. (shrink)

Peterson, Karlawish, and Largent’s “Supported Decision Making with People at the Margins of Autonomy” brings welcome attention to the rights of people with cognitive impairment and provides...

Psychiatric genetic research investigates the genetic basis of psychiatric disorders with the aim of more effectively understanding, treating, or, ultimately, preventing such disorders. Given the challenges of recruiting research participants into such studies, the potential for long‐term benefits of such research, and seemingly minimal risk, a strong claim could be made that all non‐acute psychiatric inpatients, including forensic and involuntary patients, should be included in such research, provided they have capacity to consent. There are tensions, however, regarding the ethics of (...) recruiting psychiatric inpatients into such studies. In this paper our intention is to elucidate the source of these tensions from the perspective of research ethics committee interests and decision‐making. We begin by defining inpatient status and outline some of the assumptions surrounding the structures of inpatient care. We then introduce contemporary conceptions of vulnerability, including Florencia Luna’s account of vulnerability which we use as a framework for our analysis. While psychiatric inpatients could be subject to consent‐related vulnerabilities, we suggest that a particular kind of exploitation‐related vulnerability comes to the fore in the context of our case study. Moreover, a subset of these ethical concerns takes on particular weight in the context of genetic research in low‐ and middle‐income countries. At the same time, the automatic exclusion of inpatients from research elicits justice‐related vulnerabilities. (shrink)

Since Plato’s Republic, philosophers have outlined their expectations for political leaders and have offered judgments on the actions and decisions made by political leaders in their given context. It turns out that the American philosopher, William James, participates in this philosophical tradition. Although it has been assumed by professional philosophers—and even scholars of William James’s work—that James has no political philosophy, we argue that James’s political philosophy becomes both practical and useful for making judgments about and against political leaders.

Emergency care research sometimes involves incapacitated adults as research participants. The ethical principle of respect for autonomy may not necessarily apply to an incapacitated person unable to act in an autonomous manner, although it can be argued that researchers still have a duty of respect towards such people because they have moral status despite being incapacitated. Sharing some common ground with theories of moral status based on ‘humanness’ and the ability for rational thought is the notion of human dignity, which (...) features in arguments regarding researcher conduct with incapacitated patients. However, human dignity premised upon the unique ability of humans for rational thought and moral self-regulation is contingent upon these capabilities – a limitation that possibly makes dignity a less useful framework for research conduct in emergency care research. In this article, I will discuss the different conceptions of human dignity – as equality, status and virtue – and then draw on more recent literature that explains human dignity as a social constraint and as a factor influencing the conduct of healthcare professionals and researchers. I will address questions of whether dignity as a principle ought to apply only to those who have the ability to think rationally, or to all humans regardless of their condition or mental status. I will argue that, in relation to offering protection to research participants in emergency conditions, it is immaterial which view is taken. (shrink)

A target question for the scientific study of consciousness is how dimensions of consciousness, such as the ability to feel pain and pleasure or reflect on one’s own experience, vary in different states and animal species. Considering the tight link between consciousness and moral status, answers to these questions have implications for law and ethics. Here we point out that given this link, the scientific community studying consciousness may face implicit pressure to carry out certain research programs or interpret results (...) in ways that justify current norms rather than challenge them. We show that because consciousness largely determines moral status, the use of nonhuman animals in the scientific study of consciousness introduces a direct conflict between scientific relevance and ethics—the more scientifically valuable an animal model is for studying consciousness, the more difficult it becomes to ethically justify compromises to its well-being for consciousness research. Finally, in light of these considerations, we call for a discussion of the immediate ethical corollaries of the body of knowledge that has accumulated and for a more explicit consideration of the role of ideology and ethics in the scientific study of consciousness. (shrink)

This book aims to answer two main questions about Aristotle’s theory of causality and causal explanation, especially in relation to natural science: (1) How does he answer the main philosophical questions about causes to which he thinks his predecessors’ answers are flawed? (2) How do his answers bear on the main questions we confront in thinking about causality in general? The texts that deal with causality directly are analyzed against the background of his criticisms of his predecessors and his broader (...) views about explanation, highlighting their theoretically important commitments. This allows us to reveal the conceptual architecture of his theory. The basic theory is then applied to two questions about causality, one metaphysical and one epistemological. The metaphysical question is how to account for the relation between causes and what they cause, in light of a fundamental tension between different desiderata for causal explanations. Aristotle’s answer is pluralistic: he does not think that there is one metaphysical relationship between causes and what they cause even within a given mode of causality. The epistemological question asks how we grasp causes, and grasp them in a way that yields scientific understanding. Aristotle’s answer is again a pluralist one: metaphysically different phenomena demand different cognitive resources, and some are more accessible than others. Nevertheless, there is a discernible path from simpler to more sophisticated types of cognitive grasp on causality, in such a way that Aristotle can plausibly satisfy the epistemological constraints he thinks his predecessors cannot. Aristotle thus aims to provide a non-reductionist account of causality that still leaves room for a substantive conception of understanding in natural science. (shrink)

The complexity and inefficiency of the U.S. health care system complicates the distribution of life-saving medical technologies. When the public health is at stake, however, there are alternatives. The proposal for a national PrEP program published in this issue of the Journal applies some of the lessons of the national COVID vaccine campaign to HIV prevention. In doing so, it draws on other examples of public health approaches to the financing of medical technology, from vaccines for children to hepatitis C (...) treatment. (shrink)

Many people have an aptitude for religious experience and spirituality but don't know how to develop this or take it further. Modern societies offer little assistance, and traditional religions are overly preoccupied with their own organizational survival. Minding the Self: Jungian meditations on contemporary spirituality offers suggestions for individual spiritual development in our modern and post-modern times. Here, Murray Stein argues that C.G. Jung and depth psychology provide guidance and the foundation for a new kind of modern spirituality.Murray (...) class='Hi'>Stein explores the problem of spirituality within the cultural context of modernity and offers a way forward without relapsing into traditional or mythological modes of consciousness. Chapters work towards finding the proper vessel for contemporary spirituality and dealing with the ethical issues that crop up along the way. Stein shows how it is an individual path but not an isolationist one, often using many resources borrowed from a variety of religious traditions: it is a way of symbol, dream and experiences of the numinous with hints of transcendence as these come into personal awareness. Minding the Self: Jungian meditations on contemporary spirituality uses research from a wide variety of fields, such as dream-work and the neuroscience of the sleeping brain, clinical experience in Jungian psychoanalysis, anthropology, ethics, Zen Buddhism, Jung's writings and the recently published Red Book. It will be of interest to psychoanalysts, Jungian scholars, undergraduates, graduate and post-graduate students and anyone with an interest in modern spirituality. (shrink)

In spite of accelerated economical growth disadvantaged groups might be »non-winners« of a European Single Market now determinating the structures of any future »European House«. The responsibility of diaconia is to prevent a split between those citizens who are able to of T er mobility and flexibility and rely on effective multinational pressure-groups and those who do not. With help from concerned organs of the E. C. diaconia might benefit from an enhanced exchange of experiences, define the social responsibility of (...) the churches in Europe and participate in the shaping of a common future. (shrink)

Human diploid fibroblasts have a finite proliferative lifespan in culture, at the end of which they are ararrested with G1 phase DNA contents. Upon serum stimulation, senescent cells are deficient in carrying out a subset of early signal transduction events such as activation of protein kinase C and induction of c‐fos. Later in G1, they uniformly fail to express late G1 genes whose products are required for DNA synthesis, implying that they are unable to pass the R point. Failure to (...) pass the R point may occur because senescent cells are unable to phosphorylate the retinoblastoma protein, owing to the accumulation of inactive complexes of cyclin E/Cdk2 and possibly cyclin D/Cdk4. Senescent cells contain high amounts of p21, a potent cyclin‐dependent kinase inhibitor whose levels are also elevated in cells arrested in G1 following DNA damage, suggesting that both arrests might share a common mechanism. Cell aging is accompanied by a progressive shortening of chromosomal telomeres, which could be perceived by the cells as a form of DNA damage that gives rise to the signals that inactivate the cell cycle machinery. (shrink)