The whole of Marx's project confronts the narrow concerns of political philosophy by embedding it in social philosophy and a certain understanding of the aesthetic. From those of aesthetic production to the "poetry of the future" (as Marx writes in the Eighteenth Brumaire), from the radical modernism of bourgeois development to the very idea of association (which defined one of the main lines of tradition in the history of aesthetics), steady references to Dante, Shakespeare and Goethe, and the idea that (...) bourgeois politics is nothing but a theatrical stage: the aesthetic has a prominent place in the constellation of Marx's thought. This book offers an original and challenging study of both Marx in the aesthetic, and the aesthetic in Marx. It differs from previous discussions of Marxist aesthetic theory as it understands the works of Marx themselves as contributions to thinking the aesthetic. This is an engagement with Marx's aesthetic that takes into account Marx's broader sense of the aesthetic, as identified by Eagleton and Buck-Morss - as a question of sense perception and the body. (shrink)

A study found that women participating in mammography screening were content with the programme and the paternalistic invitations that directly encourage participation and include a pre-specified time of appointment. We argue that this merely reflects that the information presented to the invited women is seriously biased in favour of participation. Women are not informed about the major harms of screening, and the decision to attend has already been made for them by a public authority. This short-circuits informed decision-making and (...) the legislation on informed consent, and violates the autonomy of the women. Screening invitations must present both benefits and harms in a balanced fashion, and should offer, not encourage, participation. It should be stated clearly that the choice not to participate is as sensible as the choice to do so. To allow this to happen, the responsibility for the screening programmes must be separated from the responsibility for the information material. (shrink)

U ovome radu istražujem Polanyijeve glavne argumente za akademsku slobodu. Akademska i politička sloboda međusobno su blisko povezane: ako država preuzme kontrolu nad znanošću, to dovodi do kolapsa same slobode u cijelome društvu. Njegovi argumenti protiv totalitarizma oslanjaju se na njegovu anti-pozitivističku filozofiju znanosti. On definira totalitarizam kao poricanje akademske slobode koje se temelji na pragmatičkom poimanju znanosti i instrumentalističkim interpretacijama moralnih vrijednosti. Polanyijeva ideja znanosti je duhovni, idealistički opis zajednice slobodnih intelektualaca koji su strastveno posvećeni potrazi za istinom i (...) imaju autonomnu zajednicu s vlastitim pravilima i autonomnim upravljanjem. Potraga za istinom radi nje same je bitan cilj znanosti, koji se može postići jedino ako znanost ostane slobodna od političkih, ideoloških i ekonomskih utejcaja. Tvrdim da Polanyijevi uvidi mogu biti relevantni i danas, kada znanost može postati instrument profitno orijentiranih praktičnih potreba umjesto potrage za istinom samom i kada se humanistika često smatra nepotrebnom.In the present essay I investigate Polanyi’s main arguments for academic freedom. Academic and political freedom are closely related to each other: if state takes control over science, it will lead to the collapse of freedom itself in the whole society. His arguments against totalitarianism rely on his anti-positivist philosophy of science. He diagnoses totalitarianism as a denial of academic freedom which is based on a pragmatist view of science and instrumentalist interpretation of moral values. Polanyi’s idea of science is a spiritual, idealistic description of a community of free intellectuals who are passionately committed to seeking the truth and have an autonomous community with its own rules and autonomous direction. Seeking the truth for its own sake is the essential goal of science, which can be accomplished only if it remains free from political, ideological and economical influences. I will argue that Polanyi’s insights can still be relevant today, when science can become an instrument of profit-oriented practical needs instead of seeking the truth itself, and the humanities are often considered unnecessary.Dans cet essai, j’examine les principaux arguments de Polany pour la liberté académique. La liberté académique et politique sont étroitement liées : si l’Etat prend le contrôle de la science, cela conduira à l’effondrement de la liberté elle-même dans toute la société. Ses arguments contre le totalitarisme reposent sur sa philosophie anti-positiviste de la science. Il diagnostique le totalitarisme comme un refus de la liberté académique fondé sur une conception pragmatique de la science et une interprétation instrumentaliste des valeurs morales. L’idée de la science de Polany est une description spirituelle, idéaliste, d’une communauté d’intellectuels libres, passionnément dédiés à la recherche de la vérité, et qui ont une communauté avec ses propres règles et une direction autonome. La recherche de la vérité pour elle-même est l’objectif essentiel de la science, ce qui peut être accompli uniquement si elle demeure libre des influences politiques, idéologiques et économiques. J’affirme que les visions de Polany peuvent toujours être pertinentes aujourd’hui, alors que la science peut devenir un instrument des besoins pratiques orientés vers le profit au lieu de chercher la vérité elle-même, et alors que les sciences humaines sont souvent considérées comme inutiles.Im präsenten Artikel gehe ich Polanyis Hauptargumentation für akademische Freiheit auf den Grund. Die akademische und politische Freiheit sind miteinander nahe verwandt: Unterzieht der Staat die Wissenschaft seiner Kontrolle, endet dies im Kollaps der Freiheit selbst in der gesamten Gesellschaft. Polanyis Begründung gegen den Totalitarismus stützt sich auf dessen antipositivistische Philosophie der Wissenschaft. Er diagnostiziert den Totalitarismus als Versagung der akademischen Freiheit, die auf dem pragmatischen Blickpunkt der Wissenschaft als auch der instrumentalistischen Interpretation der Moralwerte basiert. Polanyis Wissenschaftsvorstellung ist eine spirituelle, idealistische Schilderung einer Gemeinschaft freier Intellektueller, die sich der Suche nach Wahrheit glutvoll gewogen zeigt und über eine autonome Community mit eigenen Regeln sowie autonomer Verwaltung verfügt. Die Erkundung der Wahrheit um ihrer selbst willen repräsentiert das essenzielle Vorhaben der Wissenschaft, welches sich allein unter Bewahrung ihrer Independenz von politischen, ideologischen bzw. wirtschaftlichen Einflüssen zuwege bringen lässt. Ich halte dafür, Polanyis Einblicke hätten auch heutzutage Relevanzpotenzial, zu der Zeit, wenn sich die Wissenschaft auf ein Werkzeug des profitorientierten praktischen Begehrens reduzieren könnte, anstatt nach der Wahrheit selbst zu fahnden, und die Geisteswissenschaften gehäuft als entbehrlich abgestempelt werden. (shrink)

Internalist approaches to epistemic justification are, though controversial, considered a live option in contemporary epistemology. Accordingly, if ‘active’ externalist approaches in the philosophy of mind—e.g. the extended cognition and extended mind theses—are _in principle_ incompatible with internalist approaches to justification in epistemology, then this will be an epistemological strike against, at least the _prima facie_ appeal of, active externalism. It is shown here however that, contrary to pretheoretical intuitions, neither the extended cognition _nor_ the extended mind theses are in (...) principle incompatible with two prominent versions of epistemic internalism—viz., accessibilism and mentalism. In fact, one possible diagnosis is that pretheoretical intuitions regarding the incompatibility of active externalism with epistemic internalism are symptomatic of a tacit yet incorrect identification of epistemic internalism with epistemic individualism. Thus, active externalism is not in principle incompatible with epistemic internalism per se and does not significantly restrict one’s options in epistemology. (shrink)

Legal scholarship exploring the nature of evidence and the process of juridical proof has had a complex relationship with formal modeling. As evident in so many fields of knowledge, algorithmic approaches to evidence have the theoretical potential to increase the accuracy of fact finding, a tremendously important goal of the legal system. The hope that knowledge could be formalized within the evidentiary realm generated a spate of articles attempting to put probability theory to this purpose. This literature was both (...) insightful and frustrating. Much light was shed on the legal system, but it also quickly became evident that the tools of probability theory were in many ways ill-constructed for the task. Fundamental incompatibilities between the structure of legal decision making and the extant formal tools were identified, and it became evident that many of the purported explanations of legal phenomena were internally inconsistent. As a consequence, interest in this type of formal modeling declined, and attention was directed toward different kinds of explanations of the phenomena. Perhaps under the influence of a recent trend toward various types of formal modeling in legal scholarship, a recent burst of articles, rather than attempting to explain the macro structure of trials, which was the previous object of interest, attempts to quantify the probative value of various items of evidence in ways consistent with the formal features of various probability theories, and then to study decision making from that perspective. For example, the value of evidence is often purported to be its likelihood ratio, that is, the probability of discovering or receiving the evidence given a hypothesis (e.g., the defendant did it) divided by the probability of discovering or receiving the evidence given the negation of the hypothesis (the defendant didn't do it). Alternatively, the value of evidence is purported (more contextually) to be the information gain it provides, defined as the increase in probability it provides for a hypothesis above the probability of the hypothesis based on the other available evidence. Both conceptions then assume that all of the various probability assessments conform or ought to conform to the dictates of Bayes' theorem (that maintains consistency among such assessments); empirical studies are then done testing the extent to which this is so and proposing how the law can increase the probability that it is so. The general criticisms of using Bayes' theorem as a formal model of juridical proof are well known and were integral to the last wave of interest in formal modeling of the evidentiary process. This paper thus for the most part puts aside that more general issue, and focuses specifically on mathematical modeling of the value of particular items of evidence. The paper demonstrates that formal modeling has only limited value in explaining the value of legal evidence, much more limited than those constructing and discussing the models assume, and thus that the conclusions they draw about the value of evidence are unwarranted. This is done through a discussion of four recent examples that attempt to quantify evidence relating to, respectively, carpet fibers, infidelity, DNA random-match evidence, and character evidence used to impeach a witness. This article thus makes two contributions. First, and most importantly, it is another demonstration of the complex relationship between algorithmic tools and legal decision making. Second, at a minimum it points out serious pitfalls for analytical or empirical studies of juridical proof. (shrink)

This book explores the tradition, impact, and contemporary relevance of two key ideas from Western Marxism: Georg Lukács's concept of reification, in which social aspects of humanity are viewed in objectified terms, and Guy Debord's concept of the spectacle, where the world is packaged and presented to consumers in uniquely mediated ways. Bringing the original, yet now often forgotten, theoretical contexts for these terms back to the fore, Johan Hartle and Samir Gandesha offer a new look at the (...) importance of Western Marxism from its early days to the present moment-and reveal why Marxist cultural critique must continue to play a vital role in any serious sociological analysis of contemporary society. (shrink)

One of the more draining aspects of being a clinical ethicist is dealing with the emotions of patients, family members, as well as healthcare providers. Generally, by the time a clinical ethicist is called into a case, stress levels are running high, patience is low, and interpersonal communication is strained. Management of this emotional burden of clinical ethics is an underexamined aspect of the profession and academic literature. The emotional nature of doing clinical ethics consultation may be better addressed (...) by utilizing concepts and tools from clinical psychology. Management of countertransference, the natural emotional reaction by the therapist toward the patient, is a widely discussed topic in the psychotherapeutic literature. This concept can be adapted to the clinical ethics encounter by broadening it beyond the patient-therapist relationship to refer to the ethics consultant's emotional response toward the patient, the family, or other members the healthcare team. Further, it may aid the consultant because a recognition of the source and nature of these reactions can help maintain ‘critical distance’ and minimize bias in the same way that a psychologist maintains neutrality in psychotherapy. This paper will offer suggestions on how to manage these emotional responses and their burden in the clinical ethics encounter, drawing upon techniques and strategies recommended in the psychotherapeutic literature. Using these techniques may improve consultation outcomes and reduce the emotional burden on the clinical ethicist. (shrink)

Philosophy of mind and cognitive science (e.g., Clark and Chalmers 1998; Clark 2010; Palermos 2014) have recently become increasingly receptive tothe hypothesis of extended cognition, according to which external artifacts such as our laptops and smartphones can—under appropriate circumstances—feature as material realisers of a person’s cognitive processes. We argue that, to the extent that the hypothesis of extended cognition is correct, our legal and ethical theorising and practice must be updated, by broadening our conception of personal assault so as to (...) include intentional harm towards gadgets that have been appropriately integrated. We next situate the theoretical case for extended personal assault within the context of some recent ethical and legal cases and close with some critical discussion. (shrink)

The relationship between dementia and criminal behavior perplexes legal and health care systems. Dementia is a progressive clinical syndrome defined by impairment in at least two cognitive domains that interferes with one's activities of daily. Dementia symptoms have been associated with behaviors that violate social norms and constitute criminal actions. A failure to address a gap in policies that support appropriate management of individuals with dementia reflects a failure in our social obligation to care for those who (...) are most vulnerable amongst us. Categorical protections, informed by precedent models applied to juveniles and individuals with psychiatric illness, could help meet a social obligation to provide protections to individuals with dementia. We propose an approach that integrates affirmative defenses to mitigate criminal liability and sentencing restrictions to prevent cruel and unusual punishment. (shrink)

This volume is dedicated to Mario Bunge in honor of his sixtieth birthday. Mario Bunge is a philosopher of great repute, whose enormous output includes dozens of books in several languages, which will culminate with his Treatise on Basic Philosophy projected in seven volumes, four of which have already appeared [Reidel, I 974ff. ]. He is known for his works on research methods, the foundations of physics, biology, the social sciences, the diverse applications of mathematical methods and of systems (...) analysis, and more. Bunge stands for exact philosophy, classical liberal social philosophy, rationalism and enlightenment. He is brave, even relentless, in his attacks on subjectivism, mentalism, and spiritualism, as well as on positivism, mechanism, and dialectics. He believes in logic and clarity, in science and open-mindedness - not as the philosopher's equivalent to the poli tician's rhetoric of motherhood and apple pie, but as a matter of everyday practice, as qualities to cultivate daily in our pursuit of the life worth living. Bunge's philosophy often has the quality of Columbus's egg, and he is prone to come to swift and decisive conclusions on the basis of argu ments which seem to him valid; he will not be perturbed by the fact that most of the advanced thinkers in the field hold different views. (shrink)

Philosophy of mind and cognitive science have recently become increasingly receptive to the hypothesis of extended cognition, according to which external artifacts such as our laptops and smartphones can—under appropriate circumstances—feature as material realizers of a person's cognitive processes. We argue that, to the extent that the hypothesis of extended cognition is correct, our legal and ethical theorizing and practice must be updated by broadening our conception of personal assault so as to include intentional harm toward gadgets that have been (...) appropriately integrated. We next situate the theoretical case for extended personal assault within the context of some recent ethical and legal cases and close with critical discussion. (shrink)

Let be a class of models with a notion of ‘strong’ submodel and of canonically prime model over an increasing chain. We show under appropriate set-theoretic hypotheses that if K is not smooth , then K has many models in certain cardinalities. On the other hand, if K is smooth, we show that in reasonable cardinalities K has a unique homogeneous-universal model. In this situation we introduce the notion of type and prove the equivalence of saturated with homogeneous-universal.

Volunteering, or taking part in unpaid work for the benefit of others, can be a powerful positive experience with returns to both individual well-being and community projects. Volunteering is positively associated with mental health in observational studies with community samples but has not been systematically examined as a potential part of treatment interventions with clinical adolescent samples. In this manuscript, we review the empirical evidence base connecting volunteerism to mental health and well-being, outline potential mechanisms based (...) in the theoretical literature from developmental science, and discuss the existing clinical approaches that support community volunteering as a part of treatment. Drawing on this review, we propose that including volunteering as a component of clinical treatment approaches for adolescent depression can be a powerful intervention for adolescents. (shrink)

: The Centers for Disease Control and Prevention (CDC) has recommended that HIV testing be routinely offered to certain patients in hospitals with a high prevalence of HIV infection and on all pregnant women. The CDC does not, however, offer implementation level guidelines for obtaining informed consent. We provide a moral justification for requiring informed consent for HIV testing and propose guidelines for securing such consent. In particular we argue that genuine informed consent can be secured without elaborate counseling, (...) such as that currently used at Counseling and Testing Sites, provided that sufficient written notice is given to the patients before testing and that they are specifically asked for permission. (shrink)

In a reflective and richly entertaining piece from 1979, Doug Hofstadter playfully imagined a conversation between ‘Achilles’ and an anthill (the eponymous ‘Aunt Hillary’), in which he famously explored many ideas and themes related to cognition and consciousness. For Hofstadter, the anthill is able to carry on a conversation because the ants that compose it play roughly the same role that neurons play in human languaging; unfortunately, Hofstadter’s work is notably short on detail suggesting how this magic might be achieved1. (...) Conversely in this paper - finally reifying Hofstadter’s imagination - we demonstrate how populations of simple ant-like creatures can be organised to solve complex problems; problems that involve the use of forward planning and strategy. Specifically we will demonstrate that populations of such creatures can be configured to play a strategically strong - though tactically weak - game of HeX (a complex strategic game).We subsequently demonstrate how tactical play can be improved by introducing a form of forward planning instantiated via multiple populations of agents; a technique that can be compared to the dynamics of interacting populations of social insects via the concept of meta-population. In this way although, pace Hofstadter, we do not establish that a meta-population of ants could actually hold a conversation with Achilles, we do successfully introduce Aunt Hillary to the complex, seductive charms of HeX. (shrink)

Two arguments against the compatibility of epistemic internalism and content externalism are considered. Both arguments are shown to fail, because they equivocate on the concept of justification involved in their premises. To spell out the involved equivocation, a distinction between subjective and objective justification is introduced, which can also be independently motivated on the basis of a wide range of thought experiments to be found in the mainstream literature on epistemology. The subjective/objective justification distinction is also ideally suited for providing (...) new insights with respect to central issues within epistemology, including the internalism/externalism debate and the New Evil Demon intuition. (shrink)

Four-month-old infants sometimes can perceive the unity of a partly hidden object. In each of a series of experiments, infants were habituated to one object whose top and bottom were visible but whose center was occluded by a nearer object. They were then tested with a fully visible continuous object and with two fully visible object pieces with a gap where the occluder had been. Pattems of dishabituation suggested that infants perceive the boundaries of a partly hidden (...) object by analyzing the movements of its surfaces: infants perceived a connected object when its ends moved in a common translation behind the occluder. Infants do not appear to perceive a connected object by analyzing the colors and forms of surfaces: they did not perceive a connected object when its visible parts were stationary, its color was homogeneous, its edges were aligned, and its shape was simple and regular. These findings do not support the thesis, from gestalt psychology, that object perception first arises as a consequence of a tendency to perceive the simplest, most regular configuration, or the Piagetian thesis that object perception depends on the prior coordination of action. Perception of objects may depend on an inherent conception of what an object is. (shrink)

Given the widening gap between the number of individuals on transplant waiting lists and the availability of donated organs, as well as the recent plateau in donations based on neurological criteria, there has been a growing interest in expanding donation after circulatory determination of death. While the prevalence of this form of organ donation continues to increase, many thorny ethical issues remain, often creating moral distress in both clinicians and families. In this article, we address one of these issues, namely, (...) the challenges surrounding patient and surrogate informed consent for donation after circulatory determination of death. First we discuss several general concerns regarding consent related to this form of organ donation, and then we address additional issues that are unique to three different patient categories: adult patients with medical decision-making capacity or potential capacity, adult patients who lack capacity, and pediatric patients. (shrink)

Nurse practitioners (NPs) are increasingly called on to provide high‐quality health‐care particularly for people who face significant barriers to accessing services. Although discourses of social justice have become relatively common in nursing and health services literature, critical analyses of how NP roles articulate with social justice issues have received less attention. In this study, we examine the role of NPs from a critical social justice perspective. A critical social justice lens raises morally significant questions, for example, why certain individuals (...) and groups bear a disproportionate burden of illness and suffering; what social conditions contribute to disparities in health and social status; and what social mandate NPs ought to develop in response to these realities. In our analysis, we draw on lessons learned from the initial Canadian experience with the introduction of NPs in the 1970s to consider the renewed and burgeoning interest in NPs in Canada, Australia and elsewhere. As we argue, a critical social justice perspective (in addition to the biomedical foci of NP practice) will be essential to sustaining long‐term, socially responsive NP roles and achieving greater equity in health and health‐care. (shrink)

Community volunteering is an under-utilized, at least under-researched, strategy to supplement existing treatment for affective disorders. We present findings from a feasibility study incorporating community volunteering into clinical treatment for depression and anxiety among adolescents and young adults. This exploratory pilot study had four aims: to investigate recruitment feasibility; to describe participants’ experiences with volunteering; to explore psychosocial assets by which volunteering might decrease depressive and anxiety symptoms; and to document preliminary changes in mental health outcomes before and after (...) the volunteering intervention. Interviews and surveys were employed with participants newly diagnosed with: mild to moderate depression, mild to moderate anxiety, or adjustment disorder. Recruitment was feasible overall, successes and challenges are discussed. Experiences with volunteering were very positive. Qualitative findings revealed perceived positive effects of volunteering on mood and well-being such as helping with social anxiety and being a positive distraction. Qualitative findings revealed several psychosocial assets that improved related to volunteering. On average, participants reported a 19% decrease in depressive symptoms from the pre-survey to the post-survey. Although more research is warranted, the implication of this study for practicing psychologists treating adolescents and young adults for mild to moderate depression and/or anxiety is that they may wish to consider incorporating community volunteer activities into treatment. Volunteering was a desirable activity for interested participants in treatment for affective disorders. (shrink)

Scholars of early Chinese philosophy frequently point to the nontranscendent, organismic conception of the cosmos in early China as the source of China's unique perspective and distinctive values. One would expect recent works in Confucian ethics to capitalize on this idea. Reviewing recent works in Confucian ethics by P. J. Ivanhoe, David Nivison, R. P. Peerenboom, Henry Rosemont, and Tu Wei-Ming, the author analyzes these new studies in terms of the extent to which their representation of Confucian ethics reflects and (...) is consistent with the view that in early China the cosmos was conceived to be organismic, nontranscendent, and nondualistic. (shrink)

Background: The traditional approach to resolving ethics concerns may not address underlying organisational issues involved in the evolution of these concerns. This represents a missed opportunity to improve quality of care “upstream”. The purpose of this study was to understand better which organisational issues may contribute to ethics concerns. Methods: Directed content analysis was used to review ethics consultation notes from an academic children’s hospital from 1996 to 2006 (N = 71). The analysis utilised 18 categories of organisational issues derived (...) and modified from published quality improvement protocols. Results: Organisational issues were identified in 68 of the 71 (96%) ethics consult notes across a range of patient settings and reasons for consultation. Thirteen of the 18 categories of organisational issues were identified and there was a median of two organisational issues per consult note. The most frequently identified organisational issues were informal organisational culture (eg, collective practices and approaches to situations with ethical dimensions that are not guided by policy), policies and procedures (eg, staff knows policy and/or procedural guidelines for an ethical concern but do not follow it) and communication (eg, communication about critical information, orders, or hand-offs repeatedly does not occur among services). Conclusions: Organisational issues contribute to ethical concerns that result in clinical ethics consults. Identifying and addressing organisational issues such as informal culture and communication may help decrease the recurrence of future similar ethics concerns. (shrink)

The literature on affective determinants of physical activity is growing rapidly. The present paper aims to provide greater clarity regarding the definition and distinctions among the various affect-related constructs that have been examined in relation to PA. Affective constructs are organized according to the Affect and Health Behavior Framework, including: affective response to PA; incidental affect; affect processing; and affectively charged motivational states. After defining each category of affective construct, we provide examples of relevant research showing how each construct may (...) relate to PA behavior. We conclude each section with a discussion of future directions for research. (shrink)

In this paper we attempt to sharpen and to provide an answer to the question of when human beings first become conscious. Since it is relatively uncontentious that a capacity for raw sensation precedes and underpins all more sophisticated mental capacities, our question is tantamount to asking when human beings first have experiences with sensational content. Two interconnected features of our argument are crucial. First, we argue that experiences with sensational content are supervenient on facts about electrical activity (...) in the cerebral cortex which can be ascertained through EEG readings. Second, we isolate from other notions of a‘functioning brain’that which is required to underpin the view that a cortex is functioning in a way which could give rise to rudimentary conscious experiences. We investigate the development in the human fetus of the anatomical and chemical pathways which underpin cortical activity and the growth and maturation of the electrical circuitry specifically associated with sensational content in adult experience. We conclude that a fetus becomes conscious at about 30 to 35 weeks after conception; an answer based on a careful analysis of EEG readings at various stages of cortical development. Finally, we survey the possible ethical ramifications of our answer. (shrink)

It has been proposed that performance in the think – no think task represents a laboratory analogue of the voluntary form of memory repression. The central prediction of this repression hypothesis is that performance in the TNT task will be influenced by emotional characteristics of the material to be remembered. This prediction was tested in two experiments by asking participants to learn paired associates in which the first item was either emotionally positive or emotionally negative . The second word was (...) always emotionally neutral . Consistent with the repression hypothesis, significant memory suppression was observed in both experiments following ‘no think’ instructions for memories associated with emotionally negative material. No suppression was observed for memories associated with emotionally positive information. Implications of these findings for the relationship between performance in the TNT task and the controversial notion of memory repression are considered. (shrink)

This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering (...) from brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

Despite the increasingly multinational nature of the workplace, there have been few studies of the convergence and divergence in beliefs about ethics-based leadership across cultures. This study examines the meaning of ethical and unethical leadership held by managers in six societies with the goal of identifying areas of convergence and divergence across cultures. More specifically, qualitative research methods were used to identify the attributes and behaviors that managers from the People’s Republic of China (the PRC), Hong Kong, the Republic (...) of China (Taiwan), the United States (the U.S.), Ireland, and Germany attribute to ethical and unethical leaders. Across societies, six ethical leadership themes and six unethical leadership themes emerged from a thematic analysis of the open-ended responses. Dominant themes for ethical and unethical leadership for each society are identified and examined within the context of the core cultural values and practices of that society. Implications for theory, research, and management practice are discussed. (shrink)

The unprecedented outbreak of Ebola virus disease in West Africa has raised several novel ethical issues for global outbreak preparedness. It has also illustrated that familiar ethical issues in infectious disease management endure despite considerable efforts to understand and mitigate such issues in the wake of past outbreaks. To improve future global outbreak preparedness and response, we must examine these shortcomings and reflect upon the current state of ethical preparedness. To this end, we focus our efforts in this article on (...) the examination of one substantial area: ethical guidance in pandemic plans. We argue that, due in part to their focus on considerations arising specifically in relation to pandemics of influenza origin, pandemic plans and their existing ethical guidance are ill-equipped to anticipate and facilitate the navigation of unique ethical challenges that may arise in other infectious disease pandemics. We proceed by outlining three reasons why this is so, and situate our analysis in the context of the EVD outbreak and the threat posed by drug-resistant tuberculosis: different infectious diseases have distinct characteristics that challenge anticipated or existing modes of pandemic prevention, preparedness, response, and recovery, clear, transparent, context-specific ethical reasoning and justification within current influenza pandemic plans are lacking, and current plans neglect the context of how other significant pandemics may manifest. We conclude the article with several options for reflecting upon and ultimately addressing ethical issues that may emerge with different infectious disease pandemics. (shrink)

As improvements in neuroscience have enabled a better understanding of disorders of consciousness as well as methods to treat them, a hurdle that has become all too prevalent is the denial of coverage for treatment and rehabilitation services. In 2011, a settlement emerged from a Vermont District Court case, Jimmo v. Sebelius, which was brought to stop the use of an “improvement standard” that required tangible progress over an identifiable period of time for Medicare coverage of services. While the use (...) of this standard can have deleterious effects on those with many chronic conditions, it is especially burdensome for those in the minimally conscious state, where improvements are unpredictable and often not manifested through repeatable overt behaviors. Though the focus of this paper is on the challenges of brain injury and the minimally conscious state, which an estimated 100,000 to 200,000 individuals suffer from in the United States, the post-Jimmo arguments presented can and should have a broad impact as envisioned by the plaintiffs who brought the case on behalf of multiple advocacy groups representing patients with a range of chronic care conditions. (shrink)

ABSTRACT In this paper we attempt to sharpen and to provide an answer to the question of when human beings first become conscious. Since it is relatively uncontentious that a capacity for raw sensation precedes and underpins all more sophisticated mental capacities, our question is tantamount to asking when human beings first have experiences with sensational content. Two interconnected features of our argument are crucial. First, we argue that experiences with sensational content are supervenient on facts about electrical (...) activity in the cerebral cortex which can be ascertained through EEG readings. Second, we isolate from other notions of a‘functioning brain’that which is required to underpin the view that a cortex is functioning in a way which could give rise to rudimentary conscious experiences. We investigate the development in the human fetus of the anatomical and chemical pathways which underpin (immature) cortical activity and the growth and maturation of the electrical circuitry specifically associated with sensational content in adult experience. We conclude (tentatively) that a fetus becomes conscious at about 30 to 35 weeks after conception; an answer based on a careful analysis of EEG readings at various stages of cortical development. Finally, we survey the possible ethical ramifications of our answer. (shrink)

In his book “Medical Philosophy: Conceptual issues in Medicine”, Mario Bunge provides a unique account of medical philosophy that is deeply rooted in a realist ontology he calls “systemism”. According to systemism, the world consists of systems and their parts, and systems possess emergent properties that their parts lack. Events within systems may form causes and effects that are constantly conjoined via particular mechanisms. Bunge supports the views of the evidence-based medicine movement that randomized controlled trials (RCTs) provide the best (...) evidence to establish the truth of causal hypothesis; in fact, he argues that _only_ RCTs have this ability. Here, we argue that Bunge neglects the important feature of patients being open systems which are in steady interaction with their environment. We show that accepting this feature leads to counter-intuitive consequences for his account of medical hypothesis testing. In particular, we point out that (i) the confirmation of hypotheses is inherently stochastic and affords a probabilistic account of both confirmation and evidence which we provide here; (ii) RCTs are neither necessary nor sufficient to establish the truth of a causal claim; (iii) testing of causal hypotheses requires taking into account background knowledge and the context within which an intervention is applied. We conclude that there is no “best” research methodology in medicine, but that different methodologies should coexist in a complementary fashion. (shrink)

The practice of covertly administering medication is controversial. Although condemned by some as overly paternalistic, others have suggested that it may be acceptable if patients have permanent mental incapacity and refuse needed treatment. Ethical, legal, and clinical considerations become more complex when the mental incapacity is temporary and when the medication actually serves to restore autonomy. We discuss these issues in the context of a young man with schizophrenia. His mother had been giving him antipsychotic medication covertly in his (...) soup. Should the doctor continue to provide a prescription, thus allowing this to continue? We discuss this case based on the “four principles” ethical framework, addressing the conflict between autonomy and beneficence/non-maleficence, the role of antipsychotics as an autonomy restoring agent, truth telling and the balance between individual versus family autonomy. (shrink)

We formulate and analyze the dynamics of an influenza pandemic model with vaccination and treatment using two preventive scenarios: increase and decrease in vaccine uptake. Due to the seasonality of the influenza pandemic, the dynamics is studied in a finite time interval. We focus primarily on controlling the disease with a possible minimal cost and side effects using control theory which is therefore applied via the Pontryagin’s maximum principle, and it is observed that full treatment effort should be (...) given while increasing vaccination at the onset of the outbreak. Next, sensitivity analysis and simulations (using the fourth order Runge-Kutta scheme) are carried out in order to determine the relative importance of different factors responsible for disease transmission and prevalence. The most sensitive parameter of the various reproductive numbers apart from the death rate is the inflow rate, while the proportion of new recruits and the vaccine efficacy are the most sensitive parameters for the endemic equilibrium point. (shrink)

Parental refusal of a recommended treatment is not an uncommon scenario in the neonatal intensive care unit. These refusals may be based upon the parents’ perceptions of their child’s projected quality of life. The inherent subjectivity of quality of life assessments, however, can exacerbate disagreement between parents and healthcare providers. We present a case of parental refusal of surgical intervention for necrotizing enterocolitis in an infant with Bartter syndrome and develop an ethical framework in which to consider the appropriateness (...) of parental refusal based upon an infant’s projected quality of life. (shrink)

A referral was made to our Cardiac Transplant Program for a patient who was in the New Jersey Prison System. The Medical Director of the New Jersey Department of Corrections called regarding a 39-year-old inmate who was being treated in a New Jersey hospital that has a unit for prisoners from a nearby cor- rectional facility. The referring physician described the patient to our Medical Director of heart transplantation as a “murderer” who had been incarcerated since 1987 and sentenced to (...) prison for 30 years without eligibility for parole before completion of his 30-year sentence. The patient was being treated in the CCU of the facility and according to preliminary studies, was suffering from a possible dilated cardiomyopathy. There was evidence of a prior cerebrovascular accident (etiology unknown) with a dense hemiplegia of the left side. The patient was alert but unable to care for himself. There were a number of specific tests necessary to evaluate the patient's candidacy for heart transplantation before actually placing him-on a waiting list. However, the transplant director was uncertain about having the patient brought to our facility for further testing and called some members of the Transplant Selection Committee team to discuss the case. (shrink)

This book presents contributions from an internal symposium organized to celebrate the 80th anniversary of the Specola Vaticana, or Vatican Observatory, in the Papal Palace of Castel Gandolfo. The aim is to provide an overview of the scientific and cultural work being undertaken at the Observatory today and to describe the outcomes of important recent investigations. The contents cover interesting topics in a variety of areas, including planetary science and instrumentation, stellar evolution and stars, galaxies, cosmology, quantum gravity, the history (...) of astronomy, and interactions between science, philosophy, and theology. On September 29, 1935, Pope Pius XI officially inaugurated the new headquarters of the Specola Vaticana at Castel Gandolfo. With new telescopes, a new astrophysical laboratory for spectrochemical analysis, and a young staff comprising Jesuit scientists, this inauguration marked the beginning of an intense period of scientific achievements at the Observatory. This anniversary book, featuring contributions from members of the current Observatory staff and adjunct scholars, will appeal to all with an interest in the history of the Specola Vaticana and its significance for astronomy. (shrink)

Although previous work has linked parent autonomy support to the development of children’s executive function skills, the role of specific autonomy-supportive behaviors has not been thoroughly investigated. We compiled data from four preschool-age samples in the Midwestern United States to examine three relevant autonomy-supportive behaviors and their associations with child EF. We coded parent autonomy-supportive behaviors from a 10-min interaction between parent and child dyads working on challenging jigsaw puzzles together. Children completed a battery of EF. Overall, child EF (...) was most consistently correlated with the offering choice subscale. Additionally, only the offering choice subscale predicted child EF while controlling for the other autonomy support subscales and child age. These results suggest that parent provision of choice is an especially relevant aspect of autonomy-supportive parenting and may be important to the development of EF in early childhood. Future research should directly measure children’s experience with choice and how it relates to emerging EF. (shrink)

Zuk et al. (2023) explore personality, mood, and behavioral (PMB) changes in DBS and aDBS, though have not invoked what is known about the similarities and differences for other available brain sti...

D.T. a 35-year-old woman, was found to have breast cancer. At the time of mastectomy axillary lymph nodes were positive and the cancer was classified as adenocarcinoma, grade 4. The patient underwent conventional chemotherapy. When it became apparent the disease was metastatic, the patient's oncologist contacted a well-known cancer center regarding the possibility of treating the patient with high dose chemotherapy and autologous bone marrow transplantation. The patient's health insurance provider informed the patient, however, that the treatment—estimated to cost (...) in the range of $150,000–200,000—was “considered experimental or research in nature” and therefore was not included in coverage. D.T. did not pursue this further. Approximately 2 years later, cancer was detected in the patient's spine. This time she applied to another well-known cancer center for HDC/ABMT. The cancer center agreed to accept her on the condition of proof of ability to pay for the treatment. Again her insurer refused coverage on the same grounds as before. D.T. found another source for the money, underwent treatment, then sued the insurance carrier. She sought a declaratory judgment that the treatment was covered under the insurance policy. The court ruled in favor of D.T. finding the contract phrase “considered experimental” ambiguous. (shrink)

Purpose This paper aims to explore the ethical and social impact of augmented visual field devices, identifying issues that AVFDs share with existing devices and suggesting new ethical and social issues that arise with the adoption of AVFDs. Design/methodology/approach This essay incorporates both a philosophical and an ethical analysis approach. It is based on Plato’s Allegory of the Cave, philosophical notions of transparency and presence and human values including psychological well-being, physical well-being, privacy, deception, informed consent, ownership and (...) property and trust. Findings The paper concludes that the interactions among developers, users and non-users via AVFDs have implications for autonomy. It also identifies issues of ownership that arise because of the blending of physical and virtual space and important ways that these devices impact, identity and trust. Practical implications Developers ought to take time to design and implement an easy-to-use informed consent system with these devices. There is a strong need for consent protocols among developers, users and non-users of AVFDs. Social implications There is a social benefit to users sharing what is visible on their devices with those who are in close physical proximity, but this introduces tension between notions of personal privacy and the establishment and maintenance of social norms. Originality/value There is new analysis of how AVFDs impact individual identity and the attendant ties to notions of ownership of the space between an object and someone’s eyes and control over perception. (shrink)

& Using functional magnetic resonance imaging, we examined whether individual differences in amygdala activation in response to negative relative to neutral information are related to differences in the speed with which such information is evaluated, the extent to which such differences are associated with medial prefrontal cortex function, and their relationship with measures of trait anxiety and psychological well-being (PWB). Results indicated that faster judgments of negative relative to neutral information were associated with increased left and (...) right amygdala activation. In the prefrontal cortex, faster judgment time was associated with relative decreased activation in a cluster in the ventral anterior cingulate cor-. (shrink)

OBJECTIVES: To study the ethical reasoning of nurses and physicians, and to assess whether or not modified focus groups are a valuable tool for this purpose. DESIGN: Discussion of cases in modified focus groups, each consisting of three physicians and three nurses. The discussion was taped and analysed by content analysis. SETTING: Five departments of internal medicine at Danish hospitals. SAMPLE: Seven discussion groups. MAIN MEASUREMENTS: Ethical content of statements, style of statements, time used by each participant. RESULTS: Danish physicians (...) and nurses do not differ in the kind of ethical reasoning they use, but physicians use more of the discussion time than nurses, they use a more assertive style of argumentation, and the solutions chosen are usually first put forward by physicians. CONCLUSION: The results and informal comparisons with similar data from long qualitative interviews indicate that groups of this kind are a useful tool for gathering data on ethical reasoning. (shrink)

OBJECTIVES: To study the ethical reasoning of nurses and physicians, and to assess whether or not modified focus groups are a valuable tool for this purpose. DESIGN: Discussion of cases in modified focus groups, each consisting of three physicians and three nurses. The discussion was taped and analysed by content analysis. SETTING: Five departments of internal medicine at Danish hospitals. SAMPLE: Seven discussion groups. MAIN MEASUREMENTS: Ethical content of statements, style of statements, time used by each participant. RESULTS: Danish physicians (...) and nurses do not differ in the kind of ethical reasoning they use, but physicians use more of the discussion time than nurses, they use a more assertive style of argumentation, and the solutions chosen are usually first put forward by physicians. CONCLUSION: The results and informal comparisons with similar data from long qualitative interviews indicate that groups of this kind are a useful tool for gathering data on ethical reasoning. (shrink)

Marine interstitial environments are teeming with an extraordinary diversity of coexisting microeukaryotic lineages collectively called “meiofauna.” Interstitial habitats are broadly distributed across the planet, and the complex physical features of these environments have persisted, much like they exist today, throughout the history of eukaryotes, if not longer. Although our general understanding of the biological diversity in these environments is relatively poor, compelling examples of developmental heterochrony (e.g., pedomorphosis) and convergent evolution appear to be widespread among meiofauna. Therefore, an improved (...) understanding of meiofaunal biodiversity is expected to provide some of the deepest insights into the following themes in evolutionary biology: (i) the origins of novel body plans, (ii) macroevolutionary patterns of miniaturization, and (iii) the intersection of evolution and community assembly – e.g., “community convergence” involving distantly related lineages that span the tree of eukaryotes. (shrink)

Environmental governance has emerged as a recent perspective to explain the link between corporate governance mechanisms and environmental performance such as pollution reduction. We extend current models by incorporating the crucial role of the underlying institutional logics in terms of an a priori focus on either shareholder rights or stakeholder inclusion, which, in turn, can be traced back to the legal origin of a specific country. Using data on a sample of common and civil law countries, we find support for (...) our predictions that a shareholder-focused common law legal origin is associated with significantly higher emissions of CO2, and also that international environmental agreements like the Kyoto protocol seem to have a more pronounced effect in shareholder-centric economies than thus far assumed. (shrink)