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

This is the sixth volume in the Oxford Classical Texts series of Livy and contains a Latin text, together with full apparatus criticus and Latin introduction, of Books 36-40, which cover the period from 192 to 179 BC. This momentous era in the history of Republican Rome begins with the war with Antiochus, which resulted in Rome's indirect control of Greece and Asia, and concludes with the death of Philip V of Macedon, foreshadowing the Third Macedonian War. During these years (...) Rome also struggled for the increasing dominance of northern Italy and Spain. On the domestic front, Livy depicts this period as the beginning of Roman moral decline, as reflected in such events as the trials of the Scipios, the censorship of Cato, and the Bacchanalia. Since much of the account by Polybius is fragmentary, Livy's narrative is the main source for the history of the period. (shrink)

A semantics for quantified modal logic is presented that is based on Kleene's notion of realizability. This semantics generalizes Flagg's 1985 construction of a model of a modal version of Church's Thesis and first-order arithmetic. While the bulk of the paper is devoted to developing the details of the semantics, to illustrate the scope of this approach, we show that the construction produces (i) a model of a modal version of Church's Thesis and a variant of a modal set theory (...) due to Goodman and Scedrov, (ii) a model of a modal version of Troelstra's generalized continuity principle together with a fragment of second-order arithmetic, and (iii) a model based on Scott's graph model (for the untyped lambda calculus) which witnesses the failure of the stability of non-identity. (shrink)

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

This book examines from different perspectives the moral significance of non-human members of the biotic community and their omission from climate ethics literature. The complexity of life in an age of rapid climate change demands the development of moral frameworks that recognize and respect the dignity and agency of both human and non-human organisms. Despite decades of careful work in non-anthropocentric approaches to environmental ethics, recent anthologies on climate ethics have largely omitted non-anthropocentric approaches. This multidisciplinary volume of international scholars (...) tackles this lacuna by presenting novel work on non-anthropocentric approaches to climate ethics. Written in an accessible style, the text incorporates sentiocentric, biocentric, and ecocentric perspectives on climate change. With diverse perspectives from both leading and emerging scholars of environmental ethics, geography, religious studies, conservation ecology, and environmental studies, this book will offer a valuable reading for students and scholars of these fields. (shrink)

The use of hydraulic fracturing to extract oil or gas from shales is a subject of controversy. There are many scientific questions about the risks associated with the technique, and much research remains to be done. ReFINE is a research consortium led by Newcastle University and Durham University in the UK, focusing on the environmental impacts of shale gas and oil exploitation using fracking methods. The project was established to answer questions raised by members of the public across Europe on (...) the risks of fracking. It aims to inform the debate surrounding fracking by undertaking scientific research, which will be peer-reviewed and openly accessible. This case study discusses the structure of ReFINE and the issues associated with using funding from oil and gas companies to support the research. (shrink)

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

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

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

In line with the British Psychological Society's recent recommendations for teaching the history of psychology, this comprehensive undergraduate textbook emphasizes the philosophical, cultural and social elements that influenced psychology's development. The authors demonstrate that psychology is both a human (e.g. psychoanalytic or phenomenological) and natural (e.g. cognitive) science, exploring broad social-historical and philosophical themes such as the role of diverse cultures and women in psychology and the complex relationship between objectivity and subjectivity in the development of psychological knowledge. The result (...) is a fresh and balanced perspective on what has traditionally been viewed as the collected achievements of a few 'great men'. With a variety of learning features, including case studies, study questions, thought experiments and a glossary, this new textbook encourages students to critically engage with chapter material and analyze themes and topics within a social, historical and philosophical framework. (shrink)

Cicero's philosophical works are now exciting renewed interest, in part because he provides vital evidence of the views of the Greek philosophers of the Hellenistic age, and partly because of the light he casts on the intellectual life of first century Rome. This edition uses the 1997 Clarendon text by the acclaimed translator P.G. Walsh.