BackgroundClinical Ethics Support Services have been established to support healthcare professionals in addressing ethically sensitive issues in clinical practice and, in many countries, they are under development. In the context of growing CESS, exploring how healthcare professionals experience and address clinical ethics issues in their daily practice represents a fundamental step to understand their potential needs. This is even more relevant in the context of extremely sensitive diseases, such as cancer. On this basis, we carried out a qualitative study conducting (...) in-depth semi-structured interviews with stakeholders of a major comprehensive cancer centre in Italy, with the twofold aim of investigating what ethical issues arise in the context of clinical oncology and how they are addressed, as well as stakeholders’ expectations about a potential CESS to be implemented within the Institution.MethodsThe study was conducted within the theoretical framework of Grounded Theory. Participants were healthcare professionals and other key stakeholders working within the cancer centre. The semi-structured interview aimed at exploring common ethical aspects of oncology, investigating stakeholders’ professional experience in dealing with clinical ethics issues, their expectations and requests regarding ethics support services. Transcripts of the interviews were coded and analysed according to the principles of Grounded Theory.ResultsTwenty-one stakeholders were interviewed. Our analysis showed a wide consensus on the identification of ethically relevant issues, above all those concerning communication, end-of-life, and resource allocation. The absence of institutional tools or strategies to address and manage ethical issues at the patient bedside emerged, and this is reflected in the widespread request for their development in the future. The ideal support service should be fast and flexible in order to adapt to different needs and clinical cases.ConclusionsThe interviewees showed a limited degree of ‘ethical awareness’: despite having reported many issues in clinical practice, they could hardly identify and describe the ethical aspects, while complaining about a lack of ethical resources in their management. To build a truly effective support service, it therefore seems appropriate to take such context into consideration and address the emerged needs. Ethical sensitivity seems to be key and it becomes even more relevant in critical clinical areas, such as the therapeutic pathways of terminally ill patients. (shrink)

In their contribution, Kok et al raise a relevant, though often underestimated, issue: clinical ethics support services are often assumed to lead to an improvement of quality of care at the organisational level, but evidence in support of this claim is weak, if not completely lacking.1 Therefore, the authors propose a complex theoretical model connecting a specific kind of CESS, moral case deliberation, with mechanisms for quality of care improvement at the individual and the organisational level. The proposal is original, (...) and the topic discussed of great interest not only to practitioners and researchers dealing with CESS, but also to health policy-makers and managers of healthcare system, for all of whom it is indeed crucial to understand whether and how ethics support can positively impact quality of care. However, despite its undoubtful merits, we feel that some claims and model’s underlying assumptions might require in-depth scrutiny and more solid justification. i. First, the authors discuss two different approaches to understanding quality of care: the first approach, which they define as reductionist, interprets quality as an outcome-oriented, quantitative, and therefore, measurable function. The second approach defines quality …. (shrink)

Italian Constitutional Justice in Global Context is the first book ever published in English to provide an international examination of the Italian Constitutional Court, offering a comprehensive analysis of its principal lines of jurisprudence, historical origins, organization, procedures, and its current engagement with transnational European law. The ItCC represents one of the strongest and most successful examples of constitutional judicial review, and is distinctive in its structure, institutional dimensions, and well-developed jurisprudence. Moreover, the ItCC has developed a distinctive voice among (...) global constitutional actors in its adjudication of a broad range of topics from fundamental rights and liberties to the allocations of governmental power and regionalism. Nevertheless, in global constitutional dialog, the voice of the ItCC has been almost entirely absent due to a relative lack of both English translations of its decisions and of focused scholarly commentary in English.This book describes the "Italian Style" in global constitutional adjudication, and aims to elevate Italian constitutional jurisprudence to an active participant role in global constitutional discourse. The authors have carefully structured the work to allow the ItCC's own voice to emerge. It presents broad syntheses of major areas of the Court's case law, provides excerpts from notable decisions in a narrative and analytical context, addresses the tension between the ItCC and the Court of Cassation, and positions the development, character, and importance of the ItCC's jurisprudence in the larger arc of global judicial dialog. (shrink)

Clinical Ethics Committees (CECs), as distinct from Research Ethics Committees, were originally established with the aim of supporting healthcare professionals in managing controversial clinical ethical issues. However, it is still unclear whether they manage to accomplish this task and what is their impact on clinical practice. This systematic review aims to collect available assessments of CECs’ performance as reported in literature, in order to evaluate CECs’ effectiveness. We retrieved all literature published up to November 2019 in six databases (PubMed, Ovid (...) MEDLINE, Scopus, Philosopher’s Index, Embase and Web of Science), following PRISMA guidelines. We included only articles specifically addressing CECs and providing any form of CECs performance assessment. Twenty-nine articles were included. Ethics consultation was the most evaluated of CECs’ functions. We did not find standardized tools for measuring CECs’ efficacy, but 33% of studies considered “user satisfaction” as an indicator, with 94% of them reporting an average positive perception of CECs’ impact. Changes in patient treatment and a decrease of moral distress in health personnel were reported as additional outcomes of ethics consultation. The highly diverse ways by which CECs carry out their activities make CECs’ evaluation difficult. The adoption of shared criteria would be desirable to provide a reliable answer to the question about their effectiveness. Nonetheless, in general both users and providers consider CECs as helpful, relevant to their work, able to improve the quality of care. Their main function is ethics consultation, while less attention seems to be devoted to bioethics education and policy formation. (shrink)

Suppose you’re certain that a claim—say, ‘Frida is tall’—does not have a determinate truth value. What attitude should you take towards it? This is the question of the cognitive role of indeterminacy. This paper presents a puzzle for theories of cognitive role. Many of these theories vindicate a seemingly plausible principle: if you are fully certain that A, you are rationally required to be fully certain that A is determinate. Call this principle ‘Certainty’. We show that Certainty, in combination with (...) some minimal side premises, entails a very implausible claim: whenever you’re certain that it’s indeterminate whether A, it is rationally required that you reject A. This is a surprising result, which requires abandoning at least some intuitive views about indeterminacy and cognitive role. (shrink)

We show how mereotopological notions can be expressed by extending intuitionistic propositional logic with propositional quantification and a strong modal operator. We first prove completeness for the logics wrt Kripke models; then we trace the correspondence between Kripke models and topological spaces that have been enhanced with an explicit notion of expressible region. We show how some qualitative spatial notions can be expressed in topological terms. We use the semantical and topological results in order to show how in some extensions (...) of the logics it is possible to express connectedness, non-emptiness and a set of jointly exhaustive, pairwise disjoint, binary relations that play a significant role in qualitative spatial reasoning. (shrink)

One of the innovative approaches in contemporary philosophical ontology consists in the assumption of a plurality of ontologies based on different metaphysical presuppositions. Such presuppositions involve, among others, the identification of relevant properties for the objects of our domain as a guiding principle in uncovering what it is to be considered intrinsic and what could be the mere effect of selection preferences based on objective or subjective criteria. A remarkable example of the application of a background metaphysical theory in astrophysics (...) is the problem of selection biases in detecting cosmological objects, such as supernovae, galaxies and gamma-ray bursts. We will show that it is valuable to be aware of the importance of uncovering this type of background theory to better understand selection effects and to promote a novel approach in scientific research. (shrink)

Although the role of emotion in socioeconomic decision making is increasingly recognised, the impact of specific emotional disorders, such as anxiety disorders, on these decisions has been surprisingly neglected. Twenty anxious patients and twenty matched controls completed a commonly used socioeconomic task (the Ultimatum Game), in which they had to accept or reject monetary offers from other players. Anxious patients accepted significantly more unfair offers than controls. We discuss the implications of these findings in light of recent models of anxiety, (...) in particular the importance of interpersonal factors and assertiveness in an integrated model of decision making. Finally, we were able to show that pharmacological serotonin used to treat anxious symptomatology tended to normalise decision making, further confirming and extending the role of serotonin in co-operation, prosocial behaviour, and social decision making. These results show, for the first time, a different pattern of socioeconomic behaviour in anxiety disordered patients, in addition to the known memory, attentional and emotional biases that are part of this pathological condition. (shrink)

Theories of embodied cognition hypothesize interdependencies between psychological well-being and physical posture. The purpose of this study was to assess the feasibility of objectively measuring posture, and to explore the relationship between posture and affect and other patient centered outcomes in breast cancer survivors with persistent postsurgical pain over a 12-week course of therapeutic Qigong mind-body training. Twenty-one BCS with PPSP attended group Qigong training. Clinical outcomes were pain, fatigue, self-esteem, anxiety, depression, stress and exercise self-efficacy. Posture outcomes were vertical (...) spine and vertical head angles in the sagittal plane, measured with a 3D motion capture system in three conditions: eyes open, eyes open relaxed and eyes closed. Assessments were made before and after the Qigong training. The association between categorical variables was measured by Cramer’s V. In the EO condition, most participants who improved in fatigue and anxiety scales also had better vertical head values. For the EOR condition, a moderate correlation was observed between changes in vertical head angle and changes in fatigue scale. In the EC condition, most of the participants who improved in measures of fatigue also improved vertical head angle. Additionally, pain severity decreased while vertical spine angle improved. These preliminary findings support that emotion and other patient centered outcomes should be considered within an embodied framework, and that Qigong may be a promising intervention for addressing biopsychosocially complex interventions such as PPSP in BCSs. (shrink)

Recreational Drugs European Network (ReDNet) project aims to use the Psychonaut Web Mapping Project database (Psychonaut Web Mapping Group, 2009) containing novel psychoactive compounds usually not mentioned in the scientific literature and thus unknown to clinicians as a unique source of information. The database will be used to develop an integrated ICT prevention approach targeted at vulnerable individuals and focused on novel synthetic and herbal compounds and combinations. Particular care will be taken in keeping the health professionals working directly with (...) young people showing problematic behaviors regularly updated in terms of novel compounds and combinations as well. A user-friendly project website will be developed aimed primarily at delivering the information/prevention approaches, but will also be a way of communicating with project partners and relevant stakeholders (e.g. thematic forum facilities, instant messages, blogs, video chat, wikiblog, newsletters distributed via mailing list). The website will support various ICT prevention tools, including an SMS alert service. Different areas and sections will be aimed specifically at the different target groups. -/- . (shrink)

Suppose that you're certain that a certain sentence, e.g. "Frida is tall", lacks a determinate truth value. What cognitive attitude should you take towards it—reject it, suspend judgment, or what else? We show that, by adopting a seemingly plausible principle connecting credence in A and Determinately A, we can prove a very implausible answer to this question: i.e., all indeterminate claims should be assigned credence zero. The result is striking similar to so-called triviality results in the literature on modals and (...) conditionals. (shrink)

In this paper the PA-completeness of modal logic is studied by syntactical and constructive methods. The main results are theorems on the structure of the PA-proofs of suitable arithmetical interpretationsS of a modal sequentS, which allow the transformation of PA-proofs ofS into proof-trees similar to modal proof-trees. As an application of such theorems, a proof of Solovay's theorem on arithmetical completeness of the modal system G is presented for the class of modal sequents of Boolean combinations of formulas of the (...) form p i,m i=0, 1, 2, ... The paper is the preliminary step for a forthcoming global syntactical resolution of the PA-completeness problem for modal logic. (shrink)

This paper is the second part of the syntactic demonstration of the Arithmetical Completeness of the modal system G, the first part of which is presented in [9]. Given a sequent S so that ⊢GL-LIN S, ⊬G S, and given its characteristic formula H = char(S), which expresses the non G-provability of S, we construct a canonical proof-tree T of ~ H in GL-LIN, the height of which is the distance d(S, G) of S from G. T is the syntactic (...) countermodel of S with respect to Gand is a tool of general interest in Provability Logic, that allows some classification in the set of the arithmetical interpretations. (shrink)

This paper is the first of a series of three articles that present the syntactic proof of the PA-completeness of the modal system G, by introducing suitable proof-theoretic objects, which also have an independent interest. We start from the syntactic PA-completeness of modal system GL-LIN, previously obtained in [7], [8], and so we assume to be working on modal sequents S which are GL-LIN-theorems. If S is not a G-theorem we define here a notion of syntactic metric d(S, G): we (...) calculate a canonical characteristic fomula H of S (char(S)) so that ⊢G ∼ H → (∼S) and ⊢GL-LIN ∼ H, and the complexity σ of ∼ H gives the distance d(S, G) of S from G. Then, in order to produce the whole completeness proof as an induction on this d(S, G), we introduce the tree-interpretation of a modal sequent Q into PA, that sends the letters of Q into PA-formulas describing the properties of a GL-LIN-proof P of Q: It is also a d(*, G)-metric linked interpretation, since it will be applied to a proof-tree T of ∼ H with H = char(S) and σ(∼ H) = d(S, G). (shrink)

This paper is the final part of the syntactic demonstration of the Arithmetical Completeness of the modal system G; in the preceding parts [9] and [10] the tools for the proof were defined, in particular the notion of syntactic countermodel. Our strategy is: PA-completeness of G as a search for interpretations which force the distance between G and a GL-LIN-theorem to zero. If the GL-LIN-theorem S is not a G-theorem, we construct a formula H expressing the non G-provability of S, (...) so that ⊢GL-LIN ∼ H and so that a canonical proof T of ∼ H in GL-LIN is a syntactic countermodel for S with respect to G, which has the height θ(T) equal to the distance d(S, G) of S from G. Then we define the interpretation ξ of S which represents the proof-tree T in PA. By induction on θ(T), we prove that ⊢PA Sξ and d(S, G) > 0 imply the inconsistency of PA. (shrink)

This volume succeeds the same authors' well-known An Introduction to Modal Logic and A Companion to Modal Logic. We designate the three books and their authors NIML, IML, CML and H&C respectively. Sadly, George Hughes died partway through the writing of NIML.

In the last two decades there has been renewed interest in visualization in logic and mathematics. Visualization is usually understood in different ways but for the purposes of this article I will take a rather broad conception of visualization to include both visualization by means of mental images as well as visualizations by means of computer generated images or images drawn on paper, e.g. diagrams etc. These different types of visualization can differ substantially but I am interested in offering a (...) characterization of visualization that is as broad as possible. The article describes and explains (1) the way in which visual thinking fell into disrepute, (2) the renaissance of visual thinking in mathematics over recent decades, (3) the ways in which visual thinking has been rehabilitated in epistemology of mathematics and logic. (shrink)

Knowing is an activity through which agents and world produce themselves. This is often expressed by the enactive claim that agents bring forth a world. I analyse this idea for different modes of agent–environment engagement: interactional, transactional, and constitutional. Something is produced in each case. Bringing forth a world is not only an epistemic but an ontological claim. Acts in their fine structure result from a process of fact production, or f/acts. F/acts co-emerge with their 'preconditions', e.g.intentions, affordances, across the (...) subject/object divide. F/acts define their inner temporality and affectivity, comprising both event and experience. A plurality of worlds is admitted in this enactive view, without entailing antirealism. We cannot bring forth just any world. World resistance organizes action and experience. I touch on the implications for objectivity and free will and discuss the primordiality of activity, community, and relationality. From a notion of groundlessness in early enactive work, I suggest that a participatory universe is better conceived as a meshwork of groundless grounds. (shrink)

Sulla scia di un percorso già segnato da appuntamenti importanti e coinvolgenti istituzioni e studiosi italiani e stranieri, centri di studi specializzati, il Volume che qui si presenta raccoglie i contributi del Convegno Internazionale di Studi dedicato a: Lévinas e la cultura del XX secolo, tenutosi a Napoli tra il 10 ed il 12 aprile 2000: G. Lissa, S. Trigano, I. Kajon, E. Méir, S. Petrosino, E. D’Antuono, M. Signore, M. Zarader, D. Cohen-Lévinas, J. Colette, E. Baccarini, D. Banon, P. (...) Amodio, E. Arseneva, è. Levine, F. Ciaramelli, M. Caporale, G. Giannini. (shrink)

In the last decades, Systems Biology (including cancer research) has been driven by technology, statistical modelling and bioinformatics. In this paper we try to bring biological and philosophical thinking back. We thus aim at making diferent traditions of thought compatible: (a) causality in epidemiology and in philosophical theorizing—notably, the “sufcient-component-cause framework” and the “mark transmission” approach; (b) new acquisitions about disease pathogenesis, e.g. the “branched model” in cancer, and the role of biomarkers in this process; (c) the burgeoning of omics (...) research, with a large number of “signals” and of associations that need to be interpreted. In the paper we summarize frst the current views on carcinogenesis, and then explore the relevance of current philosophical interpretations of “cancer causes”. We try to ofer a unifying framework to incorporate biomarkers and omic data into causal models, referring to a position called “evidential pluralism”. According to this view, causal reasoning is based on both “evidence of diference-making” (e.g. associations) and on “evidence of underlying biological mechanisms”. We conceptualize the way scientists detect and trace signals in terms of information transmission, which is a generalization of the mark transmission theory developed by philosopher Wesley Salmon. Our approach is capable of helping us conceptualize how heterogeneous factors such as micro and macro-biological and psycho-social—are causally linked. This is important not only to understand cancer etiology, but also to design public health policies that target the right causal factors at the macro-level. (shrink)

The list of katēgoriai presented at the start of Top. I 9 was traditionally interpreted as a version of the canonical Aristotelian list of categories, and as largely equivalent to the list we find in Categories 4. Accordingly, its first item, the ‘what it is’, was identified with the category of substance. This interpretation has been challenged by several scholars, all sharing the view that the ‘what it is’ in Top. I 9 cannot be substance, since it collects items belonging (...) to all Aristotelian categories (e. g. human being, colour, length). Rather, they say, it is a manner of predication – i. e. essential predication – and can only determine an ontologically miscellaneous class of items. Against this family of proposals, I argue afresh that the traditional interpretation is almost entirely correct. To this purpose, I take advantage of the distinction between kinds of predicate and kinds of predication. (shrink)

The essay’s main goal is to see what connection (if any) may be drawn between McDowell’s theoretical quietism and Hegel’s idea of philosophy. McDowell’s view is explicitly rooted in Wittgenstein’s belief that «philosophy leaves everything as it is» and that its task only «consists in assembling reminders for a particular purpose», but it may be interesting to investigate whether this quietism, as he has recently reiterated, is merely «Wittgensteinian» or has a broader import. The issue is approached «sideways on». The (...) essay starts with a discussion of David Foster Wallace’s view that «the most obvious, ubiquitous, important realities are often the ones that are hardest to see and talk about» and it bridges the gap between Hegel and McDowell’s Wittgensteinianism by resorting to an examination of Charles Taylor’s «qualitative conception of action». (shrink)

Ponto de partida do presente artigo é uma interrogação acerca do significado existencial das proposições. Em primeiro lugar, é considerada a ideia de existência simbólica na lógica de MacColl, ao mesmo tempo que se assinalam os problemas que, na perspectiva de Bertrand Russell, estão associados com a auta-referência e o significado da classe-nula. Por outro lado, o artigo demonstra também até que ponto a própria perspectiva de Russell não está livre de problemas, de ambiguidades e de mudanças de opinião. O (...) autor do artigo partilha a crítica de Russell sobre o significado do quantificador, acabando por usar Russell contra Russell, ou seja, a réplica russelliana de 1957 a G. J. Warnock contra a réplica russelliana de 1905 a MacColl. Assim, a partir de uma análise lógica do debate entre Russell e MacColl, o artigo procede a uma investigação da relação entre Lógica e Ontologia, considerando de um modo especial o caso dos objectos não-existentes. /// Moving from a technical, logical point of view in the RusselUMacColl debate about the existential import of propositions and the significance of the null-class, the paper tries to inquiry the relationship between logic and ontology, considering in special the case ofnon existing objects, Russell's philosophical treatment of the existential quantification gains his full meaning in his realistic perspective. But it is possible to use this treatment versus Russell intentions, to deny that there is a supplementary (in space-time) existence, that "lies wholly outside Symbolic Logic". (shrink)

We advocate and develop a states-based semantics for both nominal and adjectival confidence reports, as in "Ann is confident/has confidence that it's raining", and their comparatives "Ann is more confident/has more confidence that it's raining than that it's snowing". Other examples of adjectives that can report confidence include "sure" and "certain". Our account adapts Wellwood's account of adjectival comparatives in which the adjectives denote properties of states, and measure functions are introduced compositionally. We further explore the prospects of applying these (...) tools to the semantics of probability operators. We emphasize three desirable and novel features of our semantics: (i) probability claims only exploit qualitative resources unless there is explicit compositional pressure for quantitative resources; (ii) the semantics applies to both probabilistic adjectives (e.g., "likely") and probabilistic nouns (e.g., "probability"); (iii) the semantics can be combined with an account of belief reports that allows thinkers to have incoherent probabilistic beliefs (e.g. thinking that A & B is more likely than A) even while validating the relevant purely probabilistic claims (e.g. validating the claim that A & B is never more likely than A). Finally, we explore the interaction between confidence-reporting discourse (e.g., "I am confident that...") and belief-reports about probabilistic discourse (e.g.,"I think it's likely that.."). (shrink)

In this research, we present the most important characteristics of the so called and so much explored Jesuit Edition of Newton’s Philosophi? Naturalis Principia Mathematica edited by Thomas Le Seur and Fran?ois Jacquier in the 1739-1742. The edition, densely annotated by the commentators (the notes and the comments are longer than Newton’s text itself) is a very treasure concerning Newton’s ideas and his heritage, e.g., Newton’s geometry and mathematical physics. Conspicuous pieces of information as to history of physics, history of (...) mathematics and epistemology can be drawn from it. This paper opens a series of study concerning Jesuit Edition, whose final scope is to put in evidence all the conceptual aspects of such edition and its role inside the spread of scientific ideas and inside the complex relation science, popularization & society. (shrink)

A fundamental problem in game theory is the possibility of reaching equilibrium outcomes with undesirable properties, e.g., inefficiency. The economics literature abounds with models that attempt to modify games in order to avoid such undesirable properties, for example through the use of subsidies and taxation, or by allowing players to undergo a bargaining phase before their decision. In this paper, we consider the effect of such transformations in Boolean games with costs, where players control propositional variables that they can set (...) to true or false, and are primarily motivated to seek the satisfaction of some goal formula, while secondarily motivated to minimise the costs of their actions. We adopt preparation sets as our basic solution concept. A preparation set is a set of outcomes that contains for every player at least one best response to every outcome in the set. Prep sets are well-suited to the analysis of Boolean games, because we can naturally represent prep sets as propositional formulas, which in turn allows us to refer to prep formulas. The preference structure of Boolean games with costs makes it possible to distinguish between hard and soft prep sets. The hard prep sets of a game are sets of valuations that would be prep sets in that game no matter what the cost function of the game was. The properties defined by hard prep sets typically relate to goal-seeking behaviour, and as such these properties cannot be eliminated from games by, for example, taxation or subsidies. In contrast, soft prep sets can be eliminated by an appropriate system of incentives. Besides considering what can happen in a game by unrestricted manipulation of players’ cost function, we also investigate several mechanisms that allow groups of players to form coalitions and eliminate undesirable outcomes from the game, even when taxes or subsidies are not a possibility. (shrink)