Advances in life-saving technologies in the past few decades have challenged our traditional understandings of death. Traditionally, death was understood to occur when a person stops breathing, their heart stops beating and they are cold to the touch. Today, physicians determine death by relying on a diagnosis of ‘total brain failure’ or by waiting a short while after circulation stops. Evidence has emerged, however, that the conceptual bases for these approaches to determining death are fundamentally flawed and depart substantially from (...) the established biological conception of death. We argue that the current approach to determining death consists of two different types of unacknowledged legal fictions. These legal fictions were developed for practices that are largely ethically legitimate but need to be reconciled with the law. The considerable debate over the determination of death in the medical and scientific literature has not informed the public that vital organs are being procured from still-living donors and it seems unlikely that this information can remain hidden for long. Given the instability of the status quo and the difficulty of making the substantial legal changes required by complete transparency, we argue for a second-best policy solution: acknowledging the legal fictions involved in determining death to move in the direction of greater transparency. This may someday result in more substantial legal change to directly confront the challenges raised by life-sustaining and life-preserving technologies without the need for fictions. (shrink)

Many research ethics guidelines now oblige researchers to offer research participants the results of research in which they participated. This practice is intended to uphold respect for persons and ensure that participants are not treated as mere means to an end. Yet some scholars have begun to question a generalised duty to disclose research results, highlighting the potential harms arising from disclosure and questioning the ethical justification for a duty to disclose, especially with respect to individual results. In support of (...) this view, we argue that current rationales for a duty of disclosure do not form an adequate basis for an ethical imperative. We review policy guidance and scholarly commentary regarding the duty to communicate the results of biomedical, epidemiological and genetic research to research participants and show that there is wide variation in opinion regarding what should be disclosed and under what circumstance. Moreover, we argue that there is fundamental confusion about the notion of “research results,” specifically regarding three core concepts: the distinction between aggregate and individual results, amongst different types of research, and across different degrees of result veracity. Even where policy guidance and scholarly commentary have been most forceful in support of an ethical imperative to disclose research results, ambiguity regarding what is to be disclosed confounds ethical action. (shrink)

Soil is fragile and nonrenewable but the most basic of natural resources. It has a capacity to tolerate continuous use but only with proper management. Improper soil management and indiscriminate use of chemicals have contributed to some severe global environmental issues, e.g., volatilization losses and contamination of natural waters by sediments and agricultural fertilizers and pesticides. The increasing substitution of energy for labor and other cultural inputs in agriculture is another issue. Fertilizers and chemicals account for about 25% of the (...) production energy investment in agriculture. An additional 60% is accounted for by machinery, gasoline, electricity, and power-related inputs. Fertilizer additions to cropland are not utilized fully and significant amounts, depending on conditions, are either lost in surface runoff or leached into the ground water. The annual discharge of dissolved solids from agricultural lands to the waterways in the USA is substantial. The increasing use of herbicides in agriculture is a threat to the quality of surface and ground water, although this threat is dependent upon both the chemistry of the compound and the ecosystem in which it is used. Especially within the Third World, development of an environmental ethic and environmental laws have not kept pace with the increase in pesticide use. Above all is the severe and global problem of soil degradation currently occurring at the rate of five to seven million hectares per year. The policy and moral aspects of these issues are discussed. (shrink)

Transplantation of vital organs has been premised ethically and legally on "the dead donor rule" (DDR)—the requirement that donors are determined to be dead before these organs are procured. Nevertheless, scholars have argued cogently that donors of vital organs, including those diagnosed as "brain dead" and those declared dead according to cardiopulmonary criteria, are not in fact dead at the time that vital organs are being procured. In this article, we challenge the normative rationale for the DDR by rejecting the (...) underlying premise that it is necessarily wrong for physicians to cause the death of patients and the claim that abandoning this rule would exploit vulnerable patients. We contend that it is ethical to procure vital organs from living patients sustained on life support prior to treatment withdrawal, provided that there is valid consent for both withdrawing treatment and organ donation. However, the conservatism of medical ethics and practical concerns make it doubtful that the DDR will be abandoned in the near future. This leaves the current practice of organ transplantation based on the "moral fiction" that donors are dead when vital organs are procured. (shrink)

Ethical guidelines for conducting clinical trials have historically been based on a perceived therapeutic obligation to treat and benefit the patient-participants. The origins of this ethical framework can be traced to the Hippocratic oath originally written to guide doctors in caring for their patients, where the overriding moral obligation of doctors is strictly to do what is best for the individual patient, irrespective of other social considerations. In contrast, although medicine focuses on the health of the person, public health is (...) concerned with the health of the entire population, and thus, public health ethics is founded on the societal responsibility to protect and promote the health of the population as a whole. From a public health perspective, research ethics should be guided by giving due consideration to the risks and benefits to society in addition to the individual research participants. On the basis of a duty to protect the population as a whole, a fiduciary obligation to realise the social value of the research and the moral responsibility to distribute the benefits and burdens of research fairly across society, how a public health perspective on research ethics results in fundamental re-assessments of the proper course of action for two salient topical issues in research ethics is shown: stopping trials early for reasons of efficacy and the conduct of research on less expensive yet less effective interventions. (shrink)

Although established in the law and current practice, the determination of death according to neurological criteria continues to be controversial. Some scholars have advocated return to the traditional circulatory and respiratory criteria for determining death because individuals diagnosed as ‘brain dead’ display an extensive range of integrated biological functioning with the aid of mechanical ventilation. Others have attempted to refute this stance by appealing to the analogy between decapitation and brain death. Since a decapitated animal is obviously dead, and ‘brain (...) death’ represents physiological decapitation, brain dead individuals must be dead. In this article we refute this ‘decapitation gambit.’ We argue that decapitated animals are not necessarily dead, and that, moreover, the analogy between decapitation and the clinical syndrome of brain death is flawed. (shrink)

Background: Expanded newborn screening generates incidental results, notably carrier results. Yet newborn screening programmes typically restrict parental choice regarding receipt of this non-health serving genetic information. Healthcare providers play a key role in educating families or caring for screened infants and have strong beliefs about the management of incidental results. Methods: To inform policy on disclosure of infant sickle cell disorder (SCD) carrier results, a mixed-methods study of healthcare providers was conducted in Ontario, Canada, to understand attitudes regarding result management (...) using a cross-sectional survey (N = 1615) and semistructured interviews (N = 42). Results: Agreement to reasons favouring disclosure of SCD carrier results was high (65.1%–92.7%) and to reasons opposing disclosure was low (4.1%–18.1%). Genetics professionals expressed less support for arguments favouring disclosure (35.3%–78.8%), and more agreement with arguments opposing disclosure (15.7%–51.9%). A slim majority of genetics professionals (51.9%) agreed that a reason to avoid disclosure was the importance of allowing the child to decide to receive results. Qualitatively, there was a perceived “duty” to disclose, that if the clinician possessed the information, the clinician could not withhold it. Discussion: While a majority of respondents perceived a duty to disclose the incidental results of newborn screening, the policy implications of these attitudes are not obvious. In particular, policy must balance descriptive ethics (ie, what providers believe) and normative ethics (ie, what duty-based principles oblige), address dissenting opinion and consider the relevance of moral principles grounded in clinical obligations for public health initiatives. (shrink)

: Catholic teaching has no moral difficulties with research on stem cells derived from adult stem cells or fetal cord blood. The ethical problem comes with embryonic stem cells since their genesis involves the destruction of a human embryo. However, there seems to be significant promise of health benefits from such research. Although Catholic teaching does not permit any destruction of human embryos, the question remains whether researchers in a Catholic institution, or any researchers opposed to destruction of human embryos, (...) could participate in research on cultured embryonic stem cells, or whether a Catholic institution could use any therapy that ultimately results from such research. This position paper examines how such research could be conducted legitimately in a Catholic institution by using an ethical analysis involving a narrative context, the nature of the moral act, and the principle of material cooperation, along with references to significant ethical assessments. It also offers tentative guidelines that could be used by a Catholic institution in implementing such research. (shrink)

Background It has been suggested that researchers are obliged to offer summary findings to research participants to demonstrate respect for persons, and that this may increase public trust in, and awareness of, the research enterprise. Yet little research explores researchers' attitudes and practices regarding the range of initiatives that might serve these ends. Methods Results of an international survey of 785 eligible authors of genetics research studies in autism or cystic fibrosis are reported. Results Of 343 researchers who completed the (...) survey (44% response rate), the majority agreed that their team should (i) inform participants of summary findings (90.7%) and (ii) ensure they gain an awareness of developments in the field (86.9%). Additionally, the majority reported that in practice, their team (i) informs participants of summary findings (69.4%) and (ii) provides other types of relevant non-results information (eg, state of science in the field, opportunities for research participation) (67.9%). Conclusion Researchers endorsed the obligation of communicating with research participants by providing summary findings and other research-related information in equal measure. In light of these findings, it is suggested that while the provision of summary results may contribute to efforts to discharge the obligation of respect for persons, it may be neither a necessary nor a sufficient means to this end. (shrink)

A real is called properly n-generic if it is n-generic but not n+1-generic. We show that every 1-generic real computes a properly 1-generic real. On the other hand, if m > n ≥ 2 then an m-generic real cannot compute a properly n-generic real.

Late in 1990, the Center for the Study of Ethics in the Professions at Illinois Institute of Technology (lIT) received a grant of more than $200,000 from the National Science Foundation to try a campus-wide approach to integrating professional ethics into its technical curriculum.! Enough has now been accomplished to draw some tentative conclusions. I am the grant's principal investigator. In this paper, I shall describe what we at lIT did, what we learned, and what others, especially philosophers, can learn (...) from us. We set out to develop an approach that others could profitably adopt. I believe that we succeeded. (shrink)

This report describes the rationale, approaches, organization, and resource development leading to a large-scale deletion bin map of the hexaploid wheat genome. Accompanying reports in this issue detail results from chromosome bin-mapping of expressed sequence tags representing genes onto the seven homoeologous chromosome groups and a global analysis of the entire mapped wheat EST data set. Among the resources developed were the first extensive public wheat EST collection. Described are protocols for sequencing, sequence processing, EST nomenclature, and the assembly of (...) ESTs into contigs. These contigs plus singletons were used for selection of distinct sequence motif unigenes. Selected ESTs were rearrayed, validated by 5′ and 3′ sequencing, and amplified for probing a series of wheat aneuploid and deletion stocks. Images and data for all Southern hybridizations were deposited in databases and were used by the coordinators for each of the seven homoeologous chromosome groups to validate the mapping results. Results from this project have established the foundation for future developments in wheat genomics. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Male provisioning ability may have evolved as a “good dad” indicator through sexual selection, whereas male creativity may have evolved partly as a “good genes” indicator. If so, women near peak fertility (midcycle) should prefer creativity over wealth, especially in short-term mating. Forty-one normally cycling women read vignettes describing creative but poor men vs. uncreative but rich men. Women’s estimated fertility predicted their short-term (but not long-term) preference for creativity over wealth, in both their desirability ratings of individual men (r=.40, (...) p<.01) and their forced-choice decisions between men (r=.46, p<.01). These preliminary results are consistent with the view that creativity evolved at least partly as a good genes indicator through mate choice. (shrink)

We agree with Berger and Miller that the focus on cultural competence in medical education fails to name or confront key drivers of health inequity such as structural racism, social determin...

We study the relative complexity of equivalence relations and preorders from computability theory and complexity theory. Given binary relationsR,S, a componentwise reducibility is defined byR≤S⇔ ∃f∀x, y[x R y↔fS f].Here,fis taken from a suitable class of effective functions. For us the relations will be on natural numbers, andfmust be computable. We show that there is a${\rm{\Pi }}_1^0$-complete equivalence relation, but no${\rm{\Pi }}_k^0$-complete fork≥ 2. We show that${\rm{\Sigma }}_k^0$preorders arising naturally in the above-mentioned areas are${\rm{\Sigma }}_k^0$-complete. This includes polynomial timem-reducibility on (...) exponential time sets, which is${\rm{\Sigma }}_2^0$, almost inclusion on r.e. sets, which is${\rm{\Sigma }}_3^0$, and Turing reducibility on r.e. sets, which is${\rm{\Sigma }}_4^0$. (shrink)

We say that E is R-sparse if f(Ek) has no interior, for each k 2 N and f : Rk ! R de nable in R. (Throughout, \de nable" means \de nable without parameters".) In this note, we consider the extent to which basic metric and topological properties of subsets of R de nable in (R;E)# are determined by the corresponding properties of subsets of R de nable in (R;E), when R is an o-minimal expansion of (R;<;+;0;1) and E is (...) R-sparse. The precise statement of the main result is a bit complicated, but we can state some special cases now. (shrink)

Bernard Williams charges that the moral psychology built into R. M. Hare’s utilitarianism is incoherent in virtue of demanding a bifurcated kind of moral thinking that is possible only for agents who fail to reflect properly on their own practical decision making. I mount a qualified defence of Hare’s view by drawing on the account of the ‘reactive attitudes’ found in P. F. Strawson’s ‘Freedom and Resentment’. Against Williams, I argue that the ‘resilience’ of the reactive attitudes ensures that our (...) taking an instrumental view of our dispositions to experience guilt and compunction, as Hare calls for us to do while engaged in ‘critical’ moral thinking, will not prevent us from experiencing these feelings as people ordinarily do while we are thinking ‘intuitively’. I also consider the implications of my argument for consequentialism more generally and (briefly) Kantianism. (shrink)

We study arithmetic and hyperarithmetic degrees of categoricity. We extend a result of E. Fokina, I. Kalimullin, and R. Miller to show that for every computable ordinal $\alpha$, $\mathbf{0}^{}$ is the degree of categoricity of some computable structure $\mathcal{A}$. We show additionally that for $\alpha$ a computable successor ordinal, every degree $2$-c.e. in and above $\mathbf{0}^{}$ is a degree of categoricity. We further prove that every degree of categoricity is hyperarithmetic and show that the index set of structures with (...) degrees of categoricity is $\Pi_{1}^{1}$-complete. (shrink)

We improve on and generalize a 1960 result of Maltsev. For a field F, we denote by $H(F)$ the Heisenberg group with entries in F. Maltsev showed that there is a copy of F defined in $H(F)$, using existential formulas with an arbitrary non-commuting pair of elements as parameters. We show that F is interpreted in $H(F)$ using computable $\Sigma _1$ formulas with no parameters. We give two proofs. The first is an existence proof, relying on a result of Harrison-Trainor, (...) Melnikov, R. Miller, and Montalbán. This proof allows the possibility that the elements of F are represented by tuples in $H(F)$ of no fixed arity. The second proof is direct, giving explicit finitary existential formulas that define the interpretation, with elements of F represented by triples in $H(F)$. Looking at what was used to arrive at this parameter-free interpretation of F in $H(F)$, we give general conditions sufficient to eliminate parameters from interpretations. (shrink)

The philosophy of Wittgenstein is both novel and enigmatic. What is his new revolutionizing methodology? What is his aim, his purpose, his intention? What does he mean by the puzzling terms ‘forms of life’, ‘language-games’, ‘seeing as’? The key to the answers, according to the thesis of this paper, lies in Wittgenstein’s conception of the ‘Weltanschauung’. By the explanation of the use of this term, the entire philosophy of Wittgenstein may become illuminated with new meaning and interpretation. In understanding the (...) meaning of the word ‘Weltanschauung’ we shall come to understand why Wittgenstein used his new method, just what that method was, and what the impact of the concept and method had on the terms ‘Language-game’, ‘forms of life’ and ‘seeing as’. (shrink)

pt. 1. A critique of current educational aims.--pt. 2. Reason.--pt. 3. Education and reason.

In this paper, we continue investigations into the asymptotic behavior of solutions of differential equations over o-minimal structures.Let ℜ be an expansion of the real field (ℝ, +, ·).A differentiable mapF= (F1,…,F1): (a, b) → ℝiisℜ-Pfaffianif there existsG: ℝ1+l→ ℝldefinable in ℜ such thatF′(t) =G(t, F(t)) for allt∈ (a, b) and each component functionGi: ℝ1+l→ ℝ is independent of the lastl−ivariables (i= 1, …,l). If ℜ is o-minimal andF: (a, b) → ℝlis ℜ-Pfaffian, then (ℜ,F) is o-minimal (Proposition 7). We (...) say thatF: ℝ → ℝlis ultimately ℜ-Pfaffian if there existsr∈ ℝ such that the restrictionF↾(r, ∞) is ℜ-Pfaffian. (In general,ultimatelyabbreviates “for all sufficiently large positive arguments”.)The structure ℜ isclosed under asymptotic integrationif for each ultimately non-zero unary (that is, ℝ → ℝ) functionfdefinable in ℜ there is an ultimately differentiable unary functiongdefinable in ℜ such that limt→+∞[g′(t)/f(t)] = 1- If ℜ is closed under asymptotic integration, then ℜ is o-minimal and definesex: ℝ → ℝ (Proposition 2).Note that the above definitions make sense for expansions of arbitrary ordered fields. (shrink)