In a research proposal recently submitted to one of the research ethics committees in Wales, children suffering from otitis media, or ‘glue ear’ as it is more familiarly known, were to be tested for allergic reactions to a number of substances using skin-prick tests. Small lancets would be used to pierce the skin of the forearm, allowing the penetration of traces of the allergenic reagent. The size of the subsequent inflamed area of skin would be measured. To demonstrate the expected (...) correlation between glue ear and an allergic reaction, it would be necessary to see whether other children who did not suffer from glue ear also had the same reactions. If they did not, of course, then some causal association between the reaction and the disease condition could be inferred and investigated, with the hope of improving the treatment of the disease itself. (shrink)

The purpose of medical humanities is to improve the delivery of effective health care through a better understanding of disease in society, and in the individual. The interfaces between the science of medicine and the arts, philosophy, sociology and law interpret causes and effects of disease. The field of medical ethics is the most prominent offspring of this wider debate, yet the context of disease in the life of the individual and of society is profound and far-reaching. The influences of (...) medicine on the humanities and vice versa are all around, yet only recently have they been recognised in the wider world of health care. How can you encapsulate the essence of medical humanities and teach it to health professionals? Medical Humanities is designed to fill the need for a clear, well illustrated text that both provides the principles for the individual reader, and encourages discussion. The issues are explored in four main sections. Based on a highly successful seminar, and with contributions from leading writers, thinkers, and teachers, this book provides a comprehensive and authoritative reference for what is becoming a professional requirement in medicine. It will be invaluable for clinicians and students alike. (shrink)

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: as a salutary reminder of the extent to which thereality even of the human body is constructed; and as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy''s traditional questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and the (...) body familiar in daily experience. Toulmin''s epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate. (shrink)

In this book the author argues that human musical understanding is rooted in the traditions of culture and that experience of music depends crucially on what the individual brings to it.

Recruiting patients into clinical research is essential for the advancement of medical knowledge. However, when the physician undertaking the care of the patient is also responsible for recruitment into clinical research, a situation arises of an inter-role breach of confidentiality which is distinguishable from other conflicts of interest. Such discord arises as the physician utilizes confidential information obtained within the therapeutic relationship beyond its primary objective, and safeguards ought to be observed in order to avert this important, and generally overlooked, (...) problem. The moral worth of the pledge of confidentiality is based not on its innate value but on its being a promise on which subsequent interactions and disclosures are founded. Within the patient-doctor interaction, confidentiality is an important facet of the promised fidelity and, as such, a loose interpretation of the notion threatens the essence of the relationship, and any violation thereof requires compelling moral justification. To avoid conflict, patients' confidential information ought not be used for the purpose of recruitment, which needs to be undertaken through general education and non-directed appeals, and a preliminary consent to be approached for research should be obtained from the patient prior to her being identified as a suitable research subject. Securing this prior consent would avoid one source of potential, albeit unintended, coercion. (shrink)

Many bioethics questions are resistant to journalistic exploration on account of their inherently philosophical dimensions. Such dimensions are ill-suited to what we may term the internal goods (in MacIntyre's sense) of the newspapers and mass media generally, which constrain newspaper coverage to an abbreviated form of narrative that, whilst not in itself objectionable, is nonetheless inimical to the conduct of philosophical reflection. The internal goods of academic bioethics, by contrast, include attention to philosophical questions inherent in bioethical issues and value-enquiry. (...) The danger for bioethics is that its agenda for reflective enquiry will, if dictated by this abbreviated narrative, be distorted in terms of both range and priorities, to the inevitable neglect of questions having a philosophical dimension to them. This danger can be avoided by a constructive partnership between the media and academic bioethics. The success of this partnership relies on four suggested provisos, for the meeting of which both journalists and academics bear responsibility. (shrink)

Using fictionalized case studies this series follows four patients through the medical process, from onset through Diagnosis, Treatment and PrognosisVolume 1: Symptom. Examines the idea of 'symptom' as a route to understanding the structure of clinical practice -- Volume 2: Diagnosis. Explores the meaning of 'diagnosis' as a complex, culturally mediated interaction between individuals, scientific discoveries, social negotiation and historical change. -- Volume 3: Treatment. Considers the concept of treatment as an active process which produces an outcome, be it effective, (...) inappropriate or inadequate. Enlightening reading. -- Volume 4: Prognosis. Contemplates the challenge of the prognosis, attempting to make sense of life and death. Considers, through personal and professional perspectives, the role of the medical profession in guiding patient experience.--. (shrink)

This text offers a concise explanation of how philosophical concepts underpin much medical activity, and how being aware of this can improve everyday practice. It is not a basic introduction to philosophy, but restricts itself to those aspects that have a direct impact on medical professionals.

Throughout the world, research ethics committees are relied on to prevent unethical research and protect research subjects. Given that reliance, the composition of committees and the manner in which decisions are arrived at by committee members is of critical importance. There have been Instances in which an inadequate review process has resulted in serious harm to research subjects. Deficient committee review was identified as one of the factors In a study in New Zealand which resulted in the suffering and death (...) of many women diagnosed with carcinoma in situ. (shrink)

Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren Holm (...) in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)

A Decent Proposal: Ethical Review of Clinical Research Donald Evans and Martyn Evans Centre for Philosophy and Health Care University of Wales Swansea, UK The investigation and development of modern medicines and medical technology can create numerous ethical dilemmas both for clinical researchers and research ethics committees. A Decent Proposal: Ethical Review of Clinical Research seeks to facilitate and encourage good clinical research by exploring the concerns, responsibilities, general issues and particular pitfalls associated with ethical aspects of (...) research. It provides practical guidelines for researchers on how to improve the quality of research design, while for those appointed to scrutinise research proposals it offers advice on how to apply consistent, careful and critical reasoning to the process of assessing ethical standards. As such, it will provide invaluable assistance to clinical researchers and ethics committees alike in understanding the moral challenges posed by modern health care. (shrink)

‘Virtue signaling’ is the practice of using moral talk in order to enhance one’s moral reputation. Many find this kind of behavior irritating. However, some philosophers have gone further, arguing that virtue signaling actively undermines the proper functioning of public moral discourse and impedes moral progress. Against this view, I argue that widespread virtue signaling is not a social ill, and that it can actually serve as an invaluable instrument for moral change, especially in cases where moral argument alone does (...) not suffice. Specifically, virtue signaling can change the broader public’s social expectations, which can in turn motivate the adoption of new, positive social norms. I also argue that the reputation-seeking motives underlying virtue signaling impose important constraints on virtue signalers’ behavior, which serve to keep the worst excesses of virtue signaling in check. (shrink)

How is human social intelligence engaged in the course of ordinary conversation? Standard models of conversation hold that language production and comprehension are guided by constant, rapid inferences about what other agents have in mind. However, the idea that mindreading is a pervasive feature of conversation is challenged by a large body of evidence suggesting that mental state attribution is slow and taxing, at least when it deals with propositional attitudes such as beliefs. Belief attributions involve contents that are decoupled (...) from our own primary representation of reality; handling these contents has come to be seen as the signature of full-blown human mindreading. However, mindreading in cooperative communication does not necessarily demand decoupling. We argue for a theoretical and empirical turn towards “factive” forms of mentalizing here. In factive mentalizing, we monitor what others do or do not know, without generating decoupled representations. We propose a model of the representational, cognitive, and interactive components of factive mentalizing, a model that aims to explain efficient real-time monitoring of epistemic states in conversation. After laying out this account, we articulate a more limited set of conversational functions for nonfactive forms of mentalizing, including contexts of meta-linguistic repair, deception, and argumentation. We conclude with suggestions for further research into the roles played by factive versus nonfactive forms of mentalizing in conversation. (shrink)

Character judgments play an important role in our everyday lives. However, decades of empirical research on trait attribution suggest that the cognitive processes that generate these judgments are prone to a number of biases and cognitive distortions. This gives rise to a skeptical worry about the epistemic foundations of everyday characterological beliefs that has deeply disturbing and alienating consequences. In this paper, I argue that this skeptical worry is misplaced: under the appropriate informational conditions, our everyday character-trait judgments are in (...) fact quite trustworthy. I then propose a mindreading-based model of the socio-cognitive processes underlying trait attribution that explains both why these judgments are initially unreliable, and how they eventually become more accurate. (shrink)

In recent years, there has been a heated debate about how to interpret findings that seem to show that humans rapidly and automatically calculate the visual perspectives of others. In the current study, we investigated the question of whether automatic interference effects found in the dot-perspective task (Samson, Apperly, Braithwaite, Andrews, & Bodley Scott, 2010) are the product of domain-specific perspective-taking processes or of domain-general “submentalizing” processes (Heyes, 2014). Previous attempts to address this question have done so by implementing inanimate (...) controls, such as arrows, as stimuli. The rationale for this is that submentalizing processes that respond to directionality should be engaged by such stimuli, whereas domain-specific perspective-taking mechanisms, if they exist, should not. These previous attempts have been limited, however, by the implied intentionality of the stimuli they have used (e.g. arrows), which may have invited participants to imbue them with perspectival agency. Drawing inspiration from “novel entity” paradigms from infant gaze-following research, we designed a version of the dot-perspective task that allowed us to precisely control whether a central stimulus was viewed as animate or inanimate. Across four experiments, we found no evidence that automatic “perspective-taking” effects in the dot-perspective task are modulated by beliefs about the animacy of the central stimulus. Our results also suggest that these effects may be due to the task-switching elements of the dot-perspective paradigm, rather than automatic directional orienting. Together, these results indicate that neither the perspective-taking nor the standard submentalizing interpretations of the dot-perspective task are fully correct. (shrink)

Recent theoretical and philosophical movements within the study of material culture are more carefully attending to the variety of ways in which human artefacts, institutions, and cultural developments extend, shape and alter human cognition over time. Material Engagement Theory in particular has set out to map, explore and understand the relational nature of mind and material world as can be read through cultural artefacts. Within the context of MET, the neurological concept of metaplasticity has been expanded to include the affective (...) domains of technology, materials, and things in the neurological development and architecture of the plastic human mind; a ‘transactional’ relationship between a plastic mind and a plastic material world that are correlated at the ontological level. The challenges of mapping this metaplasticity of mind lie in understanding how the mind and material culture should be understood in relation to the constantly changing lifeworlds of humans over time; the ecological, social, technological and environmental contexts that form the historical specificity of cognitive development. This paper explores how the historical specificity of metaplasticity can be made tangible through the study of material culture, focusing upon the particular activity of oil painting. It will be argued that paintings can provide clues to the historical specificity of the mind that crosses the lifeworld of human action; the technological, phenomenological, philosophical, material, and social conditions underpinning the creation of a painted mark. Drawing from a range of sources that have a root within a Deleuzian process philosophy, the paper builds an account of painting that can be read as expressing the encultured and historical manipulation of paint as an expressive material in itself; an action rendered visible that express the historical emergence of mind. (shrink)

Phillips and colleagues convincingly argue that knowledge attribution is a faster, more automatic form of mindreading than belief attribution. However, they do not explain what it is about knowledge attribution that lends it this cognitive advantage. I suggest an explanation of the knowledge-attribution advantage that would also help to distinguish it from belief-based and minimalist alternatives.

Regulated secretory proteins are stored within specialized vesicles known as secretory granules. It is not known how proteins are sorted into these organelles. Regulated proteins may possess targeting signals which interact with specific sorting receptors in the lumen of the trans‐Golgi network (TGN) prior to their aggregation to form the characteristic dense‐core of the granule. Alternatively, sorting may occur as the result of specific aggregation of regulated proteins in the TGN. Aggregates may be directed to secretory granules by interaction of (...) a targeting signal on the surface with a sorting receptor. Novel targeting signals which confer on regulated proteins a tendency to aggregate under certain conditions, and in so doing cause them to be incorporated into secretory granules, have been implicated. Specific targeting signals may also play a role in directing membrane proteins to secretory granules. (shrink)

Theories of affective influences on cognition posit that negative mood may increase cognitive load, causing a decrement in task performance (Seibert & Ellis, [1991]. Irrelevant thoughts, emotional mood states, and cognitive task performance. Memory & Cognition, 19(5), 507–513), or cause a shift to more analytic thinking, which benefits tasks requiring attention to detail (Schwarz & Clore, [1983]. Mood, misattribution, and judgments of well-being: Informative and directive functions of affective states. Journal of Personality and Social Psychology, 45(3), 513–523). We previously reported (...) that individuals who are higher in the trait of emotional reactivity performed better on an inhibitory task with increasing negative mood whereas low-reactive individuals showed the converse pattern (Gabel & McAuley, [2018]. Does mood help or hinder executive functions? Reactivity may be the key. Personality and Individual Differences, 128, 94–99; [2020]. React to act: Negative mood, response inhibition, and the moderating role of emotional reactivity. Motivation and Emotion, 44(6), 862–869). Because high-reactive individuals are more accustomed to negative affect (Nock et al., [2008]. The emotion reactivity scale: Development, evaluation, and relation to self-injurious thoughts and behaviors. Behavior Therapy, 39(2), 107–116), we speculated that negative mood engendered analytic thinking but without a task-incongruent increase in cognitive load – thereby facilitating performance. Here, we induced a heuristic or analytic approach to information processing prior to performance of an inhibitory task and expected different results pending the thinking style induced. In the heuristic condition, increasing negative mood was associated with better performance for high-reactive participants but not their low-reactive counterparts. In the analytic condition, increasing negative mood was associated with better performance irrespective of emotional reactivity. Our results are consistent with the notion that negative mood engenders analytic thinking which may benefit response inhibition provided it does not increase task-incongruent cognitive load. (shrink)

The concept of “ethical research” holds considerable sway over the ways in which contemporary biomedical, natural, and social science investigations are funded, regulated, and practiced within a variety of countries. Some commentators have viewed this “new” means of governance positively; others, however, have been resoundingly critical, regarding it as restrictive and ethics bodies and regulations unfit for the task they have been set. Regardless, it is clear that science today is an “ethical” business. The ways in which formal and informal (...) ethical discourses and practices—what might be called “regimes of normativity”—structure scientific work and the meanings it is ascribed with have, however, been underexplored. This article attends to how science and ethics articulate; how they are, in many ways, co-produced. Exploring these processes of co-production casts into sharp relief the essential emotionality of science; the relationships investigators have with their colleagues, work, and research participants pulse with emotion, potentially shaping in important ways the very kinds of knowledge that laboratories produce. (shrink)

The development of the fifth edition of the American Psychiatric Association9s _Diagnostic and Statistical Manual of Mental Disorders_—the DSM-5—has reenergised and driven further forward critical discourse about the place and role of diagnosis in mental health. The DSM-5 has attracted considerable criticism, not least about its role in processes of medicalisation. This paper suggests the need for a sociology of psychiatric critique. Sociological analysis can help map fields of contention, and cast fresh light on the assumptions and nuances of debate (...) around the DSM-5; it underscores the importance of diagnosis to the governance of social and clinical life, as well as the wider discourses critical commentaries connect with and are activated by. More normatively, a sociology of critique can indicate which interests and values are structuring the dialogues being articulated, and just how diverse clinical opinion regarding the DSM can actually be. This has implications for the considerations of health services and policy decision-makers who might look to such debates for guidance. (shrink)

There is much law and many guidelines surrounding the whole issue of the indemnity for human volunteers when it comes to clinical trials. The system that had been put in place to protect individual volunteer drug trialists seems largely to have worked by the fact that there are so few examples of legal cases being issued. However, recent events have shown that when the system fails it fails somewhat spectacularly. The difficulty for groups such as the ethics committee is that (...) lawyers look for targets to try and meet the difference between the claims and the monies available and it might therefore always be possible that the ethics committee becomes centre stage in terms of the pursuit of the action. (shrink)

This article challenges the assumption inherent in many ethics codes that duties only arise when the project is sufficiently advanced that a formal research proposal can be put before an ethics committee for approval. Certain social science methodologies do not lend themselves to a simple demarcation between the preparation and the implementation of the research. It is therefore imperative that consideration is given to researchers' ethical duties prior to formal review. The problem of demarcation and of defining a duty are (...) explored in the particular context of a potential research project involving research on taxi-drivers' experiences of crime and the strategies that they employ to avoid victimisation. Two key issues emerge. First, in what circumstances, if any, can information supplied during this gestation period be used as ‘research data’? Secondly, there are concerns about the researcher's identity and role at this stage. These issues, and others, need to be the subject of further consideration by the relevant bodies so that researchers receive meaningful guidance on the duty prior to ethics review. (shrink)

Gorgias’ On Not-Being survives only in two divergent summaries. Diels–Kranz's classic edition prints the better-preserved version that appears in Sextus’ Aduersus Mathematicos. Yet, in recent years there has been rising interest in a second summary that survives as part of the anonymous De Melisso, Xenophane, Gorgia. The text of MXG is more difficult; it contains substantial lacunae that often make it much harder to make grammatical let alone philosophical sense of. As Alexander Mourelatos reports, one manuscript has a scribal note (...) that reads: "The original contains many errors; no one should blame me; I just copy what I see.". The treatise's state of preservation has aptly prompted Michael Gagarin to liken it to a black hole: "something we cannot see directly but know must exist because of certain effects it has on other objects.". (shrink)

The years from 1918 to 1945 remain central to European History. It was a breath-taking time during which the very best and very worst attributes of Mankind were on display. In the euphoria of peace which followed the end of the First World War, the Baltic States emerged as independent forces on the world stage, participating in thrilling experiments in national and transnational governance. Later, following economic collapse and in the face of rising totalitarianism among even Europe’s most cultured nations, (...) Baltic communities succumbed to nationalism too. During wartime, Baltic peoples became both victims and, sometimes, victimisers. Ultimately their victimhood lasted until the end of the Cold War, yielding consequences still discernible at the start of the twenty first century. Taking the period 1918 to 1945 as pivotal, this collection of essays examines some of the key themes in Baltic History as they are emerging today. These include appreciations of identity, autonomy and the rights of national minorities; the everyday and social foundations of international security; and the importance of historical memory to popular and political identities. (shrink)

The current industrial revolution is said to be driven by the digitization that exploits connected information across all aspects of manufacturing. Standards have been recognized as an important enabler. Ontology-based information standard may provide benefits not offered by current information standards. Although there have been ontologies developed in the industrial manufacturing domain, they have been fragmented and inconsistent, and little has received a standard status. With successes in developing coherent ontologies in the biological, biomedical, and financial domains, an effort called (...) Industrial Ontologies Foundry (IOF) has been formed to pursue the same goal for the industrial manufacturing domain. However, developing a coherent ontology covering the entire industrial manufacturing domain has been known to be a mountainous challenge because of the multidisciplinary nature of manufacturing. To manage the scope and expectations, the IOF community kicked-off its effort with a proof-of-concept (POC) project. This paper describes the developments within the project. It also provides a brief update on the IOF organizational set up. (shrink)

The question has long confounded philosophers and scientists, and it is this so-called explanatory gap between biological life and consciousness that Evan ...