Traditionally, physicians and parents made decisions about children’s health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children — of diverse levels of cognitive development — are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning (...) children’s ‘best interest’. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families. (shrink)

ObjectiveHead and neck cancer treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: the prevalence, level, and course of body image concerns; correlates of upon cancer diagnosis body image concerns; predictors of immediate post-treatment body image concerns; and association between body image concerns (...) and levels of anxiety, depression, suicidal ideation, support, and alcohol and drug misuse.MethodsTwo hundred and twenty-three, newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model.ResultsSixty-eight percent of patients with HNC presented some level of body image concerns. Body image concerns at baseline and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment, 89% presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism.ConclusionThis longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions. (shrink)

This paper argues that efforts to understand historically remote patterns of thought are driven away from their original meaning if the investigation focuses on reconstruction of concepts , instead of cognitive ‘complexes’. My paper draws on research by Jan Assmann, Jean-Jacques Glassner, Keimpe Algra, Alex Purves, Nicholas Wyatt, and others on the cultures of Ancient Greece, Israel, Egypt, Mesopotamia, and Etruria through comparative analyses of the semantic fields of spatial and temporal terms, and how these terms are shaped by (...) their relation to the sphere of the sacred. It shows that there are three super-ordinate timeframes - the cyclical, the linear and the static - each of which is composed of lower-order cycles (days, lunar months, and seasons). These timeframes reflect their cultures’ ideas about the nature, scope and power of the gods, and structure the common point-of-view about the present, the past and eternity. There are also super-ordinate spatial frames which reflect their cultures’ ideas about the heavens and which structure both the sacred precinct and the profane field of action and exchange. Close analysis of texts that use words such as eternity, forever, past, present, and future, for example, do not reveal that there is anything like a general abstract concept of time in virtue of which some thing or event can be said to be in time or to have its own time. Archaic patterns of thought do not differ from our “ modern ” patterns in having different concepts, but in not having anything like concepts at all. (shrink)

Alex Oliver and Timothy Smiley provide a new account of plural logic. They argue that there is such a thing as genuinely plural denotation in logic, and expound a framework of ideas that includes the distinction between distributive and collective predicates, the theory of plural descriptions, multivalued functions, and lists.

In Ep. 50, Spinoza argues at length that “someone who calls God one or unique does not have a true idea of God, or is speaking improperly about him.” This text is striking, given the declarations in many writings, including the Ethics, that God is the one, unique substance. While recent commentators have attempted to render Ep. 50 consistent with the rest of Spinoza’s corpus, I instead argue that Spinoza’s stance on God’s oneness evolved over the course of his career. (...) This evolution, which in fact contains a number of twists and turns, is driven not only by consideration of the proper meaning of ‘one’ and ‘unique’ but also by the question of whether God’s essence and God’s existence are numerically identical. Regarding the latter, I argue that Spinoza came to reject this identity claim late in life, and that this explains his final change in viewpoint regarding God’s oneness in Ep. 83. (shrink)

Resumo: Neste ensaio, pretende-se uma aproximação crítica e interpretativa sobre o conceito de “devir negro”, na atualidade, trazido, sobretudo, pelo pensador camaronês Achille Mbembe. Seu pensamento se insere num contexto de fluidez da compreensão desses temas, a partir da lógica capitalista, no continente africano e no mundo. Dessa maneira, buscou-se refletir acerca da constituição do pensamento de Mbembe e da forma como ele compreendeu as práticas de governamentabilidade, na superação da dominação colonial. Defende-se que é preciso afirmar-se negro, para negar (...) o lugar que lhe foi imputado, ou seja, empreender um processo de negação para um “devir”. Portanto, negar-se como “o outro” do “outro”, mas, sim, afirmar-se como seu igual na diferença. Com efeito, a estereotipia negativa contra o negro e o aprofundamento das diferenças entre os grupos étnicos ganham novas e outras dimensões, em função do modo de exploração capitalista.: In this essay, a critical and interpretive aproach to the concept of “devir black” is nowadays brought, above all, from Cameroonian thinker Achille Mbembe. His thinking is part of a context of fluidity in the understanding of these themes based on capitalist logic in the African continent and in the world. In this way, we sought to reflect the constitution of Mbembe’s thought and the way he understood the practices of governance in overcoming colonial domination. It is argued that it is necessary to claim to be black instead of denying the place attributed to it, that is, to undertake a process of denial for a “becoming”. Therefore, to deny yourself as “the other” of the “other”, but rather to assert yourself as your equal in difference. Indeed, the negative stereotypy against blacks and the deepening of differences between ethnic groups, takes on new dimensions, based on the mode of capitalist exploitation. (shrink)

This paper uses Carl Ginet's concept of “disinterested justification” to identify the boundaries of the epistemic authority of courts. It claims that courts exercise this authority only in the “interest-free” zone, in which their determinations of disputed facts’ probabilities can be made and justified on epistemic grounds alone. This is not the case with the “interest-laden” domain, where courts allocate risks of error under conditions of uncertainty. This domain is controlled by the risk-allocating evidentiary rules: burdens of proof, corroboration, hearsay, (...) opinion, character, and others. These rules are driven by moral and political, rather than epistemic, reasons. Their role is to allocate the risk of error among plaintiffs, defendants, and prosecution by setting forth probability thresholds for findings of fact and the criteria for adequacy of the evidence upon which those findings can be made. (shrink)

Alex Oliver; XI*—A Few More Remarks on Logical Form, Proceedings of the Aristotelian Society, Volume 99, Issue 1, 1 June 1999, Pages 247–272, https://doi.org/10.

The debate over when medical research may be performed in developing countries has steered clear of the broad issues of social justice in favor of what seem more tractable, practical issues. A better approach will reframe the question of justice in international research in a way that makes explicit the links between medical research, the social determinants of health, and global justice.

The “fair benefits” approach to international research is designed to produce results that all can agree are fair without taking a stand on divisive questions of justice. But its appealing veneer of collaboration masks ambiguities at both a conceptual and an operational level. An attempt to put it into practice would look a lot like an auction, leaving little reason to think the outcomes will satisfy even minimal conditions of fairness.

To give substance to the rhetoric of ‘learning health systems’, a variety of novel trial designs are being explored to more seamlessly integrate research with medical practice, reduce study duration and reduce the number of participants allocated to ineffective interventions. Many of these designs rely on response adaptive randomisation. However, critics charge that RAR is unethical on the grounds that it violates the principle of equipoise. In this paper, I reconstruct critiques of RAR as holding that it is inconsistent with (...) five important ethical principles. I then argue that these criticisms rest on a faulty view of equipoise encouraged by the idea that a RAR study models the beliefs of a single rational agent about the relative merits of the interventions being studied. I outline a view in which RAR models an idealised health system in which diverse communities of fully informed experts shrink or grow as their constituent members update their expert opinions in light of reliable medical evidence. I show how a proper understanding of clinical equipoise can reconcile this conception of RAR with these five ethical principles. This analysis removes an in-principle objection to RAR and sheds important light on the relationship between clinical equipoise and transient diversity in the scientific community. (shrink)

This article argues that lingering uncertainty about the normative foundations of research ethics is perpetuated by two unfounded dogmas of research ethics. The first dogma is that clinical research, as a social activity, is an inherently utilitarian endeavor. The second dogma is that an acceptable framework for research ethics must impose constraints on this endeavor whose moral force is grounded in role-related obligations of either physicians or researchers. This article argues that these dogmas are common to traditional articulations of the (...) equipoise requirement and to recently articulated alternatives, such as the non-exploitation approach. Moreover, important shortcomings of these approaches can be traced to their acceptance of these dogmas. After highlighting these shortcomings, this article illustrates the benefits of rejecting these dogmas by sketching the broad outlines of an alternative called the "integrative approach" to clinical research. (shrink)

In the WebSurf task, humans forage for videos paying costs in terms of wait times on a time-limited task. A variant of the task in which demands during the wait time were manipulated revealed the role of attention in susceptibility to sunk costs. Consistent with parallel tasks in rodents, previous studies have found that humans preferred shorter delays, but waited longer for more preferred videos, suggesting that they were treating the delays economically. In an Amazon Mechanical Turk sample, we replicated (...) these predicted economic behaviors for a majority of participants. In the lab, participants showed susceptibility to sunk costs in this task, basing their decisions in part on time they have already waited, which we also observed in the subset of the mTurk sample that behaved economically. In another version of the task, we added an attention check to the wait phase of the delay. While that attention check further increased the proportion of subjects with predicted economic behaviors, it also removed the susceptibility to sunk costs. These findings have important implications for understanding how cognitive processes, such as the deployment of attention, are key to driving re-evaluation and susceptibility to sunk costs. (shrink)

Before participants can be enrolled in a clinical trial, an institutional review board must determine that the risks that the research poses to participants are ‘reasonable.’ This paper examines the two dominant frameworks for assessing research risks and argues that each approach suffers from significant shortcomings. It then considers what issues must be addressed in order to construct a framework for risk assessment that is grounded in a compelling normative foundation and might provide more operationally precise guidance to the deliberations (...) of various stakeholders. The paper concludes by sketching the outlines of what is referred to as the ‘Integrative Approach’ to risk assessment and by highlighting some of the ways in which this approach may be more promising than current alternatives. (shrink)

We present a plural logic that is as expressively strong as it can be without sacrificing axiomatisability, axiomatise it, and use it to chart the expressive limits set by axiomatisability. To the standard apparatus of quantification using singular variables our object-language adds plural variables, a predicate expressing inclusion (is/are/is one of/are among), and a plural definite description operator. Axiomatisability demands that plural variables only occur free, but they have a surprisingly important role. Plural description is not eliminable in favour of (...) quantification; on the contrary, quantification is definable in terms of it. Predicates and functors (function signs) can take plural as well as singular terms as arguments, and both many-valued and single-valued functions are expressible. The system accommodates collective as well as distributive predicates, and the condition for a predicate to be distributive is definable within it; similarly for functors. An essential part of the project is to demonstrate the soundness and completeness of the calculus with respect to a semantics that does without set-theoretic domains and in which the use of settheoretic extensions of predicates and functors is replaced by the sui generis relations and functions for which the extensions were at best artificial surrogates. Our metalanguage is designed to solve the difficulties involved in talking plurally about individuals and about the semantic values of plural items. (shrink)

The threat of biological and chemical terrorism highlights a growing tension in research ethics between respecting the interests of individuals and safeguarding and protecting the common good. But what it actually means to protect the common good is rarely scrutinized. There are two conceptions of the common good that provide very different accounts of the limits of permissible medical research. Decisions about the limits of acceptable medical research in defense of the common good should be carried out only within the (...) latter framework. (shrink)

Individuals diagnosed with conduct disorder (CD) in childhood and adolescence are at risk for increasingly maladaptive and dangerous behaviors, which unchecked, can lead to antisocial personality disorder (ASPD) in adulthood. Children with CD, especially those with the callous unemotional subgroup qualifier (“limited prosocial emotions”/dsm‐5), present with a more severe pattern of delinquency, aggression, and antisocial behavior, all markings of prodrome ASPD. Given this recognized diagnostic trajectory, with a pathological course playing out tragically at the individual, familial, and societal level, and (...) lack of effective remediation via current standards of care, we posit an alternate treatment approach; case‐specific compulsory moral habilitation aimed at rectifying the undeveloped affective domain of adolescents and young adults suffering from these disorders. We begin with a brief historical overview of response to mental illness, review CD and ASPD diagnostic criteria and treatment limitations, and posit a unique neurohabilitative approach that focuses on the absent affective moral development of these populations. Next, we invoke a public health safety argument to justify case‐specific compulsory moral habilitation, discuss neurotechnologies to be considered in treatment, and conclude with ethical considerations and suggestions for further research. (shrink)

Some commentators worry that a plurinational constitutional order can only ever be an inherently unstable modus vivendi. They fear that the accommodation of sub-state nationalism will tend to undermine the viability of constitutional democracies. This article enlists Ronald Dworkin's theory of ‘law as integrity’ to show how these concerns might be assuaged. My central claim is that the expressive value of integrity can drive a divided society in the direction of an eventual community of principle, even in the absence of (...) a common political identity. I argue that this model of political community is a more plausible prescription for divided societies than the theory that competing nationalisms might be superseded by constitutional patriotism. I go on to explain, however, that integrity has a better chance of realizing this potential if the generally judge-centric focus of Dworkin's theory is expanded to make greater room for non-judicial interpretative responsibility. Occasional references are made to the example of Northern Ireland to illustrate my points. (shrink)

The treaty of Atlantis -- Legitimacy in history -- American encyclope-deism (revolutions and open societies I) -- The well of the Caliph (revolutions and open societies II) -- Paradise won -- Slouching toward Geneva -- Conclusion : academic counter-enlightenment and the recline of the West.

Raimond Gaita affirms absolute goodness as the only thing with the power to keep fully among us the worst kind of evildoer. At issue in this goodness is a wonder that he ties to joy. Yet Gaita does not, perhaps cannot, imagine this power with respect to the evildoer concretely enough for it to move us in the way his account requires. An aspect of his writings that resists the emphasis on a joyous wonder may assist our thinking about the (...) relation to the evildoer. (shrink)

The article addresses Raimond Gaita's attempt to construe the ethical in terms of a notion of speech that is tied to presence (each of us, he holds, is called to become someone ‘authentically present in speech and deed’ (Gaita 1991, p. 145)), a notion through which he articulates a sense both of human uniqueness – speech demands that one find one's own words – and of human fellowship: to find one's words is to achieve the depth that enables one to (...) be taken seriously by others. The article argues, however, that the notion of speech is caught in a double bind; for it requires a spontaneity that is incompatible with the self‐presence that it also requires. In a way that Gaita cannot acknowledge, goodness is beyond speech. (shrink)

The essays in this collection are by some of the leading figures in their fields and they touch on the most recent turnings in Quine's work.

This article argues that considerations about the role and predictability of intellectual innovation make the protection of intellectual property morally obligatory even when it greatly reduces short-term welfare. Since the provision of good new ideas is the only productive input not subject to decreasing marginal productivity, welfarist considerations require that no impediment to its maximal provision be erected and the potentially substantial welfare losses imposed by a patent system be mitigated by taxation of other sources of wealth and income. Key (...) Words: patent system • welfarism • decreasing marginal productivity. (shrink)

Some concerns raised by gender violence have been taken up by churches and individuals within them over the last ten years or so, but now the World Council of Churches has set up a project to work specifically on Overcoming Violence Against Women. The project has a three-fold task aimed at enabling constructive engagement with the issue of gender violence: to support and encourage the churches' to develop a network of concerned theologians; to establish an accessible resource base. The prevalence (...) of violence against women in all parts of society, including churches and Christian communities, raises theological questions. Some areas of language, doctrine and the interpretation of Scripture need to be examined and perhaps reconsidered, to provide theologies consistent with churches as communities of safety, respect and justice for women. (shrink)

The fundamental thesis of David Lewis's "Parts of Classes" is that the nonempty subsets of a set are mereological parts of it. This paper shows that Lewis's considerations in favor of this thesis are unpersuasive. First, common speech provides no support. Second, the formal analogy between mereology and the Boolean algebra of sets can be explained without accepting the thesis. Third, it is very doubtful that the thesis is fruitful. Certainly, Lewis's claim that it helps us understand set theory is (...) unwarranted. (shrink)

Many philosophers call themselves ‘naturalists’ because they believe theism is incompatible with science. However, many also hold that science is compatible with many other theistic beliefs about morality, free will, the mind, and the meaning of life. Those naturalists who reject these other beliefs need a different label for their view. This article recommends the term ‘scientism’.

The social sciences need to take seriously their status as divisions of biology. As such they need to recognize the central role of Darwinian processes in all the phenomena they seek to explain. An argument for this claim is formulated in terms of a small number of relatively precise premises that focus on the nature of the kinds and taxonomies of all the social sciences. The analytical taxonomies of all the social sciences are shown to require a Darwinian approach to (...) human affairs, though not a nativist or genetically driven theory by any means. Non-genetic Darwinian processes have the fundamental role on all human affairs. I expound a general account of how Darwinian processes operate in human affairs by selecting for strategies and sets of strategies individuals and groups employ. I conclude by showing how a great deal of social science can be organized in accordance with Tinbergen’s approach to biological inquiry, an approach required by the fact that the social sciences are all divisions of biology, and in particular the studies of one particular biological species. (shrink)

Within international development [1], public health [2], and clinical medicine [3]–[5], there is increasing interest in determining whether cash payments or other economic incentives can be used to influence the choices and behavior of individuals and groups in order to promote desired health goals. However, a number of complex issues affect the review and approval by research ethics committees of research studying the effectiveness of using financial incentives to promote desired health goals. Current ethical and regulatory frameworks regard the provision (...) of gifts or cash payments to participants in human research as potentially problematic. Specifically, these frameworks imply that such incentives may undermine the autonomy of participant choice, hinder the disclosure of medical information, exacerbate social inequalities, or result in the exploitation or degradation of vulnerable populations [6]–[9]. Typically, these frameworks provide guidance about payment to research participants to reimburse expenses, to compensate for time and effort, to provide insurance coverage, or as an incentive to participate in the research itself. However, the issue of payment as a component of the research intervention is relatively new. RECs thus lack explicit guidance about ethical issues surrounding research that evaluates the use of financial incentives as an intervention to promote health. (shrink)

The lyric is a form or genre of poetry often intimately related to subjectivity. But is a lyricism divested of the subject possible? By examining the philosophical refl ections of Philippe Lacoue-Labarthe upon lyricism, poetry, and their relation to subjectivity, this article explicates how an impersonal lyricism is not only possible, but perhaps necessary. If we wish to do justice to the phrasing or saying of poetic language, then we must endeavour to think the displacement of the subject in and (...) by the very language that the poem expresses. Following Lacoue-Labarthe, this article explores the paradoxical turn of lyricism—that it is bound to the subject, but not to its personal expression; rather, to its disappearance, its displacement, in the expression of language itself. By tracing a sketch of Lacoue-Labarthe’s poetics, relating this thought to the lyrical theories of Hamburger and Culler, and providing a brief explication of one of Lacoue-Labarthe’s “poetic” writings, lyricism is shown to be the testament to the disappearance of the subject, the remainder of a disappearance already passed insofar as the poem remains. What remains is that the lyrical subject would be no “subject” at all—only language itself, intimating its own diction. (shrink)

Geach's account of the Aristotelian logic of categorical sentences supplemented the views shared by Frege, Russell, Quine and others. I argue that this particular predicate logic approach and Geach's points apply to only one variety of natural language categorical sentences. For example, it takes the universal categorical as a universal conditional “If anything is a man, then it is mortal”. A different natural language form can and should be invoked: “Every man is a mortal.” Employing special restricted quantifiers in a (...) version of predicate logic, we justify a full square of opposition and the rules of quality and quantity that Geach rejected. (shrink)

If SAMCRO can legitimately declare war, then the Sons of Anarchy may still be bad boys, but at least they' are not immoral butchers. The just war theory spells out the criteria that must be met for the use of armed force to be morally justified. They are: Just Cause, Proportionality, Necessity, Right Authority, and Likelihood of Success. To be just, a war must fulfill all six criteria. The chapter presents arguments that suggest, in principle at least, that SAMCRO does (...) have the authority to declare war against an adversary. The club is not so different from existing political institutions. Like all great television, Sons of Anarchy can teach us a lot about the real world. We do not need to condone everything SAMCRO does. But we should be careful not to condemn everything the club does either, even when it resorts to violence. (shrink)