European and international regulation of human health research is typified by a morass of interconnecting laws, diverse and divergent ethical frameworks, and national and transnational standards. There is also a tendency for legislators to regulate in silos—that is, in discrete fields of scientific activity without due regard to the need to make new knowledge as generalisable as possible. There are myriad challenges for the stakeholders—researchers and regulators alike—who attempt to navigate these landscapes. This Delphi study was undertaken in order to (...) provide the first interdisciplinary and crosscutting analysis of health research regulation, as it is experienced by such stakeholders in the UK context. As well as reinforcing existing understandings of the regulatory environment, Delphi participants called for greater collaboration, and even co-production, of processes involved in health research regulation. On the basis of this research, we offer insights about how health research regulation can become a matter with which a wider range of stakeholders—including researchers, regulators, publics and research sponsors—can engage. The evidence supports the normative claim that health research regulation should continue to move away from strict, prescriptive rules-based approaches, and towards flexible principle-based regimes that allow researchers, regulators and publics to co-produce regulatory systems serving core principles. By unpacking thorny concepts and practices at the heart of health research regulation—including the public interest and public engagement—our results have the potential to situate and breathe life into them. The results also demonstrate that while proportionality is well-recognised as a crucial element of flexible regulatory systems, more must be done to operationalise this as an ethical assessment of the values and risks at stake at multiple junctures in the research trajectory. This is required if we are to move beyond proportionality as a mere risk-management tool. Compliance culture no longer accurately reflects the needs and expectations of researchers or regulators, nor does it necessarily produce the best research. Embracing uncertainty—both as a human practice and a regulatory objective—may represent the brighter future for health research. (shrink)

Legal and ethical issues involved in group work are reviewed and discussed. Variations in different professional ethics codes are discussed. Recommendations for consideration by group leaders are made.

This book explores the theories of transhumanism and posthumanism, two philosophies that deal with radically changing bodies, minds, and even the nature of humanity itself.

I argue that the appropriateness of an assertion is sensitive to context—or, really, the “common ground”—in a way that hasn’t previously been emphasized by philosophers. This kind of context-sensitivity explains why some scientific conclusions seem to be appropriately asserted even though they are not known, believed, or justified on the available evidence. I then consider other recent attempts to account for this phenomenon and argue that if they are to be successful, they need to recognize the kind of context-sensitivity that (...) I argue for. (shrink)

The task of theologizing literature in the twentieth century -- Bergonsian conceptions of time : duration, dualism, intention -- Meeting the eternal in the present : Bergsonsism and the theology of present time in C.S. Lewis's The great divorce -- T.S. Eliot's Bergonsian "always present" : incarnation and duration in Four quartets -- W.H. Auden's themes of time and dualism : the Bergsonsian theology of "kairos and logos.".

Since its inception in 2010, the Network for Public Health Law has aligned with federal, state, tribal, and local public health practitioners to assess how law can promote and protect the public’s health. In 2013, Network authors illustrated major trends in public health laws and policies emanating from an internal assessment of thousands of requests for technical assistance nationally. More recently, the Robert Wood Johnson Foundation has invited the Network and other partners to consider new ideas and strategies toward building (...) a “culture of health.” Per Figure 1, RWJF’s conception of a culture of health emphasizes key action areas essential to the promotion of health across all sectors and diverse populations. (shrink)

A number of philosophers of science have argued that there are important differences between robustness in modeling and experimental contexts, and—in particular—many of them have claimed that the former is non-confirmatory. In this paper, I argue for the opposite conclusion: robust hypotheses are confirmed under conditions that do not depend on the differences between and models and experiments—that is, the degree to which the robust hypothesis is confirmed depends on precisely the same factors in both situations. The positive argument turns (...) on the fact that confirmation theory doesn’t recognize a difference between different sources of evidence. Most of the paper is devoted to rebutting various objections designed to show that it should. I end by explaining why philosophers of science have (often) gone wrong on this point. (shrink)

While the UK Home Office’s proposals to preventively detain people with what it has called dangerous severe personality disorder have been subjected to debate and criticism the deeply troubling jurisprudential issues in these proposals have not yet entered into public debate in a way that their seriousness deserves.1 It is good that a commentator as well known as Professor Szasz is speaking out on this issue.Professor Szasz focuses upon a crucial question by calling into question the medicalisation of terms like (...) dangerousness and mental illness.2 There is a great temptation for legislators and the public to treat these terms as if they are purely scientific terms and to think of risk assessment as a precise science. I don’t share Professor’s Szasz’s worry about how psychiatry is using these terms but I think there are some important questions about how these concepts function in the public sphere.This issue is important enough to justify the use of some rhetorical claims because such claims can serve to bring out what are neglected and important issues. In raising the following objections I am not attempting to refute the message that is in Szasz’s article or to say that he is not making an important point but rather to attempt to sharpen the issues and to suggest ways that we can respond to Professor Szasz’s challenge.Psychiatry has progressed in a number of ways since Professor Szasz wrote The Myth of Mental Illness.3 The science is much better, we have much better medications, and psychiatrists are acutely aware of the tension between treating their patient and their obligations to the public interest.So when Professor Szasz says: “Psychiatrists offer to relieve the disturbed person of the burden of coping …. (shrink)

In an influential paper, Wendy Parker argues that agreement across climate models isn’t a reliable marker of confirmation in the context of cutting-edge climate science. In this paper, I argue that while Parker’s conclusion is generally correct, there is an important class of exceptions. Broadly speaking, agreement is not a reliable marker of confirmation when the hypotheses under consideration are mutually consistent—when, e.g., we’re concerned with overlapping ranges. Since many cutting-edge questions in climate modeling require making distinctions between mutually consistent (...) hypotheses, agreement across models will be generally unreliable in this domain. In cases where we are only concerned with mutually exclusive hypotheses, by contrast, agreement across climate models is plausibly a reliable marker of confirmation. (shrink)

The best and most popular argument for probabilism is the accuracy-dominance argument, which purports to show that alethic considerations alone support the view that an agent’s degrees of belief should always obey the axioms of probability. I argue that extant versions of the accuracy-dominance argument face a problem. In order for the mathematics of the argument to function as advertised, we must assume that every omniscient credence function is classically consistent; there can be no worlds in the set of dominance-relevant (...) worlds that obey some other logic. This restriction cannot be motivated on alethic grounds unless we’re also willing to accept that rationality requires belief in every metaphysical necessity, as the distinction between a priori logical necessities and a posteriori metaphysical ones is not an alethic distinction. To justify the restriction to classically consistent worlds, non-alethic motivation is required. And thus, if there is a version of the accuracy-dominance argument in support of probabilism, it isn’t one that is grounded in alethic considerations alone. (shrink)

A number of theorists have argued that Scanlon's contractualist theory both "gets around" and "solves" the non-identity problem. They argue that it gets around the problem because hypothetical deliberation on general moral principles excludes the considerations that lead to the problem. They argue that it solves the problem because violating a contractualist moral principle in one's treatment of another wrongs that particular other, grounding a person-affecting moral claim. In this paper, I agree with the first claim but note that all (...) it shows is that the act is impersonally wrong. I then dispute the second claim. On Scanlon's contractualist view, one wrongs a particular other if one treats the other in a way that is unjustifiable to that other on reasons she could not reasonably reject. We should think of person-affecting wronging in terms of the reasons had by the actual agent and the actual person affected by the agent's action. In non-identity cases, interpersonal justifiability is therefore shaped both by the reason to reject the treatment provided by the bad suffered and the reason to affirm the treatment provided by the goods had as a result of existing. I argue it would be reasonable for the actual person to find the treatment justifiable, and so I conclude that Scanlon's contractualist metaethics does not provide a narrow person-affecting solution to the non-identity problem on its own terms. I conclude that the two claims represent a tension within Scanlon's contractualist theory itself. (shrink)

The author argues non-human, sentient animals have aggregation-trumping rights by explaining why and how they should be included in the scope of Kantian contractualism. He explains that the beings to whom we owe duties—who can be wronged by our treatment—are all those with the capacity for first-person, subjective experience; i.e., all sentient beings. To determine what duties we owe to such beings, we should reflect on the principles for the general regulation of behavior that could be hypothetically justified to their (...) imaginary perfectly reasonable counterparts; i.e., even though animals actually cannot understand or reflect on the reasons we have for treating them in a particular way, burdening them unjustifiably is wrong to them. The author argues this inclusive contractualist theory can explain all the distinctive moral phenomena that T. M. Scanlon’s approach does and so is a more attractive contractualist moral theory. (shrink)

When Michael Oakeshott died in 1990, there were only a handful of scholarly monographs about his thought. Twenty years later, in contrast, the burgeoning number of studies of his thought prompted o...

Generalizing the notion of a tight almost disjoint family, we introduce the notions of a tight eventually different family of functions in Baire space and a tight eventually different set of permutations of $\omega $. Such sets strengthen maximality, exist under $\mathsf {MA} (\sigma \mathrm {-centered})$ and come with a properness preservation theorem. The notion of tightness also generalizes earlier work on the forcing indestructibility of maximality of families of functions. As a result we compute the cardinals $\mathfrak {a}_e$ and (...) $\mathfrak {a}_p$ in many known models by giving explicit witnesses and therefore obtain the consistency of several constellations of cardinal characteristics of the continuum including $\mathfrak {a}_e = \mathfrak {a}_p = \mathfrak {d} < \mathfrak {a}_T$, $\mathfrak {a}_e = \mathfrak {a}_p < \mathfrak {d} = \mathfrak {a}_T$, $\mathfrak {a}_e = \mathfrak {a}_p =\mathfrak {i} < \mathfrak {u}$, and $\mathfrak {a}_e=\mathfrak {a}_p = \mathfrak {a} < non(\mathcal N) = cof(\mathcal N)$. We also show that there are $\Pi ^1_1$ tight eventually different families and tight eventually different sets of permutations in L thus obtaining the above inequalities alongside $\Pi ^1_1$ witnesses for $\mathfrak {a}_e = \mathfrak {a}_p = \aleph _1$.Moreover, we prove that tight eventually different families are Cohen indestructible and are never analytic. (shrink)

Surgical devices are often marketed before there is good evidence of their safety and effectiveness. Our paper discusses the ethical issues associated with the early marketing and use of new surgical devices from the perspectives of the six groups most concerned. Health Canada, which is responsible for licensing new surgical devices, should amend their requirements to include rigorous clinical trials that provide data on effectiveness and safety for each new product before it is marketed. Industry should comply with all Health (...) Canada requirements to obtain licenses for new products. Until Health Canada requires effectiveness and safety data, industry should cooperate with physicians in appropriate studies before releasing new products and should make balanced presentations of all the available evidence. Surgeons should, before using a new surgical device, assess the evidence on its effectiveness and safety and ensure they are properly trained and competent in using the device. Surgeons should provide their patients with an evaluation of the available evidence and inform them about possible complications and the surgeon's level of experience with the new device. Patients, who should be given an honest evaluation of the available evidence, possible complications, and the surgeon's experience, should be encouraged to evaluate the evidence and information to their own satisfaction to ensure that fully informed consent is given. Health institutions, responsible for regulating practice within their walls, should review new devices for safety, effectiveness, and economic impacts, before allowing their use. They should also limit the use of new surgical devices to surgeons trained and competent in the new technology. Professional societies should provide guidance on the early adoption of new surgical devices and technologies. We urge all those involved in the development, licensing, and use of new surgical devices to aim for higher ethical standards to protect the health and safety of patients requiring surgery. The lowest acceptable ethical standard would require device manufacturers to provide surgeons with accurate and timely information on the efficacy and safety of their products, allowing surgeons and patients to evaluate the evidence (and the significance of information not yet available) before surgery. (shrink)

Bentham’s famous remark was a response to the assertation of natural rights that did not depend on law or some other foundation for their normative force.1 Whatever we make of that claim, it flags a problem for making and evaluating rights-based arguments in medical ethics. He wasn’t trying to say that rights are all meaningless, nor that we can readily do without them. Rather, it’s an objection to a particular way of asserting rights where they are taken to express free (...) standing claims that don’t require further defence or justification. Whether or not the rise of human rights in medical law has enriched the ability of the courts to deal with complex issues in a nuanced way is debatable, but there’s no doubting their prominence and unavoidability.2 For medical ethics, rights analysis requires paying heed to the kind of rights in play when arguing about ethics, as well as what’s distinctive about rights analysis. For many, rights operate as strong moral assertions intended to override other, less weighty, considerations and Ronald Dworkin claimed that we should view rights as a way of expressing particularly important claims that should constrain the state in its actions.3 Rights imply duties and focussing on a right's correlative duty can …. (shrink)

The kind of expertise someone who specialises in ethics has, or indeed whether it makes sense to talk of moral expertise, is keenly debated and is a far from settled issue. It has been of interest to moral philosophers, partly because of the light it might shine on the nature of morality.1 2 It has also been debated within medical ethics, with some arguing against the idea that expertise in moral philosophy translates into ethical expertise and others arguing that skills (...) in ethical justification can be viewed as ethical expertise.3 4 This issue of the Journal of Medical Ethics includes a number of papers that demonstrate the importance of ethical expertise and some of the distinctive elements of it. Public involvement in research is seen in a number of countries as something valuable and in some, such as Australia, it can be a criterion for research grants. The UK National Standards for Public Involvement in Research are discussed in this issue of JME and McCoy et al provide a good illustration of why ethical expertise is important for framing public policy.5 The appeal of stakeholders having some say into research projects, particularly when they are funded via taxation is easy to understand, so who would not see public involvement as a good thing? However, McCoy et al claim that while there is a substantial and growing literature on public involvement in research that tends to emphasise the importance of public involvement, it doesn’t explain how or what this looks like when …. (shrink)

When explaining the inadequacy of the words “Cheer him up” to describe the purpose of offering a drink to a murderer, TS Elliot’s Sweeney remarks, > Well here again that don’t apply > > But I’ve gotta use words when I talk to you.1 The importance of words to medical ethics cannot be denied. While a narrow view of conceptual analysis is not conducive to good medical ethics,2 the adequacy and clarity of the words we use continues to be the (...) foundation for all ethical analysis. While some key ideas such as ‘paternalism’3 or ‘coercion’4 are well theorised and tend to be used in a consistent way that most understand, other words that are important to ethics, often are not. Our ability to notice, perceive and understand ethical issues is the starting point for all ethical inquiry. The ethical words we choose structure and give content to our ethical perception. As Kant observed, ‘Thoughts without content are empty, intuitions without concepts are …. (shrink)

This study is about the interaction of scientific expertise and local knowledge in the context of a contested issue: the quality and quantity of safe drinking water available to some residents in one Canadian community. The authors articulate the boundary work in which scientific and technological expertise and discourse are played out against local knowledge and water needs to prevent the construction of a water main extension that would provide a group of residents with the same water that others in (...) the community already access. The authors draw on an extensive database constructed during a three-year ethnographic study of one community; the data base includes the transcript of a public meeting, newspaper clippings, interviews, and communications between residents and town council. The authors show not only that scientists and residents differ in their assessment of water quality and quantity but also that there is a penchant for undercutting residents in their attempts to make themselves heard in the political process. (shrink)

Objective: The aim of the current study was to investigate associations, unique and interactive, between mothers’ and children’s histories of childhood sexual abuse (CSA) and children’s psychiatric outcomes using an intergenerational perspective. Further, we were particularly interested in examining whether maternal reflective functioning about their own trauma (T-RF) was associated with lower likelihood of children’s abuse exposure (among children of CSA-exposed mothers). Method: One hundred and eleven children (Mage= 9.53 years; 43 sexual abuse victims) and their mothers (Mage= 37.99; 63 (...) sexual abuse victims) participated in this study. Mothers completed the Parent Development Interview (PDI), which yielded assessments of RF regarding their own experiences of abuse, and also reported on their children’s internalizing and externalizing symptoms. Results: Children of CSA-exposed mothers were more likely to have experienced CSA. A key result was that among CSA-exposed mothers, higher maternal T-RF regarding their own abuse was associated with lower likelihood of child CSA-exposure. Mothers’ and children’s CSA histories predicted children’s internalizing and externalizing symptoms, such that CSA exposure for mother or child was associated with greater symptomatology in children. Conclusions: The findings show that the presence of either maternal or child CSA is associated with more child psychological difficulties. Importantly in terms of identifying potential protective factors, maternal T-RF is associated with lower likelihood of CSA exposure in children of CSA-exposed mothers. We discuss these findings in the context of the need for treatments focusing on increasing Trauma - RF in mothers and children in the context of abuse to facilitate adaptation and reduce the intergenerational risk. (shrink)

In the target article, we presented the hypothesis that parasite-stress variation was a causal factor in the variation of in-group assortative sociality, cross-nationally and across the United States, which we indexed with variables that measured different aspects of the strength of family ties and religiosity. We presented evidence supportive of our hypothesis in the form of analyses that controlled for variation in freedom, wealth resources, and wealth inequality across nations and the states of the USA. Here, we respond to criticisms (...) from commentators and attempt to clarify and expand the parasite-stress theory of sociality used to fuel our research presented in the target article. (shrink)

Artificial intelligence (AI) and its introduction into clinical pathways presents an array of ethical issues that are being discussed in the JME. 1–7 The development of AI technologies that can produce text that will pass plagiarism detectors 8 and are capable of appearing to be written by a human author 9 present new issues for medical ethics. One set of worries concerns authorship and whether it will now be possible to know that an author or student in fact produced submitted (...) work. That seems likely to be a general worry for secondary and higher education, as well as for all academic journals. Thus far generative AI chatbots do not seem to be able to produce a fully referenced and well-argued ethics article, but they probably could generate a blog or student essay that would... (shrink)

"Psychiatry and Philosophy of Science" explores conceptual issues in psychiatry from the perspective of analytic philosophy of science. Through an examination of those features of psychiatry that distinguish it from other sciences - for example, its contested subject matter, its particular modes of explanation, its multiple different theoretical frameworks, and its research links with big business - Rachel Cooper explores some of the many conceptual, metaphysical and epistemological issues that arise in psychiatry. She shows how these pose interesting challenges for (...) the philosopher of science while also showing how ideas from the philosophy of science can help to solve conceptual problems within psychiatry. Cooper's discussion ranges over such topics as the nature of mental illnesses, the treatment decisions and diagnostic categories of psychiatry, the case-history as a form of explanation, how psychiatry might be value-laden, the claim that psychiatry is a multi-paradigm science, the distortion of psychiatric research by pharmaceutical industries, as well as engaging with the fundamental question whether the mind is reducible to something at the physical level. "Psychiatry and Philosophy of Science" demonstrates that cross-disciplinary contact between philosophy of science and psychiatry can be immensely productive for both subjects and it will be required reading for mental health professionals and philosophers alike. (shrink)

Hilbert’s choice operators τ and ε, when added to intuitionistic logic, strengthen it. In the presence of certain extensionality axioms they produce classical logic, while in the presence of weaker decidability conditions for terms they produce various superintuitionistic intermediate logics. In this thesis, I argue that there are important philosophical lessons to be learned from these results. To make the case, I begin with a historical discussion situating the development of Hilbert’s operators in relation to his evolving program in the (...) foundations of mathematics and in relation to philosophical motivations leading to the development of intuitionistic logic. This sets the stage for a brief description of the relevant part of Dummett’s program to recast debates in metaphysics, and in particular disputes about realism and anti-realism, as closely intertwined with issues in philosophical logic, with the acceptance of classical logic for a domain reflecting a commitment to realism for that domain. Then I review extant results about what is provable and what is not when one adds epsilon to intuitionistic logic, largely due to Bell and DeVidi, and I give several new proofs of intermediate logics from intuitionistic logic+ε without identity. With all this in hand, I turn to a discussion of the philosophical significance of choice operators. Among the conclusions I defend are that these results provide a finer-grained basis for Dummett’s contention that commitment to classically valid but intuitionistically invalid principles reflect metaphysical commitments by showing those principles to be derivable from certain existence assumptions; that Dummett’s framework is improved by these results as they show that questions of realism and anti-realism are not an “all or nothing” matter, but that there are plausibly metaphysical stances between the poles of anti-realism and realism, because different sorts of ontological assumptions yield intermediate rather than classical logic; and that these intermediate positions between classical and intuitionistic logic link up in interesting ways with our intuitions about issues of objectivity and reality, and do so usefully by linking to questions around intriguing everyday concepts such as “is smart,” which I suggest involve a number of distinct dimensions which might themselves be objective, but because of their multivalent structure are themselves intermediate between being objective and not. Finally, I discuss the implications of these results for ongoing debates about the status of arbitrary and ideal objects in the foundations of logic, showing among other things that much of the discussion is flawed because it does not recognize the degree to which the claims being made depend on the presumption that one is working with a very strong logic. (shrink)

Psychedelic-assisted Psychotherapy combines the use of psychedelic compounds, such as psilocybin, with psychotherapy. PAP has shown some promise as a novel treatment for Major Depressive Disorder, and empirical research suggests that its efficacy turns on the altered states induced by psychedelic compounds. In this paper we draw on the literature of phenomenology to explain the therapeutic potential of psychedelic experiences. Svenaeus characterises mental illness as a form of suffering that entails three distinct but related experiences of alienation or “unhomelike being-in-the-world”: (...) illness suffering, which relates to embodiment; existential suffering, which relates to self-narratives, and political suffering, which relates to social relationships. Ratcliffe further characterises the experience of MDD in phenomenological terms as a loss of pre-intentional possibility that manifests as excessive noematic feeling in the experience of embodiment, restrictive narratives in the construction of self, and disconnectedness in experience of the social world. We contend that PAP ameliorates the suffering associated with MDD by inducing and consolidating a state of broadened pre-intentional possibility—one that entails sudden, profound and enduring changes in embodiment, self-narratives, and social experience. We argue further that this phenomenological account is consistent with a bio-psycho-social model of mental health and illness, and we frame it as an argument supporting the plausibility of recent claims about treatment success. This helps to justify ongoing future empirical research in this setting. (shrink)

Representation is central to contemporary theorizing about the mind/brain. But the nature of representation--both in the mind/brain and more generally--is a source of ongoing controversy. One way of categorizing representational types is to distinguish between the analog and the digital: the received view is that analog representations vary smoothly, while digital representations vary in a step-wise manner. I argue that this characterization is inadequate to account for the ways in which representation is used in cognitive science; in its place, I (...) suggest an alternative taxonomy. I will defend and extend David Lewis's account of analog and digital representation, distinguishing analog from continuous representation, as well as digital from discrete representation. I will argue that the distinctions available in this four-fold account accord with representational features of theoretical interest in cognitive science more usefully than the received analog/digital dichotomy. (shrink)