_ Source: _Volume 31, Issue 2, pp 147 - 165 Though Hobbes consistently differentiates between the ‘subject’ and ‘servant’ across Elements of Law, On the Citizen, and Leviathan, we currently lack an exhaustive account of the Hobbesian servant. In this paper, I argue that the distinction would have profound consequences for one’s disposition toward both the commonwealth and the community at large. Because the servant joins under the immediate threat of violence and covenants directly with the sovereign, we would expect (...) her initial experience to contribute to a fundamentally more pessimistic attitude toward the commonwealth and atomistic understanding of her place in the body politic. On one level, this distinction could be used to distinguish privileged populations from otherwise marginalized groups. On another level, however, in revealing both the brute reality of sovereign power and the ways in which she is alienated from it, the servant gives us a more accurate understanding of the commonwealth than the subject’s own. (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)

The literature on self-driving cars and ethics continues to grow. Yet much of it focuses on ethical complexities emerging from an individual vehicle. That is an important but insufficient step towards determining how the technology will impact human lives and society more generally. What must complement ongoing discussions is a broader, system level of analysis that engages with the interactions and effects that these cars will have on one another and on the socio-technical systems in which they are embedded. To (...) bring the conversation of self-driving cars to the system level, we make use of two traffic scenarios which highlight some of the complexities that designers, policymakers, and others should consider related to the technology. We then describe three approaches that could be used to address such complexities and their associated shortcomings. We conclude by bringing attention to the “Moral Responsibility for Computing Artifacts: The Rules”, a framework that can provide insight into how to approach ethical issues related to self-driving cars. (shrink)

Conservatives and liberals disagree sharply on matters of morality and public policy. We propose a novel account of the psychological basis of these differences. Specifically, we find that conservatives tend to emphasize the intrinsic value of actions during moral judgment, in part by mentally simulating themselves performing those actions, while liberals instead emphasize the value of the expected outcomes of the action. We then demonstrate that a structural emphasis on actions is linked to the condemnation of victimless crimes, a distinctive (...) feature of conservative morality. Next, we find that the conservative and liberal structural approaches to moral judgment are associated with their corresponding patterns of reliance on distinct moral foundations. In addition, the structural approach uniquely predicts that conservatives will be more opposed to harm in circumstances like the well-known trolley problem, a result which we replicate. Finally, we show that the structural approaches of conservatives and liberals are partly linked to underlying cognitive styles. Collectively, these findings forge a link between two important yet previously independent lines of research in political psychology: cognitive style and moral foundations theory. (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)

Too many patients are injured in the course of care. Clinicians may mistakenly cause new harm to a patient or fail to take established steps to improve the presenting condition. Medical institutions within which they work may lack mechanisms to reduce errors or prevent them from harming patients. Many, perhaps even most, injuries are preventable, probably numbering in the hundreds of thousands a year for hospital care alone. Long ignored by medical practitioners and health-care payers and little appreciated by the (...) public, the problem of medical injury is finally receiving high-level policy attention. Much credit goes to the Institute of Medicine for its landmark report of November 1999, which marshaled the evidence about medical injuries and highlighted new approaches to systematic improvement of safety within systems of care. (shrink)

From computerized medical records to databases of pharmacological interactions and automated provisional EKG readings, the emergence of information technology has significantly altered the practice of medicine. Information technology has been widely used to enhance diagnosis and treatment and to improve communication between providers. The advent of the Internet also brings far-reaching implications for patient–physician communication, challenging physicians, patients, and policymakers to consider its impact on the delivery of medical care and the therapeutic relationship. A new set of practices by patients (...) and physicians is unfolding in cyberspace, ranging from the use of e-mail to communicate between physicians and patients in an existing relationship to one-to-one consultations with an anonymous physician and ongoing online treatment, such as psychotherapy. These practices are emerging in both the for-profit and not-for-profit spheres. (shrink)

As a natural example of a 1-random real, Chaitin proposed the halting probability Ω of a universal prefix-free machine. We can relativize this example by considering a universal prefix-free oracle machine U. Let [Formula: see text] be the halting probability of UA; this gives a natural uniform way of producing an A-random real for every A ∈ 2ω. It is this operator which is our primary object of study. We can draw an analogy between the jump operator from computability theory (...) and this Omega operator. But unlike the jump, which is invariant under the choice of an effective enumeration of the partial computable functions, [Formula: see text] can be vastly different for different choices of U. Even for a fixed U, there are oracles A =* B such that [Formula: see text] and [Formula: see text] are 1-random relative to each other. We prove this and many other interesting properties of Omega operators. We investigate these operators from the perspective of analysis, computability theory, and of course, algorithmic randomness. (shrink)

Too many patients are injured in the course of care. Clinicians may mistakenly cause new harm to a patient or fail to take established steps to improve the presenting condition. Medical institutions within which they work may lack mechanisms to reduce errors or prevent them from harming patients. Many, perhaps even most, injuries are preventable, probably numbering in the hundreds of thousands a year for hospital care alone. Long ignored by medical practitioners and health-care payers and little appreciated by the (...) public, the problem of medical injury is finally receiving high-level policy attention. Much credit goes to the Institute of Medicine for its landmark report of November 1999, which marshaled the evidence about medical injuries and highlighted new approaches to systematic improvement of safety within systems of care. (shrink)

BackgroundSarcomas are a diverse group of neoplasms that vary greatly in clinical presentation and responsiveness to treatment. Given the differences in the sites of involvement, rarity, and treatment modality, a multidisciplinary approach is required. Previous literature suggests patients with sarcoma suffer from poorer quality of life especially physical and functional wellbeing. Adolescent and young adult patients are an underrepresented population in cancer research and have differing factors influencing QoL.MethodsRetrospective analysis of Young Adult patients enrolled in the Sarcoma Tissue Repository at (...) University of Iowa. QoL was assessed using the self-report FACT-G questionnaire at enrollment and 12 months post-diagnosis; overall scores and the 4 wellbeing subscales were calculated. Linear mixed effects models were used to measure the association between the rate of change in FACT-G subscale scores and baseline clinical, comorbidity, and treatment characteristics.Results49 patients were identified. 57.1% of patients had a malignancy involving an extremity. Mean FACT-G scores of overall wellbeing improved from baseline to 12 months. Social and emotional wellbeing did not differ significantly between baseline and 12 months. Physical wellbeing and functional wellbeing scores improved from baseline to 12 months. No difference was seen for FACT-G overall scores for age, sex, laterality, marital status, performance status, having children, clinical stage, limb surgery, chemotherapy, or tumor size. A difference was demonstrated in physical wellbeing scores for patients with baseline limitation compared to those with no baseline limitation. A difference was demonstrated in social wellbeing based on anatomical site.ConclusionYoung adults with sarcoma treated at a tertiary center had improvements in overall reported QoL at 12 months from diagnosis. Overall baseline QoL scores on FACT-G were lower than the general adult population for YA patients with sarcoma but at 12 months became in line with general population norms. The improvements seen merit further investigation to evaluate how these change over the continuum of care. Quality of life changes may be useful outcomes of interest in sarcoma trials. (shrink)

Firearm injury in the United States is a public health crisis in which physicians are uniquely situated to intervene. However, their ability to mitigate harm is limited by a complex array of laws and regulations that shape their role in firearm injury prevention. This piece uses four clinical scenarios to illustrate how these laws and regulations impact physician practice, including patient counseling, injury reporting, and the use of court orders and involuntary holds. Unintended consequences on clinical practice of laws intended (...) to reduce firearm injury are also discussed. Lessons drawn from these cases suggest that physicians require more nuanced education on this topic, and that policymakers should consult front-line healthcare providers when designing firearm policies. (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.

Varieties of Ethical Reflection brings together new cultural and religious perspectives—drawn from non-Western, primarily Asian, philosophical sources—to globalize the contemporary discussion of theoretical and applied ethics.

In this paper, I defend the claim that Christian theology gives us good reason to think that virtue is relative to individuals and communities, i.e., that what character traits are virtues for individuals is relative to individuals and to the communities of which they are members. I begin by reviewing the theological claims that I take to be relevant. I then argue that these claims make it plausible to conclude that virtue is morally redemptive and therefore relative to individuals and (...) communities. I then seek to use these conclusions to illuminate the discussion of the correctiveness of virtue. Finally I respond to some objections and suggest some further ways that my views could be developed. (shrink)

BackgroundThe U.S. Food and Drug Administration traditionally has kept confidential significant amounts of information relevant to the approval or non-approval of specific drugs, devices, and biologics and about the regulatory status of such medical products in FDA’s pipeline.ObjectiveTo develop practical recommendations for FDA to improve its transparency to the public that FDA could implement by rulemaking or other regulatory processes without further congressional authorization. These recommendations would build on the work of FDA’s Transparency Task Force in 2010.MethodsIn 2016-2017, we convened (...) a team of academic faculty from Harvard Medical School, Brigham and Women’s Hospital, Yale Medical School, Yale Law School, and Johns Hopkins Bloomberg School of Public Health to develop recommendations through an iterative process of reviewing FDA’s practices, considering the legal and policy constraints on FDA in expanding transparency, and obtaining insights from independent observers of FDA.ResultsThe team developed 18 specific recommendations for improving FDA’s transparency to the public. FDA could adopt all these recommendations without further congressional action.FundingThe development of the Blueprint for Transparency at the U.S. Food and Drug Administration was funded by the Laura and John Arnold Foundation. (shrink)

Arthur Miller is one of the most important and enduring playwrights of the last fifty years. This new edition of The Theater Essays has been expanded by nearly fifty percent to include his most significant articles and interviews since the book's initial publication in 1978. Within these pages Miller discusses the roots of modern drama, the nature of tragedy, and the state of contemporary theater; offers illuminating observations on Ibsen, Strindberg, Chekhov, O'Neill, and Williams; probes the different approaches (...) and attitudes toward theater in Russia, China, and at home; and, of course, provides valuable insights into his own vast dramatic corpus. For this edition the literary chronology and cast and production information have been updated, and an extensive new bibliography has been added. The Theater Essays confirms Arthur Miller's standing as a brilliant, eloquent commentator on drama and culture. No one interested in theater should be without this definitive collection. (shrink)

This essay presents an account of what it takes to live a philosophical way of life: practitioners must be committed to a worldview, structure their lives around it, and engage in truth‐directed practices. Contra John Cooper, it does not require that one’s life be solely guided by reason. Religious or tradition‐based ways of life count as truth directed as long as their practices are reasons responsive and would be truth directed if the claims made by their way of life are (...) correct. The essay argues that these three conditions can be met by progressors as well as sages. Making progress in how one acts in the world, and improving one’s understanding and direction through being part of a community is living a philosophical way of life. The offered view acknowledges more ways to develop the art of living and enables a broader range of people to count as living philosophically. (shrink)

I propose a theory of moral obligation that is inspired by the way obligation has been understood in the Anabaptist tradition. I use the resources of the theory to explain and defend the appropriateness of the Anabaptist claim that Christian ethics is unique. I also use the theory to show that some of the standard objections to Christian pacifism, the most visibly distinctive feature of Anabaptist ethics, are misplaced when pacifism is understood as an application of the theory I defend. (...) Finally, I suggest some theological and theoretical advantages this theory. (shrink)

For any subset $Z \subseteq {\mathbb {Q}}$, consider the set $S_Z$ of subfields $L\subseteq {\overline {\mathbb {Q}}}$ which contain a co-infinite subset $C \subseteq L$ that is universally definable in L such that $C \cap {\mathbb {Q}}=Z$. Placing a natural topology on the set ${\operatorname {Sub}({\overline {\mathbb {Q}}})}$ of subfields of ${\overline {\mathbb {Q}}}$, we show that if Z is not thin in ${\mathbb {Q}}$, then $S_Z$ is meager in ${\operatorname {Sub}({\overline {\mathbb {Q}}})}$. Here, thin and meager both mean “small”, (...) in terms of arithmetic geometry and topology, respectively. For example, this implies that only a meager set of fields L have the property that the ring of algebraic integers $\mathcal {O}_L$ is universally definable in L. The main tools are Hilbert’s Irreducibility Theorem and a new normal form theorem for existential definitions. The normal form theorem, which may be of independent interest, says roughly that every $\exists $-definable subset of an algebraic extension of ${\mathbb Q}$ is a finite union of single points and projections of hypersurfaces defined by absolutely irreducible polynomials. (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)

Despite a recent surge of interest in philosophy as a way of life, it is not clear what it might mean for philosophy to guide one's life, or how a “philosophical” way of life might differ from a life guided by religion, tradition, or some other source. We argue against John Cooper that spiritual exercises figure crucially in the idea of philosophy as a way of life—not just in the ancient world but also today, at least if the idea is (...) to be viable. In order to make the case we attempt to clarify the nature of spiritual exercises, and to explore a number of fundamental questions, such as “What role does reason have in helping us to live well?” Here we distinguish between the discerning and motivational powers of reason, and argue that both elements have limitations as guides to living well. (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)

Initial responses to questionnaires used to assess participants' understanding of informed consent for malaria vaccine trials conducted in the United States and Mali were tallied. Total scores were analyzed by age, sex, literacy (if known), and location. Ninety-two percent (92%) of answers by United States participants and 85% of answers by Malian participants were correct. Questions more likely to be answered incorrectly in Mali related to risk, and to the type of vaccine. For adult participants, independent predictors of higher scores (...) were younger age and female sex in the United States, and male sex in Mali. Scores in the United States were higher than in Mali (P = 0.005). Despite this difference participants at both sites were well informed overall. Although interpretation must be qualified because questionnaires were not intended as research tools and were not standardized among sites, these results do not support concerns about systematic low understanding among research participants in developing versus developed countries. (shrink)