This text includes practical coverage of all the issues likely to be of concern to students during their medical careers.

Humanitarian healthcare work presents a range of ethical challenges for expatriate healthcare professionals, including tragic choices requiring the selection of a least-worst option. In this paper we examine a particular set of tragic choices related to the prioritization of care and allocation of scarce resources between individuals in situations of widespread and urgent health needs. Drawing on qualitative interviews with clinicians, we examine the nature of these choices. We offer recommendations to clinical teams and aid organizations for preparing and supporting (...) frontline clinicians in their efforts to determine the least-worst option, and in their responsibility for making such choices. (shrink)

Managing non-communicable diseases in crisis-affected and fragile humanitarian contexts requires special attention because primary health care systems often collapse or become compromised in such settings. As a result, addressing and managing these diseases become more challenging. Humanitarian organizations that intervene in crisis situations are increasingly including NCD management in the services they support and provide; however, they encounter a range of issues such as ensuring the quality of care, sustainability of programs, and the possibility of unintended harms. This case study (...) explores ethical considerations raised by a mobile NCD program run by an international humanitarian organization in a country affected by a protracted civil war. (shrink)

As rationing decisions become more of an immediate reality for healthcare practitioners it is important to design mechanisms that facilitate carefully deliberated outcomes. No individual can be expected to be able to cover wide debate on their own, so an exercise has been designed that helps generate consensus decisions from diverse opinions. The exercise was piloted with two groups, an undergraduate medical class and the members of a general practice. Though the aims were different for each group, the tool was (...) useful to both for producing the desired outcomes. Expert and non-expert knowledge were drawn upon and rationing prioritisation lists regarding funding of infertility treatment were generated. A description of the exercise and the results produced by the two groups are provided, as well as the theoretical placement for the significance of forming consensus from diversity. (shrink)

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, Sjöberg, (...) Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for examining the moral (...) dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors. The elements also help minimize or avoid certain miscalculations and harms. Emphasis is placed on the shared humanity of those who provide and those who receive assistance, acknowledgement of limits and risks related to the contributions of expatriate health care professionals, and the importance of providing skillful and relevant assistance. These elements articulate a moral posture for expatriate health care professionals that contributes to orienting the practice of clinicians in ways that reflect respect, humility, and solidarity. Health care professionals whose understanding and actions are consistent with the ethics of engaged presence will be oriented toward introspection and reflective practice and toward developing, sustaining and promoting collaborative partnerships. (shrink)

Humanitarian healthcare work presents a range of ethical challenges for expatriate healthcare professionals, including tragic choices requiring the selection of a least-worst option. In this paper we examine a particular set of tragic choices related to the prioritization of care and allocation of scarce resources between individuals in situations of widespread and urgent health needs. Drawing on qualitative interviews with clinicians, we examine the nature of these choices. We offer recommendations to clinical teams and aid organizations for preparing and supporting (...) frontline clinicians in their efforts to determine the least-worst option, and in their responsibility for making such choices. (shrink)

Authorship of a scientific paper is important in recognition of one’s work, and in the academic setting, helps in professional promotion. Conflicting views of authorship have led to disputes and debates in many scientific communities. Addressing ethical issues in medical research and publishing, and conforming to the requirements of international organizations and local research ethics boards, has become an essential part of the research endeavor. Ethical issues of biomedical authorship have been a matter of debate for years. Authorship problems may (...) involve problems with integrity, including ghost authorship and guest authorship. Some scientific disciplines, such as engineering or social sciences, may not have a firm guideline for authorship criteria; however this article reviews the criteria of authorship recommended by related international organizations of biomedical field and discusses common scenarios that may lead to authorship disputes and misconducts as well as issues related to authorship in multicenter studies. The paper also discusses possible scenarios that might be legitimate to make changes in authorship lists. (shrink)

The most common solutions to the problem of high pharmaceutical prices have taken the form of regulations, price negotiations, or changes in drug coverage by insurers. These measures for the most part transfer the burden of drug expenditures between pharmaceutical companies and payers or between payers. The aim of this study is to propose an alternative model for the relationship between the main stakeholders involved in the price setting and purchasing of pharmaceuticals, one that encourages a more cooperative approach. We (...) draw from principles of ethics and health economics and apply them to the context of the pharmaceutical industry. The model prioritises two objectives, to make drugs financially accessible to the patients who need them, and to keep pharmaceutical companies viable and profitable. It is centered around the sharing of financial risk between the main stakeholders, which we describe as ‘enlightened risk sharing’. After establishing the foundations of this model, we expand on the type of policies that can follow these principles with current day examples. (shrink)

In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for examining the moral (...) dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors. The elements also help minimize or avoid certain miscalculations and harms. Emphasis is placed on the shared humanity of those who provide and those who receive assistance, acknowledgement of limits and risks related to the contributions of expatriate health care professionals, and the importance of providing skillful and relevant assistance. These elements articulate a moral posture for expatriate health care professionals that contributes to orienting the practice of clinicians in ways that reflect respect, humility, and solidarity. Health care professionals whose understanding and actions are consistent with the ethics of engaged presence will be oriented toward introspection and reflective practice and toward developing, sustaining and promoting collaborative partnerships. (shrink)

The application of evidence-based medicine helps clinicians avoid unnecessary procedures and decreases unnecessary harm for future patients while sparing economic burdens. Randomised controlled trials most accurately produce best research evidence. In arthroscopic surgery, however, many procedures have been extensively used without supportive evidence verified with RCTs. In this paper, we introduce two procedures, where over 30 years of procedure usage has continued prior to garnering evidence for the inefficacy of the procedures. The situations are attributed to the fact that clinical (...) trials in arthroscopic surgeries are challenging given the use of placebo controls. A placebo-control RCT can accurately answer research questions about efficacy and safety of surgical procedures; however, the majority of arthroscopic surgeries in practice have not been rigorously tested against placebo surgeries. This is because preparing surgical placebo controls, known as sham surgeries, are ethically controversial. Also considering that high-quality study results often do not change clinical practice due to insufficient knowledge translation, the benefits of such trials may be uncertain to society at large. Additionally, there are a lack of clear guidelines for conducting arthroscopic placebo surgeries in RCTs. We hope that this article helps drive discussion about appropriate use of placebo surgeries in RCTs to produce the best quality evidence in arthroscopic surgery. (shrink)

The Médecins Sans Frontières ethics review board has been solicited in an unprecedented way to provide advice and review research protocols in an ‘emergency’ mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, ranging from epidemiological research, to behavioural research, infectivity studies and clinical trials with investigational products at early development stages. This article examines the MSF ERB’s experience addressing issues related to both the process of review and substantive ethical issues (...) in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms. Having noticed different standards across ethics committees, we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the ‘optimal’ ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process. (shrink)

Non-Invasive Prenatal Testing is a technology which provides information about fetal genetic characteristics very early in pregnancy by examining fetal DNA obtained from a sample of maternal blood. NIPT is a morally complex technology that has advanced quickly to market with a strong push from industry developers, leaving many areas of uncertainty still to be resolved, and creating a strong need for health policy that reflects women’s social and ethical values. We approach the need for ethical policy-making by studying the (...) use of NIPT and emerging policy in the province of Ontario, Canada. Using an adapted version of constructivist grounded theory, we conducted interviews with 38 women who have had personal experiences with NIPT. We used an iterative process of data collection and analysis and a staged coding strategy to conduct a descriptive analysis of ethics issues identified implicitly and explicitly by women who have been affected by this technology. The findings of this paper focus on current ethical issues for women seeking NIPT, including place in the prenatal pathway, health care provider counselling about the test, industry influence on the diffusion of NIPT, consequences of availability of test results. Other issues gain relevance in the context of future policy decisions regarding NIPT, including funding of NIPT and principles that may govern the expansion of the scope of NIPT. These findings are not an exhaustive list of all the potential ethical issues related to NIPT, but rather a representation of the issues which concern women who have personal experience with this test. Women who have had personal experience with NIPT have concerns and priorities which sometimes contrast dramatically with the theoretical ethics literature. These findings suggest the importance of engaging patients in ethical deliberation about morally complex technologies, and point to the need for more deliberative patient engagement work in this area. (shrink)

Research involving migrant youth involves navigating and negotiating complex challenges in order to uphold their rights and dignity, but also all while maintaining scientific rigour. COVID-19 has changed the global landscape within many domains and has increasingly highlighted inequities that exist. With restrictions focusing on maintaining physical distancing set in place to curb the spread of the virus, conducting in-person research becomes complicated. This article reflects on the ethical and methodological challenges encountered when conducting qualitative research during the pandemic with (...) Syrian migrant youth who are resettled in Canada. The three areas discussed from the study are recruitment, informed consent and managing the interviews. Special attention to culture as being part of the study’s methodology as an active reflexive process is also highlighted. The goal of this article is to contribute to the growing understanding of complexities of conducting research during COVID-19 with populations which have layered vulnerabilities, such as migrant youth. This article hopes that the reflections may help future researchers in conducting their research during this pandemic by being cognizant of both the ethical and methodological challenges discussed. (shrink)

BackgroundThe amount of research utilizing health information has increased dramatically over the last ten years. Many institutions have extensive biobank holdings collected over a number of years for clinical and teaching purposes, but are uncertain as to the proper circumstances in which to permit research uses of these samples. Research Ethics Boards (REBs) in Canada and elsewhere in the world are grappling with these issues, but lack clear guidance regarding their role in the creation of and access to registries and (...) biobanks.MethodsChairs of 34 REBS and/or REB Administrators affiliated with Faculties of Medicine in Canadian universities were interviewed. Interviews consisted of structured questions dealing with diabetes-related scenarios, with open-ended responses and probing for rationales. The two scenarios involved the development of a diabetes registry using clinical encounter data across several physicians' practices, and the addition of biological samples to the registry to create a biobank.ResultsThere was a wide range of responses given for the questions raised in the scenarios, indicating a lack of clarity about the role of REBs in registries and biobanks. With respect to the creation of a registry, a minority of sites felt that consent was not required for the information to be entered into the registry. Whether patient consent was required for information to be entered into the registry and the duration for which the consent would be operative differed across sites. With respect to the creation of a biobank linked to the registry, a majority of sites viewed biobank information as qualitatively different from other types of personal health information. All respondents agreed that patient consent was needed for blood samples to be placed in the biobank but the duration of consent again varied.ConclusionParticipants were more attuned to issues surrounding biobanks as compared to registries and demonstrated a higher level of concern regarding biobanks. As registries and biobanks expand, there is a need for critical analysis of suitable roles for REBs and subsequent guidance on these topics. The authors conclude by recommending REB participation in the creation of registries and biobanks and the eventual drafting of comprehensive legislation. (shrink)

The conduct of research in settings affected by disasters such as hurricanes, floods and earthquakes is challenging, particularly when infrastructures and resources were already limited pre-disaster. However, since post-disaster research is essential to the improvement of the humanitarian response, it is important that adequate research ethics oversight be available. We aim to answer the following questions: 1) what do research ethics committee members who have reviewed research protocols to be conducted following disasters in low- and middle-income countries perceive as the (...) key ethical concerns associated with disaster research?, and 2) in what ways do REC members understand these concerns to be distinct from those arising in research conducted in non-crisis situations? This qualitative study was developed using interpretative description methodology; 15 interviews were conducted with REC members. Four key ethical issues were identified as presenting distinctive considerations for disaster research to be implemented in LMICs, and were described by participants as familiar research ethics issues that were amplified in these contexts. First, REC members viewed disaster research as having strong social value due to its potential for improving disaster response, but also as requiring a higher level of justification compared to other research settings. Second, they identified vulnerability as an overarching concern for disaster research ethics, and a feature that required careful and critical appraisal when assessing protocols. They noted that research participants’ vulnerabilities frequently change in the aftermath of a disaster and often in unpredictable ways. Third, they identified concerns related to promoting and maintaining safety, confidentiality and data security in insecure or austere environments. Lastly, though REC members endorsed the need and usefulness of community engagement, they noted that there are significant challenges in a disaster setting over and above those typically encountered in global health research to achieve meaningful community engagement. Disaster research presents distinctive ethical considerations that require attention to ensure that participants are protected. As RECs review disaster research protocols, they should address these concerns and consider how justification, vulnerability, security and confidentially, and community engagement are shaped by the realities of conducting research in a disaster. (shrink)

While evaluation of ethical aspects in health technology assessment has gained much attention during the past years, the integration of ethics in HTA practice still presents many challenges. In response...

BackgroundWhile evaluation of ethical aspects in health technology assessment has gained much attention during the past years, the integration of ethics in HTA practice still presents many challenges. In response to the increasing demand for expansion of health technology assessment methodology to include ethical issues more systematically, this article reports on a multi-stage study that aimed at construction of a framework for improving the integration of ethics in HTA.MethodsThe framework was developed through the following phases: 1) a systematic review and (...) content analysis of guidance documents for ethics in HTA; 2) identification of factors influencing the integration of ethical considerations in HTA; 3) preparation of an action-oriented framework based on the key elements of the existing guidance documents and identified barriers to and facilitators of their implementation; and 4) expert consultation and revision of the framework.ResultsThe proposed framework consists of three main components: an algorithmic flowchart, which exhibits the different steps of an ethical inquiry throughout the HTA process, including: defining the objectives and scope of the evaluation, stakeholder analysis, assessing organizational capacity, framing ethical evaluation questions, ethical analysis, deliberation, and knowledge translation; a stepwise guide, which focuses on the task objectives and potential questions that are required to be addressed at each step; and a list of some commonly recommended or used tools to help facilitate the evaluation process.ConclusionsThe proposed framework can be used to support and promote good practice in integration of ethics into HTA. However, further validation of the framework through case studies and expert consultation is required to establish its utility for HTA practice. (shrink)

The humanitarian sector continually faces organizational and operational challenges to respond to the needs of populations affected by war, disaster, displacement, and health emergencies. With the goal of improving the effectiveness and efficiency of response efforts, humanitarian innovation initiatives seek to develop, test, and scale a variety of novel and adapted practices, products, and systems. The innovation process raises important ethical considerations, such as appropriately engaging crisis-affected populations in defining problems and identifying potential solutions, mitigating risks, ensuring accountability, sharing benefits (...) fairly, and managing expectations. This paper aims to contribute to knowledge and practice regarding humanitarian innovation ethics and presents two components related to a value-sensitive approach to humanitarian innovation. First is a mapping of how ethical concepts are mobilized in values statements that have been produced by a diverse set of organizations involved in humanitarian innovation. Analyzing these documents, we identified six primary values (do-no-harm, autonomy, justice, accountability, sustainability, and inclusivity) around which we grouped 12 secondary values and 10 associated concepts. Second are two proposed activities that teams engaged in humanitarian innovation can employ to foreground values as they develop and refine their project’s design, and to anticipate and plan for challenges in enacting these values across the phases of their project. A deliberate and tangible approach to engaging with values within humanitarian innovation design can help to ground humanitarian innovation in ethical commitments by increasing shared understanding amongst team members, promoting attentiveness to values across the stages of innovation, and fostering capacities to anticipate and respond to ethically challenging situations. (shrink)

BackgroundThe role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues.MethodsWe conducted seven (...) day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly.ResultsBroad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research.ConclusionBecause no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record for purposes other than clinical care. This could be done, for example, through a web-based patient portal to their electronic health record. Researchers and policy makers should continue to engage the public to promote greater public understanding of the research process and to look for feasible alternatives to existing approaches to project-specific consent for observational research. (shrink)

BackgroundStigma refers to a distinguishing personal trait that is perceived as or actually is physically, socially, or psychologically disadvantageous. Little is known about the opinion of those who have more or less stigmatizing health conditions regarding the need for consent for use of their personal information for health research.MethodsWe surveyed the opinions of people 18 years and older with seven health conditions. Participants were drawn from: physicians' offices and clinics in southern Ontario; and from a cross-Canada marketing panel of individuals (...) with the target health conditions. For each of five research scenarios presented, respondents chose one of five consent choices: (1) no need for me to know; (2) notice with opt-out; (3) broad opt-in; (4) project-specific permission; and (5) this information should not be used. Consent choices were regressed onto: demographics; health condition; and attitude measures of privacy, disclosure concern, and the benefits of health research. We conducted focus groups to discuss possible reasons for observed consent choices.ResultsWe observed substantial variation in the control that people wish to have over use of their personal information for research. However, consent choice profiles were similar across health conditions, possibly due to sampling bias. Research involving profit or requiring linkage of health information with income, education, or occupation were associated with more restrictive consent choices. People were more willing to link their health information with biological samples than with information about their income, occupation, or education.ConclusionsThe heterogeneity in consent choices suggests individuals should be offered some choice in use of their information for different types of health research, even if limited to selectively opting-out. Some of the implementation challenges could be designed into the interoperable electronic health record. However, many questions remain, including how best to capture the opinions of those who are more privacy sensitive. (shrink)

In 2016, following pandemic influenza threats and the 2014–2016 Ebola virus disease outbreaks, the WHO developed a guidance document for managing ethical issues in infectious disease outbreaks. In this article, we analyse some ethical issues that have had a predominant role in decision making in response to the current COVID-19 pandemic but were absent or not addressed in the same ways in the 2016 guidance document. A pandemic results in a health crisis and social and political crises both nationally and (...) globally. The ethical implications of these global effects should be properly identified so that appropriate actions can be taken globally and not just in national isolation. Our analysis, which is a starting point to test the broader relevance of the 2016 WHO document that remains the only available guidance document applicable globally, concludes that the WHO guidance should be updated to provide reasoned and thoughtful comprehensive ethics advice for the sound management of the current and future pandemics. (shrink)

It is clear that in the eyes of a growing number of humanitarian fieldworkers and decision-makers, palliative care is something humanitarian organizations should strive to provide as they address the needs of populations affected by crises. What remains less clear are the moral justifications underlying the push to do so. This chapter dives beneath surface prescriptions of what “ought to be” the place of palliative care within humanitarian response. It presents and analyses a series of evocative statements made by 24 (...) humanitarian healthcare actors about why, on what bases, and with what caveats, care for the dying deserves more attention within humanitarian healthcare response. Embedded in these statements are sometimes explicit, sometimes implicit ideas about what it means be a human and a humanitarian, and what humans need and deserve. Clarifying the experiences, practical considerations, understandings of care and responsibility, and norms and values underlying these feelings renders these available for more thorough reflection, discussion, and debate. (shrink)

Thinkers in related fields such as philosophy, psychology, and education define metacognition in a variety of different ways. Based on an emerging standard definition in psychology, we present evidence for metacognition in animals, and argue that mindreading and metacognition are largely orthogonal.

Smith et al. demonstrate the viability of animal metacognition research. We commend their effort and suggest three avenues of research. The first concerns whether animals are explicitly aware of their metacognitive processes. The second asks whether animals have metaknowledge of their own uncertain responses. The third issue concerns the monitoring/control distinction. We suggest some ways in which these issues elucidate metacognitive processes in nonhuman animals.

The way in which medical professionals engage in bioethical issues ultimately reflects the type of care such patients are likely to receive. It is therefore critical for doctors and other health care professionals to have a broad understanding of disability. Our purpose in this paper is to explore ways of teaching bioethical issues to first year medical students by integrating alternative approaches. Such approaches include (a) the use of the narrative format, (b) the inclusion of a disability perspective, and (c) (...) the presentation and facilitation of classes by people with disabilities. We consider how these new kinds of presentations are evaluated by students, faculty, people with disabilities and professional ethicists. We hope new knowledge may provide health care professionals with a greater understanding of the perspectives of patients with disabilities, who are confronted by conflicting ethical values and frameworks for decision-making in their interaction with such professionals. (shrink)

`Being sensitive' in nursing was explored using Schwartz-Barcott and Kim's hybrid model of concept development, producing a tentative definition of the concept. Three phases were employed: theoretical, empirical/fieldwork and analytical. An exploration of the literature identified where the common idea of `being sensitive' as a nurse was embedded and demonstrated that a theoretical development of this fundamental aspect of nursing was absent. The empirical phase was conducted using semistructured interviews with nine expert palliative care and cancer nurses. This method was (...) particularly useful for the exploration of this concept because of its firm grounding in practical example. A definition of what the concept `being sensitive' means in nursing, and subsequent clarification of `being insensitive', have been posed from the research process undertaken. The essential nature of this concept being integral to nursing practice is emphasized. Potential implications for the development of nursing practice through teaching of this concept were identified. (shrink)

The program of Reverse Mathematics (Simpson 2009) has provided us with the insight that most theorems of ordinary mathematics are either equivalent to one of a select few logical principles, or provable in a weak base theory. In this paper, we study the properties of the Dirac delta function (Dirac 1927; Schwartz 1951) in two settings of Reverse Mathematics. In particular, we consider the Dirac Delta Theorem, which formalizes the well-known property \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} (...) \setlength{\oddsidemargin}{-69pt} \begin{document}$${\int_\mathbb{R}f(x)\delta(x)\,dx=f(0)}$$\end{document} of the Dirac delta function. We show that the Dirac Delta Theorem is equivalent to weak König’s Lemma (see Yu and Simpson in Arch Math Log 30(3):171–180, 1990) in classical Reverse Mathematics. This further validates the status of WWKL0 as one of the ‘Big’ systems of Reverse Mathematics. In the context of ERNA’s Reverse Mathematics (Sanders in J Symb Log 76(2):637–664, 2011), we show that the Dirac Delta Theorem is equivalent to the Universal Transfer Principle. Since the Universal Transfer Principle corresponds to WKL, it seems that, in ERNA’s Reverse Mathematics, the principles corresponding to WKL and WWKL coincide. Hence, ERNA’s Reverse Mathematics is actually coarser than classical Reverse Mathematics, although the base theory has lower first-order strength. (shrink)

I argue against traditional virtue epistemology on which knowledge is a success due to a competence to believe truly, by revealing an in-principle problem with the traditional virtue epistemologist’s explanation of Gettier cases. The argument eliminates one of the last plausible explanation of Gettier cases, and so of knowledge, in terms of non-factive mental states and non-mental conditions. I then I develop and defend a different kind of virtue epistemology, on which knowledge is an exercise of a competence to know. (...) I show how the account, while circular, is not viciously so. It explains both how knowledge is a mental state, as well as the relationship between knowledge and justification, including justified false beliefs and Gettier cases. Moreover, although direct virtue epistemology is compatible with many views on the nature of belief, it can explain how knowledge might be metaphysically more fundamental than belief as well. (shrink)

Part 1. FOUNDERS AND FIRSTCOMERS1: David Zimmerman: 'Protests Butter no Parsnips': Lord Beveridge and the Rescue of Refugee Academics from Europe, 1933-19382: William Lanouette: A Narrow Margin of Hope: Leo Szilard in the Founding Days of CARA3: Paul Weindling: From Refugee Assistance to Freedom of Learning: the Strategic Vision of A. V. Hill, 1933-19644: Gustav Born: Refugee Scientists in a New Environment5: Georgina Ferry: Max Perutz and the SPSLPART 2. TESS - THE LINCHPIN6: Paul Broda: Esther Simpson: A Correspondence7: (...) Lewis Elton: Eva and EstherPART 3. ASSOCIATES AND ALLIES8: Gerald Kreft: 'Dedicated to Represent the True Spirit of the German Nation in the World': Philipp Schwartz, Founder of the Notgemeinschaft9: Tibor Frank: Organized Rescue Operations in Europe and the United States, 1933-194510: Susan Cohen: In Defence of Academic Women Refugees: The British Federation of University Women11: Stina Lyon: Karl Mannheim and Viola Klein: Refugee Sociologists in Search of Social Democratic PracticePART 4. REVERSING THE GAZE12: Christian Fleck: Austrian Refugee Social Scientists13: Antoon de Baets: Plutarch's Thesis: The Contribution of Refugee Historians to Historical Writing, 1945-201014: Marina Yu Sorokina: Within Two Tyrannies: The Soviet Academic Refugees of the Second World War15: Antonín Kostlán and Soña Strbáñová: Czech Scholars in Exile, 1948-198916: Shula Marks: 'Bending the rules': South African Refugees in the UK, 1960-198017: Alan Phillips: Refugee Academics from Chile: WUS-SPSL CollaborationLucia Muñoz: Postscript. (shrink)

The experience of uncertainties in exploring the unknown—and dealing with them—is a key characteristic of what it means to be a life science researcher, but we have only started to understand how this characteristic shapes cultures of knowledge production, particularly in times when other—more social—uncertainties enter the field. Although the lab studies tradition has explored the workings of epistemic uncertainties, the range of potent uncertainty experiences in research cultures has been broadened within the neoliberal reorganization of academic institutions. Most importantly, (...) the stronger dependency on competitive project funding has led to increased social uncertainties. Being employed part-time and for shorter periods of time, researchers often find themselves in the precarious situation of high employment uncertainty. This article argues that the currently predominant form of organizing academic research creates a structural link between epistemic and social uncertainties. It then describes empirically different modes of coping with these uncertainties that researchers deploy and that seem to have become a variable in the governance of research cultures. To do so, it takes the academic life sciences in Austria as an example and explores them using approaches from both science and technology studies and labor studies. (shrink)

The thought and work of the Jesuit Francisco Suárez (1548-1617) is widely acknowledged as the culmination point of the contribution of the theologians and jurists of the so-called School of Salamanca to the development of modern Western law. This collection of studies on the legal work of Suárez explores some of his major forays into the law. Both his theoretical system-building as well as his interventions in practical questions are covered. Next to discussions on the nature of law and its (...) different categorisations, they extend to various subbranches of the law including family law, property law, the law of obligations, criminal law and international law. Contributors are: Dominique Bauer, Daniel Schwartz, João Manuel Azevedo Alexandrino Fernandes, Lisa Brunori, Wim Decock, Bart Wauters, Gaëlle Demelemestre, and Jean-Paul Coujou. (shrink)

ABSTRACTWhile over the last few decades AI research has largely focused on building tools and applications, recent technological developments have prompted a resurgence of interest in building a genuinely intelligent artificial agent – one that has a mind in the same sense that humans and animals do. In this paper, I offer a theoretical and methodological framework for this project of investigating “artificial minded intelligence” that can help to unify existing approaches and provide new avenues for research. I first outline (...) three desiderata that a framework for AMI research should satisfy. In Section 1, I further motivate the desiderata as well as the need for a new framework. Section 2 develops a general methodological approach, the “generative methodology,” and Section 3 develops a version of this methodology, the “Competence Framework for AI research”. (shrink)

The present study provides evidence that valence focus and arousal focus are important processes in determining whether a dimensional or a discrete emotion model best captures how people label their affective states. Individuals high in valence focus and low in arousal focus fit a dimensional model better in that they reported more co-occurrences among like-valenced affective states, whereas those lower in valence focus and higher in arousal focus fit a discrete model better in that they reported fewer co-occurrences between like-valenced (...) affective states. Taken together, these findings suggest that one static, nomothetic theory may not accurately describe the subjective affective experience of all individuals. (shrink)

In discussions concerning intersubjectivity the notion of expression has come to play a part of increasing significance. Expression shifts our point of departure away from subjectivity as something mysterious hidden within the body to subjectivity as altogether embodied and embedded in the world. In this article I engage writings by Maurice Merleau-Ponty to argue that expression is essentially something that happens in a communicative space in between self and other while at the same time giving rise to both. I show (...) how locating expression in a shared space between self and other is a way of emphasizing that self and other are not only expressive of selfhood, but are also expressed by one another and emerge in relation to one another. I point to this understanding of expression as a way of recognizing that there is both a fundamental reciprocity and asymmetry between self and other. (shrink)

Here’s a nice, simple view. Knowing that p is the sole fundamental aim and achievement in the epistemic domain. It is a manifestation of epistemic competence, and we can metaphysically explain both the existence and the normative status of all other epistemic states in terms of knowledge and the competence it manifests. In this paper I will defend this view from a challenge from Ernest Sosa that knowledge is too weak and primitive to do the work the Simple View asks (...) it to do. He claims that we not only need knowing that p, but also reflectively knowing that p and knowing full well that p. I argue that Sosa is mistaken. Good old knowledge, what Sosa calls animal knowledge, when properly understood, can do all of the work that reflective knowledge and knowing full well are supposed to do. Knowledge, at least in the epistemic domain, is all you need. In section 1, I explain in more detail the challenge that Sosa poses for the Simple View, and consequently my direct virtue epistemology. I then explain Sosa’s accounts of reflective knowledge and knowing full well, further clarifying the debate. In sections 2, 3, and 4, I consider Sosa’s arguments that reflective knowledge and knowing full well are distinctive epistemic achievements. Section 2 addresses his argument from the epistemic evaluability of suspending belief. Section 3 addresses his arguments for the claim that a variety of cases can only be adequately accounted for by invoking these other states. Section 4 addresses his arguments about the role of reflective knowledge in rebutting dream skepticism. Responding to Sosa’s arguments also helps to clarify certain features of knowledge and epistemic competence. I conclude by reviewing these features. (shrink)

Building on group discussions and interviews with life science researchers in Austria, this paper analyses the narratives that researchers use in describing what they feel responsible for, with a particular focus on how they perceive the societal responsibilities of their research. Our analysis shows that the core narratives used by the life scientists participating in this study continue to be informed by the linear model of innovation. This makes it challenging for more complex innovation models [such as responsible research and (...) innovation ] to gain ground in how researchers make sense of and conduct their research. Furthermore, the paper shows that the life scientists were not easily able to imagine specific practices that would address broader societal concerns and thus found it hard to integrate the latter into their core responsibilities. Linked to this, researchers saw institutional reward structures as strongly focused on scientific excellence. Thus, they saw reward structures as competing with—rather than incentivising—broader notions of societal responsibility. This narrative framing of societal responsibilities is indicative of a structural marginalisation of responsibility practices and explains the claim, made by many researchers in our sample, that they cannot afford to spend time on such practices. The paper thus concludes that the core ideas of RRI stand in tension with predominant narrative and institutional infrastructures that researchers draw on to attribute meaning to their research practices. This suggests that scientific institutions still have a core role to play in providing new and context-specific narratives as well as new forms of valuing responsibility practices. (shrink)

When cognitive scientists are looking for the neural basis of consciousness or the computational processes underlying vision, what are they looking to find? I argue for a new account of this explanatory project in cognitive science (and the special sciences more generally) on which it is best understood on close analogy with causal explanation in the special sciences. Causal explanations cite causal difference-makers: they explain how certain events causally depend on other events. Generative explanations cite generative difference-makers: they explain how (...) certain events obtain in virtue of (and so are generated by) other events. I show how that this generative difference-making account (GDM) extends well regarded developments in philosophical work on causal explanation, helps to usefully clarify and expands the hypothesis space of a key project in cognitive science – that of understanding how underlying nonmental processes give rise to the mental, including consciousness. In section 2, I develop GDM by close analogy with causal explanation, and locate both of them as species of a more general project in the special sciences: that of discovering what makes a difference to what. In section 3, I motivate GDM by contrasting it with other rival accounts, including correlationist, identity, and grounding accounts, as well as Carl Craver’s constitutive relevance account. In section 4, I tie all of the strands of the preceding discussion together to show how GDM provides a new and compelling response to the so-called hard problem of consciousness. (shrink)

The question of whether clinical ethics consultants may engage in patient advocacy in the course of consultation has not been addressed, but it highlights for the field that consultants? allegiances, and the boundaries of appropriate professional practice, must be better understood. I consider arguments for and against patient advocacy in clinical ethics consultation, which demonstrate that patient advocacy is permissible, but not central to the practice of consultation. I then offer four recommendations for consultants who engage in patient advocacy, and (...) consider the implications of this issue for the field.1. (shrink)

We initiate the reverse mathematics of general topology. We show that a certain metrization theorem is equivalent to Π2 1 comprehension. An MF space is defined to be a topological space of the form MF(P) with the topology generated by $\lbrace N_p \mid p \in P \rbrace$ . Here P is a poset, MF(P) is the set of maximal filters on P, and $N_p = \lbrace F \in MF(P) \mid p \in F \rbrace$ . If the poset P is countable, (...) the space MF(P) is said to be countably based. The class of countably based MF spaces can be defined and discussed within the subsystem ACA0 of second order arithmetic. One can prove within ACA0 that every complete separable metric space is homeomorphic to a countably based MF space which is regular. We show that the converse statement, "every countably based MF space which is regular is homeomorphic to a complete separable metric space," is equivalent to Π2 1-CA0. The equivalence is proved in the weaker system Π1 1-CA0. This is the first example of a theorem of core mathematics which is provable in second order arithmetic and implies Π2 1 comprehension. (shrink)

Clinical delusions are difficult to investigate in the laboratory because they co-occur with other symptoms and with intellectual impairment. Partly for these reasons, researchers have recently begun to use hypnosis with neurologically intact people in order to model clinical delusions. In this paper we describe striking analogies between the behavior of patients with a clinical delusion of mirrored self misidentification, and the behavior of highly hypnotizable subjects who receive a hypnotic suggestion to see a stranger when they look in the (...) mirror. Based on these analogies, we argue that the use of hypnosis is a reliable method to investigate the surface features of clinical delusions. But to what extent can hypnosis successfully recreate delusions? Can it also contribute to a better understanding of delusion formation? Although clinical delusions and hypnotically induced beliefs are different in etiology, some analogies can be identified in the underlying processes that characterise them, based on the two-factor theory of delusion formation. (shrink)

In modern zoos, enrichment programs have become a standard part of animal care routines. Although 'higher' primates usually receive complex enrichment programs, encompassing many types of enrichment, these are less common for prosimians. These animals often largely receive food-based enrichment, as was previously the case at Auckland Zoo, where the ring-tailed lemur enrichment schedule contained only three different items, all food-related. Lemurs tend to be considered less curious and quick to learn than other primates, as well as being less manually (...) dextrous, and for these reasons can be overlooked for complex enrichment. However, they have strong sensory abilities, in particular an acute sense of smell (Sauther et al 1999). This paper describes an enrichment program designed for the lemurs at Auckland Zoo with the aim of stimulating all senses. (shrink)

Section I examines historical philosophical understandings of expertise in order to situate the current institution of bioethics. Section II focuses on philosophical analyses of the concept of expertise, asking, among other things, how it should be understood, how it can be acquired, and what such expertise warrants. Finally, section III addresses topics in bioethics and how ethics expertise should or should not be brought to bear in these areas, including expertise in the court room, in the hospital room, in the (...) media, and in making policy. 2. A GUIDED HISTORICAL TOUR As Scott LaBarge points out, Plato’s dialogues can be viewed as an extended treatment of the concept of moral expertise, so it is fitting to begin the volume with an examination of “Socrates and Moral Expertise”. Given Socrates’ protestations that he knows nothing, LaBarge observes that it would be interesting to determine both what a Socratic theory of moral expertise might be and whether Socrates qualified as such an expert. Plato’s model of moral expertise is what LaBarge calls “demonstrable expertise”, which is concerned mainly with the ability to attain a goal and to explain how one did it. The problem with this account is that when one tries to solve the various problems in the model – for example, allowing that moral expertise is not an all-or-nothing skill – then one is immediately faced with the “credentials problem”. As LaBarge puts it, “... (shrink)