Specialists and primary care physicians play an integral role in treating the twin epidemics of pain and addiction. But inadequate access to specialists causes much of the treatment burden to fall on primary physicians. This article chronicles the differences between treatment contexts for both pain and addiction — in the specialty and primary care contexts — and derives a series of reforms that would empower primary care physicians and better leverage specialists.

Excessive prescribing of pain medications after surgery has contributed to the epidemic of opioid misuse and diversion in the United States. Pain specialists may be particularly well situated to address these issues. We describe an attempt to reverse the trend at an orthopedic surgical hospital by implementing a peri-operative assessment and treatment service which minimizes preoperative opioid use, when necessary implements addiction treatment, and encourages early tapering from opioids.

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

The dispute over the exact nature and status of possible worlds in Leibniz’s philosophy has proven difficult to resolve. The standard view, that there is one unique actual world and that possible worlds exist solely as ideas within God’s understanding, sits in tension with important metaphysical and theological components of Leibniz’s system. For example, Leibniz takes possible individuals to have some “essence or reality” in themselves and to strive for existence, which allows him to ground counterfactual claims and to overcome (...) necessitarianism. However, scholars have long seen these claims as being at odds with God’s creation of one unique actual world. Catherine Wilson (2000) challenges the standard view’s claim that possible worlds are substantially different from the actual world, arguing instead that Leibniz’s metaphysical commitments are consistent with there being more than one actual world and that Leibniz has no way to block the claim that God would generate more than one such world. In this paper, I expand on Wilson’s account and argue, contrary to the standard view, that the key theses at the heart of Leibniz’s philosophical system entail modal realism—for Leibniz, there can be no ontological difference between possible and actual worlds. (shrink)

Scientists know that human activities, primarily fossil fuel combustion, are causing Earth’s temperature to increase. Yet in 2021, only 60% of the US population understood that human activities are the primary cause of global warming. We experimentally test whether information about the human causes of global warming influences Americans’ beliefs and concerns about global warming and support for climate policies. We find that communicating information about the human-causes of global warming increases public understanding that global warming is human-caused. This information, (...) both alone and with additional information about climate impacts and policy solutions, also increases public concern about global warming and support for climate policies, although the effects on climate concern and policy support are smaller. Importantly, the treatment effects are consistent across political party, with no backlash effects among Republicans. This suggests that when informed about climate change causes, impacts and solutions, most Americans can update their own climate change beliefs, risk perceptions, and policy support. (shrink)

Brain-computer interfaces (BCIs) have been successfully used by adults, but little information is available on BCI use by children, especially children with severe multiple impairments who may need technology to facilitate communication. Here we discuss the challenges of using non-invasive BCI with children, especially children who do not have another established method of communication with unfamiliar partners. Strategies to manage these challenges require consideration of multiple factors related to accessibility, cognition, and participation. These factors include decisions regarding where (home, clinic, (...) or lab) participation will take place, the number of sessions involved, and the degree of participation necessary for success. A strategic approach to addressing the unique challenges inherent in BCI use by children with disabilities will increase the potential for successful BCI calibration and adoption of BCI as a valuable access method for children with the most significant impairments in movement and communication. (shrink)

Normative ethical theories owe us an account of how to evaluate decisions under risk and uncertainty. Deontologists seem at a disadvantage here: our best decision theories seem tailor-made for consequentialism. For example, decision theory enjoins us to always perform our best option; deontology is more permissive. In this paper, we discuss and defend the idea that, when some pro-tanto wrongful act is all-things considered permissible, because it is a ‘lesser evil’, it is often merely permissible, by the lights of deontology. (...) We show that this raises new problems for deontological decision theory, and we show that to resolve them, we need to take a more innovative approach to morally evaluating decision-making under risk and uncertainty. (shrink)

The National Science Foundation's Second Merit Criterion, or Broader Impacts Criterion , was introduced in 1997 as the result of an earlier Congressional movement to enhance the accountability and responsibility as well as the effectiveness of federally funded projects. We demonstrate that a robust understanding and appreciation of NSF BIC argues for a broader conception of research ethics in the sciences than is currently offered in Responsible Conduct of Research training. This essay advocates augmenting RCR education with training regarding broader (...) impacts. We demonstrate that enhancing research ethics training in this way provides a more comprehensive understanding of the ethics relevant to scientific research and prepares scientists to think not only in terms of responsibly conducted science, but also of the role of science in responding to identified social needs and in adhering to principles of social justice. As universities respond to the mandate from America COMPETES to “provide training and oversight in the responsible and ethical conduct of research”, we urge institutions to embrace a more adequate conception of research ethics, what we call the Ethical Dimensions of Scientific Research, that addresses the full range of ethical issues relevant to scientific inquiry, including ethical issues related to the broader impacts of scientific research and practice. (shrink)

What is known? And how do we come to know it? These are the primary points of focus for metaphysics and epistemology, respectively. Here, in one of the classic works of early-modern empiricist philosophy, John Locke (1632-1704) attempts to answer these basic human questions by moving away from the rationalist notion of innate ideas to establish the concept of the tabula rasa in which the mind is initially impressed with ideas through perception of the external world of substance. The formation (...) of basic ideas through the perception of primary and secondary qualities, and the more sophisticated development of concepts, is discussed as Locke departs from a purely mental view of knowledge to ground what we know in the firmer soil of empirical observation and in the mind's ability to interrelate ideas from perception. The careful reasoning of Locke's Essay has made it an enduring part of the history of of Western philosophy. (shrink)

Evolutionary activity statistics and their visualization are introduced, and their motivation is explained. Examples of their use are described, and their strengths and limitations are discussed. References to more extensive or general accounts of these techniques are provided.

Which systems/organisms are conscious? New tests for consciousness (‘C-tests’) are urgently needed. There is persisting uncertainty about when consciousness arises in human development, when it is lost due to neurological disorders and brain injury, and how it is distributed in nonhuman species. This need is amplified by recent and rapid developments in artificial intelligence (AI), neural organoids, and xenobot technology. Although a number of C-tests have been proposed in recent years, most are of limited use, and currently we have no (...) C-tests for many of the populations for which they are most critical. Here, we identify challenges facing any attempt to develop C-tests, propose a multidimensional classification of such tests, and identify strategies that might be used to validate them. (shrink)

A major approach to the ethics of artificial intelligence is to use social choice, in which the AI is designed to act according to the aggregate views of society. This is found in the AI ethics of “coherent extrapolated volition” and “bottom–up ethics”. This paper shows that the normative basis of AI social choice ethics is weak due to the fact that there is no one single aggregate ethical view of society. Instead, the design of social choice AI faces three (...) sets of decisions: standing, concerning whose ethics views are included; measurement, concerning how their views are identified; and aggregation, concerning how individual views are combined to a single view that will guide AI behavior. These decisions must be made up front in the initial AI design—designers cannot “let the AI figure it out”. Each set of decisions poses difficult ethical dilemmas with major consequences for AI behavior, with some decision options yielding pathological or even catastrophic results. Furthermore, non-social choice ethics face similar issues, such as whether to count future generations or the AI itself. These issues can be more important than the question of whether or not to use social choice ethics. Attention should focus on these issues, not on social choice. (shrink)

Atrial natriuretic peptides appear to elicit their actions in some target tissues by binding to a novel cell‐surface transmembrane protein which possesses both peptide binding and guanylate cyclase activities. Ligand binding stimulates enzyme activity to produce increased intracellular concentrations of cyclic GMP which, in turn, mediates the cell's physiological response.

The Laws was Plato's last work, his longest, and one of his most difficult. In contrast to the Republic, which presents an abstract ideal not intended for any actual community, the Laws seems to provide practical guidelines for the establishment and maintenance of political order in the real world. With this book, the distinguished classicist Seth Benardete offers an insightful analysis and commentary on this rich and complex dialogue. Each of the chapters corresponds to one of the twelve books (...) of the Laws, illuminating the major themes and arguments, which have to do with theology, the soul, justice, and education. The Greek word for law, "nomos," also means musical tune. Bernardete shows how music--in the broadest sense, including drama, epic poetry, and even puppetry--mediates between reason and the city in Plato's philosophy of law. Most broadly, however, Benardete here uncovers the concealed ontological dimension of the Laws, explaining why it is concealed and how it comes to light. In establishing the coherence and underlying organization of Plato's last dialogue, Benardete makes a significant contribution to Platonic studies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 41.1 (2003) 136-137 [Access article in PDF] John Watkins. Human Freedom after Darwin: A Critical Rationalist View. Chicago: Open Court Publishing, 1999. Pp. xi + 348. Cloth, $49.95. Paper, $24.95. John Watkins examines man's place in nature since Darwin. As a critical rationalist, using the methods of science, Watkins hopes to construct a world-view which challenges competing hypotheses and supports his own. He (...) recognizes that his view is, also, a candidate for critical rejection. All scientific views are, in principle, fallible. He divides his book into two parts: Naturalism and Freedom. [End Page 137]In evolutionary development, he accepts, as critically established, the sequence: matter before life, life before mind, and, no mind without a brain. Thus, naturalism is preferred beforesupernaturalism or divine intervention. These guides may support a continuous, steady evolutionaryprocess or discontinuity, mutations, and various stages of change. Darwin acceptedthe former and held physical changes were unaffected by consciousness. All change is, in principle,present from the beginning and unfolds over time. Darwin's view, then, is deterministic.Watkins challenges this position and argues for consciousness affecting physical change in new and unpredictable ways. It is herein that the possibility of animal and human freedom lies. Watkins gives examples of the actions of the hunter and hunted among animals, and of strategies developed by humans during crises, to support the view that there are novel and unpredictable actions by conscious beings. These actions can hardly be called predetermined in the nature of things. There is a huge difference between a general genetic structure for kinds of behavior and specific actions during crises (not that these are the only instances of freedom). At any rate, there is a reciprocal action between an individual and its environment and not merely a unilinear one.In Part II, Freedom, Watkins examines some classical, philosophical views of human freedom. He gives brief, but penetrating, analyses of Hobbes, Descartes, Hume, Kant, Schopenhauer, and Spinoza. Either they account for human action in strictly physical terms that are causally deterministic or they turn to non-empirical sources that are not verifiable. Since the latter make no difference in our account of behavior, they are entities multiplied beyond necessity. Those who give a completely deterministic view—Hobbes, Hume, and Schopenhauer—offer no continuum between cause and chance. Chance turns out to depend upon our ignorance of causes; further examination would show it causally determined.Watkins seems most sympathetic to Spinoza's treatment. In his hard-headed naturalism, Spinoza rejects any non-natural or supernatural accounts of human behavior. He is a strict determinist where man's confrontation with nature is concerned. Human emotions are passive and react to our environment; they do not affect it. Human reason makes no difference, but in its capacity to contemplate eternal truths it offers a way out. Instead of reacting to nature, man may transcend it. This transcendence is the key to Spinoza's view of the intellectual love of God, and human freedom. Watkins criticizes this flight from man's place in nature and the limited use of reason. In this vein, Spinoza seems to abandon the confrontation of nature for a flight to eternal truths. For Watkins, however, reasons must be used in confronting nature. As we saw, he claims that reason may have an effect upon the environment that is novel and unpredictable. Human agency is a part of the evolutionary story. Human agency is not an either/or proposition. There are degrees of effectiveness in human response to nature.In his analysis of human freedom, Watkins turns to the works of Newton, Faraday, Einstein, and others. In studying the problems posed by the consideration of natural phenomena during their time, they showed intellectual perspicacity of the highest order. Faraday's unified field theory brought electrical and magnetic phenomena, previously thought to be disparate, together. Newton's laws of motion brought celestial and terrestrial mechanics under one theory. Einstein changed the way in which space, time, mass, energy, and light were conceived. In a real sense, they were... (shrink)

Normative ethical theories owe us an account of how to evaluate decisions under risk and uncertainty. Deontologists seem at a disadvantage here: our best decision theories seem tailor-made for consequentialism. For example, decision theory enjoins us to always perform our best option; deontology is more permissive. In this paper, we discuss and defend the idea that, when some pro-tanto wrongful act is all-things considered permissible, because it is a ‘lesser evil’, it is often merely permissible, by the lights of deontology. (...) We show that this raises new problems for deontological decision theory, and we show that to resolve them, we need to take a more innovative approach to morally evaluating decision-making under risk and uncertainty. (shrink)

This paper critiques a number of standard ways of understanding the role of the metalanguage in a semantic theory for natural language, including the idea that disquotation plays a nontrivial role in any explanatory natural language semantics. It then proposes that the best way to understand the role of a semantic metalanguage involves recognizing that semantics is a model-based science. The metalanguage of semantics is language for articulating features of the theorist's model. Models are understood as mediating instruments---idealized structures used (...) to represent select aspects of the world, aspects the theorist is seeking some theoretical understanding of. The aspect of reality we are seeking some understanding of in semantics is a dimension of human linguistic competence---informally, knowledge of meaning. (shrink)

The concept of responsible leadership has garnered increased attention in recent years. Indeed, irresponsibility on the part of organizational leaders appears to represent an area of growing concern to the greater public. Accordingly, it is appropriate that increased scholarly attention be devoted to an understanding of this concept. But with that said, the purpose of this article is to identify three caveats about which researchers and practitioners should be concerned as work in this area proceeds. These caveats pertain to: (1) (...) definitional issues, (2) the importance of theory and research that is not ideologically driven or biased, and (3) the positioning of responsible leadership within the greater body of leadership theory and research. Additional concerns are considered including the measurement of responsible leadership and research strategies. (shrink)

Artificial intelligence experts are currently divided into “presentist” and “futurist” factions that call for attention to near-term and long-term AI, respectively. This paper argues that the presentist–futurist dispute is not the best focus of attention. Instead, the paper proposes a reconciliation between the two factions based on a mutual interest in AI. The paper further proposes realignment to two new factions: an “intellectualist” faction that seeks to develop AI for intellectual reasons and a “societalist faction” that seeks to develop AI (...) for the benefit of society. The paper argues in favor of societalism and offers three means of concurrently addressing societal impacts from near-term and long-term AI: advancing societalist social norms, thereby increasing the portion of AI researchers who seek to benefit society; technical research on how to make any AI more beneficial to society; and policy to improve the societal benefits of all AI. In practice, it will often be advantageous to emphasize near-term AI due to the greater interest in near-term AI among AI and policy communities alike. However, presentist and futurist societalists alike can benefit from each others’ advocacy for attention to the societal impacts of AI. The reconciliation between the presentist and futurist factions can improve both near-term and long-term societal impacts of AI. (shrink)

Epistemic modal operators give rise to something very like, but also very unlike, Moore's paradox. I set out the puzzling phenomena, explain why a standard relational semantics for these operators cannot handle them, and recommend an alternative semantics. A pragmatics appropriate to the semantics is developed and interactions between the semantics, the pragmatics, and the definition of consequence are investigated. The semantics is then extended to probability operators. Some problems and prospects for probabilistic representations of content and context are explored.

Understanding human behaviour, thoughts, and emotional expressions can be challenging in the global context. Due to cultural differences, the study of psychology cannot be de-contextualised. This calls for unearthing of the explanatory systems that exist in Africa to understand and account for behaviour, emotions, and cognition of Africans. This call is addressed through the emergence of African Psychology (AP) or Indigenous Psychology in Africa (IPA) as a legitimate science of human experience. This Element discusses the motivations for AP, centrality of (...) culture, demarcations of AP, and the different strands within AP. It highlights issues related to African philosophy, African cultural anthropology, African philosophy of science, and suitable methodological approaches for AP research. It also discusses some selected theoretical contributions and applications of AP. The Element concludes that AP researchers and practitioners need to pursue interdisciplinarity and avoid meaningless rejection of good ideas from other cultural settings. (shrink)

Despite its enduring insights, Durkheim’s theory of suicide fails to account for a significant set of cases because of its overreliance on structural forces to the detriment of other possible factors. In this paper, we develop a new theoretical framework for thinking about the role of culture in vulnerability to suicide. We argue that by focusing on the cultural dynamics of excessive regulation, particularly at the meso level, a more robust sociological model for suicide could be offered that supplements structure-heavy (...) Durkheimian theory. In essence, we argue that the relevance of cultural regulation to suicide rests on the (1) degree to which culture is coherent in sociocultural places, (2) existence of directives related to prescribing or proscribing suicide, (3) degree to which these directives translate into internalized meanings affecting social psychological processes, and (4) degree to which the social space is bounded. We then illustrate how our new theory provides useful insights into three cases of suicide largely neglected within sociology: specifically, suicide clusters in high schools, suicide in the military, and suicides of “despair” among middle-aged white men. We conclude with implications for future sociological research on suicide and suicide prevention. (shrink)

This paper defends a counterexample to Modus Tollens, and uses it to draw some conclusions about the logic and semantics of indicative conditionals and probability operators in natural language. Along the way we investigate some of the interactions of these expressions with 'knows', and we call into question the thesis that all knowledge ascriptions have truth-conditions.