The term “normal” is culturally ubiquitous and conceptually vague. Interestingly, it appears to be a descriptive-normative-hybrid which, unnoticedly, bridges the gap between the descriptive and the normative. People’s beliefs about normality are descriptive and prescriptive and depend on both an average and an ideal. Besides, the term has generally garnered popularity in medicine. However, if medicine heavily relies on the normal, then it should point out how it relates to the concept of health or to statistics, and what, after all, (...) normal means. Most importantly, the normativity of the normal needs to be addressed. Since the apparently neutral label “normal” can exclude, stigmatize, and marginalize people who are defined in contrast to it as abnormal, health professionals should think twice before using the term with patients. The present critical perspective advocates against using the term “normal,” as long as no understanding of a person’s individual normality has been attained. It advocates for the right to autonomously determine one’s own normality. For health professionals I do not see worthwhile benefits of subscribing to the concept of “normality” and imposing it on their patients. But I do see many risks. (shrink)

Parents frequently attempt to shield their children from distressing prognostic information. Pediatric oncology providers sometimes follow parental request for non-disclosure of prognostic information to children, invoking what we call the stability of the family argument. They believe that if they inform the child about terminal prognosis despite parental wishes, cohesion and family structure will be severely hampered. In this paper, we argue against parental request for non-disclosure. Firstly, we present the stability of the family argument in more detail. We, then, (...) set out the (conceptual, legal, systemic) entitativity of the family and the kind of value the stability of the family argument assumes, before we set on to critically evaluate the argument. Our analysis shows that disclosure of prognostic information to children does not necessarily destabilize the family to a greater extent than non-disclosure. In fact, a systemic perspective suggests that mediated disclosure is more likely to result in a (long-term) stability of the family than non-disclosure. It is in the interest of the family to resist the initial aversive reaction to delivering bad news. In the final part, we draw a set of recommendations on how to facilitate decision-making in face of parental request for non-disclosure. (shrink)

This paper addresses psychological factors that might interfere with informed consent on the part of stable patients as potential early-phase clinical trial participants. Thirty-six semistructured interviews with patients who had either diabetes or gout were conducted. We investigated stable patients’ attitudes towards participating in a fictitious first-in-human trial of a novel intervention. We focused on an in-depth analysis of those statements and explanations that indicated the existence of psychological factors impairing decision-making capacity. Three main themes emerged: insufficient comprehension of the (...) inherent logic of clinical trials, the recourse to trust over comprehension, and visceral factors that override deliberative process. Overall, our results indicate a limited psychological capacity on the part of stable patients to meet the requirements of informed consent as set by Declaration of Helsinki. A redesigned informed consent procedure should take account of these psychological realities. (shrink)

The goal is to present how shared decision-making in paediatric oncology occurs from the viewpoints of parents and physicians. Eight Swiss Pediatric Oncology Group centres participated in this prospective study. The sample comprised a parent and physician of the minor patient. Surveys were statistically analysed by comparing physicians’ and parents’ perspectives and by evaluating factors associated with children’s actual involvement. Perspectives of ninety-one parents and twenty physicians were obtained for 151 children. Results indicate that for six aspects of information provision (...) examined, parents’ and physicians’ perceptions differed. Moreover, parents felt that the children were more competent to understand diagnosis and prognosis, assessed the disease of the children as worse, and reported higher satisfaction with decision-making on the part of the children. A patient’s age and gender predicted involvement. Older children and girls were more likely to be involved. In the decision-making process, parents held a less active role than they actually wanted. Physicians should take measures to ensure that provided information is understood correctly. Furthermore, they should work towards creating awareness for systematic differences between parents and physicians with respect to the perception of the child, the disease, and shared decision-making. (shrink)

In den letzten Jahren berichteten mehr und mehr Frauen von Gewalt und Respektlosigkeit in der Geburtshilfe. Inzwischen hat sich auch die Forschung verstärkt dieses Themas angenommen. Prävalenzschätzungen sind jedoch aufgrund erheblicher methodischer Schwächen noch nicht hinreichend genau zu beziffern. Die Vielzahl und Vielfalt der bestehenden Forschungsergebnisse lassen dennoch den Schluss zu, dass es in der Geburtshilfe in fast allen Regionen der Erde regelmäßig zu Gewalt und Respektlosigkeit und damit zu Menschenrechtsverletzungen kommt. Die Folgen reichen bis hin zu Posttraumatischen Belastungsstörungen, was (...) nahelegt, dass dieser Missstand sowohl aus Menschenrechts-Gründen als auch aus Gründen der öffentlichen Gesundheit nicht übergangen werden darf. Daher ist es außerordentlich besorgniserregend, wenn geburtshilfliche Fachpersonen im Angesicht solcher Berichte und Forschung in einen Modus der Selbstverteidigung verfallen und die Erfahrungen der Frauen in Frage sowie Abrede stellen, anstatt zuvorderst mit Empathie zu reagieren. Der vorliegende Text wendet sich einigen dieser Reaktionsmuster seitens geburtshilflicher Fachpersonen zu: einem falsch verstandenen Objektivitätsanspruch und der mithin abwegigen Forderung, die subjektiven Erfahrungen der Frauen zu objektivieren, einer leugnenden und herablassenden Wortwahl sowie einer mangelnden Anerkennung des von den Frauen Geschilderten und einer aus berufsethischer Perspektive unzureichend fürsorglichen Haltung. Solcherlei Reaktionen sind nicht nur unzulässig, sondern lassen ebenjenen Respekt vermissen, den die betroffenen Frauen sich während der Geburt wünschten und dessen Abwesenheit sie verletzte oder gar traumatisierte. Schließlich sollten Gewalt und Respektlosigkeit in der Geburtshilfe sowie die beschriebenen Reaktionen darauf vor dem Hintergrund geschlechtsspezifischer Machtverhältnisse und Gewalt an Frauen generell diskutiert werden. (shrink)

Background While the theoretical benefits and harms of Artificial Intelligence (AI) have been widely discussed in academic literature, empirical evidence remains elusive regarding the practical ethical challenges of developing AI for healthcare. Bridging the gap between theory and practice is an essential step in understanding how to ethically align AI for healthcare. Therefore, this research examines the concerns and challenges perceived by experts in developing ethical AI that addresses the healthcare context and needs. Methods We conducted semi-structured interviews with 41 (...) AI experts and analyzed the data using reflective thematic analysis. Results We developed three themes that expressed the considerations perceived by experts as essential for ensuring AI aligns with ethical practices within healthcare. The first theme explores the ethical significance of introducing AI with a clear and purposeful objective. The second theme focuses on how experts are concerned about the tension that exists between economic incentives and the importance of prioritizing the interests of doctors and patients. The third theme illustrates the need to develop context-sensitive AI for healthcare that is informed by its underlying theoretical foundations. Conclusions The three themes collectively emphasized that beyond being innovative, AI must genuinely benefit healthcare and its stakeholders, meaning AI also aligns with intricate and context-specific healthcare practices. Our findings signal that instead of narrow product-specific AI guidance, ethical AI development may need a systemic, proactive perspective that includes the ethical considerations (objectives, actors, and context) and focuses on healthcare applications. Ethically developing AI involves a complex interplay between AI, ethics, healthcare, and multiple stakeholders. (shrink)

The aim of the study is to encourage a critical debate on the use of normality in the medical literature on DSD or intersex. For this purpose, a scoping review was conducted to identify and map the various ways in which “normal” is used in the medical literature on DSD between 2016 and 2020. We identified 75 studies, many of which were case studies highlighting rare cases of DSD, others, mainly retrospective observational studies, focused on improving diagnosis or treatment. The (...) most common use of the adjective normal was in association with phenotypic sex. Overall, appearance was the most commonly cited criteria to evaluate the normality of sex organs. More than 1/3 of the studies included also medical photographs of sex organs. This persistent use of normality in reference to phenotypic sex is worrisome given the long-term medicalization of intersex bodies in the name of a “normal” appearance or leading a “normal” life. Healthcare professionals should be more careful about the ethical implications of using photographs in publications given that many intersex persons describe their experience with medical photography as dehumanizing. (shrink)

Evidence shows that during birth women frequently experience unconsented care, coercion, and a loss of autonomy. For many countries, this contradicts both the law and medical ethics guidelines, which emphasize that competent and fully informed women’s autonomy must always be respected. To better understand this discordance, we empirically describe perinatal maternity care providers’ and women’s moral deliberation surrounding coercive measures during birth. Data were obtained from 1-on-1 interviews with providers (N = 15) and women (N = 14), and a survey (...) of women (N = 118). Analyses focused on an in-depth exploration of responses to a question on the permissibility of coercion in birth whose wording was borrowed from a Swiss medical-ethical guideline. Reasons for and against a principle permissibility of coercive measures in birth were grouped into clusters of reasons to build a coherent explanatory framework. Factors considered morally relevant when deliberating on coercion included women’s decisional capacity, beneficence/non-maleficence, authority through knowledge on the part of providers, flaws of the medical system, or the imperative to protect the most vulnerable. Also, we identified various misconceptions, such as the conviction that a pathological birth can justify coercion or that fetal rights can justifiably infringe on women’s autonomy. Information and education on the issue of coercion in birth are urgently needed to enable women to fully exercise their reproductive autonomy, to prevent long-term adverse health outcomes of women and children, and to reconcile the medical vigilance which has lead to a reduction of perinatal morbidity and mortality with women’s enfranchisement in their own care. (shrink)

BackgroundNormality is both a descriptive and a normative concept. Undoubtedly, the normal often operates normatively as an exclusionary tool of cultural authority. While it has prominently found its way into the field of medicine, it remains rather unclear in what sense it is used. Thus, our study sought to elucidate people’s understanding of normality in medicine and to identify concepts that are linked to it.MethodsUsing convenient sampling, we carried out a cross-sectional survey. Since the survey was advertised through social media, (...) we employed an online survey. We performed descriptive and inferential analyses. Predictors were chosen in a theory-driven manner.ResultsIn total, 323 persons from 21 countries completed the survey. Analysis revealed that the overall acceptance of normality in medicine was associated with notions of injustice, authority, discrimination, and with having a medical profession. More precisely, for the field of mental health, injustice insensitivity, genderism and transphobia, and authority were positively associated with a person’s acceptance of normality; and, for the field of physical health, injustice insensitivity and having a medical profession were positively associated with a person’s acceptance of normality. Finally, participants’ acceptance of the use of normality in the area of mental health was lower than in the area of physical health.ConclusionsWhat is considered normal has implications for clinical practice, both at an individual and at a policy-level. Acknowledging its normalistic condition, the discipline of medicine has to confront itself with its own contribution to the augmentation of social inequalities through the excessive reliance on the concept of normality. Research that centers the lived experiences of those who are being systematically marginalized because they are deemed abnormal is needed. By empirically elucidating the conceptual relationships between normality in medicine and other variables, we provide points of leverage to deprive normality of its normative power. For medicine, this is needed to first do no harm. (shrink)

The key objective of this study is to revisit selected education reforms and interventions by central government during the period c.1918–1950 in order to evaluate their impact on the development o...

In this article, the author lists three problems that make any serious discussion about the ethics of leadership a very difficult undertaking. He then proposes a new, postindustrial paradigm of leadership. Using that understanding of leadership, two different sets of ethical analyses of leadership are possible: (I) those concerned with the process of leadership and (2) those concerned with the content of leadership (the changes proposed by the leaders and collaborators). In the end, the author suggests that the industrial paradigm (...) of ethics (the 18th century liberal philosophy) is inadequate to deal with the ethical decision making that leaders and collaborators must do in the 21 st century. Thus, a postindustrial paradigm of ethics must be developed to enable leaders and collaborators to make the tough ethical choices that will be demanded in the new millennium. (shrink)

This book defends a form of ethical intuitionism, according to which (i) there are objective moral truths; (ii) we know some of these truths through a kind of immediate, intellectual awareness, or "intuition"; and (iii) our knowledge of moral truths gives us reasons for action independent of our desires. The author rebuts all the major objections to this theory and shows that the alternative theories about the nature of ethics all face grave difficulties.

Reporting biases refer to a truncated pool of published studies with the resulting suppression or omission of some empirical findings. Such biases can occur in positive research paradigms that try to uncover correlations and causal relationships in the social world by using the empirical methods of science. Furthermore, reporting biases can come about because of authors who do not write papers that report unfavorable results despite strong efforts made to find previously accepted evidence and because of a higher rejection rate (...) of studies documenting contradictory evidence. Reporting biases are a serious concern because the conclusions of systematic reviews and meta-analyses can be misleading. The authors show that published evidence in win-win corporate social responsibility research tends to overestimate efficiency. The research field expects to find a positive association between corporate social performance and corporate financial performance, and findings meet that expectation. The authors explain how this pattern may reflect reporting bias. The empirical results show strong tentative evidence for a positive reporting bias in the CSP–CFP literature but only weak tentative evidence for CSP efficiency. The study also examines which factors, such as time trends, publication outlet, and study characteristics, are associated with higher reporting biases within this literature. (shrink)

The first edition of The Scientific Background to Modern Philosophy took the dialogue of science and philosophy from Aristotle through to Newton. This second edition adds eight chapters, taking the dialogue through the Enlightenment and up to Darwin. This anthology is an attempt to help bridge the gap between the history of science and the history of philosophy.

Part I: The representation of life -- Can life be given a real definition? -- The representation of the living individual -- The representation of the life-form itself -- Part II: Naive action theory -- Types of practical explanation -- Naive explanation of action -- Action and time -- Part III: Practical generality -- Two tendencies in practical philosophy -- Practices and dispositions as sources of the goodness of individual actions -- Practice and disposition as sources of individual action.

Virtually all philosophers agree that for a belief to be epistemically justified, it must satisfy certain conditions. Perhaps it must be supported by evidence. Or perhaps it must be reliably formed. Or perhaps there are some other "good-making" features it must have. But does a belief's justification also require some sort of awareness of its good-making features? The answer to this question has been hotly contested in contemporary epistemology, creating a deep divide among its practitioners. Internalists, who tend to focus (...) on scientific or theoretical beliefs as the ideal, insist that such awareness is required for justification. Externalists, who think children's ordinary beliefs in obvious facts are paradigm cases of justified belief, say it isn't required. Michael Bergmann's book offers a decisive refutation of internalism and a sustained defense of externalism. (shrink)

Externalist theories of justification create the possibility of cases in which everything appears to one relevantly similar with respect to two propositions, yet one proposition is justified while the other is not. Internalists find this difficult to accept, because it seems irrational in such a case to affirm one proposition and not the other. The underlying internalist intuition supports a specific internalist theory, Phenomenal Conservatism, on which epistemic justification is conferred by appearances.

Few have done more than Martin Gutzwiller to clarify the connection between classical time-dependent motion and the time-independent states of quantum systems. Hence it seems appropriate to include the following discussion of the origins of the time-dependent Schrödinger equation in this volume dedicated to him.

The threshold law for N-body fragmentation under dipole forces is formulated. It emerges from the energy dependence of the normalization of the correlated continuum wave function for N fragments. It is shown that the dipole threshold law plays a key role in understanding all threshold fragmentation phenomena since it links the classical threshold law for long-range Coulomb interactions to the statistical law for short-range interactions. Furthermore, a tunnelling mechanism is identified as the common feature which occurs for all three classes (...) of interactions, short-range, dipole and Coulomb. (shrink)

In view of the numerous accounting and corporate scandals associated with various forms of moral misconduct and the recent financial crisis, economics and business programs are often accused of actively contributing to the amoral decision making of their graduates. It is argued that theories and ideas taught at universities engender moral misbehavior among some managers, as these theories mainly focus on the primacy of profit-maximization and typically neglect the ethical and moral dimensions of decision making. To investigate this criticism, two (...) overlapping effects must be disentangled: the self-selection effect and the treatment effect. Drawing on the concept of moral judgment competence, we empirically examine this question with a sample of 1773 bachelor’s and 501 master’s students. Our results reveal that there is neither a self-selection nor a treatment effect for economics and business studies. Moreover, our results indicate that—regardless of the course of studies—university education in general does not seem to foster students’ moral development. (shrink)

At the University of Sheffield during 2011 and 2012, a leading group of philosophers, psychologists, and others gathered to explore the nature and significance of implicit bias. The two volumes of Implicit Bias and Philosophy emerge from these workshops. Each volume philosophically examines core areas of psychological research on implicit bias as well as the ramifications of implicit bias for core areas of philosophy. Volume I: Metaphysics and Epistemology is comprised of two parts: “The Nature of Implicit Attitudes, Implicit Bias, (...) and Stereotype Threat,” and “Skepticism, Social Knowledge, and Rationality.” The first part contains chapters examining the relationship between implicit attitudes and “dual process” models of the mind; the role of affect in the formation and change of implicit associations; the unity (or disunity) of implicit attitudes; whether implicit biases are mental states at all; and whether performances on stereotype-relevant tasks are automatic and unconscious or intentional and strategic. The second part contains chapters examining implicit bias and skepticism; the effects of implicit bias on scientific research; the accessibility of social stereotypes in epistemic environments; the effects of implicit bias on the self-perception of members of stigmatized social groups as rational agents; the role of gender stereotypes in philosophy; and the role of heuristics in biased reasoning. (shrink)

In this engaging and spirited text, Michael Lynch argues that truth does matter, in both our personal and political lives. He explains that the growing cynicism over truth stems in large part from our confusion over what truth is.

This study examines the role of human rights violations as a harbinger of civil wars to come, as well as the links between repression, state weakness, and conflict. Human rights violations are both part of the escalating process that may end in civil war and can contribute to an escalation of conflict to civil war, particularly in weak states. The role of government repression and state weakness in leading to civil war is tested empirically. The results show that both closely (...) correlate with civil war onset, especially if they are observed in combination. A two-stage model shows that, while low-level conflict leads to human rights violations, they increase the risk of an escalation to civil war in turn. Human rights violations are identified as an important aspect of understanding civil war onset as the result of an escalation over time and a clear early warning sign of wars to come. (shrink)

Dignity plays a central role in current thinking about law and human rights, but there is sharp disagreement about its meaning. Combining conceptual precision with a broad historical background, Michael Rosen puts these controversies in context and offers a novel, constructive proposal. “Penetrating and sprightly...Rosen rightly emphasizes the centrality of Catholicism in the modern history of human dignity. His command of the history is impressive...Rosen is a wonderful guide to the recent German constitutional thinking about human dignity...[Rosen] is in (...) general an urbane and witty companion, achieving his aim of accessibly written philosophy.” —Samuel Moyn, The Nation “[An] elegant, interesting and lucid exploration of the concept of dignity...Drawing on classical, liberal and Catholic traditions, Rosen hopes to rehabilitate dignity to its rightful place near the centre of moral thought...Rosen's admirable book deserves wide attention from political theorists, jurisprudes and political philosophers.” —Simon Blackburn, Times Higher Education “Dignity deserves to be widely read, not only for its intrinsic interest, but also as a corrective to the habit of discussing such topics in abstraction from their social context. Whether or not one agrees with Rosen's arguments, there can be no doubt he has widened our horizons.” —Rae Langton, Times Literary Supplement. (shrink)

Michael G. Titelbaum presents a new Bayesian framework for modeling rational degrees of belief—the first of its kind to represent rational requirements on agents who undergo certainty loss.

edition (unseen), $12.95. traditions, bringing into being new modes of understanding. Paper Anthropology, and particularly ethnography, is torn between two quests, one to capture the diversity of social life and the other to discover universal principles structuring that diversity. Jackson examines these quests within the context of ethnographic fieldwork, focusing on the relationship between ethnographers and the people they study. He is concerned with defining the anthropological project as something more than the projection of the anthropologist's traditions and concerns onto (...) an alien culture. Rather, he would have the project open a genuine dialogue between people from different cultures or Annotation copyrighted by Book News, Inc., Portland, OR. (shrink)

Examining alumni perspectives from three multi-term service-learning programs, this study highlights the dimensions of the cohort experience that alumni credit as critical to their learning and dev...

At the heart of ethics reside the concepts of good and bad; they are at work when we assess whether a person is virtuous or vicious, an act right or wrong, a decision defensible or indefensible, a goal desirable or undesirable. But there are many varieties of goodness and badness. At their core lie intrinsic goodness and badness, the sort of value that something has for its own sake. It is in virtue of intrinsic value that other types of value (...) may be understood, and hence that we can begin to come to terms with questions of virtue and vice, right and wrong, and so on. This book investigates the nature of intrinsic value: just what it is for something to be valuable for its own sake, just what sort of thing can have such value, just how such a value is to be computed. In the final chapter, the fruits of this investigation are applied to a discussion of pleasure, pain, and displeasure and also of moral virtue and vice, in order to determine just what value lies within these phenomena. (shrink)

While philosophers hold that it is patently absurd to blame robots or hold them morally responsible [1], a series of recent empirical studies suggest that people do ascribe blame to AI systems and robots in certain contexts [2]. This is disconcerting: Blame might be shifted from the owners, users or designers of AI systems to the systems themselves, leading to the diminished accountability of the responsible human agents [3]. In this paper, we explore one of the potential underlying reasons for (...) robot blame, namely the folk's willingness to ascribe inculpating mental states or "mens rea" to robots. In a vignette-based experiment (N=513), we presented participants with a situation in which an agent knowingly runs the risk of bringing about substantial harm. We manipulated agent type (human v. group agent v. AI-driven robot) and outcome (neutral v. bad), and measured both moral judgment (wrongness of the action and blameworthiness of the agent) and mental states attributed to the agent (recklessness and the desire to inflict harm). We found that (i) judgments of wrongness and blame were relatively similar across agent types, possibly because (ii) attributions of mental states were, as suspected, similar across agent types. This raised the question - also explored in the experiment - whether people attribute knowledge and desire to robots in a merely metaphorical way (e.g., the robot "knew" rather than really knew). However, (iii), according to our data people were unwilling to downgrade to mens rea in a merely metaphorical sense when given the chance. Finally, (iv), we report a surprising and novel finding, which we call the inverse outcome effect on robot blame: People were less willing to blame artificial agents for bad outcomes than for neutral outcomes. This suggests that they are implicitly aware of the dangers of overattributing blame to robots when harm comes to pass, such as inappropriately letting the responsible human agent off the moral hook. (shrink)

In previous work I have argued against internalism by means of a dilemma intended to force all internalists to accept one of two undesirable options: either their internalism is unmotivated or it is saddled with vicious regress problems. Recently it has been argued that Phenomenal Conservatism—a theory of justification according to which justification depends on seemings—is a kind of internalism that can escape this dilemma. In this paper, I argue that Phenomenal Conservatism cannot escape my dilemma for internalism. In order (...) to do this, it is helpful to get clear on what Phenomenal Conservatism is saying, and for that reason I begin, in section I, by examining in some detail what seemings are. I then argue, in the remainder of the paper, that, whichever horn of the dilemma for internalism they take, Phenomenal Conservatives are in trouble. (shrink)

Can an ugly experiment be a good experiment? Philosophers have identified many beautiful experiments and explored ways in which their beauty might be connected to their epistemic value. In contrast, the present chapter seeks out (and celebrates) ugly experiments. Among the ugliest are those being designed by AI algorithms. Interestingly, in the contexts where such experiments tend to be deployed, low aesthetic value correlates with high epistemic value. In other words, ugly experiments can be good. Given this, we should conclude (...) that beauty is not generally necessary or sufficient for epistemic value, and increasing beauty will not generally tend to increase epistemic value. (shrink)

Radical skepticism endorses the extreme claim that large swaths of our ordinary beliefs, such as those produced by perception or memory, are irrational. The best arguments for such skepticism are, in their essentials, as familiar as a popular science fiction movie and yet even seasoned epistemologists continue to find them strangely seductive. Moreover, although most contemporary philosophers dismiss radical skepticism, they cannot agree on how best to respond to the challenge it presents. In the tradition of the 18th century Scottish (...) philosopher, Thomas Reid, Radical Skepticism and Epistemic Intuition joins this discussion by taking up four main tasks. First, it identifies the strongest arguments for radical skepticism, namely, underdetermination arguments, which emphasize the gap between our evidence and our ordinary beliefs based on that evidence. Second, it rejects all inferential or argument-based responses to radical skepticism, which aim to lay out good noncircular reasoning from the evidence on which we base our ordinary beliefs to the conclusion that those beliefs are probably true. Third, it develops a commonsense noninferential response to radical skepticism with two distinctive features: it consciously and extensively relies on epistemic intuitions, which are seemings about epistemic goods, such as knowledge and rationality, and it can be endorsed without difficulty by both internalists and externalists in epistemology. Fourth, and finally, it defends this commonsense epistemic-intuition-based response to radical skepticism against a variety of objections, including those connected with underdetermination worries, epistemic circularity, disagreement problems, experimental philosophy, and concerns about whether it engages skepticism in a sufficiently serious way. (shrink)