As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that bear (...) a disproportionate burden of suffering in the allocation of the new potential treatment. This recommendation is justified not only for new drugs with uncertain effects, but also for drugs of certain benefit or vaccines. For states with significant health disparities, such as Michigan, this allocation priority may help to repair them. In fact, any other allocation strategy may make them worse. (shrink)

Clinical ethicists are often presented with the question: Is this plan or action ethical? The simple answer, which is as predictable as it is glib, is always: “it depends.” Recognizing and analyzin...

One of the more draining aspects of being a clinical ethicist is dealing with the emotions of patients, family members, as well as healthcare providers. Generally, by the time a clinical ethicist is called into a case, stress levels are running high, patience is low, and interpersonal communication is strained. Management of this emotional burden of clinical ethics is an underexamined aspect of the profession and academic literature. The emotional nature of doing clinical ethics consultation may be better addressed by (...) utilizing concepts and tools from clinical psychology. Management of countertransference, the natural emotional reaction by the therapist toward the patient, is a widely discussed topic in the psychotherapeutic literature. This concept can be adapted to the clinical ethics encounter by broadening it beyond the patient-therapist relationship to refer to the ethics consultant's emotional response toward the patient, the family, or other members the healthcare team. Further, it may aid the consultant because a recognition of the source and nature of these reactions can help maintain ‘critical distance’ and minimize bias in the same way that a psychologist maintains neutrality in psychotherapy. This paper will offer suggestions on how to manage these emotional responses and their burden in the clinical ethics encounter, drawing upon techniques and strategies recommended in the psychotherapeutic literature. Using these techniques may improve consultation outcomes and reduce the emotional burden on the clinical ethicist. (shrink)

The field of clinical bioethics strongly advocates for the use of advance directives to promote patient autonomy, particularly at the end of life. This paper reports a study of clinical bioethicists’ perceptions of the professional consensus about advance directives, as well as their personal advance care planning practices. We find that clinical bioethicists are often sceptical about the value of advance directives, and their personal choices about advance directives often deviate from what clinical ethicists acknowledge to be their profession’s recommendations. (...) Moreover, our respondents identified a pluralistic set of justifications for completing treatment directives and designating surrogates, even while the consensus view focuses on patient autonomy. Our results suggest important revisions to academic discussion and public-facing advocacy about advance care planning. (shrink)

Deep brain stimulation (DBS), a surgical procedure involving the implantation of electrodes in the brain, has rekindled the medical community’s interest in psychosurgery. Whereas many researchers argue DBS is substantially different from psychosurgery, we argue psychiatric DBS—though a much more precise and refined treatment than its predecessors—is nevertheless a form of psychosurgery, which raises both old and new ethical and legal concerns that have not been given proper attention. Learning from the ethical and regulatory failures of older forms of psychosurgery (...) can help shed light on how to address the regulatory gaps that exist currently in DBS research. To show why it is important to address the current regulatory gaps within psychiatric DBS, we draw on the motivations underlying the regulation of earlier forms of psychosurgery in the US. We begin by providing a brief history of psychosurgery and electrical brain stimulation in the US. Against this backdrop, we introduce psychiatric DBS, exploring current research and ongoing clinical trials. We then draw out the ethical and regulatory similarities between earlier forms of psychosurgery and psychiatric DBS. As we will show, the factors that motivated strict regulation of earlier psychosurgical procedures mirror concerns with psychiatric DBS today. We offer three recommendations for psychiatric DBS regulation, which echo earlier motivations for regulating psychosurgery, along with new considerations that reflect the novel technologies used in DBS. (shrink)

Supernatural agent concepts are regarded as a defining trait of religion. The interaction of the minimally counterintuitive mnemonic effect and the hypersensitive agency detection device may be employed to explain the universal presence of concepts of gods and deities. Using the measure of free-recall, a broad model of cultural transmission investigated this pan-cultural transmission bias with a large age-representative sample in UK and China. Results were analyzed by four-way mixed ANOVA considering counterintuitiveness, familiarity, ontological category, and delay, and with age (...) as a covariate. A significant interaction of counterintuitiveness × HADD was found for both UK and China samples. These findings support assertions that supernatural agent concepts are more easily transmitted than other concepts because the present study finds that concepts similar to supernatural agents were more readily recalled. (shrink)

Despite the lack of evidence for their effectiveness, the use of physical restraints for patients is widespread. The best ethical justification for restraining patients is that it prevents them from harming themselves. We argue that even if the empirical evidence supported their effectiveness in achieving this aim, their use would nevertheless be unethical, so long as well known exceptions to informed consent fail to apply. Specifically, we argue that ethically justifiable restraint use demands certain necessary and sufficient conditions. These conditions (...) are that the physician obtain informed consent for their application, that their application be medically appropriate, and that restraints be the least liberty-restricting way of achieving the intended benefit. It is a further question whether their application is ever medically appropriate, given the dearth of evidence for their effectiveness. (shrink)

Default positions, predetermined starting points that aid in complex decision-making, are common in clinical medicine. In this article, we identify and critically examine common default positions in clinical ethics practice. Whether default positions ought to be held is an important normative question, but here we are primarily interested in the descriptive, rather than normative, properties of default positions. We argue that default positions in clinical ethics function to protect and promote important values in medicine—respect for persons, utility, and justice. Further, (...) default positions in clinical ethics may also guard against harm. Where default positions exist, there are epistemic burdens to overturn them. The person wishing to reject the default position, rather than the person endorsing it, bears this burden. The person who bears the burden of meeting the epistemic requirements must provide evidence proportional to the degree of harm the default position protects against. Default positions that protect against significant harm impose significant epistemic requirements to overturn. This asymmetry not only makes medical decision-making more economical but also serves to promote and protect certain values. The identification and analysis of common and recognizable default positions can help to identify other default positions and the conditions under which their associated epistemic requirements are met. The article concludes with considerations of potential problems with the use of default positions in clinical ethics. (shrink)

Contemporary legends – also called urban legends – are common throughout our society. Distinct from mere rumors passed around social media, anecdotes of pseudoscientific discoveries, or medical misinformation, contemporary legends are important because, rather than merely transmitting false ideas or information about medicine, they model distinct and primarily antagonistic patterns of interaction between patients and providers via their narrative components. And, while legends that patients tell about their distrust for doctors are fairly well-studied, less attention has been paid to the (...) kinds of legends that providers tell about patients. Many of these legends portray the likely patient as foolish, incompetent, and the ultimate source of his or her own medical condition. A partial solution to the challenges created by clashing, mutually belittling narratives can be found in the principles of narrative medicine, which strives to replace a received, stereotyped narrative with an individualized narrative constructed together by provider and patient. This paper will provide a definition of contemporary medical legends, analyze the unique narrative structure, develop a brief taxonomy of common themes, and describe how the structure and theme elucidate interesting and previously unexamined tensions within the provider-patient relationship. (shrink)

Graphical AbstractGene editing with engineered nucleases introduce double-strand breaks that are repaired by error-prone nonhomologous end-joining (NHEJ). In article number 1900126, Sara G. Trimidal et al. propose that the length and type or resulting indels can now be controlled by editing with different engineered nucleases or by manipulating the expression of NHEJ genes.

Genome editing with engineered nucleases (GEENs) introduce site‐specific DNA double‐strand breaks (DSBs) and repairs DSBs via nonhomologous end‐joining (NHEJ) pathways that eventually create indels (insertions/deletions) in a genome. Whether the features of indels resulting from gene editing could be customized is asked. A review of the literature reveals how gene editing technologies via NHEJ pathways impact gene editing. The survey consolidates a body of literature that suggests that the type (insertion, deletion, and complex) and the approximate length of indel edits (...) can be somewhat customized with different GEENs and by manipulating the expression of key NHEJ genes. Structural data suggest that binding of GEENs to DNA may interfere with binding of key components of DNA repair complexes, favoring either classical‐ or alternative‐NHEJ. The hypotheses have some limitations, but if validated, will enable scientists to better control indel makeup, holding promise for basic science and clinical applications of gene editing. Also see the video abstract here https://youtu.be/vTkJtUsLi3w. (shrink)

In 2016, a multidisciplinary body of scholars within the International Commission on Stratigraphy—the Anthropocene Working Group—recommended that the world officially recognize the Anthropocene as a new geological epoch. The most contested claim about the Anthropocene, that humans are a major geological and environmental force on par with natural forces, has proven to be a hotbed for discussion well beyond the science of geology. One reason for this is that it compels many natural and social scientists to confront problems and systems (...) that transgress traditional disciplinary boundaries, and as a result, calls for interdisciplinary research are now gaining traction. Proponents of such transgressions have dubbed the new scientific order that will result “Anthropocene Science”, and rhetoric notwithstanding, such discussions exemplify how recent changes within science justify rethinking a prevailing image of how science is done, and with it, the working relationship between scholars in the humanities, natural scientists, and social scientists. (shrink)

Machery & Mallon [The moral psychology handbook (pp. 3–47). New York, NY: Oxford University Press, 2010] argue that existing evidence does not support the claim that moral cognition, understood as a specific form of normative cognition, is a product of evolution. Instead, they suggest that the evidence only supports the more modest claim that a general capacity for normative cognition evolved. They argue that if this is the case then the prospects for evolutionary debunking arguments are bleak. A debunking argument (...) which relied on the fact that normative cognition in general evolved might threaten all areas of normative belief, including the epistemic norms upon which the argument relies. For the sake of argument, we accept their claim that specifically moral cognition did not evolve. However, we reject their contention that this critically undermines evolutionary debunking arguments of morality. A number of strategies are available to solve what we call the “containment problem,” or how to effectively debunk morality without thereby debunking normative cognition tout court. Furthermore, debunking arguments need not rely on the claim that normative cognition in general evolved. So long as at least some aspects of moral cognition have evolved, this may be sufficient to support an evolutionary debunking argument against many of our moral beliefs. Thus, even if Machery & Mallon are right that specifically moral cognition did not evolve, research in evolutionary psychology may have radical implications for moral philosophy. (shrink)

1. A multidisciplinary group of scholars within the International Commission on Stratigraphy – known as the Anthropocene Working Group – recently recommended the Anthropocene as a new geological ep...

In this article we describe our approach to understanding wrongdoing in medical research and practice, which involves the statistical analysis of coded data from a large set of published cases. We focus on understanding the environmental factors that predict the kind and the severity of wrongdoing in medicine. Through review of empirical and theoretical literature, consultation with experts, the application of criminological theory, and ongoing analysis of our first 60 cases, we hypothesize that 10 contextual features of the medical environment (...) (including financial rewards, oversight failures, and patients belonging to vulnerable groups) may contribute to professional wrongdoing. We define each variable, examine data supporting our hypothesis, and present a brief case synopsis from our study that illustrates the potential influence of the variable. Finally, we discuss limitations of the resulting framework and directions for future research. (shrink)

This book provides the English-speaking world with a comprehensive account of the still largely unknown work of Schelling's philosophy of mythology and revelation. Its achievement, however, is not archival but philosophical, elucidating the relation between Schelling and onto-theology. It explains how Schelling dealt with the problem of nihilism and onto-theology well before Nietzsche and Heidegger, arguing that Schelling surpasses onto-theology or the philosophy of presence a century prior to Heidegger. Overall, the author provocatively suggests that Heidegger is perhaps Schelling's genuine (...) heir and by comprehensively interpreting Schelling's multifaceted late lectures he analyzes issues as diverse as the Ancient relation between thinking and Being, the Medieval debate between voluntarism and intellectualism, the overcoming of modern subjectivism and German Idealism as well as many themes in contemporary philosophy. The presentation is systematic rather than thematic, following Schelling's ages of the world through the Past, Present and Future. The results are daring, departing from the half-century long canonical reading of the late Schelling since Walter Schulz. This book is valuable for Schelling-scholars, historians of philosophy and theologians alike. (shrink)

We argue for an imaginative analog of desire from premises about imaginative engagement with fiction. There's a bit about the paradox of fiction, too.

This book provides the English-speaking world with a comprehensive account of the still largely unknown work of Schelling’s philosophy of mythology and revelation. Its achievement, however, is not archival but philosophical, elucidating the relation between Schelling and onto-theology. It explains how Schelling dealt with the problem of nihilism and onto-theology well before Nietzsche and Heidegger, arguing that Schelling surpasses onto-theology or the philosophy of presence a century prior to Heidegger. Overall, the author provocatively suggests that Heidegger is perhaps Schelling’s genuine (...) heir and by comprehensively interpreting Schelling’s multifaceted late lectures he analyzes issues as diverse as the Ancient relation between thinking and Being, the Medieval debate between voluntarism and intellectualism, the overcoming of modern subjectivism and German Idealism as well as many themes in contemporary philosophy. (shrink)

Is the world internally connected by a web of necessary connections or is everything loose and independent? Followers of David Hume accept the latter by upholding Hume’s Dictum, according to which there are no necessary connections between distinct existences. Roughly put, anything can coexist with anything else, and anything can fail to coexist with anything else. Hume put it like this: “There is no object which implies the existence of any other if we consider these objects in themselves.” Since Hume’s (...) day, Hume’s Dictum has played a major role in philosophy, especially in contemporary metaphysics. In ruling out necessary connections, Hume’s Dictum implies that causal relations and the laws of nature are contingent. It makes other demands on our metaphysics of science as well; for example, it places restrictions on our metaphysics of counterfactuals, dispositions, and explanation. The principle has applications in other areas too. Hume’s Dictum places constraints on our theories of abstract objects and moral properties. For example, Hume’s Dictum rules out the view that moral properties are distinct from, but necessarily connected to, non-moral properties. While Hume’s Dictum is a prominent principle in metaphysics, few Humeans have defended the principle at length. It is assumed more often than it is argued for. As a result, Hume’s Dictum no longer enjoys the reputation it once did. It’s common to hear complaints about the lack of arguments in support of Hume’s Dictum. Moreover, philosophers are increasingly willing to defend views that are at odds with Hume’s Dictum. A striking example of this is the recent explosion of interest in views that take causal relations and the laws of nature to be necessary. Humeans can no longer afford to be complacent. An extended defense of Hume’s Dictum is called for, and that’s what this dissertation aims to offer. This dissertation has three parts. In the first part, I lay out some preliminaries and offer a precise formulation of Hume’s Dictum. In the second part, I develop three arguments in favor of Hume’s Dictum. In the final part, I defend Hume’s Dictum against objections. (shrink)

Alzheimer’s disease (AD) in its most common form results in cognitive changes in memory function leading to dementia due to underlying neurodegenerative disease. Recent research advancements in AD...

SummaryThe incidence of family breakdown and stress has been examined in an unselected group of 92 South Wales families, each containing a patient suffering from Huntington's chorea, and related to the onset and duration of the disease, age of the patient, and behavioural symptoms shown. The frequency of actual and attempted suicide is analysed and the effects of the disorder on the primary care agent for the patient discussed. Some of the effects on children and the needs of the families (...) for support and practical help are outlined. It is concluded that family support is an essential factor in any programme aimed at the long-term alleviation and prevention of Huntington's chorea. (shrink)

Despite the fact that the nature of the properties of causation is rarely discussed within the mental causation debate, the implicit assumption is that they are universals as opposed to tropes. However, in recent literature on the problem of mental causation, a new solution has emerged which aims to address the problem by appealing to tropes. It is argued that if the properties of causation are tropes rather than universals, then a psychophysical reductionism can be advanced which does not face (...) the problem of multiple realizability. However, the 'trope solution' rests upon the assumption that one can combine a trope monism with a type dualism. I argue that such a combination cannot be allowed. Given a plausible interpretation of types within a trope ontology, trope monism in fact entails type monism. Consequently, if one identifies mental tropes with physical tropes, one must also identify mental and physical types and in doing so face a modified version of the multiple realizability argument. (shrink)

Interpreting Figurative Meaning critically evaluates the recent empirical work from psycholinguistics and neuroscience examining the successes and difficulties associated with interpreting figurative language. There is now a huge, often contradictory literature on how people understand figures of speech. Gibbs and Colston argue that there may not be a single theory or model that adequately explains both the processes and products of figurative meaning experience. Experimental research may ultimately be unable to simply adjudicate between current models in psychology, linguistics and philosophy (...) of how figurative meaning is interpreted. Alternatively, the authors advance a broad theoretical framework, motivated by ideas from 'dynamical systems theory', that describes the multiple, interacting influences which shape people's experiences of figurative meaning in discourse. This book details past research and theory, offers a critical assessment of this work and sets the stage for a new vision of figurative experience in human life. (shrink)

Employment-based vaccine mandates have worse consequences for existing than prospective employees. Prospective employees are not yet dependent on a particular employment arrangement, so they are better positioned to respond to such mandates. Yet despite this asymmetry in consequences, Smith argues that if vaccine mandates are justified for prospective employees, they are similarly justified for existing employees. This paper responds to Smith’s argument. First, Smith holds that bona fide occupational requirements are actions that are necessary for the safe and effective completion (...) of one’s job. As such, they apply to existing and prospective employees alike. However, I argue that the existence of effective alternative interventions precludes vaccination from being considered a bona fide occupational requirement under current circumstances. Second, Smith holds that if a requirement is justified for prospective employees, it is justified for existing employees, despite the asymmetry in consequences. However, I argue that since vaccination is not a bona fide requirement, the asymmetry in the harms of mandates experienced by prospective versus existing employees entails an asymmetry in the justification required to mandate vaccination for each group. As such, vaccination can be considered a requirement for prospective employees while not being required for existing employees. (shrink)

Inspired by Plantinga’s Evolutionary Argument Against Naturalism (EAAN), we develop an argument—the “Scriptural Argument Against Dogmatic Protestantism” (SAADP)—that Protestants who accept the doctrine of sola scriptura cannot reasonably hold that Catholic and Eastern churches are in doctrinal error. If sola scriptura is true and Catholic and Eastern Churches have fallen into error, it is improbable that any Protestant can reliably form true beliefs about controversial points of Christian doctrine, including sola scriptura or suggestions that Catholic and Eastern Christians are in (...) error. We evaluate potential responses to SADDP, considering how SAADP should affect ecumenical doctrinal debates. (shrink)

The richness of the term “unsettling” has made it readily employable for phenomenological accounts of racism in philosophy of race literature; yet, the term has been left largely under-theorized. Here, I argue that unsettling encounters can be said to occur when the unfamiliar other has come into contact with the boundary of one’s existential home. For many white people, interracial interactions produce an (often unwarranted) feeling of physical danger, but as I hope to show, this habitual (mis)perception of such encounters (...) is not merely a conditioned response; it also functions to subvert situations that might unsettle white identifies partially constituted by phenomenological demarcations of space along racial lines. Drawing on empirical literature and recent developments in critical phenomenology, I suggest that by exercising habitual, racist gestures and perceptions, white people (mis)perceive ontological threats to their worldview—e.g., a bookish Black student or a masculine gay man—as ontically threatening so as to avoid the kind of work and existential anguish that altering one’s normative expectations would require. (shrink)