In the summer of 1998, the Wisconsin State legislature amended its child protection laws. Under new child abuse provisions, Wisconsin judges can confine pregnant women who abuse alcohol or drugs for the duration of their pregnancies. South Dakota enacted similar legislation almost simultaneously. The South Dakota statute requires mandatory drug and alcohol treatment for pregnant women who abuse those substances and classifies such activity as child abuse. In addition, the South Dakota legislation gives relatives the power to commit pregnant women (...) involuntarily for two days; a court order can place the pregnant women in custody for up to nine months. These recent legislative “successes” follow scores of failed attempts by legislators in other states to establish fetal protection laws aimed at women who use and abuse drugs and alcohol during pregnancy. (shrink)

In the summer of 1998, the Wisconsin State legislature amended its child protection laws. Under new child abuse provisions, Wisconsin judges can confine pregnant women who abuse alcohol or drugs for the duration of their pregnancies. South Dakota enacted similar legislation almost simultaneously. The South Dakota statute requires mandatory drug and alcohol treatment for pregnant women who abuse those substances and classifies such activity as child abuse. In addition, the South Dakota legislation gives relatives the power to commit pregnant women (...) involuntarily for two days; a court order can place the pregnant women in custody for up to nine months. These recent legislative “successes” follow scores of failed attempts by legislators in other states to establish fetal protection laws aimed at women who use and abuse drugs and alcohol during pregnancy. (shrink)

In the summer of 1998, the Wisconsin State legislature amended its child protection laws. Under new child abuse provisions, Wisconsin judges can confine pregnant women who abuse alcohol or drugs for the duration of their pregnancies. South Dakota enacted similar legislation almost simultaneously. The South Dakota statute requires mandatory drug and alcohol treatment for pregnant women who abuse those substances and classifies such activity as child abuse. In addition, the South Dakota legislation gives relatives the power to commit pregnant women (...) involuntarily for two days; a court order can place the pregnant women in custody for up to nine months. These recent legislative “successes” follow scores of failed attempts by legislators in other states to establish fetal protection laws aimed at women who use and abuse drugs and alcohol during pregnancy. (shrink)

On March 9, 1993, in the first ruling of its kind, the Maryland Court of Appeals declared that physicians and hospitals may be sued for failing to inform patients of a practitioner’s human immunodeficiency virus status. What is more significant, these suits may be pursued even in instances when the physician has followed universal precautions and the patient did not contract the virus that causes acquired immunodeficiency syndrome. The Maryland court addressed two central questions in Faya v. Almaraz. First, do (...) HIV-infected physicians have a legal duty to inform their patients of their HIV status? And, second, can patients recover damages for fear induced by a physician’s conduct? While one finds numerous precedents that authorize actions to recover damages based purely on fear of disease and emotional distress, the Faya court’s holdings on the issue significantly expand the scope of potential liability. Moreover, the court’s analysis of the informed consent and HIV-infected physician issue is incomplete, inconsistent, and represents an unjustified and unwise departure from traditional informed consent theory. It, and its progeny, may have widespread and dire repercussions. (shrink)

The dramatic appearance of managed care organizations (MCOs) on the U.S. health scene has generated tremendous anxiety among health care providers and patients. These fears are based on the belief that managed care techniques pose greater risks of under treatment than do fee-for-service modes of payment. In addition, many physicians and patients resent the limits placed on clinical autonomy by the MCO model and the stresses that it places on the traditional physician-patient relationship. These misgivings have been exacerbated by the (...) mostly negative response to MCOs in the media and academia. Legislatures have responded to these claims and public fears with a wave of regulatory initiatives. Some of these regulations are attempts to protect patients. Others, however, are motivated primarily by antipathy toward the concept of managed care itself. This essay is an attempt to develop a social ethic of regulation and argues that the sole reason that private enterprise may be justifiably limited is when it presents a risk of harm to others or society. While some regulation and proposed regulation of MCOs meet this standard, much legislation represents an unjustified attempt to limit or handicap otherwise legal behavior merely because a segment of the population and medical profession find it aesthetically unpleasing and oppose its approach to the delivery of health services. (shrink)

According to a 2001 market report, titled “The Cure Is in Hand,” handheld computers, or personal digital assistants, will “dramatically change the way that physicians practice medicine.” Such enthusiasm has resulted in an extraordinarily rapid diffusion of PDAs into a wide range of clinical settings. One report states that 47% of internists use PDAs once a day with rates of daily usage reaching 70% for resident physicians. Another study found clinical usage as high as 85% in teaching hospitals. The rapidly (...) expanding employment of PDAs, however, has been uneven. Some clinicians have explored the devices’ benefits more thoroughly than their colleagues. Similarly, a number of potentially valuable uses of the handheld computer have been ignored or remain insufficiently developed by the medical community and the health delivery system at large. (shrink)

This essay examines the so-called phenomenon of defensive medicine and the problematic aspects of attempting to maintain the safest legal position possible. While physicians face genuine litigation threats they frequently overestimate legal peril. Many defensive practices are benign, but others alter patient care and increase costs in ways that are ethically suspect. Physicians should learn to evaluate realistically the legal risks of their profession and weigh the emotional, physical, and financial costs to the patient before employing a defensive measure.

Hurwicz (Social Choice and public decision making. Essays in honor of Kenneth J. Arrow, Cambridge University Press, Cambridge, 1986) was the first to study an approach to implementation theory based on choice functions instead of preference relations. We argue that the solution concept used by him, the generalized Nash equilibrium, is not really compatible with the idea that individual behavior is describable by a choice function. A new solution concept that better fits the choice function framework is then introduced. (...) Using this, we investigate what behavioral assumptions are needed for the full characterizations of Nash implementable social choice correspondences to still hold. We will show that a condition known as Property α is central. (shrink)

This article presents a corpus linguistic analysis of the development in future-oriented political journalism in four Danish newspapers in the period 1997–2013. Keyword analysis and concordance analysis are applied within a framework of grammatical-semantic theory of tense and modal verbs and semantic-pragmatic theory of time meaning, modality and speech acts. The results suggest, unexpectedly, that the newspapers – and news reports in particular – seem to have become less future-oriented in the period. At the same time, however, the articles – (...) and particularly news commentary, in itself increasing – might have become slightly more speculative. Thus, the journalists themselves have become the main source of ‘guessing’, that is, predicting and speculating, with the keywords vil and ville, including unreal and counterfactual speculations in the past tenses. (shrink)

The primary psychological process leading aggressive children to grow into dysfunctional adults is a defensive mindset, which encompasses a pattern of deviant social information processing steps, including hypervigilance to threat; hostile attributional biases; psychophysiological reactivity, experience of rage and testosterone release (in males); aggressive problem-solving styles; aggressogenic decision-making biases; and deficient behavioral skills. These processes are acquired in childhood and predict adult maladjustment outcomes, including incarceration and premature death. The antecedents of defensive mindset lie in early childhood experiences of trauma (...) and threat. The Fast Track (FT) intervention was designed to improve social competence in aggressive children. A randomized controlled trial demonstrated that FT is effective in preventing externalizing psychopathology; the primary mediating factor is the reduction of defensive mindset processes. This Element concludes with insights that defensive mindset might also explain dysfunction in other realms, including school culture, parenting, marriage, the workplace, intergroup relationships, politics, and international relations. (shrink)

The religious belief in personal immortality depends on the evidence for the existence of God, an immaterial soul or mind, and human nature. We also need to support the view that God will always want to maintain relationships with us in the afterlife. So, immortality is a hard sell. The suffering of innocent victims suggests that the existence of a loving God is not self-evident. Furthermore, the soul's separation from the body at death raises the troublesome problem of personal identity. (...) How can that be me in the afterlife without my body? The tradition from Plato to Descartes plants the seed of personal immortality in our rational nature. But the deconstruction of human nature suggests that our species is not special. Yet, the belief in immortality lingers. The first step in the reconstruction of personal immortality is found in systems theory, or belief that the whole individuates the part. This view suggests that we are the outcome of relationships rather than eternal natures entering into relationships. We are the product of relationships taking place at three basic levels. 1. In psyche where being human is the result of a tendency toward good and evil. 2. As social entities where the existence of other human beings individuates us. 3. In being's unconcealment where the intelligibility of things provides a foundation for epistemic life. Heidegger's view of the nothing or horizon surrounding being allows us to identify God as creator entering into personal relationships with us - a view supported by contemporary science. That will be me in the afterlife, if the relationships that individuate me in my _pre-mortem_ state continue into my _post-mortem_ existence. The reversal in being's unconcealment suggests that human death continues the cycle of personal existence. (shrink)

Recent research on genetic and biological diversity suggests that they underlie, and are the source of renewable resources--which are themselves more fundamental than non-renewable resources. If this is the case, then our understandings of the "limits to growth" debate will need modification and current approaches to development--in both the industrial countries and in the Third World--will need reconceptualization. A major part of this will involve a reversal of roles and priorities for agricultural and industrial development. Also, more sustainable/regenerative types of (...) agriculture and food systems will need to be developed. Current explorations along these lines are briefly reviewed. Finally, the links between this and the wider need to develop more sustainable societies are examined. (shrink)

Whether to treat autism as exculpatory in any given circumstance appears to be influenced both by models of autism and by theories of moral responsibility. This article looks at one particular combination of theories: autism as theory of mind challenges and moral responsibility as requiring appropriate experience of the reactive attitudes. In pursuing this particular combination of ideas, we do not intend to endorse them. Our goal is, instead, to explore the implications of this combination of especially prominent ideas about (...) autism and about moral responsibility. These implications can be quite serious and practical for autists and those who interact directly with autists, as well as for broader communities as they attend to the fair, compassionate, and respectful treatment of increasing numbers of autistic adults. We find that these theories point to a limited range of situations in which autists should not be blamed for transgressive actions for which neurotypical individuals should be blamed. We build on what others have written on these issues by bringing in a recent cognitive model of the role theory of mind plays in empathy, by discussing the social implications of the theoretical findings, and by raising questions about the compatibility of reactive attitude theories of moral responsibility with the neurodiversity approach to autism. (shrink)

Agricultural research raises fundamental ethical and value questions going beyond those in other fields both because of its public funding and because its results have significant impacts on habitats and other species. Questions about the sustainability of modern agriculture, which are shared with other sectors, require us to examine alternative visions and structures. These can be seen to range from status quo preserving ideologies to change-oriented utopias. It is argued that at the national level current ideologies—which include positivistic approaches and (...) belief in the neutrality of technology—mask real structural and policy choices as well as their ethical and value implications. At the international level, the export of fossil-fuel based modes of agriculture to the developing countries raises additional structural, policy, value, and ethical issues. (shrink)

Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical terms on (...) which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery."Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education. (shrink)

The premise of this article is that technologies are not neutral in terms of their design objectives, their scale, and the fact that they reflect the physical and social environments in which they have developed. Specific agricultural technologies, the midwestern plow, the California tomato harvester, and various biotechnologies, are evaluated in these terms and shown to have generally predictable impacts upon rural regions and farmers. Finally, the article examines a series of major threats such as climate change that require the (...) rethinking and restructuring of agriculture along more sustainable lines, something the can be accomplished only with a conscious recognition of the non-neutrality of technologies. (shrink)

As a neurodevelopmental condition that affects cognitive functioning, autism has been used as a test case for theories of moral responsibility. Most of the relevant literature focuses on autism’s impact on theory of mind and empathy. Here I examine aspects of autism related to executive function. I apply an account of how we might fail to be reasons responsive to argue that autism can increase the frequency of excuses for transgressive behavior, but will rarely make anyone completely exempt from moral (...) responsibility in general. On this account, although excuses may apply more often to autists than to others, the excuses that apply to autists are just the same excuses that can apply to anyone. (shrink)

In the article Privacy and Health Practices in the Digital Age, the authors describe current privacy challenges for digital health data and review the theoretical framework on privacy in the contex...

Drawing on broad definitions of technology and engineering as well as precedents in the philosophical literature, this paper makes the novel argument that the purposeful design of one’s unique good life using existing philosophical concepts is an engineering activity. Whether as a metaphor or as an engineering activity in its own right, a sampling of important benefits and perspectives provided for well-being by the presented “life engineering” framework are highlighted. A key strength of the framework is the conceptual simplicity, with (...) minimal sacrifices in completeness or consistency. This necessitates a tradeoff of limited precision for any one practical implementation. Consistent conceptual definitions for wisdom, virtue and the good life are presented within an informative ethics. Only a descriptive evaluation to aid in conceptual understanding is discussed, no prescriptive normative evaluations are made. The good life is defined to be one in which the minimum requirements are met and then performance is good, but no attempt is made to define what is good. A fundamental limitation of the framework stems from the inherent focus of technology on human utility. Although no novel fundamental conclusions are drawn in this paper, the presented framework is demonstrated to correspond with numerous ethical precepts of many existing philosophical traditions. (shrink)

McCoy, Liu, Lutz, and Sisti (2020) raise concerns about “partial representation,” in which nonelected advocates or advocacy organizations fail to engage and hold themselves accountable to the full range of people they purport to represent. They are right to point out that the autism community is vulnerable to partial representation. This open peer commentary notes some elements among those engaged with autism that may not fit under the type of “federated model” of representation McCoy, et al recommend. Advocates should tread (...) carefully to avoid some types of harm that do not arise when forming federations on other topics. The influence of antivaxxers and other questionable or harmful movements might even lead us to think, despite the value of open debate and engagement, that there is benefit to partial representation if it prevents potential harms that could arise from legitimizing dangerous practices. (shrink)

In a time when we as a society are in the process of deciding what our basic rights to health care are, it is critically important for us to have a full and complete understanding of what constitutes health. We argue for an analysis of health according to which certain states are healthy not in themselves but because they allow an individual to reach actual goals. Recognizing that the goals of an individual considered from the point of view of biology (...) and the goals of the same individual considered as an agent in the world might be different, we introduce a distinction between the health of an individual qua organism and the health of an individual qua person. We then argue that this distinction characterizes the evaluations made by patients and healthcare providers better than the widely discussed distinction between disease and illness. (shrink)

Michelle Garcia Winner’s Social Thinking Curriculum is widely used by schools across the USA and has garnered attention internationally. The curriculum addresses social language and behavior deficits among those on the autism spectrum. Although many embrace this curriculum without reservation, the emphasis on social conformity, including avoiding behaviors that make others uncomfortable, merits scrutiny. Individuals who have difficulty understanding social cues and conventions can derive tremendous benefit from learning to fit in, for example, or learning what is likely to make (...) others uncomfortable and why. However, too much emphasis on pleasing others can reinforce undesirable tendencies. For example, autism is already linked to avoidant personality disorder. An emphasis on avoiding making others uncomfortable may also inhibit the development of principled ethical thinking and action. Reframing social thinking to treat it not (or not only) as an end in itself, but as a way to achieve a variety of social and personal goals would go a long way toward addressing the weaknesses of the Social Thinking Curriculum. (shrink)

We suggest that there is confusion between why consciousness developed and what additional functions, through continued evolution, it has co-opted. Consider episodic memory. If we believe that episodic memory evolved solely to accurately represent past events, it seems like a terrible system—prone to forgetting and false memories. However, if we believe that episodic memory developed to flexibly and creatively combine and rearrange memories of prior events in order to plan for the future, then it is quite a good system. We (...) argue that consciousness originally developed as part of the episodic memory system—quite likely the part needed to accomplish that flexible recombining of information. We posit further that consciousness was subsequently co-opted to produce other functions that are not directly relevant to memory per se, such as problem-solving, abstract thinking, and language. We suggest that this theory is compatible with many phenomena, such as the slow speed and the after-the-fact order of consciousness, that cannot be explained well by other theories. We believe that our theory may have profound implications for understanding intentional action and consciousness in general. Moreover, we suggest that episodic memory and its associated memory systems of sensory, working, and semantic memory as a whole ought to be considered together as the conscious memory system in that they, together, give rise to the phenomenon of consciousness. Lastly, we suggest that the cerebral cortex is the part of the brain that makes consciousness possible, and that every cortical region contributes to this conscious memory system. (shrink)