Believing that p, assuming that p, and imagining that p involve regarding p as true—or, as we shall call it, accepting p. What distinguishes belief from the other modes of acceptance? We claim that conceiving of an attitude as a belief, rather than an assumption or an instance of imagining, entails conceiving of it as an acceptance that is regulated for truth, while also applying to it the standard of being correct if and only if it is true. We argue (...) that the second half of this claim, according to which the concept of belief includes a standard of correctness, is required to explain the fact that the deliberative question whether to believe that p is transparent to the question whether p. This argument raises various questions. Is there such a thing as deliberating whether to believe? Is the transparency of the deliberative question whether to believe that p the same as the transparency of the factual question whether I do believe that p? We will begin by answering these questions and then turn to a series of possible objections to our argument. (shrink)

Why, when asking oneself whether to believe that p, must one immediately recognize that this question is settled by, and only by, answering the question whether p is true? Truth is not an optional end for first-personal doxastic deliberation, providing an instrumental or extrinsic reason that an agent may take or leave at will. Otherwise there would be an inferential step between discovering the truth with respect to p and determining whether to believe that p, involving a bridge premise that (...) it is good (in whichever sense of good one likes, moral, prudential, aesthetic, allthings-considered, etc.) to believe the truth with respect to p. But there is no such gap between the two questions within the first-personal deliberative perspective; the question whether to believe that p seems to collapse into the question whether p is true. (shrink)

When we deliberate whether to believe some proposition, we feel immediately compelled to look for evidence of its truth. Philosophers have labelled this feature of doxastic deliberation 'transparency'. I argue that resolving the disagreement in the ethics of belief between evidentialists and pragmatists turns on the correct explanation of transparency. My hypothesis is that it reflects a conceptual truth about belief: a belief that p is correct if and only if p. This normative truth entails that only evidence can be (...) a reason for belief. Although evidentialism does not follow directly from the mere psychological truth that we cannot believe for non-evidential reasons, it does follow directly from the normative conceptual truth about belief which explains why we cannot do so. (shrink)

Why, when asking oneself whether to believe that p, must one immediately recognize that this question is settled by, and only by, answering the question whether p is true? Truth is not an optional end for first-personal doxastic deliberation, providing an instrumental or extrinsic reason that an agent may take or leave at will. Otherwise there would be an inferential step between discovering the truth with respect to p and determining whether to believe that p, involving a bridge premise that (...) it is good to believe the truth with respect to p. But there is no such gap between the two questions within the first-personal deliberative perspective; the question whether to believe that p seems to collapse into the question whether p is true. (shrink)

The value of any kind of data is greatly enhanced when it exists in a form that allows it to be integrated with other data. One approach to integration is through the annotation of multiple bodies of data using common controlled vocabularies or ‘ontologies’. Unfortunately, the very success of this approach has led to a proliferation of ontologies which itself creates obstacles to integration. The Open Biomedical Ontologies (OBO) consortium has set in train a strategy to overcome this problem. Existing (...) OBO ontologies, including the Gene Ontology, are undergoing a process of coordinated reform and new ontologies being created on the basis of an evolving set of shared principles governing ontology development. The result is an expanding family of ontologies designed to be interoperable, logically well-formed, and to incorporate accurate representations of biological reality. We describe the OBO Foundry initiative, and provide guidelines for those who might wish to become involved. (shrink)

To prepare for potential human infection challenge studies involving SARS-CoV-2, we convened a multidisciplinary working group to address ethical questions regarding whether and how much SAR...

Why can't deliberation conclude in an intention except by considering whether to perform the intended action? I argue that the answer to this question entails that reasons for intention are determined by reasons for action. Understanding this feature of practical deliberation thus allows us to solve the toxin puzzle.

Allocating access to unapproved COVID-19 drugs available via Pre-Approval Access pathways or Emergency Use Authorization raises unique challenges at the intersection of clinical care and research....

It is common for philosophers to claim that doxastic voluntarism, the view that an agent can form beliefs voluntarily, is false, and therefore that agents do not have the kind of control over their beliefs required for a straightforward application of deontological concepts such as obligation or duty in the domain of epistemology. The role that the denial of doxastic voluntarism plays in an argument to the effect that agents do not have obligations with respect to belief is simply this.

Contemporary Kantianism is often regarded as both a position within normative ethics and as an alternative to metaethical moral realism. We argue that it is not clear how contemporary Kantianism can distinguish itself from moral realism. There are many Kantian positions. For reasons of space we focus on the position of one of the most prominent, contemporary Kantians, Christine Korsgaard. Our claim is that she fails to show either that Kantianism is different or that it is better than realism. Our (...) strategy is to argue that what are supposed to be claims that conflict with realism in fact do not. (shrink)

The U.S. federal regulations require investigators conducting nonbeneficial research to obtain the assent of children who are capable of providing it. Unfortunately, there has been no analysis of which children are capable of assent or even what abilities ground the capacity to give assent. Why should investigators be required to obtain the positive agreement of some children, but not others, before enrolling them in research that does not offer a compensating potential for direct benefit? We argue that the scope of (...) children's research decision making should be based on the principles of respect for autonomy and nonmaleficence. These principles imply that the threshold for assent should be fixed at 14 years of age, and a dissent requirement should be adopted for all children in the context of nonbeneficial research. (shrink)

This article is a collective writing experiment undertaken by philosophers of education affiliated with the PESGB (Philosophy of Education Society of Great Britain). When asked to reflect on questions concerning the Philosophy of Education in a New Key in May 2020, it was unsurprising that the effects of the coronavirus pandemic on society and on education were foremost in our minds. We wanted to consider important philosophical and educational questions raised by the pandemic, while acknowledging that, first and foremost, it (...) is a human tragedy. With nearly a million deaths reported worldwide to date, and with everyone effected in one way or another by Covid-19, there is a degree of discomfort, and a responsibility to be sensitive, in reflecting and writing about it academically. Members of this ‘Covid Collective’ come from various countries, with perspectives from Great Britain and Ireland well represented, and we see academic practice as a globally connected enterprise, especially since the digital revolution in academic publishing. The concerns raised in this article relate to but move beyond Covid-19, reflecting the impact of neoliberalism [and other political developments] on geopolitics with educational concerns as central to our focus. (shrink)

Background: Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed. Objective: To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation. Methods: A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff when moral distress was present. (...) The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale. Results: Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment. Conclusions: Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness. (shrink)

Advances in life-saving technologies in the past few decades have challenged our traditional understandings of death. Traditionally, death was understood to occur when a person stops breathing, their heart stops beating and they are cold to the touch. Today, physicians determine death by relying on a diagnosis of ‘total brain failure’ or by waiting a short while after circulation stops. Evidence has emerged, however, that the conceptual bases for these approaches to determining death are fundamentally flawed and depart substantially from (...) the established biological conception of death. We argue that the current approach to determining death consists of two different types of unacknowledged legal fictions. These legal fictions were developed for practices that are largely ethically legitimate but need to be reconciled with the law. The considerable debate over the determination of death in the medical and scientific literature has not informed the public that vital organs are being procured from still-living donors and it seems unlikely that this information can remain hidden for long. Given the instability of the status quo and the difficulty of making the substantial legal changes required by complete transparency, we argue for a second-best policy solution: acknowledging the legal fictions involved in determining death to move in the direction of greater transparency. This may someday result in more substantial legal change to directly confront the challenges raised by life-sustaining and life-preserving technologies without the need for fictions. (shrink)

Using medical advances to enhance human athletic, aesthetic, and cognitive performance, rather than to treat disease, has been controversial. Little is known about physicians? experiences, views, and attitudes in this regard. We surveyed a national sample of physicians to determine how often they prescribe enhancements, their views on using medicine for enhancement, and whether they would be willing to prescribe a series of potential interventions that might be considered enhancements. We find that many physicians occasionally prescribe enhancements, but doctors hold (...) nuanced and ambiguous views of these issues. Most express concerns about the potential effects of enhancements on social equity, yet many also believe specific enhancements that are safe and effective should be available but not covered by insurance. These apparently contradictory views might reflect inherent tensions between the values of equity and liberty, which could make crafting coherent social policies on medical enhancements challenging. [Supplementary materials are available for this article. Go to the publisher's online edition of American Journal of Bioethics for the following free supplemental resource(s): An additional table (Table 5) referred to on p. 5]. (shrink)

The ethical principle of ‘respect for persons’ in clinical research has traditionally focused on protecting individuals’ autonomy rights, but respect for participants also includes broader, although less well understood, ethical obligations to regard individuals’ rights, needs, interests and feelings. However, there is little empirical evidence about how to effectively convey respect to potential and current participants. To fill this gap, we conducted exploratory, qualitative interviews with participants in a clinical genomics implementation study. We interviewed 40 participants in English or Spanish (...) about their experiences with respect in the study and perceptions of how researchers in a hypothetical observational study could convey respect or a lack thereof. Most interviewees were female, identified as Hispanic/Latino or non-Hispanic white, reported annual household income under US$60 000 and did not have a Bachelor’s degree ; 30% had limited health literacy. We identified four key domains for demonstrating respect: personal study team interactions, with an emphasis on empathy, appreciation and non-judgment; study communication processes, including following up and sharing results with participants; inclusion, particularly ensuring materials are understandable and procedures are accessible; and consent and authorisation, including providing a neutral informed consent and keeping promises regarding privacy protections. While the experience of respect is inherently subjective, these findings highlight four key domains that may meaningfully demonstrate respect to potential and current research participants. Further empirical and normative work is needed to substantiate these domains and evaluate how best to incorporate them into the practice of research. (shrink)

In recent years, there has been an escalation in cases of cyber violence, which has had a chilling effect on users' behavior toward social media sites. This article explores the causes behind cyber violence and provides empirical data for developing means for effective prevention. Using elements of the stimulus–organism–response theory, we constructed a model of cyber-violence behavior. A closed-ended questionnaire was administered to collect data through an online survey, which results in 531 valid responses. A proposed model was tested using (...) partial least squares structural equation modeling using SmartPLS 3.0, v. Research findings show that information inequality is a strong external stimulus with a significant positive impact on digital distrust and negative emotion. However, the effects of information overload on digital distrust and the adverse effects of communication overload on negative emotions should not be ignored. Both digital distrust and negative emotions have significant positive impacts on cyber violence and cumulatively represent 11.5% changes in cyber violence. Furthermore, information overload, communication overload, information inequality, and digital distrust show a 27.1% change in negative emotions. This study also presents evidence for competitive mediation of digital distrust by information overload, information inequality, and cyber violence. The results of this study have implications for individual practitioners and scholars, for organizations, and at the governmental level regarding cyber-violence behavior. To test our hypotheses, we have constructed an empirical, multidimensional model, including the role of specific mediators in creating relationships. (shrink)

The current COVID-19 pandemic and the previous SARS/MERS outbreaks of 2003 and 2012 have resulted in a series of major global public health crises. We argue that in the interest of developing effective and safe vaccines and drugs and to better understand coronaviruses and associated disease mechenisms it is necessary to integrate the large and exponentially growing body of heterogeneous coronavirus data. Ontologies play an important role in standard-based knowledge and data representation, integration, sharing, and analysis. Accordingly, we initiated the (...) development of the community-based Coronavirus Infectious Disease Ontology in early 2020. -/- As an Open Biomedical Ontology (OBO) library ontology, CIDO is open source and interoperable with other existing OBO ontologies. CIDO is aligned with the Basic Formal Ontology and Viral Infectious Disease Ontology. CIDO has imported terms from over 30 OBO ontologies. For example, CIDO imports all SARS-CoV-2 protein terms from the Protein Ontology, COVID-19-related phenotype terms from the Human Phenotype Ontology, and over 100 COVID-19 terms for vaccines (both authorized and in clinical trial) from the Vaccine Ontology. CIDO systematically represents variants of SARS-CoV-2 viruses and over 300 amino acid substitutions therein, along with over 300 diagnostic kits and methods. CIDO also describes hundreds of host-coronavirus protein-protein interactions (PPIs) and the drugs that target proteins in these PPIs. CIDO has been used to model COVID-19 related phenomena in areas such as epidemiology. The scope of CIDO was evaluated by visual analysis supported by a summarization network method. CIDO has been used in various applications such as term standardization, inference, natural language processing (NLP) and clinical data integration. We have applied the amino acid variant knowledge present in CIDO to analyze differences between SARS-CoV-2 Delta and Omicron variants. CIDO's integrative host-coronavirus PPIs and drug-target knowledge has also been used to support drug repurposing for COVID-19 treatment. -/- CIDO represents entities and relations in the domain of coronavirus diseases with a special focus on COVID-19. It supports shared knowledge representation, data and metadata standardization and integration, and has been used in a range of applications. (shrink)

Mark Schroeder has recently presented apparent counterexamples to the standard account of the distinction between the right and the wrong kinds of reasons. We argue that these examples appear to refute the standard account only because they blur the distinction between two kinds of reasoning: reasoning about whether to intend or believe that p and reasoning about whether to take up the question of whether to intend or believe that p.

Brain death, or the determination of death by neurological criteria, has been described as a legal fiction. Legal fictions are devices by which the law treats two analogous things (in this case, biological death and brain death) in the same way so that the law developed for one can also cover the other. Some scholars argue that brain death should be understood as a fiction for two reasons: the way brain death is determined does not actually satisfy legal criteria requiring (...) the permanent cessation of all brain function, and brain death is not consistent with the biological conception of death as involving the irreversible cessation of the functioning of an organism as a whole. Critics counter that the idea that brain death is a legal fiction is deceptive and undemocratic. I will argue that diagnosing brain death as a hidden legal fiction is a helpful way to understand its historical development and current status. For the legal‐fictions approach to be ethically justifiable, however, the fact that brain death is a legal fiction not aligned with the standard biological conception of death must be acknowledged and made transparent. (shrink)

Based on the social exchange theory, the aim of this study is to identify the association between job stress state anger, emotional exhaustion and job turnover intention. This study postulates that job related stress and state anger among nurses during COVID-19 subsequently leads to their job turnover intentions. In addition, the study also aims to see the mediating role of emotional exhaustion between COVID-19-related job stress, state anger, and turnover intentions. The sample of this study is gathered from 335 registered (...) nurses working in Pakistani hospitals dealing with COVID-19-related patients. The interrelationships between variables are checked by using structural equation modeling through AMOS. Key findings confirm that COVID-19-related job stress and state anger had a significant effect on nurses’ turnover intentions. Furthermore, emotional exhaustion mediated the relationship between COVID-19-related job stress, state anger, and turnover intentions. There is a lack of research which has assessed the impact of Novel COVID-19-related job stress and state anger on nurses’ turnover intentions in hospitals, providing empirical evidence from a developing country-Pakistan. This study offers managerial implications for hospital management and health policymakers. Moreover, nursing managers need to pay attention to nurses’ turnover intentions who are facing the issue at the front line as patients receive their initial treatment from nurses in the COVID-19 outbreak. (shrink)

Decisions regarding life-sustaining medical treatments for young children with profound disabilities can be extremely challenging for families and clinicians. In this study, Brick and colleagues1 surveyed adult residents of the UK about their attitudes regarding withdrawal of treatment using a series of vignettes of infants with varying levels of intellectual and physical disability, based on real and hypothetical cases.1 This is an interesting study on an important topic. We first highlight the limitations of using these survey data to inform public (...) policy and then offer a different interpretation from the authors’ regarding their findings about the value the public appears to place on relational capacity. The authors asked members of the lay public to interpret a disabled child’s best interest in a series of vignettes. The respondents were 92% white; 59% were atheist or reported no religious affiliation. Though the authors note this lack of diversity as a limitation, we would add that this limitation is particularly problematic in this context. Minority views on this issue may differ significantly from the majority perspective. When the stakes are high, use of public opinion data to directly inform policy requires, at a minimum, a representative sample reflecting both the true diversity of views within the public and a method to justly account for the alternate views of the minority. Even if the sampled population were more …. (shrink)

Two prejudices have hampered our understanding of John Stuart Mill’s central argument for free speech. One prejudice is that arguments for free speech can only be made in terms of values or rights. This prejudice causes us to miss the depth of Mill’s argument. He does not argue that silencing speech is harmful or violates rights, but instead that silencing speech is a uniquely self-undermining act; it undermines the ground upon which it is based. But even if we overcome this (...) prejudice and appreciate the self-undermining character of Mill’s argument, the prejudice that epistemic justification is a completable task blinds us to the role of open-mindedness in his argument; and failing to see this leads us to wrongly conclude that his argument is invalid. It is only once we have overcome both prejudices that we can appreciate the depth and power of Mill’s argument for free speech. (shrink)

Medical student and resident participation in global health experiences (GHEs) has significantly increased over the last decade. In response to growing student interest and the proven impact of such experiences on the education and career decisions of resident physicians, many medical schools have begun to establish programmes dedicated to global health education. For the innumerable benefits of GHEs, it is important to note that medical students have the potential to do more harm than good in these settings when they exceed (...) their actual capabilities as physicians-in-training. While medical training programmes are beginning to provide students with the knowledge to put their GHEs in context, they must remember that they also bear the responsibility of training their students in a framework to approach these experiences in a principled and professional way. It is necessary that these institutions provide adequate and formalised preparation for both clinical and ethical challenges of working in resource-poor settings. This paper outlines potential benefits and risks of GHEs and delineates recommendations to some of the current issues. (shrink)

The recent Ebola outbreak in West Africa began in the spring of 2014 and has since caused the deaths of over 6,000 people. Since there are no approved treatments or prevention modalities specifically targeted at Ebola Virus Disease , debate has focused on whether unproven interventions should be offered to Ebola patients outside of clinical trials. Those engaged in the debate have responded rapidly to a complex and evolving crisis, however, and this debate has not provided much opportunity for in-depth (...) analysis. Additionally, the existing literature on access to unproven therapies has focused on contexts like HIV/AIDS and oncology, which are very different than the Ebola epidemic. In this paper, we examine the ethical issues surrounding access to unproven therapies in the context of the recent Ebola outbreak to yield new insights about this controversial and unsettled issue. We argue first that, in this context, the interests of patients in obtaining access to unproven therapies are not fully aligned.. (shrink)

Volume 20, Issue 6, June 2020, Page 17-19.

The rapid development of CRISPR-based gene editing has been accompanied by a polarized governance debate about the status of CRISPR-edited crops as genetically modified organisms. This article argues that the polarization around the governance of gene editing partly reflects a failure of public engagement with the current state of research in genomics and postgenomics. CRISPR-based gene-editing technology has become embedded in a narrow narrative about the ease and precision of the technique that presents the gene as a stable object under (...) technological control. By tracing the considerably destabilized scientific understanding of the gene in genomics and postgenomics, this article highlights that this publicly mediated ontology strategically avoids positioning the “ease of CRISPR-based editing” in the wider context of the “complexity of the gene.” While this strategic narrowness of CRISPR narratives aims to create public support for gene-editing technologies, we argue that it stands in the way of socially desirable anticipatory governance and open public dialogue about societal promises and the unintended consequences of gene editing. In addressing the polarization surrounding CRISPR-based editing technology, the article emphasizes the need for engagement with the complex state of postgenomic science that avoids strategic simplifications of the scientific literature in promoting or opposing the commercial use of the gene-editing technology. (shrink)

The maturing of metaethics has been accompanied by widespread, but relatively unarticulated, discontent that mainstream metaethics is fundamentally on the wrong track. The malcontents we have in mind do not simply champion a competitor to the likes of noncognitivism or realism; they disapprove of the supposed presuppositions of the existing debate. Their aim is not to generate a new theory within metaethics, but to go beyond metaethics and to transcend the distinctions it draws between metaethics and normative ethics and between (...) cognitivism and non-cognitivism. In our experience, the differences with traditional metaethics go deep enough that it can feel as if two different paradigms are talking past each other. We attempt to bring clarity and focus to this rather inchoate debate by simultaneously articulating the general issues involved and engaging in a detailed case study of one of the prominent representatives of this discontent, Christine Korsgaard. We argue that Korsgaard fails to go beyond metaethics–indeed, fails even to provide a theory within metaethics. Our strategy for showing this is to argue that her claims are compatible with both cognitivism and non-cognitivism. We have argued elsewhere that her distinctive claims are compatible with realism. Here we focus on the crucial role that claims about agency and the will seem to play her in work and, according to our interpretation, in her attempts to go beyond mainstream metaethics. We show in detail that these claims are actually compatible with non-cognitivism. Though our discussion often focuses on her work in particular, it has clear implications for other attempts to obviate the debates of traditional metaethics. (shrink)

There is wide agreement that communities in lower-income countries should benefit when they participate in multinational research. Debate now focuses on how and to what extent these communities should benefit. This debate has identified compelling reasons to reject the claim that whatever benefits a community agrees to accept are necessarily fair. Yet, those who conduct clinical research may conclude from this rejection that there is no reason to involve communities in the process of deciding how they benefit. Against this possibility, (...) the present manuscript argues that involving host communities in this process helps to promote four important goals: protecting host communities, respecting host communities, promoting transparency, and enhancing social value. (shrink)