In the 1960s, newborn screening programs tested for a single very rare but serious disorder. In recent years, thanks to the development of new screening technology, they have expanded into panels of tests; a federally sponsored expert group has recommended that states test for twenty-nine core disorders and twenty-five secondary disorders. By the standards used to decide whether to introduce new preventive health services into clinical use, the decision-making in newborn screening policy has been lax.

Classic statements of research ethics advise against permitting physician-investigators to obtain consent for research participation from patients with whom they have preexisting treatment relationships. Reluctance about “dual-role” consent reflects the view that distinct normative commitments govern physician–patient and investigator–participant relationships, and that blurring the research–care boundary could lead to ethical transgressions. However, several features of contemporary research demand reconsideration of the ethics of dual-role consent. Here, we examine three arguments advanced against dual-role consent: that it creates role conflict for the (...) physician-investigator; that it can compromise the voluntariness of the patient-participant’s consent; and that it promotes therapeutic misconceptions. Although these concerns have merit in some circumstances, they are not dispositive in all cases. Rather, their force—and the ethical acceptability of dual-role consent—varies with features of the particular study. As research participation more closely approximates usual care, it becomes increasingly acceptable, or even preferable, for physicians to seek consent for research from their own patients. It is time for a more nuanced approach to dual-role consent. (shrink)

Long time delay before lasing in a II-VI laser diode has been observed. Due to this delay, a nominal threshold current increases as the width of applied current pulse becomes shorter. This delay is attributed to the internal Q switching caused by the balance of injected carriers, temperature rise and gain-guiding. By fitting the calculated data to the experimental ones, rates of refractive index change with carrier concentration and with temperature have been estimated.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Hegel on Self-Consciousness: Desire and Death in the Phenomenology of SpiritAndy R. GermanRobert B. Pippin. Hegel on Self-Consciousness: Desire and Death in the Phenomenology of Spirit. Princeton-Oxford: Princeton University Press, 2011. Pp. viii + 103. Cloth, $29.95.If Hegel's system cannot be understood without the Phenomenology of Spirit, it is certainly impossible to understand the Phenomenology without understanding its famous transition, in chapter 4, to self-consciousness and the (perhaps (...) all-too-famous) master-slave dialectic. In these published lectures, then, Robert Pippin has compelling reasons for seeking the heart of the Phenomenology in two of its crucial assertions: that "Self-Consciousness is desire itself" and that "Self-Consciousness attains its satisfaction only in another self-consciousness" (¶¶167 and 175 in Miller's translation).Pippin's Hegel is essentially Kantian, concerned with the apperceptive nature of self-consciousness, i.e. not as mere receptivity to sensory or intellectual form, but as an activity, a judging or "taking" the world to be such and so. For Kant, this activity is transcendental or purely formal, the unification of the spatio-temporal manifold by a continuous, apperceptive "I" (31). Pippin argues that Hegel jettisons Kantian formality in favor of a broader question: how, rather than being subject to my desires, am I the subject of my desires? (32). An answer is possible only if self-consciousness is neither observational nor an immediate self-presence but instead (i) a practical achievement (15) that (ii) requires other self-conscious subjects (19). Unlike Platonic erōs, then, which points away from human life, self-conscious desire is constant self-examination of the reasons for our actions or beliefs. This is Hegel's version of Kant's insight that reason is the desire for justification, ultimately before "all others" (56–57).Thus we pivot to the claim that the successful or "satisfying" achievement of self-consciousness involves recognition by others. "Our answerability to the world," as Pippin writes, "is inextricably bound up with... our answerability to each other" (61). Unlike John McDowell's interpretation of the master-slave dialectic as an analogy for the struggle between the passive and active elements within one mind (42), Pippin argues that self-consciousness is social all the way down. It is "something like having a position," i.e. avowing a practical commitment or making a normative claim (65), which implies the presence of another self-conscious subject who recognizes my right to such claims, or challenges that right, even to the outermost—a struggle to the death over recognition and authority. Self-consciousness, then, is "not... a reflection of some substantive or metaphysical nature but... a social achievement... bound up with... social conflict" (75). On the decisive point, Pippin agrees with Brandom's neo-pragmatism: "[S]elf-conscious beings do not have natures, they have histories" (68), specifically, the history of struggle and reconciliation among rational, mutually recognizing subjects.But what, then, does recognition mean and how does it "satisfy"? And in what does our "answerability to others" consist if there is no "non-question begging... standard" (83) by which to judge our answers? Hegel, Pippin writes, "has a ‘pragmatic' or a ‘historicized' or ‘dialogical' view of what counts as the appeal to reasons.... He understands practical reason as a kind of interchange of attempts at justification among persons... " (84). Justification, however, cannot mean an appeal to nature. Indeed, in the struggle for recognition, self-conscious freedom means indifference to mere natural life or desire. Nature no longer points to philosophical wholeness, as our love of seeing does in Aristotle's Metaphysics. To paraphrase Pippin's titles, he shows with superior clarity that Hegel's idealism really is modernism: i.e. the most thoroughgoing rejection of the Greek link between eleutheria and eudaimonia.But when Hegel writes of "the point where knowledge no longer needs to go beyond itself... where Concept corresponds to object and object to Concept" as the necessary "goal" of knowledge (¶80), this suggests that the "interchange of justifications" reaches an end. Even if this end is the socio-political order of mutual recognition among rational persons, it is surely not the mere fact of recognition that satisfies us... (shrink)

How do people understand questions about cause and prevent? Some theories propose that people affirm that A causes B if A's occurrence makes a difference to B's occurrence in one way or another. Other theories propose that A causes B if some quantity or symbol gets passed in some way from A to B. The aim of our studies is to compare these theories' ability to explain judgements of causation and prevention. We describe six experiments that compare judgements for causal (...) paths that involve a mechanism, i.e. a continuous process of transmission or exchange from cause to effect, against paths that involve no mechanism yet a change in the cause nevertheless brings about a change in the effect. Our results show that people prefer to attribute cause when a mechanism links cause to effect. In contrast, prevention is sensitive both to the presence of an interruption to a causal mechanism and to a change in the outcome in the absence of a mechanism. In this sense, ‘prevent’ means something different than ‘cause not'. We discuss the implications of our results for existing theories of causation. (shrink)

Low mean fundamental frequency (F 0) in men’s voices has been found to positively influence perceptions of dominance by men and attractiveness by women using standardized speech. Using natural speech obtained during an ecologically valid social interaction, we examined relationships between multiple vocal parameters and dominance and attractiveness judgments. Male voices from an unscripted dating game were judged by men for physical and social dominance and by women in fertile and non-fertile menstrual cycle phases for desirability in short-term and long-term (...) relationships. Five vocal parameters were analyzed: mean F 0 (an acoustic correlate of vocal fold size), F 0 variation, intensity (loudness), utterance duration, and formant dispersion (D f , an acoustic correlate of vocal tract length). Parallel but separate ratings of speech transcripts served as controls for content. Multiple regression analyses were used to examine the independent contributions of each of the predictors. Physical dominance was predicted by low F 0 variation and physically dominant word content. Social dominance was predicted only by socially dominant word content. Ratings of attractiveness by women were predicted by low mean F 0, low D f , high intensity, and attractive word content across cycle phase and mating context. Low D f was perceived as attractive by fertile-phase women only. We hypothesize that competitors and potential mates may attend more strongly to different components of men’s voices because of the different types of information these vocal parameters provide. (shrink)

Volume 19, Issue 5, May 2019, Page W3-W4.

This commentary on coderre & katz, wiesenfeld-hallin et al., and dickenson focuses on: (a) the brain as an under-recognized contributor to pain facilitation at the spinal cord; (b) these brain-to-spinal pathways being activated by learning or by body infection/inflammation; and (c) the resultant spinal release of anti-analgesic neuropeptides, activators of the NMDA-NO cascade, and activators of glia.

Knowledge and Ignorance of Self in Platonic Philosophy is the first volume of essays dedicated to the whole question of self-knowledge and its role in Platonic philosophy. It brings together established and rising scholars from every interpretative school of Plato studies, and a variety of texts from across Plato's corpus - including the classic discussions of self-knowledge in the Charmides and Alcibiades I, and dialogues such as the Republic, Theaetetus, and Theages, which are not often enough mined for insights about (...) this crucial philosophical topic. The rich variety of readings and hermeneutical methods allows for an encompassing view of the relevant scholarly debates. The volume is intended to serve as a standard resource for further research on Plato's treatment of self-knowledge, and will highlight the relevance of Plato's thought to contemporary debates on selfhood, self-reflection and subjectivity. (shrink)

The conflicts of interest that may arise in relationships between academic researchers and industry continue to prompt controversy. The bulk of attention has focused on financial aspects of these relationships, but conflicts may also arise in the legal obligations that faculty acquire through consulting contracts. However, oversight of faculty members' consulting agreements is far less vigorous than for financial conflicts, creating the potential for faculty to knowingly or unwittingly contract away important rights and freedoms. Increased regulation could prevent this, but (...) it is unclear what forms of oversight universities view as feasible and effective. In this article, we report on a Delphi study to evaluate several approaches for oversight of consulting agreements by medical schools. The panel was comprised of 11 senior administrators with responsibility for oversight of faculty consulting relationships. We found broad agreement among panelists regarding the importance of institutional oversight to protect universities' interests. There was strong support for two specific approaches: providing educational resources to faculty and submitting consulting agreements for institutional review. Notwithstanding the complexities of asserting authority to regulate private consulting agreements between faculty members and companies, medical school administrators reached consensus that several approaches to improving institutional oversight are feasible and useful. (shrink)

Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its purpose. Intervention (...) participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (shrink)

Which sounds composed the first spoken languages? Archetypal sounds are not phylogenetically or archeologically recoverable, but comparative linguistics and primatology provide an alternative approach. Labial articulations are the most common speech sound, being virtually universal across the world's languages. Of all labials, the plosive ‘p’ sound, as in ‘Pablo Picasso’, transcribed /p/, is the most predominant voiceless sound globally and one of the first sounds to emerge in human infant canonical babbling. Global omnipresence and ontogenetic precocity imply that /p/‐like sounds (...) could predate the first major linguistic diversification event(s) in humans. Indeed, great ape vocal data support this view, namely, the only cultural sound shared across all great ape genera is articulatorily homologous to a rolling or trilled /p/, the ‘raspberry’. /p/‐like labial sounds represent an ‘articulatory attractor’ among living hominids and are likely among the oldest phonological features to have ever emerged in linguistic systems. (shrink)

In the second edition Preface of Religion Within the Bounds of Bare Reason Kant responds to an anonymous review of the first edition. We present the first English translation of this obscure book review. Following our translation, we summarize the reviewer's main points and evaluate the adequacy of Kant's replies to five criticisms, including two replies that Kant provides in footnotes added in the second edition. A key issue is the reviewer's claim that Religion adopts an implied standpoint, described using (...) transcendental terminology. Kant could have avoided much confusion surrounding Religion, had he taken this review more seriously. We therefore respond to three objections that Kant failed to address: how the Wille–Willkür distinction enables the propensity to evil to be viewed as coexisting with freedom of choice; how moral improvement is possible, even though the propensity to evil is necessary and universal; and how a ‘deed’ can be regarded as ‘noumenal’.Send article to KindleTo send this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle. Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service.The Implied Standpoint of Kant's Religion: An Assessment of Kant's Reply to an Early Book Review of Religion Within the Bounds of Bare ReasonVolume 18, Issue 1Stephen R. Palmquist and Steven Otterman DOI: https://doi.org/10.1017/S1369415412000295Your Kindle email address Please provide your Kindle [email protected]@kindle.com Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Dropbox To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox. The Implied Standpoint of Kant's Religion: An Assessment of Kant's Reply to an Early Book Review of Religion Within the Bounds of Bare ReasonVolume 18, Issue 1Stephen R. Palmquist and Steven Otterman DOI: https://doi.org/10.1017/S1369415412000295Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Google Drive To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive. The Implied Standpoint of Kant's Religion: An Assessment of Kant's Reply to an Early Book Review of Religion Within the Bounds of Bare ReasonVolume 18, Issue 1Stephen R. Palmquist and Steven Otterman DOI: https://doi.org/10.1017/S1369415412000295Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Export citation. (shrink)

Physicians often struggle with ethical issues surrounding intervention in their relatives’ health care. Many editorials, letters, and surveys have been written on this topic, but there is no systematic review of its prevalence. An Ovid Medline search was conducted for articles in English, written between January 1950 and December 2010, using the key words family member, relatives, treatment, prescribing, physician, and ethics. The search identified 41 articles (editorials, letters, and surveys). Surveys were reviewed to explore demographics of these treating physicians (...) and reasons for and against intervention. Physicians often intervene directly or indirectly in the health care of relatives. The most common reasons were convenience, cost savings, and the perception of having greater knowledge or concern than colleagues. Lost objectivity, fear of misdiagnosis, and inability to provide complete care were the main considerations against intervention. The characteristics of treating doctors were nonspecific. Most surveys recommend against this practice except for emergencies or minor ailments. This review included only a few surveys with small sample size and only assessed scientific literature written in English after 1950. Survey data may be biased by physicians’ self-reporting. In conclusion, most doctors occasionally intervene in their relatives’ care. The decision to do so is determined by multiple factors. Physicians should treat only short-term or minor illnesses within their scope of practice. Future research should evaluate doctors’ attitudes toward their relatives, medical student feelings about treating family, and intervention frequencies of medical and nonmedical professionals. (shrink)

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

The Nature of Concepts examines a central issue for all the main disciplines in cognitive science: how the human mind creates and passes on to other human minds a concept. An excellent cross-disciplinary collection with contributors including Steven Pinker, Andy Clarke and Henry Plotkin.

Matter and Form explores the relationship between natural science and political philosophy from the classical to contemporary eras, taking an interdisciplinary approach to the philosophic understanding of the structure and process of the natural world and its impact on the history of political philosophy. It illuminates the importance of philosophic reflection on material nature to moral and political theorizing, mediating between the sciences and humanities and making a contribution to ending the isolation between them.

Six African countries participated in an intercontinental professional development workshop developed by the science and math staff at the University of Iowa and supported by the Africa-America Institute. The 11-day workshop was designed to produce changes in goal setting, assessment practices, instruction, and curriculum structures for high school teachers. The article provides a detailed description of the workshop and discusses evidence of workshop successes. Preworkshop and postworkshop vision statements and curriculum units were used to track the progression of five Kenyan (...) educators as they moved toward constructivist-based practices. Teachers enhanced their views of science and math learning outcomes and learning environment as the workshop progressed. Specifically, teachers moved from emphasizing better grades and exam scores to greater student use of science and math skills. They also shifted from a heavily teacher-centered classroom view to a more student-centered classroom view. (shrink)

Dementia is an illness that raises important questions about our own attitudes to illness and aging. It also raises very important issues beyond the bounds of dementia to do with how we think of ourselves as people - fundamental questions about personal identity. Is the person with dementia the same person he or she was before? Is the individual with dementia a person at all? In a striking way, dementia seems to threaten the very existence of the self. This book (...) brings together philosophers and practitioners to explore the conceptual issues that arise in connection with this increasingly common illness. Drawing on a variety of philosophers such as Descartes, Locke, Hume, Wittgenstein, the authors explore the nature of personal identity in dementia. They also show how the lives and selfhood of people with dementia can be enhanced by attention to their psychosocial and spiritual environment. Throughout, the book conveys a strong ethical message, arguing in favour of treating people with dementia with all the dignity they deserve as human beings. The book covers a range of topics, stretching from talk of basic biology to talk of a spiritual understanding of people with dementia. Accessibly written by leading figures in psychiatry and philosophy, the book presents a unique and long overdue examination of an illness that features in so many of our lives. (shrink)

The current investigation was designed to examine the association of parenting during late childhood and early adolescence, a time of rapid physical development, with biological propensity for inflammation. Based on life course theory, it was hypothesized that parenting during this period of rapid growth and development would be associated with biological outcomes and self-reported health assessed in young adulthood. It was expected that association of parenting with health would be mediated either by effects on methylation of a key inflammatory factor, (...) Tumor necrosis factor (TNF), or else by association with a pro-inflammatory shift in the distribution of mononuclear blood cells. Supporting expectations, in a sample of 398 African American youth residing in rural Georgia, followed from age 11 to age 19, parenting at ages 11–13 was associated with youth reports of better health at age 19. We found that parenting was associated with changes in TNF methylation as well as with changes in cell-type composition. However, whereas methylation of TNF was a significant mediator of the association of parenting with young adult health, variation in mononuclear white blood cell types was not a significant mediator of the association of parenting with young adult health. The current research suggests the potential value of examining the health-related effects of parenting in late childhood and early adolescence. Further examination of protection against pro-inflammatory tendencies conferred by parenting appears warranted. (shrink)

This article presents the first results of a study of the decisions made by health professionals in South Australia concerning the management of death, dying, and euthanasia, and focuses on the findings concerning the attitudes and practices of medical practitioners. Mail-back, self-administered questionnaires were posted in August 1991 to a ten per cent sample of 494 medical practitioners in South Australia randomly selected from the list published by the Medical Board of South Australia. A total response rate of 68 per (...) cent was obtained, 60 per cent of which (298) were usable returns. It was found that forty-seven per cent had received requests from patients to hasten their deaths. Nineteen per cent had taken active steps which had brought about the death of a patient. Sixty-eight per cent thought that guidelines for withholding and withdrawal of treatment should be established. Forty-five per cent were in favour of legalisation of active euthanasia under certain circumstances. (shrink)

Governments around the world have faced the challenge of how to respond to the recent outbreak of a novel coronavirus disease. Some have reacted by greatly restricting the freedom of citizens, while others have opted for less drastic policies. In this paper, I draw a parallel with vaccination ethics to conceptualize two distinct approaches to COVID-19 that I call altruistic and lockdown. Given that the individual measures necessary to limit the spread of the virus can in principle be achieved voluntarily (...) as well as through enforcement, the question arises of how much freedom governments ought to give citizens to adopt the required measures. I argue that an altruistic approach is preferable on moral grounds: it preserves important citizen freedoms, avoids a number of potential injustices, and gives people a much-needed sense of meaning in precarious times. (shrink)

The Last Gift is an observational HIV cure-related research study conducted with people with HIV at the end of life (EOL) at the University of California San Diego. Participants agree to voluntarily donate blood and other biospecimens while living and their bodies for a rapid research autopsy postmortem to better understand HIV reservoir dynamics throughout the entire body. The Last Gift study was initiated in 2017. Since then, 30 volunteers were enrolled who are either (1) terminally ill with a concomitant (...) condition and have a prognosis of 6 months or less or (2) chronically ill with multiple comorbidities and nearing the EOL.Multiple ethical and logistical challenges have been revealed during this time; here, we share our lessons learnt and ethical analysis. Issues relevant to healthcare research include surrogate informed consent, personal and professional boundaries, challenges posed conducting research in a pandemic, and clinician burnout and emotional support. Issues more specific to EOL and postmortem research include dual roles of clinical care and research teams, communication between research personnel and clinical teams, legally required versus rapid research autopsy, identification of next of kin/loved ones and issues of inclusion. Issues specific to the Last Gift include logistics of body donation and rapid research autopsy, and disposition of the body as a study benefit.We recommend EOL research teams to have clear provisions around surrogate informed consent, rotate personnel to maintain boundaries, limit direct contact with staff associated with clinical care and have a clear plan for legally required versus research autopsies, among other recommendations. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

BackgroundOne of the next frontiers in HIV research is focused on finding a cure. A new priority includes people with HIV (PWH) with non-AIDS terminal illnesses who are willing to donate their bodies at the end-of-life (EOL) to advance the search towards an HIV cure. We endeavored to understand perceptions of this research and to identify ethical and practical considerations relevant to implementing it.MethodsWe conducted 20 in-depth interviews and 3 virtual focus groups among four types of key stakeholders in the (...) United States (PWH, biomedical HIV cure researchers, HIV clinicians, and bioethicists) to obtain triangulated viewpoints because little was known about the ethics of this topic. Each group was queried as to ethical considerations, safeguards, and protections for conducting HIV cure-related research at the EOL to ensure this research remains acceptable.ResultsAll four key stakeholder groups generally supported HIV cure-related research conducted at the EOL because of the history of altruism within the PWH community and the potential for substantial scientific knowledge to be gained. Our informants expressed that: (1) Strong stakeholder and community involvement are integral to the ethical and effective implementation, as well as the social acceptability of this research; (2) PWH approaching the EOL should not inherently be considered a vulnerable class and their autonomy must be respected when choosing to participate in HIV cure-related research at the EOL; (3) Greater diversity among study participants, as well as multi-disciplinary research teams, is necessitated by HIV cure-related research at the EOL; (4) The sensitive nature of this research warrants robust oversight to ensure a favorable risk/benefit balance and to minimize the possibility of therapeutic misconception or undue influence; and (5) Research protocols should remain flexible to accommodate participants’ comfort and needs at the EOL.ConclusionBecause of the ethical issues presented by HIV cure-related research at the EOL, robust ethical safeguards are of utmost importance. The proposed ethical and practical considerations presented herein is a first step in determining the best way to maximize this research’s impact and social value. More much inquiry will need to be directed towards understanding context-specific and cultural considerations for implementing EOL HIV cure research in diverse settings. (shrink)

How do minds emerge from developing brains? According to the representational features of cortex are built from the dynamic interaction between neural growth mechanisms and environmentally derived neural activity. Contrary to popular selectionist models that emphasize regressive mechanisms, the neurobiological evidence suggests that this growth is a progressive increase in the representational properties of cortex. The interaction between the environment and neural growth results in a flexible type of learning: minimizes the need for prespecification in accordance with recent neurobiological evidence (...) that the developing cerebral cortex is largely free of domain-specific structure. Instead, the representational properties of cortex are built by the nature of the problem domain confronting it. This uniquely powerful and general learning strategy undermines the central assumption of classical learnability theory, that the learning properties of a system can be deduced from a fixed computational architecture. Neural constructivism suggests that the evolutionary emergence of neocortex in mammals is a progression toward more flexible representational structures, in contrast to the popular view of cortical evolution as an increase in innate, specialized circuits. Human cortical postnatal development is also more extensive and protracted than generally supposed, suggesting that cortex has evolved so as to maximize the capacity of environmental structure to shape its structure and function through constructive learning. (shrink)

Robotization is an increasingly pervasive feature of our lives. Robots with high degrees of autonomy may cause harm, yet in sufciently complex systems neither the robots nor the human developers may be candidates for moral blame. John Danaher has recently argued that this may lead to a retribution gap, where the human desire for retribution faces a lack of appropriate subjects for retributive blame. The potential social and moral implications of a retribution gap are considerable. I argue that the retributive (...) intuitions that feed into retribution gaps are best understood as deontological intuitions. I apply a debunking argument for deontological intuitions in order to show that retributive intuitions cannot be used to justify retributive punishment in cases of robot harm without clear candidates for blame. The fundamental moral question thus becomes what we ought to do with these retributive intuitions, given that they do not justify retribution. I draw a parallel from recent work on implicit biases to make a case for taking moral responsibility for retributive intuitions. In the same way that we can exert some form of control over our unwanted implicit biases, we can and should do so for unjustifed retributive intuitions in cases of robot harm. (shrink)

Moralization is a social-psychological process through which morally neutral issues take on moral significance. Often linked to health and disease, moralization may sometimes lead to good outcomes; yet moralization is often detrimental to individuals and to society as a whole. It is therefore important to be able to identify when moralization is inappropriate. In this paper, we offer a systematic normative approach to the evaluation of moralization. We introduce and develop the concept of ‘mismoralization’, which is when moralization is metaethically (...) unjustified. In order to identify mismoralization, we argue that one must engage in metaethical analysis of moralization processes while paying close attention to the relevant facts. We briefly discuss one historical example and two contemporary cases related to COVID-19 that we contend to have been mismoralized in public health. We propose a remedy of de-moralization that begins by identifying mismoralization and that proceeds by neutralizing inapt moral content. De-moralization calls for epistemic and moral humility. It should lead us to pull away from our tendency to moralize—as individuals and as social groups—whenever and wherever moralization is unjustified. (shrink)

Preventive vaccination can protect not just vaccinated individuals, but also others, which is often a central point in discussions about vaccination. To date, there has been no systematic study of self- and other-directed motives behind vaccination. This article has two major goals: first, to examine and distinguish between self- and other-directed motives behind vaccination, especially with regard to vaccinating for the sake of third parties, and second, to explore some ways in which this approach can help to clarify and guide (...) vaccination debates and policy. I propose conceiving of vaccination in terms of three basic elements: the vaccination decision-maker, the vaccine recipient and the primary beneficiary. I develop a taxonomy based on the relations between these elements to distinguish four kinds of vaccination: self-protective, paternalistic, altruistic and indirect. I finally discuss the case of human papillomavirus vaccine regulation for men and women to show how each kind of vaccination is associated with and raises specific ethical questions. (shrink)

The potential for vaccines to prevent the spread of infectious diseases is crucial for vaccination policy and ethics. In this paper, I discuss recent evidence that the current COVID-19 vaccines have only a modest and short-lived effect on reducing SARS-CoV-2 transmission and argue that this has at least four important ethical implications. First, getting vaccinated against COVID-19 should be seen primarily as a self-protective choice for individuals. Second, moral condemnation of unvaccinated people for causing direct harm to others is unjustified. (...) Third, the case for a harm-based moral obligation to get vaccinated against COVID-19 is weak. Finally, and perhaps most significantly, coercive COVID-19 vaccination policies (e.g., measures that exclude unvaccinated people from society) cannot be directly justified by the harm principle. (shrink)