The Institute of Medicine has called on health care leaders to transform their health systems into “learning health care systems,” capable of studying and continuously improving their practices. Learning health care systems commit to carrying out numerous kinds of investigations, ranging from clinical effectiveness studies to quality improvement research and implementation science. There has been progress in realizing the IOM's vision, but also many challenges. One of these challenges has been lingering uncertainty about whether the data collection and monitoring central (...) to learning health care systems is actually research and if so, what kind of ethical oversight it should have. This is not a new question. Yet so far, there has been no foundational analysis of the fit between the existing human subjects protection framework in use in the United States and the new kinds of data collection activities that are being, and increasingly will be, undertaken by learning health care systems. Two companion feature articles in this volume, by a team at Johns Hopkins, fill this void. (shrink)

Examines how violence has been conceptually and rhetorically put to use in continental social theory.

_Examines how violence has been conceptually and rhetorically put to use in continental social theory._.

There are countless circumstances under which random individuals COULD act together to prevent something morally bad from happening or to remedy a morally bad situation. But when OUGHT individuals to act together in order to bring about a morally important outcome? Building on Philip Pettit’s and David Schweikard’s account of joint action, I will put forward the notion of joint duties: duties to perform an action together that individuals in so-called random or unstructured groups can jointly hold. I will show (...) how this account of joint duties is preferable to one which defends individual duties to cooperate. I then discuss the limits of joint duties and the ways in which one can fail to comply with them. It will become apparent that the circumstances under which individuals in random collectives acquire such joint duties are rare. (shrink)

Why equality cannot be conditional on a shared human “nature” but has to be for all For centuries, ringing declarations about all men being created equal appealed to a shared human nature as the reason to consider ourselves equals. But appeals to natural equality invited gradations of natural difference, and the ambiguity at the heart of “nature” enabled generations to write of people as equal by nature while barely noticing the exclusion of those marked as inferior by their gender, race, (...) or class. Despite what we commonly tell ourselves, these exclusions and gradations continue today. In Unconditional Equals, political philosopher Anne Phillips challenges attempts to justify equality by reference to a shared human nature, arguing that justification turns into conditions and ends up as exclusion. Rejecting the logic of justification, she calls instead for a genuinely unconditional equality. Drawing on political, feminist, and postcolonial theory, Unconditional Equals argues that we should understand equality not as something grounded in shared characteristics but as something people enact when they refuse to be considered inferiors. At a time when the supposedly shared belief in human equality is so patently not shared, the book makes a powerful case for seeing equality as a commitment we make to ourselves and others, and a claim we make on others when they deny us our status as equals. (shrink)

People hold wildly opposing and very strong views on the question whether mental disorders are brain disorders, and the disagreement is primarily a conceptual one, not one about whether there are,...

Analytic metaphysics has recently discovered biology as a means of grounding metaphysical theories. This has resulted in long-standing metaphysical puzzles, such as the problems of personal identity and material constitution, being increasingly addressed by appeal to a biological understanding of identity. This development within metaphysics is in significant tension with the growing tendency amongst philosophers of biology to regard biological identity as a deep puzzle in its own right, especially following recent advances in our understanding of symbiosis, the evolution of (...) multi-cellular organisms and the inherently dynamical character of living systems. Moreover, and building on these biological insights, the broadly substance ontological framework of metaphysical theories of biological identity appears problematic to a growing number of philosophers of biology who invoke process ontology instead. This volume addresses this tension, exploring to what extent it can be dissolved. For this purpose, the volume presents the first selection of essays exclusively focused on biological identity and written by experts in metaphysics, the philosophy of biology and biology. The resulting cross-disciplinary dialogue paves the way for a convincing account of biological identity that is both metaphysically constructive and scientifically informed, and will be of interest to metaphysicians, philosophers of biology and theoretical biologists. (shrink)

There is a longstanding debate about genetics research into intelligence. Some scholars question the value of focusing on genetic contributions to intelligence in a society where social and environmental determinants powerfully influence cognitive ability and educational outcomes. Others warn that censoring certain research questions, such as inquiries about genetic differences in intellectual potential, compromises academic freedom. Still others view interest in this subject as a corollary to a long and troublesome history of eugenics research. The dawn of a new era (...) in genome sequencing as a commodity will sustain scientific interest in the genetics of intelligence for the foreseeable future, but deep‐rooted challenges threaten the scientific merit of the research. The use of imprecise definitions of study populations, the difficult nature of studying the environment, and the potential of researcher bias are inextricably linked with concerns about the trustworthiness and utility of research in this area. Leadership by the genetics community is essential to ensure the value and trustworthiness of these studies. (shrink)

would like for them to know that I am in pain or this part of my body hurts or the other part hurts — that I am not lying about it. To examine me and to cut down on the pain….And help me out.Patient with Sickle Cell Disease, Focus Group ParticipantPain in the United States is widely recognized to be undertreated; however, the capacity to treat pain has never been greater. The causes of this undertreatment are varied. As we focus (...) on pain and why it is too often ineffectively treated, we also discover that this undertreatment afflicts some more than others. What divides the some from the others isn't limited to one factor, but one particularly disturbing factor is race and ethnicity. Racial and ethnic minority populations are at higher risk for oligoanalgesia, or the ineffective treatment of pain. Only through further study of the differences in pain treatment based on race and ethnicity can we develop strategies to reduce the disparities in care. (shrink)

The standard view of ignorance is that it consists in the mere lack of knowledge or true belief. Duncan Pritchard has recently argued, against the standard view, that ignorance is the lack of knowledge/true belief that is due to an improper inquiry. I shall call, Pritchard’s alternative account the Normative Account. The purpose of this article is to strengthen the Normative Account by providing an independent vargument supporting it.

It is commonly accepted – not only in the philosophical literature but also in daily life – that ignorance is a failure of some sort. As a result, a desideratum of any ontological account of ignorance is that it must be able to explain why there is something wrong with being ignorant of a true proposition. This article shows two things. First, two influential accounts of ignorance – the Knowledge Account and the True Belief Account – do not satisfy this (...) requirement. They fail to provide a satisfying normative account of the badness of ignorance. Second, this article suggests an alternative explanation of what makes ignorance a bad cognitive state. In a nutshell, ignorance is bad because it is the manifestation of a vice, namely, of what Cassam calls “epistemic insouciance”. (shrink)

This paper has its genesis in concerns about the return to “the real” in social and political theory and analysis. This trend is linked to a reaction against the “linguistic turn”, on the grounds that an exclusive focus on language undercuts political analysis by refusing to engage with “material reality”. Foucault and “discourse” are common targets of this critique. Against this interpretation, the authors direct attention to the analytic and political usefulness of Foucault’s concept of “discursive practices”, which, it argues, (...) has been much misunderstood. Discursive practices, as developed by Foucault, refers to the practices of discourses, meaning knowledge formations, not to linguistic practices or language use. The focus is on how knowledge is produced through plural and contingent practices across different sites. Such an approach bridges a symbolic-material distinction and signals the always political nature of “the real”. (shrink)

Prison work creates ethical challenges for which a training program was initiated for Dutch prison staff to foster their Moral Craftsmanship (MCS). The concept of MCS is not yet defined and operationalized in literature. This explorative study aims to 1) define MCS, 2) identify conceptual elements of MCS, and 3) develop a measurement tool for MCS. A document and literature study provided input for the definition and selection of conceptual elements related within DCIA policy documents, identifying three conceptual levels of (...) MCS: individual (cognition, attitude, and actions), team, and leadership. This first MCSQ consists of seventy-one items distributed across the domains: values and norms, judgment and reasoning, consultation, implementation, looking back, interactions, and leadership. We tested its usability via ‘think-aloud interviews.’ Validation of the current version of the MCS-Questionnaire and consensus among experts about what to include or exclude in the concept of MCS are needed for further development. (shrink)

The most remarkable about the continuity in Chomsky's thought about language is that it takes place against a theoretical landscape in constant flux, the landscape of generative grammar. Chomsky introduced a central distinction between E‐languages and I‐language, the internalized knowledge of language that each speaker has and which is the result of the interaction between his or her language faculty and the (limited) experience that he or she had of his or her mother tongue during language acquisition. The Faculty of (...) Language narrowly understood corresponds to “the abstract linguistic computational system alone, independent of the other systems with which it interacts”. This chapter aims to follow the trail of Chomsky's strongly reiterated claim throughout the years that language is not primarily a tool for communication, but rather, a tool for thought. (shrink)

This Element has two aims. The first is to discuss arguments philosophers have made about the difference God's existence might make to questions of general interest in metaethics. The second is to argue that it is a mistake to think we can get very far in answering these questions by assuming a thin conception of God, and to suggest that exploring the implications of thick theisms for metaethics would be more fruitful.

"Deleuze plonge la critique kantienne transcendantale dans le bain dissolvant d'un empirisme renouvelé. Ce livre se propose de restituer cette entreprise, et d'analyser l'étonnante création de ce concept, que Deleuze mène depuis ses premières monographies jusqu'à Différence et Répétition dans un dialogue fécond avec l'histoire de la philosophie. Par quelles opérations de distorsion et de collage, Deleuze compose-t-il l'empirisme de Hume, la théorie du signe comme force de Nietzsche, le virtuel et les multiplicités de Bergson, les modes de Spinoza, les (...) individualisations impersonnelles de Simondon pour renouveler la théorie kantienne du transcendantal? C'est tout l'objet de cette enquête, qui permet d'entrer dans le laboratoire du penseur, pour saisir la philosophie se faisant, mais qui permet également d'expliquer l'insistance du transcendantal dans toute son oeuvre"--P. [4] of cover. (shrink)

Our moral obligations can sometimes be collective in nature: They can jointly attach to two or more agents in that neither agent has that obligation on their own, but they – in some sense – share it or have it in common. In order for two or more agents to jointly hold an obligation to address some joint necessity problem they must have joint ability to address that problem. Joint ability is highly context-dependent and particularly sensitive to shared (or even (...) common) beliefs. As such, joint ability can be deliberately generated in a given collection of agents by providing information related to collective goals and contributory actions. As moral agents, we regularly face problems wherein the outcome of our actions depends on how others choose. There are two ways of deliberating about our own choices in such cases. We can either think of our choices as best responses to others’ choices (I-mode reasoning). Or we can think of our own choices as contributions to the collectively best option (even when we do not know how others are (likely) to choose) (we-mode reasoning). In deliberating about the right (individual) course of action vis-à-vis collective action problems, agents regularly we-frame the case at hand, that is, they include options in their deliberation that are only collectively available, and they we-reason with regard to their individual contributory actions. It is a necessary condition for collective obligations that potential collaborators facing a joint necessity case have grounds to privilege we-reasoning over reasoning in I-mode. (shrink)

The traditional concept of prime matter – a purely potential substratum that persists through substantial change and serves to constitute the generated substance – has played a dwindling part in Aristotelian scholarship over the centuries. In medieval interpretations of Aristotle, prime matter was thought to play these two roles in all substantial changes, not only in changes at the level of the four elements. In more recent centuries, traditional prime matter was relegated only to the context of substantial changes between (...) the four elements. And in the last few decades of Aristotelian scholarship, it has become common either to downplay or even to eliminate prime matter’s role in elemental changes too. I will support the traditional concept of prime matter by showing that it aligns Aristotle’s view of elemental change with one of the central constraints on matter imposed in his Physics to a degree that cannot be achieved on the non-traditional interpretations: the need for matter to be in potentiality in a way that avoids the two problematic extremes of mere persistence, on the one hand, and destruction, on the other. This point will be supported by Aristotle’s rejection of both monism and pluralism in On Generation and Corruption. Second, I will argue that Aristotle calls for precisely the same kind of potentiality in a very different context: his critique of Anaxagoras’s view of matter in the Generation of Animals. Here the very same problematic extremes of mere persistence and destruction that plague the alternate views to traditional prime matter also plague the dominant views on the matter for animal generation. Especially since Aristotle takes living things to be paradigmatic substances, these comparisons suggest that the apparent idiosyncrasies of elemental transformation which have motivated interpreters to depart from traditional prime matter may not be so idiosyncratic after all. And if that is so, it may be that the problem lies not so much with traditional prime matter as with our assumptions about how persistence and constitution work in substantial change according to Aristotle. In the end, this line of argument opens the door to three new potential interpretations of the matter for substantial generation in Aristotle, interpretations which align with his concept of potentiality and – to varying degrees – with traditional prime matter as well. (shrink)

Theodor W. Adornos posthum veröffentlichte Ästhetische Theorie exponiert die Krise der Kunst im Zeitalter ihrer gesellschaftlichen Integration. Gesättigt mit der Erfahrung konkreter Kunstwerke, hinterfragt sie das tradierte Kategoriensystem philosophischer Ästhetik. Der vorliegende Band unternimmt erstmals eine kommentierende Auslegung, um den dichten Text aufzuschließen und ein Weiterdenken von Adornos kritischer Ästhetik anzuregen.

Genetic research aimed at understanding human health and disease is grounded in the study of genetic variation. The inclusion of research subjects with diverse ancestral backgrounds is essential for genetic and genomic research that fully explores human diversity. Large-scale cohort studies and biobanks in Europe and the United States often do not include the breadth of ethnic and racial diversity observed in their countries' citizens. This article explores the findings of a qualitative study of U.S. scientists' understanding and views of (...) the NIH Policy and Guidelines on the Inclusion of Minorities as Subjects in Clinical Research. The findings suggest that the policy restricts how scientists use racial and ethnic categories to define and report their study populations and does little to motivate their efforts to increase the inclusion of non-European ancestral populations in genetic and genomic research. (shrink)

Research on emotion and psychopathology has blossomed due in part to the translation of affective science theory and methods to the study of diverse disorders. This translational approach has helped the field to hone in more precisely on the nature of emotion deficits to identify antecedent causes and maintaining processes, and to develop promising new interventions. The future of emotion research in psychopathology will benefit from three inter-related areas, including an emphasis on emotion difficulties that cut across traditional diagnostic boundaries (...) (i.e., a transdiagnostic approach), the explicit linking of emotion and cognition in behavioral and neuroimaging studies in psychopathology, and continued translation of the latest conceptualizations of emotion to the study of psychopathology. (shrink)

This book explores the way in which, working within the investigative tradition associated with the Royal Society, the philosopher John Locke (1632-1704) used ...

In this paper, I respond to commentaries on my book “Are Mental Disorders Brain Disorders?”. The topics I discuss are: accounts of function and dysfunction, constraints on the relationship between processes at the level of the brain and the mind, externalism in psychiatry, implications for moral responsibility and the question whether my account is a form of conceptual engineering. I defend my account and argue that the key criterion for whether mental disorders are brain disorders is whether we can map (...) dysfunctional psychological processes onto specific differences in brain function. I also acknowledge that my commentators have identified points where my account needs further development. (shrink)

Human persons exist longer than a single moment in time; they persist through time. However, so far it has not been possible to make this natural and widespread assumption metaphysically comprehensible. The philosophical debate on personal identity is rather stuck in a dilemma: reductionist theories explain personal identity away, while non-reductionist theories fail to give any informative account at all. This chapter argues that this dilemma emerges from an underlying commitment, shared by both sides of in the debate, to an (...) ontology which that gives the priority to static unchanging things. The claim defended here is that the dilemma of personal identity can be overcome if we acknowledge the biological nature of human persons and switch to a process- ontological framework that takes process and change to be ontologically primary. Human persons are biological higher-order processes, rather than things, and their identity conditions can be scientifically investigated. (shrink)

Recent work in positive psychology demonstrates the importance of self-transcendence: understanding oneself to be part of something greater than the self, such as a family, community, or tradition of sacred practice. Self-transcendence is positively associated with wellbeing and a sense of meaning and purpose. Philosophers have argued that self-transcendent motivation has a central role in good character, or virtue. Positive psychologists are just now beginning to integrate the aim of developing such motivation in character interventions. In this paper we draw (...) attention to an important but overlooked condition on effectively developing self-transcendent motivation constitutive of virtue: such a process must engage the subject’s will in the right way. If a process does not meet this condition it will fail to produce motivation constitutive of virtue according to leading philosophical accounts of virtue. We identify a suite of strategies for cultivating motivations that do meet this condition but have not been explored in relation to character interventions, namely, reappraisal strategies from the extended process model of emotion regulation (EPM-ER). (shrink)

As genetic and genomic research has progressed since the sequencing of the human genome, scientists have continued to struggle to understand the role of genetic and socio-cultural factors in racial and ethnic health disparities. Recognition that race and ethnicity correlate imperfectly with differences in allele frequency, environmental exposures, and significant health outcomes has made framing the relationship between genetic variation, race, ethnicity, and disease one of the most heated debates of the genome era. Because racial and ethnic identities reflect a (...) complicated mix of social and genetic factors, critics have argued that use of racial and ethnic categories as analytical variables in biomedical research lacks rigor, leads to potentially dangerous stereotyping in medical practice, and sends harmful messages of innate racial difference to the broader public.Concerns over the current lack of diversity in human genetic and genomic studies have developed in parallel to discussions of the appropriate use of racial and ethnic categories during the research process. (shrink)

The effects of non-standard Philosophy on Epistemelogy.

Since its publication in 1935, Kenneth Burke's Permanence and Change, a text that can serve as an introduction to all of Burke's theories, has become a landmark of rhetorical study. Using new archival sources and by contextualizing the theory in the past and present, Ann George offers the first sustained exploration of Burke's work and seeks to clarify the notoriously difficult book for both amateurs and scholars of rhetoric in Kenneth Burke's Permanence and Change: A Critical Companion.

Abstract This article raises a worry concerning Ernest Sosa's way of solving the problem of epistemic circularity. Sosa's solution to the problem of epistemic circularity relies on the following claim of sufficiency: for S to deserve to be credited for his true belief, it is sufficient that his belief is, in a sense to be made clear, ?apt?. I argue that this solution undersells the notion of credit. I present three kinds of cases in which the attribution of credit to (...) a believer requires more than the possession of apt beliefs and I defend these cases against possible misinterpretations. (shrink)