The ethics of Wolfhart Pannenberg has a nomological dimension at its center. Based on the history of the natural law tradition, Pannenberg maintains the possibility of the natural law theory on the following five grounds. -/- The theological ground is his understanding of the Decalogue, the Sermon on the Mount, and the Pauline interpretation of the law. For its historical ground, Pannenberg articulates the natural law theories of Patristic theology and the theologies of Troeltsch and Brunner. The ontological ground is (...) the order of the world, which God established in the process of history. The anthropological ground is the mutuality of human society. The latter two dimensions are related to the epistemological ground, which is based on the hermeneutics of universal history. -/- Pannenberg attempts to combine the law, the gospel, and love in relation to the Kingdom of God. Thus, Pannenberg’s Kingdom ethics is nomological as well as eschatological. (shrink)

Knowledge of mechanisms is critical for causal reasoning. We contrasted two possible organizations of causal knowledge—an interconnected causal network, where events are causally connected without any boundaries delineating discrete mechanisms; or a set of disparate mechanisms—causal islands—such that events in different mechanisms are not thought to be related even when they belong to the same causal chain. To distinguish these possibilities, we tested whether people make transitive judgments about causal chains by inferring, given A causes B and B causes C, (...) that A causes C. Specifically, causal chains schematized as one chunk or mechanism in semantic memory led to transitive causal judgments. On the other hand, chains schematized as multiple chunks led to intransitive judgments despite strong intermediate links. Normative accounts of causal intransitivity could not explain these intransitive judgments. (shrink)

This study examined the mediating role of meaning in life in the effect of calling on posttraumatic stress disorder and posttraumatic growth among navy soldiers of the Republic of Korea deployed to the Gulf of Aden, Somalia. Participants responded to the questionnaire survey three times at 4-month intervals. From the first, second, and third surveys, data were collected for 223, 195, and 103 respondents, respectively. Results showed that calling had a negative effect on PTSD, fully mediated by meaning in life, (...) whereas calling had a positive effect on PTG, partially mediated by meaning in life. Our findings suggest that calling acts as a positive psychological resource for maintaining the meaning in life throughout stressful events experienced during deployment, thereby reducing posttraumatic stress symptoms and promoting post-deployment psychological growth. Finally, theoretical and practical implications and the need for follow-up studies are discussed. (shrink)

BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from (...) January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

Is the societal-level of analysis sufficient today to understand the values of those in the global workforce? Or are individual-level analyses more appropriate for assessing the influence of values on ethical behaviors across country workforces? Using multi-level analyses for a 48-society sample, we test the utility of both the societal-level and individual-level dimensions of collectivism and individualism values for predicting ethical behaviors of business professionals. Our values-based behavioral analysis indicates that values at the individual-level make a more significant contribution to (...) explaining variance in ethical behaviors than do values at the societal-level. Implicitly, our findings question the soundness of using societal-level values measures. Implications for international business research are discussed. (shrink)

This article provides current Schwartz Values Survey (SVS) data from samples of business managers and professionals across 50 societies that are culturally and socioeconomically diverse. We report the society scores for SVS values dimensions for both individual- and societal-level analyses. At the individual-level, we report on the ten circumplex values sub-dimensions and two sets of values dimensions (collectivism and individualism; openness to change, conservation, self-enhancement, and self-transcendence). At the societal-level, we report on the values dimensions of embeddedness, hierarchy, mastery, affective (...) autonomy, intellectual autonomy, egalitarianism, and harmony. For each society, we report the Cronbach’s α statistics for each values dimension scale to assess their internal consistency (reliability) as well as report interrater agreement (IRA) analyses to assess the acceptability of using aggregated individual level values scores to represent country values. We also examined whether societal development level is related to systematic variation in the measurement and importance of values. Thus, the contributions of our evaluation of the SVS values dimensions are two-fold. First, we identify the SVS dimensions that have cross-culturally internally reliable structures and within-society agreement for business professionals. Second, we report the society cultural values scores developed from the twenty-first century data that can be used as macro-level predictors in multilevel and single-level international business research. (shrink)

This article provides current Schwartz Values Survey data from samples of business managers and professionals across 50 societies that are culturally and socioeconomically diverse. We report the society scores for SVS values dimensions for both individual- and societallevel analyses. At the individual- level, we report on the ten circumplex values sub- dimensions and two sets of values dimensions. At the societal- level, we report on the values dimensions of embeddedness, hierarchy, mastery, affective autonomy, intellectual autonomy, egalitarianism, and harmony. For each (...) society, we report the Cronbach' s? statistics for each values dimension scale to assess their internal consistency as well as report interrater agreement analyses to assess the acceptability of using aggregated individual level values scores to represent country span sp. (shrink)

This study employs the uses and gratification approach to investigate how different forms of Facebook use are linked to bridging social capital and bonding social capital. A survey of 152 college students was conducted to address research questions and to test hypotheses. Factor analysis identified six unique uses and gratifications: (a) information seeking, (b) entertainment, (c) communication, (d) social relations, (e) escape, and (f) Facebook applications. Findings reveal that intensity of Facebook use and the use of Facebook for social relations (...) are positive predictors of bridging social capital, whereas the use of Facebook for escape is negatively linked to bonding social capital. (shrink)

ABSTRACT I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments. INTRODUCTION In contrast to the classic model of randomized-control trials, often with a large number of (...) subjects enrolled, precision medicine attempts to optimize therapeutic outcomes by focusing on the individual.[i] A recent publication highlights the strengths and weakness of both traditional evidence-based medicine and precision medicine.[ii] Plus, it outlines a tension in the shift from evidence-based medicine’s inductive reasoning style (the collection of data to postulate general theories) to precision medicine’s abductive reasoning style (the generation of an idea from the limited data available).[iii] The paper’s main example is the application of precision medicine for the treatment of cancer.[iv] I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. As the name suggests, brain-computer interfaces are a significant advancement in neurotechnology that directly connects someone’s brain to external or implanted devices.[v] Among the various kinds of brain-computer interfaces, adaptive deep brain stimulation devices require numerous personalized adjustments to their settings during the implantation and computation stages in order to provide adequate relief to patients with treatment-resistant disorders. What makes these devices unique is how adaptive deep brain stimulation integrates a sensory component to initiate the stimulation. While not commonly at the level of sophistication as self-supervising or generative large language models,[vi] they currently allow for a semi-autonomous form of neuromodulation. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments.[vii] ANALYSIS I. The State of Precision Medicine in Oncology and the Epistemological Shift While a thorough overview of precision medicine for the treatment of cancer is beyond the scope of this article, its practice can be roughly summarized as identifying clinically significant characteristics a patient possesses (e.g., genetic traits) to land on a specialized treatment option that, theoretically, should benefit the patient the most.[viii] However, in such a practice of stratification patients fall into smaller and smaller populations and the quality of evidence that can be applied to anyone outside these decreases in turn.[ix] As inductive logic helps to articulate, the greater the number of patients that respond to a particular therapy the higher the probability of its efficacy. By straying from this logical framework, precision medicine opens the treatment of cancer to more uncertainty about the validity of these approaches to the resulting disease subcategories.[x] Thus, while contemporary medical practices explicitly describe some treatments as “personalized”, they ought not be viewed as inherently better founded than other therapies.[xi] A relevant contemporary case of precision medicine out of Norway focuses on the care of a patient with cancer between the ventricles of the heart and esophagus, which had failed to respond to the standard regimen of therapies over four years.[xii] In a last-ditch effort, the patient elected to pay out-of-pocket for an experimental immunotherapy (nivolumab) at a private hospital. He experienced marked improvements and a reduction in the size of the tumor. Understandably, the patient tried to pursue further rounds of nivolumab at a public hospital. However, the hospital initially declined to pay for it given the “lack of evidence from randomised clinical trials for this drug relating to this [patient’s] condition.”[xiii] In rebuttal to this claim, the patient countered that he was actually similar to a subpopulation of patients who responded in “open‐label, single arm, phase 2 studies on another immune therapy drug” (pembrolizumab).[xiv] Given this interpretation of the prior studies and the patient’s response, further rounds of nivolumab were approved. Had the patient not had improvements in the tumor’s size following a round of nivolumab, then pembrolizumab’s prior empirical evidence in isolation would have been insufficient, inductively speaking, to justify his continued use of nivolumab.[xv] The case demonstrates a shift in reasoning from the traditional induction to abduction. The phenomenon of ‘cancer improvement’ is considered causally linked to nivolumab and its underlying physiological mechanisms.[xvi] However, “the weakness of abductions is that there may always be some other better, unknown explanation for an effect. The patient may for example belong to a special subgroup that spontaneously improves, or the change may be a placebo effect. This does not mean, however, that abductive inferences cannot be strong or reasonable, in the sense that they can make a conclusion probable.”[xvii] To demonstrate the limitations of relying on the abductive standard in isolation, commentators have pointed out that side effects in precision medicine are hard to rule out as being related to the initial intervention itself unless trends from a group of patients are taken into consideration.[xviii] As artificial intelligence (AI) assists the development of precision medicine for oncology, this uncertainty ought to be taken into consideration. The implementation of AI has been crucial to the development of precision medicine by providing a way to combine large patient datasets or a single patient with a large number of unique variables with machine learning to recommend matches based on statistics and probability of success upon which practitioners can base medical recommendations.[xix] The AI is usually not establishing a causal relationship[xx] – it is predicting. So, as AI bleeds into medical devices, like brain-computer interfaces, the same cautions about using abductive reasoning alone should be carried over. II. Responsive Neurostimulation, AI, and Personalized Medicine Like precision medicine in cancer treatment, computer-brain interface technology similarly focuses on the individual patient through personalized settings. In order to properly expose the intersection of AI, precision medicine, abductive reasoning, and implantable neurotechnologies, the descriptions of adaptive deep brain stimulation systems need to deepen.[xxi] As a broad summary of adaptive deep brain stimulation, to provide a patient with the therapeutic stimulation, a neural signal, typically referred to as a local field potential,[xxii] must first be detected and then interpreted by the device. The main adaptive deep brain stimulation device with premarket approval, the NeuroPace Responsive Neurostimulation system, is used to treat epilepsy by detecting and storing “programmer-defined phenomena.”[xxiii] Providers can optimize the detection settings of the device to align with the patient’s unique electrographic seizures as well as personalize the reacting stimulation’s parameters.[xxiv] The provider adjusts the technology based on trial and error. One day machine learning algorithms will be able to regularly aid this process in myriad ways, such as by identifying the specific stimulation settings a patient may respond to ahead of time based on their electrophysiological signatures.[xxv] Either way, with AI or programmers, adaptive neurostimulation technologies are individualized and therefore operate in line with precision medicine rather than standard treatments based on large clinical trials. Contemporary neurostimulation devices are not usually sophisticated enough to be prominent in AI discussions where the topics of neural networks, deep learning, generative models, and self-attention dominate the conversation. However, implantable high-density electrocorticography arrays (a much more sensitive version than adaptive deep brain stimulation systems use) have been used in combination with neural networks to help patients with neurologic deficits from a prior stroke “speak” through a virtual avatar.[xxvi] In some experimental situations, algorithms are optimizing stimulation parameters with increasing levels of independence.[xxvii] An example of neurostimulation that is analogous to the use of nivolumab in Norway surrounds a patient in the United States who was experiencing both treatment-resistant OCD and temporal lobe epilepsy.[xxviii]Given the refractory nature of her epilepsy, implantation of an adaptive deep brain stimulation system was indicated. As a form of experimental therapy, her treatment-resistant OCD was also indicated for the off-label use of an adaptive deep brain stimulation set-up. Another deep brain stimulation lead, other than the one implanted for epilepsy, was placed in the patient’s right nucleus accumbens and ventral pallidum region given the correlation these nuclei had with OCD symptoms in prior research. Following this, the patient underwent “1) ambulatory, patient-initiated magnet-swipe storage of data during moments of obsessive thoughts; (2) lab-based, naturalistic provocation of OCD-related distress (naturalistic provocation task); and (3) lab-based, VR [virtual reality] provocation of OCD-related distress (VR provocation task).”[xxix] Such signals were used to identify when to deliver the therapeutic stimulation in order to counter the OCD symptoms. Thankfully, following the procedure and calibration the patient exhibited marked improvements in their OCD symptoms and recently shared her results publicly.[xxx] In both cases, there is a similar level of abductive justification for the efficacy of the delivered therapy. In the case study in which the patient was treated with adaptive deep brain stimulation, they at least had their neural activity tested in various settings to determine the optimum parameters for treatment to avoid them being based on guesswork. Additionally, the adaptive deep brain stimulation lead was already placed before the calibration trials were conducted, meaning that the patient had already taken on the bulk of the procedural risk before the efficacy could be determined. Such an efficacy test could have been replicated in the first patient’s cancer treatment, had it been biopsied and tested against the remaining immunotherapies in vitro. Yet, in the case of cancer with few options, one previous dose of a drug that appeared to work on the patient may justify further doses. However, as the Norwegian case presents, corroboration with known responses to a similar drug (from a clinical trial) could be helpful to validate the treatment strategy. (It should be noted that both patients were resigned to these last resort options regardless of the efficacy of treatment.) There are some elements of inductive logic seen with adaptive deep brain stimulation research in general. For example, abductively the focus could be that patient X’s stimulation parameters are different from patient Y’s and patient Z’s. In contrast, when grouped as subjects who obtained personalized stimulation, patients X, Y, and Z demonstrate an inductive aspect to this approach’s safety and/or efficacy. The OCD case holds plenty of abductive characteristics in line with precision medicine’s approach to treating cancer and as more individuals try the method, there will be additional data. With the gradual integration of AI into brain-computer interfaces in the name of efficacy, this reliance on abduction will continue, if not grow, over time. Moving forward, if a responsive deep brain stimulation treatment is novel and individualized (like the dose of nivolumab) and there is some other suggestion of efficacy (like clinical similarities to other patients in the literature), then it may justify insurance coverage for the investigative intervention, absent other unrelated reasons to deny it. III. Ethical Implications and Next Steps While AI’s use in oncology and neurology is not yet as prominent as its use in other fields (e.g., radiology), it appears to be on the horizon for both.[xxxi] AI can be found in both the functioning of the neurotechnologies as well as the implementation of precision medicine. The increasing use of AI may serve to further individualize both oncologic and neurological therapies. Given these implications and the handful of publications cited in this article, it is important to have a nuanced evaluation of how these treatments, which heavily rely on abductive justification, ought to be managed. The just use an abductive approach may be difficult as AI infused precision medicine is further pursued. At baseline, such technology relies on a level of advanced technology literacy among the general public and could exclude populations who lack access to basic technological infrastructure or know-how from participation.[xxxii] Even among nations with adequate infrastructure, as more patients seek out implantable neurotechnologies, which require robust healthcare resources, the market will favor patient populations that can afford this complex care.[xxxiii] If patients already have the means to pay for an initial dose/use of a precision medicine product out of pocket, should insurance providers be required to cover subsequent treatments?[xxxiv] That is, if a first dose of a cancer drug or a deep brain stimulator over its initial battery life is successful, patients may feel justified in having the costs of further treatments covered. The Norwegian patient’s experience implies there is a precedent for the idea that some public insurance companies ought to cover successful cancer therapies, however, insurance companies may not all see themselves as obligated to cover neurotechnologies that rely on personalized settings or that are based on precision/abductive research more than on clinical trials. CONCLUSION The fact that the cases outlined above rely on abductive style of reasoning implies that there may not be as strong a justification for coverage by insurance, as they are both experimental and individualized, when compared to the more traditional large clinical trials in which groups have the same or a standardized protocol (settings/doses). If a study is examining the efficacy of a treatment with a large cohort of patients or with different experimental groups/phases, insurance companies may conclude that the resulting symptom improvements are more likely to be coming from the devices themselves. A preference for inductive justification may take priority when ruling in favor of funding someone’s continued use of an implantable neurostimulator. There are further nuances to this discussion surrounding the classifications of these interventions as research versus clinical care that warrant future exploration, since such a distinction is more of a scale[xxxv] than binary and could have significant impacts on the “right-to-try” approach to experimental therapies in the United States.[xxxvi] Namely, given the inherent limitations of conducting large cohort trials for deep brain stimulation interventions on patients with neuropsychiatric disorders, surgically innovative frameworks that blend abductive and inductive methodologies, like with sham stimulation phases, have traditionally been used.[xxxvii] Similarly, for adaptive brain-computer interface systems, if there are no large clinical trials and instead only publications that demonstrate that something similar worked for someone else, then, in addition to the evidence that the first treatment/dose worked for the patient in question, the balance of reasoning would be valid and arguably justify insurance coverage. As precision approaches to neurotechnology become more common, frameworks for evaluating efficacy will be crucial both for insurance coverage and for clinical decision making. ACKNOWLEDGEMENT This article was originally written as an assignment for Dr. Francis Shen’s “Bioethics & AI” course at Harvard’s Center for Bioethics. I would like to thank Dr. Shen for his comments as well as my colleagues in the Lázaro-Muñoz Lab for their feedback. - [i] Jonathan Kimmelman and Ian Tannock, “The Paradox of Precision Medicine,” Nature Reviews. Clinical Oncology 15, no. 6 (June 2018): 341–42, https://doi.org/10.1038/s41571-018-0016-0. [ii] Henrik Vogt and Bjørn Hofmann, “How Precision Medicine Changes Medical Epistemology: A Formative Case from Norway,” Journal of Evaluation in Clinical Practice 28, no. 6 (December 2022): 1205–12, https://doi.org/10.1111/jep.13649. [iii] David Barrett and Ahtisham Younas, “Induction, Deduction and Abduction,” Evidence-Based Nursing 27, no. 1 (January 1, 2024): 6–7, https://doi.org/10.1136/ebnurs-2023-103873. [iv] Vogt and Hofmann, “How Precision Medicine Changes Medical Epistemology,” 1208. [v] Wireko Andrew Awuah et al., “Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications,” World Neurosurgery, May 22, 2024, S1878-8750(24)00867-2, https://doi.org/10.1016/j.wneu.2024.05.104. [vi] Mark Riedl, “A Very Gentle Introduction to Large Language Models without the Hype,” Medium (blog), May 25, 2023, https://mark-riedl.medium.com/a-very-gentle-introduction-to-large-language-models-without-the-hype-5 f67941fa59e. [vii] David E. Burdette and Barbara E. Swartz, “Chapter 4 - Responsive Neurostimulation,” in Neurostimulation for Epilepsy, ed. Vikram R. Rao (Academic Press, 2023), 97–132, https://doi.org/10.1016/B978-0-323-91702-5.00002-5. [viii] Kimmelman and Tannock, 2018. [ix] Kimmelman and Tannock, 2018. [x] Simon Lohse, “Mapping Uncertainty in Precision Medicine: A Systematic Scoping Review,” Journal of Evaluation in Clinical Practice 29, no. 3 (April 2023): 554–64, https://doi.org/10.1111/jep.13789. [xi] Kimmelman and Tannock, “The Paradox of Precision Medicine.” [xii] Vogt and Hofmann, 1206. [xiii] Vogt and Hofmann, 1206. [xiv] Vogt and Hofmann, 1206. [xv] Vogt and Hofmann, 1207. [xvi] Vogt and Hofmann, 1207. [xvii] Vogt and Hofmann, 1207. [xviii] Vogt and Hofmann, 1210. [xix] Mehar Sahu et al., “Chapter Three - Artificial Intelligence and Machine Learning in Precision Medicine: A Paradigm Shift in Big Data Analysis,” in Progress in Molecular Biology and Translational Science, ed. David B. Teplow, vol. 190, 1 vols., Precision Medicine (Academic Press, 2022), 57–100, https://doi.org/10.1016/bs.pmbts.2022.03.002. [xx] Stefan Feuerriegel et al., “Causal Machine Learning for Predicting Treatment Outcomes,” Nature Medicine 30, no. 4 (April 2024): 958–68, https://doi.org/10.1038/s41591-024-02902-1. [xxi] Sunderland Baker et al., “Ethical Considerations in Closed Loop Deep Brain Stimulation,” Deep Brain Stimulation 3 (October 1, 2023): 8–15, https://doi.org/10.1016/j.jdbs.2023.11.001. [xxii] David Haslacher et al., “AI for Brain-Computer Interfaces,” 2024, 7, https://doi.org/10.1016/bs.dnb.2024.02.003. [xxiii] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 103–4; “Premarket Approval (PMA),” https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P100026. [xxiv] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 104. [xxv] Burdette and Swartz, 126. [xxvi] Sean L. Metzger et al., “A High-Performance Neuroprosthesis for Speech Decoding and Avatar Control,” Nature 620, no. 7976 (August 2023): 1037–46, https://doi.org/10.1038/s41586-023-06443-4. [xxvii] Hao Fang and Yuxiao Yang, “Predictive Neuromodulation of Cingulo-Frontal Neural Dynamics in Major Depressive Disorder Using a Brain-Computer Interface System: A Simulation Study,” Frontiers in Computational Neuroscience 17 (March 6, 2023), https://doi.org/10.3389/fncom.2023.1119685; Mahsa Malekmohammadi et al., “Kinematic Adaptive Deep Brain Stimulation for Resting Tremor in Parkinson’s Disease,” Movement Disorders 31, no. 3 (2016): 426–28, https://doi.org/10.1002/mds.26482. [xxviii] Young-Hoon Nho et al., “Responsive Deep Brain Stimulation Guided by Ventral Striatal Electrophysiology of Obsession Durably Ameliorates Compulsion,” Neuron 0, no. 0 (October 20, 2023), https://doi.org/10.1016/j.neuron.2023.09.034. [xxix] Nho et al. [xxx] Nho et al.; Erik Robinson, “Brain Implant at OHSU Successfully Controls Both Seizures and OCD,” OHSU News, accessed March 3, 2024, https://news.ohsu.edu/2023/10/25/brain-implant-at-ohsu-successfully-controls-both-seizures-and-ocd. [xxxi] Awuah et al., “Bridging Minds and Machines”; Haslacher et al., “AI for Brain-Computer Interfaces.” [xxxii] Awuah et al., “Bridging Minds and Machines.” [xxxiii] Sara Green, Barbara Prainsack, and Maya Sabatello, “The Roots of (in)Equity in Precision Medicine: Gaps in the Discourse,” Personalized Medicine 21, no. 1 (January 2024): 5–9, https://doi.org/10.2217/pme-2023-0097. [xxxiv] Green, Prainsack, and Sabatello, 7. [xxxv] Robyn Bluhm and Kirstin Borgerson, “An Epistemic Argument for Research-Practice Integration in Medicine,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 43, no. 4 (July 9, 2018): 469–84, https://doi.org/10.1093/jmp/jhy009. [xxxvi] Vijay Mahant, “‘Right-to-Try’ Experimental Drugs: An Overview,” Journal of Translational Medicine 18 (June 23, 2020): 253, https://doi.org/10.1186/s12967-020-02427-4. [xxxvii] Michael S. Okun et al., “Deep Brain Stimulation in the Internal Capsule and Nucleus Accumbens Region: Responses Observed during Active and Sham Programming,” Journal of Neurology, Neurosurgery & Psychiatry 78, no. 3 (March 1, 2007): 310–14, https://doi.org/10.1136/jnnp.2006.095315. (shrink)

Episodic memory has been analyzed in a number of different ways in both philosophy and psychology, and most controversy has centered on its self-referential, autonoetic character. Here, we offer a comprehensive characterization of episodic memory in representational terms and propose a novel functional account on this basis. We argue that episodic memory should be understood as a distinctive epistemic attitude taken toward an event simulation. In this view, episodic memory has a metarepresentational format and should not be equated with beliefs (...) about the past. Instead, empirical findings suggest that the contents of human episodic memory are often constructed in the service of the explicit justification of such beliefs. Existing accounts of episodic memory function that have focused on explaining its constructive character through its role in future-oriented mental time travel do justice neither to its capacity to ground veridical beliefs about the past nor to its representational format. We provide an account of the metarepresentational structure of episodic memory in terms of its role in communicative interaction. The generative nature of recollection allows us to represent and communicate the reasons why we hold certain beliefs about the past. In this process, autonoesis corresponds to the capacity to determine when and how to assert epistemic authority in making claims about the past. A domain where such claims are indispensable are human social engagements. Such engagements commonly require the justification of entitlements and obligations, which is often possible only by explicit reference to specific past events. (shrink)

We develop a partial solution to the meta-problem of consciousness that builds on our previous psychological account of an apparent explanatory gap. Drawing from empirical work on explanatory cognition and conceptual development, we sketch a profile of cognitive systems for which primitive concepts facilitate explanatory gaps. This account predicts that there will be multiple explanatory gaps. We suggest that this is borne out by the existence of primitivist theories in multiple philosophical domains.

Using the principles and sometimes the conclusions of his teacher Adolf Stöhr, Cleve insists that he is giving a philosophical interpretation and not simply a philological reconstruction of these Pre-Socratics. The philosophers have been divided into 1) "Religious Reformers", 2) "Philosophers of Nature", 3) "Champions of Culture Politics"—"The Glossomorphics". There will certainly be disagreement on some of Cleve's interpretations but it must be said that Cleve carries through his philosophical reconstruction with admirable lucidity and consistency though, occasionally, some of his (...) criticisms of the "philologists" are rather waspish. Nevertheless, this is a splendid and important study which is a tribute to the author's erudition and insight.—D. J. B. (shrink)

continent. 2.2 (2012): 76–81 Comments on Eugene Thacker’s “Cosmic Pessimism” Nicola Masciandaro Anything you look forward to will destroy you, as it already has. —Vernon Howard In pessimism, the first axiom is a long, low, funereal sigh. The cosmicity of the sigh resides in its profound negative singularity. Moving via endless auto-releasement, it achieves the remote. “ Oltre la spera che piú larga gira / passa ’l sospiro ch’esce del mio core ” [Beyond the sphere that circles widest / penetrates (...) the sigh that issues from my heart]. 1 The axiomatic sigh of the pessimist is in a way the pure word of philosophy, a thought that thinks without you, speaks where you are not. The live pneumatic form of the soul’s eventual exit from the dead body’s mouth, the sigh restores consciousness to the funeral of being, to the passing away that is existence. Pessimism speaks in piercing aphorisms because first it sighs. “Beyond the sphere passeth the arrow of our sigh. Hafiz! Silence.” 2 … pessimism is guilty of that most inexcusable of Occidental crimes—the crime of not pretending it’s for real. To the pessimist, the ‘real’ world—the world on whose behalf we are expected to wake up in the morning—is a ceaseless index of its own unreality. The pessimist’s day is not an illumined space for the advancement of experience and action, but a permanently and inescapably reflective zone, the vast interior of a mirror where each thing is only insofar as it is, at best, a false image of itself. Within this speculative situation, inside the doubleness of the mirror, pessimism splits into two paths, false and true, one that tries to fix pessimism (establish a relation with the mirror) and decides in favor of the apparent real, and another that totally falls for pessimism (enters the mirror) and communes with the greater reality of the unreal. These two paths are distinguished by their relation to pessimism’s guilt vis-à-vis the world’s reality-project. The first form, that which remains pessimism for the world and puts on a smiling face, stays guilty to itself (i.e. unconscious) and thus turns hypocritical, becoming at once the pessimism of the commoner who really just wants things to be better for himself and the pessimism of the elite who wants to critically refashion reality in his own image. The general form of this worldly, hypocritical pessimism is the impulse to ‘make the world a better place’, which is the global mask under which the world is diurnally made worse. The second form, that which follows pessimism away from the world and ceases to put on a smiling face, refuses guiltiness as itself theessential Occidental mode of pretense and turns honest, becoming at once the intelligent pessimism required of all ordinary action and the radical pessimism necessary for self-knowledge: seeing that no one is capable of doing good. The general form of this universal, honest pessimism is the impulse not to worry, to give up and embrace dereliction, which is the only real way the world is actually improved. Where worldly pessimism is the engine productive of interminably warring secular and sacred religions (good-projects), universal pessimism strives hopelessly for the paradise of a supremely instantiated pessimus: things are getting so bad that there is no longer any time for them to get worse; things are so constantly-instantly worst that this is BEST. Cosmic pessimism is the mode of universal pessimism which can yet discourse with the world, which has not chosen silence and can spread the inconceivably BAD NEWS in an orderly form ( kosmos ) that the world can understand (if it wanted to). … the result of a confusion between the world and a statement about the world. That is what the world is (the result of a confusion between the world and a statement about the world). … a generalized misanthropy without the anthropos. Pessimism crystallizes around this futility—it is its amor fati , rendered as musical form. Pessimism’s love of fate is a blind love, a love of the blindness of being human in a cosmos conceived around the human’s eclipse, a heavy levitation in the contradictory space between the inescapability of its having been and the impossibility of its will-be. Pessimism’s song of futility is a sensible way of loving fate, with a minimum of eros, by means of a kind of matrimonial love of the fatal. As music, pessimism stays open to the irreparable and the inexorable without the binding of affirmation, in the apparent absence of the radical, infinitely surplus will that absolute amor fati seems to require. Crying, laughing, sleeping—what other responses are adequate to a life that is so indifferent? “Unless a man aspires to the impossible, the possible that he achieves will scarcely be worth the trouble of his achieving it. We should aspire to the impossible, to absolute and infinite perfection [….] The apocatastasis is more than a mystical dream: it is a norm of action, it is a beacon for high deeds [….] For true charity is a species of invasion [….] It is not charity to rock and lull our fellow men to sleep in the inertia and heaviness of matter, but rather to arouse them to anguish and torment of spirit.” 3 … the impossibility of ever adequately accounting for one’s relationship to thought. “The paroxysm of interior experience leads you to regions where danger is absolute, because life which self-consciously actualizes its roots in experience can only negate itself [….] There are no arguments [….] On the heights of despair, the passion for the absurd is the only thing that can still throw a demonic light on chaos [….] I live because the mountains do not laugh and the worms do not sing .” 4 It took three attempts before she was fully decapitated, all the while she continued, perhaps miraculously, to sing. According to the earliest account of Cecilia’s martyrdom, the beheading turns out worse. After not severing her head in three strokes, “the cruel executioner left her half dead” (seminecem eam cruentus carnifex dereliquit). 5 Cecilia’s effortlessly powerful endurance of the three strokes—a fitting icon for pessimism as an art of dereliction—demonstrates the “passivity and absence of effort [….] in which divine transcendence is dissolved.” 6 There’s a ghost that grows inside of me, damaged in the making, and there’s a hunt sprung from necessity, elliptical and drowned. Where the moving quiet of our insomnia offers up each thought, there’s a luminous field of grey inertia, and obsidian dreams burnt all the way down. Like words from a pre-waking dream. There is no reason to think that they are not. NOTES 1. Dante Alighieri. Vita Nuova . ed. and trans. Dino S. Cervigni and Edward Vasta. Notre Dame: University of Notre Dame Press. 1995. 41:10. 2. Hafiz of Shiraz. The Divan . trans. H. Wilberforce Clarke. London: Octagon Press. 1974. 10.9. 3. Miguel de Unamuno. The Tragic Sense of Life in Men and Nations . trans. Anthony Kerrigan. Princeton: Princeton University Press. 1972. 305-6. 4. E.M. Cioran. On the Heights of Despair . trans. Ilinca Zarifopol-Johnston. Chicago: University of Chicago Press. 1992. 9-10. 5. Giacomo Laderchi. S. Caeciliae Virg[inis] et Mart[yris] Acta. . . Rome. 1723. 38. 6. Georges Bataille. On Nietzsche . trans. Bruce Boone. London: Continuum. 2004. 135. See Nicola Masciandaro. “ Half Dead: Parsing Cecilia .” A Commentary on Eugene Thacker’s "Cosmic Pessimism" Gary J. Shipley Pessimism is the refusal to seek distraction, the refusal to remodel failure into a platform for further (doomed) possibilities, the refusal of comfort, the acceptance of the sickness of healthy bodies, the cup of life overflowing with cold vomit. If, as Ligotti suggests when discussing Invasion of the Body Snatchers , 1 humans prefer the anxieties of their familiar human lives to the contentment of an alien one, then the pessimist, we could argue, represents some perverted combination of the two, preferring (presuming he has a choice) the defamiliarization of human life to the contentment of its unquestioned mundanity. The quasi-religious state of mind that Wittgenstein would mention on occasion, that of “feeling absolutely safe,” 2 is a state the pessimist could only imagine being approximated by death, or perhaps some annihilative opiate-induced stupor. This Wittgensteinian commingling of certainty and faith looks every bit the futile gesture, a mere rephrasing of collapse or partial collapse. The only certainty open to the pessimist is that of the toxic formula of life itself—a formula known and lacuna-free. Certainty, far from being the gateway to deliverance, becomes the definitive impediment; and the possibility of salvation, as long as it remains, becomes crucially reliant on postulations of ignorance, epistemic gaps, a perennial incompleteness: “the perfect safety of wooed death […] the warm bath of physical dissolution, the universal unknown engulfing the miniscule unknown.” 3 The height of Leibniz’s Panglossian insanity nurtured the idea that our knowing everything—via the universal calculus—could be accurately described a triumph, as opposed to a nightmare in which our every futility is laid bare. Stagnancy and boredom are perhaps two of the greatest ills of Western civilisation, and the most potent pessimism tells you that you’re stuck with both. The most we can hope for, by way of salvation, is to throw open our despair to the unknown. The fact that Schopenhauer’s pessimism stopped short of morality and allowed him to play the flute, as Nietzsche complained, highlights the predicament of a man who despite having adorned nothingness with a smiling face still found himself alive. The demand here is that it be felt: a cross-contamination of intellect and emotion. The safety net of numerous parentheses makes for a failed philosophy, rather than a philosophy of failure. Depressives make bad pessimists, because, unless they choose to die, living will always infect them with necessities of hope, forcing them to find something, anything (all the various “as ifs”) to make existence tolerable. For as Cioran observed, while “[d]epressions pay attention to life, they are the eyes of the devil, poisoned arrows which wound mortally any zest and love of life. Without them we know little, but with them, we cannot live.” 4 And even when cured of our depressions we’ll find ourselves consumed, eaten alive by the hyper-clinical (borderline autistic) mania that replaces them: a predicament captured all too clearly in the microscriptual fictions of Robert Walser, where spectral men and women stifle their depressive madness with protective comas of detail, their failed assimilations buried beneath thick crusts of remote data. Like Beckett’s Malone their stories may have ended, but cruelly their lives have not. Pessimism is an extraneous burden (a purposeless weight) that makes everything else harder to carry, while at the same time scooping it out and making it lighter. If pessimism had a sound it would be the harsh non-noise of tinnitus—the way that every person would hear themselves if they refused their distractions long enough to listen: a lungless scream from the extrasolar nothing of the self. The music of pessimism—if indeed we can imagine such a thing—is the reverberating echo of the world’s last sound, conjectured but never heard, audible only in its being listened for. The one consolation of this hollow paradox of audibility being, that “he will be least afraid of becoming nothing in death who has recognized that he is already nothing now.” 5 The pessimist suffers a derangement of the real, a labyrinthitis at the nucleus of his being: he’s the stumbling ghost relentlessly surprised that others can see him. If Cioran’s refusal is manifested in sleep (when even saying ‘no’ is too much of a commitment), then Pessoa’s resides in the dreams inside that sleep. Pessoa chooses to exploit the fact that he’s being “lived by some murmuring non-entity both shadowy and muddied” 6 by growing more voids to live him. His is a Gnostic breed of sleep, “sleeping as if the universe were a mistake,” 7 a sleep that dreams through Thacker’s cosmic pessimism (“a pessimism of the world-without-us.”, “the unhuman orientation of deep space and deep time” 8 ), through the critical error of there being anything at all when there could be nothing. The metaphysical pessimist is someone who, however well life treats them, still desires to wake from it, as from the poisonous air of a bad dream. Pessimism is a paradox of age, being simultaneously young and old; its youth residing in a refusal to accept the authority of existence (its rich history, its inherent beneficence), a refusal to “get over” the horror of what it sees with its perpetually fresh eyes, and its maturity in the unceremonious disposal of the philosophical playthings (those futile architectures) of adolescence. As Thacker remarks: “Pessimism abjures all pretenses towards system—towards the purity of analysis and the dignity of critique.” 9 A sentiment shared with Pessoa, who duly categorizes those that choose to enact this futile struggle: “The creators of metaphysical systems and of psychological explanations are still in the primary stage of suffering.” 10 If the pessimist has shared a womb with anyone, it’s with the mystic and not the philosopher. As Schopenhauer tells us: “The mystic is opposed to the philosopher by the fact that he begins from within, whereas the philosopher begins from without. […] But nothing of this is communicable except the assertions that we have to accept on his word; consequently he is unable to convince.” 11 The crucial difference between the mystic and the pessimist is not the latter’s impassivity and defeatism, but his unwillingness/inability to contain in any way the spread of his voracious analyticity, his denial of incompleteness, his exhaustive devotion to failure. The truth of our predicament, though heard, is destined to remain unprocessed. Like the revelations of B.S. Johnson’s Haakon (“We rot and there’s nothing that can stop it / Can’t you feel the shaking horror of that?” 12 ) the pessimist’s truths are somehow too obvious to listen to, as if something inside us were saying, “Of course, but haven’t we gotten over that?” Pessimism is simple and ugly, and has no desire to make itself more complex or more attractive. The true moral pessimist knows that the Utilitarian’s accounts will always be in the red. He can see that for all his computational containments, his only honest path is a negative one, and that such a path has but one logical destination: that of wholesale human oblivion. Thacker notes how at the core of pessimism lies the notion of “the worst,” through which death is demoted by the all-pervasive suffering of a life that easily eclipses its threat. And so with doom made preferable to gloom, death begins to glint with promise, “like beauty passing through a nightmare.” 13 But even among pessimists suicide is, for the most part, thought to be an error. Schopenhauer, for instance, regarded suicide a mistake grounded in some fundamentally naïve disappointment or other. Pessoa too thought suicide an onerous escape tactic: “To die is to become completely other. That’s why suicide is a cowardice: it’s to surrender ourselves completely to life.” 14 There is a call here to be accepting of and creative with the puppetry of your being, an insistence that it’s somehow a blunder to attempt to hide in death from the horrors you find inlife. 15 Tied up with this perseverance is the slippery notion of the good death, for maybe, as Blanchot warns, suicide is rarely something we can hope to get right, for the simple reason that “you cannot make of death an object of the will.” 16 “Even in cases where the entire corpus of an author is pessimistic, the project always seems incomplete,” 17 and this is not simply because the project itself belies something yet to be disclosed, but because the project itself is a thing waiting. It waits on a cure it knows will not come, but for which it cannot do anything (as long as it continues to do anything) but wait. NOTES 1. See Thomas Ligotti. The Conspiracy Against the Human Race . New York: Hippocampus Press. 2010. 91. 2. Ludwig Wittgenstein. “A Lecture on Ethics.” Philosophical Review . (74) 1. 1965. 8. 3. Vladimir Nabokov. Pale Fire . New York: Vintage. 1989. 221. 4. E. M. Cioran. The Book of Delusions . trans. Camelia Elias. Hyperion. 5.1. (2010): 75. 5. Arthur Schopenhauer. The World as Will and Representation. vol. 2 . trans. E .F J. Payne. New York: Dover. 1966. 609. 6. Eugene Thacker. “Cosmic Pessimism.” continent. . 2.2 (2012): 67. 7. Fernando Pessoa. The Book of Disquiet . trans. Richard Zenith. London: Penguin. 2002. 35. 8. Eugene Thacker. “Cosmic Pessimism.” continent. . 2.2 (2012): 68. 9. Ibid. 73. 10. Fernando Pessoa. The Book of Disquiet . trans. Richard Zenith. London: Penguin. 2002. 341. 11. Arthur Schopenhauer. The World as Will and Representation. vol. 2 . trans. E .F J. Payne. New York: Dover. 1966. 610-11. 12. B.S Johnson. “You’re Human Like the Rest of Them.” in Jonathan Coe. Like a Fiery Elephant: The Story of B.S. Johnson . London: Picador. 2004. 177. 13. Fernando Pessoa. The Book of Disquiet . trans. Richard Zenith. London: Penguin. 2002. 415. 14. Ibid. 199. 15. “Suicide is, after all, the opposite of the poem.” Anne Sexton. No Evil Star: Selected Essays, Interviews and Prose . ed. Steven Gould Axelrod. Ann Arbor: University of Michigan Press. 1985. 92. 16. Maurice Blanchot. The Space of Literature . trans. Ann Smock. Lincoln: University of Nebraska Press. 1989. 105. 17. Eugene Thacker. “Cosmic Pessimism.” continent. . 2.2 (2012): 75. (shrink)

Char et al. describe an interesting and useful approach in their paper, “Identifying ethical considerations for machine learning healthcare applications.” Their proposed framework, which see...

Open peer commentary on the article “Sensorimotor Direct Realism: How We Enact Our World” by Michael Beaton. Upshot: This commentary is broadly sympathetic to the claims made in the target article. I start by questioning whether we can have direct access to an external reality in such a way that our experience is not intrinsically private. I then suggest that the argument for direct realism presented here is inconclusive with regard to whether external objects play a causal or a constitutive (...) role. (shrink)