Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient’s values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge (...) the information needs of the individual patient. The aim of this paper is to describe ‘core information sets’ which are defined as a minimum set of consensus-derived information about a given procedure to be discussed with all patients. Importantly, they are intended to catalyse discussion of subjective importance to individuals. The model described in this paper applies health services research and Delphi consensus-building methods to an idea orginally proposed 30 years ago. The hypothesis is that, first, large amounts of potentially-important information are distilled down to discrete information domains. These are then, secondly, rated by key stakeholders in multiple iterations, so that core information of agreed importance can be defined. We argue that this scientific approach is key to identifying information important to all stakeholders, which may otherwise be communicated poorly or omitted from discussions entirely. Our methods apply systematic review, qualitative, survey and consensus-building techniques to define this ‘core information’. We propose that such information addresses the ‘reasonable patient’ standard for information disclosure but, more importantly, can serve as a spring board for high-value discussion of importance to the individual patient. The application of established research methods can define information of core importance to informed consent. Further work will establish how best to incorporate this model in routine practice. (shrink)

Robert Nozick's adherence to Locke's puzzling doctrine about punishment can seem strange. Why does Nozick follow Locke in claiming that individuals in a state of nature have a right to punish any wrongdoer?Here reflection on this question proceeds by stages to a conclusion that Nozick as well as any other state-of-nature theorist of similar stripe should find disturbing. For, as we shall see, what Nozick describes as the general right of a minimal state to punish cannot arise within a state (...) of nature from the more plausible right of individuals to punish only those who harm them. (shrink)

Seeing art is not as easy as it looks, because there is more to seeing art than meets the eye. This essay examines some of the presuppositions involved in seeing something as art. In opposition to the view of A.C. Danto that to see something as art is merely to identify it as art, I shall suggest that to see something as art is to appreciate it in a specifiable way. In addition, I shall argue that considerations sometimes deemed adventitious (...) are in fact inescapably involved in the appreciation of all works of art, and in particular, that it is impossible to entirely eliminate intentional and genetic considerations from our critical Judgments. (shrink)

Philosophers have applied the framework of constitutive grounds to make sense of the disagreement between subjectivism and objectivism. The framework understands the two theories as being involved in a disagreement about the extent to which value is determined by attitudes. Although the framework affords us with some useful observations about how this should be interpreted, the question how value can be determined by attitudes in the first place is left largely unanswered. Here we explore the benefits of a positive interpretation (...) which aims to address this oversight and make the framework more informative. This interpretation, which is inspired by the recent work of Schroeder and Sobel, claims that the relevant sense in which value can be determined by attitudes is discovered by seeing how facts can be endowed with the normative property of being a reason. We argue that this interpretation significantly deepens our understanding of the disagreement between subjectivism and objectivism. (shrink)

This study examines the family environments and hormone profiles of 316 individuals aged 2 months-58 years residing in a rural village on the east coast of Dominica, a former British colony in the West Indies. Fieldwork was conducted over an eight-year period (1988–1995). Research methods and techniques include radioimmunoassay of cortisol and testosterone from saliva samples (N=22,340), residence histories, behavioral observations of family interactions, extensive ethnographic interview and participant observation, psychological questionnaires, and medical examinations.Analyses of data indicate complex, sex-specific effects (...) of family environment on endocrine function. Male endocrine profiles exhibit greater sensitivity to presence of father than do female endocrine profiles. Father-absent males tend to have (a) low cortisol levels during infancy, (b) high or abnormal cortisol profiles during childhood and adolescence, and (c) high cortisol and low testosterone levels during adulthood compared with those of males raised with a resident father. These results indicate that early family environment has significant effects on endocrine response throughout male life histories. (shrink)

Background: Post-traumatic stress disorder is a prevalent, debilitating, and costly psychiatric disorder. Evidenced-based psychotherapies, including Cognitive Processing Therapy, are effective in treating PTSD, although a fair proportion of individuals show limited benefit from such treatments. CPT requires cognitive demands such as encoding, recalling, and implementing new information, resulting in behavioral change that may improve PTSD symptoms. Individuals with PTSD show worse cognitive functioning than those without PTSD, particularly in acquisition of verbal memory. Therefore, memory dysfunction may limit treatment gains in (...) CPT in some individuals with PTSD. Methods and Analysis: Here, we present a protocol describing the Cognition and PsychoTherapy in PTSD study, a prospective, observational study examining how cognitive functioning affects treatment response in CPT for PTSD. The study aims to recruit 105 outpatient veterans with PTSD between the ages of 18 and 70 years. Prior to beginning 12 sessions of CPT, Veteran participants will have standardized assessments of mood and functioning and complete a comprehensive neurocognitive battery assessing episodic learning, attention and speed of processing, language ability, executive control, and emotional functioning. This study aims to fill gaps in the current literature by: examining the specificity of memory effects on treatment response; exploring how baseline cognitive functioning impacts functional outcomes; and examining potential mechanisms, such as memory for treatment content, that might explain the effects of baseline memory functioning on PTSD symptom trajectory. Discussion: If successful, this research could identify clinically relevant neurocognitive mechanisms that may impact PTSD psychotherapy and guide the development of individualized treatments for PTSD. (shrink)

Self-knowledge is the focus of considerable attention from philosophers: Knowing Our Own Minds gives a much-needed overview of current work on the subject, bringing together new essays by leading figures. Knowledge of one's own sensations, desires, intentions, thoughts, beliefs, and other attitudes is characteristically different from other kinds of knowledge: it has greater immediacy, authority, and salience. The contributors examine philosophical questions raised by the distinctive character of self-knowledge, relating it to knowledge of other minds, to rationality and agency, externalist (...) theories of psychological content, and knowledge of language. Together these original, stimulating, and closely interlinked essays demonstrate the special relevance of self-knowledge to a broad range of issues in epistemology, philosophy of mind, and philosophy of language. (shrink)

Many system architects select their system methodologies without explicit consideration of the philosophical perspectives that impact their decisions. This paper describes how the concepts of ontology and epistemology apply in systems science. Ontology is how we specify terms of reference for existence, allowing us to understand the theory of existence via an ‘existence framework’. Epistemology, the theory of knowledge, allows us to explore new models and theories of knowledge acquisition so the best system-based methodologies can be deployed to solve complex (...) system problems. After introducing these concepts, the paper presents system science issues and assesses the impact of ontological, axiological and epistemological perspectives on system methodology selection, research, system design and deployment. An ontological viewpoint such as realism, as an objective view is contrasted versus nationalism, a personal perceptional view. An epistemological viewpoint is explored comparing knowledge as a product of sensory perception or rational reflection. The paper’s significant contribution is that it helps system architects understand that their philosophical views of systems science impact their system methodology choices. (shrink)

Organizational ethics programs often are created to address tensions in organizational values that have been identified through repeated clinical ethics consultation requests. Clinical ethicists possess some core competencies that are suitable for the leadership of high-quality organizational ethics programs, but they may need to develop new skills to build these programs, such as familiarity with healthcare delivery science, healthcare financing, and quality improvement methodology. To this end, we suggest that clinical ethicists build organizational ethics programs incrementally and via quality improvement (...) projects undertaken in collaboration with senior clinical leaders. Organizational ethics programs often differ from clinical ethics programs in their membership and processes, and likely will require ethicists to forge new partnerships with a wide array of organizational leaders. With attention to the ways that organizational ethics programs differ from clinical ethics programs, and investment in quality improvement methodology and formal institutional needs assessments, clinical ethics leaders can position an organizational ethics program to advocate effectively for visible and compelling alignment of leadership decision making with the values of the organization. (shrink)

Since its publication in 1965, Brian Barry's seminal work has occupied an important role in the revival of Anglo-American political philosophy. A number of ideas and terms in it have become part of the standard vocabulary, such as the distinction between "ideal-regarding" and "want-regarding" principles and the division of principles into aggregative and distributive. The book provided the first precise analysis of the concept of political values having trade-off relations and its analysis of the notion of the public interest (...) has also been significant. (shrink)

This paper addresses a family of issues surrounding the biological phenomenon of resistance and its representation in realist ontologies. The treatments of resistance terms in various existing ontologies are examined and found to be either overly narrow, internally inconsistent, or otherwise problematic. We propose a more coherent characterization of resistance in terms of what we shall call blocking dispositions, which are collections of mutually coordinated dispositions which are of such a sort that they cannot undergo simultaneous realization within a single (...) bearer. A definition of ‘protective resistance’ is proposed for use in the Infectious Disease Ontology (IDO) and we show how this definition can be used to characterize the antibiotic resistance in Methicillin-Resistant Staphylococcus aureus (MRSA). The ontological relations between entities in our MRSA case study are used alongside a series of logical inference rules to illustrate logical reasoning about resistance. A description logic representation of blocking dispositions is also provided. We demonstrate that our characterization of resistance is sufficiently general to cover two other cases of resistance in the infectious disease domain involving HIV and malaria. (shrink)

This essay addresses the question whether artificial speakers can perform speech acts in the technical sense of that term common in the philosophy of language. We here argue that under certain conditions artificial speakers can perform speech acts so understood. After explaining some of the issues at stake in these questions, we elucidate a relatively uncontroversial way in which machines can communicate, namely through what we call verbal signaling. But verbal signaling is not sufficient for the performance of a speech (...) act. To explain the difference, we elucidate the notion of a speech act developed by Austin in the mid-twentieth century and then discuss Strawson’s influential proposal for how that notion may be related to Grice’s conception of speaker meaning. We then refine Strawson’s synthesis in light of Armstrong’s reconceptualization of speaker meaning in terms of objectives rather than intentions. We next extend this conception of speech acts to the cases of recorded, proxy, and conditional speech acts. On this basis, we propose that a characteristic role for artificial speakers is as proxies in the performance of speech acts on behalf of their human creators. We also consider two objections to our position, and compare our approach with others: while other authors appeal to notions such as “quasi-assertion,” we offer a sharp characterization of what artificial speakers can do that does not impute intentions or similarly controversial powers to them. We conclude by raising doubts that our strategy can be applied to speech acts generally. (shrink)