Much of the sustained attention on pandemic preparedness has focused on the ethical justification for plans for the “crisis” phase of a surge when, despite augmentation efforts, the demand for life...

When patients are admitted to the hospital, they are generally expected to remain in or within close proximity to their assigned rooms in order to promote their safety and appropriate medical care. Although there are circumstances when patients may safely leave their hospital room or floor, guidance within the medical literature for the management of patient movement within the hospital are lacking. Excessive restrictions on patient movement may be seen as overly paternalistic, while lax requirements may interfere with high quality (...) care, patient safety and efficient hospital practice. As a result, guidance in the form of institutional policy is warranted. Such policy development should take into consideration the potential clinical, legal, and ethical concerns in balancing the competing values of patients’ preferences and respect for autonomy, while ensuring high quality, safe, and efficacious medical care. This paper will provide a framework for hospitals to create institution-specific patient movement policies that are fair, systematic, and transparent. (shrink)

This paper describes an AFOSR-supported basic research program that focuses on developing a new framework for combining hard with soft data in order to improve space situational awareness. The goal is to provide, in an automatic and near real-time fashion, a ranking of possible threats to blue assets (assets trying to be protected) from red assets (assets with hostile intentions). The approach is based on Conceptual Spaces models, which combine features from traditional associative and symbolic cognitive models. While Conceptual Spaces (...) are revolutionary, they lack an underlying mathematical framework. Several such frameworks have attempted to represent Conceptual Spaces, but by far the most robust is the model developed by Holender. His model utilizes integer linear programming in order to obtain an overall similarity value between observations and concepts that support the formation of hypotheses. This paper will describe a method for building Conceptual Spaces models for threats that utilizes ontologies as a means to provide a clear semantic foundation for this inferencing process; in particular threat ontologies and space domain ontologies are developed and employed in this approach. A space situational awareness use-case is presented involving a kinetic kill scenario and results are shown to assess the performance of this fusion-based inferencing framework. (shrink)

Patients rely on, benefit from, and are strongly influenced by physicians’ recommendations. In spite of the centrality and importance of physicians’ recommendations to clinical care, there is only a scant literature describing the conceptual process of forming a clinical recommendation, and no discrete professional standards for making individual clinical recommendations. Evidence-based medicine and shared decision making together are intended to improve medical decision making, but there has been limited attention to how a recommendation is discretely formulated from either of those (...) processes or how patients’ preferences ought to be considered and how much weight they should hold. Moreover, physicians’ bias has been reported to strongly influence how a recommendation is derived, thereby undermining the quality of healthcare decisions and patients’ trust. To demonstrate a potential for improving the quality of decisions, this article proposes a conceptual framework for how physicians should reach a clinical recommendation and apply the process in practice. For preference-sensitive clinical decisions—that is, clinical decisions when patients’ values and preferences are relevant—the process for reaching a recommendation should be transparent to patients and should be based solely on the medical evidence and patients’ values and preferences. When patients’ preferences for care do not prioritize health, physicians decide whether their recommendation will prioritize a welfare-enhancing versus an autonomy-enhancing approach. When there are gaps in understanding how physicians derive their clinical recommendations and how to further improve the quality of the decisions, the author calls for further empiric research. (shrink)

The American Journal of Bioethics, Volume 12, Issue 5, Page 9-11, May 2012.

This is a complex case of a younger man with unclear social supports and a disabling diabetic infection that is limiting his ability to be and possibly feel productive. The patient appears to be ha...

This paper provides a method for characterizing space events using the framework of conceptual spaces. We focus specifically on estimating and ranking the likelihood of collisions between space objects. The objective is to design an approach for anticipatory decision support for space operators who can take preventive actions on the basis of assessments of relative risk. To make this possible our approach draws on the fusion of both hard and soft data within a single decision support framework. Contextual data is (...) also taken into account, for example data about space weather effects, by drawing on the Space Domain Ontologies, a large system of ontologies designed to support all aspects of space situational awareness. The framework is coupled with a mathematical programming scheme that frames a mathematically optimal approach for decision support, providing a quantitative basis for ranking potential for collision across multiple satellite pairs. The goal is to provide the broadest possible information foundation for critical assessments of collision likelihood. (shrink)

Some things, but only some things, are by nature subject to standards. Why? I explain and develop what I call nature-first constitutivism, which says that what something is determines what it should be. Nature is the basis of normativity. I explain this view in terms of a unique type of property which particulars of a genus can lack even though those properties partially determines the nature of the genus. Such properties partially describe the nature of a genus and are thereby (...) normative for the particulars of that genus. Particulars of genera with such essential properties are by nature subject to standards with respect to those properties. Particulars of genera without such properties are not by nature subject to standards. (shrink)

What explains why we are subjects for whom objects can have value, and what explains which objects have value for us? Axiologicians say that the value of humanity is the answer. I argue that our value, no matter what it is like, cannot perform this task. We are animals among others. An explanation of the value of objects for us must fit into an explanation of the value of objects for animals generally. Different objects have value for different animals. Those (...) differences depend on differences in animal natures and, in particular, on the diverse characteristic capacities of different animals. Once we invoke animal natures, there is nothing for the value of animality, including the value of humanity, to explain. (shrink)

Intellectualism is the widespread view that practical reason is a species of theoretical reason, distinguished from others by its objects: reasons to act. I argue that if practical reason is a species of theoretical reason, practical judgments by nature have nothing to do with action. If they have nothing to do with action, I cannot act from my representation of reasons for me to act. If I cannot act from those representations, those reasons cannot exist. If they cannot exist, neither (...) can a species of theoretical reason about them. Intellectualism is thus self-undermining. (shrink)

The possibility of error conditions the possibility of normative principles. I argue that extant interpretations of this condition undermine the possibility of normative principles for our action because they implicitly treat error as a perfection of an action. I then explain how a constitutivist metaphysics of capacities explains why error is an imperfection of an action. Finally, I describe and defend the interpretation of the error condition which follows.

The overall goal of the approach developed in this paper is to estimate the likelihood of a given kinetic kill scenario between hostile spacebased adversaries using the mathematical framework of Complex Conceptual Spaces Single Observation. Conceptual spaces are a cognitive model that provide a method for systematically and automatically mimicking human decision making. For accurate decisions to be made, the fusion of both hard and soft data into a single decision framework is required. This presents several challenges to this data (...) fusion framework. The first is the challenge involved in handling multiple complex terminologies, which is addressed by drawing on a set of Space Domain Ontologies. Another challenge is the complex combinatorics involved when considering all possible feature combinations. This can be mitigated by using integer linear programming optimization that is outlined by the Complex Conceptual Spaces Single Observation mathematical model framework. A third challenge is the complicated physics that is involved in a spacecraft collision that must be addressed to obtain a better understanding of threat assessment. Overcoming these various challenges allows for a quantitative ranking for the potential of a kinetic kill collision across multiple spacecraft pairs. In addition to overcoming these challenges this paper will break down threat assessment into four domains and identify a ranking of threat both for each individual domain and for the four domains combined. Simulation results are shown to verify the developed concepts. (shrink)

Properly understood, the instrumental rule says to take means that actually suffice for my end, not, as is nearly universally assumed, to intend means that I believe are necessary for my end. This alternative explains everything the standard interpretation can—and more, including grounding certain correctness conditions for exercises of our will unexplained by the standard interpretation.

The prime number theorem, established by Hadamard and de la Vallée Poussin independently in 1896, asserts that the density of primes in the positive integers is asymptotic to 1/ln x. Whereas their proofs made serious use of the methods of complex analysis, elementary proofs were provided by Selberg and Erdos in 1948. We describe a formally verified version of Selberg's proof, obtained using the Isabelle proof assistant.

Previous work has shown that the Complex Conceptual Spaces − Single Observation Mathematical framework is a useful tool for event characterization. This mathematical framework is developed on the basis of Conceptual Spaces and uses integer linear programming to find the needed similarity values. The work of this paper is focused primarily on space event characterization. In particular, the focus is on the ranking of threats for malicious space events such as a kinetic kill. To make the Conceptual Spaces framework work, (...) the similarity values between the contents of observations on the one hand and the properties of the entities observed on the other needs to be found. This paper shows how to exploit Dempster-Shafer theory to implement a statistical approach for finding these similarities values. This approach will allow a user to identify the uncertainty involved in similarity value data, which can later be propagated through the developed mathematical model in order for the user to know the overall uncertainty in the observation-to-concept mappings needed for space event characterization. (shrink)

Because the process of moving from moral principles and facts to action-guiding moral conclusions has not been articulated clearly enough to be useful in a practical way, we designed a systematic approach to aid learners and clinicians in their application of ethical principles to the resolution of clinical dilemmas. Our model for clinical moral reasoning is intended to provide a clear and replicable structure that makes the thought process involved in reasoning about clinical cases explicit. In this paper we present (...) the model and demonstrate how it can be used in three clinical cases. (shrink)

Practical cognitivism is the view that practical reason is our will, not an intellectual capacity whose exercises can influence those of our will. If practical reason is our will, thoughts about how I am to act have an essential tie to action. They are intentions. Thoughts about how others are to act, though, lack such a tie to action. They are beliefs, not intentions. How, then, can these thoughts form a unified class? I reject two answers which deny the differences (...) between such thoughts about myself and those about others, one of which says that all such thoughts are intentions, the other that all are beliefs. I then reject a shared assumption which says that a class of thoughts is unified only if all its elements are all of one type of thought. I instead argue that this class is unified even though some elements are intentions, others beliefs, because such beliefs depend on those intentions in various ways. (shrink)

Practical cognitivism is the view that practical reason is the self-conscious will and that practical cognition is self-conscious volition. This essay addresses two puzzles for practical cognitivism. In akratic action, I act as I understand is illegitimate and not as I understand is legitimate. In permissible action, I act as I understand is legitimate and also do not act as I understand is legitimate. In both types of action, practical cognition seems to come apart from volition. How, then, can practical (...) reason be our will and practical cognition be volition? Practical cognitivists can solve these puzzles because the claims that practical reason is our will and that practical cognition is volition are about the nature of a capacity, and the nature of a capacity establishes standards of correctness for its exercises. Akratic action is a type of erroneous exercise of practical reason as tripping is an erroneous exercise our capacity to walk. Permissible action is a successful exercise of practical reason as stepping first with my right foot rather than my left is a successful exercise of my capacity to walk. The puzzles of akratic and permissible action do not refute practical cognitivism. (shrink)

Regulating affective responses to acute stress has the potential to improve health, performance, and well-being outcomes. Using the biopsychosocial model of challenge and threat as an organizing framework, we review how appraisals inform affective responses and highlight research that demonstrates how appraisals can be used as regulatory tools. Arousal reappraisal, specifically, instructs individuals on the adaptive benefits of stress arousal so that arousal is conceptualized as a coping resource. By reframing the meaning of signs of arousal that accompany stress, it (...) is possible to break the link between stressful situations, and malignant physiological responses and experiences of negative affect. Applications of arousal reappraisal for academic contexts and clinical science, and directions for future research are discussed. (shrink)

This study examined the drivers of climate change innovations and the effects of these innovations on firm outcomes in a sample of 203 firms in the South Australian wine cluster. The results of structural equation modeling analysis suggest that absorptive capacity has a direct effect on climate change innovations, and stimulates knowledge exchanges between firms in the cluster. KEs between firms in the cluster in turn directly affect the climate change innovations. The findings suggest a perhaps counterintuitive interrelationship between firm- (...) and cluster-level impacts, in which KEs between firms in the cluster play a partial mediating role in the innovation process. The study further finds that climate change innovations are related to firm performance and reductions in greenhouse gases : mitigative innovations lead to greater GHG reductions while adaptive innovations impact on FP. Contributions of the findings are discussed, as are future research directions. (shrink)

The biopsychosocial model of challenge and threat posits that resource and demand appraisals interact in situations of acute stress to determine affective responses, and concomitant physiological responses, motivation, and decisions/behaviors. Regulatory approaches that alter appraisals to regulate challenge and threat affective states have the potential to facilitate coping. This reply clarifies the conceptualization of one such regulatory approach, arousal reappraisal, and suggests avenues for future research. However, it is important to note that arousal reappraisal is not a “silver bullet” for (...) improving stress outcomes, nor should this strategy be expected to positively impact all individuals. More work is needed to better elucidate how psychological and biological stress processes interact to shape health. (shrink)

1.1 Some examples of rule induction on permutations . . . . . . . 6 1.2 Ways of making new permutations . . . . . . . . . . . . . . . 7 1.3 Further results . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1.4 Removing elements . . . . . . . . . . (...) . . . . . . . . . . . . . . 8.. (shrink)

Is the exemplar of modern ethical theory estranged from their intimates because the motive of duty dominates their motivational psychology? While this challenge against modern ethical theory is familiar, I argue that with respect to a certain strand of Kantian ethical theory, it does not so much as make sense. I explain the content and functional role of the motive of duty in the psychology of the moral exemplar, stressing in particular how that motive shapes and informs the content of (...) others, including those characteristic of intimacy. I argue that to the extent that a subject does not integrate their motive of duty with their other motives, their moral and intimate relationships are compromised, and on the same grounds, because intimate relationships are interpersonal relationships and the motive of duty just is the motive to respect another person as a separate person. (shrink)

Volume 20, Issue 7, July 2020, Page 145-147.

Explores how the emotional experience of gratitude has been enlisted in neoliberal governance through the language of debt. In The Art of Gratitude, Jeremy David Engels sketches a genealogy of gratitude from the ancient Greeks to the contemporary self-help movement. One of the most striking things about gratitude, Engels finds, is how consistently it is described using the language of indebtedness. A chief purpose of this, he contends, is to make us more comfortable living lives in debt, with (...) the nefarious effect of pacifying the citizenry so we are less likely to speak out about social and economic injustice. To counteract this, he proposes an alternative art of gratitude-as-thanksgiving that is inspired by Indian philosophy, particularly the yoga philosophy of the Bhagavad Gita and Patanjali’s Yoga-Sutras. He argues that this art of gratitude can challenge neoliberalism by reorienting our politics away from resentment, anger, and guilt and toward a democratic ethic of thanksgiving and the common good. Jeremy David Engels is the Sherwin Early Career Professor in the Rock Ethics Institute and Associate Professor of Communication Arts and Sciences at Penn State University. He is the author of The Politics of Resentment: A Genealogy and Enemyship: Democracy and Counter-Revolution in the Early Republic. (shrink)

BackgroundThe pursuit of a cure for HIV is a high priority for researchers, funding agencies, governments and people living with HIV (PLWH). To date, over 250 biomedical studies worldwide are or have been related to discovering a safe, effective, and scalable HIV cure, most of which are early translational research and experimental medicine. As HIV cure research increases, it is critical to identify and address the ethical challenges posed by this research.MethodsWe conducted a scoping review of the growing HIV cure (...) research ethics literature, focusing on articles published in English peer-reviewed journals from 2013 to 2021. We extracted and summarized key developments in the ethics of HIV cure research. Twelve community advocates actively engaged in HIV cure research provided input on this summary and suggested areas warranting further ethical inquiry and foresight via email exchange and video conferencing.DiscussionDespite substantial scholarship related to the ethics of HIV cure research, additional attention should focus on emerging issues in six categories of ethical issues: (1) social value (ongoing and emerging biomedical research and scalability considerations); (2) scientific validity (study design issues, such as the use of analytical treatment interruptions and placebos); (3) fair selection of participants (equity and justice considerations); (4) favorable benefit/risk balance (early phase research, benefit-risk balance, risk perception, psychological risks, and pediatric research); (5) informed consent (attention to language, decision-making, informed consent processes and scientific uncertainty); and (6) respect for enrolled participants and community (perspectives of people living with HIV and affected communities and representation).ConclusionHIV cure research ethics has an unfinished agenda. Scientific research and bioethics should work in tandem to advance ethical HIV cure research. Because the science of HIV cure research will continue to rapidly advance, ethical considerations of the major themes we identified will need to be revisited and refined over time. (shrink)

This article is constructed through a series of linked aphorisms that articulate the relations between autonomy, sense, the world, different people’s worlds, disagreement, and wonder. It advances anthroponomy—the organization of humankind to support autonomous life. In the context of the planetary, sociallycaused environmental changes of today such as global warming or the risk of a mass extinction cascade, a part of autonomous engagement with our planetary situation is developing an autonomous conception of it—a conception of our situation that makes sense (...) to us. This pluralistic idea has consequences for environmentalism, notably around coloniality, and the reduction of different autonomous worlds to a dominant world, which is currently part of the discourse of the Anthropocene. The aphorisms in this article develop a reflective path toward autonomous conceptions of our planetary situation given the reality of coloniality in how that situation is understood. One result of this path is to open up a way for people to become more autonomously engaged with our environmental situation, an engagement grounded in wonder and critical of the discourse of the “Anthropocene”. (shrink)

Climate change, while potentially impacting many industries, appears to have considerable significance to the wine industry. Yet little is known about how firms acquire knowledge and gain an understanding of climate change and its impacts. This study, exploratory in nature and studying firms from the wine-producing region of Tasmania, is one of the first in the management literature to use cluster theory to examine the climate change issue. Firms are predicted to exchange knowledge about climate change more readily with other (...) firms internal to the sub-cluster than with those external to the sub-cluster. The hypothesis does not find support. The study also proposes that the different characteristics of knowledge can either increase or decrease their flows in and around clusters. Specifically, “public” knowledge about climate change is predicted to flow more freely than “private” knowledge about climate change. The hypothesis does not find support. Finally, firms are expected to acquire knowledge about climate change from sources other than cluster-entrenched firms, and in particular peak national industry bodies. The hypothesis finds partial support. A discussion of the findings is presented along with future research directions. (shrink)

The Ethics Consultation Quality Assessment Tool (ECQAT) establishes standards by which the quality of ethics consultation records (ECRs) can be assessed. These standards relate to the ethics question, consultation-specific information, ethical analysis, and recommendations and/or conclusions, and result in a score associated with one of four levels of ethics consultation quality. For the ECQAT to be useful in assessing and improving the quality of healthcare ethics consultations, individuals who rate the quality of ECRs need to be able to reliably use (...) the tool.We developed a short course to train ethics consultants in using the ECQAT, and evaluated whether the participants (1) achieved an acceptable level of calibration in matching expert-established quality scores for a set of ethics consultations, and (2) were satisfied with the course. We recruited 28 ethics consultants to participate in a virtual, six-session course. At each session participants and faculty reviewed, rated, and discussed one to two ECRs. The participants’ calibration in matching expert-established quality scores improved with repeated exposure at all levels of ethics consultation quality. Participants were generally more accurate when assessing consultation quality at the dichotomous level of “acceptable” (scores of three or four) versus “unacceptable” (scores of one or two) than they were with a more specific score. Participants had higher rates of accuracy with the extreme ratings of “strong” (level four) or “poor” (level one). Although participants were highly satisfied with the course, only a minority of participants achieved the prespecified acceptable level of calibration (that is, 80 percent or greater accuracy between their score and expert-established scores). These results suggest that ECQAT training may require more sessions or need modification in the protocol to achieve higher reliability in scoring. Such trainings are an important next step in ensuring that the ECQAT is a tool that can be used to promote improvement in ethics consultation quality. (shrink)

A number of natural language constructions seem to provide access to structured pluralities — that is, pluralities of pluralities. A body of semantic work has debated how to model this additional structure and the extent to which it depends on pragmatics. In this article, after controlling for the distinction between ambiguity and underspecification, we present new data showing that structured pluralities are sometimes but not always available, depending on the form of the plural noun phrase used. We show that these (...) results challenge two longstanding theories of plurality. We sketch two different ways to account for these data and describe some of the diverging predictions they make. (shrink)

Task shifting is increasingly used to address human resource shortages impacting HIV service delivery in low- and middle-income countries. By shifting basic tasks from higher- to lower-trained cadres, such as Community Health Workers, task shifting can reduce overhead costs, improve community outreach, and provide efficient scale-up of essential treatments like antiretroviral therapies. Although there is rich evidence outlining positive outcomes that CHWs bring into HIV programs, important questions remain over their place in service delivery. These challenges often reflect concerns over (...) whether CHWs can mitigate HIV through a means that does not overlook the ethical and practical constraints that undergird their work. Ethical and practical guidance thus needs to become the cornerstone of CHW deployment. This paper analyzes such challenges through the lens of Ethical Principlism. We examined papers identifying substantive and ethical challenges impacting CHWs as they provide HIV services in low- and middle-income contexts. To do this, we analyzed papers written in English and published from year 2000 or later. These articles were identified using MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar databases. In total, 465 articles were identified, 78 of which met our inclusion criteria. Article reference lists and grey literature were also examined. CHWs experience specific challenges while carrying out their duties, such as conducting emotionally- and physically-demanding tasks with often inadequate training, supervision and compensation. CHWs have also been poorly integrated into health systems, which not only impacts quality of care, but can hinder their prospects for promotion and lead to CHW disempowerment. As we argue, these challenges can be addressed if a set of ethical principles is prioritized, which specifically entail the principles of respect for persons, justice, beneficence, proportionality and cultural humility. CHWs play a crucial role in HIV service delivery, yet the ethical challenges that can accompany their work cannot be overlooked. By prioritizing ethical principles, policymakers and program implementers can better ensure that CHWs are combatting HIV through a means that does not exploit or take their critical role within service delivery for granted. (shrink)