Battle lines have been drawn over involuntary treatment. On one side, there are those who oppose involuntary psychiatric treatments under any condition. Activists who take up this cause often don't acknowledge that psychiatric symptoms can render people dangerous to themselves or others. They also don't allow for the idea that the civil rights of an individual may be at odds with the heartbreak of a caring family. On the other side are groups pushing for increased use of involuntary treatment. These (...) proponents are quick to point out that people with psychiatric illnesses often don't recognize that they are ill, which (from their perspective) makes the discussion of civil rights moot. They may gloss over the sometimes dangerous side effects of psychiatric medications, and they often don't admit that patients, even after their symptoms have abated, are sometimes unhappy that treatment was inflicted upon them. In Committed, psychiatrists Dinah Miller and Annette Hanson offer a thought-provoking and engaging account of the controversy surrounding involuntary psychiatric care in the United States. They bring the issue to life with first-hand accounts from patients, clinicians, advocates, and opponents. Looking at practices such as seclusion and restraint, involuntary medication, and involuntary electroconvulsive therapy--all within the context of civil rights-- Miller and Hanson illuminate the personal consequences of this controversial practice through voices of people who have been helped by the treatment they had as well as those who have been traumatized by it. The authors explore the question of whether involuntary treatment has a role in preventing violence, suicide, and mass murder. They delve into the controversial use of court-ordered outpatient treatment at its best and at its worst. Finally, they examine innovative solutions--mental health court, crisis intervention training, and pretrial diversion--that are intended to expand access to care while diverting people who have serious mental illness out of the cycle of repeated hospitalization and incarceration. They also assess what psychiatry knows about the prediction of violence and the limitations of laws designed to protect the public. (shrink)

In this paper we provide a psychological explanation for ‘grounding observations’—observations that are thought to provide evidence that there exists a relation of ground. Our explanation does not appeal to the presence of any such relation. Instead, it appeals to certain evolved cognitive mechanisms, along with the traditional modal relations of supervenience, necessitation and entailment. We then consider what, if any, metaphysical conclusions we can draw from the obtaining of such an explanation, and, in particular, if it tells us anything (...) about whether we ought to posit a relation of ground. (shrink)

David Miller is the foremost exponent of the purist critical rationalist doctrine and here presents his mature views, discussing the role that logic and argument play in the growth of knowledge, criticizing the common understanding of argument as an instrument of justification, persuasion or discovery and instead advocating the critical rationalist view that only criticism matters. Miller patiently and thoroughly undoes the damage done by those writers who attack critical rationalism by invoking the sterile mythology of induction and (...) justification that it seeks to sweep away. In addition his new material on the debate on verisimilitude is essential reading for all working in this field. (shrink)

This paper argues for a particular view about in what metaphysical equivalence consists: namely, that any two metaphysical theories are metaphysically equivalent if and only if those theories are strongly hyperintensionally equivalent. It is consistent with this characterisation that said theories are weakly hyperintensionally distinct, thus affording us the resources to model the content of propositional attitudes directed towards metaphysically equivalent theories in such a way that non-ideal agents can bear different propositional attitudes towards metaphysically equivalent theories.

The idea that our conscious decisions determine our actions has been challenged by a report suggesting that the brain starts to prepare for a movement before the person concerned has consciously decided to move . Libet et al. claimed that their results show that our actions are not consciously initiated. The current article describes two experiments in which we attempted to replicate Libet et al.'s comparison of participants' movement-related brain activity with the reported times of their decisions to move and (...) also the reported times of their decisions of which hand to move. We also looked at the distribution of participants' reports over time to evaluate an alternative explanation of Libet et al.'s results. Although the Readiness Potential was usually present before all of the decisions to move, consistent with the findings of Keller and Heckhausen and Libet et al. , we found that many reported decision times were before the onset of the Lateralized Readiness Potential, which measures hand-specific movement preparation. The latter finding is consistent with the conclusion that the LRP always started after the conscious decision to move. We conclude that even though activity related to movement anticipation may be present before a conscious decision to move, the cortical preparation necessary for the movement to happen immediately may not start until after the conscious decision to move. (shrink)

Gentzen’s sequent calculi LK and LJ are landmark proof systems. They identify the structural rules of weakening and contraction as notable inference rules, and they allow for an elegant statement and proof of both cut elimination and consistency for classical and intuitionistic logics. Among the undesirable features of those sequent calculi is that their inferences rules are low-level and frequently permute over each other. As a result, large-scale structures within sequent calculus proofs are hard to identify. In this paper, we (...) present a different approach to designing a sequent calculus for classical logic. Starting with Gentzen’s LK proof system, we examine the proof search meaning of his inference rules and classify those rules as involving either don’t care nondeterminism or don’t know nondeterminism. Based on that classification, we design the focused proof system LKF in which inference rules belong to one of two phases of proof construction depending on which flavor of nondeterminism they involve. We then prove that the cut rule and the general form of the initial rule are admissible in LKF. Finally, by showing that the inference rules for LK are all admissible in LKF, we can give a relative completeness proof for LKF provability with respect to LK provability. We shall also apply these properties of the LKF proof system to establish other meta-theoretic properties of classical logic, including Herbrand’s theorem. (shrink)

This paper depicts a case study of an organizational strategy for the promotion of ethical practice when introducing a new, high-risk, ethically-charged medical practice like Medical Assistance in Dying (MAiD). We describe the development of an interprofessional program that enables the delivery of high-quality, whole-person MAiD care that is values-based and sustainable. A “care ecology” strategy recognizes the interconnected web of relationships and structures necessary to support a quality experience of MAiD for patients, families, and clinicians. This program exemplifies a (...) care ecology approach that addresses common barriers to entry to MAiD practice, and also meets the needs of a variety of stakeholders through the creation of patient and family resources, team supports, standards of practice, professional development opportunities, organizational infrastructure, and community partnerships. We also describe how a thriving care ecology evolves to remain resilient, and to enable integration as the needs of the organization, team and program change over time. The design and development of this program may be adapted to other jurisdictions and organizations where MAiD is introduced, or where new patient populations become eligible for MAiD. This care ecology model may also be applicable to the creation of sustainable programs that provide other morally controversial or novel clinical services. (shrink)

Ethical guidelines for conducting clinical trials have historically been based on a perceived therapeutic obligation to treat and benefit the patient-participants. The origins of this ethical framework can be traced to the Hippocratic oath originally written to guide doctors in caring for their patients, where the overriding moral obligation of doctors is strictly to do what is best for the individual patient, irrespective of other social considerations. In contrast, although medicine focuses on the health of the person, public health is (...) concerned with the health of the entire population, and thus, public health ethics is founded on the societal responsibility to protect and promote the health of the population as a whole. From a public health perspective, research ethics should be guided by giving due consideration to the risks and benefits to society in addition to the individual research participants. On the basis of a duty to protect the population as a whole, a fiduciary obligation to realise the social value of the research and the moral responsibility to distribute the benefits and burdens of research fairly across society, how a public health perspective on research ethics results in fundamental re-assessments of the proper course of action for two salient topical issues in research ethics is shown: stopping trials early for reasons of efficacy and the conduct of research on less expensive yet less effective interventions. (shrink)

There is ample discussion of MBA self-serving values in the corporate social responsibility literature, and yet empirical studies regarding the corporate manifestations and consequences of those values are scant. In a comprehensive study of major US public corporations, we find that MBA CEOs are more apt than their non-MBA counterparts to engage in short-term strategic expedients such as positive earnings management and suppression of R&D, which in turn are followed by compromised firm market valuations.

In their important paper “Autonomous Agents”, Floridi and Sanders use “levels of abstraction” to argue that computers are or may soon be moral agents. In this paper we use the same levels of abstraction to illuminate differences between human moral agents and computers. In their paper, Floridi and Sanders contributed definitions of autonomy, moral accountability and responsibility, but they have not explored deeply some essential questions that need to be answered by computer scientists who design artificial agents. One such question (...) is, “Can an artificial agent that changes its own programming become so autonomous that the original designer is no longer responsible for the behavior of the artificial agent?” To explore this question, we distinguish between LoA1 (the user view) and LoA2 (the designer view) by exploring the concepts of unmodifiable, modifiable and fully modifiable tables that control artificial agents. We demonstrate that an agent with an unmodifiable table, when viewed at LoA2, distinguishes an artificial agent from a human one. This distinction supports our first counter-claim to Floridi and Sanders, namely, that such an agent is not a moral agent, and the designer bears full responsibility for its behavior. We also demonstrate that even if there is an artificial agent with a fully modifiable table capable of learning* and intentionality* that meets the conditions set by Floridi and Sanders for ascribing moral agency to an artificial agent, the designer retains strong moral responsibility. (shrink)

This paper defends a view that falls somewhere between the two extremes of inflationary and deflationary accounts of holes, and it does so by rejecting the initial conceptualisation of holes in terms of absences. Once we move away from this conception, I argue, we can see that there are no special metaphysical problems associated with holes. Rather, whatever one’s preferred metaphysics of paradigm material objects, that account can equally be applied to holes. This means that like the deflationist, I am (...) entity monist: I reject the idea that there are any immaterial beings. On the other hand, like the inflationist I reject the idea that we should identify holes with parts or surfaces of paradigm objects. Like the inflationist, I hold that there exist entities in roughly the regions of space-time where pre-theoretically we would say there exist holes, and those entities are holes. Call this latter part of the view—that where the folk are apt to claim there is a hole, that hole has roughly the dimensions that the folk attribute to it—hole-instinctivism (the view that our instincts about hole location/dimension are roughly right). Ultimately I embrace hole conventionalism, a view that includes commitment to both entity monism and hole-instinctivism. According to hole conventionalism, holes are no more ontologically problematic than statues, nor are they of a fundamentally different ontological kind from statues. (shrink)

We argued last year in this journal that extensive integration of research and care is a worthy goal of health system design, and we second the call from Ruth Faden and colleagues to move toward learning health care systems. As they recognize, learning health care systems demand the coordination of research and medical ethics—two sets of normative commitments that have long been considered distinct. In offering a novel ethics framework for such systems, Faden et al. advance the scholarly debate about (...) how best to do this and challenge us to think more deeply about its practical implications. However, we believe that at least three issues they raise require additional attention. First, the research‐care distinction has more normative bite than they are willing to concede. Second, the role for independent oversight requires clarification. Finally, they neglect the concept of stewardship as a guiding obligation of learning health care systems. (shrink)

COVID-19 vaccine research success and emergency use authorizations have shown the life sciences’ potential for positive health impact. But they also underscore potentially divergent and conf...

As software developers design artificial agents , they often have to wrestle with complex issues, issues that have philosophical and ethical importance. This paper addresses two key questions at the intersection of philosophy and technology: What is deception? And when is it permissible for the developer of a computer artifact to be deceptive in the artifact’s development? While exploring these questions from the perspective of a software developer, we examine the relationship of deception and trust. Are developers using deception to (...) gain our trust? Is trust generated through technological “enchantment” warranted? Next, we investigate more complex questions of how deception that involves AAs differs from deception that only involves humans. Finally, we analyze the role and responsibility of developers in trust situations that involve both humans and AAs. (shrink)

BackgroundThe U.S. Food and Drug Administration traditionally has kept confidential significant amounts of information relevant to the approval or non-approval of specific drugs, devices, and biologics and about the regulatory status of such medical products in FDA’s pipeline.ObjectiveTo develop practical recommendations for FDA to improve its transparency to the public that FDA could implement by rulemaking or other regulatory processes without further congressional authorization. These recommendations would build on the work of FDA’s Transparency Task Force in 2010.MethodsIn 2016-2017, we convened (...) a team of academic faculty from Harvard Medical School, Brigham and Women’s Hospital, Yale Medical School, Yale Law School, and Johns Hopkins Bloomberg School of Public Health to develop recommendations through an iterative process of reviewing FDA’s practices, considering the legal and policy constraints on FDA in expanding transparency, and obtaining insights from independent observers of FDA.ResultsThe team developed 18 specific recommendations for improving FDA’s transparency to the public. FDA could adopt all these recommendations without further congressional action.FundingThe development of the Blueprint for Transparency at the U.S. Food and Drug Administration was funded by the Laura and John Arnold Foundation. (shrink)

In this paper we examine the case of Tay, the Microsoft AI chatbot that was launched in March, 2016. After less than 24 hours, Microsoft shut down the experiment because the chatbot was generating tweets that were judged to be inappropriate since they included racist, sexist, and anti-Semitic language. We contend that the case of Tay illustrates a problem with the very nature of learning software that interacts directly with the public, and the developer's role and responsibility associated with it. (...) We make the case that when LS interacts directly with people or indirectly via social media, the developer has additional ethical responsibilities beyond those of standard software. There is an additional burden of care. (shrink)

The purpose of this study was to examine how elementary preservice teachers ( n = 35) experienced museums as potential sites for K-5 students to read museums using two lenses: to learn the history of the place in which they live and examine how museum authors craft texts to tell those stories. Along with exploring historical content, preservice teachers studied the museum as an informational text. Through this experience, preservice teachers discovered: 1) the five informational text structures museum authors used (...) to present information and 2) how museum authors conveyed contemporary and social issues using various forms of writing. Additionally, the museum experience provided a context in which the preservice teachers could engage in critical literacy practices. (shrink)

This study investigates the ethical climate types presented in the Korean tourism industry, the differences in the perceptions of these ethical climate types based on individual/organizational characteristics, and the influence of ethical climate types based on job satisfaction/organizational commitment. Empirical findings of this study identify six ethical climate types and demonstrate significant difference and significant influence of the proposed relationships. This research contributes to the existing body of academic work by using empirical data collected from 820 respondents across 14 companies (...) within the Korean tourism industry, to demonstrate the relationship between actual ethical climate types and ethical climate related factors. The findings of this study identify the new factor ‹moral caring,’ which describes an environment characterized by decisions that maximize collective interest, but based on an individual employee’s personal values and ethics. Such a factor has important implications for the service industry, where face-to-face encounters typify the relationship between employee and consumer. (shrink)

Traditionally, those writing on blame have been concerned with blaming others, including when one has the standing to blame others. Yet some alleged problems for such accounts of standing arise when we focus on self-blame. First, if hypocrites lack the standing to blame others, it might seem that they also lack the standing to blame themselves. But this would lead to a bootstrapping problem, wherein hypocrites can only regain standing by doing that which they lack the standing to do. Second, (...) in addition to hypocrites, there may be hypercrites, who blame themselves more severely than others. Leading accounts for why hypocrites lack standing to blame others would also seem to imply that hypercrites lack the standing to blame others, but some may find this counterintuitive. We argue that neither of these problems from self-blame poses a unique threat to leading accounts of standing. (shrink)

Mood disorders, including major depressive disorder and bipolar disorder, are highly prevalent, frequently disabling, and sometimes deadly. Additional research and more effective medications are desperately needed, but clinical trials research in mood disorders is fraught with ethical issues. Although many authors have discussed these issues, most do so from a theoretical viewpoint. This manuscript uses available empirical data to inform a discussion of the primary ethical issues raised in mood disorders research. These include issues of consent and decision-making capacity, including (...) patients’ motivations for participating in research. We also address drug withdrawals, placebo controls, and the overall safety of research. Finally, we examine the extant literature for studies discussing potential indirect benefits of clinical trials research to participants. Taken together, the evidence suggests that clinical trials research incorporating drug withdrawals and placebo controls can be conducted safely and ethically, even in patients with severe or treatment-resistant mood disorders. In fact, given the dearth of effective treatment options for this population, it is our opinion that a moral imperative exists to extend the offer of research participation to severely ill or treatment-resistant groups. (shrink)

_ Source: _Page Count 28 This paper develops four proposals for explicating the notion of an ersatz part. It then evaluates each proposal with respect to a number of jobs for which ersatz parts are posited. We argue that each of the four notions of ersatz parthood do better with respect to some jobs, and worse with respect to others. Thus, we think, it’s horses for courses: which notion of ersatz part one chooses will be sensitive to which metaphysical project (...) one is pursuing. (shrink)

Over the past 5 years, a series of articles in leading American newspapers has revealed the extent to which the conduct of clinical trials may be affected by inducements offered by corporate research sponsors and accepted by some unscrupulous physicians. The cases described were disturbing. They involved physicians engaged in excessive “enrollment activities” in exchange for money. Some of these physicians perpetrated fraud, falsifying their recruitment records in order to increase their profits. Others ignored exclusion criteria designed to ensure the (...) safety of subjects and the validity of research results, referring their patients to research investigating treatments for conditions from which they did not suffer. One of the articles reports that physicians focusing exclusively on commercial research regularly divulge annual incomes upwards of $1,000,000 with profits in excess of $300,000. Two physicians accumulated well over $10,000,000 through clinical trials activities in less than a decade. (shrink)

, from Stanford Encyclopaedia of Philosophy.

:In this article, we present an educational intervention that embeds ethics education within research laboratories. This structure is designed to assist students in addressing ethical challenges in a more informed way, and to improve the overall ethical culture of research environments. The project seeks to identify factors that students and researchers consider relevant to ethical conduct in science, technology, engineering, and math and to promote the cultivation of an ethical culture in experimental laboratories by integrating research stakeholders in a bottom-up (...) approach to developing context-specific, ethics-based guidelines. An important assumption behind this approach is that direct involvement in the process of developing laboratory specific ethical guidelines will positively influence researchers’ understanding of ethical research and practice issues, their handling of these issues, and the promotion of an ethical culture in the respective laboratory. The active involvement may increase the sense of ownership and integration of further discussion on these important topics. Based on the project experiences, the project team seeks to develop a module involving the bottom-up building of codes-of-ethics-based guidelines that can be used by a broad range of institutions and that will be distributed widely. (shrink)

The development of photodynamic therapy and anti-vascular endothelial growth factor agents have revolutionized the treatment of retinal diseases, transforming the retina subspecialty by ushering in an age of pharmacological treatments for a wide range of diseases, including age-related macular degeneration.

A letter to the editor from Howard Brody, David Buchanan, and Franklin G. Miller in response to the recent article by Erik Malmqvist Understanding Exploitation," March-April 2011).

Over the past 5 years, a series of articles in leading American newspapers has revealed the extent to which the conduct of clinical trials may be affected by inducements offered by corporate research sponsors and accepted by some unscrupulous physicians. The cases described were disturbing. They involved physicians engaged in excessive “enrollment activities” in exchange for money. Some of these physicians perpetrated fraud, falsifying their recruitment records in order to increase their profits. Others ignored exclusion criteria designed to ensure the (...) safety of subjects and the validity of research results, referring their patients to research investigating treatments for conditions from which they did not suffer. One of the articles reports that physicians focusing exclusively on commercial research regularly divulge annual incomes upwards of $1,000,000 with profits in excess of $300,000. Two physicians accumulated well over $10,000,000 through clinical trials activities in less than a decade. (shrink)

In this book Fox and Miller define public administration theory and public management doctrine as an orthodoxy that is intellectually bankrupt and democratically unacceptable. Constitutionalism and communitarianism get similar treatment. Next, the authors construct a new theoretical position defined as constructivism and based on critical theory, phenomenology and structuration theory.

In this paper we describe the objectives of teaching medical ethics to undergraduates and the teaching methods used. We describe a workshop used in the University of Liverpool Department of Psychiatry, designed to enhance ethical sensitivity in psychiatry. The workshop reviews significant historical and current errors in the ethical practice of psychiatry and doctors' defence mechanisms against accepting responsibility for deficiencies in ethical practice. The workshop explores the student doctors' own group ethos in response to ethical dilemmas, and demonstrates how (...) the individual contributes to and is responsible for the group ethos through participation and also through nonparticipation. The student feedback about the workshop is reviewed. The Toronto Ethical Sensitivity Instrument was used to assess whether or not the workshop altered sensitivity. Compared to a control group the attenders' sensitivity was significantly increased (on Student's t-test p equals or is less than 0.002). (shrink)

A twenty‐person working group convened to discuss the ethical and policy considerations of the controversial intervention called “growth attenuation,” and if possible to develop practical guidance for health professionals. A consensus proved elusive, but most of the members did reach a compromise.