Evidence-based medicine (EBM), by its ability to decrease irrational variations in health care, was expected to improve healthcare quality and outcomes. The utility of EBM principles evolved from individual clinical decision-making to wider foundational clinical practice guideline applications, cost containment measures, and clinical quality performance measures. At this evolutionary juncture one can ask the following questions. Given the time-limited exigencies of daily clinical practice, is it tenable for clinicians to follow guidelines? Whose or what interests are served by applying performance (...) assessments? Does such application improve medical care quality? What happens when the best interests of vested parties conflict? Mindful of the constellation of socially and clinically relevant variables influencing health outcomes, is it fair to apply evidence-based performance assessment tools to judge the merits of clinical decision-making? Finally, is it fair and just to incentivize clinicians in ways that might sway clinical judgment? To address these questions, we consider various clinical applications of performance assessment strategies, examining what performance measures purport to measure, how they are measured and whether such applications demonstrably improve quality. With attention to the merits and frailties associated with such applications, we devise and defend criteria that distinguish between justice-sustaining and justice-threatening performance-based clinical protocols. (shrink)

Do terminally ill patients who have exhausted all other available, government-approved treatment options have a constitutional right to experimental treatment that may prolong their lives? On May 2, 2006, a divided panel of the U.S. Court of Appeals for the District of Columbia, in a startling opinion, Abigail Alliance for Better Access to Developmental Drugs v. Von Eschenbach, held “Yes.” The plaintiffs, Abigail Alliance for Better Access to Developmental Drugs and Washington Legal Foundation, sought to enjoin the Food and Drug (...) Administration from refusing to allow the sale of investigational new drugs that had not yet received FDA approval. The terminally ill plaintiffs contended that they quite literally could not wait that long for the drugs. With no other treatment options available, the plaintiffs urged the court to recognize a fundamental, constitutional right to take potentially life-saving or life-prolonging drugs, even though the treatment had not been fully tested through human trials for safety and effectiveness and could not be legally marketed to the public. (shrink)

On May 2, 2006, a divided panel of the U.S. Court of Appeals for the District of Columbia, in a startling opinion, Abigail Alliance for Better Access to Developmental Drugs v. Eschenbach, held that terminally ill patients who have exhausted all other available options have a constitutional right to experimental treatment that FDA has not yet approved. Although ultimately overturned by the full court, Abigail Alliance generated considerable interest from various constituencies. Meanwhile, FDA proposed similar regulatory amendments, as have lawmakers (...) on both sides of the aisle in Congress. But proponents of expanded access fail to consider public health and consumer safety concerns. In particular, allowing patients to try unproven treatments, outside of controlled clinical trials risks both the study's outcome and the health of patients who might benefit from the deliberate, careful process of new drug approval as it currently operates under FDA's auspices. (shrink)

Snap‐shots of live theatre: the use of photography to research governance in operating room nursing The use of photography is an underreported method of research in the nursing literature. This paper explores its use in an ethnographic research project, the fieldwork of which was undertaken by the first author. The aim was to examine the governance of operating room nursing in the clinical setting and the theoretical orientation was the work of Michel Foucault. The focus of this paper is on (...) how photography was used as a means of data generation. To establish some context we begin by drawing on writers from sociology and anthropology to provide an overview of the status of vision and visual research methods in contemporary social research. We then move to a brief discussion of the uses of photography in social research and the limitations imposed by ethical considerations of its use in clinical nursing settings. As well, the process and approach involved in this research project, and issues of analysis are discussed. Three ‘snap‐shots’ of operating room nursing, taken by participants, are presented. Each is analysed in terms of its contributions to the research process as well as its substantive contribution to the theoretical framework and the research aims. (shrink)

The Patient Protection and Affordable Care Act represents the most significant reform of the United States health care system in decades. ACA also substantially amplifies the federal role in health care regulation. Among other provisions, ACA expands government health care programs, imposes detailed federal standards for commercial health insurance policies, creates national requirements on employers and individuals, and enlists state administrative capacity to implement various federal reforms. In response, a persistent voice in the protracted, contentious debate surrounding ACA was, and (...) continues to be, resistance from states. The rhetoric of federalism — states’ rights, reserved powers, state sovereignty, limited government, and local diversity — resonates deeply even around provisions of ACA that do not specifically implicate state interests. For example, the loudest and most persistent state objections target the new mandate that individuals maintain health insurance, a requirement imposed by ACA and enforced through federal tax penalties. (shrink)

The Patient Protection and Affordable Care Act represents the most significant reform of the United States health care system in decades. ACA also substantially amplifies the federal role in health care regulation. Among other provisions, ACA expands government health care programs, imposes detailed federal standards for commercial health insurance policies, creates national requirements on employers and individuals, and enlists state administrative capacity to implement various federal reforms. In response, a persistent voice in the protracted, contentious debate surrounding ACA was, and (...) continues to be, resistance from states. The rhetoric of federalism — states’ rights, reserved powers, state sovereignty, limited government, and local diversity — resonates deeply even around provisions of ACA that do not specifically implicate state interests. For example, the loudest and most persistent state objections target the new mandate that individuals maintain health insurance, a requirement imposed by ACA and enforced through federal tax penalties. (shrink)

In long Midwestern winters, two things are certain: snow and basketball. But two things that you cannot count on are snow day school closures and a home-team collegiate basketball championship. In Kansas last winter, we had both. Winter precipitation was much above average, resulting in a rare invocation of the University's inclement weather policy to cancel classes in early February. And the Kansas Jayhawks basketball team brought home the National Collegiate Athletic Association championship trophy for the first time in two (...) decades. The Chancellor commemorated the achievement with a campuswide celebration, including all-day class cancellation. This is all well and good. I am all for respecting Mother Nature's forces and celebrating remarkable athletic accomplishments.But the combination of events does leave law professors nearing the end of the semester in a bit of a quandary. How to make up the cancelled classes to ensure compliance with American Bar Association accreditation instructional hours requirements? How to cover the missed course content? How to find mutually agreeable make-up class times and locations with a group of busy, upper-level law students? (shrink)

In long Midwestern winters, two things are certain: snow and basketball. But two things that you cannot count on are snow day school closures and a home-team collegiate basketball championship. In Kansas last winter, we had both. Winter precipitation was much above average, resulting in a rare invocation of the University's inclement weather policy to cancel classes in early February. And the Kansas Jayhawks basketball team brought home the National Collegiate Athletic Association championship trophy for the first time in two (...) decades. The Chancellor commemorated the achievement with a campuswide celebration, including all-day class cancellation. This is all well and good. I am all for respecting Mother Nature's forces and celebrating remarkable athletic accomplishments.But the combination of events does leave law professors nearing the end of the semester in a bit of a quandary. How to make up the cancelled classes to ensure compliance with American Bar Association accreditation instructional hours requirements? How to cover the missed course content? How to find mutually agreeable make-up class times and locations with a group of busy, upper-level law students? (shrink)

Suicide among Veterans experiencing or at risk for homelessness remains a significant public health concern. Conducting research to understand and meet the needs of this at-risk population remains challenging due to myriad factors. To address this challenge, the United States Department of Veterans Affairs convened the Health Services Research and Development Suicide Prevention in Veterans Experiencing Homelessness: Research and Practice Development meeting, bringing together subject-matter experts in the fields of homelessness and suicide prevention, both from within and outside of VA. (...) During the meeting, attendees identified 10 potential research priorities at the intersection of suicide prevention and homelessness. After the meeting, Delphi methodology was used to achieve consensus on the relative importance of the identified research domains. Through this iterative Delphi process, agreement was reached regarding the need to increase understanding of barriers and facilitators to suicide risk assessment and emergency intervention for Veterans experiencing homelessness by examining the perspectives of both Veterans and healthcare providers. Elucidating the complex relationships between risk periods, subgroups, suicide means, and drivers of suicide among Veterans experiencing homelessness was also considered a top priority. This article documents the Delphi process and provides a research agenda for researchers, funding agencies, and policymakers to prioritize the most relevant and potentially impactful research domains aimed at preventing suicide among Veterans experiencing or at risk for homelessness. (shrink)

Scholars explore from many fresh angles the interweavings of two of the richest strands of human culture-music and esotericism-with examples from the medieval period to the modern age. Music and esotericism are two responses to the intuition that the world holds hidden order, beauty, and power. Those who compose, perform, and listen to music have often noted that music can be a bridge between sensory and transcendent realms. Such renowned writers as Boethius expanded the definition of music to encompass not (...) only sounded music but also the harmonic fabric of human and cosmic life. Those who engage in pursuits called "esoteric," from ancient astrology, magic, and alchemy to recent and more novel forms of spirituality, have also remarked on the relevance of music to their quests. Esotericists have composed music in order to convey esoteric meaning, performed music to create esoteric influences, and listened to music to raise their esoteric awareness. The academic study of esotericism is a young field, and few researchers have probed the rich interface between the musical and esoteric domains. In Explorations in Music and Esotericism, scholars from numerous fields introduce the history of esotericism and current debates about its definition and extent. The book's sixteen chapters present rich instances of connections between music and esotericism, organized with reference to four aspects of esotericism: as a form of thought; as the keeping and revealing of secrets; as an identity; and as a signifier. Edited by Marjorie Roth and Leonard George. Contributors: Elizabeth Abbate, Malachai Komanoff Bandy, Adam Bregman, Charles E. Brewer, Benjamin Dobbs, Anna Gawboy, Pasquale Giaquinto, Adam Knight Gilbert, Joscelyn Godwin, Virginia Christy Lamothe, Andrew Owen, Christopher Scheer, Codee Ann Spinner, Woodrow Steinken, and Daphne Tan. (shrink)

If the world itself is metaphysically indeterminate in a specified respect, what follows? In this paper, we develop a theory of metaphysical indeterminacy answering this question.

Trait Selective Abortions (TSA) have come under critique as a medical practice that presents potential disabled infants as burdens and lacking the potential for meaningful lives. This paper, using the author’s background as a disabled person, contends that the philosophy underpinning TSAs reflects liberal society’s lack of a theory of needs. The author argues for a care ethics based approach informed by disability analyses to engage with TSAs.

Classic analysis of the subject and the development of personal probability; one of the greatest controversies in modern statistcal thought.

Since Mueller’s 1958 article calling Hegelian dialectics a “legend,” it has been fashionable to deny that Hegel used thesis-antithesis-synthesis dialectics. But in truth, Hegel’s Phenomenology of Spirit has 28 dialectics hidden on four outline levels, and The Philosophy of History has 10 more on three outline levels. In Phenomenology’s macrodialectic, Hegel’s nonsupernatural Spirit–all reality, everything in the universe, including man and artificial objects–advances from unconscious + union (thesis) to conscious + separation (antithesis) to a synthesis of conscious (from the antithesis) (...) + union (from the thesis). Previous interpretations of Phenomenology have missed this dialectic: they have assumed that Spirit’s journey begins with consciousness, whereas the journey actually begins in the primordial state of nature, before man arrives and provides Spirit with its Mind (the collective mind of man). Mind then misperceives itself as a multitude of separate alien “objects”–things other than itself. The macrodialectic and all other dialectics are based on Christianity’s Johannine separation-and-return mythology; all Hegelian dialectics separate from a concept in the thesis, going to that something’s opposite (antithesis), and then return to the thesis concept. Thus, in Hegel’s master-and-slave dialectic (God = master, man = slave), man advances from potential + freedom to actual + bondage (religiosity) to actual + freedom (atheism). Only Marx and Tillich understood Hegelian dialectics. Marx’s basic dialectic (one of four) saw history separating from and returning to Communism, going from communal ownership + poverty (primitive communism, or gens) to private ownership + wealth (slavery, feudalism, capitalism) to communal ownership + wealth (final communism). Tillich’s basic dialectic (one of many) separates from and returns to God, advancing from Yes to God + Yes to supernaturalism (theism) to No to God + No to supernaturalism (atheism) to Yes to God + No to supernaturalism (humanism: humanity is the nonsupernatural “God above the God of theism”). (shrink)

Human Dignity The mercurial concept of human dignity features in ethical, legal, and political discourse as a foundational commitment to human value or human status. The source of that value, or the nature of that status, are contested. The normative implications of the concept are also contested, and there are two partially, or even wholly, … Continue reading Human Dignity →.

Focuses on the encounters of feminist and queer theories, on the ways in which basic terms such as - sex, gender, and sexuality change meaning as they move from one body of theory to another. This book includes essays by Judith Butler, Evelynn Hammonds, Biddy Martin, Kim Michasiw, Carole-Anne Tyler, and Elizabeth Weed.

The author offers perspectives that can assist healthcare managers in achieving the highest ethical standards as they face their roles as healthcare providers, employers, and community service organizations. He also examines how to comply with relevant laws and regulations, provide high quality patient care with limited resources, and more.

Introduction: human rights in healthcare -- A right to treatment? the allocation of resouces in the National Health Service -- Ensuring quality healthcare: an issue of rights or duties? -- Autonomy and consent in medical treatment -- Treating incompetent patients: beneficence, welfare and rights -- Medical confidentiality and the right to privacy -- Property right in the body -- Medically assisted conception and a right to reproduce? -- Termination of pregnancy: a conflict of rights -- Pregnancy and freedom of choice (...) -- The right to life at the end of life -- The law and ethics of assisted dying: is there a right to die? (shrink)

According to an orthodox view, the capacity for conscious experience (sentience) is relevant to the distribution of moral status and value. However, physicalism about consciousness might threaten the normative relevance of sentience. According to the indeterminacy argument, sentience is metaphysically indeterminate while indeterminacy of sentience is incompatible with its normative relevance. According to the introspective argument (by François Kammerer), the unreliability of our conscious introspection undercuts the justification for belief in the normative relevance of consciousness. I defend the normative relevance (...) of sentience against these objections. First, I demonstrate that physicalists only have to concede a limited amount of indeterminacy of sentience. This moderate indeterminacy is in harmony with the role of sentience in determining moral status. Second, I argue that physicalism gives us no reason to expect that introspection is unreliable with respect to the normative relevance of consciousness. (shrink)

Proposals to release genetically engineered organisms in the wild raise complex ethical issues related to their safe and equitable implementation. While there is broad agreement that community and public engagement is vital to decision‐making in this context, more discussion is needed about who should be engaged in such activities and in what ways. This article identifies Indigenous peoples as key stakeholders in decisions about gene‐editing in the wild and argues that engagement activities need not only include Indigenous peoples but also (...) be designed, conducted, and analyzed in ways that confront longstanding power imbalances that dismiss Indigenous expertise. We offer specific recommendations to guide deliberative activities to not only be inclusive of Indigenous peoples but also to empower their diverse, situated knowledges. We call on those committed to the inclusive design of broad public deliberation to pursue strategies that shift dominant power dynamics to include Indigenous communities in more meaningful ways. (shrink)

Geoffrey Scarre has recently argued that the version of qualitative hedonism which I attribute to Mill is unsatisfactory for various reasons. In his view, even if it is formally compatible with value monism, involves non-hedonistic elements and offers an implausible account of the relationship between and pleasures. In this paper, I show that his objections, which are similar in spirit to those pressed earlier by Bradley, Moore and others against Mill, are unfounded where not confused. The Mill/Riley line does (...) not rely on non-hedonistic standards and has sufficient flexibility to account for many different kinds of pleasures and pleasing activities. It remains a coherent version of qualitative hedonism, worthy of further consideration and study. (shrink)

Analyzes the meaning expressed in music, the social and psychological sources of meaning, and the methods of musical communication This is a book meant for ...

Many researchers and intellectuals warn about extreme risks from artificial intelligence. However, these warnings typically came without systematic arguments in support. This paper provides an argument that AI will lead to the permanent disempowerment of humanity, e.g. human extinction, by 2100. It rests on four substantive premises which it motivates and defends: first, the speed of advances in AI capability, as well as the capability level current systems have already reached, suggest that it is practically possible to build AI systems (...) capable of disempowering humanity by 2100. Second, due to incentives and coordination problems, if it is possible to build such AI, it will be built. Third, since it appears to be a hard technical problem to build AI which is aligned with the goals of its designers, and many actors might build powerful AI, misaligned powerful AI will be built. Fourth, because disempowering humanity is useful for a large range of misaligned goals, such AI will try to disempower humanity. If AI is capable of disempowering humanity and tries to disempower humanity by 2100, then humanity will be disempowered by 2100. This conclusion has immense moral and prudential significance. (shrink)

John Gray, much influenced by Isaiah Berlin and building on work by the late John Rees and the late Fred Berger, has recently stated three ‘fatal’ objections which virtually all analysts seem to find persuasive against John Stuart Mill's classic doctrine of liberty. First, Gray thinks it ‘an obvious objection to Mill's project that conceptions of harm vary with competing moral outlooks, so that no Principle of Liberty whose application turns on judgements about harm can expect to resolve disputes between (...) exponents of opposed moral perspectives’. Even if we overlook Mill's strange silence in the matter and supply him with a reasonable definition of harm, it remains clear that the liberty principle ‘is not, and cannot be, the very simple principle Mill sought’. For ‘Mill's principle is in its very nature radically incomplete. It tells us what we may not do, but not what we ought to do.’ To know when liberty should in fact be restrained, ‘we must look to other principles—chiefly the Principle of Utility itself’. But if general utility alone can ‘tell us how much liberty may be given up for how much harm-prevention’, then ‘there can be no question of adherence to [an] exceptionless principle such as Mill's Principle of Liberty’. Thus, even if we believe that Mill's version of utilitarianism is coherent, his judgements about the regulation of conduct must depend on a highly complex and controversial moral doctrine. (shrink)

Presents an historical analysis of social contract theory by considering the works of prominent philosophers.

Which artificial intelligence (AI) systems are agents? To answer this question, I propose a multidimensional account of agency. According to this account, a system's agency profile is jointly determined by its level of goal-directedness and autonomy as well as is abilities for directly impacting the surrounding world, long-term planning and acting for reasons. Rooted in extant theories of agency, this account enables fine-grained, nuanced comparative characterizations of artificial agency. I show that this account has multiple important virtues and is more (...) informative than alternatives. More speculatively, it may help to illuminate two important emerging questions in AI ethics: 1. Can agency contribute to the moral status of non-human beings, and how? 2. When and why might AI systems exhibit power-seeking behaviour and does this pose an existential risk to humanity? (shrink)

The science of animal consciousness investigates (i) which animal species are conscious (the distribution question) and (ii) how conscious experience differs in detail between species (the quality question). We propose a framework which clearly distinguishes both questions and tackles both of them. This two-tier account distinguishes consciousness along ten dimensions and suggests cognitive capacities which serve as distinct operationalizations for each dimension. The two-tier account achieves three valuable aims: First, it separates strong and weak indicators of the presence of consciousness. (...) Second, these indicators include not only different specific contents but also differences in the way particular contents are processed (by processes of learning, reasoning or abstraction). Third, evidence of consciousness from each dimension can be combined to derive the distinctive multi-dimensional consciousness profile of various species. Thus, the two-tier account shows how the kind of conscious experience of different species can be systematically compared. (shrink)

Abstract“Force dynamics” refers to a previously neglected semantic category—how entities interact with respect to force. This category includes such concepts as: the exertion of force, resistance to such exertion and the overcoming of such resistance, blockage of a force and the removal of such blockage, and so forth. Force dynamics is a generalization over the traditional linguistic notion of “causative”: it analyzes “causing” into finer primitives and sets it naturally within a framework that also includes “letting,”“hindering,”“helping,” and still further notions. (...) Force dynamics, moreover, appears to be the semantic category that uniquely characterizes the grammatical category of modals, in both their basic and epistemic usages. In addition, on the basis of force dynamic parameters, numerous lexical items fall into systematic semantic patterns, and there exhibit parallelisms between physical and psychosocial reference. Further, from research on the relation of semantic structure to general cognitive structure, it appears that the concepts of force interaction that are encoded within language closely parallel concepts that appear both in early science and in naive physics and psychology. Overall, force dynamics thus emerges as a fundamental notional system that structures conceptual material pertaining to force interaction in a common way across a linguistic range: the physical, psychological, social, inferential, discourse, and mental-model domains of reference and conception. (shrink)

Explores the continuities and discontinuities in the work of Henri Bergson and Gilles Deleuze.

In this paper we outline the activities of young girls in a Toba community of northern Argentina and examine the effect of girl helpers on time allocation of nursing women. Activity budgets were obtained for 41 girls aged 3 to 15 using spot observations. Girls spent substantial portions of observations engaged in helping behaviors. Individual values varied with age, anthropometric characteristics, and birth order. Activity budgets of 21 nursing women were obtained through focal observation sessions. Women living in households with (...) girls aged 7 to 15 allocated 17% less time to domestic work and 9% more time to socializing during afternoon observation sessions. For nursing women in this community, direct childcare (provided by the infant’s own mother) seemed to be a priority. Living with a girl helper did not have any measurable effect on the frequency or duration of nursing, or on the time that women spent caring for their infants. Based on these findings, hypotheses are outlined for future work on the effect of girl helpers on women’s fertility. (shrink)

The Postlude, written for this edition, looks back at the predictions made more than twenty-five years ago and speculates about what the coming decades may hold ...

This thesis is about making decisions when we are uncertain about what will happen, how valuable it will be, and even how to make decisions. Even the most sure-footed amongst us are sometimes uncertain about all three, but surprisingly little attention has been given to the latter two. The three essays that constitute my thesis hope to do a small part in rectifying this problem. The first essay is about the value of finding out how to make decisions. Society spends (...) considerable resources funding people (like me) to research decision-making, so it is natural to wonder whether society is getting a good deal. This question is so shockingly underresearched that bedrock facts are readily discoverable, such as when this kind of information is valuable. My second essay concerns whether we can compare value when we are uncertain about value. Many people are in fact uncertain about value, and how we deal with this uncertainty hinges on these comparisons. I argue that value comparisons are only sometimes possible; I call this weak comparability. This essay is largely a synthesis of the literature, but I also present an argument which begins with a peculiar view of the self: it is as if each of us is a crowd of different people separated by time (but connected by continuity of experience). I’m not the first to endorse this peculiar view of the self, but I am the first to show how it supports the benign view that value is sometimes comparable. We may be uncertain of any decision rules, even those that would tell us how to act when we face uncertainty in decision rules. We may be uncertain of how to decide how to decide how to... And so on. If so, we might have to accept infinitely many decision rules just to make any mundane decision, such as whether to pick up a five-cent piece from the gutter. My third essay addresses this problem of regress. I think all of our decisions are forced: we must decide now or continue to deliberate. Surprisingly, this allows us to avoid the original problem. I call this solution “when forced, do your best”. (shrink)