Rare diseases, defined as having a prevalence inferior to 1/2000, are poorly understood scientifically and medically. Appropriate diagnoses and treatments are scarce, adding to the burden of living with chronic medical conditions. The moral significance of rare disease experiences is often overlooked in qualitative studies conducted with adults living with rare diseases. The concept of morally problematic situations arising from pragmatist ethics shows promise in understanding these experiences. The objectives of this study were to (1) acquire an in-depth understanding of (...) morally problematic situations experienced by adults living with rare diseases in the province of Québec and (2) to develop an integrative model of the concept of morally problematic situations. To this end, an online survey targeting this population was developed through a participatory action research project. Respondents provided 90 long testimonies on the most important morally problematic situations they faced, often in healthcare settings. An integrative model was developed based on various qualitative analyses of these testimonies and relevant literature. The integrative model showcases that morally problematic situations have causes (i.e., contextual and relational factors, personal factors, jeopardized valuations), have affective repercussions (i.e., emotions and feelings, internal tensions), prompt action (i.e., through empowerment strategies leading to the evolution of situations), and elicit outcomes (i.e., factual consequences, residual emotions and feelings, positive or negative resolutions). In sum, this study advances understanding of the moral experiences of adults living with rare diseases while proposing a comprehensive conceptual tool to guide future empirical bioethics research on moral experiences. (shrink)

Integrating large language models (LLMs) like GPT-4 into medical ethics is a novel concept, and understanding the effectiveness of these models in aiding ethicists with decision-making can have significant implications for the healthcare sector. Thus, the objective of this study was to evaluate the performance of GPT-4 in responding to complex medical ethical vignettes and to gauge its utility and limitations for aiding medical ethicists. Using a mixed-methods, cross-sectional survey approach, a panel of six ethicists assessed LLM-generated responses to eight (...) ethical vignettes. The main outcomes measured were relevance, reasoning, depth, technical and non-technical clarity, as well as acceptability of GPT-4’s responses. The readability of the responses was also assessed. Of the six metrics evaluating the effectiveness of GPT-4’s responses, the overall mean score was 4.1/5. GPT-4 was rated highest in providing technical (4.7/5) and non-technical clarity (4.4/5), whereas the lowest rated metrics were depth (3.8/5) and acceptability (3.8/5). There was poor-to-moderate inter-rater reliability characterised by an intraclass coefficient of 0.54 (95% CI: 0.30 to 0.71). Based on panellist feedback, GPT-4 was able to identify and articulate key ethical issues but struggled to appreciate the nuanced aspects of ethical dilemmas and misapplied certain moral principles. This study reveals limitations in the ability of GPT-4 to appreciate the depth and nuanced acceptability of real-world ethical dilemmas, particularly those that require a thorough understanding of relational complexities and context-specific values. Ongoing evaluation of LLM capabilities within medical ethics remains paramount, and further refinement is needed before it can be used effectively in clinical settings. (shrink)

Background Rare diseases are generally poorly understood from scientific and medical standpoints due, to their complexity and low prevalence. As a result, individuals living with rare diseases struggle to obtain timely diagnoses and suitable care. These clinical difficulties add to the physical and psychological impacts of living with chronic and often severe medical conditions. From the standpoint of pragmatist ethics, the morally problematic situations that adults living with rare diseases experience matter crucially. However, there is little known about these experiences.Methods (...) A survey study was conducted with 121 adults living with rare diseases in Québec, Canada, to identify morally problematic situations encountered in the healthcare system and everyday life as part of a participatory action research project. Morally problematic situations elicited internal tensions and constraints to agency.Results Adults living with rare diseases experienced morally problematic situations of stigmatization, disbelief, and sometimes abuse in the healthcare system. These situations were compounded by diagnostic delays, inadequate care, and suboptimal follow-up, and led some individuals to opt-out of medical care. In their personal lives, these individuals sometimes found themselves in situations of physical and financial dependency. They often also had to give up professional occupations, academic training, or life projects.Conclusions Adults living with rare diseases experience important morally problematic situations navigating the healthcare system and their everyday lives, some of which could be alleviated through interventions developed through future participatory action research. (shrink)

Our ability to locate moral responsibility is often thought to be a necessary condition for conducting morally permissible medical practice, engaging in a just war, and other high-stakes endeavors. Yet, with increasing reliance upon artificially intelligent systems, we may be facing a wideningresponsibility gap, which, some argue, cannot be bridged by traditional concepts of responsibility. How then, if at all, can we make use of crucial emerging technologies? According to Colin Allen and Wendell Wallach, the advent of so-called ‘artificial moral (...) agents’ (AMAs) is inevitable. Still, this notion may seem to push back the problem, leaving those who have an interest in developing autonomous technology with a dilemma. We may need to scale-back our efforts at deploying AMAs (or at least maintain human oversight); otherwise, we must rapidly and drastically update our moral and legal norms in a way that ensures responsibility for potentially avoidable harms. This paper invokes contemporary accounts of responsibility in order to show how artificially intelligent systems might be held responsible. Although many theorists are concerned enough to develop artificial conceptions ofagencyor to exploit our present inability to regulate valuable innovations, the proposal here highlights the importance of—and outlines a plausible foundation for—a workable notion ofartificial moral responsibility. (shrink)

In this book Daniel Wegner offers a novel understanding of the relation of consciousness, the will, and our intentional and voluntary actions. Wegner claims that our experience and common sense view according to which we can influence our behavior roughly the way we experience that we do it is an illusion.

We propose a new interpretation of the equation E=mc² in special relativity by generalizing ideas of ontological emergence to fundamental physics. This allows us to propose that mass, as a property, can be considered to emerge from energy, using a well-known definition of weak ontological emergence. Einstein’s famous equation gains in this way a clearer philosophical interpretation, one that avoids the problems of previous attempts, and is fully consistent with the kinematic properties of special relativity, while yielding fresh insights concerning (...) the nature of mass. (shrink)

We often think about the alternatives to a decision that has been made. Thinking in this way is known as counterfactual thinking, that is, thinking about what could have been had an alternative dec...

Supporters of open borders sometimes argue that the state has no pro tanto right to restrict immigration, because such a right would also entail a right to exclude existing citizens for whatever reasons justify excluding immigrants. These arguments can be defeated by suggesting that people have a right to stay put. I present a new form of the exclusion argument against closed borders which escapes this “right to stay put” reply. I do this by describing a kind of exclusion that (...) has not been discussed in depth, which I call “territorial exclusion.” Territorial exclusion is the process according to which the group that wishes to exclude current citizens secedes from the territory in which those citizens reside. I argue that the wrongness of territorial exclusion explains why there is no pro tanto right for a state to exclude immigrants, because otherwise there would be a pro tanto right for the state to kick people out by seceding from the territory they inhabit. Because kicking people out like this is typically wrong, borders cannot be closed. (shrink)

I defend the cosmopolitan instrumentalist theory of secession, according to which a group has a right to secede only if this would promote cosmopolitan justice. I argue that the theory is preferable to other theories of secession because it is an entailment of cosmopolitanism, which is independently attractive, and because, unlike other theories of secession, it allows us to give the answers we want to give in cases like secession of the rich or secession that would make things worse for (...) minorities. I defend the view against the objections that it allows for colonialism and annexation, that it is not a distinct theory, and that it is impractical. (shrink)

Wittgenstein famously remarks that ‘the meaning of a word is its use’ (PI §43). Whether or not one views this as gesturing at a ‘theory’ of meaning, or instead as aiming primarily at dissuading us from certain misconceptions of language that are a source of puzzlement, it is clear that Wittgenstein held that for certain purposes the meaning of an expression could profitably be characterised as its use. Throughout his later writings, however, Wittgenstein’s appeal to the notion of use pulls (...) in two directions. In several places, Wittgenstein seems to connect the notion of an expression’s meaning with that of use in the sense of usage or practice. More specifically, he suggests that for an expression to possess meaning is for there to be a practice of employing it according to certain rules. ‘That’, he tells us, ‘is why there exists a correspondence between the concepts “rule” and “meaning”’ (OC §62; cf. PG 68; PO 51; RFM VI §28; VW 103). Indeed, Wittgenstein goes so far as to say, ‘The rule-governed nature of our languages permeates our life’ (RC §303). Call the view that the meaning of an expression is determined by a general principle governing its use, rulism. (shrink)

Majority rule is often regarded as an important democratic principle. But modern democracies divide voters into districts. So if the majority should rule, which majority should rule? Should it be the popular majority, or an electoral majority (i.e., either the majority of voters in the majority of districts, or the majority of voters in districts that contain the majority of the population)? I argue that majority rule requires rule by the popular majority. This view is not novel and may seem (...) obvious. But it is rarely defended, and often rejected. I defend it by arguing that this view about which majority should rule is best supported by the arguments for why the majority should rule, and best avoids the arbitrary and perverse verdicts of rule by electoral majorities. I close by considering the significant practical implications of the view. The Electoral College is often criticized on the basis that the winner of the popular vote doesn’t always win the election. But all district-based democracies have this feature, so all district-based democracies must be reformed if they are to satisfy the principle of majority rule. (shrink)

As a strategy for exploring the relationship between understanding and knowledge, we consider whether epistemic luck – which is typically thought to undermine knowledge – undermines understanding. Questions about the etiology of understanding have also been at the heart of recent theoretical debates within epistemology. Kvanvig (2003) put forward the argument that there could be lucky understanding and produced an example that he deemed persuasive. Grimm (2006) responded with a case that, he argued, demonstrated that there could not be lucky (...) understanding. In this paper, we empirically examine how participants' patterns of understanding attributions line up with the predictions of Kvanvig and Grimm. We argue that the data challenge Kvanvig's position. People do not differentiate between knowing-why and understanding-why on the basis of proper etiology: attributions of knowledge and understanding involve comparable (and minimal) roles for epistemic luck. We thus posit that folk knowledge and understanding are etiologically symmetrical. (shrink)

According to an influential recent view, S is propositionally justified in believing p iff S is in no position to know that S is in no position to know p. I argue that this view faces compelling counterexamples.

I argue that there is a tension between two of the most distinctive theses of Sven Rosenkranz’s Justification as Ignorance: the central thesis concerning justification, according to which an agent has propositional justification to believe p iff they are in no position to know that they are in no position to know p and the desire to avoid logical omniscience by imposing only “realistic” idealizations on epistemic agents.

Ludwig Wittgenstein's notoriously elusive later writings are dominated by remarks on language. However, while the textual analysis of Wittgenstein's writings is presently a booming industry, the tendency is to focus narrowly on exegetical matters with little attention to their bearing on philosophy at large. Moreover, one finds in contemporary philosophy of language various ideas with a distinctively Wittgensteinian ring to them but whose pedigree is uncertain. This volume brings together distinguished Wittgenstein scholars and renowned philosophers of language in order to (...) examine just what Wittgenstein has to say about language and to assess its significance for current philosophy. The topics discussed include the connection between the meaning of a word and its use, the bearing the context of utterance has on how words are to be understood, the role of rules in the employment of language and whether Wittgenstein's reflections on these issues encourage sceptical or relativist thoughts."--BOOK JACKET. (shrink)

When policymakers craft rules for use by the general public, they must take into account the ways in which their rules are likely to be misapplied. Should contractualists and rule consequentialists do the same when they search for rules whose general acceptance would be non-rejectable or ideal? I argue that these theorists face a dilemma. If they ignore the possibility of misapplication, they end up with an unrealistic view that rejects rules designed to protect us from others’ mistakes. On the (...) other hand, if they take misapplication into account, they end up rejecting rules that appeal to what really matters morally in favor of easier-to-apply proxies for these rules. This leaves them unable to say why certain wrong acts are wrong, which in turn may lead them to mistaken verdicts about moral worth and wronging. I show how this misapplication dilemma applies to standard contractualist and rule consequentialist theories, but also suggest how it might generalize to other two-level theories, including those designed to avoid the ideal world objection. (shrink)

Daniel Whistler argues that Hemsterhuis' philosophy matters and that its exclusion from the canon of modern philosophy has been unjust. This is not just because of its influence on later thinkers, but is primarily because Hemsterhuis' philosophy contains a rich assemblage of ideas and philosophical practices.

El presente artículo pretende aportar información concisa y útil acerca de un género cinematográfico sumamente apreciado por la crítica: el cine no narrativo. Para ello, en una primera parte se resaltan los fundamentos teóricos, sobre todo antropológicos, que dan a las películas no narrativas su carácter central, tanto estructural como elocutivo, como reflejo de un arte que reproduce el origen de los mitos; en una segunda parte se ofrecen ejemplos concretos de su funcionamiento con base en esos fundamentos y se (...) infieren los modos en que esas películas son recibidas por la audiencia; finalmente, se concluye cuál ha sido la influencia e importancia de este tipo de cine a lo largo de la historia y se explora el posible futuro de este tipo de cine. El método empleado es inductivo y cualitativo, por lo que la interpretación personal tiene primacía en este trabajo. (shrink)

A large and growing body of research in computational psychiatry draws on Bayesian modelling to illuminate the dysfunctions and aberrations that underlie psychiatric disorders. After identifying the chief attractions of this research programme, we argue that its typical focus on abstract, domain-general inferential processes is likely to obscure many of the distinctive ways in which the human mind can break down and malfunction. We illustrate this by appeal to psychosis and the social phenomenology of delusions.

Having concepts is a distinctive sort of cognitive capacity. One thing that conceptual thought requires is obeying the Generality Constraint: concepts ought to be freely recombinable with other concepts to form novel thoughts, independent of what they are concepts of. Having concepts, then, constrains cognitive architecture in interesting ways. In recent years, spurred on by the rise of evolutionary psychology, massively modular models of the mind have gained prominence. I argue that these architectures are incapable of satisfying the Generality Constraint, (...) and hence incapable of underpinning conceptual thought. I develop this argument with respect to two well-articulated proposals, due to Dan Sperber and Peter Carruthers. Neither proposal gives us a satisfactory explanation of Generality within the confines of a genuinely modular architecture. Massively modular minds may display considerable behavioral and cognitive flexibility, but not humanlike conceptualized thought. (shrink)

Plato's dialogues frequently criticize traditional Greek myth, yet Plato also integrates myth with his writing. Daniel S. Werner confronts this paradox through an in-depth analysis of the Phaedrus, Plato's most mythical dialogue. Werner argues that the myths of the Phaedrus serve several complex functions: they bring nonphilosophers into the philosophical life; they offer a starting point for philosophical inquiry; they unify the dialogue as a literary and dramatic whole; they draw attention to the limits of language and the limits (...) of knowledge; and they allow Plato to co-opt cultural authority as a way of defining and legitimating the practice of philosophy. Platonic myth, as a species of traditional tale, is thus both distinct from philosophical dialectic and similar to it. Ultimately, the most powerful effect of Platonic myth is the way in which it leads readers to participate in Plato's dialogues and to engage in a process of self-examination. (shrink)

In recent years, an old challenge to informed consent has been rediscovered: the challenge of ignorance. Several authors argue that due to the presence of irreducible ignorance in certain treatments, giving informed consent to these treatments is not possible. The present paper examines in what ways ignorance is believed to prevent informed consent and which treatments are affected by that. At this, it becomes clear that if the challenge of ignorance truly holds, it poses a major problem to informed consent. (...) The paper argues, however, that from both an empirical and a theoretical point of view, it is not convincing that ignorance prevents informed consent. Still, it seems important that the presence of irreducible ignorance is openly discussed during the informed consent process. (shrink)

Este trabajo explora las representaciones de las mujeres en una selección de manuales escolares empleados en las escuelas paraguayas durante el período 1989-2020, con el objetivo de analizar el papel histórico atribuido a las mujeres en los relatos escolares acerca de la Guerra de la Triple Alianza. Se sostiene que a pesar del proceso de revisión del currículo escolar y la política educativa iniciado con la transición democrática en 1989 persisten las representaciones hegemónicas de las mujeres ligadas al nacionalismo, afianzando (...) los roles tradicionales de género en el marco de una sociedad patriarcal. (shrink)

I argue that an act can be wrong _because_ it wrongs a particular person. I then show how this thesis serves as a constraint on moral theories, using Kantian ethics as a case study.

En este artículo se realiza una semblanza general del pensador colombiano Darío Botero Uribe, en especial, sobre sus ideas en torno al pensamiento latinoamericano. En este sentido, se aborda el problema de la particularidad y la universalidad del pensamiento, la crítica de la modernización y el colonialismo intelectual, el problema de la cultura y de su puesto en la filosofía latinoamericana y colombiana, a la vez que establece una relación con la problemática del mestizaje indoamericano.

La igualdad entre hombres y mujeres no será plena mientras que no transformemos el orden patriarcal que sigue sustentando una diferenciación jerárquica entre unos y otras. Ello pasa por revisar la masculinidad tradicional y la racionalidad construida a imagen y semejanza del varón. Un reto que supone a su vez transformar las relaciones entre lo público y lo privado, así como las bases del conocimiento y de una concepción de lo humano basada en los privilegios masculinos y en la negación (...) de la diversidad.Equality will not be full if we don’t transform the patriarchal order that continues to support a hierarchical differentiation between men and women. This calls for reviewing the traditional masculinity and the rationality constructed in the image and the likeness of the male. A challenge which in turn means to transform the relationship between public and private, and the basis of knowledge and a conception of humanity based on male privilege and the denial of diversity. (shrink)

The objectives of the present study were to adapt a grief intervention program to family caregivers of patients with dementia, and assess its effectiveness in improving the symptoms of grief and other health-related variables. The intervention was based on Shear and Bloom's grief intervention program, with the necessary adaptations for use in the grieving process for a family member's illness. A total of 52 family caregivers of individuals with dementia participated. They were evaluated using a battery of self-report measures assessing (...) grief, overload, resilience, post-traumatic growth, experiential avoidance, health-related quality of life, and benefits of care. The results suggest that the program is effective in improving grief symptoms, caregiver burden, resilience, post-traumatic growth, and quality of life of family caregivers. It is necessary to create and implement interventions targeting caregivers' feelings and manifestations of ambiguous grief, because there is a lack of programs providing an efficient solution for the mental and physical health of caregivers, and because of the human and socioeconomic cost involved in neglecting this group. (shrink)

Having concepts is a distinctive sort of cognitive capacity. One thing that conceptual thought requires is obeying the Generality Constraint: concepts ought to be freely recombinable with other concepts to form novel thoughts, independent of what they are concepts of. Having concepts, then, constrains cognitive architecture in interesting ways. In recent years, spurred on by the rise of evolutionary psychology, massively modular models of the mind have gained prominence. I argue that these architectures are incapable of satisfying the Generality Constraint, (...) and hence incapable of underpinning conceptual thought. I develop this argument with respect to two well-articulated proposals, due to Dan Sperber and Peter Carruthers. Neither proposal gives us a satisfactory explanation of Generality within the confines of a genuinely modular architecture. Massively modular minds may display considerable behavioral and cognitive flexibility, but not humanlike conceptualized thought. (shrink)

A common approach for measuring the effectiveness of an education system or a school is the estimation of the impact that school interventions have on students’ academic performance. However, the latest trends aim to extend the focus beyond students’ acquisition of knowledge and skills, and to consider aspects such as well-being in the academic context. For this reason, the 2015 edition of the international assessment system PISA incorporated a new tool aimed at evaluating the socio-affective variables related to the well-being (...) of students. It is based on a definition focused on the five dimensions proposed in PISA theoretical framework: cognitive, psychological, social, physical and material. The main purpose of this study is to identify the well-being components that significantly affect student academic performance and to estimate the magnitude of school effects on the well-being of students in OECD countries, the school effect being understood as the ability of schools to increase subjective student well-being. To achieve this goal, we analyzed the responses of 234,000 students from thirty-five OECD countries to PISA 2015 questionnaires. Specifically, we considered non-cognitive variables in the questionnaires and student performance in science. The results indicated that the cognitive well-being dimension, composed of enjoyment of science, self-efficacy and instrumental motivation, as well as the test anxiety all had a consistent relationship with student performance across countries. In addition, the school effect, estimated through a two-level hierarchical linear model, in terms of student well-being was systematically low. While the school effect accounted for approximately 25% of the variance in the results for the cognitive dimension, only 5-9% of variance in well-being indicators was attributable to it. This suggests that the influence of school on student welfare is weak, and the effect is similar across countries. The present study contributes to the general discussion currently underway about the definition of well-being and the connection between well-being and achievement. The results highlighted two complementary concerns: there is a clear need to promote socio-emotional education in schools, and it is important to develop a rigorous framework for well-being assessment. The implications of the results and proposals for future studies are discussed. (shrink)

BackgroundPatient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients’ expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is (...) currently undergoing this particular process.MethodsQualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods.Results and discussionPatient autonomy is much more than a simple notion defined as the patient’s right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies.Conclusions Knowing how to respect the various facets of patients’ autonomy should be part of physician’s professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia. (shrink)

We show a sentence and modal square of opposition and equivalence to be expanded into an hexagon according to oe suggestion from William of Sherwood. This expansión is permittedby two sentence and modal rules.The logical relations of the square allow us to formulate several theorems in order to show a glimpse of the Medieval Logic complexity.