Overdiagnosis is an emerging problem in health policy and practice: we address its definition and ethical implications. We argue that the definition of overdiagnosis should be expressed at the level of populations. Consider a condition prevalent in a population, customarily labelled with diagnosis A. We propose that overdiagnosis is occurring in respect of that condition in that population when the condition is being identified and labelled with diagnosis A in that population ; this identification and labelling would be accepted as (...) correct in a relevant professional community; but the resulting label and/or intervention carries an unfavourable balance between benefits and harms. We identify challenges in determining and weighting relevant harms, then propose three central ethical considerations in overdiagnosis: the extent of harm done, whether harm is avoidable and whether the primary goal of the actor/s concerned is to benefit themselves or the patient, citizen or society. This distinguishes predatory, misdirected and tragic overdiagnosis; the degree of harm moderates the justifiability of each type. We end with four normative challenges: methods for adjudicating between professional standards and identifying relevant harms and benefits should be procedurally just; individuals, organisations and states are differently responsible for addressing overdiagnosis; overdiagnosis is a matter for distributive justice: the burdens of both overdiagnosis and its prevention could fall on the least-well-off; and communicating about overdiagnosis risks harming those unaware that they may have been overdiagnosed. These challenges will need to be addressed as the field develops. (shrink)

Emotion processing is known to be impaired in psychopathy, but less is known about the cognitive mechanisms that drive this. Our study examined experiencing and suppression of emotion processing in psychopathy. Participants, violent offenders with varying levels of psychopathy, viewed positive and negative images under conditions of passive viewing, experiencing and suppressing. Higher scoring psychopathics were more cardiovascularly responsive when processing negative information than positive, possibly reflecting an anomalously rewarding aspect of processing normally unpleasant material. When required to experience emotional (...) response, by ‘getting into the feeling’ of the emotion conveyed by a negative image, higher factor 1 psychopathic individuals showed reduced responsiveness, suggesting that they were less able to do this. These data, together with the absence of corresponding differences in subjective self-report might be used to inform clinical strategies for normalising emotion processing in psychopathic offenders to improve treatment outcome, and reduce risk amongst this client group. (shrink)

The proliferation of digital data and internet-based research technologies is transforming the research landscape, and researchers and research ethics communities are struggling to respond to the ethical issues being raised. This paper discusses the findings from a collaborative project that explored emerging ethical issues associated with the expanding use of digital data for research. The project involved consulting with researchers from a broad range of disciplinary fields. These discussions identified five key sets of issues and informed the development of guidelines (...) orientated to meet the needs of researchers and ethics committee members. We argue that establishing common approaches to assessing ethical risks of research involving digital data will promote consistency in the ethical standards for research, enable the smooth functioning of ethics committees, and sustain public confidence in research. We conclude with recommendations for the development of educational resources for ethics committees, data management guidelines and further public education. (shrink)

In this paper we aim to think systematically about, formulate, and begin addressing some of the challenges to applying theories of moral responsibility to behaviors shaped by a particular subset of unsettling psychological complexities: namely, implicit biases.

Improving the resilience of urban road networks suffering from various disruptions has been a central focus for urban emergence management. However, to date the effective methods which may mitigate the negative impacts caused by the disruptions, such as road accidents and natural disasters, on urban road networks is highly insufficient. This study proposes a novel adaptive signal control strategy based on a doubly dynamic learning framework, which consists of deep reinforcement learning and day-to-day traffic dynamic learning, to improve the network (...) performance by adjusting red/green time split. In this study, red time split is regarded as extra traffic flow to discourage drivers to use affected roads, so as to reduce congestion and improve the resilience when urban road networks are subject to different levels of disruptions. In addition, we utilize the convolution neural network as Q-network to approximate Q values, link flow distribution and link capacity are regarded as the state space, and actions are denoted as red/green time split. A small network is utilized as a numerical example, and a fixed time signal control and other two adaptive signal controls are employed for the comparisons with the proposed one. The results show that the proposed adaptive signal control based on deep reinforcement learning can achieve better resilience in most of the cases, particularly in the scenarios of moderate and severe disruptions. This study may shed light on the advantages of the proposed adaptive signal control dealing with major emergencies compared to others. (shrink)

To understand public discourse in the United States on genetic causation of behavioral disorders, we analyzed media representations of genetic research on addiction published between 1990 and 2010. We conclude first that the media simplistically represent biological bases of addiction and willpower as being mutually exclusive: behaviors are either genetically determined, or they are a choice. Second, most articles provide only cursory or no treatment of the environmental contribution. A media focus on genetics directs attention away from environmental factors. Rhetorically, (...) media neglect the complexity underlying the etiology the addiction and direct focus back toward individual causation and responsibility. (shrink)

This article addresses theoretical problems around the notion of ‘choice’, using empirical data from a three-year, ESRC-funded study of identity, transition and footwear among both women and men. With a focus on female participants who wore, or had worn high-heeled shoes, it draws on Budgeon’s argument for viewing the body as event, as becoming, and Finch’s use of the concept of display, to explore the temporalities of high-heeled shoe wear, particularly as an aspect of ‘dressing up’. Data from both focus (...) groups and year-long case studies allowed everyday and life course patterns of high-heeled shoe wear to be explored – in many cases, as they unfolded. This material has led us to critique the linear, goal-oriented nature of a modernist ‘project of the self’, and to argue that identification, as a dynamic process, may often be erratic, partial and temporary. Emphasized femininity, it is suggested, can be ‘displayed’ episodically, as an aspect of ‘doing gender’, a perspective that problematizes notions of a ‘post-feminist masquerade’ that inevitably secures gender retrenchment. Through an examination of the occasions and non-occasions that pattern the temporalities of women’s lives, therefore, the article demonstrates a distinction between displaying femininity and doing gender, one that simultaneously sheds light on their relationship with one another. (shrink)

In health care, the provision of pertinent information to patients is not just a moral imperative but also a legal obligation, often articulated through the lens of obtaining informed consent. Codes of medical ethics and many national laws mandate the disclosure of basic information about diagnosis, prognosis, and treatment alternatives. However, within publicly funded health care systems, other kinds of information might also be important to patients, such as insights into the health care priorities that underlie treatment offers made. While (...) conventional perspectives do not take this as an obligatory part of the information to be shared with patients, perhaps through viewing it as clinically “non-actionable,” we advocate for a paradigm shift. Our proposition diverges from the traditional emphasis on actionability. We contend that honoring patients as equal moral agents necessitates, among other principles, a commitment to honesty. Withholding specific categories of information pertinent to patients’ comprehension of their situation is inherently incompatible with this principle. In this article, we advocate for a recalibration of the burden of proof. Rather than requiring special justifications for adding to the standard set of information items, we suggest that physicians should be able to justify excluding relevant facts about the patient’s situation and the underlying considerations shaping health care professionals’ choices. This perspective prioritizes transparency and empowers patients with a comprehensive understanding, aligning with the ethos of respect for the patient as person. (shrink)

Contesting Conformity investigates the writings of Tocqueville, Mill, and Nietzsche in order to examine the relationship between non-conformity and modern democracy. Jennie Ikuta argues that non-conformity is an intractable issue for democracy while non-conformity is often important for cultivating a just polity, non-conformity can also undermine democracy. Democracy therefore needs non-conformity, but not in an unconditional way. This book examines this intractable relationship, and offers resources for navigating the relationship in contemporary democracies in ways that promote justice and freedom.

This article argues that understanding any space or site relies on a knowledge of its fourth dimension - the timescape. It will explore this by situating the investigation in the museum - a place of heightened contrivance which could easily be shallowly interpreted as "mere style". It will defend a new method of investigating museum temporality which combines both phenomenology and literary theory, and will replace the idea of geo-epistemology with geochronic epistemology: an understanding of context and situation which takes (...) on time as well as spatial location. In so doing, it moves on from notions of the museum as a place out of time, situating it in the networks of meaning, power and politics in which we have lived and are living. Thus, "the whole space of the exhibition" as Lyotard said, "becomes the remains of all time": the Museum on the Edge of Forever. (shrink)

The focus of much sensory language research has been on vocabulary and codability, not how language is used in communication of sensory perceptions. We make a case for discourse-oriented research about sensory language as an alternative to the prevailing vocabulary orientation. To consider the language of sound in authentic textual data, we presented participants with 20 everyday sounds of unknown sources and asked them to describe the sounds in as much detail as possible, as if describing them to someone who (...) could not hear them. We explored how the participants use language to describe these sounds. Do they describe their listening experiences (stressful), sound properties (intermittent beeping), and/or the events that caused the sounds (eating an apple)? The results show that out of these three soundscape elements, events are the most frequent and most indispensable element. We let the results from the study illustrate the need for more discursive data in studies of sensory language and argue that there is no designated language of sound. Our study highlights that in order to account for sensory language use, we need an analytical framework that accommodates discursive language in a non-trivial way beyond stable couplings between individual words and meanings. (shrink)

Does the real difference between non-consequentialist and consequentialist theories lie in their approach to value? Non-consequentialist theories are thought either to allow a different kind of value (namely, agent-relative value) or to advocate a different response to value ('honouring' rather than 'promoting'). One objection to this idea implies that all normative theories are describable as consequentialist. But then the distinction between honouring and promoting collapses into the distinction between relative and neutral value. A proper description of non-consequentialist theories can only (...) be achieved by including a distinction between temporal relativity and neutrality in addition to the distinction between agent-relativity and agent-neutrality. (shrink)

In this essay, I argue that to create a genomics that offers more gifts than weights, central attention must be paid to questions of justice. This will require expanding bioethical imaginations so that they grasp and can respond to questions of structural inequity. It will necessitate building novel coalitions and collaborations that turn the attention of bioethical governance away from narrow individual questions such as, “Do I consent?” and toward the broader collective question, is this just? What kind of lives (...) and collectivities are made possible? What rights and principles should govern them? The essay ends with one example of this novel coalition building arising from the Science and Justice Research Center at the University of California, Santa Cruz. It draws lessons from this effort to build new alliances that bridge the social sciences and natural sciences, arts and engineering, to create new kinds of training and thinking that create a genomics that more adequately responds to fundamental questions of justice. (shrink)

Catholic legal and doctrinal tradition defined two main cases for the canonization of saints: until very recently, sainthood was related either to martyrdom or to the heroic practice of virtues, ascertained through a well-defined judicial procedure. In 2017, Pope Francis renewed this ancient tradition by introducing a third case, consisting in the “offering of life”, namely the sacrifice of one’s life in the name of charity, intended as Christian love for the others. The “offering of life” is placed at the (...) center of an ongoing process of mediation between papal authority, the judicial praxis of the causes for canonization, and ecclesiastic law. The introduction of this new type of sainthood can be explained in light of the growing difficulty to apply the two traditional grids of behavior established by the Church in the evaluation of the life of new kinds of persons who enjoy a widespread fame of sanctity, but are not conform to the strict jurisprudential criteria of martrydrom and heroicity. Therefore, the debate surrounding the “offering of life” entails a dialectics between the necessity of a rationalized set of models, providing precise—and thus evaluable—“narrative programs” and defining a circumscribed number of canonizable human types, and the unprecedented multiplication of instances of sanctity in the contemporary world. (shrink)

Responding to the climate crisis requires social and economic innovation—because climate change is a symptom of patriarchal capitalist systems that are concentrating—rather than distributing—wealth and power. Despite the need for social and economic innovation, technological innovation continues to be prioritized in climate policy and climate investments. This paper reviews the dangers of technological optimism in climate policy by exploring its links to patriarchal systems and masculinity. The disproportionate focus on science and technology emerges from and reinforces “climate isolationism,” a term (...) that I use to refer to the common framing of climate change as an isolated discrete, scientific problem in need of technological solutions. This framing stems from assumptions of patriarchal white-male conceptions of privilege and power that evolve from a colonizing and controlling mindset. Masculine technological optimism is dangerous because it is exclusive, it minimizes the need for social change and social innovation, and it is ineffective in catalyzing inclusive societal transformation. This paper argues that embracing feminist, antiracist values is necessary for transformative climate policies, economic justice, and climate justice. (shrink)

The ever increasing ability of medical technology to reshape the human body in fundamental ways—from organ and tissue transplants to reconstructive surgery and prosthetics—is something now largely taken for granted. But for a philosopher, such interventions raise fundamental and fascinating questions about our sense of individual identity and its relationship to the physical body. Drawing on and engaging with philosophers from across the centuries, Jenny Slatman here develops a novel argument: that our own body always entails a strange dimension, (...) a strangeness that enables us to incorporate radical physical changes. (shrink)

This paper examines the crowded landscape of conferences and organizations within which the International Foundation for Science (IFS) was shaped in the early 1970s. The IFS aimed to support scientists from developing countries, circumventing the bureaucracy of established international organizations such as UNESCO and the Organization for Economic Co-operation and Development (OECD). The new foundation was a potential rival to such institutions, which ironically provided the conditions essential to its emergence. Their conferences, board meetings and assemblies, where scientists and policy (...) makers convened, provided key infrastructure for the development of the IFS. This infrastructure appears simultaneously both as an almost invisible feature of international science policy, and as a political problem. The solution to this problem was Stockholm: a geographical place that was also placeless, occupying both national and international status, desirable in its political, scientific and geographical neutrality. In an organizational context, academies and scientific societies who found their role circumscribed by existing international institutions used the IFS to argue for their particular role and expertise in funding and promoting scientific development. Geographically and politically, neutral Sweden provided a setting which was located between East and West, and which added to the country's own reputation for championing the causes of developing nations. (shrink)

Informed by Critical Race Theory, this quantitative study supports civic educators in understanding the role of classroom climate and racial identity in students’ civic engagement during a statewide middle school civics mandate (n = 4707). Findings reveal that students of color experience higher civic engagement and lower civic attitude scores than white-identifying peers, after controlling for school, classroom, and affluence indicators. Students’ perception of whiteness (or perhaps majority status) appeared to correlate with positive civic knowledge and civic attitude, but relative (...) civic inaction. These findings suggest differences in civic outcomes as early as middle school between white-identifying students and students of color. Such differences offer implications for civic education interventions that address not only effective instruction, but civic inequities, students’ perceived agency, and curricular content. (shrink)

Efforts have been dedicated to the understanding of social-ecological systems, an important focus in ethnobiological studies. In particular, ethnobiological investigations have found evidence and tested hypotheses over the last 30 years on the interactions between human groups and their environments, generating the need to formulate a theory for such systems. In this article, we propose the social-ecological theory of maximization to explain the construction and functioning of these systems over time, encompassing hypotheses and evidence from previous ethnobiological studies. In proposing (...) the theory, we present definitions and two conceptual models, an environmental maximization model and a redundancy generation model. The first model seeks to address biota selection and its use by human populations. The second emphasizes how the system organizes itself from the elements that were incorporated into it. Furthermore, we provide the theoretical scenario of plant selection and use from an evolutionary perspective, which explicitly integrates the phylogenetic relationships of plants (or other living resources) and human beings. (shrink)

This paper reconsiders the debates around the interpretation of Parmenides’ Being, in order to draw out the preconceptions that lie behind such debates and to scrutinize the legitimacy of applying them to a text such as Parmenides’ poem. With a focus on the assumptions that have driven scholars to seek clarity within the notoriously ambiguous verse of the poem, I ask whether it is possible to develop an analysis of Parmenides’ Being that is sympathetic both to his clear interest in (...) argument, logic, knowledge and truth and to his ambiguous expression and cultural and literary resonances. (shrink)

When defining science as a problem-solving activity, philosophers of science have mainly focussed on "the context of discovery," the process of finding creative solutions to problems; and "the context of justification," the process of evaluating new theories. This article takes a step backward and proposes ways to find problems with a creative potential: (1) Seek areas of theoretical controversy—respect all the facts and set out to find a new theory that can encompass the contradictions; (2) move beyond the realm of (...) research proper—take an interest in phenomena that do not fit into any established theory or frame of reference; (3) give a break to discovery by chance—be attentive and welcoming to unexpected results; (4) look for exceptions—treat them as first-class facts instead of ignoring them or trying to explain them away. (shrink)

It is now taken for granted in many circles that substantial psychological variability exists across human populations; we do not merely differ in the ways we behave, but in the ways we think, as well. Versions of this view have been around since early interest in ‘cultural relativism’ in cultural psychology and anthropology, but Joe Henrich, Steven Heine, and Ara Norenzayan’s 2010 paper, ‘The Weirdest People in the World?’ has had an exciting and catalyzing impact on the field, getting researchers (...) involved in discussions of human nature to take cross-cultural cognitive diversity seriously. Reviewing a broad selection of comparative studies from across the behavioral sciences, in social psychology, cognitive... (shrink)

Braun explores the use of digital twin technology in medicine with a particular emphasis on the question of how such simulations can represent a person.1 In defining some first conditions for ethically justifiable forms of representation of digital twins, he argues that digital twins do not threaten an embodied person, as long as that person retains control over their simulated representation via dynamic consent, and ideally with the option to choose both form and usage of the simulation. His thoughtful elaboration (...) provides insight into the challenges inherent in interactions between a person and their digital twin, emphasising the modes of control required to respect personal modes of freedom. This individual-centric approach to the question of representation leaves out the important ethical consideration of ensuring that all, not merely some, can be represented. Braun describes dynamic consent as a necessary mode of control, arguing that where a person is unable to give consent, ‘such simulations threaten to become illegitimate representations. They would then shift the kind of interaction from representation to illegitimate forms of prediction or surveillance and thereby could lead to infringements to individual modes of freedom.’ Consequently, the implementation of digital twin technology in healthcare would seem to exclude the most vulnerable members of society from participation in and benefiting from medical innovation, …. (shrink)

Our daily experience, dominated by the corporate clock that so many of us contort ourselves to fit inside, is destroying us. It wasn't built for people, it was built for profit. This is a book that tears open the seams of reality as we know it-the way we experience time itself-and rearranges it, reimagining a world not centered around work, the office clock, or the profit motive. Explaining how we got to the point where time became money, Odell offers us (...) new models to live by--inspired by pre-industrial cultures, ecological, and geological time--that make a more humane, more hopeful way of living seem possible. In this dazzling, subversive, and deeply hopeful reframing of time, Jenny Odell takes us on a journey through other temporal habitats. As planet-bound animals, we live inside shortening and lengthening days, alongside gardens growing, birds migrating, and cliffs eroding. The stretchy quality of waiting and desire, the way the present may suddenly feel marbled with childhood memory, the slow but sure procession of a pregnancy, or the time it takes to heal from injuries--physical or emotional. Odell urges us to become stewards of these different rhythms of life, to imagine a life, identity, and source of meaning outside of the world of work and profit, and to understand that the trajectory of our lives--or the life of the planet--is not a foregone conclusion. In that sense, "saving" time-recovering its fundamentally irreducible and inventive nature-could also mean that time saves us. (shrink)

Self-knowledge is a difficult thing. Many have had the experience of knowing that a friend or partner is in a bad mood before she herself realizes it. Similarly, with mental illness it seems that a person may be sick without realizing it, or even while denying it outright. Anosognosia, the lack of awareness that one is mentally ill, is most visible in cases of dementia or brain damage, but recent insights in psychology have shown that healthy human beings too generally (...) lack accurate introspective awareness in matters of our own well-being.1 Getting this right—whether or not someone is flourishing2 psychologically—is crucial in psychiatry, and self-report cannot always be relied upon.At the same time, many have been... (shrink)

It is the researcher's responsibility to provide accurate, complete, and unbiased verbal and written information yet, as this essay discusses, challenges to meaningful research consent abound in the communication between researcher and subject. This discussion of these challenges is far from exhaustive, but it will flag some of the potholes that researchers must anticipate on the sometimes rocky road to eliciting meaningful consent. These include, but are not limited to, inadequate scientific literacy, poorly written consent forms, and even the deployment (...) of scientific terms and seductive acronyms like CURE and MIRACL. Studies with acronyms, for example, enroll five times as many patients as those without, are more likely to be published by prestigious journals, and have higher Jadad methodologic quality scores although they are no more likely to conclude with positive findings. Other barriers to researcher-subject communication include: widely differing beliefs and customs, semiotics, socioeconomic status, iatrophobia, and dramatically different histories of treatment in the medical-research arena. (shrink)

This paper considers the question of whether predictions of wrongdoing are relevant to our moral obligations. After giving an analysis of ‘won’t’ claims (i.e., claims that an agent won’t Φ), the question is separated into two different issues: firstly, whether predictions of wrongdoing affect our objective moral obligations, and secondly, whether self-prediction of wrongdoing can be legitimately used in moral deliberation. I argue for an affirmative answer to both questions, although there are conditions that must be met for self-prediction to (...) be appropriate in deliberation. The discussion illuminates an interesting and significant tension between agency and prediction. (shrink)

Boorse’s biostatistical theory states that diseases should be defined in ways that reflect disturbances of biological function and that are objective and value free. We use three examples from contemporary medicine that demonstrate the complex issues that arise when defining the boundaries of disease: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction. We argue that the biostatistical theory fails to provide sufficient guidance on where the boundaries of disease should be drawn, contains ambiguities relating to choice of reference class, (...) and is out of step with medical processes for identifying disease boundaries. Although proponents of the biostatistical theory might regard these practical issues as irrelevant to the aim of providing a theoretical account of disease, we take them to indicate the need for a theoretical account that is adequate for current needs—including limiting new forms of medicalization that are driven by the identification of disease based on dysfunction. Our processes for determining the boundaries for disease need to recognize that there is no value-free method for making these decisions. (shrink)

The aim of this thematic literature review is to explore nurses' perceptions of ethical issues in the care of older people. Electronic databases were searched from September 1997 to September 2007 using specific key words with tight inclusion criteria, which revealed 17 primary research reports. The data analysis involved repeated reading of the findings and sorting of those findings into four themes. These themes are: sources of ethical issues for nurses; differences in perceptions between nurses and patients/relatives; nurses' personal responses (...) to ethical issues; and the patient—nurse relationship. The findings reveal that ageism is one of the major sources of the ethical issues that arise for nurses caring for older people. Education and organizational change can combat ageist attitudes. Wider training is required in the care of older people, workplace skills, palliative care and pain management for older people. The demands of a changing global demography will necessitate further research in this field. (shrink)

I develop a theory of counterfactuals about relative computability, i.e. counterfactuals such as 'If the validity problem were algorithmically decidable, then the halting problem would also be algorithmically decidable,' which is true, and 'If the validity problem were algorithmically decidable, then arithmetical truth would also be algorithmically decidable,' which is false. These counterfactuals are counterpossibles, i.e. they have metaphysically impossible antecedents. They thus pose a challenge to the orthodoxy about counterfactuals, which would treat them as uniformly true. What’s more, I (...) argue that these counterpossibles don’t just appear in the periphery of relative computability theory but instead they play an ineliminable role in the development of the theory. Finally, I present and discuss a model theory for these counterfactuals that is a straightforward extension of the familiar comparative similarity models. (shrink)

The core idea of social constructivism in mathematics is that mathematical entities are social constructs that exist in virtue of social practices, similar to more familiar social entities like institutions and money. Julian C. Cole has presented an institutional version of social constructivism about mathematics based on John Searle’s theory of the construction of the social reality. In this paper, I consider what merits social constructivism has and examine how well Cole’s institutional account meets the challenge of accounting for the (...) characteristic features of mathematics, especially objectivity and applicability. I propose that in general social constructivism shows promise as an ontology of mathematics, because the view can agree with mathematical practice and it offers a way of understanding how mathematical entities can be real without conflicting with a scientific picture of reality. However, I argue that Cole’s specific theory does not provide an adequate social constructivist account of mathematics. His institutional account fails to sufficiently explain the objectivity and applicability of mathematics, because the explanations are weakened and limited by the three-level theoretical model underlying Cole’s account of the construction of mathematical reality and by the use of the Searlean institutional framework. The shortcomings of Cole’s theory give reason to suspect that the Searlean framework is not an optimal way to defend the view that mathematical reality is socially constructed. (shrink)

The social model of disability gives us the tools not only to challenge the discrimination and prejudice we face, but also to articulate the personal experience of impairment. Recognition of difference is therefore a key part of the assertion of our common humanity and of an ethics of care that promotes our human rights.