Surgeons have an ethical obligation to ensure all patients, regardless of their personal characteristics, receive the same quality of care. Established surgeons also have an obligation to ensure equal treatment for their peers and for those who would like to join the field. The commitment to ethical hiring and working standards entails making certain all individuals have the same opportunities free from discriminatory practices. The world of business has long realized the positive implications of having a diverse and inclusive workforce. (...) Studies have shown a positive correlation between increased racial and gender diversity and company performance. Diversity can lead to an increase in knowledge by sharing ideas with individuals who come from different life experiences and breakdown cultural barriers. We have already begun to see the impact of ignoring the importance of diversity within healthcare, including surgery. Healthcare disparities are defined by the NIH as “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups.” Healthcare disparities persist despite decades acknowledging their existence, and they are pernicious and prevalent in surgery. One proposed method to help reduce or eliminate healthcare disparities is to increase the diversity of the workforce treating the patients, which would in turn reduce potential bias the patients face in the healthcare setting. Implicit bias can play a key role in interactions with patients and colleagues and needs to be explored on an individual basis. Cultural competence training can also provide surgeons the ability to effectively communicate with not only a diverse population of patients but also a diverse surgical workforce. All surgeons regardless of their role can have a positive impact on diversity as it relates to patient care and the surgical workforce. (shrink)

To help professionals in all health care disciplines grapple with ethical issues, Ahronheim (medicine, New York Medical College), Moreno (biomedical ethics, U. of Virginia) and Zuckerman (Center for Ethics in Medicine, Beth Israel Medical Center) review the history and theory of clinical ethics and present 31 case studies analyzed from medical, ethical and legal perspectives. This second edition expands the original discussions of ethical dilemmas caused by advances in medical genetics, organ transplants, HIV medicine and other developments. The appendix includes (...) Internet references, suggested readings and other resources. (shrink)

Basement membranes are thin sheets of extracellular proteins situated in close contact with cells at various locations in the body. They have a great influence on tissue compartmentalization and cellular phenotypes from early embryonic development onwards. The major constituents of all basement membranes are collagen IV and laminin, which both exist as multiple isoforms and each form a huge irregular network by self assembly. These networks are connected by nidogen, which also binds to several other components (proteoglycans, fibulins). Basement membranes (...) are connected to cells by several receptors of the integrin family, which bind preferentially to laminins and collagen IV, and via some lectin‐type interactions. The formation of basement membranes requires cooperation between different cell types since nidogen, for example, is usually synthesized by cells other than those exposed to the basement membranes. Thus many molecular interactions, of variable affinities, determine the final shape of basement membranes and their preferred subanatomical localization. (shrink)

Three‐ to 4‐month‐old infants show asymmetric exclusivity in the acquisition of cat and dog perceptual categories. The cat perceptual category excludes dog exemplars, but the dog perceptual category does not exclude cat exemplars. We describe a connectionist autoencoder model of perceptual categorization that shows the same asymmetries as infants. The model predicts the presence of asymmetric retroactive interference when infants acquire cat and dog categories sequentially. A subsequent experiment conducted with 3‐ to 4‐month‐olds verifies the predicted pattern of looking time (...) behaviors. We argue that bottom‐up, associative learning systems with distributed representations are appropriate for modeling the operation of short‐term visual memory in early perceptual category learning. (shrink)

Many of us are inclined to accept something like the following principle: We can only be properly morally assessed for what is in our control. And yet our ordinary practices seem to frequently violate this principle. The resulting tension, and the attempt to resolve it, is the problem of moral luck. For example, we tend to punish and think worse of the negligent driver who kills a child than we do the equally negligent driver who was lucky there was no (...) child in his path. Thus, the lucky outcomes of our actions do seem to affect the extent to which we hold and are held responsible, but these are not things over which we exercise control. And, as Thomas Nagel famously illustrated in his response to Bernard Williams (the two of which papers form the founding documents of the moral luck debate), the influence of luck is not limited to outcomes. For the circumstances in which we find ourselves and, indeed, our very constitution are also shaped by luck. Since the publication of Williams's and Nagel's papers, the existence and breadth of moral luck has been hotly debated. This debate is not a mere intellectual trifle but, as the essays in this volume illustrate, a debate which lies at the heart of free will, responsibility, identity, causation, and self-creation. (shrink)

This paper compares the recently proposed Robust Full Computational Tree Logic to model robustness in concurrent systems with other computational tree logic -based logics. RoCTL* extends CTL* with the addition of the operators Obligatory and Robustly, which quantify over failure-free paths and paths with one more failure respectively. This paper focuses on examining the succinctness and expressiveness of RoCTL* by presenting translations to and from RoCTL*. The core result of this paper is to show that RoCTL* is expressively equivalent to (...) CTL* but is non-elementarily more succinct. That is, RoCTL* does not add any expressive power over CTL*, but can represent some properties using vastly reduced formulae. We present a translation from RoCTL* into CTL* that preserves truth but may result in non-elementary growth in the length of the translated formula, as each nested Robustly operator may result in an extra exponential blowup. However, we show that this translation is optimal in the sense th.. (shrink)

About one third of patients with epilepsy have seizures refractory to the medical treatment. Electrical stimulation mapping is the gold standard for the identification of “eloquent” areas prior to resection of epileptogenic tissue. However, it is time-consuming and may cause undesired side effects. Broadband gamma activity recorded with extraoperative electrocorticography during cognitive tasks may be an alternative to ESM but until now has not proven of definitive clinical value. Considering their role in cognition, the alpha and beta bands could further (...) improve the identification of eloquent cortex. We compared gamma, alpha and beta activity, and their combinations for the identification of eloquent cortical areas defined by ESM. Ten patients with intractable focal epilepsy participated in a delayed-match-to-sample task, where syllable sounds were compared to visually presented letters. We used a generalized linear model approach to find the optimal weighting of each band for predicting ESM-defined categories and estimated the diagnostic ability by calculating the area under the receiver operating characteristic curve. Gamma activity increased more in eloquent than in non-eloquent areas, whereas alpha and beta power decreased more in eloquent areas. Diagnostic ability of each band was close to 0.7 for all bands but depended on multiple factors including the time period of the cognitive task, the location of the electrodes and the patient’s degree of attention to the stimulus. We show that diagnostic ability can be increased by 3–5% by combining gamma and alpha and by 7.5–11% when gamma and beta were combined. We then show how ECoG power modulation from cognitive testing can be used to map the probability of eloquence in individual patients and how this probability map can be used in clinical settings to optimize ESM planning. We conclude that the combination of gamma and beta power modulation during cognitive testing can contribute to the identification of eloquent areas prior to ESM in patients with refractory focal epilepsy. (shrink)

In my contribution to this volume, I (BHS) comment on on the stultifying rhetoric of contemporary analytic moral theory as illustrated in Judith Jarvis Thomson's Tanner Lectures, with particular reference to Thomson's anxieties about the moral relativism exhibited by college freshman and to her efforts--quite strained, in my view, and inevitably unsuccessful--to demonstrate the existence of objective judgments in matters of morality and taste .

In the past thirty years, two fundamental issues have emerged in the philosophy of science. One concerns the appropriate attitude we should take towards scientific theories--whether we should regard them as true or merely empirically adequate, for example. The other concerns the nature of scientific theories and models and how these might best be represented. In this ambitious book, da Costa and French bring these two issues together by arguing that theories and models should be regarded as partially rather (...) than wholly true. They adopt a framework that sheds new light on issues to do with belief, theory acceptance, and the realism-antirealism debate. The new machinery of "partial structures" that they develop offers a new perspective from which to view the nature of scientific models and their heuristic development. Their conclusions will be of wide interest to philosophers and historians of science. (shrink)

Accumulating evidence for the unique social, behavioral, and physical health benefits of positive emotion and related well-being constructs has led to the development and testing of positive psychological interventions to increase emotional well-being and enhance health promotion and disease prevention. PPIs are specifically aimed at improving emotional well-being and consist of practices such as gratitude, savoring, and acts of kindness. The purpose of this narrative review was to examine the literature on PPIs with a particular focus on positive emotion outcomes. (...) We evaluated the evidence on the effects of PPIs on positive emotion specifically, and discussed the range of evidence regarding the relative responsiveness of emotion measures to PPIs in order to gain a better understanding of the specific emotional pathways through which PPIs influence psychological and physical well-being. We conclude with recommendations for best evaluating effects of PPIs on positive emotion outcomes. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

In this article, we explore the implications of opposing domains theory for developing ethical leaders. Opposing domains theory highlights a neurological tension between analytic reasoning and socioemotional reasoning. Specifically, when we engage in analytic reasoning, we suppress our ability to engage in socioemotional reasoning and vice versa. In this article, we bring together the domains of neuroscience, psychology, and ethics, to inform our theorizing around ethical leadership. We propose that a key issue for ethical leadership is achieving a healthy balance (...) between analytic reasoning and socioemotional reasoning. We argue that organizational culture often encourages too heavy a reliance on nonemotional forms of reasoning to arrive at moral judgments. As a result, leaders run the risk of suppressing their ability to pay attention to the human side of moral dilemmas and, in doing so, dehumanize colleagues, particularly subordinates, and clients. (shrink)

Heintz & Scott-Phillips propose that the partner choice ecology of our ancestors required Gricean cognitive pragmatics for reputation management, which caused a tendency toward showing and expecting prosociality that subsequently scaffolded language evolution. Here, we suggest a cognitively leaner explanation that is more consistent with comparative data and posits that prosociality and eventually language evolved along with cooperative breeding.

Background Studies describing physicians’ experiences with sedation at the end of life are indispensible for informed palliative care practice, but they are scarce. We describe the accounts of physicians from the USA and the Netherlands, two countries with different regulations on end-of-life decisions regarding their use of sedation.Methods Qualitative face-to-face interviews were held in 2007–2008 with 36 physicians , including primary care physicians and specialists. We applied purposive sampling and conducted constant comparative analyses.Results In both countries, the use of sedation (...) was described in diverse terms, especially in the USA, and was often experienced as emotionally challenging. Respondents stated different and sometimes multiple intentions for their use of sedation. Besides alleviating severe suffering, most Dutch respondents justified its use by stating that it does not hasten death, while most American respondents indicated that it might hasten death but that this was justifiable as long as that was not their primary intention. While many Dutch respondents indicated that they initiated open discussions about sedation proactively to inform patients about their options and to allow planning, the accounts of American respondents showed fewer and less-open discussions, mostly late in the dying process and with the patient's relatives.Conclusions The justification for sedation and the openness with which it is discussed were found to differ in the accounts of respondents from the USA and the Netherlands. Further clarification of practices and research into the effect and effectiveness of the use of sedation is recommended to enhance informed reflection and policy making. (shrink)

The Proceedings of the National Summit on Legal Preparedness for Obesity Prevention and Control is based on a two-part conceptual framework composed of public health and legal perspectives. The public health perspective comprises the six target areas and intervention settings that are the focus of the obesity prevention and control efforts of the Centers for Disease Control and Prevention.This paper presents the legal perspective. Legal preparedness in public health is the underpinning of the framework for the four “assessment” papers and (...) the four “action” papers that are integral to the application of public health law to any particular health issue. In addition, this paper gives real-world grounding to the legal framework through examples that illustrate the four core elements of legal preparedness in public health that are at work in obesity prevention and control. (shrink)

The Proceedings of the National Summit on Legal Preparedness for Obesity Prevention and Control is based on a two-part conceptual framework composed of public health and legal perspectives. The public health perspective comprises the six target areas and intervention settings that are the focus of the obesity prevention and control efforts of the Centers for Disease Control and Prevention.This paper presents the legal perspective. Legal preparedness in public health is the underpinning of the framework for the four “assessment” papers and (...) the four “action” papers that are integral to the application of public health law to any particular health issue. In addition, this paper gives real-world grounding to the legal framework through examples that illustrate the four core elements of legal preparedness in public health that are at work in obesity prevention and control. (shrink)

. This paper reports the preliminary results from a semester-long ethics project at an AACSB accredited, regional comprehensive undergraduate school. This project culminated in an Ethics Awareness Week, which highlight a case study of the controversial EverQuest® multi-player online game. Issues of project planning and design are outlined, the dynamics of a business program-wide approach to ethics are social responsibility are presented, student survey results are presented and analyzed, and issues related to ongoing research are discussed. Nonparametric survey results indicate (...) that the greatest effect in student’s self reported enhanced understanding and interest in issues of business ethics is present when multiple pedagogical methods, e.g., case studies, lectures, assignments, and an Oxford-style debate, are applied by a number of faculty members over an extended time period. The paper concludes with a discussion of future research issues as well as a series of prescriptions for planning, organizing, and implementing such an extended activity. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Da Costa and French explore the consequences of adopting a 'pragmatic' notion of truth in the philosophy of science. Their framework sheds new light on issues to do with belief, theory acceptance, and the realism-antirealism debate, as well as the nature of scientific models and their heuristic development.

An introduction to the model-theoretic approach in the philosophy of science is given and it is argued that this program is further enhanced by the introduction of partial structures. It is then shown that this leads to a natural and intuitive account of both "iconic" and mathematical models and of the role of the former in science itself.

Learning to drive is a significant event for the transition to adulthood and delay or avoidance may have social, practical, and psychological implications. For those with Developmental Coordination Disorder, driving presents a considerable challenge, and the literature shows that there are differences in driving ability between individuals with and without DCD. The aim of the current research is to further our understanding of the mechanisms underlying the driving experiences of individuals with DCD. Nineteen participants with DCD and 36 controls aged (...) 18–57 years took part in this study. Participants completed standardized tests, questionnaires and a driving simulation task designed to measure speed, road positioning, and rate of change of steering in three conditions with increasing perceptual complexity. Results indicate that behaviors for all participants changed as the perceptual demands of the task increased. However, drivers with DCD were more affected than all other groups, driving more slowly, and driving further to the right. These findings illustrate how the impact of both internal and external constraints negatively affect the success of the driving task for individuals with DCD compared to their TD peers. (shrink)

The mathematical concept of pragmatic truth, first introduced in Mikenberg, da Costa and Chuaqui (1986), has received in the last few years several applications in logic and the philosophy of science. In this paper, we study the logic of pragmatic truth, and show that there are important connections between this logic, modal logic and, in particular, Jaskowski's discussive logic. In order to do so, two systems are put forward so that the notions of pragmatic validity and pragmatic truth can be (...) accommodated. One of the main results of this paper is that the logic of pragmatic truth is paraconsistent. The philosophical import of this result, which justifies the application of pragmatic truth to inconsistent settings, is also discussed. (shrink)

In 1986, philosopher-bioethicist Samuel Gorovitz published an essay entitled “Baiting Bioethics,” in which he reported on various criticisms of bioethics that were “in print, or voiced in and around … the field” at that time, and set forth his assessment of their legitimacy. He gave detailed attention to what he judged to be the particularly fierce and “irresponsible attacks” on “the moral integrity” and soundness of bioethics contained in two papers: “Getting Ethics” by philosopher William Bennett and “Medical Morality Is (...) Not Bioethics,” coauthored by us. Gorovitz attributed some of the criticisms that bioethics was eliciting to the fact that this new, rapidly rising, and increasingly visible field had brought “scholars and practitioners together who otherwise would have little exposure to one another's disciplines. Their interactions are mutually enriching at times,” he declared, “but mutually baffling and even infuriating at other times.” In this latter regard, he suggested that “perhaps” Fox and Swazey's characterization of bioethics in the article he dissected “reflects a general revulsion at endeavors they see as inadequately like the social sciences or insufficiently respectful of them.” He went on to say that despite his objections to our “complaints” about bioethics—especially to our claim that “autonomy [had] been an unduly emphasized value” in the field—he had “a lingering sense” that there might be “a grain of truth” in them. Gorovitz ended his essay with an affirmation about the “benefit” that bioethics can derive from “responsible” and even from “irresponsible” criticism. “The unexamined discipline invites the philosopher's critical scrutiny no less than the unexamined life,” he aphoristically concluded. a. (shrink)

How does microbiota research impact our understanding of biological individuality? We summarize the interdisciplinary summer school on "Microbiota, Symbiosis and Individuality: Conceptual and Philosophical Issues" (July 2019), which was supported by a European Research Council starting grant project "Immunity, DEvelopment, and the Microbiota" (IDEM). The summer school centered around interdisciplinary group work on four facets of microbiota research: holobionts, individuality, causation, and human health. The conceptual discussion of cutting-edge empirical research provided new insights into microbiota and highlights the value of (...) incorporating into meetings experts from other disciplines, such as philosophy and history of science. (shrink)

We apply the recently elaborated notions of 'pragmatic truth' and 'pragmatic probability' to the problem of the construction of a logic of inductive inference. It is argued that the system outlined here is able to overcome many of the objections usually levelled against such attempts. We claim, furthermore, that our view captures the essentially cumulative nature of science and allows us to explain why it is indeed reasonable to accept and believe in the conclusions reached by inductive inference.