Background: Post-traumatic stress disorder is a prevalent, debilitating, and costly psychiatric disorder. Evidenced-based psychotherapies, including Cognitive Processing Therapy, are effective in treating PTSD, although a fair proportion of individuals show limited benefit from such treatments. CPT requires cognitive demands such as encoding, recalling, and implementing new information, resulting in behavioral change that may improve PTSD symptoms. Individuals with PTSD show worse cognitive functioning than those without PTSD, particularly in acquisition of verbal memory. Therefore, memory dysfunction may limit treatment gains in (...) CPT in some individuals with PTSD. Methods and Analysis: Here, we present a protocol describing the Cognition and PsychoTherapy in PTSD study, a prospective, observational study examining how cognitive functioning affects treatment response in CPT for PTSD. The study aims to recruit 105 outpatient veterans with PTSD between the ages of 18 and 70 years. Prior to beginning 12 sessions of CPT, Veteran participants will have standardized assessments of mood and functioning and complete a comprehensive neurocognitive battery assessing episodic learning, attention and speed of processing, language ability, executive control, and emotional functioning. This study aims to fill gaps in the current literature by: examining the specificity of memory effects on treatment response; exploring how baseline cognitive functioning impacts functional outcomes; and examining potential mechanisms, such as memory for treatment content, that might explain the effects of baseline memory functioning on PTSD symptom trajectory. Discussion: If successful, this research could identify clinically relevant neurocognitive mechanisms that may impact PTSD psychotherapy and guide the development of individualized treatments for PTSD. (shrink)

The book is divided into three sections. In the first section, Lynch presents what he calls “truisms about truth.” The first truism is that truth is objective. Accepting a kind of Aristotelian realism, Lynch defines “true beliefs” as “those that portray the world as it is and not as we may hope, fear, or wish it to be”. The second truism is that truth is good. The point here is not that truth is morally good, but that it (...) is generally pursued, and the opposite is generally avoided and even ridiculed. Closely related to this is the third truism: truth is a worthy goal of inquiry. The fourth truism is that truth is worth caring about for its own sake. To help recognize this, he refers the reader to the movie, The Matrix. While some may choose to enter the matrix for a short period of bliss, most would prefer to live an authentic life of truth, in the real world. (shrink)

Although many bioethicists have given attention to the special health issues of Africa and to the ethics of research on the continent, only a handful have considered these issues through the lens of African moral thought. The question has been for the most part neglected as to what a distinctively African moral perspective would be for the analysis and teaching of bioethics issues. To address the oversight, the authors of this paper describe embarking on a project aimed at incorporating African (...) moral perspective, values and philosophy into a teaching curriculum. The authors clarify the rationale for the project and discuss the strategies employed in Africanizing the bioethics curriculum. (shrink)

I give an account how the principle of ‘respect for autonomy’ dominates the field of bioethics, and how it came to triumph over its competitors, ‘respect for persons’ and ‘respect for free power of choice’. I argue that ‘respect for autonomy’ is unsatisfactory as a basic principle of bioethics because it is grounded in too individualistic a worldview, citing concerns of African theorists and other communitarians who claim that the principle fails to acknowledge the fundamental importance of understanding persons within (...) the nexus of their communal relationships. I defend the claim that ‘respect for persons’ is a more appropriate principle, as it is able to acknowledge both individual decision making and the essential relationality of persons. I acknowledge that my preference for ‘respect for persons’ is problematic because of the important debate around the definition of ‘personhood’ in bioethics discourse. Relying on Thaddeus Metz's conception of moral status, I propose a relational definition of personhood that distinguishes between persons with agency and persons without agency, arguing that we have different moral obligations to these distinct categories of persons. I claim that this conception of personhood is better able to accommodate our moral intuitions than conventional approaches, and that it is able to do so without being speciesist or question-begging. (shrink)

The Children’s Act and its associated regulations allow for virginity tests to be performed on male and female children over the age of 16. This is subject to a number of legislated conditions, including that informed consent should be obtained. In this article I argue that, whilst it is important that the right to social and cultural practice be protected in South Africa, virginity testing is a practice that cannot be morally justified. Firstly, I defend the claim that the practice (...) is inherently unjust. At least some of those subjected to the tests will inevitably experience the undesirable consequences of a false test result. The practice is also discriminatory as it typically and unjustly targets girl children, since boys are far less commonly tested. I argue further that the practice perpetuates a harmful patriarchal social order. Finally, I contend that any attempts to justify this legislation are fatally flawed, because it is fundamentally irrational, since there is no reliable means of testing for virginity. (shrink)

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory (...) determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

Background Surgery for intersex infants should be delayed until individuals are able to decide for themselves, except where it is a medical necessity. In an ideal world, this single principle would suffice and such surgeries could be totally prohibited. Unfortunately, the world is not perfect, and, in some places, intersex neonates are at risk of being abandoned, mutilated or even killed. As long as intersex persons are at such high risk in some places, any ethical guidelines for intersex surgeries will (...) need to take these extreme risks of harm into account. Main text I therefore argue for five basic principles that ought to inform ethics guidelines for surgical interventions in intersex children, specifically in contexts in which such children are at risk of significant harm. What I set out to come up with is a set of principles that do not completely prohibit surgery, but only allow it where a strong case can be made for its necessity, in the best interests of the child, and where there is some kind of oversight to prevent misuse. The first principle is that interventions as drastic as these surgeries should only be performed when there is strong evidence that they are beneficial and not harmful. The second principle is that in surgeries should normally only be performed in cases of true medical necessity. Principle three is that surgeries should normally be delayed until such time as the intersex person is mature enough to assent to treatment or decide against it. Principle four is that the conventional ethical requirements regarding truth telling apply equally to intersex children as to anyone else. The final principle is that where physicians or parents think that surgery is in the best interests of the child, the burden of proof lies with them. Conclusion It is hoped that these principles might help medical teams and parents make better decisions about intersex surgeries on children, and they would make such surgeries very rare indeed, if they happen at all. (shrink)

A recent study using a crossmodal matching task showed that the identity of a talker could be recognized even when the auditory and visual stimuli that were being matched were different sentences spoken by the talker. This finding implies that general temporal features of a person's speech are shared across the auditory and visual modalities.

Contributing reviewersThe editors of Philosophy, Ethics, and Humanities in Medicine would like to thank all our reviewers who have contributed to the journal in Volume 10.

The Patient Protection and Affordable Care Act turns to a nontraditional mechanism to improve public health: employer -provided financial incentives for healthy behaviors. Critics raise questions about incentive programs' effectiveness, employer involvement, and potential discrimination. We support incentive program development despite these concerns. The ACA sets the stage for a broad-based research and implementation agenda through which we can learn to structure incentive programs to not only promote public health but also address prevalent concerns.

Individuals can often take steps to preserve or improve their own health. They can eat appropriate quantities of healthy foods, exercise, and refrain from smoking. They can obtain preventive care and adhere to their physicians’ advice about how best to manage their health. But they often fail to take these steps.A widespread failure to adopt healthy behaviors can significantly erode public health while increasing health care costs. Obesity, for example, increases the risk of heart disease, stroke, liver disease, and certain (...) cancers. By one estimate, it is responsible for almost 10 percent of medical spending in the United States, or about $147 billion per year. Smoking increases the risk of heart disease, stroke, lung disease, and cancer; it accounts for nearly 20 percent of deaths each year in the United States and about $96 billion in health care expenditures. (shrink)

Kevin Lynch's books are the classic underpinnings of modern urban planning and design, yet they are only a part of his rich legacy of ideas about human purposes and values in built form. City Sense and City Design brings together Lynch's remaining work, including professional design and planning projects that show how he translated many of his ideas and theories into practice. An invaluable sourcebook of design knowledge, City Sense and City Design completes the record of one (...) of the foremost environmental design theorists of our time and leads to a deeper understanding of his distinctively humanistic philosophy. The editors, both former students of Lynch, provide a cogent summary of his career and of the role he played in shaping and transforming the American urban design profession during the 1950s, the 1960s, and the 1970s. Each of the seven thematic groupings of writings and projects that follow begins with a short introduction explaining their content and their background. The essays in part I focus on the premises of Lynch's work: his novel reading of large-scale built environments and the notion that the design of an urban landscape should be as meaningful and intimate as the natural landscape. In part II, excerpts from Lynch's travel journals reveal his early ideas on how people perceive and interpret their surroundings—ideas that culminated in his seminal work, The Image of the City. This part of the book also presents Lynch's experiments with children and his assessment of environmental-perception research. The examples of both small-scale and large-scale analysis of visual form in part III are followed by three parts on city design. These include Lynch's more theoretical works on complex planning decisions involving both functional (spatial and structural organization) and normative (how the city works in human terms) approaches, articles discussing the principles that guided Lynch's teaching and practice of city design, and descriptions of Lynch's own projects in the Boston area and elsewhere. The book concludes with essays written late in Lynch's career, fantasy pieces describing utopias and offering new design freedoms and scenarios warning of horrifying "cacotopias.". (shrink)

The HealthyFood program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members. Members receiving the lowest cash back level were randomized to one of six arms: Arm 1 : 10% cash back, no weekly text, standard monthly text; Arm 2: 10% cash back, generic weekly text, standard monthly text; Arm 3: 10% cash back, (...) personalized weekly text, standard monthly text; Arm 4: 25% cash back, personalized weekly text, standard monthly text; Arm 5: 10 + 15%NET cash back, personalized weekly text, standard monthly text; and, Arm 6: 10 + 15%NET cash back, personalized weekly text, unbundled monthly text. In the 10 + 15%NET cash back, the cash back amount was the baseline 10% plus 15% of the net difference between healthy and unhealthy spending. The generic text included information on HF and healthy eating, while the personalized text had individualized feedback on purchases. The standard monthly text contained the cash back amount. The unbundled monthly text included the amount lost due to unhealthy purchases. The primary outcome was the average monthly percent healthy food spending. Secondary outcomes were the percent unhealthy food spending, and the percent healthy and unhealthy food items. Of the members contacted, 20 opted out, and 2841 met all inclusion criteria. There were no between-arm differences in the examined outcomes. The largest mean difference in percent healthy spending was between Arm 1 and Arm 2, and the largest mean difference in percent unhealthy spending was also between Arm 1 and Arm 2, but no differences were statistically significant after correction for multiple comparisons. None of the tested financial incentive structures or text strategies differentially affected food purchasing. Notably, more than doubling the cash back amount and introducing a financial disincentive for unhealthy purchases did not affect purchasing. These findings speak to the difficulty of changing shopping habits and to the need for innovative strategies to shift complex health behaviors. NCT02486588 Increasing Engagement with a Healthy Food Benefit. The trial was prospectively registered on July 1, 2015. (shrink)

In his article, a unified brain-based determination of death is described by James Bernat (2024) as a permanent cessation of systemic circulation causing a permanent cessation of brain circulation...

Willful ignorance is an important concept in criminal law and jurisprudence, though it has not received much discussion in philosophy. When it is mentioned, however, it is regularly assumed to be a kind of self-deception. In this article I will argue that self-deception and willful ignorance are distinct psychological kinds. First, some examples of willful ignorance are presented and discussed, and an analysis of the phenomenon is developed. Then it is shown that current theories of self-deception give no support to (...) the idea that willful ignorance is a kind of self-deception. Afterwards an independent argument is adduced for excluding willful ignorance from this category. The crucial differences between the two phenomena are explored, as are the reasons why they are so easily conflated. (shrink)

Men often make riskier decisions than women across a wide range of real-life behaviors. Whether this sex difference is accentuated, diminished, or stable under stressful conditions is, however, contested in the scientific literature. A critical blind spot lies amid this contestation: Most studies use standardized, laboratory-based, cognitive measures of decision making rather than complex real-life social simulation tasks to assess risk-related behavior. To address this blind spot, we investigated the effects of acute psychosocial stress on risk decision making in men (...) and women using a standardized cognitive measure and a novel task that simulated a real-life social situation. Participants were exposed to either an acute psychosocial stressor or an equivalent control condition. Stressor-exposed participants were further characterized as high- or low-cortisol responders. Results confirmed that the experimental manipulation was effective. On the IGT, participants characterized as low-cortisol responders made significantly riskier decisions than those characterized as high-cortisol responders. Similarly, in the online chatroom, participants characterized as low-cortisol responders were, relative to those in the Non-Stress group, significantly more likely to make risky decisions. Together, these results suggest that at lower levels of cortisol both men and women tend to make riskier decisions in both economic and social spheres. (shrink)

Alfred Mele's deflationary account of self-deception has frequently been criticised for being unable to explain the “tension” inherent in self-deception. These critics maintain that rival theories can better account for this tension, such as theories which suppose self-deceivers to have contradictory beliefs. However, there are two ways in which the tension idea has been understood. In this article, it is argued that on one such understanding, Mele's deflationism can account for this tension better than its rivals, but only if we (...) reconceptualize the self-deceiver's attitude in terms of unwarranted degrees of conviction rather than unwarranted belief. This new way of viewing the self-deceiver's attitude will be informed by observations on experimental work done on the biasing influence of desire on belief, which suggests that self-deceivers don’t manage to fully convince themselves of what they want to be true. On another way in which this tension has been understood, this account would not manage so well, since on this understanding the self-deceiver is best interpreted as knowing, but wishing to avoid, the truth. However, it is argued that we are under no obligation to account for this since it is a characteristic of a different phenomenon than self-deception, namely, escapism. (shrink)

Available in paperback under the title Good City Form With the publication of The Image of the City, Kevin Lynch embarked on the process of exploration of city form. A Theory of Good City Form, his most important book, is both a summation and an extension of his vision, a high point from which he views cities past and possible. The central section of the book develops a new normative theory of city form—an identification of the characteristics that (...) good human settlements should possess. This follows an examination of three existing normative theories—those which see the city as a model of the cosmos, as a machine, and as a living organism—which are shown to be finally inadequate and unable to hold up under sustained analysis. In addition, an appendix demonstrates the inadequacies of a number of functional theories—those whose aim is simply to describe how settlements work rather than to evaluate how they ought to work. Among these theories are models of cities as ecological systems, as fields of force, as systems of linked decisions, or as areas of class conflict. Lynch puts forth his own theory by searching out the qualities that produce good settlements, qualities that allow "development, within continuity, via openness and connection." He identifies five interrelated dimensions of performance—vitality, sense, fit, access, and control—and two "meta-criteria," efficiency and justice. As in all of Lynch's writing, the theory flows from and leads back to specific examples and everyday realities. The final section of the book is concerned with applications of the theory. (shrink)

The self-deception debate often appears polarized between those who think that self-deceivers intentionally deceive themselves (‘intentionalists’), and those who think that intentional actions are not significantly involved in the production of self-deceptive beliefs at all. In this paper I develop a middle position between these views, according to which self-deceivers do end up self-deceived as a result of their own intentional actions, but where the intention these actions are done with is not an intention to deceive oneself. This account thus (...) keeps agency at the heart of self-deception, while also avoiding the paradox associated with other agency-centered views. (shrink)

A distinction can be made between those who think that self-deception is frequently intentional and those who don’t. I argue that the idea that self-deception has to be intentional can be partly traced to a particular invalid method for analyzing reflexive expressions of the form ‘Ving oneself’ (where V stands for a verb). However, I take the question of whether intentional self-deception is possible to be intrinsically interesting, and investigate the prospects for such an alleged possibility. Various potential strategies of (...) intentional self-deception are examined in relation to Alfred Mele’s suggestion that doing something intentionally implies doing it knowingly. It is suggested that the best prospects for an intentionalist theory of self-deception lie with a strategy involving the control of attention. (shrink)

A prevalent assumption among philosophers who believe that people can intentionally deceive themselves (intentionalists) is that they accomplish this by controlling what evidence they attend to. This article is concerned primarily with the evaluation of this claim, which we may call ‘attentionalism’. According to attentionalism, when one justifiably believes/suspects that not-p but wishes to make oneself believe that p, one may do this by shifting attention away from the considerations supportive of the belief that not-p and onto considerations supportive of (...) the belief that p. The details of this theory are elaborated, its theoretical importance is pointed out, and it is argued that the strategy is supposed to work by leading to the repression of one’s knowledge of the unwelcome considerations. However, I then show that the assumption that this is possible is opposed by the balance of a relevant body of empirical research, namely, the thought-suppression literature, and so intentionalism about self-deception cannot find vindication in the attentional theory. (shrink)

Stubborn belief, like self-deception, is a species of motivated irrationality. The nature of stubborn belief, however, has not been investigated by philosophers, and it is something that poses a challenge to some prominent accounts of self-deception. In this paper, I argue that the case of stubborn belief constitutes a counterexample to Alfred Mele’s proposed set of sufficient conditions for self-deception, and I attempt to distinguish between the two. The recognition of this phenomenon should force an amendment in this account, and (...) should also make a Mele-style deflationist think more carefully about the kinds of motivational factors operating in self-deception. (shrink)

This article discusses a kind of knowledge classifiable as knowledge-wh but which seems to defy analysis in terms of the standard reductive theory of knowledge-wh ascriptions, according to which they are true if and only if one knows that p, where this proposition is an acceptable answer to the wh-question ‘embedded’ in the ascription. Specifically, it is argued that certain cases of knowing what an experience is like resist such treatment. I argue that in some of these cases, one can (...) know that p, where an acceptable answer to the question ‘What’s the experience like?’ is that p, but where one does not know what the experience is like. This could point to the distinctiveness of this sort of knowledge. (shrink)

The notion of basic action has recently come under attack based on the idea that any putative basic action can always be divided into more basic sub-actions. In this paper it is argued that this criticism ignores a key aspect of the idea of basic action, namely, the ‘anything else’ part of the idea that basic actions are not done by doing anything else. This aspect is clarified, and it is argued that doing the sub-actions of which a putative basic (...) action consists does not amount to doing something different from doing that putative basic action. (shrink)

According to the pragmatic hypothesis testing theory, how much evidence we require before we believe something varies depending on the expected costs of falsely believing and disbelieving it. This theory has been used in the self-deception debate to explain our tendencies towards self-deceptive belief formation. This article argues that the application of this theory in the self-deception debate has overlooked the distinction between belief and acceptance, and that the theory in all likelihood models acceptance rather than belief, in which case (...) it is probably not relevant to the explanation of self-deception. It is suggested, however, that doxastic error costs might be relevant to explaining some types of self-deception, though they feature in an evolutionary explanation of it rather than a psychological one. (shrink)

From time to time philosophers and scientists have made sensational, provocative claims that certain things do not exist or never happen that, in everyday life, we unquestioningly take for granted as existing or happening. These claims have included denying the existence of matter, space, time, the self, free will, and other sturdy and basic elements of our common-sense or naïve world-view. Around the middle of the twentieth century an argument was developed that can be used to challenge many such skeptical (...) claims based on linguistic considerations, which came to be known as the Paradigm Case Argument ... (shrink)

This paper investigates whether we can know how to do basic actions, from the perspective according to which knowing how to do something requires knowledge of a way to do it. A key argument from this perspective against basic know-how is examined and is found to be unsound, involving the false premise that there are no ways of doing basic actions. However, a new argument along similar lines is then developed, which contends that there are no ways of doing basic (...) actions in any sense that matters for acquiring knowledge-how. This requires coming to a deeper understanding of ways of doing things than has hitherto been sought, which should be useful for further theorizing in this area. It is concluded that analyses of knowing-how in terms of knowledge of ways are inconsistent with the common assumption that there is basic know-how. (shrink)

Though the psychoanalytic method of interpretation is seen by psychoanalysts as a reliable scientific tool for investigating the unconscious mind, its reputation has long been marred by what’s known as the consensus problem: where different analysts fail to reach agreement when they interpret the same phenomena. This has long been thought, by both practitioners and observers of psychoanalysis, to undermine its claim to scientific status. The causes of this problem, however, are dimly understood. In this paper I attempt to illuminate (...) one important cause of the consensus problem by investigating the role which reliance on ‘associative evidence’ has in generating consensus failures. Various options for overcoming the difficulties with this form of clinical evidence are then examined. It is argued that these problems can be mitigated by the notion of overall associative fit, though they are exacerbated by certain loose standards used for what counts as acceptable associative evidence. The possibility of using more rigorous standards is discussed. (shrink)