Obstructive sleep apnea (OSA) severely impacts sleep and has long-term health consequences. Treating sleep apnea with continuous positive airway pressure (CPAP) not only relieves obstructed breathing, but also improves sleep. CPAP improves sleep by reducing apnea-induced awakenings. CPAP may also improve sleep by enhancing features of sleep architecture assessed with electroencephalography (EEG) that maximize sleep depth and neuronal homeostasis, such as the slow oscillation and spindle EEG activity, and by reducing neurophysiological arousal during sleep (i.e., beta EEG activity). We examined (...) cross-sectional differences in quantitative EEG characteristics of sleep, assessed with power spectral analysis, in 29 adults with type 2 diabetes treated with CPAP and 24 adults undergoing SHAM CPAP treatment (total n = 53). We then examined changes in spectral characteristics of sleep as the SHAM group crossed over to active CPAP treatment (n = 19). Polysomnography (PSG) from the CPAP titration night was used for the current analyses. Analyses focused on EEG frequencies associated with sleep maintenance and arousal. These included the slow oscillation (0.5–1 Hz), sigma activity (12–16 Hz, spindle activity), and beta activity (16–20 Hz) in F3, F4, C3, and C4 EEG channels. Whole night non-rapid eye movement (NREM) sleep and the first period of NREM spectral activity were examined. Age and sex were included as covariates. There were no group differences between CPAP and SHAM in spectral characteristics of sleep architecture. However, SHAM cross-over to active CPAP was associated with an increase in relative 12–16 Hz sigma activity across the whole night and a decrease in average beta activity across the whole night. Relative slow oscillation power within the first NREM period decreased with CPAP, particularly for frontal channels. Sigma and beta activity effects did not differ by channel. These findings suggest that CPAP may preferentially enhance spindle activity and mitigate neurophysiological arousal. These findings inform the neurophysiological mechanisms of improved sleep with CPAP and the utility of quantitative EEG measures of sleep as a treatment probe of improvements in neurological and physical health with CPAP. (shrink)

Moral Internalism proposes a necessary link between judging that an action is right/wrong and being motivated to perform/avoid that action. Internalism is central to many arguments within ethics, including the claim that moral judgments are not beliefs, and the claim that certain types of moral skepticism are incoherent. However, most of the basis for accepting Internalism rests on intuitions that have recently been called into question by empirical work. This paper further investigates the intuitions behind Internalism. Three experiments show not (...) only that these intuitions are not widespread, but that they are significantly influenced by normative evaluations of the situation in question. These results are taken to undermine Internalist intuitions, and contribute to the growing body of evidence showing that normative evaluations influence supposedly non-normative judgments. (shrink)

BackgroundThe use of genetic test results in risk-rated insurance is a significant concern internationally, with many countries banning or restricting the use of genetic test results in underwriting. In Australia, life insurers’ use of genetic test results is legal and self-regulated by the insurance industry (Financial Services Council (FSC)). In 2018, an Australian Parliamentary Inquiry recommended that insurers’ use of genetic test results in underwriting should be prohibited. In 2019, the FSC introduced an industry self-regulated moratorium on the use of (...) genetic test results. In the absence of government oversight, it is critical that the impact, effectiveness and appropriateness of the moratorium is monitored. Here we describe the protocol of our government-funded research project, which will serve that critical function between 2020 and 2023.MethodsA realist evaluation framework was developed for the project, using a context-mechanism-outcome (CMO) approach, to systematically assess the impact of the moratorium for a range of stakeholders. Outcomes which need to be achieved for the moratorium to accomplish its intended aims were identified, and specific data collection measures methods were developed to gather the evidence from relevant stakeholder groups (consumers, health professionals, financial industry and genetic research community) to determine if aims are achieved. Results from each arm of the study will be analysed and published in peer-reviewed journals as they become available.DiscussionThe A-GLIMMER project will provide essential monitoring of the impact and effectiveness of the self-regulated insurance moratorium. On completion of the study (3 years) a Stakeholder Report will be compiled. The Stakeholder Report will synthesise the evidence gathered in each arm of the study and use the CMO framework to evaluate the extent to which each of the outcomes have been achieved, and make evidence-based recommendations to the Australian federal government, life insurance industry and other stakeholders. (shrink)

Medicine is not merely a job that requires technical expertise, but a profession concerned with making the best decisions and recommendations with reference to, and in consultation with, the patient. This means that the skill set required for healthcare professionals in order to provide good care is a combination of scientific knowledge, technical aptitude, and affective qualities or virtues such as compassion and empathy.

BackgroundResearch proactively and deliberately aims to bring about specific changes to how societies function and individual lives fare. However, in the ever-expanding field of ethical regulations and guidance for researchers, one ethical consideration seems to have passed under the radar: How should researchers act when pursuing actual, societal changes based on their academic work?Main textWhen researchers engage in the process of bringing about societal impact to tackle local or global challenges important concerns arise: cultural, social and political values and institutions (...) can be put at risk, transformed or even hampered if researchers lack awareness of how their ‘acting to impact’ influences the social world. With today’s strong focus on research impacts, addressing such ethical challenges has become urgent within in all fields of research involved in finding solutions to the challenges societies are facing. Due to the overall goal of doing something good that is often inherent in ethical approaches, boundaries to researchers’ impact of something good is neither obvious, nor easy to detect. We suggest that it is time for the field of bioethics to explore normative boundaries for researchers’ pursuit of impact and to consider, in detail, the ethical obligations that ought to shape this process, and we provide a four-step framework of fair conditions for such an approach. Our suggested approach within this field can be useful for other fields of research as well.ConclusionWith this paper, we draw attention to how the transition from pursuing impact within the Academy to trying to initiate and achieve impact beyond the Academy ought to be configured, and the ethical challenges inherent in this transition. We suggest a stepwise strategy to identify, discuss and constitute consensus-based boundaries to this academic activity. This strategy calls for efforts from a multi-disciplinary team of researchers, advisors from the humanities and social sciences, as well as discussants from funding institutions, ethical committees, politics and the society in general. Such efforts should be able to offer new and useful assistance to researchers, as well as research funding agencies, in choosing ethically acceptable, impact-pursuing projects. (shrink)

Large-scale sequencing tests, including whole-exome and whole-genome sequencing, are rapidly moving into clinical use. Sequencing is already being used clinically to identify therapeutic opportunities for cancer patients who have run out of conventional treatment options, to help diagnose children with puzzling neurodevelopmental conditions, and to clarify appropriate drug choices and dosing in individuals. To evaluate and support clinical applications of these technologies, the National Human Genome Research Institute and National Cancer Institute have funded studies on clinical and research sequencing under (...) the Clinical Sequencing Exploratory Research program as well as studies on return of results. Most of these studies use sequencing in real-world clinical settings and collect data on both the application of sequencing and the impact of receiving genomic findings on study participants. They are occurring in the context of controversy over how to obtain consent for exome and genome sequencing. (shrink)

Unintended negative outcomes on child behavior due to lockdown and home confinement following the corona virus disease pandemic needs highlighting to effectively address these issues in the current and future health crises. In this sub-study of the ODIN-study, the objectives were to determine whether the Danish lockdown and home confinement following the COVID-19 pandemic affected changes in emotional-behavioral functioning of pre-school-aged children using the validated Strength and Difficulties Questionnaire answered by parents shortly before lockdown and 3 weeks into lockdown, and (...) moreover, to examine whether baseline family and social characteristics could predict change in child emotional-behavioral functioning during lockdown. Parents of 40 children with a mean age of 5.0 completed the baseline questionnaire and the lockdown follow-up questionnaire. The SDQ-Total difficulties score and Prosocial Behavioral score changed significantly from pre- to lockdown [SDQ-TD mean: 6.0 and 7.9; P = 0.02, respectively and PSB mean: 8.5 and 7.9; P = 0.03, respectively]. Attending leisure time activities before lockdown was a predicting factor of changes to the worse in the children’s SDQ-TD scores, with a mean difference in SDQ-TD between those with and without activities of 3.16 ; P = 0.03. In conclusion, the study showed a modest decrease in child-emotional behavioral functioning during the COVID-19 lockdown, potentially due to parental stress. Although these results might not be generalizable due to small sample size and selected population, the results point to a need of a greater awareness of child mental wellbeing during a lockdown situation. (shrink)

How do multiple obligations to give, to receive, and to reciprocate contribute to the evolution of international society? This question can be derived from the works of the French anthropologist and sociologist Marcel Mauss, in particular from his classic essay The Gift, published in 1925. The aim of this article is to introduce Mauss’ theory of the gift to international political theorists, to develop a general theoretical argument from his claim about the universality of gift-giving, and to lay out the (...) plan of the Special Issue. First, we explore the basic concepts of gift-giving and reciprocity and how they highlight a type of exchange that differs from market exchange and from other forms of quid-pro-quo interactions. Second, we consider the Marshall Plan as an iconic and controversial example of international gift-giving. Third, we use Martin Wight’s division of international political thought into realism, rationalism, and revolutionism to locate the work of Mauss and neo-Maussian scholars within th... (shrink)

In much the same way that genomic technologies are changing the complexion of biomedical research, the issues they generate are changing the agenda of IRBs and research ethics. Many of the biggest challenges facing traditional research ethics today — privacy and confidentiality of research subjects; ownership, control, and sharing of research data; return of results and incidental findings; the relevance of group interests and harms; the scope of informed consent; and the relative importance of the therapeutic misconception — have become (...) important policy issues over the last 20 years because of the ways they have been magnified by genomic research efforts. Research that examines the ethical, legal, and social implications of human genomics research has become a burgeoning international field of scholarship over the last 20 years, thanks in part to its support first by the genome research funding bodies in the U.S. and then by national science agencies in other countries. (shrink)

This article examines the role of medical doctors, AI designers, and other stakeholders in making applied AI and machine learning ethically acceptable on the general premises of shared decision-making in medicine. Recent policy documents such as the EU strategy on trustworthy AI and the research literature have often suggested that AI could be made ethically acceptable by increased collaboration between developers and other stakeholders. The article articulates and examines four central alternative models of how AI can be designed and applied (...) in patient care, which we call the ordinary evidence model, the ethical design model, the collaborative model, and the public deliberation model. We argue that the collaborative model is the most promising for covering most AI technology, while the public deliberation model is called for when the technology is recognized as fundamentally transforming the conditions for ethical shared decision-making. (shrink)

Machine learning and other forms of artificial intelligence can improve parts of clinical decision making regarding the gathering and analysis of data, the detection of disease, and the provis...

Handeln, Personsein, Menschenwürde und zahlreiche Fragen der Angewandten Ethik – das ist das weite Spektrum dieser Festschrift und auch des Denkens von Ralf Stoecker, dem sie gewidmet ist. Ganz in seinem Geiste laden die Beiträge des Bandes dazu ein, zusammen zu denken und zusammenzudenken, was – möglicherweise – zusammengehört.

Handeln, Personsein, Menschenwürde und zahlreiche Fragen der Angewandten Ethik – das ist das weite Spektrum dieser Festschrift und auch des Denkens von Ralf Stoecker, dem sie gewidmet ist. Ganz in seinem Geiste laden die Beiträge des Bandes dazu ein, zusammen zu denken und zusammenzudenken, was – möglicherweise – zusammengehört.

The welfare of farmed fish is often regarded with less concern than the welfare of other husbandry animals, as fish are not universally classified as sentient beings. In Norway, farmed fish and other husbandry animals are legally protected under the same laws. Additionally, the legislature has defined a number of aquaculture-specific amendments, including mandatory welfare courses for fish farmers who have a key role in securing animal welfare, also with regards to noting welfare challenges in the production process. This article (...) uses fish welfare courses as a site from which to inquire about the common-sense understanding of fish welfare in Norwegian fish farming. The focus is specifically on fish farm employees, their experiences of welfare-related issues and contradictions in their daily work, and the struggle to act responsibly in aquaculture settings. Through participant observation at welfare courses, as well as interviews and conversations with fish farm workers, the article details how challenges are experienced ‘on the ground’, and suggests how fish farm workers’ own experiential knowledge might be mobilized to improve the general welfare of farmed fish. (shrink)

I Norge er ikke surrogati tillatt, og myndighetene fraråder norske statsborgere å benytte seg av surrogati i utlandet. I denne artikkelen fokuserer vi på kommersiell gestational surrogati og stiller spørsmålet: Bør man tillate at norske statsborgere benytter seg av surrogati i India? De etiske problemstillingene rundt surrogati er mange og sammensatte og blir spesielt utfordrende når tjenesten tilbys i et land med store kulturelle og økonomiske forskjeller både internt og i forhold til Norge. Vi baserer analysen og drøftingen av dette (...) etisk utfordrende spørsmålet på Beauchamps og Childress sin veletablerte metodiske tilnærming innen biomedisinsk etikk. Vi anvender de fire allmennmoralske prinsipper: respekt for autonomi, velgjørenhet, ikke-skade og rettferdighet på sakskomplekset for å synliggjøre spenningene involvert i dette etiske dilemmaet. Med full bevissthet om at det ikke finnes noen lettvinte og omkostningsfrie løsninger på dilemmaer generelt og dette spesielt, konkluderer vi med at interessene til de berørte parter, og spesielt surrogatmødrenes, kan bli bedre ivaretatt om surrogati tillates under omfattende reguleringer. Dersom man velger å gjøre praksisen illegal, vil man også miste mulighetene til å påvirke prosessen og sikre rettighetene til de involverte partene.Nøkkelord: surrogati, Norge–India, utnyttelse, autonomi, regulering av prosessenEnglish summary: Should Norwegian citizens be permitted to use surrogacy in India?Surrogacy is not permitted in Norway, and the government strongly advises against Norwegian citizens travelling abroad to have children through the use of the surrogacy industry. In this article, we focus on commercial gestational surrogacy and debate the question: Should Norwegian citizens be permitted to use surrogacy in India? The ethical concerns regarding surrogacy are complex and are especially challenging when the service is offered in a country with big cultural and economic differences both internal and in comparison to Norway. We base our analysis of this ethical, challenging question on Beauchamp’s and Childress’s well-established approach within biomedical ethics. We apply the four principles of respect for autonomy, beneficence, nonmaleficence and justice to shed light on the conflicts of interests in this ethical dilemma. With full awareness that there are no simple and correct solutions to dilemmas in general and on this issue, especially, our conclusion is that the interests of the involved parties, and especially those of the surrogate mothers, might be better attended to if surrogacy is allowed with extensive regulations. If this practice is made illegal, the opportunity to influence the process and secure the rights of the involved parties is lost. (shrink)

Protecting the public's health has recently regained prominence in political and public discussions. Threats of bioterrorism following September 11, 2001 and the deliberate dissemination of anthrax later that fall, the reemergence of novel or resurgent infectious diseases, and rapid increases in diseases associated with sedentary lifestyles, poor diets, and smoking have all raised the profile of public health. The U.S. government has responded with increased funding, reorganization, and new policies for the population's health, safety, and security. Politicians and the public (...) more clearly understand the importance of law in improving the public's health. Recognizing that many public health laws have not been meaningfully reformed in decades, law- and policy-makers and public health practitioners have focused on the legal foundations for public health. Laws provide the mission, functions, and powers of public health agencies, set standards for their actions, and safeguard individual rights. (shrink)

The commentary brings up two topics. The first concerns whether and how a patient’s socioeconomic status should count in clinical care. We provide a brief summary of Puschel and colleagues’ view and discuss it in relation to other accounts. We share their conclusion; considering SES in clinical care can be justified from a fairness perspective. Yet, we question the claim that this is a new perspective, and argue that the reason for the claim of novelty is an insufficient use of (...) references. This leads to the second topic, which is a discussion of citation practices in philosophical/ethics papers. We describe common deviations from academic standards, and suggest how unfortunate practices can be reduced. (shrink)

The terms ‘compatibilism’ and ‘incompatibilism’ were introduced in the mid-20th century to name conflicting views about the logical relationship between the thesis of determinism and the thesis that someone has free will. These technical terms were originally introduced within a specific research paradigm, the classical analytic paradigm. This paradigm is now in its final stages of degeneration and few free-will theorists still work within it (i.e. using its methods, granting its substantive background assumptions, etc.). This chapter discusses how the ambiguity (...) of the terms ‘incompatibilism’ and ‘compatibilism’ took root as the classical analytic paradigm declined and why this matters to the contemporary debate. Among other things, I explain why the ambiguity of these anachronistic terms, though relatively innocuous when they were first introduced, is now encouraging theorists to tolerate and perpetuate serious philosophical errors (e.g. to conflate relations as different in kind and importance as correlation and causation, to promote uncontentiously invalid arguments, and to equivocate in ways that keep the free-will debate mired in pseudo-stalemates). I also suggest a new framework for anyone looking for relief from the confusion and deadlock created by quixotic attempts to redefine classical narratives and jargon so that they adequately describe the dialectical contours of the contemporary free-will debate. In addition, this new framework allows philosophers to start cross-pollinating work on free will and other problems, e.g. the paradox of moral luck. -/- A selection from the publication is available to download here. For full version, please gmail me, username: kristin.mickelson.42 -/- . (shrink)

Derk Pereboom's Four-Case Argument is among the most famous and resilient manipulation arguments against compatibilism. I contend that its resilience is not a function of the argument's soundness but, rather, the ill-gotten gain from an ambiguity in the description of the causal relations found in the argument's foundational case. I expose this crucial ambiguity and suggest that a dilemma faces anyone hoping to resolve it. After a thorough search for an interpretation which avoids both horns of this dilemma, I conclude (...) that none is available. Rather, every metaphysically coherent interpretation invites either a hard- or soft-line reply to Pereboom's argument. I then consider a recharacterization of the dilemma which seems to clear the way for the defence of a revised Four-Case Argument. I address this rejoinder by identifying a still more fundamental problem shared by all viable interpretations of the manipulation cases, showing that each involves a type of manipulation which undermines the victim's agency. Because this diagnosis supports a soft-line reply to every viable interpretation of the argument and can be endorsed by any compatibilist, I consider it the final piece of the Soft-line Solution to the Four-Case Argument. Finally, I suggest a new taxonomy of manipulation arguments, arguing that none that employs the suppressive variety of manipulation found in Pereboom's argument offers a threat to compatibilism. -/- (For direct download option, search Kristin M. Mickelson, Soft-line Solution). (shrink)

*As mentioned in Peter Coy's NYT essay "When Being Good Is Just a Matter of Being Lucky" (2023) -/- ----- -/- How is the problem of free will related to the problem of moral luck? In this essay, I answer that question and outline a new solution to the paradox of moral luck, the source-paradox solution. This solution both explains why the paradox arises and why moral luck does not exist. To make my case, I highlight a few key connections (...) between the paradox of moral luck and two related problems, namely the problem of free will and determinism and the paradox of self-creation. Piecing together intuitions, arguments, and insights from recent work on each of these three problems, I argue that the type of control necessary for moral responsibility can only be had by someone who is a genuine source of his own actions, but the relevant notion of sourcehood admits no coherent characterization. If our commonsense view of moral responsibility is incoherent, it is unsurprising that our commitment to the existence of morally responsible agents commits us to some paradoxical things—e.g. to both the existence and impossibility of moral luck. For more information about this article, please write to gmail account: kristin.mickelson.42. (shrink)

Background Posthumous organ procurement is hindered by the consenting process. Several consenting systems have been proposed. There is limited information on public relative attitudes towards various consenting systems, especially in Middle Eastern/Islamic countries. Methods We surveyed 698 Saudi Adults attending outpatient clinics at a tertiary care hospital. Preference and perception of norm regarding consenting options for posthumous organ donation were explored. Participants ranked (1, most agreeable) the following, randomly-presented, options from 1 to 11: no-organ-donation, presumed consent, informed consent by donor-only, (...) informed consent by donor-or-surrogate, and mandatory choice; the last three options ± medical or financial incentive. Results Mean(SD) age was 32(9) year, 27% were males, 50% were patients’ companions, 60% had ≥ college education, and 20% and 32%, respectively, knew an organ donor or recipient. Mandated choice was among the top three choices for preference of 54% of respondents, with an overall median[25%,75%] ranking score of 3[2,6], and was preferred over donor-or-surrogate informed consent (4[2,7], p vs. 11[6,11], respectively, p = 0.002). Compared to females, males more perceived donor-or-surrogate informed consent as the norm (3[1,6] vs. 5[3,7], p vs. 8[4,9], p vs. 5[2,7], p Conclusions We conclude that: 1) most respondents were in favor of posthumous organ donation, 2) mandated choice system was the most preferred and presumed consent system was the least preferred, 3) there was no difference between preference and perception of norm in consenting systems ranking, and 4) financial (especially in females) and medical (especially in males) incentives reduced preference. (shrink)

The influence of pervasive cultural norms on people’s actions constitutes a longstanding problem for autonomy theory. On the one hand, such norms often seem to elude the kind of reflection that autonomous agency requires. On the other hand, they are hardly entirely beyond the pale of autonomy: people do sometimes reflect critically on them and resist them. This paper draws on phenomenological accounts of embodiment in order to reconcile these observations. We suggest that pervasive cultural norms exert a strong and (...) elusive, but occasionally resistible, influence because they are incorporated – they operate on the largely pre-reflective bodily level of human existence. As an illustration we discuss parental decisions about surgery for children born with unclear sex, decisions permeated by deeply entrenched norms about sexual difference and genital appearance. (shrink)

The article examines how some culturally shared and corporeally enacted beliefs and norms about sexed and racialized embodiment can form embodied agency, and this with the aid of the concepts of incorporation and excorporation. It discusses how the phenomenological concept of excorporation can help us examine painful experiences of how one's lived body breaks in the encounter with others. The article also examines how a continuous excorporation can result in bodily alienation, and what embodied resistance can mean when one has (...) undergone or undergoes excorporation. Elaborating on the work of, among others, Maurice Merleau-Ponty, Martin Heidegger, Drew Leder, and Sarah Ahmed, I discuss incorporation and excorporation of beliefs and norms regarding sexual difference, such as beliefs and norms regarding female and male embodiment, through a reading of Jeffrey Eugenides' novel Middlesex. I also suggest that it is useful to understand the postcolonial scholar Frantz Fanon's narrative of how he could not but attend to his own skin color while living in France in the 1940s and 1950s, in terms of excorporation. Whereas these are different narratives in many ways, I regard them as helpful for clarifying what excorporation implies and what analytic work this concept can enable. (shrink)

In vitro fertilization with reception of oocytes from partners allows lesbian mothers to share biological motherhood. The gestational mother receives an egg from her partner who becomes the genetic mother. This article examines the ethics of IVF with ROPA with a focus on the welfare of the woman and the resulting child, on whether ROPA qualifies as a “legitimate” medical therapy that falls within the goals of medicine, and on the meaning and value attributed to a biologically shared bond between (...) parents and child. We also contrast IVF with ROPA with egg donor IVF for heterosexual couples and intrafamilial live uterus transplantation with IVF, and show how Swedish legislation makes certain ways of sharing biological bonds out of place. In Sweden, IVF with ROPA is illegal, egg donor IVF for heterosexual couples is allowed and practiced as is sperm donor IVF for lesbians, and live uterus transplantation is performed within a research project. But is ROPA really ethically more problematic than these other cases? The article argues that IVF with ROPA gives rise to fewer ethical questions than does live uterus transplantation with IVF and, in some cases, egg donor IVF. (shrink)

Great hope has been placed on biobank research as a strategy to improve diagnostics, therapeutics and prevention. It seems to be a common opinion that these goals cannot be reached without the participation of commercial actors. However, commercial use of biobanks is considered morally problematic and the commercialisation of human biological materials is regulated internationally by policy documents, conventions and laws. For instance, the Council of Europe recommends that: “Biological materials should not, as such, give rise to financial gain”. Similarly, (...) Norwegian legislation reads: “Commercial exploitation of research participants, human biological material and personal health data in general is prohibited”. Both articles represent kinds of common moral intuitions. A problem, however, is that legislative documents are too vague and provide room for ample speculation. Through the use of focus group interviews with Norwegian biobank donors, we have tried to identify lay intuitions and morals regarding the commercial use of biobanks. Our findings indicate that the act of donation and the subsequent uses of the samples belong to two different spheres. While concerns around dignity and commodification were present in the first, injustice and unfairness were our informants’ major moral concerns in the latter. Although some opposition towards commercial actors was voiced, these intuitions show that it is possible to render commercial use of biobanks ethically acceptable based on frameworks and regulations which hinder commodification of the human body and promote communal benefit sharing. (shrink)

Expressive theories of state action seek to identify and assess the ‘meaning’ implicit in state action, such as legislation and public policies. In expressive theories developed by relational egalitarians, state action must ‘express’ equal concern and respect for citizens. However, it is unclear how precisely we can determine and assess the meaning of what states do. This paper considers how an expressive theory could be developed, given the commitments of a relational account of equality, and how such a theory would (...) relate to relational egalitarianism more broadly. I suggest that expressive considerations should be tied more closely than they are in the current literature to agents’ attitudes and to their intentions. I discuss a range of real-world policies that are problematic for what they can be taken to express. (shrink)

With pre-implantation genetic diagnosis (PGD), genetic testing and selective transfer of embryos is possible. In the future, germ-line gene therapy (GLGT) applied to embryos before implantation, in order to introduce missing genes or replace mutant ones, may be possible. The objective of this dissertation is to analyse moral aspects of these technologies, as described by eighteen British, Italian and Swedish gynaecologists and geneticists. The objective is systematised into three parts: research interviews and qualitative analysis, philosophical analysis, and elaboration of a (...) framework that supports the combination of analytic methods. PGD was described as positive since it enabled some couples at risk for a genetic disease to have a child without the disease. PGD was described as in different senses ‘better’ than methods for prenatal diagnosis and selective termination of pregnancy. It was also described as positive since it provided couples at risk with one more option, even if it did not result in the birth of a healthy child. However, interviewees were concerned about the difficulty of defining and evaluating genetic disease. They were also concerned about patients’ choices, and about exaggerated use or misuse. Whereas PGD gave rise to ambivalence in terms of how to understand, describe and evaluate it, GLGT was often described as unrealistic or undesirable. The results of the qualitative analysis are used in a philosophical analysis of the concepts of choice, autonomous choice, ambivalence, trust and ambivalence in trust relations. A set of distinct characteristics of each concept are elaborated. The results of the philosophical analysis are used in the discussion of the results of the qualitative analysis. The study shows that the technologies imply both ‘new’ ways to perform ‘old’ medical practices and ‘new’ practices. Old moral questions are reformulated. New moral questions are added. Against the background of this, the concept of genetic identity is discussed. Key words: empirical ethics, pre-implantation genetic diagnosis, germ-line gene therapy, qualitative research, philosophical analysis, medical progress, genetic disease, choice, autonomous choice, ambivalence, trust, genetic identity. (shrink)

I suggest a pluralistic account of folk psychology according to which not all predictions or explanations rely on the attribution of mental states, and not all intentional actions are explained by mental states. This view of folk psychology is supported by research in developmental and social psychology. It is well known that people use personality traits to predict behavior. I argue that trait attribution is not shorthand for mental state attributions, since traits are not identical to beliefs or desires, and (...) an understanding of belief or desire is not necessary for using trait attributions. In addition, we sometimes predict and explain behavior through appeal to personality traits that the target wouldn't endorse, and so could not serve as the target's reasons. I conclude by suggesting that our folk psychology includes the notion that some behavior is explained by personality traits—who the person is—rather than by beliefs and desires—what the person thinks. Consequences of this view for the debate between simulation theory and theory theory, as well as the debate on chimpanzee theory of mind are discussed. (shrink)

Recent years have seen a rise in the number of sociological, anthropological, and ethnological works on the gift metaphor in organ donation contexts, as well as in the number of philosophical and theological analyses of giving and generosity, which has been mirrored in the ethical debate on organ donation. In order to capture the breadth of this field, four frameworks for thinking about bodily exchanges in medicine have been distinguished: property rights, heroic gift-giving, sacrifice, and gift-giving as aporia. Unfortunately, they (...) all run into difficulties in terms of both making sense of the relational dimensions of postmortem and live organ donations and being normatively adequate in the sense of shedding light and providing guidance on ethical concerns when body parts are donated. For this reason, this article presents a phenomenological framework of giving-through-sharing, based on Maurice Merleau-Ponty’s philosophy. This framework makes sense of relational dimensions of postmortem and live organ donation. It also sheds light on three highly debated concerns in organ donation ethics: indebtedness on the part of recipients, the fact that some live donors do not experience donation as a matter of choice, and the potentially painful experience of donors’ relatives, who need to make decisions about postmortem organ donation at a time of bereavement. It can indirectly support what may be called a normalization of bodily exchanges in medicine. (shrink)

This paper is based on the comments I gave to Alfred Mele regarding his original Zygote Argument during my presentation at a small workshop on manipulation arguments in Budapest back in 2012. After those comments, Mele changed the conclusion of his original Zygote Argument (OZA) from a positive, explanatory conclusion to a negative, non-explanatory conclusion--and, correspondingly, redefined 'incompatibilism' so that it would no longer refer in his work to the view that determinism precludes (undermines, eliminates, destroys, etc.) free will, but (...) refers narrowly to the perhaps spurious association claim that appears in the conclusion of the revised Zygote Argument (Mele 2013+). Yet, over the last decade, Mele has made no comment in print about the changes he made, the invalidity objection that led to them, nor to the fact that his revised Zygote Argument was originally presented by me as a (non-optimal) reaction to my invalidity objection to his original Zygote Argument. To my knowledge, Mele has only mentioned this 2015 paper once, at it was not in the context of understanding manipulation arguments; it was, rather, in the context of defending his revised, non-explanatory definition of 'incompatibilism' at the opening of Aspects of Agency (p. 6, n. 4). There, Mele singles out *just this 2015 paper* as a place where they'll find what Mele degrades as a type of nonstandard/nontraditional definition of 'incompatibilism' that he rejects. This is notable because Mele provides no empirical evidence that his preferred definition is standard, and most (including Lehrer, who coined the term) reject the negative, non-explanatory, association-based definition that Mele came to endorse in the aftermath of my invalidity objection to OZA. So, if Mele had a genuine concern about philosophers who use the term 'incompatibilism', then Mele could have--and should have--named almost any leading figure in free will for this purpose (since most--including Pereboom, Vihvelin, Haji, etc.) reject the non-explanatory definition that Mele-2013+ now endorses. Yet, for untold reasons, Mele isolated the working definition of 'incompatibilism' used in one paper by one unemployed junior researcher to use as his example--even though Neil Levy had used this same definition in previously published work (eg. Levy 2011). Moreover, if Mele were genuinely interested in helping his readers understand the ambiguity of terms like 'compatibilism' and 'incompatibilism' it is a mystery that he referenced a paper in which nothing of substance hung on the definitions given to these terms -- especially considering that he might have instead pointed them to my OTHER 2015 paper, "A Critique of Vihvelin's Three-Fold Classification" in which the MAIN AIM of the paper is to expose the difficulties facing anyone who wants to define the terms 'compatibilism' and 'incompatibilism' in a way that everyone will accept (including a critique of the negative, non-explanatory "incompossibilist" definition that Mele adopted after my objection to OZA). By all appearances, Mele's main aim in citing specifically THIS paper and none of my other work was to give readers the false impression that my working definition of 'incompatibilism' played some role in my charge that his argument is invalid (which it doesn't, given that the term doesn't appear in either the premises or conclusion of that argument). Mele adds to this unseemly rhetorical campaign in his book *Manipulation Agents* where he mentions an invalidity objection in the intro (p. 84) and then discusses that objection in the final lines of Chapter 5 of the book (p. 120-121). The invalidity objection discussed here is completely pedantic, has never been seriously raised in the primary literature (and was previously addressed in multiple places my multiple philosophers, including me), and has nothing whatever to do with my invalidity objection. In other words, Mele was content to discuss an invalidity objection that no one has ever had to an argument that is clearly valid while completely ignoring the ONLY substantive invalidity objection to his argument in print. This is unfortunate, because it has led to serious confusion --including the patently false description of my invalidity objection to OZA as an objection to the revised version of the Zygote Argument that Mele adopted in *response* my objection (e.g., Capes mistakenly claims "Mickelson (2015) contends that arguments like this [i.e. like the revised Zygote Argument] are invalid. But that’s because she defines “incompatibilism” differently than I’ve defined it here" in his "Manipulation Arguments and Direct Arguments" chapter in the 2023 Wiley-Blackwell Companion to Free Will; I did not say this, and the definition of 'incompatibilism' is irrelevant to my objection). In "The Zygote Argument Is Invalid--Now What?", I simply use the invalidity of the simple 2-premise Zygote Argument as a foil to make a series of more philosophically significant points (e.g. regarding the dialectical structure of the free-will debate, the role of best-explanation reasoning, and to develop the first-ever "master manipulation argument"). Mele has yet to address my reasons for calling attention to the non-trivial invalidity of his OZA or to any of my answers to the "Now What?" question in this paper, even though this question and my proposed answers to this question are the paper's main point. For those interested in a more recent discussion of how the logical and metaphilosophical observations made in this "Now What?" paper have helped to move the free-will debate forward, I suggest looking at the discussions of the "paradigm shift" in the free-will debate that helps to explain why the free-will debate has become mired in stalemates and empty verbal disputes that are found, for example, in my contributions to the Wiley-Blackwell Companion to Free Will (Intro and Chapter 4, 2023) and my paper "Free Will, Self-Creation, and the Paradox of Moral Luck" (2019). (shrink)

In the article by Kristin Voigt in the April 2013 issue of Cambridge Quarterly of Healthcare Ethics, quotation marks around certain phrases were deleted.

In this essay, I suggest that Spinoza acknowledges a distinction between formal reality that is infinite and timelessly eternal and formal reality that is non-infinite (i. e., finite or indefinite) and non-eternal (i. e., enduring). I also argue that if, in Spinoza’s system, only intelligible causation is genuine causation, then infinite, timelessly eternal formal reality cannot cause non-infinite, non-eternal formal reality. A denial of eternal-durational causation generates a puzzle, however: if no enduring thing – not even the sempiternal, indefinite individual (...) composed of all finite, enduring things – is caused by the infinite, eternal substance, then how can Spinoza consistently hold that the one infinite, eternal substance is the cause of all things and that all things are modes of that substance? At the end of this essay, I sketch how Spinoza could deny eternal-durational causation while still holding that an infinite, eternal God is the cause of all things and that all things are modes. I develop the interpretation more in the companion essay.1 1 In “Spinoza’s Monism II,” in the next issue of this journal. (shrink)

An old question in Spinoza scholarship is how finite, non-eternal things transitively caused by other finite, non-eternal things (i. e., the entities described in propositions like E1p28) are caused by the infinite, eternal substance, given that what follows either directly or indirectly from the divine nature is infinite and eternal (E1p21–23). In “Spinoza’s Monism I,” “Spinoza’s Monism I,” in the previous issue of this journal. I pointed out that most commentators answer this question by invoking entities that are indefinite and (...) sempiternal, but argued that perhaps we should not be so quick to assume that in Spinoza’s system, an infinite and eternal substance could cause such indefinite, sempiternal entities. But if such eternal-durational causation is denied, then it seems harder to see how Spinoza’s system could be coherent: if Spinoza holds that the infinite, eternal substance cannot cause anything that is not infinite and not eternal, then how can he also hold that all things are modes immanently caused by substance (E1p15, E1p18, E1p25)? In this essay, I explain how Spinoza’s system could be understood in light of a denial of eternal-durational causation. On the interpretation I offer, God is the cause of all things and all things are modes because the essences of all things follow from the divine nature and all essences enjoy infinite, eternal reality as modes immanently caused by the infinite, eternal substance. The same non-substantial essences can also be conceived as enjoying non-infinite, non-eternal reality, but so conceived, they are enduring, finite (or sempiternal, indefinite) entities that cannot be conceived as modes caused by and inhering in the one infinite, eternal substance. I conclude by pointing out that if we take this interpretive route, we do have to understand Spinoza as committed to acosmism, or a denial of the reality of the world – at least the world of enduring, finite things. (shrink)

The notion of individual responsibility has gained prominence in recent debates about health care. First, responsibility has been proposed as a rationing criterion; second, some policies use rewards and sanctions to encourage individuals to ‘take responsibility’ for their health; finally, acting responsibly within the health care system is portrayed as a requirement of reciprocity. The aim of this paper is two-fold. First, I assess these different kinds of appeal to individual responsibility from the perspective of equality. The literature has identified (...) important concerns about equality and fairness with proposals to use individual responsibility as a rationing criterion; I suggest that there are similar concerns about incentive schemes and reciprocity-based appeals to individual responsibility. The analysis will draw on luck egalitarian accounts of equality, which emphasise the importance of individual responsibility. This allows me to pursue the second objective for paper: to reconsider the luck egalitarian perspective on these different appeals to responsibility. Applying the arguments of recent contributions to the luck egalitarian literature to the health arena suggests that luck egalitarians need not support the use of responsibility as a rationing criterion, and they can also identify problems with incentives and reciprocity-based arguments. However, the language of individual responsibility and its prominence in public debates may have implications for individuals’ health and well-being, which raises challenging issues for luck egalitarians as they attempt to apply their theory to the real world. (shrink)

In the context of animal cognitive research, anthropomorphism is defined as the attribution of uniquely human mental characteristics to animals. Those who worry about anthropomorphism in research, however, are immediately confronted with the question of which properties are uniquely human. One might think that researchers must first hypothesize the existence of a feature in an animal before they can, with warrant, claim that the property is uniquely human. But all too often, this isn't the approach. Rather, there is an a (...) priori argument against attributing some properties to animals. Which features are thought to be uniquely human on a priori grounds? The class can be quite large, including psychological states such as beliefs and desires, personality traits such as confidence or timidity, emotions such as happiness or anger, social organizational properties such as culture or friendship, moral behavior such as punishment or rape. For convenience, I will refer to the members of the class as "psychological properties". One critic includes feeling, purpose, intentionality, consciousness, and even cognition in his list of psychological properties that are incorrectly attributed to animals (Kennedy 1992). Among the critics, there is quite a bit of disagreement about what counts as an anthropomorphic attribution, and this alone should raise questions about the charge. We can identify two different questions about the practice of attributing psychological properties to animals within a scientific context. First we can ask whether it is scientifically respectable to examine questions about the mental, psychological, cultural, etc. states of animals. Those who bemoan anthropomorphism think that we ought not even ask such questions. I will look at the worries about asking the question, and argue that there is no special problem with it. The second question arises with an affirmative answer to the first. Given that it is scientifically respectable to examine whether an animal has a psychological property, there must be some scientifically respectable method for doing the examination.. (shrink)

My two principal aims in this essay are interconnected. One aim is to provide a new interpretation of the ‘infinite modes’ in Spinoza’s Ethics. I argue that for Spinoza, God, conceived as the one infinite and eternal substance, is not to be understood as causing two kinds of modes, some infinite and eternal and the rest finite and non-eternal. That there cannot be such a bifurcation of divine effects is what I take the ‘infinite mode’ propositions, E1p21–23, to establish; E1p21–23 (...) show that each and every one of the immanent effects of an infinite and eternal God is an infinite and eternal mode. The other aim is to show that these propositions can be understood as part of an extended critical response to Descartes’s infamous doctrine that God creates eternal truths and true and immutable natures. If we have the correct (Spinozan) conceptions of what God is and how God works, we see that an eternal and infinite God can only be understood to cause ‘eternal truths,’ and that these eternal truths are infinite and eternal modes of God. (shrink)

This essay begins by dividing the traditional problem of free will and determinism into a “correlation” problem and an “explanation” problem. I then focus on the explanation problem, and argue that a standard form of abductive (i.e. inference to the best-explanation) reasoning may be useful in solving it. To demonstrate the fruitfulness of the abductive approach, I apply it to three standard accounts of free will. While each account implies the same solution to the correlation problem, each implies a unique (...) solution to the explanation problem. For example, all libertarian-friendly accounts of free will imply that it is impossible to act freely when determinism is true. However, only a narrow subset of libertarians have the theoretical resources to defend the incompatibilist claim that deterministic laws (qua being deterministic) undermine free will, while other libertarians must reject this incompatibilist view. -/- [Version: Nov. 12, 2018]. (shrink)

"The Manipulation Argument has recently taken center stage in the free-will debate, yet little else can be said of this newcomer that is uncontroversial. At present, even the most fundamental elements of the Manipulation Argument--its structure, conclusion, and target audience--are a matter of dispute. As such, we cannot begin, as we ideally would, with a simple and relatively uncontroversial overview of the argument. Instead, clarifying the debate over the basic structure and general conclusion of the Manipulation Argument will be our (...) goal." -/- UPDATE: I now refer to an isolated objection to the counterexample step as a hardline reply, an isolated attack on the generalization step a softline reply, and an isolated response to the explanation step as an "al dente" reply. Al dente replies have been given in Mele's 2005 critique of the Four-Case Argument and my 2015 (2012) critique of Mele's Zygote Argument. I also now refer to a manipulation argument which has a generalization step that concludes to impossibilism and an explanation step which proposes an explanation for the impossibility of free will as a "Master Manipulation Argument" (examples of master manipulation arguments include Mickelson 2015 and 2019). (shrink)

Our objective was to better understand the values and ethical dilemmas surrounding advance care planning through stories told by registered nurses and licensed social workers, who were employed as care managers within Area Agencies on Aging. We conducted eight focus groups in which care managers were invited to tell their stories and answer open-ended questions focusing on their interactions with consumers receiving home-based long-term care. Using narrative analysis to understand how our participants thought through particular experiences and what they valued, (...) we identified seven themes representative of their work with consumers and families: humility, respect, responsibilities, boundaries, empowerment, courage, and veracity. (shrink)

The study of animal cognition raises profound questions about the minds of animals and philosophy of mind itself. Aristotle argued that humans are the only animal to laugh, but in recent experiments rats have also been shown to laugh. In other experiments, dogs have been shown to respond appropriately to over two hundred words in human language. In this introduction to the philosophy of animal minds Kristin Andrews introduces and assesses the essential topics, problems and debates as they cut across (...) animal cognition and philosophy of mind. She addresses the following key topics: what is cognition, and what is it to have a mind? What questions should we ask to determine whether behaviour has a cognitive basis? the science of animal minds explained: ethology, behaviourist psychology, and cognitive ethology rationality in animals animal consciousness: what does research into pain and the emotions reveal? What can empirical evidence about animal behaviour tell us about philosophical theories of consciousness? does animal cognition involve belief and concepts; do animals have a ‘Language of Thought’? animal communication other minds: do animals attribute ‘mindedness’ to other creatures? moral reasoning and ethical behaviour in animals animal cognition and memory. Extensive use of empirical examples and case studies is made throughout the book. These include Cheney and Seyfarth’s ververt monkey research, Thorndike’s cat puzzle boxes, Jensen’s research into humans and chimpanzees and the ultimatum game, Pankseep and Burgdorf’s research on rat laughter, and Clayton and Emery’s research on memory in scrub-jays. Additional features such as chapter summaries, annotated further reading and a glossary make this an indispensable introduction to those teaching philosophy of mind, animal cognition. It will also be an excellent resource for those in fields such as ethology, biology and psychology. (shrink)