Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a number of (...) ways. One possible solution to this clinical dilemma is through the use of conversational artificial intelligence using large language models (LLMs). There is considerable interest in the potential benefits of such models in medicine. For delegated procedural consent, LLM could improve patients’ access to the relevant procedural information and therefore enhance informed decision-making. In this paper, we first outline a hypothetical example of delegation of consent to LLMs prior to surgery. We then discuss existing clinical guidelines for consent delegation and some of the ways in which current practice may fail to meet the ethical purposes of informed consent. We outline and discuss the ethical implications of delegating consent to LLMs in medicine concluding that at least in certain clinical situations, the benefits of LLMs potentially far outweigh those of current practices. (shrink)

When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such (...) a PPP were more accurate, on average, than human surrogates in identifying patient preferences, the proposed algorithm would nevertheless fail to respect the patient’s (former) autonomy since it draws on the ‘wrong’ kind of data: namely, data that are not specific to the individual patient and which therefore may not reflect their actual values, or their reasons for having the preferences they do. Taking such criticisms on board, we here propose a new approach: the Personalized Patient Preference Predictor (P4). The P4 is based on recent advances in machine learning, which allow technologies including large language models to be more cheaply and efficiently ‘fine-tuned’ on person-specific data. The P4, unlike the PPP, would be able to infer an individual patient’s preferences from material (e.g., prior treatment decisions) that is in fact specific to them. Thus, we argue, in addition to being potentially more accurate at the individual level than the previously proposed PPP, the predictions of a P4 would also more directly reflect each patient’s own reasons and values. In this article, we review recent discoveries in artificial intelligence research that suggest a P4 is technically feasible, and argue that, if it is developed and appropriately deployed, it should assuage some of the main autonomy-based concerns of critics of the original PPP. We then consider various objections to our proposal and offer some tentative replies. (shrink)

A number of authors have commented on the topic of mandated reporting in cases of suspected child maltreatment and the application of this requirement to researchers. Most of these commentaries focus on the interpretation of current legal standards and offer opinions for or against the imposition of mandated reporting laws on research activities. Authors on both sides of the issue offer ethical arguments, although a direct comparison and analysis of these opposing arguments is rare. This article critically examines the ethical (...) arguments made by authors on both sides of the debate. The conclusion is reached that researchers should be mandated reporters of child maltreatment because the current arguments do not justify their exclusion from current ethical and legal standards. The author makes recommendations for the ethically responsible conduct of research in regard to this topic and legal implications are discussed. (shrink)

Critical social theory has long been marked by a deep, creative, and productive relationship with psychoanalysis. Whereas Freud and Fromm were important cornerstones for the early Frankfurt School, recent thinkers have drawn on the object-relations school of psychoanalysis. Transitional Subjects is the first book-length collection devoted to the engagement of critical theory with the work of Melanie Klein, Donald Winnicott, and other members of this school. Featuring contributions from some of the leading figures working in both of these fields, including (...) Axel Honneth, Joel Whitebook, Noëlle McAfee, Sara Beardsworth, and C. Fred Alford, it provides a synoptic overview of current research at the intersection of these two theoretical traditions while also opening up space for further innovations. Transitional Subjects offers a range of perspectives on the critical potential of object-relations psychoanalysis, including feminist and Marxist views, to offer valuable insight into such fraught social issues as aggression, narcissism, “progress,” and torture. The productive dialogue that emerges augments our understanding of the self as intersubjectively and socially constituted and of contemporary “social pathologies.” Transitional Subjects shows how critical theory and object-relations psychoanalysis, considered together, have not only enriched critical theory but also invigorated psychoanalysis. (shrink)

This essay introduces a running symposium on the work of Richard Rorty and its legacy fifteen years after his passing. The arc of Rorty's thought defines a trajectory through American pragmatism, tracing a variation unimagined until he expressed it. His work raised Anglophone philosophers’ interest in American pragmatism as never before and also focused the interest of the whole world on American pragmatism as never before, even though the result was to define a pragmatism saturated with nominalism and suppressing the (...) most original qualities of the sources that he celebrated. (shrink)

This is an introduction to a volume of articles containing highlights from the fifty-third Annual Meeting of the Society for Phenomenology and Existential Philosophy (SPEP) hosted by Loyola University–New Orleans with Tulane University from October 23–25, 2014. Many of the articles included here mine the rich and productive vein of post-Kantian critical philosophy that inspires so much work in Continental philosophy; hence the title of our volume is “Legacies of Critique.” The volume opens with the “Co-director’s Address” by outgoing SPEP (...) co-director Amy Allen. (shrink)

This article aims to give an analysis of the phenomena of unjust misappropriation of marginalised groups’ terms online, using the example misappropriation of ‘woke’ from the Black community on Twitter. I argue that using terms such as these outside their original context warps their meaning, decreasing the intelligibility of the experiences of the marginalised agents who use them when attempting to express themselves both within their community and without. I intend to give an analysis of this phenomena, with the expectation (...) that understanding it better will provide a crucial step in combatting it. To this end, I argue it can be understood as a specialised form of what Kristie Dotson calls ‘contributory injustice’, injustices which involve the suppression of a marginalised community’s existing hermeneutical resources, combined with a specific consequence of what Boyd and Marwick call ‘context collapse’, the removal of social norms created through the homogenising effect of social media sites like Twitter. The result is a novel misappropriation phenomenon, I label ‘Context-Collapsed Contributory Injustice’ or ‘CC.CI’. This type of misappropriation is particularly harmful due to it being faster-acting than historical varieties of misappropriation. Furthermore, unchecked continual cases of CC.CI can cause a novel from of what Miranda Fricker calls ‘hermeneutical injustice’, which is demarcated from standard cases by its ability to reintroduce conceptual lacunas through undermining existing hermeneutical resources. I finish by disambiguating cases of CC.CI from natural meaning change and critically analysing some existing philosophical treatments of “woke”. (shrink)

This article deals with a highly debated text, namely 2 Maccabees 12, specifically the problematic verses (38–45) which contain a theology that is distinctly non-Jewish in import. Indeed, most recent scholars concerned with this passage do not seem to be unanimous apropos the best interpretation of the events that are described, resulting in a range of different opinions concerning, inter alia, the afterlife, purgatory and/or doctrinal disputes between Pharisees and Sadducees. By means of an interpretivist or constructivist epistemology, the authors (...) advocate that normally, traditional Judaism emphasises personal, individual responsibility and accountability, whereas in this text God is portrayed as requiring material, financial payment for wrongdoing and not individual תשובה [teshuvah]. This is in contradistinction to, inter alia, Exodus 30:11–16 and theologically Jewish ‘transgression’ has clearly metamorphosed into Christian ‘sin’. In addition, Judas Maccabeus seems to have retained a half-shekel methodology (employed for Jewish men of military age – soldiers) whilst emphasising the ‘atonement for your lives’ from Exodus 30:11–16 in a more literalistic, materialistic, non-Jewish sense whilst de-emphasising the real need to maintain the Temple as well as the proper, traditional rules of תשובה. (shrink)

Given the strong mimetic and dramatic qualities found in Judith the authors make the suggestion that perhaps, before LXX Judith became a fixed, written text, the basic fabula might well have been part of an oral tradition. The authors accept that an appropriately written dramatic work, whether transmitted through reading or an oral presentation, by means of its performative qualities, has the potential to achieve immediacy. Here, the audience may become captivated with its own familiarity and memory of popular, communally (...) shared narratives. Accordingly, this article attempts to find evidence in the Greek text of LXX Judith for a possible oral precursor. In this context, corroboration is sought for the employment of verbal aspect and mood of the Greek language as well as instances of drama, theatrics, bodily gestures, mnemonic devices or special emphasis on the employment of the senses such as sight, taste and smell. The authors suggest that based on an analysis of the text of Chapter 13, there is much circumstantial evidence for the Judith fabula once being an oral narrative – one that embodies the dramatic and even encourages audience participation. This characteristic strongly suggests the removal of the fourth wall – the notion of an imaginary boundary between any fictional work and its audience. Contribution: This article shows that Judith 13 is indeed the climax of the narrative. However, it goes further. It is a vivid scene with various performative aspects. There are props, dialogue and audience participation. This research is cutting-edge and paves the way for new explorations. (shrink)

This article explores home dissatisfaction using methods modelled on those used to understand negative body image and its causes. We found that a substantial proportion of UK participants (13–39%) expressed dissatisfaction with their homes. Although the strongest association was between home dissatisfaction and reported physical problems, there was evidence that dissatisfaction is also predicted by experiencing pressure from the media and your family to improve your home, as well as reporting a greater tendency to compare your home to others’. The (...) results of the study provide initial evidence for a sociocultural explanation of home dissatisfaction, analogous to sociocultural explanations of body dissatisfaction. (shrink)

In this commentary, we critique the appropriate behavioural features for evolutionary genetic analysis, the role of the environment, and the viability of a general evolutionary genetic model for all common mental disorders. In light of these issues, we suggest that the authors may have prematurely discounted the role of some of the mechanisms they review, particularly balancing selection. (Published Online November 9 2006).

The Septuagint Book of Judith and its derivatives have had an enormous influence on the history of Western Europe and the Christian church. Judith has been employed in various situations to incite violence against a perceived opposition. In this regard, this article focuses on the climax of this book (Jdt 13:1–9) as performance text. In this context, many of the insights proffered by Perry in his seminal work Insights from Performance Criticism (2016) have been expanded upon from the perspective of (...) a Greek and/or Hellenistic environment.Contribution: The value of reading LXXJudith as performance is clearly demonstrated. The conclusion is reached that this pericope is indeed highly subversive. Suggestion is also made that, contrary to more conservative wisdom, with reference specifically to LXXJudith 13:1–9, the Judith fabula is not really reconciliatory in nature. Rather, it seems to provoke conflict between competing powers. (shrink)

Hans Jonas’s establishment of an ethics of responsibility entails the simultaneous rejection of the modern notion of progress and the recovery of a form of “metaphysical speculation” that aids man in his search for an objective standard of value. Looking mostly at Jonas’s philosophical biology in The Phenomenon of Life and Mortality and Morality, this paper shows how Jonas’s thought on value judgments rests upon his critique of progress and science. The ethics of perfectibility and progress, Jonas shows, leads to (...) a predicament in which the modern mind must navigate between the dangers present in the hubristic hopes of technological progress and the nihilism he finds in the thought of Martin Heidegger. Jonas’s philosophical biology serves as a critique of these positions that opens up an alternative orientation toward nature—one that grounds not only the ethics of responsibility but the uniquely human activity of reflection. The critique of progress serves, then, as a propaedeutic to the ethics of responsibility and the recovery of an image of man as the reflective animal. Such a recovery of metaphysical speculation from the dogmas of the physical sciences helps encourage a “new humility” in the face of man’s technological power. Jonas hopes to replace man’s desire for self-overcoming with the fear that his “Promethean immoderation” will lead to the biosphere's destruction. This fear acknowledges the limits of man’s knowledge and is thereby accompanied by a posture of Socratic ignorance and the reengagement with the philosophia perennis. That is, a less hubristic ethical theory depends upon a modest philosophical stance toward the whole. Only on the grounds of this epistemological modesty can we hope to proceed into the future with both caution and wisdom. (shrink)

The inaugural volume of the Pitt-Konstanz series, devoted to the work of philosopher Adolf Grünbaum, encompasses the philosophical problems of space, time, and cosmology, the nature of scientific methodology, and the foundations of psychoanalysis.

DNA replication requires the unwinding of the parental duplex, which generates (+) supercoiling ahead of the replication fork. It has been thought that removal of these (+) supercoils was the only method of unlinking the parental strands. Recent evidence implies that supercoils can diffuse across the replication fork, resulting in interwound replicated strands called precatenanes. Topoisomerases can then act both in front of and behind the replication fork. A new study by Sogo et al. [J Mol Biol 1999;286:637–643 (Ref. 1)], (...) using a topological analysis, provides the best evidence that precatenanes exist in negatively supercoiled, partially replicated molecules in vivo. BioEssays 21:805–808, 1999. © 1999 John Wiley & Sons, Inc. (shrink)

The book aims at equipping you with 21st Century Skills key life skills that will drive your future employability, promotion and career success. These are required for effective reasoning, writing and decision-making in changing, evolving environments. You give reasons for what you do and think every day. You argue. You often argue about things that matter to you. For example you might argue that you are the best candidate for promotion, about whether your company should invest in China, about the (...) best way to help a friend or about what the right thing to do is in an ethical dilemma. The list is up to you. If you work your way carefully through this book you will become better at reasoning both in terms of understanding and clarifying other peoples’ arguments and also at producing increasingly sophisticated and compelling arguments of your own. You will learn how to recognize common but often seductive mistakes in reasoning and so be empowered to avoid making these mistakes yourself. Your writing and oral presentations will improve and you will hone your ability to define crucial terms in argument, debate and discussion. As this book is specifically written with everyday language considerations in mind, it is a valuable tool for anyone to understand, evaluate and construct arguments in ordinary language. (shrink)