This paper is a study about Philadelphia’s comprehensive user engagement sites (CUESs) as the authors address and examine issues related to the upcoming implementation of a CUES while seeking solutions for its disputed questions and plans. Beginning with the federal drug schedules, the authors visit some of the medical and public health issues vis-à-vis safe injection facilities (SIFs). Insite, a successful Canadian SIF, has been thoroughly researched as it represents a paradigm for which a Philadelphia CUES can expand upon. Also, (...) the existing criticisms against SIFs are revisited while critically unpackaged and responded to in favor of the establishment. In the main section, the authors propose the layout and services of the upcoming CUES, much of which would be in congruent to Vancouver’s Insite. On the other hand, the CUES would be distinct from Insite, as the authors emphasize, in that it will offer an information center run by individuals in recovery and place additional emphasis on early education for young healthcare professionals by providing them a platform to work at the site. The paper will also briefly investigate the implementation of a CUES site under an ethical scope of the Harm Reduction Theory. Lastly, the authors recommend some strategic plans that the Philadelphia City government may consider employing at this crucial stage. (shrink)

The authors work in a variety of clinical ethics consultation services (CECSs) that employ a range of methods and approaches. This article discusses the approach to ethics consultation at the Center for Medical Ethics and Health Policy at Baylor College of Medicine and describes the development and transformation of the authors’ CECSs. It discusses how one CECS shifted from a nascent program with only fifty consultations a year to a vibrant, heavily staffed service with five hundred ethics consultations a year.

Table of Contents -/- 1. Introduction and Overview: Two Entitlement Projects, Peter J. Graham, Nikolaj J.L.L. Pedersen, Zachary Bachman, and Luis Rosa -/- Part I. Engaging Burge's Project -/- 2. Entitlement: The Basis of Empirical Warrant, Tyler Burge 3. Perceptual Entitlement and Scepticism, Anthony Brueckner and Jon Altschul 4. Epistemic Entitlement Its Scope and Limits, Mikkel Gerken 5. Why Should Warrant Persist in Demon Worlds?, Peter J. Graham -/- Part II. Extending the Externalist Project -/- 6. Epistemic Entitlement (...) and Epistemic Competence, Ernest Sosa 7. Extended Entitlement, Adam Carter and Duncan Pritchard 8. Moorean Pragmatics, Social Comparisons and Common Knowledge, Allan Hazlett 9. Internalism and Entitlement to Rules and Methods, Joshua Schecter -/- Part III. Engaging Wright's Project -/- 10. Full Bloodied Entitlement, Martin Smith 11. Pluralist Consequentialist Anti-Scepticism, Nikolaj Jang Lee Linding Pedersen 12. Against (Neo-Wittensteinian) Entitlements, Annalisa Coliva 13. The Truth Fairy and the Indirect Consequentialist, Daniel Elstein and Carrie S. I. Jenkins 14. Knowledge for Nothing, Patrick Greenough . (shrink)

We review the "Entitlement" projects of Tyler Burge and Crispin Wright in light of recent work from and surrounding both philosophers. Our review dispels three misunderstandings. First, Burge and Wright are not involved in a common “entitlement” project. Second, though for both Wright and Burge entitlement is the new notion, “entitlement” is not some altogether third topic not clearly connected to the nature of knowledge or the encounter with skepticism. Third, entitlement vs. justification does not align with the externalism vs. (...) internalism distinction. (shrink)

Members of the field of philosophy have, just as other people, political convictions or, as psychologists call them, ideologies. How are different ideologies distributed and perceived in the field? Using the familiar distinction between the political left and right, we surveyed an international sample of 794 subjects in philosophy. We found that survey participants clearly leaned left (75%), while right-leaning individuals (14%) and moderates (11%) were underrepresented. Moreover, and strikingly, across the political spectrum, from very left-leaning individuals and moderates to (...) very right-leaning individuals, participants reported experiencing ideological hostility in the field, occasionally even from those from their own side of the political spectrum. Finally, while about half of the subjects believed that discrimination against left- or right-leaning individuals in the field is not justified, a significant minority displayed an explicit willingness to discriminate against colleagues with the opposite ideology. Our findings are both surprising and important, because a commitment to tolerance and equality is widespread in philosophy, and there is reason to think that ideological similarity, hostility, and discrimination undermine reliable belief formation in many areas of the discipline. (shrink)

Developmental psychopathology holds promise for elucidating the structure of self-awareness. Here we studied social emotions in matched groups of children and adolescents with and without autism. Our aims were to determine whether there are potentially dissociable aspects of self-awareness, and to reconsider how the qualities of young children's engagement with other persons influences the development of their sense of self.

Background: There is a growing interest in using cognitive behavioural therapy with people who have Asperger Syndrome and comorbid mental health problems. Aims: To examine whether modified group CBT for clinically significant anxiety in an AS population is feasible and likely to be efficacious. Method: Using a randomised assessor-blind trial, 52 individuals with AS were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised to (...) treatment were followed-up for 24 weeks. Results: The conversion rate for this trial was high, while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared to those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety. Conclusions: Trials of psychological therapies with this population are feasible. Larger definitive trials are now needed. Declaration of Interest: None Trial Registration: ISRCTN 30265294, UKCRN 8370. (shrink)

RAID-II is a high-bandwidth, network-attached storage server designed and implemented at the University of California at Berkeley. In this paper, we measure the performance of RAID-II and evaluate various architectural decisions made during the design process. We first measure the end-to-end performance of the system to be approximately 20 MB/s for both disk array reads and writes. We then perform a bottleneck analysis by examining the performance of each individual subsystem and conclude that the disk subsystem limits performance. By adding (...) a custom interconnect board with a high-speed memory and bus system and parity engine, we are able to achieve a performance speedup of 8 to 15 over a comparative system using only off-the-shelf hardware. (shrink)

Recent studies show that racism still exists in the American medical profession, the fact of which legitimizes the historically long-legacy of mistrust towards medical profession and health authorities among African Americans. Thus, it was suspected that the participation of black patients in end-of-life care has always been significantly low stemmed primarily from their mistrust of the medical profession. On the other hand, much research finds that there are other reasons than the mistrust which makes African Americans feel reluctant to the (...) end-of-life care, such as cultural-religious difference and genuine misunderstanding of the services. If so, two crucial questions are raised. One is how pervasive or significant the mistrust is, compared to the other factors, when they opt out of the end-of-life care. The other is if there is a remedy or solution to the seemingly broken relationship. While no studies available answer these questions, we have conducted an experiment to explore them. The research was performed at two Philadelphia hospitals of Mercy Health System, and the result shows that Black patients’ mistrust is not too great to overcome and that education can remove the epistemic obstacles as well as overcome the mistrust. (shrink)

Social norms and values may be important predictors of how people engage with and regulate their negative emotional experiences. Previous research has shown that social expectancies (the perceived social pressure not to feel negative emotion (NE)) exacerbate feelings of sadness. In the current research, we examined whether social expectancies may be linked to how people process emotional information. Using a modified classical flanker task involving emotional rather than non-emotional stimuli, we found that, for those who experienced low levels of NE, (...) social expectancies were linked to the selective avoidance of negative emotional information. Those who experienced high levels of NE did not show a selective avoidance of negative emotional information. The findings suggest that, for people who experience many NEs, social expectancies may lead to discrepancies between how they think they ought to feel and the kind of emotional information they pay attention to. (shrink)

With this issue we initiate the policy of expanding the scope of Tulane Studies in Philosophy to include, in addition to the work of members of the department, contributions from philosophers who have earned advanced degrees from Tulane and who are now teaching in other colleges and universities. The Editor THE LOGIC OF OUR LANGUAGE ROBERT L. ARRINGTON Wittgenstein wrote in the Tractatus that "logic is not a body of doctrine, but a mirror-image of the world. " 1 In line (...) with his suggestion that a proposition is a 'picture', Wittgenstein argued that propositions 'show' the logical structure of the real. He was insistent, however, that "the apparent logical form of a proposition need not be its real one. " 2 As a result of this we can misunderstand the structure of fact. Philosophical problems arise just when "the logic of our language is mis understood. " 3 It is common knowledge that much of this view of logic was rejected by Wittgenstein himself in the Philosophical Investi gations. There we are told that language has no ideal or sublime 4 logic which mirrors the structure of the extra-linguistic world. Consequently, inferences from the structure of language to the structure of that extra-linguistic world are invalid. Reality can be 'cut up' in any of a number of ways by language. Wittgenstein adopted a view of philosophy which would render that discipline a non-explanatory, non-critical study of the multiple ways in which language can be used. (shrink)

Starting January 1, 2017, the Oregon Health Authority (OHA, henceforth) made a sweeping decision that no elective surgery is to be performed for Medicaid recipients who smoke tobacco. The authors of this paper investigate the administrative procedures behind the OHA’s decision, explore some possible ethical arguments for and against the decision, and render our ethical verdict about the ban and our suggestion for the OHA. Meanwhile, since this issue involves the problems of smoking-related addiction, the agent’s autonomy which may be (...) understood in the light of moral freedom and rationality/irrationality, and our society’s perception about obesity and cigarette smoking; the paper engages in a deeper philosophical debate about the problems beyond the legal purview of the ban. (shrink)

Building on the long-standing tradition of challenging oppression and questioning whose interests are being served in the field of language education, we report on a study that involved a group of U.S.-based graduate students who collaborated with a ninth-grade English teacher in Nepal. The study comes out of a larger project that sought to internationalize the curriculum of a graduate educational linguistics course at a U.S. university. At the heart of this internationalizing curriculum endeavour was a commitment to expose graduate (...) students in the U.S. to the issues of language teaching outside of the U.S. This was done through co-designing of a unit of lessons, with six graduate students meeting virtually with their teacher partner, Ditya, in Nepal over the course of a semester. The graduate students and Ditya constitute our research participants. The graduate student participants learned about the need to develop pedagogical materials that were relevant to the local context in Nepali classroom, and not attempt to transplant a Western-centric curriculum onto the Nepali classroom. In keeping with recent calls to decolonize higher education, we illustrate how critical theory in general and decolonizing pedagogy in particular can be infused into a U.S. graduate curriculum by drawing on the rich, indigenous knowledge and resources of a teacher collaborator from the Global South. We do this by reporting how this critical, decolonizing goal was realized through collaborative professionalism, which is characterized by the sharing of knowledge, skills, and experience to improve student achievement, reflection, dialogue and collective responsibility. (shrink)

The Deaf culture in the United States is a unique culture that is not widely understood. To members of the Deaf community in the United States, deafness is not viewed as a disease or pathology to be treated or cured; instead it is seen as a difference in human experience. Members of this community do not hide their deafness; instead they take great pride in their Deaf identity. The Deaf culture in the United States is very communitarian not individualistic. Mary (...) Beth and Dominic are a married couple in their late 20s who are genetically deaf. They are active members in the Deaf community and work as advocates for individuals who are deaf, family members of Deaf people and sign language interpreters who identify with the Deaf culture. Mary Beth and Dominic approach the fertility clinic with a request that they only want a child with the genetic gene for deafness. They would want the embryos that do not have the gene to be destroyed. This would entail creating a child who would have the gene for deafness. Medically and ethically, should the fertility clinic agree to the couple’s request? The authors argue that the couple's request should be denied and provide reasons for it from the perspectives of foundational and clinical ethics. (shrink)

Ebola is a deadly disease with no cure; there is no vaccine developed yet. Many died during the 2014 outbreak in West Africa, and many healthcare professionals went to the virus infected area to treat the patients while placing their lives in danger. Not every medical professional placed in the field is a fully trained specialist, and sometimes one or two under-trained doctors are in charge of the entire clinic with some nurses and operating technicians. When unexpected outbreaks of the (...) virus occur in the places, the doctor(s) would encounter medical and ethical dilemmas. Should they leave or stay? In fact, this dilemma is not confined to the Ebola pandemic but relevant to all similar cases. In this paper, three authors, a medical resident, a clinical bioethicist, and a theoretical bioethicist respond to the dilemma. (shrink)

As the Zika virus pandemic continues to bring worry and fear to health officials and medical scientists, Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) have recommended that residents of the Zika-infected countries, e.g., Brazil, and those who have traveled to the area should delay having babies which may involve artificial contraceptive, particularly condom. This preventive policy, however, is seemingly at odds with the Roman Catholic Church’s position on the contraceptive. As least since the promulgation of (...) Paul VI’s 1968 encyclical, Humanae Vitae, the Church has explicitly condemned artificial birth control as intrinsic evil. However, the current pontiff, Pope Francis, during his recent visit to Latin America, remarked that the use of artificial contraception may not be in contradiction to the teaching of Humanae Vitae while drawing a parallel between the current Zika Crisis and the 1960’s Belgian Congo Nun Controversy. The pope mentioned that the traditional ethical principle of the lesser of two evils may be the doctrine that justified the exceptions. The authors of this paper attempt to expand the theological rationale of the pope’s suggestion. In so doing, the authors rely on casuistical reasoning as an analytic tool that compares the Belgian Congo Nun case and the given Zika case, and suggest that the former is highly similar to, if not the same as, the latter in terms of normative moral feature. That is, in both cases the use of artificial contraception is theologically justified in reference to the criteria that the doctrine of the lesser of two evils requires. The authors wish that the paper would provide a solid theological-ethical ground based on which condom-use as the most immediate and effective preventive measure can be recommended in numerous Catholic hospitals as well as among Catholic communities in the world, particularly the most Zika-affected and largest Catholic community in the world, Brazil – 123 million present Brazilian citizens are reported to be Roman Catholic. (shrink)

This anthology is the most ambitious, comprehensive, and authoritative English-language sourcebook of Korean civilization ever assembled. Encompassing social intellectual, religious, and literary traditions from ancient times through World War II, this collection reveals the grand corpus of thought, beliefs, and customs unique to the Korean people. Volume I features three major periods of Korean history: the Three Kingdoms and Unified Silla (57 B.C.-935), Koryo (918-1392), and Early Choson (1392-1600). Each section begins with a broad historical introduction to provide context and (...) perspective, and contains representative writings from the era, with commentary, background, and analysis. (shrink)

This is the most comprehensive and authoritative English-language anthology of primary source material on Korean civilization ever assembled. Encompassing social, intellectual, religious, and literary traditions, this volume covers the seventeenth century to the modern period. Contemporary histories, social documents, Buddhist scripture, philosophical treatises, and popular literature selected for this book reflect the dynasties and eras that helped fashion the late Choson (1600-1860) and Modern (1860-1945) periods.

Examines climate change, military intervention and financial collapse to reveal how truth is used by competing interests to shape individual behaviour, attitudes and identity.

Although shared decision-making is a standard in medical care, unilateral decisions through process-based conflict resolution policies have been defended in certain cases. In patients who do not stand to receive proportional clinical benefits, the harms involved in interventions such as cardiopulmonary resuscitation seem to run contrary to the principle of non-maleficence, and provision of such interventions may cause clinicians significant moral distress. However, because the application of these policies involves taking choices out of the domain of shared decision-making, they face (...) important ethical and legal problems, including a recent challenge to their constitutionality. In light of these concerns, we suggest a re-conceptualization of informed non-dissent as an alternative approach in cases where the application of process-based policies is being considered. This clinician-directed communication model still preserves what is valuable in such policies and salvages professional integrity, while minimising ethical and legal challenges. (shrink)

In his book Autonomous Knowledge J. Adam Carter argues that the possibility of radical cognitive enhancement shows the need for epistemology to be significantly updated. Reflection on the possibility of such enhancement shows that doxastic autonomy matters. If a belief fails to be autonomous, it cannot qualify as knowledge. Sects. 1-3 of this paper introduce the key components of Carter's autonomy framework and his considerations on the value of knowledge (including his proposed solution to the value problem, i.e. the challenge (...) of accounting for why knowledge has greater value than any of its proper parts). Sects. 4-7 offer a critical appraisal of Carter's framework. We are not convinced that Carter has succeeded in showing that there is an autonomous belief condition on knowledge. In this paper, however, we shall not engage with this issue. Instead, for the sake of our critical discussion, we shall assume that autonomous belief is a condition on knowledge and engage Carter on a cluster of issues concerning axiology. (shrink)

There are no national recommendations for routine screening for sickle cell trait, nor is there guidance on whether or how to notify donors that they might be tested or identified as having sickle cell trait. As a result, the organizations that collect blood have implemented variable policies about whether and how to inform prospective donors of the possible screening and discovery of this noncommunicable condition. The question of what they should do is related to the broader question of how to (...) handle incidental and secondary findings. In a recent report, the Presidential Commission for the Study of Bioethical Issues outline a framework for handling such findings in the clinical, research, and direct‐to‐consumer contexts. While the commission's report did not directly address incidental and secondary findings in the public health context of blood donation, it made several overarching recommendations that apply in all contexts where such findings might arise. This essay outlines the special issues raised by discovering sickle cell trait in blood donation and considers the implications of the commission's framework for that problem. (shrink)

BackgroundPast research shows that physicians experience high ill-being but also high well-being.ObjectiveTo shed light on how medical faculty’s experiences of their job demands and job resources might differentially affect their ill-being and their well-being with special attention to the role that the work-life interface plays in these processes.MethodsQualitative thematic analysis was used to analyze interviews from 30 medical faculty at a top research hospital in Canada.FindingsMedical faculty’s experiences of work-life conflict were severe. Faculty’s job demands had coalescing effects on their (...) stress, work-life conflict, and exhaustion. Although supportive job resources helped to mitigate the negative effects of job demands, stimulating job resources contributed to greater work-life conflict, stress, and exhaustion. Thus, for these medical faculty job resources play a dual-role for work-life conflict. Moreover, although faculty experienced high emotional exhaustion, they did not experience the other components of burnout. Some faculty engaged in cognitive reappraisal strategies to mitigate their experiences of work-life conflict and its harmful consequences.ConclusionThis study suggests that the precise nature and effects of job demands and job resources may be more complex than current research suggests. Hospital leadership should work to lessen unnecessary job demands, increase supportive job resources, recognize all aspects of job performance, and, given faculty’s high levels of work engagement, encourage a climate that fosters work-life balance. (shrink)

In May of 2006, the Abigail Alliance for Better Access to Development Drugs appeared to have won a victory when a divided panel of the Court of Appeals for the District of Columbia Circuit ruled that “terminally ill, mentally competent adult patients” had a constitutionally protected right to access investigational medications. This victory was short lived, however. On August 7, 2007, the D.C. Circuit sitting en banc reversed this earlier decision, marking a setback in Abigail's campaign for removal of the (...) regulatory barriers that currently prevent terminally ill patients from gaining early access to investigational drugs. This loss represents a big blow for Abigail's cause, because there is no guarantee that they will have another day in court, and attaining their goal through other branches of the government remains uncertain. (shrink)

In May of 2006, the Abigail Alliance for Better Access to Development Drugs appeared to have won a victory when a divided panel of the Court of Appeals for the District of Columbia Circuit ruled that “terminally ill, mentally competent adult patients” had a constitutionally protected right to access investigational medications. This victory was short lived, however. On August 7, 2007, the D.C. Circuit sitting en banc reversed this earlier decision, marking a setback in Abigail's campaign for removal of the (...) regulatory barriers that currently prevent terminally ill patients from gaining early access to investigational drugs. This loss represents a big blow for Abigail's cause, because there is no guarantee that they will have another day in court, and attaining their goal through other branches of the government remains uncertain. (shrink)