How do physicians handle informing patients of their diagnoses and how much information do patients really want? How do registered nurses view both sides of this question? Three questionnaires were constructed and administered in a mid-size hospital in New York state. Physicians and nurses underestimate the number of patients who want detailed information. Patients who earn more than average, have a college education, and who are under age 60 are more likely to want information, and state that their physician should (...) give it to them. Only 42% of physicians state that patients want a detailed description of their diagnosis and treatment options. Physicians educated outside the USA appeared to be more likely to change their criteria for informing patients and, along with American-educated nurses, were more willing to participate in formal discussions of the issue. Physicians should comply with the wishes of patients for information and include them in the team deciding on diagnosis and treatment. (shrink)

Many believe that the ethical problems of donation after cardiocirculatory death (DCD) have been "worked out" and that it is unclear why DCD should be resisted. In this paper we will argue that DCD donors may not yet be dead, and therefore that organ donation during DCD may violate the dead donor rule. We first present a description of the process of DCD and the standard ethical rationale for the practice. We then present our concerns with DCD, including the following: (...) irreversibility of absent circulation has not occurred and the many attempts to claim it has have all failed; conflicts of interest at all steps in the DCD process, including the decision to withdraw life support before DCD, are simply unavoidable; potentially harmful premortem interventions to preserve organ utility are not justifiable, even with the help of the principle of double effect; claims that DCD conforms with the intent of the law and current accepted medical standards are misleading and inaccurate; and consensus statements by respected medical groups do not change these arguments due to their low quality including being plagued by conflict of interest. Moreover, some arguments in favor of DCD, while likely true, are "straw-man arguments," such as the great benefit of organ donation. The truth is that honesty and trustworthiness require that we face these problems instead of avoiding them. We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death. These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent. These are tall orders, and require open public debate. Until this debate occurs, we call for a moratorium on the practice of DCD. (shrink)

Peer review is a widely accepted instrument for raising the quality of science. Peer review limits the enormous unstructured influx of information and the sheer amount of dubious data, which in its absence would plunge science into chaos. In particular, peer review offers the benefit of eliminating papers that suffer from poor craftsmanship or methodological shortcomings, especially in the experimental sciences. However, we believe that peer review is not always appropriate for the evaluation of controversial hypothetical science. We argue that (...) the process of peer review can be prone to bias towards ideas that affirm the prior convictions of reviewers and against innovation and radical new ideas. Innovative hypotheses are thus highly vulnerable to being “filtered out” or made to accord with conventional wisdom by the peer review process. Consequently, having introduced peer review, the Elsevier journal Medical Hypotheses may be unable to continue its tradition as a radical journal allowing discussion of improbable or unconventional ideas. Hence we conclude by asking the publisher to consider re-introducing the system of editorial review to Medical Hypotheses. (shrink)

Food choices are a key determinant of dietary intake, with brain regions, such as the mesolimbic and prefrontal cortex maturing at differential rates into adulthood. More needs to be understood about developmental changes in healthy and unhealthy food perceptions and preference. We investigated how food perceptions and preference vary as a function of age and how food attributes impact age-related changes. One hundred thirty-nine participants completed computerized tasks to rate high-calorie and low-calorie food cues for taste, health, and liking, followed (...) by 100 binary food choices based on each participant’s ratings. Dietary self-control was considered successful when the healthier food was chosen. Self-control success ratio was the proportion of success trials over total number of choices. Beta-weights for health and taste were calculated as each attribute’s influence on food preference. Adiposity measurements included BMI z-score and waist-to-height ratio. High-calorie foods were rated more tasty and less healthy with increasing age. Older participants liked high-calorie foods more, and β-taste was associated with age. Significant age-by-WHtR interactions were observed for health and taste ratings of high-calorie foods, β-taste, and marginally for preference of high-calorie foods. Stratifying by WHtR, we found age-related increases in taste and preference ratings of high-calorie foods in the high WHtR group alone. In contrast, age-related decreases in health ratings of high-calorie foods were significant in the low WHtR group alone. Age and β-taste were significantly associated in the high WHtR group and only marginally significant with low WHtR. Although participants rated low-calorie foods as less tasty and less healthy with increasing age, there was no association between age and preference for low-calorie foods. Participants made faster food choices with increasing age regardless of WHtR, with a significant age-by-WHtR interaction on reaction time. There were no age-related effects in self-control success ratio and β-health. These results suggest that individual differences in age and central adiposity play an important role in preference for high-calorie foods, and a higher importance of food tastiness in food choice may contribute to greater preference for high-calorie foods with increasing age. (shrink)

The most recent commentator on this line, D. R. Shackleton Bailey, states that ‘spiritus is breath rather than odour’ and he has the support of some commentators, Marcilius, for example, who amends notus to motus, and Hertzberg, who takes it as sweet breath, citing Mart. 3. 65. 1. So also most translators : an exception is D. Paganelli who translates ‘aucun souffle, aucune odeur d'adultère’. However, the parallels cited by Shackleton Bailey are irrelevant to this situation: Afranius 243, Ach. Tat. (...) 2. 37. 9, and Claud. Carm. Min. 29. 33 all refer to the period just before, during, or immediately after the sexual act. It is most unlikely that this is the case in Propertius' poem. Propertius has come to see if Cynthia has spent the night alone; it is not a question of catching her inflagrante delicto, but of finding some rival there or the evidence of his stay not yet removed. Cynthia is indignant at her lover's suspicions and lest he should think that his rival had left earlier, she coarsely specifies the evidence that Propertius might expect to find, including spiritus admisso notus adulterio. (shrink)

The most recent commentator on this line, D. R. Shackleton Bailey, states that ‘spiritus is breath rather than odour’ and he has the support of some commentators, Marcilius, for example, who amends notus to motus, and Hertzberg, who takes it as sweet breath, citing Mart. 3. 65. 1. So also most translators : an exception is D. Paganelli who translates ‘aucun souffle, aucune odeur d'adultère’. However, the parallels cited by Shackleton Bailey are irrelevant to this situation: Afranius 243, Ach. Tat. (...) 2. 37. 9, and Claud. Carm. Min. 29. 33 all refer to the period just before, during, or immediately after the sexual act. It is most unlikely that this is the case in Propertius' poem. Propertius has come to see if Cynthia has spent the night alone; it is not a question of catching her inflagrante delicto, but of finding some rival there or the evidence of his stay not yet removed. Cynthia is indignant at her lover's suspicions and lest he should think that his rival had left earlier, she coarsely specifies the evidence that Propertius might expect to find, including spiritus admisso notus adulterio. (shrink)

Some twenty years ago, W. F. R. Hardie focused his attention on an issue which has since become a programmatic theme for Aristotelian scholars. He wrote: "In speaking of the good for man Aristotle hesitates between an inclusive and an exclusive formulation. [He further fails] to make explicit the distinction between the comprehensive plan and the paramount end". Since that time, virtually everyone writing on Aristotle's ethics has essayed a view about what Aristotle said or should have said about the (...) best human life. (shrink)

Political liberals ask citizens not to appeal to certain considerations, including religious and philosophical convictions, in political deliberation. We argue that political liberals must include a demanding requirement of intellectual modesty in their ideal of citizenship in order to motivate this deliberative restraint. The requirement calls on each citizen to believe that the best reasoners disagree about the considerations that she is barred from appealing to. Along the way, we clarify how requirements of intellectual modesty relate to moral reasons for (...) deliberative restraint. And we argue against attempts to weaken our requirement of intellectual modesty by emphasizing those moral reasons. (shrink)

Psychopaths continue to be demonised by the media and estimates suggest that a disturbing percentage of the population has psychopathic tendencies. This timely and controversial new book summarises what we already know about psychopathy and antisocial behavior and puts forward a new case for its cause - with far-reaching implications. Presents the scientific facts of psychopathy and antisocial behavior. Addresses key questions, such as: What is psychopathy? Are there psychopaths amongst us? What is wrong with psychopaths? Is psychopathy due to (...) nature or nurture? And can we treat psychopaths? Reveals the authors' ground-breaking research into whether an underlying abnormality in brain development leaves psychopaths with an inability to feel emotion or fear. The resulting theory could lead to early diagnosis and revolutionize the way society, the media and the state both views and contends with the psychopaths in our midst. (shrink)

David Benatar argues that coming into existence is always a harm, and that – for all of us unfortunate enough to have come into existence – it would be better had we never come to be. We contend that if one accepts Benatar’s arguments for the asymmetry between the presence and absence of pleasure and pain, and the poor quality of life, one must also accept that suicide is preferable to continued existence, and that his view therefore implies both anti-natalism (...) and pro-mortalism . This conclusion has been argued for before by Elizabeth Harman – she takes it that because Benatar claims that our lives are ‘awful’, it follows that ‘we would be better off to kill ourselves’ (Harman 2009: 784). Though we agree with Harman’s conclusion, we think that her argument is too quick, and that Benatar’s arguments for non-pro-mortalism deserve more serious consideration than she gives them. We make our case using a tripartite structure. We start by examining the prima facie case for the claim that pro-mortalism follows from Benatar’s position, presenting his response to the contrary, and furthering the dialectic by showing that Benatar’s position is not just that coming into existence is a harm, but that existence itself is a harm. We then look to Benatar’s treatment of the Epicurean line, which is important for him as it undermines his anti-death argument for non-pro-mortalism. We demonstrate that he fails to address the concern that the Epicurean line raises, and that he cannot therefore use the harm of death as an argument for non-pro-mortalism. Finally, we turn to Benatar’s pro-life argument for non-pro-mortalism, built upon his notion of interests, and argue that while the interest in continued existence may indeed have moral relevance, it is almost always irrational. Given that neither Benatar’s anti-death nor pro-life arguments for non-pro-mortalism work, we conclude that pro-mortalism follows from his anti-natalism, As such, if it is better never to have been, then it is better no longer to be. -/- . (shrink)

Empathy is a lay term that is becoming increasingly viewed as a unitary function within the field of cognitive neuroscience. In this paper, a selective review of the empathy literature is provided. It is argued from this literature that empathy is not a unitary system but rather a loose collection of partially dissociable neurocognitive systems. In particular, three main divisions can be made: cognitive empathy , motor empathy, and emotional empathy. The two main psychiatric disorders associated with empathic dysfunction are (...) considered: autism and psychopathy. It is argued that individuals with autism show difficulties with cognitive and motor empathy but less clear difficulties with respect to emotional empathy. In contrast, individuals with psychopathy show clear difficulties with a specific form of emotional empathy but no indications of impairment with cognitive and motor empathy. (shrink)

This study investigated the performance of boys with psychopathic tendencies and comparison boys, aged 9 to 17 years, on two tasks believed to be sensitive to amygdala and orbitofrontal cortex func- tioning. Fifty-one boys were divided into two groups according to the Psychopathy Screening Device (PSD, P. J. Frick & R. D. Hare, in press) and presented with two tasks. The tasks were the gambling task (A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994) and the Intradimensional/ (...) Extradimensional (ID/ED) shift task (R. Dias, T. W. Robbins, & A. C. Roberts, 1996). The boys with psychopathic tendencies showed impaired performance on the gambling task. However, there were no group differences on the ID/ED task either for response reversal or extradimensional set shifting. The implications of these results for models of psychopathy are discussed. (shrink)

This study investigates the ability of individuals with psychopathy to perform passive avoidance learning and whether this ability is modulated by level of reinforcement/punishment. Nineteen psychopathic and 21 comparison individuals, as defined by the Hare Psychopathy Checklist Revised (Hare, 1991), were given a passive avoidance task with a graded reinforcement schedule. Response to each rewarding number gained a point reward specific to that number (i.e., 1, 700, 1400 or 2000 points). Response to each punishing number lost a point punishment specific (...) to that number (i.e., the loss of 1, 700, 1400 or 2000 points). In line with predictions, individuals with psychopathy made more passive avoidance errors than the comparison individuals. In addition, while the performance of both groups was modulated by level of reward, only the performance of the comparison population was modulated by level of punishment. The results are interpreted with reference to a computational account of the emotional learning impairment in individuals with psychopathy. (shrink)

We provide a justification for political liberalism’s Reciprocity Principle, which states that political decisions must be justified exclusively on the basis of considerations that all reasonable citizens can reasonably be expected to accept. The standard argument for the Reciprocity Principle grounds it in a requirement of respect for persons. We argue for a different, but compatible, justification: the Reciprocity Principle is justified because it makes possible a desirable kind of political community. The general endorsement of the Reciprocity Principle, we will (...) argue, helps realize joint political rule and relationships of civic friendship. The main obstacle to the realization of these values is the presence of reasonable disagreement about religious, moral, and philosophical issues characteristic of liberal societies. We show the Reciprocity Principle helps to overcome this obstacle. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What Emotional Responding Is to Blame It Might Not Be to ResponsibilityR. J. R. Blair (bio)Keywordsblame, responsibility, emotional responses, psychopathyIn this interesting paper, Levy argues that by failing the moral/conventional distinction task (Blair 1995), individuals with psychopathy show a fundamental inability to categorize moral harms and as such their moral responsibility for their actions is reduced. He argues that, although we might still wish to incarcerate such individuals to (...) prevent them inflicting further harm on others, we should be less enthusiastic to blame them for their actions.In many respects, I agree with much of Levy's treatise. I certainly do not regard ascriptions of blame as useful in my own work with this population. I believe that our goal should be to fully understand the nature of their emotional deficit to be able to treat it similarly to other researchers who work to treat other emotional disorders. To me, Levy's argument appears sound.However, I offer three considerations and raise questions within these considerations that might further the debate. First, not all rules involve care-based emotional responses to victims. As Levy notes, this is the origin of the moral/conventional distinction. The problem here is that we do consider someone responsible if they break a conventional transgression. The student talking in class is generally considered blameworthy for this action as long as they knew that the rule of not talking during the lesson applied to that classroom. Yet, there is no victim and no care-based emotional response. Here, the only thing necessary to ascribe blame and responsibility is that the individual knew that a rule exists. Given this holds for conventional transgressions, why must we necessarily make a special case, with respect to responsibility, for moral transgressions?I believe that Levy is fully aware of this concern. He specifically makes reference to moral responsibility and writes that:the kind and degree of wrongness, and therefore blame, which attaches to infringements of the rules [against double parking or line-jumping] is very different, and usually much less significant, than the kind and degree attaching to moral wrongs. For psychopaths, all offences are merely conventional, and therefore—from their point of view—none of them are all that serious.(2007, p. 132)But the danger here is that issues of blame and responsibility may become highly relativistic and hinge on the strength of the emotional reaction. This is a problem because, although we might judge someone as more blameworthy if he intentionally [End Page 149] runs over five people rather than one, do we really consider that there is a distinction in moral responsibility between these two cases? If not, might not responsibility relate to factual knowledge of the existence of the rule against the transgression rather than the emotional response to the transgression?Second, there is considerable debate regarding whether psychopathy represents a taxon or a continuum (e.g., Vasey et al. 2005; Edens et al. 2006). Assuming it does represent a continuum, then we have an additional concern. How little of an emotional response to the transgression reduces one's moral responsibility and blame? Is it only the very reduced (although usually not absent) levels of emotional response that are shown by individuals with psychopathy? Or should we consider moral responsibility and blame proportional to the level of the emotional response? If this latter option is adopted, then what should we do about individuals who show heightened emotional responses, for example, patients with specific anxiety disorders (Rauch, Shin, and Wright 2003)? There are already some data that inhibited children (a developmental precursor to some anxiety disorders; Kagan and Snidman 1999) show heightened conscience development (Asendorpf and Nunner-Winkler 1992). If such children commit moral transgressions, should we regard them as more morally responsible and more blameworthy than regular folks?Third, the issue of intention received little attention in this paper. I have been considered to show a similar lack of attention to intention in the past (Nichols 2002) and, moreover, in some respects the issue was of limited concern given Levy's main goals. However, I mention it because so much of whether we consider someone responsible for their actions and... (shrink)

Section I gives an overview of the contents of “Words and Contents”, and lays out the plan for this Critical Notice. Section II expounds Vallée’s Perry-inspired Pluri-Propositional semantic framework, and Section III is an in-depth case study, focused on complex demonstratives. In Sections IV-V we develop some criticisms, and in Section VI we suggest a solution to these difficulties, which builds on Vallée’s innovative work.

Philosophy &Public Affairs, Volume 47, Issue 1, Page 72-103, Winter 2019.

Recent interest in emotion as the basis for moral development began with work involving individuals with psychopathic tendencies, and a recent paper with this population has allowed fresh insights (Glenn, Iyer, Graham, Koleva, & Haidt, 2009). Two main conclusions suggested by this paper are: (i) that systems involved in different forms of morality can be differentiated; and (ii) that systems involved in justice reasoning likely include amygdala and/or ventromedial prefrontal cortex, even if the specifics of their functional contribution to justice (...) development remain unidentified. (shrink)