Mitochondrial replacement techniques, known in the popular media as 'three-parent' or 'three-person' IVFs, have the potential to enable women with mitochondrial diseases to have children who are genetically related to them but without such diseases. In the debate regarding whether MRTs should be made available, an issue that has garnered considerable attention is whether MRTs affect the characteristics of an existing individual or whether they result in the creation of a new individual, given that MRTs involve the genetic manipulation of (...) the germline. In other words, do MRTs affect the qualitative identity or the numerical identity of the resulting child? For instance, a group of panelists on behalf of the UK Human Fertilisation and Embryology Authority has claimed that MRTs affect only the qualitative identity of the resulting child, while the Working Group of the Nuffield Council on Bioethics has argued that MRTs would create a numerically distinct individual. In this article, I shall argue that MRTs do create a new and numerically distinct individual. Since my explanation is different from the NCOB's explanation, I shall also offer reasons why my explanation is preferable to the NCOB's explanation. (shrink)

Background Rapid ethical access to personal health information to support research is extremely important during pandemics, yet little is known regarding patient preferences for consent during such crises. This follow-up study sought to ascertain whether there were differences in consent preferences between pre-pandemic times compared to during Wave 1 of the COVID-19 global pandemic, and to better understand the reasons behind these preferences. Methods A total of 183 patients in the pandemic cohort completed the survey via email, (...) and responses were compared to the distinct pre-pandemic cohort ; all were patients of a large Canadian cancer center. The survey covered broad versus study-specific consent; opt-in versus opt-out contact approach; levels of comfort sharing with different recipients; perceptions of commercialization; and options to track use of information and be notified of results. Four focus groups were subsequently conducted to elucidate reasons motivating dominant preferences. Results Patients in the pandemic cohort were significantly more comfortable with sharing all information and biological samples, sharing information with the health care institution, sharing information with researchers at other hospitals, sharing PHI provincially, nationally and internationally compared to the pre-pandemic cohort. Discomfort with sharing information with commercial companies remained unchanged between the two cohorts. Significantly more pandemic cohort patients expressed a wish to track use of PHI, and to be notified of results. Thematic analysis uncovered that transparency was strongly desired on outside PHI use, particularly when commercialization was involved. Conclusions In pandemic times, patients were more comfortable sharing information with all parties, except with commercial entities, where levels of discomfort remained unchanged. Focus groups identified that the ability to track and receive results of studies using one’s PHI is an important way to reduce discomfort and increase trust. These findings meaningfully inform wider discussions on the use of personal health information for research during global crises. (shrink)

In an analysis of artificially intelligent systems for medical diagnostics and treatment planning we argue that patients should be able to exercise a right to withdraw from AI diagnostics and treatment planning for reasons related to (1) the physician’s role in the patients’ formation of and acting on personal preferences and values, (2) the bias and opacity problem of AI systems, and (3) rational concerns about the future societal effects of introducing AI systems in the health care sector.

This discussion treats a set of familiar social derelictions as consequences of the perversion of a universalistic moral theory in the service of an ill-considered or insufficiently examined personal agenda.The set includes racism, sexism, anti-Semitism, homophobia, and class elitism, among other similar pathologies, under the general heading of discrimination. The perversion of moral theory from which these derelictions arise, I argue, involves restricting its scope of application to some preferred subgroup of the moral community of human beings. -/- The following (...) analysis of higher-order discrimination suggests that we often select the individuals who constitute such subgroups for reasons that we ourselves would reject on moral grounds were we to examine them carefully, but that we choose instead to put our rational resources in the service of avoiding any such examination at all costs. The implication is that arguments that truncate the scope of moral theory in fact justify bestowing the gift of moral treatment on a select few who deserve it no more than the many from whom we withhold it. Therefore, it would be precipitous to conclude that universalistic moral theory can be legitimately restricted in its practical scope of application in any way at all. (shrink)

Why do some physicians continue to treat patients who are clearly dying or persistently unconscious, while others consider medical intervention to be futile past a certain point? No doubt, medical decisions vary in part because clinical information is often ambiguous in individual cases and because it may support more than one reasonable interpretation of a patient's chances for survival or improvement if a particular treatment is administered. Also, cases vary considerably to the extent that a patient's or a family (...) member's preferences for treatment are communicated, understood, and implemented. But, beyond these contingencies, patients at the end of life may receive more, less, or different treatment because physicians themselves are social actors, individuals who bring to bear on their clinical decisions a variety of personal attitudes, values, concerns, and interests. Legal defensiveness, religious vitalism, authoritarianism, intolerance of ambiguity, and other traits may influence physicians’ behavior, but each may be concealed under the rubric of what is “medically indicated” or “medically appropriate.”. (shrink)

Why do some physicians continue to treat patients who are clearly dying or persistently unconscious, while others consider medical intervention to be futile past a certain point? No doubt, medical decisions vary in part because clinical information is often ambiguous in individual cases and because it may support more than one reasonable interpretation of a patient's chances for survival or improvement if a particular treatment is administered. Also, cases vary considerably to the extent that a patient's or a family (...) member's preferences for treatment are communicated, understood, and implemented. But, beyond these contingencies, patients at the end of life may receive more, less, or different treatment because physicians themselves are social actors, individuals who bring to bear on their clinical decisions a variety of personal attitudes, values, concerns, and interests. Legal defensiveness, religious vitalism, authoritarianism, intolerance of ambiguity, and other traits may influence physicians’ behavior, but each may be concealed under the rubric of what is “medically indicated” or “medically appropriate.”. (shrink)

When patients are not able to speak for themselves, surrogate decision makers are asked to guide treatment decisions and formulate a plan of care in accordance with what the patients would have wanted. This necessitates an exploration into the patients’ views about life and how it should be lived, how the patients constructed their identity or life story, and their attitudes towards sickness and suffering. When an individual appoints a surrogate, such as a healthcare power of attorney, a common presumption (...) is that this designation evinces merit. This obscures the possibility of multiple other considerations that influence individual choice. This article presents a clinical case in which the claim to know someone best created a controversy that brought treatment decisions to a standstill. Further, it illuminates how the question, “Given the current medical condition, what would this person want?” risks presuming that a singular, unambiguous preference exists and that one person can provide the answer. Clinical ethicists can play a vital role in situations when there is a dispute among a designated surrogate and family members over a patient’s preference. By embracing the complexity of the desire to synthesize seemingly irreconcilable perspectives about identity, uncovering the reasons that underlie disagreement, and guiding inquiry in such a way that allows stakeholders to move beyond the conflict, clinical ethicists can facilitate decision making that honors the patient and may mitigate moral distress. (shrink)

Integrity is a critical determinant of the effectiveness of research organizations in terms of producing high quality research and educating the new generation of scientists. A number of responsible conduct of research (RCR) training programs have been developed to address this growing organizational concern. However, in spite of a significant body of research in ethics training, it is still unknown which approach has the highest potential to enhance researchers’ integrity. One of the approaches showing some promise in improving researchers’ integrity (...) has focused on the development of ethical decision-making skills. The current effort proposes a novel curriculum that focuses on broad metacognitive reasoning strategies researchers use when making sense of day-to-day social and professional practices that have ethical implications for the physical sciences and engineering. This sensemaking training has been implemented in a professional sample of scientists conducting research in electrical engineering, atmospheric and computer sciences at a large multi-cultural, multi-disciplinary, and multi-university research center. A pre-post design was used to assess training effectiveness using scenario-based ethical decision-making measures. The training resulted in enhanced ethical decision-making of researchers in relation to four ethical conduct areas, namely data management, study conduct, professional practices, and business practices. In addition, sensemaking training led to researchers’ preference for decisions involving the application of the broad metacognitive reasoning strategies. Individual trainee and training characteristics were used to explain the study findings. Broad implications of the findings for ethics training development, implementation, and evaluation in the sciences are discussed. (shrink)

Why do some physicians continue to treat patients who are clearly dying or persistently unconscious, while others consider medical intervention to be futile past a certain point? No doubt, medical decisions vary in part because clinical information is often ambiguous in individual cases and because it may support more than one reasonable interpretation of a patient's chances for survival or improvement if a particular treatment is administered. Also, cases vary considerably to the extent that a patient's or a family (...) member's preferences for treatment are communicated, understood, and implemented. But, beyond these contingencies, patients at the end of life may receive more, less, or different treatment because physicians themselves are social actors, individuals who bring to bear on their clinical decisions a variety of personal attitudes, values, concerns, and interests. Legal defensiveness, religious vitalism, authoritarianism, intolerance of ambiguity, and other traits may influence physicians’ behavior, but each may be concealed under the rubric of what is “medically indicated” or “medically appropriate.”. (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)

This provocative study revives a classical idea about rationality by developing analogies between the structure of personality and the structure of society in the context of contemporary work in the philosophy of mind, ehtics, decision theory, and social choice theory.

In lieu of an abstract, here is a brief excerpt of the content:Postmodern Assumptions of Philosophy of PsychiatryThe author reports no conflicts of interest.This paper makes claims for relevance of philosophy to psychopathology, as inspired in part by the work of Karl Jaspers. Yet there is no such thing as philosophy, in a general sense; there are philosophies, or as Jaspers would prefer, there is philosophizing (Ehrlich & George, 1994; Jaspers, 1951). Jaspers' approach to philosophy was akin to Freud's approach (...) to psychology: the goal was to make unconscious assumptions conscious. The unconscious assumption in the present paper is that there is such a thing as philosophy, which could then be useful for psychopathology. In effect, the author is probably meaning academic philosophy, or mainstream thinking in current philosophy of psychiatry. If that is the meaning, then Jaspers' question would be: What are the unconscious underlying assumptions of modern academic philosophy of psychiatry? The author's paper does not ask that question. But if we do, my answer would be that current mainstream philosophy of psychiatry has a basic worldview, another concept very central to Jaspers' thinking (Rindermann, 2021). Its worldview is postmodernist relativism about truth and skepticism about science, especially biology as applied to psychiatry. This unconscious assumption in modern philosophy of psychiatry is a major impediment in any benefits it might provide to psychiatry and psychopathology, as will be explained in the rest of this commentary.The paper refers to major depressive disorder (MDD) without appreciating that the term itself makes assumptions which the paper wishes to argue should be in the province of philosophy to analyze. The term MDD is not the same as depression, although the paper synonymizes the two. This synonym is an unanalyzed assumption, namely, that the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic system validly defines psychopathology. It clearly does not, for reasons that modern philosophy of psychiatry has not accurately analyzed (Ghaemi, 2014).About a decade ago, when DSM-5 was being developed, colleagues in the field of philosophy of psychiatry had worked for decades on psychiatric diagnosis, and there was initial hope that the time had come for an impact (Kendler et al., 2008). The leader of the prior edition of DSM was unhappy [End Page 17] with the fifth revision. A set of essays were published where philosophers and psychiatrists engaged the former DSM leader about psychiatric diagnosis (Frances, 2013). His response, with a somewhat derisive reference to "philosophyland," was eye opening to me. He explicitly stated that DSM revisions were not based on science or facts, but on "pragmatism," on the beliefs of DSM leaders about what was best for the profession or society. In short, it was admitted that DSM was a social construction, just as postmodern thinking had said about psychiatric diagnosis since Foucault. Yet this admission was made unconsciously; DSM leadership does not use that phrase, nor does it understand its conceptual foundations. Surprisingly to me, colleagues in the world of philosophy and psychiatry also failed to make the obvious connection, or if they did, they seemed to have little problem with it (Phillips et al., 2012). Social constructionism was their worldview too.In effect, philosophy of psychiatry had nothing to provide; it did not analyze or critique the philosophical worldview of DSM leadership; it shared that worldview and participated in it (Kendler, 2013).The result, in my view, is that mainstream philosophy of psychiatry has failed in the role which it could have played, the role of making the unconscious postmodern assumptions of psychiatry conscious, and criticizing those assumptions. Instead, it applauded them.My broader critique of mainstream philosophy of psychiatry gets played out in papers such as this one in relation to the DSM term MDD, which should be dropped because it is not a scientifically sound term; it has many conceptual and scientific falsehoods within it, which both a philosophical analysis and a scientific analysis would demonstrate.The term MDD was invented in the DSM-III process in the late 1970s to get votes for passage of that third revision by the American Psychiatric Association in 1980 (Decker, 2013). It literally was a social construction. To the extent that it had any scientific basis, it had its roots in the... (shrink)

I have little to say on this passage, where it seems necessary to maintain the vulgate notwith standing its obvious defects. My only reason for discussing it is to call attention to the strangeness of Jebb's proceeding when seeking to support Hermann's conjecture παλλλοιν which he admits into the text. The objection to Hermann's view is that, as he himself admits, there is no evidence that πáλληλος could be used in the sense of λληλιφóνος. For that, I suppose, is the (...) meaning of ‘mutual hands,’ which both Jebb and Campbell suggest as a translation, although ‘mutual violence’ would be better. But the chief purpose of this note is to protest against the mode of interpretation applied to Philo de Mose 3. 36. II. p. 175 M. διà τàς ν δασι καí πνρì γνιμéνας συνχς καì παλλλονς φθορáς Turnebu s rightl yrenders ‘alternas interneciones,’ and why Jebb supposes him to have meant ‘mutual’ I do not know. Anyhow he admits that Philo used the word in its ordinary sense of successive, and proceeds to paraphrase ‘owing to the continuous and rapid succession of calamities by flood and fire’ . All this is quite beside the mark, for the reference is to the alternate destruction of the world at the κπρωσις by fire and at the ξγρωσιςby water. I must take leave to refer to the evidence collected in my book on Zeno and Cleanthes, p. 253, to which should be added a most instructive passage of Origen : περì τν κακν λóγος ο μνóντων ì ν τατᾦ διà τν τοι τηροσαν τà πì γ$$$ς πρóνοιαν κατακλνσμο καì κπνρ03CE;σσι καθαíρονσαν.Add the passages from Lucan quoted by Mr. Heitland in his Introduction, p. xliii. (shrink)

What does the law demand when it requires citizens to conform to standards of reasonableness? I propose and defend the view that the law should demand that citizens conform their behavior to some actual conduct in society. I contrast this idea against what might be called the ``empty vessel'' view of reasonableness, where the standard is understood to function like an empty vessel in the law, allowing courts to use various norms and moral judgments to determine what seems reasonable (...) in the circumstances. The empty vessel account is the more common approach for understanding reasonableness, but it leaves obscure whether and how assessments about appropriate conduct connect with facts about citizens' actual conduct. I argue for a ``binocular'' view that focuses our attention on actual practices and thereby establishes how these standards provide a stable guide to conduct and support the rule of law. (shrink)

In this paper, we argue that our moral concern for future well-being should reduce over time due to important practical considerations about how humans interact with spacetime. After surveying several of these considerations (around equality, special duties, existential contingency, and overlapping moral concern) we develop a set of core principles that can both explain their moral significance and highlight why this is inherently bound up with our relationship with spacetime. These relate to the equitable distribution of (1) moral concern in (...) a universe that we can only causally affect in one temporal direction; (2) access to the benefits from using spacetime as a resource; and (3) the burdens of care given (1) and (2). We conclude by considering the practical implications of our argument and find that, while it is often assumed that a preference for present over future well-being weakens the case for existential risk mitigation, this likely is not the case. (shrink)

Robots are now associated with various aspects of our lives. These sophisticated machines have been increasingly used in different manufacturing industries and services sectors for decades. During this time, they have been a factor in causing significant harm to humans, prompting questions of liability. Industrial robots are presently regarded as products for liability purposes. In contrast, some commentators have proposed that robots be granted legal personality, with an overarching aim of exonerating the respective creators and users of these artefacts from (...) liability. This article is concerned mainly with industrial robots that exercise some degree of self-control as programmed, though the creation of fully autonomous robots is still a long way off. The proponents of the robot’s personality compare these machines generally with corporations, and sporadically with, inter alia, animals, and idols, in substantiating their arguments. This article discusses the attributes of legal personhood and the justifications for the separate personality of corporations and idols. It then demonstrates the reasons for refusal of an animal’s personality. It concludes that robots are ineligible to be persons, based on the requirements of personhood. (shrink)

We consider the role of preferences in the assessment of an agent's freedom, visualized as the opportunity for choice. After discussing several possible intuitive approaches to the problem, we explore an approach based on the notion of preference orderings that a reasonable person may possibly have. Using different sets of axioms, we characterize the rules for ranking opportunity sets in terms of freedom. We also show that certain axioms for ranking opportunity sets are incompatible.

In this paper, I set out two ethical complications for Rid and Wendler’s proposal that a “Patient Preference Predictor” (PPP) should be used to aid decision making about incapacitated patients’ care. Both of these worries concern how a PPP might categorize patients. In the first section of the paper, I set out some general considerations about the “ethics of apt categorization” within stratified medicine and show how these challenge certain PPPs. In the second section, I argue for a more specific—but (...) more contentious—claim that proper respect for the autonomy of incapacitated patients might require us to act on reasons which they could endorse and show how this claim places important limits on the categories employed by an ethically acceptable PPP. The conclusion shows how these concerns about apt categorization relate to more familiar worries about Rid and Wendler’s proposals. (shrink)

Brian Hedden defends a radical view about the relationship between rationality, personal identity, and time. On the standard view, personal identity over time plays a central role in thinking about rationality, because there are rational norms for how a person's attitudes and actions at one time should fit with her attitudes and actions at other times. But these norms are problematic. They make what you rationally ought to believe or do depend on facts about your past that aren't part (...) of your current perspective on the world, and they make rationality depend on controversial, murky metaphysical facts about what binds different instantaneous snapshots into a single person extended in time. Hedden takes a different approach, treating the relationship between different time-slices of the same person as no different from the relationship between different people. On his account, the locus of rationality is the time-slice rather than the temporally extended agent. This impersonal, time-slice-centric approach to rationality yields a unified approach to the rationality of beliefs, preferences, and actions where what rationality demands of you is solely determined by your evidence, with no special weight given to your past beliefs or actions. (shrink)

Here we present what we believe is a novel account of what languages are, along with an axiomatically rich representation of languages and language-related data that is based on this account. We propose an account of languages as aggregates of dispositions distributed across aggregates of persons, and in doing so we address linguistic competences and the processes that realize them. This paves the way for representing additional types of language-related entities. Like demographic data of other sorts, data about languages may (...) be of use to researchers in a number of areas, including biomedical research. Data on the languages used in clinical encounters are typically included in medical records, and capture an important factor in patient-provider interactions. Like many types of patient and demographic data, data on a person’s preferred and primary languages are organized in different ways by different systems. This can be a barrier to data integration. We believe that a robust framework for representing language in general and preferred and primary language in particular – which has been lacking in ontologies thus far – can promote more successful integration of language-related data from disparate data sources. (shrink)

As persons, beings with a capacity for autonomy, we face a certain practical task in living out our lives. At any given period we find ourselves with many desires or preferences, yet we have limited resources, and so we cannot satisfy them all. Our limited resources include insufficient economic means, of course; few of us have either the funds or the material provisions to obtain or pursue all that we might like. More significantly, though, we are limited to a (...) single life and one of finite duration. We also age, and pursuits that were possible at earlier points within a life may become impossible at later stages; we thus encounter not only an ultimate time limit but episodic limits as well. Because we must live our lives with limited resources—material and temporal—we are pressed to choose among and to order our preferences. Without some selection and ordering, few if any of them would be satisfied, and we would be unable to live lives that are recognizably good at all. Moreover, we would be unable to function well as the autonomous beings that we are. Our practical task then is to form a coherent, stable, and attractive ordering of aims—to develop a conception of our good. (shrink)

Mark Coeckelbergh (Int J Soc Robot 1:217–221, 2009) argues that robot ethics should investigate what interaction with robots can do to humans rather than focusing on the robot’s moral status. We should ask what robots do to our sociality and whether human–robot interaction can contribute to the human good and human flourishing. This paper extends Coeckelbergh’s call and investigate what it means to live with disembodied AI-powered agents. We address the following question: Can the human–AI interaction contribute to our moral (...) development? We present an empirically informed philosophical analysis of how the AI personal assistant Siri changes its users’ way of life, based on the responses obtained from 20 semi-directive individual interviews with Siri users. We identify changes in the users’ social interaction associated with the adoption of Siri. These changes include: (1) the indirect effect of reducing opportunities of human interaction, (2) the second-order effect of diminished expectations toward each other in a community, and (3) the acquired preference to obtain hassle-free interaction with Siri over human interaction. We examine them in relation to concerns that are voiced in the current debates over the rise of AI, namely the suspicion that humans could become overly reliant on AI (Danaher 2019) and the worry that social AI could impede on moral development (Fröding and Peterson, Ethics Inf Technol 23:207–214, 2012; Li, Ethics Inf Technol 23:543–550, 2021). We analyze the ethical costs that come from these changes in light of virtue ethics and address potential objections along the way. We end by offering directions for thinking about how to live with AI personal assistant while preserving favorable conditions for moral development. (shrink)

This comment responds to Kevin Warwick’s article on predictability and responsibility with respect to brain-machine interfaces in action. It compares conventional responsibility for device use with the potential consequences of phenomenological human-machine integration which obscures the causal chain of an act. It explores two senses of “responsibility”: 1) when it is attributed to a person, suggesting the morally important way in which the person is a causal agent, and 2) when a person is accountable and, on the basis of fairness (...) about rewards and sanctions, has a duty to act responsibly and accept liability. The comment suggests that, in the absence of absolute knowledge and predictability, we continue to engage in practical forms of reasoning about the responsibility for BMI-use in ways which are inclusive of uncertainties about the liability of persons versus devices and those who create them. (shrink)

Environmentalist philosophers often paint a holistic picture, stressing such things as the continuity of humanity with wider nature and our membership of the 'natural community' . The implication seems to be that a non-anthropocentric philosophy requires that we strongly identify ourselves with nature and therefore that we downplay any human/non-human distinction. An alternative view, I think more interesting and plausible, stresses the distinction between humanity and a nature valued precisely for its otherness. In this article I discuss some of its (...) main elements, and some of the difficulties involved with keeping nature's otherness in focus. Firstly (in sections 1-5), I try to clarify what I take to be the otherness-based position by distinguishing it from the apparently similar views of John Passmore, Robert Elliott and Keekok Lee, and some opposed holistic views, especially of J. Baird Callicott. Then, in the second half of the article (sections 6-7), I argue that if nature is valued in virtue of its otherness, this value is best thought of as an extrinsic, final and objective good, where 'objectivity' is a 'method of understanding', in Thomas Nagel's sense. Although I give some reasons for preferring an otherness account to certain alternative positions, I make no overall attempt to 'prove' that nature is valuable for its otherness. My aim is to show that, if it is, then this seems the best way to understand that value. (shrink)

Any great new theoretical framework has an epistemological and an ontological aspect to its philosophy as well as an axiological one, and one needs to understand all three aspects in order to grasp the deep aspiration and idea of the theoretical framework. Presently, there is a widespread effort to understand C. S. Peirce's (1837–1914) pragmaticistic semeiotics, and to develop it by integrating the results of modern science and evolutionary thinking; first, producing a biosemiotics and, second, by integrating it with the (...) progress in cybernetics, information science, and system theory to create a cybersemiotics. In this paper, we focus on the understanding of the evolution of the universe that Peirce produced as an alternative to the mechanistic view underlying classical physics and try to place man in an evolving universe as a creative, aesthetical agent. It is true that modern non-equilibrium physics has made a modern foundation for a profound physical understanding of the basic evolutionary processes in the universe. But science still has not produced a theory that can explain how the creativity of the universe could produce signification, interpretation, and first-person consciousness. To this end, Peirce's thoughts on agapastic evolution coupled with the aesthetically influence of the growth of ideas and reasonableness on man could make a contribution. (shrink)

The degree and nature of patient involvement in consultations with health professionals influences problem and needs recognition and management, and public accountability. This paper suggests a framework for understanding the scope for patient involvement in such consultations. Patients are defined as co-producers of formal health services, whose potential for involvement in consultations depends on their personal rights, responsibilities and preferences. Patients' rights in consultations are poorly defined and, in the National Health Service (NHS), not legally enforceable. The responsibilities of (...) patients are also undefined. I suggest that these are not to deny, of their own volition, the rights of others, which in consultations necessitate mutuality of involvement through information-exchange and shared decision-making. Preferences should be met insofar as they do not militate against responsibilities and rights. (shrink)

Background To describe the preferences for disclosure of individual biomarker results among mothers participating in a longitudinal birth cohort. Methods We surveyed 343 mothers that participated in the Health Outcomes and Measures of the Environment Study about their biomarker disclosure preferences. Participants were told that the study was measuring pesticide metabolites in their biological specimens, and that the health effects of these low levels of exposure are unknown. Participants were asked whether they wanted to receive their results and (...) their child's results. In addition, they were asked about their preferred method (letter vs in person) and format (more complex vs less complex) for disclosure of results. Results Almost all of the study participants wanted to receive their individual results (340/343) as well as their child's results (342/343). However, preferences for receiving results differed by education level. Mothers with less than a college degree preferred in-person disclosure of results more often than mothers with some college education or a college degree (34.3% vs 17.4% vs 7.9%, p<0.001). Similarly, mothers with less than a college education preferred a less complex disclosure format than mothers with some college education or a college degree (59.7% vs 79.1% vs 86.3%, p<0.0001). Conclusion While almost all study participants preferred to receive results of their individual biomarker tests, level of education was a key factor in predicting preferences for disclosure of biomarker results. To ensure effective communication of this information, disclosure of biomarker results should be tailored to the education level of the study participants. (shrink)

As these opening quotes acknowledge, the Prisoner’s Dilemma (PD) represents a core puzzle within the formal mathematics of game theory.3 Its rise in conspicuity is evident figure 2.1 above demonstrating a relatively steady rise in incidences of the phrase’s usage between 1960 to 1995, with a stable presence persisting into the twenty first century. This famous two-person “game,” with a stock narrative cast in terms of two prisoners who each independently must choose whether to remain silent or speak, each advancing (...) self-interest at the expense of the other and thereby achieving a mutually suboptimal outcome, mires any social interaction it is applied to into perplexity. The logic of this game proves the inverse of Adam Smith’s invisible hand: individuals acting on self interest will achieve a mutually suboptimal outcome. However, as this chapter illuminates, the assumptions underlying game theory drive this conclusion. (shrink)

In his late work Religion within the Boundaries of Mere Reason, Immanuel Kant struggles to answer a straightforward, yet surprisingly difficult, question: how is radical conversion--a complete reorientation of a person's most deeply held values--possible? In this book, Ryan S. Kemp and Christopher Iacovetti examine how this question gets taken up by Kant's philosophical heirs: Schelling, Fichte, Hegel and Kierkegaard. More than simply developing a novel account of each thinker's position, Kemp and Iacovetti trace how each philosopher formulates his (...) theory in response to tensions in preceding views, culminating in Kierkegaard's claim that radical conversion lies outside a person's control. Kemp and Iacovetti close by examining some of the moral-psychological implications of Kierkegaard's account, particularly the question of how someone might responsibly relate to values that have, by their own admission, been acquired in contingent and accidental fashion. (shrink)

When Oxford published Emotion and Adaptation, the landmark 1991 book on the psychology of emotion by internationally acclaimed stress and coping expert Richard Lazarus, Contemporary Psychology welcomed it as "a brightly shining star in the galaxy of such volumes." Psychiatrists, psychologists and researchers hailed it as a masterpiece, a major breakthrough in our understanding of the emotional process and its central role in our adaptation as individuals and as a species. What was still needed, however, was a book for general (...) readers and health care practitioners that would dispel the myths still surrounding cultural beliefs about emotion and systematically explain the relevance of the new research to the emotional dramas of our everyday lives.Now, in Passion and Reason, Lazarus draws on his four decades of pioneering research to bring readers the first book to move beyond both clinical jargon and "feel-good" popular psychology to really explain, in plain, accessible language, how emotions are aroused, how they are managed, and how they critically shape our views of ourselves and the world around us. With his co-author writer Bernice Lazarus, Dr. Lazarus explores the latest findings on the short and long-term causes and effects of various emotions, including the often conflicting research on stress management and links between negative emotions and heart disease, cancer, and other aspects of physical and psychological health. Lazarus makes a strong case that contrary to common assumption, emotions are not irrational--our emotions and our analytical thought processes are inextricably linked.While not a "how-to" book, Passion and Reason does describe how readers can interpret what lies behind their own emotions and those of their families, friends, and co-workers, and how to manage them more effectively. Exploring fifteen emotions in depth, from love to jealousy, the authors show how the personal meaning we give to the events and conditions of our lives trigger such emotions as anger, anxiety, guilt, and pride. They provide fascinating vignettes to frame a "biography" of each emotion. Some are composite case histories drawn from Dr. Lazarus's long career, but most are stories of people the Lazaruses have known over the years--people whose emotional fears, conflicts, and desires mirror readers' own. The Lazaruses also offer a special chapter on the diverse strategies of coping people use in managing their emotions, and another, "When Coping Fails," on psychotherapy and its approaches to emotional stress and dysfunction, from traditional Freudian psychoanalysis to continuing research into relaxation techniques, meditation, hypnosis, and biofeedback.Packed with insight and compellingly readable, Passion and Reason will enrich all readers fascinated by our emotional lives. (shrink)

A new history of liberalism which argues that liberalism has been predicated on definite morality and should be viewed as an attempt to encompass both fear and hope. Liberalism, argues Alan Kahan, is the search for a society in which people need not be afraid. Freedom from fear is the most basic freedom. If we are afraid, we are not free. These insights, found in Montesquieu and Judith Shklar, are the foundation of liberalism. What liberals fear has changed over time (...) (revolution, reaction, totalitarianism, religious fanaticism, poverty, and now populism) but the great majority of liberal thinkers have relied on three pillars to ward off their fears and to limit the concentrated power that causes fear: freedom, markets, and morals, or, to put it another way, politics, economics, and religion or morality. Most liberal thinkers emphasize one or two pillars more than another, but it is typical of liberalism down to the Second World War to rely on all three, although there were always minority voices who preferred to stand on only one leg. After WWII, "thin" procedural/market liberals, who wanted to strip any moral or religious basis or purpose from liberalism, dominated "thick" liberal moralists, who thought liberalism needed a moral basis and/or goal. It is the political contention of this book that liberalism is most convincing as program, language, and social analysis when it relies on all three pillars, and that the relative weakness of liberalism at the end of the twentieth century had much to do with neglect of the moral pillar of liberalism. Its historical contention is that for much of the past two centuries it did rely on all three pillars. But Kahan also argues that liberalism is not only a party of fear. It is also a party of hope, or the party of progress. Many of the contradictions typical of liberalism derive from the seemingly contradictory effort to encompass both hope and fear. If in case of conflict fear often trumps hope for liberals (loss aversion applies in politics as much as in economics), and utopia is subject to indefinite postponement, progress in personal autonomy and development has always been at the heart of liberalism. Liberals typically support their hopes on the same three pillars of freedom, markets, and morals which they use to ward off their fears. Nevertheless, in one respect those historians and political theorists who identify liberalism with laissez-faire economics are not wrong. It is characteristic of liberalism then that it bases its hopes not on the state but on civil society, which for liberals is the common source of a free politics, a free market, and of morals. Alan S. Kahan is Professor of History at the Université de Versailles. His previous books include Tocqueville, Democracy, and Religion: Checks and Balances for Democratic Souls (Oxford 2015), Alexis de Tocqueville (Continuum Books) and Mind vs Money: The War Between Intellectuals and Capitalism (Transaction Publishing, 2010). (shrink)

Generally, I find gatherings of the Association for the Scientific Study of Consciousness more interesting and congenial than the Tucson conferences. There are at least two reasons for this, the first one obvious: the former is smaller. Less crowds, more chances to participate in discussions . The second reason reflects my predispositions, and of course those of the ASSC: the talks, research, and speculation are closely data-driven. I find it highly refreshing to attend talks on consciousness which are reporting experiments (...) done by groups employing stringent quality controls, and to hear speculation which is carefully restrained to inferences that closely and clearly follow from consensually verified data. I find it hopeful that researchers have not abandoned lines of inquiry which have decades of experiments to back them up merely because they have not yet found answers to some particular questions. But hey, these are my own biases; I'm someone who thinks the Skeptical Inquirer is a valuable resource. (shrink)

Much academic work (in philosophy, economics, law, etc.), as well as common sense, assumes that ill health reduces well-being. It is bad for a person to become sick, injured, disabled, etc. Empirical research, however, shows that people living with health problems report surprisingly high levels of well-being - in some cases as high as the self-reported well-being of healthy people. In this chapter, I explore the relationship between health and well-being. I argue that although we have good reason to believe (...) that health problems causing pain and death typically do reduce well-being, health problems that limit capabilities probably don't reduce well-being nearly as much as most people suppose. I then briefly explore the consequences of this conclusion for political philosophy and ethics. If many health problems don't significantly reduce well-being, why should governments go to great expense to prevent or treat them? Why should parents be obliged to ensure the health of their children? (shrink)

We created paired moral dilemmas with minimal contrasts in wording, a research strategy that has been advocated as a way to empirically establish principles operative in a domain‐specific moral psychology. However, the candidate “principles” we tested were not derived from work in moral philosophy, but rather from work in the areas of consumer choice and risk perception. Participants were paradoxically less likely to choose an action that sacrifices one life to save others when they were asked to provide more reasons (...) for doing so (Experiment 1), and their willingness to sacrifice lives depended not only on how many lives would be saved, but on the number of lives at risk (Experiment 2). The latter effect was also found in a within‐subjects design (Experiment 3). These findings suggest caution in the use of artificial dilemmas as a key testbed for revealing principled bases for moral judgment. (shrink)

OBJECTIVES: To measure the preference regarding disclosure of a serious diagnosis, and its determinants, of the Lebanese public. DESIGN AND SETTING: Non-random sample survey of 400 persons interviewed in health care facilities in Beirut in 1995. RESULTS: Forty-two per cent of respondents generally preferred truth not to be disclosed directly to patients. Preference for disclosure was associated with younger age, better education and tendency to rapport-building with physicians. There were no meaningful associations between place of residence (urban/rural), level of religious (...) practice, or religious affiliation, and preference for disclosure. CONCLUSIONS: Under one plausible interpretation, this survey suggests that the expectation for concealment will decrease as the advantage of knowledge in better coping with disease is understood by an increasingly better educated public, and that the Lebanese public will increasingly come to expect direct and full disclosure of serious diagnoses. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:HUME'S BUNDLES, SELF-CONSCIOUSNESS AND KANT Even if we are inclined to view Hume's attempt to explain ascriptions of personal identity as an abysmal failure, we might still be sympathetic toward his proposal to replace the going substance theory of the nature of mind with his bundle account. Thus we might fault Hume for erecting an unachievably high standard for personal identity, or round on him for excluding bodily criteria (...) 2... from his solution, but nonetheless applaud his spiriting away of the Cartesian soul substance leaving his "true idea of the human mind" (261) as a collection of perceptions in its stead. However, Hume's concern to give an account of the idea of the unity of a human mind in terms of related perceptions has run into notoriously rough sledding, not the least of which is the fact that Hume himself in his Appendix to "Of Personal Identity" seems to abandon his bundle theory in despair. In this paper I shall first be concerned to examine the criticism of his bundle theory which Hume brings forth in the Appendix and explain why I think the core difficulty remains insoluble for Hume. I shall then go on to suggest that the unworkability of Húmete bundle theory is directly tied to his failure to appreciate certain features of the peculiarly first person nature of his question about the make-up of minds. In thus emphasizing the place of the first person voice in my interpretation I am stealing a leaf, if not a chapter, from Kant. But this is as it should be since one of the aims of this essay is to provide an interpretation of Hume's difficulties with his account of the nature of mind which explains part of the reason why 'self-consciousness' (or 'apperception') looms so very large in the Critique of Pure Reason attack upon Hume's type of bundle theory. 60. 1. Hume's Second Thoughts In a burst of self criticism at the Appendix to the section on personal identity, Hume brings forth this objection to his own efforts:...Having thus loosen' d all our particular perceptions, when I proceed to explain the principle of connexion, which binds them together, and makes us attribute to them a real simplicity and identity; I am sensible, that my account is very defective, and that nothing but the seeming evidence of the precedent reasonings cou'd have indue' d me to receive it (635). After additional reflections Hume encapsulates his objection thus:...All my hopes vanish, when I come to explain the principles, that unite our successive perceptions in our thought or consciousness (6SS-6). What is the defect Hume calls to our attention? Notice first that the footnote on page 635 explicitly refers us back to that part of his account Hume considers defective; and when we look back to the text of the Treatise in question, page 260, we find it is precisely there that Hume uses the analogy of a republic to sketch his bundle theory of the unity of mind in terms of the two associative principles, resemblance and causation. So it must somehow be that this account in terms of the associative principles is mistaken. But what then is the mistake? According to Hume it is that he cannot 'explain' the principles which unite the discrete percepts. Now it seems to me there are only two possible things Hume could mean in saying this. He could mean either (1) that the principles which connect the percepts of one mind are instances of the associative principles, but he cannot explain them; or (2) there must be other, non-associative, principles which connect the percepts of a single mind and these he cannot explain. 61. I think we can safely conclude (1) cannot represent Hume's misgivings when he says he is unable to explain the uniting principles of the mental bundles. There is first the fact that he does not call into question his general programme of accounting for the nature of the unity of complex things by the principles of causation, resemblance and contiguity — for example, ships, plants, animals, houses and rivers (e.g. 257f) — but only his... (shrink)

Despite the therapeutic potential of human embryonic stem (HES) cells, many people believe that HES cell research should be banned. The reason is that the present method of extracting HES cells involves the destruction of the embryo, which for many is the beginning of a person. This paper examines a number of compromise solutions such as parthenogenesis, the use of defective embryos, genetically creating a "pseudo embryo" that can never form a placenta, and determining embryo death, and argues that none (...) of these proposals are likely to satisfy embryoists, that is, those who regard the embryo as a person. This paper then proposes a method of extracting HES cells, what might be called the Blastocyst Transfer Method, that meets the ethical requirements of embryoists, and it considers some possible concerns regarding this method. It concludes by encouraging future HES cell research to investigate this method. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases. Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s. Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz (E) and Dignitas (D) between 2001 and 2004 and (...) investigated by the University of Zurich’s Institute of Legal Medicine (E: n = 147; D: n = 274, total: 421). Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 (n = 149) were compared with the data of the present study. Results: More women than men were assisted in both organisations (D: 64%; E: 65%). Dignitas provided more assistance to non-residents (D: 91%; E: 3%; p = 0.000), younger persons (mean age in years (SD): D: 64.5 (14.1); E: 76.6 (13.3); p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis (D: 79%; E: 67%; p = 0.013). Lethal medications were more often taken orally in cases assisted by Dignitas (D: 91%; E: 76%; p = 0.000). The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s (women: 52% to 65%, p = 0.031; mean age in years (SD): 69.3 (17.0) to 76.9 (13.3), p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026). Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases.Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s.Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz and Dignitas between 2001 and 2004 and investigated by the University (...) of Zurich’s Institute of Legal Medicine. Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 were compared with the data of the present study.Results: More women than men were assisted in both organisations. Dignitas provided more assistance to non-residents, younger persons : D: 64.5 ; E: 76.6 ; p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis. Lethal medications were more often taken orally in cases assisted by Dignitas. The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s : 69.3 to 76.9, p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026).Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Jeremy Waldron has recently raised the question of whether there is anything approximating the creative self-authorship of personal autonomy in the writings of Immanuel Kant. After considering the possibility that Kantian prudential reasoning might serve as a conception of personal autonomy, I argue that the elements of a more suitable conception can be found in Kant’s Tugendlehre, or “Doctrine of Virtue”—specifically, in the imperfect duties of self-perfection and the practical love of others. This discovery is important for at least three (...) reasons: first, it elucidates the relationship among the various conceptions of autonomy employed by personal-autonomy theorists and contemporary Kantians; second, it brings to the surface previously unnoticed or undernoticed features of Kant’s moral theory; and third, it provides an essential line of defense against certain critiques of contemporary Kantian theories, especially that of John Rawls. (shrink)

Is understanding subject to a factivity constraint? That is, must the agent’s representation of some subject matter be accurate in order for her to understand that subject matter? ‘No’, I argue in this paper. As an alternative, I formulate a novel manipulationist account of understanding. Rather than correctly representing, understanding, on this account, is a matter of being able to manipulate a representation of the world to satisfy contextually salient interests. This account of understanding is preferable to factivism, I argue, (...) mainly for simplicity reasons. While it explains the intuitive data about understanding as successfully as factivist accounts, it is simpler by virtue of reducing the value truth bestows on understanding to that of usability. (shrink)

This study is part of a comprehensive investigation of ethical thinking among male and female physicians and nurses. Nine women physicians with different levels of expertise, working in various wards in paediatric clinics at two of the university hospitals in Norway, narrated 37 stories about their experience of being in ethically difficult care situations. All of the interviewees’ narrations were concerned with problems relating to both action ethics and relation ethics. The main focus was on problems in a relation ethics (...) perspective. The most common themes in an action ethics perspective were overtreatment and withholding treatment. The more experienced physicians reasoned differently from the group of less experienced physicians and they coped with pressure in different ways. The less experienced physicians disclosed their professional experience yet seemed uncertain, while putting on an air of certainty, but the more experienced physicians disclosed both their professional and personal experience of caregiving and they seemed to allow themselves to feel uncertain in their certainty. Both groups emphasized a need for deep discussion between colleagues about their being in ethically difficult care situations. (shrink)