Gilles de la Tourette syndrome (TS) is a childhood neuropsychiatric disorder characterised by the presence of motor and vocal tics. Patients with malignant TS experience severe disease sequelae; risking morbidity and mortality due to tics, self-harm, psychiatric comorbidities and suicide. By definition, those cases termed ‘malignant’ are refractory to all conventional psychiatric and pharmacological regimens. In these instances, deep brain stimulation (DBS) may be efficacious. Current 2015 guidelines recommend a 6-month period absent of suicidal ideation before DBS is offered to (...) patients with TS. We therefore wondered whether it may be ethically justifiable to offer DBS to a minor with malignant TS. We begin with a discussion of non-maleficence and beneficence. New evidence suggests that suicide risk in young patients with TS has been underestimated. In turn, DBS may represent an invaluable opportunity for children with malignant TS to secure future safety, independence and fulfilment. Postponing treatment is associated with additional risks. Ultimately, we assert this unique risk-benefit calculus justifies offering DBS to paediatric patients with malignant TS. A multidisciplinary team of clinicians must determine whether DBS is in the best interest of their individual patients. We conclude with a suggestion for future TS-DBS guidelines regarding suicidal ideation. The importance of informed consent and assent is underscored. (shrink)

Background: COVID-19 pandemic has led to heightened moral distress among healthcare providers. Despite evidence of gendered differences in experiences, there is limited feminist analysis of moral distress. Objectives: To identify types of moral distress among women healthcare providers during the COVID-19 pandemic; to explore how feminist political economy might be integrated into the study of moral distress. Research Design: This research draws on interviews and focus groups, the transcripts of which were analyzed using framework analysis. Research Participants and Context: 88 (...) healthcare providers, based in British Columbia Canada, participated virtually. Ethical Considerations: The study received ethical approval from Simon Fraser University. Findings: Healthcare providers experienced moral dilemmas related to ability to provide quality and compassionate care while maintaining COVID-19 protocols. Moral constraints were exacerbated by staffing shortages and lack of access to PPE. Moral conflicts emerged when women tried to engage decision-makers to improve care, and moral uncertainty resulted from lack of clear and consistent information. At home, women experienced moral constraints related to inability to support children’s education and wellbeing. Moral conflicts related to lack of flexible work environments and moral dilemmas developed between unpaid care responsibilities and COVID-19 risks. Women healthcare providers resisted moral residue and structural constraints by organizing for better working conditions, childcare, and access to PPE, engaging mental health support and drawing on professional pride. Discussion: COVID-19 has led to new and heightened experiences of moral distress among HCP in response to both paid and unpaid care work. While many of the experiences of moral distress at work were not explicitly gendered, implicit gender norms structured moral events. Women HCP had to take it upon themselves to organize, seek out resources, and resist moral residue. Conclusion: A feminist political economy lens illuminates how women healthcare providers faced and resisted a double layering of moral distress during the pandemic. (shrink)

Most moral philosophers agree that if a moral agent is incapable of performing some act ϕ because of a physical incapacity, then they do not have a reason to ϕ. Most also claim that if an agent is incapable of ϕ-ing due to a psychological incapacity, brought about by, for example, an obsession or phobia, then this does not preclude them from having a reason to ϕ. This is because the 'ought implies can' principle is usually interpreted as a claim (...) about physical, rather than psychological, capacities. In this paper I argue for an opposing view: if we don't have reasons to do things that we are physically incapable of doing, then neither do we have reasons to do things we are psychologically incapable of doing. I also argue that extending the 'ought implies can' principle to psychological capacities makes the principle more attractive. (shrink)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

It is commonly believed that disability disqualifies people from full participation in or recognition by society. This view is rooted in eugenic logic, which tells us that our world would be a better place if disability could be eliminated. In opposition to this position, I argue that that disability is inherent in the human condition and consider the bioethical question of why we might want to conserve rather than eliminate disability from our shared world. To do so, I draw together (...) an eclectic, rather than systematic, configuration of counter-eugenic arguments for conserving disability. The idea of preserving intact, keeping alive, and even encouraging to flourish denoted by conserve suggests that disabilities would be better understood as benefits rather than deficits. I present, then, a reading of disability as a potentially generative resource rather than unequivocally restrictive liability. In other words, what I consider here is the cultural and material contributions disability offers to the world. (shrink)

we always get to this difficult conversation one way or another when I'm talking to friends who have kids with disabilities. It goes like this: "If there had been a test for autism when my wife was pregnant with our son," my close friend tells me, "she would definitely have had an abortion." He tells me this with candor because he knows I know that this does not mean that he regrets having the son, grown up now, that they do (...) have. Parents with disabled children are usually rightfully wary about engaging in such conversations, but perhaps because I have a significant congenital genetic disability myself, we talk together about this with intimacy and mutual understanding. With his reflection about what we now... (shrink)

This article offers the critical concept misfit in an effort to further think through the lived identity and experience of disability as it is situated in place and time. The idea of a misfit and the situation of misfitting that I offer here elaborate a materialist feminist understanding of disability by extending a consideration of how the particularities of embodiment interact with the environment in its broadest sense, to include both its spatial and temporal aspects. The interrelated dynamics of fitting (...) and misfitting constitute a particular aspect of world-making involved in material-discursive becoming. The essay makes three arguments: the concept of misfit emphasizes the particularity of varying lived embodiments and avoids a theoretical generic disabled body; the concept of misfit clarifies the current feminist critical conversation about universal vulnerability and dependence; the concept of misfitting as a shifting spatial and perpetually temporal relationship confers agency and value on disabled subjects. (shrink)

Commentary on Rob Sparrow’s (2022) target article, “Human Germline Genome Editing: On the Nature of Our Reasons to Genome Edit,” should consider the collection of articles Sparrow has authored on g...

En 2018, première véritable année de la présidence de Trump, il devint parfaitement clair que la relation transatlantique était entrée dans une phase de profond désaccord, suscitant quantités de témoignages et de commentaires pessimistes dans la presse anglo-américaine. A partir de ce constat, l’article reconsidère l’étude du « transatlantique » en tant qu’aire géographique. Il aborde la manière d’appréhender le temps (la périodisation), l’espace (l’échelle) et la discipline (la méthodologie) afin de remettre en question les hypothèses classiques et d’ouvrir de (...) nouvelles voies pour la recherche, la formation identitaire et l’engagement émancipateur. (shrink)

A scholarly edition of a work by Adam Smith. The edition presents an authoritative text, together with an introduction, commentary notes, and scholarly apparatus.

ABSTRACT:In this article we investigate a philosophical problem for normative business ethics theory suggested by a phenomenon that contemporary psychologists call “bounded ethicality,” which can be identified with the putative fact that well-intentioned people, constrained by psychological limitations, make ethical choices inconsistent with their own ethical beliefs and commitments. When one combines the idea that bounded ethicality is pervasive with the idea that a person morally ought to do something only if she can, it raises a doubt about the practical (...) relevance of the moral principles that business ethics theory prescribes. We call this doubt the Radical Behavioral Challenge. It consists in the idea that people cannot generally conform to the normative ethical principles that business ethics theorists prescribe, and that these principles are therefore practically irrelevant. We answer the Radical Behavioral Challenge and explore normative implications of our answer. (shrink)

WE must first state the subject of our inquiry and the faculty to which it belongs: its subject is demonstration and the faculty that carries it out demonstrative science.

In this paper, it will be argued that each time a procedure in a representational system is functioning adequately and automatically, the child steps up to a metaprocedural level and considers the procedure as a unit in its own right. Data will be drawn from microdevelopment in children's creation of external memory devices (i.e., changes in representation of a spatial task during a one hour's session) as well as from macrodevelopment in language acquisition (i.e., changes occurring over age in a (...) study of nominal determiners, pronouns and gender markers). These two aspects of development of representational systems are examined with respect to the spontaneous passage from concrete reference to abstract systems, from idiosyncratic to conventional notations, from redundant to economic marking, from unifunctional to plurifunctional meaningful units. These micro‐ and manodevelopmental changes take place in a spontaneous fashion despite the fact that the child's earlier system is adequate for successfully conveying the information required. A discussion will be made of the way in which children tend to indicate externally, by unifunctional markers, information which was implicit in their earlier use of an adult‐like system. They appear to be striving for the delicate balance between encoding and decoding efforts, ultimately leading to a felicitous representational system. Metaprocedural behavior is hypothesized to act as a control mechanism in the striving for this delicate balance of information content and information processing effort. It also appears to act as a control mechanism for the interprocedural organizotion of what was previously a plethora of juxtaposed, unconnected procedures yielding superficially analogous behavior. The stepping‐up to a metaprocedural level seems to occur each time the child has a handle on his currently functioning, goal‐oriented system. This enables the child to treat the system, or procedures which are part thereof, as units functioning in their own right. Thus there appears to be a deep‐rooted psychological tendency for a representational tool which functions well procedurally to become subsequently a problem‐space per se. (shrink)

Vladimir JankéLéVitch, who teaches philosophy at the Sorbonne, is one of the most highly individual philosophical writers in France today. He has been publishing books for some quarter of a century on both philosophy and music, of which the most recent, entitled La Rhapsodie: Verve et improvisation musicale , unites his two specialities. It is with his philosophical work that I want to deal here.

The study of genetic developmental disorders originally seemed to hold the promise for those of a nativist persuasion of demonstrating pure dissociations between different cognitive functions, as well as the existence of innately specified modules in the brain and the direct mapping of mutated genes to specific cognitive-level outcomes. However, more recent research within a neuroconstructivist perspective has challenged this promise, arguing that earlier researchers lost sight of one fundamental explanatory factor in both the typical and atypical case: the actual (...) process of ontogenetic development. The paper is divided into three parts on evolution, genetics, and ontogeny. Each section starts by examining nativist claims about innateness and modularity of function, and subsequently evaluates them within a neuroconstructivist approach to human development. (shrink)

Written by the 11th-century Spanish Arab, Abh Muhammad ibn MucnOn Twilight and the Rising of Cloudsdh's value of around 52 miles remained standard until the 17th century, when it was revised sharply downward in consideration of atmospheric refraction and barometric studies. The treatise itself survives in a single Hebrew exemplar, 25 Latin exemplars, and an Italian exemplar derived from the Latin. At the heart of this present study is a critical text based on a fullscale comparative transcription of 22 of (...) the Latin manuscripts, ranging in date from the 13th to the 17th century. (shrink)

The exportation of unethical practices to low- and middle-income countries has been conceived as a prevalent practice which needs to be examined more closely. Such a practice might point towards the exploitation of vulnerable population groups. We conducted a survey among Mexican research ethics committee members to explore the issue of ethics dumping in Mexico by understanding how its existence and contributing factors and norms are perceived by these ethics committee members. We designed an exploratory survey based on a five-point (...) Likert scale, following an established, validated and published methodology. The questionnaire included both open close-ended questions. The aspects covered in the questionnaire were introductory questions on the existence of ethical issues; general perception on ethics dumping in Mexico; lack of voluntariness, undue inducement, and therapeutic misconception as exploitation risks; existence of exploitative practices; norms facilitating ethics dumping; acceptable levels of benefit to Mexico; boundaries of ethics dumping. The survey was administered to a sample of research ethics committee members from public and private Mexican hospitals in 2016. Most of the ethics committee members believed clinical trials are generally ethically sound, though almost a majority think that ethics dumping is a common occurrence and that it is a serious issue. Most agree that ethics dumping needs to be addressed. They also identified other issues such as ethical issues related to patient participation and ethics committees. Further, most committee members agree that undue inducement and therapeutic misconception affect voluntariness, and that both individuals and communities receive appropriate benefits. From the perspective of Mexican research ethics committee members, ethics dumping commonly exists in Mexican clinical trials, as well as several related issues such as ethical issues on patient participation and ethics committees, as well as voluntariness issues. Further, most members believed these issues need to be addressed. However, most were also of the opinion that clinical trials are generally ethically compliant. This points to the need for further studies on the reasons for these perspectives. (shrink)

I have at least four close friends who seem to be ideal qualified recipients of WET. My friends have a variety of eyes: some prosthetic, some wandering, some misaligned, some absent, some shrouded...

Introduction i. Adam Smith's Lectures at Glasgow University Adam Smith was elected to the Chair of Logic at Glasgow University on 9 January, and admitted to ...

This title is written to match GCSE Religious Studies AQA B, option 2 and can be used as part of a full course or short course. It contains summaries and practise exam questions at the end of each section to help prepare for exams.

In this open peer commentary, we concur with the three target articles’ analysis and positions on abortion in the special issue on Roe v. Wade as the exercise of reproductive liberty essential for the bioethical commitment to patient autonomy and self-determination. Our proposed OPC augments that analysis by explicating more fully the concept crucial to Roe of fetal personhood. We explain that the development and use of predictive reproductive technologies over the fifty years since Roe has changed the literal image, (...) and thereby the epistemological landscape, through which a prospective parent comes to know the fetus. The logic of Roe required a legal and ethical denial of fetal personhood to prioritize maternal autonomy over claims to fetal moral personhood. Our claim is that such a denial may be more complicated today. The fetal person genetic testing and reproductive imaging now presents to prospective parents has become an increasingly individualized, distinct medicalized picture of a developing person with which a parent can either identify or differentiate. In contrast, the fetal person of Roe was an abstract and vague figure stripped of most human particulars, a pregnancy rather than the specific individualized human entity reproductive technology now presents as a person to prospective parents. We discuss the implications of this shift and call for a more capacious analysis of reproductive ethics that works towards both reproductive and disability justice. (shrink)

Weaving together personal experience, disability studies scholarship, and art criticism, this paper explores the relationship between embodied experience of the world and the demands placed on us to conform to it. Misfitting forces us to recognize the fundamental distinction between flesh and world, and with it both the limits and possibilities of the human capacity to act and to be. The fundamental misfit all humans share is that we emerge from the sheltering womb into a material world that is indifferent (...) to our individual existence. That is to say, mortality is the fundamental misfit of the human condition. It is in this sense that flesh emplaced in world is always a relationship of misfitting. The existential and social repair that misfitting calls for is attentive care and love, an attitude of welcome and openness to all body-minds, whether expected or unexpected, whether fit or misfit. (shrink)

Lockdowns and related policies of behavioral and economic restriction introduced in response to the COVID-19 pandemic are criticized, drawing on three sets of ideas and arguments that are organized in accordance with the likely degree of controversy associated with their guiding assumptions. The first set of arguments makes use of cost–benefit reasoning within a broadly utilitarian framework, emphasizing uncertainty, the role of worst-case scenarios, and the need to consider at least the medium term as well as immediate effects. The second (...) draws on assumptions about the political value of basic liberties. The third draws on ideas about the roles of different stages within human life. (shrink)