Co-authored letter to the APA to take a lead role in the recognition of teaching in the classroom, based on the participation in an interdisciplinary Conference on the Role of Advocacy in the Classroom back in 1995. At the time of this writing, the late Myles Brand was the President of Indiana University and a member of the IU Department of Philosophy.

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Error is a neglected epistemological category in the history of science. This neglect has been driven by the commonsense idea that its elimination is a general good, which often renders it invisible or at least not worth noticing. At the end of the sixteenth century across Europe, medicine increasingly focused on “popular errors,” a genre where learned doctors addressed potential patients to disperse false belief about treatments. By the mid-seventeenth century, investigations into popular error informed the working methodology of natural (...) philosophers, rather than just physicians. In 1646, Thomas Browne published Pseudodoxia Epidemica, a large volume on popular error. Despite Browne’s formal training as a physician, this work examined only a few medical errors and instead aspired to be an encyclopedia of error. Pseudodoxia Epidemica was highly popular, running to six editions, and was known by the Fellows of the Royal Society. Influenced by Browne, alongside Bacon’s theory of the idols, natural philosophic practice in the late sixteenth and seventeenth century developed a focus on error that revised traditional attention to the discovery of knowledge. Fellows such as Robert Boyle and Robert Hooke proposed new ways to secure truth under the far-reaching influence of Bacon’s refutations of “natural human reason” distorted by false idols, of syllogistic logic, and of “theories,” his label for traditional philosophical systems that bias thought toward falsity. In three parts, this article traces the progression in early modern scientific approaches to handling error, and especially medical error – from physicians’ efforts to identify and eradicate it through collaborative effort, to the striking tension in Browne’s work between seeking to eliminate error while also showing a marked tolerance for it, to the Royal Society’s Baconian objective of instrumentalizing error to find truth. Error emerges as its own epistemic category that serves as a driving force toward knowledge production. (shrink)

Aims: To assess patient receipt of written information. To ensure patients understand the written information about a resuscitation policy and to determine whether they disapproved of or had concerns about the policy. Methods: All admissions to four wards of the hospital were approached for an interview. A set questionnaire was asked by one of 2 interviewers. Results: 72% of 572 admissions were interviewed. Refusal accounted for only 2 of the people not interviewed. 11% were unable to advocate for themselves by (...) reason of mental incompetence, inability to communicate or impairment secondary to their illness. Of the 401 interviewed only 49% recalled receiving the patient information booklet. Few patients (17%) recalled reading the information in the patient information booklet. They were all then given the paragraph about the hospital’s resuscitation policy. 352 were asked their understanding and only 61% demonstrated that they understood the paragraph. 91% of all 401 patients approved of the hospital having the option of DNR orders. 31% of people however had concerns related to DNR orders. These are discussed. Conclusions: Many acutely unwell patients are unable to advocate for themselves. Written information is a poor method of communicating with patients. There was limited receipt of the information and many misunderstood the paragraph about the hospitals resuscitation policy. There was a wide range of patient thoughts and concerns expressed. (shrink)

Marsilio Ficino’s fame as a translator, not least due to his contributions to theology and the development of hermeticism, has already been established by Frances Yates and debated by Wouter Hanegraaff. For each of his translations of Greek texts, Ficino wrote a preface to guide and to manipulate the reader. This paper presents an analysis of the auctoritas in the paratext of the Corpus Hermeticum, analyzing it as a rhetorical device used by Ficino to express his ideas, particularly the role (...) of Hermes Trismegistus. Ficino used his rhetorical skill not only to translate from Greek to Latin but also to support his theories in commentaries, letters, or, in this case, prefaces. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

For much of 2021, allocating the scarce supply of Covid‐19 vaccines was the world's most pressing bioethical challenge, and similar challenges may recur for novel therapies and future vaccines. In the United States, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) identified three fundamental ethical principles to guide the process: maximize benefits, promote justice, and mitigate health inequities. We argue that critical components of the recommended protocol were internally inconsistent with these principles. Specifically, the ACIP (...) violated its principles by recommending overly broad health care worker priority in phase 1a, using being at least seventy‐five years of age as the only criterion to identify individuals at high risk of death from Covid‐19 during phase 1b, failing to recommend place‐based vaccine distribution, and implicitly endorsing first‐come, first‐served allocation. More rigorous empirical work and the development of a complete ethical framework that recognizes trade‐offs between principles may have prevented these mistakes and saved lives. (shrink)

IntroductionDeep brain stimulation (DBS) is increasingly used to treat the symptoms of various neurologic and psychiatric conditions. People can undergo the procedure during reproductive years but the safety of DBS in pregnancy remains relatively unknown given the paucity of published cases. We thus conducted a review of the literature to determine the state of current knowledge about DBS in pregnancy and to determine how eligibility criteria are approached in clinical trials with respect to pregnancy and the potential for pregnancy.MethodsA literature (...) review was conducted in EMBASE to identify articles involving DBS and pregnancy. Two reviewers independently analyzed the articles to confirm inclusion. Data extracted for analysis included conditions treated, complications at all stages of pregnancy, neonatal/pediatric outcomes, and DBS target. A second search was then conducted using www.clinicaltrials.gov. The same two reviewers then assessed whether each trial excluded pregnant individuals, lactating individuals, or persons of childbearing age planning to conceive. Also assessed was whether contraception had to be deemed adequate prior to enrollment.ResultsThe literature search returned 681 articles. Following independent analysis and agreement of two reviewers, 8 pregnancy related DBS articles were included for analysis. These articles described 27 subjects, 29 pregnancies (2 with subsequent pregnancies), and 31 infants (2 twin pregnancies). There was 1 preterm birth at 35 weeks, and 3 patients who experienced discomfort from the DBS battery (i.e., impulse generator) placement site. All 27 patients had a DBS device implanted before they became pregnant, which remained in use throughout their pregnancy. There was exclusion of pregnant individuals from 68% of 135 interventional trials involving DBS. Approximately 44% of these trials excluded persons of childbearing age not on “adequate contraception” or wishing to conceive in the coming years. Finally, 22% excluded breastfeeding persons.ConclusionThe data from 29 pregnancies receiving DBS treatment during pregnancy was not associated with unexpected pregnancy or post-partum complication patterns. Many clinical trials have excluded pregnant individuals. Documentation of outcomes in larger numbers of pregnancies will help clarify the safety profile and will help guide study designs that will safely include pregnant patients. (shrink)

ABSTRACTIn 1651, Alexander Ross published an attack on Thomas Browne's Pseudodoxia Epidemica, Bacon's Natural History and William Harvey's De generatione. Ross's work, Arcana Microcosmi, defended Aristotelian natural philosophy against the ‘new philosophy’ that figures like Bacon, Harvey and Browne represented. Though Ross's attacks on these authors make up no more than half of the treatise’s contents, the book’s paratextual materials emphasise scientific debate. While Ross's authorial approach advocates reading exclusively ancient authorities for the sake of glossing and transmitting their knowledge (...) to a wider public, in order to argue against the new philosophy Ross must engage with its textual production. Furthermore, his works advertise their focus on Bacon, Harvey and Browne, which would have attracted a readership drawn to new scientific approaches to knowledge formation. Ross's polemic represents an effort to model his devotion to ancient authority while also generating a reading public that would resist the new approach to reading that the new philosophy proposed. (shrink)

It has recently been argued that a person’s moral judgments (about both their own and others’ actions) are constrained by the nature and extent of their relevant ignorance and, thus, that such judgments are determined in the first instance by the person’s epistemic circumstances. It has been argued, in other words, that the epistemic is logically prior to other normative (e.g., ethical, prudential, pecuniary) considerations in human decision-making, that these other normative considerations figure in decision-making only after (logically and temporally) (...) relevant ignorance has constrained the decision-maker’s menu of options. If this is right, then a person’s moral judgments in some set of circumstances should vary with their knowledge and ignorance of these circumstances. In this study, we test the hypothesis of the logical priority of the epistemic. We describe two experiments in which subjects’ knowledge and ignorance of relevant consequences were manipulated. In the second experiment, we also compared the effect of ignorance on moral judgments with that of personal force, a factor previously shown to influence moral judgments. We found broad empirical support for the armchair arguments that epistemic considerations are logically prior to normative considerations. (shrink)

It has recently been argued that a person’s moral judgments (about both their own and others’ actions) are constrained by the nature and extent of their relevant ignorance and, thus, that such judgments are determined in the first instance by the person’s epistemic circumstances. It has been argued, in other words, that the epistemic is logically prior to other normative (e.g., ethical, prudential, pecuniary) considerations in human decision-making, that these other normative considerations figure in decision-making only after (logically and temporally) (...) relevant ignorance has constrained the decision-maker’s menu of options. If this is right, then a person’s moral judgments in some set of circumstances should vary with their knowledge and ignorance of these circumstances. In this study, we test the hypothesis of the logical priority of the epistemic. We describe two experiments in which subjects’ knowledge and ignorance of relevant consequences were manipulated. In the second experiment, we also compared the effect of ignorance on moral judgments with that of personal force, a factor previously shown to influence moral judgments. We found broad empirical support for the armchair arguments that epistemic considerations are logically prior to normative considerations. (shrink)

"Deborah McCauley and Laura Porter's text combines descriptions of the pictures with the history of the churches and interviews with members. They create a representative window into the material and oral culture of central Appalachia's independent Holiness heritage. Mountain Holiness is a book that will fascinate anyone who cares about these traditions, as well as anyone concerned with the preservation of America's most vital folkways."--BOOK JACKET.

When developing computational models to analyze the tradeoffs between climate risk management strategies (i.e., mitigation, adaptation, or geoengineering), scientists make explicit and implicit decisions that are influenced by their beliefs, values and preferences. Model descriptions typically include only the explicit decisions and are silent on value judgments that may explain these decisions. Eliciting scientists’ mental models, a systematic approach to determining how they think about climate risk management, can help to gain a clearer understanding of their modeling decisions. In order (...) to identify and represent the role of values, beliefs and preferences on decisions, we used an augmented mental models research approach, namely values-informed mental models (ViMM). We conducted and qualitatively analyzed interviews with eleven climate risk management scientists. Our results suggest that these scientists use a similar decision framework to each other to think about modeling climate risk management tradeoffs, including eight specific decisions ranging from defining the model objectives to evaluating the model’s results. The influence of values on these decisions varied between our scientists and between the specific decisions. For instance, scientists invoked ethical values (e.g., concerns about human welfare) when defining objectives, but epistemic values (e.g., concerns about model consistency) were more influential when evaluating model results. ViMM can (i) enable insights that can inform the design of new computational models and (ii) make value judgments explicit and more inclusive of relevant values. This transparency can help model users to better discern the relevance of model results to their own decision framing and concerns. (shrink)

Jacques Lacan's innovative development of Freudian psychoanalysis entails a differentiation between registers of the "symbolic," "imaginary," and "real," and then an analysis of the way these three registers are held together as three rings of the "Borromean knot." This work is taken a significant step further in his 1975-76 Seminar XXIII, and is sometimes thought to mark the shift to a "later Lacan.,, The seminar shifts its focus from "symptom" (as a coded message to the Other, repetitively sent even unbeknownst (...) to the subject) to the "sinthome" as a device by which the subject configures and is configured by a little circuit of messages. The Borromean knot is now seen as held together in some circumstances by the " sinthome." In this paper I explore what Lacan has to say about language, the Borromean knot, James Joyce, and God, and then turn to explore the place of symptoms, "sinthomes" and psychoanalysis itself in relation to psychiatry and contemporary culture. This paper is in two parts. In the first I review main lines of argument in Seminar XXIII, and then in the second part I embed Lacan's account in the broader cultural processes in which our clinical work must be read in order to be rewritten. (shrink)

The role of power in healthcare can raise many ethical challenges. Power is ownership, whether given, ceded, or taken of another person’s autonomy. When a person has power over someone else, they can control or strongly influence the decision-making freedom of that person. From the principalist perspective1,2 of healthcare ethics, denying a person their freedom to choose, should only occur when justifying conditions related to beneficence and nonmaleficence are sufficiently satisfied. In healthcare, it is rare to be able to identify (...) situations where paternalism is justified. However, experience suggests that abusive power in healthcare is used too frequently without justifying criteria. (shrink)

Failings in patient care and quality in NHS Trusts have become a recurring theme over the past few years. In this paper, we examine the Care Quality Commission’s Guidance about Compliance: Essential Standards of Quality and Safety and ask how NHS Trusts might be better supported in fulfilling the regulations specified therein. We argue that clinical ethics committees (CECs) have a role to play in this regard. We make this argument by attending to the many ethical elements that are highlighted (...) in the Commission’s Regulations and by providing practical examples of how CECs can (and in some case already do) provide ethics support to health professionals and trusts. Although CECs have been traditionally associated with case consultation, i.e., discrete problems caused by individual circumstances, in the previous 10 years the literature suggests that clinical ethics services have become more integrated into the life of the health care organization and are increasing construed as proactive agents of systematic change. We provide evidence from a recent survey of UK clinical ethics services that this trend is present in the UK. (shrink)

: From 1902 onward, Peirce viewed esthetics, ethics, and logic as "normative sciences," interconnected spheres of philosophical inquiry that constitute his main work in value theory. The normative sciences provide the basis for a theoretical investigation of questions of value detached from practical interests. Because the normative sciences maintain Peirce's well-known insistence on realism, they set his pragmaticism apart from the more "nominalistic" pragmatism of James and Dewey. The paper aims to clarify Peirce's idea of the normative sciences, to show (...) how his realism applies in the sphere of value, and to explore his views on the proper relation between theory and practice. The concluding section suggests examples of how we might understand Peirce's rich and innovative concept of normative esthetics.Resumo: De 1902 em diante, Peirce considerava a estética, a ética e a lógica como "ciências normativas", esferas interconexas de inquirição filosófica que constituem seu principal trabalho em teoria do valor. As ciências normativas fornecem a base para uma investigação teorética de questões sobre valor independentes de interesses práticos. Porque as ciências normativas mantém a notória insistência de Peirce no realismo, elas colocam seu pragmaticismo à parte do pragmatismo mais "nominalista" de James e Dewey. O artigo almeja esclarecer a idéia de Peirce das ciências normativas, mostrar como seu realismo se aplica à esfera do valor, e explorar suas visões da própria relação entre ciência e prática. A seção concludente sugere exemplos de como podemos entender o rico e inovador conceito peirciano de estética normativa. (shrink)

Volume XVI Phenomenology of Emotions, Systematical and Historical Perspectives Aim and Scope: The New Yearbook for Phenomenology and Phenomenological Philosophy provides an annual international forum for phenomenological research in the spirit of Husserl's groundbreaking work and the extension of this work by such figures as Scheler, Heidegger, Sartre, Levinas, Merleau-Ponty and Gadamer. Contributors: Esteban Marín Ávila, Thiemo Breyer, Jakub Čapek, Mariano Crespo, Roberta De Monticelli, John J. Drummond, Søren Engelsen, Maria Gyemant, Mirja Hartimo, Elisa Magrì, Ronny Miron, Anthony J. Steinbock, (...) Panos Theodorou, Íngrid Vendrell Ferran, Antonio Zirión Quijano, and Nate Zuckerman. Submissions: Manuscripts, prepared for blind review, should be submitted to the Editors electronically via e-mail attachments. (shrink)

Insight, by F. H. Parker.--Why be uncritical about the life-world? By H. B. Veatch.--Homage to Saint Anselm, by R. Jordan.--Art and philosophy, by J. M. Anderson.--The phenomenon of world, by R. R. Ehman.--The life-world and its historical horizon, by C. O. Schrag.--The Lebenswelt as ground and as Leib in Husserl: somatology, psychology, sociology, by E. Paci.--Life-world and structures, by C. A. van Peursen.--The miser, by E. W. Straus.--Monetary value and personal value, by G. Schrader.--Individualisms, by W. L. McBride.--Sartre the (...) individualist, by W. Desan.--The nature of social man, by M. Natanson.--The problem of the will and philosophical discourse, by P. Ricoeur.--Structuralism and humanism, by M. Dufrenne.--The illusion of monolinear time, by N. Lawrence.--Can grammar be thought? By J. M. Edie.--The existentialist critique of objectivity, by S. J. Todes and H. L. Dreyfus.--Bibliography (p. 391-400). (shrink)

When weighing up which inhaler to prescribe, a doctor may prioritise a patient’s preferences over the expected harms from the associated carbon emissions. Parker argues that this is wrong.1 Doctors have a pro-tanto duty to switch from a high-carbon metered-dose inhaler (MDI) to a low-carbon dry-powdered inhaler (DPI)—even though this provides no direct patient benefit—unless switching would undermine trust or significantly worsen a patient’s health. He goes on to state that even if DPIs are more expensive for the National (...) Health Service (NHS) then this is justified so long as it does not ‘significantly threaten’ the NHS’ ability to protect and promote health. This may appear to be a radical proposal, challenging the ethical principles of autonomy, health entitlements and justly distributed resources. However, we will claim that it is only radical in so far as one perceives (A) patient autonomy and healthcare entitlements as existing within a vacuum, unrelated to other foundational ethics concerns and (B) the health consequences of a given healthcare budget are limited solely to the designated recipients rather than all affected parties. Here, we test the claim that our responsibility for promoting patient autonomy …. (shrink)

Parker carefully argues that from a close reading of Calvin's major writings one must conclude that Calvin conceded less to natural theology than is commonly supposed.--F. E. B.

The central claim of this paper is that American states’ use of so-called “triggering conditions” to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering (...) conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations, and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. (shrink)

The empirical data do not unequivocally support a consistent fixed capacity of four chunks. We propose an alternative account whereby capacity is limited by the precision of specifying the temporal and spatial context in which items appear, that similar psychophysical constraints limit number estimation, and that short term memory (STM) is continuous with long term memory (LTM).

Gary Becker and others have done important work to broaden the content of self interest, but have not departed from seeing rationality in terms of the exclusive pursuit of self-interest. One reason why committed behavior is important is that a person can have good reason to pursue objectives other than self interest maximization (no matter how broadly it is construed). Indeed, one can also follow rules of behavior that go beyond the pursuit of one's own goals, even if the goals (...) include non-self-interested concerns. By living in a society, one develops possible reasons for considering other people's goals as well, which takes one beyond an exclusive concentration on one's own goals, not to mention the single-minded pursuit of one's own self interest. The recognition of other people's goals may be a part of rational thought. If rational behavior may depart from the relentless pursuit of one's own goals, commitment has to be important in a theory of rationality. Furthermore, seeing the role of commitment in human behavior can have explanatory importance in allowing us to understand behavior patterns that are hard to fit into the narrow format of contemporary rational choice theory. Commitment is, thus, important both for practical reason and for causal explanation. Footnotes1 Paper presented at a Workshop on Rationality and Commitment at the University of St. Gallen, May 13–15, 2004. (shrink)