A policy of “preventive detention” has recently been debated in the British Parliament. Alarmed by the high-profile criminal activities of people suspected of having dangerous severe personality disorder , the government have made clear their intention to “indeterminately but reviewably detain” people with DSPD, after diagnosis by forensic psychiatrists, even if the individuals are yet to commit an offence. Such a policy may improve the safety of the public, but has obvious implications for civil liberties. This essay criticises the morality (...) of the government's intention and rejects the notion that the medical profession could ethically collude with such a policy. (shrink)

“Informed consent” is a legal instrument that allows individuals to define their own interests and to protect their bodily privacy. In current medical practice, patients who have consented to surgery are considered to have implied consent to anaesthesia, even though anaesthesia is associated with its own particular set of risks and consequences that are quite separate from those associated with surgery. In addition, anaesthetists often perform interventions that are the only medical treatment received by a patient. Anaesthetists, therefore, should always (...) obtain separate consent for anaesthesia, and should regard the process of consent as a stimulus for active, fluid reciprocal discussion with patients about treatment options. (shrink)

This study provides a comparison of thinking style and ethical decision-making patterns between 386 U.S. students and 506 students from the People’s Republic of China enrolled in undergraduate business education in their respective countries. Contrary to our expectations, the Chinese students demonstrated a significantly greater linear thinking style compared to American students. As hypothesized, both Chinese and U.S. students possessing a balanced linear and nonlinear thinking style profile demonstrated greater ethical intent across a series of ethics vignettes. Chinese students also (...) were more likely to adopt an act utilitarian rationale, an ethical philosophy that in practice may violate government regulations or social rules to benefit one’s family instead of society for explaining their decisions across the vignettes. We conclude with a discussion of important theoretical as well as practical and potential future implications based on this comparative study. (shrink)

We examine the ethical, social, and regulatory barriers that may hinder research on therapeutic potential of certain controversial controlled substances like marijuana, heroin, or ketamine. Hazards for individuals and society and potential adverse effects on communities may be good reasons for limiting access and justify careful monitoring of these substances. Overly strict regulations, fear of legal consequences, stigma associated with abuse and populations using illicit drugs, and lack of funding may, however, limit research on their considerable therapeutic potential. We review (...) the surprisingly sparse literature and address the particular ethical concerns pertinent to research with illicit and addictive substances, such as undue inducement, informed consent, therapeutic misconception, and risk to participants, researchers, and institutions. We consider the perspectives of key research stakeholders and explore whether they may be infected with bias. We conclude by proposing an empirical research agenda to provide an evidentiary basis for ethical reasoning. (shrink)

The spectacular development of medical knowledge over the last two centuries has brought intrusive advances in the capabilities of medical technology. These advances have been remarkable over the last century, but especially over the last few decades, culminating in such high technology interventions as heart transplants and renal dialysis. These increases in medical powers have attracted societal interest in acquiring more such knowledge. They have also spawned concerns regarding the use of human subjects in research and regarding the byproducts of (...) basic research as in the recent recombinant DNA debate. As a consequence of the development of new biomedical knowledge, physicians and biomedical scientists have been placed in positions of new power and responsibility. The emergence of this group of powerful and knowledgeable experts has occasioned debates regarding the accountability of physicians and biomedical scientists. But beyond that, the very investment of resources in the acquisition of new knowledge has been questioned. Societies must decide whether finite resources would not be better invested at this juncture, or in general, in the alleviation of the problems of hunger or in raising general health standards through interventions which are less dependent on the intensive use of high technology. To put issues in this fashion touches on philosophical notions concerning the claims of distributive justice and the ownership of biomedical knowledge. (shrink)

The nonvisual self-touch rubber hand paradigm elicits the compelling illusion that one is touching one’s own hand even though the two hands are not in contact. In four experiments, we investigated spatial limits of distance and alignment on the nonvisual self-touch illusion and the well-known visual rubber hand illusion. Common procedures and common assessment methods were used. Subjective experience of the illusion was assessed by agreement ratings for statements on a questionnaire and time of illusion onset. The nonvisual self-touch illusion (...) was diminished though never abolished by distance and alignment manipulations, whereas the visual rubber hand illusion was more robust against these manipulations. We assessed proprioceptive drift, and implications of a double dissociation between subjective experience of the illusion and proprioceptive drift are discussed. (shrink)

Black-white, male-female — these and other markers, applied maliciously or not, enable the social dominance of one group.

This commentary analyses the quantitative parameters of Reichle et al.'s model, using estimates when explicit information is not provided. The analysis highlights certain features that appear to be necessary to make the model work and ends by noting a possible problem concerning the variability associated with oculomotor programming.

Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...) coding framework to identify normative statements by clinicians regarding what considerations should guide surrogates’ decisions, including whether clinicians explained one or more of Buchanan and Brock’s three standard principles of SDM to family members. Results Clinicians made at least one statement about how to perform the surrogate role in 24 conferences ). We observed three general types of normative guidance provided to surrogates, with some conferences containing more than one type of guidance: counselling about one or more standard principles of SDM ; counselling surrogates to make decisions centred on the patient as a person, without specifying how to accomplish that ; and counselling surrogates to make decisions based on the family’s values. Conclusions Clinicians did not provide normative guidance about the surrogate role in two-thirds of family conferences for incapacitated patients at high risk for death. When they did, clinicians’ guidance was often incomplete and sometimes conflicted with standard principles of SDM. Future work is needed to understand whether providing explicit guidance on how to perform the surrogate role improves decision-making or mitigates surrogates’ psychological distress. (shrink)

I shared Raanan Gillon’s1 surprise at Robert Veatch’s criticism of the white coat ceremonies,2 and I think that the points raised by Veatch were quite adequately countered by Gillon’s response. The provocative points raised by Veatch do stimulate some valuable critical thinking about the process, although I think Veatch was carried away a bit by hyperbole. To label the drama of the ceremony as “ominous” goes a bit far by any criterion.I should like to describe an oath taking initiation (...) ceremony in use at the Ben Gurion University Faculty of Health Sciences for almost three decades, its history, features, current practice, and conclusions. I believe that Veatch’s specific objections are addressed by our process and merit consideration by other institutions as well.When the medical school was founded in 1974 the then dean , Professor Moshe Prywes, met with the just entering class several weeks before the onset of the academic year during a summer preliminary orientation period . Professor Prywes, an imaginative, charismatic innovator with a flair for public relations and the dramatic, suggested to the entering class that they take the physician’s oath during the first weeks of the academic year, coinciding with their first exposure to patients . He explained that he wanted the students to regard themselves as already bearing responsibilities and duties, and not just rights. He saw them as “change agents” working to upgrade the medical care and the health of the patients and community, right from the first days of their schooling.I had just arrived in Israel as a new immigrant to assume the foundation professorship of medicine, coming from …. (shrink)

The concept of free will is fraught with controversy, as readers of this volume likely know. Philosophers disagree about what free will is, whether we have it, what mitigates or destroys it, and what it's good for. Indeed, philosophers even disagree about how to fix the referent of the term 'free will' for purposes of describing and exploring these disagreements. What one person considers a reasonably neutral working definition of 'free will' is often considered question-begging or otherwise misguided by another. (...) Such disputes make it difficult to summarize the problem of free will, roughly the debate over the nature and existence of free will, in a clear and uncontentious way. In generic terms, however, the two basic solutions to the problem of free will are free-willism, the view that we have free will, and free-will denialism, i.e. the view that we do not have free will. As stated here, neither denialism nor free-willism constitutes a complete solution to the problem of free will; to be complete, a proposed solution must also tell us a convincing story about what free will is and that, as it turns out, is a very difficult task indeed. One historically popular way of approaching the problem of free will is to ask about the relationship between free will and determinism: "Does free will stand in relation R to determinism: yes or no?" This is just a template for a question, of course. To transform this template-question into a substantive question with a clear meaning, we need to flesh out the template's free-will relatum, its determinism relatum, and give a precise value to relation R. There is, however, no uncontroversial way to do this. In addition to the standard difficulties raised by fixing the referent of 'free will', philosophers hold radically different views about what is-or should be-meant by 'determinism', Shabo ), and they identify relations which are as substantively different as correlation and causation when characterizing relation R. In practical terms, then, it may be best to think of the problem of determinism as a loose collection of disagreements about how to best spell out and answer the template-question, and how asking and answering such questions would help us to solve the problem of free will. (shrink)

In On the Origin of Species, Charles Darwin put forward his theory of natural selection. Conventionally, Darwin's argument for this theory has been understood as based on an analogy with artificial selection. But there has been no consensus on how, exactly, this analogical argument is supposed to work – and some suspicion too that analogical arguments on the whole are embarrassingly weak. Drawing on new insights into the history of analogical argumentation from the ancient Greeks onward, as well as on (...) in-depth studies of Darwin's public and private writings, this book offers an original perspective on Darwin's argument, restoring to view the intellectual traditions which Darwin took for granted in arguing as he did. From this perspective come new appreciations not only of Darwin's argument but of the metaphors based on it, the range of wider traditions the argument touched upon, and its legacies for science after the Origin. (shrink)

The sudden emergence of the COVID-19 pandemic brought global disruption to every aspect of society including healthcare, supply chain, the economy, and social interaction. Among the many emergent considerations were the safety and public health of the public, patients, essential workers, and healthcare professionals. In certain locations, clinical research was halted—or terminated—in deference to the immediate needs of patient care, and clinical trials focusing on the treatment and prevention of coronavirus infection were prioritized over studies focusing on other diseases. Difficult (...) decisions were made rapidly; flexibility and reconsideration were necessary not only because the intensity and severity of infection varied over time and by locale but also because knowledge of the disease and understanding of its treatment grew. Here we discuss the ethical challenges in decision-making and competing ethical tensions during the pandemic in an effort to advance future preparedness. (shrink)

Few figures of the Middle Ages command the attention of so many modern disciplines as Robert Grosseteste (c. 1170-1253). Theology, Philosophy, History, and Science are all areas which his life and thought continue to have significance and to inspire re-interpretation. Accompanied by a series of original commentaries, this new edition of Grosseteste's work, with English translation, draws together the perspectives of modern scientists and medieval specialists. Volume I of a six volume series, Knowing and Speaking presents two of the earliest (...) of Grosseteste's works, the treatises On the Liberal Arts and On the Generation of Sounds. These are accompanied by a significant Middle English treatise on the Seven Liberal Arts whose anonymous fifteenth-century author translated and excerpted passages from Grosseteste's treatises in a re-imagining of their structure and function.0Each work is treated separately within the volume, which is constructed in three parts. On the Liberal Arts sets Grosseteste's thoughts on the arts subjects and emphasises moral concerns about the purpose of learning. On the Generation of Sounds builds on the theories and statements of On the Liberal Arts in connection to the production of sound, elaborating the earlier position, relating the generation of sounds to human vocal and speech production. (shrink)

The success of deep brain stimulation (DBS) for movement disorders and the improved understanding of the neurobiologic and neuroanatomic bases of psychiatric diseases have led to proposals to expand current DBS applications. Recent preclinical and clinical work with Alzheimer's disease and obsessive-compulsive disorder, for example, supports the safety of stimulating regions in the hypothalamus and nucleus accumbens in humans. These regions are known to be involved in addiction and overeating associated with obesity. However, the use of DBS targeting these areas (...) as a treatment modality raises common ethical considerations, which include informed consent, coercion, enhancement, threat to personhood, and manipulation of the reward center. Pilot studies for both of these conditions are currently investigational. If these studies show promise, then there is a need to address the ethical concerns related to the initiation of clinical trials including the reliability of preclinical evidence, patient selection, study design, compensation for participation and injury, cost-effectiveness, and the need for long-term follow-up. Multidisciplinary teams are necessary for the ethical execution of such studies. In addition to establishing safety and efficacy, the consideration of these ethical issues is vital to the adoption of DBS as a treatment for these conditions. We offer suggestions about the pursuit of future clinical trials of DBS for the treatment of addiction and overeating associated with obesity and provide a framework for addressing ethical concerns related to treatment. (shrink)

The rubber hand paradigm is used to create the illusion of self-touch, by having the participant administer stimulation to a prosthetic hand while the Examiner, with an identical stimulus , administers stimulation to the participant’s hand. With synchronous stimulation, participants experience the compelling illusion that they are touching their own hand. In the current study, the robustness of this illusion was assessed using incongruent stimuli. The participant used the index finger of the right hand to administer stimulation to a prosthetic (...) hand while the Examiner used a paintbrush to administer stimulation to the participant’s left hand. The results indicate that this violation of tactile expectations does not diminish the illusion of self-touch. Participants experienced the illusion despite the use of incongruent stimuli, both when vision was precluded and when visual feedback provided clear evidence of the tactile mismatch. (shrink)

The aim of this chapter is to address the role of memory in past-life convictions. Although it is commonly accepted in the modern media - and popular western culture more generally - that people believe they have lived before because the memory contains detailed verifiable facts, little is known about how people actually reason about the veracity of their previous existence. To our knowledge, the current project is the most extensive research that probes the role of memory in past life (...) convictions. More specifically, we explore two questions. First, to what extent does memory lead to past-life belief, and is this conviction based on external validation or via the episodic sense of personal identity contained in the memory? Second, what is the conception of self on which one's current self is taken to be the same as the past-life self? -/- In what follows, we propose that memory plays an important role in convincing people that they have lived before. Fundamentally, this memory is episodic insofar as it represents the event as happened to the encoder. This memory contrasts with semantic memory - memory of facts...Further, we contend that it is the episodic sense of personal identity (rather than external validation) that typically contributes to the belief in a past life. Finally, we argue that the conception of self implicated in past-life belief is the non-trait conception. Of course, this fits naturally with the idea that the belief in a past life issues partly from the episodic sense of identity, since it is the non-trait conception of self that is implicated in the episodic sense of identity... -/- Our proposal in this chapter can be construed as a psychological extension of Reid's point in the context of past-life belief. People assume that they are the same person as someone in earlier times, despite large variations in the traits between those individuals, and they think this partly because of the testimony of their episodic memory. If our account is correct, then it makes the belief in a past life less bizarre, at least psychologically. For we are suggesting that the episodic sense of personal identity that led to your conviction that you existed at the time of your sixteenth birthday celebrations some decades ago, is also involved in other people's convictions that they existed 200 years ago. This proposal is also situated in recent cognitive approaches to the study of religion and religious experiences, which suggests that extraordinary convictions are often underpinned by the ordinary processes of social cognition (e.g. see Barrett 2000; Barrett 2007; Boyer 2001; Lawson and McCauley 1990; for reincarnation, see White Forthcoming-a,-b). (shrink)

A simple experimental paradigm creates the powerful illusion that one is touching one’s own hand even when the two hands are separated by 15 cm. The participant uses her right hand to administer stimulation to a prosthetic hand while the Examiner provides identical stimulation to the participant’s receptive left hand. Change in felt position of the receptive hand toward the prosthetic hand has previously led to the interpretation that the participant experiences self-touch at the location of the prosthetic hand, and (...) experiences a sense of ownership of the prosthetic hand. Our results argue against this interpretation. We assessed change in felt position of the participant’s receptive hand but we also assessed change in felt position of the participant’s administering hand. Change in felt position of the administering hand was significantly greater than change in felt position of the receptive hand. Implications for theories of ownership are discussed. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

This article analyzes U.S. court cases involving reproductive technologies in terms of their implications for reproductive choice, mothers' versus fathers' rights, definitions and evaluations of parenting, and the nuclear family structure. The analysis reveals that the courts have tended not to recognize how social conditions shape women's reproductive choices, to promote fathers' rights more than mothers' rights, to ignore the social relationships that constitute childbearing and child rearing and value men's over women's biological contribution to these processes, to reflect certain (...) assumptions about the proper roles of mothers and fathers, and to privilege the nuclear family. The implications of developing reproductive technology policy for an understanding of the relationships among gender, reproductive technologies, and the state are considered, and recommendations for the equitable regulation of these technologies are offered. (shrink)

As part of a review symposium on DARWIN'S ARGUMENT BY ANALOGY: FROM ARTIFICIAL TO NATURAL SELECTION (2021), the journal METASCIENCE invited Roger White, Jon Hodge and me to submit a response to the thoughtful commentaries on our book by Andrea Sullivan-Clarke, David Depew and Andrew Inkpen.