Excessive prescribing of pain medications after surgery has contributed to the epidemic of opioid misuse and diversion in the United States. Pain specialists may be particularly well situated to address these issues. We describe an attempt to reverse the trend at an orthopedic surgical hospital by implementing a peri-operative assessment and treatment service which minimizes preoperative opioid use, when necessary implements addiction treatment, and encourages early tapering from opioids.

The dispute over the exact nature and status of possible worlds in Leibniz’s philosophy has proven difficult to resolve. The standard view, that there is one unique actual world and that possible worlds exist solely as ideas within God’s understanding, sits in tension with important metaphysical and theological components of Leibniz’s system. For example, Leibniz takes possible individuals to have some “essence or reality” in themselves and to strive for existence, which allows him to ground counterfactual claims and to overcome (...) necessitarianism. However, scholars have long seen these claims as being at odds with God’s creation of one unique actual world. Catherine Wilson (2000) challenges the standard view’s claim that possible worlds are substantially different from the actual world, arguing instead that Leibniz’s metaphysical commitments are consistent with there being more than one actual world and that Leibniz has no way to block the claim that God would generate more than one such world. In this paper, I expand on Wilson’s account and argue, contrary to the standard view, that the key theses at the heart of Leibniz’s philosophical system entail modal realism—for Leibniz, there can be no ontological difference between possible and actual worlds. (shrink)

Specialists and primary care physicians play an integral role in treating the twin epidemics of pain and addiction. But inadequate access to specialists causes much of the treatment burden to fall on primary physicians. This article chronicles the differences between treatment contexts for both pain and addiction — in the specialty and primary care contexts — and derives a series of reforms that would empower primary care physicians and better leverage specialists.

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

Brain-computer interfaces (BCIs) have been successfully used by adults, but little information is available on BCI use by children, especially children with severe multiple impairments who may need technology to facilitate communication. Here we discuss the challenges of using non-invasive BCI with children, especially children who do not have another established method of communication with unfamiliar partners. Strategies to manage these challenges require consideration of multiple factors related to accessibility, cognition, and participation. These factors include decisions regarding where (home, clinic, (...) or lab) participation will take place, the number of sessions involved, and the degree of participation necessary for success. A strategic approach to addressing the unique challenges inherent in BCI use by children with disabilities will increase the potential for successful BCI calibration and adoption of BCI as a valuable access method for children with the most significant impairments in movement and communication. (shrink)

Scientists know that human activities, primarily fossil fuel combustion, are causing Earth’s temperature to increase. Yet in 2021, only 60% of the US population understood that human activities are the primary cause of global warming. We experimentally test whether information about the human causes of global warming influences Americans’ beliefs and concerns about global warming and support for climate policies. We find that communicating information about the human-causes of global warming increases public understanding that global warming is human-caused. This information, (...) both alone and with additional information about climate impacts and policy solutions, also increases public concern about global warming and support for climate policies, although the effects on climate concern and policy support are smaller. Importantly, the treatment effects are consistent across political party, with no backlash effects among Republicans. This suggests that when informed about climate change causes, impacts and solutions, most Americans can update their own climate change beliefs, risk perceptions, and policy support. (shrink)

The National Science Foundation's Second Merit Criterion, or Broader Impacts Criterion , was introduced in 1997 as the result of an earlier Congressional movement to enhance the accountability and responsibility as well as the effectiveness of federally funded projects. We demonstrate that a robust understanding and appreciation of NSF BIC argues for a broader conception of research ethics in the sciences than is currently offered in Responsible Conduct of Research training. This essay advocates augmenting RCR education with training regarding broader (...) impacts. We demonstrate that enhancing research ethics training in this way provides a more comprehensive understanding of the ethics relevant to scientific research and prepares scientists to think not only in terms of responsibly conducted science, but also of the role of science in responding to identified social needs and in adhering to principles of social justice. As universities respond to the mandate from America COMPETES to “provide training and oversight in the responsible and ethical conduct of research”, we urge institutions to embrace a more adequate conception of research ethics, what we call the Ethical Dimensions of Scientific Research, that addresses the full range of ethical issues relevant to scientific inquiry, including ethical issues related to the broader impacts of scientific research and practice. (shrink)

We investigate a basic probabilistic dynamic semantics for a fragment containing conditionals, probability operators, modals, and attitude verbs, with the aim of shedding light on the prospects for adding probabilistic structure to models of the conversational common ground.

Normative ethical theories owe us an account of how to evaluate decisions under risk and uncertainty. Deontologists seem at a disadvantage here: our best decision theories seem tailor-made for consequentialism. For example, decision theory enjoins us to always perform our best option; deontology is more permissive. In this paper, we discuss and defend the idea that, when some pro-tanto wrongful act is all-things considered permissible, because it is a ‘lesser evil’, it is often merely permissible, by the lights of deontology. (...) We show that this raises new problems for deontological decision theory, and we show that to resolve them, we need to take a more innovative approach to morally evaluating decision-making under risk and uncertainty. (shrink)

The second issue of Ordo IV of the Amsterdam edition of the Latin texts of Erasmus comprises the Querela Pacis and Erasmus’ Latin translations of some of Plutarch’s Moralia . The Complaint of Peace deals with peace and war, and the tension between love of one’s country and St. Paul’s admonishment to unity in Christianity.

Evolutionary activity statistics and their visualization are introduced, and their motivation is explained. Examples of their use are described, and their strengths and limitations are discussed. References to more extensive or general accounts of these techniques are provided.

Normative ethical theories owe us an account of how to evaluate decisions under risk and uncertainty. Deontologists seem at a disadvantage here: our best decision theories seem tailor-made for consequentialism. For example, decision theory enjoins us to always perform our best option; deontology is more permissive. In this paper, we discuss and defend the idea that, when some pro-tanto wrongful act is all-things considered permissible, because it is a ‘lesser evil’, it is often merely permissible, by the lights of deontology. (...) We show that this raises new problems for deontological decision theory, and we show that to resolve them, we need to take a more innovative approach to morally evaluating decision-making under risk and uncertainty. (shrink)

Epistemic modal operators give rise to something very like, but also very unlike, Moore's paradox. I set out the puzzling phenomena, explain why a standard relational semantics for these operators cannot handle them, and recommend an alternative semantics. A pragmatics appropriate to the semantics is developed and interactions between the semantics, the pragmatics, and the definition of consequence are investigated. The semantics is then extended to probability operators. Some problems and prospects for probabilistic representations of content and context are explored.

This paper defends a counterexample to Modus Tollens, and uses it to draw some conclusions about the logic and semantics of indicative conditionals and probability operators in natural language. Along the way we investigate some of the interactions of these expressions with 'knows', and we call into question the thesis that all knowledge ascriptions have truth-conditions.

When I tell you that it’s raining, I describe a way the world is—viz., rainy. I say something whose truth turns on how things are with the weather in the world. Likewise when I tell you that the weatherman thinks that it’s raining. Here the truth of what I say turns on how things are with the weatherman’s state of mind in the world. Likewise when I tell you that I think that it’s raining. Here the truth of what I (...) say turns on how things are with my state of mind in the world. (shrink)

Fast‐forward two hundred years to the opening sequence of Alien: Resurrection where United Systems Military (USM) science officers aboard the Auriga are toying with her DNA—salvaged from frozen blood samples on Fiorina 161—to try to create a cloned version of the alien queen that was growing inside her at the time of her death. The absurd is what links the two— Ripley's desire to make some sense out of her troubling existence and the fact that the world is unable to (...) offer her any such sense. French essayist, Albert Camus, repeatedly stresses this point in different, sometimes rather poetic, ways throughout his classic essay, “The Myth of Sisyphus”. Ripley‐8 has one messed‐up and confusing life. When Camus talks about philosophical suicide, he is really talking about an irrational “leap of faith”. Ripley and Call are both artificial creations living a similar sort of existence. (shrink)

I develop a conception of expressivism according to which it is chiefly a pragmatic thesis about some fragment of discourse, one imposing certain constraints on semantics. The first half of the paper uses credal expressivism about the language of probability as a stalking-horse for this purpose. The second half turns to the question of how one might frame an analogous form of expressivism about the language of deontic modality. Here I offer a preliminary comparison of two expressivist lines. The first, (...) expectation expressivism, looks again to Bayesian modelling for inspiration: it glosses deontically modal language as characteristically serving to express decision-theoretic expectation (expected utility). The second, plan expressivism, develops the idea (due to Gibbard 2003) that this language serves to express 'plan-laden' states of belief. In the process of comparing the views, I show how to incorporate Gibbard's modelling ideas into a compositional semantics for attitudes and modals, filling a lacuna in the account. I close with the question whether and how plan expressivism might be developed with expectation-like structure. (shrink)

In this paper, we suggest that affect meets the traditional definition of “cognition” such that the affect–cognition distinction is phenomenological, rather than ontological. We review how the affect–cognition distinction is not respected in the human brain, and discuss the neural mechanisms by which affect influences sensory processing. As a result of this sensory modulation, affect performs several basic “cognitive” functions. Affect appears to be necessary for normal conscious experience, language fluency, and memory. Finally, we suggest that understanding the differences between (...) affect and cognition will require systematic study of how the phenomenological distinction characterising the two comes about, and why such a distinction is functional. (shrink)

This is a study in the meaning of natural language probability operators, sentential operators such as probably and likely. We ask what sort of formal structure is required to model the logic and semantics of these operators. Along the way we investigate their deep connections to indicative conditionals and epistemic modals, probe their scalar structure, observe their sensitivity to contex- tually salient contrasts, and explore some of their scopal idiosyncrasies.

Philosophy as criticism of categories, by A. Seth.--The relation of philosophy to science, by R. B. Haldane and J. S. Haldane.--Logic as the science of knowledge, by B. Bosanquet.--The historical method, by W. R. Sorley.--The rationality of history, by D. G. Ritchie.--The philosophy of art, W. P. Ker.--The social organism, by H. Jones.--The struggle for existence, by J. Bonar.--Pessimism and the religious consciousness, by T. B. Kilpatrick.

As Quine observed, the following sentence has a reading which, if true, would be of special interest to the authorities: Ralph believes that someone is a spy. This is the reading where the quantifier is naturally understood as taking wide scope relative to the attitude verb and as binding a variable within the scope of the attitude verb. This essay is interested in addressing the question what the semantic analysis of this kind of reading should look like from a Fregean (...) perspective—a perspective according to which attitude states are generally relations to structured Fregean thoughts composed of senses. The Fregean view faces a challenge of compositionality here. This essay describes the challenge and offers a response on the Fregean's behalf. (shrink)

Man's place in the cosmos.--The present position of the philosophical sciences.--The "new" psychology and automatism.--A new theory of the absolute.--Mr. Balfour and his critics.