Unlike critically ill neonates, care of children with complex cardiac disease increasingly involves use of invasive technologies—such as ventricular assist devices (VAD)—or emergent surgical proced...

In the pediatric heart-failure population, severity of illness often forces therapeutic decisions to be made under time-pressure, such that mechanical circulatory support (MCS) can be offered as a...

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)

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.

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)

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)

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)

This book sorts out the confusion created by the use of the term "postmodern" in relation to widely divergent theological positions. Four different types of postmodern theology are distinguished in the preface: constructive, deconstructive, liberationist, and conservative. Two forms of each type are discussed in the book. Writing from a constructive, postmodern perspective, the authors enter into dialogue with the deconstructive postmodernism of Mark C. Taylor and Jean-François Lyotard, with the liberationist postmodernism of Harvey Cox and Cornel West, and with (...) the conservative postmodernism of George William Rutler and John Paul II. (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)

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.

Which systems/organisms are conscious? New tests for consciousness (‘C-tests’) are urgently needed. There is persisting uncertainty about when consciousness arises in human development, when it is lost due to neurological disorders and brain injury, and how it is distributed in nonhuman species. This need is amplified by recent and rapid developments in artificial intelligence (AI), neural organoids, and xenobot technology. Although a number of C-tests have been proposed in recent years, most are of limited use, and currently we have no (...) C-tests for many of the populations for which they are most critical. Here, we identify challenges facing any attempt to develop C-tests, propose a multidimensional classification of such tests, and identify strategies that might be used to validate them. (shrink)

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)

A major approach to the ethics of artificial intelligence is to use social choice, in which the AI is designed to act according to the aggregate views of society. This is found in the AI ethics of “coherent extrapolated volition” and “bottom–up ethics”. This paper shows that the normative basis of AI social choice ethics is weak due to the fact that there is no one single aggregate ethical view of society. Instead, the design of social choice AI faces three (...) sets of decisions: standing, concerning whose ethics views are included; measurement, concerning how their views are identified; and aggregation, concerning how individual views are combined to a single view that will guide AI behavior. These decisions must be made up front in the initial AI design—designers cannot “let the AI figure it out”. Each set of decisions poses difficult ethical dilemmas with major consequences for AI behavior, with some decision options yielding pathological or even catastrophic results. Furthermore, non-social choice ethics face similar issues, such as whether to count future generations or the AI itself. These issues can be more important than the question of whether or not to use social choice ethics. Attention should focus on these issues, not on social choice. (shrink)

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 House We Live In explores the commonalities underlying three classical approaches to virtue ethics-Aristotelean, Buddhist, and Confucian-to develop a flourishing-based ethics capable of addressing the problems of liberal democracies. This book will appeal to scholars and to general readers.

What is known? And how do we come to know it? These are the primary points of focus for metaphysics and epistemology, respectively. Here, in one of the classic works of early-modern empiricist philosophy, John Locke (1632-1704) attempts to answer these basic human questions by moving away from the rationalist notion of innate ideas to establish the concept of the tabula rasa in which the mind is initially impressed with ideas through perception of the external world of substance. The formation (...) of basic ideas through the perception of primary and secondary qualities, and the more sophisticated development of concepts, is discussed as Locke departs from a purely mental view of knowledge to ground what we know in the firmer soil of empirical observation and in the mind's ability to interrelate ideas from perception. The careful reasoning of Locke's Essay has made it an enduring part of the history of of Western philosophy. (shrink)

Artificial intelligence experts are currently divided into “presentist” and “futurist” factions that call for attention to near-term and long-term AI, respectively. This paper argues that the presentist–futurist dispute is not the best focus of attention. Instead, the paper proposes a reconciliation between the two factions based on a mutual interest in AI. The paper further proposes realignment to two new factions: an “intellectualist” faction that seeks to develop AI for intellectual reasons and a “societalist faction” that seeks to develop AI (...) for the benefit of society. The paper argues in favor of societalism and offers three means of concurrently addressing societal impacts from near-term and long-term AI: advancing societalist social norms, thereby increasing the portion of AI researchers who seek to benefit society; technical research on how to make any AI more beneficial to society; and policy to improve the societal benefits of all AI. In practice, it will often be advantageous to emphasize near-term AI due to the greater interest in near-term AI among AI and policy communities alike. However, presentist and futurist societalists alike can benefit from each others’ advocacy for attention to the societal impacts of AI. The reconciliation between the presentist and futurist factions can improve both near-term and long-term societal impacts of AI. (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.