Taking care of a hyperactive child at school gives 2 meanings to the word ‘care’: worrying about a vulnerable person and health care with the recognition of his behaviour disorder, the unruly pupil becomes a disabled pupil. But how does an undisciplined pupil become a psychiatric case? How do you recognise a hyperactive child at school, that is, from a medical point of view, a child with ADD/ADHD (Attention Deficient Disorder with or without Hyperactivity)? Teachers contribute to the medical diagnosis (...) by filling in behavioural tests. Then, in order to be taken care of, the child will need to have his hyperactivity recognised as a disability. To help the teacher, the doctor will give them advice on how to teach the child. Nevertheless, this desirable partnership raises difficulties. Between a paramedical support teacher and an educationalist doctor isn’t there a risk of witnessing a dilution of roles? The lifting of doctor-patient confidentiality called for by some teachers is emblematic of this confusion. Canguilhem’s distinction between normal and pathological will guide our reflection on the medical care of the hyperactive child at school. This case arouses an ethical issue about the medicalisation of our society. (shrink)

In this article, I consider the harms inflicted upon transgender persons through “misgendering,” that is, such deployments of gender terms that diminish transgender persons' self-respect, limit the discursive resources at their disposal to define their own gender, and cause them microaggressive psychological harms. Such deployments are morally contestable, that is, they can be challenged on ethical or political grounds. Two characterizations of “woman” proposed in the feminist literature are critiqued from this perspective. When we consider what would happen to transgender (...) women upon the broad implementation of these characterizations within transgender women's social context, we discover that they suffer from two defects: they either exclude at least some transgender women, or else they implicitly foster hierarchies among women, marginalizing transgender women in particular. In conclusion, I claim that the moral contestability of gender-term deployments acts as a stimulus to regularly consider the provisionality and revisability of our deployments of the term “woman.”. (shrink)

In a series of important papers, Justin D’Arms and Daniel Jacobson argue that all extant neo-sentimentalists are guilty of a conflation error that they call the moralistic fallacy. One commits the moralistic fallacy when one infers from the fact that it would be morally wrong to experience an affective attitude—e.g., it would be wrong to be amused—that the attitude does not fit its object—e.g., that it is not funny. Such inferences, they argue, conflate the appropriateness conditions of attitudinal responses with (...) the fittingness conditions of the associated evaluative properties. Further, they argue that moral considerations are irrelevant for determining if amusement fits its object. We agree that a strong moralizing of humor is wrongheaded and that jokes can be quite funny even in cases where we have a compelling moral reason to not be amused. However, we argue that pace D’Arms and Jacobson moral considerations can be relevant for property ascription. On our view, in order for a joke to be funny, a properly sensitive agent must take herself to have a contributory reason to be amused, and in some cases that she lacks such a reason is best explained by appeal to moral considerations. We use this constraint as the basis of what we call our modest proposal for a modest sentimentalism. (shrink)

There has long been interest in identifying and studying ‘‘successful psychopaths.” This study sampled psychologists with an interest in law, attorneys, and clinical psychology professors to obtain descriptions of individuals considered to be psychopaths who were also successful in their endeavors. The results showed a consistent description across professions and convergence with descriptions of traditional psychopathy, though the successful psychopathy profile had higher scores on conscientiousness, as measured within the five-factor model (FFM). These results are useful in documenting the existence (...) of successful psychopathy, demonstrating the potential benefit of informant methodology, and providing an FFM description that distinguishes successful psychopaths from unsuccessful psychopaths studied more routinely within prison settings. (shrink)

BackgroundSocial support plays an important role for health outcomes. Support for those living with chronic conditions may be particularly important for their health, and even for their survival. The role of support for the survival of cancer patients after receiving an allogeneic hematopoietic cell transplant is understudied. To better understand the link between survival and support, as well as different sources and functions of support, we conducted two studies in alloHCT patients. First, we examined whether social support is related to (...) survival. Second, we examined who provides which support and which specific support-related functions and tasks are fulfilled by lay caregivers and healthcare professionals.MethodsIn Study 1, we conducted a retrospective chart review of alloHCT patients and registered availability of a dedicated lay caregiver and survival. In Study 2, we prospectively followed patients after alloHCT from the same hospital, partly overlapping from Study 1, who shared their experiences of support from lay caregivers and healthcare providers in semi-structured in-depth interviews 3 to 6 months after their first hospital discharge.ResultsPatients with a dedicated caregiver had a higher probability of surviving to 100 days than patients without a caregiver, OR = 2.84, p = 0.042. Study 2 demonstrated the importance of post-transplant support due to patients’ emotional needs and complex self-care regimen. The role of lay caregivers extended to many areas of patients’ daily lives, including support for attending doctor’s appointments, managing medications and financial tasks, physical distancing, and maintaining strict dietary requirements. Healthcare providers mainly fulfilled medical needs and provided informational support, while lay caregivers were the main source of emotional and practical support.ConclusionThe findings highlight the importance of studying support from lay caregivers as well as healthcare providers, to better understand how they work together to support patients’ adherence to recommended self-care and survival. (shrink)

In a recent contribution to this journal, Arjaliès (J Bus Ethics 92:57—78, 2010) suggests that the emergence of socially responsible investment (SRI) in France can be best described as a social movement with a collective identity that aimed to challenge the dominant logic of the financial market. Such an account is at odds with a body of empirical studies that approaches SRI in the French context as a process of market creation led by loosely coordinated actors with contradictory and conflicting (...) interests and values, who have mainly complied with—rather than opposed—the existing dominant financial logic of the asset-management field. In this comment, we build on this prior research to contest Arjaliès' perspective on both theoretical and empirical grounds, with the aim of highlighting the shortcomings of conflating social movements and other forms of collective actions in understanding the building of new markets in organization theory and SRI studies. We contend that in mistaking for social movement forms of collective actions that underpin the emergence of markets, scholars of organization theory may confuse distinct mechanisms in their explanation of SRI emergence across countries, overlook the complex dynamics and interactions of markets and social movements, and, most importantly, fail to evaluate the real political significance of SRI as an empirical phenomenon. We propose that future research on SRI distinguishes carefully "social-movement research as a theoretical framework" from "social movement as an empirical phenomenon" in order to avoid such drawbacks while benefiting from recent advances in social-movement research. (shrink)

Why do some global health initiatives receive priority from international and national political leaders while others receive minimal attention? We propose a framework for analyzing this question consisting of four categories of factors: the strength of the actors involved in the initiative, the power of the ideas they use to frame the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself.We apply this framework to the case of a global initiative to reduce (...) maternal mortality, launched in 1987. Using a process-tracing methodology commonly employed in qualitative research, we conducted archival research and interviewed actors involved in the initiative. We find that despite two decades of effort the initiative remains in an early phase of development, hampered by difficulties in all these categories. However, the initiative's twentieth anniversary year, 2007, presents opportunities to build political momentum. To generate political priority advocates will need to address several challenges, including the creation of effective institutions to guide the initiative and the development of a public positioning of the issue that convinces political leaders to act.We draw on the framework and case study to suggest areas for future research on the determinants of political priority for global health initiatives, a subject that has attracted much speculation but little scholarship. (shrink)

Sometimes referred to as "the last taboo," money has remained something of a secret within psychoanalysis. Ironically, while it is an ingredient in almost every encounter between analyst and patient, the analyst's personal feelings about money are rarely discussed openly or in any great depth. So what is it about money that relegates it to the background, both on the couch and off? In _Money Talks_, Brenda Berger, Stephanie Newman, and their excellent cast of contributors address this and other questions (...) surrounding the tender topic of money, how we talk about it, and how it talks to us. Its multiple meanings are explored in the contexts of patients and analysts and the ways in which they relate, in the training and practice of the analysts themselves, as well as the psychological and cultural consequences of having too much or too little in both flush and tight economic times. Throughout, a clinical sensibility is brought to bear on money's softly spoken place in therapy and life. _Money Talks_ paves the way for an open discourse into the psychology of money and its pervasive influence on the psyche of both patient and analyst. (shrink)

ZusammenfassungDieser Beitrag ist Teil des Forums COVID-19: Perspektiven in den Geistes- und Sozialwissenschaften. Mit Blick auf die sozialwissenschaftliche Katastrophenforschung des Kalten Krieges als Herkunftsort und als historisches Vergleichsmoment beschäftigt sich der Artikel mit der bisherigen sozialwissenschaftlichen Auseinandersetzung mit der COVID-19-Krise. Er behandelt erstens, wie die Rolle von sozialer Ungleichheit erörtert wird, zweitens die Idee der Katastrophe als „große Enthüllerin“ und drittens das Verhältnis von Katastrophenwissenschaft, Öffentlichkeit und Politik.

Couples therapy has long been regarded as one of the most demanding forms of psychotherapy because of the way it challenges therapists to combine the insights of dynamic psychology with the power and clarity of systems dynamics. In this exciting new volume, Gordon Wheeler and Stephanie Backman, couples therapists with broad training and long years of experience, present dramatic new approaches that at last integrate the dynamic/self-organizational and the systemic/behavioral schools of thought. Building on the insights of Gestalt psychology and (...) psychotherapy, the authors show us how a truly phenomenological approach, based on the clients' own experience and goals, holds the key to a dramatic increase in therapeutic power and flexibility. The fifteen engaging chapters demonstrate the application of this approach to issues of intimacy, self-construction, power and abuse, "resistance," growth, and shame - and to such diverse and challenging populations as abuse survivors and their partners, remarried couples, gay and lesbian couples, and couples with "personality" or "character" disorders. In the process, the authors offer a fresh perspective that will serve to re-energize the couples therapist's work in this challenging area. _On Intimate Ground_ contributes new insights to many of the most timely and provocative questions in the field today. (shrink)

Lara Buchak argues that her version of rank-weighted utilitarianism can accommodate an implication of the separateness of persons known as “the shift,” since it requires individuals to be more willing to accept risk for themselves than to accept inequality in society. I argue that this is mistaken. Buchak’s model fails to yield the shift when the decision-maker is distinct from the affected individual, as well as in certain social decisions where the risk attitude of the group is known. These findings (...) suggest that models which derive social choice rules from individual decision rules will generally fail to uphold separateness. (shrink)

This exploratory research aims to identify the accommodation and support measures, the challenges and the needs, for students with disabilities in teaching internship context. By answering an online questionnaire, 158 SH trainees in teaching in Belgium and Quebec, affirm, for the most part, that their situation of disability has repercussions on their internships. Their main challenges and needs are related to organization and written communication. However, few accommodation and support measures have been established during the internship.

Game-theoretic rationality is not generally observed in human behavior. One important reason is that subjects do not perceive the tasks in the same way as the experimenters do. Moreover, the rich history of cooperation that participants bring into the laboratory affects the decisions they make.

Theory in Africa, Africa in Theory explores the place of Africa in archaeological theory, and the place of theory in African archaeology. The centrality of African models in reconstructions is explored, focusing on materiality and agency in the past. The differences between how African models are used in western theoretical discourse and the use of that theory within Africa are also highlighted, as a means to explore the nature of theory itself. Thus, this dual purposed volume is a timely intervention (...) into archaeological theory, deconstructing the taken-for-granted foundations of the ways we approach the past. (shrink)

De Marco et al 1 argue that the standard account of medical ‘invasiveness’ (as ‘incision’ or ‘insertion’) fails to capture three aspects of its existing use, namely that invasiveness can come in degrees, often depends on features of alternative medical interventions and can be non-physical. They propose a new schematic account that suggests that medical interventions can possess ‘basic invasiveness’ (which can come in degrees and of which they suggest at least two types: physical and mental), and ‘threshold invasiveness’ which (...) can depend on the alternatives a specific intervention is being compared with. While we agree that the standard account of invasiveness fails to capture existing use and are supportive of their aim, here we express scepticism about the practical utility of De Marco et al ’s revised account. Our scepticism concerns the application of De Marco et al’s revised account in the narrow context of clinician–patient communication and deliberation about medical interventions within clinical practice, which we see as a crucial context for its use. While De Marco et al do not specify the contexts in which their revised account could be used, we assume from their discussion of treatment interventions (e.g. non-invasive prenatal testing, ventilation) and their comparison to ‘more or less invasive’ options, that at least one of the purposes in mind for …. (shrink)

ZusammenfassungDieser Beitrag ist Teil des Forums COVID-19: Perspektiven in den Geistes- und Sozialwissenschaften. Mit Blick auf die sozialwissenschaftliche Katastrophenforschung des Kalten Krieges als Herkunftsort und als historisches Vergleichsmoment beschäftigt sich der Artikel mit der bisherigen sozialwissenschaftlichen Auseinandersetzung mit der COVID-19-Krise. Er behandelt erstens, wie die Rolle von sozialer Ungleichheit erörtert wird, zweitens die Idee der Katastrophe als „große Enthüllerin“ und drittens das Verhältnis von Katastrophenwissenschaft, Öffentlichkeit und Politik.This paper is part of Forum COVID-19: Perspectives in the Humanities and Social Sciences.The (...) article connects and juxtaposes current day discussions on the social effects of the COVID-crisis with the history of social science disaster research during the Cold War. It elaborates on statements regarding the role of social inequalities in disaster, the idea of the “revealing” nature of disaster and crisis, and the relationship between disaster science, public and politics. (shrink)

Developments in neuroscience have raised the possibility that pharmaceuticals may be used to enhance memory, mood, and attention in people who do not have an illness or disorder, a practice known as “cognitive enhancement.” We describe historical experiences with two medicinal drugs for which similar enhancement claims were made, cocaine in the late 19th and early 20th centuries, and amphetamines in the mid 20th century. These drugs were initially introduced as medicinal agents in Europe and North America before becoming more (...) widely used for a variety of purposes, including what would nowadays be considered cognitive enhancement. Their trajectory of use conformed to the typical use cycle of psychotropic drugs. There was an initial steep rise in prescribing for medical use, followed by expanded nonmedical use that was fueled by enthusiasm for the drugs’ effects. As the number of regular users increased, problems related to use (such as addiction) became apparent, societal concern increased, and laws were passed banning nonmedical use and eventually, medical use. This historical experience draws attention to the adverse side effects of enhancement use that only become apparent with regular, wide-scale use of a drug. We highlight the similarities between the enthusiasms for cocaine and amphetamines and the current enthusiasms for using prescription stimulants for cognitive enhancement. We argue bioethicists should not encourage the cognitive enhancement use of drugs such as methylphenidate in the absence of evidence on the efficacy and safety of their use for cognitive enhancement purposes. (shrink)

Compared to evidence-based public health, evidence-based medicine is a more familiar phrase. Evidence-based medicine has become increasingly popular in the past decade, due in large part to the emergence of computerized database search technology and advanced statistical tools which allow researchers to quickly identify and summarize vast amounts of scientific information.Today, the concept of evidence-based public health is gaining momentum and has grown in popularity. However, the term “evidence-based” lacks clarification and is subject to a variety of interpretations. The evidence (...) that supports evidence-based medicine or public health may include individual experience, anecdotal information, the content of a single scientific article, or the results of a sophisticated systematic review of scientific literature. The imprecise language used to describe evidence leads to confusion over what types of evidence are most appropriate in answering different types of questions. (shrink)

There is disagreement in the literature about the exact nature of the phenomenon of empathy. There are emotional, cognitive, and conditioning views, applying in varying degrees across species. An adequate description of the ultimate and proximate mechanism can integrate these views. Proximately, the perception of an object's state activates the subject's corresponding representations, which in turn activate somatic and autonomic responses. This mechanism supports basic behaviors that are crucial for the reproductive success of animals living in groups. The Perception-Action Model, (...) together with an understanding of how representations change with experience, can explain the major empirical effects in the literature. It can also predict a variety of empathy disorders. The interaction between the PAM and prefrontal functioning can also explain different levels of empathy across species and age groups. This view can advance our evolutionary understanding of empathy beyond inclusive fitness and reciprocal altruism and can explain different levels of empathy across individuals, species, stages of development, and situations. Key Words: altruism; cognitive empathy ; comparative; emotion; emotional contagion; empathy ; evolution; human; perception-action; perspective taking. (shrink)

Ideomotor theory of human action control proposes that activation of a motor representation can occur either through internally-intended or externally-perceived actions. Critically, sometimes these alternatives of eliciting a motor response may be conflicting, for example, when intending one action and perceiving another, necessitating the recruitment of enhanced action-control to avoid motor mimicry. Based on previous neuroimaging evidence, suggesting that reduced mimicry is associated with self-related processing, we aimed to experimentally enhance these action-control mechanisms during motor contagion by inducing self-focus. In (...) two within-subjects experiments, participants had to enforce their action intention against an external motor contagion tendency under heightened and normal self-focus. During high self-focus participants showed reduced motor mimicry, induced either by mirror self-observation or self-referential judgments. This indicates that a self-focus provoking situation can enhance online action-control mechanisms, needed to resist unintentional motor contagion tendencies and thereby enables a modulation of automatic mirroring responses. (shrink)

Peut-on prédire si un projet sera jugé socialement acceptable par ses principales parties prenantes? Dans un contexte où l’acceptabilité sociale en est venue à être considérée comme une condition à la réalisation de tout grand projet, cette question s’avère centrale pour tout développeur de projet, de même que pour les investisseurs qui les soutiennent. C’est dans cette perspective qu’a été développé l’Indice du risque social dans les projets miniers, une initiative soutenue par l’Autorité des marchés financiers à laquelle a travaillé (...) une équipe interdisciplinaire de chercheurs. Au-delà de jeter un éclairage sur la pertinence d’aller de l’avant ou non avec un projet, cet outil prédictif peut surtout permettre de moduler ledit projet, de concert avec ses parties prenantes, pour le rendre davantage acceptable à leurs yeux. Nous souhaitons ici rendre compte des possibilités offertes par cet indice en l’appliquant à deux projets miniers récemment discutés au Québec, soit le projet de mine aurifère développé par Osisko dans la municipalité de Malartic, en Abitibi-Témiscamingue, et celui de Mine Arnaud, à Sept-Îles, qui vise cette fois l’exploitation de l’apatite. Cet exercice nous permet de réaffirmer la pertinence de l’outil que constitue l’Indice, mais également de relever les limites qui lui sont inhérentes. (shrink)

Compared to evidence-based public health, evidence-based medicine is a more familiar phrase. Evidence-based medicine has become increasingly popular in the past decade, due in large part to the emergence of computerized database search technology and advanced statistical tools which allow researchers to quickly identify and summarize vast amounts of scientific information.Today, the concept of evidence-based public health is gaining momentum and has grown in popularity. However, the term “evidence-based” lacks clarification and is subject to a variety of interpretations. The evidence (...) that supports evidence-based medicine or public health may include individual experience, anecdotal information, the content of a single scientific article, or the results of a sophisticated systematic review of scientific literature. The imprecise language used to describe evidence leads to confusion over what types of evidence are most appropriate in answering different types of questions. (shrink)

Unconsented pelvic exams under anesthesia are assaults cloaked in defense of healthcare education. Preemptive linguistic qualifiers “presumed” or “implied” attempt to justify such violations with flippancy toward their oxymoronic implications: to suggest a priori that consent can be assumed undermines its otherwise standalone social, ethical, and medico-legal reverence. In this paper I conceptualize “medical sexual assault” and argue that presumed consent for intimate exams exemplifies its definition. By bluntly describing pelvic exams as “penetration,” this work aims to reify the intimate (...) reality of the clinical label “pelvic exam” and to call attention to cisheteronormative and androcentric assumptions involved in its practice. Additionally, this scholarship seeks to create a foundation toward broader work in conceptualizing clinical rape culture. Given recent national survey data indicating a surprising frequency of unconsented intimate exams, detailed language as to their problematics is necessary for ongoing legal and ethical efforts. Explicit consent for intimate exams must be the standard of care for conscious and unconscious patients. (shrink)

Stars are conspicuously absent from reflections on natural kinds and scientific classifications, with gold, tiger, jade, and water getting all the philosophical attention. This is too bad for, as this paper will demonstrate, interesting philosophical lessons can be drawn from stellar taxonomy as regards two central, on-going debates about natural kinds, to wit, the monism/pluralism debate and the realism/antirealism debate. I’ll show in particular that stellar kinds will not please the essentialist monist, nor for that matter will it please the (...) pluralist embracing promiscuous realism à la Dupré. (shrink)

With the growth of precision medicine research on health data and biospecimens, research institutions will need to build and maintain long-term, trusting relationships with patient-participants. While trust is important for all research relationships, the longitudinal nature of precision medicine research raises particular challenges for facilitating trust when the specifics of future studies are unknown. Based on focus groups with racially and ethnically diverse patients, we describe several factors that influence patient trust and potential institutional approaches to building trustworthiness. Drawing on (...) these findings, we suggest several considerations for research institutions seeking to cultivate long-term, trusting relationships with patients: Address the role of history and experience on trust, engage concerns about potential group harm, address cultural values and communication barriers, and integrate patient values and expectations into oversight and governance structures. (shrink)

Much research on cognitive development focuses either on early-emerging domain-specific knowledge or domain-general learning mechanisms. However, little research examines how these sources of knowledge interact. Previous research suggests that young infants can make inferences from samples to populations (Xu & Garcia, 2008) and 11- to 12.5-month-old infants can integrate psychological and physical knowledge in probabilistic reasoning (Teglas, Girotto, Gonzalez, & Bonatti, 2007; Xu & Denison, 2009). Here, we ask whether infants can integrate a physical constraint of immobility into a statistical (...) inference mechanism. Results from three experiments suggest that, first, infants were able to use domain-specific knowledge to override statistical information, reasoning that sometimes a physical constraint is more informative than probabilistic information. Second, we provide the first evidence that infants are capable of applying domain-specific knowledge in probabilistic reasoning by using a physical constraint to exclude one set of objects while computing probabilities over the remaining sets. (shrink)

Moral duties are regularly attributed to groups. Does this make conceptual sense or is this merely political rhetoric? And what are the implications for these individuals within groups? Collins outlines a Tripartite Model of group duties that can target political demands at the right entities, in the right way and for the right reasons.

Many meta-ethicists are alethists: they claim that practical considerations can constitute normative reasons for action, but not for belief. But the alethist owes us an account of the relevant difference between action and belief, which thereby explains this normative difference. Here, I argue that two salient strategies for discharging this burden fail. According to the first strategy, the relevant difference between action and belief is that truth is the constitutive standard of correctness for belief, but not for action, while according (...) to the second strategy, it is that practical considerations can constitute motivating reasons for action, but not for belief. But the former claim only shifts the alethist's explanatory burden, and the latter claim is wrong—we can believe for practical reasons. Until the alethist can offer a better account, then, I argue that we should accept that there are practical reasons for belief. (shrink)

Plausibly, only moral agents can bear action-demanding duties. This places constraints on which groups can bear action-demanding duties: only groups with sufficient structure—call them ‘collectives’—have the necessary agency. Moreover, if duties imply ability then moral agents (of both the individual and collectives varieties) can bear duties only over actions they are able to perform. It is thus doubtful that individual agents can bear duties to perform actions that only a collective could perform. This appears to leave us at a loss (...) when assigning duties in circumstances where only a collective could perform some morally desirable action and no collective exists. But, I argue, we are not at a loss. This article outlines a new way of assigning duties over collective acts when there is no collective. Specifically, we should assign collectivisation duties to individuals. These are individual duties to take steps towards forming a collective, which then incurs a duty over the action. I give criteria for when individuals have collectivisation duties and discuss the demands these duties place on their bearers. (shrink)

Popper: I do admit that at any moment we are prisoners caught in the framework of our theories; our expectations; our past experiences; our language. But we are prisoners in a Pickwickian sense: if we try, we can break out of our framework at any time. Admittedly, we shall find ourselves again in a framework, but it will be a better and roomier one; and we can at any moment break out of it again.Kuhn: If that possibility were routinely available, (...) there ought to be no very special difficulties about stepping into someone else's framework in order to evaluate it. My critics' attempts to step into mine suggest, however, that changes of framework, of theory, of language, or of paradigm pose deeper problems of both .. (shrink)

A good account of normative reasons should explain not only what makes practical and epistemic reasons a unified kind of thing, but also why practical and epistemic reasons are substantively differ...

A surfeit of research confirms that people activate personal, affective, and conceptual representations when perceiving the states of others. However, researchers continue to debate the role of self–other overlap in empathy due to a failure to dissociate neural overlap, subjective resonance, and personal distress. A perception–action view posits that neural-level overlap is necessary during early processing for all social understanding, but need not be conscious or aversive. This neural overlap can subsequently produce a variety of states depending on the context (...) and degree of common experience and emotionality. We outline a framework for understanding the interrelationship between neural and subjective overlap, and among empathic states, through a dynamic-systems view of how information is processed in the brain and body. (shrink)

This chapter argues that the best way for a non-naturalist to explain why the normative supervenes on the natural is to claim that, while there are some sui generis normative properties whose essences cannot be fully specified in non-normative terms and do not specify any non-normative sufficient conditions for their instantiation, there are certain hybrid normative properties whose essences specify both naturalistic sufficient conditions for their own instantiation and sufficient conditions for the instantiation of certain sui generis normative properties. This (...) is the only metaphysical explanation for supervenience on offer, the chapter argues, that can both clearly maintain the pre-theoretical commitments of non-naturalism, and provide a metaphysical explanation not just for supervenience, but for all metaphysical necessities involving natural and normative properties. (shrink)

Digital phenotyping will potentially enable earlier detection and prediction of mental illness by monitoring human interaction with and through digital devices. Notwithstanding its promises, it is certain that a person’s digital phenotype will at times be at odds with their first-person testimony of their psychological states. In this paper, we argue that there are features of digital phenotyping in the context of psychiatry which have the potential to exacerbate the tendency to dismiss patients’ testimony and treatment preferences, which can be (...) instances of epistemic injustice. We first explain what epistemic injustice is, and why it is argued to be an extensive problem in health and disability settings. We then explain why epistemic injustice is more likely to apply with even greater force in psychiatric contexts, and especially where digital phenotyping may be involved. Finally, we offer some tentative suggestions of how epistemic injustice can be minimised in digital psychiatry. (shrink)

Growing interest in embedded research approaches—where research is incorporated into clinical care—has spurred numerous studies to generate knowledge relevant to the real-world needs of patients and other stakeholders. However, it also has presented ethical challenges. An emerging challenge is how to understand the nature and extent of investigators’ obligations to patient-subjects. Prior scholarship on investigator duties has generally been grounded upon the premise that research and clinical care are distinct activities, bearing distinct duties. Yet this premise—and its corresponding implications—are challenged (...) when research and clinical care are deliberately integrated. After presenting three case studies from recent pragmatic clinical trials, we identify six differences between explanatory trials and embedded research that limit the application of existing scholarship for ascertaining investigator duties. We suggest that these limitations indicate a need to account for the implications of usual care and to move beyond a narrow focus on the investigator-subject dyad, one that better reflects the team- and institution-based nature of contemporary health systems. (shrink)

Noninvasive, prenatal whole genome sequencing may be a technological reality in the near future, making available a vast array of genetic information early in pregnancy at no risk to the fetus or mother. Many worry that the timing, safety, and ease of the test will lead to informational overload and reproductive consumerism. The prevailing response among commentators has been to restrict conditions eligible for testing based on medical severity, which imposes disputed value judgments and devalues those living with eligible conditions. (...) To avoid these difficulties, we propose an unrestricted testing policy, under which prospective parents could obtain information on any variant of known significance after a careful informed consent process that uses an interactive decision aid to deliver a mandatory presentation on the purposes, techniques, and limitations of genomic testing, as well as optional resources for reflection and consultation. This process would encourage thoughtful, informed deliberation... (shrink)

A memoir of one womanÆs struggle against breast cancer reveals how she channeled her energy to transform her life, even as she was dying.

In a recent and provocative essay, Christopher Bartel attempts to resolve the gamer’s dilemma. The dilemma, formulated by Morgan Luck, goes as follows: there is no principled distinction between virtual murder and virtual pedophilia. So, we’ll have to give up either our intuition that virtual murder is morally permissible—seemingly leaving us over-moralizing our gameplay—or our intuition that acts of virtual pedophilia are morally troubling—seemingly leaving us under-moralizing our game play. Bartel’s attempted resolution relies on establishing the following three theses: (1) (...) virtual pedophilia is child pornography, (2) the consumption of child pornography is morally wrong, and (3) virtual murder is not murder. Relying on Michael Rea’s definition of pornography, I argue that we should reject thesis one, but since Bartel’s moral argument in thesis two does not actually rely thesis one that his resolution is not thereby undermined. Still, even if we grant that there are adequate resources internal to Bartel’s account to technically resolve the gamer’s dilemma his reasoning is still unsatisfying. This is so because Bartel follows Neil Levy in arguing that virtual pedophilia is wrong because it harms women. While I grant Levy’s account, I argue that this is the wrong kind of reason to resolve the gamer’s dilemma because it is indirect. What we want is to know what is wrong with virtual child pornography itself. Finally, I suggest alternate moral resources for resolving the gamer’s dilemma that are direct in a way that Bartel’s resources are not. (shrink)