Implementation of guidelines regarding breaches of electronic health information requires an anticipatory stance and physician and patient education regarding security and monitoring measures and methods of redress. Adopting a preventive ethics, rather than a crisis management, model may also increase physician awareness of how the information they choose to include and privilege within the health record may expose patients to added harms if not done mindfully.

Disparities in access to, and utilization of, treatment for depression among African-American and Caucasian elderly adults have been well-documented. Less fully explored are the multidimensional factors responsible for these disparities. The intersection of cultural constructs, socioeconomic factors, multiple levels of racism, and stigma attending both mental health issues and older age may help to explain disparities in the treatment of the depressed elderly. Personalized medicine with its promise of developing interventions tailored to an individual's health needs and genetically related response (...) to treatment might seem a promising antidote to the documented underutilization of standard depression treatments by African Americans. However, this paper examines the multidimensional factors associated with disparities in effective treatment of depression among African-American and Caucasian elderly adults and argues the scientific and ethical importance of pursuing various paths to address multiple levels and sources of stigma and mistrust if pharmacogenomics is to help, rather than exacerbate, disparities in depression treatment. Seven recommendations are offered to increase the likelihood that developments in pharmacogenomics will reduce disparities in depression treatment. (shrink)

Personalized medicine with its promise of developing interventions tailored to an individual's health need and genetically related response to treatment might seem a promising antidote to the documented underutilization of standard depression treatments by African Americans. In addition, understanding depression not merely in biochemical terms but also in genetic terms might seem to counter cultural beliefs and stigma that attach to depression when conceived as a mood or behavioral problem under an individual's control. After all, if there is one thing (...) for which a person is not responsible and cannot be blamed, it is her genes. Nevertheless, for multiple reasons, a personalized medical approach to depression treatment, and its attendant conceptualization of depression and treatment response as genetically influenced, present the risk of exacerbating well-documented disparities in access to, and utilization of, treatment for depression among African-American and Caucasian elderly adults. (shrink)

Recent magnetic resonance imaging and pathological studies have indicated that axonal loss is a major contributor to disease progression in multiple sclerosis. 1 H magnetic resonance spectroscopy, through measurement of N -acetyl aspartate, a neuronal marker, provides a unique tool to investigate this. Patients with primary progressive multiple sclerosis have few lesions on conventional MRI, suggesting that changes in normal appearing white matter, such as axonal loss, may be particularly relevant to disease progression in this group. To test this hypothesis (...) NAWM was studied with MRS, measuring the concentration of N -acetyl derived groups. Single-voxel MRS using a water-suppressed PRESS sequence was carried out in 24 patients with primary progressive multiple sclerosis and in 16 age-matched controls. Ratios of metabolite to creatine concentration were calculated in all subjects, and absolute concentrations were measured in 18 patients and all controls. NA/Cr was significantly lower in NAWM in patients than in controls, as was the absolute concentration of NA. There was no significant difference in the absolute concentration of creatine between the groups. This study supports the hypothesis that axonal loss occurs in NAWM in primary progressive multiple sclerosis and may well be a mechanism for disease progression in this group. (shrink)

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A probability distribution is regular if it does not assign probability zero to any possible event. While some hold that probabilities should always be regular, three counter-arguments have been posed based on examples where, if regularity holds, then perfectly similar events must have different probabilities. Howson and Benci et al. have raised technical objections to these symmetry arguments, but we see here that their objections fail. Howson says that Williamson’s “isomorphic” events are not in fact isomorphic, but Howson is speaking (...) of set-theoretic representations of events in a probability model. While those sets are not isomorphic, Williamson’s physical events are, in the relevant sense. Benci et al. claim that all three arguments rest on a conflation of different models, but they do not. They are founded on the premise that similar events should have the same probability in the same model, or in one case, on the assumption that a single rotation-invariant distribution is possible. Having failed to refute the symmetry arguments on such technical grounds, one could deny their implicit premises, which is a heavy cost, or adopt varying degrees of instrumentalism or pluralism about regularity, but that would not serve the project of accurately modelling chances. (shrink)

Recent work has defended “Euclidean” theories of set size, in which Cantor’s Principle (two sets have equally many elements if and only if there is a one-to-one correspondence between them) is abandoned in favor of the Part-Whole Principle (if A is a proper subset of B then A is smaller than B). It has also been suggested that Gödel’s argument for the unique correctness of Cantor’s Principle is inadequate. Here we see from simple examples, not that Euclidean theories of set (...) size are wrong, but that they must be either very weak and narrow or largely arbitrary and misleading. (shrink)

To what extent should we focus on implicit bias in order to eradicate persistent social injustice? Structural prioritizers argue that we should focus less on individual minds than on unjust social structures, while equal prioritizers think that both are equally important. This article introduces the framework of transactive memory into the debate to defend the equal priority view. The transactive memory framework helps us see how structure can emerge from individual interactions as an irreducibly social product. If this is right, (...) then debiasing interventions are structural interventions. One upshot is that the utility of the individual versus structural distinction is not apparent for the purposes of intervention. (shrink)

We explore the idea that a group or ‘team’ of individuals can be an agent in its own right and that, when this is the case, individual team members use team reasoning, a distinctive mode of reasoning from that of standard decision theory. Our approach is to represent team reasoning explicitly, by means of schemata of practical reasoning in which conclusions about what actions should be taken are inferred from premises about the decision environment and about what agents are seeking (...) to achieve. We use this theoretical framework to compare team reasoning with the individual reasoning of standard decision theory, and to compare various theories of team agency and collective intentionality. (shrink)

Schopenhauer’s pessimistic philosophy is a depressing read. He writes many pages about how suffering is the norm, and any happiness we feel is merely a temporary alleviation of suffering. Even so, his account of suffering rings true to many readers. What are we to do with our lives if Schopenhauer is right, and we are doomed to suffer? In this paper, I use William James’ pragmatic method to find practical implications of Schopenhauer’s pessimism. I provide a model for how we (...) are to live our lives in a suffering world, a model that provides means to reduce suffering. (shrink)

The first study, along with edition and translation, of Chrysostomus Javelli’s epitome of the _Liber de bona fortuna_ (1531), a work permitting insight into the early modern understanding of fortune, fate, and free will.

David Lewis is widely credited with the first formulation of common knowledge and the first rigorous analysis of convention. However, common knowledge and convention entered mainstream game theory only when they were formulated, later and independently, by other theorists. As a result, some of the most distinctive and valuable features of Lewis' game theory have been overlooked. We re-examine this theory by reconstructing key parts in a more formal way, extending it, and showing how it differs from more recent game (...) theory. In contrast to current theories of common knowledge, Lewis' theory is based on an explicit analysis of the modes of reasoning that are accessible to rational individuals and so can be used to analyse the genesis of common knowledge. Lewis' analysis of convention emphasises the role of inductive reasoning and of salience in the maintenance of conventions over time. Footnotes Earlier versions of this paper were presented at the 13th Amsterdam Colloquium at the University of Amsterdam, at a workshop on social norms at Wissenschaftskolleg zu Berlin, and at seminars at Tilburg University and the University of Bristol. We are grateful for comments from participants at those meetings, from two anonymous referees, and from Michael Bacharach, Nick Bardsley, Cristina Bicchieri, Luc Bovens, Simon Grant, David McCarthy, Shepley Orr, Brian Skyrms, Peter Vanderschraaf, Peter Wakker and Jörgen Weibull. Robert Sugden's work was supported by the Leverhulme Trust. (shrink)

Feminist Political Theory provides both a wide-ranging history of western feminist thought and a lucid analysis of contemporary debates. It offers an accessible and thought-provoking account of complex theories, which it relates to 'real-life' issues such as sexual violence, political representation and the family. This timely new edition has been thoroughly updated to incorporate the most recent developments in feminism and feminist scholarship throughout, in particular taking into account the impact of black and postmodern feminist thought on feminist political theory.

The puzzle of petitionary prayer: if we ask for the best thing, God was already going to do it, and if we ask for something that's not the best, God's not going to grant our request. In this paper, we give a new solution to the puzzle.

Newton published his deduction of universal gravity in Principia (first ed., 1687). To establish the universality (the particle-to-particle nature) of gravity, Newton must establish the additivity of mass. I call ‘additivity’ the property a body's quantity of matter has just in case, if gravitational force is proportional to that quantity, the force can be taken to be the sum of forces proportional to each particle's quantity of matter. Newton's argument for additivity is obscure. I analyze and assess manuscript versions of (...) Newton's initial argument within his initial deduction, dating from early 1685. Newton's strategy depends on distinguishing two quantities of matter, which I call ‘active’ and ‘passive’, by how they are measured. These measurement procedures frame conditions on the additivity of each quantity so measured. While Newton has direct evidence for the additivity of passive quantity of matter, he does not for that of the active quantity. Instead, he tries to infer the latter from the former via conceptual analyses of the third law of motion grounded largely on analogies to magnetic attractions. The conditions needed to establish passive additivity frustrate Newton's attempted inference to active additivity. (shrink)

Ethics and Organizations provides a rich and valuable overview of an increasingly important issue for management and organizations in contemporary society. Debates about equal opportunities, environmental responsibility, consumer redress, and corporate governance have given ethics a prominent place in the study of organizations in their social and natural environments. Within the organization, new management styles that seek to energize employees by manipulating their beliefs have highlighted the moral-ethical principles at issue in contemporary management. At the same time, debates around postmodernism (...) and relativism have moved ethics to a new centrality in contemporary social theory. This volume addresses the questions that these and other developments raise for the study of management and organizations, from a multidisciplinary perspective. Ethics and Organizations will be invaluable to advanced-level students and academics engaged in analyzing the moral, political, and ethical dimensions of organization theory and organizational practice. (shrink)

EDITORS' INTRODUCTION Perhaps the single most broadly unifying feature of the early new archaeology was the demand that archaeologists not take the aims and ...

This book develops a comprehensive framework for ethics in the helping professions based on bioethicist Bernard Gert's theory of common morality. The prevailing model of ethics education is built upon adherence to codes of ethics applied largely through the use of decision-making trees. While a firm understanding of a professions code of ethics and all relevant laws is essential to responsible practice, this approach to teaching ethics excludes the opportunity for students to acquire a holistic, and grounded understanding of moral (...) action. The framework proposed in this text moves beyond codes of ethics, and allows students to develop a cohesive sense of ethical reasoning that both validates their moral intuition and challenges moral assumptions. The theory of a common morality uses a systematic, step-by-step approach that readers and practitioners can apply to all questions of moral action and behaviour. While there is no such thing as a single right answer to any ethical question, by following this approach practitioners can confidently eliminate the bad decisions, allowing them to feel more secure in their decision and practice. (shrink)

This primer on authentic education explores how mind and heart can work together in the learning process. Moving beyond the bankruptcy of our current model of education, Parker Palmer finds the soul of education through a lifelong cultivation of the wisdom each of us possesses and can share to benefit others.

Epistemic burdens – the nature and extent of our ignorance (that and how) with respect to various courses of action – serve to determine our incentive structures. Courses of action that seem to bear impossibly heavy epistemic burdens are typically not counted as options in an actor’s menu, while courses of action that seem to bear comparatively heavy epistemic burdens are systematically discounted in an actor’s menu relative to options that appear less epistemically burdensome. That ignorance serves to determine what (...) counts as an option means that epistemic considerations are logically prior to moral, prudential, and economic considerations: in order to have moral, prudential, or economic obligations, one must have options, and epistemic burdens serve to determine our options. One cannot have obligations without doing some epistemic work. We defend this claim on introspective grounds. We also consider how epistemic burdens distort surrogate decision-making. The unique epistemology of surrogate cases makes the priority of the epistemic readily apparent. We then argue that anyone who accepts a principle similar to ought implies can is committed to the logical priority of the epistemic. We also consider and reject several possible counterarguments. -/- . (shrink)

We present a new class of models of players’ reasoning in non-cooperative games, inspired by David Lewis's account of common knowledge. We argue that the models in this class formalize common knowledge of rationality in a way that is distinctive, in virtue of modelling steps of reasoning; and attractive, in virtue of being able to represent coherently common knowledge of any consistent standard of individual decision-theoretic rationality. We contrast our approach with that of Robert Aumann, arguing that the former avoids (...) and diagnoses certain paradoxes to which the latter may give rise when extended in particular ways. (shrink)

This book offers a fresh framework for the historical understanding of revolutions and ideas about revolution.

Burnout among health professionals is at epidemic proportions. In response, many health institutions have emphasised the importance of self-care, relying particularly on the idea that doctors who are burned out provide worse care for their patients. Although not made explicit, this suggests that doctors might have a responsibility to their patients (and perhaps others) to practice self-care. This chapter explores the potential grounds for such an obligation. We suggest that while there is potential for a limited obligation of self-care, institutional (...) emphasis on this risks instrumentalising doctors' well-being, minimising institutional responsibilities and workers' rights, and being excessively demanding for individuals. (shrink)

This book takes the discursive and postmodern turn in psychotherapy a significant step forward and will be of interest to all those working in mental health who want to work wiht clients in ways that will facilitate challenges to oppression and processes of emancipation. It achieves this by: · reflecting on the role of psychotherapy in contemporary culture · developing critiques of language in psychotherapy that unravel its claims to personal truth · the reworking of a place in the transforative (...) therapeutic practice Deconstruction is brought to bear on the key conceptual and pragmatic issues that therapists and clinical psychologists face, and the project of therapy is opened up to critical attention and reconstruction. The book provides clear reviews of different viewpoints and will help readers to orient themselves on the complex terrain of debates. (shrink)

The practice of medicine frequently involves the unconsented restriction of liberty. The reasons for unilateral liberty restrictions are typically that being confined, strapped down, or sedated are necessary to prevent the person from harming themselves or others. In this paper, we target the ethics of chemical restraints, which are medications that are used to intentionally restrict the mental states associated with the unwanted behaviors, and are typically not specifically indicated for the condition for which the patient is being treated. Specifically, (...) we aim to identify the conditions under which chemical restraints are ethically permissible. It is wrong to assume that what is morally true of physical restraints is also true of chemical restraints. Our aim is thus to identify the conditions under which chemical restraints are permissible while distinguishing these conditions from those of the application of physical restraints. (shrink)

Transcranial direct current stimulation (tDCS) is a brain stimulation technique known for its relative safety and minimal invasiveness. tDCS has demonstrated efficacy as a potential treatment for certain neurological disorders, such as Parkinson’s disease, and has been shown to enhance a range of cognitive abilities under certain contexts. As a result, this technique has captured the interest of both the research community and the public at large. However, efforts to gather information about the effects of tDCS on the brain are (...) still in their infancy, leading to concerns about informed consent as it pertains to the possible risks associated with tDCS treatment. The ability to purchase tDCS equipment in the form of commercial, direct-to-consumer devices, generates even more cause for ethical concern, given the unknowns surrounding this technology and its potential broader societal impact. Previous research has touched on the many ethical issues raised by the emergence of this technology, including under what circumstances its use is justifiable and appropriate. In this paper, we survey recent normative and empirical works pertaining to the ethics of tDCS with the goal of summarizing the current state of ethical debate surrounding its use in the contexts of both therapy and cognitive enhancement, with a particular emphasis on the latter. Our analysis of the collected research finds that issues pertaining to user safety are paramount within existing scholarship; that tDCS use in children is an emerging area of concern entailing special considerations; and that regulatory bodies and legal agencies have struggled to implement appropriate, impactful regulation pertaining to tDCS and related technologies in order to balance public welfare against individual autonomy. This analysis will facilitate future efforts to develop bioethical approaches to tDCS by highlighting the ethical dimensions of tDCS prioritized in existing literature and identifying areas where further ethical consideration is needed. (shrink)

An experiment is reported which tests for positive confirmation bias in a setting in which individuals choose what information to buy, prior to making a decision. The design – an adaptation of Wason's selection task – reveals the use that subjects make of information after buying it. Strong evidence of positive confirmation bias, in both information acquisition and information use, is found; and this bias is found to be robust to experience. It is suggested that the bias results from a (...) pattern of reasoning which, although producing sub-optimal decisions, is internally coherent and which is self-reinforcing. (shrink)

Realizing the benefits of translating psychiatric genomics research into mental health care is not straightforward. The translation process gives rise to ethical challenges that are distinctive from challenges posed within psychiatric genomics research itself, or that form part of the delivery of clinical psychiatric genetics services. This article outlines and considers three distinct ethical concerns posed by the process of translating genomic research into frontline psychiatric practice and policy making. First, the genetic essentialism that is commonly associated with the genomics (...) revolution in health care might inadvertently exacerbate stigma towards people with mental disorders. Secondly, the promises of genomic medicine advance a narrative of individual empowerment. This narrative could promote a fatalism towards patients' biology in ways that function in practice to undermine patients' agency and autonomy, or, alternatively, a heightened sense of subjective genetic responsibility could become embedded within mental health services that leads to psychosocial therapeutic approaches and the clinician-patient therapeutic alliance being undermined. Finally, adopting a genomics-focused approach to public mental health risks shifting attention away from the complex causal relationships between inequitable socio-economic, political, and cultural structures and negative mental health outcomes. The article concludes by outlining a number of potential pathways for future ethics research that emphasizes the importance of examining appropriate translation mechanisms, the complementarity between genetic and psychosocial models of mental disorder, the implications of genomic information for the clinician-patient relationship, and funding priorities and resource allocation decision making in mental health. (shrink)

Some theorists argue that moral bioenhancement ought to be compulsory. I take this argument one step further, arguing that if moral bioenhancement ought to be compulsory, then its administration ought to be covert rather than overt. This is to say that it is morally preferable for compulsory moral bioenhancement to be administered without the recipients knowing that they are receiving the enhancement. My argument for this is that if moral bioenhancement ought to be compulsory, then its administration is a matter (...) of public health, and for this reason should be governed by public health ethics. I argue that the covert administration of a compulsory moral bioenhancement program better conforms to public health ethics than does an overt compulsory program. In particular, a covert compulsory program promotes values such as liberty, utility, equality, and autonomy better than an overt program does. Thus, a covert compulsory moral bioenhancement program is morally preferable to an overt moral bioenhancement program. (shrink)

As the science and technology of the brain and mind develop, so do the ways in which brains and minds may be surveilled and manipulated. Some cognitive libertarians worry that these developments undermine cognitive liberty, or “freedom of thought.” I argue that protecting an individual’s cognitive liberty undermines others’ ability to use their own cognitive liberty. Given that the threatening devices and processes are not relevantly different from ordinary and frequent intrusions upon one’s brain and mind, strong protections of cognitive (...) liberty may proscribe neurotechnological intrusions, but also ordinary intrusions. Thus, the cognitive libertarian position “hog-ties” others’ use of their own liberties. This problem for the cognitive libertarian is the same problem that ordinary libertarianism faces in protecting individual rights to property and person. But the libertarian strategies for resolving the problem don’t work for the cognitive libertarian. I conclude that the right to mental privacy is weaker than what cognitive libertarians want it to be. (shrink)

John Broome has developed an account of rationality and reasoning which gives philosophical foundations for choice theory and the psychology of rational agents. We formalize his account into a model that differs from ordinary choice-theoretic models through focusing on psychology and the reasoning process. Within that model, we ask Broome’s central question of whether reasoning can make us more rational: whether it allows us to acquire transitive preferences, consistent beliefs, non-akratic intentions, and so on. We identify three structural types of (...) rationality requirements: consistency requirements, completeness requirements, and closedness requirements. Many standard rationality requirements fall under this typology. Based on three theorems, we argue that reasoning is successful in achieving closedness requirements, but not in achieving consistency or completeness requirements. We assess how far our negative results reveal gaps in Broome's theory, or deficiencies in choice theory and behavioral economics. (shrink)

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

Despite the lack of evidence for their effectiveness, the use of physical restraints for patients is widespread. The best ethical justification for restraining patients is that it prevents them from harming themselves. We argue that even if the empirical evidence supported their effectiveness in achieving this aim, their use would nevertheless be unethical, so long as well known exceptions to informed consent fail to apply. Specifically, we argue that ethically justifiable restraint use demands certain necessary and sufficient conditions. These conditions (...) are that the physician obtain informed consent for their application, that their application be medically appropriate, and that restraints be the least liberty-restricting way of achieving the intended benefit. It is a further question whether their application is ever medically appropriate, given the dearth of evidence for their effectiveness. (shrink)

Julian Savulescu argues for two principles of reproductive ethics: reproductive autonomy and procreative beneficence, where the principle of procreative beneficence is conceptualised in terms of a duty to have the child, of the possible children that could be had, who will have the best opportunity of the best life. Were it to be accepted, this principle would have significant implications for the ethics of reproductive choice and, in particular, for the use of prenatal testing and other reproductive technologies for the (...) avoidance of disability, and for enhancement. In this paper, it is argued that this principle should be rejected, and it is concluded that while potential parents do have important obligations in relation to the foreseeable lives of their future children, these obligations are not best captured in terms of a duty to have the child with the best opportunity of the best life. (shrink)

Social problems such as racism, sexism, and inequality are often cited as structural rather than individual in nature. What does it mean to invoke a social structural explanation, and how do such explanations relate to individualistic ones? This article explores recent philosophical debates concerning the nature and usages of social structural explanation. I distinguish between two central kinds of social structural explanation: those that are autonomous from psychology, and those that are not. This distinction will help clarify the explanatory power (...) that each type of SSE has, points of convergence with methodological traditions such as critical theory and rational choice theory, and the difficulties that each type of SSE faces. (shrink)