Conceptual clarity is essential when engaging in dialogue to avoid unnecessary disagreement and to promote mutual understanding. In this issue devoted to clinical bioethics, the authors exemplify the virtue of careful conceptual analysis as they explore complex clinical questions regarding the essential nature of medicine, the boundaries of killing and letting die, the meaning of irreversibility in definitions of death, the argument for a right to try experimental medications, the ethical borders in complex medical billing, and the (...) definition and modeling of complex disease states. (shrink)

Knauff and Gazzo Castañeda (2022) criticise the use of the term “new paradigm” in the psychology of reasoning and raise important issues about how to advance research in the field. In this commentary I argue that for the latter it would be helpful to clarify further the concepts that reasoning theories rely on, and to strengthen the links between the theories and the empirical observations that would and would not be compatible with them.

Rebecca Brown and Julian Savulescu1 focus on individuals’ responsibility regarding health-related behaviours. They rightly argue that paying attention to diachronic and dyadic aspects of responsibility can further illuminate the highly multifaceted concept of personal responsibility for health. Their point of departure is a pragmatic one. They note that personal responsibility ‘is highly intuitive, [that] responsibility practices are a commonplace feature of almost all areas of human life and interpersonal relationship [and that] the pervasiveness of this concept [suggest] the improbability of (...) banishing it entirely’. Indeed, despite—or perhaps even quite independent of—decades of mostly sceptical conceptual analysis of the concept of personal responsibility by philosophers and others, it endures, if not flourishes. These separate dynamics raise the question of how, in years ahead, the debate on responsibility can be furthered most effectively, and how nuanced conceptual distinctions can effectively inform policy and practice. The authors’ table 1 matrix illustrates how different levels of control and knowledge people had at different timepoints might be grouped in categories of low, moderate or high demandingness: for policy makers sympathetic to the authors’ proposal that high levels of demandingness should undermine responsibility attributions, or for advocacy groups seeking to lobby on their behalf, several questions likely arise, including: How should …. (shrink)

From a scientific standpoint, the world is more prepared than ever to respond to infectious disease outbreaks; paradoxically, globalization and air travel, antimicrobial resistance, the threat of bioterrorism, and newly emerging pathogens driven by ecological, socioeconomic, and environmental factors, have increased the risk of global epidemics.1,2,3 Following the 2002–2003 severe acute respiratory syndrome (SARS), global efforts to build global emergency response capabilities to contain infectious disease outbreaks were put in place.4,5,6 But the recent H1N1, Ebola, and Zika global epidemics have (...) shown unnecessary delays and insufficient coordination in response efforts.7,8,9,10 In a thoughtful and compelling essay,11 Thana C. de Campos argues that greater clarity in the definition of pandemics would probably result in more timely effective emergency responses, and pandemic preparedness. In her view, a central problem is that the definition of pandemics is based solely on disease transmission across several countries, and not on spread and severity together, which conflates two very different situations: emergency and nonemergency disease outbreaks. A greater emphasis on severity, such that pandemics are defined as severe and rapidly spreading infectious disease outbreaks, would make them “true global health emergencies,” allowing for priority resource allocation and effective collective actions in emergency response efforts. Sympathetic to the position taken by de Campos, here I highlight some of the challenges in the definition of severity during an infectious disease outbreak. (shrink)

Introduction One of popular science’s primary functions is to make what would otherwise be inaccessible, specialist knowledge accessible to the lay reader. But popular science puts its imagined reader in something of a dilemma, for one does not have to look very far to find bitter argument among science writers; argument that takes place beyond the limits of the scientific community: witness the ill-tempered exchanges between Mary Midgley and Richard Dawkins in the journal Philosophy in the l...

This paper argues that the existing definition of pandemics is not nuanced enough, because it is predicated solely on the criterion of spread, rather than on the criteria of spread and severity. This definitional challenge is what I call ‘the conflation problem’: there is a conflation of two different realities of global health, namely global health emergencies (i.e., severe communicable diseases that spread across borders) and nonemergencies (i.e., communicable or noncommunicable diseases that spread across borders and that may be severe). (...) To put this argument forth, this paper begins by discussing the existing and internationally accepted definition of pandemics, its requirements, as well as its strengths (section 1). Section 2 then considers the problem with the standard definition of pandemics (i.e., the conflation problem) and some examples of it. Finally, section 3 evaluates some practical implications of the conflation problem to then explore conceptual clarity as the adequate solution. (shrink)

Smaldino argues that evolutionary theories of social behavior do not adequately explain the emergence of group-level traits, including differentiation of roles and organized interactions among individuals. We find Smaldino's account to be commendable but incomplete. Our commentary focuses on a simple question that has not been adequately addressed: What is a group?

Many of the debates concerning the existence of economic rights obfuscate the meaning of the possession of a right to an economic good. In order to provide clarification, several theoretical questions must be probed. This essay explores each of these issues in order to demonstrate that greater conceptual clarity repudiates the arguments against the existence of economic rights. It also seeks to attenuate the vexing problem of necessary and painful tradeoffs between competing rights claims. The final portion of (...) this essay heuristically demonstrates how greater conceptual clarity can aid us in dealing with complex policy issues involving competing rights claims. (shrink)

Volume 19, Issue 5, May 2019, Page 66-68.

As necessary austerity measures make major inroads into western health services, this paper investigates the philology of austerity and finds that there are two subtly similar yet importantly different derivations from the Latin and the Greek. The Latin austerus is an abstract term meaning dry, harsh, sour; whereas the Greek austeros has a more embodied and literal meaning of making the tongue dry. What seems an initially subtle difference between the metaphorical and the metonymic plays out as involving seriously different (...) outcomes between harsh economic measures and the literal effects on the people suffering under measures that actually make the tongue dry. The paper argues that between the trope and the literal that which Wittgenstein described as ‘a language game’ ensues wherein the metaphorical through a sleight of grammar is passed off as being real while, the literal effects on real people is downplayed as metaphorical ‘collateral damage’. The paper further argues that within this grammar that forces itself upon us, the game of capital is played out through what the author terms an austerity bargain that is levelled by the financial elites: healthy capitalism equals a healthy society. The paper then examines the six elements of the social determinants of health and what actually contributes to a healthy society. Rather than being under an individual threat of exclusion from what Marx termed a superabundance, the paper considers the irreducible differences between the game of capital's individualism, and, the social determinants of health's social inclusion, legitimization and that which Habermas termed public authentication. The paper concludes that not only do necessary austerity measures need to be critiqued but that they radically undermine what determines a healthy society. It follows also that the social determinants of health, radically undermine the bargain inherent for the privileged few within the game of capital. (shrink)

Midwest Studies In Philosophy, EarlyView.

This issue of The Journal of Medicine and Philosophy exemplifies the diverse range of topics that fall under the scope of bioethics and the philosophy of medicine. The eight essays in this number challenge many of the underlying assumptions made in the philosophy of medicine, health care, the abortion debate, the nature of harm, disability, the moral status of human beings, and pandemic lockdown procedures.

Barzykowski and Moulin link déjà vu and involuntary autobiographical memories to the process of retrieval. They make no reference to Tulving's SPI-model. In this, it is proposed that information is acquired serially (S), stored in parallel (P), and retrieved independently (I). This model offers an alternative, elegant, view of involuntary autobiographical memory retrieval, as well as of déjà vus.

Bioethics, Volume 36, Issue 7, Page 816-817, September 2022.

In recent analytic philosophy, there is a growing interest in the project of conceptual engineering. This paper examines two ways this project might be applied to scientific research, specifically anthropological research. It argues that both of them are harmful to this research. Specifically, it argues that a reliance on the axiological standards of analytic philosophy conflicts with the goal of empirical adequacy. Section one proffers two forms that the engineering project might take when applied to the science. Section two (...) proffers a case study drawn from anthropology. Specifically, it lays out Evans-Pritchard’s Witchcraft, Oracles, and Magic Among the Azande, paying particular attention to the inconsistency he discovered in Azande witchcraft. Sections three and four argue that attempting to remove this inconsistency via the two forms of engineering disable critical features of emic research and discard empirical findings. Finally, I close by noting how the conflict between axiological standards and empirical adequacy might generalize beyond anthropology. (shrink)

Researchers often refer to “research integrity”, “scientific integrity”, “research misconduct”, “scientific misconduct” and “research ethics”. However, they may use some of these terms interchangeably despite conceptual distinctions. The aim of this paper is to clarify what is signified by several key terms related to research integrity, and to suggest clearer conceptual delineation between them. To accomplish this task, it provides a conceptual analysis based upon definitions and general usage of these phrases and categorization of integrity-breaching behaviours in (...) literature and guidelines, including clarification of the different domains and agents involved. In the first part of the analysis, following some initial clarifications, I explore the distinction between internal and external rules of integrity. In the second part, I explore the distinction between integrity and lack of misconduct, before suggesting a recategorisation of different types of integrity breach. I conclude that greater clarity is needed in the debate on research integrity. Distinguishing between scientific and research integrity, reassessing the relative gravity of different misbehaviours in light of this distinction, and recognising all intentional breaches of integrity as misconduct may help to improve guidelines and education. (shrink)

A comprehensive proposal for a conceptual framework for describing conscious experience in dreams, integrating philosophy of mind, sleep and dream research, and interdisciplinary consciousness studies. Dreams, conceived as conscious experience or phenomenal states during sleep, offer an important contrast condition for theories of consciousness and the self. Yet, although there is a wealth of empirical research on sleep and dreaming, its potential contribution to consciousness research and philosophy of mind is largely overlooked. This might be due, in part, to (...) a lack of conceptual clarity and an underlying disagreement about the nature of the phenomenon of dreaming itself. In Dreaming, Jennifer Windt lays the groundwork for solving this problem. She develops a conceptual framework describing not only what it means to say that dreams are conscious experiences but also how to locate dreams relative to such concepts as perception, hallucination, and imagination, as well as thinking, knowledge, belief, deception, and self-consciousness. Arguing that a conceptual framework must be not only conceptually sound but also phenomenologically plausible and carefully informed by neuroscientific research, Windt integrates her review of philosophical work on dreaming, both historical and contemporary, with a survey of the most important empirical findings. This allows her to work toward a systematic and comprehensive new theoretical understanding of dreaming informed by a critical reading of contemporary research findings. Windt's account demonstrates that a philosophical analysis of the concept of dreaming can provide an important enrichment and extension to the conceptual repertoire of discussions of consciousness and the self and raises new questions for future research. (shrink)

As a comparatively recent development, the adventure-sports coach struggles for a clear and distinct identity. The generic term ‘instructor’ no longer characterizes the role and function of this subgroup of outdoor professionals. Indeed, although the fields of adventure/outdoor education and leadership are comparatively well researched, the arrival of this ‘new kid on the block’ appears to challenge both the adventure-sports old guard and traditional views of sports coaching. In an attempt to offer clarity and stimulate debate, this paper attempts (...) to conceptualize the adventure-sports coach in the context of the existing roles in the field and current motivations for activity in the outdoors. We identify issues that are specific to the adventure-sports coach while also recognizing those skills and competencies shared with other professionals, both in the adventure sports profession and traditional sports coaching fields. Based on this review, we offer a conceptual model which may be used to focus debate, stimulate research and, at a possible later stage, to underpin accreditation, training and professional development. (shrink)

The intuition of clarity-valence association seems to be pervasive in daily life, however, whether there exists a potential association between clarity (i.e., operationalized as visual resolution) and affect in human cognition remains unknown. The present study conducted five experiments, and demonstrated the clarity-valence congruency effect, that is, the evaluations showed performance advantage in the congruent conditions (clear-positive, blurry-negative). Experiment 1 through 3 demonstrated the influence of the perception of clarity on the conceptualization of affective valence, while (...) Experiment 4 & 5 verified the absence of the influence of conceptualization on perception, thus the unidirectionality of clarity-valence association in cognition is confirmed. The findings extend the affective perceptual-conceptual associations into the dimension of clarity, thus providing support for the ideas of embodied cognition as well as implications for our preference for clarity and aversion to blur. (shrink)

Åsa Maria Wikforss has proposed a response to Burge's thought-experiments in favour of social externalism, one which allows the individualist to maintain that narrow content is truth-conditional without being idiosyncratic. The narrow aim of this paper is to show that Wikforss' argument against social externalism fails, and hence that the individualist position she endorses is inadequate. The more general aim is to attain clarity on the social externalist thesis. Social externalism need not rest, as is typically thought, on the (...) possibility of incomplete linguistic understanding or conceptual error. I identify the unifying principle that underlies the various externalist thought-experiments. (shrink)

Recent efforts to talk about the self in a postmodern dialect have created a dilemma: How can one conceptualize the human self as multiple, fluid, contextual, and radically relational while also maintaining that it is intentional, private, focused, and accountable? Creative Dwelling weaves elements of feminist psychology and process theology into a dynamic interdiscplinary dialogue about human subjectivity. The result brings a new coherence and vitality to our search for more inclusive and adequate ways of understanding our humanity. The theologicl (...) implications are profound: the dynamics of empathy and clarity impel the author to reframe characteristics of the divine nature, sin, salvation, and spirituality. The book culminates in a study of "dwelling" as a new, iconoclastic, and visionary metaphor for our experiences of the ever-emerging self. (shrink)

Moral distress is a phenomenon that has been receiving increasing attention in nursing and other health care disciplines. Moral distress is a concept that entered the nursing literature – and subsequently the health care ethics lexicon – in 1984 as a result of the work done by American philosopher and bioethicist Andrew Jameton. Over the past decade, research into moral distress has extended beyond the profession of nursing as other health care disciplines have come to question the impact of moral (...) constraint on individual practitioners, professional practice, and patient outcomes. Along with increased interest in the phenomenon of moral distress have come increasing critiques – critiques that in their essence point to a serious lack of conceptual clarity in the definition, study, and application of the concept. Foundational to gaining conceptual clarity in moral distress in order to develop strategies to prevent and ameliorate the experience is a careful revisiting of the epistemological assumptions underpinning our knowledge and use of the concept of moral distress. It is our contention that the conceptual challenges reveal flaws in the original understanding of moral distress that are based on an epistemological stance that holds a linear conception of cause and effect coupled with a simplistic perspective of ‘constraint’ and ‘agency’. We need a more nuanced approach to our study of moral distress such that our ontological and epistemological stances help us to better appreciate the complexity of moral agents acting in organizational contexts. We believe that critical realism offers such a nuanced approach. (shrink)

Koonin argues that CRISPR-Cas systems present the best-known case in point for Lamarckian evolution because they satisfy his proposed criteria for the specific inheritance of acquired adaptive characteristics. We see two interrelated issues with Koonin’s characterization of CRISPR-Cas systems as Lamarckian. First, at times he appears to confuse an account of the CRISPR-Cas system with an account of the mechanism it employs. We argue there is no evidence for the CRISPR-Cas system being “Lamarckian” in any sense. Second, it is unclear (...) whether the mechanism is more “Lamarckian” than many other forms of genetic change already well-characterized in Darwinian terms. We present three conceptually distinct senses in which the mechanism of IAC may be considered Lamarckian and argue that only the strongest sense of goal-directed IAC would be difficult to accommodate in a Darwinian account. As the CRISPR-Cas mechanism does not qualify as “Lamarckian” in this strong sense, we argue there is no conceptual value in calling it “Lamarckian”. Finally, we suggest that CRISPR-Cas systems do hold the potential for genuinely non-Darwinian, directed evolution in a way that Koonin did not discuss, involving their potential use as a human gene-editing tool. (shrink)

The future of health research will be characterised by three continuing trends: rising demand for health data; increasing impracticability of obtaining specific consent for secondary research; and decreasing capacity to effectively anonymise data. In this context, governments, clinicians and the research community must demonstrate that they can be responsible stewards of health data. IRBs and RECs sit at heart of this process because in many jurisdictions they have the capacity to grant consent waivers when research is judged to be of (...) particular value. However, several different terms are used to refer to this value, indicating a lack of conceptual clarity regarding the appropriate test for access to health data for research without consent. In this paper we do three things. First we describe the current confusion and instability in terminology relating to public interest in the context of consent waivers. Second we argue for harmonisation of terminology on the grounds of clarity, transparency and consistency. Third we argue that the term ‘public interest’ best reflects the normative work required to justify consent waivers because it is the broadest of the competing terms. ‘Public interest’ contains within its scope positive and negative implications of a study, as well as welfare, justice and rights considerations. In making this argument, we explain the normative basis for consent waivers, and provide a starting place for further discussion about the precise conditions in which a given study can be said to advance the public interest. Ipsos MORI study found that: … the public would be broadly happy with administrative data linking for research projects provided Those projects have social value, broadly defined. Data are de-identified. Data are kept secure. Businesses are not able to access the data for profit. (shrink)

Despite recognition of the importance of family in health‐care and progress in family theory development, there has been limited transfer of family theory to acute care nursing practice. We argue that this family theory–practice gap results from a persistent lack of conceptual clarity in family nursing and other barriers. Lack of conceptual clarity takes the form of conceptual overlap and semantic inconsistency, as well as the complexity of language found in the family nursing literature. Barriers (...) include practice contexts, relational problems, and knowledge types. Our exploration begins with a brief discussion of the intimate link between nursing theory and practice followed by an overview of some issues associated with the family nursing theory–practice gap. Based on a synthesis of family nursing literature, problems associated with conceptual clarity in family nursing theory are explored. We conclude with recommendations for family nursing research to develop concepts grounded in nursing practice. (shrink)

In their recent debate, Hubert Dreyfus rejects John McDowell’s claim that perception is permeated with "mindedness" and argues instead that ordinary embodied coping is largely "nonconceptual." This argument has important, yet largely unacknowledged consequences for normative social theory, which this article demonstrates through a critique of Charles Taylor’s Verstehen thesis. If Dreyfus is right that "the enemy of expertise is thought," then Taylor is denied his defense against charges of relativism, which is that maximizing the interpretive clarity of social (...) practices unequivocally makes for better practices. Verstehen social theory, I argue, must consider both the gains and losses of the attempt to make the meaning of our practices explicit. (shrink)

Well-being is said to concern what is good for persons. But the words ‘good for’ are indeterminate enough to support the worry that philosophers working on well-being might not be quarreling over the same conceptual territory. To allay these worries, it would be helpful to provide an analysis of prudential goodness that is substantive enough to coordinate disagreement about and adjudicate between competing theories of well-being, and yet not so substantive that it begs any important questions at the normative (...) level. The present paper is a sustained attempt to locate such a general characterization. My results are largely negative, although I conclude by cautiously supporting the idea that progress in well-being discussions requires employing more specific, stipulative characterizations of well-being rather than attempting to use a highly general characterization as a touchstone for well-being theorization. (shrink)

With the emergence of large digitized collections of historical texts, scholarship in the humanities has increasingly turned to studying texts as data. This article argues that seeing text as data is particularly apt for the study of conceptual history. The quantitative perspective allows for rethinking the analytical terminology used to study the transformation of political and social terminology. Further, quantitative conceptual history requires re-evaluation on four levels. First, it forces scholars of conceptual history to reconsider the role (...) of reception in the spread and lexicalization of linguistic innovations. Second, it forces them to assess how to interpret quantitative analyses of linguistic change. Third, the use of quantitative methods calls for clarity in describing what is being measured and what is being interpreted based on quantitative analyses. Fourth, the use of machine-learning methods for conceptual history should remain careful. They can be very useful for exploration, but should be combined with count-based methods to provide concrete proof. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:On the Importance of Conceptual ContrastsMadness, Reason, and Mad PrideAwais Aftab, MD (bio)Garson (2023) offers an engaging historical and philosophical discussion around the importance Late Modern thinkers assigned to the task of differentiating madness from idiocy (or more specifically, to the tripartite distinction of sanity, madness, and idiocy). Based on this analysis, Garson’s identifies the need to offer a positive account of mental illness—one that does not define (...) the essence of mental illness exclusively as the absence, lack, or failure of the power of reasoning. Following the Late Modern thinkers (Locke, Kant, Wigan, and Heinroth), Garson concludes that madness is infused with reason, and what characterizes madness is the presence of reason in an altered and mutated form. This is all worth taking seriously. My own assessment of this historical and philosophical material nonetheless differs from that of Garson. To recognize madness as possessing reason within it in an altered form may be of less profound significance than he thinks it is. Garson’s discussion commendably highlights the importance of making conceptual contrasts explicit in definitional debates, and this should indeed lead us to search for contrasts that are more philosophically illuminating (what is better will depend on the context of inquiry). However, in my view, the recognition of madness as altered reason neither reframes the project of defining “mental disorder” nor does it provide an intellectual scaffolding for mad activism.The significance of “madness contains reason within in but in an altered or perverse form” is difficult to translate into contemporary scientific terms, and the fuzziness and historical baggage around the terms “madness,” “reason,” and “perversion” does not make it easy. “Mental disorder” or “psychopathology” means to us something quite different than what madness meant to Late Modern thinkers, and while “madness” remains a popular term in philosophical literature, there is no clarity on the nature of overlap between the domain of madness and the domain of conditions currently classified by the diagnostic manuals. Mental disorders, as currently conceptualized, include a motley of conditions that were previously characterized using terms such as idiocy, madness, neuroses, and psychopathic personalities. [End Page 297]From our contemporary vantage point, to compare idiocy and madness is to make a distinction within the domain of psychopathology. We are comparing two groups of psychiatric conditions. The lessons we derive from this comparison do not necessarily extrapolate well to a comparison of mental disorders with something outside the domain of psychopathology. To the extent that psychopathology is inclusive of both idiocy and madness, psychiatric disorders both contain and do not contain “reason” within them. The domain is heterogenous in this regard, and broad generalizations about the nature of reason in the mental disorders would be simplistic at best and inaccurate at worst. Other distinctions that we have made within the domain of psychopathology have included organic versus functional, neurosis versus psychosis, categories versus continua, and distinctions used within nosology have included operationalized criteria versus phenomenology, idiographic versus nomothetic, medical versus non-medical, description versus explanation, and so on (Aftab & Ryznar, 2021; Zachar, Banicki, & Aftab, 2023), all of which have the potential to offer a positive account of some aspect of psychopathology.It is worth nothing that the distinction between “absence of reason” versus “perversion of reason” is analogous to the common distinction between absence of function and altered function in patho-physiology. Such a distinction exists for almost every function that exists. Consider vision: absence of vision (blindness) and altered vision (illusions, distortions, hallucinations). Consider hypoesthesia (reduced sense of touch) and paraesthesia (altered sense of touch—tingling, pricking, burning, etc.). Garson alludes to diminished sexual capacity versus paraphilia as an analogy, but he does not seem to appreciate that the analogy applies much more broadly. Is the distinction between absence of reason versus perversion of reason of any greater significance than the distinction between blindness and hallucination? If we were to say, “What distinguishes hallucination from blindness is not the failure, absence, or lack of sight, but its presence—albeit in a perverse and mutated form,” how profound would it really be for our notions of disorder? Or imagine some Late Modern physician saying that a disturbance of speech and... (shrink)

The American Board of Internal Medicine (ABIM) Foundation has recently initiated a campaign called “Choosing Wisely,” which is aimed at reducing “low-value” care services. Lists of low-value care services are being developed and the ABIM Foundation is urging the American Medical Association and other organizations to get behind the lists, disseminate them, and implement them. Yet, there are many ethical questions that remain about the development, dissemination, and implementation of these low-value care lists. In this paper I argue for (...) class='Hi'>conceptual clarity with respect to the label “low-value care.” Thus far it has not been precisely defined, and I argue that there are actually 10 distinct categories of low-value care. I discuss the ethical challenges and considerations associated with each category. I also provide arguments that can be used to justify the reduction of some of these categories of low-value care. These arguments rely on Rawlsian and Hegelian notions of justice, as well as on concepts about the fiduciary obligations of physicians. Finally, I outline the various mechanisms that could be utilized for the reduction of low-value care (i.e., incentives, punishments, nonrational influences such as appeals to social norms, emotions, or ego, and creation of conditions that make avoidance easy such as defaults and reminders). I provide normative guidelines for the use of each. (shrink)

The introduction of the Diagnostic and Statistical Manual of Mental Disorders in May 2013 is being hailed as the biggest event in psychiatry in the last 10 years. In this paper I examine three important issues that arise from the new manual: Expanding nosology: Psychiatry has again broadened its nosology to include human experiences not previously under its purview. Consequence-based ethical concerns about this expansion are addressed, along with conceptual concerns about a confusion of "construct validity" and "conceptual (...) validity" and a failure to distinguish between "disorder" and "nondisordered conditions for which we help people." The role of claims about societal impact in changes in nosology: Several changes in the DSM-5 involved claims about societal impact in their rationales. This is due in part to a new online open comment period during DSM development. Examples include advancement of science, greater access to treatment, greater public awareness of condition, loss of identify or harm to those with removed disorders, stigmatization, offensiveness, etc. I identify and evaluate four importantly distinct ways in which claims about societal impact might operate in DSM development. Categorisation nosology to spectrum nosology: The move to "degrees of severity" of mental disorders, a major change for DSM-5, raises concerns about conceptual clarity and uniformity concerning what it means to have a severe form of a disorder, and ethical concerns about communication. (shrink)

The introduction of the Diagnostic and statistical manual of mental disorders in May 2013 is being hailed as the biggest event in psychiatry in the last 10 years. In this paper I examine three important issues that arise from the new manual: Expanding nosology: Psychiatry has again broadened its nosology to include human experiences not previously under its purview . Consequence-based ethical concerns about this expansion are addressed, along with conceptual concerns about a confusion of “construct validity” and “ (...) class='Hi'>conceptual validity” and a failure to distinguish between “disorder” and “non disordered conditions for which we help people.” The role of claims about societal impact in changes in nosology: Several changes in the DSM-5 involved claims about societal impact in their rationales. This is due in part to a new online open comment period during DSM development. Examples include advancement of science, greater access to treatment, greater public awareness of condition, loss of identify or harm to those with removed disorders, stigmatization, offensiveness, etc. I identify and evaluate four importantly distinct ways in which claims about societal impact might operate in DSM development. Categorisation nosology to spectrum nosology: The move to “degrees of severity” of mental disorders, a major change for DSM-5, raises concerns about conceptual clarity and uniformity concerning what it means to have a severe form of a disorder, and ethical concerns about communication. (shrink)

This article argues for the importance of conceptual clarity in the debate about the so-called right not to know. This is vital both at the theoretical and the practical level. It is suggested that, unlike many formulations and attempts to give effect to this right, what is at stake is not merely an aspect of personal autonomy and therefore cannot and should not be reduced only to a question of individual choice. Rather, it is argued that the core (...) interests that can be protected by the right not to know are better conceived of as privacy interests rather than autonomy interests. This not only helps us to understand what is in play but also informs regulatory, professional, and legal responses to handling information and taking decisions about whether or not to disclose information to persons about themselves. The practical implications of this conceptualization are explored in the context of feedback policies in health-related research. (shrink)

To say that a philosophical dispute is ‘merely verbal’ seems to be an important diagnosis. If that diagnosis is correct for a particular dispute, then the right thing to do would be to declare that dispute to be over. The topic of what the disputing parties were fighting over was just a pseudo-problem (thus not really a problem), or at least – if there is a sense in which also merely verbal disputes indicate some problem, for example, insufficient clarity (...) of terminology – this problem is not substantial, or not as substantial as the disputing parties believed their problem initially to be. In this paper I will try to clarify what it means if we diagnose that two arguing parties are having a merely verbal dispute. (shrink)

This important philosophical statement by an eminent scientist is written with such clarity and directness, and derives from so broad a humanistic perspective, that the thoughtful reader will find it as rewarding as it is instructive. The author's purpose in this undertaking is to: "...outline a system of thought in which notions or values can find a place along with the ideas of causal relationships that are applied in the physical sciences. The essential doctrine of this system, which is (...) taken from the metaphysical picture developed by Alfred North Whitehead... is the assumption that, in every act occurring in the universe, experience derived from that which has gone before is integrated with conceptions concerning possibilities in the future." Analyzing and extending Whitehead's picture, Dr. Burgers argues that the physical view of causality in itself is too restrictive for a general description of the universe, and is valid only for those phenomena where values are irrelevant. His concern is to introduce the entire panorama with its complementary physical and conceptual aspects in such a way that a wider view of causality is obtained, whereby an opening is found for the explanation of life. The author points out that the concept of "organism" implies "purpose," and is thus not amenable to complete description in the terms of molecular biology. Although most evolutionary steps are the result of unplanned chance effects, the recognition and conception of future possibilities are factors in the evolutionary trend: "The existence of matter is the result of persistent repetition of certain patterns. Matter is a set of habits of the universe; it is these habits which are studied in physics. [But] life is more than habit: it is the coordination of spontaneity... a struggle against mere randomness.... "It is the key of the philosophy here presented to consider expectations and valuations not as accidental by-products of physical states of matter, but as essential forms of functioning.". (shrink)

Based on its prevalence, there is an urgent need to better understand the mechanisms, opportunities and risks of sexual interaction in digital contexts that are related with sexual arousal. While there is a growing body of literature on SIDC, there is also a lack of conceptual clarity and classification. Therefore, based on a conceptual analysis, we propose to distinguish between sexual interaction through, via, and with digital technologies. Sexual interactions through digital technologies are face-to-face sexual interactions that (...) have been started digitally or are accompanied by digital technology. Sexual interactions via digital technology are technology-mediated interpersonal sexual interactions. Sexual interactions with digital technology occur when the technology itself has the role of an interaction partner. The three types of SIDC and their respective subtypes are explained and backed up with empirical studies that are grouped according to two major mediators: consent and commerce. Regarding the causes and consequences of the three types of SIDC we suggest a classification that entails biological, psychological, social, economic, and technological factors. Regarding implications of SIDC we suggest to focus on both opportunities and risks for sexual health. The proposed conceptual framework of SIDC is meant to inform future research. (shrink)

Although random mutation is central to models of evolutionary change, a lack of clarity remains regarding the conceptual possibilities for thinking about the nature and role of mutation in evolution. We distinguish several claims at the intersection of mutation, evolution, and directionality and then characterize a previously unrecognized category: complex conditioned mutation. Empirical evidence in support of this category suggests that the historically famous fluctuation test should be revisited, and new experiments should be undertaken with emerging experimental techniques (...) to facilitate detecting mutation rates within specific loci at an ultra‐high, individual base pair resolution. (shrink)

Many research institutions and funders have recently stated their commitment to actively support and promote ‘Equality, Diversity and Inclusion’ (EDI) in various aspects of health research including Patient and Public Involvement (PPI). However, translating this commitment into specific research projects presents significant challenges that existing approaches, practical guidelines and initiatives have not adequately addressed. In this paper, we explore how the lack of clear justifications for the EDI commitment in existing guidelines inadvertently complicates the work of those involved with PPI (...) and we stress the need for conceptual clarity for any EDI effort to yield meaningful results. Our focus centres on the first principle of the EDI discourse, ‘equality’, particularly in the form of ‘equality of opportunity’ as outlined in current guidance provided by the National Institute of Health Research in the United Kingdom. We examine challenges related to justifying and implementing a general, unspecified commitment to equality of opportunity and explain that this reflects a lack of consensus regarding the moral value of PPI in research – a profound problem that remains unaddressed. We then discuss how the presence of several opposing moral perspectives on PPI, makes determining the most appropriate way of addressing barriers to involvement complex and controversial, raising ethical implications for the work of health researchers, PPI specialists and coordinators. Finally we make suggestions on how future research can enrich the concept of ‘equality of opportunity’ in PPI and improve practice. While our primary focus is on the NIHR, a strong advocate of PPI in research, this analysis will point to normative and ethical considerations that may be relevant to other research institutions and funding organisations aiming to promote equality of opportunity in their public and patient involvement strategies. (shrink)

Moral repair is an important way for firms to heal moral relationships with stakeholders following a transgression. The concept is rooted in recognition theory, which is often used to develop normative perspectives and prescriptions, but the same theory has also propelled a view of moral repair as premised on negotiation between offender and victim(s), which involves the complex social construction of the transgression and the appropriate amends. The tension between normative principles and socioconstructivist implementation begs the question how offending firms (...) should approach moral repair. Addressing this question, we develop a two-level conceptualization of moral repair, distinguishing between procedural and substantive levels of practice, which accommodate normativity and socioconstructivism, respectively. In so doing, we enrich the literature by 1) promoting conceptual clarity, 2) refining understanding of the moral repair process, and 3) suggesting the use of a unified, configurational approach to studying (nonlinear) relations between amends and moral outcomes. (shrink)

The lack of engagement of philosophy with decisions made under conditions of risk and uncertainty has lately received increasing attention. But philosophers have devoted little thought to the development of a conceptual framework for distinguishing different types of risks. This article begins by illustrating the need for a more nuanced conceptual framework. As the normative considerations risks give rise to are highly varied, ethicists need to distinguish between different types of risks. It then offers two ideas. First, it (...) proposes that we understand ‘risk’ as a multi-dimensional concept, i.e. a concept that can always be evaluated in different dimensions, e.g. a qualitative, a quantitative and an epistemic dimension. While this understanding of risk underlies the current practice of risk analysis, making it explicit is of value, in particular for the philosophical debate. It draws attention to the diversity of risks, helps to group them sensibly and sharpens existing arguments. Second, the article introduces a novel account of the notion ‘systemic risk’. Criticising existing accounts, it proposes we understand ‘systemic risk’ as referring to a risk that endangers the functioning of a system and originates in the system or its background noise, where a system is conceived of as a set of interdependent, interacting components that form a complex, functionally defined whole. The article identifies a number of structural features shared by systemic risks and evaluates the distinctive normative considerations they give rise to. It then argues that the notion ‘systemic risk’ is particularly suited to characterise some of the most pressing risks faced in an increasingly interconnected world. While the notion ‘systemic risk’ rests on the understanding of ‘risk’ as a multi-dimensional concept, it also complements it. Its necessity shows that in addressing risks, it is sometimes helpful to move beyond a characterisation based solely on their dimensions. (shrink)

Background Informed consent is one of the key principles of conducting research involving humans. When research participants give consent, they perform an act in which they utter, write or otherwise provide an authorisation to somebody to do something. This paper proposes a new understanding of the informed consent as a compositional act. This conceptualisation departs from a modular conceptualisation of informed consent procedures. Methods This paper is a conceptual analysis that explores what consent is and what it does or (...) does not do. It presents a framework that explores the basic elements of consent and breaks it down into its component parts. It analyses the consent act by first identifying its basic elements, namely: a) data subjects or legal representative that provides the authorisation of consent; b) a specific thing that is being consented to; and c) specific agent(s) to whom the consent is given. Results This paper presents a framework that explores the basic elements of consent and breaks it down into its component parts. It goes beyond only providing choices to potential research participants; it explains the rationale of those choices or consenting acts that are taking place when speaking or writing an authorisation to do something to somebody. Conclusions We argue that by clearly differentiating the goals, the procedures of implementation, and what is being done or undone when one consent, one can better face the challenges of contemporary data-intensive biomedical research, particularly regarding the retention and use of data. Conceptualising consent as a compositional act enhances more efficient communication and accountability and, therefore, could enable more trustworthy acts of consent in biomedical science. (shrink)

This article adds to the small but growing body of hate crime legal scholarship in the United Kingdom by examining the meaning of the term ‘hostility’ as prescribed under section 28 of the Crime and Disorder Act 1998. The article highlights the confusion which has occurred within the lower courts as to the distinction between section 28(1)(a), which proscribes ‘demonstrations’ of hostility, and section 28(1)(b), which proscribes offences ‘motivated’ by hostility. In addition to this confusion has been a clear reluctance (...) to apply section 28(1)(a) by some judges in cases where the demonstration of hostility appears to be incidental, as against causal, to the offence committed. The article argues that in order to provide greater clarity in law, the words ‘demonstrates … hostility’ must be interpreted to include, not only acts that are motivated by, or which are intended to express prejudice or hatred, but any conduct carried out during an offence where the offender is aware his behaviour is likely to be perceived by right-minded individuals as indicating hostility towards the victim’s identity. The article concludes that such a broad approach to conceptualizing hostility is justified based on the need for the state to expressly denounce all public displays of identity-based prejudice. The approach also acknowledges the harmful effects that all expressions of hate (motivated by hostility or not) have on victims, minority communities and to the cohesiveness of Britain’s multicultural society. (shrink)

With the rise of positive psychology, the role of teachers’ emotions and interpersonal communication skills has been recently highlighted in the literature. However, the preventive role of teacher enthusiasm and clarity in reducing EFL students’ boredom has not caught sufficient attention among L2 scholars. Against this gap, this article, first, presented the definitions, dimensions, and conceptualizations of teacher enthusiasm, clarity, and students’ boredom. Next, theoretical and empirical backgrounds were provided to support the claim that enthusiasm and clarity (...) of EFL teachers can stop students’ classroom boredom. Additionally, the study presented the implications and future directions of this line of research for different people such as EFL teachers, teacher trainers, and L2 scholars. The ideas can improve their awareness of teachers’ positive emotions, interpersonal skills, and their roles in L2 education. (shrink)