This book is intended to help transform epistemology - the traditional study of knowledge - into a rigorous discipline by removing conceptual roadblocks and developing formal tools required for a fully naturalized epistemology. The evolutionary approach which Harms favours begins with the common observation that if our senses and reasoning were not reliable, then natural selection would have eliminated them long ago. The challenge for some time has been how to transform these informal musings about evolutionary epistemology into a rigorous (...) theoretical discipline capable of complementing current scientific studies of the evolution of cognition with a philosophically defensible account of meaning and justification. (shrink)

The concept of information tempts us as a theoretical primitive, partly because of the respectability lent to it by highly successful applications of Shannon’s information theory, partly because of its broad range of applicability in various domains, partly because of its neutrality with respect to what basic sorts of things there are. This versatility, however, is the very reason why information cannot be the theoretical primitive we might like it to be. “Information,” as it is variously (...) used, is systematically ambiguous between whether it involves continuous or discrete quantities, causal or noncausal relationships, and intrinsic or relational properties. Many uses can be firmly grounded in existing theory, however. Continuous quantities of information involving probabilities can be related to information theory proper. Information defined relative to systems of rules or conventions can be understood relative to the theory of meaning . A number of causal notions may possibly be located relative to standard notions in physics. Precise specification of these distinct properties involved in the common notion of information can allow us to map the relationships between them. Consequently, while information is not in itself the kind of single thing that can play a significant unifying role, analyzing its ambiguities may facilitate headway toward that goal. (shrink)

Information theory offers a measure of "mutual information" which provides an appropriate measure of tracking efficiency for the naturalistic epistemologist. The statistical entropy on which it is based is arguably the best way of characterizing the uncertainty associated with the behavior of a system, and it is ontologically neutral. Though not appropriate for the naturalization of meaning, mutual information can serve as a measure of epistemic success independent of semantic maps and payoff structures. While not containing payoffs (...) as terms, mutual information places both upper and lower bounds on payoffs. This constitutes a non-trivial relationship to utility. (shrink)

Evolutionary theory offers the possibility of building an epistemology that requires neither a theory of truth nor a definition of knowledge, thus bypassing some of the more notable difficulties with standard approaches to epistemology. Following a critique of one of the most popular approaches to thinking about cultural evolution I argue for a frequentist approach to evolutionary epistemology, and that cultural transmission should be understood as coordinated phenotypic variability within groups of closely related organisms. I construct a formal system which (...) allows the analysis of the evolution of networks of multiple interacting populations. Of particular epistemological interest is the relationship between genetic evolution and the evolution of cultural entities. The information-theoretic notion of "mutual information" is employed to quantify the transfer of information from the environment as it determines genetic fitnesses into the distribution of acquired traits Two simple models are constructed and analyzed. A two-level model of the navigation of a colony of bacteria demonstrates how selection on inherited traits affects the acquisition of information on the level of transient behavioral traits. A three-level model of bumblebee foraging shows how information about the environment is caught up in distributions of acquired foraging preferences--a bee-analog of human cognitive states. The Appendix contains an analytic proof of information gain under selection. (shrink)

Part II: Modeling Chapter 3: Single Populations Chapter 4: Multiple Populations Chapter 5: Information [ “The Use of Information Theory in Epistemology”, Philosophy of Science ...] Chapter 6: A two level model for Bacterial Epistemology Chapter 7: A three level model for Bumblebee Epistemology [ “Reliability and Novelty”.

It is common in attempts to extend the theory of evolution to culture to generalize from the causal basis of biological evolution, so that evolutionary theory becomes the theory of copying processes. Generalizing from the formal dynamics of evolution allows greater leeway in what kinds of things cultural entities can be, if they are to evolve. By understanding the phenomenon of cultural transmission in terms of coordinated phenotypic variability, we can have a theory of cultural evolution which allows us to (...) avoid the various difficulties with the elaboration of informational entities such as the cultural replicator, or meme. Such an account is a boon to the project of evolutionary epistemology since it confirms the presumption in favor of the general adaptiveness of culture, illuminating rather than obscuring the inherent intimacy of our relationship to (e.g.) our ideas. (shrink)

What does a naturalistic epistemologist do? Content Type Journal Article Pages 1-4 DOI 10.1007/s11016-011-9531-7 Authors William F. Harms, Humanities and Social Sciences, Seattle Central Community College, 1701 Broadway, Seattle, WA 98122-9905, USA Journal Metascience Online ISSN 1467-9981 Print ISSN 0815-0796.

Two experiments examined similarities and differences in the effects of consciously and unconsciously perceived rewards on the active maintenance of goal-relevant information. Participants could gain high and low monetary rewards for performance on a word span task. The reward value was presented supraliminally or subliminally at different stages during the task. In Experiment 1, rewards were presented before participants processed the target words. Enhanced performance was found in response to higher rewards, regardless whether they were presented supraliminally or subliminally. (...) In Experiment 2, rewards were presented after participants processed the target words, i.e., during maintenance. Performance increased in response to relatively high rewards when they were presented subliminally, but decreased when they were presented supraliminally. We conclude that both consciously and unconsciously perceived rewards boost resources supporting the maintenance of task-relevant information. Conscious processing of rewards can, however, heavily interfere with an ongoing maintenance process and impair performance. (shrink)

Information about the environment is captured in human biological systems on a variety of interacting levels – in distributions of genes, linguistic particulars, concepts, methods, theories, preferences, and overt behaviors. I investigate some of the basic principles which govern such a hierarchy by constructing a comparatively simple three-level selection model of bee foraging preferences and behaviors. The information-theoretic notion of ''''mutual information'''' is employed as a measure of efficiency in tracking a changing environment, and its appropriateness in (...) epistemological applications is discussed at some length. In particular, information accumulated in mid-level preference distributions exhibits suggestive properties for the purposes of naturalistic epistemology. It also appears that the novelty of scientific objects and representations and the rapidity of scientific change relative to genetic change need present no obstacle to the use of such models in explanations of scientific progress and the reliability of scientific judgement. (shrink)

Recently, we showed that conscious and unconscious rewards affect the active maintenance of goal-relevant information differently. Here, we elaborate on the mechanisms enabling the boosting or disrupting effects of consciously processed high rewards, and discuss a few methodological and theoretical implications that may be worth considering in future research on the role of reward processing in working memory performance.

The governance of nanotechnology seeks to limit its risks, without constraining opportunities. The literature on the effectiveness of approaches to governance has neglected approaches that impact directly on the behavior of a researcher. We analyze the effectiveness of legal regulations versus regulation via self-commitment. Then, we refine this model by analyzing competition and autonomy as key contingency factors. In the first step, qualitative interviews with nanotechnology researchers are conducted to reflect this model. In the second step, its empirical relevance is (...) tested using a survey of 90 nanotech researchers. The results indicate that legal regulations, as well as self-commitment to an informal CoC reduce the scope of behavior. Finally, that competition and autonomy affect the relative strength of these governance factors. (shrink)

This paper examines how expertise is treated as a separable domain of epistemics by looking at simulated intensive care shift-handovers between resident physicians. In these handovers, medical information about a patient is transferred from an outgoing physician to an incoming physician. These handovers contain different interactional activities, such as discussing the patient identifiers, giving a clinical impression, and discussing tasks and focus points. We found that with respect to knowledge about the patient, the OPs display an orientation to a (...) knowledge imbalance, but with respect to procedures, reasoning, and activities, they display an orientation to a knowledge balance. We use ‘expertise’ to refer to this latter type of knowledge. ‘Expertise’ differs from, and adds to, how knowledge is often treated in epistemics in that it is concerned with professional competence or ‘knowing how’. In terms of epistemics, the participants in the handovers orient to a steep epistemic or knowledge gradient when it concerns the patient, while simultaneously displaying an orientation to a horizontal expertise gradient. (shrink)

Sometimes we believe that others receive harmful information. However, Marschak’s value of information framework always assigns non-negative value under expected utility: it starts from the decision maker’s beliefs – and one can never anticipate information’s harmfulness for oneself. The impact of decision makers’ capabilities to process information and of their expectations remains hidden behind the individual and subjective perspective Marschak’s framework assumes. By introducing a second decision maker as a point of reference, this paper introduces (...) a way for evaluating others’ information from a cross-individual, imperfect expectations perspective for agents maximising expected utility. We define the cross-value of information that can become negative – then the information is “harmful” from a cross-individual perspective – and we define (mutual) cost of limited information processing capabilities and imperfect expectations as an opportunity cost from this same point of reference. The simple relationship between these two expected utility-based concepts and Marschak’s framework is shown, and we discuss evaluating short-term reactions of stock market prices to new information as an important domain of valuing others’ information. (shrink)

The amount of content, both on and offline, to which people in reasonably affluent nations have access has increased to the point that it has raised concerns that we are now suffering from a harmful condition of ‹information overload.’ Although the phrase is being used more frequently, the concept is not yet well understood – beyond expressing the rather basic idea of having access to more information than is good for us. This essay attempts to provide a (...) philosophical explication of the concept of information overload and is therefore what philosophers call ‹conceptual analysis’ – a task that, along with normative ethical analysis, is distinctive to Anglo-American style analytic philosophy. I will begin with an analysis of the atomic concepts expressed by the terms ‹information’ and ‹overload’ and then attempt to give a philosophical explanation of the concept of information overload that more precisely identifies exactly what the condition amounts to. (shrink)

The amount of content, both on and offline, to which people in reasonably affluent nations have access has increased to the point that it has raised concerns that we are now suffering from a harmful condition of ‹information overload.’ Although the phrase is being used more frequently, the concept is not yet well understood – beyond expressing the rather basic idea of having access to more information than is good for us. This essay attempts to provide a (...) philosophical explication of the concept of information overload and is therefore what philosophers call ‹conceptual analysis’ – a task that, along with normative ethical analysis, is distinctive to Anglo-American style analytic philosophy. I will begin with an analysis of the atomic concepts expressed by the terms ‹information’ and ‹overload’ and then attempt to give a philosophical explanation of the concept of information overload that more precisely identifies exactly what the condition amounts to. (shrink)

A study found that women participating in mammography screening were content with the programme and the paternalistic invitations that directly encourage participation and include a pre-specified time of appointment. We argue that this merely reflects that the information presented to the invited women is seriously biased in favour of participation. Women are not informed about the major harms of screening, and the decision to attend has already been made for them by a public authority. This short-circuits informed decision-making and (...) the legislation on informed consent, and violates the autonomy of the women. Screening invitations must present both benefits and harms in a balanced fashion, and should offer, not encourage, participation. It should be stated clearly that the choice not to participate is as sensible as the choice to do so. To allow this to happen, the responsibility for the screening programmes must be separated from the responsibility for the information material. (shrink)

The UK Supreme Court in Montgomery v Lanarkshire Health Board adopts an approach to information disclosure in connection with clinical treatment that moves away from medical paternalism towards a more patient-centred approach. In doing so, it reinforces the protection afforded to informed consent and autonomous patient decision making under the law of negligence. However, some commentators have expressed a concern that the widening of the healthcare providers’ duty of disclosure may provide impetus, in future cases, for courts to adopt (...) a more rigorous approach to the application of causation principles. The aim would be to limit liability but, in turn, it would also limit autonomy protection. Such a restrictive approach has recently been adopted in Australia as a result of the High Court decision in Wallace v Kam. This paper considers whether such an approach is likely under English negligence law and discusses case law from both jurisdictions in order to provide a point of comparison from which to scope the post- Montgomery future. (shrink)

BackgroundHealth data holds great potential for improved treatments. Big data research and machine learning models have been shown to hold great promise for improved diagnostics and treatment planning. The potential is tied, however, to the availability of personal health data. In recent years, it has been argued that data from health records should be available for health research, and that individuals have a duty to make the data available for such research. A central point of debate is whether such secondary (...) use of health data requires informed consent.Main bodyIn response to recent writings this paper argues that a requirement of informed consent for health record research must be upheld. It does so by exploring different contrasting notions of the duty of easy rescue and arguing that none of them entail aperfectduty to participate in health record research. In part because the costs of participation cannot be limited to 1) the threat of privacy breaches, but includes 2) the risk of reduced trust and 3) suboptimal treatment, 4) stigmatization and 5) medicalisation, 6) further stratification of solidarity and 7) increased inequality in access to treatment and medicine. And finally, it defends the requirement of informed consent by arguing that the mere possibility of consent bias provides a rather weak reason for making research participation mandatory, and that there are strong, independent reasons for making.ConclusionArguments from the duty of easy rescue in combination with claims about little risk of harm and potential consent bias fail to establish not only aperfectduty to participate in health record research, but also that participation in such research should be mandatory. On the contrary, an analysis of these arguments indicates that the duty to participate in research is most adequately construed as animperfectduty, and reveals a number of strong reasons for insisting that participation in health records research is based on informed consent. (shrink)

Providing individuals with the information necessary to make informed decisions is now considered an ethical standard for health systems and general practitioners.

Gamma radioactivity produced by human technology is the most dangerous industrial product to life. Two recent global catastrophic events in which nuclear plants were involved, separated only by 25 years, have confirmed that, independently of the usage of nuclear weapons, achieving the 100% of security in the nuclear energy management was and still is a complete unrealistic idea. Although the guarantee of offering information of food and drink products quality concerning the date of expiry or the ingredients content is (...) nowadays stipulated in laws around many countries, this is not the case of the radiation safety. An important investment to offer information concerning gamma radiation safety conditions in food and drink products offered by markets, which also could help to localize quickly, possible radioactive slight incidents, is here discussed. The implementation of a previous consumer-behaviour experiment in markets is also suggested. (shrink)

The principle of informed consent obligates physicians to explain possible side effects when prescribing medications. This disclosure may itself induce adverse effects through expectancy mechanisms known as nocebo effects, contradicting the principle of nonmaleficence. Rigorous research suggests that providing patients with a detailed enumeration of every possible adverse event—especially subjective self-appraised symptoms—can actually increase side effects. Describing one version of what might happen (clinical “facts”) may actually create outcomes that are different from what would have happened without this information (...) (another version of “facts”). This essay argues that the perceived tension between balancing informed consent with nonmaleficence might be resolved by recognizing that adverse effects have no clear black or white “truth.” This essay suggests a pragmatic approach for providers to minimize nocebo responses while still maintaining patient autonomy through “contextualized informed consent,” which takes into account possible side effects, the patient being treated, and the particular diagnosis involved. (shrink)

The risks of harm to nonhuman primates, and the absence of benefits for them, are critically important to decisions about nonhuman primate research. Current guidelines for review and practice tend to be permissive for nonhuman primate research as long as minimal welfare requirements are fulfilled and human medical advances are anticipated. This situation is substantially different from human research, in which risks of harms to the individual subject are typically reduced to the extent feasible. A risk threshold is needed for (...) the justification of research on nonhuman primates, comparable to the way risk thresholds are set for vulnerable human subjects who cannot provide informed consent. Much of the laboratory research conducted today has inadequate standards, leading to common physical, psychological, and social harms. (shrink)

A growing number of bioethics papers endorse the harm threshold when judging whether to override parental decisions. Among other claims, these papers argue that the harm threshold is easily understood by lay and professional audiences and correctly conforms to societal expectations of parents in regard to their children. English law contains a harm threshold which mediates the use of the best interests test in cases where a child may be removed from her parents. Using Diekema9s seminal paper as an example, (...) this paper explores the proposed workings of the harm threshold. I use examples from the practical use of the harm threshold in English law to argue that the harm threshold is an inadequate answer to the indeterminacy of the best interests test. I detail two criticisms: First, the harm standard has evaluative overtones and judges are loath to employ it where parental behaviour is misguided but they wish to treat parents sympathetically. Thus, by focusing only on ‘substandard’ parenting, harm is problematic where the parental attempts to benefit their child are misguided or wrong, such as in disputes about withdrawal of medical treatment. Second, when harm is used in genuine dilemmas, court judgments offer different answers to similar cases. This level of indeterminacy suggests that, in practice, the operation of the harm threshold would be indistinguishable from best interests. Since indeterminacy appears to be the greatest problem in elucidating what is best, bioethicists should concentrate on discovering the values that inform best interests. (shrink)

This paper provides a systematic account of how artificial intelligence (AI) technologies could harm nonhuman animals and explains why animal harms, often neglected in AI ethics, should be better recognised. After giving reasons for caring about animals and outlining the nature of animal harm, interests, and wellbeing, the paper develops a comprehensive ‘harms framework’ which draws on scientist David Fraser’s influential mapping of human activities that impact on sentient animals. The harms framework is fleshed out with examples inspired by both (...) scholarly literature and media reports. This systematic account and framework should help inform ethical analyses of AI’s impact on animals and serve as a comprehensive and clear basis for the development and regulation of AI technologies to prevent and mitigate harm to nonhumans. (shrink)

This paper critically analyses ‘the paradox of autonomy and consent in maternity care’. It argues that maternity care has certain features that increase the need for explicit attention to, and respect for, both autonomy and rigorous informed consent processes. And, moreover, that the resulting need is considerably greater than in almost all other areas of medicine. These features are as follows: (1) maternity care involves particularly socially sensitive body parts that are regularly implicated in consent‐centred procedures, as well as in (...) unconsented interventions, in ordinary, non‐medical life; and (2) much of maternity care (especially intervening in childbirth) is medically unique, in that it harms one patient (the mother) not primarily for the promotion of her own health but for the benefit of another (the baby). The apt comparison, within medicine, is therefore with non‐therapeutic research and transplantation medicine—both of which have elevated consent requirements characterized by very rigorous consent processes. At the same time—and this delivers the titular paradox—the importance of autonomy and consent in maternity care is at particular risk of being denied or disregarded. Jointly, these considerations make a very strong case for change: attention to and respect for autonomy and consent should be (1) core values; (2) key points of practical attention in the years ahead; and (3) central quality indicators in maternity care. (shrink)

Research on organizational epistemic vice alleges that some organizations are epistemically malevolent, i.e. they habitually harm others by deceiving them. Yet, there is a lack of empirical research on epistemic malevolence. We connect the discussion of epistemic malevolence to the empirical literature on organizational deception. The existing empirical literature does not pay sufficient attention to the impact of an organization’s ability to control compromising information on its deception strategy. We address this gap by studying eighty high-penalty corporate misconduct cases (...) between 2000 and 2020 in the United States. We find that organizations use two different strategies to deceive: Organizations ‘sow doubt’ when they contest information about them or their impacts that others have access to. By contrast, organizations ‘exploit trust’ when they deceive others by obfuscating, concealing, or falsifying information that they themselves control. While previous research has focused on cases of ‘sowing doubt’, we find that organizations ‘exploit trust’ in the majority of cases that we studied. This has important policy implications because the strategy of ‘exploiting trust’ calls for a different response from regulators and organizations than the strategy of ‘sowing doubt’. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Invisible HarmKimberly ZieselmanI’m a 48–year–old intersex woman born with Androgen Insensitivity Syndrome (AIS) writing to share my personal experience as a patient affected by a Difference of Sex Development (DSD). Although I appear to be a DSD patient “success story”, in fact, I have suffered and am unsatisfied with the way I was treated as a young patient in the 1980’s, and the continued lack of appropriate care for (...) intersex people even today.As the Executive Director of the advocacy organization Advocates for Informed Choice and a board member of the AIS–DSD Support Group since 2012, I have heard doctors reference the “silent happy majority” of DSD patients all too often. They speak [End Page 122] of patients who were treated in childhood and went on to live (seemingly) contented lives. It appears however that doctors have drawn this conclusion from the fact that most of their patients have not returned to complain about their treatment. While there is little evidence to support the success doctors claim, there is quite a bit of evidence that suggests my suffering is the norm rather than the exception.Medical professionals would likely include me in that “silent majority,” only seeing a woman who identifies and appears typically female, graduated law school, married for over twenty years, with adopted children and a successful career. And while I have been fortunate in many ways, I no longer want my voice to be presumed buried within that silent majority. Instead, I am speaking out today to tell my story.My StoryAt age 15 I was diagnosed with amenorrhea and referred to a reproductive oncologist who told my parents I had a partially developed uterus and ovaries that would likely soon become cancerous. We were told my vagina was abnormally short and might require surgery in order to have heterosexual intercourse.Neither my parents nor I was ever told I had AIS and XY chromosomes, or that the gonads being removed were testes, not ovaries. I was told I needed a “full hysterectomy” to prevent cancer and hormone replacement therapy. That summer I spent my 16th birthday recuperating from surgery. I spent the next 25 years living a lie.A lie that has had a profound and harmful impact on me.At some level, I knew I was not being told the whole truth. My parents’ and the doctors’ actions signaled to me something more might be going on. But I was afraid to ask questions; my parents were distressed and I didn’t want to cause them any more pain. Over the years I have wondered just how much my parents knew but withheld from me (albeit with good intentions). I sensed something awful was being hidden from me, and I didn’t know whom I could trust.When I asked my doctor if I could meet someone else with my condition, I was told I was different, that there was “nobody” with my medical condition in the world, that my situation was “very rare.” I was told to get on with my life and not talk about my surgery because it wasn’t important; I was healthy and could adopt if I wanted to become a parent. I was told I must take a hormone pill each day for the rest of my life to stay healthy.But what I heard was, “you are not a real woman: you are a damaged freak, so go out and fake the rest of your life and be sure nobody knows your secret.” So that’s what I did. I was a “good girl” and took my pills, didn’t ask questions and did what the men in white coats asked me to do. There was no support provided for either my parents or me. No social workers, no therapists. Perhaps most shockingly, there was no true informed consent.A few years ago I was diagnosed with post-traumatic stress syndrome caused by anxiety I had been harboring for over two decades about my past surgery and fear of getting cancer. I decided to obtain my medical records from the hospital and discover the truth.Covering several pages of... (shrink)

In this paper I argue that philosophers of science have an obligation to recognize and engage with the social nature of the sciences they assess if those sciences are morally relevant. Morally-relevant science is science that has the potential to risk harm to humans, non-humans, or the environment. My argument and the approach I develop are informed by an analysis of the philosophy of biology literature on the criticism of evolutionary psychology, the study of the evolution of human psychology and (...) behaviour. From this literature, I tease out two different methods of scientific critique. The first I call the “truth-detectional” approach. Those who take this approach are first and foremost concerned about the truth of EP claims as that truth can be determined by evidence. The second I call the “social-dimensional” approach. Those who take this approach talk about the production and truth of EP claims but within a social framework. On this account, the legitimacy and perceived legitimacy of EP claims are not separate from the institutional and social processes and values that lend to their production. I show that the truth-detectional approach risks harms to society and to the philosophy of science, but that the social-dimensional approach avoids these harms. Philosophers of science, therefore, should take a social-dimensional approach to the assessment of morally-relevant science. (shrink)

Sufferers of body integrity identity disorder (BIID) experience a severe, non-delusional mismatch between their physical body and their internalised bodily image. For some, healthy limb amputation is the only alleviation for their significant suffering. Those who achieved an amputation, either self-inflicted or via surgery, often describe the procedure as resulting in relief. However, in England, surgeons who provide ‘elective amputations’ could face prosecution for causing grievous bodily harm (GBH) under section 18 of the Offences Against the Persons Act 1861. Whether (...) such a therapeutic intervention should be classified as GBH depends on the presence of harm, as, without harm, it is hard to argue that GBH has occurred. However, there is no agreed-upon definition of what constitutes harm. Such a definitional absence then begs the question, what is harm? It is this question which this article addresses, using the provision of healthy limb amputation in cases of BIID as an example. Drawing on metaphysics, this article will seek to clarify three separate contemporary models of harm: the counter-temporal, the counterfactual, and the non-comparative. Each model will be applied to the scenario of a surgeon carrying out a BIID-induced, therapeutic, healthy limb amputation, and in each, how harm may, or may not, be understood to have been caused will be explored. It concludes that an unexamined conception of harm is ill-equipped for employment in suspected cases of GBH when it is unclear whether harm has been caused and that a better-informed understanding of harm is required in cases where there is potential disagreement, be that in instances of BIID or a myriad of other borderline scenarios. (shrink)

Nocebo effects occur when an individual experiences undesirable physiological reactions caused by doxastic states that are not a treatment’s core or characteristic features.1 As Scott Gelfand2 points out, there are numerous studies that have shown that the disclosure of a treatment’s side effects to a patient increases the risk of the side effects. From an ethical point of view, nocebo effects caused by the disclosures of side effects present a challenging problem. On the one hand, clinicians’ duty to inform patients (...) of the consequences (including possible side effects) of their treatments is critical in ensuring that patients’ autonomy is respected. Patients cannot act autonomously if relevant information is withheld from them (without their consent, perhaps). On the other hand, clinicians also ought to minimize harm to patients. (shrink)

What is a crime? A common answer is that crimes are harms. One particular argument is that morality forms the connection between crimes and harms: crimes are not any kind of harm, but specifically a kind of immorality. This position is consistent with natural law jurisprudence which claims that law and morality are inseparably linked. It is also consistent with standard defences of retribution whereby punishment is justified where deserved and to the degree deserved. Retributivist desert is present for individuals (...) that possess some degree of moral responsibility for causing or attempting to cause evil. For example, the murderer deserves severe punishment because he is morally responsible for another person’s death and this act is sufficiently evil to warrant severe punishment. -/- The idea that crimes are harms to morals — and so their immorality informs their criminality and the corresponding severity of punishment — has also found favour with so-called ‘expressivist’ theories of punishment defended by Joel Feinberg, Antony Duff and others. These theories argue that punishment has an expressivist function of communication public disapproval to criminal offenders for their moral wrongdoings where punishment is proportionate to immorality. -/- The justification of crimes as harms to morals is part of a venerable tradition that has come to be increasingly seen as discredited. Most academics working in law (and even more practising lawyers) reject natural law jurisprudence and support some version of the separability thesis of legal positivism where law and morality are held to be separable, but not intrinsically and necessarily linked. Yet, curiously, retributivist theories, including expressivism, have been on the ascendency with a growing number of legal philosophers defending the idea of crimes as harms to morals and, therefore, moving in a contrary direction to most others working in law and academic law. -/- I believe this general position is deeply problematic and should be rejected. This chapter focuses specifically on expressivist theories as the increasingly more popular variant of retributivism in academic circles today. The next section provides an overview of expressivism. The following sections argue that it is not compelling both as a view about the criminal law, but also as a theory about punishment. I close the chapter with ideas about criminal harms might be better understood. I argue that crimes might be a kind of harm, but not the kinds of harm endorsed by retributivists and, more specifically, expressivists. (shrink)

This paper analyzes in the use of virtual reality when used to induce full-body ownership in violent offenders in order to elicit empathetic feelings by allowing them to embody the virtual body of a victim of domestic abuse. The authors explore potentially harmful effects to individuals participating in this kind of therapy and question whether consent is fully informed. The paper concludes with guidelines for ethical research and rehabilitation using this innovative technology.

In a recent discussion, Walter Glannon discusses a number of ways we might try to minimize harm to patients who experience intraoperative awareness. In this response I direct attention to a possibility that deserves further attention. It might be that a kind of psychological intervention – namely, informing patients of the possibility of intraoperative awareness and of what to expect in such a case – would constitute a unique way to respect patient autonomy, as well as minimize the harm that (...) typically follows intraoperative awareness events. (shrink)

The glaring lack of formal and informal caregivers in Germany has not only become apparent in hospitals and nursing homes but also in home care arrangements. One tension is particularly pertinent in such arrangements: a ‘family-oriented’ logic of the long-term care insurance and the individual wishes of those in need of care meet the actual possibilities of family carers. This care gap has been compensated for by 24-hour care workers, so-called ‘live-ins’, from Eastern Europe for some years. This contribution maps (...) the ‘live-ins’ situation comprehensively from an ethical perspective. Based on different constellations regarding the ‘live-ins’ status as a professional nurse or non-professional caregiver, which ethical principles and moral norms are affected by whom and potentially conflict with each other in such home care arrangements at a micro and meso level of care are outlined. Special attention is paid to the tension between self-care and care for others, and to questions of the shared responsibility in and social responsibility of those external services that are involved in home care in addition to the ‘live-in’. In order to uncover, understand and influence the current ethical problems, an ethical framework that considers both the divergent interests of all individuals involved in the home care arrangement and their mutual dependency and vulnerability is needed. (shrink)

People in extraordinary situations are vulnerable. As research participants, they are additionally threatened by abuse or exploitation and the possibility of harm through research. To protect people against these threats, informed consent as an instrument of self-determination has been introduced. Self-determination requires autonomous persons, who voluntarily make decisions based on their values and morals. However, in nursing research, this requirement cannot always be met. Advanced age, chronic illness, co-morbidity and frailty are reasons for dependencies. These in turn lead to limited (...) abilities or opportunities for decision-making and self-determination. Exclusion of vulnerable people from research projects would disadvantage them by not covering their needs, which would violate the ethical principles of justice and beneficence. Commonly, vulnerability is attributed to social groups. The consequence for individuals, attributed as belonging to such a vulnerable group, is that the principles of respect for autonomy, justice and beneficence are subordinated to the principle of non-maleficence, understood as avoiding the risk to cause more harm than good. In addition, group-specific attribution could lead to stigmatizing because labelling a person as deviation from a norm violates integrity. For clinical nursing research, the question arises how the protection of vulnerable people could be granted without compromising ethical principles. The concept of relational ethics provides a possible approach. It defines vulnerability as the relation between a person’s health status and the extent to which this person is dependent on the researcher and the research context. Vulnerability is not attributed solely to a person but to a situation, meaning the person is viewed in context. By combining vulnerability as a context-related and situational concept with existing approaches of informed consent, the different ethical principles can be balanced and preserved at every step of the research process. (shrink)

In the article ‘After-birth abortion: why should the baby live?’ arguments are made in favour of the moral permissibility of intentionally killing newborn infants, under particular conditions. Here we argue that their arguments are based on an indefensible view of personhood, and we question the logic of harm and interest that informs their arguments. Furthermore, we argue that the conclusions here are so contrary to ordinary moral intuitions that the argument and conclusions based upon it—including those which defend more mainstream (...) methods of abortion—should be treated with immediate suspicion. (shrink)

This article develops loneliness as a political and social justice issue by illustrating the harmful personal and social consequences of the medical jurisdiction over and constitution of variations in sex characteristics. Whilst connections between loneliness, health and illness have been well established, this work customarily identifies the ways illness can lead to, or be caused by, loneliness. Instead, I provide an account of the central role of medicalisation and medical management in producing loneliness. By doing so, I underline the (...) imperative for medical practice to consider its influence upon social and personal, as well as physical, wellbeing. Drawing on stories shared through solicited diaries followed by in-depth interviews with seven people with sex variations and two parents in the UK, I show how accounts of loneliness help to illuminate the violence of abandonment, silencing and marginalisation that often goes unheard, together with hidden or normalised systems of harm. Building on concepts of ethical loneliness and ontological loneliness, I show how structural violations operate to injure trust and self-worth, leading to social unease. I argue for the importance of people with sex variations finding sites of comfort and acceptance, but note the ways that some forms of medicalisation can inhibit alliances and community formation, despite diagnoses also carrying the potential to facilitate informal support structures and collective identities. By bringing together intersex studies with discourses of loneliness, I develop a better understanding of loneliness as a product of social and systemic violence, and the ways in which medical discourses tie in with larger structures of oppression, coercion and control. This article concludes by underlining the need for structural change in our approach to and understanding of sex variations, and with a call for us to become more attentive to these stories of medical harm, to ensure that they are heard and to seek necessary justice. (shrink)

Nocebo effects occur when an individual experiences undesirable physiological reactions caused by doxastic states that are not a treatment’s core or characteristic features.1 As Scott Gelfand2 points out, there are numerous studies that have shown that the disclosure of a treatment’s side effects to a patient increases the risk of the side effects. From an ethical point of view, nocebo effects caused by the disclosures of side effects present a challenging problem. On the one hand, clinicians’ duty to inform patients (...) of the consequences (including possible side effects) of their treatments is critical in ensuring that patients’ autonomy is respected. Patients cannot act autonomously if relevant information is withheld from them (without their consent, perhaps). On the other hand, clinicians also ought to minimize harm to patients. (shrink)

Unlike its friendly cousin the placebo effect, the nocebo effect (the effect of expecting a negative outcome) has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent (in clinical trials and clinical practice) has centred almost exclusively on the need to inform patients about (...) intervention risks with patients to preserve their autonomy. Researchers have failed to consider the harm caused by the way in which the information is conveyed. In this paper, I argue that the magnitude of nocebo effects must be measured using control groups consisting of untreated patients. And, because the nocebo effect can produce harm, the principle of non-maleficence must be taken into account alongside autonomy when obtaining (ethical) informed consent and communicating intervention risks with patients. (shrink)

Drawing on the work of previous scholars and information presented in previous chapters, Chapter 9 exposes the many harms of sexism and male privilege among social justice activists. Key harms include individual psychological harms (such as fear and stress, shame and self-hatred, and broken trust and despair), harms to organizations (such as squandered time, skills, people power, and funds), and harms to the effectiveness and integrity of the Animal Ethics Movement.

The purpose of this article is not to affirm or deny particular philosophical positions, but to explore the limits of intelligibility about what post-mortem harm means, especially in the light of improper post-mortem procedures at Bristol and Alder Hey hospitals in the late 1990s. The parental claims of post-mortem harm to dead children at Alder Hey Hospital are reviewed from five different philosophical perspectives, eventually settling on a crucial difference of perspective about how we understand harm to the dead. On (...) the one hand there is the broadly 'analytical' tradition1 of thinking that predicates the notion of harm on the basis of an existing subject. Since the dead are non-existent persons, it makes little sense to view the dead as being harmed. On the other hand, there is a phenomenological perspective, where the dead, in respect to the experience of grief, are existentially absent. This forms the basis that it is possible to harm grieving parent's experiences of how their dead are treated. The article ends with a short examination of what harming the dead implies for traditional bioethical concerns, namely, obtaining informed consent from significant others when planning medical research on the newly dead. (shrink)

Broad genome-wide testing is increasingly finding its way to the public through the online direct-to-consumer marketing of so-called personal genome tests. Personal genome tests estimate genetic susceptibilities to multiple diseases and other phenotypic traits simultaneously. Providers commonly make use of Terms of Service agreements rather than informed consent procedures. However, to protect consumers from the potential physical, psychological and social harms associated with personal genome testing and to promote autonomous decision-making with regard to the testing offer, we argue that current (...) practices of information provision are insufficient and that there is a place – and a need – for informed consent in personal genome testing, also when it is offered commercially. The increasing quantity, complexity and diversity of most testing offers, however, pose challenges for information provision and informed consent. Both specific and generic models for informed consent fail to meet its moral aims when applied to personal genome testing. Consumers should be enabled to know the limitations, risks and implications of personal genome testing and should be given control over the genetic information they do or do not wish to obtain. We present the outline of a new model for informed consent which can meet both the norm of providing sufficient information and the norm of providing understandable information. The model can be used for personal genome testing, but will also be applicable to other, future forms of broad genetic testing or screening in commercial and clinical settings. (shrink)

The carbon emissions of global health care activities make up 4–5% of total world emissions, placing it on par with the food sector. Carbon emissions are particularly relevant for health care because of climate change health hazards. Doctors and health care professionals must connect their health care delivery with carbon emissions and minimize resource use when possible as a part of their obligation to do no harm. Given that reducing carbon is a global ethical priority, the informed consent process in (...) health care delivery must change. I argue that the expanded role of bioethicists in this climate crisis is to promote and support “green informed consent:” the sharing of climate information with patients, offering options for lower-carbon health care, and accepting the patient’s right to decline treatments which are deemed too carbon intensive for their values. (shrink)