Cognitive archaeologists attempt to infer the cognitive and cultural features of past hominins and their societies from the material record. This task faces the problem of _minimum necessary competence_: as the most sophisticated thinking of ancient hominins may have been in domains that leave no archaeological signature, it is safest to assume that tool production and use reflects only the lower boundary of cognitive capacities. Cognitive archaeology involves selecting a model from the cognitive sciences and then assessing some aspect of (...) the material record through that lens. We give examples to show that background theoretical commitments in cognitive science that inform those models lead to different minimum necessary competence results. This raises an important question: what principles should guide us in selecting a model from the cognitive sciences? We outline two complementary responses to this question. The first involves using _independent_ lines of evidence to converge on a particular capacity. This can then influence model choice. The second is a broader suggestion. Theoretical diversity is a good thing in science, but is only beneficial over a limited amount of time. According to recent modelling work, one way of limiting diversity is to introduce extreme priors. We argue that having a broad spectrum of views in the philosophy of cognitive science may actually help cognitive archaeologists address the problem of minimum necessary competence. (shrink)

We are grateful for the careful reading and insightful responses of the several peer commentaries to our proposed approach to requests to withhold or withdraw life support therapies among patients...

We are grateful for the careful reading and insightful responses of the several peer commentaries to our proposed approach to requests to withhold or withdraw life support therapies among patients...

In lieu of an abstract, here is a brief excerpt of the content:Protecting Human Research SubjectsThe Office for Protection from Research RisksJoan Paine Porter (bio)The office for Protection from Research Risks (OPRR), located within the National Institutes of Health, has two divisions: Human Subject Protections and Animal Welfare. This article will address the overall responsibilities and current projects relating to human subject protections.OPRR implements the Department of Health and Human Services' (HHS) regulations for the protection of human subjects (45 CFR (...) 46 (1991)). These regulations fulfill the responsibilities set forth in the Public Health Service (PHS) Act with regard to institutional review boards (IRB) and other protections for human subjects involved in biomedical and behavioral research conducted or supported by HHS. The PHS Act also mandates a program to clarify ethical issues in biomedical research involving human subjects and to address violations of the rights of human subjects of research (P.L. 99-158 (1985)).OPRR staff negotiate assurances of compliance with institutions conducting Federally-supported research involving human subjects. The assurances describe the policies and procedures each institution will follow to fulfill the requirements of the regulations, including specific IRB composition and functions.In addition, OPRR cosponsors with the Food and Drug Administration and awardee institutions a series of regional workshops that address human subject protections issues. These are attended by IRB members, institutional officials, research investigators, and others involved with human subject protections.Current ActivitiesNumerous activities are underway in OPRR. The following describes only a few of the initiatives and studies aimed at helping develop policies and procedures to protect human subjects of research."Points to Consider" DocumentsOPRR is currently working with the National Center for Human Genome Research (NCHGR) to develop a "points to consider" document for IRBs and others involved in large genetic pedigree studies. Many questions have emerged [End Page 279] on topics such as how subjects should be recruited, with whom information should be shared about others in the family, social risks of disclosure in employment and insurance, the circumstances and timing of informing subjects about study results, and involvement of children. OPRR and NCHGR hope to assemble a group this fall to review and refine the points that are now being developed jointly. A conference in South Carolina organized by the American Association for Advancement in the Sciences entitled "Project on the Ethical and Legal Implications of Genetic Testing," helped generate advice, and identified some of the more controversial issues in design and conduct of genetic research that involves large groups of family members.Another "points to consider" effort concerns enrollment of women and minorities in research. The PHS has established a policy that members of these groups must be included in research projects unless there are valid scientific justifications for their exclusion which can be made on a project by project basis (ADAMHA/NIH Policy 1990; NIH/ADAMHA Policy 1990). OPRR has commissioned several scholarly papers to help in developing "points to consider" for IRBs as they balance issues of equitable selection of subjects and protection of these selected individuals. Concerns about enrolling women of childbearing age in research that may be harmful to a fetus, and liability issues frequently dominate discussion in this area. The papers will address ethical, legal, and statistical aspects of enrollment of minorities and women as well as provide a description of various practices and roles of IRBs in addressing goals of fair selection of participants and appropriate protections.OPRR is also working with the PHS Panel on Women, Adolescents and Children to produce a document, also in the form of "points to consider" guidance, concerning enrollment of children who are wards of the state in HIV-related research. Subpart D of the regulations for the protection of human subjects (45 CFR 46) specifically addresses research involving children who are wards of the state, including the special protections that must be provided. State and local officials who have authority to enroll foster care children in research have indicated a desire to obtain advice in this area.The IRB GuidebookA major project that is now being completed under contract to the Poynter Center at Indiana University is the IRB Guidebook. It will revise and expand the current IRB Guidebook produced in the 1980s... (shrink)

This paper posits a feminist aesthetic of reading, ‘re-captivation,’ which accounts for both the reader's pleasure and his/her ethical responsibility. Re-captivation is distinguished by its introspective and ethical characteristics; it is a pleasure informed by the pain of misrecognition, i.e. acknowledgement of one's own complicity in systems of oppression. After a brief explanation of re-captivation, this paper describes my experience viewing the film Menace II Society. Using my paths of identification and emotional response to this film as my (...) data, I analyze the complexities and ambiguities resulting from my practice of re-captivation. (shrink)

There is growing interest in the role of new urban agriculture models to increase local food production capacity in cities of the Global North. Urban rooftop greenhouses and hydroponics are examples of such models receiving increasing attention as a technological approach to year-round local food production in cities. Yet, little research has addressed the unintended consequences of new modes of urban farming and food distribution, such as increased competition with existing peri-urban and rural farmers. We examine how small-scale farmers perceive (...) and have responded to a recently established rooftop greenhouse and online marketplace enterprise in Montréal, Canada. Drawing on interviews with key informants and small-scale farmers, we find that peri-urban and rural producers have been affected in three key ways that represent tensions, adaptations, and synergies arising from this new urban agriculture and food distribution enterprise. First, many farmers are concerned about increased competition and value conflation with the ideals of community supported agriculture and organic farming. Second, some farmers have adapted by developing novel marketing strategies and working with local bridge organizations to collectively market their produce to urban consumers. Third, a few farmers have decided to wholesale their produce to this new enterprise, allowing them to specialize production and avoid marketing their produce directly to urban consumers. Our study suggests that the emergence of a new form of alternative food network in Montréal has created both positive and negative disruptions for existing small-scale producers. Advocates for the expansion of new urban food production and distribution models should therefore give greater consideration to the effects on other actors in the local food system. (shrink)

Frédérique de Vignemont argues on the basis of several empirical counterexamples that Bain and Klein are wrong about the relationship between pain and bodily care. I argue that the force of the putative counterexamples is weak. Properly understood, the association between pain and care is preserved in a way that is consistent with both de Vignemont's own views and the empirical facts.

Ben Rich, J.D., Ph.D., presents a scholarly, passionate view of the ethics of the His manuscript is detailed, analytical, and compassionate. No reasonable sensitive person, especially a physician committed to caring for patients, can disagree with the proposal that human beings should have their physical, emotional, and spiritual pain tended to aggressively, meticulously, and compassionately. Similarly, the same individuals advocating for such pain management would agree that no one should go to jail unless he or she is guilty (...) of a serious crime, that decent people should not be robbed or murdered, that children should not be hungry or homeless, and that all citizens of the United States deserve healthcare. Our society attempts to achieve these goals. Laws are written, discussed, and approved by state and federal congresses, voted on by citizens, and theoretically upheld by the courts, churches, and decent individuals. But, unless the world suddenly becomes inhabited by virtuous, ethical humans who can unfailingly differentiate from then, in spite of an abundance of laws and lawyers, doctors, and nurses, this world will continue to have pain and suffering. And, although we want to hold our doctors, politicians, educators, champion athletes, and others to than the average citizen, it is best to remind ourselves frequently that all humans can be weak and are bound to make imprecise judgments, that there is not a homogenous definition of that values and religious beliefs are variable. (shrink)

Maura Tumulty has raised two objections to my imperative account of pain.1 First, she argues that there is a disanalogy between pains and other imperative sensations like itch, hunger, and thirst. Suppose (with Hall) one thinks that an itch says “Scratch here!”2 Scratch the itch, and it dutifully disappears. Not so with pain. The pain of a broken ankle has the content ‘Do not put weight on that ankle!’ Yet the coddled ankle still throbs: obeying the imperative (...) does not extinguish it. Second, Tumulty argues that the imperative account cannot handle certain pains, particularly pains of the deep viscera. On my account, pains proscribe against taking action with the painful body part. Yet some pains are associated with body parts over which we have no control. Kidney stones cause intense pain, but I cannot (voluntarily) control my kidney. What action, then, could that pain possibly proscribe? Lacking such a story, it is hard to say (as I do) that pains are exhausted by their imperative content. (shrink)

In a recent article in this journal, Carl Knight and Andreas Albertsen argue that Rawlsian theories of distributive justice as applied to health and healthcare fail to accommodate both palliative care and the desirability of less painful treatments. The asserted Rawlsian focus on opportunities or capacities, as exemplified in Normal Daniels’ developments of John Rawls’ theory, results in a normative account of healthcare which is at best only indirectly sensitive to pain and so unable to account for the value (...) of efforts of which the sole purpose is pain reduction. I argue that, far from undermining the Rawlsian project and its application to problems of health, what the authors’ argument at most amounts to is a compelling case for the inclusion of freedom from physical pain within its index of primary goods. (shrink)

Williams argues that humans have evolved special purpose adaptations for eliciting medical attention from others, such as a specific facial expression of pain. She also recognises that such adaptations would almost certainly have coevolved with adaptations for providing and responding to medical care. The placebo response may be one such adaptation, and any evolutionary account of pain must also address this important phenomenon.

The ability of RtoP to deliver has been mixed, but it is a bit early in RtoP's young life to judge what it will be when it grows up as a mature policy tool. There is reason to question, as well, whether Somalia and Darfur are the best tests of RtoP's potential.

Pain medication is one of the responses to the mercy argument that utilitarian ethicists use for justifying active euthanasia on the grounds of prevention of cruelty and appeal to beneficence. The researcher reinforces the significance of pain medication in meeting this challenge and considers it the most preferred response among various other responses. It is because of its realism and effectiveness. In exploring the mechanism and considerations related to pain medication, the researcher briefly touches the Catholic (...) ethical position on the issue, a position that cannot be ignored in the development of contemporary bioethics. The researcher particularly deliberates on the contemporary Islamic discourse on the issue; by furthering the debate in line with the Islamic legal maxims and general guidance from the primary sources of Islamic law and ethics. The resolution on the issue is sought by synthesizing the views and legal maxims (al-Qawaid al-Fiqhiyyah) on the issue, which in conclusion provide justification for pain medication by considerably regarding pain as necessity and pressing need. However, such resolution allows pain medication to the limit and proportion that removes the pain and prohibits overdosing the patient with medication that may directly cause the death. (shrink)

Objective: Parental influence during children’s “everyday” pain events is under-explored, compared to clinical or experimental pains. We trialed two digital reporting methods for parents to record the real-world context surrounding their child’s everyday pain events within the family home.Methods: Parents completed a structured e-diary for 14 days, reporting on one pain event experienced by their child each day, and describing child pain responses, parental supervision, parental estimates of pain severity and intensity, and parental catastrophizing, distress, (...) and behavioral responses. During the same 2-week period, a subsample of parent-child pairs completed digital ecological momentary assessments, immediately after any chosen pain event. Children reported their current pain while parents estimated the child’s pain and indicated their own distress.Results: “Everyday” pain events frequently featured minor injuries to the child’s head, hands or knees, and child responses included crying and non-verbal comments. Pain events occurred less frequently when parents had been supervising their child, and supervising parents reported lower levels of worry and anxiety than non-supervising parents. Child sex was significantly associated with parental estimates of pain intensity, with parents of girls giving higher estimates than parents of boys. Child age was significantly associated with both the number of pain events and with parental estimates of pain intensity and child distress: the youngest children experienced the fewest pain events but received higher pain and distress estimates from parents than older children. Hierarchal Linear Modeling revealed that parental estimates of pain severity were significant positive predictors of parental distress and catastrophizing in response to a specific pain event. Furthermore, higher levels of parental catastrophic thinking in response to a specific pain event resulted in increased distress, solicitousness, and coping-promoting behaviors in parents. The EMA data revealed that children reported significantly higher pain intensity than their parents.Conclusion: The electronic pain diary provided a key insight into the nature of “everyday” pain experiences around the family home. Digital daily reporting of how the family copes with “everyday” events represents a viable means to explore a child’s everyday pains without disrupting their home environment. (shrink)

Social exclusion has a significant impact on cognition, emotion, and behavior. Some behavioral studies investigated how social exclusion affects pain empathy. Conclusions were inconsistent, and there is a lack of clarity in identifying which component of pain empathy is more likely to be affected. To investigate these issues, we used a Cyberball task to manipulate feelings of social exclusion. Two groups participated in the same pain empathy task while we recorded event-related potentials when participants viewed static images (...) of body parts in painful and neutral situations. The results showed early N2 differentiation between painful and neutral pictures in the central regions in both groups. The pattern at the late controlled processing stage was different. Parietal P3 amplitudes for painful pictures were significantly smaller than those for neutral pictures in the social exclusion group; they did not differ in the social inclusion group. We observed a parietal late positive potential differentiation between painful and neutral pictures in both groups. LPP amplitudes were significantly smaller in the social exclusion group than those in the social inclusion group for painful stimuli. Our results indicate that social exclusion does not affect empathic responses during the early emotional sharing stage. However, it down-regulates empathic responses at the late cognitive controlled stage, and this modulation is attenuated gradually. The current study provides neuroscientific evidence of how social exclusion dynamically influences pain empathy. (shrink)

Learning new movement patterns is a normal part of daily life, but of critical importance in both sport and rehabilitation. A major question is how different sensory signals are integrated together to give rise to motor adaptation and learning. More specifically, there is growing evidence that pain can give rise to alterations in the learning process. Despite a number of studies investigating the role of pain on the learning process, there is still no systematic review to summarize and (...) critically assess investigations regarding this topic in the literature. Here in this systematic review, we summarize and critically evaluate studies that examined the influence of experimental pain on motor learning. Seventeen studies that exclusively assessed the effect of experimental pain models on motor learning among healthy human individuals were included for this systematic review, carried out based on the preferred reporting items for systematic reviews and meta-analyses statement. The results of the review revealed there is no consensus regarding the effect of pain on the skill learning acquisition and retention. However, several studies demonstrated that participants who experienced pain continued to express a changed motor strategy to perform a motor task even 1 week after training under the pain condition. The results highlight a need for further studies in this area of research, and specifically to investigate whether pain has different effects on motor learning depending on the type of motor task. (shrink)

Why are pains bad for us? A natural answer is that it is just because of how they feel (or their felt-qualities). But this answer is cast into doubt by cases of people who are unbothered by certain pains of theirs. These pains retain their felt-qualities, but do not seem bad for the people in question. In this paper, I offer a new response to this problem. I argue that in such cases, the pains in question have become “just (...) more of the same,” and for this reason have ceased to be bad for the relevant individuals. It is because they (implicitly) recognise this that they are unbothered by such pains. (shrink)

BackgroundMental stress and imbalance of its two neural stress systems, the autonomic nervous system and the hypothalamic–pituitary–adrenal axis, are associated with chronic prostatitis/chronic pelvic pain syndrome and erectile dysfunction. However, the comprehensive analyses of psychological stress and stress systems are under-investigated, particularly in CP/CPPS patients complicated by lower urinary tract symptoms and ED.Materials and methodsParticipants were 95 patients in CP/CPPS+ED group, 290 patients in CP/CPPS group, 124 patients in ED group and 52 healthy men in control group. The National (...) Institutes of Health Chronic Prostatitis Symptom Index, the International Index of Erectile Function-5 and the International Prostate Symptom Score were used for assessing the disease severity of CP/CPPS, LUTS and ED. Psychometric self-report questionnaires including the Beck Anxiety Inventory, Perceived Stress Scale, Type A Personality Test and Symptom Checklist 90 were completed for distress from physical symptoms. Twenty-five subjects per group were randomly selected for further investigating the changes of the HPA axis and ANS. Saliva samples were taken on 3 consecutive days at 8 specific times with strict reference to time of morning awakening for evaluation of free cortisol. Heart rate variability as marker of the ANS was measured using 24 h electrocardiography, and time-and frequency-domain variables were analyzed.ResultsThe BAI and SCL-90 scores were significantly higher in the CP/CPPS+ED, CP/CPPS and ED groups compared with the control group. The PSS scores of both groups with ED were significantly higher than the control group. Compared with the CP/CPPS group, the differences of PSS, SCL-90 and TAPT scores were statistically significant in CP/CPPS+ED patients. The IPSS scores were shown to have significantly positive correlations with BAI, PSS and SCL-90 in the CP/CPPS patients. However, in all subjects, the IIEF-5 scores were shown to have significantly negative correlations with BAI, PSS, SCL-90 and quality of life score in NIH-CPSI. Cortisol awakening response parameters and diurnal cortisol levels did not significantly vary between the four groups. Time-dependent parameters of HRV also did not differ significantly across groups. In the frequency domain analysis, low frequency was significantly lower in ED patients when compared with CP/CPPS+ED patients and healthy controls, high frequency power was significantly higher in healthy controls compared to patients with ED, CP/CPPS and CP/CPPS+ED, and the CP/CPPS+ED group had significantly higher LF/HF ratio than the control group.ConclusionCP/CPPS and ED patients score exceedingly high on most psychosocial variables. The symptom scores of LUTS and ED positively correlate with the severity of psychological stress. Our findings also suggest that the ANS sympathovagal imbalance is associated with ED and LUTS in CP/CPPS, whereas HPA axis activity is not. (shrink)

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/uws) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of (...) artificial nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/uws more respondents agreed with treatment withdrawal when they considered that VS/uws patients did not feel pain (77%) as compared to those who thought VS/uws did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)

The question of whether a fetus can experience pain is an immense challenge. The issue demands consideration of the physical and psychological basis of being and the relation between the two. At the center of this debate is the question of how it is that we are conscious, a question that has inspired the writing of some of our most brilliant contemporary philosophers and scientists, with one commentary suggesting surrender. In my earlier review I attempted to draw together the (...) various strands of thinking that had attacked the question of fetal pain and relate them back to the bigger question of consciousness. In their vituperative response, Benatar and Benatar bite off my finger before looking to where I am pointing. I will examine each of their criticisms and attempt to redirect the readers' interest towards examining the subjectivity of pain and the mediating links between physiology and experience. (shrink)

Chronic pain affects a large part of the population causing functional disability, being often associated with coexisting psychological disorders, such as depression and anxiety, besides cognitive deficits, and sleep disturbance. The world elderly population has been growing over the last decades and the negative consequences of chronic pain for these individuals represent a current clinical challenge. The main painful complaints in the elderly are related to neurodegenerative and musculoskeletal conditions, peripheral vascular diseases, arthritis, and osteoarthritis, contributing toward poorly (...) life quality, social isolation, impaired physical activity, and dependence to carry out daily activities. Organ dysfunction and other existing diseases can significantly affect the perception and responses to chronic pain in this group. It has been proposed that elderly people have an altered pain experience, with changes in pain processing mechanisms, which might be associated with the degeneration of circuits that modulate the descending inhibitory pathways of pain. Aging has also been linked to an increase in the pain threshold, a decline of painful sensations, and a decrease in pain tolerance. Still, elderly patients with chronic pain show an increased risk for dementia and cognitive impairment. The present review article is aimed to provide the state-of-art of pre-clinical and clinical research about chronic pain in elderly, emphasizing the altered mechanisms, comorbidities, challenges, and potential therapeutic alternatives. (shrink)

McCaffery's definition of pain has proven to be one of the most consequential in nursing and healthcare more generally. She put forward this definition in response to the persistent undertreatment of pain. However, despite raising her definition to the status of a dogma, the undertreatment remains a real problem. This essay explores the contention that McCaffery's definition of pain elides critical aspects of it, aspects that demand consideration when treating pain. In section I, I set (...) the stage. I discuss how McCaffery's definition and her understanding of pain science interrelate. In section II, I raise three problems for this understanding. In section III, I argue that these problems stem from an incoherency in her definition. Finally, in section IV, I draw from hospice nursing as well as philosophy and the social sciences to redefine ‘pain’ so that an intersubjective feature of it is foregrounded. I also briefly discuss one implication this redefinition has for pain management. (shrink)

By definition, pain is a sensory and emotional experience that is felt in a particular part of the body. The precise relationship between somatic events at the site where pain is experienced, and central processing giving rise to the mental experience of pain remains the subject of debate, but there is little disagreement in scholarly circles that both aspects of pain are critical to its experience. Recent experimental work, however, suggests a public view that is at (...) odds with this conceptualisation. By demonstrating that the public does not necessarily endorse central tenets of the “mental” view of pain (subjectivity, privacy, and incorrigibility), experimental philosophers have argued that the public holds a more “body-centric” view than most clinicians and scholars. Such a discrepancy would have important implications for how the public interacts with pain science and clinical care. In response, we tested the hypothesis that the public is capable of a more “mind-centric” view of pain. Using a series of vignettes, we demonstrate that in situations which highlight mental aspects of pain the public can, and does, recognize pain as a mental phenomenon. We also demonstrate that the public view is subject to context effects, by showing that the public’s view is modified when situations emphasizing mental and somatic aspects of pain are presented together. (shrink)