The possible-worlds semantics for modality says that a sentence is possibly true if it is true in some possible world. Given classical prepositional logic, one can easily prove that every consistent set of propositions can be embedded in a ‘maximal consistent set’, which in a sense represents a possible world. However the construction depends on the fact that standard modal logics are finitary, and it seems false that an infinite collection of sets of sentences each finite subset of which is (...) intuitively ‘possible’ in natural language has the property that the whole set is possible. The argument of the paper is that the principles needed to shew that natural language possibility sentences involve quantification over worlds are analogous to those used in infinitary modal logic. (shrink)

Keine ausführliche Beschreibung für "Einführung in die Modallogik" verfügbar.

Some organisations make vaccination a condition of employment. This means prospective employees must demonstrate they have been vaccinated (eg, against measles) to be hired. But it also means organisations must decide whether _existing_ employees should be expected to meet newly introduced vaccination conditions (eg, against COVID-19). Unlike prospective employees who will not be _hired_ if they do not meet vaccination conditions, existing employees who fail to meet new vaccination conditions risk being _fired_. The latter seems worse than the former. Hence, (...) objections to vaccination mandates commonly centre on the harms that will be visited on existing employees who are unwilling to be vaccinated. However, because this objection does not necessarily entail the claim that vaccination is unnecessary for the effective and safe performance of certain jobs, those making this objection should have less of an objection, or no objection at all (at least on these grounds), to introducing vaccination requirements in some cases for _prospective_ employees. Yet, in this paper, I shall argue that if one has reason to believe vaccination requirements can be justified for prospective employees, one should also believe they are justified for existing employees _despite_ any asymmetry in consequences experienced by the two groups. As a consequence, common objections made against vaccination mandates grounded solely in the harms that may be experienced by existing employees who are unwilling to be vaccinated should be considered unpersuasive. (shrink)

We present a multiscale integrationist interpretation of the boundaries of cognitive systems, using the Markov blanket formalism of the variational free energy principle. This interpretation is intended as a corrective for the philosophical debate over internalist and externalist interpretations of cognitive boundaries; we stake out a compromise position. We first survey key principles of new radical views of cognition. We then describe an internalist interpretation premised on the Markov blanket formalism. Having reviewed these accounts, we develop our positive multiscale account. (...) We argue that the statistical seclusion of internal from external states of the system—entailed by the existence of a Markov boundary—can coexist happily with the multiscale integration of the system through its dynamics. Our approach does not privilege any given boundary, nor does it argue that all boundaries are equally prescient. We argue that the relevant boundaries of cognition depend on the level being characterised and the explanatory interests that guide investigation. We approach the issue of how and where to draw the boundaries of cognitive systems through a multiscale ontology of cognitive systems, which offers a multidisciplinary research heuristic for cognitive science. (shrink)

South Africa shared with the world the warning of a new strain of SARS-CoV2, Omicron, in November 2021. As a result, many high-income countries (HICs) instituted complete travel bans on persons leaving South Africa and other neighbouring countries. These bans were unnecessary from a scientific standpoint, and they ran counter to the International Health Regulations. In short, South Africa was penalized for sharing data. Data sharing during pandemics is commonly justified by appeals to solidarity. In this paper, we argue that (...) solidarity is, at best, an aspirational ideal to work toward but that it cannot ground an obligation to share data. Instead, low-and-middle income countries (LIMCs) should be guided by the principle of reciprocity, which states that we ought to return good for good received. Reciprocity is necessarily a conditional principle. LMICs, we argue, should only share data during future pandemics on the condition that HICs provide enforceable assurances that the benefits of data sharing will be equitably distributed and that LMICs won’t be penalized for sharing information. (shrink)

This paper presents a version of neurophenomenology based on generative modelling techniques developed in computational neuroscience and biology. Our approach can be described as _computational phenomenology_ because it applies methods originally developed in computational modelling to provide a formal model of the descriptions of lived experience in the phenomenological tradition of philosophy (e.g., the work of Edmund Husserl, Maurice Merleau-Ponty, etc.). The first section presents a brief review of the overall project to naturalize phenomenology. The second section presents and evaluates (...) philosophical objections to that project and situates our version of computational phenomenology with respect to these projects. The third section reviews the generative modelling framework. The final section presents our approach in detail. We conclude by discussing how our approach differs from previous attempts to use generative modelling to help understand consciousness. In summary, we describe a version of computational phenomenology which uses generative modelling to construct a computational model of the inferential or interpretive processes that best explain this or that kind of lived experience. (shrink)

This paper aims to address the relevance of the natural sciences for transcendental phenomenology, that is, the issue of naturalism. The first section distinguishes three varieties of naturalism and corresponding forms of naturalization: an ontological one, a methodological one, and an epistemological one. In light of these distinctions, in the second section, I examine the main projects aiming to “naturalize phenomenology”: neurophenomenology, front-loaded phenomenology, and formalized approaches to phenomenology. The third section then considers the commitments of Husserl’s transcendental phenomenology with (...) respect to the three varieties of naturalism previously discussed. I argue that Husserl rejected strong and weak forms of epistemological naturalism, strong methodological naturalism, and ontological naturalism. The fourth section presents the argument that Husserl endorsed a weak, conditional form of methodological naturalism. This point is illustrated with Husserl’s proposal of “somatology,” a natural science apt to study the corporeality of the lived body. The final section addresses the complementarity and respective limits of the transcendental phenomenological and the natural scientific frameworks. I argue that, on Husserl’s account, the function of transcendental phenomenology with respect to the natural sciences is to provide them with an epistemological foundation and an ontological clarification. I suggest that certain natural sciences can be understood, within the transcendental phenomenological framework, as “sciences of constitution,” that is, as sciences investigating the contribution of real structures acting as conditions of possibility for the occurrence of certain kinds of comprehensive unities in lived experience. (shrink)

The most powerful lesson learned from the 2013-2016 outbreak of Ebola in West Africa was that we do not learn our lessons. A common sentiment at the time was that Ebola served as a “wake-up call”—an alarm which signalled that an outbreak of that magnitude should never have occurred and that we are ill-prepared globally to prevent and respond to them when they do. Pledges were made that we must learn from the outbreak before we were faced with another. Nearly (...) five years later the world is in the grips of a pandemic of the severe acute respiratory syndrome coronavirus 2 that causes coronavirus disease 2019. It is therefore of no surprise that we are now yet again hearing that the COVID-19 pandemic serves as the “wake-up call” we need and that there are many lessons to be learned to better prepare us for future outbreaks. Will anything be different this time around? We argue that nothing will fundamentally change unless we truly understand and appreciate the nature of the lessons we should learn from these outbreaks. Our past failures must be understood as moral failures that offer moral lessons. Unless we appreciate that we have a defect in our collective moral attitude toward remediating the conditions that precipitate the emergence of outbreaks, we will never truly learn. (shrink)

Three experiments are reported in which the relationships between task format, item type, and strategy usage were investigated for a two-dimensional relational inference task. Contrary to past findings with linear syllogisms, it was found that parallel presentation (presenting problem statements simultaneously) did not result in any increased use of deduction rule processes compared with serial presentation (presenting problem statements individually). Instead, the results suggested that mental models were used by the majority of subjects, and that multiple models were more likely (...) to be constructed with parallel presentation. It is proposed that, in general, multiple model construction will be more frequent for deduction tasks where the cognitive load is relatively low. Hence, contrary to suggestions by Polk and Newell (1995), reasoning in this way appears to be prevalent and highly robust - where supported by task format - even where the use of this strategy is disadvantageous. (shrink)

The exercise of identifying lessons in the aftermath of a major public health emergency is of immense importance for the improvement of global public health emergency preparedness and response. Despite the persistence of the Ebola Virus Disease outbreak in West Africa, it seems that the Ebola ‘lessons learned’ exercise is now in full swing. On our assessment, a significant shortcoming plagues recent articulations of lessons learned, particularly among those emerging from organizational reflections. In this article we argue that, despite not (...) being recognized as such, the vast majority of lessons proffered in this literature should be understood as ethical lessons stemming from moral failures, and that any improvements in future global public health emergency preparedness and response are in large part dependent on acknowledging this fact and adjusting priorities, policies and practices accordingly such that they align with values that better ensure these moral failures are not repeated and that new moral failures do not arise. We cannot continue to fiddle at the margins without critically reflecting on our repeated moral failings and committing ourselves to a set of values that engenders an approach to global public health emergencies that embodies a sense of solidarity and global justice. (shrink)

Many researchers have suggested that premise interpretation errors can account, at least in part, for errors on categorical syllogisms. However, although it is possible to show that people make such errors in simple inference tasks, the evidence for them is far less clear when actual syllogisms are administered. Part of the problem is due to the lack of clear predictions for the solutions that would be expected when using modified quantifiers, assuming that correct inferences are made from them. This paper (...) presents the expected solutions for Gricean, reversible, and reversible Gricean interpretations, and evaluates these using three datasets (two currently available, and one new). The evidence supported the adoption of reversible and reversible Gricean interpretations, but not Gricean interpretations on their own. These results suggest that the categorical syllogism task tends to induce different quantifier interpretations from those identified in simple inference tasks. (shrink)

Ever since they were first published, the works of Bernard Mandeville have met with a few careful readers as well as with a larger number of stupid or unscrupulous assailants. Both classes are faithfully recorded at the end of F. B. Kaye's splendid edition of The Fable of the Bees , which has helped to revive interest in Mandeville, and which has moulded the current estimate of his ideas: the treatment of Mandeville in such a work as Basil Willey's Eighteenth (...) Century Background is confessedly based almost entirely on Kaye. My purpose in this paper is to suggest some modifications of the account given by Kaye, and to make claims for Mandeville's importance in one particular field, the relation of ethics to politics. (shrink)

Health equity is increasingly identified as a principal goal to be achieved through public health policies and activities. However, what is to be measured in the assessment of health equity and how inequities in health ought to be redressed are among the pressing questions that must be answered if health equity is to serve as a meaningful and consistent ethical guide for measurement and intervention in public health. In this article I argue that the concept of health equity, in the (...) form it is predominantly found in public health, suffers from normative indeterminacy and is therefore unlikely to provide actionable normative guidance to public health policy-makers, practitioners and researchers. I argue that the concept of health equity, as it is commonly defined in public health, ultimately rests upon assumptions of a more fundamental, yet tacit, conception of justice to do its normative work. In this vein, I expand upon a critique of Margaret Whitehead’s oft-cited definition of health equity made by James Wilson to raise additional reasons not explored by Wilson, or others, as to why Whitehead’s definition remains inadequate in providing normative guidance to policy-makers, practitioners and researchers in public health. (shrink)

The unprecedented outbreak of Ebola virus disease in West Africa has raised several novel ethical issues for global outbreak preparedness. It has also illustrated that familiar ethical issues in infectious disease management endure despite considerable efforts to understand and mitigate such issues in the wake of past outbreaks. To improve future global outbreak preparedness and response, we must examine these shortcomings and reflect upon the current state of ethical preparedness. To this end, we focus our efforts in this article on (...) the examination of one substantial area: ethical guidance in pandemic plans. We argue that, due in part to their focus on considerations arising specifically in relation to pandemics of influenza origin, pandemic plans and their existing ethical guidance are ill-equipped to anticipate and facilitate the navigation of unique ethical challenges that may arise in other infectious disease pandemics. We proceed by outlining three reasons why this is so, and situate our analysis in the context of the EVD outbreak and the threat posed by drug-resistant tuberculosis: different infectious diseases have distinct characteristics that challenge anticipated or existing modes of pandemic prevention, preparedness, response, and recovery, clear, transparent, context-specific ethical reasoning and justification within current influenza pandemic plans are lacking, and current plans neglect the context of how other significant pandemics may manifest. We conclude the article with several options for reflecting upon and ultimately addressing ethical issues that may emerge with different infectious disease pandemics. (shrink)

Scholars often turn to Livy’s famous digression on Aulus Cossus and the spolia opima (4.17–20) to shed light on his larger political inclinations. These readings generally regard Livy as either an Augustan (or at least a patriotic Roman) or an apolitical skeptic. Yet neither view, I argue, fully explains the Cossus affair. What is needed is an interpretation that recognizes the political nature of the Cossus digression and its skepticism toward Augustus. Attending to Livy’s rhetorical strategy in the digression allows (...) us to see it as an instance of oblique criticism of Augustus and his control over Roman life. The explanatory power of this reading extends to episodes from the life of Romulus as well. I argue Livy uses these stories to make a theoretical argument about the nature of despotism, namely, that it seeks to control narratives of the past just as much as it aims for political domination. (shrink)

Open peer commentary on the article “A Moving Boundary, a Plastic Core: A Contribution to the Third Wave of Extended-Mind Research” by Timotej Prosen. Abstract: We argue that the free-energy principle (FEP) can indeed be used to articulate a conception of the boundaries of cognitive systems that meets the desiderata of third-wave extended-mind research. We point out that Markov blankets under the FEP definitionally constitute the means through which internal and external states are coupled, and so do not isolate systems (...) from their environment. We argue that the nested, multiscale boundaries of the FEP formulation are indeed plastic and open to re-negotiation. Finally, we appeal to the formulation of niche construction under the FEP to argue that the extension of cognitive boundaries in this formulation is both synchronic and diachronic. (shrink)

In their target paper, Bruineberg and colleagues provide us with a timely opportunity to discuss the formal constructs and philosophical implications of the free energy principle. I critically discuss their proposed distinction between Pearl and Friston blankets. I then critically assess the distinction between inference with a model and inference within a model in light of instrumentalist approaches to science.

The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore not a purely scientific or technical exercise, but are fundamentally grounded in ethics. The latest (...) treaty draft reflects these ethical considerations by including a section entitled Guiding Principles and Approaches. Most of these principles are ethical—they establish core values that undergird the treaty. Unfortunately, the treaty draft's set of principles are numerous, overlapping, and show inadequate coherence and consistency. We propose two improvements to this section of the draft pandemic treaty. First, key guiding ethical principles should be clearer and more precise than they currently are. Second, the link between ethical principles and policy implementation should be clearly established and define boundaries on acceptable interpretation, ensuring that signatories abide by these principles. (shrink)

In democratic theory, “legitimacy” refers to the set of conditions that must be in place in order for the claims to authority of somebody to be deemed appropriate, and for their claims to compliance to be warranted. Though criteria of legitimacy have been elaborated in the context of democratic states, there is no reason for them not to be drawn up, with appropriate amendments, for other kinds of authority structures. This paper examines the claims to authority made over researchers by (...) international bodies governing research ethics, who exercise their authority by the research ethics guidelines they produce (including recent revisions to the Declaration of Helsinki and CIOMS Guidelines). We argue that discussions of such bodies and sets of guidelines often elide questions of justification and questions of legitimacy, and that the grounds that might allow us to mount a strong case for the latter are at present sorely underdeveloped. (shrink)

The primary aim of menu labelling should be understood as informing consumers such that they are better able to make informed food purchasing and consumption decisions; the extent to which consumers’ behaviours or, indeed, health outcomes, are affected may be contingent on several other factors and should therefore be considered more distal aims of what menu labelling intends to, or is able to, achieve. It is of importance to be clear about the nature and scope of menu labelling, including what (...) it might reasonably be expected to achieve, in order to elucidate the morally relevant equity considerations that ought to accompany the design and implementation of such interventions. This commentary attempts to begin to specify what these equity considerations ought to look like given the specific situational and dispositional factors associated with menu labelling. It concludes that the goals of menu labelling interventions should be, at a minimum, to strive to give consumers equality of access to nutrition information and/or the equal opportunity or capability to make informed food decisions in the eating out environment. These considerations support a universal approach to menu labelling, but may also require targeted strategies to attend to the needs of those less capable of making informed food decisions. (shrink)

Older age is one of the greatest risk factors for severe outcomes from COVID-19. If we believe it is important to use limited supplies of COVID-19 vaccines to protect the most vulnerable and prevent deaths, then available doses should be allocated with significant priority to older adults. Yet, we should resist the conclusion that age should be the sole criterion for COVID-19 vaccine prioritisation or that no younger populations (eg, those under the age of 60) should be prioritised until all (...) older adults have been vaccinated. This article examines arguments that are commonly presented to abandon ‘complex’ vaccine prioritisation schemes in favour of ‘just using age’ (eg, prioritising those 80 years of age and older and then decreasing in a 5-year age bands until the entire population has had the opportunity to be vaccinated), and articulates the ethical reasons why these arguments are not persuasive. (shrink)

The American Journal of Bioethics, Volume 12, Issue 6, Page 15-17, June 2012.

An important debate in the reasoning literature concerns the extent to which inference processes are domain-free or domain-specific. Typically, evidence in support of the domain-specific position comprises the facilitation observed when abstract reasoning tasks are set in realistic context. Three experiments are reported here in which the sources of facilitation were investigated for contextualised versions of Raven's Progressive Matrices (Richardson, 1991) and non-verbal analogies from the AH4 test (Richardson & Webster, 1996). Experiment 1 confirmed that the facilitation observed for the (...) contextualised matrices was in part due to extraneous aspects of commentaries originally intended to activate domainspecific processes. Experiments 2 and 3 indicated that the remainder of the facilitation for the matrices, and all of the facilitation for the analogies, could be explained by visual salience: Converting the item elements into realistic objects had enabled them and their transitions to be identified more easily. Hence, performance at simplified abstract items was as good as, or better than, at contextualised items. It is concluded that facilitation effects cannot be interpreted as showing that domain-specific processes constitute a self-contained system separate from domain-free processes. In turn, this means that domain-free processes cannot be dismissed as being unimportant for reasoning. (shrink)

In his 2000 book, From Chaos to Coercion: Detention and the Control of Tuberculosis, Richard Coker makes a number of important observations and arguments regarding the use of coercive public health measures in response to infectious disease threats. In particular, Coker argues that we have a tendency to neglect public health threats and then demand immediate action, which can leave policymakers with fewer effective options and may require (or may be perceived as requiring) more aggressive, coercive measures to achieve public (...) health goals. While Coker makes a convincing case as to why we should find it ethically problematic when governments find themselves in this position and resort to coercion, left outstanding is the question of whether this should preclude governments and health authorities from using coercion if and when they do find themselves in this position. In this paper, I argue that, while we should consider it ethically objectionable when governments resort to coercion because they have neglected a public health threat, its causes, and other possible responses to that threat, this should not then necessarily rule out the use of coercion in such circumstances; that there are ethically objectionable antecedents for why coercion is being considered should not necessarily or automatically cause us to think coercion in such cases cannot be justified. I address an objection to this argument and draw several conclusions about how governments’ use of coercion in public health should be evaluated. (shrink)

Volume 20, Issue 9, September 2020, Page 41-44.

Three experiments explore the role of working memory in motor skill acquisition and performance. Traditional theories postulate that skill acquisition proceeds through stages of knowing, which are initially declarative but later procedural. The reported experiments challenge that view and support an independent, parallel processing model, which predicts that procedural and declarative knowledge can be acquired separately and that the former does not depend on the availability of working memory, whereas, the latter does. The behaviour of these two processes was manipulated (...) by providing or withholding visual (and auditory) appraisal of outcome feedback. Withholding feedback was predicted to inhibit the use of working memory to appraise success and, thus, prevent the formation of declarative knowledge without affecting the accumulation of procedural knowledge. While the first experiment failed to support these predictions, the second and third experiments demonstrated that procedural and declarative knowledge can be acquired independently. It is suggested that the availability of working memory is crucial to motor performance only when the learner has come to rely on its use. (shrink)

The protection of human subjects in biomedical research relies on two principal mechanisms: assessing and comparing the risks and potential benefits of proposed research, and obtaining potential subjects' informed consent. While these have been discussed extensively in the literature, no attention has been paid to whether the processes should be different when the objective of an experimental biomedical intervention is to improve individual appearance, performance, or capability rather than to prevent, cure, or mitigate disease . This essay examines this question (...) in order to ensure that subjects in biomedical enhancement research receive adequate protection. (shrink)

There are two critical steps in determining whether a medical experiment involving human subjects can be conducted in an ethical manner: assessing risks and potential benefits and obtaining potential subjects’ informed consent. Although an extensive literature on both of these aspects exists, virtually nothing has been written about human experimentation for which the objective is not to prevent, cure, or mitigate a disease or condition, but to enhance human capabilities. One exception is a 2004 article by Rebecca Dresser on preimplantation (...) genetic modification — one of the most controversial enhancement technologies — in which she states, “Under existing research ethics principles, it would be unethical for investigators to perform modifications exposing embryos expected to develop into healthy children to significant risk in exchange for a possible physical or mental enhancement.” But Dresser does not explain why such an experiment would be unethical under existing principles, and her conclusion is not self-evident. (shrink)

Despite continuing controversies regarding the vital status of both brain-dead donors and individuals who undergo donation after circulatory death (DCD), respecting the dead donor rule (DDR) remains the standard moral framework for organ procurement. The DDR increases organ supply without jeopardizing trust in transplantation systems, reassuring society that donors will not experience harm during organ procurement. While the assumption that individuals cannot be harmed once they are dead is reasonable in the case of brain-dead protocols, we argue that the DDR (...) is not an acceptable strategy to protect donors from harm in DCD protocols. We propose a threefold alternative to justify organ procurement practices: (1) ensuring that donors are sufficiently protected from harm; (2) ensuring that they are respected through informed consent; and (3) ensuring that society is fully informed of the inherently debatable nature of any criterion to declare death. (shrink)

The United States, along with other nations and international organizations, has developed an elaborate system of ethical norms and legal rules to govern biomedical research using human subjects. These policies govern research that might provide direct health benefits to participants and research in which there is no prospect for participant health benefits. There has been little discussion, however, about how well these rules would apply to research designed to improve participants’ capabilities or characteristics beyond the goal of good health. When (...) mentioned at all in the literature, this so-called enhancement research, as opposed to research aimed at diagnosing, preventing, curing, or treating illnesses or medical conditions, is usually dismissed without explanation. (shrink)

Active inference offers a unified theory of perception, learning, and decision-making at computational and neural levels of description. In this article, we address the worry that active inference may be in tension with the belief–desire–intention model within folk psychology because it does not include terms for desires at the mathematical level of description. To resolve this concern, we first provide a brief review of the historical progression from predictive coding to active inference, enabling us to distinguish between active inference formulations (...) of motor control and active inference formulations of decision processes. We then show that, despite a superficial tension when viewed at the mathematical level of description, the active inference formalism contains terms that are readily identifiable as encoding both the objects of desire and the strength of desire at the psychological level of description. We demonstrate this with simple simulations of an active inference agent motivated to leave a dark room for different reasons. Despite their consistency, we further show how active inference may increase the granularity of folk-psychological descriptions by highlighting distinctions between drives to seek information versus reward—and how it may also offer more precise, quantitative folk-psychological predictions. Finally, we consider how the implicitly conative components of active inference may have partial analogues in other systems describable by the broader free energy principle to which it conforms. (shrink)

Systems thinking has emerged as a means of conceptualizing and addressing complex public health problems, thereby challenging more commonplace understanding of problems and corresponding solutions as straightforward explanations of cause and effect. Systems thinking tries to address the complexity of problems through qualitative and quantitative modeling based on a variety of systems theories, each with their own assumptions and, more importantly, implicit and unexamined values. To date, however, there has been little engagement between systems scientists and those working in bioethics (...) and public health ethics. The goal of this paper is to begin to consider what it might mean to combine systems thinking with public health ethics to solve public health challenges. We argue that there is a role for ethics in systems thinking in public health as a means of elucidating implicit assumptions and facilitating ethics debate and dialogue with key stakeholders. (shrink)

IntroductionThe value of a short life characterized by disability has been hotly debated in the literature on fetal and neonatal outcomes.MethodsWe conducted a scoping review to summarize the available empirical literature on the experiences of families in the context of trisomy 13 and 18 (T13/18) with subsequent thematic analysis of the 17 included articles.FindingsThemes constructed include (1) Pride as Resistance, (2) Negotiating Normalcy and (3) The Significance of Time.InterpretationOur thematic analysis was guided by the moral experience framework conceived by Hunt (...) and Carnevale (2011) in association with the VOICE (Views On Interdisciplinary Childhood Ethics) collaborative research group.RelevanceThis article will be of interest and value to healthcare professionals and bioethicists who support families navigating the medically and ethically complex landscape of T13/18. (shrink)

: All three main articles in the issues of the Kennedy Institute of Ethics Journal endorse the view that genetic enhancement should be permitted, including human germ-line genetic enhancement. However, unregulated, wealth-based access to genetic enhancement in general, and germ-line enhancement in particular, would create intolerable risks for society. Although there are a number of practical problems raised by proposals to regulate or restrict access to genetic enhancement, which will make it difficult if not impossible to muster support for any (...) effective restrictions until we begin to experience the societal problems that genetic enhancement will create, it is important to consider now what restrictions would be appropriate, how they would be imposed, and what changes would be needed in existing laws and institutions to facilitate them. Without this type of groundwork, there is no way society will be in a position to act in time. (shrink)

American medicine has long sought to control the standard of care that physicians are expected to provide to their patients. One effort to insulate the standard of care from external interference, called a “safe harbors” approach, would enable physicians to avoid liability for malpractice if they adhered to medical practice guidelines. The idea is to eliminate the “battle of experts” and reduce defensive medicine by requiring judges and juries to accept guidelines as conclusive evidence of the standard of care. Yet (...) current efforts to improve the guideline development process, including the use of evidence-based guidelines, are unlikely to be able to overcome the shortcomings that led a similar safe harbors initiative to fail in the early 1990s. Moreover, there is no adequate justification for conferring this degree of self-regulatory power on the medical profession. (shrink)