ObjectivesTo explore the objectives and outcomes most appropriate for evaluating clinical ethics support services (CESs) in the USA.MethodsA three-round e-Delphi was sent to two professional medical ethics listservs (Medical College of Wisconsin-Bioethics and American Society for Bioethics and Humanities) as well as 19 individual experts. The survey originally contained 15 objectives and 9 outcomes. In round 1, participants were asked to validate the content of these lists. In round 2, we had 17 objectives and 10 outcomes, and participants were asked (...) to rank them for appropriateness in a top 10 list of objectives and a top 5 list of outcomes.ResultsParticipants came to a high(at least 70%) level of agreement on seven objectives: mediate, educate, develop policy, improve the moral quality of a decision or action, counsel, create a moral space and manage moral distress. Participants came to a moderate (at least 51%) level of agreement on three objectives: empower, awareness of ethics and preventative ethics. Participants also came to a moderate (at least 51%) level of agreement on five outcomes: ethical justification, transformation of institution, improvement of quality of life, principled consensus and satisfaction with the expertise of a CES.ConclusionThis e-Delphi identified 10 objectives and 5 outcomes that are a good starting point for developing outcome measures to evaluate CESs in the USA, while reminding us of the diversity of perspectives still evident in the field. (shrink)

BackgroundCognitive dysfunctions, both subjective and detectable at psychometric testing, may follow SARS-CoV-2 infection. However, the ecological-functional relevance of such objective deficits is currently under-investigated. This study thus aimed at investigating the association between objective cognitive measures and both physical and cognitive, ecological-functional outcomes in post-COVID-19.MethodsForty-two COVID-19-recovered individuals were administered the Mini-Mental State Examination and the Montreal Cognitive Assessment. The Functional Independence Measure was adopted to assess functional-ecological, motor/physical and cognitive outcomes at admission and discharge.ResultsWhen predicting both T0/T1 FIM-total (...) and-Motor scores based on MMSE/MoCA scores, premorbid risk for cognitive decline and disease-related features, no model yielded a significant fit. However, the MoCA - but not the MMSE significantly predicted T0/T1 FIM-Cognitive scores. The MoCA was significantly related only to T0/T1 FIM-Cognitive Memory items.DiscussionCognitive measures are not associated with physical/motor everyday-life outcomes in post-COVID-19 patients. The MoCA may provide an ecological estimate of cognitive functioning in this population. (shrink)

Background There has been little attention paid to research on the outcomes of clinical ethics support or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes. Objective To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation, prior to MCD participation, and to compare results between respondents. Methods This mixed-methods (...) study used both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions. Results 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were ‘more open communication’, ‘better mutual understanding’, ‘concrete actions’, ‘see the situation from different perspectives’, ‘consensus on how to manage the situation’ and ‘find more courses of action’. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents. Conclusions Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD. (shrink)

Two hundred and sixty-three subjects each gave examples for one of five geographic categories: geographic features, geographic objects, geographic concepts, something geographic, and something that could be portrayed on a map. The frequencies of various responses were significantly different, indicating that the basic ontological terms feature, object, etc., are not interchangeable but carry different meanings when combined with adjectives indicating geographic or mappable. For all of the test phrases involving geographic, responses were predominantly natural features such as mountain, river, lake, (...) ocean, hill. Artificial geographic features such as town and city were listed hardly at all for geographic categories, an outcome that contrasts sharply with the disciplinary self-understanding of academic geography. However, geographic artifacts and fiat objects, such as roads, cities, boundaries, countries, and states, were frequently listed by the subjects responding to the phrase something that could be portrayed on a map. In this paper, we present the results of these experiments in visual form, and provide interpretations and implications for further research. (shrink)

The power to change the natural environment has received relatively little attention in public health law, yet is a core concern within environmental and agricultural law. Examples from environmental and agricultural law may inform efforts to change the natural environment in order to reduce the health impacts of climate change. Public health lawyers who attend to the natural environment may succeed in elevating health concerns within the environmental and agricultural law spheres, while gaining new tools for their public health law (...) toolbox. (shrink)

Objective: Deep brain stimulation targeted to the ventral intermediate nucleus of the thalamus is effective for motor symptoms in essential tremor, but there is limited data on cognitive outcomes. We examined cognitive outcomes in a large cohort of ET DBS patients.Methods: In a retrospective analysis, we used repeated-measures ANOVA testing to examine whether the age of tremor onset, age at DBS surgery, hemisphere side implanted with lead, unilateral vs. bilateral implantations, and presence of surgical complications influenced the cognitive outcomes. (...) Neuropsychological outcomes of interest were verbal memory, executive functioning, working memory, language functioning, visuospatial functioning, and general cognitive function.Results: We identified 50 ET DBS patients; 29 males; the mean age of tremor onset was 35.84 years with a median age of 38 years. The mean age at DBS was 68.18 years. There were 37 unilateral 30 left, seven right, and 13 bilateral brain implantations. In the subgroup analysis, there was a significant interaction between assessment and age of tremor onset ; F = 4.47; p = 0.043 for working memory. The post hoc testing found improvements for younger onset ET. Similarly, there was a significant interaction between assessment and complications vs. no complications subgroups; F = 4.34; p = 0.043 for verbal memory with worsening scores seen for ET patients with complications. The remaining tests were not significant.Conclusion: In this large cohort of ET patients with, DBS was not accompanied by a significant decline in many cognitive domains. These outcomes were possibly related to the selection of patients with normal cognitive functioning before surgery, unilateral DBS implantations for the majority, and selection of patients with optimal response to DBS. (shrink)

We reconsider the nonlocal aspects of quantum mechanics with special reference to the EPR argument. We first confine our considerations to the correlations between the outcomes of measurements on spatially distant constituents, without worrying about the measurement problem. We pay particular attention to the relativistic aspects of the problem. Our first conclusion is that, when developed along the lines we follow, the EPR inference that quantum correlations and locality together imply incompleteness, is appropriate. We then investigate whether the other common (...) conclusion from the EPR argument, i.e. that standard quantum theory implies a spooky action at a distance, is correct. We emphasize the crucial role played by the locality assumption and we discuss the use of counterfactuals in the ‘relativistic’ reformulation of the EPR argument. We show that the above conclusion is false if understood as saying that standard quantum theory exhibits, at least with reference to possessed elements of physical reality, some sort of parameter dependence. Thus, in a sense, the coexistence of quantum mechanics with relativity is even more peaceful than commonly thought. We then go through a similar analysis by taking explicitly into account the measurement process. We point out the difficulties which one meets when confronting reduction mechanisms with relativistic requirements. This leads us to recognize the necessity of reconsidering the criteria for attributing objective properties to individual physical systems. Our final conclusion is that, in principle, it is perfectly possible to build up theories leading to the objectification of macroscopic properties which do not imply any spooky action at a distance. (shrink)

Climate change assessments rely upon scenarios of socioeconomic developments to conceptualize alternative outcomes for global greenhouse gas emissions. These are used in conjunction with climate models to make projections of future climate. Specifically, the estimations of greenhouse gas emissions based on socioeconomic scenarios constrain climate models in their outcomes of temperatures, precipitation, etc. Traditionally, the fundamental logic of the socioeconomic scenarios—that is, the logic that makes them plausible—is developed and prioritized using methods that are very subjective. This introduces a fundamental (...) challenge for climate change assessment: The veracity of projections of future climate currently rests on subjective ground. We elaborate on these subjective aspects of scenarios in climate change research. We then consider an alternative method for developing scenarios, a systems dynamics approach called ‘Cross-Impact Balance’ (CIB) analysis. We discuss notions of ‘objective’ and ‘objectivity’ as criteria for distinguishing appropriate scenario methods for climate change research. We distinguish seven distinct meanings of ‘objective,’ and demonstrate that CIB analysis is more objective than traditional subjective approaches. However, we also consider criticisms concerning which of the seven meanings of ‘objective’ are appropriate for scenario work. Finally, we arrive at conclusions regarding which meanings of ‘objective’ and ‘objectivity’ are relevant for climate change research. Because scientific assessments uncover knowledge relevant to the responses of a real, independently existing climate system, this requires scenario methodologies employed in such studies to also uphold the seven meanings of ‘objective’ and ‘objectivity.’. (shrink)

Several scholars have recently entertained proposals for "epistocracy," a political regime in which decision-making power is concentrated in the hands of a society's most informed and competent citizens. These proposals rest on the claim that we can expect better political outcomes if we exclude incompetent citizens from participating in political decisions because competent voters are more likely to vote "correctly" than incompetent voters. We develop what we call the objection from selection bias to epistocracy: a procedure that selects voters on (...) the basis of their observed competence---as epistocracy does---will often be "biased" in the sense that competent voters will be, on average, more likely than incompetent voters to possess certain attributes that reduce the probability of voting correctly. Our objection generalizes the "demographic objection" discussed in previous literature, showing that the range of realistic scenarios in which epistocracy is vulnerable to selection bias is substantially broader than previous discussions appreciate. Our discussion also shows that previous discussions have obscured the force of the threat of selection bias. Since we lack reasons to believe that epistocratic proposals can avoid selection bias, we have no reason to seriously entertain epistocracy as a practical proposal. (shrink)

Objective Bayesianism has been criticised on the grounds that objective Bayesian updating, which on a finite outcome space appeals to the maximum entropy principle, differs from Bayesian conditionalisation. The main task of this paper is to show that this objection backfires: the difference between the two forms of updating reflects negatively on Bayesian conditionalisation rather than on objective Bayesian updating. The paper also reviews some existing criticisms and justifications of conditionalisation, arguing in particular that the diachronic (...) Dutch book justification fails because diachronic Dutch book arguments are subject to a reductio: in certain circumstances one can Dutch book an agent however she changes her degrees of belief . One may also criticise objective Bayesianism on the grounds that its norms are not compulsory but voluntary, the result of a stance. It is argued that this second objection also misses the mark, since objective Bayesian norms are tied up in the very notion of degrees of belief. (shrink)

AimsIn this pilot mixed-methods study, we examined the participants experiences of engaging in virtual drawing tasks and the impact of an olfactory stimulus on outcomes of affect, stress, self-efficacy, anxiety, creative agency, and well-being.MethodsThis study used a parallel mixed-methods, simple block randomization design. The study participants included 24 healthy adults aged 18 to 54 years, including 18 women and six men. The participants completed two 1-h immersive virtual art making sessions and were randomly assigned to receive either a fragrance or (...) a non-fragrance condition for the first session. Quantitative and qualitative datasets were collected concurrently and integrated during data analysis.ResultsThe quantitative results indicated that the fragrance condition demonstrated a significant reduction in negative affect, namely, reduced feelings of negativity when compared to the non-fragrance condition. A trend toward improvement in self-efficacy was also seen in the fragrance condition. No significant changes were found for fragrance or non-fragrance conditions for positive affect, anxiety, and creative agency. The qualitative findings included five themes related to art making experiences in virtual reality in both conditions: fun and joy; novelty of virtual media, experimentation, and play; relaxation and calm; learning curve; and physical discomfort and disorientation. Four themes were identified for virtual art content and visual qualities: nature imagery, references to memories and personal symbols, fantasy and play within imagery, and depiction of everyday objects.ConclusionsOverall, the participants reported positive responses to the novel virtual art making experiences which were further heightened by the inclusion of the fragrance stimulus for negative affect. These preliminary findings need to be replicated with larger sample sizes to confirm the outcomes and the trends that were seen in this pilot study. Further research is recommended to examine the differences between experiences of virtual and traditional art media and to examine different olfactory stimuli promoting focus and concentration. (shrink)

This paper argues that objective consequentialism is incompatible with the rationales of ‘ “ought” implies “can” ’ – with the considerations, that is, that explain or justify this principle. Objective consequentialism is the moral doctrine that an act is right if and only if there is no alternative with a better outcome, and wrong otherwise. An act is obligatory if and only if it is wrong not to perform it. According to ‘ “ought” implies “can” ’, a (...) person is morally obligated to φ only if the person can φ. The rationales of ‘ “ought” implies “can” ’ include considerations related to intuitive plausibility, action-guidance, blameworthiness and fairness, and the nature of practical reasons. (shrink)

There are two distinct views on how to formulate an objective consequentialist account of the deontic status of actions, actualism and possibilism. On an actualist account, what matters to the deontic status of actions is only the value of the outcome an action would have, if performed. By contrast, a possibilist account also takes into account the value of the outcomes that an action could have. These two views come apart in their deontic verdicts when an agent is (...) imperfect in an avoidable way, viz., when agent brings about less good than she could. In this paper, I offer an argument against actualism that draws on the connection between moral obligation and practical reasons. (shrink)

Why should one person obey another? Why (to ask the question from the first-person perspective) ought I to submit to another and follow her judgment rather than my own? In modern political thought, which denies that some are born rulers and others are born to be ruled, the most prominent answer has been: “Because I have consented to her authority.” By making authority conditional on the subjects’ consent, political philosophers have sought to reconcile authority’s hierarchical structure with the equal moral (...) standing of governor and governed. Yet such consent accounts of authority have long been deemed problematic on a number of grounds, not the least of which is that few citizens have given their consent to the state under whose laws they live. So unless we are willing to deny the state’s authority over those who have not consented, or revert to the pre-modern assumption of a natural political hierarchy, we must find another way of reconciling authority with our standing as free and equal moral agents. In recent political and legal philosophy, the most influential solution to this problem has been Joseph Raz’s service conception of authority, according to which legitimate authority, while it does not require the consent of the governed, must exist for their sake, or serve them. The normal way to justify someone’s authority, on the service conception, is to show that, by treating her directives as binding, the subjects are likely better to conform to reasons that apply to them anyway. The service conception has, however, recently been criticized (by, among others, Thomas Christiano, Scott Hershovitz, and Jeremy Waldron) for being insufficiently attuned to the significance that procedural, and in particular democratic, features of political and legal institutions have for the justification of their authority. If these ‘democratic critics’ are right, then two commitments that many in the liberal-democratic tradition may find independently attractive turn out to be in tension: the liberal idea that authority is normally legitimate only insofar as it serves its subjects, and the democratic idea that legitimate authority can (and regularly does) rest on fair procedures. In this article I argue that the critics’ arguments rest on a misunderstanding of the service conception; yet their worries point the way to an under-appreciated and interesting view of democracy as an authoritative arbitration procedure. After introducing the service conception’s view of justified authority, I briefly distinguish a broad and a narrow interpretation of it, and suggest that we should embrace the latter to make sense of the idea that political authority serves its subjects (Section I). Next I turn to the objection raised by the democratic critics: the service conception, they say, cannot make room for the intrinsic fairness of democratic procedures because it is preoccupied with the quality of outcomes (Section II). But, I argue, the objection rests on an illicit identification of two different kinds of outcomes: the outcome of the decision-making procedure on the one hand, the outcome or result of treating that first outcome as authoritative on the other. Distinguishing between these is crucial for an adequate understanding of democracy’s authority. While the service conception is indeed organized around the latter, this does not commit it to an exclusive concern with the former; yet it is a singular commitment to the former that is problematic from a democratic point of view (Section III). To bring home this point, I sketch a model of authority as arbitration that is frequently overlooked in recent discussions of authority even though it is centrally concerned with procedural (and ultimately democratic) values and fits squarely into the service conception of authority (Section IV). (shrink)

Prenatal genetic diagnosis with new high-performance technologies such as genomic array adds great complexity to the ethical dilemmas that already exist in current medicine. The main objective of this study was to carry out an analysis and bioethical reflections centred on the outcome associated with the use of the genetic array technique in 185 pregnancies at the Hospital Universitario y Politécnico La Fe (Valencia, Spain). It is an observational, descriptive and cross-sectional study during the years 2014 to 2017, (...) inclusive. We analyse the results and the follow-up of the 185 cases in which this prenatal genetic study was carried out by array technique. Of the 185 prenatal genetic studies carried out, 165 showed no copy number variants (normal result) and in the 20 remaining pregnancies (10.81%), a dose change was detected. Abortion was carried out in 11 cases with pathological and/or probably pathological abnormalities. Of the 165 cases in which no dose variant was detected, an abortion was carried out in 49 cases, which represents 29.7%. The introduction of new genomic analysis techniques to invasive prenatal diagnosis highlights the ethical problems that arise above all in the interpretation of genetic variants detected and genetic counselling, while emphasising the need for correct informed consent and it adds, if possible, more controversy to a subject with great bioethical substance such as abortion. (shrink)

The Levelling-Down Objection is a standard objection to monistic egalitarian theories where equality is the only thing that has intrinsic value. Most egalitarians, however, are value pluralists; they hold that, in addition to equality being intrinsically valuable, the egalitarian currency in which we are equal or unequal is also intrinsically valuable. In this paper, I shall argue that the Levelling-Down Objection still minimizes the weight that the intrinsic badness of inequality could have in the overall intrinsic evaluation of outcomes, given (...) a certain way of measuring the badness of inequality, namely, the Additive Individual-Complaints Measure. (shrink)

Anders, Rudi Mathematics is objective and unambiguous, but as soon as mathematics is applied to anything in the human world, human values complicate the issues. Two apples for two people equals one apple for each person, but compassion for a starving person, or other human values, can alter the outcome.

This paper is a realist argument for the existence of “social objects”. Social objects, I argue, are the outcome states of a contingent causal process and in turn posses causal properties. This argument has consequences for what we can mean by realism and consequences for the development of a realist methodology. Realism should abandon the notion of natural necessity in favour of a view that the “real” nature of the social world is contingent and necessity is only revealed in (...) outcome states. This, I argue, has both theoretical and methodological implications and I develop my argument through two case studies, of homelessness and ethnicity. (shrink)

Most of the debate surrounding standards in medical care, issues of medical audit and what constitutes benefit from health care assumes that what is obtained from health care is health and only that. This is an assumption which most health economists at least implicitly appear to endorse. This paper questions that assumption. There are various outcomes beyond health and there are various processes involved in health care about which patients are not indifferent. This paper calls for a fuller investigation as (...) to what it is that patients want from their health services and the adoption of a more pluralistic conception of health care benefits. It is further argued that the objectives of health care systems are those in which citizensqua citizens also have interests and which may be different from those of patients. It is yet less likely that citizens’ interests in health care will be restricted to health. (shrink)

Background: Leadership style adopted by nursing managers is a key element in progress and development of nursing and quality of healthcare services received by the patients. In this regard, the role of ethical leadership is of utmost importance. Objectives: The objective of the study was to elaborate on the ethical leadership and its role in professional progress and growth of nurses in the light of work condition in health providing institutes. Methods: The study was carried out as a qualitative (...) study following conventional content analysis method. In total, 14 nursing faculty members and nursing managers at different levels were selected through purposive sampling method. Semi-structured interviews were used for data gathering. The data were analyzed using latent content analysis and constant comparison analysis. Ethical considerations: This study was conducted in accordance with ethical issues in research with human participants and national rules and regulations related to informed consent and confidentiality. The study was approved by the Committee of Ethics in Research at the Shahid Beheshti University of Medical Sciences in Tehran, Iran, under the code: sbmu.rec.1393.695 on 15 February 2015. Findings: Five subcategories were obtained based on the analysis, which constituted two main categories including “all-inclusive satisfaction” and “productivity.” Nursing leaders highlighted the point that their ethical behavior creates “inner satisfaction of the leader,” “employees’ job satisfaction,” and “patients’ satisfaction.” Improvement of productivity was another outcome of ethical behavior of the leaders. This kind of behavior resulted in “providing better services” and “inspiring ethical behavior in the employees.” It has great influence on progress and growth of the nursing profession. Conclusion: By creating an ethical climate, ethical leadership leads to positive and effective outcomes—for the patients as well as for the nurses and the leaders—and professional progress and development of the nursing profession. Therefore, an ethical work environment that supports nurses’ progress and development can be developed by paying more attention to moralities in recruitment, teaching ethical values to the leaders, and using a systematic and objective approach to assess morality in the environment. (shrink)

This paper offers a critique of the Bayesian interpretation of quantum mechanics with particular focus on a paper by Caves, Fuchs, and Schack containing a critique of the “objective preparations view” or OPV. It also aims to carry the discussion beyond the hardened positions of Bayesians and proponents of the OPV. Several claims made by Caves et al. are rebutted, including the claim that different pure states may legitimately be assigned to the same system at the same time, and (...) the claim that the quantum nature of a preparation device cannot legitimately be ignored. Both Bayesians and proponents of the OPV regard the time dependence of a quantum state as the continuous dependence on time of an evolving state of some kind. This leads to a false dilemma: quantum states are either objective states of nature or subjective states of belief. In reality they are neither. The present paper views the aforesaid dependence as a dependence on the time of the measurement to whose possible outcomes the quantum state serves to assign probabilities. This makes it possible to recognize the full implications of the only testable feature of the theory, viz., the probabilities it assigns to measurement outcomes. Most important among these are the objective fuzziness of all relative positions and momenta and the consequent incomplete spatiotemporal differentiation of the physical world. The latter makes it possible to draw a clear distinction between the macroscopic and the microscopic. This in turn makes it possible to understand the special status of measurements in all standard formulations of the theory. Whereas Bayesians have written contemptuously about the “folly” of conjoining “objective” to “probability,” there are various reasons why quantum-mechanical probabilities can be considered objective, not least the fact that they are needed to quantify an objective fuzziness. But this cannot be appreciated without giving thought to the makeup of the world, which Bayesians refuse to do. Doing this on the basis of how quantum mechanics assigns probabilities, one finds that what constitutes the macroworld is a single Ultimate Reality, about which we know nothing, except that it manifests the macroworld or manifests itself as the macroworld. The so-called microworld is neither a world nor a part of any world but instead is instrumental in the manifestation of the macroworld. Quantum mechanics affords us a glimpse “behind” the manifested world, at stages in the process of manifestation, but it does not allow us to describe what lies “behind” the manifested world except in terms of the finished product—the manifested world, for without the manifested world there is nothing in whose terms we could describe its manifestation. (shrink)

We apply the distinction between parameter independence and outcome independence to the linear and nonlinear models of a recent nonrelativistic theory of continuous state vector reduction. We show that in the nonlinear model there is a set of realizations of the stochastic process that drives the state vector reduction for which parameter independence is violated for parallel spin components in the EPR-Bohm setup. Such a set has an appreciable probability of occurrence (≈ 1/2). On the other hand, the linear (...) model exhibits only extremely small parameter dependence effects. We investigate some specific features of the models and we recall that, as has been pointed out recently, if one wants to be able to speak of definite outcomes (or equivalently of possessed objective elements of reality) at finite times, one has to slightly change the criteria for their attribution to physical systems. The concluding section is devoted to a detailed discussion of the difficulties which one meets when one tries to take, as a starting point for the formulation of a relativistic theory, a nonrelativistic scheme which exhibits parameter dependence. Here we derive a theorem which identifies the precise sense in which the occurrence of parameter dependence forbids a genuinely relativistic generalization. Finally we show how the appreciable parameter dependence of the nonlinear model gives rise to problems with relativity, while the extremely weak parameter dependence of the linear model does not give rise to any difficulty, provided one takes into account the appropriate criteria for the attribution of definite outcomes. (shrink)

Evolutionary psychologists argue that selective pressures in our ancestral environment yield a highly specialized set of modular cognitive capacities. However, recent papers in developmental psychology and neuroscience claim that evolutionary accounts of modularity are incompatible with the flexibility and plasticity of the developing brain. Instead, they propose cortical and neuronal brain structures are fixed through interactions with our developmental environment. Buller and Gray Hardcastle contend that evolutionary accounts of cognitive development are unacceptably rigid in light of evidence of cortical plasticity. (...) The developing structure of the brain is both too random and too sensitive to external stimuli to be the product of a fixed genetic mechanism. They also claim that the complexity of the human brain cannot be explained in terms of our meager genetic endowment. There simply are not enough genes to program the intricate neuronal structures that are essential to cognition. I argue that neither of these arguments are persuasive. Small numbers of genes can function to determine diverse phenotypical outcomes through evolutionarily selected developmental systems. Similarly, theories of modularity do not rule out the possibility that innate cognitive systems exploit environmental regularities to guide the developing structure of the brain. Consequently, the anti-adaptionist consequences of these positions should be rejected. (shrink)

The terms ``objectivity'''' and ``objective'''' are among the mostused yet ill-defined terms in the philosophy of science and epistemology. Common to all thevarious usages is the rhetorical force of ``I endorse this and you should too'''', orto put it more mildly, that one should trust the outcome of the objectivity-producing process.The persuasive endorsement and call to trust provide some conceptual coherenceto objectivity, but the reference to objectivity is hopefully not merely an attemptat persuasive endorsement. What, in addition to (...) epistemological endorsement,does objectivity carry with it? Drawing on recent historical and philosophical work,I articulate eight operationally accessible and distinct senses of objectivity.While there are links among these senses, providing cohesion to the concept, I argue thatnone of the eight senses is strictly reducible to the others, giving objectivity itsirreducible complexity. (shrink)

In this article I defend the capability approach by focusing on its built-in gender-sensitivity and on its concern with comprehensive outcomes and informationally-rich evaluation of well-being, two elements of Sen's work that are too rarely put together. I then try to show what the capability approach would have to gain by focusing on trans-positional objectivity (as Elizabeth Anderson does) and by leaving behind the narrow confines of states in favor of a more cosmopolitan stance. These preliminary discussions are followed by (...) two more precise applications. At first, I show how a gender-sensitive capability approach that respects the criteria of trans-positional objectivity and cosmopolitanism can enhance the agency of women inhabiting third-world societies. I turn next to show how mainstream feminism can insulate itself against criticisms such as bell hooks' by switching to trans-positional objectivity in public reasoning. (shrink)

Abuse of a dominant position is one of the key aspects in EC competition law. The Court of Justice and General Court acknowledge that sometimes the actions of dominant undertaking that might be recognized as abusive should not be prohibited on the basis of Article 102 TFEU, if undertaking provides objective justification or proves that its actions generate positive effect which outweighs negative outcome on competition. Therefore, actions that usually are regarded as predatory pricing, which is one of (...) the forms of the abuse of a dominant position, in case of special circumstances might be recognized as legitimate. In the present case, attention should be devoted to objective justifications, since this provides the basis for evaluation of legitimate, pro-competitive reasons that explain why undertakings may establish prices lower than costs. This article is devoted to the analysis of objective justification, which might prove that allegedly abusive behaviour is actually legitimate. Plenty of factors might be recognized as objective justifications, therefore it is quite difficult to provide a finite list of justifications. (shrink)

Acts of civil disobedience and conscientious objection provide valuable indications of the congruence of political outcomes with citizens’ conceptions of justice and the good. As their primary concern is substantive, their logic seems extraneous to procedural approaches to justice. Accordingly, it has often been argued that these latter condemn citizens to a ‘deaf-and-blind’ acceptance of the outcomes of agreed procedures. A closer analysis of such acts of contestation shall reveal that although, for proceduralism, the outcomes of just procedures cannot be (...) contested as unjust, they may be contested on the ground of values other than justice, such as someone’s religious/ethical allegiances. Proceduralism about justice will be thus shown to be consistent with the commitment to realising certain outcome-oriented values. (shrink)

Although our eyes receive incomplete and ambiguous information, our perceptual system is usually able to successfully construct a stable representation of the world. In the case of ambiguous figures, however, perception is unstable, spontaneously alternating between equally possible outcomes. The present study compared EEG responses to ambiguous figures and their unambiguous variants. We found that slight figural changes, which turn ambiguous figures into unambiguous ones, lead to a dramatic difference in an ERP (“event-related potential”) component at around 400 ms. This (...) result was obtained across two different categories of figures, namely the geometric Necker cube stimulus and the semantic Old/Young Woman face stimulus. Our results fit well into the Bayesian inference concept, which models the evaluation of a perceptual interpretation’s reliability for subsequent action planning. This process seems to be unconscious and the late.. (shrink)

This study uses a scientific realist methodology to explain how social outcomes of community care interventions are produced, sustained and contextually dependent. We evaluate an organization dedicated to wound care and leg health known as the Lindsay Leg Club network, so far studied mostly from a phenomenological perspective, to demonstrate the generative role of places where Leg Clubs are located, with objects in their environment, and people who organize and run Leg Clubs, with their agency and intentionality. We theorize the (...) explanatory role of these contextual features with the concept of affordances. Our approach shows that the phenomenological findings from community care evaluation are not unequivocal. Instead, researchers should recognize the nuanced nature of causality in social programmes, which requires a consideration of the links between community care interventions, how people respond to them and the conditions under which these responses are enacted. (shrink)

In classical physics, probabilistic or statistical knowledge has been always related to ignorance or inaccurate subjective knowledge about an actual state of affairs. This idea has been extended to quantum mechanics through a completely incoherent interpretation of the Fermi-Dirac and Bose-Einstein statistics in terms of "strange" quantum particles. This interpretation, naturalized through a widespread "way of speaking" in the physics community, contradicts Born's physical account of Ψ as a "probability wave" which provides statistical information about outcomes that, in fact, cannot (...) be interpreted in terms of 'ignorance about an actual state of affairs'. In the present paper we discuss how the metaphysics of actuality has played an essential role in limiting the possibilities of understating things differently. We propose instead a metaphysical scheme in terms of powers with definite potentia which allows us to consider quantum probability in a new light, namely, as providing objective knowledge about a potential state of affairs. (shrink)

Pekka Lahti is a prominent exponent of the renaissance of foundational studies in quantum mechanics that has taken place during the last few decades. Among other things, he and coworkers have drawn renewed attention to, and have analyzed with fresh mathematical rigor, the threat of inconsistency at the basis of quantum theory: ordinary measurement interactions, described within the mathematical formalism by Schrödinger-type equations of motion, seem to be unable to lead to the occurrence of definite measurement outcomes, whereas the same (...) formalism is interpreted in terms of probabilities of precisely such definite outcomes. Of course, it is essential here to be explicit about how definite measurement results (or definite properties in general) should be represented in the formalism. To this end Lahti et al. have introduced their objectification requirement that says that a system can be taken to possess a definite property if it is certain (in the sense of probability 1) that this property will be found upon measurement. As they have gone on to demonstrate, this requirement entails that in general definite outcomes cannot arise in unitary measuring processes.In this paper we investigate whether it is possible to escape from this deadlock. As we shall argue, there is a way out in which the objectification requirement is fully maintained. The key idea is to adapt the notion of objectivity itself, by introducing relational or perspectival properties. It seems that such a “relational perspective” offers prospects of overcoming some of the long-standing problems in the interpretation of quantum mechanics. (shrink)

According to luck egalitarianism, inequalities are justified if and only if they arise from choices for which it is reasonable to hold agents responsible. This position has been criticised for its purported harshness in responding to the plight of individuals who, through their own choices, end up destitute. This paper aims to assess the Harshness Objection. I put forward a version of the objection that has been qualified to take into account some of the more subtle elements of the luck (...) egalitarian approach. Revising the objection in this way suggests that the Harshness Objection has been overstated by its proponents: because luck egalitarians are sensitive to the influence of unequal brute luck on individuals’ choices, it is unlikely that there will be any real world cases in which the luck egalitarian would not have to provide at least partial compensation. However, the Harshness Objection still poses problems for the luck egalitarian. First, it is not clear that partial compensation will be sufficient to avoid catastrophic outcomes. Second, the Harshness Objection raises a theoretical problem in that a consistent luck egalitarian will have to regard it as unjust if any assistance is provided to the victim of pure option luck, even if such assistance could be provided at no cost. I consider three strategies the luck egalitarian could pursue to accommodate these concerns and conclude that none of these strategies can be maintained without either violating basic luck egalitarian principles or infringing upon individual liberty. (shrink)

Participants struck 500 golf balls to a concealed target. Outcome feedback was presented at the subjective or objective threshold of awareness of each participant or at a supraliminal threshold. Participants who received fully perceptible feedback learned to strike the ball onto the target, as did participants who received feedback that was only marginally perceptible . Participants who received feedback that was not perceptible showed no learning. Upon transfer to a condition in which the target was unconcealed, performance increased (...) in both the subjective and the objective threshold condition, but decreased in the supraliminal condition. In all three conditions, participants reported minimal declarative knowledge of their movements, suggesting that deliberate hypothesis testing about how best to move in order to perform the motor task successfully was disrupted by the impoverished disposition of the visual outcome feedback. It was concluded that sub-optimally perceptible visual feedback evokes implicit processes. (shrink)

Background: Many people with aphasia and people without brain injury talk to themselves in their heads, i.e., have “inner speech.” Inner speech may be more preserved compared with spoken speech for some people with aphasia and may serve a variety of functions (e.g., emotion regulation), which motivates us to provide a high-fidelity characterization of it. Researchers have used multiple methods to measure this internal phenomenon in the past, which we combine here for the first time in a single study. -/- (...) Aims: We compare performance between individuals with and without aphasia on inner speech tasks that assess inner speech “inthe- moment” to general subjective impressions of inner speech to tease apart the relationship of aphasia severity to inner speech. Methods and Procedures: Twenty people with mild-moderate aphasia and twenty neurotypical controls completed several inner speech tasks, including objective silent rhyme judgements (picture, written, and auditory), subjective reports of inner speech during naming, and subjective rating scales about inner speech experience more generally. -/- Outcomes and Results: In-the-moment inner speech during silent rhyming tasks was associated with aphasia severity only for picture and written rhyming but not auditory rhyming. In-the-moment inner speech reports during silent naming were not associated with aphasia severity, nor were the subjective ratings about general inner speech experience. Individuals with and without aphasia demonstrated a variety of subjective general inner speech experiences, demonstrating heterogeneity of this phenomenon more broadly. -/- Conclusions: Methods of measuring inner speech complement each other and speak to different facets of the inner speech phenomenon, and clinicians and researchers must carefully choose the method(s) that will provide the information about inner speech that they desire. (shrink)

The Luck Objection is an influential family of challenges to libertarianism. In recent years, discussions of the Luck Objection have reached an impasse of sorts. On one hand, existing responses to the objection have failed to satisfy libertarianism’s many critics. On the other hand, a growing number of libertarians seem unimpressed by existing formulations of the objection. To break the impasse, I present a two-stage version of the objection. The first stage has the limited objective of showing that supposed (...) exercises of free will resemble certain nonactions in being truly random outcomes. The second stage seeks to show that we aren’t morally responsible for supposed exercises of free will if they are truly random outcomes. The leading idea is that such actions, qua truly random outcomes of our prior mental states, don’t meet a plausible guidance requirement for morally responsible agency. (shrink)

I claim that objective consequentialism faces a problem stemming from the existence in some situations of a plurality of chances relevant to the outcomes of an agent’s acts. I suggest that this phenomenon bears structural resemblance to the well-known Reference Class problem. I outline a few ways in which one could attempt to deal with the issue, suggesting that it is the higher-level chance that should be employed by OC.

The four principles approach to bioethics, an approach most associated with the work of Tom Beauchamp and James Childress, is supposed to provide a framework for reasoning through moral issues in medicine. One might wonder, if one were to guide one’s thinking by the method suggested by principlism, will one identify and perform the objectively morally right action? Will one’s decision making be justified, and consequently, will the action that flows from that decision itself be justified? In this paper, I (...) show that principlism can, and has been, characterized in these two different ways. I also argue that when it is understood according to the first characterization, the view cannot be put into practice. However, when it is understood as an account of justification, there is reason to think that it is indeed action-guiding. Given the problems that confront the first version of the view, perhaps it is best to understand principlism, and biomedical ethical theories generally, not as action-guiding theories of right action, but rather, as procedures by which one’s decisions and actions in medicine can achieve a reasonable degree of moral justification. (shrink)

One central objection to the maximin payoff criterion is that it focuses on the state that yields the lowest payoffs regardless of how low these are. We allow different states to have different sets of possible outcomes and show that the original axioms of Milnor (1954) continue to characterize the maximin payoff criterion, provided that the sets of payoffs achievable across states overlap. If instead payoffs in some states are always lower than in all others then ignoring the “bad” states (...) is no longer inconsistent with these axioms. Similar dependence on overlap of outcome spaces across states holds for the minimax regret and maximin joy criteria. (shrink)

Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centred outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions have effectively (...) remediated patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centred TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centred TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centred outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarised, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilisation of multivariate prediction models to inform individually-tailored interventions targeting a range of health conditions. (shrink)

Abstract: This paper restates the thesis of 'The Requirements of Justice and Liberal Socialism" where it was argued that liberal socialism best meets Rawlsian requirements of justice. The recent responses to this paper by Jan Narveson, Jeppe von Platz, and Alan Thomas merit examination and comment. This paper shows that if Rawlsian justice is to be met, then non-personal property must be subject to public control. If just outcomes merit the public control of non-personal property and this control is not (...) utilized, then justice has been subordinated to the objectively less important institution of private property. (shrink)

The Slogan claims a connection between evaluations of outcomes and evaluations of welfare. Temkin’s main strategy is to argue that no theory of welfare is plausible as both a theory of welfare and as a theory of outcomes. He considers three theories of welfare: hedonism, preference satisfaction theory, and objective list theory. In the case of hedonism and objective list theory, Temkin’s arguments are not new. The argument against hedonism, for example, engages a familiar and inconclusive debate against (...) hedonism as a theory of outcomes: the hedonist claims that mental states alone are relevant for judging alternative outcomes; the anti-hedonist replies that something in addition to mental states, such as desert or equality, is also relevant, and indeed is sometimes more important than any mental state; the hedonist replies that any allegiance to values such as desert or equality stems from their usual connection to promoting pleasurable mental states, and that, absent this connection, we no longer value them; the anti-hedonist denies that this is so. (shrink)

BackgroundClinical ethics consultations can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. ObjectiveThe primary (...) objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization.MethodsWe searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. ResultsForty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality, process factors, and clinical factors. The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes.ConclusionsThis scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC. (shrink)

The use of composite outcomes is becoming widespread in clinical trials. By combining individual outcome measures into a composite, researchers claim a composite can increase statistical precision and trial efficiency, expediting the trial by reducing sample size and cost, and consequently enabling researchers to answer questions that could not otherwise be answered. Another rationale given for using a composite is that it provides a measure of the net effect of the intervention that is more patient-relevant than any single (...) class='Hi'>outcome measure. Critics, on the other hand, argue that the use of composites threatens the scientific objectivity of the trial by introducing new risks, and that in practice components are inconsistently defined, unreasonably combined, and inadequately reported. Philosophical scrutiny can help shed light in these disagreements and disentangle ethical and epistemological issues of composites in clinical trials. I examine common use of composites in cardiovascular trials, and show how composite results can be problematic, even misleading, if the proper range of scientific decisions and their consequences are ignored when judging the composite. Philosophies of science that are principled on normative versions of the argument from inductive risk can help explicate issues with composites. I conclude by suggesting ways of remedying composite issues in clinical trials. (shrink)

In this paper, I motivate and defend the distinction between an objective and a subjective moral sense of “ought.” I begin by looking at the standard way the distinction is motivated, namely by appealing to relatively simple cases where an agent does something she thinks is best, but her action has a tragic outcome. I argue that these cases fail to do the job—the intuitions they elicit can be explained without having to distinguish between different senses of “ought.” (...) However, these cases are on the right track—I argue that more sophisticated versions of the cases provide strong motivation for the distinction. I then discuss two important problems for the distinction: the “which ‘ought’ is more important?” problem, and the “annoying profusion of ‘oughts’” problem. I argue that each of these problems can be solved in several different ways. (shrink)

ABSTRACT This study uses a scientific realist methodology to explain how social outcomes of community care interventions are produced, sustained and contextually dependent. We evaluate an organization dedicated to wound care and leg health known as the Lindsay Leg Club network, so far studied mostly from a phenomenological perspective, to demonstrate the generative role of places where Leg Clubs are located, with objects in their environment, and people who organize and run Leg Clubs, with their agency and intentionality. We theorize (...) the explanatory role of these contextual features with the concept of affordances. Our approach shows that the phenomenological findings from community care evaluation are not unequivocal. Instead, researchers should recognize the nuanced nature of causality in social programmes, which requires a consideration of the links between community care interventions, how people respond to them and the conditions under which these responses are enacted. (shrink)

In this paper I explore a version of standard (expected utility) decision theory in which the probability parameter is interpreted as an objective chance believed by agents to obtain and values of this parameter are fixed by indicative conditionals linking possible actions with possible outcomes. After reviewing some recent developments centering on the common-cause counterexamples to the standard approach, I introduce and briefly discuss the key notions in my own approach. (This approach has essentially the same results as the (...) causal approach in common-cause cases.) I then discuss the Rule of Dominance and find, in the context of the present proposal, that it cannot serve as an independent source of action justification. Turning next to Newcomb''s Problem, I argue that the much discussed issue of back-tracking counterfactuals is something of a red herring for decision theory. Once the twin distractions of back-tracking counterfactuals and Dominance Reasoning are set aside the 1-box solution emerges as a natural consequence of the present proposal. It is of interest that this proposal agrees with the causal approach in the standard common-cause examples and the expected-utility approach in the Newcomb case: one can be smart and rich and keep on smoking. (shrink)

The paper examines the place of power in the action theories of Francisco Suarez and Thomas Hobbes. Power is the capacity to produce or determine outcomes. Two cases of power are examined. The first is freedom or the power of agents to determine for themselves what they do. The second is motivation, which involves a power to which agents are subject, and by which they are moved to pursue a goal. Suarez, in the Metaphysical Disputations, uses Aristotelian causation to model (...) these two forms of power. Freedom is efficient causation, but in a special form that I explain as involving something that ordinary causation does not – the contingent determination of outcomes. Motivating power is final causation, which Suarez characterizes as the power of a goal or end to move us to attain it through its goodness or desirability. Suarez regards these two forms of power as consistent – we can be moved by the goodness of a goal freely to determine for ourselves that we act in order to attain it. Hobbes denied the existence of all forms of power beyond ordinary causation, the power of one motion in matter to determine another. So he denied the very existence both of freedom and of any form of motivating power beyond the ordinary causal power of desires as materially based psychological states to produce actions. The goodness itself of a goal never moves us, whether to desire the goal in the first place or to act in order to attain it. The paper examines Hobbes’s arguments and their consequence – establishing the foundations for Hume’s scepticism about practical reason. (shrink)