Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.Trial RegistrationISRCTN89993391. (shrink)
Do laypeople think that moral responsibility is compatible with determinism? Recently, philosophers and psychologists trying to answer this question have found contradictory results: while some experiments reveal people to have compatibilist intuitions, others suggest that people could in fact be incompatibilist. To account for this contradictory answers, Nichols and Knobe (2007) have advanced a ‘performance error model’ according to which people are genuine incompatibilist that are sometimes biased to give compatibilist answers by emotional reactions. To test for this hypothesis, we (...) investigated intuitions about determinism and moral responsibility in patients suffering from behavioural frontotemporal dementia. Patients suffering from bvFTD have impoverished emotional reaction. Thus, the ‘performance error model’ should predict that bvFTD patients will give less compatibilist answers. However, we found that bvFTD patients give answers quite similar to subjects in control group and were mostly compatibilist. Thus, we conclude that the ‘performance error model’ should be abandoned in favour of other available model that best fit our data. (shrink)
The starting point of this work is the gap between two distinct traditions in information engineering: knowledge representation and data-driven modelling. The first tradition emphasizes logic as a tool for representing beliefs held by an agent. The second tradition claims that the main source of knowledge is made of observed data, and generally does not use logic as a modelling tool. However, the emergence of fuzzy logic has blurred the boundaries between these two traditions by putting forward fuzzy rules as (...) a Janus-faced tool that may represent knowledge, as well as approximate non-linear functions representing data. This paper lays bare logical foundations of data-driven reasoning whereby a set of formulas is understood as a set of observed facts rather than a set of beliefs. Several representation frameworks are considered from this point of view: classical logic, possibility theory, belief functions, epistemic logic, fuzzy rule-based systems. Mamdani's fuzzy rules are recovered as belonging to the data-driven view. In possibility theory a third set-function, different from possibility and necessity plays a key role in the data-driven view, and corresponds to a particular modality in epistemic logic. A bi-modal logic system is presented which handles both beliefs and observations, and for which a completeness theorem is given. Lastly, our results may shed new light in deontic logic and allow for a distinction between explicit and implicit permission that standard deontic modal logics do not often emphasize. (shrink)
This paper discusses the critical necessity of teaching students about the social and ethical responsibilities of scientists. Both a university scientist and a middle school science teacher reflect on the value of teaching the ethical issues that confront scientists. In the development of the atomic bomb in the US-led Manhattan Project, scientists faced the growing threat of atomic bombs by the Germans and Japanese and the ethical issues involved in successfully completing such a destructive weapon. The Manhattan Project is a (...) prime example of the types of ethical dilemmas and social responsibilities that scientists may confront. (shrink)
Expressing doubts about death criteria can serve healthy purposes, but can also cause a number of harms, including decreased organ donation rates and distress for donor families and health care staff. This paper explores the various causes of doubts about death criteria—including religious beliefs, misinformation, mistrust, and intellectual questions—and recommends responses to each of these. Some recommended responses are relatively simple and noncontroversial, such as providing accurate information. However, other responses would require significant changes to the way we currently do (...) business. Policymakers should establish minimum national standards for determining death to foster a trustworthy system; academics and publishers have a duty to publish only materials that substantially engage and advance the debate to minimize the harm caused by divided expert opinion; and opposition to the dead donor rule should be conceptually separated from doubts about death criteria. (shrink)
Evidence exists that behavioral and social science researchers have been frustrated with regulations and institutional review boards (IRBs) from the 1970s through today. Making matters worse, many human participants protection instruction programs - now mandated by IRBs - offer inadequate reasons why researchers should comply with regulations and IRBs. Promoting compliance either for its own sake or to avoid penalties is contrary to the developmental aims of moral education and may be ineffective in fostering the responsible conduct of research. This (...) article explores the concept of professional virtue and argues that compliance is capable of becoming a professional virtue like scientific honesty. This requires, however, that regulatory and IRB demands contribute to human well-being and to the aims of research as a profession and that researchers, therefore, internalize the norms that underlie regulatory and IRB demands. This, in turn, requires a series of changes in the way society develops, promulgates, and enforces regulatory and IRB rules. The challenge is, simply put, to embed compliance into the world of living morality. (shrink)
Monshi and Zieglmayer's case study presents Sri Lankan participants as having views on the privacy of health information that differ radically from those commonly found in Western nations. This article explores 2 questions that their case study raises for the ethical review of research in international settings: First, are allegedly universal ethical principles - of the sort promulgated in the Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978) - useful in international settings?, (...) and second, how should research oversight bodies address the challenges that arise in international behavioral and social science research? (shrink)
This short paper about fuzzy set-based approximate reasoning first emphasizes the three main semantics for fuzzy sets: similarity, preference and uncertainty. The difference between truth-functional many-valued logics of vague or gradual propositions and non fully compositional calculi such as possibilistic logic (which handles uncertainty) or similarity logics is stressed. Then, potentials of fuzzy set-based reasoning methods are briefly outlined for various kinds of approximate reasoning: deductive reasoning about flexible constraints, reasoning under uncertainty and inconsistency, hypothetical reasoning, exception-tolerant plausible reasoning using (...) generic knowledge, interpolative reasoning, and abductive reasoning (under uncertainty). Open problems are listed in the conclusion. (shrink)
This paper investigates simple syntactic methods for revising prioritized belief bases, that are semantically meaningful in the frameworks of possibility theory and of Spohn''s ordinal conditional functions. Here, revising prioritized belief bases amounts to conditioning a distribution function on interpretations. The input information leading to the revision of a knowledge base can be sure or uncertain. Different types of scales for priorities are allowed: finite vs. infinite, numerical vs. ordinal. Syntactic revision is envisaged here as a process which transforms a (...) prioritized belief bases into a new prioritized belief base, and thus allows a subsequent iteration. (shrink)
Numerous countries are heading toward digital infrastructures. In particular this new technology promises to help support methods for elections. However, one should be careful that such an infrastructure does not hinder the voting and representation issues. On the contrary, it should support those issues and help citizens have a clearer picture of the underlying mechanisms. This paper deals with the limits of voting procedures as they are described in classical collective choice theory and reflects on ways to aggregate electronic votes (...) stemming from various individuals that would be at the same time democratic, decisive and rational which is not feasible when candidate rankings alone are taken into account. This paper shows how electronic voting procedures could improve the situation by introducing preference-based votes. (shrink)
Here we describe the five steps of evidence-based practice as applied to research ethics review and apply these steps to three exemplar dilemmas: incentive payments in substance abuse research; informed consent for biobanking; and placebo-controlled trials involving pregnant women in order to demonstrate the potential of empirical data to inform and improve IRB decision-making.
In this article we describe our approach to understanding wrongdoing in medical research and practice, which involves the statistical analysis of coded data from a large set of published cases. We focus on understanding the environmental factors that predict the kind and the severity of wrongdoing in medicine. Through review of empirical and theoretical literature, consultation with experts, the application of criminological theory, and ongoing analysis of our first 60 cases, we hypothesize that 10 contextual features of the medical environment (...) (including financial rewards, oversight failures, and patients belonging to vulnerable groups) may contribute to professional wrongdoing. We define each variable, examine data supporting our hypothesis, and present a brief case synopsis from our study that illustrates the potential influence of the variable. Finally, we discuss limitations of the resulting framework and directions for future research. (shrink)
This article examines the clergy sexual abuse crisis in the Roman Catholic Church from an ethical point of view. The article uses the RRICC values model of ethical decision making (i.e., responsibility, respect, integrity, competence, concern) to review the behavior of Catholic bishops and other religious superiors as they have tried to manage clergy sex offenders and their victims. Hopefully, the recent press attention and resulting policy changes on these matters from the U.S. Council of Catholic Bishops will increase the (...) chances that future decisions will be ethical ones. (shrink)
This paper presents and discusses several methods for reasoning from inconsistent knowledge bases. A so-called argued consequence relation, taking into account the existence of consistent arguments in favour of a conclusion and the absence of consistent arguments in favour of its contrary, is particularly investigated. Flat knowledge bases, i.e., without any priority between their elements, are studied under different inconsistency-tolerant consequence relations, namely the so-called argumentative, free, universal, existential, cardinality-based, and paraconsistent consequence relations. The syntax-sensitivity of these consequence relations is (...) studied. A companion paper is devoted to the case where priorities exist between the pieces of information in the knowledge base. (shrink)
Anticipation allows a system to adapt to conditions that have not yet come to be, either externally to the system or internally. Autonomous systems actively control their own conditions so as to increase their functionality (they self-regulate). Living systems self-regulate in order to increase their own viability. These increasingly stronger conditions, anticipation, autonomy and viability, can give an insight into progressively stronger classes of models of autonomy. I will argue that stronger forms are the relevant ones for Artificial Life. This (...) has consequences for the design of and accurate simulation of living systems. Keywords: autonomy, modelling, function, simulation, anticipation, emergence DUBOIS’ CONJECTURE Autonomy basically means self-regulation. Self-regulation implies internal control of system states to achieve greater functionality, either internally or interactively with the environment. Functionality, as a teleological notion, implies that the system must be directed by likely future states; that is, it must anticipate and (possibly) adapt to likely future states. Functionality does not require autonomy (assuming functional goals are externally set), but merely that current states of the system can select suitable future states on the basis of suitable input. In this.. (shrink)
This anthology is the first devoted exclusively to On Certainty. The essays are grouped under four headings: the Framework, Transcendental, Epistemic and Therapeutic readings, and an introduction helps explain why these readings need not be seen as antagonistic. Contributions from W.H. Brenner, Alice Crary, Michael Kober, Edward Minar, Howard Mounce, Daniele Moyal-Sharrock, Thomas Morawetz, D.Z. Phillips, Duncan Pritchard, Rupert Read, Anthony Rudd, Joachim Schulte, Avrum Stroll, Michael Williams.
This anthology focuses on the extraordinary contributions Wittgenstein made to several areas in the philosophy of psychology - contributions that extend to psychology, psychiatry, sociology and anthropology. To bring them a richly-deserved attention from across the language barrier, Danièle Moyal-Sharrock has translated papers by eminent French Wittgensteinians. They here join ranks with more familiar renowned specialists on Wittgenstein's philosophical psychology. While revealing differences in approach and interests, this coming together of some of the best minds on the subject discloses (...) a surprising degree of consensus, and gives us the clearest picture yet of Wittgenstein as a philosopher of psychology. (shrink)
Transpersonal psychology first emerged as an academic discipline in the 1960s and has subsequently broadened into a range of transpersonal studies. Jorge Ferrer (2002) has called for a 'revisioning' of transpersonal theory, dethroning inner experience from its dominant role in defining and validating spiritual reality. In the current paradigm he detects a lingering Cartesianism, which subtly entrenches the very subject-object divide that transpersonalists seek to overcome. This paper outlines the development and current shape of the transpersonal movement, compares Ferrer's epistemology (...) with the heterophenomenology of Daniel Dennett, and speculates on the integration of the latter into transpersonal theory. (shrink)
Drawing on Christopher Boorse's Biostatistical Theory (BST), Norman Daniels contends that a genuine health need is one which is necessary to restore normal functioning – a supposedly objective notion which he believes can be read from the natural world without reference to potentially controversial normative categories. But despite his claims to the contrary, this conception of health harbors arbitrary evaluative judgments which make room for intractable disagreement as to which conditions should count as genuine health needs and therefore which needs (...) should be met. I begin by offering a brief summary of Boorse's BST, the theory to which Daniels appeals for providing the conception of health as normal functioning upon which his overall distributive scheme rests. Next, I consider what I call practical objections to Daniels's use of Boorse's theory. Finally I recount Elseljin Kingma's theoretical objection to Boorse's BST and discuss its impact on Daniels's overall theory. Though I conclude that Boorse's view, so weakened, will no longer be able to sustain the judgments which Daniels's theory uses it to reach, in the end, I offer Daniels an olive branch by briefly sketching an alternative strategy for reaching suitably objective conclusions regarding the health and/or disease status of various conditions. (shrink)
This collection is a much-needed remedy to the confusion about which varieties of enactivism are robust yet viable rejections of traditional representionalism...
One of the most influential philosophical voices in the consciousness studies community is that of Daniel Dennett. Outside of consciousness studies, Dennett is well-known for his work on numerous topics, such as intentionality, artificial intelligence, free will, evolutionary theory, and the basis of religious experience. (Dennett, 1984, 1987, 1995c, 2005) In 1991, just as researchers and philosophers were beginning to turn more attention to the nature of consciousness, Dennett authored his Consciousness Explained. Consciousness Explained aimed to develop both a theory (...) of consciousness and a powerful critique of the then mainstream view of the nature of consciousness, which Dennett called,. (shrink)
In The illusion of conscious will , Daniel Wegner offers an exciting, informative, and potentially threatening treatise on the psychology of action. I offer several interpretations of the thesis that conscious will is an illusion. The one Wegner seems to suggest is "modular epiphenomenalism": conscious experience of will is produced by a brain system distinct from the system that produces action; it interprets our behavior but does not, as it seems to us, cause it. I argue that the evidence Wegner (...) presents to support this theory, though fascinating, is inconclusive and, in any case, he has not shown that conscious will does not play a crucial causal role in planning, forming intentions, etc. This theory's potential blow to our self-conception turns out to be a glancing one. (shrink)
Questions about Leibniz's views on the ontological status of the corporeal world have been at the center of debate in Leibniz scholarship for more than two decades, and one of the major players in these debates has been Daniel Garber. Having sketched his influential position in a number of articles over the years, he now gives full expression to his view in this highly anticipated and long-awaited book.
In A New Form of Agent-Based Virtue Ethics , Daniel Doviak develops a novel agent-based theory of right action that treats the rightness (or deontic status) of an action as a matter of the action’s net intrinsic virtue value (net-IVV)—that is, its balance of virtue over vice. This view is designed to accommodate three basic tenets of commonsense morality: (i) the maxim that “ought” implies “can,” (ii) the idea that a person can do the right thing for the wrong reason, (...) and (iii) the idea that a virtuous person can have “mixed motives.” In this paper, I argue that Doviak’s account makes an important contribution to agent-based virtue ethics, but it needs to be supplemented with a consequentialist account of the efficacy of well-motivated actions—that is, it should be transformed into a mixed (motives-consequences) account, while retaining its net-IVV calculus. This is because I believe that there are right-making properties external to an agent’s psychology which it is important to take into account, especially when an agent’s actions negatively affect other people. To incorporate this intuition, I add to Doviak’s net-IVV calculus a scale for outcomes . The result is a mixed view which accommodates tenets (ii) and (iii) above, but allows for (i) to fail in certain cases. I argue that, rather than being a defect, this allowance is an asset because our intuitions about ought-implies-can break down in cases where an agent is grossly misguided, and our theory should track these intuitions. (shrink)
Norman Daniels argues that health is important for justice because it affects the distribution of opportunities. He claims that a just society should guarantee fair opportunities by promoting and restoring the “normal functioning” of its citizens, that is, their health. The scope of citizens' mutual obligations with respect to health is defined by a reasonable agreement that, according to Daniels, should be based on the distinction between normal functioning and pathology drawn by the biomedical sciences. This paper deals with the (...) question whether it is legitimate to ascribe the responsibility of defining this important moral boundary to the biomedical sciences, which Daniels regards as value neutral. Daniels appeals to Christopher Boorse's sophisticated bio-statistical theory (BST) to show the plausibility of a value-neutral distinction between normal functioning and pathology. Here I argue that a careful analysis of the concept of normal functioning, such as the one offered by the recent critique by Elselijn Kingma, shows that it depends from evaluative assumptions. This, I argue, implies that Daniels's theory must give up its naturalistic commitments. In the conclusion, the paper offers a detailed discussion and an objection to one of Daniels's arguments in favor of a moderate form of normativism that remains too close to Boorse's naturalism. (shrink)
Just health: meeting health needs fairly is an ambitious book, in which Norman Daniels attempts to bring together in a single framework all his work on health and justice from the past 25 years. One major aim is to reconcile his earlier work on the special moral importance of healthcare with his later work on the social determinants of health. In his earlier work, Daniels argued that healthcare is of special moral importance because it protects opportunity. In this later work, (...) Daniels argues that the social determinants of health (which in fact tend to have a larger effect on health outcomes than healthcare does) should also be considered special. This paper argues that it is a mistake to base a theory of justice for health on the claim that health (or the social determinants of health) are "special", for three reasons. First, once we realise that health is to a large part socially determined by features such as distribution of income, which are also of independent importance for justice, we cannot talk about a theory of justice for health in isolation from an overall theory of justice. Second, when we are trying to work out the place of health in a general theory of justice, being told that health (or the social determinants of health) is special is unhelpful. The relevant starting point should rather be whether health matters in a fundamental way for justice, or whether it matters merely for the effects it has on those goods which are of fundamental importance for justice. Third, treating the social determinants of health as special would in fact be counterproductive in terms of the broad approach to justice Daniels favours. (shrink)
