Genomic research projects that collect tissues from deceased organ and tissue donors must obtain the authorization of family decision makers under difficult circumstances that may affect the authorization process. Using a quasi-experimental design, the Ethical, Legal, and Social Issues (ELSI) substudy of the Genotype-Tissue Expression (GTEx) project compared the recall and understanding of the donation authorization process of two groups: family members who had authorized donation of tissues to the GTEx project (the comparison group) and family members who had authorized (...) organ and tissue donations in years previous, who subsequently participated in two different mock-authorization processes that mimicked the GTEx authorization process (the intervention groups). Participants in the comparison and intervention groups were matched on key demographic characteristics.We found that participants in the intervention groups who experienced a mock-authorization process demonstrated better recall of the tissue donation request than members of the comparison group. Our data indicate that the stress associated with the loss of a loved one limited the ability of family members to recall details about the GTEx project. However, we found a similar lack of knowledge in both the comparison and the intervention group participants, suggesting lack of knowledge may be due to the complexity and unfamiliarity of the information presented to them during the authorization process. We discuss these findings in the context of everyday clinical decision making in cognitively challenging conditions. (shrink)

Direct Realists believe that perception involves direct awareness of an object not dependent for its existence on the perceiver. Howard Robinson rejects this doctrine in favour of a Sense-Datum theory of perception. His argument against Direct Realism invokes the principle ‘same proximate cause, same immediate effect’. Since there are cases in which direct awareness has the same proximate cerebral cause as awareness of a sense datum, the Direct Realist is, he thinks, obliged to deny this causal principle. I suggest (...) that although Direct Realism is in more than one respect implausible, it does not succumb to Robinson’s argument. The causal principle is true only if ‘proximate cause’ means ‘proximate sufficient cause’, and the Direct Realist need not concede that there is a sufficient cerebral cause for direct awareness of independent objects. (shrink)

This is a response to a paper by N.M.L. Nathan in which he argues that the attempt to provide a global justification of our entire set of beliefs necessarily leads to an infinite regress, in contrast with cases of local uncertainty, which he thinks can be resolved without regress. I argue that if he is right about the local uncertainty case, then he should not fear a regress in the global case, as the two situations are more similar than (...) he supposes. (shrink)

For William James, work was the problem. Ultimately, going to work was the resolution, and James's quest for meaningful work remains as relevant at the end of the twentieth century as it was in the nineteenth. Weaving letters, diaries, drawings, and published texts, Becoming William James provides a convincing biographical analysis rich in detail and tone. In his new introduction, Howard M. Feinstein adds biological psychiatry to psychoanalytic and family systems theories to inform our understanding of a complex man. (...) In addition, he discusses whether James's mental illness might have been treated with drugs. (shrink)

Berkeley confidently asserts the connection between his attack on abstract ideas and immaterialism, But how the connection works has puzzled modern commentators. I construct an argument resting on the imagist theory of thought which connects anti-ionism and immaterialism and try to show that it is berkeleian. I then suggest that, Without the mistaken imagist theory, A similar and still interesting argument can be constructed to the weaker conclusion that matter is essentially unknowable.

The Vatican’s position on in vitro fertilization (IVG), found in the ’Instruction on Bioethics’ (1987), is that all IVF is immoral, for it violates the normative procreative act of married spouses. The dilemma created is, if all instances of IVF are immoral, then God’s act in the Incarnation (granting the traditional doctrine) must also have been immoral. Conversely, if God’s act in the Incarnation was not immoral, then at least some cases of human IVF are not immoral either. A resolution (...) is offered. Two diagrams are employed. (shrink)

I claim that there are four major strands of argument for externalism and set out to discuss three of them. The four are: (A) That referential thoughts are object-dependent. This I do not discuss. (B) That the semantics of natural kind terms is externalist. (C) That all semantic content, even of descriptive terms, stems from the causal relations of representations to the things or properties they designate in the external world. (D) That, because meaning is a social product and no (...) individual can capture the whole social practice that defines a concept, what the speaker means always outruns what he can know.I briefiy discuss (C) and (D) and conclude that they cannot be correct, because, if they were, the content of every thought would permanently transcend the refiective grasp of all thinkers. Then I discuss (B) and conclude that, though Putnam shows something interesting about natural kind terms -- namely that a real verbal definition requires science -- this has none of the consequences for philosophy of mind that it is normally supposed to have. (shrink)

Interaction of ligands such as epidermal growth factor and interferon‐γ with the extracellular domains of their plasma membrane receptors results in internalization followed by translocation into the nucleus of the ligand and/or receptor. There has been reluctance, however, to ascribe signaling importance to this, the focus instead being on second messenger pathways, including mobilization of kinases and inducible transcription factors (TFs). The latter, however, fails to explain the fact that so many ligands stimulate the same second messenger cascades/TFs, and yet (...) show distinct gene activation profiles. This is particularly apt in the case of the seven STAT TFs that are held to be the mediators of the distinct cellular functions of over 60 ligands. The current review focuses on five representative nuclear localizing ligands for which there is documentation of translocation into the cytosol and nucleus through well‐characterized pathways, in addition to a role in gene activation by ligand/receptor in the nucleus. BioEssays 26:993‐1004, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

The 1964 theorem of John Bell shows that no model that reproduces the predictions of quantum mechanics can simultaneously satisfy the assumptions of locality and determinism. On the other hand, the assumptions of signal locality plus predictability are also sufficient to derive Bell inequalities. This simple theorem, previously noted but published only relatively recently by Masanes, Acin and Gisin, has fundamental implications not entirely appreciated. Firstly, nothing can be concluded about the ontological assumptions of locality or determinism independently of each (...) other—it is possible to reproduce quantum mechanics with deterministic models that violate locality as well as indeterministic models that satisfy locality. On the other hand, the operational assumption of signal locality is an empirically testable (and well-tested) consequence of relativity. Thus Bell inequality violations imply that we can trust that some events are fundamentally unpredictable, even if we cannot trust that they are indeterministic. This result grounds the quantum-mechanical prohibition of arbitrarily accurate predictions on the assumption of no superluminal signalling, regardless of any postulates of quantum mechanics. It also sheds a new light on an early stage of the historical debate between Einstein and Bohr. (shrink)

This essay examines neoconservative criticisms of equity planning, and the challenges against the right of government to regulate local development and land use. The specific concern of this essay is how, or if, local development administrators (equity planners), should use their discretionary powers to ensure that city officials and private developers promote and protect the interests of urban residents, particularly the poor and disadvantaged. The essay begins by discussing the alleged conflict said to exist between needy urban residents and the (...) more secure urban taxpayers. The contrary views of equity planners are then reviewed, and the tensions within the neoconservative arguments are exposed and critiqued. Finally, the dispute between equity planners and neoconservatives is further explored by examining the dispute over the voucher system to address the problem of equal educational opportunity in urban communities. (shrink)

The concept of a reason is now central to many areas of contemporary philosophy. Key theses in ethics, epistemology, political philosophy, philosophy of action, and the philosophy of the emotions, among others, have come to be framed in terms of reasons. And yet, despite their centrality, theorists seem to take inconsistent things for granted about how reasons work, what kinds of things can be reasons, what reasons favor, and more. Somehow reasons have come to be both indispensable and impenetrable. -/- (...) The Fundamentals of Reasons offers a comprehensive introduction to the philosophy of reasons. Focusing on the twin roles of reasons in explanation and deliberation, the book not only emphasizes what has made reasons central across philosophy but it also explores why philosophers have such incompatible pictures about what reasons are and how they work. Working from the inside out, Howard and Schroeder identify contentious assumptions about not only the internal structure of reasons but also their relationship to other important concepts, and then show how these contentious assumptions shape the many downstream applications of reasons in ethics, epistemology, political philosophy, and beyond. -/- This mildly opinionated exploration of key questions about the significance and nature of reasons helps the reader to navigate this important part of the philosophical landscape and to get clearer about why reasons seem important and what their import, ultimately, is. (shrink)

Some rules seem more important than others. The moral rule to keep promises seems more important than the aesthetic rule not to wear brown with black or the pool rule not to scratch on the eight ball. A worrying number of metaethicists are increasingly tempted to explain this difference by appealing to something they call “authoritative normativity” – it’s because moral rules are “authoritatively normatively” that they are especially important. The authors of this chapter argue for three claims concerning “authoritative (...) normativity”: (1) that motivation for it originates in a parochial conception of “normative flavours”; (2) that arguments against alternative ways of explaining e.g., morality’s importance are overblown; and (3) that there are strong reasons against theorizing in terms of “authoritative normativity”. The overarching aim is not to show that “authoritative normativity” is incoherent or entirely unmotivated. Rather, it is to discuss some of “authoritative normativity’s” deeper commitments to correct the impression that is it largely benign or that it is entailed by familiar and popular “metanormative” positions. Authoritative normativity, it seems to us, is a solution in search of a problem. (shrink)

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

While it is tempting to suppose that an act has moral worth just when and because it is motivated by sufficient moral reasons, philosophers have, largely, come to doubt this analysis. Doubt is rooted in two claims. The first is that some facts can motivate a given act in multiple ways, not all of which are consistent with moral worth. The second is the orthodox view that normative reasons are facts. I defend the tempting analysis by proposing and defending a (...) heterodox account of both normative and motivating reasons that is inspired by Donald Davidson’s primary reasons. We should adopt the heterodox view, I argue, because it addresses an overlooked but fatal defect in the orthodox conception of reasons, of which challenges to the tempting analysis are a special case. (shrink)