Delusions are bizarre and distressing beliefs that characterize certain mental illnesses. They arise without clear reasons and are remarkably persistent. Recent models of delusions, drawing on a neuroscientific understanding of learning, focus on how delusions might emerge from abnormal experience. We believe that these models can be extended to help us understand why delusions persist. We consider prediction error, the mismatch between expectancy and experience, to be central. Surprising events demand a change in our expectancies. This involves making what we (...) have learned labile, updating and binding the memory anew: a process of memory reconsolidation. We argue that, under the influence of excessive prediction error, delusional beliefs are repeatedly reconsolidated, strengthening them so that they persist, apparently impervious to contradiction. (shrink)
The debate over how to best guide HIV-infected mothers in resource-poor settings on infant feeding is more than two decades old. Globally, breastfeeding is responsible for approximately 300,000 HIV infections per year, while at the same time, UNICEF estimates that not breastfeeding (formula feeding with contaminated water) is responsible for 1.5 million child deaths per year. The largest burden of these infections and deaths occur in Sub-Saharan Africa. Using this region as an example of the burden faced more generally in (...) other resource-poor settings, we contrast the evolution of the clinical standard of care for infant feeding with HIV-infected mothers in high-income countries to the current international clinical guidelines for HIV-infected mothers and infant feeding in resource-poor settings. While the international guidelines of exclusive breastfeeding for a 6-month period seem to offer the least-worst strategy for reducing mother-to-child transmission of HIV during infancy while conferring some immunity through breastfeeding post-6 months, we argue that the impact of the policy on mothers and healthcare workers on the ground is not well understood. The harm reduction approach on the level of health policy translates into a complicated, painful moral dilemma for HIV-positive mothers and those offering them guidance on infant feeding. We argue that the underlying socio-economic disparities that continue to fuel the need for a harm reduction policy on infant feeding and the harm to women and children justify: (1) that higher priority be given to solving the infant feeding dilemma with improved data on safe feeding alternatives, and (2) support of innovative, community-driven solutions that address the particular economic and cultural challenges that continue to result in HIV-transmission to children within these communities. (shrink)
We surveyed the approaches of 661 geneticists in 18 nations to 14 clinical cases and asked them to give their ethical reasons for choosing these approaches. Patient autonomy was the dominant value in clinical decision-making, with 59% of responses, followed by non-maleficence (20%), beneficence (11%) and justice (5%). In all, 39% described the consequences of their actions, 26% mentioned conflicts of interest between different parties and 72% placed patient welfare above the welfare of others. The U.S., Canada, Sweden, and U.K. (...) led in responses favoring autonomy. There were substantial international differences in moral reasoning. Gender differences in responses reflected women's greater attention to relationships and supported feminist ethical theories. (shrink)
If the force on a particle fails to satisfy a Lipschitz condition at a point, it relaxes one of the conditions necessary for a locally unique solution to the particle’s equation of motion. I examine the most discussed example of this failure of determinism in classical mechanics—that of Norton’s dome—and the range of current objections against it. Finding there are many different conceptions of classical mechanics appropriate and useful for different purposes, I argue that no single conception is preferred. Instead (...) of arguing for or against determinism, I stress the wide variety of pragmatic considerations that, in a specific context, may lead one usefully and legitimately to adopt one conception over another in which determinism may or may not hold. (shrink)
This article assesses the significance of a “politics of life”, also termed biopolitics, for any theological analysis of death. By charting the manner in which modern theological approaches to death are closely related to political attempts to secure life (especially in the work of Hobbes), the piece hopes to offer a theological history of the present from which a theology of death might be re-envisioned.
Much has been written as of late on the status of the physical Church- Turing thesis and the relation between physics and computer science in general. The following discussion will focus on one such article . The purpose of these notes is not so much to argue for a particular thesis as it is to solicit a dialog that will help clarify our own thoughts.
As the potential for the first human trials of somatic cell gene therapy nears, two ethical issues are examined: (1) problems of moral choice for members of institutional review boards who consider the first protocols, for parents, and for the clinical researchers, and the special protections that may be required for the infants and children to be involved, and (2) ethical objections to somatic cell therapy made by those concerned about a putative inevitable progression of genetic knowledge from therapy to (...) mass genetic engineering in human reproduction. The author's viewpoint is that a consensus exists on the required moral approach to somatic cell therapy, but that no moral approach yet exists for experiments beyond this level, especially in the germline cells of human beings. Keywords: gene therapy, somatic cells, germ cells, institutional review boards, genetic engineering CiteULike Connotea Del.icio.us What's this? (shrink)
The clock hypothesis of relativity theory equates the proper time experienced by a point particle along a timelike curve with the length of that curve as determined by the metric. Is it possible to prove that particular types of clocks satisfy the clock hypothesis, thus genuinely measure proper time, at least approximately? Because most real clocks would be enormously complicated to study in this connection, focusing attention on an idealized light clock is attractive. The present paper extends and generalized partial (...) results along these lines with a theorem showing that, for any timelike curve in any spacetime, there is a light clock that measures the curve’s length as accurately and regularly as one wishes. (shrink)
Although the incidence and composition of HECs has been well characterized, little is known about how HECs assess their performance. In order to describe the incidence of HEC self-evaluation, the methods HECs use to evaluate their performance, and the characteristics of HECs that influence self-evaluation, we surveyed the readers ofHospital Ethics. 290 HECs in 45 U.S. states, the District of Columbia, Puerto Rico and three Canadian provinces, completed questionnaires. Of the 241 HECs included in the data analysis, 97.9% had performed (...) some self-evaluation. Responding committees largely made formative rather than summative evaluations and appeared to evaluate performance in light of their own objectives rather than basing assessments on specific structural, process, and outcome measures of quality. Responding committees used certain evaluation criteria more extensively than others — among these, the number of participants and staff knowledge of the service provided — with the choice of criteria differing with the function being evaluated. Eight characteristics of HECs influenced the probability of self-evaluation, including age, number of beds and meetings, the existence of a mission statement, and a budget. The presence of certain characteristics made HECs six times more likely to evaluate their performance than HECs without the characteristic. (shrink)
This article reflects on the author's modest experience as an expert witness in two trials: Osheroff vs. Greenspan (1983), and In the Matter of Baby K (1994). Bioethicists' expertise as scholar-teachers and consultants on particular issues merits qualification by judges as expert witnesses. The article argues that a different kind of expertise – strong moral advocacy – is required to be an effective expert witness. The major lessons of expert witnessing for the author concern the demands and strains on the (...) bioethicist's role as scholar, teacher, and consultant. The Baby K case is analyzed in some detail, due to its importance for bioethics, ethics consultation, and the testimony of bioethicists on either side of the case. Rules of thumb are offered to guide decisions as to choices regarding expert witnessing, as well as a discussion of the interaction of law and bioethics. (shrink)