Book reviewed in this article: The Willowbrook Wars: A Decade of Struggle for Social Justice. By David J. Rothman and Sheila M. Rothman.

Introduction: making the invisible visible -- The nobility of the material -- Research at war -- The guilded age of research -- The doctor as whistle-blower -- New rules for the laboratory -- Bedside ethics -- The doctor as stranger -- Life through death -- Commissioning ethics -- No one to trust -- New rules for the bedside -- Epilogue: The price of success.

Addresses the issues at the heart of international medicine and social responsibility. A number of international declarations have proclaimed that health care is a fundamental human right. But if we accept this broad commitment, how should we concretely define the state’s responsibility for the health of its citizens? Although there is growing debate over this issue, there are few books for general readers that provide engaging accounts of critical incidents, practices, and ideas in the field of human rights, health care, (...) and medicine. Included in the book are case studies of such issues as AIDS among orphans in Romania, organ trafficking, prison conditions, health care rationing, medical research in the third world, and South Africa’s constitutionally guaranteed right of access to health care. It uses these topics to address themes of protection of vulnerable populations, equity and fairness in delivering competent medical care, informed consent and the free flow of information, and state responsibility for ensuring physical, mental, and social well-being. (shrink)

Although HIV disease has set a new model for resolving the tensions between civil liberties and public health interests, with an unprecedented commitment to individual privacy and autonomy, the resurgence of tuberculosis has sparked new and troublesome concerns. One particularly intense controversy has emerged around the value and appropriateness of single disease hospitals. In HIV disease, the single hospital turns out to be an altogether unsuitable and unnecessary innovation. In the instance of tuberculosis, however, it appears to have a critical (...) and legitimate role, particularly for involuntary commitment of patients who have been non-compliant with treatment regimens. To be sure, that role must be carefully circumscribed and the facilities themselves closely monitored. But a hospital dedicated to tuberculosis now occupies a central place in public policy that is not to be found for HIV disease. What considerations promote this difference, and how a single disease hospital for tuberculosis may avoid the pitfalls that make it so inapposite for HIV, are the two questions this essay will be exploring. (shrink)

Although HIV disease has set a new model for resolving the tensions between civil liberties and public health interests, with an unprecedented commitment to individual privacy and autonomy, the resurgence of tuberculosis has sparked new and troublesome concerns. One particularly intense controversy has emerged around the value and appropriateness of single disease hospitals. In HIV disease, the single hospital turns out to be an altogether unsuitable and unnecessary innovation. In the instance of tuberculosis, however, it appears to have a critical (...) and legitimate role, particularly for involuntary commitment of patients who have been non-compliant with treatment regimens. To be sure, that role must be carefully circumscribed and the facilities themselves closely monitored. But a hospital dedicated to tuberculosis now occupies a central place in public policy that is not to be found for HIV disease. What considerations promote this difference, and how a single disease hospital for tuberculosis may avoid the pitfalls that make it so inapposite for HIV, are the two questions this essay will be exploring. (shrink)

The Physician Payments Sunshine Act requires health care product manufacturers to report to the federal government payments more than $10 to physicians. Bringing unprecedented transparency to medicine, PPSA holds great potential for enabling medical stakeholders to manage conflicts of interest and build patient trust—crucial responsibilities of medical professionalism. The authors conducted six focus groups with 42 physicians in Chicago, IL, San Francisco, CA, and Washington, DC, to explore attitudes and experiences around PPSA. Participants valued the concept of transparency but were (...) wary of the law's design and consequences. They downplayed PPSA's potential and felt it undermined public trust. Showing broad unawareness of COI, they dismissed the notion of industry influence and welcomed company “perks.” Misapprehensions may leave physicians unprepared to advance the opportunities PPSA holds for professionalism. The authors offer recommendations for government and medicine to improve physicians' and other stakeholders' understandings and use of the data. (shrink)

Book reviewed in this article: Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making. By David J. Rothman.

This essay explores the evolution of the tension between the principles of autonomy and beneficence in American health care over the past several decades. In retrospect it is clear that the social movements of the 1960s and 70s set the tone and the goals for the emergence of a new emphasis on patient autonomy. Indeed, the impact of civil liberties-minded lawyers on the promotion of a commitment to autonomy is far more vital than the term “bioethics” commonly suggests. Tracing the (...) impact of this principle on clinical encounters over the past 25 years makes apparent that consumers have extended their influence over a wide range of treatment decisions. This influence is now being reinforced by an extraordinary information revolution, which includes the computer, the web, the dot.coms, the search engines, and such novel practices as Direct-to-Consumer advertising by pharmaceutical companies. The impact of these developments may be seen in such diverse issues as physician-assisted suicide and the failure of national health insurance initiatives. (shrink)

Book reviewed in this article: Conscience and Convenience: The Asylum and its Alternatives in Progressive America. By David J. Rothman.

The essays in this book discuss the originally proposed Baldwin effect, how it was modified over time, and its possible contribution to contemporary empirical...

The Darwinian concept of natural selection was conceived within a set of Newtonian background assumptions about systems dynamics. Mendelian genetics at first did not sit well with the gradualist assumptions of the Darwinian theory. Eventually, however, Mendelism and Darwinism were fused by reformulating natural selection in statistical terms. This reflected a shift to a more probabilistic set of background assumptions based upon Boltzmannian systems dynamics. Recent developments in molecular genetics and paleontology have put pressure on Darwinism once again. Current work (...) on self-organizing systems may provide a stimulus not only for increased problem solving within the Darwinian tradition, especially with respect to origins of life, developmental genetics, phylogenetic pattern, and energy-flow ecology, but for deeper understanding of the very phenomenon of natural selection itself. Since self-organizational phenomena depend deeply on stochastic processes, self-organizational systems dynamics advance the probability revolution. In our view, natural selection is an emergent phenomenon of physical and chemical selection. These developments suggest that natural selection may be grounded in physical law more deeply than is allowed by advocates of the autonomy of biology, while still making it possible to deny, with autonomists, that evolutionary explanations can be modeled in terms of a deductive relationship between laws and cases. We explore the relationship between, chance, self-organization, and selection as sources of order in biological systems in order to make these points. (shrink)

I argue that virtual reality is a sort of genuine reality. In particular, I argue for virtual digitalism, on which virtual objects are real digital objects, and against virtual fictionalism, on which virtual objects are fictional objects. I also argue that perception in virtual reality need not be illusory, and that life in virtual worlds can have roughly the same sort of value as life in non-virtual worlds.

It is often argued that human emotions, and the cognitions that accompany them, involve refinements of, and extensions to, more basic functionality shared with other species. Such refinements may rely on common or on distinct processes and representations. Multi-level theories of cognition and affect make distinctions between qualitatively different types of representations often dealing with bodily, affective and cognitive attributes of self-related meanings. This paper will adopt a particular multi-level perspective on mental architecture and show how a mechanism of subsystem (...) differentiation could have allowed an evolutionarily “old” role for emotion in the control of action to have altered into one more closely coupled to meaning systems. We conclude by outlining some illustrative consequences of our analysis that might usefully be addressed in research in comparative psychology, cognitive archaeology, and in laboratory research on memory for emotional material. (shrink)

Traditional scientific views of rationality are couched in economic terms; choosing an option that does not maximize expectancy is irrational. The construct has been extended metaphorically so that the term “irrational” now describes any decision deemed foolish by the evaluator. For everyday decisions that do not involve money, a decision maker’s utilities are generally not known to an onlooker. Therefore, the pejorative label may be applied inappropriately because the evaluation is distorted by incorrect assessment of the decision maker’s goals. We (...) tie this linguistic confusion to the predominance of gambling studies within decision making research. For noneconomic decisions, we propose an alternative definition, one inspired by a theory of everyday decisions. We label a decision irrational if is inconsistent with a policy previously established by the decision maker. The hierarchical structure of everyday decisions, along with the descriptive multiattribute utility model, are core elements in the theory presented by Weiss et al. (2010 Theory and Decision, 68, 101–114). The theory holds that fast changing considerations are a crucial element in the evaluation of decision options. The momentary salience attached to a consequence can change with current, often fleeting circumstances. An option that would usually be rejected can quickly become too tempting to resist. Most people exhibit this kind of irrationality, violating a personal policy, some of the time—and they are not necessarily foolish to do so. (shrink)

Sometimes it feels as though we can control our minds. We catch ourselves looking out the window when we should be paying attention to someone talking, for example, and we purposefully return our attention to the conversation. Or we wrest our minds away from the bothersome thought of an upcoming dental appointment to focus on anything we can find that makes us less nervous. Control attempts such as these can meet with success, leaving us feeling the masters of our consciousness. (...) Yet at other times.. (shrink)

Doctors’ strikes are legally permissible in the UK, with the situation differing in other countries. But are they morally permissible? Doug McConnell and Darren Mann have systematically attempted to dismiss the arguments for the moral impermissibility of doctors’ strikes and creatively attempted to provide further moral justification for them. Unfortunately for striking doctors, they fail to achieve this. Meanwhile, junior doctors’ strikes have continued in the UK through 2023 and have now extended into 2024. In this response, which focuses on (...) the UK situation and specifically junior doctors’ strikes in the National Health Service (NHS) in England, I will demonstrate a central problem with their arguments—namely that they underplay the harms caused by prolonged doctors’ strikes by ignoring the harms to patients with cancer. This weakens their conclusion that strikes are morally permissible in terms of the conditions and thresholds they set. I then provide a psychological critique of their justification for strikes in terms of the interests of the public. It follows that invoking the controversial concept of supererogatory action is ungrounded but also absurd when you consider time-critical cancer care. If those representing striking doctors wish to maintain a modicum of moral respectability, they should mitigate for patients with cancer and negotiate reasonably and with urgency. (shrink)

Academic staff owe a duty of fidelity to uphold institutional standards of integrity. They also have their own values and conceptions of integrity as well as personal responsibilities and commitments. The question of how academic practitioners address or reconcile conflicting values and responsibilities has been underexplored in the literature. Before we can examine effectiveness of academic integrity strategies and develop best practices, we need to examine the breadth of integrity decisions. To this end we posited the academic integrity problem as (...) a set of seven dilemmas and presented them to post-secondary education staff located in Europe, North America, Oceania, and Asia. We asked the participants to recommend a solution to each dilemma. This yielded a modest sample of 498 themes across 30 categories. We expected the responses to fall on a binary scale where decisions either support the integrity or ignore it. However, the data suggests that academic integrity decisions are better suited to continuum where participants aim to reconcile personal and institutional obligations. We further argue that academic integrity decisions are predicated on personal experience and therefore pose a challenge for policy standardization and enforcement. We conclude with a discussion of the implications of the findings for practice. (shrink)

Introduction Adolescents’ physical activity (PA) behavior can be driven by several psychosocial determinants at the same time. Most analyses use a variable-based approach that examines relations between PA-related determinants and PA behavior on the between-person level. Using this approach, possible coexistences of different psychosocial determinants within one person cannot be examined. Therefore, by applying a person-oriented approach, this study examined a) which profiles regarding PA-related psychosocial variables typically occur in female sixth-graders, b) if these profiles deliver a self-consistent picture according (...) to theoretical assumptions, and c) if the profiles contribute to the explanation of PA. Materials and Methods The sample comprised 475 female sixth-graders. Seventeen PA-related variables were assessed: support for autonomy, competence and relatedness in PE as well as their satisfaction in PE and leisure-time; behavioral regulation of exercise (five subscales); self-efficacy and social support from friends and family (two subscales). Moderate-to-vigorous PA was measured using accelerometers. Data were analyzed using the self-organizing maps (SOM) analysis, a cluster analysis including an unsupervised algorithm for non-linear models. Results According to the respective level of psychosocial resources, a positive, a medium and a negative cluster were identified. This superordinate cluster solution represented a self-consistent picture that was in line with theoretical assumptions. The three-cluster solution contributed to the explanation of PA behavior, with the positive cluster accumulating an average of six minutes more moderate-to-vigorous PA per day than the medium cluster and ten minutes more than the negative cluster. Additionally, SOM detected a subgroup within the positive cluster that benefited from a specific combination of intrinsic and external regulations with regard to PA. Discussion The results underline the relevance of the assessed psychosocial determinants of PA behavior in female sixth-graders. The results further indicate that the different psychosocial resources within a given person do not develop independently of one another, which supports the use of a person-oriented approach. In addition, the SOM analysis identified subgroups with specific characteristics, which would have remained undetected using variable-based approaches. Thus, this approach offers the possibility to reduce data complexity without overlooking subgroups with special demands that go beyond the superordinate cluster solution. (shrink)

I reply to seven commentaries on “The Virtual and the Real”. In response to Claus Beisbart, Jesper Juul, Peter Ludlow, and Neil McDonnell and Nathan Wildman, I clarify and develop my view that virtual are digital objects, with special attention to the nature of digital objects and data structures. In response to Alyssa Ney and Eric Schwitzgebel, I clarify and defend my spatial functionalism, with special attention to the connections between space and consciousness. In response to Marc Silcox, I clarify (...) and develop my view of the value of virtual worlds, with special attention to the case where we experience these worlds as virtual. (shrink)

Some business schools have integrated business ethics issues into their core functional courses rather than simply offering a separate ethics course. To accommodate such a strategy, functional faculty members usually teach ethical issues, a task for which they are rarely trained. However, learning materials are available: some core course textbooks provide additional coverage of ethics, and case studies (and accompanying teaching notes for instructors) are also available which cover ethical issues.This paper reports on an analysis of these materials. We find (...) that a sample of the leading textbooks provides only very superficial coverage of ethical issues. Cases provide a wide range of issues suitable for class discussion, but their teaching notes in many cases provide little guidance for instructors unfamiliar with teaching ethics. Thus there remains a need for teaching resources for business faculty new to teaching ethics. (shrink)

Cultured meat, like any new technology, raises inevitable ethical issues. For example, on animal ethics grounds, it may be argued that reformed livestock farming in which animals’ lives are worth living constitutes a better alternative than cultured meat, which, along with veganism, implies the extinction of farm animals. Another ethical argument is that, just as we would undermine human dignity by producing and consuming meat that is grown from human cells, eating meat that is grown from nonhuman animal cells would (...) violate animal dignity because it is a way to create an us and them, which would make veganism the only ethical option. The present study challenges this argument. First, I examine the fundamental issue of whether cultured meat provides such an attack on animal dignity. The second issue is whether, assuming that it is true that cultured meat undermines animal dignity, it would be acceptable to reject cultured meat even though this implies sacrificing nonhuman animals. (shrink)

The book is an extended study of the problem of consciousness. After setting up the problem, I argue that reductive explanation of consciousness is impossible , and that if one takes consciousness seriously, one has to go beyond a strict materialist framework. In the second half of the book, I move toward a positive theory of consciousness with fundamental laws linking the physical and the experiential in a systematic way. Finally, I use the ideas and arguments developed earlier to defend (...) a form of strong artificial intelligence and to analyze some problems in the foundations of quantum mechanics. (shrink)

[This is an edited version of a keynote talk at the conference on Neural Information Processing Systems (NeurIPS) on November 28, 2022, with some minor additions and subtractions.] -/- There has recently been widespread discussion of whether large language models might be sentient or conscious. Should we take this idea seriously? I will break down the strongest reasons for and against. Given mainstream assumptions in the science of consciousness, there are significant obstacles to consciousness in current models: for example, their (...) lack of recurrent processing, a global workspace, and unified agency. At the same time, it is quite possible that these obstacles will be overcome in the next decade or so. I conclude that while it is somewhat unlikely that current large language models are conscious, we should take seriously the possibility that successors to large language models may be conscious in the not-too-distant future. (shrink)

In their paper “Members First: The Ethics of Donating Organs and Tissues to Groups,” Timothy Murphy and Robert Veatch question the ethical underpinnings of LifeSharers, a grass-roots effort to increase the supply of organs by giving organ donors preferred access to organs.

We propose an alternative resolution of Simpson's paradox in multiple classification experiments, using a different maximum likelihood estimator. In the center of our analysis is a formal representation of free choice and randomization that is based on the notion of incompatible measurements.We first introduce a representation of incompatible measurements as a collection of sets of outcomes. This leads to a natural generalization of Kolmogoroff's axioms of probability. We then discuss the existence and uniqueness of the maximum likelihood estimator for a (...) probability weight on such a generalized sample space, given absolute frequency data.As a first example, we discuss an estimation problem with censured data that classically admits only biased ad hoc estimators.Next, we derive an explicit solution of the maximum likelihood estimation problem for a large class of experiments that arise from various kids of compositions of sample spaces. We identify the (categorical) direct sum of sample spaces as a representation of “free choice,” and the (categorical) direct product as a representation of “randomization.”Finally, we apply the foregoing discussion to the case of multiple classification experiments in order to show that there is no Simpson's paradox if the difference between free choice and randomization is recognized in the structure of the experiment.A comparison between our new estimator and the “usual” calculation can be summarized as follows: Pooling the data over one classification factor in the “usual” way in fact destroys or ignores the information contained in it, whereas our proposed maximum likelihood estimator is a proper marginal over this factor that “averages out” the information contained in it. The estimators agree with each other in the case of proportional sample sizes. (shrink)

There is a long tradition in philosophy of using a priori methods to draw conclusions about what is possible and what is necessary, and often in turn to draw conclusions about matters of substantive metaphysics. Arguments like this typically have three steps: first an epistemic claim , from there to a modal claim , and from there to a metaphysical claim.

Rethinking the powers of the imagination, Søren Kierkegaard both anticipates and challenges contemporary approaches to a descriptive philosophy of religion. In contrast to the reigning approaches to religion in his day, Kierkegaard reconceives philosophy as, first of all, descriptive of human, including specifically ethical and religious, existence. To this end, he develops conceptual tools, including a descriptive ontology of human existence, a “pluralist epistemology” exploring both cognitive and passional dimensions of religion, and a role for the poetic in philosophy, strikingly (...) expressed in his observer figures who “imaginatively construct” “thought projects” to explore human existence. While this new descriptive account anticipates subsequent approaches to the philosophy of religion, it could be interpreted as another “objectivist” endeavor, yet Kierkegaard attempts more in this descriptive philosophy. He imaginatively deploys conceptual and rhetorical strategies maieutically to both describe and elicit self-reflection aimed at transformation, thus expanding the imagination’s uses for his readers. Comparing Kierkegaard to Pierre Hadot’s recovery of ancient Greek philosophy as “a way of life” will show how Kierkegaard also engages the particularity of “the Christian principle”, with implications for how philosophy can both describe and elicit the pathos of other religious traditions as well. (shrink)

This engaging Handbook identifies and critically examines the moral opportunities and challenges typically attributed to artificial intelligence. It provides a comprehensive overview and examination of the most pressing and urgent problems with this technology by drawing on a wide range of analytical methods, traditions, and approaches.

Does consciousness collapse the quantum wave function? This idea was taken seriously by John von Neumann and Eugene Wigner but is now widely dismissed. We develop the idea by combining a mathematical theory of consciousness (integrated information theory) with an account of quantum collapse dynamics (continuous spontaneous localization). Simple versions of the theory are falsified by the quantum Zeno effect, but more complex versions remain compatible with empirical evidence. In principle, versions of the theory can be tested by experiments with (...) quantum computers. The upshot is not that consciousness-collapse interpretations are clearly correct, but that there is a research program here worth exploring. (shrink)

This chapter analyzes aspects of the relationship between consciousness and intentionality. It focuses on the phenomenal character and the intentional content of perceptual states, canvassing various possible relations among them. It argues that there is a good case for a sort of representationalism, although this may not take the form that its advocates often suggest. By mapping out some of the landscape, the chapter tries to open up territory for different and promising forms of representationalism to be explored in the (...) future. In particular, it argues for a nonreductive, narrow, and Fregean variety of representationalism, which contrasts strongly with more widely explored varieties. It concludes with some words about the fundamental relationship between consciousness and intentionality. (shrink)