The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the protocol, summarize the protocol, and discuss the major ethical challenges (...) encountered, along with our answers to the challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments.We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the pandemic and similar public health emergencies. (shrink)

Wright’s “adaptive landscape” has been influential in evolutionary thinking but controversial, especially because the landscape that organisms encounter is altered by the evolutionary process itsel...

In addition to considering sociocultural, political, economic, and ethical factors, effectively engaging socioscientific issues requires that students understand and apply scientific explanations and the nature of science. Promoting such understandings can be achieved through immersing students in authentic real-world contexts where the SSI impacts occur and teaching those students about how scientists comprehend, research, and debate those SSI. This triangulated mixed-methods investigation explored how 60 secondary students’ trophic cascade explanations changed through their experiencing place-based SSI instruction focused on the Yellowstone (...) wolf reintroduction, including scientists’ work and debates regarding that issue. Furthermore, this investigation determined the association between the students’ post place-based SSI instruction trophic cascade explanations and NOS views. Findings from this investigation demonstrate that through the place-based SSI instruction students’ trophic cascade explanations became significantly more accurate and complex and included more ecological causal mechanisms. Also, significant and moderate to moderately large correlations were found between the accuracy and contextualization of students’ post place-based SSI instruction NOS views and the complexity of their trophic cascade explanations. Empirical substantiation of the association between the complexity of students’ scientific explanations and their NOS views responds to an understudied area in the science education research. It also encourages the consideration of several implications, drawn from this investigation’s findings and others’ prior work, which include the need for NOS to be forefront alongside and in connection with science content in curricular standards and through instruction focused on relevant and authentic place-based SSI. (shrink)

Fox’s update of her pivotal 2007 study on ethics consultations in U.S. hospitals found that the gap in ethics consultations is widening between large teaching hospitals and small community hospital...

We applaud Dienes & Perner's efforts while raising some concerns regarding their assimilation of diverse data into a unifying framework. Some of the findings need not fit the framework they suggest. It is also not always clear what, above logico-semantic consistency, assimilation adds to the data that do fit their framework. These concerns are highlighted with reference to their arguments regarding the developmental data and the neuropsychological data, respectively.

Karl Rahner (1904–1984) has exercised a profound influence on Catholic theology. This paper reconstructs both why and how Rahner’s ideas were received in the United States since the 1950s. American theologians did much more than simply repeat what the German Jesuit had outlined. Rather, they made use of his thought in order to do theology constructively. Thus, even today Rahner’s influence in the US is quite noticeable.

The brain's reliance on glucose as a primary fuel source is well established, but psychological models of cognitive processing that take energy supply into account remain uncommon. One exception is research on self-control depletion, where debate continues over a limited-resource model of self-control depletion. This model argues that transient reduction in self-control after exertion of prior self-control is caused by the depletion of brain glucose, and that self-control processes are special, perhaps unique, in this regard. This model has been argued (...) to be physiologically implausible in several recent reviews. This paper attempts to correct some inaccuracies that have occurred during debate over the physiological plausibility of this model. We contend that not only is such limitation of cognition by constraints on glucose supply plausible, it is well established in the neuroscience literature across several cognitive domains. Conversely, we argue that there is no evidence that self-control is special in regard to its metabolic cost. Mental processes require physical energy, and the body is limited in its ability to supply the brain with sufficient energy to fuel mental processes. This article reviews current findings in brain metabolism and seeks to resolve the current conflict in the field regarding the physiological plausibility of the self-control glucose-depletion hypothesis. (shrink)

Angelaki, Volume 16, Issue 1, Page 1-3, 01Mar2011.

Current methods of obtaining an informed consent leave much to be desired. Patients rarely read consent forms or understand all of the risks, benefits, or alternatives associated with their treatment. Evaluating the advantages and disadvantages of treatment options often presents a more significant challenge for patients with lower levels of health literacy. This article reviews the evidence of shortcomings in our informed consent system and then explores the potential for a new approach to engage patients at all levels of health (...) literacy in their treatment decisions. Specifically, the article will examine the potential of shared decision-making to bridge gaps in knowledge, increase patient adherence to treatment, and improve health outcomes in low health literacy patient populations. Leveling barriers to treatment information for disadvantaged populations should be a public health imperative, especially if it can be shown to improve health outcomes and reduce health disparities. (shrink)

Current methods of obtaining an informed consent leave much to be desired. Patients rarely read consent forms or understand all of the risks, benefits, or alternatives associated with their treatment. Evaluating the advantages and disadvantages of treatment options often presents a more significant challenge for patients with lower levels of health literacy. This article reviews the evidence of shortcomings in our informed consent system and then explores the potential for a new approach to engage patients at all levels of health (...) literacy in their treatment decisions. Specifically, the article will examine the potential of shared decision-making to bridge gaps in knowledge, increase patient adherence to treatment, and improve health outcomes in low health literacy patient populations. Leveling barriers to treatment information for disadvantaged populations should be a public health imperative, especially if it can be shown to improve health outcomes and reduce health disparities. (shrink)

The rise of multi-stakeholder institutions (MIs) involving the ultra-processed food (UPF) industry has raised concerns among food and public health scholars, especially with regards to enhancing the legitimacy and influence of transnational food corporations in global food governance (GFG) spaces. However, few studies have investigated the governance composition and characteristics of MIs involving the UPF industry, nor considered the implications for organizing global responses to UPFs and other major food systems challenges. We address this gap by conducting a network analysis (...) to map global MIs involving the UPF industry, drawing data from web sources, company reports, business and market research databases, and academic and grey literature. We identified 45 such global food system MIs. Of these, executives from the UPF industry or affiliated interest groups held almost half (_n_ = 263, or 43.8%) of the total 601 board seat positions. Executives from a small number of corporations, especially Unilever (_n_ = 20), Nestlé (_n_ = 17), PepsiCo Inc (_n_ = 14), and The Coca-Cola Company (_n_ = 13) held the most board seat positions, indicating centrality to the network. Board seats of these MIs are dominated by executives from transnational corporations (_n_ = 431, or 71.7%), high-income countries (_n_ = 495, or 82.4%), and four countries (United States, Switzerland, United Kingdom, and the Netherlands) (_n_ = 350, or 58.2%) in particular. This study shows that MIs involving the UPF industry privilege the interests of corporations located near exclusively in the Global North, draw legitimacy through affiliations with multi-lateral agencies, civil society groups and research institutions, and represent diverse corporate interests involved in UPF supply chains. Corporate-anchored multi-stakeholderism, as a form of GFG governance, raises challenges for achieving food systems transformation, including the control and reduction of UPFs in human diets. (shrink)

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

It is unclear whether the regulatory distinction between non-identifiable and identifiable information—information used to determine informed consent practices for the use of clinically derived samples for genetic research—is meaningful to patients. The objective of this study was to examine patients' attitudes and preferences regarding use of anonymous and identifiable clinical samples for genetic research. Telephone interviews were conducted with 1,193 patients recruited from general medicine, thoracic surgery, or medical oncology clinics at five United States academic medical centers. Wanting to know (...) about research being done was important to 72% of patients when samples would be anonymous and to 81% of patients when samples would be identifiable. Only 17% wanted to know about the identifiable scenario but not the anonymous scenario. Curiosity-based reasons were the most common among patients who wanted to know about anonymous samples. Of patients wanting to know about either scenario, approximately 57% would require researchers to seek permission, whereas 43% would be satisfied with notification only. Patients were more likely to support permission in the anonymous scenario if they had more education, were Black, less religious, in better health, more private, and less trusting of researchers. The sample, although not representative of the general population, does represent patients at academic medical centers whose clinical samples may be used for genetic research. Few patients expressed preferences consistent with the regulatory distinction between non-identifiable and identifiable information. Data from this study should cause policy-makers to question whether this distinction is useful in relation to research with previously collected clinically derived samples. (shrink)

Exploring the Illusion of Free Will and Moral Responsibility is an edited collection of new essays by an internationally recognized line-up of contributors. It is aimed at readers who wish to explore the philosophical and scientific arguments for free will skepticism and their implications.

Reducing health disparities and improving health outcomes are fundamental principles in global health. Environmental justice remains underrecognized and undervalued as a key driver of health dispar...

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps, and other notations in the work. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may (...) freely copy and distribute this work, as no entity has a copyright on the body of the work.As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Broadening access to both computational and educational resources is crit- ical to diffusing machine learning (ML) innovation. However, today, most ML resources and experts are siloed in a few countries and organizations. In this article, we describe our pedagogical approach to increasing access to applied ML through a massive open online course (MOOC) on Tiny Machine Learning (TinyML). We suggest that TinyML, applied ML on resource-constrained embedded devices, is an attractive means to widen access because TinyML leverages low-cost and globally (...) accessible hardware and encourages the development of complete, self-contained applications, from data collection to deployment. To this end, a collaboration between academia and industry produced a four part MOOC that provides application-oriented instruction on how to develop solutions using TinyML. The series is openly available on the edX MOOC platform, has no prerequisites beyond basic programming, and is designed for global learners from a variety of backgrounds. It introduces real-world applications, ML algorithms, data-set engineering, and the ethi- cal considerations of these technologies through hands-on programming and deployment of TinyML applications in both the cloud and on their own microcontrollers. To facili- tate continued learning, community building, and collaboration beyond the courses, we launched a standalone website, a forum, a chat, and an optional course-project com- petition. We also open-sourced the course materials, hoping they will inspire the next generation of ML practitioners and educators and further broaden access to cutting-edge ML technologies. (shrink)

BioPortal is a Web portal that provides access to a library of biomedical ontologies and terminologies developed in OWL, RDF(S), OBO format, Protégé frames, and Rich Release Format. BioPortal functionality, driven by a service-oriented architecture, includes the ability to browse, search and visualize ontologies (Figure 1). The Web interface also facilitates community-based participation in the evaluation and evolution of ontology content.

Returning genomic research results to family members raises complex questions. Genomic research on life-limiting conditions such as cancer, and research involving storage and reanalysis of data and specimens long into the future, makes these questions pressing. This author group, funded by an NIH grant, published consensus recommendations presenting a framework. This follow-up paper offers concrete guidance and tools for implementation. The group collected and analyzed relevant documents and guidance, including tools from the Clinical Sequencing Exploratory Research Consortium. The authors then (...) negotiated a consensus toolkit of processes and documents. That toolkit offers sample consent and notification documents plus decision flow-charts to address return of results to family of living and deceased participants, in adult and pediatric research. Core concerns are eliciting participant preferences on sharing results with family and on choice of a representative to make decisions about sharing after participant death. (shrink)

ABSTRACT The little-studied presidency of Benjamin Harrison offers valuable insights into the surprising role that political ideas can play in government. Harrison was a highly qualified president who demonstrated energetic leadership and political skill, but whose ideological commitment to the Republican party as a quasi-sacred enterprise overrode other important considerations, thereby contributing to one of the greatest economic catastrophes in U.S. history: the Depression of 1893-1897. His ideas about the Republican party were forged in its early years, when it (...) led the political battle against slavery; but when Harrison became president, the party’s interests in trade protectionism, veterans’ pensions, and silver drove him to support policies that eventually sent the economy into a tailspin from which it took years to recover. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Russell's leviathan by Mark S. Lippincott 1. INTRODUCTION BERTRAND RUSSELL'S POLITICAL thought underwent several metamorphoses in his nearly seventy years of political activism and writing. Indeed, many commentators on Russell take this as the overarching attribute ofhis politics. Alan Ryan writes that "Russell's career defies summary analysis; his life was much too long and his activities too various. His philosophical allegiances were no more stable than his emotional allegiances, (...) and his political allegiances no more stable than either."1 Likewise, Benjamin Barber suggests that "Russell had to contend with staying alive; and by the time he was ninety, consistency must have seemed to him less like the hobgoblin of little minds than the hallmark Of a short life."2 Ryan, Barber and others come to different conclusions about Russell's engagements with pacifism, anarcho-syndicalism, socialism and liberalism, but their efforts, taken collectively, signal a growing appreciation for the fluidity of Russell's politics. This essay treats the diversity of Russell's "political allegiances" as a first step 1 Alan Ryan, Bertrand Russell: a Political Life (London: Allen Lane The Penguin Press, 1988), p. l. 2 Benjamin R. Barber, "Solipsistic Politics: Bertrand Russell and Empiricist Liberalism", in his The Conquest ofPolitics: Liberal Philosophy in Democratic Times (Princeton: Princeton U. P., 1988), p. 25. Russell's leviathan 7 toward a new understanding of his political thought. Yet, unlike so much commentary on Russell, the search for the overarching concept or unifying theme is eschewed. The core premise of the argument is that to understand the political Russell, it is necessary to suspend the urge to unify. What is crucial is an openness to the extraordinary variety and range of his political interests and reflections. Once this step is taken, it becomes possible to uncover the degree to which Russell's eclectic activism is reflected in his approach to political theory. It becomes possible to see that his statements on a particular political issue are embedded with concepts selected from various sources within the western tradition ofpolitical discourse. In addition, this approach highlights the conceptual background of some of Russell's more contentious political statements which seem so characteristically out of character. The issue selected for this essay arises from one of the most controversial and least understood acts in Russell's life. It concerns his public statements following World War II that the United States might do well to use its monopoly of atomic bombs to force the Soviet Union into abandoning the development of its own atomic weapons. Past attempts to explain this episode range from cursory denials and dismissals of its importance, to assertions that it was the step-child of Russell's Russophobia.3 If one examines these state3 The argument for threatening the Soviet Union into renouncing nuclear weapons is advanced by Russell in several public statements: "The Bomb and Civilization", Forward, 29 Sept. 1945; "Humanity's Last Chance", Cavalcade, 20 Oct. 1945; speech in the House of Lords, Hansard,_'2,~Nov. 1945; "The Atomic Bomb and the Prevention of War", Polemic, July-Aug. 1946; speech in the House of Lords, Hansard, 30 April 1947; "Still Time for Good Sense", '47 Magazine ofthe Year, Nov. 1947; "International Government", The New Commonwealth, Jan. 1948. Ronald Clark provides an important guide to Russell's statements during this period in Vie Life of Bertrand Russell (London : CapelWeidenfeld & Nicolson, 1975), but he does not examine the philosophical background. Alan Ryan comes closest to seeing Russell's theoretical link with Hobbes, but he leaves it as a passing remark about Russell's attitude towards world government during the First World War: "It is as if Russell had read Hobbes's Leviathan and been carried away by Hobbes's argument that the state of nature and the war of all against all was so dreadful that any rational man would fly to absolute monarchy for protection. Russell generalizes Hobbes's argument to the international sphere, but it fails to ask how men who get themselves into a 'war of all against all' can be expected to get themselves out again, and fails to show how they have done 8 Russell summer 1990 ments with an eye to Russell's... (shrink)

The overwhelming consensus amongst epistemologists is that there is no salient epistemological difference between the addressees of a speaker’s testimony and non-addressees. I argue that this overwhelming consensus is mistaken. Addressees of a speaker’s testimony are entitled to pass the epistemic buck or defer justificatory responsibility for their beliefs back to the testimonial speaker, while non-addressees are not. I then develop a provisional account of address that is in a position to mark this epistemic distinction between addressees and non-addressees.

The motivational constraint on normative reasons says that a consideration is a normative reason for an agent to act only if it is logically possible for the agent to act for that reason, or at least to be moved so to act. The claim figures Zelig-like in philosophical debates about practical reasons: on hand, occasionally prominent, but never the focus of discussion. However, because it is entailed by a number of prominent views about normative reasons—including various forms of internalism and (...) some views that closely connect reasons to good practical reasoning—its truth or falsehood has important implications. Mark Schroeder (2007) and Julia Markovits (2014) have recently criticized the Motivational Constraint on the grounds of so-called “elusive reasons”: reasons for some agent to act that are such that it is logically impossible both that they are normative reasons for that agent and the agent is moved to act for those reasons. In response, a number of philosophers (Sinclair 2016; Ridge and McKeever 2012; Paakkunainen 2017) have attempted to reconcile blindspot reasons with the motivational constraint. My aim in this paper is to show that these conciliatory strategies fail to overcome the challenge posed by elusive reasons. First, I examine each strategy and argue that it unsuccessful on its own terms. Second, I adduce another type of elusive reason not heretofore discussed in the literature, and I argue that these strategies also cannot make this kind of reason consistent with the motivational constraint. Finally, I defend the existence of this kind of reason against an important objection. (shrink)

Marking the centenary of Walter Benjamin's immensely influential essay, "Toward the Critique of Violence," this critical edition presents readers with an altogether new, fully annotated translation of a work that is widely recognized as a classic of modern political theory. The volume includes twenty-one notes and fragments by Benjamin along with passages from all of the contemporaneous texts to which his essay refers. Readers thus encounter for the first time in English provocative arguments about law and violence advanced (...) by Hermann Cohen, Kurt Hiller, Erich Unger, and Emil Lederer. A new translation of selections from Georges Sorel's Reflections on Violence further illuminates Benjamin's critical program. The volume also includes, for the first time in any language, a bibliography Benjamin drafted for the expansion of the essay and the development of a corresponding philosophy of law. An extensive introduction and afterword provide additional context. With its challenging argument concerning violence, law, and justice-which addresses such topical matters as police violence, the death penalty, and the ambiguous force of religion-Benjamin's work is as important today as it was upon its publication in Weimar Germany a century ago. (shrink)

Kant’s notion of (what I will call) rational sympathy solves a problem about how we can voluntarily fulfill our imperfect duty to adopt those ends of others which have value only because they have been set by rational agents, ends which I will refer to as merely permissible ends (MPEs). Others’ MPEs are individuated in terms of their own concepts of their MPEs, and we can only adopt their MPEs in terms of their concepts, since to adopt them in terms (...) of different concepts would be to adopt different ends. Others’ concepts of their MPEs may contain marks of the first person, and should contain no marks of law apart from permissibility. Rational sympathy allows us to adopt ends individuated in terms of concepts with marks of these kinds because rational sympathy allows us to voluntarily adopt others’ first-person perspectives in imagination, and to voluntarily shape our contingent feelings so that such concepts motivate us despite their underdetermination by law. (shrink)

The concept of hospitality has seen a strong revival in the literature on migration and among pro-migrant activists. However, its meaning, its scope, and the nature of the obligations it imposes remain contested. Open-border advocates see hospitality as a moral principle of openness that should trump nationalist arguments for closure, while nationalists tap into the home analogy and compare the state to a household welcoming migrants as guests, whose stay should accordingly be temporary and marked by gratitude. Some consider hospitality (...) a virtue that should translate into a personal responsibility to open one’s doors to others, while some politicise the concept to apply it to borders and state duties towards migrants. This paper unpacks the various literal and metaphorical meanings of the age-old concept of hospitality, and the shortcomings of its rhetorical uses. It then argues for a conception of hospitality as a principle of care towards displaced people. Hospitality alleviates ordinary obstacles that prevent a functional life in a new environment and allows for home-making practices. It is triggered by the vulnerability created by displacement, i.e., the material, emotional and political harms resulting from the loss of a home. (shrink)

Kant’s theory of friendship is crucial in defending his ethics against the longstanding charge of emotional detachment. But his theory of friendship is vulnerable to this charge too: the Kantian sage can appear to reject sympathetic suffering when she cannot help a suffering friend. I argue that Kant is committed to the view that both sages and ordinary people must suffer in sympathy with friends even when they cannot help, because sympathy is necessary to fulfill the imperfect duty to adopt (...) others’ merely permissible ends, and we ought to take friends’ MPEs as our own. MPEs are individuated in terms of concepts which include marks of the first person, and no marks of law other than permissibility. To adopt ends of others individuated in terms of such concepts rather than merely promote them as means to different ends, those concepts must engage with one’s feelings in a way that requires sympathy. (shrink)

© 2015, Springer-Verlag Berlin Heidelberg.Genetic studies have identified single nucleotide polymorphisms associated with the risk of prostate cancer. It remains unclear whether such genetic variants are associated with disease aggressiveness. The NCI-SPORE Genetics Working Group retrospectively collected clinicopathologic information and genotype data for 36 SNPs which at the time had been validated to be associated with PC risk from 25,674 cases with PC. Cases were grouped according to race, Gleason score and aggressiveness. Statistical analyses were used to compare the frequency (...) of the SNPs between different disease cohorts. After adjusting for multiple testing, only PC-risk SNP rs2735839 was significantly and inversely associated with aggressive and high-grade disease in European men. Similar associations with aggressive and high-grade disease were documented in African-American subjects. The G allele of rs2735839 was associated with disease aggressiveness even at low PSA levels in both European and African-American men. Our results provide further support that a PC-risk SNP rs2735839 near the KLK3 gene on chromosome 19q13 may be associated with aggressive and high-grade PC. Future prospectively designed, case-case GWAS are needed to identify additional SNPs associated with PC aggressiveness. (shrink)

This dissertation offers a phenomenology of that mode of self-interpretation in which it becomes possible for an interpreter to intentionally participate in the production of moral norms to which the interpreter himself or herself feels bound. Part One draws on Richard Rorty's notion of the "ironist" in order to thematize the phenomenon I call "moral friction"; a condition in which an interpreter becomes explicitly aware of the historical and cultural contingencies of their own moral vocabularies, practices, and concerns and as (...) a result find themselves incapable of feeling the normative weight implicit in these. Part Two draws on Heidegger's existential analytic of human being, Gadamer's development of Hermeneutic Phenomenology, and Hegel's notion of "sublation" in order to map how novel interpretations can irreversibly displace the coherence of older interpretations. I call this form of interpretation "moral phenomenology." Finally, in Part Three, I utilize a selective phenomenology of musical improvisation to plot the unique temporal orientation of self-interpretation that results from intentionally deploying this irreversible displacement of older interpretations that involve normative moral implications. I call the form of life that is marked by this hermeneutic mode the "improviser." The result is a description of a form of life in which it becomes possible to explicitly participate in the production of moral norms within a historical and culturally contingent context that nevertheless preserves standards of rational justification for normative moral judgment without the need for atemporal first principles. The availability of this mode of self-interpretation displaces the sharp distinction between non-normative descriptive phenomenology and normative moral reasoning by placing the latter within a non-teleological historical practice that engages in the production of interpretations which irreversibly displace older interpretations--a practice that is governed by the critical cultivation of contingent moral norms within the open investigation into the good life for human being. (shrink)