Specialists and primary care physicians play an integral role in treating the twin epidemics of pain and addiction. But inadequate access to specialists causes much of the treatment burden to fall on primary physicians. This article chronicles the differences between treatment contexts for both pain and addiction — in the specialty and primary care contexts — and derives a series of reforms that would empower primary care physicians and better leverage specialists.

Excessive prescribing of pain medications after surgery has contributed to the epidemic of opioid misuse and diversion in the United States. Pain specialists may be particularly well situated to address these issues. We describe an attempt to reverse the trend at an orthopedic surgical hospital by implementing a peri-operative assessment and treatment service which minimizes preoperative opioid use, when necessary implements addiction treatment, and encourages early tapering from opioids.

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

The dispute over the exact nature and status of possible worlds in Leibniz’s philosophy has proven difficult to resolve. The standard view, that there is one unique actual world and that possible worlds exist solely as ideas within God’s understanding, sits in tension with important metaphysical and theological components of Leibniz’s system. For example, Leibniz takes possible individuals to have some “essence or reality” in themselves and to strive for existence, which allows him to ground counterfactual claims and to overcome (...) necessitarianism. However, scholars have long seen these claims as being at odds with God’s creation of one unique actual world. Catherine Wilson (2000) challenges the standard view’s claim that possible worlds are substantially different from the actual world, arguing instead that Leibniz’s metaphysical commitments are consistent with there being more than one actual world and that Leibniz has no way to block the claim that God would generate more than one such world. In this paper, I expand on Wilson’s account and argue, contrary to the standard view, that the key theses at the heart of Leibniz’s philosophical system entail modal realism—for Leibniz, there can be no ontological difference between possible and actual worlds. (shrink)

Scientists know that human activities, primarily fossil fuel combustion, are causing Earth’s temperature to increase. Yet in 2021, only 60% of the US population understood that human activities are the primary cause of global warming. We experimentally test whether information about the human causes of global warming influences Americans’ beliefs and concerns about global warming and support for climate policies. We find that communicating information about the human-causes of global warming increases public understanding that global warming is human-caused. This information, (...) both alone and with additional information about climate impacts and policy solutions, also increases public concern about global warming and support for climate policies, although the effects on climate concern and policy support are smaller. Importantly, the treatment effects are consistent across political party, with no backlash effects among Republicans. This suggests that when informed about climate change causes, impacts and solutions, most Americans can update their own climate change beliefs, risk perceptions, and policy support. (shrink)

Brain-computer interfaces (BCIs) have been successfully used by adults, but little information is available on BCI use by children, especially children with severe multiple impairments who may need technology to facilitate communication. Here we discuss the challenges of using non-invasive BCI with children, especially children who do not have another established method of communication with unfamiliar partners. Strategies to manage these challenges require consideration of multiple factors related to accessibility, cognition, and participation. These factors include decisions regarding where (home, clinic, (...) or lab) participation will take place, the number of sessions involved, and the degree of participation necessary for success. A strategic approach to addressing the unique challenges inherent in BCI use by children with disabilities will increase the potential for successful BCI calibration and adoption of BCI as a valuable access method for children with the most significant impairments in movement and communication. (shrink)

Normative ethical theories owe us an account of how to evaluate decisions under risk and uncertainty. Deontologists seem at a disadvantage here: our best decision theories seem tailor-made for consequentialism. For example, decision theory enjoins us to always perform our best option; deontology is more permissive. In this paper, we discuss and defend the idea that, when some pro-tanto wrongful act is all-things considered permissible, because it is a ‘lesser evil’, it is often merely permissible, by the lights of deontology. (...) We show that this raises new problems for deontological decision theory, and we show that to resolve them, we need to take a more innovative approach to morally evaluating decision-making under risk and uncertainty. (shrink)

What is known? And how do we come to know it? These are the primary points of focus for metaphysics and epistemology, respectively. Here, in one of the classic works of early-modern empiricist philosophy, John Locke (1632-1704) attempts to answer these basic human questions by moving away from the rationalist notion of innate ideas to establish the concept of the tabula rasa in which the mind is initially impressed with ideas through perception of the external world of substance. The formation (...) of basic ideas through the perception of primary and secondary qualities, and the more sophisticated development of concepts, is discussed as Locke departs from a purely mental view of knowledge to ground what we know in the firmer soil of empirical observation and in the mind's ability to interrelate ideas from perception. The careful reasoning of Locke's Essay has made it an enduring part of the history of of Western philosophy. (shrink)

The National Science Foundation's Second Merit Criterion, or Broader Impacts Criterion , was introduced in 1997 as the result of an earlier Congressional movement to enhance the accountability and responsibility as well as the effectiveness of federally funded projects. We demonstrate that a robust understanding and appreciation of NSF BIC argues for a broader conception of research ethics in the sciences than is currently offered in Responsible Conduct of Research training. This essay advocates augmenting RCR education with training regarding broader (...) impacts. We demonstrate that enhancing research ethics training in this way provides a more comprehensive understanding of the ethics relevant to scientific research and prepares scientists to think not only in terms of responsibly conducted science, but also of the role of science in responding to identified social needs and in adhering to principles of social justice. As universities respond to the mandate from America COMPETES to “provide training and oversight in the responsible and ethical conduct of research”, we urge institutions to embrace a more adequate conception of research ethics, what we call the Ethical Dimensions of Scientific Research, that addresses the full range of ethical issues relevant to scientific inquiry, including ethical issues related to the broader impacts of scientific research and practice. (shrink)

Which systems/organisms are conscious? New tests for consciousness (‘C-tests’) are urgently needed. There is persisting uncertainty about when consciousness arises in human development, when it is lost due to neurological disorders and brain injury, and how it is distributed in nonhuman species. This need is amplified by recent and rapid developments in artificial intelligence (AI), neural organoids, and xenobot technology. Although a number of C-tests have been proposed in recent years, most are of limited use, and currently we have no (...) C-tests for many of the populations for which they are most critical. Here, we identify challenges facing any attempt to develop C-tests, propose a multidimensional classification of such tests, and identify strategies that might be used to validate them. (shrink)

Evolutionary activity statistics and their visualization are introduced, and their motivation is explained. Examples of their use are described, and their strengths and limitations are discussed. References to more extensive or general accounts of these techniques are provided.

Atrial natriuretic peptides appear to elicit their actions in some target tissues by binding to a novel cell‐surface transmembrane protein which possesses both peptide binding and guanylate cyclase activities. Ligand binding stimulates enzyme activity to produce increased intracellular concentrations of cyclic GMP which, in turn, mediates the cell's physiological response.

This paper critiques a number of standard ways of understanding the role of the metalanguage in a semantic theory for natural language, including the idea that disquotation plays a nontrivial role in any explanatory natural language semantics. It then proposes that the best way to understand the role of a semantic metalanguage involves recognizing that semantics is a model-based science. The metalanguage of semantics is language for articulating features of the theorist's model. Models are understood as mediating instruments---idealized structures used (...) to represent select aspects of the world, aspects the theorist is seeking some theoretical understanding of. The aspect of reality we are seeking some understanding of in semantics is a dimension of human linguistic competence---informally, knowledge of meaning. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 41.1 (2003) 136-137 [Access article in PDF] John Watkins. Human Freedom after Darwin: A Critical Rationalist View. Chicago: Open Court Publishing, 1999. Pp. xi + 348. Cloth, $49.95. Paper, $24.95. John Watkins examines man's place in nature since Darwin. As a critical rationalist, using the methods of science, Watkins hopes to construct a world-view which challenges competing hypotheses and supports his own. He (...) recognizes that his view is, also, a candidate for critical rejection. All scientific views are, in principle, fallible. He divides his book into two parts: Naturalism and Freedom. [End Page 137]In evolutionary development, he accepts, as critically established, the sequence: matter before life, life before mind, and, no mind without a brain. Thus, naturalism is preferred beforesupernaturalism or divine intervention. These guides may support a continuous, steady evolutionaryprocess or discontinuity, mutations, and various stages of change. Darwin acceptedthe former and held physical changes were unaffected by consciousness. All change is, in principle,present from the beginning and unfolds over time. Darwin's view, then, is deterministic.Watkins challenges this position and argues for consciousness affecting physical change in new and unpredictable ways. It is herein that the possibility of animal and human freedom lies. Watkins gives examples of the actions of the hunter and hunted among animals, and of strategies developed by humans during crises, to support the view that there are novel and unpredictable actions by conscious beings. These actions can hardly be called predetermined in the nature of things. There is a huge difference between a general genetic structure for kinds of behavior and specific actions during crises (not that these are the only instances of freedom). At any rate, there is a reciprocal action between an individual and its environment and not merely a unilinear one.In Part II, Freedom, Watkins examines some classical, philosophical views of human freedom. He gives brief, but penetrating, analyses of Hobbes, Descartes, Hume, Kant, Schopenhauer, and Spinoza. Either they account for human action in strictly physical terms that are causally deterministic or they turn to non-empirical sources that are not verifiable. Since the latter make no difference in our account of behavior, they are entities multiplied beyond necessity. Those who give a completely deterministic view—Hobbes, Hume, and Schopenhauer—offer no continuum between cause and chance. Chance turns out to depend upon our ignorance of causes; further examination would show it causally determined.Watkins seems most sympathetic to Spinoza's treatment. In his hard-headed naturalism, Spinoza rejects any non-natural or supernatural accounts of human behavior. He is a strict determinist where man's confrontation with nature is concerned. Human emotions are passive and react to our environment; they do not affect it. Human reason makes no difference, but in its capacity to contemplate eternal truths it offers a way out. Instead of reacting to nature, man may transcend it. This transcendence is the key to Spinoza's view of the intellectual love of God, and human freedom. Watkins criticizes this flight from man's place in nature and the limited use of reason. In this vein, Spinoza seems to abandon the confrontation of nature for a flight to eternal truths. For Watkins, however, reasons must be used in confronting nature. As we saw, he claims that reason may have an effect upon the environment that is novel and unpredictable. Human agency is a part of the evolutionary story. Human agency is not an either/or proposition. There are degrees of effectiveness in human response to nature.In his analysis of human freedom, Watkins turns to the works of Newton, Faraday, Einstein, and others. In studying the problems posed by the consideration of natural phenomena during their time, they showed intellectual perspicacity of the highest order. Faraday's unified field theory brought electrical and magnetic phenomena, previously thought to be disparate, together. Newton's laws of motion brought celestial and terrestrial mechanics under one theory. Einstein changed the way in which space, time, mass, energy, and light were conceived. In a real sense, they were... (shrink)

A central theme in the scholarly literature on Enlightenment Europe concerns the increased focus on the role of reason in the development of European thought, especially in the development of the new science by the natural philosophers. As a consequence, there is a tendency in both philosophical scholarship and teaching to bind philosophy and science tightly together. While there is certainly much that is correct in this approach, one motivation for pluralizing philosophy’s past is that this story leaves out a (...) great deal that is important in Enlightenment views of reason. We argue, using as an example the work of figures like Margaret Cavendish, that reason was significantly broader in scope—and that developments in science were paralleled by equally important advances in music, art, literature, medicine, philosophy, and other areas. In recognizing the lack of a sharp boundary between these areas, an inclusive canon of Enlightenment philosophy gives us this richer notion of reason. Integrating figures such as Cavendish into the canon helps us to see that the narrow focus on the scientific version of reason within Enlightenment scholarship creates a false distinction between science and the humanities and misses out on the humanistic ends for which we engage in philosophy. (shrink)

Normative ethical theories owe us an account of how to evaluate decisions under risk and uncertainty. Deontologists seem at a disadvantage here: our best decision theories seem tailor-made for consequentialism. For example, decision theory enjoins us to always perform our best option; deontology is more permissive. In this paper, we discuss and defend the idea that, when some pro-tanto wrongful act is all-things considered permissible, because it is a ‘lesser evil’, it is often merely permissible, by the lights of deontology. (...) We show that this raises new problems for deontological decision theory, and we show that to resolve them, we need to take a more innovative approach to morally evaluating decision-making under risk and uncertainty. (shrink)

The concept of responsible leadership has garnered increased attention in recent years. Indeed, irresponsibility on the part of organizational leaders appears to represent an area of growing concern to the greater public. Accordingly, it is appropriate that increased scholarly attention be devoted to an understanding of this concept. But with that said, the purpose of this article is to identify three caveats about which researchers and practitioners should be concerned as work in this area proceeds. These caveats pertain to: (1) (...) definitional issues, (2) the importance of theory and research that is not ideologically driven or biased, and (3) the positioning of responsible leadership within the greater body of leadership theory and research. Additional concerns are considered including the measurement of responsible leadership and research strategies. (shrink)

Epistemic modal operators give rise to something very like, but also very unlike, Moore's paradox. I set out the puzzling phenomena, explain why a standard relational semantics for these operators cannot handle them, and recommend an alternative semantics. A pragmatics appropriate to the semantics is developed and interactions between the semantics, the pragmatics, and the definition of consequence are investigated. The semantics is then extended to probability operators. Some problems and prospects for probabilistic representations of content and context are explored.

Understanding human behaviour, thoughts, and emotional expressions can be challenging in the global context. Due to cultural differences, the study of psychology cannot be de-contextualised. This calls for unearthing of the explanatory systems that exist in Africa to understand and account for behaviour, emotions, and cognition of Africans. This call is addressed through the emergence of African Psychology (AP) or Indigenous Psychology in Africa (IPA) as a legitimate science of human experience. This Element discusses the motivations for AP, centrality of (...) culture, demarcations of AP, and the different strands within AP. It highlights issues related to African philosophy, African cultural anthropology, African philosophy of science, and suitable methodological approaches for AP research. It also discusses some selected theoretical contributions and applications of AP. The Element concludes that AP researchers and practitioners need to pursue interdisciplinarity and avoid meaningless rejection of good ideas from other cultural settings. (shrink)

This paper defends a counterexample to Modus Tollens, and uses it to draw some conclusions about the logic and semantics of indicative conditionals and probability operators in natural language. Along the way we investigate some of the interactions of these expressions with 'knows', and we call into question the thesis that all knowledge ascriptions have truth-conditions.

Compiled by scholars at the court of Liu An, king of Huainan, in the second century B.C.E, _The Huainanzi_ is a tightly organized, sophisticated articulation of Western Han philosophy and statecraft. Outlining "all that a modern monarch needs to know," the text emphasizes rigorous self-cultivation and mental discipline, brilliantly synthesizing for readers past and present the full spectrum of early Chinese thought. _The Huainanzi_ locates the key to successful rule in a balance of broad knowledge, diligent application, and the penetrating (...) wisdom of a sage. It is a unique and creative synthesis of Daoist classics, such as the _Laozi_ and the _Zhuangzi_; works associated with the Confucian tradition, such as the _Changes_, the _Odes_, and the _Documents_; and a wide range of other foundational philosophical and literary texts from the _Mozi_ to the _Hanfeizi_. The product of twelve years of scholarship, this remarkable translation preserves _The Huainanzi_'s special rhetorical features, such as parallel prose and verse, and showcases a compositional technique that conveys the work's powerful philosophical appeal. This path-breaking volume will have a transformative impact on the field of early Chinese intellectual history and will be of great interest to scholars and students alike. (shrink)

When I tell you that it’s raining, I describe a way the world is—viz., rainy. I say something whose truth turns on how things are with the weather in the world. Likewise when I tell you that the weatherman thinks that it’s raining. Here the truth of what I say turns on how things are with the weatherman’s state of mind in the world. Likewise when I tell you that I think that it’s raining. Here the truth of what I (...) say turns on how things are with my state of mind in the world. (shrink)

This article considers the implications for film analysis of the presence or absence of a manual crank. More specifically, it looks at the 16 mm Time and Motion Study Projector as used in behavioral research in the 1960s and 1970s. The controversial concept of ‘interactional synchrony’, or the dance-like coordination of people in conversation, emerged from the use of this hand-turned projector. William S. Condon developed the concept along with the technique of microanalysis. Starting with the projector manufactured by Bell (...) & Howell, he made numerous improvements to facilitate observation—‘sweeping’ over segments of very short duration to discover the rhythmic synchrony of all filmed participants. It led him to a theory of ‘process’ in communication, and in the reception of speech in particular. People always ‘danced’ to the tune of their own voice, and their listeners ‘danced’ to the tune of the speaker—at intervals of one-sixth or one-eighth of a second. This also led Condon to an epistemology of discovery derived partly from philosophy but mostly from his machinery. The universe, he said, is a ‘continuum of order’ whose structures are preserved through translations of order: of thought into speech, speech into vibrations, vibrations into neurons, and back into behavior. The only exceptions are people with disabilities, like the autistics Condon studied from the 1970s onward. But the very distinction of normal and pathological was epiphenomenal to his scanning technique; it was rooted in material and formal qualities of film and of the projector whose crank he turned often. (shrink)