A recent update to the Geneva Declaration’s ‘Physician Pledge’ involves the ethical requirement of physicians to share medical knowledge for the benefit of patients and healthcare. With the spread of COVID-19, pockets exist in every country with different viral expressions. In the Chareidi religious community, for example, rates of COVID-19 transmission and dissemination are above average compared with other communities within the same countries. While viral spread in densely populated communities is common during pandemics, several reasons have been suggested to (...) explain the blatant flouting of public health regulations. It is easy to fault the Chareidi population for their proliferation of COVID-19, partly due to their avoidance of social media and internet aversion. However, the question remains: who is to blame for their community crisis? The ethical argument suggests that from a public health perspective, the physician needs to reach out and share medical knowledge with the community. The public’s best interests are critical in a pandemic and should supersede any considerations of cultural differences. By all indications, therefore, the physician has an ethical obligation to promote population healthcare and share medical knowledge based on ethical concepts of beneficence, non-maleficence, utilitarian ethics as well as social, procedural and distributive justice. This includes the ethical duty to reduce health disparities and convey the message that individual responsibility for health has repercussions within the context of broader social accountability. Creative channels are clearly demanded for this ethical challenge, including measured medical paternalism with appropriate cultural sensitivity in physician community outreach. (shrink)

In patients with schizophrenia, consent postmortem for organ donation for transplantation and research is usually obtained from relatives. By means of a questionnaire, the authors investigate whether patients with schizophrenia would agree to family members making such decisions for them as well as compare decisions regarding postmortem organ transplantation and brain donation between patients and significant family members. Study results indicate while most patients would not agree to transplantation or brain donation for research, a proportion would agree. Among patients who (...) declined organ donation for transplantation or brain research, almost half of family members would have agreed to brain donation for research and over 40% to organ transplantation. Male relatives are more likely to agree to organ donation from their deceased relatives for both transplantation and research. The authors argue that it is important to respect autonomy and interests of research subjects even if mentally ill and even if no longer living. Consent may be assisted by appropriate educational interventions prior to patient death. (shrink)

During the Nazi era, physicians provided expertise and a veneer of legitimacy enabling crimes against humanity. In a creative educational initiative to address current ethical dilemmas in clinical medicine, we conduct ethics learning missions bringing senior physicians to relevant Nazi era sites in either Germany or Poland. The tours share a core curriculum contextualising history and medical ethics, with variations in emphasis. Tours to Germany provide an understanding of the theoretical origins of the ethical violations and crimes of Nazi physicians. (...) Tours to Poland address the magnitude of the Nazi physician’s atrocities as well as displays of heroism by Jewish and righteous among the nations' physicians. Exemplary as well as shameful physician behaviour is analysed from an ethical perspective. A combination of unique educational methodologies maximises learning and personal growth, enabling participants to examine ethically complex clinical situations with extrapolation to modern-day medical practice. Learning is designed with relevance to contemporary medical ethics dilemmas such as beginning and end-of-life issues, providing tenets from which participants can develop as more ethical and informed physicians. Participant feedback confirms efficacy and worth of these growth-promoting ethics learning tours which should be expanded to other international groups and settings. (shrink)

Extreme intentional and deliberate violence against innocent people, including acts of terror and school shootings, poses various ethical challenges, some related to the practice of medicine. We discuss a dilemma relating to deliberate violence, in this case the aftermath of a terror attack, in which there are multiple injured individuals, including the terror perpetrator. Normally, the priority of medical treatment is determined based on need. However, in the case of a terror attack, there is reason to question this. Should the (...) perpetrator of extreme violence receive medical treatment on the scene before the victims if he or she is designated as the most seriously injured? Or rather, should victims receive medical care priority if they are also in some life-threatening danger, although not at the same level of severity as the perpetrator? We present two opposing approaches: the conventional ‘no-exceptions’ approach, which gives priority to the terrorist, and the justice-oriented ‘victim first’ approach, which gives priority to the victims. Invoking concepts of retributive justice, distributive justice and corrective justice, this latter approach suggests that ‘value-neutrality’ can lead to injustice. Perpetrators of terror-like violence should be treated as an act of humanism and good ethical medical practice. However, in clear and obvious terror-like situations, to treat the perpetrators of violence before their victims may be unjust. Thus, in some specific situations, the ‘victim first’ approach may be considered a legitimate alternative triage policy. (shrink)

Euthanasia and physician assisted-suicide are terms used to describe the process in which a doctor of a sick or disabled individual engages in an activity which directly or indirectly leads to their death. This behavior is engaged by the healthcare provider based on their humanistic desire to end suffering and pain. The psychiatrist's involvement may be requested in several distinct situations including evaluation of patient capacity when an appeal for euthanasia is requested on grounds of terminal somatic illness or when (...) the patient is requesting euthanasia due to mental suffering. We compare attitudes of 49 psychiatrists towards euthanasia and assisted suicide with a group of 54 other physicians by means of a questionnaire describing different patients, who either requested physician-assisted suicide or in whom euthanasia as a treatment option was considered, followed by a set of questions relating to euthanasia implementation. When controlled for religious practice, psychiatrists expressed more conservative views regarding euthanasia than did physicians from other medical specialties. Similarly female physicians and orthodox physicians indicated more conservative views. Differences may be due to factors inherent in subspecialty education. We suggest that in light of the unique complexity and context of patient euthanasia requests, based on their training and professional expertise psychiatrists are well suited to take a prominent role in evaluating such requests to die and making a decision as to the relative importance of competing variables. (shrink)

In principle, all patients deserve to receive optimal medical treatment equally. However, in situations in which there is scarcity of time or resources, medical treatment must be prioritized based on a triage. The conventional guidelines of medical triage mandate that treatment should be provided based solely on medical necessity regardless of any non-medical value-oriented considerations (“worst-first”). This study empirically examined the influence of value-oriented considerations on medical triage decision–making. Participants were asked to prioritize medical treatment relating to four case scenarios (...) of an emergency situation resulting from a car collision. The cases differ by situational characteristics pertaining to the at-fault driver, which were related to culpability attribution. In three case scenarios most participants gave priority to the most severely injured individual, unless the less severely injured individual was their brother. Nevertheless, in the aftermath of a vehicle-ramming terror attack most participants prioritized the less severely injured individual (“victim-first”). Our findings indicate that when caregivers are presented with concrete highly conflictual triage situations their choices may be based on value-oriented considerations related to contextual characteristics of the emergency situation. Philosophical and practical ramifications of our findings are discussed. (shrink)

In Nazi Germany, approximately 200 000 mentally ill people were murdered under the guise of euthanasia. Relatively little is known regarding the fate of the Jewish mentally ill patients targeted in this process, long before the Holocaust officially began. For the Nazis, Jewish mentally ill patients were doubly cursed since they embodied both “precarious genes” and “racial toxin”. To preserve the memory of the victims, Yad Vashem, the leading institution dedicated to documentation of the Holocaust, actively collects information and documents (...) the fate of victims in an open online database. Recently, a list of approximately 1200 names of Jewish mentally ill euthanasia victims has been compiled from hospital archives. Their fate remains unknown to surviving family members. Given the duty to preserve medical confidentiality, can this list be publicised for public interest and for notifying families—publicising names and death circumstances, including where “killed” would immediately indicate that the person had had a mental illness? Does the right to medical confidentiality lapse upon death? Is time elapsed since death a factor? Can opposing obligations of preserving victims’ memory over-ride medical confidentiality? What if a family member objects to a grandparent’s name being exposed on the list of mentally ill patients? This article considers these issues as well as the “rational” and “non-rational” factors in ethical decisional making surrounding this unique dilemma. Several possible solutions are proposed including preserving the list in a locked database for access by families and researchers, publicising in the media that such a list exists, publishing the information online without any identifiers and submitting the information to historians, allowing them to process the data as they see fit. (shrink)

By titling his paper “Slowing the Slide Down the Slippery Slope of Medical Assistance in Dying: Mutual Learnings for Canada and the US,” Daryl Pullman, an esteemed medical ethicist, uses a rhetoric...

Thirty-eight individuals (mean age: 34.8 years old) participating in a 3-month yoga and meditation retreat were assessed before and after the intervention for psychometric measures, brain derived neurotrophic factor (BDNF), circadian salivary cortisol levels, and pro- and anti-inflammatory cytokines. Participation in the retreat was found to be associated with decreases in self-reported anxiety and depression as well as increases in mindfulness. As hypothesized, increases in the plasma levels of BDNF and increases in the magnitude of the cortisol awakening response (CAR) (...) were also observed. The normalized change in BDNF levels was inversely correlated with BSI-18 anxiety scores at both the pre-retreat (r = 0.40, p < 0.05) and post-retreat (r = 0.52, p < 0.005) such that those with greater anxiety scores tended to exhibit smaller pre- to post-retreat increases in plasma BDNF levels. In line with a hypothesized decrease in inflammatory processes resulting from the yoga and meditation practices, we found that the plasma level of the anti-inflammatory cytokine Interleukin-10 was increased and the pro-inflammatory cytokine Interleukin-12 was reduced after the retreat. Contrary to our initial hypotheses, plasma levels of other pro-inflammatory cytokines, including Interferon Gamma (IFN-γ), Tumor Necrosis Factor (TNF-α), Interleukin-1β (IL-1β), Interleukin-6 (IL-6), and Interleukin-8 (IL-8) were increased after the retreat. Given evidence from previous studies of the positive effects of meditative practices on mental fitness, autonomic homeostasis and inflammatory status, we hypothesize that these findings are related to the meditative practices throughout the retreat; however, some of the observed changes may also be related to other aspects of the retreat such as physical exercise-related components of the yoga practice and diet. We hypothesize that the patterns of change observed here reflect mind-body integration and well-being. The increased BDNF levels observed is a potential mediator between meditative practices and brain health, the increased CAR is likely a reflection of increased dynamic physiological arousal, and the relationship of the dual enhancement of pro- and anti-inflammatory cytokine changes to healthy immunologic functioning is discussed. (shrink)

I was asked to evaluate M by her medical oncologist, Dr. T. As a psychiatrist, I was to perform the duties of a mental health specialist in the care of this fifty‐eight‐year‐old woman with metastatic breast cancer who had requested physician aid in dying. Dr. T had no specific concerns, but she was adhering to the letter of the law by referring the patient to me—a “mental health specialist”—because, according to the patient’s medical history, there was “evidence of a mental (...) disorder.” That evidence was comprised of depression treated in the remote past. Some years before California passed its End of Life Options Act in 2015, M had begun talking with Dr. T about the circumstances under which she might no longer want to be alive and might even choose to take active steps to end her life. She had fairly specific and durable criteria for knowing “when the time had come.” In our interview, she asserted very clearly that the time had not come but that, with the law now active, she hoped to have access to a lethal prescription in case it did. (shrink)

We have seen through many examples that data science and artificial intelligence can reinforce structural inequalities like sexism and racism. Data is power, and that power is distributed unequally. This book offers a vision for a feminist data science that can challenge power and work towards justice. This book takes a stand against a world that benefits some (including the authors, two white women) at the expense of others. It seeks to provide concrete steps for data scientists seeking to learn (...) how feminism can help them work towards justice, and for feminists seeking to learn how their own work can carry over to the growing field of data science. It is addressed to professionals in all fields where data-driven decisions are being made, as well as to communities that want to better understand the data that surrounds them. It is written for everyone who seeks to better understand the charts and statistics that they encounter in their day-to-day lives, and for everyone who seeks to better communicate the significance of such charts and statistics to others. This is an example-driven book written with a broad audience of scholars, students, and practitioners in mind. It offers a way of thinking about data, both their uses and their limits, that is informed by direct experience, by a commitment to action, and by the ideas associated with intersectional feminist thought. (shrink)

Welcome to the Post-Truth era-- a time in which the art of the lie is shaking the very foundations of democracy and the world as we know it. The Brexit vote; Donald Trump's victory; the rejection of climate change science; the vilification of immigrants; all have been based on the power to evoke feelings and not facts. So what does it all mean and how can we champion truth in in a time of lies and 'alternative facts'? In this eye-opening (...) and timely book, Post-Truth is distinguished from a long tradition of political lies, exaggeration and spin. What is new is not the mendacity of politicians but the public's response to it and the ability of new technologies and social media to manipulate, polarise and entrench opinion. Where trust has evaporated, conspiracy theories thrive, the authority of the media wilt and emotions matter more than facts. Now, one of the UK's most respected political journalists, Matthew d'Ancona investigates how we got here, why quiet resignation is not an option and how we can and must fight back. (shrink)

We hypothesised that belief in conspiracy theories would be predicted by the general tendency to attribute agency and intentionality where it is unlikely to exist. We further hypothesised that this tendency would explain the relationship between education level and belief in conspiracy theories, where lower levels of education have been found to be associated with higher conspiracy belief. In Study 1 participants were more likely to agree with a range of conspiracy theories if they also tended to attribute intentionality and (...) agency to inanimate objects. As predicted, this relationship accounted for the link between education level and belief in conspiracy theories. We replicated this finding in Study 2, whilst taking into account beliefs in paranormal phenomena. These results suggest that education may undermine the reasoning processes and assumptions that are reflected in conspiracy belief. (shrink)

I challenge the common view that trust is characteristically risky compared to distrust by drawing attention to the moral and epistemic risks of distrust. Distrust that is based in real fear yet fails to target ill will, lack of integrity, or incompetence, serves to marginalize and exclude individuals who have done nothing that would justify their marginalization or exclusion. I begin with a characterization of the suite of behaviors characteristic of trust and distrust. I then survey the epistemic and moral (...) hazards of distrust, in particular, distrust’s propensity to bias interpretation, to perpetuate itself, to confirm itself, to dishonor, and to insult. Taking seriously these moral and epistemic hazards requires taking affirmative measures to respond to them. I elaborate one such response: “humble trust”. The practice of humble trust issues from skepticism about the warrant of one’s own felt attitudes of trust and distrust, curiosity about who might be unexpectedly responsive to trust and in which contexts, and commitment to abjure and to avoid distrust of the trustworthy. Humble trust enables individuals to trust that they will be trusted. (shrink)

It is not certain when or by whomandwere first technically distinguished asgenusandspecies. The distinction does not appear in Plato's extant writings, whereas Aristotle seems to take it for granted in theTopics, which is usually regarded as among his earliest treatises. In his dialogues Plato seems able to useinterchangeably to denote any group or division in a diairesis, including the group that is to be divided.

This is an introduction to, and survey of, the constructive approaches to pure mathematics. The authors emphasise the viewpoint of Errett Bishop's school, but intuitionism. Russian constructivism and recursive analysis are also treated, with comparisons between the various approaches included where appropriate. Constructive mathematics is now enjoying a revival, with interest from not only logicans but also category theorists, recursive function theorists and theoretical computer scientists. This account for non-specialists in these and other disciplines.

Everything we do relies on causation. We eat and drink because this causes us to stay alive. Courts tell us who causes crimes, criminology tell us what causes people to commit them. D.H. Mellor shows us that to understand the world and our lives we must understand causation. _The Facts of Causation_, now available in paperback, is essential reading for students and for anyone interested in reading one of the ground-breaking theories in metaphysics. We cannot understand the world and our (...) place in it without understanding causation. Yet a complete account of the nature and implications of causation does not exist. D.H Mellor's new book is that account. (shrink)

Screen-based virtual worlds have been described as fundamentally disembodying. Contrary to this, the aim of this article is to provide a phenomenological analysis of bodily presence in one case of screen-based virtuality. By integrating phenomenology with qualitative research methodologies, I explore esports practitioners’ experiences of bodily presence in League of Legends (LoL). Here, descriptions from real-life esports practitioners are analyzed within the phenomenological framework of ‘incorporation’. My analysis shows that the practitioners’ experience and engage with their virtual world not just (...) by incorporating their physical gaming equipment, but also through incorporation of virtual abilities and tools specific to the game world. Having shown that the LoL practitioner’s body spans both physical and virtual space without leaving the body behind, I situate these results within the discussion of virtual presence in video games. I claim that the practitioners’ sense of presence can be accounted for by situating the integrated physical and virtual tools and abilities within the phenomenological framework of the ‘nullpoint’, understood as a bodily field of activity shaped by our incorporated skills and tools. (shrink)

In our information societies, tasks and decisions are increasingly outsourced to automated systems, machines, and artificial agents that mediate human relationships, by taking decisions and acting on the basis of algorithms. This raises a critical issue: how are algorithmic procedures and applications to be appraised and governed? This question needs to be investigated, if one wishes to avoid the traps of ICTs ending up in isolating humans behind their screens and digital delegates, or harnessing them in a passive role, by (...) curtailing their freedom and autonomy. (shrink)

Guidelines around the world require children to provide assent for their participation in most research studies. Yet, little further guidance is provided on how review committees should implement this requirement, including which children are capable of providing assent and when the requirement for assent may be waived on the grounds that the research offers participating children the potential for important clinical benefit. The present paper argues that the assent requirement is supported by the importance of allowing children who are capable (...) to make their own decisions. This suggests children are capable of assent when they become able to understand the research in question. While development varies across individual children, existing data suggest most children develop this ability by approximately age 14. Until instruments are developed to assess the assent capacity of individual children, this age should be used as the threshold for assent. In addition, the importance of protecting children from harm suggests that the sustained dissent of all children, including those who are unable to provide assent, should be respected. While the assent requirement may be waived when research participation offers the potential for important medical benefit that is unavailable outside the research context, analysis suggests that children’s sustained dissent should be respected in all cases. (shrink)

The principle that physicians should always act in the best interests of the present patient is widely endorsed. At the same time, and often within the same document, it is recognised that there are appropriate exceptions to this principle. Unfortunately, little, if any, guidance is provided regarding which exceptions are appropriate and how they should be handled. These circumstances might be tenable if the appropriate exceptions were rare. Yet, evaluation of the literature reveals that there are numerous exceptions, several of (...) which pervade clinical medicine. This situation leaves physicians without adequate guidance on when to allow exceptions and how to address them, increasing the chances for unfairness in practice. The present article considers the range of exceptions, illustrates how the lack of guidance poses ethical concern and describes an alternative account of physician obligations to address this concern. (shrink)

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 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 (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be (...) preserved, reproduced, and made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

" -- Africa Today "The excellence of this book lies in the wealth of perspectives that it brings to the discussion on what constitutes philosophy, rationality, ...

This study investigates the performance of psychopathic individuals on tasks believed to be sensitive to dorsolateral prefrontal and orbitofrontal cortex (OFC) functioning. Psychopathic and non-psychopathic individuals, as defined by the Hare psychopathy checklist revised (PCL-R) [Hare, The Hare psychopathy checklist revised, Toronto, Ontario: Multi-Health Systems, 1991] completed a gambling task [Cognition 50 (1994) 7] and the intradimensional/extradimensional (ID/ED) shift task [Nature 380 (1996) 69]. On the gambling task, psychopathic participants showed a global tendency to choose disadvantageously. Specifically, they showed an (...) impaired ability to show learning over the course of the task. On the ID/ED task, the performance of psychopathic individuals was not significantly different from incarcerated controls on attentional set-shifting, but significant impairments were found on response reversal. These results are interpreted with reference to an OFC and amygdala dysfunction explanation of psychopathy. (shrink)

Ambivalence is a form of inner volitional conflict that we experience as being irresolvable without significant cost. Because of this, very few of us relish feelings of ambivalence. Yet for many in the Western philosophical tradition, ambivalence is not simply an unappealing experience that's hard to manage. According to Unificationists--whose view finds its historical roots in Plato and Augustine and is ably defended by contemporary philosophers such as Harry Frankfurt and Christine Korsgaard--ambivalence is a failure of well-functioning agency. The reasons (...) for this, we're told, are threefold. First, it precludes agents from resolving their wills in a way that is necessary for autonomy. Second, it precludes agents from fully affirming their live and, in particular, from fully affirming the choices they make. As a result, ambivalence robs them of an important source of meaning. Finally, ambivalence causes agents to act in self-defeating ways. In so doing, they act without integrity. Ambivalence is thus seen as a threat to a trio of important agential goods, and as a result, it imperils the best forms of human agency. -/- Against the Unificationists, D. Justin Coates argues that ambivalence does not preclude volitional resolution or normatively significant forms of affirmation. Nor does it guarantee self-defeat. Consequently, ambivalence as such is no threat to autonomy, meaning, or integrity. In assessing these arguments, ambivalence is also revealed to have an important role in securing the very goods that unificationists contend it undermines. The reason for this is that each of these goods requires the agent to be normatively competent. But normative competence itself, Coates argues, often leads agents to be ambivalent. The best forms of human agency are therefore shown to be not only compatible with ambivalence but as regularly requiring it. Ambivalence is thus not a volitional defect, but a crucial constituent of well-functioning agency. (shrink)

The concern of this book is the nature of religious belief and the ways in which philosophical enquiry is related to it. Six chapters present the positive arguments the author wishes to put forward to discusses religion and rationality, scepticism about religion, language-games, belief and the loss of belief. The remaining chapters include criticisms of some contemporary philosophers of religion in the light of the earlier discussions, and the implications for more specific topics, such as religious education, are investigated. The (...) book ends with a general attempt to say something about the character of philosophical enquiry, and to show how important it is to realise this character in the philosophy of religion. (shrink)

It is widely held that if an agent is not morally responsible for her action – i.e., if she is not deserving of blame – then we have a (decisive) reason to refrain from blaming her. But though this is true, the fact that someone is deserving of blame isn’t clearly sufficient for there to be most allthings- considered reason for blaming that person. Other considerations bear on this question as well. Coates offers an account of some of these considerations (...) – particularly those that can serve as deontic constraints on blame. He also offers a reply to those skeptical of the “ethics of blame” on the grounds that such theorizing invariably appeals to the “wrong kind of reasons.”. (shrink)

D. D. Raphael; I—The Presidential Address*: The Standard of Morals, Proceedings of the Aristotelian Society, Volume 75, Issue 1, 1 June 1975, Pages 1–12E, https.

Objectives—To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effectDesign, subjects and setting–A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on “Death and Dying” was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on “Decisions near the End of Life”.Results–Practitioners accept the relevance of concepts widely (...) disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/ withdrawing treatment. Within the UK nurses' group a “rationalist” axis of respondents who describe themselves as having “no religion” are closer to the bioethics consensus on withholding and withdrawing treatment.Conclusions—Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)