Ample research links mothers’ postpartum depression (PPD) to adverse interactions with their infants. However, most studies relied on general population samples, whereas a substantial number of women are at elevated depression risk. The purpose of this study was to describe mothers’ interactions with their 6- and 12-month-old infants among women at elevated risk, although with a range of symptom severity. We also identified higher-order factors that best characterized the interactions and tested longitudinal consistency of these factors from 6 to 12 (...) months of infant age. We leveraged data from eight projects across the United States (n = 647), using standardized depression measures and an adaptation of the NICHD Mother-Infant Interaction Scales. Overall, these depression-vulnerable mothers showed high levels of sensitivity and positive regard and low levels of intrusiveness, detachment, and negative regard with their infants. Factor analyses of maternal behaviors identified two overarching factors—“positive engagement” and “negative intrusiveness” that were comparable at 6 and 12 months of infant age. Mothers’ ability to regulate depressed mood was a key behavior that defined “positive engagement” in factor loadings. An exceptionally strong loading of intrusiveness on the second factor suggested its central importance for women at elevated depression risk. Mothers with severe depressive symptoms had significantly more “negative intrusiveness” and less “positive engagement” with their 6-month-old infants than women with moderate or fewer depressive symptoms, suggesting a potential tipping point at which symptoms may interfere with the quality of care. Results provide the foundation for further research into predictors and moderators of women’s interactions with their infant among women at elevated risk for PPD. They also indicate a need for evidence-based interventions that can support more severely depressed women in providing optimal care. (shrink)

Logical monism is the claim that there is a single correct logic, the 'one true logic' of our title. The view has evident appeal, as it reflects assumptions made in ordinary reasoning as well as in mathematics, the sciences, and the law. In all these spheres, we tend to believe that there aredeterminate facts about the validity of arguments. Despite its evident appeal, however, logical monism must meet two challenges. The first is the challenge from logical pluralism, according to which (...) there is more than one correct logic. The second challenge is to determine which form of logicalmonism is the correct one. One True Logic is the first monograph to explicitly articulate a version of logical monism and defend it against the first challenge. It provides a critical overview of the monism vs pluralism debate and argues for the former. It also responds to the second challenge by defending a particularmonism, based on a highly infinitary logic. It breaks new ground on a number of fronts and unifies disparate discussions in the philosophical and logical literature. In particular, it generalises the Tarski-Sher criterion of logicality, provides a novel defence of this generalisation, offers a clearnew argument for the logicality of infinitary logic and replies to recent pluralist arguments. (shrink)

The importance of patients taking an active role in their healthcare is recognized internationally, to improve safety and effectiveness in practice. There is still, however, some ambiguity about the conceptualization of that patient role; it is referred to interchangeably in the literature as engagement, involvement, and participation. The aim of this discussion paper is to examine and conceptualize the concepts of patient engagement, involvement, and participation within healthcare, particularly nursing. The concepts were found to have semantic differences and similarities, although, (...) from a nursing perspective, they can be summoned to illustrate the establishment of a mutual partnership between a patient and a nurse. The individualization of such processes requires the joint effort of engagement, involvement, or participation, represented by interactive actions of both the patient (asking questions, telling/speaking up, knowledge acquisition, learning, and decision‐making) and the nurse (recognizing, responding, information sharing, teaching, and collaborating). Suggesting that the concepts can be used interchangeably comes with some caution, requiring that nurses embrace patients playing a role in their health and healthcare. Further research and practice development should focus on how patients and nurses receive and respond to each other to establish patient engagement, involvement, and participation. (shrink)

In medical research, hypothesis tests are used to determine if a novel treatment is efficacious in comparison to a control treatment. Traditionally two-sided tests are recommended and one-sided tests are not. In this review the arguments for two- and one-sided tests are presented. It is argued that in many applications one-sided tests are appropriate and that two-sided tests may expose research subjects to unnecessary risk, and are therefore unethical.

The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore not a purely scientific or technical exercise, but are fundamentally grounded in ethics. The latest (...) treaty draft reflects these ethical considerations by including a section entitled Guiding Principles and Approaches. Most of these principles are ethical—they establish core values that undergird the treaty. Unfortunately, the treaty draft's set of principles are numerous, overlapping, and show inadequate coherence and consistency. We propose two improvements to this section of the draft pandemic treaty. First, key guiding ethical principles should be clearer and more precise than they currently are. Second, the link between ethical principles and policy implementation should be clearly established and define boundaries on acceptable interpretation, ensuring that signatories abide by these principles. (shrink)

The isomorphism invariance criterion of logical nature has much to commend it. It can be philosophically motivated by the thought that logic is distinctively general or topic neutral. It is capable of precise set-theoretic formulation. And it delivers an extension of ‘logical constant’ which respects the intuitively clear cases. Despite its attractions, the criterion has recently come under attack. Critics such as Feferman, MacFarlane and Bonnay argue that the criterion overgenerates by incorrectly judging mathematical notions as logical. We consider five (...) possible precisifications of the overgeneration argument and find them all unconvincing. (shrink)

Ontological monists hold that there is only one way of being, while ontological pluralists hold that there are many; for example, concrete objects like tables and chairs exist in a different way from abstract objects like numbers and sets. Correspondingly, the monist will want the familiar existential quantifier as a primitive logical constant, whereas the pluralist will want distinct ones, such as for abstract and concrete existence. In this paper, we consider how the debate between the monist and pluralist relates (...) to the standard test for logicality. We deploy this test and show that it favors the monist. (shrink)

A self-fulfilling prophecy in neuroprognostication occurs when a patient in coma is predicted to have a poor outcome, and life-sustaining treatment is withdrawn on the basis of that prediction, thus directly bringing about a poor outcome for that patient. In contrast to the predominant emphasis in the bioethics literature, we look beyond the moral issues raised by the possibility that an erroneous prediction might lead to the death of a patient who otherwise would have lived. Instead, we focus on the (...) problematic epistemic consequences of neuroprognostic SFPs in settings where research and practice intersect. When this sort of SFP occurs, the problem is that physicians and researchers are never in a position to notice whether their original prognosis was correct or incorrect, since the patient dies anyway. Thus, SFPs keep us from discerning false positives from true positives, inhibiting proper assessment of novel prognostic tests. This epistemic problem of SFPs thus impedes learning, but ethical obligations of patient care make it difficult to avoid SFPs. We then show how the impediment to catching false positive indicators of poor outcome distorts research on novel techniques for neuroprognostication, allowing biases to persist in prognostic tests. We finally highlight a particular risk that a precautionary bias towards early withdrawal of life-sustaining treatment may be amplified. We conclude with guidelines about how researchers can mitigate the epistemic problems of SFPs, to achieve more responsible innovation of neuroprognostication for patients in coma. (shrink)

For years a debate has raged within the various literatures of philosophy, psychiatry, and psychology over whether, and to what degree, the concepts that characterize psychopathology are social constructions that reflect cultural values. While the majority position among philosophers has been normativist, i.e., that the conception of a mental disorder is value-laden, a vocal and cogent minority have argued that psychopathology results from malfunctions that can be described by terminology that is objective and scientific. Scientists and clinicians have tended to (...) endorse the objectivist position, with some notable exceptions. (shrink)

This collection offers cutting-edge chapters on themes related to the philosophical work of Owen Flanagan. Flanagan is an influential philosopher in the late 20th and early 21st Century, whose wide-ranging work spans philosophy of mind (especially consciousness, identity, and the self), ethics and moral psychology, comparative philosophy, and philosophical study of psychopathology (especially disorders of self, dreams, and addiction). Flanagan is the author of numerous scholarly and popular articles, and of 10 books. The chapters present proposals for productive interdisciplinary (...) research exploring the mind, ethics, personhood, consciousness, religious cognition, mental disorders, addiction, the narrative self, virtue, the social sciences, forgiveness, or comparative philosophy. (shrink)

There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and (...) somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes ; limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice. (shrink)

Attention to individual choice is a valuable dimension of public health policy; however, the creation of effective public health programmes requires policy makers to address the material and social structures that determine a person’s chance of actually achieving a good state of health. This statement summarizes a well understood and widely held view within public health practice. In this article, we (i) argue that advocates for public health can and should defend this emphasis on ‘structures’ by reference to citizen autonomy (...) and not simply by emphasizing concern for counter-balancing values such as ‘population health’ or ‘fairness’, (ii) map and critically explore the contrasting conceptions of autonomy that feature in such debates, with particular attention to conceptions of autonomy that might feature in the defence of an emphasis on structures. We draw on (i) a relational conception of autonomy and (ii) the distinction that can be made between autonomous deliberation and autonomous action to suggest that offering people the opportunity to make choices about their health without also supporting their capability to achieve the object of these choices falls short of what is often considered to be morally and politically important about promoting autonomy in relation to health. (shrink)

Thought: A Journal of Philosophy, Volume 10, Issue 3, Page 188-198, September 2021.

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)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

This paper traces some lines of influence between post-Kantianism and Critical Theory. In the first part of the paper, we discuss Fichte and Hegel; in the second, we discuss Horkheimer, Adorno, and Honneth.

Background There is broad international agreement from clinicians and academics that healthcare rationing should be undertaken as explicitly as possible, and the BMA have publicly supported the call for more accountable priority setting for some time. However, studies in the UK and elsewhere suggest that clinicians experience a number of barriers to rationing openly, and the information needs of patients at the point of provision are largely unknown. Methodology In-depth interviews were undertaken with NHS professionals working at the community level (...) of provision, and with patients and professionals receiving or providing treatment for morbid obesity and breast cancer (n=52). Results Nearly all patients wanted to know about healthcare rationing and had high expectations of their clinical professionals to provide all relevant information about treatment options. However, professionals did not always understand these information requirements, and cases of implicit rationing were common. The existence of relevant national guidance was not always known about, meaning that patients were often reliant on other sources of information about treatment options, which included the popular media, the internet, patient advocacy groups and informal networks of support. Discussion Clinical professionals need to understand patients' need for detailed information when it comes to rationing, and to understand that they are the main gateway for this to be provided. However, disclosure could be distressing for both patients and professionals, and thus the most sensitive and acceptable ways to make this information available requires further investigation. (shrink)

After #MeToo, academics have become increasingly focused on the liberal concept of consent. Either problematized as a means of distinguishing between sex and rape, or vaunted as a tool for having better sex, consent remains central to discussions of sexual violence. Returning to Andrea Dworkin’s thought, this article argues that contemporary feminists must move beyond consent and recenter the problem of violence to theorize rape. Dworkin, alongside Catharine MacKinnon and Carole Pateman, critiques consent for disguising the violence of rape, sex, (...) and pornography. By defining violence as a process of objectification, Dworkin exposes rape, pornography, and most controversially, consensual heterosexual intercourse as “a new kind of death.” She, in turn, calls for the feminist exercise of violence as a tactic of disclosure that promises to make visible patriarchal violence hidden by consent and sexualization. Moving beyond consent to recenter the problem of violence, I conclude, opens up new avenues for feminist action and brings into view the seemingly unthinkable possibility of a world without rape. (shrink)

This article argues that a person’s well-being at a time and the goodness of her life are two distinct values. It is commonly accepted as platitudinous that well-being is what makes a life good for the person who lives it. Even philosophers who distinguish between well-being at a time and the goodness of a life still typically assume that increasing a person’s well-being at some particular moment, all else equal, necessarily improves her life on the whole. I develop a precise (...) statement of this standard assumption, and then show that it is subject to counterexamples. The possibility of such counterexamples depends only on premises similar to those sometimes invoked to argue that a person’s well-being over a long period is not simply the aggregate well-being of the shorter periods that compose the long period. The refutation of the standard assumption linking well-being and life-goodness entails that these are distinct and sometimes divergent values. As an alternative to the standard assumption, it is proposed that well-being is best understood as an ingredient in a good life. (shrink)

This article addresses three questions about well-being. First, is well-being future-sensitive? I.e., can present well-being depend on future events? Second, is well-being recursively dependent? I.e., can present well-being depend on itself? Third, can present and future well-being be interdependent? The third question combines the first two, in the sense that a yes to it is equivalent to yeses to both the first and second. To do justice to the diverse ways we contemplate well-being, I consider our thought and discourse about (...) well-being in three domains: everyday conversation, social science, and philosophy. This article’s main conclusion is that we must answer the third question with no. Present and future well-being cannot be interdependent. The reason, in short, is that a theory of well-being that countenances both future-sensitivity and recursive dependence would have us understand a person’s well-being at a time as so intricately tied to her well-being at other times that it would not make sense to consider her well-being an aspect of her state at particular times. It follows that we must reject either future-sensitivity or recursive dependence. I ultimately suggest, especially in light of arguments based on assumptions of empirical research on well-being, that the balance of reasons favors rejecting future-sensitivity. (shrink)

Seven COVID-19 vaccines are now being distributed and administered around the world (figure correct at the time of submission), with more on the horizon. It is widely accepted that healthcare workers should have high priority. However, questions have been raised about what we ought to do if members of priority groups refuse vaccination. Using the case of influenza vaccination as a comparison, we know that coercive approaches to vaccination uptake effectively increase vaccination rates among healthcare workers and reduce patient morbidity (...) if properly implemented. Using the principle of least restrictive alternative, we have developed an intervention ladder for COVID-19 vaccination policies among healthcare workers. We argue that healthcare workers refusing vaccination without a medical reason should be temporarily redeployed and, if their refusal persists after the redeployment period, eventually suspended, in order to reduce the risk to their colleagues and patients. This ‘conditional’ policy is a compromise between entirely voluntary or entirely mandatory policies for healthcare workers, and is consistent with healthcare workers’ established professional, legal and ethical obligations to their patients and to society at large. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

I propose a construal of aesthetic value that gives us reason to emphasize some aesthetic practices over others. This construal rests on the existence of a central aesthetic value, namely apprehension-testing intricacy within an appropriate domain. I address three objections: the objection that asks how an aesthetic value based on intricacy can account for the value of minimalism; the objection that asks about the difference between intricacy within a medium and intricacy between media; and the objection that asks about the (...) danger of a regress. I then say that, although this central aesthetic value can in principle allow us to adjudicate between aesthetic practices, we have epistemic limits (about the potential of certain artistic domains to allow for apprehension-testing intricacy) that prevent adjudication in some cases. Even if there is a difference between the vastness of the potential-intricacy-fields somewhere down the line, it is too far for us to see. (shrink)

A brief article introducing *One True Logic*. The book argues that there is one correct foundational logic and that it is highly infinitary.

With the world grappling with continued spread of monkeypox internationally, vaccines play a crucial role in mitigating the harms from infection and preventing spread. However, countries with the greatest need - particularly historically endemic countries with the highest monkeypox case-fatality rates - are not able to acquire scarce vaccines. This is unjust, and requires rectification through equitable allocation of vaccines globally. We propose applying the Fair Priority Model for such allocation, which emphasizes three key principles: 1) preventing harm; 2) prioritizing (...) the disadvantaged; and 3) treating people with equal moral concern. Post-exposure prophylaxis (PEPV) has the most potential to mitigate harm, and so ensuring countries have sufficient supply for PEPV should be the first priority. And historically endemic countries, which face disadvantages that compound potential harms from monkeypox, should be the first recipients of such vaccines. Once sufficient supply is allocated for countries to apply PEPV, global allocation could move on to pre-exposure prophylaxis (PrEP), again prioritizing historically endemic countries first before distribution to the rest of the global community, based on projected number of cases and vulnerability to harm. (shrink)