This paper defends a counterfactual account of explanation, according to which successful explanation requires tracing patterns of counterfactual dependence of a special sort, involving what I call active counterfactuals. Explanations having this feature must appeal to generalizations that are invariant--stable under certain sorts of changes. These ideas are illustrated by examples drawn from physics and econometrics.

Minors are generally considered incompetent to provide legally binding decisions regarding their health care, and parents or guardians are empowered to make those decisions on their behalf. Parental authority is not absolute, however, and when a parent acts contrary to the best interests of a child, the state may intervene. The best interests standard is the threshold most frequently employed in challenging a parent''s refusal to provide consent for a child''s medical care. In this paper, I will argue that the (...) best interest standard provides insufficient guidance for decision-making regarding children and does not reflect the actual standard used by medical providers and courts. Rather, I will suggest that the Harm Principle provides a more appropriate threshold for state intervention than the Best Interest standard. Finally, I will suggest a series of criteria that can be used in deciding whether the state should intervene in a parent''s decision to refuse medical care on behalf of a child. (shrink)

This paper explores the impacts of neurological intervention on selfhood with reference to recipients’ claims about changes to their self-understanding following Deep Brain Stimulation for treatment of Parkinson’s Disease. In the neuroethics literature, patients’ claims such as: “I don’t feel like myself anymore” and “I feel like a machine”, are often understood as expressing threats to identity. In this paper I argue that framing debates in terms of a possible threat to identity—whether for or against the proposition, is mistaken (...) and occludes what is ethically salient in changes from DBS. Rather, by adopting a relational narrative approach to identity and autonomy, I show that the ethically salient issue from DBS is impacts on autonomous agency—whether one’s actions and beliefs are one’s own, and how DBS may hinder, or foster, embodied, relational autonomy competences. This approach recognizes that if sufficiently significant, impacts on autonomy competences may pose a threat to one’s ability to contribute to the process of authoring one’s own life and so pose a threat to identity formation. I argue this approach resolves the confusion in the literature about whether and how DBS threatens identity and provides a complex picture of how DBS may affect selfhood by disrupting narrative identity formation and revision, distorting agency and/or undermining autonomy. (shrink)

Recent years have seen growing interest in modifying interventionist accounts of causal explanation in order to characterise noncausal explanation. However, one surprising element of such accounts is that they have typically jettisoned the core feature of interventionism: interventions. Indeed, the prevailing opinion within the philosophy of science literature suggests that interventions exclusively demarcate causal relationships. This position is so prevalent that, until now, no one has even thought to name it. We call it “intervention puritanism” (I-puritanism, for short). In (...) this paper, we mount the first sustained defence of the idea that there are distinctively noncausal explanations which can be characterized in terms of possible interventions; a position we call “intervention liberalism” (I-liberalism, for short). While many have followed James Woodward (2003) in committing to I-puritanism, we trace support for I-liberalism back to the work of Jaegwon Kim (1974). Furthermore, we analyse two recent sources of scepticism regarding I-liberalism: debate surrounding mechanistic constitution; and attempts to provide a monistic account of explanation. We show that neither literature provides compelling reasons for adopting I-puritanism. Finally, we present a novel taxonomy of available positions upon the role of possible interventions in explanation: weak causal imperialism; strong causal imperialism; monist intervention puritanism; pluralist intervention puritanism; monist intervention liberalism; and finally, the specific position defended in this paper, pluralist intervention liberalism. (shrink)

Non-reductive interventionist theories of causation and methodologies of causal reasoning embedded in that theoretical framework have become increasingly popular in recent years. This paper argues that one variant of an interventionist account of causation, viz. the one presented, for example, in Woodward (2003 ), is unsuited as a theoretical fundament of interventionist methodologies of causal reasoning, because it renders corresponding methodologies incapable of uncovering a causal structure in a finite number of steps. This finding runs counter to Woodward's own assessment (...) and to other recent studies which presume that Woodward's version of interventionism is effectively applicable to uncover causal structures, e.g. Campbell (2007 ) or Shapiro and Sober (2007 ). (shrink)

Non-reductive interventionist theories of causation and methodologies of causal reasoning embedded in that theoretical framework have become increasingly popular in recent years. This paper argues that one variant of an interventionist account of causation, viz. the one presented, for example, in Woodward (2003), is unsuited as a theoretical fundament of interventionist methodologies of causal reasoning, because it renders corresponding methodologies incapable of uncovering a causal structure in a finite number of steps. This finding runs counter to Woodward's own assessment and (...) to other recent studies which presume that Woodward's version of interventionism is effectively applicable to uncover causal structures, e.g. Campbell (2007) or Shapiro and Sober (2007). (shrink)

Background: The Marathon runners must have the proper technical preparation to reach excellence and to achieve adequate psychological preparation for the race. Against this background, the current study aims to describe the implementation results of a cognitive-behavioral intervention based on psychological skills training for marathon runners.Methods: Fourteen amateur male marathoners with an average age of 30 were trained with various emotional and cognitive control techniques to enhance their performance in competition. Various psychological variables, related to the subjects level of (...) perceived stress, and to qualitative characteristics of their thoughts were measured before and after the target marathon race. Results were analyzed through non-parametric tests for two related samples. The Cohen's d effect size for single-group pretest-posttest repeated measures were also performed.Results: Statistical analysis reveals that, controlling for age and running experience, the intervention decreased significantly the level of perceived stress and the occurrence of negative thoughts before the race, during, and after the race.Conclusion: Training in cognitive control and relaxation techniques, as part of the psychological skills training could determine the quality of performance of marathon runners. (shrink)

Academic misconduct runs rampant across higher education institutions in the US and internationally. Ample empirical research has identified myriad student variables that predict AM. However, two variables have been unexamined: the quality of conceptual knowledge university students have on AM and the relation between goals for going to university and reception to intervention on AM. Quantitative content analysis on written responses by 356 first-year university students reported surface-level knowledge of AM, frequent citation of extrinsic goals, and a lack of (...) association between goals and receptiveness to intervention. Results corroborate prior research on university students’ limited understanding of AM. Results suggest that efforts to address AM do not need to tailor intervention components to match students’ goals for attending university. (shrink)

This article outlines the emergence of ABA (Applied Behaviour Analysis) in the mid-20th century, and the current popularity of ABA in the anglophone world. I draw on the work of earlier historians to highlight the role of Ole Ivar Lovaas, the most influential practitioner of ABA. I argue that reception of his initial work was mainly positive, despite concerns regarding its efficacy and use of physical aversives. Lovaas’ work, however, was only cautiously accepted by medical practitioners until he published results (...) in 1987. Many accepted the results as validation of Lovaas’ research, though both his methods and broader understanding of autism had shifted considerably since his early work in the 1960s. The article analyses the controversies surrounding ABA since the early 1990s, considering in particular criticisms made by autistic people in the ‘neurodiversity movement’. As with earlier critics, some condemn the use of painful aversives, exemplified in the campaign against the use of shock therapy at the Judge Rotenberg Center. Unlike earlier, non-autistic critics, however, many in this movement reject the ideological goals of ABA, considering autism a harmless neurological difference rather than a pathology. They argue that eliminating benign autistic behaviour through ABA is impermissible, owing to the individual psychological harm and the wider societal impact. Finally, I compare the claims made by the neurodiversity movement with those made by similar 20th- and 21st-century social movements. (shrink)

While environmental ethicists often critique metaphors of nature, they rarely recognize metaphors of environmental practice, and so fail to submit background models of human agency to similar critique. In consequence, descriptions of nature are often shaped by unassessed metaphors of practice, and then made to bear argument for that preferred model. To relieve arguments over “nature” of this vicarious burden, models of agency can and should become a primary topic within the field. In response to some initial misgivings from Eric (...) Katz and taking suggestions from Bryan Norton, Steven Vogel, Holmes Rolston, III, and others, some minimal framing criteria can be developed to promote and facilitate a broad debate over the most appropriate metaphors and models of environmental practice. (shrink)

Nathaniel Hawthorne’s The Birthmark offers a sharp lens through which to examine power, purity, and personal identity. Scientist and spiritual idealist, Aylmer, is obsessed with “correcting” the only flaw he perceives in his wife Georgina, the imprint of a small red hand on her pale cheek. For Alymer, this one “imperfection” reaches deep into Georgina’s heart, a sign of sin, decay, and mortality. It is the natural that must be overcome with science. Drawing on Hawthorne’s tragic fiction, this paper questions (...) the influence of stigma, power dynamics, and mind-body dualism in constructing disability identity within the framework of medical and spiritual practices of care. Whether in the role of a spiritual leader, chaplain, or medical professional, people providing care must first address ableism and perceptions of normalcy in relation to their own identity and calling before offering professional advice to disabled people seeking guidance or support. It is only as professional fields adopt a posture marked by courageous humility that healing practices will promote the flourishing of all people, including those with disabilities. (shrink)

BackgroundEverybody has the right to decide whether to receive specific medical treatment or not and to provide their free, prior and informed consent to do so. As dementia progresses, people with Alzheimer’s dementia (PwAD) can lose their capacity to provide informed consent to complex medical treatment. When the capacity to consent is lost, the autonomy of the affected person can only be guaranteed when an interpretable and valid advance directive exists. Advance directives are not yet common in Germany, and their (...) validity is often questionable. Once the dementia diagnosis has been made, it is assumed to be too late to write an advance directive. One approach used to support the completion of advance directives is ‘Respecting Choices’®—an internationally recognised, evidence-based model of Advance Care Planning (ACP), which, until now, has not been evaluated for the target group of PwAD. This study’s aims include (a) to investigate the proportion of valid advance directives in a memory clinic population of persons with suspected AD, (b) to determine the predictors of valid advance directives, and (c) to examine whether the offer of ACP can increase the proportion of valid advance directives in PwAD.MethodWe intend to recruit at leastN = 250 participants from two memory clinics in 50 consecutive weeks. Of these, the first 25 weeks constitute the baseline phase (no offer of ACP), the following 25 weeks constitute the intervention phase (offer of ACP). The existence and validity of an advance directive will be assessed twice (before and after the memory clinic appointment). Moreover, potential predictors of valid advance directives are assessed.DiscussionThe results of this study will enhance the development of consent procedures for advance directives of PwAD based on the ACP/Respecting Choices (R) approach. Therefore, this project contributes towards increasing the autonomy and inclusion of PwAD and the widespread acceptance of valid advance directives in PwAD.Trial RegistrationDRKS, DRKS00026691, registered 15th of October 2021,https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00026691. (shrink)

Low‐back pain can be invalidating physically as well as mentally. Despite professional help to treat and prevent low‐back pain, the pain often persists, and so do the problems related to low‐back pain. An intervention that made it possible for a significant part of patients with low‐back pain to improve health and well‐being raised the question: Why was it possible to help some and not others? The aim of the present paper was to achieve a deeper understanding of factors patients (...) experienced as helpful in professional support related to low‐back pain. This was explored using a hermeneutic‐phenomenological approach while analysing 20 interviews with patients with low‐back pain purposively chosen interviews conducted in relation to the intervention. An analysis was made using Ricoeur's interpretation theory. Data on both positive and negative experiences were read and reflected upon. We found that healthcare professionals’ adoption of a narrative approach facilitating the patient's perspective was perceived as helpful. Patients experienced this as being taken seriously; an experience that could be explained at a deeper, more nuanced level using Heidegger's philosophy. Facilitating the patient's perspective was conditional not only on the professional obtaining access to the patient's perspective but also on understanding and acknowledging the patient's existence. The challenge for healthcare professionals in this respect is to bridge the gap between the consultation's fact‐focused concern with the medical implications of low‐back pain and the patient's concern with the implications low‐back pain has for his or her personal identity and life. Listening to the patient's perspective in itself supports the subjective recovery process, while also supporting the quality of patient‐centred support and strengthening the patient's trust in its helpfulness. (shrink)

Feminist decolonial scholars have called for disengaging from the current system built on a hierarchical logic of race and gender central to modern, colonial thinking. They have looked to worlds outside the modern system to lead us out of current unjust practices harming both humans and the environment. Although policymaking may be seen as the stronghold of the current political agenda and of the structures that have led to the climate crisis, we argue that climate policies too, are also crucial (...) for rethinking and transforming societies. Our examination of climate adaptation policies in Sweden and the literature from Europe shows how policy documents ignore and unknow the oppressive intersections of gender and power despite the knowledge that exists on these issues in the public domain. Drawing on the tools of agnotology, we examine how this is achieved by strategies of ‘denial, dismissal, diversion and displacement.’ Building on feminist post and decolonial scholarship, we make explicit the gendered and racial hierarchies and dichotomies underpinning these policy documents. At the same time, we bring attention to the nuances in the policy documents we study and look for the openings that might be used to bring about transformation by making these hierarchies explicit and calling them into question. We argue that a transformation is possible through a feminist post and decolonial intervention, even in policymaking otherwise ignorant of culture, values and the colonial histories that have produced contemporary society. (shrink)

Mounting evidence suggests that participation in clinical trials confers neither advantage nor disadvantage on those enrolled. Narrow focus on the question of a “trial effect,” however, distracts from a broader mechanism by which patients may benefit from ongoing clinical research. We hypothesize that the existence of clinical trials infrastructure—the organizational culture, systems, and expertise that develop as a product of sustained participation in cooperative clinical trials research—may function as a quality improvement lever, improving the quality of care and outcomes of (...) all patients within an institution or region independent of their individual participation in trials. We further contend that this “infrastructure effect” can yield particular benefits for patients in low- and middle-income countries. The hypothesis of an infrastructure effect as a quality improvement intervention, if correct, justifies enhanced research capacity in LMIC as a pillar of health system development. (shrink)

The orthodox conception of human rights holds that human rights are moral rights possessed by all human beings simply in virtue of their humanity. In recent years, advocates of a 'political' conception of human rights have criticized this view on the grounds that it overlooks the distinctive political function performed by human rights. This article evaluates the arguments of two such critics, John Rawls and Joseph Raz, who characterize the political function of human rights as that of potential triggers for (...) intervention by one society against another. (shrink)

De Marco and colleagues claim that the standard account of invasiveness as commonly encountered ‘…does not capture all uses of the term in relation to medical interventions1 ’. This is open to challenge. Their first example is ‘non-invasive prenatal testing’. Because it involves puncturing the skin to obtain blood, De Marco et al take this as an example of how an incision or insertion is not sufficient to make an intervention invasive; here is a procedure that involves an incision, (...) but it is regarded as non-invasive. However, this ignores the context, and the term should really be understood in reference to the fetus. It is hard to believe healthcare professionals regard taking blood to measure, for example, ferritin levels as invasive but taking blood to look for fragments of fetal DNA as not. If anyone uses the term thinking it is not invasive to the mother, the solution would be to call it invasive, not redefine what is invasive. De Marco and colleagues’ second example is describing electroconvulsive therapy (ECT) as invasive. However, this is not borne out by their referenced papers. The first cited source is about non-invasive brain stimulation2 and only contains a single sentence about ECT. This sentence may suggest that their view is that ECT …. (shrink)

Animal rights positions face the ‘predator problem’: the suggestion that if the rights of nonhuman animals are to be protected, then we are obliged to interfere in natural ecosystems to protect prey from predators. Generally, rather than embracing this conclusion, animal ethicists have rejected it, basing this objection on a number of different arguments. This paper considers but challenges three such arguments, before defending a fourth possibility. Rejected are Peter Singer’s suggestion that interference will lead to more harm than good, (...) Sue Donaldson and Will Kymlicka’s suggestion that respect for nonhuman sovereignty necessitates non-interference in normal circumstances, and Alasdair Cochrane’s solution based on the claim that predators cannot survive without killing prey. The possibility defended builds upon Tom Regan’s suggestion that predators, as moral patients but not moral agents, cannot violate the rights of their prey, and so the rights of the prey, while they do exist, do not call for intervention. This idea is developed by a consideration of how moral agents can be more or less responsible for a given event, and defended against criticisms offered by thinkers including Alasdair Cochrane and Dale Jamieson. (shrink)

Most adult persons with anorexia satisfy the existing criteria widely used to assess decision-making capacity, meaning that incapacity typically cannot be used to justify coercive intervention. After rejecting two other approaches to justification, Professor Radden concludes that it is most likely not possible to justify coercive medical intervention for persons with anorexia in liberal terms, though she leaves it open whether some other framework might succeed. I shall assume here that the standard approach to assessing decisionmaking capacity is (...) adequate.1 The question then is whether we can justify—within a liberal framework—coercive intervention with the decision of a competent... (shrink)

Overdose deaths involving prescription opioids killed more than 17,000 Americans in 2017, marking a five-fold increase since 1999. High prescribing rates of opioid analgesics have been a substantial contributor to prescription opioid misuse, dependence, overdose and heroin use. There was recognition approximately ten years ago that opioid prescribing patterns were contributing to this startling increase in negative opioid-related outcomes, and federal actions, including Medicare reimbursement reform and regulatory actions, were initiated to restrict opioid prescribing. The current manuscript is a description (...) of those actions, the effect of those actions on opioid prescribing and related patient outcomes. We also describe our proposal of methods of expanding these efforts as an important piece to further reduce opioid-related misuse, dependence, and overdose death. (shrink)

In this paper, I argue that the principle of respect for autonomy can serve as the basis for laws that significantly limit conduct, including orders mandating isolation and quarantine. This thesis is fundamentally at odds with an overwhelming consensus in contemporary bioethics that the principle of respect for autonomy, while important in everyday clinical encounters, must be 'curtailed', 'constrained', or 'overridden' by other principles in times of crisis. I contend that bioethicists have embraced an indefensibly 'thin' notion of autonomy that (...) uproots the concept from its foundations in Kantian ethics. According to this thin conception, respect for autonomy, if unconditioned by competing principles (beneficence, justice, non-maleficence) would give competent adults the right to do anything they desired to do so long as they satisfied certain baseline psychological conditions. I argue that the dominant 'principlist' model of bioethical reasoning depends on this thin view of autonomy and show how it deprives us of powerful analytical tools that would help us to think seriously about the foundations of human rights, justice, and law. Then, I offer a brief sketch of a 'thick', historically grounded notion of autonomy and show what we could gain by taking it seriously. (shrink)

Organisations increasingly use automated decision-making systems (ADMS) to inform decisions that affect humans and their environment. While the use of ADMS can improve the accuracy and efficiency of decision-making processes, it is also coupled with ethical challenges. Unfortunately, the governance mechanisms currently used to oversee human decision-making often fail when applied to ADMS. In previous work, we proposed that ethics-based auditing (EBA)—that is, a structured process by which ADMS are assessed for consistency with relevant principles or norms—can (a) help organisations (...) verify claims about their ADMS and (b) provide decision-subjects with justifications for the outputs produced by ADMS. In this article, we outline the conditions under which EBA procedures can be feasible and effective in practice. First, we argue that EBA is best understood as a ‘soft’ yet ‘formal’ governance mechanism. This implies that the main responsibility of auditors should be to spark ethical deliberation at key intervention points throughout the software development process and ensure that there is sufficient documentation to respond to potential inquiries. Second, we frame AMDS as parts of larger sociotechnical systems to demonstrate that to be feasible and effective, EBA procedures must link to intervention points that span all levels of organisational governance and all phases of the software lifecycle. The main function of EBA should, therefore, be to inform, formalise, assess, and interlink existing governance structures. Finally, we discuss the policy implications of our findings. To support the emergence of feasible and effective EBA procedures, policymakers and regulators could provide standardised reporting formats, facilitate knowledge exchange, provide guidance on how to resolve normative tensions, and create an independent body to oversee EBA of ADMS. (shrink)

Background: COVID-19 has taken many lives worldwide and due to this, millions of persons are in grief. When the grief process lasts longer than 6 months, the person is in risk of developing Complicated Grief Disorder. The CGD is related to serious health consequences. To reduce the probability of developing CGD a preventive intervention could be applied. In developing countries like Mexico, the psychological services are scarce, self-applied interventions could provide support to solve this problem and reduce the health (...) impact even after the pandemic has already finished.Aims: To design and implement a self-applied intervention composed of 12 modules focused on the decrease of the risk of developing CGD, and increasing the life quality, and as a secondary objective to reduce the symptomatology of anxiety, depression, and increase of sleep quality. The Intervention Duelo COVID follows the principles of User Experience and is designed according to the needs and desires of a sample of the objective participants, to increase the adherence to the self-applied intervention, considered one of the main weaknesses of online interventions.Methods: A Randomized Controlled Trial will be conducted from the 22nd of December of 2020 to the first of June 2021. The participants will be assigned to an intervention with elements of Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Mindfulness and Positive Psychology. The control group will be a wait-list condition, that will receive the intervention 1.5–2 months after the pre-measurement were taken. The Power Size Calculation conducted through G*Power indicated the need for a total of 42 participants, which will be divided by 21 participants in each group. The platform will be delivered through responsive design assuring with this that the intervention will adapt to the screen size of cellphones, tablets, and computers.Ethics and Dissemination: The study counts with the approval of the Research Ethics Committee of the Autonomous University of Ciudad Juárez, México, and it is registered in Clinical Trials. The article is sent and registered in clinical trials before the recruitment started. The results will be reported in future conferences, scientific publications, and media. (shrink)