Extending a normal 24 hours day by four hours is unexpectedly highly disruptive to daily rhythms in gene expression in the blood. Using a paradigm in which human subjects were exposed to a 28 hours day, Archer and colleagues show how this sleep‐altering forced desynchrony protocol caused complex disruption to daily rhythms in distinct groups of genes. Such perturbations in the temporal organisation of the blood transcriptome arise quickly, and point to the fragile nature of coordinated genomic activity. Chronic disruption (...) of the daily and circadian rhythms in sleep compromise health and well‐being and this study reveals potential new molecular targets to combat the disruptive effects of shift work and jetlag. (shrink)

A limiting factor in ethics education in medical training has been difficulty in assessing competence in ethics. This study was conducted to test the concept that content analysis of pediatric residents’ personal reflections about ethics experiences can identify changes in ethical sensitivity and reasoning over time. Analysis of written narratives focused on two of our ethics curriculum’s goals: 1) To raise sensitivity to ethical issues in everyday clinical practice and 2) to enhance critical reflection on personal and professional values as (...) they affect patient care. Content analysis of written reflections was guided by a tool developed to identify and assess the level of ethical reasoning in eight domains determined to be important aspects of ethical competence. Based on the assessment of narratives written at two times (12 to 16 months/apart) during their training, residents showed significant progress in two specific domains: use of professional values, and use of personal values. Residents did not show decline in ethical reasoning in any domain. This study demonstrates that content analysis of personal narratives may provide a useful method for assessment of developing ethical sensitivity and reasoning. (shrink)

Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

BackgroundStructured, systematic methods to formulate consensus recommendations, such as the Delphi process or nominal group technique, among others, provide the opportunity to harness the knowledge of experts to support clinical decision making in areas of uncertainty. They are widely used in biomedical research, in particular where disease characteristics or resource limitations mean that high-quality evidence generation is difficult. However, poor reporting of methods used to reach a consensus – for example, not clearly explaining the definition of consensus, or not stating (...) how consensus group panellists were selected – can potentially undermine confidence in this type of research and hinder reproducibility. Our objective is therefore to systematically develop a reporting guideline to help the biomedical research and clinical practice community describe the methods or techniques used to reach consensus in a complete, transparent, and consistent manner.MethodsThe ACCORD project will take place in five stages and follow the EQUATOR Network guidance for the development of reporting guidelines. In Stage 1, a multidisciplinary Steering Committee has been established to lead and coordinate the guideline development process. In Stage 2, a systematic literature review will identify evidence on the quality of the reporting of consensus methodology, to obtain potential items for a reporting checklist. In Stage 3, Delphi methodology will be used to reach consensus regarding the checklist items, first among the Steering Committee, and then among a broader Delphi panel comprising participants with a range of expertise, including patient representatives. In Stage 4, the reporting guideline will be finalised in a consensus meeting, along with the production of an Explanation and Elaboration document. In Stage 5, we plan to publish the reporting guideline and E&E document in open-access journals, supported by presentations at appropriate events. Dissemination of the reporting guideline, including a website linked to social media channels, is crucial for the document to be implemented in practice.DiscussionThe ACCORD reporting guideline will provide a set of minimum items that should be reported about methods used to achieve consensus, including approaches ranging from simple unstructured opinion gatherings to highly structured processes. (shrink)

Adaptive immunity is unique to the vertebrates, and the molecules involved (including immunoglobulins, T cell receptors and the major histocompatibility complex molecules) seem to have diversified very rapidly early in vertebrate history. Reconstruction of gene phylogenies has yielded insights into the evolutionary origin of a number of molecular systems, including the complement system and the major histocompatibility complex (MHC). These analyses have indicated that the C5 component of complement arose by gene duplication prior to the divergence of C3 and C4, (...) which suggests that the alternative complement pathway was the first to evolve. In the case of the MHC, phylogenetic analysis supports the hypothesis that MHC class II molecules evolved before class I molecules. The fact that the MHC‐linked proteasome components that specifically produce peptides for presentation by class I MHC appear to have originated before the separation of jawed and jawless vertebrates suggests that the MHC itself may have been present at this time. Immmune system gene families have evolved by gene duplication, interlocus recombination and (in some cases) positive Darwinian selection favoring diversity at the amino acid level. (shrink)

This paper studies long-term norms concerning actions. In Meyer's Propositional Deontic Logic (PDₑL), only immediate duties can be expressed, however, often one has duties of longer durations such as: "Never do that", or "Do this someday". In this paper, we will investigate how to amend (PDₑL) so that such long-term duties can be expressed. This leads to the interesting and suprising consequence that the long-term prohibition and obligation are not interdefinable in our semantics, while there is a duality between these (...) two notions. As a consequence, we have provided a new analysis of the long-term obligation by introducing a new atomic proposition I (indebtedness) to represent the condition that an agent has some unfulfilled obligation. (shrink)

Le visage est-il un phénomène simple ou complexe? Serait-il juste de le définir comme cet aspect de l’être humain qui dépasse tout effort de compréhension et de totalisation, ou bien y a-t-il d’autres caractéristiques de ce phénomène qu’il faut inclure dans toute définition ou description du visage? Le visage est un événement fondamental. Parmi les multiples manières d’approcher l’être, de se rapporter...

From the beginning, the implications of quantum theory for our most general understanding of the world have been a matter of intense debate. Einstein argues that the theory had to be regarded as fundamentally incomplete. Its inability, for example, to predict the exact time of decay of a single radioactive atom had to be due to a failure of the theory and not due to a permanent inability on our part or a fundamental indeterminism in nature itself. In 1964, John (...) Bell derived a theorem which showed that any deterministic theory which preserved locality would have certain consequences for measurements performed at a distance from one another. An experimental check seems to show that these consequences are not, in fact, realized. The correlation between the sets of events is much stronger than any local deterministic theory could allow. What is more, this stronger correlation is precisely that which is predicted by quantum theory. The astonishing result is that local deterministic theories of the classical sort seem to be permanently excluded. Not only can the individual decay not be predicted, but no future theory can ever predict it. The contributors in this volume wrestle with this conclusion. Some welcome it; others leave open a return to at lease some kind of deterministic world, one which must however allow something like action-at-a distance. How much lit it? And how can one avoid violating relativity theory, which excludes action-at-a-distance? How can a clash between the two fundamental theories of modern physics, relativity and quantum theory, be avoided? What are the consequences for the traditional philosophic issue of causality explanation and objectivity? One thing is certain; we can never return to the comfortable Newtonian world where everything that happened was, in principle, predictable and where what happened at one measurement site could not affect another set of measurements being performed light-years away, at a distance that a light-signal could not bridge. Contributors: James T. Cushing, Abner Shimony, N. David Mermin, Jon P. Jarrett, Linda Wessels, Bas C. van Fraassen, Jeremy Butterfield, Michael L. G. Redhead, Henry P. Stapp, Arthur Fine, R. I. G. Hughes, Paul Teller, Don Howard, Henry J. Folse, and Ernan McMullin. (shrink)

This response to a variety of criticisms of _Charles Peirce and Modern Science_ restates and attempts to clarify and explain major themes of the book.

My purpose in what follows is not so much to defend the basic principle of utilitarianism as to indicate the form of it which seems most promising as a basic moral and political position. I shall take the principle of utility as offering a criterion for two different sorts of evaluation: first, the merits of acts of government, social policies, and social institutions, and secondly, the ultimate moral evaluation of the actions of individuals. I do not take it as implying (...) that the individual should live his life on the basis of constant evaluations of this sort. For there are different levels of decision making each with its appropriate criteria. For example, we each inevitably make many of our decisions from the point of view of our own personal self-fulfilment and this cannot regularly take a directly utilitarian form, nor should the utilitarian want it to do so. His claim is at most that we should sometimes review our life from the point of view of a kind of impersonal moral truth of a universalistic utilitarian character. (shrink)

In this book, T. L. Short corrects widespread misconceptions of Peirce's theory of signs and demonstrates its relevance to contemporary analytic philosophy of language, mind and science. Peirce's theory of mind, naturalistic but nonreductive, bears on debates of Fodor and Millikan, among others. His theory of inquiry avoids foundationalism and subjectivism, while his account of reference anticipated views of Kripke and Putnam. Peirce's realism falls between 'internal' and 'metaphysical' realism and is more satisfactory than either. His pragmatism is not verificationism; (...) rather, it identifies meaning with potential growth of knowledge. Short distinguishes Peirce's mature theory of signs from his better-known but paradoxical early theory. He develops the mature theory systematically on the basis of Peirce's phenomenological categories and concept of final causation. The latter is distinguished from recent and similar views, such as Brandon's, and is shown to be grounded in forms of explanation adopted in modern science. (shrink)

In the postscript to The Varieties of Religious Experience William James distinguishes two types of belief in the supernatural, conceived as an essential component in religion, crass or piecemeal supernaturalism, on the one hand, and refined supernaturalism on the other.

As the editor noted in the last number Freddie Ayer, or Professor Sir Alfred Ayer, played a considerable part in launching the vast enterprise of the Bentham edition. It is fitting, therefore, that something be said in Utilitas about his achievement as a philosopher and the extent to which he falls within the same broad empiricist and utilitarian tradition to which Bentham and J. S. Mill belonged.

This series will include monographs and collections of studies devoted to the investigation and exploration of knowledge, information, and data-processing systems of all kinds, no matter whether human, (other) animal, or machine. Its scope is intended to span the full range of interests from classical problems in the philosophy of mind and philosophical psychology through issues in cognitive psychology and sociobiology (concerning the mental capabilities of other species) to ideas related to artificial intelligence and computer science. While primary emphasis will (...) be placed upon theoretical, conceptual, and epistemological aspects of these problems and domains, empirical, experimental, and methodological studies will also appear from time to time. While most philosophers and psychologists tend to believe that the rise of cognitive psychology has occurred concomitant with the decline of operant psychology, Terry L. Smith contends that nothing could be further from the truth. He maintains that operant psychology has discovered (and continues to discover) reasonably well-confirmed causal principles of intentional behavior, which go beyond what cognitive psychology can provide, while cognitive psychology, in tum, has the potential to supply analyses (and explanations) that account for them. Smith thus advances a surprising but nonetheless illuminating perspective for appreciating the place of operant conditioning within the discipline of psychology in this rich and fascinating work. J. H. F. (shrink)

The relationship between Bentham's ‘enunciative principle’ and his ‘censorial principle’ is famously problematic. The problem's solution is that each person has an overwhelming interest in living in a community in which they, like others, are liable to punishment for behaviour condemned by the censorial principle either by the institutions of the state or by the tribunal of public opinion. The senses in which Bentham did and did not think everyone selfish are examined, and a less problematic form of psychological hedonism (...) than Bentham's is proposed. (shrink)

Controversy over providing financial incentives to research participants has a long history and remains an issue of contention in both current discussions about research ethics and for institutional review bodies/human research ethics committees which are charged with the responsibility of deciding whether such incentives fall within ethical guidelines. The arguments both for and against financial incentives have been well aired in the literature. A point of agreement for many is that inducement in the form of financial incentive is permissible when (...) the risk of harm to the individual is negligible in terms of degree and probability of occurrence. In the absence of harm to the individual, encouraging more people to participate in research would appear to be a good thing in so far as it will lead to statistically more robust research outcomes, which can then be translated into better healthcare and other practice. Whilst, on the face of it, this position seems highly defensible, I will explore the possibility that it is counterproductive – that is, providing individuals with financial incentives to become research participants may have the unintended outcome of reducing participation rates in some areas of research. In exploring this idea I will draw on empirical findings from the literature on crowding-out – the hypothesis that providing monetary incentives to people can backfire by overall reducing intrinsic motivation, in this instance intrinsic motivation to behave altruistically or undertake civic duties. (shrink)

In this book, T. L. Short places the notorious difficulties of Peirce's important writings in a more productive light, arguing that he wrote philosophy as a scientist, by framing conjectures intended to be refined or superseded in the inquiries they initiate. He argues also that Peirce held that the methods and metaphysics of modern science are amended as inquiry progresses, making metaphysics a branch of empirical knowledge. Additionally, Short shows that Peirce's scientific work expanded empiricism on empirical grounds, grounding his (...) phenomenology and subverting the fact/value dichotomy, and that he understood statistical explanations in nineteenth-century science as reintroducing the idea of final causation, now made empirical. Those innovations underlie Peirce's late ideas of a normative science and of philosophy as a branch of science. Short's rich and original study shows us how to read Peirce's writings and why they are worth reading. (shrink)

Many thinkers have said that a God whose existence is argued for metaphysically would have no religious significance even if he existed. This book examines the God or Absolute which emerges in various metaphysical systems and asks whether he, she, or it could figure in any genuinely religious outlook. The systems studied are those of Spinoza, Hegel, T. H. Green, F. H. Bradley (very briefly), Bernard Bosanquet, Josiah Royce, A. N. Whitehead, Charles Hartshorne. There is also a chapter on Kierkegaard (...) as the most important critic of metaphysical religion (especially Hegelian Christianity). The book ends with a statement of a form of absolute or pantheistic idealism espoused by the author and an indication of what religious significance it may have. (shrink)

In what follows I examine the following question: does it make a difference in moral psychology whether one adopts Aristotle's ordinary or Kant's revisionist definition of virtue as habit? Points of commensurability and critical comparison are provided by Kant's attempt to refute Aristotle's definition of virtue as a mean and by the moral problems of ignorance and weakness. These two problems are essential topics for moral psychology. I show two things. First, Kant's definition is revisionist because he excludes from moral (...) habit-formation what Aristotle includes, that is, practice in prudential calculation of a mean, and habit-formation by repetition. This follows from Kant's insistence that an act is virtuous only if the moral agent is willing freely and universally. Secondly, Aristotle's virtues modify behavior directly, whereas Kant's virtues modify behavior indirectly by creating moral feeling which, in turn, represses the temptations of the natural inclination. I suggest, thirdly, that as one approximates Kant's ideal of perfect virtue, entailed by the broad duties of beneficence and self-perfection, the difference in kind invented by Kant between virtue and prudence, as a morally neutral rational skill, erodes and becomes a difference in degree. I conclude that Aristotle's ordinary definition of virtue is better able to modify human behavior and solve these two moral problems. (shrink)

No fruitful discussion of the logic of religious belief can afford to ignore George Mavrodes' classification of propositional concepts, i.e. concepts predicable of propositions singly or in sets , as an analytical tool for pinning down the ‘person-oriented’ and ‘content-oriented’ factors in such ‘epistemic activities’ as religious proving, experiencing, and verifying. Mavrodes shows in particular that the formal model of logical soundness, i.e. valid form and true premises, has but limited application to proving, experiencing, and verifying as ways of giving (...) good reasons for religious belief. In this essay, I will show how Mavrodes' analysis of the logic of religious belief can be extended by substituting a procedural model of logical soundness for the truth-functionally formal model that he adopts. I will show further why it is desirable and, in certain instances, vital to extend his analysis in this manner. Along the way, I will explain why the extension that I am advocating augments Mavrodes' original analysis without substantially altering it or sacrificing any of its original analytical virtues. (shrink)

The four principles approach to medical ethics plus specification is used in this paper. Specification is defined as a process of reducing the indeterminateness of general norms to give them increased action guiding capacity, while retaining the moral commitments in the original norm. Since questions of method are central to the symposium, the paper begins with four observations about method in moral reasoning and case analysis. Three of the four scenarios are dealt with. It is concluded in the “standard” Jehovah’s (...) Witness case that having autonomously chosen the authority of his religious institution, a Jehovah’s Witness has a reasonable basis on which to refuse a recommended blood transfusion. The author’s view of the child of a Jehovah’s Witness scenario is that it is morally required—not merely permitted—to overrule this parental refusal of treatment. It is argued in the selling kidneys for transplantation scenario that a fair system of regulating and monitoring would be better than the present system which the author believes to be a shameful failure. (shrink)

T. L. S. Sprigge; I *—The Presidential Address: The Unreality of Time, Proceedings of the Aristotelian Society, Volume 92, Issue 1, 1 June 1992, Pages 1–20, htt.

A theory of punishment should tell us not only when punishment is permissible but also when it is a duty. It is not clear whether McCloskey's retributivism is supposed to do this. His arguments against utilitarianism consist largely in examples of punishments unacceptable to the common moral consciousness but supposedly approved of by the consistent utilitarian. We remain unpersuaded to abandon our utilitarianism. The examples are often fanciful in character, a point which (pace McCloskey) does rob them of much of (...) their force. If there was no tension between utilitarian precepts and those which come naturally to plain men, utilitarianism could have no claim to provide a critique of moralities. The utilitarian's attitude to such tensions is somewhat complicated, but what is certain is that there is more room in his system for the sentiments to which McCloskey appeals against him than McCloskey realizes. We agree with McCloskey, however, on the absurdity of substituting rule?utilitarianism for act?utilitarianism as an answer to his attacks. The distinction itself may represent a conceptual confusion. In our view, indeed, unmodified act?utilitarianism provides the best moral basis for thought about punishment. (shrink)