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)

The standard approach to treatment decision making for incapacitated patients often fails to provide treatment consistent with the patient’s preferences and values and places significant stress on surrogate decision makers. These shortcomings provide compelling reason to search for methods to improve current practice. Shared decision making between surrogates and clinicians has important advantages, but it does not provide a way to determine patients’ treatment preferences. Hence, shared decision making leaves families with the stressful challenge of identifying the patient’s preferred treatment (...) option. To address this concern, the present paper proposes to incorporate the use of a “Patient Preference Predictor” (PPP) into the shared decision-making process between surrogates and clinicians. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual’s characteristics and information on what treatment preferences are correlated with these characteristics. Use of a PPP is likely to increase the chances that incapacitated patients are treated consistent with their preferences and values and might reduce the stress and burden on their surrogates. Including a PPP in the shared decision-making process therefore has the potential to realize important ethical goals for making treatment decisions for incapacitated patients. The present paper justifies this approach on conceptual and normative grounds. (shrink)

When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such (...) a PPP were more accurate, on average, than human surrogates in identifying patient preferences, the proposed algorithm would nevertheless fail to respect the patient’s (former) autonomy since it draws on the ‘wrong’ kind of data: namely, data that are not specific to the individual patient and which therefore may not reflect their actual values, or their reasons for having the preferences they do. Taking such criticisms on board, we here propose a new approach: the Personalized Patient Preference Predictor (P4). The P4 is based on recent advances in machine learning, which allow technologies including large language models to be more cheaply and efficiently ‘fine-tuned’ on person-specific data. The P4, unlike the PPP, would be able to infer an individual patient’s preferences from material (e.g., prior treatment decisions) that is in fact specific to them. Thus, we argue, in addition to being potentially more accurate at the individual level than the previously proposed PPP, the predictions of a P4 would also more directly reflect each patient’s own reasons and values. In this article, we review recent discoveries in artificial intelligence research that suggest a P4 is technically feasible, and argue that, if it is developed and appropriately deployed, it should assuage some of the main autonomy-based concerns of critics of the original PPP. We then consider various objections to our proposal and offer some tentative replies. (shrink)

There are substantial data establishing that surrogates are often mistaken in predicting what treatments incompetent patients would have wanted and that supplements such as advance directives have not resulted in significant improvements. Rid and Wendler’s Patient Preference Predictor (PPP) proposal will attempt to gather data about what similar patients would prefer in a variety of treatment choices. It accepts the usual goal of patient autonomy and the Substituted Judgment principle for surrogate decisions. I provide reasons for questioning sole reliance (...) on autonomy when surrogates, not patients, are deciding and for giving some independent weight to patient well-being. Moreover, that family members, typical surrogates, will know best what the patient if incompetent would have wanted is not the only reason why they are chosen. The more pressing problem is that the PPP would fail to remove the more serious mistakes that empirical psychology over the last few decades has shown to infect such decision making. (shrink)

In this bold, challenging book, D. S. Clarke outlines reasons for accepting panpsychism and defends the doctrine against its critics.

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.

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. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Different types of consent are used to obtain human biospecimens for future research. This variation has resulted in confusion regarding what research is permitted, inadvertent constraints on future research, and research proceeding without consent. The National Institutes of Health Clinical Center's Department of Bioethics held a workshop to consider the ethical acceptability of addressing these concerns by using broad consent for future research on stored biospecimens. Multiple bioethics scholars, who have written on these issues, discussed the reasons for consent, the (...) range of consent strategies, and gaps in our understanding, and concluded with a proposal for broad initial consent coupled with oversight and, when feasible, ongoing provision of information to donors. This article describes areas of agreement and areas that need more research and dialogue. Given recent proposed changes to the Common Rule, and new guidance regarding storing and sharing data and samples, this is an important and tim.. (shrink)

An anthology of readings in panpsychism, spanning two millennia.

Almost traditionally, it seems, accounts of the development of the concepts of work and energy have tended to describe them within the classical framework of Newtonian mechanics. They are seen as the end products of the celebratedvis-vivadispute in the eighteenth century: the outcome of a debate within the confines of the science of rational mechanics. I would like to suggest that this may be to take too narrow a view of the case. It is to project backwards our present specialist (...) arrangement of scientific knowledge, our present divisions between the sciences, and to assume that past development was strictly guided by these divisions. And this is to make questionable historical and sociological assumptions. (shrink)

Authenticates approximately 500 lines of Aristotle's lost work the Protrepticus (Exhortation to Philosophy) contained in the circa third century AD work by Iamblichus of Chalcis entitled Protrepticus epi philosophian. Includes a complete English translation of the authenticated material.

This article traces the career path and personality of a chancery official or secretary in the service of the Gonzaga, the ruling dynasty of Mantua, in the middle years of the fifteenth century. It relates Giovanni Arrivabene to the contemporary social, political and cultural context of this secondary northern Italian power or signoria but touches the wider Italian world at many points, particularly the papal court, whether in Rome or other locations, where Giovanni’s talented younger brother served first as the (...) secretary of Cardinal Francesco Gonzaga and later as an apostolic secretary. The comparison between the two brothers and their interdependence as property owners is a recurring theme. Giovanni emerges with evident limitations which hampered the succession to his father’s superior role in the chancery, where other privileged families also tended to prevail. Humanist educated and efficient, he seems to have been a bureaucrat of routine abilities, not quite astute enough to outpace certain departmental rivals or to avoid being tainted by association with some possibly corrupt practice which caused loss of favour. His later rehabilitation, first as a provincial magistrate concerned with criminal jurisdiction and later as an estate management official, illustrates that private relationships within the narrow world of a civic quasi despotic government were all important. (shrink)

This is a criticism of quine's treatment of mass terms such as "water", "gold", Etc. In word and object. Instead of becoming singular terms referring to a "scattered object", It is argued that they either become general terms as subjects of sentences or retain their unique status as ascribed to an indicated place.

This paper attempts to outline the logical structure of imperatives. It criticizes the prevailing view that this structure is isomorphic with that for indicatives. For "mixed" imperatives with constituents in both indicative and imperative moods (e.G., Conditional imperatives with indicative antecedents) there are features unique to imperatives. These features are specified, And consequences of them are traced. Finally, Formation rules for imperatives are stated.

Since the revolution in philosophic method that began about a century ago, the focus of philosophic attention has been on language as used both in daily conversation and in specialized institutional activities such as science, law, and the arts. But language is an extremely complex and varied means of communication, and the study of it has been increasingly incorporated into such empirical disciplines as linguistics, psycho linguistics, and cognitive psychology. It is becoming less clear what aspects of language remain as (...) proper subjects of philosophical study, what are to be "kicked upstairs" (J. L. Austin's phrase) to the sciences. This work is a study of those logical features of language that remain central to philosophy after completion of kicking up. It conducts this study by describing similarities and differences between signs at differing levels, starting with natural events as primitive signs in the environments of their interpreters, and proceeding to pre linguistic signaling systems, elementary forms of language, and finally to the forms of specialized discourse used within social institutions. The investiga tion of comparative features requires isolating basic mental capacities that are present in the most primitive forms of organisms capable of sign interpretation. The problem then becomes one of tracing the emergence from these capacities of such categories as substance, attribute or quality, and quantity that we apply to natural languages. The study of sign levels is thus the construction of a genealogy of logical categories marking the develop ment of natural languages. (shrink)