The duty to protect patient welfare underpins undergraduate medical ethics and patient safety teaching. The current syllabus for patient safety emphasises the significance of organisational contribution to healthcare failures. However, the ongoing over-reliance on whistleblowing disproportionately emphasises individual contributions, alongside promoting a culture of blame and defensiveness among practitioners. Diane Vaughan’s ‘Normalisation of Deviance’ provides a counterpoise to such individualism, describing how signals of potential danger are collectively misinterpreted and incorporated into the accepted margins of safe operation. NoD is an (...) insidious process that often goes unnoticed, thus minimising the efficacy of whistleblowing as a defence against inevitable disaster. In this paper, we illustrate what can be learnt by greater attention to the collective, organisational contributions to healthcare failings by applying NoD to The Morecambe Bay Investigation. By focusing on a cluster of five ‘serious untoward incidents’ occurring in 2008, we describe a cycle of NoD affecting trust handling of events that allowed poor standards of care to persist for several years, before concluding with a poignant example of the limitations of whistleblowing, whereby the raising of concerns by a senior consultant failed to generate a response at trust board level. We suggest that greater space in medical education is needed to develop a thorough understanding of the cultural and organisational processes that underpin healthcare failures, and that medical education would benefit from integrating the teaching of medical ethics and patient safety to resolve the tension between systems approaches to safety and the individualism of whistleblowing. Data sharing not applicable as no datasets generated and/or analysed for this study. (shrink)

Discussions of the principle of alternative possibilities have largely ignored the limits of what Frankfurt-style counter-examples can show. Rather than challenging the coherence of the cases, I argue that even if they are taken to demonstrate the falsity of the principle, they cannot advance the compatibilist cause. For a forceful incompatibilist argument can be constructed from the Frankfurtian premise that agents in Frankfurtian circumstances would have done what they did even if they could have done something else. This 'counterfactual stability' (...) meets the same fate under determinism as does the ability to do otherwise. Thus the cases are irrelevant to the compatibility debate. (shrink)

For years, tour guide Daniel Lum has brought visitors as well as his children out to the remote corners of Barrow, Alaska, one of the northernmost cities in the world, to witness polar bears and walrus on the dark, sandy beaches. Over time, snapping pictures for tourists and shooting photographs of his own, he has been a first-hand witness to the profound environmental changes taking place as his homeland shifts and disappears before his eyes. As arguments over climate change (...) rage in more temperate locales, Nuvuk, the Northernmost is a poignant snapshot of life in a town where these changes are impossible to overlook. Lum's vivid photographs of wildlife, such as whales, polar bears, and birds, offer rare close-ups of animals few ever see. In addition, Lum provides vivid descriptions and pictures of daily life in and around Barrow, offering a compelling insider's introduction to living on the tip of the world. With Lum as a capable guide, Nuvuk, the Northernmost is a chance to see a rare world before it changes forever. (shrink)

In this paper I consider two accounts of scientific discovery, Robert Hudson's and Peter Achinstein's. I assess their relative success and I show that while both approaches are similar in promising ways, and address experimental discoveries well, they could address the concerns of the discovery sceptic more explicitly than they do. I also explore the implications of their inability to address purely theoretical discoveries, such as those often made in mathematical physics. I do so by showing that extending Hudson's or (...) Achinstein's account to such cases can sometimes provide a misleading analysis about who ought to be credited as a discoverer. In the final sections of the paper I work out some revisions to the Hudson/Achinstein account by drawing from a so-called structural realist view of theory change. Finally, I show how such a modified account of discovery can answer sceptical critics such as Musgrave or Woolgar without producing misleading analyses about who ought to receive credit as a discoverer in cases from the mathematical sciences. I illustrate the usefulness of this approach by providing an analysis of the case of the discovery of the Casimir effect. (shrink)

In a recent exchange, John M. Fischer and David Widerker have debated whether or not it is appropriate to employ Frankfurt-style examples in efforts to challenge the intuitively plausible “principle of alternative possibilities.” Most recently, David Widerker and Charlotte Katzoff have tried to defend Widerker’s initial claim that such examples beg the question against libertarianism. As a libertarian sympathizer, I would like very much for these arguments to go through. However, I argue here that (1) their “molinist” critique is off-target, (...) (2) their demonstration of the general falsity of Fischer’s libertarianism misses the point, and (3) they infer the relevance of alternative possibilities from the mere existence of such alternatives in a way that requires unprovided justification. (shrink)

My dissertation is a systematic defense of the moral relevance of alternative possibilities. As such, it constitutes an attack on semi-compatibilism. ;To begin, then, I defend alternative possibilities against three related but independent lines of criticism. The most prominent of these is Harry Frankfurt's now famous counterexample strategy in which cases are constructed that purport to show that a person can, in fact, be responsible even when he cannot do otherwise. Another line of criticism is John Fischer's "flicker of freedom" (...) argument, which builds on Frankfurt-type argumentation by challenging the "robustness" of alternative possibilities. Finally, some recent critics of alternative possibilities have developed "reasons-responsiveness" accounts of moral responsibility that seem further to invalidate the importance of the power to do otherwise. By extending traditional concerns and developing new objections, I argue that room remains for the possible relevance of an alternative possibilities condition on moral responsibility. ;I try to make a positive case for the plausibility of relevance by offering reasons to think that the ability to do otherwise plays an important role in our moral life. Alternatives are important, I argue, because giving up a "freedom to do otherwise" condition would put us in an epistemic bind with respect to our responsibility. That is, the kind of confidence we ordinarily have in our own moral responsibility would be unjustified if it turned out that we do not have alternatives. A second consideration in favor of the relevance of alternatives is distinctively moral. I explore and exploit the relationship between the ability to do otherwise and the putatively Kantian idea that "ought" implies "can," concluding that the semi-compatibilist must either reject both alternative possibilities and the Kantian thesis, or accept that people would not be blameworthy for their moral failures under determinism. Neither option is attractive. ;I conclude, then, that there is good reason to believe that alternative possibilities are necessary for moral responsibility and that semi-compatibilism should be rejected. Our intuitions about the importance of being able to do otherwise can still factor into the traditional arguments to the conclusion that moral responsibility is incompatible with causal determinism. (shrink)

This paper develops a new interpretation of the “table of nothing” that appears at the end of the transcendental aesthetic in the Critique of Pure Reason. In contrast to previous interpretations, which have taken it to be part of Kant’s account of the failures of reason, this paper argues that it should be understood as proffering Kant’s positive account of the objects he will be concerned with in the transcendental dialectic, namely objects that, properly understood, are nothing. I examine the (...) four nothings in turn, showing how Kant’s concern is to develop a positive account of each one that allows him to determine its object while recognizing that it in some sense is not. I introduce Allison’s distinction between error and illusion and argue that the table of nothing is Kant’s theoretical account of what illusions are as objects, and thereby explains how something like a transcendental dialectic is possible at all. (shrink)

_ Source: _Volume 11, Issue 2, pp 149 - 172 Even among sympathetic readers, there abides a sense that Proclus’ attachment to his authorities at least partially blinds him to Socratic irony. This has serious implications for his conciliation of Homer and Plato in the Sixth Essay of his _Commentary on the Republic_. A significant number of the passages in Plato’s dialogues, which Proclus takes as necessitating their agreement, appear to be examples of Socrates’ ironic mode. If this apparent necessity (...) exists only through a failure to recognize the ironic character of these statements, it would seem to indicate the truth of E.R. Dodds’ famous judgement of Proclus, that he is properly philosophical only insofar as his thought is not subject to the irrationalisms of his pagan piety. The contention of this essay is that Proclus’ project of conciliation is not, in fact, driven by a refusal to recognize Socratic irony, but by his nuanced interpretation of it, an interpretation that is clarified through a consideration of the striking parallels it has with his understanding of poetic symbol. In following this path of inquiry, it will become evident that Proclus’ position on Socratic irony, and the theological conciliation it necessitates, is not an irrational interruption of his otherwise rational system, but an integral feature of its philosophical coherence. (shrink)

As scholars have recently suggested, rhetoric has long been remiss when it comes to nondiscursive concerns beyond its traditional purview. While many have sought to broaden rhetoric's scope, no one has yet undertaken a nondiscursive rhetorical investigation of social change in an effort to reconcile the tension between a critique of agency and the perception of human responsibility. This article undertakes such a critique through Alain Badiou's concept of the event, a concept that, I contend, offers the discipline a means (...) of rethinking the opposition between relativism and flat ontology. Analyzing the self-immolation of Mohamed Bouazizi through the frame of the event, I regard Bouazizi's act as an ontic occurrence exerting influence over protestors across the Arab world while demanding collective recognition to emerge as an event. (shrink)

This paper is an examination of Reinhold Niebuhr's embrace of the paradoxical in relation to his conception of the self. While it explores the theoretical and practical difficulties entailed in Niebuhr's account, it also seeks to defend his position, suggesting that in the light of Niebuhr's negative apologetic, the paradoxical self represents the only intelligible means of self-understanding available. Though Niebuhr never develops this epistemological ground, it may provide a way of avoiding the moral consequentialism to which Niebuhr appears to (...) be resigned. The resulting framework points toward moral pragmatism, retaining its orientation and relevance in the midst of deliberations concerning means and ends. (shrink)

We thank the commentators for their thoughtful engagement with our paper.1 In different ways, they make the same substantial point: our suggested interventions are not enough to solve the problems of organisational failure. On this we wholeheartedly agree. Organisational failure in healthcare is complex and multifaceted, it cannot be solved by one intervention in medical education. We did not intend to imply that our proposals alone would solve organisational failure, and this positioning misconstrues the aims of our paper. We had (...) more modest ambitions, we wanted to shift the analytical emphasis away from the individual and explore the implications raised by our analysis for our piece of the jigsaw—medical education. Having stepped away from such grand claims, the commentators make some valid points to which we would like to respond more specifically. Jesudason makes the distinction that normalisation of deviance (NoD) is well suited to understand institutional misfeasance but not malfeasance.2 We are inclined to agree; NoD can do some things but not all. Likewise, …. (shrink)

This study in progress addresses the question of how market competition affects corporate social performance. An empirical analysis is described designed to shed light on recent theoretical developments on the relation between market structure and stakeholder responsiveness and to inform on the old debate between Friedman and Corporate Social Responsibility.

In European countries (excluding the UK and Ireland), official statistics do not use racial or ethnic categories, but instead rely on proxies to collect data about discrimination. In the German microcensus, the proxy category adopted is ‘migration background’ (Migrationshintergrund): an individual has a ‘migration background’ when one or more of their parents does not have German citizenship by birth. We apply a coupled ethical-epistemic analysis to the ‘migration background’ category to illuminate how the epistemic issues contribute to ethical ones. Our (...) central claim is that these ethical-epistemic issues with the ‘migration background’ category are best analysed in terms of Charles Mills's ‘white ignorance’. Appealing to Annette Martín's structural account of white ignorance, we highlight the cyclical reinforcement of ignorance and racial injustice in the use of the ‘migration background’ variable. Colourblind eliminativism about race perpetuates the use of ‘migration background’, which sustains and intensifies racial injustices. (shrink)

Background Since the UK Abortion Act (1967), women have travelled from Ireland to the UK for legal abortion. In 2011 >4000 women did so. Knowledge and attitudes of medical students towards abortion have been published, however, this is the first such report from Ireland. Objective To investigate medical students’ attitudes towards abortion in Ireland. Methods All medical students at the University of Limerick, and physicians who graduated from the university within the previous 12 months, were invited via email to complete (...) an anonymous online survey. The questionnaire comprised 17 questions. Quantitative and qualitative analyses were performed. Results Response rate was 45% (n=169; 55% women; 88.2% <30 years of age; 66.7% Irish; 29.2% North American). Outcomes were: abortion should not be legally available (7.1%), abortion should be allowed in limited circumstances only (35.5%), abortion should be legally available upon request (55%). 72.8% of respondents were moderately/strongly prochoice (74% of women/71% of men/72% and 76% of Irish and North American respondents, respectively). Students aged >30 years were less likely to be prochoice (55%). While 95.2% believed that education on abortion should be offered within medical school curricula, 28.8% stated that they would decline to terminate pregnancies even if legally permitted. While 58.8% indicated that they might perform legal abortions once qualified, 25.7% would do so under limited circumstances only. Conclusions The majority of participants wanted education regarding abortion. Despite being predominantly prochoice, considerably fewer students, irrespective of nationality, indicated that they would perform abortions. (shrink)

This essay explains what the Causal Markov Condition says and defends the condition from the many criticisms that have been launched against it. Although we are skeptical about some of the applications of the Causal Markov Condition, we argue that it is implicit in the view that causes can be used to manipulate their effects and that it cannot be surrendered without surrendering this view of causation.

From dogs to gods, the science of understanding mysterious minds--including your own. Nothing seems more real than the minds of other people. When you consider what your boss is thinking or whether your spouse is happy, you are admitting them into the "mind club." It's easy to assume other humans can think and feel, but what about a cow, a computer, a corporation? What kinds of mind do they have? Daniel M. Wegner and Kurt Gray are award-winning psychologists who (...) have discovered that minds--while incredibly important--are a matter of perception. Their research opens a trove of new findings, with insights into human behavior that are fascinating, frightening and funny. The Mind Club explains why we love some animals and eat others, why people debate the existence of God so intensely, how good people can be so cruel, and why robots make such poor lovers. By investigating the mind perception of extraordinary targets--animals, machines, comatose people, god--Wegner and Gray explain what it means to have a mind, and why it matters so much. Fusing cutting-edge research and personal anecdotes, The Mind Club explores the moral dimensions of mind perception with wit and compassion, revealing the surprisingly simple basis for what compels us to love and hate, to harm and to protect. (shrink)

We explored the frequency with which typical adults make Theory of Mind attributions, and under what circumstances these attributions occur. We used an experience sampling method to query 30 typical adults about their everyday thoughts. Participants carried a Personal Data Assistant that prompted them to categorize their thoughts as Action, Mental State, or Miscellaneous at approximately 30 pseudo-random times during a continuous 10-h period. Additionally, participants noted the direction of their thought and degree of socializing at the time of inquiry. (...) We were interested in the relative frequency of ToM and how prominent they were in immediate social exchanges. Analyses of multiple choice answers suggest that typical adults: spend more time thinking about actions than mental states and miscellaneous things, exhibit a higher degree of own- versus other-directed thought when alone, and make mental state attributions more frequently when not interacting than while interacting with others . A significant 3-way interaction between thought type, direction of thought, and socializing emerged because action but not mental state thoughts about others occurred more frequently when participants were interacting with people versus when alone; whereas there was an increase in the frequency of both action and mental state attributions about the self when participants were alone as opposed to socializing. A secondary analysis of coded free text responses supports findings 1–3. The results of this study help to create a more naturalistic picture of ToM use in everyday life and the method shows promise for future study of typical and atypical thought processes. (shrink)

Should mental health insurance cover only disorders found in DSM‐IV, or should it be extended to treatment for ordinary shyness, unhappiness, and other responses to life's hard knocks?

This article interprets Hegel's hierarchical theory of race as an application of his general views about the metaphysics of classification and explanation. We begin by offering a reconstruction of Hegel's hierarchical theory of race based on the critical edition of relevant lecture transcripts: we argue that Hegel's position on race is appropriately classified as racist, that it postulates innate mental deficits of some races, and that it turns racism from an anthropological into a metaphysical doctrine by claiming that the division (...) of humankind into races (at least in the Old World) is not a brute fact, but follows a ‘higher necessity’. We then summarize our interpretation of the relevant metaphysical background to this theory. On our reading, Hegel postulates an essentialist form of explanation that explains given kinds as stages in a teleological, non-temporal process through which the nature of a superordinate kind is realized. We argue that Hegel's views about a hierarchical and necessary division of humankind into races are an application of this model to the case of human diversity, motivated by explanatory considerations and subject to confirmation bias. By way of conclusion, we address two possible attempts to ‘save’ Hegelian philosophy from its racist baggage. (shrink)

We investigate the processes underlying the feeling of control over one’s actions . Sense of agency may depend on internal motoric signals, and general inferences about external events. We used priming to modulate the sense of agency for voluntary and involuntary movements, by modifying the content of conscious thought prior to moving. Trials began with the presentation of one of two supraliminal primes, which corresponded to the effect of a voluntary action participants subsequently made. The perceived interval between movement and (...) effect was used as an implicit measure of sense of agency. Primes modulated perceived intervals for both voluntary and involuntary movements, but the modulation was greatest for involuntary movements. A second experiment showed that this modulation depended on prime–movement contiguity. We propose that sense of agency is based on a combination of internal motoric signals and external sensory evidence about the source of actions and effects. (shrink)

In a seminal 1977 article, Rumelhart argued that perception required the simultaneous use of multiple sources of information, allowing perceivers to optimally interpret sensory information at many levels of representation in real time as information arrives. Building on Rumelhart's arguments, we present the Interactive Activation hypothesis—the idea that the mechanism used in perception and comprehension to achieve these feats exploits an interactive activation process implemented through the bidirectional propagation of activation among simple processing units. We then examine the interactive activation (...) model of letter and word perception and the TRACE model of speech perception, as early attempts to explore this hypothesis, and review the experimental evidence relevant to their assumptions and predictions. We consider how well these models address the computational challenge posed by the problem of perception, and we consider how consistent they are with evidence from behavioral experiments. We examine empirical and theoretical controversies surrounding the idea of interactive processing, including a controversy that swirls around the relationship between interactive computation and optimal Bayesian inference. Some of the implementation details of early versions of interactive activation models caused deviation from optimality and from aspects of human performance data. More recent versions of these models, however, overcome these deficiencies. Among these is a model called the multinomial interactive activation model, which explicitly links interactive activation and Bayesian computations. We also review evidence from neurophysiological and neuroimaging studies supporting the view that interactive processing is a characteristic of the perceptual processing machinery in the brain. In sum, we argue that a computational analysis, as well as behavioral and neuroscience evidence, all support the Interactive Activation hypothesis. The evidence suggests that contemporary versions of models based on the idea of interactive activation continue to provide a basis for efforts to achieve a fuller understanding of the process of perception. (shrink)

expose some gaps and difficulties in the argument for the causal Markov condition in our essay ‘Independence, Invariance and the Causal Markov Condition’ ([1999]), and we are grateful for the opportunity to reformulate our position. In particular, Cartwright disagrees vigorously with many of the theses we advance about the connection between causation and manipulation. Although we are not persuaded by some of her criticisms, we shall confine ourselves to showing how our central argument can be reconstructed and to casting doubt (...) on Cartwright's claim that the causal Markov condition typically fails when there are indeterministic by-products. Why believe the causal Markov condition? Causation and manipulation The argument Indeterministic by-products and the causal Markov condition The chemical factory counterexample and PM2 Conclusions: causation and manipulability. (shrink)

A brief self-report scale was developed to assess everyday performance failures arising directly or primarily from brief failures of sustained attention . The ARCES was found to be associated with a more direct measure of propensity to attention lapses and to errors on an existing behavioral measure of sustained attention . Although the ARCES and MAAS were highly correlated, structural modelling revealed the ARCES was more directly related to SART errors and the MAAS to SART RTs, which have been hypothesized (...) to directly reflect the lapses of attention that lead to SART errors. Thus, the MAAS and SART RTs appear to directly reflect attention lapses, whereas the ARCES and SART errors reflect the mistakes these lapses are thought to cause. Boredom proneness was also assessed by the BPS, as a separate consequence of a propensity to attention lapses. Although the ARCES was significantly associated with the BPS, this association was entirely accounted for by the MAAS, suggesting that performance errors and boredom are separate consequences of lapses in attention. A tendency to even extraordinarily brief attention lapses on the order of milliseconds may have far-reaching consequences not only for safe and efficient task performance but also for sustaining the motivation to persist in and enjoy these tasks. (shrink)

Clinical trials of xenotransplantation may begin early in the next decade, with kidneys from genetically modified pigs transplanted into adult humans. If successful, transplanting pig hearts into children with advanced heart failure may be the next step. Typically, clinical trials have a specified end date, and participants are aware of the amount of time they will be in the study. This is not so with XTx. The current ethical consensus is that XTx recipients must consent to lifelong monitoring. While this (...) presents challenges to the right to withdraw in the adult population, additional and unanswered questions also linger in the paediatric population. In paediatric XTx, parents or guardians consent not only to the initial treatment of the child but also to lifelong monitoring, thus making a decision whose consequences will remain present as the child develops the capacity for assent, and finally the capacity for informed consent or refusal. This article presents and evaluates unanswered paediatric ethical questions in regard to the right to withdraw from XTx follow-up in the paediatric population. (shrink)

This paper explores the relationship between a manipulability conception of causation and the causal Markov condition (CM). We argue that violations of CM also violate widely shared expectations—implicit in the manipulability conception—having to do with the absence of spontaneous correlations. They also violate expectations concerning the connection between independence or dependence relationships in the presence and absence of interventions.

Participants were asked to carry out a series of simple tasks while following mental control instructions. In advance of each task, they either suppressed thoughts of their intention to perform the task, concentrated on such thoughts, or monitored their thoughts without trying to change them. Suppression resulted in reduced reports of intentionality as compared to monitoring, and as compared to concentration. There was a weak trend for suppression to enhance reported intentionality for a repetition of the action carried out after (...) suppression instructions had been discontinued. (shrink)

The effects of lexical context on phonological processing are pervasive and there have been indications that such effects may be modulated by attention. However, attentional modulation in speech processing is neither well documented nor well understood. Experiment 1 demonstrated attentional modulation of lexical facilitation of speech sound recognition when task and critical stimuli were identical across attention conditions. We propose modulation of lexical activation as a neurophysiologically plausible computational mechanism that can account for this type of modulation. Contrary to the (...) claims of critics, this mechanism can account for attentional modulation without violating the principle of interactive processing. Simulations of the interactive TRACE model extended to include two different ways of modulating lexical activation showed that each can account for attentional modulation of lexical feedback effects. Experiment 2 tested conflicting predictions from the two implementations and provided evidence that is consistent with bias input as the mechanism of attentional control of lexical activation. (shrink)

We report a novel task designed to elicit transient attention-lapse induced alienation of agency experiences in normal participants. When attention-related action slips occur during the task, participants reported substantially decreased self control as well as a high degree of perceived agency attributed to the errant hand. In addition, participants reported being surprised by, and annoyed with, the actions of the errant hand. We argue that ALIA experiences occur because of constraints imposed by the close and precise temporal relations between intention (...) formation and a contrary action employed in this paradigm. We note similarities between ALIA experiences and anarchic hand sign and argue that, despite important differences, both ALIA experiences and AHS phenomenology reflect failures of executive control to intervene and cancel contrary affordance-driven habitual motor plans. (shrink)

Drama, at least according to the Aristotelian view, is effective inasmuch as it successfully mirrors real aspects of human behavior. This leads to the hypothesis that successful dramas will portray fictional social networks that have the same properties as those typical of human beings across ages and cultures. We outline a methodology for investigating this hypothesis and use it to examine ten of Shakespeare’s plays. The cliques and groups portrayed in the plays correspond closely to those which have been observed (...) in spontaneous human interaction, including in hunter-gatherer societies, and the networks of the plays exhibit “small world” properties of the type which have been observed in many human-made and natural systems. (shrink)

Background Our objective was to evaluate whether the description of a machine learning (ML) app or brain imaging technology to predict the onset of schizophrenia or alcohol use disorder (AUD) influences healthcare professionals’ judgments of stigma, empathy, and compassion. Methods We randomized healthcare professionals (N = 310) to one vignette about a person whose clinician seeks to predict schizophrenia or an AUD, using a ML app, brain imaging, or a psychosocial assessment. Participants used scales to measure their judgments of stigma, (...) empathy, and compassion. Results Participants randomized to the ML vignette endorsed less anger and more fear relative to the psychosocial vignette, and the brain imaging vignette elicited higher pity ratings. The brain imaging and ML vignettes evoked lower personal responsibility judgments compared to the psychosocial vignette. Physicians and nurses reported less empathy than clinical psychologists. Conclusions The use of predictive technologies may reinforce essentialist views about mental health and substance use that may increase specific aspects of stigma and reduce others. (shrink)