Access to investigational drugs is a concern to patients and regulatory agencies. In order to determine potential trial participants’ views on access to investigational drugs, we surveyed one hundred people who had been referred to a phase I clinical trial. Most respondents indicated that patients had a right to investigational drugs, that the drugs should be offered only in the context of research, that getting access to these drugs is too hard, and that knowing the right people and being persistent (...) increased the likelihood of gaining access. Respondents did not think that investigational drugs should be given to anyone who wanted them, or that physicians were aware of the latest investigational agents. They most frequently recommended two allocation criteria: offering investigational drugs to those who would benefit most or were most needy; and allocating them to maximize scientific advancement. Respondents who understood the purpose of the trial were more likely to choose the second criterion. (shrink)

The question whether epistemological concepts are closed under deduction is an important one since many skeptical arguments depend on closure. Such skepticism can be avoided if closure is not true of knowledge (or justification). This response to skepticism is rejected by Peter Klein and others. Klein argues that closure is true, and that far from providing the skeptic with a powerful weapon for undermining our knowledge, it provides a tool for attacking the skeptic directly. This paper examines various arguments in (...) favor of closure and Klein's attempted use of closure to refute skepticism. Such a refutation of skepticism is mistaken. But the closure principle is in any case false, so the skepticism that depends on it is undermined. The appeal of the closure principle derives from a failure to recognize an important feature of our epistemological concepts, namely, their context relativity. (shrink)

Case studies and first-person stories about decision-making, written by professionals in the field, bring a uniquely personal touch to this valuable text.

In lieu of an abstract, here is a brief excerpt of the content:LettersJames L. Walsh, Moira M. McQueen, Kevin O'Rourke, and Jean deBloisEarly Delivery of the Anencephalic InfantMadam:In the March 1994 issue of the Kennedy Institute of Ethics Journal, Kevin O'Rourke and Jean deBlois have replied to an article of ours (KIEJ, December 1993) on the early induction of the anencephalic fetus. They agree with our conclusion that such early delivery may be morally acceptable, but argue that our justification is (...) flawed. Exchanges on the subject probably could continue ad nauseam; here we simply state some of the elements of their article that leave us perplexed.1. The phrase "prolonging the life of" (p. 49) has one meaning in the case of artificial life supports, which may be unwarranted interventions, but it has a different meaning when it refers to not interfering with a person's enjoyment of necessary natural means of preserving his or her life. Inducing labor prior to viability, which denies the natural means of life support without a possible substitute, has more in common with smothering a dying patient than the nonemployment of or withdrawing of artificial means of life support. To refer to the death of the fetus here as an effect is rather like saying that I suffocated you and the effect of the suffocation is your death. This is quite different from induction after viability where the induction can have different effects.2. If the authors were correct that "the prohibition on inducing delivery before viability is predicated upon the assumption that the fetus in utero is a human being with the potential for further development" (p. 49) and the anencephalic has none, why is there need to employ the principle of double effect? They say that there is no moral obligation to prolong the life of the anencephalic fetus. Just as there is no need for the principle in cases of withdrawing unwarranted artificial life support, so there would be no need for it here. Because the authors seem to perceive a complete disjunction between direct and indirect killing (allowing to die being in the category of indirect killing), it seems that they are unable to let their argument rest here, but have to justify the death that occurs.3. The example concerning smothering and the nonemployment of aggressive interventions (p. 49) explains well the difference between killing and allowing to die. But allowing to die is not indirectly killing since it occurs as a result of the disease and not from the causality of the agent.4. How can we cause something and not intend it? There are instances in which we simply "permit" evil events, but where we are not the cause. For example, evil events may be attributable to the bad will of others. Legislators make just laws knowing that some people of bad will will break them for their own advantage. Here the legislators really do permit evil. Neither are we the cause of death when we allow a person to die by not imposing unwarranted means of life support; we permit his or her death. But can we so readily designate by "permit" [End Page 184] what we knowingly choose to bring about? O'Rourke and deBlois use interchangeably "indirectly intended" and "unintended" for what is caused by our actions; "indirectly intended" is a better designation than "unintended." The whole package, including all foreseen effects, is intended. Evil "happening" (p. 51) as a result of an action that I place can refer either to evil as caused by my action or to evil as arising from a cause apart from my action. Only in this latter sense do I permit evil and not intend it, either directly or indirectly.5. The fourth condition of the principle of double effect is given as follows: "There must be a proportionately grave reason for placing the act. The greater the evil, the more cogent the reason must be for performing the act" (p. 50). How the authors can abstract from balancing goods and evils here is beyond us.6. We cannot follow the authors' use of the term "morally good" with respect to the induced delivery (p. 50). The problem is concerned with the morally right... (shrink)

The lesson is familiar. Kripke’s arguments in favor of a posteriori necessary truths annul the idea that conceivability is a guide to metaphysical possibility because determining that which is a priori is a separate issue from determining that which is necessary. Modal rationalists do not completely agree with this conclusion. Following recent work on two-dimensional semantics, David Chalmers suggests that two distinct semantic values can be assigned to a statement, depending on whether we consider possible worlds as counterfactual or counteractual. (...) The idea is that counterfactual possibilities yield familiar Kripkean intuitions, but that counteractuals fulfill the desired link between a priori conceivability and metaphysical possibility. In this paper, I discuss a problem for modalrationalism that arises through the use of material conditionals, or conditionals in the indicative mood. I then turn to Chalmers’ response, and suggest reasons why it is inadequate. I turn to another response from Chalmers, and suggest that, whilst it solves the fi rst issue, it is incapable of grounding modal rationalism. In conclusion I will suggest a way in which a tempered version of modal rationalism can be salvaged. (shrink)

This paper explores a possible Platonic grounding of human freedom in the Philebus. The Philebus presents a particularly intruiging account of the humangood and freedom alike in terms of the right relation of nous and pleasure. Through a close analysis of key passages in this dialogue I show how Plato conceives of freedom in terms of the intellect’s ordering and directing of desire and pleasure to genuinely fulfilling ends. The greatest fulfillment of desire comes together with the purest pleasure in (...) the highest actualization of reason in lifelong philosophic activity: the mixed life and good life for human beings. (shrink)

Scepticism about ought simpliciter is the view that there is no such thing as what one ought simpliciter to do. Instead, practical deliberation is governed by a plurality of normative standpoints, each authoritative from their own perspective but none authoritative simpliciter. This paper aims to resist such scepticism. After setting out the challenge in general terms, I argue that scepticism can be resisted by rejecting a key assumption in the sceptic’s argument. This is the assumption that standpoint-relative ought judgments bring (...) with them a commitment to act in accordance with those judgments. Instead, I propose an alternative account of our normative concepts according to which only ought simpliciter judgments commit one to acting in accordance with those judgments. In addition to answering the sceptical challenge, the proposal offers an independently motivated account of what makes a concept normatively authoritative. (shrink)

In this interview, James L. McClelland responds to questions regarding connectionist models of cognition, a theory inspired by information processing in the brain. McClelland explains the distinction between symbolic and non-symbolic processing for a better understanding of mental processes. He argues that connectionist models can perform the computations which we know the brain can perform. In addition, he responds to several general questions on the perspectives of computational models of cognition.

Abstract:Disturbing cases continue to be published of patients declared brain dead who later were found to have a few intact brain functions. We address the reasons for the mismatch between the whole-brain criterion and brain death tests, and suggest solutions. Many of the cases result from diagnostic errors in brain death determination. Others probably result from a tiny amount of residual blood flow to the brain despite intracranial circulatory arrest. Strategies to lessen the mismatch include improving brain death determination training (...) for physicians, mandating a test showing complete intracranial circulatory arrest, or revising the whole-brain criterion. (shrink)

Metaethical expressivism is typically characterised as the view that normative statements express desire-like attitudes instead of beliefs. However, in this paper I argue that expressivists should claim that normative statements express beliefs in normative propositions, and not merely in some deflationary sense but in a theoretically robust sense explicated by a theory of propositional attitudes. I first argue that this can be achieved by combining an interpretationist understanding of belief with a nonfactualist view of normative belief content. This results in (...) a view I call ‘interpretative expressivism’. I then argue that traditional arguments employed by expressivists that normative statements express noncognitive attitudes can just as well support the claim that normative statements express nonfactual or nonrepresentational beliefs. Finally, I argue that this view has a number of advantages to versions of expressivism that deny that normative statements express non-deflationary normative beliefs. (shrink)

Expressivists about normative thought and discourse traditionally deny that there are nondeflationary normative propositions. However, it has recently been suggested that expressivists might avoid a number of problems by providing a theory of normative propositions compatible with expressivism. This paper explores the prospects for developing an expressivist theory of propositions within the framework of cognitive act theories of propositions. First, I argue that the only extant expressivist theory of cognitive propositions—Michael Ridge's ‘ecumenical expressivist’ theory—fails to explain identity conditions for normative (...) propositions. Second, I argue that this failure motivates a general constraint—the ‘unity requirement’—that any expressivist theory of propositions must provide a unified nonrepresentational explanation of that in virtue of which propositional attitudes have the content that they have. Third, I argue that conceptual role accounts of content provide a promising framework in which to develop an expressivist theory of cognitive propositions. (shrink)

Organ donation after the circulatory determination of death requires the permanent cessation of circulation while organ donation after the brain determination of death requires the irreversible cessation of brain functions. The unified brain-based determination of death connects the brain and circulatory death criteria for circulatory death determination in organ donation as follows: permanent cessation of systemic circulation causes permanent cessation of brain circulation which causes permanent cessation of brain perfusion which causes permanent cessation of brain function. The relevant circulation that (...) must cease in circulatory death determination is that to the brain. Eliminating brain circulation from the donor ECMO organ perfusion circuit in thoracoabdominal NRP protocols satisfies the unified brain-based determination of death but only if the complete cessation of brain circulation can be proved. Despite its medical and physiologic rationale, the unified brain-based determination of death remains inconsistent with the Uniform Determination of Death Act. (shrink)

This paper examines the general prospects for conceptual role expressivism, expressivist theories that embrace conceptual role semantics. It has two main aims. The first aim is to provide a general characterisation of the view. The second aim is to raise a challenge for the general view. The challenge is to explain why normative concepts are not a species of defective concepts, where defective concepts are those that cannot meaningfully embed and participate in genuine inference. After rejecting existing attempts to answer (...) the challenge, I propose an alternative solution. However, the solution leaves conceptual role expressivism a far less distinctive and interesting position than its proponents claim. I conclude that we should be sceptical about how much expressivists gain by appealing to conceptual role semantics. (shrink)

Over the past quarter century, organ donation after the circulatory determination of death (DCD) has grown in acceptance and prevalence throughout the world (Domínguez-Gil et al. 2021). Notwithstan...

The shape of a life hypothesis holds that the temporal sequence of good or bad times in a life can itself be a valuable feature of that life. This is generally thought to be incompatible with additivism about lifetime well-being, which holds that lifetime well-being is fully determined by momentary well-being. This discussion examines Dale Dorsey’s recent argument that these views are in fact compatible. I argue that accepting the conjunction of these views requires stronger commitments than Dorsey recognizes. After (...) arguing that these commitments are problematic, I conclude that we should reject the compatibility claim. (shrink)

Mental health professionals rightfully experience significant anxiety regarding their duty to protect when working with potentially dangerous individuals. This work dispels myths and provides readers with a resource addressing the situations where a duty to protect may apply.

In lieu of an abstract, here is a brief excerpt of the content:Contemplating the Beautiful: The Practical Importance of Theoretical Excellence in Aristotle’s EthicsJames L. Wood (bio)Aristotle, unlike plato, famously distinguishes φρόνησις from, practical from theoretical wisdom, in Book VI of the Nicomachean Ethics. He distinguishes them on the basis of both their objects and their psychic spheres: is the excellence or virtue (ἀρετή) of the scientific faculty, τὸ ἐπιστημονικόν, “by which we contemplate [θεωρου̑μεν] the sort of beings whose principles (...) [ἀρχαί] do not admit of being otherwise,” while φρόνησις is an excellence of the calculative faculty, τὸ λογιστικόν, by which we contemplate “the sort of beings that admit of being otherwise” (VI.1, 1139a6–8).1 Φρόνησις is skilled and experienced deliberation about human action and emotion, and in particular about “the sort of things that relate to (πρός) living well in general” (VI.5,1140a28); so φρόνησις guides right action, and as it turns out, directly entails excellence of character, ἠθική ἀρετή (VI.13, 1145a1–2)., on the other hand, while necessary for complete happiness (VI.12, 1144a1–6), “contemplates none of the things that make a human being happy” (VI.12, 1143b19–20), because it contemplates not changeable human affairs, circumstances, and actions, but eternal and unchanging realities (VI.6–7; X.7–8; cf. On the Soul, III.9, 432b26–433a1). Θεωρία, contemplation itself, is defined with reference to in Book X, where contemplation is made the basis of the highest human happiness as the excellent activity of intellect (νου̑ς) by which “beautiful and divine” realities are apprehended (X.7, 1177a15–18 and following). In contrast, the excellence of practical activity (both φρόνησις and ἠθική ἀρετή) is explicitly distinguished from the excellent theoretical activity of νου̑ς in θεωρία and relegated to a merely “secondary” importance (X.8, 1178a9 and following).2 [End Page 391]We might well conclude from this account that theoretical activity has nothing to do with practical activity, even if each is independently necessary for complete human happiness, and even if, as Aristotle says, practical excellence is somehow necessary to prepare the way for theoretical excellence (cf. VI.13, 1145a6–11). I wish to counter this impression, however, by showing that there is a theoretical dimension to excellent practical activity.3 More precisely, I will argue that theoretical activity contributes to practical excellence by furnishing the principles (ἀρχαί) of practical reasoning to the calculative faculty and the motivating end (τέλος) of action to the irrational-appetitive (τὸ; ἄλογον) part of the soul. The intellectual faculty that performs this theoretical activity is νου̑ς; the principles that νου̑ς apprehends are the first premises of ethical and political deliberation; and the τέλος that νου̑ς holds up to the appetitive soul as an orienting and motivating object is το καλόν.4 What distinguishes this activity from the theoretical activity that furnishes the principles of scientific reasoning (ἐπιστήμη) for the sake of knowledge is both the kinds of objects studied and the purpose of the study. One typically studies mathematics or astronomy in order to gain knowledge, not to act virtuously; however, one can certainly study the principles of human nature for the sake of virtuous action (as well as knowledge), as Aristotle himself does in the Ethics and other treatises (cf. II.2, 1103b27–29).5 Moreover, the theoretical study of the most “beautiful and divine” realities, described in Book X of the Ethics and Book XII of the Metaphysics, raises the possibility of a direct contribution of θεωρία at the highest levels to πρα̑ξις through the mediating activity of νου̑ς in the contemplation of the highest beauty and divinity.In what follows I will develop and defend these points through a close examination of Aristotle’s discussion of these concepts. My argument has three main parts. The first examines the role of thought in excellent action, the second brings out [End Page 392] the significance of το καλόν as the universal object of practical excellence, and the third argues in three subsections for the contribution in different ways of theoretical to practical excellence.1. The Dependence of Desire on Thought in Excellent ActionAs is clear from his concluding remarks in Book VI, where he declares that the possession of φρόνησις entails the possession of all the virtues of character (VI.13, 1145a1–2), Aristotle holds that the ἀρεταί of practical thought and character, φρόνησις and ἠθική ἀρετή, are interdependent and mutually implicating in virtuous choice and action. Thought needs desire in order to be practically effective... (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)

A combination of emerging life support technologies and entrenched organ donation practices are complicating the physician's task of determining death. On the one hand, technologies that support or replace ventilation and circulation may render the diagnosis of death ambiguous. On the other, transplantation of vital organs requires timely and accurate declaration of death of the donor to keep the organs as healthy as possible. These two factors have led to disagreements among physicians and scholars on the precise moment of death. (...) In this article, I suggest that the debate about exactly when a person dies can benefit from distinguishing the strict biological concept of death from the medical standards for determining human death, and I show how an appreciation of the difference between the permanent and irreversible cessation of circulation is helpful in understanding the reasons for the two approaches to determining when death should be declared. (shrink)

The overall purpose of this paper is to clarify the physical meaning and epistemological status of the term 'measurement' as used in quantum theory. After a review of the essential logical structure of quantum physics, Part I presents interpretive discussions contrasting the quantal concepts observable and ensemble with their classical ancestors along the lines of Margenau's latency theory. Against this background various popular ideas concerning the nature of quantum measurement are critically surveyed. The analysis reveals that, in addition to internal (...) mathematical difficulties, all the so-called quantum theories of measurement are grounded in unjustifiable, classical presuppositions. (shrink)

Nair-Collins and Joffe (2023) highlighted the noncongruence between the language of the Uniform Determination of Death Act (UDDA) and the accepted brain death bedside testing standard by showing th...

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 22.1 (2002) 251-254 [Access article in PDF] James Fredericks Interview The 2002 winner of the Frederick J.Streng Book Award is James Fredericks, professor ofTheological Studies at Loyola Marymount University in Los Angeles, California. Professor Fredericks received the award for his book, Faith Among Faiths: Christian Theology and the Non-Christian Religions, published by Paulist Press (New York) in 2001. Buddhist-Christian Studies asked James about his (...) writing of the volume.Buddhist-Christian Studies: Why did you write Faith Among Faiths?James Fredericks: I wanted to help Christians think about the problems that the "pluralist" view of religious diversity poses for inter-religious dialogue.How does the book do that?By making a sustained criticism of the claim that religions are differing interpretations of the same transcendent "Reality." This notion is a problem for a religion of revelation, like Christianity, but also for a religion like Buddhism that has a sophisticated critique of metaphysics. Pluralist thinkers impose a meta-religious grand narrative on all the religions and demand that the religions conform to this grand narrative in the name of "tolerance."This kind of thinking has roots in the European Enlightenment and has affinities with some strands of Hindu thought, especially the "neo-Hindu" thinkers. I do not think that this approach fosters dialogue in depth. If Buddhism and Christianity are varying interpretations of the same ultimate "Reality," then what does Buddhism have to teach Christians that is of genuine theological importance? The obvious differences that distinguish Buddhism from Christianity are of little theological interest to Christians because they are of no soteriological consequence. The pluralist approach is a dead end for dialogue.And the way forward?What I call "comparative theology." I think of this as an alternative to what Christians call the "theology of religions."What's the difference?Theologies of religion interpret the meaning of other religious traditions from within the perspective of Christian tradition. Karl Rahner's theology of the anonymous Christian and Karl Barth's rejection of all religions as "unbelief" are both examples of a theology of religion. John Hick's pluralist model of religions is also a kind of theology of religions. This entire project has reached an impasse within Christianity. As an alternative, I propose that Christians recognize that Buddhism and Christianity [End Page 251] are linked by some significant similarities and distinguished from each other by significant differences.How does that break the impasse?Christians have something of genuine value to learn by entering humbly into dialogue with Buddhists. By taking differences seriously, dialogue becomes a way for Christians to do their own theology collaboratively with Buddhists. In the medieval period, Christians did theology in dialogue with Aristotle and Plato. Today, I want Christians to do theology in dialogue with Nagarjuna and Dogen. Therefore doing theology comparatively is to step beyond the notion of a theology of religions. Comparative theology does not begin with the assumption that Buddhism is a relatively obscured form of the same truth Christians affirm (Rahner) or that Buddhism and Christianity are relatively equal expressions of a truth that transcends them both (Hick). The purpose of dialogue is not to show how we are all really trying to say the same thing. ForChristians, at least, dialogue with Buddhists is a genuinely demanding way of doing theology.Any other reasons for the book?Yes. To promote friendships among Buddhists and Christians. These "inter-religious friendships" are a good way for Christians to practice their faith. My own friendships with Buddhists, both here in the USA and in Asia, are central to my spirituality and my work as a theologian. In a sense, I have never been in dialogue with "Buddhism." All my dialogues have been with actual Buddhists, with all their personal strengths and weaknesses, successes and failures. I am happy to say that, over the years, I have had some skillful teachers who have taught me not only the Dharma, but also taught me new ways to think about Christianity.Was it a difficult book to write?My book was written after years of dialogue with Buddhists and much research and... (shrink)

Notwithstanding these wise pronouncements, my project here is to characterize the biological phenomenon of death of the higher animal species, such as vertebrates. My claim is that the formulation of “whole- brain death ” provides the most congruent map for our correct understanding of the concept of death. This essay builds upon the foundation my colleagues and I have laid since 1981 to characterize the concept of death and refine when this event occurs. Although our society's well-accepted program of multiple (...) organ procurement for transplantation requires the organ donor first to be dead, the concept of brain death is not merely a social contrivance to permit us to obtain the benefits of organ procurement. Rather, the concept of whole- brain death stands independently as the most accurate biological representation of the demise of the human organism. (shrink)

This paper examines the integration and unification of the philosophy and psychology of well-being. For the most part, these disciplines investigate well-being without reference to each other. In recent years, however, with the maturing of each discipline, there have been a growing number of calls to integrate the two. While such calls are welcome, what it means to integrate well-being philosophy and psychology can vary greatly depending on one’s theoretical and practical ends. The aim of this paper is to provide (...) a novel conceptual framework for thinking about integrating well-being philosophy and psychology that systematically categorizes different kinds of integration projects. We divide existing attempts in the literature into three broad categories according to the perspective from which the integration takes place: (1) top-down meta-theoretical unification; (2) psychological integration within philosophy; and (3) philosophical integration within psychology. These categories are then broken down into various further subcategories. Our aim in providing this framework is both to facilitate the assessment and comparison of existing integration attempts and to provide a roadmap for future integration attempts. For each category, we discuss one or two representative examples of the approaches. By doing so, we hope to generate interest in the wide variety of existing integration projects, as well as to generate discussion concerning the benefits and pitfalls of different approaches. (shrink)

This paper compares the preface of Columella’s Res rustica with that of the earliest fully extant Chinese agricultural treatise, the Qimin yaoshu (‘Essential Techniques for the Common People’) of Jia Sixie. I argue that both prefaces have a similar function: to present to the reader the social world in which the author wishes his agricultural work to be understood. By drawing on authoritative literary and historical traditions, each author projects an idealized vision of farming in which the discipline acquires a (...) deep moral significance. Granting these striking similarities, the authors’ views also diverge in certain illuminating respects: these include the moral agency of agriculture, the social location of expertise, and the historical development of agriculture in relation to society. (shrink)