In the TACITUS project for using commonsense knowledge in the understanding of texts about mechanical devices and their failures, we have been developing various commonsense theories that are needed to mediate between the way we talk about the behavior of such devices and causal models of their operation. Of central importance in this effort is the axiomatization of what might be called commonsense metaphysics. This includes a number of areas that figure in virtually every domain of discourse, such as granularity, (...) scales, time, space, material, physical objects, shape, causality, functionality, and force. Our effort has been to construct core theories of each of these areas, and then to define, or at least characterize, a large number of lexical items in terms provided by the core theories. In this paper we discuss our methodological principles and describe the key ideas in the various domains we are investigating. (shrink)

Adam Smith is the best known among economists for his book, The Wealth of Nations, often viewed as the keystone of modern economic thought. For many he has become associated with a quasi-libertarian laissez-faire philosophy. Others, often heterodox economists and social philosophers, on the contrary, focus on Smith's Theory of Moral Sentiments, and explore his moral theory. There has been a long debate about the relationship or lack thereof between these, his two great works. This work treats these dimensions of (...) Smith's work as elements in a seamless moral philosophical vision, demonstrating the integrated nature of these works and Smith's other writings. This book weaves Smith into a constructive critique of modern economic analysis and builds bridges between that discourse and the other social sciences. (shrink)

Most people know precious little about the risks and benefits of participating in a clinical trial--a medical research study involving some innovative treatment for a medical problem. Yet millions of people each year participate anyway. Patients at Risk explains the reality: that our current system intentionally hides much of the information people need to make the right choice about whether to participate. Witness the following scenarios: -Hundreds of patients with colon cancer undergo a new form of keyhole surgery at leading (...) cancer centersnever -Tens of thousands of women at high risk of developing breast cancer are asked to participate in a major research study. They are told about the option of having both breasts surgically removed but not told about the option of taking a standard osteoporosis pill that might cut the risk of getting breast cancer by one-half or more. Patients at Risk written by two nationally prominent experts, is the first book to reveal the secrets that many in the research establishment have fought long and hard to keep from patients. It shows why options not commonly knownincluding getting a new treatment outside of a research studycan often be the best choice. It explains how patients can make good decisions even if there is only limited information about a treatments effect. And it does this through the eye-opening stories of what is happening daily to thousands of people. Day after day, we are learning how little we know about what really works. Headlines regularly announce that a previously unquestioned treatmenthormone replacement therapy, drugs such as Vioxx or Celebrexmay now be much riskier than we thought. The latest book in a surge of recent books criticizing the medical establishment (but the first to look at clinical trials specifically), Patients at Risk helps to empower patients to survive in a world of medical uncertainty, and makes positive recommendations for systemic reform. (shrink)

Traditionally, organ retrieval from cadavers has taken place only in cases where the declaration of death has occurred using “brain death” criteria. Under these criteria, specific tests are performed to demonstrate directly a lack of brain activity. Recently, as a result of efforts to increase organ procurement, attention has been directed at the use of so-called “non-heart-beating” donors : individuals who are declared dead not as a result of direct measurements of brain function, but rather as a result of the (...) cessation of heart and respiratory functions. Attempts to obtain organs from such individuals have recently resulted in substantial negative publicity. Claims were made that the deaths of patients were being accelerated in order to get organs, and that sometimes organs were being removed from patients who were not yet dead. (shrink)

Traditionally, organ retrieval from cadavers has taken place only in cases where the declaration of death has occurred using “brain death” criteria. Under these criteria, specific tests are performed to demonstrate directly a lack of brain activity. Recently, as a result of efforts to increase organ procurement, attention has been directed at the use of so-called “non-heart-beating” donors : individuals who are declared dead not as a result of direct measurements of brain function, but rather as a result of the (...) cessation of heart and respiratory functions. Attempts to obtain organs from such individuals have recently resulted in substantial negative publicity. Claims were made that the deaths of patients were being accelerated in order to get organs, and that sometimes organs were being removed from patients who were not yet dead. (shrink)

Why be good -- Laws and legalisms -- Moral actor, moral acts -- Paths of glory : virtues -- Moral heroes.

In the creation myth of the Timaeus Plato describes God as wishing that all things should be good so far as is possible. Wherefore, finding the whole visible sphere of the world not at rest, but moving in an irregular fashion, out of disorder He brought order, thinking that this was in every way an improvement. To achieve His end He placed intelligence in soul and soul in body, reflecting that nothing unintelligent could ever be better than something intelligent . (...) From this account of creation it would seem that God confronted a chaotic world whose disorderly motions existed in full independence of the principle of soul. Yet, in his doctrinal pronouncements in the Laws and the Pbaedrus on the origin of motion, Plato declares soul to be elder born than bodies and the prime source of all their changes and transformations. (shrink)

When seriously ill patients for whom existing treatments are inadequate are invited to participate in clinical trials that offer a new treatment, should those persons be considered “vulnerable”? And if so, what additional protections should they be accorded? This article attempts to provide some answers.

This project focuses on the extent to which disability insurers should be allowed to use genetic information in underwriting and rate-setting, but this subject cannot be completely isolated from the related questions of whether life and health insurers should also have this discretion. Federal and state laws place significant restrictions on insurers’ use of genetic information in health insurance, but regulation of such use in life and disability insurance is considerably more modest. This essay examines the reasons for this disparity (...) and discusses the implications for future proposals to regulate disability insurers’ use of genetic information in underwriting and rate-setting. The thesis is relatively simple: Communitarian values are stronger in health insurance than in life and disability insurance. Accordingly, the public is likely to acquiesce to insurers’ insistence that they be allowed to make distinctions among insureds in disability insurance that would not be tolerated in health insurance. (shrink)

Suppose that someone has a serious illness. The illness will likely lead to significant disabilities, and may even cause death. Existing treatments are unsatisfactory. The patient learns about a clinical trial, in which some allegedly promising new treatment for that illness is being tested.Such seriously ill patients for whom existing treatments are unsatisfactory have sometimes been categorized as medically vulnerable in the literature. Should these patients indeed be considered vulnerable subjects and be provided with special protections? And if the answer (...) is yes, then what are those special protections? This article explores the possible answers to these questions.The federal regulations for the protection of research subjects have several provisions addressing the concept of vulnerability. The three subparts Subparts B, C, and D deal with specific categories of vulnerable subjects, but do relatively little to address broader issues relating to vulnerability that might apply to a category such as the medically vulnerable. The Common Rule is the only section containing general discussions of vulnerability. (shrink)

Communitarian values are stronger in health insurance than in life or disability insurance. This correlates with increased tolerance for insurers' use of genetic information in disability insurance underwriting, which, in turn, is relevant to the scope and content of proposals to regulate such use.

Only 19 new molecular entities and 3 biologics were approved by the Food and Drug Administration in 2007, the lowest rate in 24 years. This disappointing output occurred despite steady clinical trial and regulatory review times, the FDA maintaining high approval rates, and the pharmaceutical industry consistently reporting increasing revenues. A government report suggests that fewer new drug applications have been submitted to the FDA by the pharmaceutical industry in recent years. These data have rekindled the debate as to the (...) origins of pharmaceutical innovation and the comparative importance of public and private sources in contributing to drug discovery. The pharmaceutical industry contends that its research is responsible for most new medicines, and that the primary public institution supporting U.S. biomedical research, the National Institutes of Health, supports medical innovation “distinct from the process of drug development.”. (shrink)

Though many more patents emerge from industry sources, drug-related patents generated in the non-profit setting appear to have greater importance than patents arising from the commercial sector, which helps demonstrate the value non-profit research institutions can have in driving drug development.

This article reviews recent developments in health care law, focusing on the engagement of law as a partner in health care innovation. The article addresses: the history and contents of recent United States federal law restricting the use of genetic information by insurers and employers; the recent federal policy recommending routine HIV testing; the recent revision of federal policy regarding the funding of human embryonic stem cell research; the history, current status, and need for future attention to advance directives; the (...) recent emergence of medical–legal partnerships and their benefits for patients; the obesity epidemic and its implications for the child’s right to health under international conventions. (shrink)

When applied in the health sector, AI-based applications raise not only ethical but legal and safety concerns, where algorithms trained on data from majority populations can generate less accurate or reliable results for minorities and other disadvantaged groups.

This article reviews recent developments in health care law, focusing on the engagement of law as a partner in health care innovation. The article addresses: the history and contents of recent United States federal law restricting the use of genetic information by insurers and employers; the recent federal policy recommending routine HIV testing; the recent revision of federal policy regarding the funding of human embryonic stem cell research; the history, current status, and need for future attention to advance directives; the (...) recent emergence of medical–legal partnerships and their benefits for patients; the obesity epidemic and its implications for the child’s right to health under international conventions. (shrink)

Challenges to Legal Theory offers the reader a fascinating journey though a variety of multi-disciplinary topics, ranging from law and literature, and law and religion, to legal philosophy and constitutional law. The collection reflects some of the challenges that the field of legal theory currently faces. It is compiled by a selection of international and Spanish scholars, whose essays are made available in English translation for the first time. The volume is based on a collection of essays, published in Spanish, (...) in honour of Professor José Iturmendi Morales, of Complutense University, Madrid, and brings the rich scholarship of pre-eminent Spanish scholars of law and legal theory to an international audience. (shrink)

Drug Safety Communications are used by the Food and Drug Administration to inform health care providers, patients, caregivers, and the general public about safety issues related to FDA-approved drugs. To assess patient knowledge of the messaging contained in DSCs related to the sleep aids zolpidem and eszopiclone, we conducted a large, cross-sectional patient survey of 1,982 commercially insured patients selected by stratified random sampling from the Optum Research Database who had filled at least two prescriptions for either zolpidem or eszopiclone (...) between July 1, 2012 and June 30, 2013. Among the 594 respondents, two-thirds reported hearing generally about drug safety information prior to starting a new drug, with the remaining one-third “rarely” or “never” hearing such information. Providers and pharmacists were primary sources of drug safety information. Two-thirds of zolpidem users and half of eszopiclone users reported having heard about the related DSC messages, ability to accurately identify the major factual messages was limited. Respondents reacted to new drug safety information about their sleep aids by reporting that they would want to learn about alternative ways to help them sleep and seek out more information about the safety of their specific sleeping pill. Opportunities may exist for the FDA to work with providers and pharmacies to help ensure the DSC information is more widely received and is more fully understood by those taking the affected medications. (shrink)

Artificial intelligence (AI) has attracted an increasing amount of attention, both positive and negative. Its potential applications in healthcare are indeed manifold and revolutionary, and within the realm of medical imaging and radiology (which will be the focus of this paper), significant increases in accuracy and speed, as well as significant savings in cost, stand to be gained through the adoption of this technology. Because of its novelty, a norm of keeping humans “in the loop” wherever AI mechanisms are deployed (...) has become synonymous with good ethical practice in some circles. It has been argued that keeping humans “in the loop” is important for reasons of safety, accountability, and the maintenance of institutional trust. However, as the application of machine learning for the detection of lumbar spinal stenosis (LSS) in this paper’s case study reveals, there are some scenarios where an insistence on keeping humans in the loop (or in other words, the resistance to automation) seems unwarranted and could possibly lead us to miss out on very real and important opportunities in healthcare—particularly in low-resource settings. It is important to acknowledge these opportunity costs of resisting automation in such contexts, where better options may be unavailable. Using an AI model based on convolutional neural networks developed by a team of researchers at NUH/NUS medical school in Singapore for automated detection and classification of the lumbar spinal canal, lateral recess, and neural foraminal narrowing in an MRI scan of the spine to diagnose LSS, we will aim to demonstrate that where certain criteria hold (e.g., the AI is as accurate or better than human experts, risks are low in the event of an error, the gain in wellbeing is significant, and the task being automated is not essentially or importantly human), it is both morally permissible and even desirable to kick the humans out of the loop. (shrink)

Based on hierarchical classification and logistic regression of early US and French COVID-19 clinical trials we show that despite the registration of a large number of trials, only a minority had characteristics usually associated with providing robust and relevant evidence.

In his book Why Not Socialism? , G.A. Cohen described several kinds of inequality that would be acceptable under socialism, yet nonetheless harmful to community. I describe another kind of inequality with this property, deriving from the legitimate transmission of preferences and values from parents to children. In the same book, Cohen proposes that the designing of a socialist allocation mechanism is a key problem for socialist theory. I maintain this is less of a problem than he believes. Finally, some (...) thoughts on the “law of motion of socialist ethos ” are offered. (shrink)

In his book Why Not Socialism?, G.A. Cohen described several kinds of inequality that would be acceptable under socialism, yet nonetheless harmful to community. I describe another kind of inequality with this property, deriving from the legitimate transmission of preferences and values from parents to children. In the same book, Cohen proposes that the designing of a socialist allocation mechanism is a key problem for socialist theory. I maintain this is less of a problem than he believes. Finally, some thoughts (...) on the “law of motion of socialist ethos” are offered. (shrink)

In this essay I enter into a recently published debate between Stephen Schiffer and Jerry Fodor concerning whether adequate sense can be made of the ceteris paribus conditions in special science laws, much of their focus being on the case of putative psychological laws. Schiffer argues that adequate sense cannot be made of ceteris paribus clauses, while Fodor attempts to overcome Schiffer's arguments, in defense of special science laws. More recently, Peter Mott has attempted to show that Fodor's response (...) to Schiffer fails, and furthermore that further study shows that the logical framework in which Schiffer and Fodor address their issue is susceptible to inconsistency.In this essay I argue that adequate sense can be made of ceteris paribus conditions. Against Mott, I argue that recent work in the model theory of non-monotonic logic indicates how his problem involving logical inconsistencies can be overcome. Against Schiffer, I argue that the claims that he makes against ceteris paribus clauses would lead to a fatal skepticism concerning indefinitely many of the claims we make about the world (and indeed that his claims would be destructive of the view of the special sciences that Schiffer himself presents in his paper), and that the semantical considerations from non-monotonic logic that I present provide a suitable framework for dealing with his complaints. Thus I come out on the whole on Fodor's side of this debate, although for my own reasons, as I argue against much of Fodor's own argumentation. (shrink)

In (1990), Jerry Fodor has defended a naturalized conception of meaning for Mentalese expressions which relies on the notion of asymmetric dependence. According to this conception, any naturalized theory of meaning must be able to account for the fact that meaning is robust, namely that any token of a certain Mentalese expression “x” retains the expression’s meaning, X, for any Y (≠ X) which happens to cause it. Now, this robustness of “x”‘s meaning can precisely be explained in terms (...) of the subsistence of an asymmetric dependence of any nomic connection between Ys and “x”‘s tokens on another nomic connection between Xs and “x”‘s tokens. According to Fodor, then, this relation between nomic connections can account in perfectly naturalistic terms for “x” meaning X, by providing a sufficient condition for such a meaning. In what follows, however, I will try to show, first, that the subsistence of asymmetric dependencies of the kind envisaged by Fodor is not enough for assigning meaning to a certain expression. Indeed, there are dependencies of this kind which are meaning-irrelevant. Secondly, I will claim that asymmetric dependence relations are not able even to support for the robustness of meaning. For there are cases in which according to the structure of these relations we would have to conclude that meaning is altered although robustness would require to have it unchanged. (shrink)

The Ethics and Regulation of Research with Human Subjects, edited by Professors Carl Coleman of Seton Hall, Jerry Menikoff of the University of Kansas, Jesse Goldner of Saint Louis University, and Nancy Dubler of the Albert Einstein College of Medicine, is an up-to-date and authoritative collection of readings on ethical, legal, and policy issues in research with human subjects. The authors have modeled their text on the casebook style commonly used in law schools. At 746 pages, plus front matter (...) and an appendix, this book contains just about everything one needs to know for a thorough grasp on human subjects research, including federal and state regulations governing this research, interpretive guidance from federal agencies, international guidelines and codes, court decisions, historical documents and case studies, and selected readings from scholarly articles and books. The book includes written comments and questions to help students understand and interpret the readings. (shrink)

Persons who commit crimes involving sexual abuse of children exploit their victims in several ways. Sex offenders use their power and authority over vulnerable children to whom they have easy access. Teachers, coaches, clergy, family members and childcare workers have been exposed as sex offenders. The Pennsylvania State University football coach, Jerry Sandusky, is now in prison for his many crimes. The widespread cover up of sexual abuse by Catholic priests in the USA and other countries is a horrendous (...) scandal. It is not surprising that law enforcement, mental health professionals, victims and their families are outraged. It is no surprise that radical interventions such as chemical or surgical castration are a response to the public pressure to protect children from molestation.I agree with Professor John McMillan's thoughtful discussion and nuanced analysis of surgical castration.1i He concludes that surgical castration of sex offenders is ethically permissible if these conditions are met: Castration should be requested by the sex offender. Informed consent from a competent sex offender is required. Consent to castration must not be coerced via threats or inducements.He also says that “castration might be useful for the reconfiguring of a life that has gone badly awry.”To supplement his discussion I will describe a state law in Texas2 that permits voluntary surgical castration for repeat child molesters while they are incarcerated as …. (shrink)

In his enormously influential The Modularity of Mind, Jerry Fodor (1983) proposed that the mind was divided into input modules and central processes. Much subsequent research focused on the modules and whether processes like speech perception or spatial vision are truly modular. Much less attention has been given to Fodor's writing on the central processes, what would today be called higher‐level cognition. In “Fodor's First Law of the Nonexistence of Cognitive Science,” he argued that central processes are “bad candidates (...) for scientific study” and would resist attempts at empirical analysis. This essay evaluates his argument for this remarkable claim, concluding that although central processes may well be “messier” than input modules, this does not mean that they cannot be studied and understood. The article briefly reviews the scientific progress made in understanding central processes in the 35 years since the book was published, showing that Fodor's prediction is clearly falsified by massive advances in topics like decision making and analogy. The essay concludes that Fodor's Law was not based on a clear argument for why the complexities of central systems could not be studied but was likely based on intuitions and preferences that were common in psychology at the time. (shrink)

In their book What Darwin Got Wrong, Jerry Fodor and Massimo Piattelli-Palmarini construct an a priori philosophical argument and an empirical biological argument. The biological argument aims to show that natural selection is much less important in the evolutionary process than many biologists maintain. The a priori argument begins with the claim that there cannot be selection for one but not the other of two traits that are perfectly correlated in a population; it concludes that there cannot be an (...) evolutionary theory of adaptation. This article focuses mainly on the a priori argument. (shrink)

I discuss Fodor's examination of what he calls 'Frege cases' and which he takes to be exceptions to psychologica laws.

Cognitive science has come down with a nasty cold, so Jerry Fodor has recently lamented, and the afflicting strain is something called concept pragmatism.1 Its chief symptom is the urge to identify the content of a concept with the inferences habitually drawn upon in its use (a ‘definition-in-use’), these serving also as its condition of possession, in knowing how to draw those inferences definitive of the concept.2 The affliction is quite fatal if Fodor is right, but the welfare of (...) the patient is of only indirect concern. What I want instead to ask here is whether the diagnosis has anything to do with the pragmatism that he says, breathlessly, has “bred monsters” down the last century—in particular, with the.. (shrink)

On October 5, 2015, Governor Jerry Brown approved bill ABX2 15, the End of Life Option Act, making California the fifth state in the country to allow physician-assisted dying. The law was modeled after Oregon's 1997 Death with Dignity Act. When the legislative special session ended on March 10, 2016, California health care providers had only ninety days to respond to the state mandate before the law would take effect, on June 9, 2016. Experience with the law so far (...) suggests several challenges with implementation. (shrink)

In international human rights law ‘jurisdiction’ is the centre of the debate on extraterritorial obligations. The purpose of the present paper is to a) analyse how facts and principles contribute t...