Some forty years ago, Norman Malcolm and Charles Hartshorne, philosophers from two distinctive schools of thought, championed, independently of each other, a form of ontological argument based on chapter III of Anselm’s Proslogion as well as on various chapters of Reply to Gaunilo.1 While different aspects of the argument are emphasized by Malcolm and Hartshorne, this second form of the ontological argument hinges on the following two points: (1) necessary existence is constitutive of the concept of God,2 and (2) therefore, (...) in understanding the concept of God, one understands that God necessarily exists in fact or in actuality. Whereas Malcolm vacillates between affirming only (1) and both (1) and (2),3 Hartshorne affirms both (1) and (2); however, he holds that Anselm’s formulation of the actual existence of God is somewhat confused. My argument here is that while (1) has some sense, (2) is a confusion arising from confounding the logical or conceptual existence of God with the actual existence of God.4. (shrink)

Starting with the puzzlement M O.C. Drury and Rush Rhees felt about Wittgenstein's admonition that believers ought not to pick and choose among the passages of the bible, this paper seeks to clarify the sense of scriptural authority in the Judeo-Christian traditions. This paper argues that (1) picking and choosing, imposing certain criteria external to the Scripture, is grammatically constitutive of accepting the authority of Scripture and (2) such a picking and choosing is guided by a tradition and its grammar. (...) It notes that Wittgenstein's stance on Scripture is itself based on (1) and (2). (shrink)

BackgroundBiobanks are considered to be key infrastructures for research development and have generated a lot of debate about their ethical, legal and social implications. While the focus has been on human genomic research, rapid advances in human microbiome research further complicate the debate.DiscussionWe draw on two cystic fibrosis biobanks in Toronto, Canada, to illustrate our points. The biobanks have been established to facilitate sample and data sharing for research into the link between disease progression and microbial dynamics in the lungs (...) of pediatric and adult patients. We begin by providing an overview of some of the ELSI associated with human microbiome research, particularly on the implications for the broader society. We then discuss ethical considerations regarding the identifiability of samples biobanked for human microbiome research, and examine the issue of return of results and incidental findings. We argue that, for the purposes of research ethics oversight, human microbiome research samples should be treated with the same privacy considerations as human tissues samples. We also suggest that returning individual microbiome-related findings could provide a powerful clinical tool for care management, but highlight the need for a more grounded understanding of contextual factors that may be unique to human microbiome research.ConclusionsWe revisit the ELSI of biobanking and consider the impact that human microbiome research might have. Our discussion focuses on identifiability of human microbiome research samples, and return of research results and incidental findings for clinical management. (shrink)

Donors to biobanks are typically asked to give blanket consent, allowing their donation to be used in any research authorized by the biobank. This type of consent ignores the evidence that some donors have moral, religious, or cultural concerns about the future uses of their donations – concerns we call “non-welfare interests”. The nature of non-welfare interests and their effect on willingness to donate to a biobank is not well understood. In order to better undersand the influence of non-welfare interests, (...) we surveyed a national sample of the US population using a probability-based internet panel. Logistic regression models assessed the demographic and attitudinal characteristics associated with participants’ willingness to give consent for unspecified future uses of their donation when presented with 7 research scenarios that raised possible non-welfare interest concerns. Most people had non-welfare interests that significantly affect their willingness to donate to a biobank using blanket consent. Some non-welfare interests are associated with subgroups but others are not. A positive attitude toward biomedical research in general was associated with increased willingness to donate, while concerns about privacy and being African American were associated with decreased willingness. Non-welfare interests matter and can diminish willingness to donate to a biobank. Our data suggest that trust in research promotes willingness to donate. Ignoring non-welfare interests could erode this trust. Donors’ non-welfare interests could be accommodated through greater transparency and easier access to information about the uses of donations. (shrink)

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

Subjects enrolled in studies testing high risk interventions for incurable or progressive brain diseases may be vulnerable to deficiencies in informed consent, such as the therapeutic misconception. However, the definition and measurement of the therapeutic misconception is a subject of continuing debate. Our qualitative pilot study of persons enrolled in a phase I trial of gene transfer for Parkinson disease suggests potential avenues for both measuring and preventing the therapeutic misconception. Building on earlier literature on the topic, we developed and (...) tested an interview guide that focuses on how the subjects decided to participate, emphasizing the integration of subjects’ various statements that are relevant to assessing the therapeutic misconception, rather than evaluating them as isolated statements. The results indicate that a subject’s understanding of the purpose of research is best explored in juxtaposition to the subject’s motivation for participating. (shrink)

The Patient Preference Predictor (PPP) proposal places a high priority on the accuracy of predicting patients’ preferences and finds the performance of surrogates inadequate. However, the quest to develop a highly accurate, individualized statistical model has significant obstacles. First, it will be impossible to validate the PPP beyond the limit imposed by 60%–80% reliability of people’s preferences for future medical decisions—a figure no better than the known average accuracy of surrogates. Second, evidence supports the view that a sizable minority of (...) persons may not even have preferences to predict. Third, many, perhaps most, people express their autonomy just as much by entrusting their loved ones to exercise their judgment than by desiring to specifically control future decisions. Surrogate decision making faces none of these issues and, in fact, it may be more efficient, accurate, and authoritative than is commonly assumed. (shrink)

Background: Financial conflict of interest in clinical research is an area of active debate. While data exist on the perspectives and roles of academic institutions, investigators, industry sponsors, and scientific journals, little is known about the perspectives of potential research participants.Methods: The authors surveyed potential research participants over the internet, using the Harris Interactive Chronic Illness Database. A potential research participant was defined by: self report of diagnosis by a health care professional and willingness to participate in clinical trials. Email (...) invitations were sent to 20 205 persons with coronary artery disease, breast cancer, or depression; a total of 6363 persons were screened; of these, 86% or 5478 met inclusion criteria and completed the survey. The outcome measures were respondents’ ratings on: importance of knowing conflict of interest information, whether its disclosure ought to be required, and its effect on willingness to participate—across seven widely discussed scenarios of financial conflicts of interest .Results: Majority responded that knowing conflict of interest information was “extremely” or “very” important; a larger majority felt financial conflicts of interest should be disclosed as part of informed consent . In all seven scenarios, a majority was still willing to participate but in some scenarios a sizable minority would be wary of participation. Respondents were more wary of individual than institutional conflicts of interest. Illness group and sociodemographic factors had modest effects and did not affect the main trends.Conclusions: The prevailing practice of non-disclosure of financial conflicts of interest in clinical research appears contrary to the values of potential research participants. (shrink)

Bioethicists have long been concerned that seriously ill patients entering early phase (‘phase I’) treatment trials are motivated by therapeutic benefit even though the likelihood of benefit is low. In spite of these concerns, consent forms for phase I studies involving seriously ill patients generally employ indeterminate benefit statements rather than unambiguous statements of unlikely benefit. This seeming mismatch between attitudes and actions suggests a need to better understand research ethics committee members’ attitudes toward communication of potential benefits and risks (...) of early phase studies to potential subjects. We surveyed the members of two U.S. research ethics committees using a phase I gene transfer study scenario, and compared the results to a previous survey of potential subjects’ perceptions and attitudes toward benefit and risk for the same protocol. The results show that there is indeed a gap between the subjects’ perceptions and the committee members’ views on what is appropriate to be communicated to research subjects. This discrepancy is the product of both the commonly assumed optimism of the subjects and to a “protective pessimism” of the research ethics committee members. We discuss this discrepancy using “frameworks of trust” and demonstrate the need to incorporate these frameworks into the existing model of informed consent. (shrink)

The language $L_A(\Finv)$ is formed by adding the quantifier $\Finv x$ , "few x", to the infinitary logic L A on an admissible set A. A complete axiomatization is obtained for models whose universe is the set of ordinals of A and where $\Finv x$ is interpreted as there exist A-finitely many x. For well-behaved A, every consistent sentence has a model with an A-recursive diagram. A principal tool is forcing for $L_A(\Finv)$.

The language $L_A$ is formed by adding the quantifier $\Finv x$ , "few x", to the infinitary logic L A on an admissible set A. A complete axiomatization is obtained for models whose universe is the set of ordinals of A and where $\Finv x$ is interpreted as there exist A-finitely many x. For well-behaved A, every consistent sentence has a model with an A-recursive diagram. A principal tool is forcing for $L_A$.

The spatial dynamics of the optical emission from an array of 50 times 50 individual microcavity plasma devices is investigated. The array is operated in argon and argon-neon mixtures close to atmospheric pressure with an ac voltage. The optical emission is analysed with phase and space resolution. It has been found that the emission is not continuous over the entire ac period, but occurs once per half period. Each of the observed emission phases shows a self-pulsing of the discharge, with (...) several bursts of emission of fixed width and repetition rate. The number of emission bursts depends on applied voltage and frequency. Spatially resolved measurements prove that the emission bursts are formed by overlapping emission pulses from single discharge cavities. Intensity differences between positive and negative half-wave can be interpreted through spatially resolved measurements of single discharge cavities. (shrink)

Selected response items and constructed response items are often found in the same test. Conventional psychometric models for these two types of items typically focus on using the scores for correctness of the responses. Recent research suggests, however, that more information may be available from the CR items than just scores for correctness. In this study, we describe an approach in which a statistical topic model along with a diagnostic classification model was applied to a mixed item format formative test (...) of English and Language Arts. The DCM was used to estimate students’ mastery status of reading skills. These mastery statuses were then included in a topic model as covariates to predict students’ use of each of the latent topics in their written answers to a CR item. This approach enabled investigation of the effects of mastery status of reading skills on writing patterns. Results indicated that one of the skills, Integration of Knowledge and Ideas, helped detect and explain students’ writing patterns with respect to students’ use of individual topics. (shrink)

It is often alleged that liberalism and nationalism are mutually antagonistic in theory and practice. Max Weber is a good example, the dominant interpretation maintains, as his political thought betrays its liberal foundation by embracing an ardent nationalism that was popular in Wilhelmine Germany. Weber was, in short, a nationalist, and thus illiberal, political thinker. Against this conventional wisdom I argue that Weber's liberal nationalism cannot be placed squarely in the authoritarian, ethnic tradition of German nationalism, and its idiosyncrasy becomes (...) evident once Weber's twofold political project of revivifying a robust civil society while imbuing it with the spirit of public citizenship is foregrounded more clearly. Thus recast, Weber's political thought reveals a strong affinity with that of Tocqueville and Mill, especially in their similar concern with moral personality and political maturity in a mass democracy. (shrink)

We suggest that the linguistic characteristics of letters also need to be considered to fully understand how a reader processes printed words. For example, studies in Korean showed that unambiguity in the assignment of letters to their appropriate onset, vowel, or coda slot is one of the main sources of the letter-transposition effect. Indeed, the cognitive system that processes Korean is tuned to the structure of the Korean writing system.

It is shown that the Lorentz-deformation property discussed in previous papers is consistent with the hadronic jet phenomenon in high-energy production processes.

While stigmatisation is universal, stigma research in low- and middle-income countries (LMIC) is limited. LMIC stigma research predominantly concerns health-related stigma, primarily regarding HIV/AIDS or mental illness from an adult perspective. While there are commonalities in stigmatisation, there are also contextual differences. The aim of this study in DR Congo (DRC), as a formative part in the development of a common stigma reduction intervention, was to gain insight into the commonalities and differences of stigma drivers (triggers of stigmatisation), facilitators (factors (...) positively or negatively influencing stigmatisation), and manifestations (practices and experiences of stigmatisation) with regard to three populations: unmarried mothers, children formerly associated with armed forces and groups (CAAFAG), and an indigenous population. Group exercises, in which participants reacted to statements and substantiated their reactions, were held with the ‘general population’ (15 exercises, n = 70) and ‘populations experiencing stigma’ (10 exercises, n = 48). Data was transcribed and translated, and coded in Nvivo12. We conducted framework analysis. There were two drivers mentioned across the three populations: perceived danger was the most prominent driver, followed by perceived low value of the population experiencing stigma. There were five shared facilitators, with livelihood and personal benefit the most comparable across the populations. Connection to family or leaders received mixed reactions. If unmarried mothers and CAAFAG were perceived to have taken advice from the general population and changed their stereotyped behaviour this also featured as a facilitator. Stigma manifested itself for the three populations at family, community, leaders and services level, with participation restrictions, differential treatment, anticipated stigma and feelings of scapegoating. Stereotyping was common, with different stereotypes regarding the three populations. Although stigmatisation was persistent, positive interactions between the general population and populations experiencing stigma were shared as well. This study demonstrated utility of a health-related stigma and discrimination framework and a participatory exercise for understanding non-health related stigmatisation. Results are consistent with other studies regarding these populations in other contexts. This study identified commonalities between drivers, facilitators and manifestations—albeit with population-specific factors. Contextual information seems helpful in proposing strategy components for stigma reduction. (shrink)

Imagination comes with varying degrees of sensory accompaniment. Sometimes imagining is phenomenologically lean (cognitive imagining); at other times, imagining involves or requires sensory presentation such as mental imagery (sensory imagining). Philosophers debate whether contradictions can obtain in fiction and whether cognitive imagining is robust enough to explain our engagement with fiction. In this paper, I defend the Principle of Poetic License by arguing for the Permissive View of fictional truth: we can have fictions in which a contradiction is true, everything (...) is true, or nothing is true. I show that imagination-based worries about impossible, unlimited, and empty fictions can be shown to be about sensory imagination and that sensory imagination isn’t necessary for fictional truth. (shrink)

In this article, I aim to do two things: first, introduce Juche, the official philosophy of the Democratic People’s Republic of Korea (“North Korea”), and second, defend Juche against Alzo David-West’s allegation that it is a nonsensical philosophy. I organize David-West’s complaints into two major strands—that Juche’s axiom is too vague to be of philosophical use and that Juche makes too stark a distinction between human vs. everything else—and offer responses to both strands. My goal isn’t to defend the regime, (...) but to present its ideology in the most charitable way so its merits and demerits can be seen more clearly in future engagements. (shrink)

Florijn’s helpful discussion of the Heringa case illustrates the difficulties in drawing a boundary on eligibility conditions for EAS. In Heringa, the Dutch Supreme Court reaffirmed...

Should the assessment of decision‐making capacity (DMC) be risk sensitive, that is, should the threshold for DMC vary with risk? The debate over this question is now nearly five decades old. To many, the idea that DMC assessments should be risk sensitive is intuitive and commonsense. To others, the idea is paternalistic or incoherent, or both; they argue that the riskiness of a given decision should increase the epistemic scrutiny in the evaluation of DMC, not increase the threshold for DMC. (...) We respond to the critics’ main concerns by providing a comprehensive account of how risk‐sensitive DMC is coherent, avoids paternalism, and best fulfills the epistemic goal of DMC evaluations. (shrink)