Abstract:Vulnerability is an important criterion to assess the ethical justification of the inclusion of participants in research trials. Currently, vulnerability is often understood as an attribute inherent to a participant by nature of a diagnosed condition. Accordingly, a common ethical concern relates to the participant’s decisionmaking capacity and ability to provide free and informed consent. We propose an expanded view of vulnerability that moves beyond a focus on consent and the intrinsic attributes of participants. We offer specific suggestions for how (...) relational aspects and the dynamic features of vulnerability could be more fully captured in current discussions and research practices. (shrink)

In this article we report relevant data that shed light on the topic of hope and patients’ expectations in the use of DBS, for standard, approved, and established indications, based on a broader qualitative study on the ethical and social challenges that healthcare providers face in the field of DBS.

In lieu of an abstract, here is a brief excerpt of the content:EugenicsMary Carrington Coutts (bio) and Pat Milmoe McCarrick (bio)The word eugenics (from the Greek eugenes or well-born) was coined in 1883 by Francis Galton, an Englishman and cousin of Charles Darwin, who applied Darwinian science to develop theories about heredity and good or noble birth (I, Kevles 1985, p. x).The entry under "eugenics" in the Encyclopedia of Bioethics notes that the term has had different meanings in different eras: (...) "a science that investigates methods to ameliorate the genetic composition of the human race; a program to foster such betterment; a social movement; and in its perverted form, a pseudo-scientific retreat for bigots and racists" (V, Ludmerer 1978, p. 457). Kevles, who places a stronger emphasis than Ludmerer on the degeneration of eugenics, says that by 1935 it "had become 'hopelessly perverted' into a pseudoscientific facade for 'advocates of race and class prejudice, defenders of vested interests of church and state, Fascists, Hitlerites, and reactionaries generally'" (I, Kevles 1985, p. 164).Phrases such as "survival of the fittest" and "struggle for existence" came into use at the end of the nineteenth century when eugenics societies were created throughout the world to popularize genetic science. "Negative eugenics" utilized marriage restriction, sterilization, or custodial commitment of those thought to have unwanted characteristics. "Positive eugenics" tried to encourage the population perceived as "superior" to have more offspring (V, Ludmerer 1978, p. 459).In the United States, after World War I, new information, such as the importance of environmental influences and the more complex concept of multi-gene effects in inheritance, diminished the scientific justification for eugenics, but this knowledge did not decrease the pressure for legislation, judicial action, or immigration controls. The U.S. Immigration Restriction Act of 1924 favored immigration from northern Europe and greatly restricted the entry of persons from other areas referred to as "biologically inferior." Between 1907 and 1937, 32 [End Page 163] states required sterilization of various citizens viewed as undesirable: the mentally ill or handicapped; those convicted of sexual, drug, or alcohol crimes; and others viewed as "degenerate" (V, Larson 1991).In Germany, interest in eugenics flourished after the turn of the century when Dr. Alfred Ploetz founded the Archives of Race-Theory and Social Biology in 1904 and the German Society of Racial Hygiene in 1905. The German term Rassenhygiene or race hygiene encompassed more than the word "eugenics;" it included all attempts to improve hereditary qualities as well as measures directed at population increase (III, Weiss 1987). By the 1920s, various German textbooks incorporated ideas of heredity and racial hygiene, and German professors were participating in the international eugenics movement. The Kaiser Wilhelm Institute of Anthropology, Human Heredity, and Eugenics was founded in 1927; by 1933 a sterilization law, the Law for the Prevention of Congenitally Ill Progeny, which originally was entitled "Eugenics in the Service of Public Welfare," indicated compulsory sterilization "for the prevention of progeny with hereditary defects" in cases of "congenital mental defects, schizophrenia, manic-depressive psychosis, hereditary epilepsy... and severe alcoholism." (III, Müller-Hill 1988, p. 10).The co-mingling of science, politics, and Weltanschauung (ideological or religious world view) caused the darkest period for eugenics when Nazi Germans embarked on their "final solution" to the Jewish "problem", or the Holocaust. The Nazi racial-hygiene program began with involuntary sterilizations and ended with genocide. Beginning with the 1933 Law for the Prevention of Congenitally Ill Progeny, 350,000 schizophrenic and other mentally ill persons were involuntarily sterilized, and marriage or sexual contact between Jews and other Germans was banned. Several hundred black children and 30,000 German Gypsies were sterilized. By 1945, when the allies liberated those remaining in Nazi concentration camps, six million Jews, 750,000 Gypsies, and 70,000 German psychiatric patients had been killed by the Nazis (III, Müller-Hill 1992, p. 47). As a result of the German experience, eugenic thought dropped to its nadir, and to the present day, the term "eugenics" invokes a sense of horror in some people.Great Britain, the United States, and Germany were the countries most involved with eugenic science in the first half of this century, but interest was present in Europe and other... (shrink)

In recent years, scholars have begun to give greater attention to the 14th-century political writer, Ptolemy of Lucca, mostly on account of his avid defense of republican government in the treatise, De regimine principum. Educated in the scholastic curriculum at the University of Paris, Ptolemy has typically been identified by scholars as one of the most thoroughly Aristotelian medieval thinkers. Ptolemy, like many of his contemporaries, peppered his writing with citations from Aristotle's major works. This article, however, examines the sources (...) employed in Ptolemy's republican arguments, finding that the legacy of Republican Rome played a far more critical role in shaping his republicanism than could be attributed to Aristotle's moral or political works. Though conversing fluently in an Aristotelian language system, Ptolemy's arguments in De regimine principum are derived, at their core, from his reading of Roman Republican sources, not from Aristotelian influence. This discovery reveals Ptolemy to be an even more artful and original writer than was previously assumed, and should add to, rather than detract from, his place as a key figure in the development of western political thought. (shrink)

Recent research has emphasized the continuities in European republican political thought from the late Middle Ages until well into the Renaissance and even beyond. Two of the central figures in the story of the persistence of republicanism are Ptolemy of Lucca, who is commonly viewed as the quintessential late medieval republican, and Niccolò Machiavelli, whose work is generally regarded as the classic statement of early modern republicanism. We argue that these two remain conceptually at considerable remove from one another, a (...) claim we illustrate by analyzing the impact of the reception, Latin translation and transmission of the Histories of Polybius, and especially the theory of constitutional change proposed in Book 6. The unavailability of the Histories to Ptolemy and its rather ample use by Machiavelli at the beginning of the Discourses signal an important divergence in the theoretical principles underlying the defense of republican institutions. In turn, this variation captures one facet of the distinct qualities of republican thought that separated the intellectual terrain of the early fourteenth century from that of the sixteenth century. (shrink)

During goals of care conversations, palliative care clinicians help patients and families determine priorities of care and align medical care with those priorities. The style and methods of communicating with families and negotiating a care plan can range from paternalistic to entirely patient driven. In this paper, we describe a case in which the palliative care clinician approached decision-making using a paradigm that is intuitive to many clinicians and which seems conceptually sound, but which has not been fully explored in (...) the bioethics literature. This paradigm, termed maternalism, allows the clinician to direct decision-making within a relationship such that best interests and autonomy are mutually reinforced, thus reflecting relational autonomy as opposed to individual autonomy. We explore whether this method is appropriate in this case and explain how it captures significant ethical features of the case that might be missed by other approaches. (shrink)

We propose Rhythmic Relating for autism: a system of supports for friends, therapists, parents, and educators; a system which aims to augment bidirectional communication and complement existing therapeutic approaches. We begin by summarizing the developmental significance of social timing and the social-motor-synchrony challenges observed in early autism. Meta-analyses conclude the early primacy of such challenges, yet cite the lack of focused therapies. We identify core relational parameters in support of social-motor-synchrony and systematize these using the communicative musicality constructs: pulse; quality; (...) and narrative. Rhythmic Relating aims to augment the clarity, contiguity, and pulse-beat of spontaneous behavior by recruiting rhythmic supports and relatable vitality; facilitating the predictive flow and just-ahead-in-time planning needed for good-enough social timing. From here, we describe possibilities for playful therapeutic interaction, small-step co-regulation, and layered sensorimotor integration. Lastly, we include several clinical case examples demonstrating the use of Rhythmic Relating within four different therapeutic approaches. These clinical case examples are introduced here and several more are included in the Supplementary Material. A suite of pilot intervention studies is proposed to assess the efficacy of combining Rhythmic Relating with different therapeutic approaches in playful work with individuals with autism. Further experimental hypotheses are outlined, designed to clarify the significance of certain key features of the Rhythmic Relating approach. (shrink)

Throughout his career, Wittgenstein was preoccupied with issues in the philosophy of perception. Despite this, little attention has been paid to this aspect of Wittgenstein's work. This volume redresses this lack, by bringing together an international group of leading philosophers to focus on the impact of Wittgenstein's work on the philosophy of perception. The ten specially commissioned chapters draw on the complete range of Wittgenstein's writings, from his earliest to latest extant works, and combine both exegetical approaches with engagements with (...) contemporary philosophy of mind. Topics covered include: perception and judgement in the _Tractatus _ aspect-perception the putative intentionality of perception representationalism. The book also includes an overview which summarises the evolution of Wittgenstein's views on perception throughout his life. With an outstanding array of contributors, _Wittgenstein and Perception_ is essential reading for students and scholars of Wittgenstein’s work, as well as those working in philosophy of mind and philosophy of perception. Contributors: Yasuhiro Arahata, Michael Campbell, William Child, Daniel Hutto, Michael O’Sullivan, Marie McGinn, Michel terHark, Charles Travis, and José Zalabardo. (shrink)

Mary Astell's A Serious Proposal to the Ladies is one of the most important and neglected works advocating the establishment of women's academies. Its reception was so controversial that Astell responded with a lengthy sequel, also in this volume. The cause of great notoriety, Astell's Proposal was imitated by Defoe in his "An Academy for Women," parodied in the Tatler, satirized on the stage, plagiarized by Bishop Berkeley, and later mocked by Gilbert and Sullivan in Princess Ida.

The Metaphysics of Morals is Kant's major work in applied moral philosophy in which he deals with the basic principles of rights and of virtues. It comprises two parts: the 'Doctrine of Right', which deals with the rights which people have or can acquire, and the 'Doctrine of Virtue', which deals with the virtues they ought to acquire. Mary Gregor's translation, revised for publication in the Cambridge Texts in the History of Philosophy series, is the only complete translation of (...) the whole text, and includes extensive annotation on Kant's difficult and sometimes unfamiliar vocabulary. A new introduction by Roger Sullivan sets the work in its historical and philosophical context. This volume will be of wide interest to students of ethics and of legal and political philosophy. (shrink)

The Metaphysics of Morals is Kant's major work in applied moral philosophy in which he deals with the basic principles of rights and of virtues. It comprises two parts: the 'Doctrine of Right', which deals with the rights which people have or can acquire, and the 'Doctrine of Virtue', which deals with the virtues they ought to acquire. Mary Gregor's translation, revised for publication in the Cambridge Texts in the History of Philosophy series, is the only complete translation of (...) the whole text, and includes extensive annotation on Kant's difficult and sometimes unfamiliar vocabulary. A new introduction by Roger Sullivan sets the work in its historical and philosophical context. This volume will be of wide interest to students of ethics and of legal and political philosophy. (shrink)

Ever since its nascent days, psychoanalysis has enjoyed an uneasy coexistence with religion. However, in recent decades, many analysts have been more interested in the healing potential of both psychoanalytic and religious experience and have explored how their respective narrative underpinnings may be remarkably similar. In _Toward Mutual Recognition_, Marie T. Hoffman takes just such an approach. Coming from a Christian perspective, she suggests that the current relational turn in psychoanalysis has been influenced by numerous theorists - analysts and philosophers (...) alike - who were themselves shaped by an embedded Christian narrative. As a result, the redemptive concepts of incarnation, crucifixion, and resurrection - central to the tenets of Christianity - can be traced to relational theories, emerging analogously in the transformative process of mutual recognition in the concepts of identification, surrender, and gratitude, a trilogy which she develops as forming the "path of recognition." Each movement on this path of recognition is given thought-provoking, in-depth attention. Chapters dedicated to theoretical perspectives utilize the thinking of Benjamin, Hegel, and Ricoeur. In her historical perspectives, she explores the personal and professional histories of analysts such as Sullivan, Fairbairn, Winnicott, Erikson, Kohut, and Ferenczi, among others, who were influenced by the Christian narrative. Uniting it all together is the clinical perspective offered in the compelling extended case history of Mandy, a young lady whose treatment embodies and exemplifies each of the steps along the path of growth in both the psychoanalytic and Christian senses. Throughout, a relational sensibility is deployed as a cooperative counterpart to the Christian narrative, working both as a consilient dialogue and a vehicle for further integrative exploration. As a result, the specter of psychoanalysis and religion as mutually exclusive gives way to the hope and redemption offered by their mutual recognition. (shrink)

Building Better Health Care Leadership for Canada explains the development and implementation of the Executive Training in Research Application program. Managed and funded by the Canadian Health Services Research Foundation in partnership with the Canadian Medical Association, the Canadian Nursing Association, and the Canadian College of Health Care executives, EXTRA is a two-year national fellowship program that uses the principles of adult learning theory as well as practical projects to educate senior health care leaders in making more consistent use of (...) research evidence in their management roles. Fellows apply the theory learned in residency sessions and educational activities to projects within their home organizations. The authors identify the imperative for better use of evidence, outline the core elements of the curriculum, and capture the real-world experience of regional leaders and fellows involved in making specific changes informed by research-based evidence within their organization. Contributors include Jean-Louis Denis, Terrence Sullivan, Owen Adams, Malcolm Anderson, Lynda Atack, Robert Bell, Sam G Campbell, Sylvie Cantin, Ward Flemons, Dorothy Forbes, J. Sonja Glass, Paula Goering, Karen Golden-Biddle, Jeffrey S. Hoch, Paul Lamarche, Ann Langley, John N. Lavis, Jonathan Lomas, Margo Orchard, Raynald Pineault, Brian D. Postl, Christine Power, Trish Reay, Jean Rochon, Denis A. Roy, Andrea Seymour, Samuel B. Sheps, Micheline Ste-Marie, Nina Stipich, David Streiner, Carl Taillon, and Muriah Umoquit. (shrink)

Sullivan's book is, as its title indicates, an attempt to present Kant's moral philosophy as a whole. In each of his writings in practical philosophy Kant concentrated on a specific problem stated clearly in his introductory remarks. A great deal of confusion has resulted from the still common practice of treating one of them, the Groundwork of the Metaphysics of Morals, as if it were the whole. Of the two complementary methods of remedying the situation, detailed textual analysis of (...) Kant's individual works in moral philosophy and a straightforward overview of the subject, Sullivan has chosen the latter. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Religious Perspectives on Bioethics, Part 2Laura Jane Bishop (bio) and Mary Carrington Coutts (bio)This is Part Two of a two part Scope Note on Religious Perspectives on Bioethics. Part One was published in the June 1994 issue of this Journal. This Scope Note has been arranged in alphabetical order by the name of the religious tradition.Contents for Parts 1 and 2Part 1I.GeneralVI.HinduismII.African Religious TraditionsVII.IslamIII.Bahá'í FaithVIII.JainismIV.Buddhism and ConfucianismIX.JudaismV.Eastern OrthodoxyPart (...) 2I.Native American ReligiousChristian Scientist TraditionsEpiscopal/AnglicanII.ProtestantismEvangelicalGeneralJehovah's WitnessAnabaptist (Church of theLutheranBrethren, Friends SocietyMethodist/Wesleyan(Quaker), and Mennonite/NazareneAmish/Hutterite)Presbyterian/ReformedAssemblies of GodSeventh-day AdventistBaptistUnitarian UniversalistChurch of Jesus Christ of theUnited Church of Christ Latter-day SaintsIII.Roman CatholicismChristian Church (Disciples of Christ)[End Page 357]IntroductionThe many religions of the world bring diverse, and occasionally divergent attitudes to bioethical issues. These beliefs may guide patients and health care professionals as they seek or provide health care. In an attempt to facilitate understanding of and access to information about these beliefs in our pluralistic and global society, this Scope Note identifies literature by the world's major religious groups on topics relating to bioethics.Topics covered by this Scope Note include general attitudes to health and health care, the physician-patient relationship, treatment refusal, abortion, contraception, sterilization, reproductive technologies, genetics, mental health, human experimentation, organ transplantation and donation, death, euthanasia, suicide, and prolongation of life. Material was not available on all of these topics for each religion.The literature gathered here represents only a small portion of the available writing on religion and medicine for these faith traditions in the United States, and is limited to that which comments explicitly on bioethical issues. Some faiths have a rich tradition of writing on bioethics, for others the literature is more limited. Variation in coverage is not intended to indicate the relative importance of a faith but reflects accessibility and space constraints. Individuals interested in obtaining additional information are encouraged to contact the National Reference Center for Bioethics Literature.It is important to remember that doctrinal and theological differences exist even within the same denomination and that views of individual patients, family members, and health care providers should be sought.Native North American ShamanismAvery, Charlene. Native American Medicine: Traditional Healing. Journal of the American Medical Association 265 (17): 2271, 2273, 1 May 1991. A brief description of the general principles of Southwestern Native American religions is provided. Most tribes believe that health and religious well-being are interconnected.Day, Thomas W. Cross-Cultural Medicine at Home. Minnesota Medicine 75 (3): 15-17, March 1992. The Ojibwe tribe's view of health incorporates spiritual health and emphasizes a holistic approach to health care that encompasses a harmonious balance between the individual, community, and nature, as well as between body, mind, and spirit.Hirschfelder, Arlene B., and Molin, Paulette. The Encyclopedia of Native American Religions. New York: Facts on File, 1992. 367 p. A survey of Native American religions is provided, including tribal histories, descriptions of religious ceremonies, and biographical sketches.Hultkrantz, Åke. Health, Religion, and Medicine in Native North American Traditions. In Healing [End Page 358] and Restoring: Health and Medicine in the World's Religious Traditions, ed. Lawrence Sullivan, pp. 327-58. New York: Macmillan, 1989. Hultkrantz summarizes the Native American attitude toward medicine and health care, explaining that belief in the supernatural and its powers is one of the most important tenets of life. Ailing persons are aided by those who have been trained to act as mediators between the sick individual and the supernatural powers. Attitudes toward health and disease, and the role of the medicine man are demonstrated through the use of examples taken from many tribes.Hultkrantz, Åke. Shamanic Healing and Ritual Drama: Health and Medicine in Native North American Religious Traditions. New York: Crossroad, 1992. 197 p. Hultkrantz surveys the varied traditions of Native North Americans and their outlook on medical care, health, and religion, and emphasizes that Native American medical beliefs... (shrink)

These new studies of Wittgenstein's Tractatus represent a significant step beyond recent polemical debate.

In this paper I consider the project of offering an evolutionary debunking explanation for transparency in doxastic deliberation. I examine Nicole Dular and Nikki Fortier’s (2021) attempt at such a project. I suggest that their account faces a dilemma. On the one horn, their explanation of transparency involves casting our mechanisms for belief formation as solely concerned with truth. I argue that this is explanatorily inadequate when we take a wider view of our belief formation practices. I show that Dular (...) and Fortier overstate the extent to which adaptive non-evidentially supported beliefs are rare, and the implausibility of disjunctive evolutionary systems. They should allow a role for the non-truth directed behaviour of our mechanisms of belief formation. On the other hand, we might restrict the explanation offered by Dular and Fortier to the deliberative context, that is, we might understand them as allowing for non-evidential belief formation outside of the deliberative context, but as identifying the key to explaining transparency in the truth-directed evolutionary mechanisms as they operate in the deliberative context. However, this would land them on the second horn of the dilemma: we would then have no different an explanation to one I have offered elsewhere (2018), an explanation which Dular and Fortier explicitly put aside as engaged in a project different from their own. I finish by briefly considering some broader implications relating to explaining transparency, the nature of belief, and the prospects for pragmatism. I conclude that Dular and Fortier’s debunking explanation of transparency bestows an implausible role for truth in fixing our beliefs, or, if it doesn’t, then we simply have the restatement of a view explicitly disavowed by the authors. We are left, then, with an explanation we ought not want, or an explanation we already had. (shrink)

We argue that the trend toward providing users with feasible and actionable explanations of AI decisions—known as recourse explanations—comes with ethical downsides. Specifically, we argue that recourse explanations face several conceptual pitfalls and can lead to problematic explanation hacking, which undermines their ethical status. As an alternative, we advocate that explanations of AI decisions should aim at understanding.

Descriptive accounts of the nature of explanation in neuroscience and the global goals of such explanation have recently proliferated in the philosophy of neuroscience and with them new understandings of the experimental practices of neuroscientists have emerged. In this paper, I consider two models of such practices; one that takes them to be reductive; another that takes them to be integrative. I investigate those areas of the neuroscience of learning and memory from which the examples used to substantiate these models (...) are culled, and argue that the multiplicity of experimental protocols used in these research areas presents specific challenges for both models. In my view, these challenges have been overlooked largely because philosophers have hitherto failed to pay sufficient attention to fundamental features of experimental practice. I demonstrate that when we do pay attention to such features, evidence for reduction and integrative unity in neuroscience is simply not borne out. I end by suggesting some new directions for the philosophy of neuroscience that pertain to taking a closer look at the nature of neuroscientific experiments. (shrink)