Patients should not always receive hard data about the risks and benefits of a medical intervention. That information should always be available to patients who expressly ask for it, but it should be part of standard disclosure only sometimes, and only for some patients. And even then, we need to think about how to offer it.

Some experts have argued that patients should routinely be told the specific magnitude and absolute probability of potential risks and benefits of screening tests. This position is motivated by the idea that framing risk information in ways that are less precise violates the ethical principle of respect for autonomy and its application in informed consent or shared decisionmaking. In this Perspective, we consider a number of problems with this view that have not been adequately addressed. The most important challenges stem (...) from the danger that patients will misunderstand the information or have irrational responses to it. Any initiative in this area should take such factors into account and should consider carefully how to apply the ethical principles of respect for autonomy and beneficence. (shrink)

In a series of recent papers, I have made three arguments about how to define “disease” and evaluate and apply possible definitions. First, I have argued that definitions should not be seen as traditional conceptual analyses, but instead as proposals about how to define and use the term “disease” in the future. Second, I have pointed out and attempted to address a challenge for dysfunction-requiring accounts of disease that I call the “line-drawing” problem: distinguishing between low-normal functioning and dysfunctioning. Finally, (...) I have used a dysfunction-requiring approach to argue that some extremely prevalent conditions, such as high blood pressure, high cholesterol, and ductal carcinoma in situ, are not diseases, but instead are risk factors. Four of the papers in this issue directly engage my previous work. In this commentary, I applaud the advances these authors make, address points of disagreement, and make suggestions about where the discussion should go next. (shrink)

In this paper, we move toward offering psychological benchmarks to measure success in building increasingly humanlike robots. By psychological benchmarks we mean categories of interaction that capture conceptually fundamental aspects of human life, specified abstractly enough to resist their identity as a mere psychological instrument, but capable of being translated into testable empirical propositions. Nine possible benchmarks are considered: autonomy, imitation, intrinsic moral value, moral accountability, privacy, reciprocity, conventionality, creativity, and authenticity of relation. Finally, we discuss how getting the right (...) group of benchmarks in human–robot interaction will, in future years, help inform on the foundational question of what constitutes essential features of being human. (shrink)

The recently revised Common Rule requires that donors of biospecimens for research be informed if their specimens might be used for commercial profit. The Common Rule, however, does not apply to sharing or selling de-identified biospecimens that are “leftover” from clinical uses. As a result, many medical researchers remain uncertain of their legal and ethical obligations when a commercial entity expresses interest in these specimens.

While several tests and strategies are recommended for colorectal cancer (CRC) screening, studies suggest that primary care providers often recommend colonoscopy without providing information about its risks or alternatives. These observations raise concerns about the quality of informed consent for screening colonoscopy.

Studies of patient decision‐making use many different measures to evaluate the quality of decisions and the decision‐making process, partly to determine whether the ethical goals of informed consent, patient autonomy, and shared decision‐making have been achieved. We describe these measures, grouped under three main approaches, and review their limitations, leading to three conclusions. First, no measure or combination of measures can provide a complete assessment of decision quality. Second, the quality of a decision is best characterized vaguely, for instance as (...) “good,” “satisfactory,” or “poor,” and these categorizations depend on qualitative judgments that go beyond quantitative measures. Third, bioethicists should focus on identifying and addressing poor or problematic decisions, rather than trying to incrementally increase decision quality, quantified by a measure. Decision‐quality measures can be useful in research and in advancing important goals of bioethics, as long as the challenges of defining and measuring decision quality are recognized. (shrink)

Blumenthal-Barby (2024) presents strong arguments that bioethicists should stop using the concept “personhood.” She points out that “person,” meaning an entity with full moral rights, is defined in...

This paperback edition reproduces the complete text of the Essay as prepared by professor Nidditch for The Clarendon Edition of the Works of John Locke. The Register of Formal Variants and the Glossary are omitted and Professor Nidditch has written a new foreword.

Part I of this article advanced a new theory of humor, the Enlightenment Theory, while contrasting it with other main theories, including the Incongruity, Repression/Relief/Release, and Superiority Theories. The Enlightenment Theory does not contradict these other theories but rather subsumes them. As argued, each of the other theories cannot account for all the aspects of humor explained by the Enlightenment Theory. Part II shows how the Enlightenment Theory meets challenging issues in humor theory where other theories falter, including failed humor, (...) motivation for humor, tickling, laughing gas, and sadistic humor. Also mentioned are the Enlightenment Theory's application to literary and musical humor and the relationship of wit to humor. -/- . (shrink)

Similarly to other accounts of disease, Christopher Boorse’s Biostatistical Theory (BST) is generally presented and considered as conceptual analysis, that is, as making claims about the meaning of currently used concepts. But conceptual analysis has been convincingly critiqued as relying on problematic assumptions about the existence, meaning, and use of concepts. Because of these problems, accounts of disease and health should be evaluated not as claims about current meaning, I argue, but instead as proposals about how to define and use (...) these terms in the future, a methodology suggested by Quine and Carnap. I begin this article by describing problems with conceptual analysis and advantages of “philosophical explication,” my favored approach. I then describe two attacks on the BST that also question the entire project of defining “disease.” Finally, I defend the BST as a philosophical explication by showing how it could define useful terms for medical science and ethics. (shrink)

We derive the first analytical formula for the density of "Dark Matter" (DM) at all length scales, thus also for the rotation curves of stars in galaxies, for the baryonic Tully–Fisher relation and for planetary systems, from Einstein's equations (EE) and classical approximations, in agreement with observations. DM is defined in Part I as the energy of the coherent gravitational field of the universe, represented by the additional equivalent ordinary matter (OM), needed at all length scales, to explain classically, with (...) inclusion of the OM, the _observed coherent_ gravitational field. Our derivation uses both EE and the Newtonian approximation of EE in Part I, to describe semi-classically in Part II the advection of DM, created at the level of the universe, into galaxies and clusters thereof. This advection happens proportional with their own classically generated gravitational field g, due to self-interaction of the gravitational field. It is based on the universal formula ρ D = λgg′ 2 for the density ρ D of DM advected into medium and lower scale structures of the observable universe, where λ is a universal constant fixed by the Tully–Fisher relations. Here g′ is the gravitational field of the universe; g′ is in main part its own source, as implied in Part I from EE. We start from a simple electromagnetic analogy that helps to make the paper generally accessible. This paper allows for the first time the exact calculation of DM in galactic halos and at all levels in the universe, based on EE and Newtonian approximations, in agreement with observations. (shrink)

This is the first of three volumes which will contain all of Locke's extant philosophical writings relating to An Essay Concerning Human Understanding, not included in other Clarendon editions like the Correspondence. It contains the earliest known drafts of the Essay, Drafts A and B, both written in 1671, and provides for the first time an accurate version of Locke's text. Virtually all his changes are recorded in footnotes on each page. Peter Nidditch, whose highly acclaimed edition of An (...) Essay Concerning Human Understanding was published in this series in 1975, used pioneering editorial techniques in his compilation of Volume 1. Most of the work was completed before his tragically early death in 1983. Volumes 2 and 3, almost wholly the work of G. A. J. Rogers will contain the third extant draft of the Essay, the Epitome and the Conduct of the Understanding. They will also include a History of the Writing of the Essay, together with other shorter writings by Locke. (shrink)

ABSTRACT One of the overarching problems of the world today is that too many people see themselves as dominating other groups of people, and dominating nature. That is a root problem. And thus part of a core solution builds from Kohlberg’s commitment to a universal moral orientation, though extended to include not only all people but the more-than-human world: animals, trees, plants, species, ecosystems, and the land itself. In this article, I make a case for this form of ethical extensionism, (...) and then present psychological evidence for it in both children and adults, including studies with inner-city Black youth and their parents. Then I build on Piaget’s, Kohlberg’s, and Turiel’s emphasis that interaction with the physical and social world is a critical mechanism for development. My corollary is this: that to reverse the incredibly fast human-caused destruction of nature—the wellsprings of human existence—we need to deepen and extend people’s interactions with nature, and with its relatively wild forms, even in urban environments. Toward this end, I discuss my current body of research and framework for urban design based on what are referred to as interaction patterns. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:
iscussion “WELL WIDE OF THE MARK”: RESPONSE TO STONE’S REVIEW OF THE ABC OF ARMAGEDDON P H. D History, Philosophy and Religious Studies / U. of Winnipeg Winnipeg, , Canada   .@. hether or not it is wise to defend one’s first book against the slings and Warrows of outrageous fortune, Bertrand Russell was never one to let indignities pass without response, and I will take my example (...) from him. Peter Stone’s review of my The ABC of Armageddon: Bertrand Russell on Science, Religion and the Next War, – is so irretrievably muddled that when he concludes “a thoroughly confused book ends on a thoroughly confused note”, this state of confusion most accurately represents the condition of the reviewer. The problem here is not an author and his book “adrift at Armageddon”, as the title of Stone’s review maintains, but a reviewer rowing furiously with one oar. Whatever inadequacies there are in The ABC of Armageddon, they are not those Stone so enthusiastically catalogues in his series of speculations as to what I might have done, but didn’t. In awaiting this review in Russell, I worried about how my various suggestions about Russell’s writing in the interwar period—even my definition of what the interwar period was—would be received. To list a few: the idea that the Great War constituted a dividing line in his work, and why; that his work in the interwar period should be judged as a whole; that his work in the interwar period was worth evaluating, not simply being dismissed as evidence of early philosophical dotage; the way Russell’s published ideas were entwined with those of his Anglo-American contemporaries; the theme of the “old savage in the new civilization” in Russell’s work, and in that of his contemporaries; the dimension of “rhetorical performance” and Russell’s deliberate stance as a  Russell, n.s.  (): – (at ). russell: the Journal of Bertrand Russell Studies n.s.  (summer ): – The Bertrand Russell Research Centre, McMaster U.  -  Discussion preacher; the differences between The Prospects of Industrial Civilization and The Scientific Outlook, on the one hand, and Religion and Science and Power: a New Social Analysis, on the other; the possible influence of Albert Schweitzer on the value of “an operational metaphysic” that allowed an older Russell to act as though ideas like “reverence for life” were true, even if they could not be proven. The list could continue. Stone overlooks all of these ideas, preferring instead to demonstrate my inability to hit targets at which he feels I should have aimed, characterizing my approach and my intentions in some unhelpful ways that are well wide of the mark. I was astounded to learn, for example, that I “assume the role of a political theorist towards Russell’s work”, and thus I “attempt to lay out an argument by Russell and critique it, so as to leave behind a stronger argument in its wake” (p. ). Because I am a political theorist, Stone concludes, “this book is simply a failure as a work of history” (p. ). Instead, being an historian he says, would have involved “situating Russell’s views in the personal and social context in which they emerged.” Writing as a “political theorist” himself (out of the Political Science department at Rochester University, where he is adjunct faculty), Stone’s defence of the historical approach is no doubt well intentioned. Had he followed his own prescription, however, he would have found this book to be substantially the same text as my dissertation (“The Old Savage and the Scientific Outlook: Science, Religion and Social Ethics in the Writings of Bertrand Russell, – ” [McMaster, ]). In the prefatory material appropriate to dissertations in Religious Studies (but not to books intended to sell) Stone would have found some of the acknowledgements and explanations whose absence he found the most irksome. Having dubbed me a political theorist, he excoriates me for an inadequate understanding of utilitarianism, instrumentalism, pragmatism and so on, utterly  In an editorial note discouraged by my editors at  Press but still permitted here, I cannot resist responding to Stone’s editorial notes disparaging the “highly inadequate” citations of Russell studies literature. I am well aware of Philip Ironside’s... (shrink)

I argue that ductal carcinoma in situ (DCIS), the tumor most commonly diagnosed by breast mammography, cannot be confidently classified as cancer, that is, as pathological. This is because there may not be dysfunction present in DCIS—as I argue based on its high prevalence and the small amount of risk it conveys—and thus DCIS may not count as a disease by dysfunction-requiring approaches, such as Boorse’s biostatistical theory and Wakefield’s harmful dysfunction account. Patients should decide about treatment for DCIS based (...) on the risks it poses and the risks and benefits of treatment, not on its disease status. (shrink)

Accounts of the concepts of function and dysfunction have not adequately explained what factors determine the line between low‐normal function and dysfunction. I call the challenge of doing so the line‐drawing problem. Previous approaches emphasize facts involving the action of natural selection (Wakefield 1992a, 1999a, 1999b) or the statistical distribution of levels of functioning in the current population (Boorse 1977, 1997). I point out limitations of these two approaches and present a solution to the line‐drawing problem that builds on the (...) second one. (shrink)

Consider the following patient: a 40-year-old man who has had back pain that radiates down his left leg, on and off for 2 months. He performs his normal activities and does not have any “red flag”...

A scholarly edition of Essay Concerning Human Understanding by P. H. Nidditch. The edition presents an authoritative text, together with an introduction, commentary notes, and scholarly apparatus.

Ethics should guide the design of electronic health records (EHR), and recognized principles of bioethics can play an important role. This approach was adopted recently by a team of informaticists designing and testing a system where patients exert granular control over who views their personal health information. While this method of building ethics in from the start of the design process has significant benefits, questions remain about how useful the application of bioethics principles can be in this process, especially when (...) principles conflict. For instance, while the ethical principle of respect for autonomy supports a robust system of granular control, the principles of beneficence and non-maleficence counsel restraint due to the danger of patients being harmed by restrictions on provider access to data. Conflict between principles has long been recognized by ethicists and has even motivated attacks on approaches that state and apply principles. In this paper we show how using ethical principles can help in the design of EHRs by first, explaining how ethical principles can and should be used generally, and then by, discuss how attention to details in specific cases can show that the tension between principles is not as bad as it initially appeared. We conclude by suggesting further ways in which the application of these (and other) principles can add value to the ongoing discussion of patient involvement in their health care. This is a new approach to linking principles to informatics design that we expect will stimulate further interest. (shrink)

This study examined preschool children’s reasoning about and behavioral interactions with one of the most advanced robotic pets currently on the retail market, Sony’s robotic dog AIBO. Eighty children, equally divided between two age groups, 34–50 months and 58–74 months, participated in individual sessions with two artifacts: AIBO and a stuffed dog. Evaluation and justification results showed similarities in children’s reasoning across artifacts. In contrast, children engaged more often in apprehensive behavior and attempts at reciprocity with AIBO, and more often (...) mistreated the stuffed dog and endowed it with animation. Discussion focuses on how robotic pets, as representative of an emerging technological genre, may be blurring foundational ontological categories, and impacting children’s social and moral development. (shrink)

Providing an overview of the intellectual roots of the worldwide environmental movement - from ancient religions and philosophies to modern science and ethics - this book synthesises them into a new philosophy of nature in which to ground ...

This paperback edition reproduces the complete text of the Essay as prepared by professor Nidditch for The Clarendon Edition of the Works of John Locke. The Register of Formal Variants and the Glossary are omitted and Professor Nidditch has written a new foreword.