When it comes to using patient data from the National Health Service for research, we are often told that it is a matter of trust: we need to trust, we need to build trust, we need to restore trust. Various policy papers and reports articulate and develop these ideas and make very important contributions to public dialogue on the trustworthiness of our research institutions. But these documents and policies are apparently constructed with little sustained reflection on the nature of trust (...) and trustworthiness, and therefore are missing important features that matter for how we manage concerns related to trust. We suggest that what we mean by ‘trust’ and ‘trustworthiness’ matters and should affect the policies and guidance that govern data sharing in the NHS. We offer a number of initial, general reflections on the way in which some of these features might affect our approach to principles, policies and strategies that are related to sharing patient data for research. This paper is the outcome of a ‘public ethics’ coproduction activity which involved members of the public and two academic ethicists. Our task was to consider collectively the accounts of trust developed by philosophers as they applied in the context of the NHS and to coproduce an argumentative position relevant to this context. (shrink)

Frege says, at the end of a discussion of formalism in the Foundations of Arithmetic, that his own foundational program “could be called formal” but is “completely different” from the view he has just criticized. This essay examines Frege’s relationship to Hermann Hankel, his main formalist interlocutor in the Foundations, in order to make sense of these claims. The investigation reveals a surprising result: Frege’s foundational program actually has quite a lot in common with Hankel’s. This undercuts Frege’s claim that (...) his own view is completely different from Hankel’s formalism, and motivates a closer examination of where the differences lie. On the interpretation offered here, Frege shares important parts of the formalist perspective, but differs in recognizing a kind of content for arithmetical terms which can only be made available via proof from prior postulates. (shrink)

Deep brain stimulation is an experimental procedure for treatment-resistant depression. Some results show promise, but blinded trials had limited success. Ethical questions center on vulnerability: especially on whether depressed patients can weigh the risks and benefits effectively, whether depression causes “desperation,” and whether media portrayals create unrealistic hopes. We interviewed 24 psychiatric inpatients with treatment-resistant depression, qualitatively analyzing their comments. Most had minimal interest in deep brain stimulators. Some might consider them if their depression worsened, if alternatives were exhausted, or (...) if the evidence were stronger. Fears focused on the surgery, adverse effects, and the novelty of the device. Patients felt the depression interfered with their ability to weigh the risks and benefits. Patients seemed highly attuned to the risks, and were skeptical that the treatment would be effective. We conclude that ethical concerns about vulnerability remain, yet patients with treatment-resistant depression were thoughtful and cautious about trying a novel therapy. (shrink)

What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these (...) basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine. (shrink)

Frege famously held that numbers play the role of objects in our language and thought, and that this role is on display when we use sentences like "The number of Jupiter's moons is four". I argue that this role is an example of a general pattern that also encompasses persons, times, locations, reasons, causes, and ways of appearing or acting. These things are 'objects' simply in the sense that they are answers to questions: they are the sort of thing we (...) search for and specify during investigation or inquiry. I support this epistemological conception of objects by studying specificational sentences, a class of sentences which includes Frege's original example. I defend an analysis of such sentences as question-answer pairs, and show how to formally represent this analysis using game-theoretical semantics. (shrink)

Background: Patient autonomy has been promoted as the most important principle to guide difficult clinical decisions. To examine whether practising physicians indeed value patient autonomy above other considerations, physicians were asked to weight patient autonomy against three other criteria that often influence doctors’ decisions. Associations between physicians’ religious characteristics and their weighting of the criteria were also examined. Methods: Mailed survey in 2007 of a stratified random sample of 1000 US primary care physicians, selected from the American Medical Association masterfile. (...) Physicians were asked how much weight should be given to the following: (1) the patient’s expressed wishes and values, (2) the physician’s own judgment about what is in the patient’s best interest, (3) standards and recommendations from professional medical bodies and (4) moral guidelines from religious traditions. Results: Response rate 51% (446/879). Half of physicians (55%) gave the patient’s expressed wishes and values “the highest possible weight”. In comparative analysis, 40% gave patient wishes more weight than the other three factors, and 13% ranked patient wishes behind some other factor. Religious doctors tended to give less weight to the patient’s expressed wishes. For example, 47% of doctors with high intrinsic religious motivation gave patient wishes the “highest possible weight”, versus 67% of those with low (OR 0.5; 95% CI 0.3 to 0.8). Conclusions: Doctors believe patient wishes and values are important, but other considerations are often equally or more important. This suggests that patient autonomy does not guide physicians’ decisions as much as is often recommended in the ethics literature. (shrink)

Garland and colleagues provide many compelling reasons for why clinicians ought to participate in pragmatic clinical trials (Garland et al. 2023), also known as effectiveness trials (Thorpe et al....

Mathematical formalism is the the view that numbers are "signs" and that arithmetic is like a game played with such signs. Frege's colleague Thomae defended formalism using an analogy with chess, and Frege's critique of this analogy has had a major influence on discussions in analytic philosophy about signs, rules, meaning, and mathematics. Here I offer a new interpretation of formalism as defended by Thomae and his predecessors, paying close attention to the mathematical details and historical context. I argue that (...) for Thomae, the formal standpoint is an _algebraic perspective_ on a domain of objects, and a "sign" is not a linguistic expression or mark, but a representation of an object within that perspective. Thomae exploits a shift into this perspective to give a purely algebraic construction of the real numbers from the rational numbers. I suggest that Thomae's chess analogy is intended to provide a model for such shifts in perspective. (shrink)

Hume's is/ought distinction has long limited the role of empirical research in ethics, saying that data about what something is cannot yield conclusions about the way things ought to be. However, interest in empirical research in ethics has been growing despite this countervailing principle. We attribute some of this increased interest to a conceptual breakdown of the is/ought distinction. MacIntyre, in reviewing the history of the is/ought distinction, argues that is and ought are not strictly separate realms but exist in (...) a close relationship that is clarified by adopting a teleological orientation. We propose that, instead of recovering a teleological orientation, society tends to generate its own goals via democratic methods like those described by Rousseau or adopt agnosticism about teleology such as described by Richard Rorty. In both latter scenarios, the distinction between is and ought is obscured, and the role for empirical research grows, but for controversial reasons. MacIntyre warns that the is/ought distinction should remain, but reminds ethicists to make careful arguments about when and why it is legitimate to move from is to ought. (shrink)

Conscientious objection among physicians is a perennial hot topic on both sides of the Atlantic. Sven Nordstrand's survey of Norwegian medical students adds fresh data to this ongoing debate.1Their starting point, whether doctors should be allowed to refuse any procedure to which they object on cultural, moral or religious grounds, is truly at the heart of the debate. Their finding that only 20.8% of students endorse this position is striking as it is less than half the number reported by Sophie (...) Strickland in her survey of medical students in the UK.2 It also suggests much less support for conscientious objection than was found among USA primary care physicians, where 78% agreed that “A physician should never do what he or she believes is morally wrong, no matter what experts say.”3These data invite speculation about why there is such dramatic variation between countries. Much can be made of Nordstrand's comments that in Norway “each citizen is assigned a particular general practitioner” and “In the Norwegian healthcare system the general practitioner has a crucial role as …. (shrink)

What does it mean to ‘give’ the value of a variable in an algebraic context, and how does giving the value of a variable differ from merely describing it? I argue that to answer this question, we need to examine the role that giving the value of a variable plays in problem-solving practice. I argue that four different features are required for a statement to count as giving the value of a variable in the context of solving an elementary algebra (...) problem: the variable must be in the scope opened by the problem statement; the values given must be in the range of the variable, which is determined by the problem; the statement giving the values must represent a complete solution; and it must be in a canonical form. This account helps us better understand elementary algebra itself, as well as the use of algebraic tools to analyze phenomena in natural language. (shrink)

Background: Genetic tests for schizophrenia may introduce risks and benefits. Among young adults at clinical high risk for psychosis, little is known about their concerns and how they assess potential risks. Methods: We conducted semistructured interviews with 15 young adults at clinical high risk for psychosis to ask about their concerns. Results: Participants expressed concerns about test reliability, data interpretation, stigma, psychological harm, family planning, and privacy. Participants’ responses showed some departure from the ethics literature insofar as participants were primarily (...) interested in reporting their results to people to whom they felt emotionally close, and expressed little consideration of biological closeness. Additionally, if tests showed an increased genetic risk for schizophrenia, four clinical high-risk persons felt obligated to tell an employer and another three would “maybe” tell an employer, even in the absence of clinical symptoms. Conclusions: These findings suggest opportunities for clinicians and genetic counselors to intervene with education and support. (shrink)

What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these (...) basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine. (shrink)

Background Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions. Objective To examine the associations between a preference for physician-directed decision-making and patient health status and sociodemographic characteristics. Methods Sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center were examined. The primary objectives were to (1) assess the extent to which patients prefer an active role in clinical decision-making, (...) and (2) determine whether religious service attendance, the importance of religion, self-rated spirituality, Charlson Comorbidity Index, self-reported health, Vulnerable Elder Score and several demographic characteristics were associated with these preferences. Results Data were collected from 8308 of 11 620 possible participants. Ninety-seven per cent of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor. In multiple regression analyses, preferring to leave decisions to the doctor was associated with older age (per year, OR=1.019, 95% CI 1.003 to 1.036) and frequently attending religious services (OR=1.5, 95% CI 1.1 to 2.1, compared with never), and it was inversely associated with female sex (OR=0.6, 95% CI 0.5 to 0.8), university education (OR=0.6, 95% CI 0.4 to 0.9, compared with no high school diploma) and poor health (OR=0.6, 95% CI 0.3 to 0.9). Conclusions Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small. (shrink)

The purpose of this article is to incorporate trans?national actors and institutions into citizenship theory both theoretically and empirically. We analyze three cases of recognition movements promoting gender, ethnic/minority and indigenous rights. Using one societal context, Sweden, we map the processes and mechanisms of power and agency (boundary?making and brokering) that shape how trans?national institutions and actors offer new forms of leverage politics to recognition movements as well as constrain their agency. These mechanisms of power are formalized in a model (...) showing the multi?level effects of leverage politics on recognition movements. Our three cases of recognition politics demonstrate the increasingly complex links between actors in policy communities across regional, national, European and international levels. They also reveal the processes implicit in our model: that policy imports are reframed when translated into specific national political cultures; and more broadly, that national citizenship frames of membership and inclusion are not easily dislodged. (shrink)

A transcription and translation of Hermann Hankel's 1867 Vorlesungen über die complexen Zahlen und ihre Functionen, I. Theil: Theorie der Complexen Zahlensysteme, a textbook on complex analysis that played an important role in the transition to modern mathematics in nineteenth century Germany.

This book will help professions and professionals to identify their contribution to society and to understand the argument in which they must engage if they are to justify their conduct. Because of their specialized expertise and power, the task is both difficult and pressing. The work is divided into two parts. Part 1 discusses the concepts 'ethics' and 'professional conduct', indicating their dimensions and contested nature. In each case, following examination and analysis of relevant literature, a conceptual framework or model (...) is proposed for locating instances of, in turn, ethics and professional conduct. In Part 2, the model of ethical choice is used to discuss the ethical justification of professional conduct in the various forms, locations, and stages provided by its social setting. In this way, it provides grounding arguments for relevant action by professionals and others dealing with professionals. The book concludes with a proposal for a national standing commission on the professions. (shrink)

This is a bugfix release to correct some errors in.zenodo.json which prevented archiving of 1.0. -/- Version 1.0: This first release of the translation contains: -/- * a full transcription of the Preface and Chapter 1 * translations of select passages in these sections * a full transcription and translation of the title pages and the table of contents through chapter 3 -/- This release was focused on working out (most of) the issues with the markup of a parallel translation (...) and with the build. Subsequent versions will contain more of the text and be more focused on translation! (shrink)

Hossack’s project in this book is to provide a new foundation for the philosophy of number inspired by the traditional idea that numbers are magnitudes.

In §57 of the Foundations of Arithmetic, Frege famously turns to natural language to support his claim that numbers are ‘self-subsistent objects’:I have already drawn attention above to the fact th...