Extracorporeal membrane oxygenation (ECMO) is typically viewed as a time-limited intervention—a bridge to recovery or transplant—not a destination therapy. However, some patients with decision-making capacity request continued ECMO support despite a poor prognosis for recovery and lack of viability as a transplant candidate. In response, critical care teams have asked for guidance regarding the ethical permissibility of unilateral withdrawal over the objections of a capacitated patient. In this article, we evaluate several ethical arguments that have been made in favor of (...) withdrawal, including distributive justice, quality of life, patients’ rights, professional integrity, and the Equivalence Thesis. We find that existing justifications for unilateral withdrawal of ECMO support in capacitated patients are problematic, which leads us to conclude that either: (1) additional ethical arguments are necessary to defend this approach or (2) the claim that it is not appropriate to use ECMO as a destination therapy should be questioned. (shrink)

While experience often affords important knowledge and insight that is difficult to garner through observation or testimony alone, it also has the potential to generate conflicts of interest and unrepresentative perspectives. We call this tension the paradox of experience. In this paper, we first outline appeals to experience made in debates about access to unproven medical products and disability bioethics, as examples of how experience claims arise in bioethics and some of the challenges raised by these claims. We then motivate (...) the idea that experience can be an asset by appealing to themes in feminist and moral epistemology, distinguishing between epistemic and justice-based appeals. Next, we explain the concern that experience may be a liability by appealing to empirical work on cognitive biases and theoretical work about the problem of partial representation. We conclude with preliminary recommendations for addressing the paradox and offer several questions for future discussion. (shrink)

Patients who experience difficulty making medical decisions are often referred to as “ambivalent.” However, the current lack of attention to the nuances between a cluster of phenomena that resemble...

Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the (...) circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (shrink)

Questions about when to limit unhelpful treatments are often raised in general medicine but are less commonly considered in psychiatry. Here we describe a survey of U.S. psychiatrists intended to characterize their attitudes about the management of suicidal ideation in patients with severely treatment-refractory illness. Respondents (n = 212) received one of two cases describing a patient with suicidal ideation due to either borderline personality disorder or major depressive disorder. Both patients were described as receiving all guideline-based and plausible emerging (...) treatments. Respondents rated the expected helpfulness and likelihood of recommending each of four types of intervention: hospitalization, additional medication changes, additional neurostimulation, and additional psychotherapy. Across both cases, most respondents said they were likely to provide each intervention, except for additional neurostimulation in borderline personality disorder, while fewer thought each intervention would be helpful. Substantial minorities of respondents indicated that they would provide an intervention they did not think was likely to be helpful. Our results suggest that while most psychiatrists recognize the possibility that some patients are unlikely to be helped by available treatments, many would continue to offer such treatments. (shrink)

Introduction. During the past two decades philosophers of psychology have considered a large variety of computational models for philosophy of mind and more recently for cognitive science. Among the suggested models are computer programs, Turing machines, pushdown automata, linear bounded automata, finite state automata and sequential machines. Many philosophers have found finite state automata models to be the most appealing, for various reasons, although there has been no shortage of defenders of programs and Turing machines. A paper by Arthur Burks (...) convinced me long ago that “all natural human functions” are, or can be fruitfully modeled to be, finite state automata with output. Further work in the field has reinforced this conviction. There is room, however, for the use of any of the above models in philosophy of mind and in the ongoing development of cognitive science. (shrink)

In this paper I argue that human pattern recognition can be simulated by automata. In particular, I show that gestalt recognition and recognition of family resemblances are within the capabilities of sufficiently complex Turing machines. The argument rests on elementary facts of automata and computability theory which are used to explicate our preanalytic, informal concepts concerning gestalt patterns and recognition. The central idea is that of a machine which "knows" its own structure. Although the paper thus aims to support mechanism, (...) especially as a framework hypothesis for perception, it contains suggestions for philosophy of science and philosophy of language as well. Some of these suggestions are sketched in the final section. (shrink)

Work done within the realm of what is sometimes called ‘descriptive ethics’ brings two questions readily to mind: How can empirical findings, in general, inform normative debates? and How can these empirical findings, in particular, inform the normative debate at hand? Brick et al 1 confront these questions in their novel investigation of public views about lives worth living and the permissibility of withdrawing life-sustaining treatment from critically ill infants. Mindful of the is-ought gap, the authors suggest modestly that their (...) data ‘may be useful when constructing guidelines for clinical practice’. In this commentary, I consider some potential limitations on the generalisability of these data in the context of policy and clinical practice, limitations which may in turn serve as directions for future empirical research. The authors’ study presented participants six case scenarios, five of which involved the possibility of withdrawing life-sustaining treatment from critically ill infants. The results revealed that “[a]lmost all respondents agreed that at some level of quality of life, life may be of no benefit or worse than death for an infant” and that “participants significantly favoured withdrawal of treatment for the most severe cases.” One salient detail in these scenarios …. (shrink)

Speculations about the role of consciousness in physical systems are frequently observed in the literature concerned with the interpretation of quantum mechanics. While only three experimental investigations can be found on this topic in physics journals, more than 800 relevant experiments have been reported in the literature of parapsychology. A well-defined body of empirical evidence from this domain was reviewed using meta-analytic techniques to assess methodological quality and overall effect size. Results showed effects conforming to chance expectation in control conditions (...) and unequivocal non-chance effects in experimental conditions. This quantitative literature review agrees with the findings of two earlier reviews, suggesting the existence of some form of consciousness-related anomaly in random physical systems. (shrink)

Save for Anthropologists, few social scientists have been among the participants in the discussions about the appropriate structure of a ‘Universal Darwinism’. Yet evolutionary theorizing about cultural, social, and economic phenomena has a long tradition, going back well before Darwin. And over the past quarter century significant literatures have grown up concerned with the processes of change operating on science, technology, business organization and practice, and economic change more broadly, that are explicitly evolutionary in theoretical orientation. In each of these (...) fields of study, the broad proposition put forth by Darwin that change proceeds through a process involving variation, systematic selection, renewed variation... has proved both persuasive and powerful. On the other hand, the evolutionary processes involved in these areas differ in essential ways from those we now know are operative in the evolution of biological species. The objective of this essay is to highlight those differences, which a ‘Universal Darwinism’ needs to encompass, if it is to be broad enough to be a theory that is applicable to the evolution of human cultures as well as evolution in biology. (shrink)

Since children are considered incapable ofgiving informed consent to participate inresearch, regulations require that bothparental permission and the assent of thepotential child subject be obtained. Assent andpermission are uniquely bound together, eachserving a different purpose. Parentalpermission protects the child from assumingunreasonable risks. Assent demonstrates respectfor the child and his developing autonomy. Inorder to give meaningful assent, the child mustunderstand that procedures will be performed,voluntarily choose to undergo the procedures,and communicate this choice. Understanding theelements of informed consent has been theparadigm for (...) assessing capacity to give assent.This method leaves the youngest, leastcognitively mature children vulnerable towaiver of assent and forced researchparticipation. Voluntariness can also becompromised by the influence of authorityfigures who can exert undue influence andcoerce children to participate in research. This paper discusses factors that may influencethe decision to give assent/permission,potential parent-child conflict in theassent/permission process and how it isresolved, and potential parental undueinfluence on research participation. Theseissues are illustrated with quotations drawnfrom a larger qualitative study of parentalpermission and child assent (data notpresented). We suggest a developmentalapproach, viewing assent as a continuum rangingfrom mere affirmation in the youngest childrento the equivalent of the informed consentprocess in the mature adolescent. (shrink)

Volume 20, Issue 2, February 2020, Page 66-68.

At the time of this writing, a widely publicized, waived-consent trial is underway. Sponsored by Northfield Laboratories, Inc. (Evanston, IL) the trial is intended to evaluate the emergency use of PolyHeme®, an oxygen-carrying resuscitative fluid that might prevent deaths from uncontrolled bleeding. The protocol allows patients in hemorrhagic shock to be randomized between PolyHeme® and saline in the field and, still without consent, randomized between PolyHeme® and blood after arrival at an emergency department. The Federal regulations that govern the waiver (...) of consent restrict its applicability to circumstances where proven, satisfactory treatments are unavailable. Blood - the standard treatment for hemorrhagic shock - is not available in ambulances but is available in hospitals. The authors argue that the in-hospital stage of the study fails to meet ethical and regulatory standards. (shrink)

Do sensory measurements deserve the label of “measurement”? We argue that they do. They fit with an epistemological view of measurement held in current philosophy of science, and they face the same kinds of epistemological challenges as physical measurements do: the problem of coordination and the problem of standardization. These problems are addressed through the process of “epistemic iteration,” for all measurements. We also argue for distinguishing the problem of standardization from the problem of coordination. To exemplify our claims, we (...) draw on olfactory performance tests, especially studies linking olfactory decline to neurodegenerative disorders. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 42-50, January/February 2022.

The neurodiversity view makes both a conceptual and a political claim. Conceptually, the neurodiversity view holds that certain neurocognitive differences currently classified as disorders—autism, most notably—are best understood as forms of diversity. Politically, it holds that, rather than being medicalized and ‘treated’, neurodiversity ought to be respected in the way other human differences—such as differences in race and sexual orientation—are respected. In this article, I challenge the arguments given in support of neurodiversity’s conceptual claim, while defending its political aims of (...) respect, inclusion, and accommodation. Although neurodiversity provides a compelling challenge to the status quo, I conclude that its most prominent arguments fall short of establishing that autism is not a disorder. As I go on to argue, however, the fact that autism is a disorder does not entail that medicalization is the only course. My view is ultimately that social change and medical intervention need not be considered mutually exclusive. (shrink)

The Oregon Basic Health Services Act of 1989 seeks to establish universal access to basic medical care for all currently uninsured Oregon residents. To control the increasing cost of medical care, the Oregon plan will restrict funding according to a priority list of medical interventions. The basic level of medical care provided to residents with incomes below the federal poverty line will vary according to the funds made available by the Oregon legislature. A rationing plan such as Oregon's which potentially (...) excludes medically necessary procedures from the basic level of health care may be just, for the right to publically-sponsored medical care is restricted by opposing rights of private property. However, the moral acceptability of the Oregon plan cannot be determined in the absence of knowing the level of resources to be provided. Finally, Oregon to date has failed to include the individuals being rationed in discussions as to how the scarce resources are to be distributed. (shrink)

A paediatric clinical trial conducted in a developing country is likely to encounter conditions or illnesses in participants unrelated to the study. Since local healthcare resources may be inadequate to meet these needs, research clinicians may face the dilemma of deciding when to provide ancillary care and to what extent. The authors propose a model for identifying ancillary care obligations that draws on assessments of urgency, the capacity of the local healthcare infrastructure and the capacity of the research infrastructure. The (...) model lends itself to a decision tree that can be adapted to the local context and resources so as to provide procedural guidance. This approach can help in planning and establishing organisational policies that govern the provision of ancillary care. (shrink)

In this paper it is argued that certain stimulus-response learning models which are adequate to represent finite automata (acceptors) are not adequate to represent noninitial state input-output automata (transducers). This circumstance suggests the question whether or not the behavior of animals if satisfactorily modelled by automata is predictive. It is argued in partial answer that there are automata which can be explained in the sense that their transition and output functions can be described (roughly, Hempel-type covering law explanation) while their (...) behaviors are in principle not predictable short of possession of their complete histories or of information concerning present internal states by indirect observation. (shrink)

We investigated how color preferences vary according to season and whether those changes could be explained by the ecological valence theory. To do so, we assessed the same participants’ preferences for the same colors during fall, winter, spring, and summer in the northeastern United States, where there are large seasonal changes in environmental colors. Seasonal differences were most pronounced between fall and the other three seasons. Participants liked fall-associated dark-warm colors—for example, dark-red, dark-orange, dark-yellow, and dark-chartreuse—more during fall than other (...) seasons. The EVT could explain these changes with a modified version of Palmer and Schloss’ weighted affective valence estimate procedure that added an activation term to the WAVE equation. The results indicate that color preferences change according to season, as color-associated objects become more/less activated in the observer. These seasonal changes in color preferences could not be characterized by overall shifts in weights along cone-contrast axes. (shrink)

First published in 1992. Routledge is an imprint of Taylor & Francis, an informa company.

First published in 1992. Routledge is an imprint of Taylor & Francis, an informa company.

Our objective is to understand how parents and children perceive their roles in decision making about research participation. Forty-five children (ages 4-15 years) with or without a chronic condition and 21 parents were the participants. A semistructured interview assessed perceptions of up to 4 hypothetical research scenarios with varying levels of risk, benefit, and complexity. Children were also administered the Peabody Picture Vocabulary Test, Third Edition, to assess verbal ability, as a proxy for the child's cognitive development. The audiotaped interviews (...) were transcribed and analyzed for themes related to parent and child decision-making roles. Both parents and children varied in their perceptions of decision-making roles. Child perceptions of parental influence on decision making as knowledge-based increased with cognitive development, whereas perceptions of parental influence as power-based decreased. Both children and parents commented that they would collaborate with each other when making decisions. Collaborative decision making appeared to increase with cognitive development. These findings suggest that approaches to child assent and parent permission should consider the parent-child relationship and how children and families typically make decisions. Future research is necessary to explain variation in the process of research decision making across children and families, explore the role of collaboration on children's decision-making skills, and understand developmental trajectories and mechanisms related to research decision making. (shrink)

Volume 20, Issue 4, May 2020, Page 48-50.

Volume 20, Issue 7, July 2020, Page 190-192.

Volume 20, Issue 4, May 2020, Page 114-116.

My brand of evolutionary economics recognizes, highlights, that modern economies are always in the process of changing, never fully at rest, with much of the energy coming from innovation. This perspective obviously draws a lot from Schumpeter. Continuing innovation, and the creative destruction that innovation engenders, is driving the system. There are winners and losers in the process, but generally the changes can be regarded as progress. The processes through which economic activity and performance evolve has a lot in common (...) with evolution in biology. In particular, at any time the economy is marked by considerable variety, there are selection forces winnowing on that variety, but also continuing emergence of new ways of doing things and often economic actors. But there also are important differences from biological evolution. In particular, both innovation and selection are to a considerable degree purposive activities, often undertaken on the basis of relatively strong knowledge. (shrink)

Volume 19, Issue 11, November 2019, Page 82-84.

Discussion of the ethics of forgoing medically provided nutrition and hydration tends to focus on adults rather than infants and children. Many appellate court decisions address the legal propriety of forgoing medically provided nutritional support of adults, but only a few have ruled on pediatric cases that pose the same issue.The cessation of nutritional support is implemented most commonly for patients in a permanent vegetative state ). An estimated 4,000 to 10,000 American children are in the permanent vegetative state, compared (...) to 10,000 to 25,000 adults. Yet the dearth of literature, case reports, and court decisions suggests that physicians and families of pediatric patients stop medically provided nutrition or seek court orders much less frequently. (shrink)