Stroke is a severe health issue, and motor recovery after stroke remains an important challenge in the rehabilitation field. Neurofeedback, as part of a brain–computer interface, is a technique for modulating brain activity using on-line feedback that has proved to be useful in motor rehabilitation for the chronic stroke population in addition to traditional therapies. Nevertheless, its use and applications in the field still leave unresolved questions. The brain pathophysiological mechanisms after stroke remain partly unknown, and the possibilities for intervention (...) on these mechanisms to promote cerebral plasticity are limited in clinical practice. In NFB motor rehabilitation, the aim is to adapt the therapy to the patient’s clinical context using brain imaging, considering the time after stroke, the localization of brain lesions, and their clinical impact, while taking into account currently used biomarkers and technical limitations. These modern techniques also allow a better understanding of the physiopathology and neuroplasticity of the brain after stroke. We conducted a narrative literature review of studies using NFB for post-stroke motor rehabilitation. The main goal was to decompose all the elements that can be modified in NFB therapies, which can lead to their adaptation according to the patient’s context and according to the current technological limits. Adaptation and individualization of care could derive from this analysis to better meet the patients’ needs. We focused on and highlighted the various clinical and technological components considering the most recent experiments. The second goal was to propose general recommendations and enhance the limits and perspectives to improve our general knowledge in the field and allow clinical applications. We highlighted the multidisciplinary approach of this work by combining engineering abilities and medical experience. Engineering development is essential for the available technological tools and aims to increase neuroscience knowledge in the NFB topic. This technological development was born out of the real clinical need to provide complementary therapeutic solutions to a public health problem, considering the actual clinical context of the post-stroke patient and the practical limits resulting from it. (shrink)

This Element introduces the philosophical literature on models, with an emphasis on normative considerations relevant to models for decision-making. Chapter 1 gives an overview of core questions in the philosophy of modeling. Chapter 2 examines the concept of model adequacy for purpose, using three examples of models from the atmospheric sciences to describe how this sort of adequacy is determined in practice. Chapter 3 explores the significance of using models that are not adequate for purpose, including the purpose of informing (...) public decisions. Chapter 4 provides a basic framework for values in modelling, using a case study to highlight the ethical challenges in building models for decision making. It concludes by establishing the need for strategies to manage value judgments in modelling, including the potential for public participation in the process. (shrink)

Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for metastatic (...) cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve “rough justice” and “supple solidarity.” The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity. (shrink)

Can Rawlsian public reason sufficiently justify public policies that regulate or restrain controversial medical and technological interventions in bioethics (and the broader social world), such as abortion, physician aid-in-dying, CRISPER-cas9 gene editing of embryos, surrogate mothers, pre-implantation genetic diagnosis of eight-cell embryos, and so on? The first part of this essay briefly explicates the central concepts that define Rawlsian political liberalism. The latter half of this essay then demonstrates how a commitment to Rawlsian public reason can ameliorate (not completely resolve) (...) many of the policy disagreements related to bioethically controversial medical interventions today. The goal of public reason is to reduce the size of the disagreement by eliminating features of the disagreement that violate the norms of public reason. The norms of public reason are those norms that are politically necessary to preserve the liberal, pluralistic, democratic character of this society. What remains is reasonable disagreement to be addressed through normal democratic deliberative processes. Specific issues addressed from a public reason perspective include personal responsibility for excessive health costs, the utility of a metaphysical definition of death for organ transplantation, and the moral status of excess embryos generated through IVF and/or their use in medical research. (shrink)

This book presents an analysis of the institutional development of selected social science and humanities disciplines in Argentina, France, Germany, Hungary, Italy, the Netherlands, Sweden and the United Kingdom. Where most narratives of a scholarly past are presented as a succession of ‘ideas,’ research results and theories, this collection highlights the structural shifts in the systems of higher education, as well as institutions of research and innovation within which these disciplines have developed. This institutional perspective will facilitate systematic comparisons between (...) developments in various disciplines and countries. Across eight country studies the book reveals remarkably different dynamics of disciplinary growth between countries, as well as important interdisciplinary differences within countries. In addition, instances of institutional contractions and downturns and veritable breaks of continuity under authoritarian political regimes can be observed, which are almost totally absent from narratives of individual disciplinary histories. This important work will provide a valuable resource to scholars of disciplinary history, the history of ideas, the sociology of education and of scientific knowledge. (shrink)

There has long been interest in identifying and studying ‘‘successful psychopaths.” This study sampled psychologists with an interest in law, attorneys, and clinical psychology professors to obtain descriptions of individuals considered to be psychopaths who were also successful in their endeavors. The results showed a consistent description across professions and convergence with descriptions of traditional psychopathy, though the successful psychopathy profile had higher scores on conscientiousness, as measured within the five-factor model (FFM). These results are useful in documenting the existence (...) of successful psychopathy, demonstrating the potential benefit of informant methodology, and providing an FFM description that distinguishes successful psychopaths from unsuccessful psychopaths studied more routinely within prison settings. (shrink)

De Bie et al. (2023) call attention at the conclusion of their essay to the “novel questions” generated by complete ectogenesis. The question I explore is how complete ectogenesis from conception t...

Accelerated approval of aducanumab for mild Alzheimer's by the U.S. Food and Drug Administration on June 7, 2021, has generated substantial medical, scientific, and ethical controversy. That approval was contrary to the nearly unanimous judgment of the FDA's Advisory Committee that little reliable evidence existed of significant benefit, even though the drug did reduce β‐amyloid. Three major ethical problems were created by this approval: (1) Medicare resources would be unjustly squandered, given the drug's $56,000 annual price and the 3.1 million (...) older potential American patients needing the drug; (2) physicians will feel ethically compelled to provide the drug to desperate, insistent patients, given FDA approval and in spite of side effects of brain bleeds and brain swelling; (3) and false hopes are generated for patients. A needed corrective by the federal government would reduce reimbursement to the bare cost of producing the drug (plus only a modest profit) until a phase IV trial has been successfully completed. (shrink)

I fundamentally agree with Childress et al. (2023) in the scenario they have constructed with Mr. J. None of the arguments they critically assess are ethically persuasive enough to justify removing...

The phrase "personalized medicine" has a built-in positive spin. Simple genetic tests can sometimes predict whether a particular individual will have a positive response to a particular drug or, alternatively, suffer costly and debilitating side effects. But little attention has been given to some challenging issues of justice raised by personalized medicine. How should we determine who would have a just claim to access particular treatments, especially very expensive ones? How effective do those treatments need to be?If there were a (...) thick, bright line separating minimal responders from maximal responders, then we could allocate these treatments in a fair and cost-effective way. But there is no bright line. The .. (shrink)

John Rawls has held up as a model of public reason the U.S. Supreme Court. I argue that the Dobbs Court is justifiably criticized for failing to respect public reason. First, the entire opinion is governed by an originalist ideological logic almost entirely incongruent with public reason in a liberal, pluralistic, democratic society. Second, Alito’s emphasis on “ordered liberty” seems completely at odds with the “disordered liberty” regarding abortion already evident among the states. Third, describing the embryo/fetus from conception until (...) birth as an “unborn human being” begs the question of the legal status of the embryo/fetus, as if an obiter dictum settled the matter. Fourth, Alito accuses the Roe court of failing to exercise judicial restraint, although Alito argued to overturn Roe in its entirety. In brief, the Dobbs opinion is an illiberal, disingenuous, ideological swamp that swallows up public reason and the reproductive rights of women. (shrink)

Lara Buchak argues that her version of rank-weighted utilitarianism can accommodate an implication of the separateness of persons known as “the shift,” since it requires individuals to be more willing to accept risk for themselves than to accept inequality in society. I argue that this is mistaken. Buchak’s model fails to yield the shift when the decision-maker is distinct from the affected individual, as well as in certain social decisions where the risk attitude of the group is known. These findings (...) suggest that models which derive social choice rules from individual decision rules will generally fail to uphold separateness. (shrink)

What should be the content of a package of health care services that we would want to guarantee to all Americans? This question cannot be answered adequately apart from also addressing the issue of fair health care rationing. Consequently, as I argue in this essay, appeal to the language of "basic," "essential," "adequate," "minimally decent," or "medically necessary" for purposes of answering our question is unhelpful. All these notions are too vague to be useful. Cost matters. Effectiveness matters. The clinical (...) circumstances of a patient matters. But what we must ultimately determine is what we mutually agree are the just claims to needed health care of each American in a relatively complex range of clinical circumstances. Answering this question will require a public moral conversation, a fair process of rational democratic deliberation aimed at defining both just claims to needed health care and just limits. (shrink)

I agree with Professor ter Meulen that there is no need to make a forced choice between “justice” and “solidarity” when it comes to determining what should count as fair access to needed health care. But he also asserts that solidarity is more fundamental than justice. That claim needs critical assessment. Ter Meulen recognizes that the concept of solidarity has been criticized for being excessively vague. He addresses this criticism by introducing the more precise notion of “humanitarian solidarity.” However, I (...) argue that these notions are still not precise enough and are in need of behavioral translation, especially in relation to the problem of fair health care rationing. More specifically, I argue that translation ought to take the form of a well-ordered process of rational democratic deliberation, which I describe and defend in this essay. Such a process is what is required to construct a working model of just solidarity as opposed to a merely abstract idealization of just solidarity. (shrink)

Galasso calls for “the actualization of the public health potential of precision medicine….as the best realistic contribution to health equity” (Galasso 2024, 83). Unfortunately, this is wishful th...

Resumo A teoria crítica tardia de Theodor W. Adorno é considerada por muitos como quietista e resignada. O presente artigo busca questionar tal veredito por meio de uma análise tanto do diagnóstico de época, feito pelo autor, quanto da relação entre teoria e práxis delineada nas obras do período tardio do pensador frankfurtiano. Sugere-se que, em vez de resignada, a teoria crítica de Adorno está engajada seja nos processos de resistência à barbárie latente, seja nas melhorias pontuais que poderiam ser (...) conseguidas no interior da ordem vigente. Tal engajamento, no entanto, não significa um abrandamento da tese de que a possibilidade de emancipação estaria bloqueada.Theodor W. Adorno's late critical theory is often regarded as quietist and resignated. This article seeks to question this verdict through an analysis of both the diagnosis of time made by the author as of the relationship between theory and praxis outlined in Frankfurtian thinker's late works. It is suggested that instead of resigned, Adorno's critical theory is engaged either in processes of resistance to the latent barbarism, whether in specific improvements that could be achieved within the existing order. This engagement, however, does not mean a mitigation of the thesis that the possibility of emancipation would be blocked. (shrink)

The Dobbs decision has precipitated renewed medical, political, and professional interest in the issue of abortion. Because this decision handed responsibility for regulation of abortion back to the states, and because the states are enacting or have enacted policies that tend to be very permissive or very restrictive, the result has been legal and professional confusion for physicians and their patients. Medical education cannot resolve either the legal or ethical issues regarding abortion. However, medical education must prepare future physicians for (...) caring for patients seeking abortion-related services. Physicians must be prepared to interact appropriately (sensitively and with integrity) with patients or colleagues whose views on abortion differ significantly from their own. This essay describes our educational effort to achieve that objective. The motto that governed this exercise was “No Easy Answers.”. (shrink)

What exactly is a “wicked problem”? It is a social or economic problem that is so complex and so interconnected with other issues that it is extraordinarily difficult or impossible to resolve. This is because all proposed resolutions generate equally complex, equally wicked problems. In this essay, I argue that precision medicine, especially in the context of the U.S. healthcare system, generates numerous wicked problems related to distributive justice. Further, I argue that there are no easy solutions to these wicked (...) problems. The need for trade-offs is inescapable. Rough justice is the best outcome we can hope for, and that outcome requires a commitment to processes of public reason that are fair and inclusive. (shrink)

Are DRGs just? This is the primary question which this essay will answer. But there is a prior methodological question that also needs to be addressed: How do we go about rationally (non-arbitrarily) assessing whether DRGs are just or not? I would suggest that grand, ideal theories of justice (Rawls, Nozick) have only very limited utility for answering this question. What we really need is a theory of “interstitial justice,” that is, an approach to making justice judgments that is suitable (...) to assessing the social practices and institutions that comprise the interstices of our social life as opposed to its basic structure. Rawls's appeal to “our considered moral judgments” provides us with a useful starting point for this task, which we shall discuss in the first part of this essay. In the second part, we shall actually assess DRGs from the perspective of interstitial justice. What we shall show is that DRGs violate a large number of our considered judgments regarding a just approach to financing health care for the elderly in a cost-effective manner. This is true to such an extent that efforts to reform DRGs and make them fairer, such as the recent effort by Robert Veatch, should be abandoned. In the concluding section of the essay we discuss one especially pernicious feature of DRGs, namely, that they represent an invisible approach to rationing access to health care. In the minds of many this is one of the virtues of DRGs. That claim needs critical examination. (shrink)

In this pathbreaking book, which includes a powerful new translation of Hesiod's Works and Days by esteemed translator David Grene, Stephanie Nelson argues that a society's vision of farming contains deep indications about its view of the human place within nature, and our relationship to the divine. She contends that both Hesiod in the Works and Days and Vergil in the Georgics saw farming in this way, and so wrote their poems not only about farming itself, but also about its (...) deeper ethical and religious implications. Hesiod, Nelson argues, saw farming as revealing that man must live by the sweat of his brow, and that good, for human beings, must always be accompanied by hardship. Within this vision justice, competition, cooperation, and the need for labor take their place alongside the uncertainties of the seasons and even of particular lucky and unlucky days to form a meaningful whole within which human life is an integral part. Vergil, Nelson argues, deliberately modeled his poem upon the Works and Days, and did so in order to reveal that his is a very different vision. Hesiod saw the hardship in farming; Vergil sees its violence as well. Farming is for him both our life within nature, and also our battle against her. Against the background of Hesiods poem, which found a single meaning for human life, Vergil thus creates a split vision and suggests that human beings may be radically alienated from both nature and the divine. Nelson argues that both the Georgics and the Works and Days have been misread because scholars have not seen the importance of the connection between the two poems, and because they have not seen that farming is the true concern of both, farming in its deepest and most profoundly unsettling sense. (shrink)

In this pathbreaking book, which includes a powerful new translation of Hesiod's Works and Days by esteemed translator David Grene, Stephanie Nelson argues that a society's vision of farming contains deep indications about its view of the human place within nature, and our relationship to the divine. She contends that both Hesiod in the Works and Days and Vergil in the Georgics saw farming in this way, and so wrote their poems not only about farming itself, but also about its (...) deeper ethical and religious implications. Hesiod, Nelson argues, saw farming as revealing that man must live by the sweat of his brow, and that good, for human beings, must always be accompanied by hardship. Within this vision justice, competition, cooperation, and the need for labor take their place alongside the uncertainties of the seasons and even of particular lucky and unlucky days to form a meaningful whole within which human life is an integral part. Vergil, Nelson argues, deliberately modeled his poem upon the Works and Days, and did so in order to reveal that his is a very different vision. Hesiod saw the hardship in farming; Vergil sees its violence as well. Farming is for him both our life within nature, and also our battle against her. Against the background of Hesiods poem, which found a single meaning for human life, Vergil thus creates a split vision and suggests that human beings may be radically alienated from both nature and the divine. Nelson argues that both the Georgics and the Works and Days have been misread because scholars have not seen the importance of the connection between the two poems, and because they have not seen that farming is the true concern of both, farming in its deepest and most profoundly unsettling sense. (shrink)

O presente estudo se destina a fazer uma breve análise sobre o direito social à educação, sua influência para o alcance da dignidade da pessoa humana e o seu alcance no formato EAD no Brasil. O artigo trata das metodologias de ensino viabilizadas pelo EAD, qual a sua contribuição na formação desses jovens e crianças e se a fruição dos benefícios desse método de ensino são possível por todas as classes sociais de forma isonômica. A pretensão é analisar como o (...) EAD pode trazer a democratização do ensino no país e qual caminho viabilizará isto. (shrink)

In this paper, I argue for the following points. First, all of us have a presumptive moral obligation to be organ donors if we are in the relevant medical circumstances at the time of death. Second, family members should not have the right to interfere with the fulfillment of that obligation. Third, the ethical basis for that obligation is reciprocity. If we want a sufficient number of organs available for transplantation, then all must be willing donors. Fourth, that likelihood is (...) diminished if individuals are entirely free to refuse to be organ donors but still would demand to be organ recipients. Fifth, although individuals would be ethically obligated to be organ donors, we still need to permit them to refuse to be organ donors. Sixth, to encourage individuals to stay within the organ donation system, we should have as a just and ethically justified policy denying individuals an organ transplant in the relevant medical circumstances if they have chosen to exit the organ donation system. Individuals would not be permitted to be organ recipients if they were unwilling to be organ donors. This is what it means to be part of what Rawls in Political liberalism (15-22) would refer to as a “fair system of social cooperation.” We refer to this as the “reciprocity requirement.”. (shrink)

Resenha de De Caux, Luiz Philipe. A Imanência da Crítica. Os sentidos da crítica na tradição frankfurtiana e pós-frankfurtiana. Edições Loyola, 2021.

Resumo: De acordo com parte da literatura, a teoria crítica de Adorno é um lamento sobre o fracasso da civilização moderna que é incapaz de dar conta de suas próprias condições de possibilidade. No presente artigo, questiono tal veredito, por meio da análise da questão de como a crítica pode ser feita e de quem seria o destinatário dela, em uma situação de quase completa dominação.: According to a certain part of the relevant literature, Adorno's critical theory is a lament (...) on the failure of modern civilization to explain its own conditions of possibility. In this paper, I question this verdict by analyzing the problem of how criticism can be done and who the addressee for it would be in a situation of almost complete domination. (shrink)

I have never doubted that the problem of inequalities in health status and access to needed care is a difficult ethical and political challenge. After reading the essays in Understanding Health Inequalities and Justice: New Conversations across the Disciplines, edited by Mara Buchbinder, Michele Rivkin-Fish, and Rebecca Walker, I concluded that despair was the only suitable response in the face of daunting ethical and political complexity. The editors of this volume have three questions in mind that they asked contributors to (...) address. How do scholars from various disciplines approach relations between health inequalities and ideals of justice? Social scientists want to offer empirical descriptions of inequalities in health status across a range of social groups, but there are numerous ways of offering such descriptions. Are they all “correct”? Philosophers and medical ethicists want to make normative judgments regarding which inequalities matter, ethically speaking. So do we need to know when considerations of justice are relevant to assessing health inequalities and which considerations of justice are most relevant in specific contexts? Ultimately, the question is which of these scholarly approaches is most useful for improving health policy. (shrink)

In the summer of 1943 Edgar Zilsel resigned from his membership in the exile organization of Austrian Social Democrats, a political movement he had joined as a young man back in Vienna. Zilsel is known as an innovative scholar bridging philosophy, history and sociology of science, and belonging to the so-called left wing of the Vienna Circle of Logical Emipricism. Details of his political convictions are less recognized. A recently detected manuscript illuminates his worldview: His resignation letter had been accompanied (...) by a short exposition of his interpretation of socialism near the end of World War II. The article introduces Zilsel, his life and work and publishes for the first time Zilsel’s statement from 1943. (shrink)

What does it mean to be a “just” and “caring” society in meeting the health care needs of the terminally ill when we have only limited resources to meet virtually unlimited health care needs? This is the question that will be the focus of this essay. Another way of asking our question would be the following: Relative to all the other health care needs in our society, especially the need for lifesaving or life-prolonging health care, how high a priority ought (...) the health care needs of persons who are terminally ill have? Should any of the health care needs of the terminally ill be assigned very low priority? Or should all their health care needs be assigned the highest priority? If we reflect a bit, we will find ourselves greatly internally conflicted. On the one hand, the “caring” side of our moral self might see terminally ill individuals as being among the “medically least well off,” and therefore, deserving virtually any medical resources that will yield any degree of good for them. (shrink)

This personal narrative tugs at the heart strings. However, personal narratives are not sufficient to justify public funding for any screening policy. We have to take seriously the ‘just caring’ problem. We have only limited resources to meet virtually unlimited health care needs. No doubt, screening tests often save lives. The author wants public funding for prostate-specific antigen screening for prostate cancer. However, why only prostate cancer? Numerous cancers at various stages can be screened for. Are all of them equally (...) deserving of public funding? What about screening for a very long list of other life-threatening medical disorders? There is nothing ethically special about cancer. Where does the money come from to pay for all these screening tests? Do we reduce expensive life-prolonging care for patients in late-stage diseases? Ultimately, a balance must be struck between saving statistical lives through screening and saving identifiable lives in the intensive care unit. Achieving a just balance requires rational democratic deliberation as justification for these choices, not personal narratives. (shrink)