Implementation of guidelines regarding breaches of electronic health information requires an anticipatory stance and physician and patient education regarding security and monitoring measures and methods of redress. Adopting a preventive ethics, rather than a crisis management, model may also increase physician awareness of how the information they choose to include and privilege within the health record may expose patients to added harms if not done mindfully.

Disparities in access to, and utilization of, treatment for depression among African-American and Caucasian elderly adults have been well-documented. Less fully explored are the multidimensional factors responsible for these disparities. The intersection of cultural constructs, socioeconomic factors, multiple levels of racism, and stigma attending both mental health issues and older age may help to explain disparities in the treatment of the depressed elderly. Personalized medicine with its promise of developing interventions tailored to an individual's health needs and genetically related response (...) to treatment might seem a promising antidote to the documented underutilization of standard depression treatments by African Americans. However, this paper examines the multidimensional factors associated with disparities in effective treatment of depression among African-American and Caucasian elderly adults and argues the scientific and ethical importance of pursuing various paths to address multiple levels and sources of stigma and mistrust if pharmacogenomics is to help, rather than exacerbate, disparities in depression treatment. Seven recommendations are offered to increase the likelihood that developments in pharmacogenomics will reduce disparities in depression treatment. (shrink)

Personalized medicine with its promise of developing interventions tailored to an individual's health need and genetically related response to treatment might seem a promising antidote to the documented underutilization of standard depression treatments by African Americans. In addition, understanding depression not merely in biochemical terms but also in genetic terms might seem to counter cultural beliefs and stigma that attach to depression when conceived as a mood or behavioral problem under an individual's control. After all, if there is one thing (...) for which a person is not responsible and cannot be blamed, it is her genes. Nevertheless, for multiple reasons, a personalized medical approach to depression treatment, and its attendant conceptualization of depression and treatment response as genetically influenced, present the risk of exacerbating well-documented disparities in access to, and utilization of, treatment for depression among African-American and Caucasian elderly adults. (shrink)

Recent magnetic resonance imaging and pathological studies have indicated that axonal loss is a major contributor to disease progression in multiple sclerosis. 1 H magnetic resonance spectroscopy, through measurement of N -acetyl aspartate, a neuronal marker, provides a unique tool to investigate this. Patients with primary progressive multiple sclerosis have few lesions on conventional MRI, suggesting that changes in normal appearing white matter, such as axonal loss, may be particularly relevant to disease progression in this group. To test this hypothesis (...) NAWM was studied with MRS, measuring the concentration of N -acetyl derived groups. Single-voxel MRS using a water-suppressed PRESS sequence was carried out in 24 patients with primary progressive multiple sclerosis and in 16 age-matched controls. Ratios of metabolite to creatine concentration were calculated in all subjects, and absolute concentrations were measured in 18 patients and all controls. NA/Cr was significantly lower in NAWM in patients than in controls, as was the absolute concentration of NA. There was no significant difference in the absolute concentration of creatine between the groups. This study supports the hypothesis that axonal loss occurs in NAWM in primary progressive multiple sclerosis and may well be a mechanism for disease progression in this group. (shrink)

Julian Savulescu argues for two principles of reproductive ethics: reproductive autonomy and procreative beneficence, where the principle of procreative beneficence is conceptualised in terms of a duty to have the child, of the possible children that could be had, who will have the best opportunity of the best life. Were it to be accepted, this principle would have significant implications for the ethics of reproductive choice and, in particular, for the use of prenatal testing and other reproductive technologies for the (...) avoidance of disability, and for enhancement. In this paper, it is argued that this principle should be rejected, and it is concluded that while potential parents do have important obligations in relation to the foreseeable lives of their future children, these obligations are not best captured in terms of a duty to have the child with the best opportunity of the best life. (shrink)

According to an adequacy-for-purpose view, models should be assessed with respect to their adequacy or fitness for particular purposes. Such a view has been advocated by scientists and philosophers...

In lieu of an abstract, here is a brief excerpt of the content:Overcoming Greed:An Eastern Christian Perspective1Valerie A. KarrasAs an Eastern Orthodox Christian, I have chosen to approach the topic of "overcoming greed" from an Eastern Christian perspective, relying particularly on the writings of some of the early theologians of the Greek East. It is not coincidental either that laissez-faire capitalism arose in the Western Christian world, or that the first strongholds of communism developed in Eastern European, traditionally Orthodox, countries. (...) Both phenomena speak to an intrinsic difference in the way in which human beings are conceived as relating to the world and to each other, both personally and communally.The traditional Eastern Christian model of the human person as not simply caretaker of creation, but fundamentally as a mediator uniting all aspects of creation in humanity's own nature,2 has led historically to a general lack of interest in exploiting creation (in fact, the worst environmental problems in the Orthodox world occurred in countries after they came under totalitarian communist domination). Similarly, the Eastern Orthodox emphasis on the relational, and even communal, nature of salvation created an environment hostile to the individualist, exploitative model upon which modern Western economics has been founded (this has been rapidly changing in post-communist Eastern European countries and Russia, however).The Eastern Church identifies this phenomenon of exploitative and abusive relationships toward nature and other persons as a consequence of the fallen condition of humanity, that is, humanity as it currently exists, in a state where our natural communion with God has been ruptured. In this context, Christianity in general and Eastern Christianity in particular recognize greed as one of the passions (equivalent to what Buddhism describes as "cravings") that are part of our fallen human nature, a consequence of our separation from God. Some of the passions are primarily physical in nature, others emotional or psychic, but in fact virtually all passions are a combination of the two.Greed, a passion of both soul and body that is endemic to our current existence, is typical of this understanding. There are two aspects to the vice of greed: (1) the emotional or spiritual dimension, that is, the acquisitive lust that usually betokens either a deep-seated insecurity or, worse, a desire for power and control; and (2) the [End Page 47] external, physical manifestations of greed in the actual acquisition of things, often to the detriment or exploitation of others. Eastern Christian writings attempt to work on both dimensions of the passion of greed, especially the spiritual, while often distinguishing between greed (a moral vice) and wealth (an amoral condition).This article will focus on two early church theologians, Clement of Alexandria and John Chrysostom. In particular, it will focus on their biblical exegeses of two pertinent New Testament passages: Jesus' conversation with a young righteous scholar of the Mosaic Law and the parable of Lazarus and the rich man, respectively. Finally, I will suggest that, for Orthodox Christians, an important key to overcoming greed is disciplined asceticism, to be practiced by all persons and not simply by monks and nuns. Asceticism—the exercise of control over the passions through fasting, prayer, chastity (understood differently for married and unmarried persons), and almsgiving—is the vehicle by which to cultivate an attitude of apatheia or passionlessness, the Christian equivalent of the Buddhist ideal of detachment.Clement was a philosopher-theologian who headed the great Christian catechetical school in Alexandria in the late second century C.E. In his treatise Who IstheRich ManWhoWill Be Saved? 3 Clement mused on the spiritual and soteriological dimensions of greed by reflecting on Jesus' encounter with the wealthy young "lawyer," that is, scholar of the Mosaic Law, who questioned Jesus on how to acquire eternal life. In his response, the young man showed himself righteous in his adherence to the demands of the law, but ultimately unwilling to commit all of himself by giving away his property, even though Jesus said that it was the price to inherit eternal life.Clement pondered whether it were therefore possible for anyone wealthy to be saved, given Jesus' declaration that "it is easier for a camel to go through the eye of a needle than for a rich man... (shrink)

Clinical geneticists are increasingly confronted with ethical tensions between their responsibilities to individual patients and to other family members. This paper considers the ethical implications of a “familial” conception of the clinical genetics role. It argues that dogmatic adherence to either the familial or to the individualistic conception of clinical genetics has the potential to lead to significant harms and to fail to take important obligations seriously.Geneticists are likely to continue to be required to make moral judgments in the resolution (...) of such tensions and may find it useful to have access to ethics training and support. (shrink)

The development of human genetics raises a wide range of important ethical questions for us all. The interpersonal dimension of genetic information in particular means that genetics also poses important challenges to the idea of patient-centredness and autonomy in medicine. How ought practical ethical decisions about the new genetics be made given that we appear, moreover, no longer to be able to appeal to unquestioned traditions and widely shared communitarian values? This paper argues that any coherent ethical approach to these (...) questions must be able both to uphold the moral status of the individual and at the same time recognise the communitarian, interpersonal dimensions both of the world in which we live and of personal autonomy itself. The paper then goes on to propose an approach to the resolution of the ethical questions raised by the use of the new genetics in reproductive choice through the development of a coherent and principled process of public reason and justification oriented towards the support and development of personal autonomy. (shrink)

One hundred and three participants solved conflict and non-conflict versions of four reasoning tasks using a two-response procedure: a base rate task, a causal reasoning task, a denominator neglect task, and a categorical syllogisms task. Participants were asked to give their first, intuitive answer, to make a Feeling of Rightness judgment, and then were given as much time as needed to rethink their answer. They also completed a standardized measure of IQ and the actively open-minded thinking questionnaire. The FORs of (...) both high- and low-capacity reasoners were responsive to conflict, such that FORs were lower for conflict relative to non-conflict problems. Consistent with the quantity hypothesis, high-capacity reasoners made a greater distinction between conflict and non-conflict items on measures of Type 2 thinking, namely, rethinking time and probability of changing answers. In contrast to the quality hypothesis, however, this rethinking time did not advantage the ability of the high-capacity group to produce normative answers, except for the base rate task. Indeed, we observed that the correlation between capacity and the probability of normative answers emerged at the initial response, rather than after rethinking. (shrink)

Can computer simulation results be evidence for hypotheses about real-world systems and phenomena? If so, what sort of evidence? Can we gain genuinely new knowledge of the world via simulation? I argue that evidence from computer simulation is aptly characterized as higher-order evidence: it is evidence that other evidence regarding a hypothesis about the world has been collected. Insofar as particular epistemic agents do not have this other evidence, it is possible that they will gain genuinely new knowledge of the (...) world via simulation. I illustrate with examples inspired by uses of simulation in meteorology and astrophysics. (shrink)

Newton published his deduction of universal gravity in Principia (first ed., 1687). To establish the universality (the particle-to-particle nature) of gravity, Newton must establish the additivity of mass. I call ‘additivity’ the property a body's quantity of matter has just in case, if gravitational force is proportional to that quantity, the force can be taken to be the sum of forces proportional to each particle's quantity of matter. Newton's argument for additivity is obscure. I analyze and assess manuscript versions of (...) Newton's initial argument within his initial deduction, dating from early 1685. Newton's strategy depends on distinguishing two quantities of matter, which I call ‘active’ and ‘passive’, by how they are measured. These measurement procedures frame conditions on the additivity of each quantity so measured. While Newton has direct evidence for the additivity of passive quantity of matter, he does not for that of the active quantity. Instead, he tries to infer the latter from the former via conceptual analyses of the third law of motion grounded largely on analogies to magnetic attractions. The conditions needed to establish passive additivity frustrate Newton's attempted inference to active additivity. (shrink)

The internet is becoming increasingly important in health care practice. The number of health-related web sites is rising exponentially as people seek health-related information and services to supplement traditional sources, such as their local doctor, friends, or family. The development of e-medicine poses important ethical challenges, both for health professionals and for those who provide clinical ethics support for them. This paper describes some of these challenges and explores some of the ways in which those who provide clinical ethics support (...) might respond creatively to them. By offering ways of responding to such challenges, both electronically and face-to-face, the providers of clinical ethics support can show themselves to be an indispensable part of good quality health care provision. (shrink)

A probability distribution is regular if it does not assign probability zero to any possible event. While some hold that probabilities should always be regular, three counter-arguments have been posed based on examples where, if regularity holds, then perfectly similar events must have different probabilities. Howson and Benci et al. have raised technical objections to these symmetry arguments, but we see here that their objections fail. Howson says that Williamson’s “isomorphic” events are not in fact isomorphic, but Howson is speaking (...) of set-theoretic representations of events in a probability model. While those sets are not isomorphic, Williamson’s physical events are, in the relevant sense. Benci et al. claim that all three arguments rest on a conflation of different models, but they do not. They are founded on the premise that similar events should have the same probability in the same model, or in one case, on the assumption that a single rotation-invariant distribution is possible. Having failed to refute the symmetry arguments on such technical grounds, one could deny their implicit premises, which is a heavy cost, or adopt varying degrees of instrumentalism or pluralism about regularity, but that would not serve the project of accurately modelling chances. (shrink)

Simulation-based weather and climate prediction now involves the use of methods that reflect a deep concern with uncertainty. These methods, known as ensemble prediction methods, produce multiple simulations for predictive periods of interest, using different initial conditions, parameter values and/or model structures. This paper provides a non-technical overview of current ensemble methods and considers how the results of studies employing these methods should be interpreted, paying special attention to probabilistic interpretations. A key conclusion is that, while complicated inductive arguments might (...) be given for the trustworthiness of probabilistic weather forecasts obtained from ensemble studies, analogous arguments are out of reach in the case of long-term climate prediction. In light of this, the paper considers how predictive uncertainty should be conveyed to decision makers. (shrink)

Spelling out in detail what we do and do not know about phenomenological experience, this book denies the common view of consciousness as a central decision...

As an application of his Material Theory of Induction, Norton (2018; manuscript) argues that the correct inductive logic for a fair infinite lottery, and also for evaluating eternal inflation multiverse models, is radically different from standard probability theory. This is due to a requirement of label independence. It follows, Norton argues, that finite additivity fails, and any two sets of outcomes with the same cardinality and co-cardinality have the same chance. This makes the logic useless for evaluating multiverse models based (...) on self-locating chances, so Norton claims that we should despair of such attempts. However, his negative results depend on a certain reification of chance, consisting in the treatment of inductive support as the value of a function, a value not itself affected by relabeling. Here we define a purely comparative infinite lottery logic, where there are no primitive chances but only a relation of ‘at most as likely’ and its derivatives. This logic satisfies both label independence and a comparative version of additivity as well as several other desirable properties, and it draws finer distinctions between events than Norton's. Consequently, it yields better advice about choosing between sets of lottery tickets than Norton's, but it does not appear to be any more helpful for evaluating multiverse models. Hence, the limitations of Norton's logic are not entirely due to the failure of additivity, nor to the fact that all infinite, co-infinite sets of outcomes have the same chance, but to a more fundamental problem: We have no well-motivated way of comparing disjoint countably infinite sets. (shrink)

Despite the lack of evidence for their effectiveness, the use of physical restraints for patients is widespread. The best ethical justification for restraining patients is that it prevents them from harming themselves. We argue that even if the empirical evidence supported their effectiveness in achieving this aim, their use would nevertheless be unethical, so long as well known exceptions to informed consent fail to apply. Specifically, we argue that ethically justifiable restraint use demands certain necessary and sufficient conditions. These conditions (...) are that the physician obtain informed consent for their application, that their application be medically appropriate, and that restraints be the least liberty-restricting way of achieving the intended benefit. It is a further question whether their application is ever medically appropriate, given the dearth of evidence for their effectiveness. (shrink)

Allan Franklin has identified a number of strategies that scientists use to build confidence in experimental results. This paper shows that Franklin's strategies have direct analogues in the context of computer simulation and then suggests that one of his strategies—the so-called 'Sherlock Holmes' strategy—deserves a privileged place within the epistemologies of experiment and simulation. In particular, it is argued that while the successful application of even several of Franklin's other strategies (or their analogues in simulation) may not be sufficient for (...) justified belief in results, the successful application of a slightly elaborated version of the Sherlock Holmes strategy is sufficient. (shrink)

A clinical ethics consultant may, at times, be called upon to make independent substantive moral judgments and then offer justifications for those judgments. A CEC does not act unprofessionally by utilizing background beliefs that are religious in nature to justify those judgments. It is important, however, for a CEC to make such judgments authentically and, when asked, to offer up one’s reasons for why one believes the judgment is true in a transparent fashion.

Purpose– The purpose of this paper is to develop a conceptual framework to contextualize young people’s lived experiences of privacy and invasion online. Social negotiations in the construction of privacy boundaries are theorized to be dependent on individual preferences, abilities and context-dependent social meanings.Design/methodology/approach– Empirical findings of three related Ottawa-based studies dealing with young people’s online privacy are used to examine the benefits of online publicity, what online privacy means to young people and the social importance of privacy. Earlier philosophical (...) discussions of privacy and identity, as well as current scholarship, are drawn on to suggest that privacy is an inherently social practice that enables social actors to navigate the boundary between self/other and between being closed/open to social interaction.Findings– Four understandings of privacy’s value are developed in concordance with recent privacy literature and our own empirical data: privacy as contextual, relational, performative and dialectical.Social implications– A more holistic approach is necessary to understand young people’s privacy negotiations. Adopting such an approach can help re-establish an ability to address the ways in which privacy boundaries are negotiated and to challenge surveillance schemes and their social consequences.Originality/value– Findings imply that privacy policy should focus on creating conditions that support negotiations that are transparent and equitable. Additionally, policy-makers must begin to critically evaluate the ways in which surveillance interferes with the developmental need of young people to build relationships of trust with each other and also with adults. (shrink)

We aim to establish the following claim: other factors held constant, the relative weights of the epistemic burdens of competing treatment options serve to determine the options that patient surrogates pursue. Simply put, surrogates confront an incentive, ceteris paribus, to pursue treatment options with respect to which their knowledge is most adequate to the requirements of the case. Regardless of what the patient would choose, options that require more knowledge than the surrogate possesses (or is likely to learn) will either (...) be neglected altogether or deeply discounted in the surrogate’s incentive structure. We establish this claim by arguing that the relation between epistemic burdens and incentives in decision-making is a general feature of surrogate decision-making. After establishing the claim, we draw out some of the implications for surrogate decision-making in medicine and offer philosophical and psychological explanations of the phenomenon. (shrink)

As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that bear (...) a disproportionate burden of suffering in the allocation of the new potential treatment. This recommendation is justified not only for new drugs with uncertain effects, but also for drugs of certain benefit or vaccines. For states with significant health disparities, such as Michigan, this allocation priority may help to repair them. In fact, any other allocation strategy may make them worse. (shrink)

Healthcare systems need to consider not only how to prevent error, but how to respond to errors when they occur. In the United Kingdom’s National Health Service, one strand of this latter response is the ‘No Blame Culture’, which draws attention from individuals and towards systems in the process of understanding an error. Defences of the No Blame Culture typically fail to distinguish between blaming someone and holding them responsible. This article argues for a ‘responsibility culture’, where healthcare professionals are (...) held responsible in cases of foreseeable and avoidable errors. We demonstrate how healthcare professionals can justifiably be held responsible for their errors even though they work in challenging circumstances. We then review the idea of ‘responsibility without blame’, applying this to cases of error in healthcare. Sensitive to the undesirable effects of blaming healthcare professionals and to the moral significance of holding individuals accountable, we argue that a responsibility culture has significant advantages over a No Blame Culture due to its capacity to enhance patient safety and support medical professionals in learning from their mistakes, while also recognising and validating the legitimate sense of responsibility that many medical professionals feel following avoidable error, and motivating medical professionals to report errors. (shrink)

Religions often operate as comprehensive worldviews, attempting to answer the deepest existential questions that human beings can ask: Who am I? Where do I come from? Where am I going after I die? How should I live? Often ethical systems are embedded and justified within these broader narratives. Inevitably, the clinical ethics consultant will encounter and engage with religiously based ethical systems. In this issue, the authors reflect seriously and deeply on the implications of such engagement.

High-level theory is the view that high-level properties---the property of being a dog, being a tiger, being an apple, being a pair of lips, etc.---can be represented in perceptual experience. Low-level theory denies this and claims that high-level properties are only represented at the level of perceptual judgment and are products of cognitive interpretation of low-level sensory information (color, shape, illumination). This paper discusses previous attempts to establish high-level theory, their weaknesses, and an argument for high-level theory that does not (...) have these weaknesses. (shrink)

It is important to separate the question of binding from the problem of consciousness. Undoubtedly, there are some close connections between the two: my conscious experience is of a bound unity. But my unconscious experiences -- subliminal impressions, masked primings, etc. -- might be bound too for all I know. Hence, some of the recent commentators speak too loosely when they talk of 40 Hz oscillations solving some problem of conscious perception.

In Sisyphus's Boulder, Eric Dietrich and Valerie Hardcastle argue that we will never get such a theory because consciousness has an essential property that..

In a recent issue of Bioethics, I argued that compulsory moral bioenhancement should be administered covertly. Alexander Zambrano has criticized this argument on two fronts. First, contrary to my claim, Zambrano claims that the prevention of ultimate harm by covert moral bioenhancement fails to meet conditions for permissible liberty‐restricting public health interventions. Second, contrary to my claim, Zambrano claims that covert moral bioenhancement undermines autonomy to a greater degree than does overt moral bioenhancement. In this paper, I rebut both of (...) these arguments, then finish by noting important avenues of research that Zambrano’s arguments motivate. (shrink)

In this essay, I hope to make clearer what the points of division between the materialists and the sceptics are. I argue that the rifts are quite deep and turn on basic differences in understanding the scientific enterprise. In section I, I outline the disagreements between David Chalmers and me, arguing that consciousness is not a brute fact about the world. In section II, I point out the fundamental difference between the materialists and the sceptics, suggesting that this difference is (...) not something that further discussion or argumentation can overcome. In the final section, I outline one view of scientific explanation and conclude that the source of conflict really turns on a difference in the rules each side has adopted in playing the game. (shrink)

We consider an approach to some philosophical problems that I call the Method of Conceptual Articulation: to recognize that a question may lack any determinate answer, and to re-engineer concepts so that the question acquires a definite answer in such a way as to serve the epistemic motivations behind the question. As a case study we examine “Galileo’s Paradox”, that the perfect square numbers seem to be at once as numerous as the whole numbers, by one-to-one correspondence, and yet less (...) numerous, being a proper subset. I argue that Cantor resolved this paradox by a method at least close to that proposed—not by discovering the true nature of cardinal number, but by articulating several useful and appealing extensions of number to the infinite. Galileo was right to suggest that the concept of relative size did not apply to the infinite, for the concept he possessed did not. Nor was Bolzano simply wrong to reject Hume’s Principle (that one-to-one correspondence implies equal number) in the infinitary case, in favor of Euclid’s Common Notion 5 (that the whole is greater than the part), for the concept of cardinal number (in the sense of “number of elements”) was not clearly defined for infinite collections. Order extension theorems now suggest that a theory of cardinality upholding Euclid’s principle instead of Hume’s is possible. Cantor’s refinements of number are not the only ones possible, and they appear to have been shaped by motivations and fruitfulness, for they evolved in discernible stages correlated with emerging applications and results. Galileo, Bolzano, and Cantor shared interests in the particulate analysis of the continuum and in physical applications. Cantor’s concepts proved fruitful for those pursuits. Finally, Gödel was mistaken to claim that Cantor’s concept of cardinality is forced on us; though Gödel gives an intuitively compelling argument, he ignores the fact that Euclid’s Common Notion is also intuitively compelling, and we are therefore forced to make a choice. The success of Cantor’s concept of cardinality lies not in its truth (for concepts are not true or false), nor its uniqueness (for it is not the only extension of number possible), but in its intuitive appeal, and most of all, its usefulness to the understanding. (shrink)

Valérie Chevassus-Marchionni | : Le « cas » de Marie de la Trinité illustre d’une manière particulière la thématique « croyance et psychanalyse ». En effet, chez cette soeur dominicaine des campagnes, la foi religieuse et la croyance en sa vocation de dévotion interfèrent très étroitement avec l’expérience psychanalytique : d’une part, elle se prête pendant quatre années à une cure psychanalytique avec le docteur Jacques Lacan, d’autre part, elle exercera elle-même quelque temps la profession de psychothérapeute. Pour Marie de (...) la Trinité, la psychanalyse arrive à un moment critique de son existence, alors que ce qu’elle nomme ses « obsessions » lui rendent la vie impossible et lui interdisent même de pratiquer sa foi ; elle se tourne alors vers des traitements divers, parfois brutaux et inhumains. Ce n’est pas la psychanalyse qui la guérira, mais c’est à partir de cette expérience qu’il lui sera donné de triompher de son mal et, en comprenant quelle en était l’origine, d’entreprendre « sa propre rééducation » et de connaître « la lumière et l’harmonie » dans sa vie de dévotion. | : The case of Mary of the Trinity illustrates in a particular way the thematic of “belief and psychoanalysis”. Indeed, in this Dominican sister, a missionary in the country, religious faith and belief in her vocation of devotion closely interfere with psychoanalytical experience : on the one hand she undergoes a four year psychoanalytical cure with Doctor Jacques Lacan ; on the other hand she works for a while as a psychotherapeutist. For Mary of the Trinity psychoanalysis appears at a critical moment in her life, just as what she calls her “obsessions” make her life unbearable and even prevent her from practising her faith ; then she tries many different treatments, sometimes brutal and inhuman. Psychoanalysis won’t cure her, but thanks to this experience, she will overcome her pain and by understanding its origin will undertake “her own reeducation” and know “light and harmony” in her life of devotion. (shrink)

SummaryThis article documents understandings and responses to mass drug administration for the treatment and prevention of lymphatic filariasis among adults and children in northern coastal Tanzania from 2004 to 2011. Assessment of village-level distribution registers, combined with self-reported drug uptake surveys of adults, participant observation and interviews, revealed that at study sites in Pangani and Muheza districts the uptake of drugs was persistently low. The majority of people living at these highly endemic locations either did not receive or actively rejected (...) free treatment. A combination of social, economic and political reasons explain the low uptake of drugs. These include a fear of treatment ; divergence between biomedical and local understandings of lymphatic filariasis; and limited and ineffective communication about the rationale for mass treatment. Other contributory factors are the reliance upon volunteers for distribution within villages and, in some locations, strained relationships between different groups of people within villages as well as between local leaders and government officials. The article also highlights a disjuncture between self-reported uptake of drugs by adults at a village level and the higher uptake of drugs recorded in official reports. The latter informs claims that elimination will be a possibility by 2020. This gives voice to a broader problem: there is considerable pressure for those implementing MDA to report positive results. The very real challenges of making MDA work are pushed to one side – adding to a rhetoric of success at the expense of engaging with local realities. It is vital to address the kind of issues raised in this article if current attempts to eliminate lymphatic filariasis in mainland coastal Tanzania are to achieve their goal. (shrink)

I examine what happens in the brain when patients experience chronic pain and when subjects are addicted to alcohol. We can find important parallels between these two cases, and these parallels can perhaps point us toward new ways of treating (or at least understanding) both issues. Interestingly, we can understand both cases as our pleasure system gone awry. In brief, I argue that chronic pain and alcohol addiction both stem from a dysregulation in our brain’s reward structure. This dysregulation in (...) what should be our pleasure circuitry pushes individuals to behave in ways counterproductive to their needs and to feel unpleasant things. In other words, there is likely both something quite right and perhaps quite wrong about how some philosophers are thinking about pain as an evaluative state. I shall be arguing that pain is both hedonic and evaluative, though perhaps not in the ways they are imagining. (shrink)

In this reply, we provide an analysis of Alter et al. response to our earlier paper. In that paper, we reported difficulty in replicating Alter, Oppenheimer, Epley, and Eyre’s main finding, namely that a sense of disfluency produced by making stimuli difficult to perceive, increased accuracy on a variety of reasoning tasks. Alter, Oppenheimer, and Epley argue that we misunderstood the meaning of accuracy on these tasks, a claim that we reject. We argue and provide evidence that the tasks were (...) not too difficult for our populations and point out that in many cases performance on our tasks was well above chance or on a par with Alter et al.’s participants. Finally, we reiterate our claim that the distinction between answer fluency and perceptual fluency is genuine, and argue that Thompson et al. provided evidence that these are distinct factors that have different downstream effects on cognitive processes. (shrink)

Although research into the biosemiotic mechanisms underlying the purposeful behavior of brainless living systems is extensive, researchers have not adequately described biosemiosis among neurons. As the conscious use of signs is well-covered by the various fields of semiotics, we focus on subconscious sign action. Subconscious semiotic habits, both functional and dysfunctional, may be created and reinforced in the brain not necessarily in a logical manner and not necessarily through repeated reinforcement. We review literature that suggests hypnosis may be effective in (...) changing subconscious dysfunctional habits, and we offer a biosemiotic framework for understanding these results. If it has been difficult to evaluate any psychological approach, including hypnosis, this may be because contemporary neuroscience lacks a theory of the sign. We argue that understanding the fluid nature of representation in biological organisms is prerequisite to understanding the nature of the subconscious and may lead to more effective of treatments for dysfunctional habits developed through personal experience or culture. (shrink)

Can the view that medical science is more important than the individual properly persuade recruitment to trials? This paper considers the nature and interests of the person and their relationships to the concepts of science and society; and analyses a conception of value used to balance the interests of science and research subjects. The implications of arguments opposing the primacy of the individual are set out to indicate their implausibility; while the primacy principle is described to show its necessity in (...) any moral society. Finally, the importance of fully informed consent to participate is explained with the requirement that the individual human life provide the criteria of moral value for human life. (shrink)

Background: Research activities in sub-Saharan Africa may be limited to delegated tasks due to the strong control from Western collaborators, which could lead to scientific production of little value in terms of its impact on social and economic innovation in less developed areas. However, the current contexts of international biomedical research including the development of public-private partnerships and research institutions in Africa suggest that scientific activities are growing in sub-Saharan Africa. This study aims to describe the patterns of clinical research (...) activities at a sub-Saharan biomedical research center. Methods: In-depth interviews were conducted with a core group of researchers at the Medical Research Unit of the Albert Schweitzer Hospital from June 2009 to February 2010 in Lambarene, Gabon. Scientific activities running at the MRU as well as the implementation of ethical and regulatory standards were covered by the interview sessions. Results: The framework of clinical research includes transnational studies and research initiated locally. In transnational collaborations, a sub-Saharan research institution may be limited to producing confirmatory and late-stage data with little impact on economic and social innovation. However, ethical and regulatory guidelines are being implemented taking into consideration the local contexts. Similarly, the scientific content of studies designed by researchers at the MRU, if local needs are taken into account, may potentially contribute to a scientific production with long-term value on social and economic innovation in sub-Saharan Africa. Conclusion: Further research questions and methods in social sciences should comprehensively address the construction of scientific content with the social, economic and cultural contexts surrounding research activities. (shrink)

Brummett and Salter propose a useful and timely taxonomy of clinical ethics expertise (2019). As the field becomes further “professionalized” this taxonomy is important, and the core of it is right. It needs some refinement around the edges, however. In their conclusion, Brummett and Salter rightly point out that there is a significant difference between the ethicist whose recommendations are procedure- and process-heavy, consensus-driven, and dialogical and the authoritarian ethicist whose recommendations flow from “private moral views” (Brummett and Salter, 2019). (...) This admission doesn’t go far enough. Brummett and Salter’s taxonomy fails to capture the notion that offering recommendations whose normative force is moral is different in kind from recommendations whose normative force is non-moral, such as those recommendations that are free of moral content or justified by convention. The difference is in kind, not scale. I argue further that clinical ethics expertise, if possible, consists at least in offering recommendations whose normative force is moral. These two claims imply that the taxonomy fails to cut clinical ethics expertise at the joints: the ethicist who offers justified non-moral normative recommendations is a different kind of ethicist from the one who offers justified moral normative recommendations, yet both are categorized as clinical ethics experts. I finish by offering a refinement of the taxonomy that more precisely categorizes clinical ethicists. (shrink)

On the one hand, we think that our conscious perceptions are tied to some stage of whatever processing stream we have. On the other hand, we think that our conscious experiences have to resemble the computational states that instantiate them. However, nothing in our alleged stream resembles our experienced perceptions. Hence, a conflict. The question is: How can we go from what we know about neurons, their connections, and firing patterns, to explaining what conscious perceptual experiences are like? No intuitive (...) answer seems plausible. Our perceptual experiences are complex and unified; however, brains divide their processing tasks into small chunks and segregate those smaller pieces across the gray matter. In this essay, I conjecture that what corresponds to our visual perceptions are higher order patterns of bifurcation in an attractor phase space. If I am correct, then the problem of the explanatory gap in philosophy, the binding problem in psychology, and the problem of perception in neuroscience disappear. If the traditional computational perspective is wrong, and sensory processing is not piece-meal, step-wise, and segregated, then there is no need for something in the head to tie things together. (shrink)

Newly developed Bayesian perspectives on schizophrenia hold out the promise that a common underlying mechanism can account for many, if not all, of the positive symptoms of schizophrenia. If this is the case, then understanding how schizophrenic minds go awry could shine light on how healthy minds maintain a sense of self. This article investigates this Bayesian promise by examining whether the approach can indeed account for the difficulties with self-awareness experienced in schizophrenia. While I conclude that it cannot, I (...) nonetheless maintain that understanding how the self breaks down in schizophrenia tells us much about how and why the self functions in normal human circumstances. I proceed first by recounting in some detail a Bayesian interpretation of perception, schizophrenia, and self-awareness, as well as some of the empirical data supporting this interpretation, then by exploring aspects of schizophrenia that this approach leaves out. I conclude by discussing what the “left out” aspects tell us about self-awareness, thereby convincing the reader that studying patients with schizophrenia is indeed a useful avenue for understanding awareness of self. (shrink)

The sensation of will is not the same thing as the will itself any more than the sensation of hunger is the same thing as being devoid of nutrients. This is not a really surprising claim, but it is the only claim to which Wegner is entitled in his book.