In order to predict and explain behavior, one cannot specify the mental state of an agent merely by saying what information she possesses. Instead one must specify what information is available to an agent relative to various purposes. Specifying mental states in this way allows us to accommodate cases of imperfect recall, cognitive accomplishments involved in logical deduction, the mental states of confused or fragmented subjects, and the difference between propositional knowledge and know-how .

A conceptual framework for studying the role of global health partnerships (GHPs) in determining policy practices on access to medication is presented. Although GHPs are of a practical nature, they are implicitly theory informed. The narratives used by GHP partners in relating to access to medication have theoretical origins. Building on the theoretical literature on models and the notion of embodied knowledge found in science and technology studies, GHPs are conceptualized as models that mediate between theory and practice. (...) The proposed framework can be used to investigate the role of theory in the creation of GHP models and how the models shape global and national policy practices. A social constructivist approach is suggested as a suitable method for empirical analysis. (shrink)

In opposition to mainstream theory of mind approaches, some contemporary perceptual accounts of social cognition do not consider the central question of social cognition to be the problem of access to other minds. These perceptual accounts draw heavily on phenomenological philosophy and propose that others' mental states are “directly” given in the perception of the others' expressive behavior. Furthermore, these accounts contend that phenomenological insights into the nature of social perception lead to the dissolution of the access problem. (...) We argue, on the contrary, that the access problem is a genuine problem that must be addressed by any account of social cognition, perceptual or non-perceptual, because we cannot cast the access problem as a false problem without violating certain fundamental intuitions about other minds. We elaborate the fundamental intuitions as three constraints on any theory of social perception: the Immediacy constraint; the Transcendence constraint; and the Accessibility constraint. We conclude with an outline of an account of perceiving other minds that meets the three constraints. (shrink)

BackgroundIt has been argued that ethics review committees—e.g., Research Ethics Committees, Institutional Review Boards, etc.— have weaknesses in reviewing big data and artificial intelligence research. For instance, they may, due to the novelty of the area, lack the relevant expertise for judging collective risks and benefits of such research, or they may exempt it from review in instances involving de-identified data.Main bodyFocusing on the example of medical research databases we highlight here ethical issues around de-identified data sharing which motivate the (...) need for review where oversight by ethics committees is weak. Though some argue for ethics committee reform to overcome these weaknesses, it is unclear whether or when that will happen. Hence, we argue that ethical review can be done by data access committees, since they have de facto purview of big data and artificial intelligence projects, relevant technical expertise and governance knowledge, and already take on some functions of ethical review. That said, like ethics committees, they may have functional weaknesses in their review capabilities. To strengthen that function, data access committees must think clearly about the kinds of ethical expertise, both professional and lay, that they draw upon to support their work.ConclusionData access committees can undertake ethical review of medical research databases provided they enhance that review function through professional and lay ethical expertise. (shrink)

Pathology and laboratory medicine are a key component of a patient’s healthcare. From academic care centres, community hospitals, to clinics across the country, pathology data are a crucial component of patient care. But for much of the modern era, pathology and laboratory medicine have been absent from health policy conversations. Though select members in the field have advocated for an enhanced presence of these specialists in policy conversations, little work has been done to thoroughly evaluate the moral and ethical obligations (...) of the pathologist and the role they play in healthcare justice and access to care. In order to make any substantive improvements in access to care, pathology and laboratory medicine must have a seat at the table. Specifically, pathologists and laboratorians can assist in bringing about change through improving clinician test choice, continuing laboratory improvement programmes, promoting just advanced diagnostic distribution, triage testing and be good stewards of healthcare dollars, and recruiting a more robust laboratory workforce. In order to get to that point, much work has to be done in pathology education and the laboratory personnel training pipeline but there also needs to be adjustments at the system level to better involve this invaluable group of specialists in these policy conversations. (shrink)

Adolescent sexuality is one of the most important reproductive health issues that confronts healthcare professionals with moral dilemmas and legal issues. In this study, we aim to justify the at-risk adolescents’ regulations on access to key reproductive health services (KRHSs) based on principles of Islamic biomedical ethics and jurisprudence. Despite the illegitimacy and prohibition of sexuality for both girls and boys in Islamic communities, in this study, using 5 principles or universal rules of purpose; certainty, no-harm; necessity; and custom, (...) we argue that first, applying these principles in the context of the no-harm principle can provide the best interests of at-risk adolescents; second, it is permissible to provide KRHSs to these adolescents with their own assent, as long as necessary, only with the intention of preventing or reducing harm. In this framework, while preventing harm, it tries to provide the best interests of at-risk adolescent. Thus, the principle of no-harm requires that the government, by designating the responsibility to healthcare professionals, protects at-risk adolescents from harm, and obliges these professionals to choose and implement the option that best suits adolescents’ interests. (shrink)

Some might argue that a right to access information is problematic, as it requires too much from others. Being a "positive right," the possession of which foists upon others a duty to provide something, an RAI might be thought to contrast with a "negative right," such as the right not to be harmed. Here, other people have duties only to refrain from performing certain actions. The critics this paper is concerned with continue that positive rights are problematic, where negative (...) rights are not, since the former obligate people to do something, which is more taxing than obligating people not to do something. So according to a critic of RAIs, such rights are difficult, if not impossible, to justify.This paper takes no position on whether an RAI is positive or negative. It also does not argue whether positive rights can be justified or not. Instead, it argues that, if an RAI is positive, then so are intellectual property rights . This is significant, as critics of RAIs may hold to IPRs. . This paper argues against that one cannot reject an RAI on the basis of its being a positive right without also losing their justification for IPRs. If this is correct, then, proponents of intellectual property who reject an RAI must find independent justification for the former, which itself will not extend to the latter.This is good news for the defender of RAIs, since the sting is removed from one potential criticism thereof. If people have an RAI, this is not anymore burdensome than other rights currently in effect. (shrink)

Block shows that we can consciously see a scene without being able to identify all the individual items in it. But in itself this fails to drive a wedge between phenomenology and access. Once we distinguish scene phenomenology from item phenomenology, the link between phenomenology and access is restored.

In this article, I discuss a trivialization worry for Hartry Field’s official formulation of the access problem for mathematical realists, which was pointed out by Øystein Linnebo (and has recently been made much of by Justin Clarke-Doane). I argue that various attempted reformulations of the Benacerraf problem fail to block trivialization, but that access worriers can better defend themselves by sticking closer to Hartry Field’s initial informal characterization of the access problem in terms of (something like) general (...) epistemic norms of coincidence avoidance. (shrink)

Key Terms: Phenomenal consciousness, access consciousness, qualitative character, subjective character, intransitive self-consciousness, disposition, categorical basis, subliminal perception, blindsight.

Within bioethics as well as in broader clinical practice, support for transgender and gender‐questioning adolescent access to pubertal suppression has often relied heavily on the desire to prevent risky, self‐destructive, and suicidal behavior. We argue that framing justifications for access to puberty suppression in this way can actually be harmful to both individual patients as well as to the broader trans population. This justification for access to care makes such access precarious, limits its scope, and introduces (...) perverse incentives to the patient population that is being served. We go on to offer an alternative, positive defense of access to puberty‐blocking treatment for transgender youth grounded in the child's right to an open future. We argue that decisions related to pubertal suppression are both importantly weighty and potentially irreversible, and show why this justification is preferable to so‐called “informed consent” approaches. (shrink)

Does perceptual consciousness require cognitive access? Ned Block argues that it does not. Central to his case are visual memory experiments that employ post-stimulus cueing—in particular, Sperling's classic partial report studies, change-detection work by Lamme and colleagues, and a recent paper by Bronfman and colleagues that exploits our perception of ‘gist’ properties. We argue contra Block that these experiments do not support his claim. Our reinterpretations differ from previous critics' in challenging as well a longstanding and common view of (...) visual memory as involving declining capacity across a series of stores. We conclude by discussing the relation of probabilistic perceptual representations and phenomenal consciousness. (shrink)

Countries that abolished donor anonymity have imposed age limits for access to certain types of information by donor offspring. In the UK and the Netherlands, a debate has started on whether these age limits should be lowered or abolished all together. This article presents some arguments against lowering the age limits as a general rule for all donor children. The focus is on whether one should give a child the right to obtain the identity of the donor at an (...) earlier age than is presently stipulated. The first argument is that there is no evidence that a change in age will increase the total well-being of the donor offspring as a group. The second argument stresses that the rights language used for the donor-conceived child isolates the child from his or her family and this is unlikely to be in the best interest of the child. Finally, lowering the age limit reintroduces the genetic father in the family and expresses the bionormative ideology that contradicts gamete donation as a practice. (shrink)

Allocating access to unapproved COVID-19 drugs available via Pre-Approval Access pathways or Emergency Use Authorization raises unique challenges at the intersection of clinical care and research....

The problems of access—retrieving linguistic structure from some mental grammar —and disambiguation—choosing among these structures to correctly parse ambiguous linguistic input—are fundamental to language understanding. The literature abounds with psychological results on lexical access, the access of idioms, syntactic rule access, parsing preferences, syntactic disambiguation, and the processing of garden‐path sentences. Unfortunately, it has been difficult to combine models which account for these results to build a general, uniform model of access and disambiguation at the (...) lexical, idiomatic, and syntactic levels. For example, psycholinguistic theories of lexical access and idiom access and parsing theories of syntactic rule access have almost no commonality in methodology or coverage of psycholinguistic data. This article presents a single probabilistic algorithm which models both the access and disambiguation of linguistic knowledge. The algorithm is based on a parallel parser which ranks constructions for access, and interpretations for disambiguation, by their conditional probability. Low‐ranked constructions and interpretations are pruned through beam‐search; this pruning accounts, among other things, for the garden‐path effect. I show that this motivated probabilistic treatment accounts for a wide variety of psycholinguistic results, arguing for a more uniform representation of linguistic knowledge and for the use of probabilistically‐enriched grammars and interpreters as models of human knowledge of and processing of language. (shrink)

BackgroundIn June 2019, the Australian state of Victoria joined the growing number of jurisdictions around the world to have legalised some form of voluntary assisted dying. A discourse of safety was prominent during the implementation of the Victorian legislation.Main textIn this paper, we analyse the ethical relationship between legislative “safeguards” and equal access. Drawing primarily on Ruger’s model of equal access to health care services, we analyse the Victorian approach to voluntary assisted dying in terms of four dimensions: (...) horizontal equity, patient agency, high quality care, and supportive social norms. We argue that some provisions framed as safeguards in the legislation create significant barriers to equal access for eligible patients.ConclusionsWhile safety is undoubtedly ethically important, we caution against an overemphasis on safeguarding in voluntary assisted dying legislation given the implications for equal access. (shrink)

Engaging communities in community-based health research is increasingly being adopted in low- and middle-income countries. The use of community advisory boards is one method of practicing community involvement in health research. To date, few studies provide in-depth accounts of the strategies that CAB members use to practice community engagement. We assessed the perspectives, experiences and practices of the first local CAB in Eswatini, which was implemented as part of the MaxART Early Access to ART for All study. Trained Swazi (...) research assistants conducted two focus group discussions and 13 semi-structured interviews with CAB members who had been part of the MaxART study for at least 2.5 years. Interviews explored CAB composition and recruitment, the activities of CAB members, the mechanisms used to engage with communities and the challenges they faced in their role. The MaxART CAB played an active role in the implementation of the Early Access to Art for All study, and activities mainly focused on: promoting ethical conduct, in particular privacy, consent and confidentiality; communication and education, communicating about the study and educating the community on the benefits of HIV testing and early access to HIV treatment; and liaising between the community and the research team. Strategies for interacting with communities were varied and included attending general community meetings, visiting health facilities and visiting public places such as cattle dipping tanks, buses, bars and churches. Differences in the approach to community engagement between CAB members living in the study areas and those residing outside were identified. The experiences of the first CAB in Eswatini demonstrate that community engagement using CABs is a valuable mechanism for engaging communities in implementation studies. Considerations that could impact CAB functioning include clearly defining the scope of the CAB, addressing issues of CAB independence, the CAB budget, providing emotional support for CAB members, and providing continuous training and capacity building. These issues should be addressed during the early stages of CAB formation in order to optimize functioning. (shrink)

Luck egalitarianism provides a reason to object to conditionality in health incentive programmes in some cases when conditionality undermines political values such as solidarity or inclusiveness. This is the case with incentive programmes that aim to restrict access to essential healthcare services. Such programmes undermine solidarity. Yet, most people's lives are objectively worse, in one respect, in non-solidary societies, because solidarity contributes both instrumentally and directly to individuals' well-being. Because solidarity is non-excludable, undermining it will deprive both the prudent (...) and the imprudent citizens of its goods. Thereby, undermining solidarity can make prudent citizens worse off than they would have otherwise been, out of no fault or choice of their own, but rather as a result of somebody else's imprudent choice. This goes against the spirit of luck egalitarianism. Therefore (luck egalitarian) justice can require us to save the imprudent and avoid conditionality in access to essential healthcare services. (shrink)

Patient online record access (ORA) is spreading worldwide, and in some countries, including Sweden, and the USA, access is advanced with patients obtaining rapid access to their full records. In the UK context, from 31 October 2023 as part of the new NHS England general practitioner (GP) contract it will be mandatory for GPs to offer ORA to patients aged 16 and older. Patients report many benefits from reading their clinical records including feeling more empowered, better understanding (...) and remembering their treatment plan, and greater awareness about medications including possible adverse effects. However, a variety of indirect evidence suggests these benefits are unlikely to accrue without supplementation from internet-based resources. Using such routes to augment interpretation of the data and notes housed in electronic health records, however, comes with trade-offs in terms of exposing sensitive patient information to internet corporations. Furthermore, increased work burdens on clinicians, including the unique demands of ORA, combined with the easy availability and capability of a new generation of large language model (LLM)-powered chatbots, create a perfect collision course for exposing sensitive patient information to private tech companies. This paper surveys how ORA intersects with internet associated privacy risks and offers a variety of multilevel suggestions for how these risks might be better mitigated. (shrink)

Starting from Marr's ideas about levels of explanation, a theory of the data structures and access processes in human memory is demonstrated on 10 tasks. Functional characteristics of human memory are captured implementation-independently. Our theory generates a multidimensional task classification subsuming existing classifications such as the distinction between tasks that are implicit versus explicit, data driven versus conceptually driven, and simple associative (two-way bindings) versus higher order (threeway bindings), providing a broad basis for new experiments. The formal language clarifies (...) the binding problem in episodic memory, the role of input pathways in both episodic and semantic (lexical) memory, the importance of the input set in episodic memory, and the ubiquitous calculation of an intersection in theories of episodic and lexical access. (shrink)

State violence against disabled people and Indigenous people as well as disabled Indigenous people has long been endemic in the US. Recent scholarship in philosophy of disability and disability studies rarely addresses the underlying issue that causes such state violence: settler-colonial conceptions of land. The aim of this article is to begin filling this gap in the literature. We detail settler colonial epistemologies and argue that the property relation underwrites operative concepts of accessibility dominant across disability theory. We show how (...) such concepts of accessibility are Lockean and thereby defined terms of the project of settler colonialism. We instead offer an Indigenized account of access, which we term deep access, that does not rely on the notion of Lockean property and that provides a coalitional path for Indigenous futures and disability justice. On our account, decolonization is and must be a deep access measure. (shrink)

In the name of safeguarding public interests and ethical principles, China’s National Health Commission bans unmarried women from using assisted reproductive technology (ART), including egg freezing. Supported by local governments, the ban has restricted single women’s reproductive rights nationwide. Although some courts bypassed the ban to allow widowed single women to use ART, they have not adopted a position in favour of single women’s reproductive autonomy, but quite the contrary. Faced with calls to relax the ban and allow single women (...) to freeze eggs electively, the National Health Commission refused to amend their policy, partly to protect women’s well-being paternalistically and partly to implement the central government’s policies to boost the birthrate and maintain traditional family structures. While the government’s concerns about elective egg freezing are not entirely unfounded, they have failed to demonstrate that banning single women’s egg freezing is a suitable, necessary and proportionate means to safeguard societal interests and ethical principles. The authority’s assumptions that women cannot make rational decisions for their health even with adequate informed consent procedures, that banning egg freezing by single women promotes a culture of having children ‘at a proper age’, and that egg freezing by single women offends China’s public moralities have not been substantiated. (shrink)

Block [Block, N. . Two neural correlates of consciousness. Trends in Cognitive Science, 9, 46–52] and Snodgrass claim that a signal detection theory analysis of qualitative difference paradigms, in particular the exclusion failure paradigm, reveals cases of phenomenal consciousness without access consciousness. This claim is unwarranted on several grounds. First, partial cognitive access rather than a total lack of cognitive access can account for exclusion failure results. Second, Snodgrass’s Objective Threshold/Strategic model of perception relies on a problematic (...) ‘enable’ approach to perception that denies the possibility of intentional control of unconscious perception and any effect of following different task instructions on the presence/absence of phenomenal consciousness. Many of Block’s purported examples of phenomenal consciousness without cognitive access also rely on this problematic approach. Third, qualitative difference paradigms may index only a subset of access consciousness. Thus, qualitative difference paradigms like exclusion failure cannot be used to isolate phenomenal consciousness, any attempt to do so still faces serious methodological problems. (shrink)

In 2007, the Ethics and Governance Council of the UK Biobank commissioned a Report on ‘Concepts of Public Good and Pubic Interest in Access Policies’. This study considered the Biobank’s role as a ‘public good’ in respect to supporting and promoting health throughout society. However, the conditions under which access by third parties to UK Biobank are justified in the public interest have not been well considered. In this article, I propose to analyse the conditions that should allow (...) such access. My argument develops UK Biobank’s function as a ‘public good’ and in terms of its responsibilities as a public health institution; both to protect the rights of the participants and in having a role in reinforcing public goals. Although these two tasks may conflict, it is possible that resolute opposition to some third-party access demands—if properly justified in terms of a public interest—will be damaging to, rather than protective of, participants’ rights. To illustrate my argument, I consider the appropriate response to an extraordinary public emergency , such as a serious criminal investigation or disaster response, in terms of an ethical access policy. (shrink)

Abstract:Although the idea of intellectual property (IP) rights—proprietary rights to what one invents, writes, paints, composes or creates—is firmly embedded in Western thinking, these rights are now being challenged across the globe in a number of areas. This paper will focus on one of these challenges: government-sanctioned copying of patented drugs without permission or license of the patent owner in the name of national security, in health emergencies, or life-threatening epidemics. After discussing standard rights-based and utilitarian arguments defending intellectual property (...) we will present another model. IP is almost always a result of a long history of scientific or technological development and numbers of networks of creativity, not the act of a single person or a group of people at one moment in time. Thus thinking about and evaluating IP requires thinking about IP as shared rights. A network approach to IP challenges a traditional model of IP. It follows that the owner of those rights has some obligations to share that information or its outcomes. If that conclusion is applied to the distribution of antiretroviral drugs, what pharmaceutical companies are ethically required to do to increase access to these medicines in the developing world will have to be reanalyzed from a more systemic perspective. (shrink)

Adolescents may often have opinions about whether they want genetic and genomic testing in both the clinic and research and about who should have access to the results. This legal analysis demonstrates that the law provides very little protection to minors' wishes.

Rational agents base their actions on information from observation, inference, introspection, or other sources. But this information comes in different kinds, and it is usually handled by different logical mechanisms. We discuss how to integrate external ‘updating information’ and internal ‘elucidating information’ into one system of dynamic epistemic logic, by distinguishing two basic informational actions: ‘bare seeing’ versus ‘conscious realization’.

European Journal of Philosophy, EarlyView.

ChatGPT – a large language model – recently passed the U.S. bar exam. The startling rise and power of generative artificial intelligence (AI) systems such as ChatGPT lead us to consider whether and how more specialized systems could be used to overcome existing barriers to the legal system. Such systems could be employed in either of the two major stages of the pursuit of justice: preliminary information gathering and formal engagement with the state’s legal institutions and professionals. We focus on (...) the former and argue that developing and deploying publicly funded AI legal advisors can reduce economic and shame-based cultural barriers to the information-gathering stage of pursuing justice. (shrink)

The Constitution of the World Health Organization affirms that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.” The Universal Declaration of Human Rights lays the foundations for the international framework for the right to health. This human right is now codified in numerous national constitutions, as well as legally binding international human rights treaties, such as the International Covenant on Economic, Social and Cultural Rights.Although medical care and access (...) to medicines are vital features of the right to health, almost two billion people lack access to essential medicines, leading to immense avoidable suffering. Improving access to essential medicines could save 10 million lives each year, four million of them in Africa and South-East Asia alone. Gross inequity is a shocking feature of the world pharmaceutical situation. (shrink)

Mathematical knowledge and moral knowledge (or normative knowledge more generally) can seem intuitively puzzling in similar ways. For example, taking apparent human knowledge of either domain at face value can seem to require accepting that we benefited from some massive and mysterious coincidence. In the mathematical case, a pluralist partial response to access worries has been widely popular. In this paper, I will develop and address a worry, suggested by some works in the recent literature like (Clarke-Doane, 2020 ), (...) that connections between ought facts and action prevent us from giving a similarly pluralist response to moral access worries. (shrink)

Surveys different potential normative underpinnings of neurodiversity-related access claims, focusing both on their legitimacy and the adjudication of conflicts between them.

Medical assistance in dying (MAiD) in Canada is a complex, novel interprofessional practice governed by stringent legal criteria. Often, patients need assistance navigating the system, and MAiD providers/assessors struggle with the administrative challenges of MAiD. Resultantly, the role of the MAiD care coordinator has emerged across the country as a novel practice dedicated to supporting access to MAiD and ensuring compliance with regulatory requirements. However, variability in the roles and responsibilities of MAiD care coordinators across Canada has highlighted the (...) need for accountability and standardization for this practice. This manuscript constitutes a first attempt to describe this emerging role, through discussion of proposed standards of practice, as well as roles and responsibilities, and ethical duties of this emergent professional practice. We detail the core commitments of MAiD care coordinators to patients, providers/assessors and institutions involved in the MAiD process. We address the core competencies that inform the unique skillset required by MAiD care coordinators to facilitate high-quality care, while highlighting the moral and ethical considerations embedded in this work. To illustrate the complexity of the MAiD care coordinator role, case examples involving ethical dilemmas encountered in practice are included. Finally, a code of ethics is proposed to serve as a guide for appropriate professional practice and conduct. This manuscript is intended to illustrate the importance of transparency and accountability for this new role that provides service to vulnerable patients and families; this is especially critical as the ethical complexity of MAiD is likely to increase with future changes in legislation opening MAiD access to new populations. (shrink)

The current concern with reforming and regulating managed care under the general rubric of “patients' rights” has eclipsed the more fundamental need to legislate the human rights of those without adequate access to any healthcare. To characterize the regulatory activity as a “rights” movement inflates its moral dimension. The concept of “rights” carries a serious and powerful moral force that is currently inappropriately applied to the parochial concerns of a segment of the population privileged to have health insurance coverage. (...) By contrast, the language of “rights” refers to a high level of universality for the most rudimentary of human concerns. If there was a universal right to become a patient equal to other patients, a concept of patients' rights would have legitimacy. As it is, however, the central determinant of this “right” is how much the insurance policy costs and what is covered. To so diminish the meaning of “right” within the miasma of managed care is to lose sight of the real possibilities of applying a positive “right” to healthcare and, in the long run, is to diminish the ethics of healthcare. (shrink)

About thirty years ago, when the Internet started to be commercialised, access to the medium became a topic of research and debate. Up-to-date evidence about key predictors, such as age, is crucial because of the Internet's ever-changing nature and the challenges associated with gaining access to it. This paper aims to give an overview of New Zealand's Internet access trends and how they relate to age. It is based on secondary analysis of data from a larger online (...) panel survey with 1,001 adult respondents. The Chi-square test of independence and Cramer's V were used in the analysis. The study provides new evidence to understand the digital divide. Specifically, it uncovers a growing disparity in the quality of Internet connectivity. Even though fibre is the most common type of broadband connection at home, older adults are less likely to have it and more likely to use wireless broadband, which is a slower connection type. Additionally, a sizable majority of people in all age categories have favourable opinions on the Internet. Interestingly, this was more prevalent among older people, although they report an increased concern about the security of their personal information online. The implications of the results are discussed and some directions for future research are proposed. (shrink)

The overturn of Roe v. Wade has resulted in fewer rights and resources for people seeking abortion care, particularly in the South. The Hyde Amendment has historically restricted abortion access for those enrolled in Medicaid. We argue here that its guarantees of minimum abortion coverage should be leveraged to offset harms where possible.

The (B) case summarizes GSK’s response to pressures to increase access to essential medicines in developing countries and subsequent developments.