Purpose Prescription stimulant use as “cognitive enhancers” has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center. -/- Method Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was voluntary and (...) anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive. -/- Results Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/ energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%). -/- Conclusions Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., “cognitive enhancement”), educational quality, and patient safety or health care quality. (shrink)

Emerging data indicates the prevalence and increased use of pharmaceutical enhancements by young medical professionals. As pharmaceutical enhancements advance and become more readily available, it is imperative to consider their impact on medical professionals. If pharmaceutical enhancements augment a person’s neurological capacities to higher functioning levels, and in some situations having higher functioning levels of focus and concentration could improve patient care, then might medical professionals have a responsibility to enhance? In this paper, I suggest medical professionals may have a (...) responsibility to use pharmaceutical enhancements. In some situations, having higher functioning levels of focus and concentration is conducive to providing the best possible care to a patient. In these circumstances medical professionals should use pharmaceutical cognitive enhancements. I conclude by examining the limitations and implications of this responsibility in the practice of medicine and areas for future research. (shrink)

Discussions about the permissibility of students using enhancements in education are often framed by the question, “Is a student who uses cognitive-enhancing drugs cheating?” While the question of cheating is interesting, it is but only one question concerning the permissibility of enhancement in education. Another interesting question is, “What kinds of students do we want in our academic institutions?” I suggest that one plausible answer to this question concerns the ideals of human excellence or virtues. The students we want in (...) our academic institutions are virtuous or, at least minimally, possess certain virtues. I argue that a virtuous student may choose to use cognitive-enhancing drugs for reasons of self-improvement. That a virtuous student may choose to use cognitive-enhancing drugs for reasons of self-improvement illustrates that under certain conditions motivation can determine the permissibility of using enhancements. Building upon this I suggest a virtues-based institutional rule for governing and guiding student-use of cognitive enhancers in an academic institution to be for the right reasons. This ideals of human excellence or virtues approach offers interesting and unique insights for issues of enhancement in education, as it might turn out, that uneasiness many people have about students using cognitive-enhancing drugs has less to do with issues of enhancement and more to do with the motivations and character of students. (shrink)

In end-of-life care discussions, I contend that the distinction between “having a life” vs. “being alive” is an underutilized distinction. This distinction is significant in separating different states of existence conflated by patients, families, and clinicians. In the clinical setting, applying this distinction in end-of-life care discussions aids patients’ and family members’ decision-making by helping them understand that being alive can differ from having a life. Moreover, this distinction helps them decide which state may be the most important to them. (...) After applying this distinction to three complex cases, I respond to the likely objection that “having a life” vs. “being alive” is less accurate and more controversial than other distinctions. I conclude by arguing that “having a life” vs. “being alive” is more accurate and less controversial than distinctions between medically indicated vs. medically inappropriate treatments, personhood, and quantity vs. quality of life. (shrink)

Conducting “difficult conversations” with patients and caregivers is one of the most difficult aspects of the medical profession. These conversations can involve communicating a terminal prognosis, advance care planning, or changing the goals of treatment. Although they are challenging, the need for these conversations is underwritten by the tenets of medical ethics. Unfortunately, medical professionals lack adequate training in communication skills and overestimate their abilities in conducting difficult conversations. I suggest that one way to improve that ability would be the (...) strategic use of pharmaceutical neuroenhancements. Pharmaceutically augmenting a professional’s capacity for recognizing masked emotional expressions might conduce to his or her development of open and responsive communication with patients and caregivers. I conclude by examining the limitations and objections to this use of a communication enhancement by illustrating that it would still require the development of, and indeed a greater emphasis on, communication skills in medical education and training. (shrink)

Peterson, Karlawish, and Largent’s “Supported Decision Making with People at the Margins of Autonomy” not only elucidates the conceptual framework but also the practical importance of suppor...

Bryan Frances’s recent argument is for the epistemic position called Live Skepticism. The Live Skepticism Argument (LSA) attempts to establish a restricted set of skeptical conclusions. The LSA’s “skeptical hypotheses” are scientific and philosophical positions that are “live actual possibilities” in an intellectual community. In order to “rule out” live hypotheses, an expert must know them to be false. However, since these are live hypotheses in this expert’s intellectual community—endorsed by others who have parallel levels of knowledge, intelligence, and understanding—this (...) expert is unable to rule them out. Consistent with the LSA is the outcome that people not exposed to these live hypotheses can know what these experts cannot. However, in this paper, I defeat the LSA by developing and defending a counterexample that focuses on the phenomenon of genius testimony. Everyone, including the LSA’s proponent, can and should allow that expertise comes in degrees. While in many cases a person’s intelligence, understanding, and knowledge are parallel to others in the field, there are some who are extraordinary in their intelligence, understanding, and knowledge (geniuses). If an expert meets with a genius, it is possible that the genius provides this individual with beliefs that can rule out a skeptical hypothesis. Therefore, an expert can have knowledge, even if the skeptical hypothesis is live and endorsed by others who have parallel levels of knowledge, intelligence, and understanding. After providing this counterexample, I present three potential objections, and show how people can know global warming exists and that smoking does not give someone cancer. I conclude by defending this counterexample from a likely reply by proponents of the LSA involving luck and knowledge. (shrink)

In 1837 the German-born astronomer F. G. W. Struve published his famous catalogue of double stars. For Struve this was the culmination of 12 years' detailed observation of a class of celestial objects lying exclusively beyond the solar system; for historians of astronomy it poses the problem of explaining why the study of double stars became a significant part of astronomical endeavour, as it did, during the 1820s and 1830s. For, although Struve's interest was extreme, it was shared to a (...) lesser extent by several eminent contemporaries, including John Herschel, Friedrich Bessel, Johann Encke, James South and Félix Savary. Their combined efforts represented an important transition in astronomy: for the first time one of the emphases of the subject moved beyond the solar system to the so-called fixed stars. The question of the emergence of interest in double stars is of historical significance, therefore, as it is related to the problem of the origins of ‘stellar astronomy’. This essay is thus intended to offer an explanation of astronomers' interest in double stars, and to tackle the related question of whether this transition constituted a major break in the history of astronomy. Furthermore it is proposed that answers to these problems may be found by considering the practice of astronomy dominant during the first half of the nineteenth century. Astronomers in this period were overwhelmingly concerned with a refined form of positional astronomy. The problems they chose to solve were by and large related to the difficulties of the accurate reduction of observational data, and the compilation of reliable tables and star charts, which were then used as a background against which the motions of solar system objects were plotted. By assessing individuals' studies of double stars within this context it can be seen firstly that such studies were no more or less than specific examples of a general case, and secondly that the stars themselves were not usually of intrinsic interest. In general it was the positions of the stars on the. (shrink)

The Irish poet W. B. Yeats once wrote, with great sapience and perception: Nor dread, nor hope attend A dying animal; A man awaits his end Dreading and hoping all. That death has ever been a problem to man is attested as far back as we can trace our species in the archaeological record—indeed, it seems to have been a problem even for that immediate precursor of homo sapiens, the so-called Neanderthal Man; for he buried his dead.

ABSTRACT This essay argues for the emergence of a cultural and epistemological divide between amateur savants and members of the Royal Academy of the Sciences in late Old Regime and revolutionary France and suggests that the amateur ideal rose in significance even as intellectual activity came to be increasingly centralized in the postrevolutionary era. At the crux of the tensions between the amateur ideal and the professionalizing reality in the immediate postrevolutionary period stood Aubin-Louis Millin and his journal, the Magasin (...) Encyclopédique. The essay examines, in particular, the revival in the pages of the Magasin Encyclopédique of interest in Nicolas-Claude Fabri de Peiresc, the seventeenth-century icon of an amateur ideal in which investigations in the natural sciences and scholarship were private, decentralized, often provincial activities. Although the sciences in the revolutionary and Napoleonic eras were often perceived as forward looking and dismissive of the past, this essay finds that a sentimental and nostalgic attachment to the past—to a myth of Peiresc—continued to play an important role in the identity of postrevolutionary men of letters. (shrink)

The book is a collection of lectures given during the spring colloquia between 2011 and 2019 at the Sorbonne. During these colloquia, a total of ten questions, such as ‘Should Logic be Mathematical...

G. E. M. Anscombe; I *—The Presidential Address: Existence and Truth, Proceedings of the Aristotelian Society, Volume 88, Issue 1, 1 June 1988, Pages 1–12, http.

Book Information Well-Being and Morality: Essays in Honour of James Griffin. Edited by Roger Crisp and Brad Hooker. Clarendon Press. Oxford. 2000. Pp. xii + 316. Hardback, £35.