Before curing was a possibility, medicine was devoted to the relief of suffering. Attention to the relief of suffering often takes a back seat in modern biomedicine. This book seeks to place suffering at the center of biomedical attention, examining suffering in its biological, psychological, clinical, religious, and ethical dimensions.

Background: Improved techniques and life sustaining technology in the neonatal intensive care unit have resulted in an increased probability of survival for extremely premature babies. The by-product of the aggressive treatment is iatrogenic pain, and this infliction of pain can be a cause of suffering and distress for both baby and nurse. Research question: The research sought to explore the caregiving dilemmas of neonatal nurses when caring for extremely premature babies. This article aims to explore the issues arising for neonatal (...) nurses when they inflict iatrogenic pain on the most vulnerable of human beings – babies ≤24 weeks gestation. Participants: Data were collected via a questionnaire to Australian neonatal nurses and semi-structured interviews with 24 neonatal nurses in New South Wales, Australia. Ethical consideration: Ethical processes and procedures set out by the ethics committee have been adhered to by the researchers. Findings: A qualitative approach was used to analyse the data. The theme ‘inflicting pain’ comprised three sub-themes: ‘when caring and torture are the same thing’, ‘why are we doing this!’ and ‘comfort for baby and nurse’. The results show that the neonatal nurses were passionate about the need for appropriate pain relief for extremely premature babies. Conclusion: The neonatal nurses experienced a profound sense of distress manifested as existential suffering when they inflicted pain on extremely premature babies. Inflicting pain rather than relieving it can leave the nurses questioning their role as compassionate healthcare professionals. (shrink)

The topics of language and subaltern social groups appear throughout Antonio Gramsci's Prison Notebooks. Although Gramsci often associates the problem of political fragmentation among subaltern groups with issues concerning language and common sense, there are only a few notes where he explicitly connects his overlapping analyses of language and subalternity. We build on the few places in the literature on Gramsci that focus on how he relates common sense to the questions of language or subalternity. By explicitly tracing out these (...) relations, we hope to bring into relief the direct connections between subalternity and language by showing how the concepts overlap with respect to Gramsci's analyses of common sense, intellectuals, philosophy, folklore, and hegemony. We argue that, for Gramsci, fragmentation of any social group's 'common sense', worldview and language is a political detriment, impeding effective political organisation to counter exploitation but that such fragmentation cannot be overcome by the imposition of a 'rational' or 'logical' worldview. Instead, what is required is a deep engagement with the fragments that make up subaltern historical, social, economic and political conditions. In our view, Gramsci provides an alternative both to the celebration of fragmentation fashionable in liberal multiculturalism and uncritical postmodernism, as well as other attempts of overcoming it through recourse to some external, transcendental or imposed worldview. This is fully in keeping with, and further elucidates Gramsci's understanding of the importance of effective 'democratic centralism' of the leadership of the party in relation to the rank and file and the popular masses. (shrink)

Animals in Disasters is a comprehensive book on animal rescue written by Dr. Dick Green who shares his experiences, best practices and lessons learned from well over 125 domestic and international disasters. It provides a step-by-step process for communities and states to more effectively address animal issues and enhance their animal response capabilities. Sections include an overview of the history of animal rescue, where we are today, and the steps needed to better prepare for tomorrow. This how-to book for (...) emergency managers who want to develop programs, craft policy, and build response capability/capacity is an ideal companion to their work. Clearly identifies the components of building a resilient community Introduces the Community Preparedness Checklist Helps readers develop and deliver effective animal response training. (shrink)

It is so generally accepted that prostitution is immoral, that this is one of the least discussed of all ethical issues. Few serious philosophical treatments of the subject have been published. Of these, at least one, Lars Ericsson's, ‘Charges against Prostitution’, throws into stark relief the apparent inconsistency of our community attitudes. For it demonstrates that, from the point of view of the simple free market liberalism, to which many subscribe, there is nothing immoral about prostitution. The prostitute is (...) a free agent who sells his or her services on the market at the going price. Why should the exchange of sexual services for money be more unsavoury than other exchanges of fee for service? The desire for sexual gratification is natural, as is the desire for food. So prostitution must be morally on a par with catering. Yet it is hemmed about by restrictions. Prostitutes are social outcasts, they may be pitied but are more often vilified and despised. From the liberal point of view, the moral disgust aroused by prostitution can only be the expression of an archaic and irrational taboo. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Intention and Wrongdoing: A Defense of the Principle of Double Effect by Joshua StuchlikMichael J. DegnanSTUCHLIK, Joshua. Intention and Wrongdoing: A Defense of the Principle of Double Effect. Cambridge: Cambridge University Press, 2021. xvi + 220 pp. Cloth, $99.99In this book Joshua Stuchlik vigorously defends the principle of double effect (PDE), which states, "There is a strict moral constraint against bringing about serious evil (harm) to an innocent (...) person intentionally, but it is permissible in a wider range of circumstances to act in a way that brings about serious evil incidentally, as a foreseen but non-intended side effect." After defining the terms of the principle and considering an intuitive case-based defense, he supports its truth based on a standard of solidarity. Since the PDE requires the distinction between intended consequences and nonintended side effects, he explains Elizabeth Anscombe's theory of intention, which supports the distinction's moral significance. He uses her theory to treat the closeness problem, the irrelevance of intention critique, and a challenge from Joshua Greene's empirical moral psychology that purports to undermine deontological constraints on causing harm.I present Stuchlik's grounding for the PDE followed by an uncontroversial example of its application. After this I consider two important objections to the PDE that Stuchlik critiques: the closeness problem and James Rachels's argument that intentions are irrelevant to judging the moral permissibility of actions. I conclude by examining Stuchlik's treatment of these challenges.Stuchlik interprets the PDE's very strict constraint against intentional killing or seriously harming the innocent as a near absolute prohibition, for he believes innocent persons are not suitable recipients of intentional harm. He grounds this constraint on the principle of solidarity. Being in solidarity with another is possessing concern for that other's sake. The ground for this concern is a shared human nature that enables members to think of themselves as making a "we." Human nature consists in the structured potentialities for knowing and freely choosing. Evidence of these rational potentialities is the human orientation toward the transcendent values of truth and goodness. Such embodied potentialities have inviolable worth.The scenarios of the precision bomber and the terror bomber illustrate the moral significance of the intended harm versus the nonintended but foreseen harm that Stuchlik adopts from Elizabeth Anscombe's action theory. Each bombers' goal is to help his country win a just war. The precision bomber pursues that goal by targeting a munitions factory. Though he foresees that many noncombatants will be killed or seriously [End Page 367] injured from the bomb, he does not necessarily intend these harms. By contrast, the terror bomber targets a civilian center necessarily intending harm for noncombatants. The PDE rules out his conduct.Anscombe's account of intention can lead to the problem of closeness in which the content of an intention is sufficiently fine-grained that an agent need not intend harm in almost any situation. Stuchlik illustrates the problem with Alexander Pruss's zookeeper scenario.An eccentric literalistic but always truthful magnate tells Sam he will donate to famine relief saving a hundred lives if and only if Sam follows his directions to the iota. Sam is to purchase a gun, sneak at night into a zoo owned by the magnate and kill the first mammal he sees. Sam sneaks into the zoo, sees a mammal in the distance, and forms the intention to shoot it. Then he notices that the mammal is human but shoots nonetheless on utilitarian grounds.In this case applying the PDE shows that Sam is simply intending that a mammal be killed. The fact that the mammal is a human is irrelevant, according to Anscombe's action theory.Stuchlik's response clarifies the scope of intention in the PDE. As stated above, the intention's content includes seriously harming an innocent human. However, if the intention ranges only over an intention to bring about an effect, E, and it turns out that E is a serious harm for an innocent human being, then applying the principle shows that Sam's action is wrong. The intended effect of killing the mammal is, as a matter of fact, an... (shrink)

G. E. Moore observed that to assert, 'I went to the pictures last Tuesday but I don't believe that I did' would be 'absurd'. Over half a century later, such sayings continue to perplex philosophers. In the definitive treatment of the famous paradox, Green and Williams explain its history and relevance and present new essays by leading thinkers in the area.

In this paper I explore the connection between Catharine Macaulay’s views on freedom of the will and her promotion of the cause of political liberty and show that the position she develops has its origins in Locke’s philosophy. I argue for the existence of a distinctive ‘Lockean’ conception of political liberty, which is grounded in an account of moral agency, and which does not fit very well into contemporary characterizations of negative, republican, or positive liberty. I demonstrate that this concept (...) of political liberty was widely disseminated during the eighteenth century and can be found in the writing of many of Macaulay’s female contemporaries, both in Great Britain and on the Continent. Recognizing this ‘Lockean’ conception of political liberty is important for understanding the connection between the idea of enlightenment and radical movements promoting political reform. Furthermore, acknowledging its widespread influence throws doubt on Jonathan Israel’s recent attempt to overthrow standard histories—according to which Locke’s rational religion is foundational for radical politics during the period—as well as Israel’s attempt to replace such standard histories with an account that locates the impetus for political reform in metaphysical monism and religious skepticism. (shrink)

Peter Singer and Peter Unger argue that moral decency requires giving away all one's “surplus” for the relief or prevention of “absolute poverty,” because not doing so is analogous to refusing to save a drowning child to avoid making one's clothes muddy. I argue that there is a crucial disanalogy between the two cases and, moreover, that there are four independent moral objections to their thesis: it is monomaniacal in ignoring the variety of morally worthy ideals and elevating self-sacrificial (...) aid to the global poor into the sole ideal; it is misanthropic in its indifference to the happiness of those it adjures to give; it is incompatible with integrity; it would have disastrous effects for the poor if it were generally adopted. I argue that genuine beneficence aims at creating or restoring the conditions that enable its beneficiaries to become self-sufficient creators themselves — creators of wealth and of meaningful and enjoyable lives. Small-scale beneficence is necessary for moral goodness, but large-scale beneficence is optional, so long as its absence is not due to a lack of regard for those in need. The uncharitable person violates the neo-Lockean non-waste proviso that we acquire or keep for ourselves and those we love as much, but only as much, as we can use or invest meaningfully or enjoyably, now or in the long run. But someone who invests all his resources in creating something of worth leads a morally worthy life even if he reserves nothing for large-scale charity. Both our capacity for beneficence, which bids us stretch out a hand to those in need, and our capacity for creation, which bids us reach for the stars, are important aspects of our humanity. The Singer-Unger ideal advocates not genuine beneficence but the profligate giving away of wealth to prolong lives, while failing to appreciate what makes life worth living. a Footnotesa I am grateful for helpful comments on this paper from Ellen Frankel Paul, Larry White (who commented on the paper at the 2005 conference of the Association for Private Enterprise Education), David Blumenfeld, and Garrett Cullity (whose comments from Australia were a wonderful example of voluntary international aid to a stranger). I would also like to thank Georgia State University, Bowling Green State University, and the Association for Private Enterprise Education for inviting me to present this paper, and the audiences at these presentations for their helpful discussion. Finally, I would like to thank Harry Dolan for his expert copyediting, which saved me from some embarrassing mistakes and infelicities. (shrink)

ABSTRACT I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments. INTRODUCTION In contrast to the classic model of randomized-control trials, often with a large number of (...) subjects enrolled, precision medicine attempts to optimize therapeutic outcomes by focusing on the individual.[i] A recent publication highlights the strengths and weakness of both traditional evidence-based medicine and precision medicine.[ii] Plus, it outlines a tension in the shift from evidence-based medicine’s inductive reasoning style (the collection of data to postulate general theories) to precision medicine’s abductive reasoning style (the generation of an idea from the limited data available).[iii] The paper’s main example is the application of precision medicine for the treatment of cancer.[iv] I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. As the name suggests, brain-computer interfaces are a significant advancement in neurotechnology that directly connects someone’s brain to external or implanted devices.[v] Among the various kinds of brain-computer interfaces, adaptive deep brain stimulation devices require numerous personalized adjustments to their settings during the implantation and computation stages in order to provide adequate relief to patients with treatment-resistant disorders. What makes these devices unique is how adaptive deep brain stimulation integrates a sensory component to initiate the stimulation. While not commonly at the level of sophistication as self-supervising or generative large language models,[vi] they currently allow for a semi-autonomous form of neuromodulation. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments.[vii] ANALYSIS I. The State of Precision Medicine in Oncology and the Epistemological Shift While a thorough overview of precision medicine for the treatment of cancer is beyond the scope of this article, its practice can be roughly summarized as identifying clinically significant characteristics a patient possesses (e.g., genetic traits) to land on a specialized treatment option that, theoretically, should benefit the patient the most.[viii] However, in such a practice of stratification patients fall into smaller and smaller populations and the quality of evidence that can be applied to anyone outside these decreases in turn.[ix] As inductive logic helps to articulate, the greater the number of patients that respond to a particular therapy the higher the probability of its efficacy. By straying from this logical framework, precision medicine opens the treatment of cancer to more uncertainty about the validity of these approaches to the resulting disease subcategories.[x] Thus, while contemporary medical practices explicitly describe some treatments as “personalized”, they ought not be viewed as inherently better founded than other therapies.[xi] A relevant contemporary case of precision medicine out of Norway focuses on the care of a patient with cancer between the ventricles of the heart and esophagus, which had failed to respond to the standard regimen of therapies over four years.[xii] In a last-ditch effort, the patient elected to pay out-of-pocket for an experimental immunotherapy (nivolumab) at a private hospital. He experienced marked improvements and a reduction in the size of the tumor. Understandably, the patient tried to pursue further rounds of nivolumab at a public hospital. However, the hospital initially declined to pay for it given the “lack of evidence from randomised clinical trials for this drug relating to this [patient’s] condition.”[xiii] In rebuttal to this claim, the patient countered that he was actually similar to a subpopulation of patients who responded in “open‐label, single arm, phase 2 studies on another immune therapy drug” (pembrolizumab).[xiv] Given this interpretation of the prior studies and the patient’s response, further rounds of nivolumab were approved. Had the patient not had improvements in the tumor’s size following a round of nivolumab, then pembrolizumab’s prior empirical evidence in isolation would have been insufficient, inductively speaking, to justify his continued use of nivolumab.[xv] The case demonstrates a shift in reasoning from the traditional induction to abduction. The phenomenon of ‘cancer improvement’ is considered causally linked to nivolumab and its underlying physiological mechanisms.[xvi] However, “the weakness of abductions is that there may always be some other better, unknown explanation for an effect. The patient may for example belong to a special subgroup that spontaneously improves, or the change may be a placebo effect. This does not mean, however, that abductive inferences cannot be strong or reasonable, in the sense that they can make a conclusion probable.”[xvii] To demonstrate the limitations of relying on the abductive standard in isolation, commentators have pointed out that side effects in precision medicine are hard to rule out as being related to the initial intervention itself unless trends from a group of patients are taken into consideration.[xviii] As artificial intelligence (AI) assists the development of precision medicine for oncology, this uncertainty ought to be taken into consideration. The implementation of AI has been crucial to the development of precision medicine by providing a way to combine large patient datasets or a single patient with a large number of unique variables with machine learning to recommend matches based on statistics and probability of success upon which practitioners can base medical recommendations.[xix] The AI is usually not establishing a causal relationship[xx] – it is predicting. So, as AI bleeds into medical devices, like brain-computer interfaces, the same cautions about using abductive reasoning alone should be carried over. II. Responsive Neurostimulation, AI, and Personalized Medicine Like precision medicine in cancer treatment, computer-brain interface technology similarly focuses on the individual patient through personalized settings. In order to properly expose the intersection of AI, precision medicine, abductive reasoning, and implantable neurotechnologies, the descriptions of adaptive deep brain stimulation systems need to deepen.[xxi] As a broad summary of adaptive deep brain stimulation, to provide a patient with the therapeutic stimulation, a neural signal, typically referred to as a local field potential,[xxii] must first be detected and then interpreted by the device. The main adaptive deep brain stimulation device with premarket approval, the NeuroPace Responsive Neurostimulation system, is used to treat epilepsy by detecting and storing “programmer-defined phenomena.”[xxiii] Providers can optimize the detection settings of the device to align with the patient’s unique electrographic seizures as well as personalize the reacting stimulation’s parameters.[xxiv] The provider adjusts the technology based on trial and error. One day machine learning algorithms will be able to regularly aid this process in myriad ways, such as by identifying the specific stimulation settings a patient may respond to ahead of time based on their electrophysiological signatures.[xxv] Either way, with AI or programmers, adaptive neurostimulation technologies are individualized and therefore operate in line with precision medicine rather than standard treatments based on large clinical trials. Contemporary neurostimulation devices are not usually sophisticated enough to be prominent in AI discussions where the topics of neural networks, deep learning, generative models, and self-attention dominate the conversation. However, implantable high-density electrocorticography arrays (a much more sensitive version than adaptive deep brain stimulation systems use) have been used in combination with neural networks to help patients with neurologic deficits from a prior stroke “speak” through a virtual avatar.[xxvi] In some experimental situations, algorithms are optimizing stimulation parameters with increasing levels of independence.[xxvii] An example of neurostimulation that is analogous to the use of nivolumab in Norway surrounds a patient in the United States who was experiencing both treatment-resistant OCD and temporal lobe epilepsy.[xxviii]Given the refractory nature of her epilepsy, implantation of an adaptive deep brain stimulation system was indicated. As a form of experimental therapy, her treatment-resistant OCD was also indicated for the off-label use of an adaptive deep brain stimulation set-up. Another deep brain stimulation lead, other than the one implanted for epilepsy, was placed in the patient’s right nucleus accumbens and ventral pallidum region given the correlation these nuclei had with OCD symptoms in prior research. Following this, the patient underwent “1) ambulatory, patient-initiated magnet-swipe storage of data during moments of obsessive thoughts; (2) lab-based, naturalistic provocation of OCD-related distress (naturalistic provocation task); and (3) lab-based, VR [virtual reality] provocation of OCD-related distress (VR provocation task).”[xxix] Such signals were used to identify when to deliver the therapeutic stimulation in order to counter the OCD symptoms. Thankfully, following the procedure and calibration the patient exhibited marked improvements in their OCD symptoms and recently shared her results publicly.[xxx] In both cases, there is a similar level of abductive justification for the efficacy of the delivered therapy. In the case study in which the patient was treated with adaptive deep brain stimulation, they at least had their neural activity tested in various settings to determine the optimum parameters for treatment to avoid them being based on guesswork. Additionally, the adaptive deep brain stimulation lead was already placed before the calibration trials were conducted, meaning that the patient had already taken on the bulk of the procedural risk before the efficacy could be determined. Such an efficacy test could have been replicated in the first patient’s cancer treatment, had it been biopsied and tested against the remaining immunotherapies in vitro. Yet, in the case of cancer with few options, one previous dose of a drug that appeared to work on the patient may justify further doses. However, as the Norwegian case presents, corroboration with known responses to a similar drug (from a clinical trial) could be helpful to validate the treatment strategy. (It should be noted that both patients were resigned to these last resort options regardless of the efficacy of treatment.) There are some elements of inductive logic seen with adaptive deep brain stimulation research in general. For example, abductively the focus could be that patient X’s stimulation parameters are different from patient Y’s and patient Z’s. In contrast, when grouped as subjects who obtained personalized stimulation, patients X, Y, and Z demonstrate an inductive aspect to this approach’s safety and/or efficacy. The OCD case holds plenty of abductive characteristics in line with precision medicine’s approach to treating cancer and as more individuals try the method, there will be additional data. With the gradual integration of AI into brain-computer interfaces in the name of efficacy, this reliance on abduction will continue, if not grow, over time. Moving forward, if a responsive deep brain stimulation treatment is novel and individualized (like the dose of nivolumab) and there is some other suggestion of efficacy (like clinical similarities to other patients in the literature), then it may justify insurance coverage for the investigative intervention, absent other unrelated reasons to deny it. III. Ethical Implications and Next Steps While AI’s use in oncology and neurology is not yet as prominent as its use in other fields (e.g., radiology), it appears to be on the horizon for both.[xxxi] AI can be found in both the functioning of the neurotechnologies as well as the implementation of precision medicine. The increasing use of AI may serve to further individualize both oncologic and neurological therapies. Given these implications and the handful of publications cited in this article, it is important to have a nuanced evaluation of how these treatments, which heavily rely on abductive justification, ought to be managed. The just use an abductive approach may be difficult as AI infused precision medicine is further pursued. At baseline, such technology relies on a level of advanced technology literacy among the general public and could exclude populations who lack access to basic technological infrastructure or know-how from participation.[xxxii] Even among nations with adequate infrastructure, as more patients seek out implantable neurotechnologies, which require robust healthcare resources, the market will favor patient populations that can afford this complex care.[xxxiii] If patients already have the means to pay for an initial dose/use of a precision medicine product out of pocket, should insurance providers be required to cover subsequent treatments?[xxxiv] That is, if a first dose of a cancer drug or a deep brain stimulator over its initial battery life is successful, patients may feel justified in having the costs of further treatments covered. The Norwegian patient’s experience implies there is a precedent for the idea that some public insurance companies ought to cover successful cancer therapies, however, insurance companies may not all see themselves as obligated to cover neurotechnologies that rely on personalized settings or that are based on precision/abductive research more than on clinical trials. CONCLUSION The fact that the cases outlined above rely on abductive style of reasoning implies that there may not be as strong a justification for coverage by insurance, as they are both experimental and individualized, when compared to the more traditional large clinical trials in which groups have the same or a standardized protocol (settings/doses). If a study is examining the efficacy of a treatment with a large cohort of patients or with different experimental groups/phases, insurance companies may conclude that the resulting symptom improvements are more likely to be coming from the devices themselves. A preference for inductive justification may take priority when ruling in favor of funding someone’s continued use of an implantable neurostimulator. There are further nuances to this discussion surrounding the classifications of these interventions as research versus clinical care that warrant future exploration, since such a distinction is more of a scale[xxxv] than binary and could have significant impacts on the “right-to-try” approach to experimental therapies in the United States.[xxxvi] Namely, given the inherent limitations of conducting large cohort trials for deep brain stimulation interventions on patients with neuropsychiatric disorders, surgically innovative frameworks that blend abductive and inductive methodologies, like with sham stimulation phases, have traditionally been used.[xxxvii] Similarly, for adaptive brain-computer interface systems, if there are no large clinical trials and instead only publications that demonstrate that something similar worked for someone else, then, in addition to the evidence that the first treatment/dose worked for the patient in question, the balance of reasoning would be valid and arguably justify insurance coverage. As precision approaches to neurotechnology become more common, frameworks for evaluating efficacy will be crucial both for insurance coverage and for clinical decision making. ACKNOWLEDGEMENT This article was originally written as an assignment for Dr. Francis Shen’s “Bioethics & AI” course at Harvard’s Center for Bioethics. I would like to thank Dr. Shen for his comments as well as my colleagues in the Lázaro-Muñoz Lab for their feedback. - [i] Jonathan Kimmelman and Ian Tannock, “The Paradox of Precision Medicine,” Nature Reviews. Clinical Oncology 15, no. 6 (June 2018): 341–42, https://doi.org/10.1038/s41571-018-0016-0. [ii] Henrik Vogt and Bjørn Hofmann, “How Precision Medicine Changes Medical Epistemology: A Formative Case from Norway,” Journal of Evaluation in Clinical Practice 28, no. 6 (December 2022): 1205–12, https://doi.org/10.1111/jep.13649. [iii] David Barrett and Ahtisham Younas, “Induction, Deduction and Abduction,” Evidence-Based Nursing 27, no. 1 (January 1, 2024): 6–7, https://doi.org/10.1136/ebnurs-2023-103873. [iv] Vogt and Hofmann, “How Precision Medicine Changes Medical Epistemology,” 1208. [v] Wireko Andrew Awuah et al., “Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications,” World Neurosurgery, May 22, 2024, S1878-8750(24)00867-2, https://doi.org/10.1016/j.wneu.2024.05.104. [vi] Mark Riedl, “A Very Gentle Introduction to Large Language Models without the Hype,” Medium (blog), May 25, 2023, https://mark-riedl.medium.com/a-very-gentle-introduction-to-large-language-models-without-the-hype-5 f67941fa59e. [vii] David E. Burdette and Barbara E. Swartz, “Chapter 4 - Responsive Neurostimulation,” in Neurostimulation for Epilepsy, ed. Vikram R. Rao (Academic Press, 2023), 97–132, https://doi.org/10.1016/B978-0-323-91702-5.00002-5. [viii] Kimmelman and Tannock, 2018. [ix] Kimmelman and Tannock, 2018. [x] Simon Lohse, “Mapping Uncertainty in Precision Medicine: A Systematic Scoping Review,” Journal of Evaluation in Clinical Practice 29, no. 3 (April 2023): 554–64, https://doi.org/10.1111/jep.13789. [xi] Kimmelman and Tannock, “The Paradox of Precision Medicine.” [xii] Vogt and Hofmann, 1206. [xiii] Vogt and Hofmann, 1206. [xiv] Vogt and Hofmann, 1206. [xv] Vogt and Hofmann, 1207. [xvi] Vogt and Hofmann, 1207. [xvii] Vogt and Hofmann, 1207. [xviii] Vogt and Hofmann, 1210. [xix] Mehar Sahu et al., “Chapter Three - Artificial Intelligence and Machine Learning in Precision Medicine: A Paradigm Shift in Big Data Analysis,” in Progress in Molecular Biology and Translational Science, ed. David B. Teplow, vol. 190, 1 vols., Precision Medicine (Academic Press, 2022), 57–100, https://doi.org/10.1016/bs.pmbts.2022.03.002. [xx] Stefan Feuerriegel et al., “Causal Machine Learning for Predicting Treatment Outcomes,” Nature Medicine 30, no. 4 (April 2024): 958–68, https://doi.org/10.1038/s41591-024-02902-1. [xxi] Sunderland Baker et al., “Ethical Considerations in Closed Loop Deep Brain Stimulation,” Deep Brain Stimulation 3 (October 1, 2023): 8–15, https://doi.org/10.1016/j.jdbs.2023.11.001. [xxii] David Haslacher et al., “AI for Brain-Computer Interfaces,” 2024, 7, https://doi.org/10.1016/bs.dnb.2024.02.003. [xxiii] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 103–4; “Premarket Approval (PMA),” https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P100026. [xxiv] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 104. [xxv] Burdette and Swartz, 126. [xxvi] Sean L. Metzger et al., “A High-Performance Neuroprosthesis for Speech Decoding and Avatar Control,” Nature 620, no. 7976 (August 2023): 1037–46, https://doi.org/10.1038/s41586-023-06443-4. [xxvii] Hao Fang and Yuxiao Yang, “Predictive Neuromodulation of Cingulo-Frontal Neural Dynamics in Major Depressive Disorder Using a Brain-Computer Interface System: A Simulation Study,” Frontiers in Computational Neuroscience 17 (March 6, 2023), https://doi.org/10.3389/fncom.2023.1119685; Mahsa Malekmohammadi et al., “Kinematic Adaptive Deep Brain Stimulation for Resting Tremor in Parkinson’s Disease,” Movement Disorders 31, no. 3 (2016): 426–28, https://doi.org/10.1002/mds.26482. [xxviii] Young-Hoon Nho et al., “Responsive Deep Brain Stimulation Guided by Ventral Striatal Electrophysiology of Obsession Durably Ameliorates Compulsion,” Neuron 0, no. 0 (October 20, 2023), https://doi.org/10.1016/j.neuron.2023.09.034. [xxix] Nho et al. [xxx] Nho et al.; Erik Robinson, “Brain Implant at OHSU Successfully Controls Both Seizures and OCD,” OHSU News, accessed March 3, 2024, https://news.ohsu.edu/2023/10/25/brain-implant-at-ohsu-successfully-controls-both-seizures-and-ocd. [xxxi] Awuah et al., “Bridging Minds and Machines”; Haslacher et al., “AI for Brain-Computer Interfaces.” [xxxii] Awuah et al., “Bridging Minds and Machines.” [xxxiii] Sara Green, Barbara Prainsack, and Maya Sabatello, “The Roots of (in)Equity in Precision Medicine: Gaps in the Discourse,” Personalized Medicine 21, no. 1 (January 2024): 5–9, https://doi.org/10.2217/pme-2023-0097. [xxxiv] Green, Prainsack, and Sabatello, 7. [xxxv] Robyn Bluhm and Kirstin Borgerson, “An Epistemic Argument for Research-Practice Integration in Medicine,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 43, no. 4 (July 9, 2018): 469–84, https://doi.org/10.1093/jmp/jhy009. [xxxvi] Vijay Mahant, “‘Right-to-Try’ Experimental Drugs: An Overview,” Journal of Translational Medicine 18 (June 23, 2020): 253, https://doi.org/10.1186/s12967-020-02427-4. [xxxvii] Michael S. Okun et al., “Deep Brain Stimulation in the Internal Capsule and Nucleus Accumbens Region: Responses Observed during Active and Sham Programming,” Journal of Neurology, Neurosurgery & Psychiatry 78, no. 3 (March 1, 2007): 310–14, https://doi.org/10.1136/jnnp.2006.095315. (shrink)

We critically survey prominent recent scholarship on the question of whether fiction can be a source of epistemic value for those who engage with it fully and appropriately. Such epistemic value might take the form of knowledge (for ‘cognitivists’) or understanding (for ‘neo-cognitivists’). Both camps may be sorted according to a further distinction between views explaining fiction’s epistemic value either in terms of the author’s engaging in a form of telling, or instead via their showing some state of affairs to (...) obtain, a special case of which is the provision of self-knowledge. Fictional works that show rather than tell often employ thought experiments. The epistemic value of some fictional works is indicated by their enabling of empathy, itself illuminated via the psychological process of experience-taking. Whether a fictional work offers epistemic value by telling or showing, there is, in principle, no bar to its being able to deliver on what it offers, and consumers of fiction who exercise epistemic vigilance may gain either knowledge or some degree of understanding from their engagement with it. (shrink)

Many of the objects that we perceive have an important characteristic: When they move, they change shape. For instance, when you watch a person walk across a room, her body constantly deforms. I suggest that we exercise a type of perceptual constancy in response to changes of this sort, which I call structure constancy. In this paper I offer an account of structure constancy. I introduce the notion of compositional structure, and propose that structure constancy involves perceptually representing an object (...) as retaining its compositional structure over time. I argue that compositional structure is represented in visual phenomenology, and I also assemble empirical evidence in support of the claim that compositional structure is recovered by the visual system. Finally, I draw out consequences of this account. I argue that structure constancy has implications for the predictive capacities of perception, and that the phenomenon places important constraints on viable accounts of both the format and reference frame of visual experience. (shrink)

Perceptual constancy has played a significant role in philosophy of perception. It figures in debates about direct realism, color ontology, and the minimal conditions for perceptual representation. Despite this, there is no general consensus about what constancy is. I argue that an adequate account of constancy must distinguish it from three distinct phenomena: mere sensory stability through proximal change, perceptual categorization of a distal dimension, and stability through irrelevant proximal change. Standard characterizations of constancy fall short in one or more (...) of these respects. I develop an account of constancy that overcomes these problems. The account has two parts: an analysis of constancy mechanisms, and an analysis of the conditions under which a constancy capacity is exercised. I then employ this account to evaluate whether constancy is a necessary condition for perceptual representation, as some have conjectured. I argue that explanatory practice in perceptual psychology fails to support this view. Rather, it fits better with the weaker principle that representation requires specific tracking of a distal dimension. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Asthma:Strangling the Caged Bird (Something Like a Prayer)Imani Perry (bio)Yet do a marvel at this curious thing; To make a poet black and bid him sing!– Countee CullenI know why the caged bird sings, ah me,When his wing is bruised and his bosom sore,—When he beats his bars and he would be free;It is not a carol of joy or glee,But a prayer that he sends from his heart's (...) deep core,But a plea, that upward to Heaven he flings—I know why the caged bird sings!– Paul Laurence DunbarAsthma is an inflammation of the airways. But that word in a Black American life is an associative one. It is emergency room visits, "treatments," and jackleg care. It is death's door. It is the vague feeling that something in the bedroom walls, school corridors, cells, coming up from the pavement, is eking away at your life. We speak of it knowingly and frequently."How is your asthma?" When Dr. Bird asked me that question, I was alarmed. I'd forgotten I had ever received the diagnosis. But there it was in my chart. There are so many words about me housed in that digital file. I expect there's more than I could guess. The chart itself is a testament to access. Not everybody has the protective surveillance of a chart or an ID, much less medical insurance. Mine is far more crowded than I'd prefer.The conditions of my life and body have made it such that I could forget my own asthma. But I think about asthma all the time, because it has snaked through my family and friends and communities. I have written, more than once, that the most powerful statement that hip hop leaves us with is this: An art form made by generations ravaged by environmental racism is defiantly profound because it depends upon the mastery of breath. Breath control is as much its hallmark as rhyming. Snatching oneself from the gates of a breath-thieving hell, with a heavy bass line, is its testimony. [End Page 213]Have you ever gasped for air? You grab at it and get almost nothing. Flail. You are rendered indeliberate. Panic is the only option in that moment. Invisible hands crush your windpipe but never touching a bone. (After this, how could you not believe in ghosts?) When you get out of it, relief spreads over you. It is euphoric at first. Then trauma settles and you ritually hold your breath and neck muscles, hypervigilant for the next time though praying against it.Black people have the highest rates of asthma in the United States. Black women are most likely to die of the disease. I am not a scientist so I can speculate about this terrible fact freely. I think it is because Black women's roles require a tamping down of suffering in the service of labor for others. Private keening and public fortitude. There is poison in our post-coloniality of being.That said, the post-coloniality of being doesn't belong alone to those with colonized and Jim Crowed histories. It is a shared though wildly unequal condition. The post-coloniality of being characterizes this epoch, post- ages of revolution and decolonization and social transformation, in which we (the big we, not the freedom-fighter we) against all better dreams, remain committed to being suffocated. And as the climate crisis shows its face, we have to admit that everybody's breath is shallowing. Everyone's body is being invaded by the ethic of accumulation, to a greater or lesser extent. And that "lesser" promise is the worst kind of seduction. Air purifiers and green detergents are nothing but stop-gap measures in a world bent on its own destruction.I could say, we, Black women, are like canaries in the coal mine. But the metaphor hits too close to home. It is too true a thing to attach it to the glibness of literary figurative language. Our airways are literally closing in. In the Black South, to be "strangled" doesn't require someone's hands around your throat. It is used the... (shrink)

Mesoscale modeling is often considered merely as a practical strategy used when information on lower-scale details is lacking, or when there is a need to make models cognitively or computationally tractable. Without dismissing the importance of practical constraints for modeling choices, we argue that mesoscale models should not just be considered as abbreviations or placeholders for more “complete” models. Because many systems exhibit different behaviors at various spatial and temporal scales, bottom-up approaches are almost always doomed to fail. Mesoscale models (...) capture aspects of multi-scale systems that cannot be parameterized by simple averaging of lower-scale details. To understand the behavior of multi-scale systems, it is essential to identify mesoscale parameters that “code for” lower-scale details in a way that relate phenomena intermediate between microscopic and macroscopic features. We illustrate this point using examples of modeling of multi-scale systems in materials science and biology, where identification of material parameters such as stiffness or strain is a central step. The examples illustrate important aspects of a so-called “middle-out” modeling strategy. Rather than attempting to model the system bottom-up, one starts at intermediate scales where systems exhibit behaviors distinct from those at the atomic and continuum scales. One then seeks to upscale and downscale to gain a more complete understanding of the multi-scale system. The cases highlight how parameterization of lower-scale details not only enables tractable modeling but is also central to understanding functional and organizational features of multi-scale systems. (shrink)

This is a timely re-appraisal of feminist political thinkers and their male contemporaries, providing a re-evaluation of feminist humanism.

We review articles about corporate political activity published in Business & Society since its beginnings 60 years ago and in a set of other leading management journals over the past decade. We present evidence that most studies of CPA use the political markets’ perspective. Under the premise that the contemporary political environment has changed significantly since the inception of the political markets’ perspective, our review asks two interconnected questions. First, to what degree have changes in the political environment challenged the (...) ability of the political markets’ perspective to understand the pillars of politics: issues, institutions, interests, and information? Second, to what degree have CPA scholars augmented or diversified their theoretical arguments to accommodate these changes in the political environment? We document the CPA literature across these dimensions and questions and note that many scholars are already adopting other theories side by side with the political markets’ perspective. (shrink)

Prevention of age-related disorders is increasingly in focus of health policies, and it is hoped that early intervention on processes of deterioration can promote healthier and longer lives. New opportunities to slow down the aging process are emerging with new fields such as personalized nutrition. Data-intensive research has the potential to improve the precision of existing risk factors, e.g., to replace coarse-grained markers such as blood cholesterol with more detailed multivariate biomarkers. In this paper, we follow an attempt to develop (...) a new aging biomarker. The vision among the project consortium, comprising both research and industrial partners, is that the new biomarker will be predictive of a range of age-related conditions, which may be preventable through personalized nutrition. We combine philosophical analysis and ethnographic fieldwork to explore the possibilities and challenges of managing aging through bodily signs that are not straightforwardly linked to symptomatic disease. We document how the improvement of measurement brings about new conceptual challenges of demarcating healthy and unhealthy states. Moreover, we highlight that the reframing of aging as risk has social and ethical implications, as it is generative of normative notions of what constitutes successful aging and good citizenship. (shrink)

What is the value of having medical students engage in creative production as part of their learning? Creating something new requires medical students to take risks and even to fail--something they tend to be neither accustomed to nor comfortable with doing. “Making stuff” can help students prepare for such failures in a controlled environment that doesn’t threaten their professional identities. Furthermore, doing so can facilitate students becoming resilient and creative problem-solvers who strive to find new ways to address vexing questions. (...) Though creating something new can be fun, this is not the main outcome of interest. Rather, the principle reason we recommend devoting precious curricular time to creative endeavors is because it helps medical students become better doctors. (shrink)

Moral theorists like Singer and Greene argue that we should discount intuitions about ‘up-close-and-personal’ moral dilemmas because they are more likely than intuitions about ‘impersonal’ dilemmas to be artifacts of evolution. But by that reasoning, it seems we should ignore the evolved, ‘up-close-and-personal’ intuition to save a drowning child in light of the too-new-to-be-evolved, ‘impersonal’ intuition that we need not donate to international famine relief. This conclusion seems mistaken and horrifying, yet it cannot be the case both that ‘up-close-and-personal’ (...) intuitions are more reliable than ‘impersonal’ intuitions, and vice versa. Thus, Singer’s evolutionary debunking argument proves too much, and should not be taken seriously. However, Singer’s debunking argument is typical of an entire class of arguments that seeks to debunk normative principles by reference to evolution. This entire class of argument, I argue, therefore also proves too much to be taken seriously. (shrink)

From the point of view of ethics, truthtelling is not a matter of speaking the truth but is rather a matter of speaking what one believes to be the truth. So too liars do not necessarily say what is false; they say what they believe to be false. Further, one can mislead without lying. An executive answering in the affirmative the question whether some employees are in excessive danger on the job will mislead if he knows that in fact most (...) employees are but does not say so. Yet he does not lie. Similarly there is no lie in an advertisement suggesting that those who use a certain product will win garner wealth and power. This article deals with the ethical and practical dimensions of truthtelling and lying only. (shrink)

In a recent monograph, Sandy Goldberg argues that epistemology should be renovated so as to accommodate the way in which human beings are dependent on others for what they know. He argues that the way to accomplish this is to consider the cognition of others to be part of the belief-forming process for the purposes of epistemic assessment when radical dependence on others is in evidence. In this paper, I argue that, contrary to what one may expect, a credit theory (...) of knowledge is well positioned to make the sort of anti-individualistic move that Goldberg advocates. Furthermore, unlike Goldberg's extended process reliabilism, an extended credit theory has a theoretically motivated way of restricting the domain of epistemic evaluation to the cognitive. Finally, I argue that, although adopting the extended cognition hypothesis would help Goldberg's position, an extended credit theory would still have the advantage. (shrink)

This book locates Christine de Pizan's argument that women are virtuous members of the political community within the context of earlier discussions of the relative virtues of men and women.

This groundbreaking work was the first to propose an inquiry into the forms, dynamics, and constructs of educational policy. This fine book remains the only treatment of educational policy incorporating an account of the differences between various kinds of educational goods. Professor Green explored the nature of policy and prospects for the future, and it is a rare treat that we can now (more than fifteen years later) revisit the text to discover his uncanny accuracy.