Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

Jaswal & Akhtar provide several quotes ostensibly from people with autism but obtained via the discredited techniques of Facilitated Communication and the Rapid Prompting Method, and they do not acknowledge the use of these techniques. As a result, their argument is substantially less convincing than they assert, and the article lacks transparency.

Meta-languages are vital to the development and usage of formal systems, and yet the nature of meta-languages and associated notions require clarification. Here we attempt to provide a clear definition of the requirements for a language to be a meta-language, together with consideration of issues of proof theory, model theory and interpreters for such a language.

Causal mediation analysis is complicated with multiple effect definitions that require different sets of assumptions for identification. This article provides a systematic explanation of such assumptions. We define five potential outcome types whose means are involved in various effect definitions. We tackle their mean/distribution’s identification, starting with the one that requires the weakest assumptions and gradually building up to the one that requires the strongest assumptions. This presentation shows clearly why an assumption is required for one estimand and not another, (...) and provides a succinct table from which an applied researcher could pick out the assumptions required for identifying the causal effects they target. Using a running example, the article illustrates the assembling and consideration of identifying assumptions for a range of causal contrasts. For several that are commonly encountered in the literature, this exercise clarifies that identification requires weaker assumptions than those often stated in the literature. This attention to the details also draws attention to the differences in the positivity assumption for different estimands, with practical implications. Clarity on the identifying assumptions of these various estimands will help researchers conduct appropriate mediation analyses and interpret the results with appropriate caution given the plausibility of the assumptions. (shrink)

Last year, we reported a new mechanism of DNA replication in mammals. It occurs inside mitochondria and entails the use of processed transcripts, termed bootlaces, which hybridize with the displaced parental strand as the replication fork advances. Here we discuss possible reasons why such an unusual mechanism of DNA replication might have evolved. The bootlace mechanism can minimize the occurrence and impact of single‐strand breaks that would otherwise threaten genome stability. Furthermore, by providing an implicit mismatch recognition system, it should (...) limit the occurrence of replication‐dependent deletions and insertions, and defend against invading elements. Such a mechanism may also limit attempts to manipulate the mammalian mitochondrial genome. (shrink)

The article reviews recent developments in England in the law of necessity as a defence to crime and calls for its further extension. It argues that the defence of necessity presents the criminal law with difficult questions of competing values and the ordering of harms. English law has taken a nuanced position on the respective roles of the courts and the legislature in the ordering of harms, although the development of the law has been pragmatic rather than coherently theorised. The (...) law has granted necessity some scope as an exculpatory principle in the law of general defences, but it has also respected the primacy of the legislature as the legitimate arbiter of many of the competitions of value that necessity throws up. The recognition of necessity has not been in the form of a single unified defence of that name. Rather it has taken the form of a number of defences, based on a principle of necessity, but with different nomenclature and different rationales. This approach to necessity is defended as right in terms of principle and policy. Any further development of necessity as a general defence should be restricted to two contexts, namely those of emergencies, and of conflicts of duty, where a danger of death or serious injury is present. (shrink)

Recent advances in virtual technologies have allowed the investigation of simulated moral actions in aversive moral dilemmas. Previous studies have employed diverse populations in order to explore these actions, with little research considering the significance of occupation on moral decision-making. For the first time, in this study we have investigated simulated moral actions in Virtual Reality made by professionally trained paramedics and fire service incident commanders who are frequently faced with and must respond to moral dilemmas. We found that specially (...) trained individuals showed distinct empathic and related personality trait scores and that these declined with years of experience working in the profession. Supporting the theory that these professionals develop resilience in moral conflict, reduced emotional arousal was observed during virtual simulations of a distressing dilemma. Furthermore, trained professionals demonstrated less regret following the execution of a moral action in virtual reality when compared to untrained control populations. We showed that, contrary to previous research, trained individuals made the same moral judgments and moral actions as untrained individuals, though showing less arousal and regret. In the face of increasing concerns regarding empathy decline in healthcare professionals, we suggest that the nature of this decline is complex and likely reflects the development of a necessary emotional resilience to distressing events. (shrink)

A growing literature testifies to the persistence of place as an incorrigible aspect of human experience, identity, and morality. Place is a common ground for thought and action, a community of experienced particulars that avoids solipsism and universalism. It draws us into the philosophy of the ordinary, into familiarity as a form of knowledge, into the wisdom of proximity. Each of these essays offers a philosophy of place, and reminds us that such philosophies ultimately decide how we make, use, and (...) understand places, whether as accidents, instruments, or fields of care. (shrink)

This book studies the work of John Stuart Mill in order to answer the question: what is political theory? Looking at what political theorists have written about this subject leads to the conclusion that they have different ways of defining political theory, resulting in different readings of political theory. In defense of this argument, Reading Mill includes three different readings of the works of John Stuart Mill and identifies a fourth type of political theorist unlikely to read Mill. (...) When it comes to the question with which the book began, the only answer is that political theory is not one but four possible practices. This means that there are four different ways of reading a political theorist and reading political theory. The book calls for political theorists to recognize the value of their different ways of understanding political theory and, as a result, to tolerate their differences where they cannot celebrate them. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Fiery Test of Critique: A Reading of Kant's Dialectic by Ian ProopsStephen HowardIan Proops. The Fiery Test of Critique: A Reading of Kant's Dialectic. Oxford: Oxford University Press, 2021. Pp. 512. Hardback, $105.00.Ian Proops's book is a substantial contribution to the thriving field of Anglophone scholarship on the Transcendental Dialectic of Kant's Critique of Pure Reason. Across five hundred pages, Proops examines the whole of the Dialectic. (...) The book is divided into three parts, following the disciplines of previous special metaphysics with which Kant critically engages in the Dialectic: rational psychology, cosmology, and theology. Discussions of transcendental illusion and the regulative use of ideas of reason are slotted into the rational psychology and theology parts, respectively.Methodologically, Proops aims to take a middle course between historical and reconstructive approaches (31–32). In historical and reconstructive modes alike, though, Proops is primarily concerned with accurately presenting and rigorously evaluating Kant's arguments in the Dialectic. These arguments come in two forms: either those of the imagined rational psychologist, cosmologist, or theologian, whom Kant ventriloquizes in order to reveal their errors; or those arguments that Kant makes in his own voice. The Fiery Test of Critique distinguishes itself from existing studies through the detail and care with which these arguments are scrutinized. Specialists will find numerous illuminating exegeses and links to a wide range of Kant's published and unpublished writings. Proops does not hesitate to identify where, in his view, Kant's arguments fail (or where those of Kant's ventriloquized metaphysicians fail in a way Kant does not intend), but he endeavors to interpret charitably and to make his own evaluative criteria explicit.The wide-ranging introduction to the book offers intriguing reflections on a metaphor Kant uses for his critique of pure reason: a "fiery test" (8; A 406/B 433). This test, Proops suggests, is best understood not as a religious ordeal by fire but as a "metallurgical assay": the testing of a coin or an ore to determine its precious metal content (9–10). This means that the test of critique "is not pass-fail" (12). Kantian critique identifies some precious metal to be retained alongside the dross (the base-metal bearer) to be discarded. The "gold" [End Page 525] and "silver" found by Kant's fiery test are, Proops contends, respectively the indirect proof of transcendental idealism that emerges from the Antinomy chapter, and the doctrinal beliefs in God and an afterlife that remain after the Paralogism and Ideal (13, 453–54).This application of Kant's metaphor indicates how far Proops diverges from the dismissive views of older Anglo-American studies of the Dialectic (the paradigm being Bennett's Kant's Dialectic [Cambridge: Cambridge University Press, 1974]). Proops's opening questions and goals show that he aims to clarify the precise character of the dogmatic metaphysical claims criticized by Kant, and to identify what of this previous tradition Kant considers worth saving and why (2–7). This focus on the positive contribution of the Dialectic to Kant's philosophy—an approach Proops shares with other recent commentators—is very welcome.For all his illuminating discussion of Kant's Feuerprobe imagery, Proops neglects to note that Kant does not simply identify worthwhile aspects of previous special metaphysics. Rather, the philosophical findings that Proops takes to be the precious results of the critical test are significantly developed in Kant's hands. That is, no pre-Kantian rational cosmologist claims that their debates provide an indirect proof of transcendental idealism (of course). Neither do pre-Kantian rational psychologists or theologians make Kant's move of conceiving of God and the immortal soul as matters of doctrinal belief, where the latter is an epistemic attitude distinct from knowledge and cognition. In the cases that Proops highlights, then, the relevant image seems to be not only a metallurgical test but also an alchemical transformation of previous metaphysical doctrines into positive "critical" results.The parts of the book on the Paralogisms and the Ideal, on which Proops has previously published, will no doubt stimulate further detailed debate among specialists. I leave these debates aside to consider the part of the... (shrink)

This is a sequel to my paper, ‘What is Scientific Realism?’, which appeared in an earlier issue of this journal (Sankey, 2000a). A number of papers by other authors on topics relating to scientific realism have followed in subsequent issues. In this paper I revisit some of the themes developed in my earlier paper in the light of these later papers. I begin by restating the key ideas of the earlier paper. Next, I mention a number of afterthoughts which I (...) have had since the appearance of the paper. I then offer some comments on three of these subsequent papers. I hope these comments advance the discussion by clarifying and developing a number of key points. (shrink)

The paper discusses the version of entity realism presented by Ian Hacking in his book, Representing and Intervening. Hacking holds that an ontological form of scientific realism, entity realism, may be defended on the basis of experimental practices which involve the manipulation of unobservable entities. There is much to be said in favour of the entity realist position that Hacking defends, especially the pragmatist orientation of his approach to realism. But there are problems with the position. The paper explores two (...) issues that reflect negatively on Hacking’s version of the entity realist position. The first issue relates to the role of description in fixing the reference of theoretical terms. The second issue relates to Hacking’s claim that the argument for entity realism based on experiment is a different kind of argument from the standard argument for scientific realism based on the success of science. (shrink)

Intellectual humility is a hot topic. One of the key questions the literature is exploring is definitional: What is intellectual humility? In their recent paper, “Intellectual Humility: Owning our Limitations,” Dennis Whitcomb, Heather Battaly, Jason Baehr, and Daniel Howard-Snyder have proposed an answer: Intellectual humility is “proper attentiveness to, and owning of, one’s intellectual limitations”. I highlight some limitations of the limitations-owning account of intellectual humility. And in conclusion, I suggest that ultimately these are not limitations that any viable (...) account of intellectual humility should own and that Whitcomb et al. should revise their view accordingly. (shrink)

Historians and philosophers of science have furnished a wide array of theoretical-historiographical terms to emphasize the discontinuities among different systems of knowledge. Some of the most famous include Thomas Kuhn’s “paradigm”, Michel Foucault’s “episteme”, and the notion of “styles of reasoning” more recently developed by Ian Hacking and Arnold Davidson. This paper takes up this theoretical-historiographical thread by assessing the values and limitations of the notion of “style” for the historical and philosophical study of science. Specifically, reflecting on various methodological (...) and theoretical concerns prompted by sexuality, translation, and East Asian studies, this paper argues that the heretofore ways in which historians and philosophers of science have used the notion of “style” are severely restricted in terms of its mere applicability to the intellectual history of Western science. The particular example of the translation of “homosexuality” into Chinese during the May Fourth era reveals that the notion of “style” has the potential of carrying a much more dynamic conceptual weight, as when used in “styles of argumentation”. The paper also engages briefly with the historiography of scientific “national styles” and ends with some concluding remarks on the limitations of “social histories from below” and the under appreciated importance of “epistemological histories of possibilities”. (shrink)

Family medicine has grown as a specialty from its early days of general practice. It was established as a Board Certified specialty in 1969. This growth and maturation can be traced in the philosophy of family medicine as articulated by Edmund D. Pellegrino, M.D. Long before it was popular to do so, Pellegrino supported the development of family medicine. In this essay I examine the development of Pellegrino's philosophical thought about family practice, and contrast it to other thinkers like Ian (...) McWhinney, Kerr White, Walter Spitzer, Donald Ransom, and Hebert Vandervoort. The arguments focus on whether the goals of family medicine and family practice (possibly two distinct entities) can be articulated, especially considering the definitional problems of family and community. I conclude by echoing Pellegrino's hope that family medicine can contribute a fresh alternative to isolated, individualistic and technological thinking in medicine. (shrink)

Constructing a particular nation, that of early modern England, is seen here as a series of theatrical performances. Shakespeare’s work is taken as a series of thought experiments. Some, like The Merchant of Venice, are reassuring that threatening circumstances and innovatory social practices are capable of being overcome or assimilated from the unknown to the known. Some, like King Lear and Hamlet, ponder the consequences of a failure to discover a resolution. Some writers have argued that England was historically quite (...) early in beginning to conceive of itself as a nation, rather than as a population of possibly heterogeneous regions subject to a dynasty, a state of affairs summarized in the by now clichéd remark attributed to the Sun King, “L’Etat, c’est moi”. For Shakespeare, if not for all of his contemporaries, the Englishman is a bit slow-witted, owing to his fondness for beef and red wine, but he is distinguishable from others and provides material for the second pieces of theater I look at. If there could be an Englishman, his experience with the absolutist pretensions of the Stuart monarchy allowed there to be a free-born Englishman (and, actually, Englishwoman). The two crucial battles of the English civil war, Marston Moor and Naseby, followed by the Army Debates of 1647–1649 form the stage for an at least aspiring egalitarianism we now know as the rights of man, or the rights of the civic person. (shrink)

Jerome Bruner is one of the grand figures of psychology. From his role as a founder of the cognitive revolution in the 1950s to his recent advocacy of cultural psychology, Bruner's influence has been dramatic and far-reaching. Such is the breadth of his vision that Bruner's work has inspired thinkers in many of the major areas of psychology and has had a powerful impact on adjacent disciplines. His writings on language acquisition, culture and education are of profound and enduring importance. (...) Focusing on the dominant themes of language, culture and self, this volume provides a comprehensive exploration of Bruner's fertile ideas and a considered appraisal of his legacy. With a distinguished list of contributors including Jerome Bruner himself, the result is an outstanding volume of interest to students and scholars in psychology, philosophy, cognitive science, anthropology, linguistics, and education. Among the contributors are Judy Dunn, Howard Gardner, Clifford Geertz, Rom Harré, David Olson, Edward Reed, Talbot Taylor, Michael Tomasello, and John Shotter. The volume is framed by an editorial introduction that considers the distinctively philosophical dimensions of Bruner's thought, and a final chapter by Bruner himself in which he re-examines prominent themes in his work in light of issues raised by the contributors. The volume will be invaluable to students and researchers in the fields of psychology, cognitive science, education, and the philosophy of mind. (shrink)

This book includes sections on brightness and light, eye movements and perception, and perception of orientation and self-motion.

Azaransky's work highlights the theological contributions of Howard Thurman, Benjamin Mays, William Stuart Nelson, Pauli Murray and Bayard Rustin. She makes a compelling case that each of these thinker-activists needs to be better appreciated for their cutting-edge theological insights based on their thought and life experience with Mohandas Gandhi and his spiritual activism. Each reinterprets their own Christian views based on this larger worldwide experience that they have gained through study and/or travel. In this way they prefigure or (...) lay the groundwork for more recent approaches to spirituality such as those held by the Black Lives Matter movement's leaders, which draws upon multiple religious traditions to find the spiritual guidance and sustenance needed to confront our world's current injustices. (shrink)

Two intellectual vices seem to always tempt us: arrogance and diffidence. Regarding the former, the world is permeated by dogmatism and table-thumping close-mindedness. From politics, to religion, to simple matters of taste, zealots and ideologues all too often define our disagreements, often making debate and dialogue completely intractable. But to the other extreme, given a world with so much pluralism and heated disagreement, intellectual apathy and a prevailing agnosticism can be simply all too alluring. So the need for intellectual humility, (...) open-mindedness, and a careful, humble commitment to the truth are apparent. In this book, Dr Church and Dr Samuelson explicate a robust and vibrant account of the philosophy and science of this most valuable virtue, and they highlight how it can be best applied and personally developed. (shrink)

While intimately familiar, gender eludes theorizing. We argue that well-known challenges to gender’s analysis originate in a subtle ambiguity: questions about gender sometimes express questions about gender categories themselves (e.g., womanhood, manhood, and so on), while at other times expressing questions about what makes someone a member of these categories. Distinguishing these questions accentuates gender’s connections to morality, making a novel “antirealist” view of gender, or as we call it, “unrealist” view, especially natural. Gender’s relations to identity, sex, and social (...) position are illuminated along the way. Taking cues from both historical and contemporary debates in metaethics about the roles that attitudes can play in metaphysical and semantic analysis, we introduce and begin developing a comprehensive non-ameliorative framework for explicating gender’s nature and our thought and talk about it. In a slogan, on the view we defend, you belong to the gender category to which you intrinsically desire to belong. (shrink)

Many contemporary act consequentialists define facts about what we should do in terms of facts about what we should prefer. They claim that we should perform an action if and only if we should prefer its outcome to the outcome of any available alternative. Some of these theorists claim they can accommodate deontic constraints, such as a constraint against killing the innocent. I argue that they can’t. If there’s a constraint against killing, then when we can prevent five killings only (...) by killing one, we shouldn’t kill—but we should prefer the outcome where we do. (shrink)

A philosophical exploration of the origin and limits of the modern world.

A layman's guide to the mechanics of Gödel's proof together with a lucid discussion of the issues which it raises. Includes an essay discussing the significance of Gödel's work in the light of Wittgenstein's criticisms.

The current study examined whether Callous-Unemotional (CU) traits, a core component of psychopathy, modulate neural responses of participants engaged in a social exchange game. In this task, participants were offered an allocation of money and then given the chance to punish the offerer. Twenty youth participated and responses to both offers and the participant’s punishment (or not) of these offers were examined. Increasingly unfair offers were associated with increased dorsal anterior cingulate cortex (dACC) activity but this responsiveness was not modulated (...) by CU traits. Increasing punishment of unfair offers was associated with increased dACC and anterior insula activity and this activity was modulated by CU traits. Higher CU trait participants showed a weaker association between activity and punishment level. These data suggest that CU traits are associated with appropriate expectations of other individual’s normative behavior but weaker representations of such information when guiding behavior of the self. (shrink)

Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surrogates regarding the possible use of PPPs as a means to help make (...) treatment decisions for decisionally-incapacitated patients. -/- Methods: This qualitative study used semi-structured interviews to determine the views of experienced surrogates [n=26] who were identified from two academic medical centers and two community hospitals. The primary outcomes were respondents’ overall level of support for the idea of using PPPs and the themes related to their views on how a PPP should be used, if at all, in practice. -/- Results: Overall, 21 participants supported the idea of using PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on substituted judgment. Major themes which emerged were that surrogates, not the patient’s preferences, should determine how treatment decisions are made, and concern that PPPs might be used to deny expensive care or be biased against minority groups. -/- Conclusions: Surrogates, like patients, strongly support the idea of using PPPs to help make treatment decisions for decisionally-incapacitated patients. These findings provide support for developing a PPP and assessing it in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions are made, including whether to use a PPP. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making. Future research is needed to assess this disagreement and consider ways to address it. (shrink)

A less analytic and more wholistic approach to philosophy, described as best overall fit or seeing how things all hang together, is defended in recent works by John Rawls and Richard Rorty and can usefully be applied to problems in philosophy of medicine. Looking at sickness and its impact upon the person as a central problem for philosophy of medicine, this approach discourages a search for necessary and sufficient conditions for being sick, and instead encourages a listing of true and (...) interesting observations about sickness which reflect the convergence of a number of different viewpoints. Among the relevant viewpoints are other humanities disciplines besides philosophy and the social sciences. Literature, in particular, provides insights into the meaning and the uniqueness of episodes of sickness in a way that philosophers may otherwise fail to grasp. (shrink)