The increased competition for a share of the market of insured patients, which arose in the wake of failed comprehensive health care reform, has provoked questions about what, if any, standards will govern new “competitive” health care organizations. Managed care arrangements, which typically shift to providers and patients some or all of the financial risk for patient care, are of special concern because they can create incentives to withhold beneficial care from patients. Of course, fee-for-service medical practice creates incentives to (...) provide unnecessary services, and managed care can avoid that type of harm. Still, as Edmund Pellegrino has noted, “managed care, by its nature, places the good of the patient into conflict with … the good of all the other patients served by the plan; the good of the plan and the organization, themselves…; and the self-interest of the physician. (shrink)

Following the seemingly endless debate over managed care liability, I cannot suppress thoughts of Yeats’s poem, “The Second Coming.” It is not the wellknown phrase, “Things fall apart; the centre cannot hold,” that comes to mind; although that could describe the feeling of a health-care system unraveling. The poem’s depiction of lost innocence — “The best lack all conviction, while the worst/Are full of passionate intensity” — does not allude to the legislature, the industry, the public, or the medical or (...) legal profession. What resonates is the poem’s evocation of humanity’s cyclical history of expectation and disappointment, with ideas as grand as justice and occupations as pedestrian as managed care. Writing in 1919, Yeats described the end of an era with images of war’s destructive forces. The poem expresses a universal desire for some miraculous rebirth or resolution of all problems: “Surely some revelation is at hand.” But instead, the brutish Sphinx-like creature emerges, possibly the Antichrist. New gods displace old gods in the cycle of civilization, and man must muddle on. (shrink)

Recent efforts to introduce competition, consistent with microeconomic theory, into the United States health care system raise questions of distributive justice. Similarities between microeconomic theory and libertarian philosophy suggest the possibility of confusing economic goals of efficiency and cost containment with social goals of equity of access to care. This paper raises the fear that if the two are confused, society may unwittingly abandon any serious effort to ensure that the poor have access to essential types of medical care, because (...) libertarian philosophy cannot justify placing any constraints, however beneficient, on the actual distribution of benefits and burdens of illness resulting from free trade. (shrink)

The men and women who serve in the armed forces, in the words of Major General Joseph Caravalho, “sign a blank check, co-signed by their families, payable to the Army, Navy, Air Force, or Marines, up to and including their lives.” It is human nature to consider such a pact in polarized terms; the pact concludes in either a celebratory homecoming or funereal mourning. But in reality, surviving catastrophic injury may incur the greatest debt. The small but real possibility of (...) losing the ability to bear biological children due to genitourinary combat injury has been a topic of discussion in hushed tones, behind closed doors. But as policy changes move the conversation into the open, we must be fully aware of the far-reaching and long-term impacts of decisions on those who have sustained genitourinary injury. In January 2016, Secretary of Defense Ashton Carter outlined a set of reforms that would improve the quality of life for military families by recognizing the importance of maintaining fertility, even in the face of severe injury. This first promising step could build a solid foundation of insuring fertility preservation for wounded service members with genitourinary injury, and it could set a precedent beyond the military for insuring treatment for people who have lost their reproductive capacity. Thus, the ethical challenges raised by the new policy require careful analysis. (shrink)

Ocean biology helps regulate global climate by fixing atmospheric CO2 and exporting it to deep waters as sinking detrital particles. New observations demonstrate that particle fragmentation is the principal factor controlling the depth to which these particles penetrate the ocean's interior, and hence how long the constituent carbon is sequestered from the atmosphere. The underlying cause is, however, poorly understood. We speculate that small, particle‐associated copepods, which intercept and inadvertently break up sinking particles as they search for attached protistan prey, (...) are the principle agents of fragmentation in the ocean. We explore this idea using a new marine ecosystem model. Results indicate that explicitly representing particle fragmentation by copepods in biogeochemical models offers a step change in our ability to understand the future evolution of biologically‐mediated ocean carbon storage. Our findings highlight the need for improved understanding of the distribution, abundance, ecology and physiology of particle‐associated copepods. (shrink)

A number of recent discussions comparing computer simulation and traditional experimentation have focused on the significance of “materiality.” I challenge several claims emerging from this work and suggest that computer simulation studies are material experiments in a straightforward sense. After discussing some of the implications of this material status for the epistemology of computer simulation, I consider the extent to which materiality (in a particular sense) is important when it comes to making justified inferences about target systems on the basis (...) of experimental results. (shrink)

Recent calls for retraction of a large body of Chinese transplant research and of Dr Jiankui He’s gene editing research has led to renewed interest in the question of publication, retraction and use of unethical biomedical research. In Part 1 of this paper, we briefly review the now well-established consequentialist and deontological arguments for and against the use of unethical research. We argue that, while there are potentially compelling justifications for use under some circumstances, these justifications fail when unethical practices (...) are ongoing—as in the case of research involving transplantations in which organs have been procured unethically from executed prisoners. Use of such research displays a lack of respect and concern for the victims and undermines efforts to deter unethical practices. Such use also creates moral taint and renders those who use the research complicit in continuing harm. In Part 2, we distinguish three dimensions of ‘non-use’ of unethical research: non-use of published unethical research, non-publication, and retraction and argue that all three types of non-use should be upheld in the case of Chinese transplant research. Publishers have responsibilities to not publish contemporary unethical biomedical research, and where this has occurred, to retract publications. Failure to retract the papers implicitly condones the research, while uptake of the research through citations rewards researchers and ongoing circulation of the data in the literature facilitates subsequent use by researchers, policymakers and clinicians. (shrink)

Philosophers continue to debate both the actual and the ideal roles of values in science. Recently, Eric Winsberg has offered a novel, model-based challenge to those who argue that the internal workings of science can and should be kept free from the influence of social values. He contends that model-based assignments of probability to hypotheses about future climate change are unavoidably influenced by social values. I raise two objections to Winsberg’s argument, neither of which can wholly undermine its conclusion but (...) each of which suggests that his argument exaggerates the influence of social values on estimates of uncertainty in climate prediction. I then show how a more traditional challenge to the value-free ideal seems tailor-made for the climate context. (shrink)

After showing how Deborah Mayo’s error-statistical philosophy of science might be applied to address important questions about the evidential status of computer simulation results, I argue that an error-statistical perspective offers an interesting new way of thinking about computer simulation models and has the potential to significantly improve the practice of simulation model evaluation. Though intended primarily as a contribution to the epistemology of simulation, the analysis also serves to fill in details of Mayo’s epistemology of experiment.

Neoliberalism and neoconservatism are two distinct political rationalities in the contemporary United States. They have few overlapping formal characteristics, and even appear contradictory in many respects. Yet they converge not only in the current presidential administration but also in their de-democratizing effects. Their respective devaluation of political liberty, equality, substantive citizenship, and the rule of law in favor of governance according to market criteria on the one side, and valorization of state power for putatively moral ends on the other, undermines (...) both the culture and institutions of constitutional democracy. Above all, the two rationalities work symbiotically to produce a subject relatively indifferent to veracity and accountability in government and to political freedom and equality among the citizenry. (shrink)

This target article presents a plausible evolutionary scenario for the emergence of the neural preconditions for language in the hominid lineage. In pleistocene primate lineages there was a paired evolutionary expansion of frontal and parietal neocortex (through certain well-documented adaptive changes associated with manipulative behaviors) resulting, in ancestral hominids, in an incipient Broca's region and in a configurationally unique junction of the parietal, occipital, and temporal lobes of the brain (the POT). On our view, the development of the POT in (...) our ancestors resulted in the neuroanatomical substrate consistent with the ability for representations in modality-neutral association cortex and, as a result of structure-imposing interaction with Broca's area, the hierarchically structured Evidence from paleoneurology and comparative primate neuroanatomy is used to argue that Homo habilis (2.5–2 million years ago) was the first hominid to have the appropriate gross neuroanatomical configuration to support conceptual structure. We thus suggest that the neural preconditions for language are met in H. habilis. Finally, we advocate a theory of language acquisition that uses conceptual structure as input to the learning procedures, thus bridging the gap between it and language. (shrink)

In this essay I explore the economic, social, environmental and cultural changes taking place in Bolsena, Italy, where agricultural livelihoods have rapidly diminished in the last two decades. I examine how gender dynamics have shifted with the changing values and livelihoods of Bolsena through three women’s narratives detailing their gendered experiences of environment, community and self. I reflect on these changes with Sabrina, who is engaged in a feminist community-based organization; Anna, who is running an alternative wine bar; and Isabella, (...) a jeweler, who is engaged in ecofeminist practices. My analysis is based on concepts developed by feminist political ecology: specifically, the theory of rooted networks from Dianne Rocheleau, Donna Haraway’s concept of naturecultures (and the work of J. K. Gibson-Graham on new economic imaginaries emerging from the politics of place. I aim to think with, reflect upon and provoke from the “otherwise”, taking into account the lived relations entwining nature and gender. My article looks at the interconnections of gender, environment and livelihoods, attentive to the daily needs, embodied interactions and labours of these three women as part of a reappropriation, reconstruction and reinvention of Bolsena’s lifeworld. By listening to the stories of their everyday lives and struggles, I show the dynamic potential of the politics of place and the efforts to build diverse economies and more ethical economic and ecological relationships based on gender-aware subjectivities and values. (shrink)

If something is to stay in the memory, it must be burned in: only that which never ceases to hurt stays in the memory. Friedrich Nietzsche ( from On the Genealogy of Morals).

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

Current conceptions of human language include a gestural component in the communicative event. However, determining how the linguistic and gestural signals are distinguished, how each is structured, and how they interact still poses a challenge for the construction of a comprehensive model of language. This study attempts to advance our understanding of these issues with evidence from sign language. The study adopts McNeill's criteria for distinguishing gestures from the linguistically organized signal, and provides a brief description of the linguistic organization (...) of sign languages. Focusing on the subcategory of iconic gestures, the paper shows that signers create iconic gestures with the mouth, an articulator that acts symbiotically with the hands to complement the linguistic description of objects and events. A new distinction between the mimetic replica and the iconic symbol accounts for the nature and distribution of iconic mouth gestures and distinguishes them from mimetic uses of the mouth. Symbiotic symbolization by hand and mouth is a salient feature of human language, regardless of whether the primary linguistic modality is oral or manual. Speakers gesture with their hands, and signers gesture with their mouths. (shrink)

Contemporary scholarship accents incipient theurgical practice for Plotinus; this lends a certain urgency to the question of his acceptance of magic. While use of magic recorded in Porphyry's Vita Plotini has received considerable attention, far less has been done to analyze actual discussion in the Enneads. Examination of key passages brings to light the context for discussion of magic, particularly issues of sympathy, prayer, astrology and divination. Equally important is Plotinus' understanding of the cosmos and role of the heavenly bodies. (...) Plotinus' affirmation of the highest part of the soul as undescended, together with the claim that our soul has a common origin with the World Soul in Soul-Hypostasis, is significant for the relative unimportance he attributes to the role and effect of magic. (shrink)

Almaatouq et al. propose a novel integrative approach to experiments. We provide three examples of how unaddressed measurement issues threaten the feasibility of the approach and its promise of promoting commensurability and knowledge integration.

Plato has received his share of bad press in this century. A number of significant schools of thought, like existentialism and phenomenology, have openly expressed impatience with Platonic ‘essentialism.’ He has even been blamed for fascism. Perhaps the problem goes back to Nietzsche’s call, at the turn of the century, to be true to the earth, our common mother. His message was aimed at otherworldly, pious Christians who, with a spiritualism worthy of the Platonists, regarded contemplative thought as the way (...) to truth. Like a doubleedged sword Nietzsche’s call was also directed against metaphysics, dogmatism and intellectualism, the fruits of which he confronted in the weighty tomes for which German scholars then were justifiably renowned. It is not surprising that in the Soviet empire, built on Marxist-Leninist atheism, Nietzsche’s words fell on receptive ears. Not only were philosophers who dared openly to identify themselves as ‘Platonist’ or ‘idealist’ banned, exiled or executed. The teaching of classical antiquity, too, was almost entirely removed from the curriculum; the ancients could be considered only from a highly restricted point of view, via Democritus, Lucretius, or Aristotle. (shrink)

This chapter contains sections titled: Introduction Qualitative Hedonism Objections to Mill's Qualitative Hedonism: Internal Inconsistency and Value Pluralism The Judgment of Competent Agents: Self‐Development and Value Measurement Self‐Development and Virtue Ethics Further Reading.

As neuroscience methods begin to dominate emotion research it is critical for researchers to remember that peripheral embodiments are critical to understanding emotional experience and emotion—behavior links. Much of modern emotion research assumes reliable mind—body connections that suggest that changes in emotional states influence bodily responses and, vice versa, that somatovisceral information shapes emotional experiences. However, there may be important qualifications to the link between the mind and the (peripheral) body. For example, the ability to sense internal and external bodily (...) states declines in older age as does activation of physiological systems, all of which may contribute to an impairment in emotional experiences and how emotions influence behavior. I describe this phenomenon as maturational dualism and suggest implications of this for emotion in older adults. (shrink)

The article examines the inter-implication between Foucault's and Derrida's representations of one another's work in the debate over Histoire de la folie and discovers a chiasmic structure between them, an inverted mirroring of each in the other, in which philosophy and historicity alternately encompass and exceed one another. At the heart of this is a problem of language (and the reason that accompanies it), which defines the limitations of the historian's work.

In an environment where astrology was widely respected, Plotinus accepted the role of heavenly bodies in answering prayer. Considering them divine, he denied them the use of memory (iv 4, 6-8); how then could he explain response to prayer received after an interval of time? Plotinus was also concerned to deny attributing intentionality in any response given, for good or evil, since that would make the astral deities responsible also for morally dubious answers. In his treatment of the issue in (...) this passage, Plotinus draws on a lengthy earlier discussion of the role of memory in the soul’s thinking and knowing (iv 3, 25-iv 4, 12), as associated primarily with that which exists in time and is characterized by αἴσθησις, i.e., the lower soul belonging to the composite living being (iv 3, 25.12-14; iv 4, 16-17). If astral deities have bodies, these are of a highly refined fiery nature, and can be affected only inasmuch as they participate in the cosmic circuit. What suppliants may regard as intentional response must therefore be understood as the effect of a type of ‘linking’ of the universe as a living organism in which all parts are coordinated in an interrelationship characterized by sympathy. This is why answers to prayer represent no more than the unintended reaction of natural forces in the universe, the very same forces also responsible for effective use of magic. If Plotinus does not assign much value to prayer, he does recognize that, as with magic, such incantations may have a harmful effect, if only for the lower soul. He therefore warns the wise person to guard against such outcomes by focusing the soul in its contemplation of what is higher, i.e., its inner life. (shrink)

Rationale, aims and objectives: Bioethics and professionalism are standard subjects in medical training programmes, and these curricula reflect particular representations of meaning and practice. It is important that these curricula cohere with the actual concerns of practicing clinicians so that students are prepared for real-world practice. We aimed to identify ethical and professional concerns that do not appear to be adequately addressed in standard curricula by comparing ethics curricula with themes that emerged from a qualitative study of medical practitioners. Method: (...) Curriculum analysis: Thirty-two prominent ethics and professionalism curricula were identified through a database search and were analysed thematically. Qualitative study: In-depth, semi-structured interviews were conducted with 20 medical practitioners. Participants were invited to reflect upon their perceptions of the ways in which values matter in their practices and their educational experiences. The themes emerging from the two studies were compared and contrasted. Results: While representations of meaning and value in ethics and professionalism curricula overlap with the preoccupations of practicing clinicians, there are significant aspects of ‘real-world’ clinical practice that are largely ignored. These fell into two broad domains: ‘sociological’ concerns about enculturation, bureaucracy, intra-professional relationships, and public perceptions of medicine; and epistemic concerns about making good decisions, balancing different kinds of knowledge, and practising within the bounds of professional protocols. Conclusions: Our findings support the view that philosophy and sociology should be included in medical school and specialty training curricula. Curricula should be reframed to introduce students to habits of thought that recognize the need for critical reflection on the social processes in which they are embedded, and on the philosophical assumptions that underpin their practice. (shrink)

Maria Morales’s striking and thought-provoking argument in Perfect Equality is that John Stuart Mill’s egalitarianism unifies his practical philosophy and that this element of his thought has been neglected in recent revisionary scholarship. Placing Mill’s arguments for the substantive value of “perfect equality” in The Subjection of Women at the center of her analysis, Morales develops a distinctive interpretation of Mill as an egalitarian liberal. Morales also aims to counter many recent communitarian critiques of liberalism as founded upon a conception (...) of the self as atomistic and individualistic. Like other Mill scholars, Morales sees Mill’s liberalism as an appealing alternative to the dominant Rawlsian theory, and she offers Mill’s approach as a response to “the still popular view that liberalism is structurally incompatible with a rich conception of the human good, particularly with a substantive commitment to equality”. Mill’s theory is not “doggedly individualistic,” and it rejects the model of liberal social life as atomistic and abstract. The well-constituted communities of the title are based upon “sympathetic, cooperative, and egalitarian values”. (shrink)

Quantum field theory is generally accepted by the modern scientific community as the most accurate paradigm for understanding the mystery of reality. This theory revolutionizes what we know as ’matter’ and how material things are connected. But is also confirms an ancient philosophical and ethical truth: the unfathomable mystery of being. Quantum field theory demonstrates that beings be in such a manner that their composite reality evades human cognition. Quantum field theory forces a rethinking of what we mean by ’world’, (...) ’beings’, ’existence’, and ’God’, and our assumptions about order, God, responsibility and systems of ethics. (shrink)