The term fuzzy logic is used in this paper to describe an imprecise logical system, FL, in which the truth-values are fuzzy subsets of the unit interval with linguistic labels such as true, false, not true, very true, quite true, not very true and not very false, etc. The truth-value set, , of FL is assumed to be generated by a context-free grammar, with a semantic rule providing a means of computing the meaning of each linguistic truth-value in as a (...) fuzzy subset of [0, 1].Since is not closed under the operations of negation, conjunction, disjunction and implication, the result of an operation on truth-values in requires, in general, a linguistic approximation by a truth-value in . As a consequence, the truth tables and the rules of inference in fuzzy logic are (i) inexact and (ii) dependent on the meaning associated with the primary truth-value true as well as the modifiers very, quite, more or less, etc. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

I explore some of the ways that assumptions about the nature of substance shape metaphysical debates about the structure of Reality. Assumptions about the priority of substance play a role in an argument for monism, are embedded in certain pluralist metaphysical treatments of laws of nature, and are central to discussions of substantivalism and relationalism. I will then argue that we should reject such assumptions and collapse the categorical distinction between substance and property.

Moral Case Deliberations are reflective dialogues with a group of participants on their own moral dilemmas. Although MCD is successful as clinical ethics support, it also has limitations. 1. Lessons learned from individual MCDs are not shared in order to be used in other contexts 2. Moral learning stays limited to the participants of the MCD; 3. MCD requires quite some organisational effort, 4. MCD deals with one individual concrete case. It does not address other, similar cases. These limitations warrant (...) research into complementary ways of providing CES to healthcare professionals. Our research objective was therefore to develop a low threshold CES tool based on a series of MCDs on autonomy in long-term care. We used a qualitative research design in which we analyzed the process and content of a series of MCDs, combined with reflections on the theoretical background of MCD. In total 28 MCDs were analyzed by means of a thematic content analysis. In various rounds of development, the results of the analysis were combined with theoretical reflections on CES. Consequently, the tool was evaluated in three focus groups and adjusted. The CES tool, called ‘moral compass’, guides the users through a series of six subsequent questions in order to methodically reflect on their concrete moral dilemma, in the form of a booklet of 23 pages. It combines a methodical element that encourages and structures a reflection process with a substantive element, including norms, values, options, strategies, and insights regarding dealing with client autonomy. By using data from a series of MCDs, combined with theoretical reflections on MCD, ethics support and moral learning, we developed a thematic, low-threshold CES tool that supports healthcare professionals in daily practice in dealing with moral questions regarding client autonomy. It integrates examples and insights from earlier MCDs on the same topic. The moral compass is not a replacement of, but can be used complementary to MCD. The feasibility and impact of the moral compass need to be investigated in an evaluative follow-up study. The methodology presented in this paper may be used to develop moral compasses on different topics in various healthcare organizations. (shrink)

Si les paroles du Qohéleth ne manquent pas de provoquer le lecteur, l’assimilation de l’homme et de la bête en QO 3,19 est certainement une des affirmations les plus rudes du texte. Cet article s’intéresse à cette étonnante pensée par une lecture des versets 3,16-21 de l’Ecclésiaste qui met en valeur l’effet de sens produit par la conjonction de deux propos dont le lien n’est pas spontané : le jugement de Dieu et la mort identique de l’homme et de la (...) bête. L’approche exégétique et littéraire montre comment Qohéleth déploie une réflexion de type fondamental sur l’homme qui, à travers une négation à la fois anthropologique et éthique, met violemment en question le sens de l’homme, de son agir, en référence au jugement et au gouvernement divin. C’est en négatif que la relation entre justice de Dieu et création apparaît. La mort de l’homme met Dieu en cause en interrogeant non seulement la pertinence d’un jugement appliqué à un homme dont la mort est semblable à celle de la bête, mais aussi le geste créateur de Dieu et les commencements, là où se décide la destinée humaine. If the words of Qoheleth do not fail to provoke the reader, the assimilation of man and animal in QO 3,19 is certainly one of the harshest affirmations of the text. The article is interested in this astonishing idea through a reading of verses 3,16-21 of Ecclesiastes, which highlights the effect of meaning produced by the conjunction of two statements whose connection is not spontaneous: the judgment of God, and a death that is identical in man and animal. An exegetical and literary approach shows how Qoheleth makes use of a fundamental type of reflection on man, who, through a negation at once anthropological and ethical, violently puts into question the meaning of man and his behavior, in reference to divine judgment and government. The relation between the justice of God and creation appears in a negative light. Man’s death implicates God by questioning, not only the pertinence of judgment applied to a man whose death is similar to that of an animal, but also the creative gesture of God and beginnings, there where human destiny is decided. (shrink)

Quentin Smith has argued that the new tenseless theory of time is faced with insurmountable problems and should be abandoned in favour of the tensed theory of time. Smith;s main argument attacks the fundamental premise of the tenseless theory: that tenseless truth conditions for tokens of tensed sentences adequately capture the meaning of tensed sentences. His position is that tenseless truth conditions cannot explain the logical relations between tensed sentences, thus the tensed theory must be accepted. Against Smith, this paper (...) adopts an alternative approach to the explanation of the entailment relations between sentences which contain indexicals. The approach drops the reliance upon tokens and instead relies on the evaluation of sentence types with respect to a context rather than upon actual or possible utterances of tokens of the types. This (new) version of the tenseless theory of time can adequately explain the relevant entailment relations between tensed sentences. (shrink)

The sports world has historically rejected the practice of tanking. I argue that this attitude is unwarranted. To do so, I introduce a concept called strategic suboptimal play (SSP), which is the practice of incurring the risk of a short-term competitive disadvantage to increase the chances of gaining a longer-term competitive advantage. Tanking is just an instance of SSP employed in higher-order games, i.e. games that are at least partially played by other games, like tournaments or seasons. Since SSP is (...) integral to every sport, there are currently no easy grounds for rejecting it outright. As such, the same is true of tanking. I will explore some possible reasons why tanking is wrongly thought objectionable, as well as some objections to and implications of my argument for competitive sports more broadly. (shrink)

This study is based on the 1983 Rural Health Survey of Ethiopia. Patterns and levels of child morbidity by age, sex, geographic region, and sanitary facilities are examined. Morbidity levels peak in the second year of life. Diarrhoeal diseases are of major importance, especially among infants and toddlers. Parasitic diseases, and respiratory diseases other than pneumonia, become increasingly important with age.There are no significant sex differentials in morbidity except for higher rates of diarrhoeal diseases among female children. Geographic differentials are (...) quite marked with particularly high morbidity levels from all disease types in the western mountainous regions of Ethiopia. Access to high quality drinking water, a latrine, and garbage disposal, are strongly related to reduced overall morbidity levels, though not necessarily to reduced diarrhoeal disease levels. (shrink)

It is often claimed that the intentions of physicians are multiple, ambiguous, and uncertain—at least with respect to end-of-life care. This claim provides support for the conclusion that the principle of double effect is of little or no value as a guide to end-of-life pain management. This paper critically discusses this claim. It argues that proponents of the claim fail to distinguish two different senses of “intention,” and that, as a result, they are led to exaggerate the extent to which (...) clinical intentions in end-of-life contexts are ambiguous and uncertain. It argues further that physicians, like others who make life and death decisions, have a duty to get clear on what their intentions are. Finally, it argues that even if the principle of double effect should be rejected, clinical intentions remain ethically significant because they condition the meaning of extraordinary clinical interventions, such as that of palliative sedation. (shrink)

A considerable number of workers interviewed have stated their belief that Jews have too much power. The notion of power in this context has a wide range. It covers the most diversified phenomena—from holding minor positions in administration or business to dominating everything and wielding unchecked power over the world. The idea of Jewish power as it fascinates our interviewees is vague and hazy. To establish its real contents, it seems advisable to discuss these statements first that refer to the (...) widest and most comprehensive concept of universal Jewish domination. In statements made by our interviewees, references to Jews as.. (shrink)

In response to counterexamples involving late preemption, David Lewis (1986) revised his original (1973) counterfactual analysis of causation to include the notion of quasi-dependence. Jonardon Ganeri, Paul Noordhof and Murali Ramachandran (1998) argue that their ‘PCA*-analysis’ of causation solves the problem of late preemption and is superior to Lewis’s analysis. I show that neither quasi-dependence nor the PCA*-analysis solves the problem of late preemption.

As you face a life-defining change, you might ask yourself: Who will I become? This can be understood as a question about the nature and character of your future life, asked from your first person, or subjective, perspective. The nature and character of your conscious, first person, lived experience is a defining constituent of what it is like to be you. Framed this way, knowing the nature of your future lived experience is a way of knowing your future self. In (...) this paper, I explore this way of understanding one’s self and its implications for understanding life-defining changes in high-stakes contexts. My exploration of this way of understanding one’s self highlights the role of experience in grasping perceptual truths, and the importance of imagination, empathy, and testimony in self-understanding and prediction. (shrink)

I claim that Mill has a theory of poetry which he uses to reconcile nineteenth century associationist psychology, the tendency of the intellect to dissolve associations, and the need for educated members of society to desire utilitarian ends. The heart of the argument is that Mill thinks reading poetry encourages us to feel the feelings of others, and thus to develop pleasurable associations with the pleasurable feelings of others and painful associations with the painful feelings of others. Once the associations (...) are developed, they are supported and maintained by our natural capacity for sympathy and by external elements in society, and provide motivation for the pursuit of utilitarian ends. Further, the additional support causes the associations to be strengthened to the extent that they come to be seen as ‘natural and necessary’, and as such are immune from the dissolving force of the intellect. (shrink)