Trust is a core feature of the physician-patient relationship, and risk is central to trust. Patients take risks when they trust their providers to care for them effectively and appropriately. Not all patients take these risks: some medical relationships are marked by mistrust and suspicion. Empirical evidence suggests that some patients and families of color in the United States may be more likely to mistrust their providers and to be suspicious of specific medical practices and institutions. Given both historical and (...) ongoing oppression and injustice in American medical institutions, such mistrust can be apt. Yet it can also frustrate patient care, leading to family and provider distress. In this paper, I propose one way that providers might work to reestablish trust by taking risks in signaling their own trustworthiness. This interpersonal step is not meant to replace efforts to remedy systemic injustice, but is an immediate measure for addressing mistrust in occurrent cases. (shrink)

Trust in medicine is often conceived of on an individual level, with respect to how people rely on particular clinicians or institutions. Yet as discussions of trust during the Covid‐19 pandemic highlighted, trust decisions are not always as individual or interpersonal as this conception suggests. Rather, individual instances of trusting behavior are related to social trust, which is conceived as a willingness to be vulnerable to people in general, based on a sense of shared norms. In this essay, I propose (...) that individual and social trust are connected to each other in what can be termed a “climate of trust.” I explain how masking trends during the pandemic facilitated a “climate of distrust,” and I consider the role that clinicians might play in transforming climates of distrust into climates of trust. (shrink)

The concept of paternalism is intricately tied to the concept of autonomy. It is commonly assumed that when paternalistic interventions are wrong, they are wrong because they impede individuals’ autonomy. Our aim in this paper is to show that the recent shift towards conceiving of autonomy relationally highlights a separate conceptual space for a nonpaternalistic kind of interpersonal intervention termed maternalism. We argue that maternalism makes a twofold contribution to the debate over the ethics of interpersonal action and decision-making. Descriptively, (...) it captures common experiences that, while not unusual in everyday life, are largely absent from the present discussion. Normatively, it describes a type of intervention with justification conditions distinct from the standard framework of paternalism. We explicate these contributions by describing six key differences between maternalism and paternalism, and conclude by anticipating and responding to potential objections. (shrink)

In evolutionary psychology predictions, women’s mate preferences shift between fertile and nonfertile times of the month to reflect ancestral fitness benefits. Our meta-analytic test involving 58 independent reports (13 unpublished, 45 published) was largely nonsupportive. Specifically, fertile women did not especially desire sex in short-term relationships with men purported to be of high genetic quality (i.e., high testosterone, masculinity, dominance, symmetry). The few significant preference shifts appeared to be research artifacts. The effects declined over time in published work, were limited (...) to studies that used broader, less precise definitions of the fertile phase, and were found only in published research. (shrink)

Ethical analyses of the effects of neural interventions commonly focus on changes to personality and behavior, interpreting these changes in terms of authenticity and identity. These phenomena have led to debate among ethicists about the meaning of these terms for ethical analysis of such interventions. While these theoretical approaches have different criteria for ethical significance, they agree that patients’ reports are concerning because a sense of self is valuable. In this paper, I question this assumption. I propose that the Buddhist (...) theory of no‐self offers a novel approach to making ethical sense of patients’ claims following deep brain stimulation. This alternative approach is based on the value of insight into patterns of cause and effect among mental states and actions. (shrink)

Brain–Computer Interface research is an interdisciplinary area of study within Neural Engineering. Recent interest in end-user perspectives has led to an intersection with user-centered design. The goal of user-centered design is to reduce the translational gap between researchers and potential end users. However, while qualitative studies have been conducted with end users of BCI technology, little is known about individual BCI researchers’ experience with and attitudes towards UCD. Given the scientific, financial, and ethical imperatives of UCD, we sought to gain (...) a better understanding of practical and principled considerations for researchers who engage with end users. We conducted a qualitative interview case study with neural engineering researchers at a center dedicated to the creation of BCIs. Our analysis generated five themes common across interviews. The thematic analysis shows that participants identify multiple beneficiaries of their work, including other researchers, clinicians working with devices, device end users, and families and caregivers of device users. Participants value experience with device end users, and personal experience is the most meaningful type of interaction. They welcome end-user input, but are skeptical of limited focus groups and case studies. They also recognize a tension between creating sophisticated devices and developing technology that will meet user needs. Finally, interviewees espouse functional, assistive goals for their technology, but describe uncertainty in what degree of function is “good enough” for individual end users. Based on these results, we offer preliminary recommendations for conducting future UCD studies in BCI and neural engineering. (shrink)

To examine whether anticipatory attention or expectancy is a cognitive process that is automatic or requires conscious control, we employed a paired-stimulus event-related potential paradigm during the transition to sleep. The slow negative ERP wave observed between two successive stimuli, the Contingent Negative Variation , reflects attention and expectancy to the second stimulus. Thirteen good sleepers were instructed to respond to the second stimulus in a pair during waking sessions. In a non-response paradigm modified for sleep, participants then fell asleep (...) while tones played. As expected, N1 decreased and P2 increased in amplitude systematically with the loss of consciousness at sleep onset; the CNV was increasingly more positive. Sleep onset latency was correlated with the amplitude of the CNV. The systematic attenuation of the CNV waveform at sleep onset and its absence in sleep indicates that anticipatory attention requires endogenous conscious control. (shrink)

The Victorian period in Britain was an “age of reform.” It is therefore not surprising that two of the era’s most eminent intellects described themselves as reformers. Both William Whewell and John Stuart Mill believed that by reforming philosophy—including the philosophy of science—they could effect social and political change. But their divergent visions of this societal transformation led to a sustained and spirited controversy that covered morality, politics, science, and economics. Situating their debate within the larger context of Victorian society (...) and its concerns, _Reforming Philosophy_ shows how two very different men captured the intellectual spirit of the day and engaged the attention of other scientists and philosophers, including the young Charles Darwin. Mill—philosopher, political economist, and Parliamentarian—remains a canonical author of Anglo-American philosophy, while Whewell—Anglican cleric, scientist, and educator—is now often overlooked, though in his day he was renowned as an authority on science. Placing their teachings in their proper intellectual, cultural, and argumentative spheres, Laura Snyder revises the standard views of these two important Victorian figures, showing that both men’s concerns remain relevant today. A philosophically and historically sensitive account of the engagement of the major protagonists of Victorian British philosophy, _Reforming Philosophy_ is the first book-length examination of the dispute between Mill and Whewell in its entirety. A rich and nuanced understanding of the intellectual spirit of Victorian Britain, it will be welcomed by philosophers and historians of science, scholars of Victorian studies, and students of the history of philosophy and political economy. (shrink)

The concepts currently operating in much medical microbiome research bear a curious resemblance to an ancient tradition of Western medicine. This tradition, humoral medicine, is concerned with the four humors: yellow and black bile, phlegm, blood. Both humoral medicine and medical microbiome research use notions of imbalance and balance for broad explanations of disease and health. Both traditions also hold that the composition of humors or microbiomes determines bodily as well as mental states. Causality in each system is often conceived (...) teleologically, meaning that humors or microbiomes "function for" the maintenance of the whole. And ultimately, each framework situates the humors or microbiomes in a multilevel interactionist theory that conceptualizes individual health within a broader environmental context. As well as critically assessing the parallels between these systems, this article sketches some explanations of how they may have arisen. The authors also evaluate the implications of these similarities for the future of medical microbiome research and suggest ways in which the field might move forward. (shrink)

This paper presents a conception of the self partially in terms of a particular notion of preference. It develops a coherentist account of when one's preferences are "authorized", or sanctioned as one's own, and presents a coherence theory of autonomous action. The view presented solves certain problems with hierarchical accounts of freedom, such as Harry Frankfurt's.

Fortunato and colleagues' target article extends both the ethical analysis and the clinical practice of nondisclosure by focusing on nocebo effects (Fortunato, Wasserman, and Menkes 2017). Instance...

BackgroundEthics consult services are well established, but often remain underutilized. Our aim was to identify the barriers and perceptions of the Ethics consult service for physicians, advance practice providers (APPs), and nurses at our urban academic medical center which might contribute to underutilization.MethodsThis was a cross-sectional single-health system, anonymous written online survey, which was developed by the UCSD Health Clinical Ethics Committee and distributed by Survey Monkey. We compare responses between physicians, APPs, and nurses using standard parametric and non-parametric statistical (...) methods. Satisfaction with ethics consult and likelihood of calling Ethics service again were assessed using a 0–100 scale using a 5-likert response structured (0 being “not helpful at all” to 100 being “extremely helpful”) and results presented using box plots and interquartile ranges (IQR).ResultsFrom January to July 2019, approximately 3800 surveys were sent to all physicians, APPs and nurses with a return rate of 5.5—10%. Although the majority of respondents had encountered an ethical dilemma (85–92.1%) only approximately half had ever requested an Ethics consult. The primary reason for physicians never having requested a consult was that they never felt the need for help (41%). For APPs the primary reasons were not knowing an Ethics consult service was available (33.3%) or not knowing how to contact Ethics (27.8%). For nurses, it was not knowing how to contact the Ethics consult service (30.8%) or not feeling the need for help (26.2%). The median satisfaction score (IQR) for Ethics consult services rated on a 0–100 scale, from physicians was 76 (29), for AAPs 89 (49), and nurses 70 (40) (p = 0.62). The median (IQR) of likelihood of consulting Ethics in the future also on a 0–100 scale was 71 (47) for physicians, 69 (45) for APPs, and 61 (45) for nurses (p = 0.79). APP’s and nurses were significantly more likely than physicians to believe that the team did not act on the Ethics consult’s recommendations.ConclusionsBased on the results presented, we were able to identify actionable steps to better engage healthcare providers—and in particular APPs and nurses—and scale up institutional educational efforts to increase awareness of the role of the Ethics consult service at our institution. Actionable steps included implementing a system of ongoing feedback that is critical for the sustainability of the Ethics service role. We hope this project can serve as a blueprint for other hospital-based Ethics consult services to improve the quality of their programs. (shrink)

Se trata de la reseña bibliográfica del libro de Emmanuel Biset et. al., Sujeto, una categoría en disputa.

As neurotechnologies continue to develop and diffuse, this fast-paced field must be guided by robust governance frameworks in order to promote responsible innovation. The article by Bublitz (2024)...

This paper investigates the relationship between structural explanation and the New Mechanistic account of explanation. The aim of this paper is twofold: firstly, to argue that some phenomena in the domain of fundamental physics, although mechanically brute, are structurally explained; and secondly, by elaborating on the contrast between SE and mechanistic explanation to better clarify some features of SE. Finally, this paper will argue that, notwithstanding their apparently antithetical character, SE and ME can be reconciled within a unified account of (...) general scientific explanation. (shrink)

Bioethics seeks to answer questions and resolve problems that change along with developments in medicine and biology. Ethical justification plays a crucial role in bioethical analysis by clarifying the reasons that support complex judgments about particular actions and general policies.1 It helps bioethicists to determine what to allow, forbid, support, and minimize. When there is disagreement, it can also aid understanding of competing positions. However, at times, disagreement on particular issues becomes so entrenched that understanding seems impossible. In such circumstances, (...) how might bioethicists proceed? In answering this question, this paper considers a particularly significant area of.. (shrink)

Comparative philosophy is gaining traction in professional academic philosophy, with specialist journals, organizations, books, and public campaigns. These inroads have been made in canonical areas of philosophy, including epistemology, metaphysics, logic, and value theory. Yet comparative philosophy still plays little role in practical applied ethics, an interdisciplinary research area in which work with practice and policy implications are dominated by the anglophone world. In this article, I explain why comparative work might be especially difficult in this type of applied ethics, (...) and I suggest how comparative philosophers might overcome these challenges to connect their theoretical work with contemporary practical issues. (shrink)

The creation of guidelines has long been a popular means of conveying normative requirements in scientific and medical research. The recent case of He Jiankui, whose research flouted both widely accepted ethical standards and a set of field-specific guidelines he co-authored, raises the question of whether guidelines are an effective means of preventing misconduct. This paper advances the theory that guidelines can facilitate moral rationalization, a form of motivated reasoning. Moral rationalization in research occurs when individuals justify their actions with (...) plausible reasons that cohere with their moral standards. This allows them to act as they want while believing in their own goodness. If guidelines facilitate moral rationalization, this has implications for research ethics training and for the work of applied ethicists. Research ethics training ought to incorporate reflection on conative features of reasoning, including incentives to commit misconduct, and applied ethicists ought to be circumspect about their use of ethics guidelines. Otherwise, they are feeding the fire of rationalization with the cognitive material practitioners need to accomplish their desired ends. (shrink)

In his article, “Defining Death: Beyond Biology,” John Lizza argues in favor of a civil definition of death, according to which the potential for consciousness and social interaction marks us as the “kind of being that we are.” In this commentary, I critically discuss this approach to the bioethical debate on the definition of death. I question whether Lizza’s account is based on a full recognition of the “practical, moral, religious, philosophical, and cultural considerations” at play in this debate. I (...) further propose that a truly ethical debate on definitions of death ought to concentrate on how different definitions of death are used in diverse contexts – what definitions of death do – and focus less on who has the right definition of death for all situations. (shrink)

Ethics training has become a common phenomenon in the training of military professionals at all levels. However, the perceived outcomes of this training remain open. In this article, we analyze the experiences of course participants who were interviewed 6–12 months after they had participated in a train-the-trainer course in military ethics developed by the Faculty of Military Sciences of the Netherlands Defence Academy. Through qualitative inductive analysis, it is shown how participants evaluate the training, how they perceive the development of (...) their moral competence, and how they see the impact of the training on their own training practice. (shrink)

Frank Jackson often writes as if his descriptivist account of public language meanings were just plain common sense. How else are we to explain how different speakers manage to communicate using a public language? And how else can we explain how individuals arrive at confident judgments about the reference of their words in hypothetical scenarios? Our aim in this paper is to show just how controversial the psychological assumptions behind in Jackson’s semantic theory really are. First, we explain how Jackson’s (...) theory goes well beyond the commonsense platitudes he cites in its defence. Second, we sketch an alternative explanation of those platitudes, the jazz model of meaning, which we argue is more psychologically realistic. We conclude that the psychological picture presupposed by Jackson’s semantic theory stands in need of a much more substantial defence than he has so far offered. (shrink)

The label ‘Translational Research’ (TR) has become ever more popular in the biomedical domain in recent years. It is usually presented as an attempt to bridge a supposed gap between knowledge produced at the lab bench and its use at the clinical bedside. This is claimed to help society harvest the benefits of its investments in scientific research. The rhetorical as well as moral force of the label TR obscure, however, that it is actually used in very different ways. In (...) this paper, we analyse the scientific discourse on TR, with the aim to disentangle and critically evaluate the different meanings of the label. We start with a brief reconstruction of the history of the concept. Subsequently, we unravel how the label is actually used in a sample of scientific publications on TR and examine the presuppositions implied by different views of TR. We argue that it is useful to distinguish different views of TR on the basis of three dimensions, related to (1) the construction of the ‘translational gap’; (2) the model of the translational process; and (3) the cause of the perceived translational gap. We conclude that the motive to make society benefit from its investments in biomedical science may be laudable, but that it is doubtful whether the dominant views of TR will contribute to this end. (shrink)

This paper explores the question of what makes an action morally worthy. I start with a popular theory of moral worth which roughly states that a right action is morally praiseworthy if and only if it is performed in response to the reasons which make the action right. While I think the account provides promising foundations for determining praiseworthiness, I argue that the view lacks the resources to adequately satisfy important desiderata associated with theories of moral worth. Firstly, the view (...) does not adequately capture the degree to which an action has moral worth, and secondly, the view does not identify if right actions produced from overdetermined motives have moral worth. However, all is not lost; I also argue that the account can satisfy the desiderata when it attends to the agent’s counterfactual motives in addition to their actual motives. By considering counterfactual motives, we can measure the robustness of the actual praiseworthy motive, and attending to motivational robustness allows the new proposal to fully satisfy the two desiderata. At the end of this paper, I respond to some criticisms typically brought against a counterfactual view of moral worth. (shrink)

Prominent accounts of collective intentional activity explain the nature of social groups by virtue of a specific criterion: goal-directedness. In doing so, these accounts offer little in the way of determining whether there are any differences among social groups. In this paper, I propose a refined framework of collective intentional activity that can distinguish among social groups better than alternative accounts, and which has revisionary but nevertheless plausible implications for the nature of the family: specifically, that certain friendship relationships may (...) count as genuinely familial, and that we ought to count them as such. I argue that social groups are distinguished by what we can expect from one another within different kinds of social groups; specifically, that there is an important difference between reciprocity that is equivalent in performance and reciprocity that is equivalent in intention; familial groups are specifically guided by this latter kind of reciprocity. This more inclusive definition of familial groups may have important implications for how such groups are supported within a given society – for instance, by recognizing certain caring relations as essential for well-being and supporting them accordingly. (shrink)

During goals of care conversations, palliative care clinicians help patients and families determine priorities of care and align medical care with those priorities. The style and methods of communicating with families and negotiating a care plan can range from paternalistic to entirely patient driven. In this paper, we describe a case in which the palliative care clinician approached decision-making using a paradigm that is intuitive to many clinicians and which seems conceptually sound, but which has not been fully explored in (...) the bioethics literature. This paradigm, termed maternalism, allows the clinician to direct decision-making within a relationship such that best interests and autonomy are mutually reinforced, thus reflecting relational autonomy as opposed to individual autonomy. We explore whether this method is appropriate in this case and explain how it captures significant ethical features of the case that might be missed by other approaches. (shrink)

Over the past year, our ethics service has had numerous consultations involving patients who use the emergency department for regular dialysis. Sometimes, they have access to outpatient hemodialysis that they forgo; other times, they've been “fired” from this kind of outpatient facility, and so the ED is their last option. In most of these cases, we're called because the patient is disruptive once admitted to the ICU and behavior plans haven't helped. But the call from a resident this March 2020 (...) morning was different, the patient had end‐stage renal disease and often missed hemodialysis, but he wasn't disruptive. “It's just that he comes in after using cocaine, and given scarcity with the coronavirus and ICU beds….” I have come to think that this is one of the more insidious effects of the pandemic: that there will be a resurgence of the view that some patients deserve health care by virtue of their compliant behavior and that those who are nonadherent don't. (shrink)

Clathrin‐mediated endocytosis is a major route for the retrieval of plasma‐membrane cargoes, and defects of this process can cause catastrophic human dysfunctions. However, the processes governing how a clathrin‐coated profile (ccp) is initiated are still murky. Despite an ever‐growing cast of molecules proposed as triggers of ccp nucleation and increasingly sophisticated bioimaging techniques examining clathrin‐mediated endocytosis, it is yet unknown if ccp formation is governed by a universal mechanism. A recent paper by Cocucci et al. has tracked single‐molecule events to (...) identify that stable accumulation of ccps requires the near‐simultaneous arrival of two AP2 adaptors bridged by one clathrin triskelion. This commentary examines the role of AP2 in cargo‐mediated endocytosis in the light of recent advances in biophotonics, chemical inhibitors and genetics, examines the claims of other molecules to be the initiators of ccp formation and proposes future directions in research into this topic.Editor's suggested further reading in BioEssays: The evolution of dynamin to regulate clathrin‐mediated endocytosis AbstractClathrin‐mediated endocytosis: What works for small, also works for big Abstract. (shrink)

Introduction: People with Spinal Cord Injury are at risk of feeling socially disconnected. Competitive esports present an opportunity for people with SCI to remotely engage in a community. The aim of this study is to discuss barriers to esports participation for people with SCI, present adaptive solutions to these problems, and analyze self-reported changes in social connection.Materials and Methods: We presented a descriptive data collected in the process of a quality improvement initiative at Mount Sinai Hospital. In 2019, seven individuals (...) with cervical SCI and quadriplegia participated in a special interest group on esports. Group scores were then analyzed for evidence of between subjects variability using a single sample t-test. A Pearson's correlation was conducted to determine the relationship between social connectedness and demographic data.Results: All players experienced functional limitations as a result of their injury but managed to design personalized gaming setups with adaptive equipment that allowed them to successfully compete in esports. All players reported a positive change in perceived social connectedness after participating in the special interest group. Score on Social Connectedness Scale negatively correlated with Time since injury.Discussion: It is feasible to create adaptive gaming setups that can be used by people with differing degrees and severity of SCI in a competitive esports environment. Technology and adaptive competitive esports have a potential to improve social connectedness and inclusion in people with quadriplegia. Further research on efficacy and effectiveness of these inclusive environments and their effects on quality of life, activity, and participation is warranted. (shrink)

The University of Perugia's Archivio storico preserves a sixteenth-century manuscript of the imprese of the Accademia degli Insensati, an institution which is well-known for its important members and affiliates in the ecclesiastical and poetic circles of Perugia and Rome. Largely unpublished, the manuscript collects forty-three imprese of academicians, drawn by different artists and miniaturists, including that of the painter and theorist Federico Zuccari. In later life Zuccari proudly made use of his Insensato nickname of Il Sonnacchioso, but here his impresa (...) is unexpectedly given as Il Desioso. This article argues that the Il Desioso impresa represents Zuccari's application to join the Accademia. Drawn by the artist himself, featuring his device of the sugarloaf and accompanied by a prose description in his own hand, the impresa can be dated by comparisons with other works made around the time of Zuccari's move from Florence to Rome. It reflects a number of the theoretical ideas from this period of his life, concerning the role of Academies, the education of the artist, and classical culture. (shrink)

The epoch-making revolution that has been taking place in mathematics and physics during the past hundred years is gradually changing our whole conception of reality and of the function of science in regard to it. We have discovered that the “common sense” view of the world which has become ingrained in the feeling-thought habits of Western man, especially since the seventeenth century, contains elements of serious limitation and even an illusion both from the standpoint of immediately intuited experience and from (...) that of demonstrated scientific fact. Moreover, by a long drawn out tortuous process, lasting over many centuries and involving the constant creation and correction of an enormously complicated scientific structure, we have finally arrived at an understanding of what may be the root of our difficulty. It seems that certain peculiarities of the over-all grammatical structure of those languages that have conditioned the feeling-thought world of the West have tended to lead us astray. Their correction, however, has so far been possible only through the invention of new esoteric languages, such as the symbolism of mathematics and the new logic. By means of these “languages of science” modern mathematicians and physicists have at last succeeded in freeing themselves from the shackles of their everyday speech and “common sense” concepts, at least so far as their scientific work is concerned. (shrink)

We introduce a novel paradigm for studying the cognitive processes used by listeners within interactive settings. This paradigm places the talker and the listener in the same physical space, creating opportunities for investigations of attention and comprehension processes taking place during interactive discourse situations. An experiment was conducted to compare results from previous research using videotaped stimuli to those obtained within the live face-to-face task paradigm. A headworn apparatus is used to briefly display LEDs on the talker’s face in four (...) locations as the talker communicates with the participant. In addition to the primary task of comprehending speeches, participants make a secondary task light detection response. In the present experiment, the talker gave non-emotionally-expressive speeches that were used in past research with videotaped stimuli. Signal detection analysis was employed to determine which areas of the face received the greatest focus of attention. Results replicate previous findings using videotaped methods. (shrink)

In his recent book Bananaworld. Quantum mechanics for primates, Jeff Bub revives and provides a mature version of his influential information-theoretic interpretation of Quantum Theory (QT). In this paper, I test Bub’s conjecture that QT should be interpreted as a theory about information, by examining whether his information-theoretic interpretation has the resources to explain (or explain away) quantum conundrums. The discussion of Bub’s theses will also serve to investigate, more in general, whether other approaches succeed in defending the claim that (...) QT is about quantum information. First of all, I argue that Bub’s interpretation of QT as a principle theory fails to fully explain quantum non-locality. Secondly, I argue that a constructive interpretation, where the quantum state is interpreted ontically as information, also fails at providing a full explanation of quantum correlations. Finally, while epistemic interpretations might succeed in this respect, I argue that such a success comes at the price of rejecting some in between the most basic scientific standards of physical theories. (shrink)

The aim of this paper is to explore the ways in which Axiomatic Reconstructions of Quantum Theory in terms of Information-Theoretic principles can contribute to explaining and understanding quantum phenomena, as well as to study their explanatory limitations. This is achieved in part by offering an account of the kind of explanation that axiomatic reconstructions of Quantum Theory provide, and re-evaluating the epistemic status of the program in light of this explanation. As illustrative case studies, I take Clifton's, Bub's and (...) Halvorson's characterization theorem and Popescu's and Rohrlich's toy models, and their explanatory contribution with respect to quantum nonlocality. On the one hand, I argue that ARQITs can aspire to provide genuine explanations of quantum nonlocality. On the other hand, I argue that such explanations cannot rule out a mechanical quantum theory. (shrink)