For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based (...) on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed "medically inappropriate" will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience. (shrink)

The ethical debate about neurotechnologies—including both drugs and implanted devices—has been largely framed around the questions of whether and when these technologies could damage or promote authenticity. Patients can experience changes in mood, behavior, emotion, or preferences—seemingly, changes in character or personality. Some describe such changes by saying they feel like different people; that they have become either more or less themselves; or that they feel as though some of their moods, behaviors, emotions or preferences are not their own. These (...) kinds of statements are used to describe both changes that a drug or device is... (shrink)

Here is Lukcs among his friends, lovers, and peers in those important years before 1918, when he converted to Communism and Marxism at the age of thirty-nine.

This discussion note responds to Mark Colyvan’s claim that there is no easy road to nominalism. While Colyvan is right to note that the existence of mathematical explanations presents a more serious challenge to nominalists than is often thought, it is argued that nominalist accounts do have the resources to account for the existence of mathematical explanations whose explanatory role resides elsewhere than in their nominalistic content.

This paper challenges contemporary portrayals in the nursing literature of the spaces within which care of patients in hospital settings is conducted. Within the wider discourse of fiscal restraint on health care spending, professional nursing has cast its disciplined eyes on details of the nurse‐patient relationship for the ostensible purpose of repairing that which is treated as individual failings of nurses to practise in ways prescribed by nursing theories. Set aside in this approach to the so‐called ‘problems’ of nursing practice (...) has been an examination of the conditions within which nurses come in contact with patients, and a critical recognition that such contacts represent skilled accomplishments of social action. In this paper, these conditions are treated as resources available to both nurses and patients to generate accounts for the nurse's presence as well as the nurse's absence. Examples from an ethnographic study of nursing practice are used to illustrate how the spaces operating between nurses and patients are not empty voids but aresocialspaces through which particular meanings about nursing care can be conveyed. (shrink)

Developing and implementing artificial intelligence (AI) systems in an ethical manner faces several challenges specific to the kind of technology at hand, including ensuring that decision-making systems making use of machine learning are just, fair, and intelligible, and are aligned with our human values. Given that values vary across cultures, an additional ethical challenge is to ensure that these AI systems are not developed according to some unquestioned but questionable assumption of universal norms but are in fact compatible with the (...) societies in which they operate. This is particularly pertinent for AI research and implementation across Africa, a ground where AI systems are and will be used but also a place with a history of imposition of outside values. In this paper, we thus critically examine one proposal for ensuring that decision-making systems are just, fair, and intelligible—that we adopt a principle of explicability to generate specific recommendations—to assess whether the principle should be adopted in an African research context. We argue that a principle of explicability not only can contribute to responsible and thoughtful development of AI that is sensitive to African interests and values, but can also advance tackling some of the computational challenges in machine learning research. In this way, the motivation for ensuring that a machine learning-based system is just, fair, and intelligible is not only to meet ethical requirements, but also to make effective progress in the field itself. (shrink)

Background: Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives (to implement research protocols and advance science), setting (research facilities), and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether (...) research nurses experience unique ethical challenges distinct from those experienced by nurses in traditional patient-care settings. Research objectives: The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice. Research design: The study utilized a qualitative descriptive design with individual interviews. Participants and research context: Participating nurses (N = 12) self-identified as having experienced ethical challenges during screening. The majority were Caucasian (90%), female (83%), and worked in outpatient settings (67%). Approximately 50% had > 10 years of research experience. Ethical considerations: The human subjects review board approved the study. Written informed consent was obtained. Findings: Predominant themes were revealed: (1) the inability to provide a probable good, or/do no harm, and (2) dual obligations (identity as a nurse vs a research nurse). The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship. Discussion: Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science. Conclusion: Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

To look into the darkness of the human soul is a frightening venture. Here Mary Midgley does so, with her customary brilliance and clarity. Midgley's analysis proves that the capacity for real wickedness is an inevitable part of human nature. This is not however a blanket acceptance of evil. Out of this dark journey she returns with an offering to us: an understanding of human nature that enhances our very humanity.

We hypothesize that effective collaboration is facilitated when individuals and environmental components form a synergy where they work together and regulate one another to produce stable patterns of behavior, or regularity, as well as adaptively reorganize to form new behaviors, or irregularity. We tested this hypothesis in a study with 32 triads who collaboratively solved a challenging visual computer programming task for 20 min following an introductory warm‐up phase. Multidimensional recurrence quantification analysis was used to examine fine‐grained (i.e., every 10 (...) s) collective patterns of regularity across team members' speech rate, body movement, and team interaction with the shared user interface. We found that teams exhibited significant patterns of regularity as compared to shuffled baselines, but there were no systematic trends in regularity across time. We also found that periods of regularity were associated with a reduction in overall behavior. Notably, the production of irregular behavior predicted expert‐coded metrics of collaborative activity, such as teams' ability to construct shared knowledge and effectively negotiate and coordinate execution of solutions, net of overall behavioral production and behavioral self‐similarity. Our findings support the theory that groups can interact to form interpersonal synergies and indicate that information about system‐level dynamics is a viable way to understand and predict effective collaborative processes. (shrink)

Matthes and I both hold that the central ethical harm of continuing to engage with the work of immoral artists lies in what doing so inadvertently expresses to others. (Matthes, 2021; Matthes, 2022; Willard, 2021; Willard, 2022). We also agree that there’s little wrong ethically with continuing to engage the work of immoral artists in private or within interpretive communities poised to place the ethical and the aesthetic in dialogue with each other. Matthes (2022, p. 523) notes that part of (...) his motivation for writing the book was the countless conversations he had with friends, colleagues, and strangers about the problem of immoral artists, and my experience–—everywhere from the doctor’s office to the classroom to the bike shop—was similar. Interpretive communities reappraise immoral artists’ art together.Outside of those contexts, we both advise caution. Liao (forthcoming) suggests that doing so comes at an unrecognized cost to our aesthetic agency because the source of aesthetic value is social. In response, Matthes (2022) argues that attending to the social expression of one’s aesthetic pursuits does not compromise our aesthetic agency. This seems right. Any reasonable account of the value of aesthetic agency should presumably allow for ordinary human decency to restrain one’s public expression of one’s aesthetic loves. The proper exercise of aesthetic autonomy requires not unbridled freedom, but sensitivity to the right kinds of reasons. (shrink)

The current picture of the history of taxonomy incorporates A. J. Cain's claim that Linnaeus strove to apply the logical method of definition taught by medieval followers of Aristotle. Cain's argument does not stand up to critical examination. Contrary to some published statements, there is no evidence that Linnaeus ever studied logic. His use of the words “genus” and “species” ruined the meaning they had in logic, and “essential” meant to him merely “taxonomically useful.” The essentialism story, a narrative that (...) has most pre-Darwinian biologists steeped in the world view of Plato and Aristotle, is ill-founded and improbable. (shrink)

Personalised medicine has been discussed as a medical paradigm shift that will improve health while reducing inefficiency and waste. At the same time, it raises new practical, regulatory, and ethical challenges. In this paper, we examine PM strategies epistemologically in order to develop capacities to address these challenges, focusing on a recently proposed strategy for developing patient-specific models from induced pluripotent stem cells so as to make individualised treatment predictions. We compare this strategy to two main PM strategies—stratified medicine and (...) computational models. Drawing on epistemological work in the philosophy of medicine, we explain why these two methods, while powerful, are neither truly personalised nor, epistemologically speaking, novel strategies. Both are forms of correlational black box. We then argue that the iPSC models would count as a new kind of black box. They would not rely entirely on mechanistic knowledge, and they would utilise correlational evidence in a different way from other strategies—a way that would enable personalised predictions. In arguing that the iPSC models would present a novel method of gaining evidence for clinical practice, we provide an epistemic analysis that can help to inform the practical, regulatory, and ethical challenges of developing an iPSC system. (shrink)

Technological advances are making devices that functionally replace body parts—artificial organs and limbs—more widely used, and more capable of providing patients with lives that are close to “normal.” Some of the ethical issues this is likely to raise relate to how such prostheses are conceptualized. Prostheses are ambiguous between being inanimate objects and sharing in the status of human bodies—which already have an ambiguous status, as both objects and subjects. At the same time, the possibility of replacing body parts with (...) artificial objects puts pressure on the normative status typically accorded to human bodies, seemingly confirming that body parts are replaceable objects. The paper argues that bodies’ normative status relies on the relation of a body to a person and shows that persons could have similar relations to prostheses. This suggests that in approaching ethical issues surrounding prostheses, it is appropriate to regard them as more like body parts than like objects. (shrink)

Recently the relevance of the philosophy of Martin Heidegger has been critiqued in nursing literature. However, this critique is based primarily upon an appropriation of Heidegger that does not reflect an understanding of meaning as grounded in temporality. Therefore, this paper aims to (1) explicate Heidegger's grounding of meaning, (2) briefly contrast Heidegger's and Husserl's notions of the origin of meaning, (3) describe how Heidegger was first introduced to nursing, and (4) illustrate through examples from a research study how the (...) philosophy of Heidegger might inform the phenomenological researcher. (shrink)

Adolescence, defined in the US as 11–21 years of age, is a critical period for prevention, as it marks the onset of risk behaviors. Minor (<18 years) self-consent and inclusion in biomedical resear...

When I first became acquainted with the thought of the American philoso pher Josiah Royce, two factors particularly intrigued me. The first was Royce's claim that the notion of community was his main metaphysical tenet; the second was his close association with the two American pragmatists, Charles Sanders Peirce and William James. Regarding the first factor, I was struck by the fact that a philosopher who died in 1916 should emphasize a topic of such contemporary significance not only in philosophy (...) but in so many other vital fields as well (sociology, psychology, politics, theology - to name only a few). Regarding the second, I was curious as to whether the pragmatism of Peirce and James might have influenced Royce during the course of their professional and personal contacts. Similarly, I wondered whether the idealism of Royce might have affected the thought of Peirce and James. To have appeased my curiosity in regard to all three thinkers, however, would have required (at least) three books. As a start I have now appeased it in regard to one. In researching the writings of Royce I found my way to the Houghton Library and to the Archives of Harvard University at Cambridge, Massa chusetts, where the unpublished manuscripts of Royce are preserved. (No editing job has yet been done on this bulk of material, though such would certainly be a welcome contribution to American philosophy. (shrink)

In his paper “William Whewell on the Consilience of Inductions” Professor Laudan has suggested that Whewell’s use of “consilience of inductions” is not the same as mine in my paper of that title. Suppose we have a theory T which entails three empirical laws L1, L2, L3. L1 is supposed already confirmed by direct evidence of its instances, but we have as yet no direct evidence for L2 or for L3. Then Laudan distinguishes two problems: Whewell’s problem: T is suggested (...) to explain L1 and is supported by L1; how much is our confidence in T increased if it also predicts L2, and L2 is subsequently directly confirmed? My problem: T is suggested to explain L1 and is supported by L1; T also entails L3; how much is our confidence that L3 will turn out a correct prediction increased by the fact that T entails it? (shrink)