What is personhood? What do we want it to be? Blumenthal-Barby (2024) offers an answer to the first question: personhood is an unhelpful, harmful, and pernicious concept in the bioethical setting....

The concept of personhood has been central to bioethics debates about abortion, the treatment of patients in a vegetative or minimally conscious states, as well as patients with advanced dementia. More recently, the concept has been employed to think about new questions related to human-brain organoids, artificial intelligence, uploaded minds, human-animal chimeras, and human embryos, to name a few. A common move has been to ask what these entities have in common with persons (in the normative sense), and then draw (...) conclusions about what we do (or do not) owe them. This paper argues that at best the concept of “personhood” is unhelpful to much of bioethics today and at worst it is harmful and pernicious. I suggest that we (bioethicists) stop using the concept of personhood and instead ask normative questions more directly (e.g., how ought we to treat this being and why?) and use other philosophical concepts (e.g., interests, sentience, recognition respect) to help us answer them. It is time for bioethics to end talk about personhood. (shrink)

In some views, philosophy’s glory days in bioethics are over. While philosophers were especially important in the early days of the field, so the argument goes, the majority of the work in bioethics today involves the “simple” application of existing philosophical principles or concepts, as well as empirical work in bioethics. Here, we address this view head on and ask: What is the role of philosophy in bioethics today? This paper has three specific aims: (1) to respond to skeptics and (...) make the case that philosophy and philosophers still have a very important and meaningful role to play in contemporary bioethics, (2) to discuss some of the current challenges to the meaningful integration of philosophy and bioethics, and (3) to make suggestions for what needs to happen in order for the two fields to stay richly connected. We outline how bioethics center directors, funders, and philosopher bioethicists can help. (shrink)

Policymakers, employers, insurance companies, researchers, and health care providers have developed an increasing interest in using principles from behavioral economics and psychology to persuade people to change their health-related behaviors, lifestyles, and habits. In this article, we examine how principles from behavioral economics and psychology are being used to nudge people (the public, patients, or health care providers) toward particular decisions or behaviors related to health or health care, and we identify the ethically relevant dimensions that should be considered for (...) the utilization of each principle. (shrink)

In bioethics, the predominant categorization of various types of influence has been a tripartite classification of rational persuasion (meaning influence by reason and argument), coercion (meaning influence by irresistible threats—or on a few accounts, offers), and manipulation (meaning everything in between). The standard ethical analysis in bioethics has been that rational persuasion is always permissible, and coercion is almost always impermissible save a few cases such as imminent threat to self or others. However, many forms of influence fall into the (...) broad middle terrain—and this terrain is in desperate need of conceptual refining and ethical analysis in light of recent interest in using principles from behavioral science to influence health decisions and behaviors. This paper aims to address the neglected space between rational persuasion and coercion in bioethics. First, I argue for conceptual revisions that include removing the “manipulation” label and relabeling this space “nonargumentative]influence,” with two subtypes: “reason-bypassing” and “reason-countering.” Second, I argue that bioethicists have made the mistake of relying heavily on the conceptual categories themselves for normative work and instead should assess the ethical permissibility of a particular instance of influence by asking several key ethical questions, which I elucidate, that relate to (1) the impact of the form of influence on autonomy and (2) the relationship between the influencer and the influenced. Finally, I apply my analysis to two examples of nonargumentative influence in health care and health policy: (1) governmental agencies such as the Food and Drug Administration (FDA) trying to influence the public to be healthier using nonargumentative measures such as vivid images on cigarette packages to make more salient the negative effects of smoking, and (2) a physician framing a surgery in terms of survival rates instead of mortality rates to influence her patient to consent to the surgery. (shrink)

Cognitive scientists have identified a wide range of biases and heuristics in human decision making over the past few decades. Only recently have bioethicists begun to think seriously about the implications of these findings for topics such as agency, autonomy, and consent. This article aims to provide an overview of biases and heuristics that have been identified and a framework in which to think comprehensively about the impact of them on the exercise of autonomous decision making. I analyze the impact (...) that these biases and heuristics have on the following dimensions of autonomy: understanding, intentionality, absence of alienating or controlling influence, and match between formally autonomous preferences or decisions and actual choices or actions. (shrink)

Bioethicists often draw sharp distinctions between hope and states like denial, self-deception, and unrealistic optimism. But what, exactly, is the difference between hope and its more suspect cousins? One common way of drawing the distinction focuses on accuracy of belief about the desired outcome: Hope, though perhaps sometimes misplaced, does not involve inaccuracy in the way that these other states do. Because inaccurate beliefs are thought to compromise informed decision making, bioethicists have considered these states to be ones where intervention (...) is needed either to correct the person’s mental state or to persuade the person to behave differently, or even to deny the person certain options. In this article, we argue that it is difficult to determine whether a patient is really in denial, self-deceived, or unrealistically optimistic. Moreover, even when we are confident that beliefs are unrealistic, they are not always as harmful as critics contend. As a result, we need to be more permissive in our approach to patients who we believe are unrealistically optimistic, in denial, or self-deceived—that is, unless patients significantly misunderstand their situation and thus make decisions that are clearly bad for them, we should not intervene by trying to change their mental states or persuade them to behave differently, or by paternalistically denying them certain options. (shrink)

Just last week (October 4, 2022), the U.S. White House released a blueprint for an A.I. Bill of Rights, consisting of “five principles and associated practices to help guide the design, use, and de...

The application of machine learning in health care holds great promise for improving care. Indeed, our own team is collaborating with experts in machine learning and statistical modeling to bu...

In an April 2023 article in JAMA Pediatrics, ‘Life Support System for the Fetonate and the Ethics of Speculation’, authors De Bie, Flake and Feudtner critique bioethicists for practising what they call ‘speculative ethics’. The authors refer to a 2017 article that they published on the Extra-uterine Environment of Neonatal Development (EXTEND) system. This system was able to keep fetonatal (newborn, but in a fetal physiological state) lambs alive outside of the parent lamb’s womb for 4 weeks. The article has (...) been accessed almost 300 000 times and received significant media attention. It also resulted in an explosion in the bioethics literature about ‘the ethics of the artificial womb’. However, the authors bemoan, these ethics discussions focused largely on unrealistic use cases of the new technology—from elective shortening of pregnancies to complete ectogenesis. The authors dubbed these discussions as ‘a technically and developmentally naive, yet sensationally speculative, pipe dream’. The use case of the EXTEND technology that is most realistic involves supporting extremely premature newborns (23–24 weeks). Other probable uses include supporting infants in later gestational ages (25–28 weeks) with pathological conditions, potentially allowing for surgeries or other therapeutics to be delivered without imposing risks on pregnant patients. To …. (shrink)

Volume 24, Issue 12, December 2024, Page 6-7.

CHAPTER INTRODUCTION At first sight Plotinus' philosophy is full of contradictions. The same entity will appear with different characteristics in different ...

The past four decades of research in the social sciences have shed light on two important phenomena. One is that human decision-making is full of predicable errors and biases that often lead individuals to make choices that defeat their own ends (i.e., the bad choice phenomenon), and the other is that individuals’ decisions and behaviors are powerfully shaped by their environment (i.e., the influence phenomenon). Some have argued that it is ethically defensible that the influence phenomenon be utilized to address (...) the bad choice phenomenon. They propose that “choice architects” learn about the various ways in which choices can be influenced and directed by the environment, and then work to design environments, broadly construed, that influence individuals towards choices that make them better off. Those who advocate intentionally creating choice environments that lead people to better choices believe that doing so is ethically permissible because (1) it makes people better off, and (2) it does so in a way that is entirely compatible with individual liberty. The evaluation of these two claims is the main focus of this paper. (shrink)

One way to test vaccines is through human challenge trials in which participants are intentionally infected with a contagious organism to expedite the process of assessing the vaccine’s effectiveness. Some experts believe challenge trials may play an important role in fighting COVID-19, especially if the vaccines under current study do not demonstrate sufficient efficacy, if spread of COVID-19 is controlled to a point that radically slows down traditional trials, or if new vaccines need to be rapidly developed for specific subpopulations.1 (...) Challenge trials involve significant time, burden and risk, requiring participants to spend 3–6 weeks in legal quarantine for 24 hours a day in a high-security facility. During this time, no inperson visitors will be allowed, except for very limited inperson contact from researchers collecting necessary data and checks. Following the quarantine period, participants will be asked to attend numerous outpatient follow-up visits over the course of months, to further monitor their response to the vaccine. Participation involves being away from family who may themselves become sick during the global pandemic, as well as potential fear and mental anguish around being a ‘first’ subject. Because there is no definitive treatment for COVID-19, participants could experience serious illness. But even with milder illness, medical experts know very little about the long-term consequences of COVID-19 infection. This raises the question of how much people should be paid for their participation in COVID-19 challenge trials. Most think participants should be paid something, but many contend that we should be …. (shrink)

In his article “Nudging and Informed Consent,” Shlomo Cohen (2013) argues, among other things, that 1) “to the extent that the nudge-influenced decision making is rational—in whatever sense,” there...

Dystonia is a movement disorder that can have a debilitating impact on motor functions and quality of life. There are 250,000 cases in the United States, most with childhood onset. Due to the limited effectiveness and side effects of available treatments, pediatric deep brain stimulation has emerged as an intervention for refractory dystonia. However, there is limited clinical and neuroethics research in this area of clinical practice. This paper examines whether it is ethically justified to offer pDBS to children with (...) refractory dystonia. Given the favorable risk-benefit profile, it is concluded that offering pDBS is ethically justified for certain etiologies of dystonia, but it is less clear for others. In addition, various ethical and policy concerns are discussed, which need to be addressed to optimize the practice of offering pDBS for dystonia. Strategies are proposed to help address these concerns as pDBS continues to expand. (shrink)

The COVID-19 pandemic will generate vexing ethical issues for the foreseeable future and many journals will be open to content that is relevant to our collective effort to meet this challenge. While the pandemic is clearly the critical issue of the moment, it’s important that other issues in medical ethics continue to be addressed as well. As can be seen in this issue, the Journal of Medical Ethics will uphold its commitment to publishing high quality papers on the full array (...) of medical ethics. At the same time, JME aims to be a premiere home for ground-breaking scholarship on the ethical issues raised by COVID-19. Toward this end, we have a number of papers that are freely available online and for which production has been fast-tracked.1–5 A challenge for authors who want to write about the pandemic is the rapidly evolving nature of the situation and the time it takes for journal content to be reviewed and published, even when fast-tracked. For that reason, all authors who would like to submit a paper on the pandemic can also submit a post to the JME blog prior to submitting a full paper to the journal. Those interested in writing for the JME blog should contact one of its editors, Hazem Zohny or Mike King. Over the last 3 weeks, 30 high-quality commentaries on the pandemic have been posted to the blog. These posts are circulated widely via the JME Twitter and Facebook feeds and have stimulated significant …. (shrink)

This is the first of a pair of papers. It focuses on the development of the most notable phlogistic theories during the period 1766–1791, including the main experiments that their proponents proposed them to interpret. There was a rapid proliferation of late phlogistic theories, particularly from 1784, and the accounts of composition and important implications of the main theories are set out and their issues analysed. Each of them either reached impasses due to internal problems, or included features that made (...) them unacceptable even to other phlogistians. The expositions and analyses of these theories are given in terms of details that were in the literature at the time or otherwise potentially understandable by the participants given contemporary practice. Some relevant methodological aspects of the history of science are discussed, and the secondary literature is briefly surveyed. The second paper deals with the contemporary development of the new chemistry, and with theory comparison and theory choice in the same period. (shrink)

This paper considers critical rationalism under an institutional perspective. It argues that a methodology must be incentive compatible in order to prevail in scientific competition. As shown by a formal game-theoretic model of scientific competition, incentive compatibility requires quality standards that are hereditary: using high-quality research as an input must increase a researcher’s chances to produce high-quality output. Critical rationalism is incentive compatible because of the way it deals with the Duhem-Quine problem. An example from experimental economics illustrates the relevance (...) of the arguments. (shrink)

This study investigated whether musical training and bilingualism are associated with enhancements in specific components of executive function, namely, task switching and dual-task performance. Participants belonging to one of four groups were matched on age and socioeconomic status and administered task switching and dual-task paradigms. Results demonstrated reduced global and local switch costs in musicians compared with non-musicians, suggesting that musical training can contribute to increased efficiency in the ability to shift flexibly between mental sets. On dual-task performance, musicians also (...) outperformed non-musicians. There was neither a cognitive advantage for bilinguals relative to monolinguals, nor an interaction between music and language to suggest additive effects of both types of experience. These findings demonstrate that long-term musical training is associated with improvements in task switching and dual-task performance. (shrink)

Introduction: why the De anima commentaries? This book will concentrate on interpretations of the De anima in late antiquity, and what we can learn from ...

An original examination of the relevance of behavioral economics for the practice of medical ethics.

This is the second of a pair of papers, of which the first showed how each of the main late phlogistic theories effectively reached impasses due to internal problems or included features which made them unacceptable even to other phlogistians. This paper deals with theory comparison and theory change. It gives an unprecedentedly detailed comparison between the available theories in 1790–1791, and shows that this was overwhelmingly in favour of the new chemistry. This time period correlates well with many chemists (...) changing to the new theory. There was a plurality of views held by individuals and there was freedom of individual choice concerning theories, yet there was also a widespread and rational change to the new chemistry. (shrink)

This paper argues that neurolinguistics has the potential to yield insights that can feed back into corpus-based Cognitive Linguistics. It starts by discussing how far the cognitive realism of probabilistic statements derived from corpus data currently goes. Against this background, it argues that the cognitive realism of usage-based models could be further enhanced through deeper engagement with neurolinguistics, but also highlights a number of common misconceptions about what neurolinguistics can and cannot do for linguistic theorizing.

This paper deals with the ethics of using knowledge about a person’s particular psychological make-up, or about the psychology of judgment and decision-making in general, to shape that person’s decisions and behaviors. Various moral concerns emerge about this practice, but one of the more elusive and underdeveloped concerns is the charge of manipulation. It is this concern that is the focus of this paper. I argue that it is not the case that any of the practices traditionally labeled as “manipulation” (...) are ipso facto morally wrong, nor is it even the case that any of these practices always has a single wrong making feature (e.g., infringement on autonomy) that is always present but may be outweighed by other morally relevant factors and be all things considered ethically permissible or morally right. I argue that the moral status depends on the extent to which the instance of influence (1) threatens or promotes autonomy, (2) has good aims and virtuous overtones or bad ones, and (3) fulfills or fails to fulfill duties, obligations, and expectations that arise out of the relationship between the influencer and influenced. I will explain in detail the moral relevance of these factors, showing why each is necessary, criteria for evaluation each, and demonstrating how they work in specific cases. (shrink)

The American Board of Internal Medicine (ABIM) Foundation has recently initiated a campaign called “Choosing Wisely,” which is aimed at reducing “low-value” care services. Lists of low-value care services are being developed and the ABIM Foundation is urging the American Medical Association and other organizations to get behind the lists, disseminate them, and implement them. Yet, there are many ethical questions that remain about the development, dissemination, and implementation of these low-value care lists. In this paper I argue for conceptual (...) clarity with respect to the label “low-value care.” Thus far it has not been precisely defined, and I argue that there are actually 10 distinct categories of low-value care. I discuss the ethical challenges and considerations associated with each category. I also provide arguments that can be used to justify the reduction of some of these categories of low-value care. These arguments rely on Rawlsian and Hegelian notions of justice, as well as on concepts about the fiduciary obligations of physicians. Finally, I outline the various mechanisms that could be utilized for the reduction of low-value care (i.e., incentives, punishments, nonrational influences such as appeals to social norms, emotions, or ego, and creation of conditions that make avoidance easy such as defaults and reminders). I provide normative guidelines for the use of each. (shrink)

In the article “Informed Consent: What Must be Disclosed and What Must be Understood?” Joseph Millum and Danielle Bromwich argue that informed consent requires satisfaction of certain disclosure an...

In ‘Reification and Assent in Research Involving Those Who Lack Capacity’, Smajdor argues that adults with impaired capacity to grant informed consent (AWIC) are often excluded from participating in biomedical research because they cannot provide informed consent, leading to decreased chances AWIC will benefit from such research. Smajdor uses Honneth’s concept of reification to propose that securing assent (rather than consent) in cases involving AWIC offers patients moral recognition that is not tied to their capacities. Assent provides this recognition by (...) including the patient in a shared moral sphere, highlighting her agency and worth without reducing her to her incapacity or a thing-to-be-managed. Assent also avoids grounding in, or a reliance on, the future development of autonomy (pp.5–6).1 Our recent research on patient and caregiver perspectives of potential paediatric deep brain stimulation (pDBS) for refractory obsessive–compulsive disorder (OCD) and dystonia demonstrates that paediatric neurosurgery patients desire the kind of recognition Smajdor associates with assent, and their caregivers largely agree.2 3 Since (generally) paediatric patients in the USA are unable to grant informed consent, their caregivers must provide it instead. This raises the question of how to properly integrate paediatric patients into the DBS decision-making process. One dimension along which this is evident is that …. (shrink)

Richard Thaler and Cass Sunstein define a nudge as “any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives.” Much has been written about the ethics of nudging competent adult patients. Less has been written about the ethics of nudging surrogates’ decision‐making and how the ethical considerations and arguments in that context might differ. Even less has been written about nudging surrogate decision‐making in the context of (...) pediatrics, despite fundamental differences that exist between the pediatric and adult contexts. Yet, as the field of behavioral economics matures and its insights become more established and well‐known, nudges will become more crafted, sophisticated, intentional, and targeted. Thus, the time is now for reflection and ethical analysis regarding the appropriateness of nudges in pediatrics. We argue that there is an even stronger ethical justification for nudging in parental decision‐making than with competent adult patients deciding for themselves. We give three main reasons in support of this: (1) child patients do not have autonomy that can be violated (a concern with some nudges), and nudging need not violate parental decision‐making authority; (2) nudging can help fulfill pediatric clinicians’ obligations to ensure parental decisions are in the child's interests, particularly in contexts where there is high certainty that a recommended intervention is low risk and of high benefit; and (3) nudging can relieve parents’ decisional burden regarding what is best for their child, particularly with decisions that have implications for public health. (shrink)

> ‘The fact about himself that the bullshitter hides, on the other hand, is that the truth-values of his statements are of no central interest to him; what we are not to understand is that his intention is neither to report the truth nor conceal it. It is just this lack of connection to a concern with truth—this indifference to how things really are—that is the essence of bullshit.’1 > —Harry Frankfurt In his paper, Nudging, informed consent, and bullshit, William (...) Simkulet accuses doctors of being bullshitters when they knowingly influence patient decision making through means other than argument and reasoning, that is, through ‘nudges.’ In these instances, he contends that they care little about patient understanding or communicating the truth about the options and, instead, care only about presenting alternatives in ways that cause patients to do what the physicians think they should do.2 However, doctors can intend to enhance patient understanding at the same time that they try to influence patients’ choices. Consider a physician who wants her patient to get a vaccine. …. (shrink)

O objetivo do presente artigo é desenvolver uma reflexão acerca de relações existentes entre informação e ação, no contexto das tecnologias informacionais de comunicação. O problema central que guiará o artigo pode ser assim formulado: Qual é a influência da informação disponível nas TICs na ação autônoma? O direcionamento de pesquisas em relação ao conceito de informação possui geralmente uma orientação técnica, não focalizando questões éticas, ontológicas e epistemológicas, que são igualmente relevantes ao se tratar desse conceito. Em contraste com (...) a orientação técnica vigente, ressaltamos a abordagem proposta por Charles S. Peirce, que caracteriza informação a partir de diferentes perspectivas: lógico-semântica, pragmática e semiótica. Partindo da hipótese que processos informacionais têm uma participação fundamental no direcionamento da ação, investigamos impactos das TICs presentes nas relações cotidianas. Discutimos transformações que as TICs têm possibilitado na relação agente-ambiente, ressaltando recursos computacionais de mineração de dados, que propiciam ações, muitas vezes direcionadas por interesses alheios àqueles dos usuários. Argumentamos que o estudo da informação é importante para entender possíveis implicações das TICs no direcionamento da ação humana. (shrink)

1. t. Optische und elektromagnetische erscheinungen unter dem einfluss von bewegungen.--2. t. Die weitere relativitätstheorie.

The relative neglect of Greek commentary by modern Aristotelian scholarship could be justified, if only the neglectors had sufficient knowledge of the material they disdain. The curt dismissal of ancient views on the active intellect by W. D. Ross is perhaps a paradigm case of misplaced condemnation, for he evidently failed to take account of what their authors were about. It would be open to those who wish to discount these commentators to argue that they were, to a greater or (...) lesser extent, influenced by their Neoplatonism, and that this impairs their judgment on Aristotelian problems. But that would not be sufficient ground for total neglect: it merely indicates the need for careful utilization. One might go so far as to ask whether it is not perfectly possible for a commentator who happened to be a Neoplatonist to offer straightforward and reasonably unbiased commentary on Aristotle. Even if the answer to that question were negative, is it not likely that such Neoplatonic views as he read into Aristotle would at least be slanted towards Aristotelianism? (shrink)

the announcement of the death of the British polar explorer captain robert scott on his return from the south Pole, which he had reached on 17 January 1912, caused a sensation in Britain and around the world. Although he lost the race to the south Pole to a norwegian party led by roald Amundsen, the recent centenary of scott’s last expedition aroused widespread interest not only in Britain but around the world. this paper examines why the British public continues to (...) consume scott’s story, with particular reference to the period since 1945. Part one examines how scott’s story has been adapted to the cultural context of post-imperial Britain, in part by emphasising the scientific aims of his last expedition. Part two moves on to emphasise how this new emphasis was supported by the royal Geographical society and the scott Polar research institute, and drew on the extensive material culture and striking visual record left by the Terra Nova expedition. (shrink)

We give a proof-theoretic and algorithmic complexity analysis for systems introduced by Morrill to serve as the core of the CatLog categorial grammar parser. We consider two recent versions of Morrill’s calculi, and focus on their fragments including multiplicative (Lambek) connectives, additive conjunction and disjunction, brackets and bracket modalities, and the! subexponential modality. For both systems, we resolve issues connected with the cut rule and provide necessary modifications, after which we prove admissibility of cut (cut elimination theorem). We also prove (...) algorithmic undecidability for both calculi, and show that categorial grammars based on them can generate arbitrary recursively enumerable languages. (shrink)

Postnational, or after or more than national, is a world that connects the international with the local. Technollaboration, is how creative digital communities use technology to improve methods and environments for collaboration. Postbiotanical, after or more than biotanical, represents the future of human-centric collectives around farming and urban living and sustainability. Village, is ambiguous and raises the question how large is local, and how does a village-centric view impact the way we treat each other? Art traditionally functions as an environment (...) for philosophical and creative activity that works to secure its borders from intruding dictatorial ethics, ideology, politics or dogma that might sully its aim to maintain its open arduous exploration of the clash between image and meaning, icon and significance, or perception and identity in reference to culture and history. Integrating technology into this discourse introduces a milieu of associations, expectations and conclusions about how technological innovation, practices and products should be steered, which can also influence what we both make and teach. The web has since evolved into a pervasively instantaneous space for more involved forms of communication (Google hangout), content sharing (SVN), publishing (blogs), community building (messageboards, Facebook), creative performance (Isadora) and more. Now creative interactive initiatives are not limited to merely making a statement or triggering a semiotic synapse, but rather can have a social impact, enacting, mobilizing and serving as a resource for the public. Telematic Art that includes the activities surrounding Digital Communities and their behaviour, does not merely provide an environment to discuss social issues, but embodies social interaction in ways in which new forms of collective expression can be realized. The development of telematics tools is empowering for the public while serving as a medium that influences how individuals interact. Between DIY/DIWO models, open source hardware, software, and creation initiatives, practivist initiatives, creative hacking ideologies, immersion, and web-based communication tools to localize the international collaborative workshop, I believe our formats for education and exchange are becoming more collective and empowering, and with the inclusion of digital social collaboration initiatives seen in myriad examples of Telematic Art, there exists the potential to motivate a mindset desiring new shifts in perception and making with the goals of serving the global community in significant and direct ways. (shrink)