The thesis of this paper is that at a fundamental level there are not distinct sets of philosophical problems related to specific kinds of rationality. The evidence presented in favor of this thesis is that the empiricist tradition has been faced with the same philosophical problems in accounting for scientific rationality as philosophy in general has faced in accounting for rationality in general; and that the nature of these problems requires that they be dealt with prior to considering questions which (...) might turn out to be distinct. (shrink)

Drug testing is widely deployed in the United States throughout the public and private sectors. This case study uses two emergent drug-testing technologies—hair analysis and the sweat patch—as examples of techniques of governance that should be subjected to the political equivalent of strict scrutiny. The article contributes to conceptual debates in science and technology studies, arguing that the study of social structure and subject formation should be integral rather than epiphenomenal to analysis in the transdisciplinary field of science and technology (...) studies. The article contextualizes the development and deployment of drug-testing technologies within the structural and epistemological categories of racial and ethnic difference, gender, sexuality, and class formation. Conflicts between proponents of the technologies and critical advocates who seek to constrain their use mark sites of productive theoretical engagement with structural sociology, racial formation theory, critical race theory, and feminist critique.1 Finally, the article demonstrates how STS analyses can contribute to the struggles of strategic counterpublics as they advocate for changing the meaning and material consequences of suspect technologies. (shrink)

Patient report of functioning is one component of the neurocognitive exam following traumatic brain injury, and standardized patient-reported outcomes measures are useful to track outcomes during rehabilitation. The Traumatic Brain Injury Quality of Life measurement system is a TBI-specific extension of the PROMIS and Neuro-QoL measurement systems that includes 20 item banks across physical, emotional, social, and cognitive domains. Previous research has evaluated the responsiveness of the TBI-QOL measures in community-dwelling individuals and found clinically important change over a 6-month assessment (...) interval in a sample of individuals who were on average 5 years post-injury. In the present study, we report on the responsiveness of the TBI-QOL Cognition–General Concerns and Executive Function item bank scores and the Cognitive Health Composite scores in a recently injured sample over a 1-year study period. Data from 128 participants with complicated mild, moderate, or severe TBI within the previous 6 months were evaluated. The majority of the sample was male, white, and non-Hispanic. The participants were 18–92 years of age and were first evaluated from 0 to 5 months post-injury. Eighty participants completed the 1-year follow-up assessment. Results show acceptable standard response mean values for all measures and minimal detectable change values ranging from 8.2 to 8.8 T-score points for Cognition–General Concerns and Executive Functioning measures. Anchor rating analysis revealed that changes in scores on the Executive Function item bank and the Cognitive Health Composite were meaningfully associated with participant-reported changes in the areas of attention, multitasking, and memory. Evaluation of change score differences by a variety of clinical indicators demonstrated a small but significant difference in the three TBI-QOL change scores by TBI injury severity grouping. These results support the responsiveness of the TBI-QOL cognition measures in newly injured individuals and provides information on the minimal important differences for the TBI-QOL cognition measures, which can be used for score interpretation by clinicians and researchers seeking patient-reported outcome measures of self-reported cognitive QOL after TBI. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

In recent years, scholars have begun to lay the groundwork to justify a distinct application of ethics to the field of public health. They have highlighted important features that differentiate public health ethics from bioethics, especially public health’s emphasis on population health rather than issues of individual health. Articulations of public health ethics also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the field of public health ethics is (...) developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of public health ethics may well be global health ethics, focusing on issues of global justice. As public health ethics evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and scholars will need to develop useful tools that practitioners may employ for identifying and tackling these ethical challenges. (shrink)

In its comprehensive overview of Alain Locke's pragmatist philosophy this book captures the radical implications of Locke's approach within pragmatism, the critical temper embedded in Locke's works, the central role of power and empowerment of the oppressed and the concept of broad democracy Locke employed.

• We define a notion of order of indiscernibility type of a structure by analogy with Mitchell order on measures; we use this to define a hierarchy of strong axioms of infinity defined through normal filters, the α-weakly Erdős hierarchy. The filters in this hierarchy can be seen to be generated by sets of ordinals where these indiscernibility orders on structures dominate the canonical functions.• The limit axiom of this is that of greatly Erdős and we use it to calibrate (...) some strengthenings of the Chang property, one of which, CC+, is equiconsistent with a Ramsey cardinal, and implies that where K is the core model built with non-overlapping extenders — if it is rigid, and others which are a little weaker. As one corollary we have:TheoremIf then there is an inner model with a strong cardinal. • We define an α-Jónsson hierarchy to parallel the α-Ramsey hierarchy, and show that κ being α-Jónsson implies that it is α-Ramsey in the core model. (shrink)

Following up on a 1989 paper on the subject, this essay revisits the question of ethical expertise in the court room. Informed by recent developments in the use of ethics experts, the authors argue 1) that the adversarial nature of court proceedings challenges the integrity of the ethicist's pedagogical role; 2) that the use of ethics experts as normative authorities remains dubious; 3) that clarification of the State's interest in “protecting the ethical integrity of the medical profession” is urgently required; (...) and 4) that the expertise of the ethicist may be more appropriately used in advising the legislature than in influencing the court. (shrink)

In this paper, we study the relationship between the cofinalityc(Sym(ω)) of the infinite symmetric group and the minimal cardinality $$\underset{\raise0.3em\hbox{$\smash{\scriptscriptstyle\thicksim}$}}{b} $$ of an unbounded familyF of ω ω.

Assuming Martin's Axiom, we compute the value of the cofinality of the symmetric group on the natural numbers. We also show that Martin's Axiom does not decide the value of the covering number of a related Mycielski ideal.

This special report is published in commemoration of the fiftieth anniversary of the “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” a landmark document that proposed a new way to define death, with implications that advanced the field of organ transplantation. This remarkable success notwithstanding, the concept has raised lasting questions about what it means to be dead. Is death defined in terms of the biological failure of the organism to (...) maintain integrated functioning? Can death be declared on the basis of severe neurological injury even when biological functions remain intact? Is death essentially a social construct that can be defined in different ways, based on human judgment? These issues, and more, are discussed and debated in this report by leading experts in the field, many of whom have been engaged with this topic for decades. (shrink)

There is an ongoing debate about the ethics of research on lifespan extension: roughly, using medical technologies to extend biological human lives beyond the current “natural” limit of about 120 years. At the same time, there is an exploding interest in the use of artificial intelligence (AI) to create “digital twins” of persons, for example by fine-tuning large language models on data specific to particular individuals. In this paper, we consider whether digital twins (or digital doppelgängers, as we refer to (...) them) could be a path toward a kind of life extension—or more precisely, a kind of person extension—that does not rely on biological continuity. We discuss relevant accounts of consciousness and personal identity and argue that digital doppelgängers may at least help us achieve some of the aims or ostensible goods of person-span extension, even if they may not count as literal extensions of our personhood on dominant philosophical accounts. We also consider relational accounts of personhood and discuss how digital doppelgängers may be able to extend personhood in a relational sense, or at least secure some of the goods associated with relevant relationships. We conclude by suggesting that a research program to investigate such issues is relevant to ongoing debates about the ethics of extending the human lifespan. (shrink)

Non-communicable diseases now account for the majority of the global burden of disease and an international campaign has emerged to raise their priority on the post-2015 development agenda. We argue, to the contrary, that there remain strong reasons to prioritize maternal and child health. Policy-makers ought to assign highest priority to the health conditions that afflict the worst off. In virtue of how little healthy life they have had, children who die young are among the globally worst off. Moreover, many (...) interventions to deal with the conditions that cause mortality in the young are low-cost and provide great benefits to their recipients. Consistent with the original Millennium Development Goals, the international community should continue to prioritize reductions in communicable diseases, neonatal conditions, and maternal health despite the shifts in the global burden of disease. (shrink)

Arthur Fine's use of prism models to provide local and deterministic accounts of quantum correlation experiments is presented and analyzed in some detail. Fine's claim that "there is... no question of the consistency of prism models... with the quantum theory" (forthcoming, p. 16) is disputed. Our criticisms are threefold: (1) consideration of the possibility of additional analyzer positions shows that prism models entail unacceptably high rejection rates in the relevant experiments; (2) similar considerations show that the models are at best (...) only superficially local and deterministic; and (3) in any case, Fine extracts the quantum correlation statistics from prism models only by resurrecting conceptual problems similar to those that his models were to designed to solve. (shrink)

Surveys and routine clinical procedures applied in research protocols are typically considered only minimally risky to participants. The apparent benign nature of "minimal risk" tasks increases the chance that investigators and Institutional Review Boards (IRBs) will overlook the probability that clinical tools will identify signs, symptoms, or definitive test results that are clinically-relevant to subjects' welfare. "Minimal risk" procedures may also pose a particular hazard to participants in clinical research by increasing the therapeutic misconception because the tasks mimic clinical care (...) and are often conducted in clinical settings. Investigators should anticipate which measures could yield clinically-important findings and should describe explicit plans for data monitoring, disclosure, and follow-up. Protocols that include reliable and valid clinical measures should prompt a more detailed risk assessment by the IRB, even when the tasks meet the regulatory criteria for minimal physical, psychological, or emotional risk. (shrink)

There is an ongoing debate about the ethics of research on lifespan extension: roughly, using medical technologies to extend biological human lives beyond the current “natural” limit of about 120 years. At the same time, there is an exploding interest in the use of artificial intelligence (AI) to create “digital twins” of persons, for example by fine-tuning large language models on data specific to particular individuals. In this paper, we consider whether digital twins (or digital doppelgängers, as we refer to (...) them) could be a path toward a kind of life extension—or more precisely, a kind of person extension—that does not rely on biological continuity. We discuss relevant accounts of consciousness and personal identity and argue that digital doppelgängers may at least help us achieve some of the aims or ostensible goods of person-span extension, even if they may not count as literal extensions of our personhood on dominant philosophical accounts. We also consider relational accounts of personhood and discuss how digital doppelgängers may be able to extend personhood in a relational sense, or at least secure some of the goods associated with relevant relationships. We conclude by suggesting that a research program to investigate such issues is relevant to ongoing debates about the ethics of extending the human lifespan. (shrink)