Background While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes. Methods Survey of 1200 paediatric surgeons, neonatologists and maternal–fetal medicine specialists. Results Of 1176 eligible physicians, 670 responded. In the setting of a lethal condition for which prenatal surgery would likely result in the child (...) surviving with a severe disability, most respondents either disagreed or strongly disagreed that they would recommend the surgery. Male physicians were twice as likely to recommend surgery for the lethal condition, as were physicians who believe that abortion is morally wrong. Older physicians were less likely to recommend surgery. For non-lethal conditions, most respondents agreed that they would recommend prenatal surgery, even if the surgery increases the risk of prematurity or fetal death. Compared with MFMs, surgeons were less likely to recommend such surgery, as were physicians not affiliated with a fetal centre, and physicians who were religious. Conclusion Physician’s attitudes about prenatal surgery relate to physicians’ beliefs about disability as well as demographic, cultural and religious characteristics. Given the variety of views, parents are likely to receive different recommendations from their doctors about the preferable treatment choice. (shrink)

This study adjudicates between two opposing accounts of morphological productivity, using English past-tense as its test case. The single-route model posits that both regular and irregular past-tense forms are generated by analogy across stored exemplars in associative memory. In contrast, the dual-route model posits that regular inflection requires use of a formal “add -ed” rule that does not require analogy across regular past-tense forms. Children saw animations of an animal performing a novel action described with a novel verb. Past-tense forms (...) of novel verbs were elicited by prompting the child to describe what the animal “did yesterday.” Collapsing across age group, the likelihood of a verb being produced in regular past-tense form was positively associated with the verb's similarity to existing regular verbs, consistent with the single-route model only. Results indicate that children's acquisition of the English past-tense is best explained by a single-route analogical mechanism that does not incorporate a role for formal rules. (shrink)

Evolutionary theory assumed that mutations occur constantly, gradually, and randomly over time. This formulation from the “modern synthesis” of the 1930s was embraced decades before molecular understanding of genes or mutations. Since then, our labs and others have elucidated mutation mechanisms activated by stress responses. Stress‐induced mutation mechanisms produce mutations, potentially accelerating evolution, specifically when cells are maladapted to their environment, that is, when they are stressed. The mechanisms of stress‐induced mutation that are being revealed experimentally in laboratory settings provide (...) compelling models for mutagenesis that propels pathogen–host adaptation, antibiotic resistance, cancer progression and resistance, and perhaps much of evolution generally. We discuss double‐strand‐break‐dependent stress‐induced mutation in Escherichia coli. Recent results illustrate how a stress response activates mutagenesis and demonstrate this mechanism's generality and importance to spontaneous mutation. New data also suggest a possible harmony between previous, apparently opposed, models for the molecular mechanism. They additionally strengthen the case for anti‐evolvability therapeutics for infectious disease and cancer. (shrink)

Progressive supranuclear palsy is a movement disorder with prominent tau neuropathology. Brain diseases with abnormal tau deposits are called tauopathies, the most common of which is Alzheimer's disease. Environmental causes of tauopathies include repetitive head trauma associated with some sports. To identify common genetic variation contributing to risk for tauopathies, we carried out a genome-wide association study of 1,114 individuals with PSP and 3,247 controls followed by a second stage in which we genotyped 1,051 cases and 3,560 controls for the (...) stage 1 SNPs that yielded P ≤ 10-3. We found significant previously unidentified signals associated with PSP risk at STX6, EIF2AK3 and MOBP. We confirmed two independent variants in MAPT affecting risk for PSP, one of which influences MAPT brain expression. The genes implicated encode proteins for vesicle-membrane fusion at the Golgi-endosomal interface, for the endoplasmic reticulum unfolded protein response and for a myelin structural component. © 2011 Nature America, Inc. All rights reserved. (shrink)

Both unipolar and bipolar depression have been linked with impairments in executive functioning. In particular, mood symptom severity is associated with differences in common EF, a latent measure of general EF abilities. The relationship between mood disorders and EF is particularly salient in adolescence and young adulthood when the ongoing development of EF intersects with a higher risk of mood disorder onset. However, it remains unclear if common EF impairments have associations with specific symptom dimensions of mood pathology such as (...) blunted positive affect, mood instability, or physiological arousal, or if differences in common EF more broadly relate to what is shared across various symptom domains, such as general negative affect or distress. To address this question, bifactor models can be applied to simultaneously examine the shared and unique contributions of particular mood symptom dimensions. However, no studies to our knowledge have examined bifactor models of mood symptoms in relation to measures of common EF. This study examined associations between common EF and general vs. specific symptom dimensions using structural equation modeling in adolescents and young adults with varying severity of mood symptoms. A General Depression factor capturing shared variance across symptoms statistically predicted lower Common EF. Additionally, a factor specific to physiological arousal was associated with lower Common EF. Anhedonia-specific and Mania-specific factors were not significantly related to Common EF. Altogether, these results indicate that deficits in common EF are driven by, or reflect, general features of mood pathology that are shared across symptom dimensions but are also specifically associated with physiological arousal. (shrink)

A prefrontal control system that is less mature than the limbic reward system in adolescence is thought to impede self-regulatory abilities, which could contribute to poor dietary choices and obesity. We, therefore, aimed to examine whether structural morphology of the prefrontal cortex and the amygdala are associated with dietary decisions and obesity in children and adolescents. Seventy-one individuals between the ages of 8–22 years participated in this study; each participant completed a computer-based food choice task and a T1- and T2-weighted (...) structural brain scans. Two indices of obesity were assessed, including age- and sex-specific body mass index and waist-to-height ratio. The behavioral task included rating 60 food stimuli for tastiness, healthiness, and liking. Based on each participant’s self-ratings, 100 binary food choices were then made utilizing a computer mouse. Dietary “self-control” was calculated as the proportion of trials where the individual chose the healthier food item over the total number of trials. Cortical thickness and amygdala subnuclei volumes were quantified using FreeSurfer 6.0 and CIT168 atlas, respectively. We found that WHtR was negatively associated with the thickness of bilateral superior frontal, left superior temporal, right insula, and right inferior temporal regions. We also found WHtR to be positively associated with the volume of the central nucleus region of the amygdala, after adjusting for the hemisphere, age, sex, and intracranial volumes. A similar data pattern was observed when BMIz was used. Moreover, we found that across all participants, thinner right superior frontal cortex and larger left CEN volumes predicted lower dietary self-control. These results suggest that differential development of the PFC and amygdala relate to obesity and dietary self-control. Further longitudinal studies are merited to determine causal relationships among altered PFC to amygdala neural circuitry, dietary self-control, and obesity. (shrink)

Abstract Medical futility is commonly understood as treatment that would not provide for any meaningful benefit for the patient. While the medical facts will help to determine what is medically appropriate, it is often difficult for patients, families, surrogate decision-makers and healthcare providers to navigate these difficult situations. Often communication breaks down between those involved or reaches an impasse. This paper presents a set of practical strategies for dealing with cases of perceived medical futility at a major cancer center. Content (...) Type Journal Article Pages 1-8 DOI 10.1007/s10730-011-9168-3 Authors Colleen M. Gallagher, Section for Integrated Ethics in Cancer Care, Unit 1430, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX 77230-1402, USA Ryan F. Holmes, St. Louis University, St. Louis, MO, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

Objective To determine whether presenting delivery room management options as defaults influences decisions to resuscitate extremely premature infants. Materials and methods Adult volunteers recruited from the world wide web were randomised to receive either resuscitation or comfort care as the delivery room management default option for a hypothetical delivery of a 23-week gestation infant. Participants were required to check a box to opt out of the default. The primary outcome measure was the proportion of respondents electing resuscitation. Data were analysed (...) using χ2 tests and multivariate logistic regression. Results Participants who were told the delivery room management default option was resuscitation were more likely to opt for resuscitation (OR 6.54 95% CI 3.85 to 11.11, p<0.001). This effect persisted on multivariate regression analysis (OR 7.00, 95% CI 3.97 to 12.36, p<0.001). Female gender, being married or in a committed relationship, being highly religious, experiences with prematurity, and favouring sanctity of life were significantly associated with decisions to resuscitate. Discussion Presenting delivery room options for extremely premature infants as defaults exert a significant effect on decision makers. The information structure of the choice task may act as a subtle form of manipulation. Further, this effect may operate in ways that a decision maker is not aware of and this raises questions of patient autonomy. Conclusion Presenting delivery room options for extremely premature infants as defaults may compromise autonomous decision-making. (shrink)

A crisis continues to brew within the pharmaceutical research and development (R&D) enterprise: productivity continues declining as costs rise, despite ongoing, often dramatic scientific and technical advances. To reverse this trend, we offer various suggestions for both the expansion and broader adoption of modeling and simulation (M&S) methods. We suggest strategies and scenarios intended to enable new M&S use cases that directly engage R&D knowledge generation and build actionable mechanistic insight, thereby opening the door to enhanced productivity. What M&S requirements (...) must be satisfied to access and open the door, and begin reversing the productivity decline? Can current methods and tools fulfill the requirements, or are new methods necessary? We draw on the relevant, recent literature to provide and explore answers. In so doing, we identify essential, key roles for agent-based and other methods. We assemble a list of requirements necessary for M&S to meet the diverse needs distilled from a collection of research, review, and opinion articles. We argue that to realize its full potential, M&S should be actualized within a larger information technology framework—a dynamic knowledge repository—wherein models of various types execute, evolve, and increase in accuracy over time. We offer some details of the issues that must be addressed for such a repository to accrue the capabilities needed to reverse the productivity decline. (shrink)

Introduction No consent for health and medical research is appropriate when the criteria for a waiver of consent are met, yet some ethics committees and data custodians still require informed consent. Methods A single-blind parallel-group randomised controlled trial: 1129 families of children born at a South Australian hospital were sent information explaining data linkage of childhood immunisation and hospital records for vaccine safety surveillance with 4 weeks to opt in or opt out by reply form, telephone or email. A subsequent (...) telephone interview gauged the intent of 1026 parents (91%) in relation to their actions and the sociodemographic differences between participants and non-participants in each arm. Results The participation rate was 21% (n=120/564) in the opt-in arm and 96% (n=540/565) in the opt-out arm (χ2 (1 df) = 567.7, p<0.001). Participants in the opt-in arm were more likely than non-participants to be older, married/de facto, university educated and of higher socioeconomic status. Participants in the opt-out arm were similar to non-participants, except men were more likely to opt out. Substantial proportions did not receive, understand or properly consider study invitations, and opting in or opting out behaviour was often at odds with parents' stated underlying intentions. Conclusions The opt-in approach resulted in low participation and a biased sample that would render any subsequent data linkage unfeasible, while the opt-out approach achieved high participation and a representative sample. The waiver of consent afforded under current privacy regulations for data linkage studies meeting all appropriate criteria should be granted by ethics committees, and supported by data custodians. Trial registration number Australian New Zealand Clinical Trials Registry ACTRN12610000332022. (shrink)

Boyer & Petersen argue that folk-economic beliefs are widespread – shaped by evolved cognitive systems – and they offer exemplar beliefs to illustrate their thesis. In this commentary, we highlight evidence of substantial variation in one of these exemplars: beliefs about immigration. Contra claims by B&P, we argue that the balance of this evidence suggests the “folk” may actually holdpositivebeliefs about the economic impact of immigration.

BackgroundThe ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines are widely endorsed but compliance is limited. We sought to determine whether journal-requested completion of an ARRIVE checklist improves full compliance with the guidelines.MethodsIn a randomised controlled trial, manuscripts reporting in vivo animal research submitted to PLOS ONE (March–June 2015) were randomly allocated to either requested completion of an ARRIVE checklist or current standard practice. Authors, academic editors, and peer reviewers were blinded to group allocation. Trained reviewers performed outcome adjudication (...) in duplicate by assessing manuscripts against an operationalised version of the ARRIVE guidelines that consists 108 items. Our primary outcome was the between-group differences in the proportion of manuscripts meeting all ARRIVE guideline checklist subitems.ResultsWe randomised 1689 manuscripts (control: n = 844, intervention: n = 845), of which 1269 were sent for peer review and 762 (control: n = 340; intervention: n = 332) accepted for publication. No manuscript in either group achieved full compliance with the ARRIVE checklist. Details of animal husbandry (ARRIVE subitem 9b) was the only subitem to show improvements in reporting, with the proportion of compliant manuscripts rising from 52.1 to 74.1% (X2 = 34.0, df = 1, p = 2.1 × 10−7) in the control and intervention groups, respectively.ConclusionsThese results suggest that altering the editorial process to include requests for a completed ARRIVE checklist is not enough to improve compliance with the ARRIVE guidelines. Other approaches, such as more stringent editorial policies or a targeted approach on key quality items, may promote improvements in reporting. (shrink)

Our world is a world of change. Children are born and grow into adults. Material possessions rust and decay with age and ultimately perish. Yet scepticism about change is as old as philosophy itself. Heraclitus, for example, argued that nothing could survive the replacement of parts, so that it is impossible to step into the same river twice. Zeno argued that motion is paradoxical, so that nothing can alter its location. Parmenides and his followers went even further, arguing that the (...) very concept of qualitative change is inconsistent. Change in any respect is impossible, they argued, as change requires difference and nothing differs from itself. Few today would accept the Eleatic conclusion that change is impossible. But the topic of change continues to be a source of much debate, as it brings together various issues that are central to metaphysics, language, and logic – including identity, persistence, time, tense, and temporal logic. Author Recommends Wasserman, Ryan. 'The Problem of Change.' Philosophy Compass 1 (2006): 1–10. This article presents the problem of change and provides a brief survey of potential solutions. Haslanger, Sally. 'Persistence Through Time.' The Oxford Handbook of Metaphysics . Eds. M. Loux and D. Zimmerman. Oxford: Oxford University Press, 2003. This article presents the problem of change and provides a detailed survey of potential solutions. Heller, Mark. 'Things Change.' Philosophy and Phenomenological Research 52 (1992): 695–704. This article presents, explains, and defends the temporal parts solution to the problem of change. Hinchliff, Mark. 'The Puzzle of Change.' Philosophical Perspectives 10 (1996): 119–36. This article presents, explains, and defends the presentist solution to the problem of change. Wasserman, Ryan. 'The Argument from Temporary Intrinsics.' Australasian Journal of Philosophy 81 (2003): 413–19. This article presents, explains, and defends the relationist solution to the problem of change. Sider, Theodore. Four-Dimensionalism . Oxford: Oxford University Press, 2001. This book provides an introduction to various issues related to the problem of change, including the nature of time, tense, and persistence. Chapter 5 presents, explains, and defends the stage-view solution to the problem of change. Online Materials Change. URL: http://plato.stanford.edu/entries/change/ The Stanford Encyclopedia of Philosophy entry on change, by Chris Mortensen. Time. URL: http://plato.stanford.edu/entries/time/ The Stanford Encyclopedia of Philosophy entry on time, by Ned Markosian. Temporal Parts. URL: http://plato.stanford.edu/entries/temporal-parts/ The Stanford Encyclopedia of Philosophy entry on temporal parts, by Katherine Hawley. Material Constitution. URL: http://plato.stanford.edu/entries/material-constitution/ The Stanford Encyclopedia of Philosophy entry on material constitution, by Ryan Wasserman. Persistence Bibliography. URL: http://tedsider.org/teaching/pp_bibliography.pdf A bibliography on change and related issues, by Theodore Sider. Sample Syllabus Books on Syllabus Rea, Michael. Material Constitution: A Reader . Lanham: Rowman & Littlefield, 1997. Sider, Theodore. Four-Dimensionalism . Oxford: Oxford University Press, 2001. van Inwagen, P. and Zimmerman, D. 2008. Metaphysics: The Big Questions . 2nd ed. Oxford: Blackwell, 2008. Week 1: Time and Tense Four-Dimensionalism , chapters 1 and 2. Markosian, Ned. 'A Defence of Presentism.' Oxford Studies in Metaphysics, Volume 1. Ed. D. Zimmerman. Oxford: Oxford University Press, 2004: 47–82. In van Inwagen, P. and Zimmerman, D. Metaphysics: The Big Questions. 2nd ed. Oxford: Blackwell, 2008: 116-123. In van Inwagen, P. and Zimmerman, D. Metaphysics: The Big Questions. 2nd ed. Oxford: Blackwell, 2008: 124-129. Week 2: Time and Persistence Four-Dimensionalism , chapter 3. McGrath, Matthew. 'Temporal Parts.' Philosophy Compass 2 (2007): 730–48. In van Inwagen, P. and Zimmerman, D. Metaphysics: The Big Questions. 2nd ed. Oxford: Blackwell, 2008: 265-267. Hawthorne, J, Scala, M., and Wasserman, R. 'Recombination, Humean Supervenience, and Causal Constraints: An Argument for Temporal Parts?' Oxford Studies in Metaphysics , Volume 1. Ed. D. Zimmerman, Oxford: Oxford University Press, 2004: 301-318. Week 3: Change and Presentism In van Inwagen, P. and Zimmerman, D. Metaphysics: The Big Questions. 2nd ed. Oxford: Blackwell, 2008: 141-149. In van Inwagen, P. and Zimmerman, D. Metaphysics: The Big Questions. 2nd ed. Oxford: Blackwell, 2008: 267-269. In van Inwagen, P. and Zimmerman, D. Metaphysics: The Big Questions. 2nd ed. Oxford: Blackwell, 2008: 269-281. Week 4: Change and Temporal Parts Four-Dimensionalism , pp. 92–8. Heller, Mark. 'Things Change.' Philosophy and Phenomenological Research 52 (1992): 695–704. Lombard, Lawrence. 'The Doctrine of Temporal Parts and the "No Change" Objection.' Philosophy and Phenomenological Research 54 (1994): 365–72. Week 5: Change, Relationism, and Adverbialism Hawley, Katherine. 'Why Temporary Properties are not Relations between Physical Objects and Times.' Proceedings of the Aristotelian Society 98 (1998): 211–16. Wasserman, Ryan. 'The Argument from Temporary Intrinsics.' Australasian Journal of Philosophy 81 (2003): 413–19. Lewis, David. 'Tensing the Copula.' Mind 111 (2002): 1–13. Caplan, Ben. 'Why so Tense about the Copula?' Mind 114 (2007): 703–8. Week 6: Change and Tropes Ehring, Douglas. 'Lewis, Temporary Intrinsics and Momentary Tropes.' Analysis 57 (1997): 254–8. MacBride, Fraser. 'Four New Ways to Change Your Shape.' Australasian Journal of Philosophy 79 (2001): 81–9. Simons, Peter. 'On Being Spread Out in Time: Temporal Parts and the Problem of Change.' Existence and Explanation . Eds. W. Spohn, B.C. van Fraassen, and B. Skyrms. Dordrecht: Kluwer, 1991: 131-147. Weeks 7 and 8: Special Topic – Material Change Four-Dimensionalism , chapter 5. Selections from Material Constitution: A Reader. Week 9: Special Topic – Change of Position In van Inwagen, P. and Zimmerman, D. Metaphysics: The Big Questions. 2nd ed. Oxford: Blackwell, 2008: 186-195. In van Inwagen, P. and Zimmerman, D. Metaphysics: The Big Questions. 2nd ed. Oxford: Blackwell, 2008: 195-215. Week 10: Special topic – Changing the Past In van Inwagen, P. and Zimmerman, D. Metaphysics: The Big Questions. 2nd ed. Oxford: Blackwell, 2008: 224-235. van Iwagen, Peter. 'Changing the Past.' Oxford Studies in Metaphysics , Volume 5 . Ed. D. Zimmerman. Oxford: Oxford University Press, 2009: 1-22. Hudson, H. and Wasserman, R. 'Van Inwagen on Time Travel and Changing the Past.' Oxford Studies in Metaphysics , Volume 5. Ed. D. Zimmerman. Oxford: Oxford University Press, 2009: 41-49. (shrink)

Photo by Karl Raymund Catabas on Unsplash “After Buddha was dead, they still showed his shadow in a cave for centuries – a tremendous, gruesome shadow. God is dead; but given the way people are, there may still for millennia be caves in which they show his shadow. – And we – we must still defeat his shadow as well!” – Friedrich Nietzsche[1] INTRODUCTION Friedrich Nietzsche famously declared that “God is dead!”[2] but lamented that his contemporaries remained living in the (...) shadow of God. For Nietzsche, the morality of his time was still based in the Christian tradition, even though faith in God was waning. Bioethics lives under a similar shadow: the shadow of Enlightenment Era-rationalism. Bioethics curricula focus on principles derived from Kantian deontology and utilitarianism. The allure of maintaining a moral framework that provides a rational method that can be handily applied to any situation remains strong. The principlist approach advanced by Tom Beauchamp and James Childress is taught to nearly all medical students in the United States,[3] and is essentially the canonical ethical framework of bioethics. In this model, the principle of autonomy is Kantian in nature, and the principles of beneficence and non-maleficence are utilitarian in nature.[4] Moreover, the presented framework is an approach that, when applied rationally to any healthcare scenario, will yield an outcome “considered moral.”[5] This reflects a faulty conception of philosophy that plagues much of bioethics, wherein the only contribution of philosophy pertinent to bioethics is moral philosophy elucidated by European thinkers in the Enlightenment Era. The landscape of moral philosophy has evolved significantly from the 18th century. However, the bioethical world has not kept up with the philosophical world, remaining instead in the shadow of antiquated moral thinking. Also lacking in bioethics are other disciplines of philosophy, such as philosophy of language, existentialism, and aesthetics, which are often given no consideration at all. The inclusion of both modern moral philosophy and other philosophical fields is necessary if bioethics is to survive its transition into modernity. l. The Shadow of Enlightenment Enlightenment Era philosophers such as Immanuel Kant argued that one need only employ reason to obtain knowledge; emotion bore no relevance when determining ethical behavior. Kant’s moral theories thus privileged a duty to act according to moral imperatives over feelings. Other Enlightenment Era philosophers such as John Locke developed systems that attempted to quantify human goods and human ills. This quantification potentially reduces human welfare and suffering to utility. Today, in the world of philosophy, such a “neutral analysis,” as Cora Diamond noted, is “dead or moribund.”[6] Bernard Williams remarked that such moral philosophy is “empty and boring,”[7] and G. E. M. Anscombe stated that it “no longer generally survives.”[8] And yet, just as the atheists in Nietzsche’s world dwelt in the moral code of a dead God, bioethicists still pursue a unified moral system that takes an input, applies some moral rules, and generates a moral outcome, like the four principles approach that Beauchamp and Childress laid out.[9] Some detractors of principlism take issue with their approach for not being unified enough and want to replace it with a procedural framework that is even more systematic and complicated. They argue that the resulting moral framework would be a “comprehensive decision procedure for arriving at answers”[10] that retains the “impartiality that is an essential part of morality.”[11] The shadow of rationalist morality has caused bioethical decision making to become detached and rigid when bioethics should concern itself with the humans whose lives it affects. A rational, divorced-from-emotion way of thinking ultimately fails to yield satisfactory results when decisions are made by and for emotional beings. Dr. Paul Farmer, among others, championed the idea that bioethics should be de-philosophized, as philosophy, cold and calculated, fails to adequately respond to the realities of those worst off.[12] Instead, Dr. Farmer emphasized the inclusion of the social sciences, like sociology and anthropology, in bioethics. Undoubtedly, Dr. Farmer was on the right track; bioethics should certainly engage directly with the people whom its decisions involve. If the narrow band of moral philosophy currently found in bioethics – that of stringent rationalism – were all that philosophy had to offer, I, too, would advocate for a de-philosophization. Ludwig Wittgenstein notes that to attempt to capture the complexity of moral thinking in a manner that employs reason alone and casts aside emotion is a “hopeless task,” like reconstructing a sharp image “from a blurred one.”[13] Unfortunately, bioethics is mired in the remnants of this hopeless task. To Dr. Farmer, the dominant moral framework was too restrictive and was unresponsive to the social and humanitarian needs of those whom bioethics is meant to help. As such, he wished to free bioethics from the shadow of a morality derived from rationalist thinkers. ll. Beyond Rationalism Like Nietzsche, who tried to resolve Europe’s post-religion vacuum by providing his society with a new way to live, Dr. Farmer wanted to replace the rationalist philosophy upon which bioethics was built with a “resocialization” of the field.[14] I agree with Dr. Farmer’s call for resocialization, as well as his denouncement of philosophy as it exists in bioethics. Evaluating risks and benefits along a predetermined array of moral principles is far too rigid and impersonal to guide what are often the most important decisions one will make. For Dr. Farmer, the most needed change was restoring the social element of bioethics. However, in advocating for this resocialization, Dr. Farmer casts philosophy as the antithesis of social science, noting that “few would regard philosophy … as a socializing discipline.”[15] I disagree. Rationalist moral philosophy may be lacking in socializing force, but there are other fields of philosophy that are responsive to our social reality. Rather than de-philosophizing bioethics, it makes more sense to replace the antisocial philosophies predominant in bioethics with prosocial philosophies better suited to it. Of course, the contribution of philosophy to bioethics is more than moral theories from the Enlightenment Era. There are more recent philosophical contributions from outside the field of moral philosophy that have roused bioethical interest. Jennifer Blumenthal-Barby, et al., argue for philosophy’s continued place in bioethics, citing Derek Parfit’s “non-identity problem,” which altered the landscape of reproductive ethics, and David Chalmers’ contributions to philosophy of consciousness, which have implications for the moral status of brain organoids.[16] Still, these are narrow applications of philosophy to highly specialized areas of bioethics, which not all bioethicists are inclined to delve into. Philosophy in bioethics should not be confined to niche applications in specialist fields but should influence all bioethical thought. Fortunately, there remains untapped a wealth of philosophical disciplines that pertains to exactly this. Philosophy of language investigates the nature of meaning and understanding in communication, which is a necessary social action. Successfully deciphering and conveying moral values in discourse is a bioethicist’s bread and butter, as is resolving disagreements and reaching agreements. Indeed, it is often the case that miscommunication lies at the root of an impasse between a doctor and a patient. An understanding of the nature of the disagreement would help resolve the conflict, as different types of disagreements require different interventions for resolution. For instance, a “substantive disagreement,”[17] in which two parties use the same terms in the same ways and have a fundamental disagreement on which outcome is more desirable, can be resolved only if one party yields to the other. On the other hand, a “merely verbal dispute,”[18] in which two parties use the same terms to represent entirely different concepts and values, requires standardization of terminological usage for its resolution. As such, no one can overstate the moral importance of successful communication in bioethics, and an exploration of language itself would prove invaluable to a bioethicist’s training. Existentialism is another subset of philosophy that acknowledges the social nature of human existence, noting that one’s being in the universe is concomitant with the existence of others sharing the same universe.[19] Thus, there is the recognition that whatever existence is, it is not complete without the existence of others. With this as a starting point, existentialists examined how to live meaningfully with others in this world. Since ethics crucially involves others, it is no surprise that existentialists pondered how to live moral lives. Existentialist conceptions of morality did not revolve around acting in accordance with a set of rules, but rather, recognized individual freedom in choosing how to act and emphasized acting authentically. In this vein, bioethicists should commit to doing what is right rather than committing to applying a set of principles. Existentialism, while part of the broader bioethics literature, is less common throughout bioethics curricula and deserves more prominence. Martin Heidegger, for instance, emphasized the difference between two types of thinking: “calculative thinking” and “meditative thinking.” Heidegger characterizes calculative thinking as a computation, wherein from some given starting conditions “definite results”[20] are determined, and contrasts this with meditative thinking, which he describes as “thinking which contemplates the meaning which reigns in everything that is.”[21] Heidegger was critical of the pervasiveness of calculative thinking, seeing it as the “ground of thoughtlessness,”[22] in which we only relate to the world in a meaningless, mechanical way. This is the emphasized type of thinking in rationalist conceptions of morality popular in bioethics; from a set of starting conditions, a series of rules are applied, and a moral outcome is calculated. Such a technique, however, discounts the personal meaning individuals place on the aspects of their lives relevant to their decision making, as well as the meaning in committing to doing what is right. Under calculative thinking, such a commitment is reduced to rote rule-following. A turn to meditative thinking would ensure that bioethical decisions comport with living meaningful lives. Even aesthetics, a discipline devoted to examining beauty and taste,[23] has a place in bioethics. Just as the viewing of a painting, the listening of a song, or the reading of a book elicits an effective response, hearing a patient’s story leaves an emotional imprint. The recounting of a traumatic moment imparts sadness, and a joyous occasion begets joy in the listener as well. As acknowledged in the field of everyday aesthetics, these aesthetic experiences often spur us to act:[24] The unsightly appearance of a polluted riverbank drives us to remove the trash; the presence of sorrow in one’s life drives us to ameliorate it. To be mindful of aesthetic experiences and allow them to affect us emotionally is paramount to the motivation of a bioethicist to serve the patient, not out of an obligation to a job description, but out of a desire to truly avail the patient of their anguish. For example, the new field of narrative medicine utilizes critical reading and literary techniques to train clinicians and bioethicists in emotional understanding and listening skills that stress the social aspects of medicine beyond rational analysis and decision making. CONCLUSION Dr. Farmer is absolutely correct; bioethics is in dire need of resocialization. It should not be the case that the justification for a moral action is essentially that “the rules say so,” or that simply by teaching such rules to medical students, the very act of making bioethical decisions that diverge from those determined by principles can be seen as an act of “bad faith … hubris or, worse, malpractice.”[25] As bioethicists are coming to realize, the rationalist philosophical traditions that bioethics was founded upon are past their expiry, and the time for change is now. Indeed, as Dr. Farmer urges, “socializing disciplines” like anthropology, history, political economy, and sociology are necessary to humanize the field of bioethics.[26] So too, however, can philosophy be a socializing discipline, if we know where to look. Bioethics should evolve. Its new goal should be to focus on meaningful human relationships, and to phase out rigid, impersonal modes of moral thinking. The limited sampling of unsatisfying moral theories from hundreds of years ago leaves many bioethics students cold, and it is easy to see why bioethicists are ready to part ways with philosophy. I believe this is a move in the wrong direction; there is a place for philosophy in the future of bioethics. Just as bioethics needs a resocialization, it is also needs of a re-philosophization. These enrichments complement one another. There is more to bioethics than mechanically determining the right course of action in a healthcare setting. Bioethics engages with the most ancient of philosophical questions: questions of what makes human existence meaningful, what makes us who we are, how we want to relate to others, how and why we feel, what our place in the world is, how we can communicate what we think, and why our moral intuitions are so compelling. We would be remiss if we did not begin to investigate additional contributions to morality from a wider range of philosophies that try to provide answers to such questions, as they offer a richness to moral thinking that cannot be gleaned from traditional bioethical approaches alone. - [1] Friedrich Wilhelm Nietzsche, The Gay Science: With a Prelude in German Rhymes and an Appendix of Songs, ed. Bernard Williams, Josefine Nauckhoff, and Adrian Del Caro, Cambridge Texts in the History of Philosophy, 109. [2] Nietzsche, 120. [3] Daniel C O’Brien, “Medical Ethics as Taught and as Practiced: Principlism, Narrative Ethics, and the Case of Living Donor Liver Transplantation,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 47, no. 1 : 97, https://doi.org/10.1093/jmp/jhab039. [4] K. D. Clouser and B. Gert, “A Critique of Principlism,” Journal of Medicine and Philosophy 15, no. 2 : 219–36, https://doi.org/10.1093/jmp/15.2.219. [5] O’Brien, “Medical Ethics as Taught and as Practiced,” 97. [6] Cora Diamond, “Having a Rough Story about What Moral Philosophy Is,” New Literary History 15, no. 1 : 168, https://doi.org/10.2307/468998. [7] Bernard Williams, Morality: An Introduction to Ethics, Canto ed, xvii. [8] G. E. M. Anscombe, “Modern Moral Philosophy,” Philosophy 33, no. 124 : 1, https://doi.org/10.1017/S0031819100037943. [9] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 7th ed, 13. [10] Clouser and Gert, 233. [11] Clouser and Gert, “A Critique of Principlism,” 235. [12] Paul Farmer and Nicole Gastineau Campos, “Rethinking Medical Ethics: A View from Below,” Developing World Bioethics 4, no. 1 : 17–41, https://doi.org/10.1111/j.1471-8731.2004.00065.x. [13] Ludwig Wittgenstein, Philosophical Investigations, ed. Joachim Schulte, trans. P. M. S. Hacker, 4th edition, 40. [14] Farmer and Campos, “Rethinking Medical Ethics,” 20. [15] Farmer and Campos, 20. [16] Jennifer Blumenthal-Barby et al., “The Place of Philosophy in Bioethics Today,” The American Journal of Bioethics: AJOB, June 30, 2021, 3–5, https://doi.org/10.1080/15265161.2021.1940355. [17] Brendan Balcerak Jackson, “Verbal Disputes and Substantiveness,” Erkenntnis 79, no. S1 : 31–54, https://doi.org/10.1007/s10670-013-9444-5. [18] C. S. I. Jenkins, “Merely Verbal Disputes,” Erkenntnis 79, no. 1 : 11–30, https://doi.org/10.1007/s10670-013-9443-6. [19] Steven Crowell, “Existentialism,” in The Stanford Encyclopedia of Philosophy, ed. Edward N. Zalta, Summer 2020, https://plato.stanford.edu/archives/sum2020/entries/existentialism/; Anita Avramides, “Other Minds,” in The Stanford Encyclopedia of Philosophy, ed. Edward N. Zalta, Winter 2020, https://plato.stanford.edu/archives/win2020/entries/other-minds/. [20] Martin Heidegger, Discourse on Thinking, Harper Torchbooks, 46. [21] Heidegger, 46. [22] Heidegger, 45. [23] Nick Zangwill, “Aesthetic Judgment,” in The Stanford Encyclopedia of Philosophy, ed. Edward N. Zalta, Winter 2021, https://plato.stanford.edu/archives/win2021/entries/aesthetic-judgment/. [24] Yuriko Saito, “Aesthetics of the Everyday,” in The Stanford Encyclopedia of Philosophy, ed. Edward N. Zalta, Spring 2021, https://plato.stanford.edu/archives/spr2021/entries/aesthetics-of-everyday/. [25] O’Brien, “Medical Ethics as Taught and as Practiced,” 112. [26] Farmer and Campos, “Rethinking Medical Ethics,” 20. (shrink)

In this paper, I analyze the verbal suffix -uŋil in Washo as an optional past tense. It is optional in the sense that it is not part of a paradigm of tenses, and morphologically tenseless clauses are also compatible with past time reference. Specifically, I claim that -uŋil is the morphological exponent of a tense feature [past], which presupposes that the reference time of the clause, denoted by a temporal pronoun, precedes the evaluation time. Meanwhile, morphologically tenseless clauses lack a (...) semantic tense restricting the value of the reference time pronoun. In comparing this analysis with one containing a covert non-future tense in morphologically tenseless clauses, I show that the range of empirical contexts that distinguish these analyses is quite narrow. However, I offer a novel argument against a covert tense analysis based on the lack of Maximize Presupposition effects. Crucially, the fact that -uŋil does not form a paradigm of tenses results in a failure for Maximize Presupposition to apply. The proposed analysis places cross-linguistic variation at the level of the paradigm of tense features, namely whether they are present or absent, and if present, whether obligatorily so. This case study from Washo thus reveals what a language where tense features are optional can look like, and more generally contributes to the growing body of literature on cross-linguistic semantics devoted to uncovering the ways in which temporal interpretation can be achieved in natural language. (shrink)

We examine Van Wynsberghe and Robbins (JAMA 25:719-735, 2019) critique of the need for Artificial Moral Agents (AMAs) and its rebuttal by Formosa and Ryan (JAMA 10.1007/s00146-020-01089-6, 2020) set against a neo-Aristotelian ethical background. Neither Van Wynsberghe and Robbins (JAMA 25:719-735, 2019) essay nor Formosa and Ryan’s (JAMA 10.1007/s00146-020-01089-6, 2020) is explicitly framed within the teachings of a specific ethical school. The former appeals to the lack of “both empirical and intuitive support” (Van Wynsberghe and Robbins 2019, p. (...) 721) for AMAs, and the latter opts for “argumentative breadth over depth”, meaning to provide “the essential groundwork for making an all things considered judgment regarding the moral case for building AMAs” (Formosa and Ryan 2019, pp. 1–2). Although this strategy may benefit their acceptability, it may also detract from their ethical rootedness, coherence, and persuasiveness, characteristics often associated with consolidated ethical traditions. Neo-Aristotelian ethics, backed by a distinctive philosophical anthropology and worldview, is summoned to fill this gap as a standard to test these two opposing claims. It provides a substantive account of moral agency through the theory of voluntary action; it explains how voluntary action is tied to intelligent and autonomous human life; and it distinguishes machine operations from voluntary actions through the categories of poiesis and praxis respectively. This standpoint reveals that while Van Wynsberghe and Robbins may be right in rejecting the need for AMAs, there are deeper, more fundamental reasons. In addition, despite disagreeing with Formosa and Ryan’s defense of AMAs, their call for a more nuanced and context-dependent approach, similar to neo-Aristotelian practical wisdom, becomes expedient. (shrink)

ABSTRACT Real-time graphical interval logic is a modal logic for reasoning about time in which the basic modality is the interval. The logic differs from other logics in that it has a natural intuitive graphical representation that resembles the timing diagrams drawn by system designers. We have developed an automted deduction system for the logic, which includes a theorem prover and a user interface. The theorem prover checks the validity of proofs in the logic and produces counterexamples to invalid proofs. (...) The user interface includes a graphical editor that enables the user to create graphical formulas on a workstation display, and a database and proof manager that tracks proof dependencies and allows graphical formulas to be stored and retrieved. In this paper we describe the logic, the automated deduction system, and an application to robotics. (shrink)

Introduction Families of patients with dementia may need support in difficult end-of-life decision making. Such guidance may be culturally sensitive. Methods To support families in Canada, a booklet was developed to aid decision making on palliative care issues. For reasons of cost effectiveness and promising effects, we prepared for its implementation in Italy, the Netherlands and Japan. Local teams translated and adapted the booklet to local ethical, legal and medical standards where needed, retaining guidance on palliative care. Using qualitative content (...) analyses, we grouped and compared adaptations to understand culturally sensitive aspects. Results Three themes emerged: (1) relationships among patient, physician and other professionals—the authority of the physician was more explicit in adapted versions; (2) patient rights and family position—adding detail about local regulations; and (3) typology of treatments and decisions. Considerations underlying palliative care decisions were detailed (Dutch and Italian versions), and the Japanese version frequently referred to professional and legal standards, and life-prolongation was a competing goal. Text on artificial feeding or fluids and euthanasia was revised extensively. Conclusions Providing artificial feeding and fluids and discussing euthanasia may be particularly sensitive topics, and guidance on these subjects needs careful consideration of ethical aspects and possible adaptations to local standards and practice. The findings may promote cross-national debate on sensitive, core issues regarding end-of-life care in dementia. (shrink)

This volume brings together papers that discuss methodological issues in conducting elicitation on semantic topics in a fieldwork situation. Each author pairs explicit methodological proposals with concrete examples of their use in the field. The range of languages discussed span 11 language families and four continents.

The concept of consciousness has been the source of much philosophical, cognitive scientific and neuroscientific discussion for the past two decades. Many scientists, as well as philosophers, argue that at the moment we are almost completely in the dark about the nature of consciousness. Stuart Sutherland, in a much quoted remark, wrote that.

... 243-) INTRODUCTION §§243- constitute the eighth 'chapter' of the book. Its point of departure is a natural query with respect to the conclusion of the ...

1. Naturalism Naturalism, it has been said, is the distinctive development in philosophy over the last thirty years. There has been a naturalistic turn away from the a priori methods of traditional philosophy to a conception of philosophy as continuous with natural science. The doctrine has been extensively discussed and has won considerable following in the USA. This is, on the whole, not true of Britain and continental Europe, where the pragmatist tradition never took root, and the temptations of scientism (...) in philosophy were less alluring. Contemporary American naturalism originates in the writings of Quine, the metaphysician of twentieth-century science. With extraordinary panache, he painted a largescale picture of human nature, of language and of the web of belief. I believe that in almost every major respect, it is, like the picture painted by Descartes, the great metaphysician of seventeenth-century science, mistaken. But it evidently appeals to the spirit of the times. So it is worthy of critical examination and careful refutation. I shall argue that the naturalistic turn is a cul-de-sac – a turn that is to be passed by if we are to keep to the highroad of good sense. Naturalism, like so many of Quine’s doctrines, was propounded in response to Carnap. As Quine understood matters, Carnap had been persuaded by Russell’s Our Knowledge of the External World that it is the task of philosophy to demonstrate that our knowledge of the external world is a logical construction out of, and hence can be reduced to, elementary experiences. Quine rejected the reductionism of Carnap’s Logischer Aufbau, and found the idealist basis uncongenial to his own dogmatic realist behaviourism, inspired by Watson and later reinforced by Skinner. The rejection of reductionism and ‘unregenerate realism’, Quine averred, were the sources of his naturalism (FME 72). What exactly was this? We can distinguish in Quine between three different but inter-related programmes for future philosophy: epistemological, ontological and philosophical naturalism. Naturalized epistemology is to displace traditional epistemology, transforming the investigation into ‘an enterprise within natural science’ (NNK 68) – a psychological enterprise of investigating how the ‘input’ of radiation, etc., impinging on the nerve endings of human beings can ‘ultimately’ result in an ‘output’ of our theoretical descriptions of the external world.. (shrink)

Two different conceptions of language dominate philosophical reflection on the nature of human language and of human linguistic powers. The first is the conception of language as a calculus of meaning, and of understanding as computational interpretation. This conception is rooted in the exigencies of function-theoretic logic. The notions pivotal to this conception are truth, truth-condition, sense and force, naming and describing (representation), and theory of meaning for natural languages. The alternative conception is an anthropological one, which conceives of language (...) above all as a form of human communicative behaviour, constituted by human practices and manifest in human action. The notions pivotal to this conception are practice, language-game, use and rule of use as given by explanations of meaning, understanding and criteria of understanding. The fundamental principles that inform each of these conceptions are explained. The radical flaws of calculus conceptions of language are laid bare. (shrink)

Incorporating significant editorial changes from earlier editions, the fourth edition of Ludwig Wittgenstein's _Philosophical Investigations_ is the definitive _en face_ German-English version of the most important work of 20th-century philosophy The extensively revised English translation incorporates many hundreds of changes to Anscombe’s original translation Footnoted remarks in the earlier editions have now been relocated in the text What was previously referred to as ‘Part 2’ is now republished as _Philosophy of Psychology – A Fragment_, and all the remarks in it (...) are numbered for ease of reference New detailed editorial endnotes explain decisions of translators and identify references and allusions in Wittgenstein's original text Now features new essays on the history of the _Philosophical Investigations_, and the problems of translating Wittgenstein’s text. (shrink)