Randomized controlled clinical trials play an important role in the development of new medical therapies. There is, however, an ethical issue surrounding the use of randomized treatment allocation when the patient is suffering from a life threatening condition and requires immediate treatment. Such patients can only benefit from the treatment they actually receive and not from the alternative therapy, even if it ultimately proves to be superior. We discuss a novel new way to analyse data from such clinical trials based (...) on the use of the recently developed theory of imprecise probabilities. This work draws an explicit distinction between the related but nevertheless distinct questions of inference and decision in clinical trials. The traditional question of scientific interest asks 'Which treatment offers the greater chance of success?' and is the primary reason for conducting the clinical trial. The question of decision concerns the welfare of the patients in the clinical trial, asking whether the accumulated evidence favours one treatment over the other to such an extent that the next patient should decline randomization and instead express a preference for one treatment. Consideration of the decision question within the framework of imprecise probabilities leads to a mathematical definition of equipoise and a method for governing the randomization protocol of a clinical trial. This paper describes in detail the protocol for the conduct of clinical trials based on this new method of analysis, which is illustrated in a retrospective analysis of data from a clinical trial comparing the anti-emetic drugs ondansetron and droperidol in the treatment of postoperative nausea and vomiting. The proposed methodology is compared quantitatively using computer simulation studies with conventional clinical trial designs and is shown to maintain high statistical power with reduced sample sizes, at the expense of a high type I error rate that we argue is irrelevant in some specific circumstances. Particular emphasis is placed on describing the type of medical conditions and treatment comparisons where the new methodology is expected to provide the greatest benefit. (shrink)

The Anthropocene is a term described by Earth Systems Science to capture the recent rupture in the history of the Earth where human action has acquired the power to alter the Earth System as a whole. While normative conclusions cannot be logically derived from this descriptive fact, this paper argues that law and philosophy ought to develop responses that are ordered around human beings. Rather than arguing for legal rights or extending rights to nature, this paper focuses on obligations. Drawing (...) on Hans Jonas, it argues that obligations are a more appropriate tool for cultivating human plurality, restraining human action and protecting future generations. (shrink)

“Real knowledge,” as I use the term, is the most highly prized form of true belief sought by an epistemic agent. This paper argues that defeasible infinitism provides a good way to characterize real knowledge and it shows how real knowledge can arise from fallible justification. Then, I argue that there are two ways of interpreting Ernest Sosa's account of real knowledge as belief that is aptly formed and capable of being fully defended. On the one hand, if beliefs are (...) aptly formed only if they have a specific causal etiology, namely that they are efficiently caused fully or partially by virtuous characteristics of the epistemic agent, then Sosa's account falls prey to what I call the problem of the Hazard of Empirical Disconfirmation. The HED problem applies to all forms of causal accounts of real knowledge and is simply that as we gain more empirical knowledge about the causal origins of our true beliefs that are the most highly prized we will discover that they do not always satisfy the required efficient causal constraints. Bluntly put, having sufficiently good reasons for our beliefs might not require that the beliefs have the requisite efficient causal etiology. On the other hand, there is a way of interpreting Sosa's views that does not include an efficient causal prerequisite. That interpretation makes Sosa's account of real knowledge almost identical to defeasible infinitism but expressed in an alternate vocabulary. Such a view is not subject to the HED problem and it can solve the deep problem in epistemology, namely how to get epistemically certain knowledge from fallible justification. (shrink)

Agues that Confucianism and other East Asian philosophical traditions can be resources for understanding and addressing current global challenges such as climate change and hunger.

Over the last century, the world's urban population increased from 224 million to over 3.5 billion, and advances in manufacturing, transportation, and communication technologies brought virtually limitless lifestyle and identity options, as well as the greatest inequalities of wealth, risk, and opportunity in history. Yet, as momentous as these changes are, they are dwarfed by the fact that human activity is now affecting planetary processes like climate. Justice concerns about future generations are no longer academic curiosities; they are global ethical (...) imperatives. This talk by Dr. Peter D. Hershock builds on recent efforts to craft an ethics of global justice around the "social emotion" of compassion, making use of Buddhist conceptual resources to de-link justice from fictions of equality and conceive it, instead, as a dynamic function of relationally-achieved equity and diversity. (shrink)

The Experiential Therapist steps outside of the medical model to explore alternative ways of thinking about mental health disorders. Peter D. Ladd argues that successful treatment results from an informed understanding of a patient’s experience, not an ability to name and categorize difficult experiences as classical disorders.

Hegemony is one of the most widely diffused concepts in the contemporary social sciences and humanities internationally, interpreted in a variety of ways in different disciplinary and national contexts. However, its contemporary relevance and conceptual coherence has recently been challenged by various theories of ‘posthegemony’. This article offers a critical assessment of this theoretical initiative. In the first part of the article, I distinguish between three main versions of posthegemony – temporal, foundational and expansive – characterized by different understandings of (...) the temporal and logical implications of hegemony. I then offer a critical assessment of the shared presuppositions of these theories, including their ‘pre-Gramscianism’, their indebtedness to Laclau and Mouffe’s formulation of hegemony, and their characterization of hegemony in terms compatible with modern theories of sovereignty. I conclude by arguing that the contradictions and oversights of the debate on posthegemony encourage us to undertake a reassessment of the real historical complexity of hegemonic politics and its different traditions of conceptualization. (shrink)

The approach the majority of neuroscientists take to the question of how consciousness is generated, it is probably fair to say, is to ignore it. Although there are active research programs looking at correlates of consciousness, and explorations of informational properties of what might be relevant neural ensembles, the tacitly implied mechanism of consciousness in these approaches is that it somehow just happens. This reliance on a “magical emergence” of consciousness does not address the “objectively unreasonable” proposition that elements that (...) have no attributes or properties that can be said to relate to consciousness somehow aggregate to produce it. Neuroscience has furnished evidence that neurons are fundamental to consciousness; at the fine and gross scale, aspects of our conscious experience depend on specific patterns of neural activity – in some way, the connectivity of neurons computes the features of our experience. So how do we get from knowing that some specific configurations of cells produce consciousness to understanding why this would be the case? Behind the voltages and currents electrophysiologists measure is a staggeringly complex system of electromagnetic fields – these are the fundamental physics of neurons and glia in the brain. The brain is entirely made of electromagnetism phenomena from the level of the atoms up. The EM field literally manifests the computations, or signaling, or information processing/activities performed by connected cellular ensembles that generate a 1st-person perspective. An investigation into the EM field at the cellular scale provides the possibility of identifying the outward signs of a mechanism in fundamental terms, as opposed to merely describing the correlates of our mental abstractions of it. (shrink)

Much of our understanding of human thinking is based on probabilistic models. This innovative book by Jerome R. Busemeyer and Peter D. Bruza argues that, actually, the underlying mathematical structures from quantum theory provide a much better account of human thinking than traditional models. They introduce the foundations for modelling probabilistic-dynamic systems using two aspects of quantum theory. The first, 'contextuality', is a way to understand interference effects found with inferences and decisions under conditions of uncertainty. The second, 'quantum (...) entanglement', allows cognitive phenomena to be modeled in non-reductionist ways. Employing these principles drawn from quantum theory allows us to view human cognition and decision in a totally new light. Introducing the basic principles in an easy-to-follow way, this book does not assume a physics background or a quantum brain and comes complete with a tutorial and fully worked-out applications in important areas of cognition and decision. (shrink)

The subaltern has frequently been understood as a figure of exclusion ever since it was first highlighted by the early Subaltern Studies collective’s creative reading of Antonio Gramsci’s carceral writings. In this article, I argue that a contextualist and diachronic study of the development of the notion of subaltern classes throughout Gramsci’s full Prison Notebooks reveals new resources for “refiguring” the subaltern. I propose three alternative figures to comprehend specific dimensions of Gramsci’s theorizations: the “irrepressible subaltern,” the “hegemonic subaltern,” and (...) the “citizen-subaltern.” Far from being exhausted by the eclipse of the conditions it was initially called upon to theorize in Subaltern Studies, such a refigured notion of the subaltern has the potential to cast light both on the contradictory development of political modernity and on contemporary political processes. (shrink)

Speech act theory has taught us 'how to do things with words'. Arresting Language turns its attention in the opposite direction - toward the surprising things that language can undo and leave undone. In the eight essays of this volume, arresting language is seen as language at rest, words no longer in service to the project of establishing conventions or instituting legal regimes. Concentrating on both widely-known and seldom-read texts from a variety of philosophers, writers, and critics - from Leibniz (...) and Mendelssohn, through Kleist and Hebel, to Benjamin and Irigaray - the book analyzes the genesis and structure of interruption, a topic of growing interest to contemporary literary studies, continental philosophy, legal studies, and theological reflection. Arresting Language identifies critical moments in philosophical and literary texts during which language itself - without any identifiable speaker - arrests otherwise continuous processes and procedures, including the process of representation and procedures for its legitimization. (shrink)

This chapter provides grounds for thinking that it is the quality of the reasons for the propositional content of our belief-states with true propositional contents, rather than the etiology of those belief-states, that determines whether the belief-state qualifies as knowledge. Normative epistemology rather than naturalized epistemology holds the key to understanding knowledge. This chapter delineates some important features of epistemic luck. It explores the etiology view and presents reasons for concluding that it cannot adequately account for epistemic luck. The chapter (...) then explores the reasons view and shows how it can account for some of the cases that are troublesome for the etiology view. There are many well-discussed and widely accepted counterexamples in the literature for each of the etiology views, with the exception of the virtue-views because those views are still relatively new. (shrink)

This chapter considers an element of Plato’s account of sense perception. In particular, it poses the question of how widely Plato construes the content of the perceptual capacity. It argues that, based on what Plato says in the Theaetetus and the Timaeus there is good reason to think that sense perception is limited to just those simple sense qualities that are made available to the soul by the individual sensory powers, i.e., colors by sight, sounds by hearing, etc. This, however, (...) raises the question of how, according to Plato, the soul becomes aware of features that are often thought to be perceptible through more than one sensory power: features like shape, motion, rest, number, etc. The chapter addresses this issue by arguing that the awareness of these features requires the co-operation of sense perception with additional capacities of the soul, in particular the capacity for reflective thought; for recognizing these features requires the deployment of basic concepts like sameness and difference. An upshot of the position defended in this chapter is that, if correct, it indicates that, for Plato, rational capacities may be more widely distributed than is often thought. (shrink)

An ongoing debate among legal scholars and public health advocates is the role of litigation in shaping public policy. For the most part, the debate has been waged at a conceptual level, with opponents and proponents arguing within fairly well-defined boundaries. The debate has been based either on speculation of what litigation could achieve or on ideological grounds as to why litigation should or should not be used this way. With the exception of Rosenberg's study of how litigation shaped policy (...) in civil rights, abortion, and environmental matters, there is almost no empirical support for either position.In recent years, the most ardent proponents of litigation as public policy have been public health advocates. Perhaps out of frustration with the inability to achieve desired public health goals through the legislative branch of government, public health advocates have pursued litigation as an alternative strategy. Beginning with tobacco class action litigation in the early 1990s and continuing with litigation against gun manufacturers at the end of that decade, public health advocates have waged a veritable litigation assault aimed at changing how public health policy is formed. (shrink)

We suggest that in the particular context of medical education, ethics can be considered in a similar way to other kinds of knowledge that are categorised and shaped by academics in the context of wider society. Moreover, the study of medical ethics education is translational in a manner loosely analogous to the study of medical education as adjunct to translational medicine. Some have suggested there is merit in the idea that much as translational research attempts to connect the laboratory scientist's (...) work to its implications for patient care, translational ethics focuses on bringing ethics scholarship into the sphere of personal and public action. We distinguish the term ‘translational ethics’ (the study of ethics being translated between academy, classroom and clinic) from other prominent definitions in the bioethics literature. To do this, we build off a notion of knowledge translation that focuses on the nonlinear movement of information that comes to professionals through multiple competing sources. We suggest that this knowledge, and particularly knowledge about ethics, becomes embodied by the individual. It is through a reflective practice that internally embedded ethics knowledge might be modified, and this work might be best carried out with a moral community that maintains a sense of practical wisdom. Applying this translational approach to the study of medical ethics education can be both academically relevant and practically useful. This view of translation can help bridge the evident, multidirectional relationships between research, education and performance. It might also create further opportunities to develop medical ethics education theory. (shrink)

When machine learning, data and AI are reshaping the human experience, Peter Hershock gives us a new way to think about attention, presence and ethics in our changing lives by balancing Western technology with Asian philosophy. He explains how Confucian and Socratic ethics can make visible what a history of choices about remaking ourselves has rendered invisible, and applies Buddhist ideas to give us an understanding about the self and consciousness. Seamlessly blending ancient Chinese, Indian and Greek philosophy, Hershock (...) responds to the challenge of staying present during the age of technology. (shrink)

Many observers have argued that the US health care system could be more efficient, and achieve better outcomes if providers focused more on improving the community's health, not just the welfare of individual patients. The passage of the Affordable Care Act in 2010 seemed to herald the promise of such reforms, and greater integration of the health care and public systems. In this article, we reassess the quest for integration, a quest we call the “integration project.” After examining the modest (...) steps taken so far toward integration, we consider some conceptual barriers to integration as well as some of the risks it might portend for the public health system. Our assessment contributes to wide-ranging debates among public health advocates, practitioners, and policymakers as to the health care system's role in protecting public health, and how the public health system can best be organized to meet expected population health challenges. (shrink)

The specific mechanisms whereby Pavlovian conditioning leads to adaptive behavior need to be elaborated. There is no evidence that it is via reduction in the “destabilizing effect that time lags have on feedback control” (Domjan et al. 2000, sect. 3.3). The adaptive value of Pavlovian conditioning goes well beyond the regulation of social behavior.

In light of such basic Buddhist teachings as karma and interdependence, the conceptions of "rights" and "human being" presupposed by the dominant currents in contemporary human rights discourse are critically evaluated here. The negative recusiveness of such a discourse and its promotion of minimum standards for secure coexistence is examined, and a Buddhist perspective on human rights forwarded in which realizing our dramatic interdependence and social virtuosity are held paramount.

That there is a heritable or familial component of susceptibility to chronic non‐communicable diseases such as type 2 diabetes, obesity and cardiovascular disease is well established, but there is increasing evidence that some elements of such heritability are transmitted non‐genomically and that the processes whereby environmental influences act during early development to shape disease risk in later life can have effects beyond a single generation. Such heritability may operate through epigenetic mechanisms involving regulation of either imprinted or non‐imprinted genes but (...) also through broader mechanisms related to parental physiology or behaviour. We review evidence and potential mechanisms for non‐genomic transgenerational inheritance of ‘lifestyle’ disease and propose that the ‘developmental origins of disease’ phenomenon is a maladaptive consequence of an ancestral mechanism of developmental plasticity that may have had adaptive value in the evolution of generalist species such as Homo sapiens. BioEssays 29: 145–154, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

This paper considers the place of the capacity for sense perception in Plato's tripartite soul. It argues, against a common recent interpretation, that despite being a capacity of the soul's appetitive part, sense perception is not independent of the soul's rational capacities. On the contrary, the soul's ability to recognize the content that it receives through sense perception depends upon the objects and the activity of its rational capacities. Defending a position of this sort requires one to suppose that despite (...) its partition, the soul, for Plato, is, with respect to the activities of its various parts, substantially unitary. There are however passages in Plato that suggest that the capacities of the non-rational soul parts, in general, and sense perception, in particular, enjoy a certain degree of autonomy and independence from reason such that they, without the input of reason, can form beliefs about, and act on the basis of, their content. These passages have been read as belying this supposition. In this paper, however, I argue that these passages are perfectly consistent with the idea that the content of the non-rational capacities of the soul depends, for its intelligibility, on the soul's rational capacities. (shrink)

The essays gathered here give voice to perspectives on the always improvised relationship between technology and cultural values from Africa, the Americas, Asia ...