Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide (...) advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: impacts on healthcare costs, the outsourcing of expertise and issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries. (shrink)

A number of Artificial Intelligence (AI) ethics frameworks have been published in the last 6 years in response to the growing concerns posed by the adoption of AI in different sectors, including healthcare. While there is a strong culture of medical ethics in healthcare applications, AI-based Healthcare Applications (AIHA) are challenging the existing ethics and regulatory frameworks. This scoping review explores how ethics frameworks have been implemented in AIHA, how these implementations have been evaluated and whether they have been successful. (...) AI specific ethics frameworks in healthcare appear to have a limited adoption and they are mostly used in conjunction with other ethics frameworks. The operationalisation of ethics frameworks is a complex endeavour with challenges at different levels: ethics principles, design, technology, organisational, and regulatory. Strategies identified in this review are proactive, contextual, technological, checklist, organisational and/or evidence-based approaches. While interdisciplinary approaches show promises, how an ethics framework is implemented in an AI-based Healthcare Application is not widely reported, and there is a need for transparency for trustworthy AI. (shrink)

The development and deployment of medical devices, along with most areas of healthcare, has been significantly impacted by the COVID-19 pandemic. This has had variable ethical implications, two of which we will focus on here. First, medical device regulations have been rapidly amended to expedite approvals of devices ranging from face masks to ventilators. Although some regulators have issued cessation dates, there is inadequate discussion of triggers for exiting these crisis standards, and evidence that this may not be feasible. Given (...) the relatively low evidence standards currently required for regulatory approval of devices, this further indefinite reduction in standards raises serious ethical issues. Second, the pandemic has disrupted the usual operations of device representatives in hospitals, providing an opportunity to examine and refine this potentially ethically problematic practice. In this paper we explain and critically analyse the ethical implications of these two pandemic-related impacts on medical devices and propose suggestions for their management. These include an endpoint for pandemic-related adjustments to device regulation or a mechanism for continued refinement over time, together with a review of device research conducted under crisis conditions, support for the removal and replacement of emergency approved devices, and a review of device representative credentialling. (shrink)

The pandemic has been the most vivid agent of change that many of us have known. But it has not changed everything: plenty of the institutions, norms, and practices that sustain racial capitalism, settler colonialism, and cisheteropatriarchy have either weathered the storm of the crisis or been nourished by its effects. And yet enough has changed for us to see that the pandemic has profoundly recontextualised those structures and systems of violence, bringing us into a fresh negotiation with, for example, (...) the question of how we discuss and imagine freedom. Responding in part to this unexpected provocation, activist-scholars Robyn Maynard and Leanne Betasamosake Simpson forged a collaboration from the lockdown of 2020, corresponding by letter to create their forthcoming book, Rehearsals for Living, due to be published by Haymarket Books (US) and Knopf (Canada) in 2022. In this interview, we asked them to explain the epistolary form of the book and expand on the concept of “rehearsal”, before inviting them to reflect on a series of issues that animate our current crises: the politics of recognition; the notion of apocalypse; ways to disrupt linear temporalities; practises of reciprocity against proprietary logics; the gendered violence of state apparatuses; and worldbuilding as a method of resistance. In their expansive answers, Robyn and Leanne draw on their experiences as organisers and educators, commenting on anticolonial struggles, the Movement for Black Lives, and the rise of abolition discourse. Stressing the need to build a multiplicity of shared homespaces in the face of racial/colonial capitalism and organized abandonment, they challenge us to rethink the predicaments and possibilities of the present, enabling us to imagine futures liberated of extractivist, carceral governance – “planting more liberatory futures in the present”, as Robyn puts it. The task of sowing those seeds is a collective praxis of rewriting the narratives that constitute us, refusing to hear that nothing can change and insisting that everything must. (shrink)

_Thoughts and Utterances_ is the first sustained investigation of two distinctions which are fundamental to all theories of utterance understanding: the semantics/pragmatics distinction and the distinction between what is explicitly communicated and what is implicitly communicated.

Belief and credal commitment sometimes seem to make less and less sense in the West. A kind of 'cultural amnesia' has taken hold, where formal religious adherence begins to seem almost unthinkable. This is especially so for the idea of divine revelation. Robyn Horner argues this means we need to re-evaluate how theology proceeds, focusing not so much on beliefs but on experience. Exploring ways in which the experiential might open human beings up to divine possibility, the author turns (...) to phenomenology because it seeks to examine unrestrictedly what is given through involved encounter. Bringing phenomenology and poststructuralism together, Horner develops the idea of revelation as an 'event' wherein God interrupts and exceeds human experience, affecting and transforming it. This striking concept, named but largely unexplored by theology, articulates a notion of supernatural revelation which now starts to appear both coherent and plausible. (shrink)

A review of the literature indicates that linear models are frequently used in situations in which decisions are made on the basis of multiple codable inputs. These models are sometimes used normatively to aid the decision maker, as a contrast with the decision maker in the clinical vs statistical controversy, to represent the decision maker "paramorphically" and to "bootstrap" the decision maker by replacing him with his representation. Examination of the contexts in which linear models have been successfully employed indicates (...) that the contexts have the following structural characteristics in common: each input variable has a conditionally monotone relationship with the output; there is error of measurement; and deviations from optimal weighting do not make much practical difference. These characteristics ensure the success of linear models, which are so appropriate in such contexts that random linear models may perform quite well. 4 examples involving the prediction of such codable output variables as GPA and psychiatric diagnosis are analyzed in detail. In all 4 examples, random linear models yield predictions that are superior to those of human judges. (shrink)

Williams, Robyn I was briefly a religious person - only on a form. When we crossed into Pakistan, having hitch-hiked from London en route to Sydney in 1966, there came a point where you could not just put a line through where it said 'religion'. I suddenly discovered what to do. I wrote 'Congregationalist hedonist'. All the officials loved it. We had lots of fun together.

Dawes points out the fallacy in many commonly held beliefs in therapy and takes issue with many current treatment methods.

Proper linear models are those in which predictor variables are given weights such that the resulting linear composite optimally predicts some criterion of interest; examples of proper linear models are standard regression analysis, discriminant function analysis, and ridge regression analysis. Research summarized in P. Meehl's book on clinical vs statistical prediction and research stimulated in part by that book indicate that when a numerical criterion variable is to be predicted from numerical predictor variables, proper linear models outperform clinical intuition. Improper (...) linear models are those in which the weights of the predictor variables are obtained by some nonoptimal method. The present article presents evidence that even such improper linear models are superior to clinical intuition when predicting a numerical criterion from numerical predictors. In fact, unit weighting is quite robust for making such predictions. The application of unit weights to decide what bullet the Denver Police Department should use is described; some technical, psychological, and ethical resistances to using linear models in making social decisions are considered; and arguments that could weaken these resistances are presented. (shrink)

Jean-Luc Marion is one of the leading Catholic thinkers of our time: a formidable authority on Descartes and a major scholar in the philosophy of religion. This book presents a concise, accessible, and engaging introduction to the theology of Jean-Luc Marion. Described as one of the leading thinkers of his generation, Marion's take on the postmodern is richly enhanced by his expertise in patristic and mystical theology, phenomenology, and modern philosophy. In this first introduction to Marion's thought, Robyn Horner (...) provides the essential background to Marion's work, as well as analysing the most significant themes for contemporary theology. This book serves as an ideal starting point for students of theology and philosophy, as well as for those seeking to further their knowledge of cutting-edge thinking in contemporary theology. (shrink)

Hegel's "highway of despair," introduced in his _Phenomenology of Spirit_, represents the tortured path traveled by "natural consciousness" on its way to freedom. Despair, the passionate residue of Hegelian critique, also indicates fugitive opportunities for freedom and preserves the principle of hope against all hope. Analyzing the works of an eclectic cast of thinkers, Robyn Marasco considers the dynamism of despair as a critical passion, reckoning with the forms of historical life forged along Hegel's highway. _The Highway of Despair_ (...) follows Theodor Adorno, Georges Bataille, and Frantz Fanon as they each read, resist, and reconfigure a strand of thought in Hegel's _Phenomenology of Spirit_. Confronting the twentieth-century collapse of a certain revolutionary dialectic, these thinkers struggle to revalue critical philosophy and recast Left Hegelianism within the contexts of genocidal racism, world war, and colonial domination. Each thinker also re-centers the role of passion in critique. Arguing against more recent trends in critical theory that promise an escape from despair, Marasco shows how passion frustrates the resolutions of reason and faith. Embracing the extremism of what Marx, in the spirit of Hegel, called the "ruthless critique of everything existing," she affirms the contemporary purchase of radical critical theory, resulting in a passionate approach to political thought. (shrink)

As the international art market globalizes the indigenous image, it changes its identity, status, value, and purpose in local and larger contexts. Focusing on a school of Australian Aboriginal painting that has become popular in the contemporary art world, Robyn Ferrell traces the influence of cultural exchanges on art, the self, and attitudes toward the other. Aboriginal acrylic painting, produced by indigenous women artists of the Australian Desert, bears a superficial resemblance to abstract expressionism and is often read as (...) such by viewers. Yet to see this art only through a Western lens is to miss its unique ontology, logics of sensation, and rich politics and religion. Ferrell explores the culture that produces these paintings and connects its aesthetic to the brutal environmental and economic realities of its people. From here, she travels to urban locales, observing museums and department stores as they traffic interchangeably in art and commodities. Ferrell ties the history of these desert works to global acts of genocide and dispossession. Rethinking the value of the artistic image in the global market and different interpretations of the sacred, she considers photojournalism, ecotourism, and other sacred sites of the western subject, investigating the intersection of modern art and postmodern culture. She ultimately challenges the primacy of the "European gaze" and its fascination with sacred cultures, constructing a more balanced intercultural dialogue that deemphasizes the aesthetic of the real championed by western philosophy. (shrink)

Originating as a proponent of U.S. exceptionalism during the Cold War, American Studies has now reinvented itself, vigorously critiquing various kinds of critical hegemony and launching innovative interdisciplinary endeavors. _The Futures of American Studies_ considers the field today and provides important deliberations on what it might yet become. Essays by both prominent and emerging scholars provide theoretically engaging analyses of the postnational impulse of current scholarship, the field's historical relationship to social movements, the status of theory, the state of higher (...) education in the United States, and the impact of ethnic and gender studies on area studies. They also investigate the influence of poststructuralism, postcolonial studies, sexuality studies, and cultural studies on U.S. nationalist—and antinationalist—discourses. No single overriding paradigm dominates the anthology. Instead, the articles enter into a lively and challenging dialogue with one another. A major assessment of the state of the field, _The Futures of American Studies_ is necessary reading for American Studies scholars. _Contributors._ Lindon Barrett, Nancy Bentley, Gillian Brown, Russ Castronovo, Eric Cheyfitz, Michael Denning, Winfried Fluck, Carl Gutierrez-Jones, Dana Heller, Amy Kaplan, Paul Lauter, Günter H. Lenz, George Lipsitz, Lisa Lowe, Walter Benn Michaels, José Estaban Muñoz, Dana D. Nelson, Ricardo L. Ortiz, Janice Radway, John Carlos Rowe, William V. Spanos. (shrink)

The aim of this dissertation is to respond to a collection of conceptual and scientific threats to compatibilist accounts of free will, particularly reasons-responsive views. Compatibilists hold that free will is compatible with the truth of determinism. Some compatibilists also claim that some actual agent at least sometimes acts freely, where it is true that she acts freely in virtue of her satisfying a specific set of control and epistemic conditions. These conditions often include the possession of certain capacities, such (...) as the capacity to recognize reasons for acting and to act on the basis of those reasons. First, I address two pressing philosophical objections to the adequacy of compatibilist accounts of free will: Are reasons-responsive accounts of free will too permissive in their class of free agents? Must reasons-responsive theorists - and compatibilists more generally - concede that some agents who are manipulated or intentionally designed by others are none the less acting freely and morally responsible for their actions? I then survey a widely proposed scientific threat to compatibilist accounts of free will - and to any account of free will that requires the same basic capacities as compatibilists do: Even if the compatibilist account accurately captures the basic capacities that an agent requires to act freely, does neuroscientific work on practical decision-making and action production limit - or worse, speak against -- our actual exercise of free will, as compatibilists conceive of it? I argue that the compatibilist need not yield to these philosophical challenges to the adequacy of their accounts of free will and to their claim that some actual agents act freely, sketching plausible compatibilist-friendly reasons to doubt the potency of each challenge. Finally, I argue that the extant incompatibilist accounts of free will suffer from a previously undiagnosed, serious problem: that there is an irreconcilable tension between the way in which philosophers motivate the incompatibilist ability to do otherwise and the way in which they formally express it. I conclude by offering a diagnosis for the future of the free will debate given the arguments advanced. (shrink)

In Responsibility and Control: A Theory of Moral Responsibility John Martin Fischer and Mark Ravizza propose an account of moral responsibility according to which an agent is morally responsible for an action just when that action is the product of her own moderately reasons-responsive mechanism, where reasons-responsiveness is explained in terms of the mechanism’s regular reasons-receptivity and weak reasons-reactivity. In a review of Fischer and Ravizza’s book Mele contends that their weakly reasons-reactivity condition is inadequate, constructing a case in which, (...) according to their theory, an extreme agoraphobic is morally responsible for his staying in his home. In this paper I modify Fischer and Ravizza’s account of moral responsibility in light of Mele’s problematic example, suggesting a refinement of their weakly reasons-reactivity requirement via a distinction between weakly sufficient reasons and strongly sufficient reasons. (shrink)

Volume 16, Issue 1, April 2020, Page 99-104.

Medical interventions are usually categorized as “invasive” when they involve piercing the skin or inserting an object into the body. Beyond this standard definition, however, there is little discussion of the concept of invasiveness in the medical literature, despite evidence that the term is used in ways that do not reflect the standard definition of medical invasiveness. We interviewed psychiatrists, patients with depression, and members of the public without depression to better understand their views on the invasiveness of several psychiatric (...) electroceutical interventions (treatments that involve electrical or magnetic stimulation of the brain) for the treatment of depression. Our study shows that people recognize several kinds of invasiveness: physical, emotional, and lifestyle. In addition, several characteristics of therapies influence how invasive they are perceived to be; these include the perceived capacity of an intervention to result in harm; how localized the effects of the intervention are; the amount of control retained by the person receiving the intervention; how permanent its effects are perceived as being; and how familiar it seemed to participants. Our findings contribute to a small literature on the concept of invasiveness, which emphasizes that categorizing an intervention as invasive, or as noninvasive, evokes a variety of other normative considerations, including the potential harm it poses and how it compares to other potential therapies. It may also draw attention away from other salient features of the intervention. (shrink)

Polysemy, understood as instances of a single linguistic expression having multiple related senses, is not a homogenous phenomenon. There are regular (apparently, rule‐based) cases and irregular (resemblance‐based) cases, which have different processing profiles. Although a primary source of polysemy is pragmatic inference, at least some cases become conventionalised and linguistically encoded. Three main issues are discussed: (a) the key differences between regular and irregular cases and the role, if any, of a “core meaning”; (b) the distinction between pragmatic polysemy and (...) semantic polysemy; and (c) the role of syntactic meaning in both generating and constraining polysemy. (shrink)

"At once rigorous, insightful, and accessible.... the most thorough study yet available on the phenomenological treatment of God as gift in Marion and Derrida. Invaluable reading for those concerned with the theological promise of contemporary Continental philosophy."-Thomas A. Carlson, University of California, Santa Barbara.

In Free Will and Luck, Mele presents a case of an agent Ernie, whose zygote was intentionally designed so that Ernie A-s in 30 years, bringing about a certain event E. Mele uses this case of original design to outline the zygote argument against compatibilism. In this paper I criticize the zygote argument. Unlike other compatibilists who have responded to the zygote argument, I contend that it is open to the compatibilist to accept premise one, that Ernie does not act (...) freely and is not morally responsible for anything he does. I argue that compatibilists should deny premise two. Diana’s effective intention to create Ernie’s zygote such that Ernie A-s in 30 years and her intervention to bring about his A-ing mark a significant difference between Ernie and normal agents in a deterministic universe with regard to how their zygotes were created that affects whether those agents act freely and are morally responsible for so acting. (shrink)

Most people working on linguistic meaning or communication assume that semantics and pragmatics are distinct domains, yet there is still little consensus on how the distinction is to be drawn. The position defended in this paper is that the semantics/pragmatics distinction holds between encoded linguistic meaning and speaker meaning. Two other ‘minimalist’ positions on semantics are explored and found wanting: Kent Bach’s view that there is a narrow semantic notion of context which is responsible for providing semantic values for a (...) small number of indexicals, and Herman Cappelen and Ernie Lepore’s view that semantics includes the provision of values for all indexicals, even though these depend on the speaker’s communicative intentions. Finally, some implications are considered for the favoured semantics/pragmatics distinction of the fact that there are linguistic elements which do not contribute to truth-conditional content but rather provide guidance on pragmatic inference. (shrink)

After reviewing factors implicated in the generation of delusional beliefs, we conclude that whilst a perceptual aberration coupled with a particular type of attri‐butional bias may be necessary to explain the specific thematic content of a bizarre delusion, neither of these factors, whether in isolation or in combination, is sufficient to explain the presence of delusional beliefs. In contrast to bias models (theories which explain delusion formation in terms of extremes of normal reasoning biases), we advocate a deficit model of (...) delusion formation–that is, delusions arise when the normal cognitive system which people use to generate, evaluate, and then adopt beliefs is damaged. Mere bias we think inadequate to explain bizarre delusions which defy commonsense and persist despite overwhelming rational counter‐argument. In particular, we propose that two deficits must be present in the normal cognitive system to explain bizarre delusions: (1) there must be some damage to sensory and/or attentional‐orient‐ing mechanisms which causes an aberrant perception–this explains the bizarre content of the causal hypothesis generated to explain what is happening; and (2) there must also be a failure of normal belief evaluation–this explains why a hypothesis, implausible in the light of general commonsense, is adopted as belief. This latter deficit occurs, we suggest, when an individual is incapable of suspending the natural favoured status of direct first‐person evidence in order to critically evaluate hypotheses, given equal pri‐ority whether based on direct or indirect sources of information. In contrast, delusions with ‘ordinary’ content may arise when a single deficit of normal belief evaluation occurs in the context of an extreme (but normal) attentional bias, thus causing failure to critically evaluate hypotheses based on misperceptions and misintrepretations of ambiguous (but ordinary) first‐person experience. (shrink)

Evidence-based medicine (EBM) was developed to ensure that health-care decisions are based on the best available research evidence. Making this evidence available to patients is supposed to increase their autonomy by putting them in a position to make better-informed choices. In this paper, I draw on work in feminist bioethics to critique EBM’s approach to involving patients in decision making, in which patients are asked merely to select their preferences among various possible treatment outcomes but are not encouraged to actively (...) contend with the effects of illness on their lives as a whole. (shrink)

A number of reports have suggested that patients who undergo deep brain stimulation may experience changes to their personality or sense of self. These reports have attracted great philosophical interest. This paper surveys the philosophical literature on personal identity and DBS and draws on an emerging empirical literature on the experiences of patients who have undergone this therapy to argue that the existing philosophical discussion of DBS and personal identity frames the problem too narrowly. Much of the discussion by neuroethicists (...) centers on the nature of the threat posed by DBS, asking whether it is best understood as a threat to personal identity, autonomy, agency, or authenticity, or as putting patients at risk of self-estrangement. Our aim in this paper is to use the empirical literature on patients’ experiences post-DBS to open up a broader range of questions - both philosophical and practical, and to suggest that attention to these questions will help to provide better support to patients, both before and after treatment. (shrink)

The general consensus emerging from decades of empirical investigation of metaphor processing is that, when appropriately contextualised, metaphorically used language is no more demanding of processing effort than literally used language. However, there is a small number of studies which contradict this position, notably Noveck, Bianco, and Castry (2001): they maintain that relevance-based pragmatic theory predicts increased cognitive costs incurred in deriving the extra effects that metaphors typically yield, and they provide experimental results that support this prediction. In our study, (...) we first surveyed and assessed the tasks and stimulus materials of many experiments on metaphor processing from the 1970's to the present day. The most telling result was an apparent disparity between the processing of metaphorical language used predicatively versus referentially. We then ran two self-paced reading experiments to test our hypothesis that when used as a predicate, metaphorical language is no more costly than literal language, but when used referentially, it does incur extra costs, even given a preceding biasing context. In the first experiment, all metaphorical referring expressions were in subject position so occurred early in the sentence; in the second experiment, we controlled for any effect of sentence position by placing metaphorical referring expressions in object position, thus later in the sentence, similar to the predicate metaphors. In both cases, metaphorical referring incurred significantly greater costs relative to literal equivalents than did metaphorical predication, with no effect of sentence position. We end with a brief analysis of why the referential use of metaphor is special and effort-demanding. (shrink)

Rising worldwide scrutiny of the PhD has focused on issues such as return on investment and career outcomes. This article investigates PhD graduate careers and knowledge transfer looking at the Hum...

Metalinguistic negation is interesting for at least the following two reasons: it is one instance of the much broader, very widespread and various, phenomenon of metarepresentational use in linguistic communication, whose semantic and pragmatic properties are currently being extensively explored by both linguists and philosophers of language; it plays a central role in recent accounts of presupposition-denial cases, such as "The king of France is not bald; there is no king of France". It is this latter employment that discussion of (...) metalinguistic negation has focused on since Horn 's key article on the subject. While Burton- Roberts saw the MN account of presupposition-denials as providing strong support for his semantic theory of presupposition, I have offered a multi-layered pragmatic account of these cases, which also involves MN, but maintains the view that the phenomenon of presupposition is pragmatic. (shrink)

The ways in which event memories may be reconstructed or transformed through discussion with others is a critical question both for understanding basic memory processes and for issues concerning legal testimony. In this research, white middle-class preschool children were interviewed first by their mothers and then by a female experimenter about personally experienced events when they were 40, 46, 58, and 70 months of age. Analyses indicated that at all four time points children only incorporated about 9% of the information (...) initially recounted by the mother into their independent recall of the event with the experimenter. Moreover, children only repeated about 20% of the information they themselves recalled across the two interviews. Additional analyses indicated that information mutually discussed by the mother and child was no more likely to be incorporated or repeated when recalling the event with the experimenter than information not mutually discussed. These results indicate that young children′s personal memories are not so fragile that they easily incorporate information provided by another into their own recall. (shrink)

One of the fundamental issues in 20th century philosophy is of the nature of individual subjective experience. I seek to show how this “nature” is revealed and hidden by a historical process outlined in History of Madness by Michel Foucault. Foucault’s philosophical and anthropological engagement with the experience of madness in The Modern Age functions as a useful tool towards this end. The psychologisation and medicalization of madness in the 19th century allowed for an endless discourse on madness. This in (...) turn permitted the language of the mad to burst open from its silence, historically present since the Great Confinement. This language of madness expressed itself poetically and artistically, thus revealing the paradoxical essence of the nature of human subjectivity as well as the particularity of its expression in the Modern Period. This particularity is elucidated from a genealogical account of the births of subjectivity and objectivity. I proceed to use this genealogy in conjunction with the language of madness to posit a prescriptive theory for aesthetic engagement. The essay seeks to show how the aesthetic experience can aid in the affirmation of the individual’s modern subjective reality. Thusly, the “goal” of the essay is to reveal affirmation, i.e., amor fati, the love of fate. (shrink)