Volume 25, Issue 2, February 2025, Page 85-87.

: Ulysses contracts have faced paternalism objections since they first were proposed. Since the contracts are designed to override a present request from a legally competent patient in favor of a past request made by that patient, enforcement of these contracts was argued to be unjustifiable strong paternalism. Recent legal developments and new theories of practical reasoning suggest that the discussion of Ulysses contracts should be revived. This paper argues that with a proper understanding of the future-directed planning embodied in (...) Ulysses contracts, the charge of strong paternalism can be answered, and the enforcement of some Ulysses contracts may be justified under the rubric of weak paternalism. (shrink)

In this article, we develop a non-rights-based argument based on beneficence (i.e., the welfare of individuals and communities) and justice as the disposition to act justly to promote equity in health care resource allocation. To this end, we structured our analysis according to the following main sections. The first section examines the work of Amartya Sen and his equality of capabilities approach and outlines a framework of health care as a fundamental human need. In the subsequent section, we provide a (...) definition of health equity based on the moral imperative to guarantee that every individual ought to have the freedom to pursue health goals and well-being. In the later part of the article, we outline a non-right approach to health care based on three pillars: (1) human flourishing, (2) justice as a disposition not a process, and (3) solidarity. (shrink)

Chapman et al. (2025) frame the issue of ethical regulation of data-centric research, including AI and large language models, in an important and challenging manner. While we agree that the risks t...

In clinical mental health research with children, both child and parent are essential members of the research team. The 3 R's of parent/child team membership are respect, rapport, and recognition. Respect and recognition include fair reimbursement for time, expense, and inconvenience, but the most important compensation for many families is the appreciation of the other team members for their sacrifice and cooperation. Reimbursement, although honoring the principles of justice and respect for persons, raises difficult issues about appropriate amount, particularly in (...) research involving children. The 3 R's are supported by the investigator 5 A's: attitude, adaptability, availability, attachment, and appreciation. Although the principles seem clear in the abstract, implementation encounters many practical problems. Perhaps the most difficult of these is determining the appropriate amount of compensation that avoids undue inducement but not at the expense of the 3 R's and 5 A's. (shrink)

How research studies should use social media to recruit research participants is a timely question. Importantly, the question is how, not if, studies should use...

Deception, cheating, and loopholes within the IRB approval process have received significant attention in the past several years. Surveys of clinical researchers indicate common deception ranging from omitting information to outright lying, and controversy surrounding the FDA's decision not to ban “IRB shopping” has raised legitimate concerns about the integrity of the IRB process. One author has described a multicenter trial as being withdrawn from consideration at one institution when rejection was imminent, in order to avoid informing other IRBs reviewing (...) the protocol of the study's rejection. This practice and IRB shopping seem at odds with the spirit, if not the “letter,” of the regulations. While at first blush these practices seem to cast aspersions on the integrity of clinical researchers, the moral issues raised go deeper than the ethics of cheating. (shrink)

Community and patient stakeholder partners serve in many roles. One particularly important role of community and patient organizations and representatives is to serve as gatekeepers; in this role, they monitor, and in some cases even determine, what research does and does not get conducted with their communities. Such gatekeeping can prevent “helicopter” research and community research fatigue. Gatekeeping can also aid in identifying and mitigating harms that might occur not only to individual participants but to third parties (who do not (...) provide consent for participation) or to the community as a whole. Although individual informed consent and independent review both aim to protect against research risks, in research with identifiable communities these protections may be insufficient to protect from other types of harms. Given the gaps in protection, the gatekeeping role of community research partners is an important supplement to informed consent and independent IRB review, but it also raises its own set of ethical challenges. Here, we discuss the limitations of informed consent and independent review in research with identifiable communities, the benefits of gatekeeping for protecting third parties and groups, types of gatekeepers, and issues in the selection of gatekeepers. (shrink)

In this case, the investigator should be allowed to enroll incompetent adults into this study, with certain safeguards. If an incompetent adult has an agent or a legally authorized representative (...

In this case, it is noted that while DNA testing and methylation are being studied as biomarkers for high-grade squamous intraepithelial lesions in the anal canal, their efficacy is no...

The American Journal of Bioethics, Volume 12, Issue 7, Page 53-54, July 2012.

This paper argues that it will be important for new genomic technologies to recognize the limits of traditional approaches to informed consent, so that other-regarding implications of genomic information can be properly contextualized and individual rights respected. Respect for individual autonomy will increasingly require dynamic consideration of the interrelated dimensions of individual and broader community interests, so that the interests of one do not undermine fundamental interests of the other. In this, protection of individual rights will be a complex interplay (...) between individual and community concerns. (shrink)

Words form a fundamental basis for our understanding of linguistic practice. However, the precise ontology of words has eluded many philosophers and linguists. A persistent difficulty for most accounts of words is the type-token distinction [Bromberger, S. 1989. “Types and Tokens in Linguistics.” In Reflections on Chomsky, edited by A. George, 58–90. Basil Blackwell; Kaplan, D. 1990. “Words.” Aristotelian Society Supplementary Volume LXIV: 93–119]. In this paper, I present a novel account of words which differs from the atomistic and (...) platonistic conceptions of previous accounts which I argue fall prey to this problem. Specifically, I proffer a structuralist account of linguistic items, along the lines of structuralism in the philosophy of mathematics [Shapiro, S. 1997. Philosophy of Mathematics: Structure and Ontology. Oxford University Press], in which words are defined in part as positions in larger linguistic structures. I then follow Szabò [1999. “Expressions and Their Representations.” The Philosophical Quarterly 49 (195): 145–163] and Parsons [1990. “The Structuralist View of Mathematical Objects.” Synthese 84: 303–346] in further defining words as quasi-concrete objects according to a representation relation. This view aims for general correspondence with contemporary generative linguistic approaches to the study of language. (shrink)

First published in 1995. Routledge is an imprint of Taylor & Francis, an informa company.

Most accounts of cognitive scaffolding focus on ways that external structure can support or augment an agent’s cognitive capacities. We call cases where the interests of the user are served benign scaffolding and argue for the possibility and reality of hostile scaffolding. This is scaffolding which depends on the same capacities of an agent to make cognitive use of external structure as in benign cases, but that undermines or exploits the user while serving the interests of another agent. We develop (...) criteria for scaffolding being hostile and show by reference to examples including the design features of electronic gambling machines and casino management systems that hostile scaffolding exists and can be highly effective. In cases where the scaffolding is deep and permits the offloading of significant cognitive work, hostile scaffolding exploitatively manipulates cognitive processing itself. Given the extent of human reliance on scaffolding this is an important and neglected vulnerability. [This is an updated version of the paper, added in February 2023.]. (shrink)

One of metaepistemology’s most central debates revolves around the question of what the source of epistemic normativity is. Epistemic instrumentalism claims that epistemic normativity is a species of means-ends normativity. One of the most prominent objections against epistemic instrumentalism features cases of epistemic indifference: Cases where there’s evidence that p yet believing that p wouldn’t promote any of the agent’s aims, wants, or needs. Still, there’s an epistemic reason for the agent to believe that p and thus epistemic instrumentalism is (...) false. In response, instrumentalists have modified their views in various ways, with new contributions still forthcoming. Here, we investigate a neglected aspect of this debate: Laypeople’s judgments on cases of epistemic indifference. In two studies, we investigated whether laypeople agree with the verdict in cases of epistemic indifference as well as the key ideas behind the more recent instrumentalist replies. Our findings indicate that a significant amount of participants found it hard to “buy into” the cases of epistemic indifference as Kelly has constructed them. Participants did generally share Kelly’s judgment in cases of epistemic indifference. Lastly, some instrumentalist replies are well suited to explain participants’ judgments that agents ought to believe in cases of epistemic indifference. (shrink)

Cumulative cultural knowledge [CCK], the knowledge we acquire via social learning and has been refined by previous generations, is of central importance to our species’ flourishing. Considering its importance, we should expect that our best epistemological theories can account for how this happens. Perhaps surprisingly, CCK and how we acquire it via cultural learning has only received little attention from social epistemologists. Here, I focus on how we should epistemically evaluate how agents acquire CCK. After sampling some reasons why extant (...) theories cannot account for CCK, I suggest that things aren’t as bleak as they might look. I explain how agents deserve epistemic credit for how CCK is transmitted in cultural learning by promoting a central need of their social group: The efficient and safe transmission of CCK. A good initial fit exists between this observation and Greco’s knowledge-economy framework. Ultimately, however, Greco’s account doesn’t straightforwardly account for CCK because of its strict focus on testimony. I point out two issues in the framework due to this focus. The resulting view advocates giving epistemic credit to agents when they act to promote their communities’ epistemic needs in the right way and highlights the various ways in which agents come to do this. (shrink)

A shared narrative in the literature on the evolution of cooperation maintains that social _learning_ evolves early to allow for the transmission of cumulative culture. Social _norms_, whilst present at the outset, only rise to prominence later on, mainly to stabilise cooperation against the threat of defection. In contrast, I argue that once we consider insights from social epistemology, an expansion of this narrative presents itself: An interesting kind of social norm — an epistemic coordination norm — was operative in (...) early and important instances of specialised social learning. I show how there’s a need for such norms in two key social learning strategies and explain how this need is constituted. In assessor-teaching (e.g. Castro et al., 2019b, 2021), epistemic coordination norms allow agents to coordinate around the _content_ of social learning, i.e., what is to be known and how this is to be done. These norms also allow agents to coordinate around the form of cultural learning in what’s sometimes called strategic social learning (Laland, 2004; Hoppitt & Laland, 2013; Heyes, 2018, Chap. 5) and elsewhere. Broadly speaking, this concerns how cultural learning is organised within the social group. The upshot is that the evolution of social learning and social norms are intertwined in important and underappreciated ways from early on. The above matters as it informs our views about the evolution of social norms more generally. Truly _social_ norms emerged to coordinate a plurality of complex behaviours and interactions, amongst them specialised social learning. I substantiate this view by contrasting it with Jonathan Birch’s views on the evolution of norms. What results is a general but cohesive narrative on the early evolution of social norms. (shrink)

? This article is reproduced by kind permission of the author and O.E.C.D. (Paris) who are publishing the material in the series Studies in the Learning Sciences (Paris, O.E.C.D., 1975).

Deep brain stimulation is an experimental procedure for treatment-resistant depression. Some results show promise, but blinded trials had limited success. Ethical questions center on vulnerability: especially on whether depressed patients can weigh the risks and benefits effectively, whether depression causes “desperation,” and whether media portrayals create unrealistic hopes. We interviewed 24 psychiatric inpatients with treatment-resistant depression, qualitatively analyzing their comments. Most had minimal interest in deep brain stimulators. Some might consider them if their depression worsened, if alternatives were exhausted, or (...) if the evidence were stronger. Fears focused on the surgery, adverse effects, and the novelty of the device. Patients felt the depression interfered with their ability to weigh the risks and benefits. Patients seemed highly attuned to the risks, and were skeptical that the treatment would be effective. We conclude that ethical concerns about vulnerability remain, yet patients with treatment-resistant depression were thoughtful and cautious about trying a novel therapy. (shrink)

: In recent literature supporting a hybrid view between metaethical cognitivism and noncognitivist expressivism, much has been made of an analogy between moral terms and pejoratives. The analogy is based on the plausible idea that pejorative slurs are used to express both a descriptive belief and a negative attitude. The analogy looks promising insofar as it encourages the kinds of features we should want from a hybrid expressivist view for moral language. But the analogy between moral terms and pejorative slurs (...) is also problematic. In this paper, I argue for two main ways in which we should distinguish between two different types of pejorative terms: slurs, on the one hand, and what I call general pejorative terms, on the other. I examine the problems with the analogy between slurs and moral terms and conclude that general pejorative terms like ‘jerk’ are a better candidate on which to model the potential dual-use behavior of moral terms. So if hybrid theorists are looking for a dual-use model for moral language, they should be careful to base their analogies on general pejoratives, rather than slurs. (shrink)

What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these (...) basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine. (shrink)

Young and colleagues . Betwixt life and death: case studies of the Cotard delusion. In P. W. Halligan & J. C. Marshall , Method in madness: Case studies in cognitive neuropsychiatry. Mahway, NJ: Lawrence Erlbaum Associates.) have suggested that cases of the Cotard delusion result when a particular perceptual anomaly occurs in the context of an internalising attributional style. This hypothesis has not previously been tested directly. We report here an investigation of attributional style in a 24-year-old woman with Cotard (...) delusion . LU’s attributional style was assessed using the Internal, Personal and Situational Attributions Questionnaire . A new measure of causal locus: the internal, personal and situational attributions questionnaire. Personality and Individual Differences, 20, 261–264.). LU showed a significantly greater proportion of internalising attributions than the control group, both overall and for negative events specifically. The results obtained thus support an association of Cotard delusion with an internalising attributional style, and are therefore consistent with the account of Young and colleagues. The potential brain basis of Cotard delusion is discussed. (shrink)

Translation of the death scene from Phaedo by Plato.

Addiction remains a challenging disorder, both to treat and to conceptualise. While the temporal dimension of addiction has been noted before, here the aim is to ground this understanding in a coherent phenomenological-neuroscience framework. Addiction is partly understood as drawing the subject into a predominantly “now” orientated existence, with the future closed or experienced as extremely distant. Another feature of this temporal structuring is that past experiences, which are crucial in advancing intentionally forward, are experienced in addiction as a void. (...) This has implications for the generation of meaning and forming of self, amongst others. While there are areas of the brain that regulate temporal processing, there is no single location. Recent addiction research has implicated the insula and in turn this area is implicated in temporal and interoceptive awareness. Similarly these areas of disruption may affect self processes. Disruption of interoception and thus of self, may help explain why addiction is complex and involves multiple aspects of subjectivity. (shrink)

The impact of our desires and preferences upon our ordinary, everyday beliefs is well-documented [Gilovich, T. . How we know what isn’t so: The fallibility of human reason in everyday life. New York: The Free Press.]. The influence of such motivational factors on delusions, which are instances of pathological misbelief, has tended however to be neglected by certain prevailing models of delusion formation and maintenance. This paper explores a distinction between two general classes of theoretical explanation for delusions; the motivational (...) and the deficit. Motivational approaches view delusions as extreme instances of self-deception; as defensive attempts to relieve pain and distress. Deficit approaches, in contrast, view delusions as the consequence of defects in the normal functioning of belief mechanisms, underpinned by neuroanatomical or neurophysiological abnormalities. It is argued that although there are good reasons to be sceptical of motivational theories , recent experiments confirm that motives are important causal forces where delusions are concerned. It is therefore concluded that the most comprehensive account of delusions will involve a theoretical unification of both motivational and deficit approaches. (shrink)

Garland and colleagues provide many compelling reasons for why clinicians ought to participate in pragmatic clinical trials (Garland et al. 2023), also known as effectiveness trials (Thorpe et al....

: In this essay, I argue that Kierkegaard endorses a “grace model” of ethical transformation – that radical normative change is not a function of agent-choice, rational or otherwise. After showing how grace functions in Kierkegaard’s account of religious transformation, I go on to argue that he offers a parallel account in the case of ethical conversion, the latter drawing from a description of transformation detailed in Kierkegaard’s Repetition. There we find an example of ethical transformation that challenges received interpretations (...) of the mechanics of Kierkegaard’s aesthetic-to-ethical transition. In the same way that God’s love is said to transform the heart of the Christian, Kierkegaard thinks that certain ethical encounters transform the desires and commitments of the aesthete. (shrink)

Not many of the answers, true enough, are known: what is really new in the study of recent African history—the two millenniums, let us say, before A.D. 1500—is not so much that the answers are being supplied as that the questions are being put. That in itself is something of a milestone. Few may have denied the eventual possibility of tracing firm outlines for that place and period; all but the merest handful have had other fish to fry. These fish (...) have been, and are, extremely important—as important as the study of human origins through the slow millenniums of the Pleistocene or, at the other end of time, as the story of colonial beginnings through the scurried decades of the last century. It is no small thing that Dart, Breuil, Leakey, and their colleagues can now assert with solid evidence behind them that Homo sapiens first saw the light in Africa; while in another direction the astonishing continuity of the African story has acquired spectacular emphasis from the recovery in southeast African waters of coelacanth, a most ancient creature whose latest known fossils had occurred in rocks that are older than seventy million years. Compared with that majestic gap in time, the centuries before European preoccupation with Africa may have seemed small and unimportant; they were in any case, and for one reason or another, largely ignored. (shrink)

Illustrating the effect of class relationships upon the institutionalizing of elaborate codes in the school, the papers in this volume each develop from the previous one and demonstrate the evolution of the concepts discussed.

Rousseau’s moral and political philosophy is grounded in a largely overlooked virtue epistemology. This essay reconstructs this epistemology with a particular focus on Rousseau’s conception of how our capacity for sensation might be cultivated to develop the judgment and wisdom that distinguish the developed virtuous agent. It proceeds in three sections. The first section focuses on Rousseau’s conception of the first stage of development, and especially his sensationist claim that all knowledge originates in sensory impressions. The second section examines the (...) maturing agent’s transition from mere sensation to the cultivation of the capacity for judgment, particularly focusing on Rousseau’s account of the agent’s shift from the passive reception of sensory impressions of discrete objects to the active and synthetic processes of comparison and association that give rise to complex ideas and to moral conceptions. The third section turns to Rousseau’s conception of the developed mind, focusing on his claim that the intellectual virtues not only require cultivation but are indispensible to the proper exercise of freedom that distinguishes the fully moral human being. (shrink)

Scholars generally agree that, according to Aristotle, factionalizers are motivated by a sense of injustice (the ‘first cause’) to redress imbalances in wealth and honor (the ‘second cause’). Recent discussions, however, have offered a misleading interpretation of Aristotle’s third cause, which he identifies as the origin of the factionalizers’ sense of injustice. It involves, most importantly, greed, hubris, and other factors such as fear and ‘disproportionate growth’. In conversation with a recent publication in Polis, this article restores the third cause (...) to its proper place in Aristotle’s account. Abusive power holders, driven by greed, hubris, and overreaching, oppress their fellow citizens – following in the tradition of Homer’s Agamemnon, Hesiod’s basileis, and Solon’s aristocrats. These power holders prompt a sense of anger, indignation, and injustice in their fellow citizens, who ultimately form factions and take action on their own behalf. (shrink)

Recent research has shown a memory advantage for minimally counterintuitive concepts, over concepts that are either intuitive or maximally counterintuitive, although the general result is heavily affected by context. Items from one such study were given to subjects who were asked to create novel stories using at least three concepts from a list containing all three types. Results indicated a preference for using MCI items, and further disclosed two styles of usage, an accommodative style and an assimilative style. The results (...) extend recent memory research and suggest extensions to recent theories intended to explain the prevalence of counterintuitive religious concepts. (shrink)

While many of the most important figures in the history of philosophy have employed the concept of the simulacrum in one way or another, a detailed study of this usage has yet to be written. In this essay, I will attempt to tell the story of a sequence in that history of that usage, by focusing on one of Deleuze's case studies of the concept of the simulacrum. To do so, I will focus primarily on one the appendices to The (...) Logic of Sense: ‘Lucretius and the Simulacrum’. In order to understand what I will call the Deleuze–Lucretius encounter, I will proceed as follows. After a few initial guiding remarks regarding the general project of the ‘inversion of Platonism’, we will outline some of the most fundamental features of atomistic physics. This will allow us to discuss Lucretius’ thoughts on the clinamen, the swerve. This, in turn, leads directly to the concept of the simulacrum. With such a picture of Lucretian physics in hand, I will pivot to a discussion of Lucretius’ ethics. The ethics consists of a critique of superstition in terms of a general project of demystification. Although this sequence will concentrate mostly on what became one of the appendices to The Logic of Sense, I will end by looking at the more general usage of Lucretian atomism, especially as it functions in Difference and Repetition and The Logic of Sense. (shrink)

Conscientious objection among physicians is a perennial hot topic on both sides of the Atlantic. Sven Nordstrand's survey of Norwegian medical students adds fresh data to this ongoing debate.1Their starting point, whether doctors should be allowed to refuse any procedure to which they object on cultural, moral or religious grounds, is truly at the heart of the debate. Their finding that only 20.8% of students endorse this position is striking as it is less than half the number reported by Sophie (...) Strickland in her survey of medical students in the UK.2 It also suggests much less support for conscientious objection than was found among USA primary care physicians, where 78% agreed that “A physician should never do what he or she believes is morally wrong, no matter what experts say.”3These data invite speculation about why there is such dramatic variation between countries. Much can be made of Nordstrand's comments that in Norway “each citizen is assigned a particular general practitioner” and “In the Norwegian healthcare system the general practitioner has a crucial role as …. (shrink)

It has become an article of faith among historians of logic that the square of opposition diagram is due not to Aristotle, but to Apuleius. I examine three Aristotelian texts and argue that Prior Analytics I.46 contains a square of opposition, making Aristotle the discoverer of the diagram.

For Ordinary Language philosophy, at issue is the use of the expressions of language, not expressions in and of themselves. So, at issue is not, for example, ordinary versus (say) technical words; nor is it a distinction based on the language used in various areas of discourse, for example academic, technical, scientific, or lay, slang or street discourses – ordinary uses of language occur in all discourses. It is sometimes the case that an expression has distinct uses within distinct discourses, (...) for example, the expression ‘empty space’. This may have both a lay and a scientific use, and both uses may count as ordinary; as long as it is quite clear which discourse is in play, and thus which of the distinct uses of the expression is in play. Though connected, the difference in use of the expression in different discourses signals a difference in the sense with which it is used, on the Ordinary Language view. One use, say the use in physics, in which it refers to a vacuum, is distinct from its lay use, in which it refers rather more flexibly to, say, a room with no objects in it, or an expanse of land with no buildings or trees. However, on this view, one sense of the expression, though more precise than the other, would not do as a replacement of the other term; for the lay use of the term is perfectly adequate for the uses it is put to, and the meaning of the term in physics would not allow speakers to express what they mean in these other contexts. (shrink)