Metabolic Bariatric Surgery (MBS) has gained significant popularity over the past decade. Legally and ethically, physicians should obtain the patient’s voluntary and informed consent before proceeding with the surgery. However, the decision to undergo MBS is often influenced by external factors, prompting questions about their impact on the patient’s ability to choose voluntarily. In addressing this issue, the study focuses on two key questions: first, which factors influence MBS candidates during the decision-making process, and second, whether these influences undermine the (...) candidates' ability to make decisions voluntarily, according to theories of autonomy. The study employed a qualitative methodology, conducting 21 in-depth semi-structured interviews with adults who had undergone bariatric surgery. The conclusions were drawn from an inductive analysis of the interview data conducted using a grounded theory approach, and by applying theories of autonomy to the empirical findings. Our study indicates that interviewees were exposed to different external influences, which had diverse effects on the interviewees' decision to undergo MBS. Category 1 influences included intentional attempts to induce people, through arguments and reason, to accept the attitudes advocated by the persuader in support of the surgery. Applying theoretical accounts of autonomy to these influences suggests that they did not compromise the interviewees’ autonomy. Category 2 influences included threats made by a physician or a family member. These influences were found to undermine autonomy. Category 3 influences included emotional manipulation, informational manipulation, and the construction of medical and social norms. Manipulations and norms were experienced differently by different interviewees, and their impact on autonomy varies depending on the theoretical framework applied. Acknowledging that the influences exerted on MBS candidates may undermine their ability to make autonomous decisions regarding surgery, we suggest reformulating the duties that apply to medical practitioners with respect to informed consent to MBS. Medical practitioners who discuss the option of MBS with candidates should be aware of the various factors that influence this choice, and actively promote the candidates’ ability to make autonomous decisions. (shrink)

A complex of transformations, carried into effect with varying tempos since the beginning of the era of industrial revolutions, has disrupted a certain number of human societies: societies which the ethnologists often call “modern” in opposing them to those labeled “traditional.”.

It is standard in set theory to assume that Cantor's Theorem establishes that the continuum is an uncountable set. A challenge for this position comes from the observation that through forcing one can collapse any cardinal to the countable and that the continuum can be made arbitrarily large. In this paper, we present a different take on the relationship between Cantor's Theorem and extensions of universes, arguing that they can be seen as showing that every set is countable and that (...) the continuum is a proper class. We examine several principles based on maximality considerations in this framework, and show how some (namely Ordinal Inner Model Hypotheses) enable us to incorporate standard set theories (including ZFC with large cardinals added). We conclude that the systems considered raise questions concerning the foundational purposes of set theory. (shrink)

In this article, we first offer a model of design knowledge types and their interrelationships in value sensitive design. Then we demonstrate that value sensitive design is a formative framework, which provides a shaping influence on practice, enables creative appropriation, and supports theory and method development.

Two countable well orderings are weakly comparable if there is an order preserving injection of one into the other. We say the well orderings are strongly comparable if the injection is an isomorphism between one ordering and an initial segment of the other. In [5], Friedman announced that the statement “any two countable well orderings are strongly comparable” is equivalent to ATR 0 . Simpson provides a detailed proof of this result in Chapter 5 of [13]. More recently, (...) class='Hi'>Friedman has proved that the statement “any two countable well orderings are weakly comparable” is equivalent to ATR 0 . The main goal of this paper is to give a detailed exposition of this result. (shrink)

In this paper we introduce some fusion properties of forcing notions which guarantee that an iteration with supports of size ⩽κ not only does not collapse κ+ but also preserves the strength of κ. This provides a general theory covering the known cases of tree iterations which preserve large cardinals [3], Friedman and Halilović [5], Friedman and Honzik [6], Friedman and Magidor [8], Friedman and Zdomskyy [10], Honzik [12]).

ABSTRACTIn 1994, the Committee on Assessing Genetic Risks of the Institute of Medicine published their recommendations regarding the ethical issues raised by advances in genetics. One of the Committee's recommendation was to inform women when test results revealed misattributed paternity, but not to disclose this information to the women's partners. The Committee's reason for withholding such information was that “'genetic testing should not be used in ways that disrupt families”. In this paper, I argue that the Committee's conclusion in favour (...) of nondisclosure to the male partner is unethical. I argue that both parties ought to be informed. (shrink)

The argument for children's rights in health care has been long in the making. The success of this position is reflected in the 1995 American Academy of Pediatrics recommendations for the role of children in health care decisionmaking, which suggest that children be given greater voice as they mature. But there are good moral and practical reasons for exercising caution in these health care situations, especially when the child and parents disagree. Parents need the moral and legal space within which (...) to make decisions that will facilitate their child's long‐term autonomy, not only her present‐day autonomy. Moreover, third‐party intrusion, by physicians or the state, should be resisted unless negligent and abusive decisions are in the making. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 41.1 (2003) 81-96 [Access article in PDF] Pragmatism:The Unformulated Method of Bishop Berkeley Lesley Friedman 1. Introduction THOUGH WELL KNOWN AS A SCIENTIST, logician, and metaphysician, Charles Sanders Peirce is perhaps best remembered as the founder of Pragmatism. Surprisingly, Peirce attributes this way of thinking—often taken as a uniquely American contribution—to Bishop George Berkeley. According to Pierce, Berkeley should be regarded as (...) the author of that method of modern pragmatism (RFB, 96): 1 Pragmaticism is... a method of thinking.... Of those who have used this way of thinking Berkeley is the clearest example.... (CP, 8.206, c.1905) Berkeley on the whole has more right to be considered the introducer of pragmatism into philosophy than any other one man.... (1903 letter to William James)In a metaphysical Club, I used to preach this principle as a sort of logical gospel, representing the unformulated method followed by Berkeley, and in conversation about it I called it 'Pragmatism.' (CP, 6.482, 1908) [End Page 81]While it is acknowledged that Peirce believed Berkeley to be "a very distinguished master of the pragmatist mode of thinking," just why Peirce makes this claim is not altogether clear. In significant ways Berkeley blundered metaphysically, according to Peirce (MS, 322, c.1907). 2 He overlooked the reality of possibility (and thus realism about generals), misunderstood the nature of existence and the ordinary notion of matter, and had an inadequate view of perception. 3 In his early work, Peirce goes so far as to criticize what looks to be Berkeley's attempt at the pragmatic method: "A better rule [than Berkeley's] for avoiding the deceits of language is this: Do things fulfil the same function practically? Then let them be signified by the same word. Do they not? Then let them be distinguished" (CP, 8.33, 1871). Moreover, while Peirce cites the Essay Towards a New Theory of Vision as using the "medium of pragmatism," others have criticized Berkeley in this very work for drawing conclusions without any experimentation. 4 Since it is precisely the pivotal role of experience and experiment that distinguish the method of pragmatism, it is puzzling that Berkeley is chosen as worthy of the title that Peirce bestows on him. My hope in this paper is to shed some light on this question. I beginwith an explication of Peirce's pragmatism and then move on to offer an account ofhow Berkeley uses this method, though never formulates it. Next, I discuss the positions Peirce understood to be consequences of the view, including critical common-sensism, fallibilism, and scholastic realism. I suggest that, although he erred on several corollary positions, Berkeley foresaw the aims, purpose, and essential points of the methodological, though not the "metaphysical side" of pragmatism. 5 2. Peircean Pragmatism Pragmatism 6 is not a metaphysical doctrine: it does not aim to ascertain the truth of things; it does not attempt to throw any "positive light on any problem" (CP, 5.464, 1907). Rather, it offers a means of distinguishing legitimate from illegitimate [End Page 82] hypotheses, so that verbal disputes—those that so often arise simply because the disputants do not understand meanings in the same way—can be resolved. It is thus "only a method of thinking"(CP, 8.206, c.1905, emphasis added).... pragmatism proposes a certain maxim which, if sound, must render needless any further rule as to the admissibility of hypotheses to rank as hypotheses, that is to say, as explanations of phenomena held as hopeful suggestions; and furthermore, this is all that the [logical] maxim of pragmatism really pretends to do.... (CP, 5.195, 1903) Seeking to lay "the dust of pseudoproblems," pragmatism allows "us to discern what pertinent facts the phenomena may present. But this is a good half of the task of philosophy" (CP, 8.186, 1903). It is worth pausing to mention that philosophy, as Peirce understands it, does not stand apart from science in the way it does today, but rather is the second of the three sciences of discovery, all of which... (shrink)

Book reviewed in this article: Women & Children in Health Care: An Unequal Majority. By Mary Briody Mahowald.

In February 1997, the Committee on Bioethics of the American Academy of Pediatrics updated its position on religious exemptions to medical care. In its earlier statement, the committee noted that forty-four states have religious exemptions to the child abuse and neglect statutes, and they argued for the repeal of these exemptions. The committee did not indude in its statement a position on religious exemptions to childhood immunization requirements that exist in forty-eight states, although this issue was discussed in committee meetings. (...) In its revised statement, the committee concluded that “The AAP does not support the stringent application of medical neglect laws when children do not receive recommended immunizations.” In this paper, we consider whether failure to immunize one's child is a form of medical neglect and, if so, whether states should repeal their religious exemptions to the immunization statutes. We argue that failure to vaccinate a child properly is medical neglect. (shrink)

This paper raises some minor questions about Lisa Tessman's book, Burdened Virtues. Friedman's questions pertain, among other things, to the adequacy of a virtue ethical focus on character, the apparent implication of virtue ethics that oppressors suffer damaged characters and are not any better off than the oppressed, the importance of whether privileged persons may have earned their privileges, and the oppositional anger that movement feminists sometimes direct against each other.

This paper addresses the knowledge required for individuals to evaluate Information and Communications Technologies decisions that relate to the organization and management of cyberspace, and to hold accountable the parties responsible for those decisions, whether the responsible party is a government actor, market actor or private individual. The authors argue that the Open Systems Interconnection model, with certain modifications, should serve as a primary educational tool in helping individuals to gain the understanding of ICT necessary to protect public interests related (...) to cyberspace. (shrink)

'...a 'must read' for all students of constitutional law, whatever their academic discipline...this excellent book accomplishes the author's purpose: it forces us to take textualism seriously.'-LEGAL STUDIES FORUM.

An adolescent’s last moment of life is an emotionally and medically complex time. Children may grapple with understanding the things happening to them and with grief of a future lost; caregivers struggle to simultaneously balance deep sorrow, hope, and love; and healthcare providers fight to maintain sound medical and ethical decision making. Increased discussion regarding adolescent end-of-life care is needed so that clinicians may better understand how to engage in ethically based medical management during these events. This holds particularly true (...) in situations where potentially conflicting ideas exist between clinicians and family members. We describe the case of an acutely and terminally ill adolescent who remained cognitively intact but with rapidly advancing multiple organ failure and whose parents requested that he remain uninformed of his critical illness and prognosis. (shrink)

The traditional living donor was very healthy. However, as the supply-demand gap continues to expand, transplant programs have become more accepting of less healthy donors. This paper focuses on the other extreme, asking whether and when individuals who have life-limiting conditions should be considered for living organ donation. We discuss ethical issues raised by 1) donation by individuals with progressive severe debilitating disease for whom there is no ameliorative therapy; and 2) donation by individuals who are imminently dying or would (...) die by the donation process itself. (shrink)

The equiconsistency of a measurable cardinal with Mitchell order o=κ++ with a measurable cardinal such that 2κ=κ++ follows from the results by W. Mitchell [13] and M. Gitik [7]. These results were later generalized to measurable cardinals with 2κ larger than κ++ .In Friedman and Honzik [5], we formulated and proved Eastonʼs theorem [4] in a large cardinal setting, using slightly stronger hypotheses than the lower bounds identified by Mitchell and Gitik , for a suitable μ, instead of the (...) cardinals with the appropriate Mitchell order).In this paper, we use a new idea which allows us to carry out the constructions in Friedman and Honzik [5] from the optimal hypotheses. It follows that the lower bounds identified by Mitchell and Gitik are optimal also with regard to the general behavior of the continuum function on regulars in the context of measurable cardinals. (shrink)

Providing effective feedback to patients in a rehabilitation training program is essential. As technologies are being developed to support patient training, they need to be able to provide the users with feedback on their performance. As there are various aspects on which feedback can be given, it is important to ensure that users are not overwhelmed by too much information given too frequently by the assistive technology. We created a rule-based set of guidelines for the desired hierarchy, timing, and content (...) of feedback to be used when stroke patients train with an upper-limb exercise platform which we developed. The feedback applies to both success on task completion and to the execution of compensatory movements, and is based on input collected from clinicians in a previous study. We recruited 11 stroke patients 1–72 months from injury onset. Ten participants completed the training; each trained with the rehabilitation platform in two configurations: with motor feedback and with no motor feedback. The two conditions were identical, except for the feedback content provided: in both conditions they received feedback on task success; in the MF condition they also received feedback on making undesired compensatory movements during the task. Participants preferred the configuration that provided feedback on both task success and quality of movement. This pilot experiment demonstrates the feasibility of a system providing both task-success and movement-quality feedback to patients based on a decision tree which we developed. (shrink)

PurposeIn Western society, the measurement of weight is prioritized over a person’s bodily experience. Hermeneutic philosopher Gadamer warned against the emphasis on measurement, rather than experience, in the medical sciences. An examination of the complexity of the experience of weight provides the opportunity to shift focus from quantifying the connection between health and weight to the experience of the person being weighed.MethodsThis qualitative hermeneutic study aims to understand people’s experiences of weight from the interviews of professionals and lay experts. Interviews (...) were analyzed using an interpretive hermeneutic method.ResultsThe interviews revealed that weight was experienced as a number imbued with meaning and bias, as a number that could be manipulated, and as a constant and anticipated bodily change. Weight change was expected and often unwelcomed, despite weight being a quality of the body that is always in flux. External measures of weight meant to monitor wellness and health inadvertently became an unhealthy fixation that prevented some participants from fully participating in life events and appreciating the stages their bodies were in.ConclusionWeight change is a necessary condition of being human, and bodies are and will be constantly changing. To achieve health and harmony, one must fit together the acceptance of change and their bodily experience of weight. It is often the preoccupation with weight, not weight itself, that gets in the way of living. (shrink)

ABSTRACTI argue that parents ought to be allowed to authorize their child's participation as an organ donor for another family member. I introduce a model of decisionmaking for children in intimate families which I call Constrained Parental Autonomy. This model permits wide parental discretion which is constrained absolutely by a broadly defined principle of respect for persons. In general, parental authorization alone is sufficient but I argue that the respect for persons constraint prevents certain donations and requires the child's assent (...) for other donations. I also consider two controversial implications of the application of this model: the objection that the model does not respect the child's right to bodily integrity, and the objection that the model does not and is unable to address intrafamilial disgreement. (shrink)

: Subpart D of 45 CFR 46 focuses on research involving children. Section 46.407 addresses research that is not otherwise approvable. The research is not otherwise approvable because either (1) it seeks to enroll healthy children, but offers no prospect of direct benefit and entails more than minimal risk; or (2) it seeks to enroll children with a disorder or condition, but offers no prospect of direct benefit and entails more than a minor increase over minimal risk. According to 46.407, (...) such research can be permissible if it is approved by a panel of experts. Prior to 2000, only two 407 panels had been convened, but in 2001, the Office for Human Research Protections received more than 20 protocols for 407 review. The first, entitled "Precursors to Diabetes in Japanese American Youth," serves here as a case study in human subject protections. (shrink)

Jeffrey Kahn and I agree that organ donation by altruistic strangers is acceptable, and that the organ procured this way ought to be allocated equitably. Our agreement in principle, however, is challenged in the details of its application. Specifically, I want to focus on three issues raised by Kahn that merit further discussion: whether relationships matter; how kidneys should be allocated; and the ethical acceptability of the expanded donor pool.

Volume 24, Issue 10, October 2024, Page 115-117.

Van Rensselaer Potter was an American biochemist who worked in the McArdle Laboratory for Cancer Research at the University of Wisconsin at Madison. In 1970, in an article in this journal, Potter coined the term bioethics to combine a new discipline that combines biological knowledge with ethics. Potter wrote, “Ethical values cannot be separated from biological facts” (p. 127). His conception was broad-ranging: “We are in great need of a land ethic, a wild-life ethic, a population ethic, a consumption ethic, (...) an urban ethic, an international ethic, a geriatric ethic, and so on. All of these problems call for actions that are based on values and biological facts. All of them involve bioethics, and survival of the .. (shrink)

To promote informed reproductive decisions, prenatal carrier testing is offered to women and couples to provide information about the risk of having a child with one or more genetic conditions. Tay Sachs Disease was one of the first conditions for which prenatal carrier testing was developed. Today, many additional conditions can be tested for, depending on prospective parental interest, family history, or ethnicity. Interestingly, most individuals and couples do not request prenatal carrier information prior to conception, and carrier testing early (...) in gestation allows only a narrow set of reproductive options. Programs have been designed to increase preconception testing, with variable success. One of the more successful attempts to increase preconception carrier testing uptake internationally has been to offer it to adolescents in high schools. (shrink)

In August 2001, the Maryland Court of Appeals harshly criticized the Kennedy Krieger Institute of Johns Hopkins University for knowingly exposing poor children to lead-based paint. The court’s decision made national news, and is worth examining because it raises several very important issues for research ethics.The research conducted by the Institute was an attempt to understand how successful different lead abatement programs were in reducing continued lead exposure to children. Previously, Julian Chisolm and Mark Farfel, of John Hopkins University, had (...) disclosed the dangers of traditional dust-generating deleading practices. In the current study, Dr. Farfel and colleagues sought to document the longevity of various lead-based paint abatement strategies. (shrink)

According to the dominant philosophical tradition, intrinsic value must depend solely upon intrinsic properties. By appealing to various examples, however, I argue that we should at least leave open the possibility that in some cases intrinsic value may be based in part on relational properties. Indeed, I argue that we should even be open to the possibility that an object''s intrinsic value may sometimes depend (in part) on its instrumental value. If this is right, of course, then the traditional contrast (...) between intrinsic value and instrumental value is mistaken. (shrink)

Most people believe that there are limits to the sacrifices that morality can demand. Although it would often be meritorious, we are not, in fact, morally required to do all that we can to promote overall good. What's more, most people also believe that certain types of acts are simply forbidden, morally off limits, even when necessary for promoting the overall good. In this provocative analysis Kagan maintains that despite the intuitive appeal of these views, they cannot be adequately defended. (...) In criticizing arguments for limited moral requirements as well as those for unconditionally prohibited acts, Kagan offers a sustained attack on two of the most basic features of ordinary common sense morality. (shrink)

Shelly Kagan argues for a hierarchical position in animal ethics where people count more than animals do, and some animals count more than others. In arguing for his account of morality, Kagan sets out what needs to be done to establish our obligations toward animals and to fulfil our duties to them.

It has been accepted since the early part of the Century that there is no problem formalizing mathematics in standard formal systems of axiomatic set theory. Most people feel that they know as much as they ever want to know about how one can reduce natural numbers, integers, rationals, reals, and complex numbers to sets, and prove all of their basic properties. Furthermore, that this can continue through more and more complicated material, and that there is never a real problem.

The Movimiento Autonomo de Mujeres in Nicaragua - birthed in part from the Sandinista Revolution of the 1980s - represents one of the largest, most diverse, and most autonomous women's movements in all of Latin America. While it's true that scholars across a wide range of disciplines have written invariably about this social movement what remains missing from this body of work is scholarship aimed at understanding, specifically, the psychology of resistance; in other words, what are the psychological mechanisms and (...) methodologies that emerge from the margins that determine the kind of social action that revolutionizes societies? Investigating the psychosocial processes behind resistance is critical to understanding a commitment to justice and the development of subjectivity necessary for enacting the political activity required for social transformation. Psychology, in particular, as author Shelly Grabe argues, is positioned to engage in a systematic exploration of the links between social and political conditions that determine how, why, and under what circumstances resistance emerges. Narrating a Psychology of Resistance documents the first-hand accounts of the Nicaraguan women's Movimiento: a coordinated mobilization of women that has weathered unremitting power differentials characterized by patriarchy and capitalism. In this collection of testimonios, Grabe gives voice to these extraordinary women and closely examines how psychological processes that emerge in response to sociopolitical oppression can lead to gendered justice and the revolutionizing of societies at large. ". (shrink)

Anyone who reflects on the way we go about arguing for or against moral claims is likely to be struck by the central importance we give to thinking about cases. Intuitive reactions to cases—real or imagined—are carefully noted, and then appealed to as providing reason to accept various claims. When trying on a general moral theory for size, for example, we typically get a feel for its overall plausibility by considering its implications in a range of cases. Similarly, when we (...) try to refine the statement of a principle meant to cover a fairly specific part of morality, we guide ourselves by testing the various possible revisions against a carefully constructed set of cases. And when arguing against a claim, we take ourselves to have shown something significant if we can find an intuitively compelling counterexample, and such counterexamples almost always take the form of a description of one or another case where the implications of the claim in question seem implausible. Even when we find ourselves faced with a case where we have no immediate and clear reaction, or where we have such a reaction, but others don't share it and we need to persuade them, in what is probably the most common way of trying to make progress we consider various analogies and disanalogies; that is to say, we appeal to still other cases, and by seeing what we want to say there, we discover what it is plausible to say in the original case. In these and other ways, then, the appeal to cases plays a central and ubiquitous role in our moral thinking. (shrink)

“Israel is to blame, and not Oslo,” writes Reuven Kaminer, a longtime member of the Israeli left. The almost instinctual tendency to delegitimize the Palestinian right to determine their future on an equal basis is the source of the current tension, he explains, arguing that the conflict continues today because Israel, backed by the United States - which has repeatedly proven not to be an “honest broker” - refuses to recognize the just national rights of the Palestinian people.

What are the limits of well-being? This question nicely captures one of the central debates concerning the nature of the individual human good. For rival theories differ as to what sort of facts directly constitute a person's being well-off. On some views, well-being is limited to the presence of pleasure and the absence of pain. But other views push the boundaries of well-being beyond this, so that it encompasses a variety of mental states, not merely pleasure alone. Some theories then (...) draw the line here, limiting well-being to the presence of the appropriately broadened set of mental states. But still others extend the limits of well-being even further, so that it is constituted in part by facts that are not themselves mental states at all; on such views, well-being is partly constituted by states of affairs that are “external” to the individual's experiences. In this essay, I want to explore some of this debate by focusing on a particular stretch of the dialectic. That is, I want to think hard about a particular connected series of arguments and counterarguments. These arguments – or, at least, the concerns they seek to express – emerge naturally in the give and take of philosophical discussion. Together they make up a rather simple story, whose plot, in very rough terms, is this: first there is an attempt to push the limits of well-being outward, moving from a narrow to a broader conception; then comes the claim that the resulting notion is too broad, and so we must retreat to a narrower conception after all. (shrink)

Moral desert -- Fault forfeits first -- Desert graphs -- Skylines -- Other shapes -- Placing peaks -- The ratio view -- Similar offense -- Graphing comparative desert -- Variation -- Groups -- Desert taken as a whole -- Reservations.