Women are the fastest-growing population of people who use drugs in the US. As a group, they are more likely than men to experience stigma, poverty, and negative mental health outcomes. This article discusses the unique needs of women drug users in the US and provides suggestions on how to leverage national attention — and federal funding — to make harm reduction services in the US more gender sensitive, and, as a result, more effective in reducing harm for women who (...) use drugs in this country. (shrink)

In a recent judgment1 the Court of Protection was highly critical of health professionals for continuing to provide clinically-assisted nutrition and hydration in the face of disagreement about the patient’s best interests, without seeking to resolve the issue. This hearing had been set up specifically to consider whether GU’s dignity had been properly protected, and if not why not, given concerns raised by the Official Solicitor about what she considered to be “a complete abrogation of responsibility to consider properly or (...) at all, and to determine whether it was in GU’s best interests and therefore lawful to continue to give him an invasive medical treatment, CANH.” In April 2014, at 63 years old and living in Thailand, GU sustained severe injuries after suffering from an electrocution accident. He sustained a cardiorespiratory arrest with a significant delay before cardiopulmonary resuscitation was started and was unconscious and unresponsive. In September 2014 he was transferred to the UK. In August 2018, GU’s brother made a request for a best interests decision concerning the continuation of CANH. The family met to discuss this and all except GU’s son, agreed that continuing CANH was not in GU’s best interests. In view of the fact that there was not unanimity among the family, a decision was made that CANH should continue. Commenting on this decision, Mr Justice Hayden said ‘the apparent assumption that in the face of family disagreement ‘ therefore will continue to be cared for by nursing staff ” is a troubling non sequitur’ and stressed that ‘family dissent to a medical consensus should never stand in the way of an incapacitated patients’ best interests being properly identified’. He also made clear that the responsibility for ensuring that a best interests assessment is undertaken rests with the …. (shrink)

Critics have often misunderstood the higher-order theory (HOT) of consciousness. Here we clarify its position on several issues, and distinguish it from other views such as the global The higher-order theory (HOT) of consciousness has often been misunderstood by critics. Here we clarify its position on several issues, and distinguish it from other views such as the global workspace theory (GWT) and early sensory models (e.g. first-order local recurrency theories). For example, HOT has been criticized for over-intellectualizing consciousness. We show (...) that while higher-order states are cognitively assembled, the requirements are actually considerably less than often presumed. In this sense HOT may be viewed as an intermediate position between GWT and early sensory views. Also, we clarify that most proponents of HOT do not stipulate consciousness as equivalent to metacognition or confidence. Further, compared to other existing theories, HOT can arguably account better for complex everyday experiences, such as of emotions and episodic memories. This makes HOT particularly useful as a framework for conceptualizing pathological mental states. (shrink)

Decision theory and folk psychology both purport to represent the same phenomena: our belief-like and desire- and preference-like states. They also purport to do the same work with these representations: explain and predict our actions. But they do so with different sets of concepts. There's much at stake in whether one of these two sets of concepts can be accounted for with the other. Without such an account, we'd have two competing representations and systems of prediction and explanation, a dubious (...) dualism. Folk psychology structures our daily lives and has proven fruitful in the study of mind and ethics, while decision theory is pervasive in various disciplines, including the quantitative social sciences, especially economics, and philosophy. My interest is in accounting for folk psychology with decision theory -- in particular, for believe and wanting, which decision theory omits. Many have attempted this task for belief. (The Lockean Thesis says that there is such an account.) I take up the parallel task for wanting, which has received far less attention. I propose necessary and sufficient conditions, stated in terms of decision theory, for when you're truly said to want; I give an analogue of the Lockean Thesis for wanting. My account is an alternative to orthodox accounts that link wanting to preference (e.g. Stalnaker (1984), Lewis (1986)), which I argue are false. I argue further that want ascriptions are context-sensitive. My account explains this context-sensitivity, makes sense of conflicting desires, and accommodates phenomena that motivate traditional theses on which 'want' has multiple senses (e.g. all-things-considered vs. pro tanto). (shrink)

You want to see the concert, but don’t want to take a long drive (even though the concert is far away). Such *strongly conflicting desire ascriptions* are, I show, wrongly predicted incompatible by standard semantics. I then object to possible solutions, and give my own, based on *some-things-considered desire*. Considering the fun of the concert, but ignoring the drive, you want to see the concert; considering the boredom of the drive, but ignoring the concert, you don’t want to take the (...) drive. (shrink)

If citizens are to make enlightened collective decisions, they need to rely on true factual beliefs, but misinformation impairs their ability to do so. Although some cases of misinformation are deliberate and amount to propaganda, cases of inadvertent misinformation are just as problematic in affecting the beliefs and behavior of democratic citizens. A review of empirical evidence suggests that this is a serious problem that cannot entirely be corrected by means of deliberation.

According to the Desiderative Lockean Thesis, there are necessary and sufficient conditions, stated in the terms of decision theory, for when one is truly said to want. What one is truly said to want, it turns out, varies remarkably by context—and to an underappreciated degree. To explain this context-sensitivity, and closure properties of wanting, I advance a Desiderative Lockean view that is distinctive in having two context-sensitive parameters.

In the past two decades, reinforcement learning has become a popular framework for understanding brain function. A key component of RL models, prediction error, has been associated with neural signals throughout the brain, including subcortical nuclei, primary sensory cortices, and prefrontal cortex. Depending on the location in which activity is observed, the functional interpretation of prediction error may change: Prediction errors may reflect a discrepancy in the anticipated and actual value of reward, a signal indicating the salience or novelty of (...) a stimulus, and many other interpretations. Anterior cingulate cortex has long been recognized as a region involved in processing behavioral error, and recent computational models of the region have expanded this interpretation to include a more general role for the region in predicting likely events, broadly construed, and signaling deviations between expected and observed events. Ongoing modeling work investigating the interaction between ACC and additional regions involved in cognitive control suggests an even broader role for cingulate in computing a hierarchically structured surprise signal critical for learning models of the environment. The result is a predictive coding model of the frontal lobes, suggesting that predictive coding may be a unifying computational principle across the neocortex. (shrink)

Algorithms wield increasing control over our lives—over the jobs we get, the loans we're granted, the information we see online. Algorithms can and often do wield their power in a biased way, and much work has been devoted to algorithmic bias. In contrast, algorithmic neutrality has been largely neglected. I investigate algorithmic neutrality, tackling three questions: What is algorithmic neutrality? Is it possible? And when we have it in mind, what can we learn about algorithmic bias?

Health promotion efforts are commonly directed towards encouraging people to discard ‘unhealthy’ and adopt ‘healthy’ behaviours in order to tackle chronic disease. Typical targets for behaviour change interventions include diet, physical activity, smoking and alcohol consumption, sometimes described as ‘lifestyle behaviours.’ In this paper, I discuss how efforts to raise awareness of the impact of lifestyles on health, in seeking to communicate the need for people to change their behaviour, can contribute to a climate of ‘healthism’ and promote the moralisation (...) of people’s lifestyles. I begin by summarising recent trends in health promotion and introducing the notion of healthism, as described by Robert Crawford in the 1980s. One aspect of healthism is moralisation, which I outline and suggest is facilitated by efforts to promote health via information provision and educational strategies. I propose that perceived responsibility plays a role in mediating the tendency to moralise about health and behaviour. Since I argue that states ought to avoid direct and indirect moralisation of people’s health-related behaviour, this suggests states must be cautious with regard to the use of responsibility-indicating interventions to promote health. (shrink)

In the article “When Parents Refuse: Resolving Entrenched Disagreements with Parents and Clinicians in Situations of Uncertainty and Complexity,” Janine Winters (2018) gets a great deal right. She...

A compositional semantics for anankastic conditionals (‘If you want p, you must φ’) has been elusive. Condoravdi and Lauer (2016) decisively object to all semantics that precede their own. CL's view rests on a response to *the problem of conflicting goals*; CL use an interpretation of 'want' on which an agent's desires don't conflict with her beliefs. But a proper response requires lack of conflict with the facts. CL's view fails. Anankastic conditionals are still a mystery.

How wrong is it to deceive a person into having sex with you? The common view seems to be that this depends on the nature of the deception. If it involves something very important, such as your identity, then the wrong done is very serious. But if it involves something more trivial, such as your natural hair colour, then the wrong seems less great. Tom Dougherty rejects this view. He argues that sexual deception is always seriously wrong. In this paper, (...) I present a response to Doughterty’s argument. I propose an analysis of the wrongness in deception according to which acts of deception, in sexual relations and elsewhere, may differ in their degree of wrongness, and some may not be seriously wrong. (shrink)

As the age of genomic medicine has advanced rapidly, many questions pertaining to the reportability of both clinical and research findings have emerged. For example, the integration of genomic test...

This book provides an original treatment of the concept of good and beauty in ancient Egypt. It seeks to examine the dimensions of _nefer,_ the term used to describe the good and the beautiful, within the context of ordinary life. Because the book is based upon original research on ancient Egypt it opens up space for a review of the aesthetics of other African societies in the Nile Valley. Thus, it serves as a heuristic for further research and scholarship.

This unique textbook utilizes an integrated, case-based approach to explore how the domains of bioethics, public health and the social sciences impact individual patients and populations. It provides a structured framework suitable for both educators (including course directors and others engaged in curricular design) and for medical and health professions students to use in classroom settings across a range of clinical areas and allied health professions and for independent study. The textbook opens with an introduction, describing the intersection of ethics (...) and public health in clinical practice and the six key themes that inform the book's core learning objectives, followed by a guide to using the book. It then presents 22 case studies that address a broad spectrum of patient populations, clinical settings, and disease pathologies. Each pair of cases shares a core concept in bioethics or public health, from community perspectives and end-of-life care to medical mistakes and stigma and marginalization. They engage learners in rigorous clinical and ethical reasoning by prompting readers to make choices based on available information and then providing additional information to challenge assumptions, simulating clinical decision-making. In addition to providing a unique, detailed clinical scenario, each case is presented in a consistent format, which includes learning objectives, questions and responses for self-directed learning, questions and responses for group discussion, references, and suggested further reading. All cases integrate the six themes of patient- and family-centered care; evidence-based practice; structural competency; biases in decision-making; cultural humility and awareness of the culture of medicine; and justice, social responsibility and advocacy. The final section discusses some challenges to evaluating courses and learning encounters that adopt the cases and includes a model framework for learner assessment. (shrink)

Volume 20, Issue 10, October 2020, Page 85-87.

The two cases presented here may at first seem very different: one patient was an adult, making autonomous decisions for herself and her fetus; the other was a child too young to meaningfully participate in the most significant decisions regarding his health. In both cases, healthcare professionals had to determine the extent to which the parents of a dying fetus or child should be permitted to make agonizing choices about how long to maintain hope and what that death will look (...) like; and in both, health professionals’ prognostications influenced their judgments about the patients’ best interests and whether they were candidates for certain interventions. While members of both healthcare teams questioned the patients’ and families’ ability to objectively consider the risks and benefits, the families were focused on the need to be able to live with the decisions made, regardless of outcome. Clinicians expressed unwillingness to perform physical actions they felt were more likely to promote harm and suffering than benefit, and experienced attendant moral distress in the face of conflicting values. In this regard, these cases are mirror images: only in the first case did the clinician, an obstetrician, have sufficient professional authority to refuse to perform the desired intervention. In the second case, the clinicians who expressed the most distress regarding the patient’s trajectory were the nurses, who largely lacked similar autonomy. Viewed together, these cases share a core question: What does paternalism look like in the contemporary era? (shrink)

Advocates anthropology as a science focused on social structure.

Ubiquitous healthcare is an emerging area of technology that uses a large number of environmental and patient sensors and actuators to monitor and improve patients' physical and mental condition. Tiny sensors gather data on almost any physiological characteristic that can be used to diagnose health problems. This technology faces some challenging ethical questions, ranging from the small-scale individual issues of trust and efficacy to the societal issues of health and longevity gaps related to economic status. It presents particular problems in (...) combining developing computer/information/media ethics with established medical ethics. This article describes a practice-based ethics approach, considering in particular the areas of privacy, agency, equity and liability. It raises questions that ubiquitous healthcare will force practitioners to face as they develop ubiquitous healthcare systems. Medicine is a controlled profession whose practise is commonly restricted by government-appointed authorities, whereas computer software and hardware development is notoriously lacking in such regimes. (shrink)

Essays omhandlende den etiske dimension i det militære liv.

The importance and urgency of using ethical principles in the creation and content of climate change policy is well recognised. This article closely examines the World Conservation Union’s (IUCN) engagement in ethical elements of international climate policy for abatement. The primary finding is the use of narrow framing around ‘nature based solutions’. The IUCNs’ own policy references to ethical principles such as fairness and justice are not adequately applied to the content of policy or to its critique. Recommendations are made (...) on how the IUCN (and NGOs generally) could enhance its ethical engagement to act consistently with the claim of moral leadership. (shrink)

The Tractatus de suppositionibus, which is cited by Gerald Odonis in his commentary on the Sentences, probably dates from ca. 1315-25. In the Sentences commentary he refers to his treatment of 'suppositio communicabilis' and its species, indicating a type of supposition whose language seems new. This article attempts to find a source for it in contemporary authors and arrives at the conclusion that 'communicabilis' is simply a synonym for 'personalis', the most common form of supposition according to Odonis.

This book investigates the potential role that states can play in cosmopolitan thinking and how states could be agents for the advancement of cosmopolitan responsibilities.

The field of ethics in psychology has devoted a great deal of attention to the ethical issues that arise when students and faculty develop mentor–mentee relationships. However, little attention has been given to examining the role of graduate students acting as mentors. Graduate students often supervise and evaluate undergraduates as a part of research and teaching responsibilities, and may act as mentors to more junior graduate students. This article discusses the unique qualities and ethical considerations of graduate students in mentoring (...) relationships. Finally, this article concludes with recommendations on ethical mentorship inspired by the American Psychological Association Ethical Principles of Psychologists and Code of Conduct. (shrink)