Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfunction, harm, and risk. We argue (...) that ‘disease’ should be considered a vague concept with a non-classical structure. On this view, overdiagnosed cases are ‘borderline’ cases of disease, falling in the zone between cases that are clearly disease, and cases that are clearly not disease. We then develop a pre ́cising definition of disease designed to provide practical help in preventing and limiting overdiagnosis. We argue that for this purpose, we can define disease as dysfunction that has a significant risk of causing severe harm to the patient. (shrink)

Gelfand quantales are complete unital quantales with an involution, *, satisfying the property that for any element a, if a b a for all b, then a a* a = a. A Hilbert-style axiom system is given for a propositional logic, called Gelfand Logic, which is sound and complete with respect to Gelfand quantales. A Kripke semantics is presented for which the soundness and completeness of Gelfand logic is shown. The completeness theorem relies on a Stone style representation theorem for (...) complete lattices. A Rasiowa/Sikorski style semantic tableau system is also presented with the property that if all branches of a tableau are closed, then the formula in question is a theorem of Gelfand Logic. An open branch in a completed tableaux guarantees the existence of an Kripke model in which the formula is not valid; hence it is not a theorem of Gelfand Logic. (shrink)

Many health care systems include programs that allow patients in exceptional circumstances to access medical interventions of as yet unproven benefit. In this article we consider the ethical justifications for—and demands on—these special access programs (SAPs). SAPs have a compassionate basis: They give patients with limited options the opportunity to try interventions that are not yet approved by standard regulatory processes. But while they signal that health care systems can and will respond to individual suffering, SAPs have several disadvantages, including (...) the potential to undermine regulatory and knowledge-generation structures that constitute significant public goods. The “balance” between these considerations depends in part on how broadly SAPs are used, but also on whether SAPs can be made to contribute to the generation of knowledge about the effects of health interventions. We argue that patients should usually be required to contribute outcome data while using SAPs. (shrink)

Recently a number of scientists have proposed substantial changes to the practice of climate modeling, though they disagree over what those changes should be. We provide an overview and critical examination of three leading proposals: the unified approach, the hierarchy approach and the pluralist approach. The unified approach calls for an accelerated development of high-resolution models within a seamless prediction framework. The hierarchy approach calls for more attention to the development and systematic study of hierarchies of related models, with the (...) aim of advancing understanding. The pluralist approach calls for greater diversity in modeling efforts, including, on some of its variants, more attention to empirical modeling. After identifying some of the scientific and institutional challenges faced by these proposals, we consider their expected gains and costs, relative to a business-as-usual modeling scenario.We find the proposals to be complementary, having valuable synergies. But since resource limitations make it unlikely that all three will be pursued, we offer some reflections on more limited changes in climate modeling that seem well within reach and that can be expected to yield substantial benefits. (shrink)

In this paper, we examine recent critiques of the debate about defining disease, which claim that its use of conceptual analysis embeds the problematic assumption that the concept is classically structured. These critiques suggest, instead, developing plural stipulative definitions. Although we substantially agree with these critiques, we resist their implication that no general definition of “disease” is possible. We offer an alternative, inductive argument that disease cannot be classically defined and that the best explanation for this is that the concept (...) is structured as a cluster. We further argue that we do not need to reject the possibility of defining the general concept “disease” to legitimate developing stipulative definitions of disease that are relative to particular purposes. A cluster definition of disease is compatible with contextually motivated definitions, which may be considered précisifications of the more general cluster concept. (shrink)

This article reports the findings of a qualitative study that explored the organizational influences on moral distress for health professionals working in pediatric intensive care units across Canada. Participants were recruited to the study from PICUs across Canada. The PICU is a high-tech, fast-paced, high-pressure environment where caregivers frequently face conflict and ethical tension in the care of critically ill children. A number of themes including relationships with management, organizational structure and processes, workload and resources, and team dynamics were identified. (...) This study provides a rare and important multi-disciplinary perspective on this topic and the findings have implications for administrators and leaders who seek to improve the moral climate of healthcare delivery. (shrink)

An increasing number of patients receive diagnoses of disease without having any symptoms. These include diseases detected through screening programs, as incidental findings from unrelated investigations, or via routine checks of various biological variables like blood pressure or cholesterol. In this article, we draw on narrative identity theory to examine how the process of making sense of being diagnosed with asymptomatic disease can trigger certain overlooked forms of harm for patients. We show that the experience of asymptomatic disease can involve (...) ‘mismatches’ between one’s beliefs about one’s health status on the one hand, and bodily sensations or past experience on the other. Patients’ attempts to integrate these diagnoses into their self-narratives often involve either forming inaccurate beliefs about bodily sensations and/or past experience, or coming to believe that feelings and experience do not necessarily track or predict health status, leading to an ongoing sense of vulnerability to ill health. These resulting alterations in self-understanding can sometimes be considered harmful, in view of their implications for ascriptions of responsibility and ongoing anxiety. (shrink)

The Covid‐19 pandemic has revealed myriad social, economic, and health inequities that disproportionately burden populations that have been made medically or socially vulnerable. Inspired by state and local governments that declared racism a public health crisis or emergency, the Anti‐Racism in Public Health Act of 2020 reflects a shifting paradigm in which racism is considered a social determinant of health. Indeed, health inequities fundamentally rooted in structural racism have been exacerbated by the Covid‐19 pandemic, which calls for the integration of (...) antiracist praxis to promote ethical public health research processes. This commentary describes ways in which antiracist praxis—which emphasizes empowerment of traditionally marginalized populations—offers strategies to explicitly address power imbalance, stigmatization, and other consequences of structural racism in public health research. (shrink)

Like all human activities, scientific research is infused with values. Scientific discovery can, for example, be valued as an end in itself. The phrase ethical values is an umbrella term for much of what people care about aside from knowledge for its own sake. Ethical values encompass reasons for caring about the harms caused by climate impacts or the injustice of how those harms are distributed. The closer that research gets to informing real-world actions, the more the design of that (...) research can be examined from the perspective of ethical values. Which societal challenges does the research aim to inform? From whose perspective does a policy analysis view potential outcomes? In this chapter we use a series of examples to illustrate how researchers’ choices regarding the treatment of uncertainties can have important consequences from the perspective of ethical values. Our aims in this chapter are: to familiarize readers with the key concept of coupled ethical–epistemic choices; to build capacity for recognizing such choices within the treatment of uncertainties; to encourage engagement with ethical values as a part of climate change research; and to offer some guidance on how to start doing so. (shrink)

Forms of Artificial Intelligence (AI) are already being deployed into clinical settings and research into its future healthcare uses is accelerating. Despite this trajectory, more research is needed regarding the impacts on patients of increasing AI decision making. In particular, the impersonal nature of AI means that its deployment in highly sensitive contexts-of-use, such as in healthcare, raises issues associated with patients’ perceptions of (un) dignified treatment. We explore this issue through an experimental vignette study comparing individuals’ perceptions of being (...) treated in a dignified and respectful way in various healthcare decision contexts. Participants were subject to a 2 (human or AI decision maker) x 2 (positive or negative decision outcome) x 2 (diagnostic or resource allocation healthcare scenario) factorial design. We found evidence of a “human bias” (i.e., a preference for human over AI decision makers) and an “outcome bias” (i.e., a preference for positive over negative outcomes). However, we found that for perceptions of respectful and dignified interpersonal treatment, it matters more who makes the decisions in diagnostic cases and it matters more what the outcomes are for resource allocation cases. We also found that humans were consistently viewed as appropriate decision makers and AI was viewed as dehumanizing, and that participants perceived they were treated better when subject to diagnostic as opposed to resource allocation decisions. Thematic coding of open-ended text responses supported these results. We also outline the theoretical and practical implications of these findings. (shrink)

Research aimed at developing and validating an instrument to assess secondary school students? perceptions of assessment tasks was conducted. Following a review of literature, a five?scale instrument of 40 items was trialled with a sample of 658 science students in 11 English secondary schools. Based on internal consistency reliability data and exploratory factor analysis, refinement decisions resulted in a five?scale instrument called the Perceptions of assessment tasks inventory (PATI). The scales of the PATI are Congruence with planned learning, Authenticity, Student (...) consultation, Transparency and Diversity. (shrink)

This book explores the dynamics of the commentary and textbook traditions in Aristotelian natural philosophy under the headings of doctrine, method, and scientific and social status. It enquires what the evolution of the Aristotelian commentary tradition can tell us about the character of natural philosophy as a pedagogical tool, as a scientific enterprise, and as a background to modern scientific thought. In a unique attempt to cut old-fashioned historiographic divisions, it brings together scholars of ancient, medieval, Renaissance and seventeenth-century philosophy. (...) The book covers a remarkably broad range of topics: it starts with the first Greek commentators and ends with Leibniz. (shrink)

The ultimate causes of sex differences in human aggressive behavior can lie mainly in evolved, inherited mechanisms that differ by sex or mainly in the differing placement of women and men in the social structure. The present commentary contrasts Campbell's evolutionary interpretation of aggression sex differences with a social structural interpretation that encompasses a wider range of phenomena.

Presenting a field-defining overview of one of the most appliable linguistic theories available today, this Handbook surveys the key issues in the study of systemic functional linguistics, covering an impressive range of theoretical perspectives. Written by some of the world's foremost SFL scholars, including M. A. K. Halliday, the founder of SFL theory, the handbook covers topics ranging from the theory behind the model, discourse analysis within SFL, applied SFL, to SFL in relation to other subfields of linguistics such as (...) intonation, typology, clinical linguistics and education. Chapters include discussion on the possible future directions in which research might be conducted and issues that can be further investigated and resolved. Readers will be inspired to pursue the challenges raised within the volume, both theoretically and practically. (shrink)

The problem that this essay will address is that of devising a viable use for psychological and intentional terms, in short, discourse concerning what-it-is-to-be-a-subject or "subjecthood" in light of, first, Derrida's deconstruction of the transcendental subject and, second, the materialist claim that recent advances in science effectively antiquate any viable role in empirical psychology for the use of terms traditionally associated with mind. I will argue that Wittgenstein's remarks concerning, among other things, the use of psychological terms, private mental objects (...) and the application of psychological terms to non-humans not only provides a clear and important connection between Derrida and contemporary materialism but that, supplemented by Daniel Dennett's intentional stance, offers an alternative model for the use of such terms in empirical psychological investigation. I will call this model a 'grammar of subjecthood'. ;Central to my argument is the claim that, as opposed to being conceived as names for mental objects or states, psychological terms are best understood as descriptive metaphors for the relationship between an organism and its bio/socio/historical context. That is, the Wittgensteinian notion of subjecthood describes a heuristic that, applied to behavior, provides information to empirical psychologists unavailable on a materialist model of explanation. A grammar of subjecthood, then, is both openly anthropomorphic, yet consistently naturalist, enlisting Dennett's intentional stance as an expansion of Wittgenstein's basic strategy. ;The success of such a strategy cannot be measured by showing in what way human beings are to be essentially distinguished from other organisms, but by how much more sense can be made out of something's behavior by speaking of it in terms of, for example, beliefs and intentions. Anything could be treated as a subject; the issue here is to what it is useful to apply such attributes. (shrink)

Lloyd (2009) contends that climate models are confirmed by various instances of fit between their output and observational data. The present paper argues that what these instances of fit might confirm are not climate models themselves, but rather hypotheses about the adequacy of climate models for particular purposes. This required shift in thinking—from confirming climate models to confirming their adequacy-for-purpose—may sound trivial, but it is shown to complicate the evaluation of climate models considerably, both in principle and in practice.

We invoke the ideal of tolerance in response to conflict, but what does it mean to answer conflict with a call for tolerance? Is tolerance a way of resolving conflicts or a means of sustaining them? Does it transform conflicts into productive tensions, or does it perpetuate underlying power relations? To what extent does tolerance hide its involvement with power and act as a form of depoliticization? Wendy Brown and Rainer Forst debate the uses and misuses of tolerance, an (...) exchange that highlights the fundamental differences in their critical practice despite a number of political similarities. Both scholars address the normative premises, limits, and political implications of various conceptions of tolerance. Brown offers a genealogical critique of contemporary discourses on tolerance in Western liberal societies, focusing on their inherent ties to colonialism and imperialism, and Forst reconstructs an intellectual history of tolerance that attempts to redeem its political virtue in democratic societies. Brown and Forst work from different perspectives and traditions, yet they each remain wary of the subjection and abnegation embodied in toleration discourses, among other issues. The result is a dialogue rich in critical and conceptual reflections on power, justice, discourse, rationality, and identity. (shrink)

Whether in characterizing Catharine MacKinnon's theory of gender as itself pornographic or in identifying liberalism as unable to make good on its promises, Wendy Brown pursues a central question: how does a sense of woundedness become the basis for a sense of identity? Brown argues that efforts to outlaw hate speech and pornography powerfully legitimize the state: such apparently well-intentioned attempts harm victims further by portraying them as so helpless as to be in continuing need of governmental protection. "Whether (...) one is dealing with the state, the Mafia, parents, pimps, police, or husbands," writes Brown, "the heavy price of institutionalized protection is always a measure of dependence and agreement to abide by the protector's rules." True democracy, she insists, requires sharing power, not regulation by it; freedom, not protection.Refusing any facile identification with one political position or another, Brown applies her argument to a panoply of topics, from the basis of litigiousness in political life to the appearance on the academic Left of themes of revenge and a thwarted will to power. These and other provocations in contemporary political thought and political life provide an occasion for rethinking the value of several of the last two centuries' most compelling theoretical critiques of modern political life, including the positions of Nietzsche, Marx, Weber, and Foucault. (shrink)

This article addresses four hypotheses: (a) that corporate social responsibility (CSR) in Asia is not homogeneous but varies among countries, (b) that the variation is explained by stages of development, (c) that globalization enhances the adoption of CSR in Asia, and (d) that national business systems structure the profile of multinational corporations’ CSR. These hypotheses are investigated through analysis of Web site reporting of 50 companies in seven Asian countries: India, Indonesia, Malaysia, the Philippines, South Korea, Singapore, and Thailand. The (...) article concludes that CSR does vary considerably among Asian countries but that this variation is not explained by development but by factors in the respective national business systems. It also concludes that multinational companies are more likely to adopt CSR than those operating solely in their home country but that the profile of their CSR tends to reflect the profile of the country of operation rather than the country of origin. (shrink)

On November 20, 1210, one day after the annual fair, ten heretics were burned in the field named Champeaux just outside the walls of Paris. Four others were incarcerated. The group of fourteen had been uncovered and captured through the aid of a spy. In the chronicles they are identified as Amalricians , named after Master Amalric of Bène, who reportedly stood at the origin of their heresies. Master Amalric himself had been condemned around 1206, shordy before his death. His (...) case is the earliest documented instance of academic censure at the University of Paris. (shrink)

Corporate and commercial values are inducing some healthcare organizations to prescribe a customer service model that reframes the provision of nursing care. In this paper it is argued that such a model is incommensurable with nursing conceived as a moral practice and ultimately places nurses at risk. Based upon understanding from ongoing research on compassion fatigue, it is proposed that compassion fatigue as currently experienced by nurses may not arise predominantly from too great a demand for compassion, but rather from (...) barriers to enacting compassionate care. These barriers are often systemic. The paradigm shift in which healthcare environments are viewed as marketplaces rather than moral communities has the potential to radically affect the evolution of nursing as a discipline. (shrink)

Wendy Donner contends here that recent commentators on John Stuart Mill's thought have focused on his notions of right and obligation and have not paid as much attention to his notion of the good. Mill, she maintains, rejects the quantitative hedonism of Bentham's philosophy in favor of an expanded qualitative version. In this book she provides an account of his complex views of the good and the ways in which these views unify his moral and political thought.

A summary of the existing literature related to moral distress (MD) and the paediatric intensive care unit (PICU) reveals a high-tech, high-pressure environment in which effective teamwork can be compromised by MD arising from different situations related to: consent for treatment, futile care, end-of-life decision making, formal decision-making structures, training and experience by discipline, individual values and attitudes, and power and authority issues. Attempts to resolve MD in PICUs have included the use of administrative tools such as shift worksheets, the (...) implementation of continuing education, and encouragement to report. The literature does not yet show these approaches to be effective in the resolution of MD. The need to acknowledge MD among PICU teams is discussed and an argument made that, to facilitate understanding among team members, practice stories need to be shared. (shrink)

Wendy Brown's work commands widespread attention and respect, and there has been considerable interest as to how it would develop after "States of Injury." This book will not disappoint.

Tolerance is generally regarded as an unqualified achievement of the modern West. Emerging in early modern Europe to defuse violent religious conflict and reduce persecution, tolerance today is hailed as a key to decreasing conflict across a wide range of other dividing lines-- cultural, racial, ethnic, and sexual. But, as political theorist Wendy Brown argues in Regulating Aversion, tolerance also has dark and troubling undercurrents. Dislike, disapproval, and regulation lurk at the heart of tolerance. To tolerate is not to (...) affirm but to conditionally allow what is unwanted or deviant. And, although presented as an alternative to violence, tolerance can play a part in justifying violence--dramatically so in the war in Iraq and the War on Terror. Wielded, especially since 9/11, as a way of distinguishing a civilized West from a barbaric Islam, tolerance is paradoxically underwriting Western imperialism. Brown's analysis of the history and contemporary life of tolerance reveals it in a startlingly unfamiliar guise. Heavy with norms and consolidating the dominance of the powerful, tolerance sustains the abjection of the tolerated and equates the intolerant with the barbaric. Examining the operation of tolerance in contexts as different as the War on Terror, campaigns for gay rights, and the Los Angeles Museum of Tolerance, Brown traces the operation of tolerance in contemporary struggles over identity, citizenship, and civilization. (shrink)

'Is politics gendered? Wendy Brown things so, and argues for this point with elegance, imagination and pungent phrases. Brown's book is challenging, provocative and...original; it does force us to question the degree to which gender controls our politics.'-THE REVIEW OF POLITICS.