Gilbert et al. argue that the neuroethics literature discussing the putative effects of Deep Brain Stimulation on personality largely ignores the scientific evidence and presents distorted claims that personality change is induced by the DBS stimulation. This study contributes to the first-hand primary research on the topic exploring DBS clinicians’ views on post-DBS personality change among their patients and its underlying cause. Semi-structured interviews were conducted with sixteen clinicians from various disciplines working in Australian DBS practice for movement disorders and/or (...) psychiatric conditions. Thematic analysis of the interviews revealed five primary themes: 1) types, frequency and duration of personality change, 2) causes of personality change, 3) impact on patient and family, 4) communication, comprehension and awareness, and 5) management. Clinicians described a variety of personality changes in Parkinson’s disease following DBS including irritability, impulsivity and impaired decision-making. The frequency of personality change seen in patients varied amongst clinicians, but changes were overwhelmingly transient. Clinicians considered both DBS stimulation and additional factors as inducing personality change. For DBS patients with major depressive disorder, a restoration of pre-morbid personality was associated with alleviation of illness. Considerations for future research of personality change following DBS include selecting suitable tools for quantitative examination and developing a common language between the scientific and ethics communities. Clinical implications including recommendations for the informed consent process for patients and families and clinicians’ management of personality change are discussed. (shrink)

Many healthcare practices expose people to risks of harmful outcomes. However, the major theories of moral philosophy struggle to assess whether, when and why it is ethically justifiable to expose individuals to risks, as opposed to actually harming them. Sven Ove Hansson has proposed an approach to the ethical assessment of risk imposition that encourages attention to factors including questions of justice in the distribution of advantage and risk, people’s acceptance or otherwise of risks, and the scope individuals have to (...) influence the practices that generate risk. This paper investigates the ethical justifiability of preventive healthcare practices that expose people to risks including overdiagnosis. We applied Hansson’s framework to three such practices: an ‘ideal’ breast screening service, a commercial personal genome testing service, and a guideline that lowers the diagnostic threshold for hypertension. The framework was challenging to apply, not least because healthcare has unclear boundaries and involves highly complex practices. Nonetheless, the framework encouraged attention to issues that would be widely recognised as morally pertinent. Our assessment supports the view that at least some preventive healthcare practices that impose risks including that of overdiagnosis are not ethically justifiable. Further work is however needed to develop and/or test refined assessment criteria and guidance for applying them. (shrink)

This paper offers a narrative approach to understanding the process of clinical reasoning in complex cases involving medical uncertainty, moral ambiguity, and futility. We describe a clinical encounter in which the pediatric health care team experienced a great deal of conflict and distrust as a result of an ineffective process of interpretation and communication. We propose a systematic method for analyzing the technical, ethical, behavioral, and existential dimensions of the clinical reasoning process, and introduce the Clinical Reasoning Discussion Tool—a dialogical (...) and interpretive device aimed at improving communication, understanding, empathy, and moral deliberation in the clinical setting. (shrink)

Public education is not just a way to organise and fund education. It is also the expression of a particular ideal about education and of a particular way to conceive of the relationship between education and society. The ideal of public education sees education as an important dimension of the common good and as an important institution in securing the common good. The common good is never what individuals or particular groups want or desire, but always reaches beyond such particular (...) desires towards that which societies as a whole should consider as desirable. This does, of course, put the common good in tension with the desires of individuals and groups. Neo-liberal modes of governance have, over the past decades, put this particular educational set up under pressure and have, according to some, eroded the very idea of the common good. This set of contributions reflects on this state of affairs, partly through an exploration of the idea of publicness itself – how it can be rearticulated and regained – and partly through reflections on the current state of education in the ‘north’ and the ‘south.’. (shrink)

In Time, Narrative, and History, David Carr argues against the narrativist claim that our lived experience does not possess the formal attributes of a story; this conclusion can be reinforced from a semiotic perspective. Our experience is mediated through temporal signs that are used again in the construction of stories. Since signs are social entities from the start, this approach avoids a problem of individualism specific to phenomenology, one which Carr takes care to resolve. A semiotic framework is also explicit (...) about a theme Carr handles implicitly: the status of representation. Representation is internal to signification, mediating our experience not just retrospectively but prospectively in the planning and execution of action. A model is presented in which the temporal organization of experience and action is formally coordinated with the temporal organization of narrative. The model is then applied to a historical event: John Batman's attempt in 1835 to purchase land from some Aboriginal tribes around what is now Melbourne. The meaning of this event is not located only in historical writing about it but in the semiotic constitution of the event itself. Changes of meaning emerge from relations between events as new events--in this case the Australian High Court's Mabo decision--align with old ones. Finally, a number of contrasts are indicated between this model and proposals made by Arthur C. Danto, Hayden White, F. R. Ankersmit, Fernand Braudel, and Paul Ricoeur. (shrink)

In the rapidly evolving healthcare environment, perhaps no role is in greater flux and redefinition than that of the clinical bioethicist. The discussion of ethics consultation in the bioethics literature has moved from an ambiguous concern regarding its proper place in the clinical milieu to the more provocative question of which methods and theories should best characterize the intellectual and practical work it claims to do. The American Society for Bioethics and Humanities addressed these concerns in its 1998 report, CoreCompetenciesforHealthCareEthicsConsultation. (...) The report tries to answer the question as to what disciplinary training, background experience, and levels of knowledge in ethics the clinical ethics consultant should have, and what specific skills and character traits the clinical ethics consultant should cultivate. In addition to acquiring knowledge of common bioethical issues, theoretical concepts in ethical theory and moral reasoning, and health-related law and policy, the report also recommends that ethics consultants demonstrate knowledge of the health beliefs and perspectives of patients and healthcare providers. In our opinion, this recommendation underscores a crucial aspect of the practice of ethics consultation in the increasingly multicultural settings of healthcare institutions. Clearly, the dynamic of American life and culture is permeated with diversity and variety as new groups suffuse their own beliefs and faith perspectives into the health sector. New immigrant groups force society to question traditional healthcare practices and to accommodate changing medical needs. (shrink)

As a way of contributing to bioethics' understanding of itself, and, more particularly, to invigorate conversation about how we can best educate future colleagues, we present here a sketch of the quarter-century-old graduate concentration in medical ethics housed in the Department of Philosophy at the University of Tennessee, Knoxville. Our hope is to incite other programs to share their histories, strategies, problems, and aspirations, so as to help the field as a whole get a clearer sense of how we are (...) putting together our future, and of how we might best go about this important job. (shrink)

In his landmark monograph, "The Politics of Jesus", John Howard Yoder challenged mainstream Christian social ethics by arguing that the New Testament account of Jesus's founding of a messianic community entails a normative politics, not only for early Christianity but for the contemporary church. This challenge is further elaborated in several important posthumous publications, especially "Preface to Theology", in which Yoder examines the development of early Christology with attention to its political and ethical implications, and "The Jewish-Christian Schism Revisited", Yoder's (...) proposal for a renewed Jewish-Christian dialogue around the moral meaning of messianism. This article interprets these writings with reference to a range of critical scholarship on and about Yoder, Yoder and Augustine, and Jewish and Christian messianism, paying particular attention to questions of political ethics. (shrink)

This volume analyzes authoritarian, reformist, Marxist and anarchist approaches to the environmental problem, exposing the relationships between environmental crises, economic structures and the role of the state.

This paper attempts to sort out some of the current tensions and ambiguities inherent in the field of bioethics as it continues to mature. In particular it focuses on the question of the methodological relevance of theory or ethical principles to the domain of clinical ethics. I offer an approach to reasoning about moral conflict that combines the insights of contemporary moral theorists, the philosophy of American pragmatism, and the skills of rhetorical deliberation. This synthetic approach locates a proper role (...) for moral theory in the practice of clinical ethics, thus linking abstract philosophical ideas about morality, humanity, suffering, and health to specific deeds, actions, and decisions in the concrete lives of particular individuals. The aim of this synthetic approach of bioethical inquiry is a rapprochement between theoretical knowledge in moral philosophy and the contextualized, relational, and practical understanding of what morality demands of us in our daily lives. I argue for a conception of bioethical inquiry that takes morality to be a study of certain practical, socially embedded concerns about matters of right and wrong, good and evil, as well as a study of the moral theories by which these actual concerns can be explored and critically evaluated. (shrink)

Background There is a growing concern about artificial intelligence (AI) applications in healthcare that can disadvantage already under-represented and marginalised groups (eg, based on gender or race). Objectives Our objectives are to canvas the range of strategies stakeholders endorse in attempting to mitigate algorithmic bias, and to consider the ethical question of responsibility for algorithmic bias. Methodology The study involves in-depth, semistructured interviews with healthcare workers, screening programme managers, consumer health representatives, regulators, data scientists and developers. Results Findings reveal considerable (...) divergent views on three key issues. First, views on whether bias is a problem in healthcare AI varied, with most participants agreeing bias is a problem (which we call the bias-critical view), a small number believing the opposite (the bias-denial view), and some arguing that the benefits of AI outweigh any harms or wrongs arising from the bias problem (the bias-apologist view). Second, there was a disagreement on the strategies to mitigate bias, and who is responsible for such strategies. Finally, there were divergent views on whether to include or exclude sociocultural identifiers (eg, race, ethnicity or gender-diverse identities) in the development of AI as a way to mitigate bias. Conclusion/significance Based on the views of participants, we set out responses that stakeholders might pursue, including greater interdisciplinary collaboration, tailored stakeholder engagement activities, empirical studies to understand algorithmic bias and strategies to modify dominant approaches in AI development such as the use of participatory methods, and increased diversity and inclusion in research teams and research participant recruitment and selection. (shrink)

The task of negotiating present ecological breakdowns is entangled crucially with the logistics of managing a globally distributed observing infrastructure. Composed of sensors aboard orbiting sate...

Originally published in 1954, on behalf of the National Institute of Economic and Social Research, this book presents a general review of British economic statistics in relation to the uses made of them for policy purposes. The text begins with an examination, in general terms, of the ways in which statistics can help in guiding or assessing policy, covering housing, coal, the development areas, agricultural price-fixing, the balance of external payments and the balance of the economy. The problems of statistical (...) application are then separately discussed under the headings of quality, presentation and availability, and organization. A full bibliography and reference table of principal British economic statistics are also included. This book will be of value to anyone with an interest in British economic history and statistics. (shrink)

This article is concerned with a discussion of the plausibility of the claim that GM technology has the potential to provide the hungry with sufficient food for subsistence. Following a brief outline of the potential applications of GM in this context, a history of the green revolution and its impact will be discussed in relation to the current developing world agriculture situation. Following a contemporary analysis of malnutrition, the claim that GM technology has the potential to provide the hungry with (...) sufficient nourishment will be discussed within the domain of moral philosophy to determine whether there exists a moral obligation to pursue this end if and only if the technology proves to be relatively safe and effective. By using Peter Singer’s duty of moral rescue, I argue that we have a moral duty to assist the third world through the distribution of such GM plants. I conclude the paper by demonstrating that my argument can be supported by applying a version of the Precautionary Principle on the grounds that doing nothing might be worse for the current situation. (shrink)

Comparing the practice of nurse practitioners to medical practice began almost 50 years ago and continues to this day. This comparison is curious since the founders of this movement did not indicate that these advanced practice nurses were to be interchangeable with physicians. Nevertheless, substantial literature indicates that nurse practitioners perform equally or better when measured against physician practice standards. This paper compares the ontology and epistemology of both professions and concludes that the philosophical foundations are so different that comparisons (...) are illogical. (shrink)

Bioethics, Volume 36, Issue 6, Page 728-730, July 2022.

Ägyptenrezeption im Mumienfilm: The Mummy 1932 und Remakes. By Yvonne Vosmann. Philippika, vol. 96. Wiesbaden: Harrassowitz Verlag, 2016. Pp. 144, illus. €34.

The National Institutes of Health is the largest biomedical research institution in the world. It has become one of the world's most highly respected research centers in part because of its efforts over the years to provide the research community with leadership in both the ethical and scientific parameters of research involving humans. As its 113th birthday approaches at the turn of the century, its great legacy is providing an environment to stimulate and nourish the diversity and creativity of ideas, (...) and thereby enable science to progress. This research must continue to be guided and tempered by consistent and critical federally-supported ethical analyses. (shrink)

We know facts, but we also know how to do things. To know a fact is to know that a proposition is true. But does knowing how to ride a bike amount to knowledge of propositions? This is a challenging question and one that deeply divides the contemporary landscape. A Critical Introduction to Knowledge-How introduces, outlines, and critically evaluates various contemporary debates surrounding the nature of knowledge-how. Carter and Poston show that situating the debate over the nature of knowledge-how (...) in other epistemological debates provides new ways to make progress. In particular, Carter and Poston explore the question of what knowledge-how involves, and how it might come apart from propositional knowledge, by engaging with key epistemological topics including epistemic luck, knowledge of language, epistemic value, virtue epistemology and social epistemology. New frontiers for research on knowledge-how are also explored relating to the internalism - externalism debate as well as embodied and extended knowledge. A Critical Introduction to Knowledge-How provides an accessible introduction to the main arguments in this important and thriving debate suited for undergraduates and postgraduates in philosophy and related areas. A strength of the book is its methodology which places a premium on placing the debates over knowledge-how in a broader conversation over the nature of knowledge. This book also offers an opinionated discussion of various lines of argument which will be of interest to professional philosophers as well. (shrink)

. This paper identifies two aspects of the structuralist position of S. Shapiro which are in conflict with the actual practice of mathematics. The first problem follows from Shapiros identification of isomorphic structures. Here I consider the so called K-group, as defined by A. Grothendieck in algebraic geometry, and a group which is isomorphic to the K-group, and I argue that these are not equal. The second problem concerns Shapiros claim that it is not possible to identify objects in a (...) structure except through the relations and functions that are defined on the structure in which the object has a place. I argue that, in the case of the definition of the so called direct image of a function, it is possible to individuate objects in structures. (shrink)

Strange inversions occur when things work in ways that turn received wisdom upside down. Hume offered a strangely inverted story about causation, and Darwin, about apparent design. Dennett suggests that a strange inversion also occurs when we project our own reactive complexes outward, painting our world with elusive properties like cuteness, sweetness, blueness, sexiness, funniness, and more. Such properties strike us as experiential causes, but they are really effects—a kind of shorthand for whole sets of reactive dispositions rooted in the (...) nuts and bolts of human information processing. Understanding the nature and origins of that strange inversion, Dennett believes, is thus key to understanding the nature and origins of human experience itself. This paper examines this claim, paying special attention to recent formulations that link that strange inversion to the emerging vision of the brain as a Bayesian estimator, constantly seeking to predict the unfolding sensory barrage. (shrink)

Philosophy of mind and cognitive science have recently become increasingly receptive to the hypothesis of extended cognition, according to which external artifacts such as our laptops and smartphones can—under appropriate circumstances—feature as material realizers of a person's cognitive processes. We argue that, to the extent that the hypothesis of extended cognition is correct, our legal and ethical theorizing and practice must be updated by broadening our conception of personal assault so as to include intentional harm toward gadgets that have been (...) appropriately integrated. We next situate the theoretical case for extended personal assault within the context of some recent ethical and legal cases and close with critical discussion. (shrink)