Managing the violent behaviour of mentally disordered offenders is challenging in all jurisdictions. We describe the ethical framework and practical management of MDOs in England and Wales in the context of the move to equivalence of healthcare between hospital and prison. We consider the similarities and differences between prison and hospital management of the violent and challenging behaviours of MDOs. We argue that both types of institution can learn from each other and that equivalence of care should extend to equivalence (...) of criminal proceedings in court and prisons for MDOs. We argue that any adjudication process in prison for MDOs is enhanced by the relevant involvement of mental health professionals and the articulation of the ethical principles underpinning health and criminal justice practices. (shrink)

Nigel Newton’s long-awaited book, building on research from his PhD of 2014, provides insights for anyone involved in values and relationships education. His research questions seek to ascertain wh...

Martin-Löf’s Constructive Type Theory (CTT) is a formal language developed in order to reason constructively about mathematics. It is thus a formal language conceived primarily as a tool to reason with rather than a formal language conceived primarily as a mathematical system to reason about. Constructive Type Theory is therefore much closer in spirit to Frege’s ideography and to the language of Russell and Whitehead’s Principia Mathematica than to the majority of logical systems (“logics”) studied by contemporary logicians. Since CTT (...) is designed as a language to reason with, much attention is paid to the explanation of basic concepts. This is perhaps the main reason why the style of presentation of CTT differs somewhat from the style of presentation typically found in, for instance, ordinary logic textbooks. For those new to the system it might be useful to approach an introduction, such as the one given below, more as a language course than as a course in mathematics. (shrink)

Human-Computer Interaction (HCI) and games set a new domain in understanding people’s motivations in gaming, behavioral implications of game play, game adaptation to player preferences and needs for increased engaging experiences in the context of HCI serious games (HCI-SGs). When the latter relate with people’s health status, they can become a part of their daily life as assistive health status monitoring/enhancement systems. Co-designing HCI-SGs can be seen as a combination of art and science that involves a meticulous collaborative process. The (...) design elements in assistive HCI-SGs for Parkinson’s Disease (PD) patients, in particular, are explored in the present work. Within this context, the Game-Based Learning (GBL) design framework is adopted here and its main game-design parameters are explored for the Exergames, Dietarygames, Emotional games, Handwriting games, and Voice games design, drawn from the PD-related i-PROGNOSIS Personalized Game Suite (PGS) (www.i-prognosis.eu) holistic approach. Two main data sources were involved in the study. In particular, the first one includes qualitative data from semi-structured interviews, involving 10 PD patients and four clinicians in the co-creation process of the game design, whereas the second one relates with data from an online questionnaire addressed by 104 participants spanning the whole related spectrum, i.e., PD patients, physicians, software/game developers. Linear regression analysis was employed to identify an adapted GBL framework with the most significant game-design parameters, which efficiently predict the transferability of the PGS beneficial effect to real-life, addressing functional PD symptoms. The findings of this work can assist HCI-SG designers for designing PD-related HCI-SGs, as the most significant game-design factors were identified, in terms of adding value to the role of HCI-SGs in increasing PD patients’ quality of life, optimizing the interaction with personalized HCI-SGs and, hence, fostering a collaborative human-computer symbiosis. (shrink)

Consent processes for clinical trials involving HIV prevention research have generated considerable debate globally over the past three decades. HIV cure/eradication research is scientifically more complex and consequently, consent processes for clinical trials in this field are likely to pose a significant challenge. Given that research efforts are now moving toward HIV eradication, stakeholder engagement to inform appropriate ethics oversight of such research is timely. This study sought to establish the perspectives of a wide range of stakeholders in HIV treatment (...) and research to inform consent processes for cure research. In total, 68 South African stakeholders participated in two qualitative research modalities. In-depth interviews were conducted with a purposive sample of 42 individuals - audiotaped with consent. Twenty-six stakeholders participated in three focus group discussions. Thematic analysis of transcribed IDIs and FGDs was conducted. The majority of respondents indicated that there could be unique challenges in HIV cure research requiring special attention. In particular, given the complexity of cure science, translation of concepts into lay language would be critical for potential participants to adequately appreciate risks and benefits in early phase research with experimental interventions. Furthermore, to aid understanding of risks and benefits against a background of desperation for a cure, specially trained facilitators would be required to assist with a psychological assessment prior to consent to avoid curative misconceptions. Long-term participant engagement to assess durability of a cure would mean that the consent process would be prolonged, necessitating annual re-consent. Building trust to maintain such long-term relationships would be critical to retain study participants. Unique consent requirements for cure research in South Africa would include significant efforts to maximise understanding of trial procedures, risks and the need for long-term follow-up. However, the psychological dimension of cure must not be underestimated. Beyond an understanding of cure science, the emotional impact of HIV cure advances the discourse from cure to healing. Consequently, the consent process for cure research would need to be enhanced to include psychological support and counselling. This has several important implications for research ethics review requirements for consent in HIV cure research. (shrink)

The Safe-by-Design approach in synthetic biology holds the promise of designing the building blocks of life in an organism guided by the value of safety. This paves a new way for using biotechnologies safely. However, the Safe-by-Design approach moves the bulk of the responsibility for safety to the actors in the research and development phase. Also, it assumes that safety can be defined and understood by all stakeholders in the same way. These assumptions are problematic and might actually undermine safety. (...) This research explores these assumptions through the use of a Group Decision Room. In this set up, anonymous and non-anonymous deliberation methods are used for different stakeholders to exchange views. During the session, a potential synthetic biology application is used as a case for investigation: the Food Warden, a biosensor contained in meat packaging for indicating the freshness of meat. Participants discuss what potential issues might arise, how responsibilities should be distributed in a forward-looking way, who is to blame if something would go wrong. They are also asked what safety and responsibility mean at different phases, and for different stakeholders. The results of the session are not generalizable, but provide valuable insights. Issues of safety cannot all be taken care of in the R&D phase. Also, when things go wrong, there are proximal and distal causes to consider. In addition, capacities of actors play an important role in defining their responsibilities. Last but not least, this research provides a new perspective on the role of instruction manuals in achieving safety. (shrink)

The aim of this note is to delineate some new systems of logic which govern the interconnections between two kinds of obligation: moral obligation and legal obligation . In consequence, we shall have in such a logic two kinds of forbideness of premission, and of indifference, but obviously definable in terms of the two obligation operators and negation.

There are unusual challenges in ethics for RAS. Perhaps the issue can best be summarised as needing to consider “technically informed ethics”. The technology of RAS raises issues that have an ethical dimension, and perhaps uniquely so due to the possibility of moving human decision-making which is implicitly ethically informed to computer systems. Further, if seeking solutions to these problems – ethically aligned design, to use the IEEE’s terminology – then the solutions must be technically meaningful, capable of realisation, capable (...) of assurance, and suitable as a basis for regulation. Thus, ethics for RAS is a rich, complex multi-disciplinary concern, and perhaps more complex than many other ethical issues facing society today. It is also fast-moving. This paper has endeavoured to give an accessible introduction to some of the key issues, noting that many of them are quite subtle, and it is not possible to do them full justice in such a short document. However, we have sought to counterbalance this by giving an extensive list of initiatives, standards, etc. that focus on ethics of RAS and AI, see Annex A. (shrink)

In [7] the authors of this paper argued in favor of the possibility to consider a Paraconsistent Approach to Quantum Superpositions. We claimed that, even though most interpretations of quantum mechanics attempt to escape contradictions, there are many hints -coming from present technical and experimental developments in QM- that indicate it could be worth while to engage in a research of this kind. Recently, Arenhart and Krause have raised several arguments against the PAQS [1, 2, 3]. In [11, 12] it (...) was argued that their reasoning presupposes a metaphysical stance according to which the physical representation of reality must be exclusively considered in terms of the equation: Actuality = Reality. However, from a different metaphysical standpoint their problems disappear. It was also argued that, if we accept the idea that quantum superpositions exist in a potential realm, it makes perfect sense to develop QM in terms of a paraconsistent approach and claim that quantum superpositions are contradictory, contextual existents. Following these ideas, and taking as a standpoint an interpretation in terms of the physical notions of power and potentia put forward in [10, 12, 15], we present a paraconsistent formalization of quantum superpositions that attempts to capture the main features of QM. (shrink)

Placebo-controlled surgical trials can provide important information about the efficacy of surgical interventions. However, they are ethically contentious as placebo surgery entails the risk of harms to recipients, such as pain, scarring or anaesthetic misadventure. This has led to claims that placebo-controlled surgical trials are inherently unethical. On the other hand, without placebo-controlled surgical trials, it may be impossible to know whether an apparent benefit from surgery is due to the intervention itself or to the placebo effect.

In this paper, I claim that the personal/subpersonal distinction is first and foremost a distinction between two kinds of psychological theory or explanation: it is only in this form that we can understand why the distinction was first introduced, and how it continues to earn its keep. I go on to examine the different ontological commitments that might lead us from the primary distinction between personal and subpersonal explanations to a derivative distinction between personal and subpersonal states. I argue that (...) on one of the most common metaphysical interpretations of the explanatory distinction, talk of a distinction between personal and subpersonal states simply makes no sense. When people insist on applying the personal/subpersonal terminology to psychological states, I allow that they are often making a genuine distinction, but one that it is best understood in terms of Stich's (1978) distinction between doxastic and subdoxastic states. I end the paper by considering some other common misinterpretations of the personal/subpersonal distinction, such as those involving consciousness, normativity, or autonomy. (shrink)

This paper presents a case for the decriminalisation of abortion in Britain in light of the increasing investigations into people experiencing pregnancy loss and prosecutions of those suspected of illegal abortion. This growing enforcement of the criminal abortion offences has coincided with the legal change to allow the home use of abortion pills through telemedicine, and comes in the context of global backlash against abortion rights. Framing abortion as a necessary healthcare service and human right, this paper demonstrates the harms (...) caused by criminalisation and highlights how the law exacerbates socio-economic and other vulnerabilities. It is later illegal abortions that tend to be prosecuted, and while there are complex reasons as to why someone might require an abortion, the law prohibits abortion beyond 24 weeks except for narrow medical reasons, creating crisis situations for those that find themselves without legal access. Decriminalisation is necessary to move away from this culture of suspicion, hostility, and stigma that has been built around abortion. (shrink)

This critical review of the literature examines recovery from borderline personality disorder to inform a deeper understanding, identifying supports and barriers to recovery, through the exploration of historical and socio-political influences. It critically evaluates research literature for the effectiveness of recovery concept implementation. This review presents the strengths of current evidence and suggestions for future considerations to better support the recovery of whaiora (people seeking wellness) by taking concepts of connection, empowerment, hope, identity and meaning-making, and interweaving them with aspects (...) of established therapies, such as Dialectal Behaviour Therapy, focussing on interpersonal effectiveness, distress tolerance, creating a life worth living, the reconstruction of stable self-image and the use of mindfulness practice. The focus is on developing interventions and responses that support self-management. (shrink)

The past twenty years have seen an increase in the importance of the body in psychology, neuroscience, and philosophy of mind. This 'embodied' trend challenges the orthodox view in cognitive science in several ways: it downplays the traditional 'mind-as-computer' approach and emphasizes the role of interactions between the brain, body, and environment. In this article, I review recent work in the area of embodied cognitive science and explore the approaches each takes to the ideas of consciousness, computation and representation. Finally, (...) I look at the current relationship between orthodox cognitive science and the study of mental disorder, and consider the implications that the embodied trend could have for issues in psychopathology. (shrink)

PurposeThe purpose of this paper is to highlight the potential of digital tools to address the significant challenge of increasing access to college and outline challenges and opportunities in effectively implementing a digital intervention across an entire school.Design/methodology/approachThe study encompasses a randomized control trial and comparative case studies. This paper highlights qualitative data focused on implementation.FindingsFindings illustrate impediments and strategies for implementing a school-wide digital intervention.Research limitations/implicationsResearch focused on one particular intervention and is thus limited in scope.Practical implicationsThe study has (...) the potential to assist practitioners in better serving students from low-income and minoritized communities through digital tools.Social implicationsThe study has implications for increasing the number of first-generation and minoritized youth who apply to and enroll in college. The study highlights digital equity issues often overlooked in ed-tech sectors.Originality/valueFew studies exist that examine the implementation of digital interventions at the school level. Focusing on digital equity in the college access space (academic and practice) is novel. (shrink)

El presente trabajo tuvo por objetivo, conocer el peso que los adolescentes confieren a las habilidades emocionales para su desempeño personal.Los resultados mostraron que los adolescentes privilegian las capacidades emocionales y sociomorales. Se presentan también experiencias de incorporación de acciones de educación emocional en el currículo docente.

This article offers a survey of the recently discovered scrapbooks collated over a number of decades by the Yorkshirewoman Dorothy Richardson. The large set of thirty-five volumes presents an important collection of press cuttings relating to the history and consequences of the French Revolution, and also contains ‘historical and miscellaneous’ material of a more eclectic nature. I argue that the texts significantly improve our understanding of Dorothy Richardson’s position as a reader, writer and researcher working in the North of England (...) at the turn of the nineteenth century. Furthermore, her set of albums raises important questions about the relationship between commonplacing and scrapbooking practices, and the capacity of such textual curatorship to function as a form of both political engagement and autobiographical expression. (shrink)

was to test the role of both early and higher visual areas in the integration of local features into global shapes. To this end, we conducted functional magnetic resonance imaging studies. Although fMRI lacks the high spatial resolution of intracortical recordings, it allows simultaneous collection of responses to the same stimulus set from multiple visual areas that is not possible with standard recording techniques. We performed these studies in monkeys, where much is known about the properties of neurons in different (...) visual areas, and in humans, where recent fMRI.. (shrink)

This paper explores the relationship between several ideas about the mind and cognition. The hypothesis of extended cognition claims that cognitive processes can and do extend outside the head, that elements of the world around us can actually become parts of our cognitive systems. It has recently been suggested that the hypothesis of extended cognition is entailed by one of the foremost philosophical positions on the nature of the mind: functionalism, the thesis that mental states are defined by their functional (...) relations rather than by their physical constituents. Furthermore, it has been claimed that functionalism entails a version of extended cognition which is sufficiently radical as to be obviously false. I survey the debate and propose several ways of avoiding this conclusion, emphasizing the importance of distinguishing the hypothesis of extended cognition from the related notion of the extended mind. (shrink)

Many models of cognitive ability and disability rely on the idea of cognition as abstract reasoning processes implemented in the brain. Research in cognitive science, however, emphasizes the way that our cognitive skills are embodied in our more basic capacities for sensing and moving, and the way that tools in the external environment can extend the cognitive abilities of our brains. This chapter addresses the implications of research in embodied cognition and extended cognition for how we think about cognitive impairment (...) and rehabilitation, how cognitive reserve mitigates neural impairment, and the distinction between medical and social models of disability. (shrink)

Daniel Dennett's distinction between personal and subpersonal explanations was fundamental in establishing the philosophical foundations of cognitive science. Since it was first introduced in 1969, the personal/subpersonal distinction has been adapted to fit different approaches to the mind. In one example of this, the ‘Pittsburgh school’ of philosophers attempted to map Dennett's distinction onto their own distinction between the ‘space of reasons’ and the ‘space of causes’. A second example can be found in much contemporary philosophy of psychology, where Dennett's (...) distinction has been presumed to be equivalent to Stephen Stich's distinction between doxastic and subdoxastic states. Both these interpretations of the personal/subpersonal distinction, and also Dennett's own philosophical views of the mind, go beyond the personal/subpersonal distinction itself. They each involve supplementing the distinction between personal and subpersonal explanations with metaphysical claims about the relationship between the two kinds of explanation and the entities they posit. (shrink)

The Declaration of Geneva is one of the core documents of medical ethics. A revision process was started by the World Medical Association in 2016. The WMA has also used this occasion to examine how the Declaration of Geneva is used in countries throughout the world by conducting a survey of all WMA constituent members. The findings are highly important and raise urgent questions for the World Medical Association and its National Medical Associations : The Declaration of Geneva is only (...) rarely used as an oath text despite the fact that physicians’ oaths are generally widespread. This is not consistent with the intention and claim of the Declaration of Geneva. The article then discusses three questions. Should there be one single binding oath? Which organization should be responsible for such an oath? Which oath is the most obvious candidate? In a globalized world and despite all cultural diversity, the medical profession should have one core moral basis which is binding for physicians all over the world. The most obvious candidate for an oath incorporating this moral basis is the Declaration of Geneva. (shrink)

Many philosophers subscribe to the view that philosophy is a priori and in the business of discovering necessary truths from the armchair. This paper sets out to empirically test this picture. If this were the case, we would expect to see this reflected in philosophical practice. In particular, we would expect philosophers to advance mostly deductive, rather than inductive, arguments. The paper shows that the percentage of philosophy articles advancing deductive arguments is higher than those advancing inductive arguments, which is (...) what we would expect from the vantage point of the armchair philosophy picture. The results also show, however, that the percentages of articles advancing deductive arguments and those advancing inductive arguments are converging over time and that the difference between inductive and deductive ratios is declining over time. This trend suggests that deductive arguments are gradually losing their status as the dominant form of argumentation in philosophy. (shrink)

As many studies around the theme of ‘too much medicine’ attest, investigations are being ordered with increasing frequency; similarly the threshold for providing treatment has lowered. Our contention is that trust is a significant factor in influencing this, and that understanding the relationship between trust and investigations and treatments will help clinicians and policymakers ensure ethical decisions are more consistently made. Drawing on the philosophical literature, we investigate the nature of trust in the patient–doctor relationship, arguing that at its core (...) it involves a transfer of discretion. We show that there is substantial empirical support for the idea that more trust will reduce the problem of too much medicine. We then investigate ways in which trust can be built, concentrating on issues of questioning, of acknowledging uncertainty and of shouldering responsibility for it. We argue that offering investigations or treatments as a way of generating trust may itself be an untrustworthy way of proceeding, and that healthcare systems should provide the institutional support for facilitating continuity, questioning and the entrusting of uncertainty. (shrink)

Perceptual experiences are not immediately responsive to reasons. You see a stick submerged in a glass of water as bent no matter how much you know about light refraction. Due to this isolation from reasons, perception is traditionally considered outside the scope of epistemic evaluability as justified or unjustified. Is perception really as independent from reasons as visual illusions make it out to be? I argue no, drawing on psychological evidence from perceptual learning. The flexibility of perceptual learning is a (...) way of responding to new epistemic reasons. The resulting perceptual experiences are epistemically evaluable as justified or unjustified. (shrink)

The role of audiences in mathematical proof has largely been neglected, in part due to misconceptions like those in Perelman and Olbrechts-Tyteca which bar mathematical proofs from bearing reflections of audience consideration. In this paper, I argue that mathematical proof is typically argumentation and that a mathematician develops a proof with his universal audience in mind. In so doing, he creates a proof which reflects the standards of reasonableness embodied in his universal audience. Given this framework, we can better understand (...) the introduction of proof methods based on the mathematician’s likely universal audience. I examine a case study from Alexander and Briggs’s work on knot invariants to show that we can fruitfully reconstruct mathematical methods in terms of audiences. (shrink)

Language provides rich social information about its speakers. For instance, adults and children make inferences about a speaker's social identity, geographic origins, and group membership based on her language and accent. Although infants prefer speakers of familiar languages, little is known about the developmental origins of humans’ sensitivity to language as marker of social identity. We investigated whether 9-month-olds use the language a person speaks as an indicator of that person's likely social relationships. Infants were familiarized with videos of two (...) people who spoke the same or different languages, and then viewed test videos of those two individuals affiliating or disengaging. Results suggest that infants expected two people who spoke the same language to be more likely to affiliate than two people who spoke different languages. Thus, infants view language as a meaningful social marker and use language to make inferences about third-party social relationships. (shrink)

In this issue of the Journal of Medical Ethics arguments are cogently made that sustainability and solidarity should be considered as core medical ethical principles, and that more explicit attention should be given to the complex context in which a decision is made.

Forms of life produce ways of suffering through the figuration of the experience of suffering within aesthetic contexts. Aesthetic experiences give “figure” to embodied experiences of suffering. Figures are not clearly outlined shapes but rather are gestural indications that are dynamically influential. Friedrich Nietzsche, in The Birth of Tragedy, deploys several “figures” of suffering, through the characters of Dionysus, Apollo, and Silenus. This article is organized into three parts. Section one articulates Nietzsche’s interpretation of Dionysus and Apollo, with a focus (...) on their connection to the problem of suffering. Section two argues that these figures do not sufficiently reply to the problem of suffering, thereby creating a new problem of suffering, which challenges traditional theodicy. Section three explores Nietzsche’s interpretation of the wisdom of Silenus. From these analyses, I argue that aesthetic contexts produce interpretations of suffering that potentially yield affective reorientation toward the meaninglessness of suffering and its challenge to a flourishing, life-affirming life. It achieves this by interpreting suffering within the space not of argument against life’s inherent goodness, but as, terribly, a part of it. (shrink)

Individuals with chronic pain often experience co-existing sleep problems and depression-related states. Chronic pain, sleep problems, and depression interrelate, and have been shown to exacerbate one another, which negatively impacts quality of life. This study explored the relationships between pain severity, pain interference, sleep quality, and depression among individuals with chronic pain. Secondly, we tested whether sleep quality may moderate the relationship between pain and depression. A cross-sectional survey was completed by 1,059 adults with non-malignant chronic pain conditions and collected (...) measures related to pain severity, pain interference, sleep quality, and depression. Multiple regression analyses found that pain severity, pain interference, and sleep quality are all significantly associated with depression. Secondly, moderated regression analyses revealed that sleep quality moderates the relationship between pain interference and depression among individuals with chronic pain such that good sleep quality attenuates the effect of pain interference on depression, and poor sleep quality amplifies the effect of pain interference on depression. These findings suggest that sleep quality may be a relevant therapeutic target for individuals with chronic pain and co-existing depression. (shrink)

Self-understanding is to a great extent defined by narrative: who we are as human beings is determined by the stories we, and others, tell about ourselves. Yet many are unable to compose coherent personal narratives, as their experiences do not fall within the scope of an accepted conceptual framework. Survivors of trauma are particularly apt to fall into this “narrative rift,” where there can be no words to describe, and hence can be no assimilation of, their experiences. Using the example (...) of child sexual abuse, and drawing on the work of Bass, Spence, Schafer, and Guignon, I propose an examination of the nature of narrative fragmentation itself. Philosophical counselling may succeed where psychoanalysis might not: for where the latter has theoretical commitments to specific narratives, the former, through its reluctance to force epistemological or metaphysical assumptions on the narrator, may well facilitate a more comprehensive self-understanding. (shrink)