Valuing life and evaluating suffering in infants with life-limiting illness

Theoretical Medicine and Bioethics - In this paper, we explore three separate questions that are relevant to assessing the prudential value of life in infants with severe life-limiting illness....     

Walden two: The morality of anarchy

The utopian label is often pinned on calls for comprehensive change as a means of dismissing them from serious consideration.... [S]ocial orders come and go, and those who indulge in utopian thinking may be more prepared for... the inevitability of widespread societal transformation.... Keeping utopia in mind can prevent our settling for minor reforms when more significant change might be possible. (Fox, 1985, p. 55)When... I called myself a benign anarchist... someone said that that was not like the dictatorship of Walden Two. But Walden Two was anarchistic.... The functions delegated to [authority figures] in the world at large were performed by the people themselves through face-to-face commendation and censure. (Skinner, 1983, p. 426, emphasis his)The issue for anarchists is not whether there should be structure or order, but what kind there should be and what its sources ought to be. The individual or group which has sufficient liberty to be self-regulating will have the highest degree of order; the imposition of order from above and outside induces resentment and rebellion where it does not encourage childlike dependence and impotence, and so becomes a force for disorder. (Barclay, 1982, p. 17).     

The pretense of psychology as science: The myth of mental illness in Statu Nascendi

If I was profoundly shocked by the Varieties [of Religious Experience, by William James], that was not because some of the facts described in it were such as I would rather not hear about. They were, on the whole, amusing. Nor was it because I thought James was doing his work clumsily. I thought he did it very well. It was because the whole thing was a fraud.... Psychology... regarded as the science of the mind, is not a science. It is what “phrenology” was in the early nineteenth century, and astrology and alchemy in the Middle Ages and the sixteenth century: the fashionable scientific fraud of the age.... There were, I held, no merely moral actions, no merely political actions, and no merely economic actions. Every action was moral, political, and economic.     

The pretense of psychology as science: The myth of mental illness in Statu Nascendi

If I was profoundly shocked by the Varieties [of Religious Experience, by William James], that was not because some of the facts described in it were such as I would rather not hear about. They were, on the whole, amusing. Nor was it because I thought James was doing his work clumsily. I thought he did it very well. It was because the whole thing was a fraud.... Psychology... regarded as the science of the mind, is not a science. It is what “phrenology” was in the early nineteenth century, and astrology and alchemy in the Middle Ages and the sixteenth century: the fashionable scientific fraud of the age.... There were, I held, no merely moral actions, no merely political actions, and no merely economic actions. Every action was moral, political, and economic.     

Legal procedures in Wanglie: a two-step, not a sidestep

Hospital policies...have a very limited role in addressing the substantive issue of authority with regard to nonbeneficial therapies. First, they could not be limited, as Mishkin suggests, to persons in a persistent vegetative state. Nonbeneficial therapies encompass many other scenarios including ineffective cancer chemotherapy or open-heart surgery on profoundly demented persons. Second, I am not convinced that families or patients could be meaningfully informed of the specific relevance of such policies to their care in advance of a dispute. Most importantly, the view that such policies are required as a foundation to withhold nonbeneficial therapy implies that patients otherwise have a new right to command the provision of nonbeneficial therapies....It may well be judicially preferable to ask directly for declarative relief from a duty to provide a treatment, as Mishkin suggests. I am not convinced that such an approach would be "ethically" superior....Third, the novel, declarative approach directly risks a precedent that would affirm the family's right to demand futile therapy....Ultimately, when public policy on this kind of dispute is clearer, a declarative strategy may well be preferable. For now, the Wanglie case has outlined the fundamental issues of this novel legal question and has generated a fruitful discussion of a complex issue in patient care and public policy.     

Memory for questions and amount of processing

Two experiments were carried out on how questions are remembered. Subjects watched a videotape of a series of simple events and then answered 18 questions about these events. The questions were all of the same general syntactic form (e.g., “Did the pencil fall against the jug on A?”, where A refers to a particular location). They were designed to elicit three sorts of answer: “yes,” “no” because the event took place at another location, and “no” because the event did not take place at all. After the subjects had answered the questions, they were given an unexpected test of their ability to recall them. A difference in the memorability of the questions was predicted on the basis of a procedural theory of comprehension and a hypothesis about memory subjects should cease to process a question when they realize that it concerns an event that did not take place, and such questions should be harder to remember because they are processed to a lesser degree than the other sorts of question. Experiment 1 confirmed the predictions, but its results in part could be accounted for by assuming that subjects recalled the original events and used them as a cue to remembering the questions. Experiment 2 eliminated this explanation by showing that when subjects do not have to answer certain questions, their recall of them is very poor. However, the same differences in the memorability of the three sorts of question were obtained for both answered and unanswered questions.     

Saying and believing: the norm commonality assumption

Philosophical Studies - One very popular assumption in the epistemological literature is that belief and assertion are governed by one and the same epistemic norm. This paper challenges this claim....     

Who or what is the preembryo?

...The moral status -- and specifically the controversial issue of personhood -- is related to attainment of developmental individuality...This contrasts with the view that holds that personhood occurs earlier, at the point of genetic uniqueness. I believe that an embryo that has developed to the point where it can be one individual and one individual only, differs in moral status from a preembryo that has not, even if in many cases we may choose to treat them similarly...In view of the conviction that the preembryo is not yet a person and that its statistical potential for becoming such is small, it is not clear that nontherapeutic experiments can be excluded in principle. However, because the preembryo does have intrinsic potential...the preembryo should be treated as a person...Any exceptions from the prima facie duty to treat the preembryo as a person should be based on criteria established at the national level....     

Some problems with cost-benefit analysis in health care

...Arnold's article is very ambitious. He suggests rules that could be followed in order to decide whether health care should be rationed. He notes that explicit assessments of costs and benefits using the same monetary unit are rarely used. The main reason, it seems to me, is that the method of cost-benefit analysis is relatively difficult to apply in the context of health care. Arnold does not address the difficulties that are related to his approach. Thus, my impression is that the interest of his provocative article lies more in its ability to foster a useful debate than in the methodology itself. In this brief commentary, I will merely list some of the theoretical problems that occurred to me while reading this article....     

Chronic illness: not-so-passive injustice?

Why is our system, which is so biased toward the provision of acute care, underserving the chronically ill?...I think the main reason...has to do with the difficulty of providing for the needs of the chronically ill through a system of largely employment-based private insurance. People who are chronically ill are likely to drop out of employment: they are not a group that employment-based insurance is intended to serve or that employers have an interest in serving....I do not believe we can shift the focus of organization of services for the chronically ill to home or family, as Douard suggests, without reforming the insurance system....     

面孔识别中脑电成分N170的研究概述

N170是在面孔刺激呈现后的130-200ms记录到的并在160~170ms时达到峰值的一种脑电负成分。目前, 在N170的研究中存在争议性的问题有：N170反映面孔结构编码还是面孔特征编码; N170是否是面孔特异性成分; 以及N170是否受注意的影响等。这些争议也为N170后续研究指明了方向, 即探讨结构编码和特征编码在诱发N170成分上起着怎样的作用; 比较不同熟悉度的刺激材料所诱发的N170反应差异; 探讨N170成分与识别电位间的关系;采用多研究方法的结合从不同层面深入揭示N170的认知机制。     

Questions of scientific responsibility: the Baltimore case

A number of cases of questionable behavior in science have been extensively reported in the media during the last two or three years. What standards are upheld by the scientific community affect the community internally, and also affect its relations with society at large, including Congress. Here I wish to address questions of scientific responsibility, using the Baltimore case as a concrete instance where they came up. The first part containing historical background is necessary to provide readers with documentation so that they can have some factual bases on which to evaluate respective positions and my conclusions that follow -- based on further but more succinctly summarized documentation. I have reproduced many quotes because I firmly believe people are entitled to be represented by their own wording. Conversely, I hold people accountable for their official positions. Some of these are reproduced in footnotes, and some longer ones are reproduced in appendices. I also do not ask to be trusted. By providing numerous references, I hope that readers who find my documentation insufficient can follow up by looking up these references.... The article is in six parts: Part I. Historical Background. This part gives mostly a historical background of the early phases of the Baltimore case. Part II. The First Issue of Responsibility. This part presents a discussion of certain scientific responsibilities based on that background, specifically: the responsibility of answering questions about one's work, and the responsibility whether to submit to authority. Part III. The NIH Investigations. This part summarizes the two NIH investigations. Part IV. The Dingell Subcommittee. This part deals with the responsibilities of a Congressional Committee vis-à-vis science. Part V. Further Issues of Responsibility. This part goes into an open ended discussion of many issues of responsibility facing scientists, vis-à-vis themselves and vis-à-vis society at large, including Congress. The list is long, and readers can look at the section and paragraph headings to get an idea of their content. Part VI. Personal Credibility, a Shift at the Grass Roots, and Baltimore's Persistence.     

Is ecology an ‘alternative’ natural science?

This article discusses whether ecology represents an alternative type of natural science, that is normatively committed. Central questions are:-how man and human action are integrated into the subject matter of ecology;-whether evaluative concepts like health are incorporated into the conceptual structure of ecology; and-whether ecology transcends the image of natural knowledge as control of nature.It is concluded that all hypotheses of ecology being inherently judgmental in character must be rejected.Like all the healing arts, ecology is through and through judgmental in character. It cannot be value-neutral.... What violates the natural harmony must be condemned; what enhances it be endorsed.... Ecology is the closest our science has yet come to an integrative wisdom. It, not physics, deserves to become the basic science of the future.     

From Metaphysical to Substantive Naturalism: A Case Study

This paper addresses two related questions. First, what is involved in giving a distinctively realist and naturalist construal of an area of discourse, that is, in so much as stating a distinctively realist and naturalist position about, for example, content or value? I defend a condition that guarantees the realism and naturalism of any position satisfying it, at least in the case of positions on content, but perhaps in other cases as well. Second, what sorts of considerations render a distinctively realist and naturalist position more plausible than its irrealist and non-naturalist rivals? The answer here focuses again on theories of content and is wholly negative. I argue that the standard array of arguments offered in support of realist and naturalist theories in fact provide equal support for a host of irrealist and non-naturalist ones. Taken together, these considerations reveal an important gap in the recent philosophical literature on content. The challenge to proponents of putatively realist and naturalist theories is to insure that those theories so much as state distinctively realist and naturalist positions and then to identify arguments that support what is distinctively realist and naturalist about them.

... the deepest motivation for intentional irrealism derives ... from a certain ontological intuition: that there is no place for intentional categories in a physicalistic view of the world; that the intentional can't be naturalized.'' Fodor (1987, p. 97).

``Realists about representational states ... must ... have some view about what it is for a state to be representational ....

Well, what would it be like to have a serious theory of representation? Here there is some consensus to work from. The worry about representation is above all that the semantic (and/or intentional) will prove permanently recalcitrant to integration in the natural order ... ''Fodor (1990, p. 32).

     

Is health-care delivery by partially trained professionals ever morally justified?

...teaching institutions should establish policies for all aspects of care provided by residents-in-training (not just for the acquisition of informed consent to treatment) and establish mechanisms to monitor how these policies are implemented and their effect on the quality of patient care and patient satisfaction with care. Clear policy on which treatments are provided by junior residents and which treatments and aspects of care are provided by senior residents is necessary for patients and their families to have control over what happens to them in the health-care institution....Teaching institutions should regularly assess whether residents are being asked to take on more responsibilities in patient care than they are prepared to do. The reasons to do this are not solely related to protecting the patient from harm. Protecting the residents-in-training from overwhelming guilt, fear, and providing them with a more humane approach to medical education should be a minimal expectation for the training of those who will be expected to provide humane care to others....     

Studying for autonomous reasons and having a promotion orientation: key predictors of individual differences in expectancies of success in English

This research used the expectancy-value theory to examine the extent to which three classes of motivation antecedents predicted secondary-school students’ expectancies of success in English....     

Caring: from philosophical concerns to practice

I read Hilde L. Nelson's article with great interest. To be "against caring" is tantamount to being against apple pie and motherhood. Caring as philosophy, theory, behavior, and ontology is pervasive in the literature of almost all socially interactive professions. Nelson's article raises common concerns about caring....My difficulties with Nelson's argument against caring center around three issues: misunderstanding of caring in nursing practice, discomfort with ambiguity, and heroism as a replacement for the ethics of care....     

Ethics is everybody's business, especially in regard to confidentiality

...Every hospital needs a policy statement devoted to confidentiality. This task is a good assignment for a hospital ethics committee. In drafting such a statement, one area that should not be overlooked is respect for confidentiality in cases used for teaching, patient conferences, and interdisciplinary meetings, including the teaching of clinical ethics! The University of Virginia's (UVA) Hospital Ethics Committee is considering a new policy statement on confidentiality....     

Welcoming Robots into the Moral Circle: A Defence of Ethical Behaviourism

Science and Engineering Ethics - Can robots have significant moral status? This is an emerging topic of debate among roboticists and ethicists. This paper makes three contributions to this debate....     

Intensionality: What are Intensional Transitives?: Jennifer Saul

This paper discusses the question of which verbs are intensional transitives. In particular, I ask which verbs Forbes should take to be intensional transitives. I argue that it is very difficult to arrive at a clear and plausible understanding of what an intensional transitive is— making it difficult to answer these questions. I end by briefly raising some questions about the usefulness of the category of intensional transitives.