The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current (...) way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

Milk contains a prominently beneficial nutritional value. Amino acids, fats, carbohydrates, vitamins, and also minerals can be found in it. Therefore, consuming it has an important role in children’s diet. Calcium is one of its most significant components, which is indispensable for bones and teeth, and for normal activity of muscle and nervous system, and also for controlling clotting processes. This manuscript reviews the key nutritional values of milk, and then determines some consumption recommendations for milk and dairy products, which (...) might support creating children’s proper diet, and also maintain their growth and calcium balance. (shrink)

As COVID-19 emerged as a phenomenon of the total environment, and despite the intertwined and complex relationships that make humanity an organic part of the Bio- and Geospheres, the majority of our responses to it have been corrective in character, with few or no consideration for unintended consequences which bring about further vulnerability to unanticipated global events. Tackling COVID-19 entails a systemic and precautionary approach to human-nature relations, which we frame as regaining diversity in the Geo-, Bio-, and Anthropospheres. Its (...) implementation requires nothing short of an overhaul in the way we interact with and build knowledge from natural and social environments. Hence, we discuss the urgency of shifting from current to precautionary approaches to COVID-19 and look, through the lens of diversity, at the anticipated benefits in four systems crucially affecting and affected by the pandemic: health, land, knowledge and innovation. Our reflections offer a glimpse of the sort of changes needed, from pursuing planetary health and creating more harmonious forms of land use to providing a multi-level platform for other ways of knowing/understanding and turning innovation into a source of global public goods. These exemplary initiatives introduce and solidify systemic thinking in policymaking and move priorities from reaction-based strategies to precautionary frameworks. (shrink)

This is an excerpt of a report that highlights and explores five questions which arose from The Unity of Consciousness and Sensory Integration conference at Brown University in November of 2011. This portion of the report explores the question: Are some of the basic units of consciousness multimodal?

Ambient assisted living technologies are increasingly presented and sold as essential smart additions to daily life and home environments that will radically transform the healthcare and wellness markets of the future. An ethical approach and a thorough understanding of all ethics in surveillance/monitoring architectures are therefore pressing. AAL poses many ethical challenges raising questions that will affect immediate acceptance and long-term usage. Furthermore, ethical issues emerge from social inequalities and their potential exacerbation by AAL, accentuating the existing access gap between (...) high-income countries and low and middle-income countries. Legal aspects mainly refer to the adherence to existing legal frameworks and cover issues related to product safety, data protection, cybersecurity, intellectual property, and access to data by public, private, and government bodies. Successful privacy-friendly AAL applications are needed, as the pressure to bring Internet of Things devices and ones equipped with artificial intelligence quickly to market cannot overlook the fact that the environments in which AAL will operate are mostly private. The social issues focus on the impact of AAL technologies before and after their adoption. Future AAL technologies need to consider all aspects of equality such as gender, race, age and social disadvantages and avoid increasing loneliness and isolation among, e.g. older and frail people. Finally, the current power asymmetries between the target and general populations should not be underestimated nor should the discrepant needs and motivations of the target group and those developing and deploying AAL systems. Whilst AAL technologies provide promising solutions for the health and social care challenges, they are not exempt from ethical, legal and social issues. A set of ELSI guidelines is needed to integrate these factors at the research and development stage. (shrink)

Durch genomweite Analysen werden vielfältige gesundheitsrelevante Informationen über eine Person gewonnen. Solche Informationen können die Behandlung von Krankheiten verbessern. Sie ermöglichen aber auch Vorhersagen, ob eine Person und deren Verwandte in Zukunft möglicherweise erkranken werden. Der neuartige Charakter des Informationseingriffs und sein prädiktive Potential bedürfen der ethischen, juristischen und ökonomischen Reflexion, damit diese Technologie zum Wohl der Patienten, der Familienangehörigen und der Solidargemeinschaft eingesetzt werden kann. Die vorliegende Schrift leistet mit ihren interdisziplinären, vom BMBF finanzierten Analysen dazu einen Beitrag. Grundlagen (...) für einen ethisch und juristisch verantwortbaren Einsatz der Genomsequenzierung zu medizinischen Zwecken werden erörtert und Eckpunkte für Kostenanalysen sowie Elemente einer “Guten klinischen Praxis” präsentiert. (shrink)

This report highlights and explores five questions which arose from The Unity of Consciousness and Sensory Integration conference at Brown University in November of 2011: 1. What is the relationship between the unity of consciousness and sensory integration? 2. Are some of the basic units of consciousness multimodal? 3. How should we model the unity of consciousness? 4. Is the mechanism of sensory integration spatio-temporal? 5. How Should We Study Experience, Given Unity Relations?

This is an excerpt of a report that highlights and explores five questions which arose from The Unity of Consciousness and Sensory Integration conference at Brown University in November of 2011. This portion of the report explores the question: Is the mechanism of sensory integration spatio-temporal?

This is an excerpt of a report that highlights and explores five questions which arose from The Unity of Consciousness and Sensory Integration conference at Brown University in November of 2011. This portion of the report explores the question: How should we model the unity of consciousness?

This is an excerpt of a report that highlights and explores five questions which arose from The Unity of Consciousness and Sensory Integration conference at Brown University in November of 2011. This portion of the report explores the question: How should we study experience, given unity relations?

Molnar argues that the problem of truthmakers for negative truths arises because we tend to accept four metaphysical principles that entail that all negative truths have positive truthmakers. This conclusion, however, already follows from only three of Molnar´s metaphysical principles. One purpose of this note is to set the record straight. I provide an alternative reading of two of Molnar´s principles on which they are all needed to derive the desired conclusion. Furthermore, according to Molnar, the four principles may be (...) inconsistent. By themselves, however, they are not. The other purpose of this note is to propose some plausible further principles that, when added to the four metaphysical theses, entail a contradiction. (shrink)

The paper aims to elucidate in better detail than before the dispute about whether or not dispositional monism—the view that all basic properties are pure powers—entails a vicious infinite regress. Particular focus is on Alexander Bird's and George Molnar's attempts to show that the arguments professing to demonstrate a vicious regress are inconclusive because they presuppose what they aim to prove, notably that powers are for their nature dependent on something else. I argue that Bird and Molnar are mistaken. It (...) is true that dispositional monism is popularly assumed to characterize powers as dependent entities, but this is not what the arguments aim to prove. They merely aim to demonstrate that it would be absurd to assume that all properties are dependent in this way. Finally, it is argued that there is an unresolved tension in Bird's and Molnar's accounts of powers. They characterize them as being for their nature dependent on the manifestations that they are for, and yet ontologically independent of those same manifestations. Until that tension is resolved, their accounts are not equipped to remove the threat of vicious regress. (shrink)

Powers are popularly assumed to be distinct from, and dependent upon, inert qualities, mainly because it is believed that qualities have their nature independently of other properties while powers have their nature in virtue of a relation to distinct manifestation property. George Molnar and Alexander Bird, on the other hand, characterize powers as intrinsic and relational. The difficulties of reconciling the characteristics of being intrinsic and at the same time essentially related are illustrated in this paper and it is argued (...) that the reasons for thinking of powers as essentially relational are based on misguided epistemological consideration. Finally, I present a way of thinking of fundamental properties as primitive natures that we can only understand in virtue of what they do but which we should not think of as being ontologically constituted by these doings. According to this view, properties are both qualities and powers. (shrink)

This article considers the question ‘What makes hope rational?’ We take Adrienne Martin’s recent incorporation analysis of hope as representative of a tradition that views the rationality of hope as a matter of instrumental reasons. Against this tradition, we argue that an important subset of hope, ‘fundamental hope’, is not governed by instrumental rationality. Rather, people have reason to endorse or reject such hope in virtue of the contribution of the relevant attitudes to the integrity of their practical identity, which (...) makes the relevant hope not instrumentally but intrinsically valuable. This argument also allows for a new analysis of the reasons people have to abandon hope and for a better understanding of non-fundamental, ‘prosaic’ hopes. (shrink)

Some philosophers working on the metaphysics of agency argue that if agency is understood in terms of settling the truth of some matters, then the power required for the exercise of intentional agency is an irreducible two-way power to either make it true that p or not-p. In this paper, the focus is on two-way powers in decision-making. Two problems are raised for theories of decision-making that are ontologically committed to irreducible two-way powers. First, recent accounts lack an adequate framework (...) for explaining decisions by the reasons of agents. Second, accepting ontologically irreducible two-way powers into one’s metaphysic of agency implies an ontological commitment to substance dualism. An ontologically less-costly alternative to irreducible two-way powers is offered. It is argued that a reductive account of two-way powers in terms of what George Molnar called “derivative powers” should be accepted. The reductive account can provide us with the truthmakers for talk about two-way powers. Moreover, the reductive account does not share the liabilities of accepting irreducible two-way powers. (shrink)

Whereas the Humean accounts of causality in terms of contiguity, temporal priority, constant conjunction, and contingency face difficulties of one sort, the dispositional explanations of causality in terms of reciprocity, simultaneity, ubiquity, and holism seem to meet difficulties of another sort. But the difficulties which dispositionalism faces may be dissipated if one can appeal consistently to the logic of naturalism, rather than to the grammar of an implicit dualism, for example, as it is illustrated when G. Molnar tried to advance (...) the analogy between the mental intentionality and the physical intentionality.The notion of integration is taken to allow a conceptual space for naturalism of one kind. It may be expressed in the thesis that there is integrationality in any entity like dispositions, such that the integrationality is a power to realize the embedded objective of it in the context where it interacts with all others. The thesis would help to see how dispositions can be intentional, how the no... (shrink)

In the intersection between eugenics past and present, disability has never been far beneath the surface. Perceived and ascribed disabilities of body and mind were one of the core sets of eugenics traits that provided the basis for institutionalized and sterilization on eugenic grounds for the first 75 years of the 20th-century. Since that time, the eugenic preoccupation with the character of future generations has seeped into what have become everyday practices in the realm of reproductive choice. As Marsha Saxton (...) (2000) and Adrienne Asch (2000, 2003) have forcefully argued, the use of prenatal screening technologies to facilitate the selective abortion of fetuses with features that signify disabling traits—the paradigm here being trisomy 21 in a fetus indicating Down Syndrome in the child—express a negative view of such disabilities sufficient to warrant terminating an otherwise wanted pregnancy. The eliminative structure of what Rosemary Garland Thompson (2012) has called eugenic logic persists in contemporary practices governing reproductive choice, social inclusion, and democratic participation and their relationship to disability. The tie between eugenics and contemporary disability studies suggests that eugenics and reflection on its history can also play a more positive role in disability politics. After focusing on eugenics in the first half of the paper, we will shift in the second half of the paper to eugenic resonances in contemporary thought and practice, concluding with some thoughts about ongoing practices of silencing and the very idea of eradicating disability. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Affect Attunement in the Caregiver-Infant Relationship and Across SpeciesExpanding the Ethical Scope of ErosCynthia WillettCompelling glimpses into the ethical capacities of our animal kin reveal new possibilities for ethical relationships encompassing humans with other animal species. Consider the remarkable report of a female bonobo in a British zoo who assists a bird found in her cage by retrieving the fallen bird, and spreading its wings so that this fellow (...) creature might fly away to its freedom. Or the report of a cat in a nursing home who curls up around dying elderly patients, and remains steadily by their side as they, unbeknownst to the medical personnel, pass away.1 Or of a sacred moment of silence by a stream for baboons in East Africa.2 Or of the ethics that spontaneously emerges among wolves at play.3 On the basis of extensive studies, biologist Frans de Waal argues that such anecdotes are far from rare, and that some core elements of moral understanding and compassion occur among a significant range of nonhuman as well as the human animal species. Apes, monkeys, and perhaps all nonhuman animals fail to display a distinctly human capacity for abstract moral reasoning. As de Waal (2006) remarks, it is difficult to tell (173–75). But our furry and feathery kin do without a doubt demonstrate rich elements of ethical response, and they often enough extend their moral concern to creatures beyond their own species. Of course, they will also bite each other’s heads off or eat their own young as well. But this is just to say that animals are neither natural [End Page 111] innocents nor savage brutes. Like us, they belong to what post-Nietzschean philosophers might frame, somewhat ironically, as a postlapsarian world of good and evil.What kind of philosophical approach could account for these postlapsarian genealogies of ethics? Biologists, primatologists, and anthropologists are drawing upon investigations of prosocial behavior to remap the boundaries of ethics, as for example in Isabelle Stengers’s call for cosmopolitical ecologies of relationships (2010, 33). Such a cosmopolitics aims to encompass our kin and kind from diverse species within the ethical boundaries of common worlds. Donna Haraway discovers an opening for Stengers’s ecology of relationships in the intimate encounters among co-evolving species, especially those she calls companion species (2008, 83). She argues, following Derrida, that the abstract reasoning processes of Stoic and Kantian cosmopolitan ethics remain closed to the participation of nonhuman animals as anything more than dependents, failing to observe the ways in which they act as companions, if not moral subjects. But then, what normative force might bind together an ethically attuned biosocial sphere that we as humans co-inhabit with other animal species?To explore this question, this essay takes its cues from well-established research on the responsive, preverbal connection of the human infant and adult caregiver (Bateson 1979; Trevarthen 1984; Stern 1985, 2010; Gibbs 2001, 2010; Hansen 2004; Anderson 2006; Papoulias and Callard 2010; Willett 1995, 2001). To this research we can add new animal studies (Smuts 1999, 2001; Fudge 2002; de Waal 2006, 2009; Bekoff 2007; Molnar 2008; Haraway 2008). These animal studies provide a basis for extending an “ethics of eros” with roots in Luce Irigaray, Michel Foucault, Enrique Dussel, Africana feminism, Freudo-Marxist critical theory, and Plato (for discussions of this tradition, see Bergoffen 1997; Huffer 2009; Willett 2001)—but reconfigured in terms of social bonds across multiple animal species. In this tradition of ethics, the lack of a cognitive-based moral subjectivity that can translate into human terms does not consign nonhuman species to a mute moral status. On the contrary, some more primordial basis for relationship and meaning may weave thin but substantial threads of a postmoral ethics across regions of the biosphere.Given the diverse modes of subjectivity among animal species, and even the lack of what we call a moral subject altogether in many species, neither ordinary modes of empathy nor of moral understanding go very far in forging multispecies social bonds. For this reason, we turn to research on “the attunement of affects” in the infant-caregiver relationship (Stern 1985). As we shall see, this... (shrink)