Current challenges in medical practice, research, and administration demand physicians who are familiar with bioethics, health law, and health economics. Curriculum directors at American Association of Medical Colleges-affiliated medical schools were sent confidential surveys requesting the number of required hours of the above subjects and the years in which they were taught, as well as instructor names. The number of relevant publications since 1990 for each named instructor was assessed by a PubMed search.In sum, teaching in (...) all three subjects combined comprises less than two percent of the total hours in the American medical curriculum, and most instructors have not recently published articles in the fields they teach. This suggests that medical schools should reevaluate their curricula and instructors in bioethics, health law, and health economics. (shrink)

James Rachels’s distinction between killing and letting die maintains that there is morally no difference between killing a terminally ill patient and letting him/her die. Therefore, active and passive euthanasia dichotomy is a distinction without a difference. Hence, if passive euthanasia is allowed, active euthanasia should be permitted too. The paper demonstrated that the distinction between killing and letting die is: (1) irrelevant to euthanasia(2) extraneous to the medical profession, and (3) methodologically degressive. Furthermore, the paper demonstrated invalidity of (...) the bare difference argument of Rachels based on the distinction because of four reasons: (1) irrelevance to American Medical Association’s statement; (2) differences between the cases such as intentionality, causality, and agency; (3) straw man fallacy, (4) and weak analogy. Therefore, the paper concluded that relating the distinction between killings and letting die to bioethics and euthanasia is unjustifiable. (shrink)

The purpose of the research. The main purpose of the study is to find out the experience of researching and solving the problem of professional burnout for physicians including family ones in the United States, by analyzing recent surveys and scientific papers of American and European scientists. Methodology. While working on the article, general scientific theoretical methods were used to accom-plish the tasks and achieve the purpose of the research. The methodological basis of the research was the structural-functional method, (...) which allowed considering the phenomenon of professional burnout as a whole with separate elements and their dependencies. Using a historical method, a brief overview of the research development by US scientists on the problem of professional burnout of physicians with a focus on key events that occurred at each of the stages highlighted in the scientific papers. A comparative method was used to compare the results of surveys of different years and topics, data presented in the proceedings of the scientists, and research approaches. Methods of systematization and generalization were used to formulate the paper’s conclusions, in particular, to highlight the essential features of the American research experience and practical problem solution of professional burnout of physicians. Results. It has been found that the professional burnout of physicians has been a matter of concern for the government, professional medical associations, and the general public for physicians of various US specialties for a long time. Although burnout affects physicians of all disciplines, it has been discovered that, among family physicians, this phenomenon exceeds the average level, especially compared to the general economically active population of the United States. Two approaches to identifying and reducing the risk of occupational burnout in the United States have been identified and characterized: the first approach covers measures aimed directly at a physician, that is, a specific individual, and the second, involves measures aimed at an organization, that is, a medical institution. It has been found that Ameri-can scientists have concluded that organizational measures are more effective, but the first approach should be applied as a first step in overcoming professional burnout. Practical meaning. The results of the research are applicable for further scientific exploration and practical problem solution of professional burnout of physicians, including family ones, in Ukraine. Prospects for further research. Meth-odology of surveys of physicians of various specialties on burnout, depresdepression and professional satisfac-tion. Factors of professional burnout for family physicians in Ukraine. (shrink)

The purpose of the research. The main purpose of the study is to find out the experience of researching and solving the problem of professional burnout for physicians including family ones in the United States, by analyzing recent surveys and scientific papers of American and European scientists. Methodology. While working on the article, general scientific theoretical methods were used to accom-plish the tasks and achieve the purpose of the research. The methodological basis of the research was the structural-functional method, (...) which allowed considering the phenomenon of professional burnout as a whole with separate elements and their dependencies. Using a historical method, a brief overview of the research development by US scientists on the problem of professional burnout of physicians with a focus on key events that occurred at each of the stages highlighted in the scientific papers. A comparative method was used to compare the results of surveys of different years and topics, data presented in the proceedings of the scientists, and research approaches. Methods of systematization and generalization were used to formulate the paper’s conclusions, in particular, to highlight the essential features of the American research experience and practical problem solution of professional burnout of physicians. Results. It has been found that the professional burnout of physicians has been a matter of concern for the government, professional medical associations, and the general public for physicians of various US specialties for a long time. Although burnout affects physicians of all disciplines, it has been discovered that, among family physicians, this phenomenon exceeds the average level, especially compared to the general economically active population of the United States. Two approaches to identifying and reducing the risk of occupational burnout in the United States have been identified and characterized: the first approach covers measures aimed directly at a physician, that is, a specific individual, and the second, involves measures aimed at an organization, that is, a medical institution. It has been found that Ameri-can scientists have concluded that organizational measures are more effective, but the first approach should be applied as a first step in overcoming professional burnout. Practical meaning. The results of the research are applicable for further scientific exploration and practical problem solution of professional burnout of physicians, including family ones, in Ukraine. Prospects for further research. Meth-odology of surveys of physicians of various specialties on burnout, depression and professional satisfac-tion. Factors of professional burnout for family physicians in Ukraine. (shrink)

Since 1964, through 7 revisions, the World Medical Association’s Declaration of Helsinki has stood as an important statement regarding the ethical principles guiding medical research with human participants. It is consulted by ethics review committees, funders, researchers, and research participants. It has been incorporated into national legislation and is routinely invoked to ascertain the ethical appropriateness of clinical trials. There is much to praise about the revision process and the latest revision, which coincides with the declaration’s 50th anniversary. (...) Nevertheless, the proposed declaration contains persistent flaws... (shrink)

Recent studies show that racism still exists in the American medical profession, the fact of which legitimizes the historically long-legacy of mistrust towards medical profession and health authorities among African Americans. Thus, it was suspected that the participation of black patients in end-of-life care has always been significantly low stemmed primarily from their mistrust of the medical profession. On the other hand, much research finds that there are other reasons than the mistrust which makes African Americans (...) feel reluctant to the end-of-life care, such as cultural-religious difference and genuine misunderstanding of the services. If so, two crucial questions are raised. One is how pervasive or significant the mistrust is, compared to the other factors, when they opt out of the end-of-life care. The other is if there is a remedy or solution to the seemingly broken relationship. While no studies available answer these questions, we have conducted an experiment to explore them. The research was performed at two Philadelphia hospitals of Mercy Health System, and the result shows that Black patients’ mistrust is not too great to overcome and that education can remove the epistemic obstacles as well as overcome the mistrust. (shrink)

Review of British Medical Association handbook on human rights and doctors.

When hospitals face surges of patients with COVID-19, fair allocation of scarce medical resources remains a challenge. Scarcity has at times encompassed not only hospital and intensive care unit beds—often reflecting staffing shortages—but also therapies and intensive treatments. Safe, highly effective COVID-19 vaccines have been free and widely available since mid-2021, yet many Americans remain unvaccinated by choice. Should their decision to forgo vaccination be considered when allocating scarce resources? Some have suggested it should, while others disagree. We offer (...) a framework for evaluating when it is ethical and briefly discuss its legality in American law. (shrink)

Medicine, like law, is a pragmatic, probabilistic activity. Both require that decisions be made on the basis of available evidence, within a limited time. In contrast to law, medicine, particularly evidence-based medicine as it is currently practiced, aspires to a scientific standard of proof, one that is more certain than the standards of proof courts apply in civil and criminal proceedings. But medicine, as Dr. William Osler put it, is an "art of probabilities," or at best, a "science of uncertainty." (...) One can better practice medicine by using other evidentiary standards in addition to the "scientific." To employ only the scientific standard of proof is inappropriate, if not impossible; furthermore, as this review will show, its application in medicine is fraught with bias. Evidence is information. It supports or undermines a proposition, whether a hypothesis in science, a diagnosis in medicine, or a fact or point in question in a legal investigation. In medicine, physicians marshal evidence to make decisions on how to best prevent, diagnose, and treat disease, and improve health. In law, courts decide the facts and render justice. Judges and juries assess evidence to establish liability, to settle custody and medical issues, and to determine a defendant's guilt or innocence. (shrink)

Published in the American Journal of Bioethics.

As a result of the world-wide COVID-19 epidemic, an internal tension in the goals of medicine has come to the forefront of public debate. Medical professionals are continuously faced with a tug of...

Rationale and objectives: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. -/- Methods: We searched the curriculum websites of all accredited medical schools (...) in Canada, the UK and the US to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta-analysis. -/- Results: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. -/- Conclusions: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited. (shrink)

This exchange of correspondence with a critic provides helpful explanations of aspects of the paper "On Evidence, Medical and Legal" by the same authors.

Recent theorists of cultural studies have noticed the emergence of metamodernity as an ideal type, categorized by an oscillation between postmodern deconstructivism and modern idealism, into a form of transcendentalism. I argue in this chapter that this type of transcendentalism, informed by the historical American Transcendentalist Movement, is the emerging ideal called “Transhumanism.” I use a case study of five Japanese anime to demonstrate how transhumanist, metamodernist, and transcendental thinking often recur in key core plot points and narratives found (...) within. I further suggest that meditation on the major themes in these anime, especially those of metamodernity and transhumanism, is necessary if we are to understand our place in the world today and into the future. -/- The final version of this paper can be found in Anime, Philosophy, and Religion, Ed. Hayashi and Anderson, by Vernon Press. See "external links" for how to order the whole volume, the final version is also available on google books (see link). -/- A previous version of this paper was awarded the Outstanding Doctoral Paper Award 2023, Southwestern Sociological Association. (shrink)

The epidemiologist Bradford Hill famously argued that in epidemiology, specificity of association (roughly, the fact that an environmental or behavioral risk factor is associated with just one or at most a few medical outcomes) is strong evidence of causation. Prominent epidemiologists have dismissed Hill’s claim on the ground that it relies on a dubious `one-cause one effect’ model of disease causation. The paper examines this methodological controversy, and argues that specificity considerations do have a useful role to play in (...) causal inference in epidemiology. More precisely, I argue that specificity considerations help solve a pervasive inferential problem in contemporary epidemiology: the problem of determining whether an exposure-outcome correlation might be due to confounding by a social factor. This examination of specificity has interesting consequences for our understanding of the methodology of epidemiology. It highlights how the methodology of epidemiology relies on local tools designed to address specific inference problems peculiar to the discipline, and shows that observational causal inference in epidemiology can proceed with little prior knowledge of the causal structure of the phenomenon investigated. I also argue that specificity of association cannot (despite claims to the contrary) be entirely explained in terms of Woodward’s well-known concept of “one-to-one” causal specificity. This is because specificity as understood by epidemiologists depends on whether an exposure (or outcome) is associated with a `heterogeneous’ set of variables. This dimension of heterogeneity is not captured in Woodward’s notion, but is crucial for understanding the evidential import of specificity of association. (shrink)

*Winner of the American Philosophical Association's 2020 Essay Prize in Latin American Thought* This essay offers a novel account of the secularity of Latin American liberation philosophy. It challenges the accepted notion that liberation philosophy applies the methods and approaches of Latin American liberation theology to the philosophical arena, thus putting liberation theology on secular grounds. While this formulation is true insofar as liberation philosophy is not bound by the hermeneutics of any particular religious tradition, this (...) formulation could be misconstrued given that liberation philosophy does not premise such secularization in an undialectical understanding of secularity as secularism that disavows religion. Rather, liberation philosophy’s secularity is dialectical in that it requires constant engagement with re-ligion, not in the hermeneutics of any specific tradition but with “the traditional question of the Absolute.” Due to this often-misunderstood element of liberation philosophy, it has frequently been “ghettoized and relegated to the ‘safe’ area of theological studies,” as Eduardo Mendieta argues. However, I contend that liberation philosophy’s secular grounds offer an original contribution to philosophy as a decolonial and postsecularist liberation philosophy, one that conceives of secularism as an aspect of coloniality to be overcome, an obstacle rather than a benefit for Latin American philosophers seeking to gain a better understanding of our historical conditions. (shrink)

Trust is a core feature of the physician-patient relationship, and risk is central to trust. Patients take risks when they trust their providers to care for them effectively and appropriately. Not all patients take these risks: some medical relationships are marked by mistrust and suspicion. Empirical evidence suggests that some patients and families of color in the United States may be more likely to mistrust their providers and to be suspicious of specific medical practices and institutions. Given both (...) historical and ongoing oppression and injustice in American medical institutions, such mistrust can be apt. Yet it can also frustrate patient care, leading to family and provider distress. In this paper, I propose one way that providers might work to reestablish trust by taking risks in signaling their own trustworthiness. This interpersonal step is not meant to replace efforts to remedy systemic injustice, but is an immediate measure for addressing mistrust in occurrent cases. (shrink)

More than thirty-five years after its first release in 1971, Don McLean’s “American Pie” still resonates deeply with music listeners and consumers of popular culture. In a 2001 public poll sponsored by the National Endowment for the Arts and the Recording Industry Association of America, McLean’s eight-and-a-half-minute masterpiece was ranked number 5 among the 365 “most memorable” songs of the twentieth century. In 2002, the song was voted into the Grammy Hall of Fame. In 1997, Garth brooks performed “ (...) class='Hi'>American Pie” at a concert in Central Park, and in 2000, pop icon Madonna performed her own version of “American Pie” on the soundtrack of her movie The Next Best Thing. In 1999, American Pie became the title of a popular – and irreverently comical – coming-of-age movie starring Jason Biggs (the movie American Pie was followed by American Pie 2 in 2001, American Wedding in 2003, and American Pie Present – Band Camp in 2005). Like the movie to which it lent its name, the song “American Pie” presents a coming-of-age narrative; and, also like the movie, the song appealed strongly and immediately to its contemporary audience. Three months after its release in November of 1971, the song reached the number one slot on the charts in January of 1972, and it remained in the Top 40 for a total of seventeen weeks (longer than any other single during the year of 1972). Unlike the movie, however, the song “American Pie” is highly nuanced and sophisticated, containing multiple allusions and layers of meaning which challenge and heighten our understanding of rock ’n’ roll music and the possibility of self-reflection and self-critique in popular culture. (shrink)

Over the past 25 years, several new “medicines” have come screeching onto health care’s various platforms, including narrative medicine, personalized medicine, precision medicine and person-centred medicine. Philosopher Miriam Solomon calls the first three of these movements different “ways of knowing” or “methods,” and argues that they are each a response to shortcomings of methods that came before them. They should also be understood as reactions to the current dominant model of medicine. In this article, I will describe our dominant model, (...) which I call “the new medical model.” I will argue that several towering problems in modern medicine can be traced to its philosophical foundations, which calls for philosophical analysis. (shrink)

This essay fills in some historical, conceptual, and pedagogical gaps that appear in the most visible and recent professional efforts to “revive” Philosophy as a Way of Life (PWOL). I present “American Philosophy and Self-Culture” as an advanced undergraduate seminar that broadens who counts in and what counts as philosophy by immersing us in the lives, writings, and practices of seven representative U.S.-American philosophers of self-culture, community-building, and world-changing: Benjamin Franklin (1706–1790), Frederick Douglass (1818–1895), William Ellery Channing (1780–1842), (...) Henry David Thoreau (1817–1862), Margaret Fuller (1810-1850), Henry Bugbee (1915–1999), and Gloria Anzaldúa (1942–2004). Students enter the class with preconceptions about who philosophers are, what they do, how they write, and the languages in which they write. Students walk out with new senses of self, place, and language that emerge through new ways of seeing, doing, and writing philosophy. (shrink)

After an intensive 4-year process, the World Medical Association (WMA) has revised its International Code of Medical Ethics (ICoME). In their report outlining this process, Parsa-Parsi et al not only describe how the WMA sought to ‘cultivat[e] international agreement’ on a ‘global medical ethos’, but also outline the philosophical framework of the ICoME: how the WMA, as the ‘global representation of the medical profession’, created and revised the ICoME through the process of international professional self-regulation.1 However, (...) there is a significant tension to be found in this framework—one which contrasts the international scope of the ICoME with the supposed source of its legitimacy. Here, we seek to characterise this tension and the doubt which it casts on the legitimacy of the ICoME. (shrink)

It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, (...) gender, class, and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems. (shrink)

Abstract: malaria is one of the most frequent hemoparasitic infections in tropical and sub-tropical countries. Malaria in Sudan is the major public health problem. This study was aimed to investigate the association of intraleukocytic pigment with malaria infection (severity, diagnosis and prognosis), and to investigate the correlation of parasite density levels with Malaria Severity. A total of 176 participants was drawn from the population of sudanese patient above 5 years, who attended or were admitted to the Bashayer Hospital, with diagnosis (...) suggestive of malaria, they were selected for inclusion in the study. Blood films were examined first for malaria parasites diagnosis ,this was followed by detection of malaria pigment in both negative and positive films.Then Immunochromatography test was done, Subsequently haemoglobin concentration was determined. This study was approves that malaria pigment in peripheral blood leukocytes is evident for malaria disease , and makes the method of pigment determination appropriate and useful in malaria diagnosis, especially in patients with an illness consistent clinically with malaria but with negative blood smear due to haemolytic anaemia .A total of 176, 73 male and 103 female aged from 7 years to 69 years , drawn to Bashayer hospital with symptoms of malaria showed ICT positive result .Blood films were positive in 98(55.7%) and negative in 78 (44.3%) of patients . Malaria pigment was observed with the mean (22.07). There was an association between ICT and malaria pigment (P-value = 0.000).There was no association between BF and malaria pigment ( P-value = 0.40).This study also approved that malaria pigment can be used in prognosis, were thirty five patient showed complications(19.9%) and 141 showed no complication(80.1%) ,there was association between complications and malaria pigment ( P-value = 0.004) .This study also validates the presence of malaria pigment in leukocyte as a marker for disease severity, there was association between severity and malaria pigment (P-value = 0.02). While there is no association between density and severity (P-value = 0.980). So we conclued, intraleukocytic malaria pigment produced by parasites during intra erythrocytic development is associated with severe disease, mortality and it is a useful diagnostic indicator in anaemic patients with negative blood smears. The varied complexities of the current diagnostic methods make the method of pigment determination appropriate and useful. Secondly, malaria pigment is significantly associated with severe malaria. Thirdly, parasitaemia levels are neither associated nor correlated with malaria severity and therefore parasitaemia alone is not a reliable measure of malaria severity. We recommend the use of malaria pigment as marker for malaria disease severity. We recommend that parasitaemia should not be used alone as an indicator of malaria severity. We further recommend that, the presence of pigment in leukocytes to be adopted for diagnosis of malaria especially in cases of negative blood films, and recommend using malaria pigment as indicator for malaria prognosis. (shrink)

Abstract: A complex parasite such as human Plasmodium is likely to generate a variety of substances that injure the hosts directly or cause immunopathology. In malaria, a blood concentration of anti-inflammatory cytokines, such as interleukin (IL-10) is increased. The present study was performed to analyze IL-10 levels in patients with malaria falciparum and healthy controls individuals and correlate with malaria density infection as well as age groups. It is a cross sectional study was carried out in Khartoum state /Sudan, a (...) total of 70 febrile patients and 20 healthy volunteers as controls were included in this study. Blood samples were collected from both patients and control candidates in (EDTA) containers for parasitological and immunological tests. Immunochromatography test and microscopic examination for both thick and thin blood films were used to detect the positive samples for Plasmodium falciparum. Enzyme linked Immunosorbant Assay (ELISA), was used for the determination of IL-10 levels. The result showed that of IL-10 levels in malaria patients were 1598.50 and SD 4771.64 while the levels in healthy participants the level was 10.39 and SD was 124.33 the difference was found to be statistically significant (P= 0.007). The levels of cytokines mentioned above were observed to be raised in malaria individual compared to healthy control candidates. (shrink)

There has been a growing concern over establishing norms that ensure the ethically acceptable and scientifically sound conduct of clinical trials. Among the leading norms internationally are the World Medical Association's Declaration of Helsinki, guidelines by the Council for International Organizations of Medical Sciences, the International Conference on Harmonization's standards for industry, and the CONSORT group's reporting norms, in addition to the influential U.S. Federal Common Rule, Food and Drug Administration's body of regulations, and information sheets by the (...) Department of Health and Human Services. There are also many norms published at more local levels by official agencies and professional groups.Any account of international standards should cover both scientific and ethical norms at once – the two are conceptually intertwined. Recent sources recognize that “[s]cientifically unsound research on human subjects is unethical in that it exposes research subjects to risks without possible benefit.”. (shrink)

Authors: Joseph M. Eble, John A. Di Camillo, Peter J. Colosi. --- NEWS RELEASE For Immediate Release February 27, 2024 Contact: Joseph M. Eble, MD Corresponding author 919-667-5206 -/- The statement, Catholics United on Brain Death and Organ Donation: A Call to Action (HTML), was published on February 27, 2024. It was prepared by Joseph Eble, a physician and President of the Tulsa Guild of the Catholic Medical Association; John Di Camillo, an ethicist of The National Catholic Bioethics Center; (...) and Peter Colosi, a philosophy professor at Salve Regina University. -/- Catholic United explains that the criteria for brain death establish only partial loss of brain function. This is now abundantly clear based on scientific studies, a recent effort to lower the legal standard for death, and updated brain death guidelines issued in October 2023. -/- Catholics United bridges a divide among faithful Catholics about whether the concept of brain death aligns with Church teaching. Some Catholics hold that brain death represents true death when there is complete and irreversible cessation of all brain activity, often called whole brain death. Others hold that brain death does not represent true death. Since the existing criteria establish only partial loss of brain function, all the endorsers—whether they accept or reject whole brain death as true death—agree that “the current brain death criteria in widespread use do not provide moral (prudential) certainty of death.” -/- Catholics United calls on health care professionals and institutions to cease organ harvesting that relies on the inadequate criteria, noting that 70% of all donors are declared dead using brain death criteria. “Given the lack of moral certainty of death whenever the current brain death criteria are used,” the statement affirms, “a clear majority of vital organ donors can be presumed alive at the time of organ harvesting.” Since the Catholic Church forbids removing vital organs when this would kill the patient, “it is therefore wrong to remove organs from patients declared dead using these inadequate criteria.” . (shrink)

The Referent Tracking paradigm, which advocates the use of instance unique identifiers to refer to the entities comprising the subject matter of patient health records, promises many benefits to those who use health record data to improve patient care. To further the adoption of the paradigm we provide an illustration of how data from an EHR application needs to be decomposed to make it accord with the tenets of Referent Tracking. We describe the ontological principles on which such decomposition needs (...) to be based in order to allow integration efforts to be applied to other EHR applications by interested parties. We find that an ordinary statement from an EHR reveals a surprising amount of "hidden" data that is revealed by its decomposition according to these principles. (shrink)

Brogaard and Salerno (2005, Nous, 39, 123–139) have argued that antirealism resting on a counterfactual analysis of truth is flawed because it commits a conditional fallacy by entailing the absurdity that there is necessarily an epistemic agent. Brogaard and Salerno's argument relies on a formal proof built upon the criticism of two parallel proofs given by Plantinga (1982, "Proceedings and Addresses of the American Philosophical Association", 56, 47–70) and Rea (2000, "Nous," 34, 291–301). If this argument were conclusive, antirealism (...) resting on a counterfactual analysis of truth should probably be abandoned. I argue however that the antirealist is not committed to a controversial reading of counterfactuals presupposed in Brogaard and Salerno's proof, and that the antirealist can in principle adopt an alternative reading that makes this proof invalid. My conclusion is that no reductio of antirealism resting on a counterfactual analysis of truth has yet been provided. (shrink)

Less than one percent of U.S. philosophers are Asian American. This essay contends that the low percentage cannot be fully explained by considerations of demographics, immigration, and "Asian culture." Completeness of explanation requires reference to racial politics and Orientalism in their historic and national dynamics. It also requires reference to various kinds of identity derogation specific to the academy and to philosophy, in particular. The essay concludes with reflection on how the "model minority" discourse adds another layer of complication (...) to the way Asian American philosophers and philosophy students negotiate their way through the academy. (shrink)

Mildred Cho and Nicole Martinez-Martin (2023) distinguish between two of the ways in which humans can be represented in medical contexts. One is technical: a digital model of aspects of a person’s...

All contributions included in the present issue were originally presented at an ‘Author Meets Critics’ session organised by Richard Zach at the Pacific Meeting of the American Philosophical Association in San Diego in the Spring of 2014.

ABSTRACT: Sellars once remarked on the “astonishing extent to which in ethics as well as in epistemology and metaphysics the fundamental themes of Kant’s philosophy contain the truth of the variations we now hear on every side” (SM x). Also astonishing was Sellars’ 1970 Presidential Address to the American Philosophical Association (APA), which borrowed its title from the phrase in Kant’s Paralogisms, “...this I or he or it (the thing) which thinks...” (B404). In its compact twenty-five pages Sellars managed (...) to sketch novel yet plausible reconstructions of central aspects of Kant’s views on self-knowledge, persons, freedom, and morality, along the way suggesting how all of those Kantian views could plausibly be rendered consistent with a naturalistic ontology. In this chapter I focus on Sellars’ APA address as an occasion for reflection on how both Kant and Sellars offer insights into how we ought best to conceive the nature of and the relationships between our thinking selves, our practical agency, and our entirely natural, material embodiment. (shrink)

Since the dawn of the internet, pornography has effectively become ubiquitous, pervasive, and increasingly normalised. Study findings show remarkable similarities in how the brain reacts to pornography, and other known addictive substances, and indicate that consuming pornography is comparable to consuming other known addictive substances. Moreover, two of the biggest risk factors for addiction are the substance’s availability and its easy accessibility, particularly in the case of younger persons. To date, pornography addiction has been conceptualised as a behavioural addiction. However, (...) the body of research data on pornography addiction does not provide conclusive support for behavioural addiction. The aim of this thesis is to put forward the idea that pornography can, and should, be conceptualised as an addictive substance, and, that when pornography is consumed, an addictive substance is consumed. In order to support this claim, there are many factors that must be addressed. I first clarify what pornography entails by exploring how it is conceptualised, what pornography ‘does’, and what it means to be a pornography consumer. Secondly, I examine the conceptualisations of substances, substance consumption and addiction, respectively, as well as the subsequent difference between substance and behavioural addiction. Thirdly, I give an inclusive overview of pornography addiction by not only examining the most recent perspectives of researchers, but also of pornography consumers. I conclude by suggesting how we should go about conceptualising pornography addiction, and then propose how the set of diagnostic criteria for pornography use disorder should be formulated for a future iteration of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. I argue that, given the abundance of academic research on substance addiction, compared to the scarcity of research on behavioural addiction, conceptualising pornography as an addictive substance is more likely to create a sense of urgency for the future research of pornography addiction than would be the case if it is considered a potential behavioural addiction. Furthermore, I argue that the classification of pornography as an addictive substance, and the inclusion of pornography use disorder in a future iteration of the DSM, will raise awareness of the potential adverse effects of pornography consumption and, therefore, the harmful consequences of pornography use disorder. (shrink)

Objectives: Machine learning (ML) has the potential to facilitate “continual learning” in medicine, in which an ML system continues to evolve in response to exposure to new data over time, even after being deployed in a clinical setting. In this article, we provide a tutorial on the range of ethical issues raised by the use of such “adaptive” ML systems in medicine that have, thus far, been neglected in the literature. -/- Target audience: The target audiences for this tutorial are (...) the developers of ML AI systems, healthcare regulators, the broader medical informatics community, and practicing clinicians. -/- Scope: Discussions of adaptive ML systems to date have overlooked the distinction between 2 sorts of variance that such systems may exhibit—diachronic evolution (change over time) and synchronic variation (difference between cotemporaneous instantiations of the algorithm at different sites)—and underestimated the significance of the latter. We highlight the challenges that diachronic evolution and synchronic variation present for the quality of patient care, informed consent, and equity, and discuss the complex ethical trade-offs involved in the design of such systems. (shrink)

Biomedical diagnostic science is a great deal less successful than we've been willing to acknowledge in bioethics, and this fact has far-reaching ethical implications. In this article I consider the surprising prevalence of medically unexplained symptoms, and the term's ambiguous meaning. Then I frame central questions that remain answered in this context with respect to informed consent, autonomy, and truth-telling. Finally, I show that while considerable attention in this area is given to making sure not to provide biological care to (...) patients without a need, comparatively little is given to the competing, ethically central task of making sure never to obstruct access to biological care for those with diagnostically confusing biological conditions. I suggest this problem arises from confusion about the philosophical value of vagueness when it comes to the line between biological and psychosocial needs. (shrink)

Nancy Jecker and Andrew Ko (2017) wish to present an account of personal identity which captures what matters to the patient and places the patient at the center of medical decisions. They focus particularly on medical interventions in the brain that can cause drastic changes in personality; under what circumstances should we say the patient has 'survived' these changes? More specifically, how can we best understand the notion of survival in a way that captures what is of concern (...) to the patient? This goal is laudable, however, their chosen account of narrative identity is ill-suited to this task for one reason in particular; it does not give sufficient guidance in predicting which medical decisions are likely to be experienced as disruptive to identity. (shrink)

A striking feature of post-modernism is its distrust of the subject. If the modern period, beginning with Descartes, sought in the subject a source of certainty, an Archimedian point from which all else could be derived, post- modernism has taken the opposite tack. Rather than taking the self as a foundation, it has seen it as founded, as dependent on the accidents which situate consciousness in the world. The same holds for the unity of the subject. Modernity, in its search (...) for a single foundation, held the subject to be an indissoluble unity. Post-modernism’s position, by contrast, is announced by Nietzsche: “The assumption of one single subject is perhaps unnecessary; perhaps it is just as permissible to assume a multiplicity of subjects, whose interaction and struggle is the basis of our thought and our consciousness in general? ...My hypotheses: The subject as multiplicity.” Given this, there is a natural correspondence between the success of post- modernism and the current interest in multiple personality disorder. In the latter, we actually have the experience of a “multiplicity of subjects” in their interaction and struggle. The subject stands there before us “as multiplicity.” It gives us a concrete case, one which raises some of the pressing questions associated with the post-modern denial of the subject. Confronting it, we ask: how real are the personalities composing the multiplicity of this disordered self? What, in fact, does this multiplicity tell us about the self? about its genesis and status? What does it reveal about “our thought and consciousness in general”? I plan, in the short compass of this paper, to sketch some answers to these questions. §1. A brief description of MPD. The American Psychiatric Association gives two criteria for (MPD) multiple personality disorder. First, and most obviously, there is “the existence within the person of two or more distinct personalities or personality states (each with its own relatively enduring pattern. (shrink)

Objective: Evaluating study environments, attention–motivation levels while studying, and studying methods of students is ex-tremely important for obtaining purposed results. This study aimed to determine study environments, attention–motivation levels while studying, and studying methods of medicine faculty students. -/- Methods: Gaziantep University School of Medicine students completed the questionnaire that included questions regarding study environments, attention–motivation levels, and studying methods. The students were asked 11 open-ended questions and 29 Likert-type questions. Statistical analyses of these questions were performed, and some of (...) the questions correlated among them. -/- Results: The statistically significant differences were determined between the average grade and questions: “I have difficulty in focusing on the subject before starting to study,” “I easily lose concentration while studying,” “I use some pharmaceuticals (except vitamins) for increasing my motivation while studying,” “I use some pharmaceuticals (except vitamins) for increasing my attention while study,” and “I only study during exams.” A significant association was also observed between the average grade and the accommodation of students. -/- Conclusion: Improving the physical conditions of the study environment of medicine faculty students will contribute to increas-ing their academic success. Making students aware of the components that negatively affect attention and motivation will also positively affect the academic success of students. In addition, determining studying methods of medicine faculty students will contribute to improving personal education strategies. (shrink)

The Asian American identity is intimately associated with upward class mobility as the model minority, yet women's earnings remain less than men's, and Asian American women are perceived to have strong family ties binding them to domestic responsibilities. As such, the exact class status of Asian American women is unclear. The immediate association of this ethnic identity with a specific class as demonstrated by the recently released Pew study that Asian Americans are “the highest-income, best-educated” ethnicity contrasts (...) with another study that finds Asian American women have the highest suicide rates in the United States. To understand these contrasting statistics, this article explores Asian American women's sense of authenticity. If the individual's sense of authenticity is intimately related with one's group identity, the association of the Asian American identity with a particular class ambivalently ensnares her as dichotomously inauthentic—as both the poor Asian American woman who fails to achieve economic upward mobility and the model minority Asian American woman who engages in assimilation practices. Feminist philosophers understand that identities change, but exactly how these transformations occur remains a mystery. The article ends with three speculations on the difficulties for practicing and recognizing individual acts that transform one's group identity. (shrink)

Introduction: The Faculty of Medicine, University of Moratuwa, established during the COVID-19 pandemic, was compelled to conduct the teaching activities online for the first intake of students until their first bar examination. Online learning is known to be linked to several health issues. This study aims to explore the academic performance and perceived health effects related to online learning in the Faculty of Medicine, Moratuwa. Methods: A descriptive cross-sectional study was conducted among all 104 first-intake students using an anonymous online (...) self-administered questionnaire to explore health effects and academic performance after ethical clearance. Results: Out of 104 students, 82 students responded (response rate=78.85%). Majority participated from home using their own laptop (74.4%) and personal Wi-Fi (69.5%) and spent 5-10 hours daily for online academic activities (72%). Majority complained of related physical (86.6%), and psychological (81.7%) health issues: eye problems (69.5%), headache (47.6%), backache (43.9%), stress (46.3%) and concentration difficulties (45.1%). The first bar examination was cleared by 84.1% with the majority (52.4%) obtaining classes. There was a statistically significant positive association (p< .05) between physical and psychological health concerns with the average screen-time spent on academic activities, but not with the academic performance. There was also no statistically significant association between screen-time and academic performance. Conclusions: Majority of students using online learning had related physical and psychological health issues which were positively associated with the screen-time though not with academic performance. Designing online activities with less screen time may be considered as a strategy to minimise health effects related to online learning. (shrink)

In its recent statement 'Sex Selection and Preimplantation Genetic Diagnosis', the Ethics Committee of the American Society of Reproductive Medicine concluded that preimplantation genetic diagnosis for sex selection for non-medical reasons should be discouraged because it poses a risk of unwarranted gender bias, social harm, and results in the diversion of medical resources from genuine medical need. We critically examine the arguments presented against sex selection using preimplantation genetic diagnosis. We argue that sex selection should be (...) available, at least within privately funded health care. (shrink)

When people are making certain medical decisions – especially potentially transformative ones – the specter of regret may color their choices. In this paper, I ask: can predicting that we will regret a decision in the future serve any justificatory role in our present decision-making? And if so, what role? While there are many pitfalls to such reasoning, I ultimately conclude that considering future retrospective emotions like regret in our decisionmaking can be both rational and authentic. Rather than indicating (...) that one is about to make a mistake or that there is some underlying value that one already cares about but is overlooking, the prediction that one will regret a decision in the future makes one confront how her present values and priorities may change as a result of her choice in ways she cannot presently anticipate. (shrink)

Translating risk estimates derived from epidemiologic study into evidence of causality for a particular patient is problematic. The difficulty of this process is not unique to the medical context; rather, courts are also challenged with the task of using risk estimates to infer evidence of cause in particular cases. Thus, an examination of how this is done in a legal context might provide insight into when and how it is appropriate to use risk information as evidence of cause in (...) a medical context. A careful study of the case of Goodman v. Viljoen, a medical malpractice suit litigated in the Ontario Superior Court of Justice in 2011, reveals different approaches to how risk information is used as or might be considered a substitute for evidence of causation, and the pitfalls associated with these approaches. Achieving statistical thresholds, specifically minimizing the probability of falsely rejecting the null hypothesis, and exceeding a relative risk of 2, plays a significant role in establishing causality of the particular in the legal setting. However, providing a reasonable explanation or establishing “biological plausibility” of the causal association also seems important, and (to some) may even take precedent over statistical thresholds for a given context. (shrink)

American history has been far from kind to Black and African Americans. As a group, they were subjected to the gruesome, racist human rights violations committed during the period of American slavery, then Jim Crow laws, economic and political rights violations, medical experimentation, redlining, and lack of representation in politics all came to remind Black Americans that their fight for equality was far from over. Recent periods of activism, however, have brought some of the current plights of (...) Black Americans to the forefront of media coverage. One such example is the greater Covid-19 vaccination hesitancy found among minority groups – specifically Black and African American communities. Despite the variety of implications such an issue has, literature surrounding the issue is relatively one-sided – often looking only at public health and medical education implications. This paper will analyze previous literature on institutional and political trust and epistemic norms, then apply them to the issue of Black American Covid-19 vaccine hesitancy. First, analyzing previous literature on institutions and trust to differentiate institutional trust from trust’s other forms. Then, developing this conception of institutional trust by applying epistemic normativity (Kauppinen 2018). Then, create an application of this conception of institutional trust to the case of Black hesitancy to Covid-19 vaccines. Finally, concludes with educational and political implications of this theory. (shrink)

This review was presented on April 20, 2011 at the American Philosophical Association Pacific Division Annual Meeting in San Diego, CA. The session, Author meets Critics: Empathy in the Context of Philosophy, was organized by the Karl Jaspers Society of North America.

During their educational life, medical students encounter several challenges, the origins and causes of which vary. This paper explores and attempts to scrutinize two of these challenges, before eventually introducing the concept of responsibility. First, this paper describes the general characteristics of medical schools, medical students, and medical education. Second, two different ethical challenges that medical students confront are then delineated: the anxiety of continuously questioning ‘while being trained, do I cause patients to receive suboptimal (...) health care?’ and occasionally feeling obligated, consequently, to breach the ethical boundaries to practice procedures on patients. Finally, the faculty of responsibility and its components are introduced and discussed as a model that can overcome these ethical challenges. (shrink)

Volume 20, Issue 3, March 2020, Page 71-73.

THE IMMORTAL FLY: ETERNAL WHISPERS. WHO IS SHE? Author: Rituparna Ray Chaudhuri. Hello, Recently my book named, ‘The Immortal Fly: Eternal Whispers : Based On True Events of a Family' been published from Partridge (USA) In Association with Penguin Random House (UK) and achieved a separate Google identity. -/- As being # the author of the book, I thought to define self in the book what is definition of 'Depression'. I wanted to explain self in many ways, but the best (...) quotation appeared to me : “My life will end someday, but it will end at my convenience.’’ -/- ***** I am missing "her". By now, years passed without 'her' . Even though, unlike before, everything is becoming to be more scattered, gloomy and desolate. She is no-where whom I share my feelings. Even now, when I do close my eyes, I can visualize the same that I had left years since on 7th February, 2019 at 8.20 A.M. in the hospital struggling a continuous period of fifty days : on the fifty one day, my father said, ”The End of our Fifty Years relationship has been completed with the Fifty Days”….’Whoever’ she was to others , but she is our legend…To me, she is ‘My Ma’. -/- The story could begin, 'I failed preciously on success of my life.' Simplicity, Innocence, Belief, Faith and Personality met unknowingly with filthy waves skillfully immersed in Betray, Sorcery, Jealousy, Greediness, Revenge, Lie... ‘’ ******* The Daughter writes, “I had asked Ma many times, but her ‘impenetrable personality’ and dynamic words to everyone with a tinge of smile as reflected on her face, she was reluctant to continue her conversation with me. I had thought, hence, I must not be indefinite on my spoken words. Who shall I blame!” Based on true story of a family came from South Calcutta (India) to a suburb, on staying at home of the Daughter’s maternal grandmother’s house, this book reveals in facts and true events how Destiny had unknowingly ‘further’ played an abominable role to Fate of The Daughter, when eventually one day on 7th February, 2019 everything was finished within 8.20A.M. The Daughter is, therefore, left alone on terrestrial with immortal words as written in her Diary, ‘Eternal Whispers’: “My words to self that I am to fulfill my Ma’s - wish. ’’ ‘’ -/- • Keywords: 1. Diary and True Events 2. The Chaotic Society 3. Fatality 4. Of A-Family 5. Science , Philosophy and Literature 6. Severe Depression 7. Medical Journey. -/- The Alternative Title of the Book: The Greatest Mistake or Fortune:: The book is mainly carrying with intense words of a journey of the relationship between a Mother with her Daughter has left readers in an abrupt situation where ,perhaps, I can define "Man is the innocent creature with 'his' personality under circumstances..." -/- . (shrink)

Recent years have witnessed intensive efforts to specify which requirements ethical artificial intelligence (AI) must meet. General guidelines for ethical AI consider a varying number of principles important. A frequent novel element in these guidelines, that we have bundled together under the term explicability, aims to reduce the black-box character of machine learning algorithms. The centrality of this element invites reflection on the conceptual relation between explicability and the four bioethical principles. This is important because the application of general ethical (...) frameworks to clinical decision-making entails conceptual questions: Is explicability a free-standing principle? Is it already covered by the well-established four bioethical principles? Or is it an independent value that needs to be recognized as such in medical practice? We discuss these questions in a conceptual-ethical analysis, which builds upon the findings of an empirical document analysis. On the example of the medical specialty of radiology, we analyze the position of radiological associations on the ethical use of medical AI. We address three questions: Are there references to explicability or a similar concept? What are the reasons for such inclusion? Which ethical concepts are referred to? (shrink)