A large proportion of the total global burden of disease is caused by emergency medical conditions. Emergency care research is essential to improving emergency medicine but this research can raise some distinctive ethical challenges, especially with regard to (1) standard of care and risk–benefit assessment; (2) blurring of the roles of clinician and researcher; (3) enrolment of populations with intersecting vulnerabilities; (4) fair participant selection; (5) quality of consent; and (6) community engagement. Despite the importance (...) of research to improve emergency care in low-income and middle-income countries (LMICs) and the widely acknowledged ethical challenges, very little has been written on the ethics of emergency care research in LMICs. This paper examines the ethical and regulatory challenges to conducting emergency care research with human participants in LMICs. We outline key challenges, present potential solutions or frameworks for addressing these challenges, and identify gaps. Despite the ethical and regulatory challenges, conducting high-quality, ethical emergency care research in LMICs is possible and it is essential for global health. (shrink)

Much of the discussion of the role of emerging technologies associated with AI, machine learning, digital simulacra, and relevant ethical considerations such as those discussed in the target article, take a relatively narrow and episodic view of a person’s healthcare needs. There is much speculation about diagnostic, treatment, and predictive applications but relatively little consideration of how such technologies might be used to address a person’s lived experience of illness and ongoing care needs. This is likely due to the (...) greater weight or priority given to acute care needs and the role of medical treatment in care provision, but it may also reflect the limitations of current technologies and our limited vision of their potential application. Such limitations are not surprising given that we are still grappling with the complexities and nuances of achieving the ethical and humanistic ideals of care, namely, care that addresses the hermeneutical, relational, contextual, temporal, and agential dimensions of a person’s health and wellbeing. (shrink)

The paper studies two fundamentally different forms in which the concept of care makes its comeback in twentieth-century thought. We make use of a distinction made by Peter Sloterdijk, who argues that the ancient and medieval ‘ascetic’ ideal of self-enhancement through practice has re-emerged in the nineteenth and twentieth centuries, particularly in the form of a rehabilitation of the Hellenistic notion of self-care (epimeleia heautou) in Michel Foucault’s late ethics. Sloterdijk contrasts this return of self-care with Martin (...) Heidegger’s concept of being-in-the-world as ‘total care’ (Sorge), an utterly ‘secularized’ understanding of the human being as irreducibly world-embedded that rejects the classical ascetic ideal of world-secession. We examine further the historical roots and emergence of these contrasting contemporary reappropriations of care in the Western tradition of thought and show them to be rooted in two different ontologies and ethics of the self as either world-secluded or world-immersed, autonomous or constitutively relational. The historical point of divergence of these two approaches to care, we argue, can be found in the Christian transformation of Hellenistic ethics. (shrink)

This article analyzes emerging artificial intelligence (AI)-enhanced lie detection systems from ethical and human resource (HR) management perspectives. I show how these AI enhancements transform lie detection, followed with analyses as to how the changes can lead to moral problems. Specifically, I examine how these applications of AI introduce human rights issues of fairness, mental privacy, and bias and outline the implications of these changes for HR management. The changes that AI is making to lie detection are altering the roles (...) of human test administrators and human subjects, adding machine learning-based AI agents to the situation and establishing invasive data collection processes as well as introducing certain biases in results. I project that the potentials for pervasive and continuous lie detection initiatives (“truth machines”) are substantial, displacing human-centered efforts to establish trust and foster integrity in organizations. I argue that if it is possible for HR managers to do so, they should cease using technologically-based lie detection systems entirely and work to foster trust and accountability on a human scale. However, if these AI-enhanced technologies are put into place by organizations by law, agency mandate, or other compulsory measures, care should be taken that the impacts of the technologies on human rights and wellbeing are considered. The article explores how AI can displace the human agent in some aspects of lie detection and credibility assessment scenarios, expanding the prospects for inscrutable, “black box” processes and novel physiological constructs (such as “biomarkers of deceit”) that may increase the potential for such human rights concerns as fairness, mental privacy, and bias. Employee interactions with autonomous lie detection systems rather with than human beings who administer specific tests can reframe organizational processes and rules concerning the assessment of personal honesty and integrity. The dystopian projection of organizational life in which analyses and judgments of the honesty of one’s utterances are made automatically and in conjunction with one’s personal profile provides unsettling prospects for the autonomy of self-representation. (shrink)

This paper attempts to show how Adorno’s thought can illuminate our reflections on the future of work. It does so by situating Adorno’s conception of genuine activity in relation to his negativist critical epistemology and his subtle account of the distinction between true and false needs. What emerges is an understanding of work that can guide our aspirations for the future of work, and one we illustrate via discussions of creative work and care work. These are types of work (...) which cater to persistent human needs, albeit ones that are distorted under present social conditions. Adorno’s thought helps us to understand why this is the case. (shrink)

Many assume that theories of distributive justice must obviously take people’s lifetimes, and only their lifetimes, as the relevant period across which we distribute. Although the question of the temporal subject has risen in prominence, it is still relatively underdeveloped, particularly in the sphere of health and healthcare. This paper defends a particular view, “momentary sufficientarianism,” as being an important element of healthcare justice. At the heart of the argument is a commitment to pluralism about justice, where theorizing about just (...) principles demands paying attention to the role particular goods play in our lives. This means that different approaches to the temporal subject—as well as other relevant issues—may be appropriate for different goods, including different goods within healthcare. In particular, the paper discusses two central goods targeted by healthcare: life-saving and pain relief. The view is offered as complementary to, rather than competitive with, lifetime approaches. As such, the paper finishes by considering how a pluralist approach, which engages both with people’s lives as a whole and with their states at particular moments, can reconcile the potentially competing claims in healthcare that emerge from these two perspectives. (shrink)

Despite its recent popularity, Emergence is still a field where philosophers and physicists often talk past each other. In fact, while philosophical discussions focus mostly on ontological emergence, physical theory is inherently limited to the epistemological level and the impossibility of its conclusions to provide direct evidence for ontological claims is often underestimated. Nevertheless, the emergentist philosopher’s case against reductionist theories of how the different levels of reality are related to each other can still gain from the assessment of paradigmatic (...) examples of discontinuity between models in physics, even though their implications must be handled with care. (shrink)

This paper addresses global bioethical challenges entailed in emerging viral diseases, focussing on their socio-cultural dimension and seeing them as symptomatic of the current era of globalisation. Emerging viral threats exemplify the extent to which humans evolved into a global species, with a pervasive and irreversible impact on the planetary ecosystem. To effectively address these disruptive threats, an attitude of preparedness seems called for, not only on the viroscientific, but also on bioethical, regulatory and governance levels. This paper analyses the (...) global bioethical challenges of emerging viral threats from a dialectical materialist (Marxist) perspective, focussing on three collisions: (1) the collision of expanding networks of globalisation with local husbandry practices; (2) the collision of global networks of mobility with disrupted ecosystems; and (3) the collision of viroscience as a globalised research field with existing regulatory frameworks. These collisions emerge in a force field defined by the simultaneity of the non-simultaneous. Evidence-based health policies invoke discontent as they reflect the normative logic of a globalised knowledge regime. The development of a global bioethics or macro-ethics requires us to envision these collisions not primarily as issues of benefits and risks, but first and foremost as normative tensions closely entangled with broader socio-economic and socio-cultural developments. (shrink)

This paper addresses the likely impact on women of being denied emergency contraception (EC) by pharmacists who conscientiously refuse to provide it. A common view—defended by Elizabeth Fenton and Loren Lomasky, among others—is that these refusals inconvenience rather than harm women so long as the women can easily get EC somewhere else nearby. I argue from a feminist perspective that the refusals harm women even when they can easily get EC somewhere else nearby.

The standard of care in the United States favors stabilizing any adult who arrives in an emergency department after a failed suicide attempt, even if he appears decisionally capacitated and refuses life-sustaining treatment. I challenge this ubiquitous practice. Emergency clinicians generally have a moral obligation to err on the side of stabilizing even suicide attempters who refuse such interventions. This obligation reflects the fact that it is typically infeasible to determine these patients’ level of decisional capacitation—among other (...) relevant information—in this unique setting. Nevertheless, I argue, stabilizing suicide attempters over their objection sometimes violates a basic yet insufficiently appreciated right of theirs—the right against bodily invasion. In such cases, it is at least prima facie wrong to stabilize a patient who wants to die even if they lack a contrary advance directive or medical order and suffer from no terminal physical illness. (shrink)

Abstract The values of the healthcare sector are fairly ubiquitous across the globe, focusing on caring and respect, patient health, excellence in care delivery, and multi-stakeholder collaboration. Many individual pharmacists embrace these core values. But their ability to honor these values is significantly determined by the nature of the system they work in. -/- The paper starts with a model of the prevailing pharmacist workforce model in Scotland, in which core roles are predominantly separated into hierarchically disaggregated jobs focused (...) on one professional ‘pillar’: Clinician /Practice Provider; Educator; Leader/Manager; and Researcher. This is the ‘Atomistic’ Model. This skills-segregation yields a workforce of individuals working in isolation rather than collaborating together, and lacking a shared information flow, purpose and identity. Key strategic flaws include suboptimal responsiveness to population and subpopulation needs, inconsistency and inequity of care, an erosion of professional agency, and lower job satisfaction. It is conjectured that this results from a lack of congruence between values, professional ethos, and organizational structure. ‘Atomism’ culminates in a syndrome of widespread professional-level cognitive dissonance. -/- The paper contrasts this with a new emerging workforce vision, The Collaborative Care Model. This new model defines a systems-first-approach, built on the principle that all jobs must include all four professional ‘pillars’. Vertical skills integration, involving education and task sharing, will support sustainability and succession planning. Horizontal skills integration (across practice, leadership and research) is included to improve responsiveness to population need and individual professional agency. The working conditions, supportive ethos, and career structure needed to make the model work are described. Moral theory and workforce theory are used to justify why the model may be more effective for population health, delivering greater job satisfaction for individuals and ultimately helping systematically realize and honor healthcare values. Finally, the paper sketches the first steps needed to implement the model at the national level, starting with the operationalization of new multi-pillar professional curricula across the career spectrum. Potential pitfalls and challenges are also discussed. -/- Co-Authors: 1. Paul Forsyth (PF) Lead Pharmacist Clinical Cardiology, Pharmacy, NHS Greater Glasgow & Clyde. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Writing - original draft (lead author), Writing - review & editing (lead author) 2. Andrew Radley (AR), Consultant in Public Health Pharmacy, NHS Tayside. Contribution: Conceptualization; Model curation; Model Theory; Writing - review & editing 3. Gordon Rushworth (GR), MPharm MSc FFRPS FRPharmS (Consultant). Programme Director, Highland Pharmacy Education & Research Centre, NHS Highland, Inverness. Contribution: Model curation; Writing - review & editing 4. Fiona Marra (FM) National Lead Clinician Scottish Infection and Immunology Network (SPAIIN) / Advanced Pharmacist HCV / HIV, NHS Greater Glasgow & Clyde. Contribution: Model curation; Writing - review & editing 5. Susan Roberts (SR) Associate Postgraduate Pharmacy Dean, NHS Education for Scotland. Contribution: Model curation; Writing - review & editing 6. Roisin O’Hare (RO) Lead Teacher Practitioner Pharmacist, Northern Ireland University Network, Southern Health and Social Care Trust. Contribution: Model curation; Writing - review & editing 7. Catherine Duggan (CD) Chief Executive Officer, International Pharmaceutical Federation (FIP). Contribution: Model curation; Writing - review & editing 8. Barry Maguire (BM) Senior Lecturer, School of Philosophy, Psychology and Life Sciences, The University of Edinburgh. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Supervision; Writing - original draft (senior academic supervisor), Writing - review & editing (senior academic supervisor) -/- . (shrink)

Mindfulness-based interventions (MBIs) are being actively implemented in a wide range of fields – psychology, mind/body health care and education at all levels – and there is growing evidence of their effectiveness in aiding present-moment focus, fostering emotional stability, and enhancing general mind/body well-being. However, as often happens with popular innovations, the burgeoning interest in and appeal of mindfulness practice has led to a reductionism and commodification – popularly labelled ‘McMindfulness’ – of the underpinning principles and ethical foundations of (...) such practice which threatens to subvert and militate against the achievement of the original aims of MBIs in general and their educational function in particular. It is argued here that mindfulness practice needs to be organically connected to its spiritual roots if the educational benefits of such practice are to be fully realised. (shrink)

The emergence of the COVID-19 pandemic initiated major disruptions to higher education systems. Physical spaces that previously supported interpersonal interaction and community were abruptly inactivated, and faculty largely took on the responsibility of accommodating classroom structures in rapidly changing situations. This study employed interviews to examine how undergraduate Science, Technology, Engineering, and Mathematics (STEM) instructors adapted instruction to accommodate the mandated transition to virtual learning and how these accommodations supported or hindered community and belonging during the onset of the pandemic. (...) Interviews with 25 STEM faculty at an undergraduate Hispanic Serving Institution revealed a wide range of accommodations they made to their courses and how they managed communication with students. Faculty strived to support student belonging with responses ranging from caring to crisis management, though some faculty expressed feelings of powerlessness when unable to accommodate certain challenges. The case of a responsive and flexible instructor is presented to highlight a productive response to a crisis. These retrospective findings point to strategies to support faculty teaching in virtual learning environments in the future; increasing opportunities for student–student and student–faculty interaction, supporting faculty in learning technologies that support these interactions and addressing faculty’s feelings of powerlessness. (shrink)

Intellectual history still quite commonly distinguishes between the episode we know as the Scientific Revolution, and its successor era, the Enlightenment, in terms of the calculatory and quantifying zeal of the former—the age of mechanics—and the rather scientifically lackadaisical mood of the latter, more concerned with freedom, public space and aesthetics. It is possible to challenge this distinction in a variety of ways, but the approach I examine here, in which the focus on an emerging scientific field or cluster of (...) disciplines—the ‘life sciences’, particularly natural history, medicine, and physiology —is, not Romantically anti-scientific, but resolutely anti-mathematical. Diderot bluntly states, in his Thoughts on the interpretation of nature, that “We are on the verge of a great revolution in the sciences. Given the taste people seem to have for morals, belles-lettres, the history of nature and experimental physics, I dare say that before a hundred years, there will not be more than three great geometricians remaining in Europe. The science will stop short where the Bernoullis, the Eulers, the Maupertuis, the Clairauts, the Fontaines and the D’Alemberts will have left it.... We will not go beyond.” Similarly, Buffon in the first discourse of his Histoire naturelle speaks of the “over-reliance on mathematical sciences,” given that mathematical truths are merely “definitional” and “demonstrative,” and thereby “abstract, intellectual and arbitrary.” Earlier in the Thoughts, Diderot judges “the thing of the mathematician” to have “as little existence in nature as that of the gambler.” Significantly, this attitude—taken by great scientists who also translated Newton or wrote careful papers on probability theory, as well as by others such as Mandeville—participates in the effort to conceptualize what we might call a new ontology for the emerging life sciences, very different from both the ‘iatromechanism’ and the ‘animism’ of earlier generations, which either failed to account for specifically living, goal-directed features of organisms, or accounted for them in supernaturalistic terms by appealing to an ‘anima’ as explanatory principle. Anti-mathematicism here is then a key component of a naturalistic, open-ended project to give a successful reductionist model of explanation in ‘natural history’, a model which is no more vitalist than it is materialist—but which is fairly far removed from early modern mechanism. (shrink)

Lawrence Nelson (2018) criticizes conscientious objection (CO) to abortion statutes as far as they permit health care providers to escape criminal liability for what would otherwise be the legally wrongful taking of a pregnant woman’s life by refusing treatment (i.e. abortion). His key argument refers to the U.S. Supreme Court judgment (Roe v. Wade 1973) that does not treat the unborn as constitutional persons under the Fourteenth Amendment. Therefore, Nelson claims that within the U.S. legal system any vital interests (...) of pregnant women must always take precedence over fetuses’ interests. While agreeing with the main thesis of the article, we believe that the author’s argument neither vindicates his claim, nor explains why those who believe that fetuses are equally protectable human beings do not have the right to refuse to perform an abortion in lifethreatening emergency circumstances (AE). Therefore, the main aim of our commentary is to outline, by referring to our earlier works on conscientious objection in health care (Z_ uradzki 2016) and cultural exemptions (Ciszewski 2016), a better and universalizable argumentative path that would lead to the same conclusion. (shrink)

In the first wave of the COVID-19 pandemic, healthcare workers in some countries were forced to make distressing triaging decisions about which individual patients should receive potentially life-saving treatment. Much of the ethical discussion prompted by the pandemic has concerned which moral principles should ground our response to these individual triage questions. In this paper we aim to broaden the scope of this discussion by considering the ethics of broader structural allocation decisions raised by the COVID-19 pandemic. More specifically, we (...) consider how nations ought to distribute a scarce life-saving resource across healthcare regions in a public health emergency, particularly in view of regional differences in projected need and existing capacity. We call this the regional triage question. Using the case study of ventilators in the COVID-19 pandemic, we show how the moral frameworks that we might adopt in response to individual triage decisions do not translate straightforwardly to this regional-level triage question. Having outlined what we take to be a plausible egalitarian approach to the regional triage question, we go on to propose a novel way of operationalising the ‘save the most lives’ principle in this context. We claim that the latter principle ought to take some precedence in the regional triage question, but also note important limitations to the extent of the influence that it should have in regional allocation decisions. (shrink)

In the last decade there has been an upsurge in the popularity of electric mountain bikes. However, opinion is divided regarding the implications of this emerging technology. Critics warn of the dangers they pose to landscapes, habitats, and ecological diversity, whilst advocates highlight their potential in increasing the accessibility of the outdoors for riders who would otherwise be socially and/or physically excluded. Drawing on interview data with 30 electric mountain bike users in England, this paper represents one of the first (...) attempts to empirically explore the experiential, ecological and socio-cultural implications of this activity. Utilising Stiegler’s (2013a) account of the pharmakon, in which technology is positioned as both remedy and poison, we suggest that the e-mountain bike’s role in the promotion of social and environmental responsibility is both complex and contradictory. Specifically, findings indicate that while this assistive technology can play a key role in facilitating deeper connections between riders as well as an ethic of care towards others, it can, at the same time, generate more individualised and automated experiences of recreational mobility in outdoor environments. (shrink)

In times of crises, public health leaders may claim that trials of public health interventions are unethical. One reason for this claim can be that equipoise—i.e. a situation of uncertainty and/or disagreement among experts about the evidence regarding an intervention—has been disturbed by a change of collective expert views. Some might claim that equipoise is disturbed if the majority of experts believe that emergency public health interventions are likely to be more beneficial than harmful. However, such beliefs are not (...) always justified: where high quality research has not been conducted, there is often considerable residual uncertainty about whether interventions offer net benefits. In this essay we argue that high-quality research, namely by means of well-designed randomized trials, is ethically obligatory before, during, and after implementing policies in public health emergencies (PHEs). We contend that this standard applies to both pharmaceutical and non-pharmaceutical interventions, and we elaborate an account of equipoise that captures key features of debates in the recent pandemic. We build our case by analyzing research strategies employed during the COVID-19 pandemic regarding drugs, vaccines, and non-pharmaceutical interventions; and by providing responses to possible objections. Finally, we propose a public health policy reform: whenever a policy implemented during a PHE is not grounded in high-quality evidence that expected benefits outweigh harms, there should be a planned approach to generate high-quality evidence, with review of emerging data at preset time points. These preset timepoints guarantee that policymakers pause to review emerging evidence and consider ceasing ineffective or even harmful policies, thereby improving transparency and accountability, as well as permitting the redirection of resources to more effective or beneficial interventions. (shrink)

Vaccine refusal forces us to confront tensions between many values, including scientific expertise, parental rights, children’s best interests, social responsibility, public trust, and community health. Recent outbreaks of vaccine-preventable and emerging infectious diseases have amplified these issues. The prospect of a coronavirus disease 2019 vaccine signals even more friction on the horizon. In this contentious sociopolitical landscape, it is therefore more important than ever for clinicians to identify ethically justified responses to vaccine refusal.

Background: In response to the pandemic caused by COVID-19, World Health Organization (WHO), together with International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), developed research protocols facilitating global collaboration and accelerating the understanding of the disease, to identify the potential symptoms and persistent sequelae in infected individuals, which can be used in different areas of health, that is, in primary care, at a hospital or outpatient level, both public and private. Objective: To describe the International Severe Acute Respiratory (...) and Emerging Infection Consortium (ISARIC) protocol as a new global collaborative platform for global clinical trials targeting post-COVID-19 patients. Methods: The standardized forms were developed from the COVID-19 Clinical Characterization Protocol (PCC) by the ISARIC/WHO working group composed of specialist researchers with experience in clinical research in different areas of medicine and public health, especially outbreaks and infectious diseases. Conclusion: It is expected that the creation of a database composed of different populations from all over the world will help in the characterization of risk factors, in the best form of clinical intervention and in the best prevention strategies for physical, neurological and psychosocial sequelae in the medium and long term in post-COVID-19 patients. (shrink)

In this paper, I will argue that 'being good' positively correlates to 'being happy.' First, I will clarify how I’ll be using the word ‘morality’ and the phrase ‘being good’. Second, I will claim that moral goodness is developed and exercised as a kind of practical skill. This will allow me to propose that ‘being good’ – like other complex and engaging skills – entails the elicitation of a kind of flow experience. Third, I will propose that ‘being good’ involves (...) achieving what I'll call ‘vertical coherency’ within one’s life and that this provides sustained engagement (‘flow’) and meaning while exercising moral goodness. Lastly, I will show why the kind of happiness that we truly want for ourselves and those we care about emerges from a moral engagement – a ‘good flow’ – of the sort described. (shrink)

COVID-19 demonstrated a global catastrophe that touched everybody, including the scientific community. As we respond and recover rapidly from this pandemic, there is an opportunity to guarantee that the fabric of our society includes sustainability, fairness, and care. However, approaches to environmental health attempt to decrease the population burden of COVID-19, toward saving patients from becoming ill along with preserving the allocation of clinical resources and public safety standards. This paper explores environmental and public health evidence-based practices toward responding (...) to Covid-19. A literature review tried to do a deep dive through the use of various search engines such as Mendeley, Research Gate, CAB Abstract, Google Scholar, Summon, PubMed, Scopus, Hinari, Dimension, OARE Abstract, SSRN, Academia search strategy toward reretrieving research publications, “grey literature” as well as reports from expert working groups. To achieve enhanced population health, it is recommended to adopt widespread evidence-based strategies, particularly in this uncertain time. As only together can evidence-informed decision-making (EIDM) can become a reality which includes effective policies and practices, transparency and accountability of decisions, and equity outcomes; these are all more relevant in resource-constrained contexts, such as Nigeria. Effective and ethical EIDM though requires the production as well as use of high-quality evidence that are timely, appropriate and structured. One way to do so is through co-production. Co-production (or co-creation or co-design) of environmental/public health evidence considered as a key tool for addressing complex global crises such as the high risk of severe COVID-19 in different nations. A significant evidence-based component of environmental/public health (EBEPH) consist of decisions making based on best accessible, evidence that is peer-reviewed; using data as well as systematic information systems; community engagement in policy making; conducting sound evaluation; do thorough program-planning frameworks; as well as disseminating what is being learned. As researchers, scientists, statisticians, journal editors, practitioners, as well as decision-makers strive to improve population health, having a natural tendency toward scrutinizing the scientific literature aimed at novel research findings serving as the foundation for intervention as well as prevention programs. The main inspiration behind conducting research ought to be toward stimulating and collaborating appropriately on public/environmental health action. Hence, there is need for a “Plan B” of effective behavioural, environmental, social as well as systems interventions (BESSI) toward reducing transmission. (shrink)

The COVID-19 (Coronavirus disease of 2019) pandemic has led to intense conversations about ventilator allocation and reallocation during a crisis standard of care. Multiple voices in the media and multiple state guidelines mention reallocation as a possibility. Drawing upon a range of neuroscientific, phenomenological, ethical, and sociopolitical considerations, the authors argue that taking away someone’s personal ventilator is a direct assault on their bodily and social integrity. They conclude that personal ventilators should not be part of reallocation pools and (...) that triage protocols should be immediately clarified to explicitly state that personal ventilators will be protected in all cases. (shrink)

There is much philosophical literature on the duty to rescue. Individuals who encounter and could save, at relatively little cost to themselves, a person at risk of losing life or limb are morally obligated to do so. Yet little has been said about the other side of the issue. There are cases in which the need for rescue could have been reasonably avoided by the rescuee. We argue for a duty to take rescue precautions, providing an account of the circumstances (...) in which it arises. This novel duty has important implications for public policy. We apply it to the situation of some of the uninsured in the United States. Given the US clinician's duty to provide emergency care to all people regardless of ability to pay, some of the uninsured have a moral duty to purchase health insurance. We defend the duty against objections, including the possibility that a right to rescue can be waived, thus undermining a duty to take rescue precautions, that the duty of many professionals is voluntarily incurred, and that a distinction between actively assumed and passively assumed risks matters morally. (shrink)

The 2010 Patient Protection and Affordable Care Act was designed to increase health insurance coverage in the United States. Its most controversial feature is the requirement that US residents purchase health insurance. Opponents of the mandate argue that requiring people to contribute to the collective good is inconsistent with respect for individual liberty. Rather than appeal to the collective good, this Viewpoint argues for a duty to buy health insurance based on the moral duty individuals have to reduce certain (...) burdens they pose on others. When some people have a duty to rescue, others may have a duty to take rescue precautions, in this case, to purchase health insurance to cover acute and emergency care needs. Requiring that individuals meet this obligation is consistent with respect of individual liberty. (shrink)

In "Frailty Triage: Is Rationing Intensive Medical Treatment on the Grounds of Frailty Ethical?," Wilkinson (2021) argues that the use of frailty scores in ICU triage does not necessarily involve discrimination on the basis of disability. In support of this argument, he claims, “it is not the disability per se that the score is measuring – rather it is the underlying physiological and physical vulnerability." While we appreciate the attention Wilkinson explicitly pays to disability in this piece, we find the (...) distinction between disability and underlying vulnerability untenable both theoretically and practically. In this peer commentary, we begin with a brief overview of research in philosophy of disability concerning the meaning of the concept itself. We argue that this research demonstrates that many forms of disability do not involve underlying vulnerabilities, and, furthermore, that Wilkinson equivocates between "disability" understood as a medical category vs. "disability" understood as a feature of lived experience. We reject Wilkinson’s distinction on these grounds and offer further considerations to avoid disability discrimination in emergency and crisis standards of care contexts. (shrink)

This topic focuses on the problems that arise in providing medical care to the population during armed conflict or martial law. Under such conditions, hospitals, clinics, and other healthcare facilities have to work in challenging circumstances with limited resources and reduced security for medical personnel. This topic explores such issues as how martial law affects the work of medical institutions, what problems arise in providing medical care to the population in war, how war affects the health of the (...) people, and what consequences it may have in the long term. Research in this area will help to understand how to organize better and prepare medical facilities to work in war conditions and ensure high-quality medical care to the population in emergencies. The methods used to write this article were analysis, synthesis, generalization, explanation, and data qualification. The primary and fundamental sources for writing an article may vary depending on the topic, but generally, the following sources can be recommended. Academic studies: these can be scholarly articles, monographs, dissertations, conference papers, and other materials related to the topic of your article. These sources can help you find information about the latest research in the field and allow you to see the approaches and methodologies used in the studies. Official sources: These can be legal documents, reports, regulations, guidelines, and other materials issued by government agencies, ministries, and other departments. These sources can help you understand the rules and regulations governing your article's topic. Expert reviews: these can be interviews with experts in the field, articles, and other materials written by well-known specialists. These sources can help you understand the views and opinions of well-known experts on the issues related to your paper. (shrink)

The Internet of Things (IoT) wireless LAN in healthcare has moved away from traditional methods that include hospital visits and continuous monitoring. The Internet of Things allows the use of certain means, including the detection, processing and transmission of physical and biomedical parameters. With powerful algorithms and intelligent systems, it will be available to provide unprecedented levels of critical data for real-time life that are collected and analyzed to guide people in research, management and emergency care. This chapter (...) provides a quick overview of IoT features and how they relate to wireless discovery and technology to deploy the medical applications you need. In the world, the revolution in any industry is to connect your products and devices to the Internet and make them independent and remotely connected, so that anyone can use and view them from anywhere and anytime. The Internet of Things provides us with a home automation system that uses smart devices to overcome this obstacle, allowing us to easily manage our appliances. A smart city is a vision to integrate a variety of information and communication solutions for residents with essential services, such as smart parking on all streets. The main motivation for using the Internet for parking objects is simply collecting data to get free parking. The IoT-based RTSSPS architecture is divided into three parts: a WSN-based smart street parking module, an IoT-based smart street parking module, and an IoT-based smart street parking module. IoT-based cloud with street parking algorithm, rating and future directions. (shrink)

I reconsider the concept of dignity in several ways in this article. My primary aim is to move dignity in a more relational direction, drawing on care ethics to do so. After analyzing the power and perils of dignity and tracing its rhetorical, academic, and historical influence, I discuss three interventions that care ethics can make into the dignity discourse. The first intervention involves an understanding of the ways in which care can be dignifying. The second intervention (...) examines whether the capacity to care should be considered a distinguishing moral power – as rationality often is – in light of which humans have dignity. In the third intervention, I cast dignity as a fundamentally relational concept and argue that relationality is constitutive not only of dignity but also of the wider enterprise of normativity. I understand relationality as the condition of connection in which all human beings stand with some other human beings. A thought experiment involving the last person on earth helps to reframe the normative significance of human relatedness. Dignity emerges as fundamentally grounded in relationality. (shrink)

A careful, theoretical clarification of gender roles has only recently begun in social and political philosophy. It is the aim of the following piece to reveal that an analysis of women’s traditional position - her distinctive activities, labor and surrounding sense of ‘mine’ - can not only make valuable contributions towards clarifying traditional property disputes, but may even provide elements for a new conception of ownership. By way of illustration, the article focusses on the influential work of John Rawls and (...) argues that - when Rawls’s own analysis and principles of justice are supplemented by an account of what is here called ‘reproductive labor’ - his theory in fact tends to a form of democratic socialism. Stated somewhat differently, my aim is to shift the terms of the property debate as posed by Rawls fromwithinhis own position. I hope to show that the real ownership question which now emerges is no longerwhether‘justice as fairness’ countenances a private property or socialist form of democracy, but what preciseformsuch a socialism should take. (shrink)

In recent years we may observe increasing interest in the development of social innovation both regarding theory as well as the practice of responding to social problems and challenges. One of the crucial challenges at the beginning of the 21st century is population ageing. Various new and innovative initiatives, programs, schemes, and projects to respond to negative consequences of this demographic process are emerging around the world. However, social theories related to ageing are still insufficiently combined with these new practices, (...) social movements, organisational models, and institutions. Many scholars are still using notions and tools from classical theories of social gerontology or the sociology of ageing such as disengagement theory, activity theory, and successful and productive ageing. Such theories do not sufficiently explain ageing in the context of, for example, a broad use of the information and communications technologies including robotics and automation, new healthcare and long-term care models, advancements in the development and governance of age-friendly environments, and public engagement of older adults into co-production of services delivered by public, private, non-governmental as well as non-formal entities. (shrink)

Introduction: The Kenyan government has put a spirited reform to ensure all Kenyans get universal healthcare. This has led to restructuring of several entities among them the health insurance industry. This is geared at alleviating the burden of catastrophic expenditure on health from the poor Kenyans. However, insurance uptake remains at less than a quarter of the population with many Kenyans still paying for healthcare out-of-pocket. These out-of-pocket payers often don’t afford the ever-increasing cost of healthcare in Kenya. This study (...) looked at how doctors deal with patients given their modality of payment. Methodology: This was an online based survey that was distributed to Kenyan doctors via email by Kenya Medical Association. The survey sought information from the respondents on how they dealt with patients given their modality of payment. In addition, respondents were asked to provide an example of a case they had dealt with that touched on each payment modality. Results: Respondents gave their experiences where insurance had influenced their clinical decisions. Codes developed from the prose were; “inability to pay”, “harmful to the patient”, “changed the prescription” among others Health insurance played a crucial role whenever respondents made decisions. Top on the list of things that the majority indicated would be considered is insurance status and/or their ability of patients to pay for the services. Conclusion: Respondents are stuck in a limbo; striving to give the best care to patients but limited by the patients’ inability to pay. In explaining their experiences, respondents explain a situation where they intend to offer the best, but patients cannot afford. This especially so for those without health insurance who end up either not getting services or at the very best, get inferior services. (shrink)

Background: The concept of digital twins has great potential for transforming the existing health care system by making it more personalized. As a convergence of health care, artificial intelligence, and information and communication technologies, personalized health care services that are developed under the concept of digital twins raise a myriad of ethical issues. Although some of the ethical issues are known to researchers working on digital health and personalized medicine, currently, there is no comprehensive review that maps (...) the major ethical risks of digital twins for personalized health care services. Objective: This study aims to fill the research gap by identifying the major ethical risks of digital twins for personalized health care services. We first propose a working definition for digital twins for personalized health care services to facilitate future discussions on the ethical issues related to these emerging digital health services. We then develop a process-oriented ethical map to identify the major ethical risks in each of the different data processing phases. Methods: We resorted to the literature on eHealth, personalized medicine, precision medicine, and information engineering to identify potential issues and developed a process-oriented ethical map to structure the inquiry in a more systematic way. The ethical map allows us to see how each of the major ethical concerns emerges during the process of transforming raw data into valuable information. Developers of a digital twin for personalized health care service may use this map to identify ethical risks during the development stage in a more systematic way and can proactively address them. Results: This paper provides a working definition of digital twins for personalized health care services by identifying 3 features that distinguish the new application from other eHealth services. On the basis of the working definition, this paper further layouts 10 major operational problems and the corresponding ethical risks. Conclusions: It is challenging to address all the major ethical risks that a digital twin for a personalized health care service might encounter proactively without a conceptual map at hand. The process-oriented ethical map we propose here can assist the developers of digital twins for personalized health care services in analyzing ethical risks in a more systematic manner. (shrink)

Given that one of the major goals of the practice of Philosophy for Children (P4C) is the development of critical thinking skills (Sharp 1987/2018, pp. 4 6), an urgent question that emerged for one of the authors, who is of Chinese Heritage and a novice practitioner at a P4C summer camp was whether this emphasis on critical thinking might make this practice incompatible with the fabric of Chinese culture. Filial piety (孝), which requires respect for one’s parents, elders, and ancestors (...) is considered an important virtue in Asian culture, as is the preservation of harmony. But if one of the goals of P4C is to teach youngsters to courageously pursue reasoned dialogue, does this not set-up young Asians for serious conflict when they come face-to-face with positions that are articulated by elders, but which are ones to which they are diametrically opposed; a racist grandmother, for instance, or an uncle who insists that those at the Tiananmen Square uprising were nothing but hooligan’s. It is this question that we will explore in this presentation. In the process, we will come to the conclusion that, when positions seem irreconcilable, rather than continuing to pursue rigorous critical interchange that may do little other than escalate insult, the facilitator, rather, ought to move toward creating a deeper understanding of each position juxtaposed against its opposing view (a process that we refer to as ‘collaborative caring’), so as to produce side-by-side understanding, knowing that communal bonds have been maintained and, hence, that the opportunity for genuine reasoned collaborative inquiry on other issues and at future times remains open. (shrink)

What is the role of lay deliberation – if any – in health-care rationing, and administration more generally? Two potential answers are suggested by recent debates on the subject. The one, which I will call the technocratic answer, suggests that there is no distinctive role for lay participation once ordinary democratic politics have set the goals and priorities which reform should implement. Determining how best to achieve those ends, and then actually achieving them, this view suggests, is a matter (...) for experts, armed with the best evidence available to them, both of the subject area involved, and of management and administrative excellence. -/- By contrast, the second, deliberative, view holds that lay deliberation has an important role in the administration and execution of government policy, both because these latter inevitably have a political element which needs to reflect democratic norms and values, and because lay people are, themselves, a source of information, even of wisdom, that experts will want to use in fulfilling their professional responsibilities. Recent debates on the value of lay participation in healthcare provision can illuminate the strengths and weaknesses of both approaches, as can the experience of NICE. So, I will start by examining two articles by Albert Weale, which attempt to clarify the role that lay deliberation should have in healthcare, before turning to the dilemmas for both the technocratic and deliberative views which emerge from the experience of NICE. (shrink)

To explain the evolutionary emergence of uniquely human skills and motivations for cooperation, Tomasello et al. (2012, in Current Anthropology 53(6):673–92) proposed the interdependence hypothesis. The key adaptive context in this account was the obligate collaborative foraging of early human adults. Hawkes (2014, in Human Nature 25(1):28–48), following Hrdy (Mothers and Others, Harvard University Press, 2009), provided an alternative account for the emergence of uniquely human cooperative skills in which the key was early human infants’ attempts to solicit care (...) and attention from adults in a cooperative breeding context. Here we attempt to reconcile these two accounts. Our composite account accepts Hrdy’s and Hawkes’s contention that the extremely early emergence of human infants’ cooperative skills suggests an important role for cooperative breeding as adaptive context, perhaps in early Homo. But our account also insists that human cooperation goes well beyond these nascent skills to include such things as the communicative and cultural conventions, norms, and institutions created by later Homo and early modern humans to deal with adult problems of social coordination. As part of this account we hypothesize how each of the main stages of human ontogeny (infancy, childhood, adolescence) was transformed during evolution both by infants’ cooperative skills “migrating up” in age and by adults’ cooperative skills “migrating down” in age. (shrink)

Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surrogates regarding the possible use of PPPs as a means to help (...) make treatment decisions for decisionally-incapacitated patients. -/- Methods: This qualitative study used semi-structured interviews to determine the views of experienced surrogates [n=26] who were identified from two academic medical centers and two community hospitals. The primary outcomes were respondents’ overall level of support for the idea of using PPPs and the themes related to their views on how a PPP should be used, if at all, in practice. -/- Results: Overall, 21 participants supported the idea of using PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on substituted judgment. Major themes which emerged were that surrogates, not the patient’s preferences, should determine how treatment decisions are made, and concern that PPPs might be used to deny expensive care or be biased against minority groups. -/- Conclusions: Surrogates, like patients, strongly support the idea of using PPPs to help make treatment decisions for decisionally-incapacitated patients. These findings provide support for developing a PPP and assessing it in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions are made, including whether to use a PPP. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making. Future research is needed to assess this disagreement and consider ways to address it. (shrink)

How could ectogestative technology disrupt gender roles, parenting practices, and concepts such as ‘birth’, ‘body’, or ‘parent’? In this chapter, we situate this emerging technology in the context of the history of reproductive technologies and analyse the potential social and conceptual disruptions to which it could contribute. An ectogestative device, better known as ‘artificial womb’, enables the extra-uterine gestation of a human being, or mammal more generally. It is currently developed with the main goal of improving the survival chances of (...) extremely premature neonates. We argue that the intended use of the technology in neonatal intensive care units, as an alternative to current incubators (’partial-ectogestation’), challenges concepts such as ‘birth’, ‘fetus’, and ‘neonate’, and has several ethico-legal implications. We moreover address a more futuristic scenario where the entire embryological and fetal development could happen within an artificial womb (’full-ectogestation’). Such a scenario reveals the disruption of gender roles, parenting practices, and concepts such as ‘mother’, ‘father’, and ‘parent’. Both full- and partial-ectogestation would have implications for engineering and design, law-making, ethics, and philosophical anthropology. (shrink)

Since Shelly Kagan pointed out the relative neglect of ill-being in philosophical discussions, several philosophers have contributed to an emerging literature on its constituents. In doing so, they have explored possible asymmetries between the constituents of ill-being and the constituents of positive well-being. This paper explores some possible asymmetries that may arise elsewhere in the philosophy of ill-being. In particular, it considers whether there is an asymmetry between the contribution made to prudential value by equal quantities of goods and bads. (...) It then considers a similar question about the contributions made to moral value by equal quantities of ill-being and positive well-being. The paper explores some of the difficulties involved in assessing these questions. It ends by considering broader differences, both practical and theoretical, between the significance of ill-being and of positive well-being. (shrink)

Those who care about and engage in politics frequently fall victim to cognitive bias. Concerns that such bias impacts scholarship recently have prompted debates—notably, in philosophy and psychology—on the proper relationship between research and politics. One proposal emerging from these debates is that researchers studying politics have a professional duty to avoid political activism because it risks biasing their work. While sympathetic to the motivations behind this proposal, I suggest several reasons to reject a blanket duty to avoid activism: (...) (1) even if it reduced bias, this duty would make unreasonable demands on researchers; (2) this duty could hinder research by limiting viewpoint diversity; (3) this duty wrongly implies that academia offers a relative haven from bias compared to politics; and (4) not all forms of political activism pose an equal risk of bias. None of these points suggest that researchers should ignore the risk of bias. Rather, researchers should focus on stronger evidence-based strategies for reducing bias than a blanket recommendation to avoid politics. (shrink)

If Annette Baier is right that ‘some degree of trust is … the very basis of morality” (Baier 2004, 180) , it is surprising that a philosopher so interested in moral psychology and interpersonal relationships such as Iris Murdoch does not explicitly discuss trust in her work. However, on closer inspection, Murdoch’s proposal of an ethics focused on realism, unselfing and attention crucially depends upon the possibility of trust – trust in reality, and in one’s own capacity for moral vision. (...) Connecting Murdoch's project with feminist philosophy and especially feminist epistemology, and drawing on the philosophy of trust developed by C. Thi Nguyen and Karen Jones, this chapter argues for a vision of 'trust in the world' implicit in Murdoch's work, where trust emerges not in the domain of personal relationships, but in our attitude towards reality, including moral reality, that is not perceived by us as merely something inert. (shrink)

Although being widely considered as only a Western tradition, individualism is not absent in traditional Chinese philosophy and culture. In some of the classic Chinese philosophic works such as Zhuangzi, we can clearly identify some elements which can be appropriately attributed to “individualism”, such as the awareness of individual “self” as an independent and unique existence, advocating individual freedom and liberty, emphasizing on the value and dignity of individual life, favoring individuals’ autonomy and privacy, pursuing unconstrained development in personality and (...) spirituality. However, due to its particular pre-Qin social cultural background and its unique Daoist philosophic origin, this kind of individualism in Zhuangzi has its own unique characteristics, which has made it distinguishable from the variety of other individualist thoughts emerged in different times and places in the West. Zhuangzi has a dynamic and open view on individual or “self”, he does not consider individuals as fixed and interchangeable “atoms” but as dynamic, changing and unique beings, he set the unlimited and indefinable Dao as the only and ultimate source for individuals to conform to, thus to release individual mind into an realm of infinite openness and freedom. Zhuangzian individualism is “inward” rather than “outward”, which means while concentrating on individuals’ freedom of spirit and innate nature, it cares less about individuals’ outside material interests and rights in social reality, and does not encourage competition and rivalry among individuals. The special type of individualism in Zhuangzi has a profound influence on Chinese culture, providing a spiritual space for the development of individuality and personality in ancient China. It also provides an alternative understanding of individual as an existence. (shrink)

This study delves into the feasibility of introducing a market in Barangay Tanagan, Calatagan, Batangas, with a primary focus on assessing its viability and potential impact on local economic development. Utilizing survey questionnaires and employing statistical analysis techniques, the research gathered data from a carefully selected sample of 366 residents out of the total population of 4,224. The study evaluates both the potential benefits and challenges associated with establishing the proposed market. Findings, subjected to thorough analysis through methods such as (...) frequency counts and weighted mean calculations, provide valuable insights into discernible patterns, emerging trends, and relevant correlations. This analytical approach contributes to a pragmatic perspective that informs and guides future studies in the field. The study reveals an interest among respondents in the establishment of public markets in their vicinity, recognizing its potential to bolster the barangay and attract diverse opportunities. The anticipated positive impact extends to fostering economic growth and enhancing local commerce in Barangay Tanagan. Consequently, based on these compelling findings, the researchers advocate for a proposal outlining the establishment of a public market in Barangay Tanagan as a means of addressing the identified needs and aspirations of the community. (shrink)

This study attempts an exposition of different perceptions of obligation to medical treatment that have emerged from the Islamic theological understanding and how they contribute to diversity of options and flexibility in clinical practice. Particularly, an attempt is made to formulate an Islamic perspective on ordinary and extraordinary means of medical treatment. This distinction is of practical significance in clinical practice, and its right understanding is also important to public funded healthcare authorities, guardians of the patients, health and life insurance (...) institutions, and employers who provide health care coverage to their employees. Not only these parties, but also lawyers and justice administration functionaries such as public prosecutors and judges are in need of understanding this distinction to deal with relevant litigations. The distinction could be made regarding terminally ill patients and non-terminally ill patients separately. The essential factors that matter in making the distinction between ordinary and extraordinary means of treatment are: (1) patient capacity (2) expert advice, and (3) nature of medication. Regarding terminally ill patients, medical treatment can become extraordinary because of (1) patient capacity and (2) nature of medication. In both these case the deciding condition applies: the expert advice taken from a group of physicians. In regards to non- terminally ill patients, extraordinary medical treatment includes three cases: (1) treatment that is known to be useless and futile, (2) treatment that endangers the life or cause more harm than what it removes, and (3) useful treatment, but the patient is unable to bear the cost. (shrink)

In this book I show that science suffers from a damaging but rarely noticed methodological disease, which I call rationalistic neurosis. It is not just the natural sciences which suffer from this condition. The contagion has spread to the social sciences, to philosophy, to the humanities more generally, and to education. The whole academic enterprise, indeed, suffers from versions of the disease. It has extraordinarily damaging long-term consequences. For it has the effect of preventing us from developing traditions and institutions (...) of learning rationally devoted to helping us learn how to make progress towards a wiser, more civilized world. On our fragile earth, overcrowded, fraught with injustice, inequality and conflict, menaced by unprecedented and terrifying technological and industrial means for change and destruction, we urgently need to acquire a little more wisdom and civilization if we are to avoid repeating horrors of the kind suffered by so many during the 20th century (and already suffered by many in the first few years of the 21st century). We can ill afford to have in our hands instruments of learning botched and bungled from the standpoint of helping us learn how to live more wisely. It may seem scarcely credible that something as important as our institutions of learning can suffer from wholesale, structural defects. Why has this not been noticed before? Why have not armies of scientists and scholars appreciated the point and, long ago, put the matter right? The answer will emerge as my argument unfolds. I will show that one of the most damaging features of rationalistic neurosis is that it has built-in methodological and institutional mechanisms which effectively conceal that anything is wrong. But there is also an immediately obvious reason: specialization, and the resulting fragmentation of academia, has resulted in a situation in which hardly anyone takes responsibility for the overall ideals, the overall aims and methods, of academic inquiry. Academics, these days, are specialists, furiously trying to keep abreast of developments in their own specialist fields. They have no time, and no inducement, to lift their eyes from their particular disciplines, and look at the whole endeavour. Science has long been under attack, at least since the Romantic movement. Blake objected to “Single vision & Newton’s sleep” and declared that “Art is the Tree of Life... Science is the Tree of Death”. Keats lamented that science will “clip an Angel’s wings” and “unweave a rainbow”. Whereas the Enlightenment had valued science and reason as tools for the liberation of humanity, Romanticism found science and reason oppressive and destructive, and instead valued art, imagination, inspiration, individual genius, emotional and motivational honesty rather than careful attention to objective fact. Much subsequent opposition to science stems from, or echoes, the Romantic opposition of Blake, Wordsworth, Keats and many others. There is the movement Isaiah Berlin has described as the “Counter-Enlightenment” (Berlin, 1979, ch. 1). There is existentialism, with its denunciation of the tyranny of reason, its passionate affirmation of the value and centrality of irrationality in human life, from Dostoevsky, Kierkegaard and Nietzsche to Heidegger and Sartre (see, for example, Barrett, 1962). There is the attack on Enlightenment ideals concerning science and reason undertaken by the Frankfurt school, by postmodernists and others, from Horkheimer and Adorno to Lyotard, Foucault, Habermas, Derrida, MacIntyre and Rorty (see Gascardi, 1999). The soul-destroying consequences of valuing science and reason too highly is a persistent theme in literature: it is to be found in the works of writers such as D.H. Lawrence, Doris Lessing, Max Frisch, Y. Zamyatin. There is persistent opposition to modern science and technology, and to scientific rationality, often associated with the Romantic wing of the green movement, and given expression in such popular books as Marcuse’s One Dimensional Man, Roszak’s Where the Wasteland Ends, Berman’s The Reenchantment of the World and Appleyard’s Understanding the Present. There is the feminist critique of science and conceptions of science: see, for example, Fox Keller (1984) and Harding (1986). And there are the corrosive implications of the so-called “strong programme” in the sociology of knowledge, and of the work of social constructivist historians of science, which depict scientific knowledge as a belief system alongside many other such conflicting systems, having no more right to claim to constitute knowledge of the truth than these rivals, the scientific view of the world being no more than an elaborate myth, a social construct (see Barnes and Bloor, 1981; Bloor, 1991; Barnes, Bloor and Henry, 1996; Shapin and Schaffer, 1985; Shapin, 1994; Pickering, 1984; Latour, 1987). This latter literature has provoked a counter-attack by scientists, historians and philosophers of science seeking to defend science and traditional conceptions of scientific rationality: see Gross and Levitt (1994), Gross, Levitt and Lewis (1996), and Koertge (1998). This debate between critics and defenders of science came abruptly to public attention with the publication of Alan Sokal’s brilliant hoax article ‘Transgressing the boundaries’ in a special issue of the cultural studies journal Social Text in 1996 entitled Science Wars: see Sokal and Bricmont (1998). What does this book have to contribute, given the above avalanche of criticism of science? The criticisms of science developed in this book are diametrically opposed to the above, in so far as the above criticisms oppose scientific rationality, seek to diminish or restrict its influence, or hold that it is unattainable. My central point is that we suffer, not from too much scientific rationality, but from not enough. What is generally taken to constitute scientific rationality is actually nothing of the kind. It is rationalistic neurosis, a characteristic, influential and damaging kind of irrationality masquerading as rationality. Science is damaged by being trapped within a widely upheld but severely defective philosophy of science; free science from this defective philosophy, provide it with a more intellectually rigorous philosophy, and it will flourish in both intellectual and humanitarian terms. And more generally, as we shall see, academic inquiry as a whole is damaged by being trapped within an intellectually defective philosophy of inquiry; free it from this defective philosophy, from its rationalistic neurosis, and it will flourish in intellectual and human terms. It is not reason that is damaging, but defective pretensions to reason — rationalistic neurosis —masquerading as reason. Thus what I seek to do here is the exact opposite of what all those who oppose science and scientific rationality do. I shall argue that Reason, the authentic article, arrived at by generalizing the progress-achieving methods of science, can have profoundly liberating and enriching consequences for all worthwhile, problematic aspects of life, and thus deserves to enter into every aspect of life. The bare bones of the argument of this book can be stated quite simply like this. Science cannot proceed without making the substantial metaphysical assumption that the universe is physically comprehensible (to some extent at least). But this conflicts with the orthodox view that in science everything is assessed impartially with respect to evidence, nothing being permanently assumed independently of evidence. So the metaphysical assumption of comprehensibility is repressed. Science pretends that no such assumption is made. But this damages science. For the assumption is substantial, influential and highly problematic. It needs to be made explicit within science so that it can be critically scrutinized, so that alternatives can be developed and considered. Pretending the assumption is not being made undermines the intellectual rigour of science, its intellectual value and success. And it does not stop there. For science also makes value assumptions. Quite properly, science is concerned to discover that which is of value. New factual knowledge devoid of all value (whether intellectual or practical) does not contribute to science. But the orthodox view of science holds that values have no place within science. As in the case of metaphysics, here too, science pretends that values have no role to play within the intellectual domain of science. And this damages science. For values are, if anything, even more influential and problematic than metaphysics (in influencing the direction of research). Here too, values need to be made explicit within science so that they can be scrutinized, so that alternatives can be developed and assessed. Pretending that values play no role within the intellectual domain damages science; both the intellectual and the practical aspects of science are adversely affected. Science fails to pursue those avenues of research that lie in the best interests of humanity. And it goes further. Science is pursued in a social, cultural, economic and political context. It is a part of various social, economic and political projects which seek to achieve diverse human objectives. But the idea that science is an integral part of humanitarian or political enterprises with political ends clashes, once again, with the official view of science that the aim of science is to improve factual knowledge. The political objectives of science are repressed. And, once again, this damages science. For, of course, the political objectives of science, like all our political objectives, are profoundly problematic. These need to be made explicit so that they can be scrutinized, so that alternatives can be developed and considered. The pretence that science does not have this political dimension once again undermines the intellectual rigour of science, and its human value. It lays science open to becoming a part of economic, corporate and political enterprises that are not in the best interests of humanity. The upshot of the line of argument just indicated is that we need to bring about a revolution in the aims and methods of science, and of academic inquiry more generally. Natural science needs to change; its relationship with the rest of academic inquiry, with social inquiry and the humanities, needs to change; and most importantly and dramatically, academic inquiry as a whole needs to change. The basic task of the academic enterprise needs to become to help humanity learn how to tackle its problems of living in more cooperatively rational ways than at present. We need to put the intellectual tasks of articulating our problems of living, and proposing and critically assessing possible solutions, possible and actual actions, at the heart of academic inquiry. The basic task needs to be to help humanity learn a bit more wisdom – wisdom being the capacity to realize what is of value in life, for oneself and others, wisdom including knowledge and technological know-how, but much else besides. Natural science, despite its flaws, has massively increased our knowledge and technological know-how. This in turn has led to a massive and sometimes terrifying increase in our power to act. Often this unprecedented power to act is used for human good, as in medicine or agriculture. But it is also used to cause harm, whether unintentionally (initially at least) as when industrialization and modern agriculture lead to global warming, destruction of natural habitats and rapid extinction of species, or intentionally, as when the technology of war is used by governments and terrorists to maim and kill. Before the advent of modern science, when we lacked the means to do too much damage to ourselves and the planet, lack of wisdom did not matter too much. Now, with our unprecedented powers to act, bequeathed to us by science, lack of wisdom has become a menace. This is the crisis behind all the other current global crises: science without wisdom. In these circumstances, to continue to pursue knowledge and technological know-how dissociated from a more fundamental quest for wisdom can only deepen the crisis. As a matter of urgency, we need to free science and academia of their neuroses; we need to bring about a revolution in the academic enterprise so that the basic aim becomes to promote wisdom by intellectual and educational means. At present science and the humanities betray both reason and humanity. The argument of this book, which I have just summarized, begins with a discussion of the philosophical and methodological problems that beset theoretical physics. At once, many of those who are concerned about moral, political and environmental issues that plague our world today, will feel impatient. What have the methodological problems of theoretical physics to do with third world poverty, war and the threat of war, pollution, extinction of species, the menace of conventional, chemical, biological and nuclear armaments? I can only plead with such a reader: patience. The root cause of the sickness of our times does indeed lie, I claim, with a methodological sickness of natural science or, even more specifically, of physical science. What makes the modern world so utterly different from all previous ages is our possession of modern science and technology. This is the instrument that has changed the conditions of human life almost beyond all recognition, and put unprecedented, and sometimes terrifying, powers into our hands. One should not dismiss out of hand the suggestion that a part of our problem may lie with this instrument, this engine, of rapid change. We see, here, too, the way in which intellectual specialization, referred to above, has effectively concealed from view the nature and extent of the problem that confronts us. The argument that I shall develop in what follows begins with physics, with problems concerning the aims and methods of physics. But it then leaps to social science, to philosophy, to the humanities, to education, to psychotherapy, and to politics: in the end there is scarcely an aspect of modern life that is not touched and, potentially, affected by the argument. How many academic experts are prepared to follow, to take seriously, an argument that ranges so recklessly across such a wide range of academic disciplines? How many non-academic non-experts? But just this is what the argument and message of this book requires. I hope that the reader will endure with patience the somewhat esoteric discussion concerning the aims and methods of physics pursued in chapter one. This may not seem to have anything much to do with the urgent problems of our times, but it does. This is in part how the intellectual disaster I seek to expose in this book conceals itself from view: it buries itself in the obscure, recondite field of the philosophy of physics. Those who devote their lives to the philosophy of physics are, by and large, too myopic to see how their specialized field of study has anything to do with the great and dreadful humanitarian problems and disasters of our age; and those who are above all concerned with these humanitarian disasters have no time at all for abstruse issues concerning the aims and methods of physics. And so the connection is never made. As it happens, the methodological neurosis of physics, with which we begin in chapter one, is actually a quite simple matter to grasp. It does not require any real knowledge of physics to understand. Indeed, physicists and philosophers of physics are much more likely to find the argument difficult to follow than are non-experts. We non-scientists can stand back and see the whole wood; scientists, trained to think in terms of the current orthodox conception of science, trapped in the thickets of research, will find this much harder to do. In an attempt to take this peculiar circumstance into account, I have arranged the exposition as follows. In chapter one I give a simple exposition of the case for declaring natural science to suffer from what I call "rationalistic neurosis"; this avoids all technicalities, and goes straight to the heart of the matter. In the appendix I tackle a host of more technical objections that may be made to the elementary argument of chapter one. So, those experts in the fields of the philosophy of physics and philosophy of science who find the argument of chapter one naïve and unconvincing, should consult the appendix before tossing the book away in disgust. I write in the hope that there will be a few who will not dismiss out of hand the suggestion that the question of how we are to go about learning how to live in wiser and more civilized ways might have something to learn from scientific learning, and will take the trouble to pursue the line of argument traced out in this book. I write in the hope that these few will grasp just how desperate our situation is, how urgent the need to change the status quo, and will do everything in their power to alert others to the need to heal the methodological sickness from which our institutions and traditions of learning at present suffer. To begin with, we need a campaigning organization, modelled perhaps on "Friends of the Earth", which might be called something like "Friends of Wisdom". (shrink)

Chest pain is the pain felt in the chest by infants, children and adolescents. In most cases the pain is not associated with the heart. It is mainly recognized by the observance or report of pain by the infant, child or adolescent by reports of distress by parents or care givers. Chest pain is not unusual in children. Lots of children are seen in ambulatory clinics, emergency rooms and hospitals and cardiology clinics. Usually there is a benign cause (...) for the pain for utmost children. Certain patients have conditions that are serious and perhaps life-threatening. Chest pain in pediatric patients needs careful physical examination and a detailed history that would point to the possibility of a serious cause. Researches of pediatric chest pain are scarce. It has been difficult to create evidence-based guidelines for evaluation. In this paper we propose an expert system to help doctors and parents, and care giver in diagnosing chest pain in infants and children. This expert System is design and implemented in SL5 Object language. (shrink)

In the small but growing literature on the philosophy of country music, the question of how we ought to understand the genre’s notion of authenticity has emerged as one of the central questions. Many country music scholars argue that authenticity claims track attributions of cultural standing or artistic self-expression. However, careful attention to the history of the genre reveals that these claims are simply factually wrong. On the basis of this, we have grounds for dismissing these attributions. Here, I argue (...) for an alternative model of authenticity in which we take claims about the relative authenticity of country music to be evidence of ‘country’ being a dual character concept in the same way that it has been suggested of punk rock and hip-hop. Authentic country music is country music that embodies the core value commitments of the genre. These values form the basis of country artists’ and audiences’ practical identities. Part of country music’s aesthetic practice is that audiences reconnect with, reify, and revise this common practical identity through identification with artists and works that manifest these values. We should then think of authenticity discourse within country music as a kind of game within the genre’s practice of shaping and maintaining this practical identity. (shrink)

In recent years, the ethical impact of AI has been increasingly scrutinized, with public scandals emerging over biased outcomes, lack of transparency, and the misuse of data. This has led to a growing mistrust of AI and increased calls for mandated ethical audits of algorithms. Current proposals for ethical assessment of algorithms are either too high level to be put into practice without further guidance, or they focus on very specific and technical notions of fairness or transparency that do not (...) consider multiple stakeholders or the broader social context. In this article, we present an auditing framework to guide the ethical assessment of an algorithm. The audit instrument itself is comprised of three elements: a list of possible interests of stakeholders affected by the algorithm, an assessment of metrics that describe key ethically salient features of the algorithm, and a relevancy matrix that connects the assessed metrics to stakeholder interests. The proposed audit instrument yields an ethical evaluation of an algorithm that could be used by regulators and others interested in doing due diligence, while paying careful attention to the complex societal context within which the algorithm is deployed. (shrink)

Motivated by the question of responsible AI and value alignment, I seek to offer a uniquely Foucauldian reconstruction of the problem as the emergence of an ethical subject in a disciplinary setting. This reconstruction contrasts with the strictly human-oriented programme typical to current scholarship that often views technology in instrumental terms. With this in mind, I problematise the concept of a technological subjectivity through an exploration of various aspects of ChatGPT in light of Foucault’s work, arguing that current systems lack (...) the reflexivity and self-formative characteristics inherent in the notion of the subject. By drawing upon a recent dialogue between Foucault and phenomenology, I suggest four techno-philosophical desiderata that would address the gaps in this search for a technological subjectivity: embodied self-care, embodied intentionality, imagination and reflexivity. Thus I propose that advanced AI be reconceptualised as a subject capable of “technical” self-crafting and reflexive self-conduct, opening new pathways to grasp the intertwinement of the human and the artificial. This reconceptualization holds the potential to render future AI technology more transparent and responsible in the circulation of knowledge, care and power. (shrink)

Tracing the leading role of emotions in the evolution of the mind, a philosopher and a psychologist pair up to reveal how thought and culture owe less to our faculty for reason than to our capacity to feel. Many accounts of the human mind concentrate on the brain’s computational power. Yet, in evolutionary terms, rational cognition emerged only the day before yesterday. For nearly 200 million years before humans developed a capacity to reason, the emotional centers of the brain were (...) hard at work. If we want to properly understand the evolution of the mind, we must explore this more primal capability that we share with other animals: the power to feel. Emotions saturate every thought and perception with the weight of feelings. The Emotional Mind reveals that many of the distinctive behaviors and social structures of our species are best discerned through the lens of emotions. Even the roots of so much that makes us uniquely human—art, mythology, religion—can be traced to feelings of caring, longing, fear, loneliness, awe, rage, lust, playfulness, and more. From prehistoric cave art to the songs of Hank Williams, Stephen T. Asma and Rami Gabriel explore how the evolution of the emotional mind stimulated our species’ cultural expression in all its rich variety. Bringing together insights and data from philosophy, biology, anthropology, neuroscience, and psychology, The Emotional Mind offers a new paradigm for understanding what it is that makes us so unique. (shrink)