—One of the promising applications of wireless sensor networks (WSNs) is monitoring of the human body for health concerns. For this purpose, a large number of small sensors are implanted in the human body. These sensors altogether provide a network of wireless sensors (WBANs) and monitor the vital signs and signals of the human body; these sensors will then send this information to the doctor. The most important application of the WBAN is the implementation of the monitoring network for (...) class='Hi'>patient safety in the hospital environment. In this case, supporting patients’ mobility is one of the basic needs, which has been underestimated in recent studies. The problem that involves providing the required energy for the units used in this type of network is challenging; for this reason, sent/ received units with very low power consumption and with a very small radius are used in order to save energy. The resulting small sending range, leads to the lack of support for patients' mobility. In this paper, the AD HOC mode is suggested for use to establish a network and a multi-path routing algorithm, for the purpose of importing patients’ mobility in hospital setting. The results of the simulation show that in addition to supporting patients' mobility, the use of the proposed idea instead of previously presented protocols, reduces delays in data transmission and energy consumption; and it also increases the delivery rate depending on the destination and the lifetime of the network, while on the other hand, it increases routing overhead. (shrink)

Introduction Current treatments for pain have limited benefits and worrying side effects. Some studies suggest that pain is reduced when clinicians deliver positive messages. However, the effects of positive messages are heterogeneous and have not been subject to meta-analysis. We aimed to estimate the efficacy of positive messages for pain reduction. -/- Methods We included randomized trials of the effects of positive messages in a subset of the studies included in a recent systematic review of context factors for treating pain. (...) Several electronic databases were searched. Reference lists of relevant studies were also searched. Two authors independently undertook study selection, data extraction, risk of bias assessment, and analyses. Our primary outcome measures were differences in patient- or observer-reported pain between groups who were given positive messages and those who were not. -/- Results Of the 16 randomized trials (1703 patients) that met the inclusion criteria, 12 trials had sufficient data for meta-analysis. The pooled standardized effect size was −0.31 (95% confidence interval [CI] −0.61 to −0.01, p = 0.04, I2 = 82%). The effect size remained positive but not statistically significant after we excluded studies considered to have a high risk of bias (standard effect size −0.17, 95% CI −0.54 to 0.19, P = 0.36, I2 = 84%). -/- Conclusion Care of patients with chronic or acute pain may be enhanced when clinicians deliver positive messages about possible clinical outcomes. However, we have identified several limitations of the present study that suggest caution when interpreting the results. We recommend further high-quality studies to confirm (or falsify) our result. -/- FUNDING -/- Alexander Mebius research has been funded through the ERC grant "Philosophy of Pharmacology: Safety, Statistical Standards, and Evidence Amalgamation" (GA: 639276). (shrink)

The development of predictive brain implant (PBI) technology that is able to forecast specific neuronal events and advise and/or automatically administer appropriate therapy for diseases of the brain raises a number of ethical issues. Provided that this technology satisfies basic safety and functionality conditions, one of the most pressing questions to address is its relation to the autonomy of patients. As Frederic Gilbert in his article asks, if autonomy implies a certain idea of freedom, or self-government, how can an (...) individual be considered to decide freely if the implanted device stands at the inception of the causal chain producing his decisions? He claims that PBIs threaten persons’ autonomy by diminishing their post-operative experience of self-control. In this commentary, I wish to discuss this claim. Contrary to Gilbert, I will suggest that PBIs do not pose a significant threat to patient’s autonomy, as self-control, but rather to his/her sense of authenticity. My claim is that the language of authenticity, already introduced in the recent bioethical literature, may offer a better way to voice some of the concerns with PBIs that Gilbert recognized. (shrink)

There is considerable enthusiasm about the prospect that artificial intelligence (AI) will help to improve the safety and efficacy of health services and the efficiency of health systems. To realize this potential, however, AI systems will have to overcome structural problems in the culture and practice of medicine and the organization of health systems that impact the data from which AI models are built, the environments into which they will be deployed, and the practices and incentives that structure their (...) development. This perspective elaborates on some of these structural challenges and provides recommendations to address potential shortcomings. (shrink)

The need to better balance the promotion of scientific and technological innovation with risk management for consumer protection has inspired several recent reforms attempting to make regulations more flexible and adaptive. The pharmaceutical sector has a long, established regulatory tradition, as well as a long history of controversies around how to balance incentives for needed therapeutic innovations and protecting patient safety. The emergence of disruptive biotechnologies has provided the occasion for regulatory innovation in this sector. This article investigates (...) the regulation of advanced biotherapeutics in the European Union and shows that it presents several defining features of an adaptive regulation regime, notably institutionalized processes of planned adaptation that allow regulators to gather, generate, and mobilize new scientific and risk evidence about innovative products. However, our in-depth case analysis highlights that more attention needs to be paid to the consequences of the introduction of adaptive regulations, especially for critical stakeholders involved in this new regulatory ecosystem, the capacity and resource requirements placed on them to adapt, and the new tradeoffs they face. In addition, our analysis highlights a deficit in how we currently evaluate the performance and public value proposition of adaptive regulations vis-à-vis their stated goals and objectives. (shrink)

Purpose Prescription stimulant use as “cognitive enhancers” has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center. -/- Method Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was voluntary and (...) anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive. -/- Results Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/ energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%). -/- Conclusions Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., “cognitive enhancement”), educational quality, and patient safety or health care quality. (shrink)

Recent years have seen the rise of ‘Just Culture’ as an ideal in the patient safety movement, with numerous hospitals and professional organisations adopting a Just Culture response to incidents ranging from non-culpable human error to intentional misconduct. This paper argues that there is a deep problem with the Just Culture model, resulting from its impoverished understanding of the value of punitive, fundamentally backward-looking, practices of holding people accountable. I show that the kind of ‘accountability’ and ‘punishment’ contemporary (...) Just Culture advocates endorse disrespects both patients and providers. I claim, first, that punishment is good because it respects participants in the healthcare system by restoring an equilibrium of social and moral status that wrongdoing disturbs, and, second, that it only does so when it communicates a backward-looking message of resentful blame. (shrink)

Healthcare systems need to consider not only how to prevent error, but how to respond to errors when they occur. In the United Kingdom’s National Health Service, one strand of this latter response is the ‘No Blame Culture’, which draws attention from individuals and towards systems in the process of understanding an error. Defences of the No Blame Culture typically fail to distinguish between blaming someone and holding them responsible. This article argues for a ‘responsibility culture’, where healthcare professionals are (...) held responsible in cases of foreseeable and avoidable errors. We demonstrate how healthcare professionals can justifiably be held responsible for their errors even though they work in challenging circumstances. We then review the idea of ‘responsibility without blame’, applying this to cases of error in healthcare. Sensitive to the undesirable effects of blaming healthcare professionals and to the moral significance of holding individuals accountable, we argue that a responsibility culture has significant advantages over a No Blame Culture due to its capacity to enhance patient safety and support medical professionals in learning from their mistakes, while also recognising and validating the legitimate sense of responsibility that many medical professionals feel following avoidable error, and motivating medical professionals to report errors. (shrink)

The issue of safety culture is one of the most important in a modern medical facility because any problems during the provision of services may lead to irreversible consequences. Not only the patient may suffer, but the doctor who assisted. Unfortunately, very little attention to this issue is paid in Ukraine. Based on this, we can say that the topic is relevant and requires studying. -/- The purpose of writing this article is the analysis of the ways of (...) forming professional safety culture in clinical medicine. The methods by which we carried out scientific research are observation, analysis, evaluation, comparison, generalization. -/- The work examined interpretation of the term "safety culture", types of innovation in which it belongs and the main methods of its creation in the medical field. -/- Safety culture in the medical field involves the right of all health care workers to use measures to prevent actions that can harm a patient or a colleague. Different approaches were considered in the interpretation of the term "safety culture" and we proposed our own: safety culture is a system of values, objectives, knowledge and skills, rules and procedures, convictions shared by representatives of a certain medical profession and supported by patients, creating a favourable working climate, atmosphere of trust and becoming an efficient tool for achieving the goals of the organization. -/- The main components of the safety culture were defined: responsibilities of managers, communication, performance, resources of safety, trust, the degree of job satisfaction, etc. Based on several studies, it was found that no country has a perfect medical system. Every system should be improved. -/- We proposed measures to fix the situation with the safety culture in health care facilities. The correct management of safety can eliminate or fix many medical errors. That is why the need for a clear program of implementation, execution and control of SC in the medical establishment is necessary. -/- Scientific novelty of this work lies in the interpretation of the term "safety culture" at medical institutions and in determining major steps towards its creation. Practical value of the work is the opportunity to implement these steps in medical institutions for improvement of the safety culture and, therefore, to reduce the risk of bad accidents during treatment. -/- Further research can address safety culture management in medical institutions on the examples from the experience of countries with effective systems of health care. (shrink)

The use of machine learning, or “artificial intelligence” (AI) in medicine is widespread and growing. In this paper, I focus on a specific proposed clinical application of AI: using models to predict incapacitated patients’ treatment preferences. Drawing on results from machine learning, I argue this proposal faces a special moral problem. Machine learning researchers owe us assurance on this front before experimental research can proceed. In my conclusion I connect this concern to broader issues in AI safety.

Personal Health Monitoring (PHM) uses electronic devices which monitor and record health-related data outside a hospital, usually within the home. This paper examines the ethical issues raised by PHM. Eight themes describing the ethical implications of PHM are identified through a review of 68 academic articles concerning PHM. The identified themes include privacy, autonomy, obtrusiveness and visibility, stigma and identity, medicalisation, social isolation, delivery of care, and safety and technological need. The issues around each of these are discussed. The (...) system / lifeworld perspective of Habermas is applied to develop an understanding of the role of PHMs as mediators of communication between the institutional and the domestic environment. Furthermore, links are established between the ethical issues to demonstrate that the ethics of PHM involves a complex network of ethical interactions. The paper extends the discussion of the critical effect PHMs have on the patient’s identity and concludes that a holistic understanding of the ethical issues surrounding PHMs will help both researchers and practitioners in developing effective PHM implementations. (shrink)

Physical activity levels of people with chronic neurological disorders are lower than those of healthy people. Problems in neurological disorders, including gait abnormalities, muscle weakness/loss of strength, spasticity, tremor, fatigue, balance disorder, and incontinence, results in lower physical activity level. After determining the situations that are contraindicated for physical activity, the patients should be evaluated by physiotherapists, and possible risks that may occur should be determined. Many studies have demonstrated that physical activity significantly reduces mortality and morbidity, increases community participation, (...) and improves health-related quality of life. These benefits show that increased physical activity and exercise should be part of the standard management of neurological disorders. In these patients, physical activity programs should be structured individually by providing appropriate environmental conditions and safety, following the assessment of the functional status and severity of the disease. The duration, intensity, and type of planned physical activity should be adjusted individually; Appropriate rest intervals should be given during the activity, and termination criteria should be determined according to individual tolerance. This literature review aims to provide an up-to-date overview of physical activity recommendations for individuals with chronic neurological disorders. (shrink)

It is wholly uncontroversial that measurements-or, more properly, propositions that are measurement reports-are often paradigmatically good cases of propositions that serve the function of evidence. In normal cases it is also obvious that stating such a report is an utterly pedestrian case of successful assertion. So, for example, there is nothing controversial about the following claims: (1) that a proposition to the effect that a particular thermometer reads 104C when properly used to determine the temperature of a particular patient (...) is evidence that the patient in question has a fever and (2) that there is nothing wrong with asserting the proposition that a particular thermometer reads 104C for appropriate reasons of communication, etc. when the thermometer has been properly used to determine the temperature of a particular patient. Here it will be shown that Timothy Williamson’s commitments to a number of principles about knowledge and assertion imply that a whole class of utterly ordinary statements like these that are used as evidence are not really evidence because they are not knowledge and so are (perversely) unassertable according to his principled commitments. This paper deals primarily with the second of these two problems and an alternative account of the norms of assertion is introduced which allows for the assertability of such measurement reports. (shrink)

What position on dualism does medicine require? Our understanding of that ques- tion has been dictated by holism, as defined by the biopsychosocial model, since the late twentieth century. Unfortunately, holism was characterized at the start with con- fused definitions of ‘dualism’ and ‘reductionism’, and that problem has led to a deep, unrecognized conceptual split in the medical professions. Some insist that holism is a nonreductionist approach that aligns with some form of dualism, while others insist it’s a reductionist view (...) that sets out to eradicate dualism. It’s important to consider each version. Nonreductive holism is philosophically consistent and clinically unprob- lematic. Reductive holism, however, is conceptually incoherent—yet it is the basis for the common idea that the boundary between medical and mental health disorders must be vague. When we trace that idea through to its implementation in medical practice, we find evidence that it compromises the safety of patient care in the large portion of cases where clinicians grapple with diagnosis at the boundary between psychiatry and medicine. Having established that medicine must embrace some form of nonreduc- tionism, I argue that Chalmers’ naturalistic dualism is a stronger prima facie candidate than the nonreductive alternatives. Regardless of which form of nonreductionism we prefer, some philosophical corrections are needed to give medicine a safe and coherent foundation. (shrink)

I explain the shutdown problem: the problem of designing artificial agents that (1) shut down when a shutdown button is pressed, (2) don’t try to prevent or cause the pressing of the shutdown button, and (3) otherwise pursue goals competently. I prove three theorems that make the difficulty precise. These theorems show that agents satisfying some innocuous-seeming conditions will often try to prevent or cause the pressing of the shutdown button, even in cases where it’s costly to do so. And (...) patience trades off against shutdownability: the more patient an agent, the greater the costs that agent is willing to incur to manipulate the shutdown button. I end by noting that these theorems can guide our search for solutions. (shrink)

Translation failure occurs when a treatment shown to be safe and effective in one type of population does not produce the same result in another. We are currently in a crisis involving the translatability of preclinical studies to human populations. Animal trials are no better than a coin toss at predicting the safety and efficacy of drugs in human trials, and the high failure rate of drugs entering human trials suggests that most of the suffering of laboratory animals is (...) futile, creating no commensurate benefit for human patients. Here, I argue that animal ethics committees have a role to play in getting us out of this crisis. Inadequate representation is a known contributor to translation failures and is a matter of both scientific and ethical concern. Ethical review committees have the authority to address it by reprioritising the values already enshrined in their guiding principles. (shrink)

Background Bronchial asthma is one of the most common chronic conditions among children. Despite the improvement in asthma treatment regimens, its prevalence and related morbidity are increasing, especially among underserved, minority children. There are barriers in the management of asthma, which may impact the quality of outcomes. The goal of this study is to explore these barriers. Methods A cross-sectional study was conducted on interview data collected through 2019 from mothers of children (aged 6 - 12 years) with asthma visiting, (...) for convenience, a public shopping mall. The interviewees were randomly selected, because they met the inclusion criteria. Participants were considered if the mother answered “yes” to the following questions: Has your child had physician-diagnosed asthma? Is your child currently taking asthma medications of asthma? Two community nurses conducted the interviews. Data was obtained using administrative questionnaires. Data were analyzed using SPSS version 21.0 (IBM Inc., Chicago, IL, USA). Descriptive statistics of percentage, mean, frequency and standard deviation were applied for categorical and continuous variables. Results Three hundred mothers participated in this study. Their average age was 36.8 years, 55% were housekeepers by profession, and 34% had obtained less than high school education. The majority of children (61%) were males, 45% had moderate asthma, and 42% had mild asthma. The most frequent types of barriers identified by parents were environmental factors (67.7%), followed by health care providers (63%), the health care system (48%), and patient or family characteristics (43%). Mothers were specifically concerned about the use, safety, and long-term complications of medications, the impact of exercise limitation on their child’s quality of life, and their own quality of life. Conclusion This study showed several barriers against asthma care in Saudi Arabia, which mainly related to environmental or personal characteristics. This highlights the need to enhance current policies within the health care system in Saudi Arabia to overcome these barriers. (shrink)

This paper aims to analyze the ethical challenges in experimental drug use during the early stage of the COVID-19 pandemic, using Germany as a case study. In Germany uniform ethical guidelines were available early on nationwide, which was considered as desirable by other states to reduce uncertainties and convey a message of unity. The purpose of this ethical analysis is to assist the preparation of future guidelines on the use of medicines during public health emergencies. The use of hydroxychloroquine, remdesivir (...) and COVID-19 convalescent plasma in clinical settings was analyzed from the perspective of the ethical principles of beneficence, non-maleficence, justice and autonomy. We observed that drug safety and drug distribution during the pandemic affects all four ethical principles. We therefore recommend to establish ethical guidelines (i) to discuss experimental treatment options with patients from all population groups who are in urgent need, (ii) to facilitate the recording of patient reactions to drugs in off-label use, (iii) to expand inclusion criteria for clinical studies to avoid missing potentially negative effects on excluded groups, and (iv) to maintain sufficient access to repurposed drugs for patients with prior conditions. (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of Molnupiravir, a novel antiviral medicine aimed (...) at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of Molnupiravir through the large-scale PANORAMIC randomised control trial. By analysing the ways in which the authorisation and clinical use of Molnupiravir complicate standard approaches to clinical equipoise, standard of care, and participant consent in the PANORAMIC randomised control trial we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

Over the past year, technology companies have made headlines claiming that their artificially intelligent (AI) products can outperform clinicians at diagnosing breast cancer, brain tumours, and diabetic retinopathy. Claims such as these have influenced policy makers, and AI now forms a key component of the national health strategies in England, the United States, and China. While it is positive to see healthcare systems embracing data analytics and machine learning, concerns remain about the efficacy, ethics, and safety of some commercial, (...) AI health solutions. This paper argues that improved regulation and guidance is urgently required to mitigate risks, ensure transparency and best practice, Without this, patients, clinicians, and other stakeholders cannot be assured of an app’s efficacy, and safety. (shrink)

This article focuses on justified responses to “immoral” behavior and crimes committed by patients undergoing neuromodulation therapies. Such patients could be held morally responsible in the basic desert sense—the one that serves as a justification of severe practices such as backward‐looking moral outrage, condemnation, and legal punishment—as long as they possess certain compatibilist capabilities that have traditionally served as the quintessence of free will, that is, reasons‐responsiveness; attributability; answerability; the abilities to act in accordance with moral reasons, second‐order volitions, or (...) Deep Self. Recently leading compatibilist neuroethicists added the condition of not feeling alienated from desires motivating a person's action. This article argues against such attempts to determine conditions under which patients undergoing neuromodulation should be subject to negative reactive attitudes and legal punishment. Compatibilism should not be used to justify basic desert moral responsibility and legal punishment. Instead, a new way of thinking about the function of moral responsibility attribution is proposed for patients with neuromodulation. Their compatibilist capabilities should serve as important indicators for determining appropriate, forward‐looking courses of action, such as quarantining and restorative treatment, to ensure the public safety and well‐being of the patients. (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)

A common objection to Sosa’s epistemology is that it countenances, in an objectionable way, unsafe knowledge. This objection, under closer inspection, turns out to be in far worse shape than Sosa’s critics have realised. Sosa and his defenders have offered two central response types to the idea that allowing unsafe knowledge is problematic: one response type adverts to the animal/reflective knowledge distinction that is characteristic of bi-level virtue epistemology. The other less-discussed response type appeals to the threat of dream scepticism, (...) and in particular, to the idea that many of our everyday perceptual beliefs are unsafe through the nearness of the dream possibility. The latter dreaming response to the safety objection to Sosa’s virtue epistemology has largely flown under the radar in contemporary discussions of safety and knowledge. We think that, suitably articulated in view of research in the philosophy and science of dreaming, it has much more going for it than has been appreciated. This paper further develops, beyond what Sosa does himself, the dreaming argument in response to those who think safety (as traditionally understood) is a condition on knowledge and who object to Sosa’s account on the grounds that it fails this condition. The payoffs of further developing this argument will be not only a better understanding of the importance of insights about dreaming against safety as a condition on knowledge, but also some reason to think a weaker safety condition, one that is relativised to SSS (i.e., skill/shape/situation) conditions for competence exercise, gets better results all things considered as an anti-luck codicil on knowledge. (shrink)

Ernest Sosa has made and continues to make major contributions to a wide variety of topics in epistemology. In this paper I discuss some of his core ideas about the nature of knowledge and scepticism. I start with a discussion of the safety account of knowledge – a view he has championed and further developed over the years. I continue with some questions concerning the role of the concept of an epistemic virtue for our understanding of knowledge. Safety (...) and virtue hang very closely together for Sosa. All this easily leads to some thoughts on epistemic scepticism and on Sosa's stance on this. (shrink)

Safety principles in epistemology are often hailed as providing us with an explanation of why we fail to have knowledge in Gettier cases and lottery examples, while at the same time allowing for the fact that we know the negations of sceptical hypotheses. In a recent paper, Sinhababu and Williams have produced an example—the Backward Clock—that is meant to spell trouble for safety accounts of knowledge. I argue that the Backward Clock case is, in fact, unproblematic for the (...) more sophisticated formulations of safety in the literature. However, I then proceed to construct two novel examples that turn out problematic for those formulations—one that provides us with a lottery-style case of safe ignorance and one that is a straightforward case of unsafe knowledge. If these examples succeed, then safety as it is usually conceived in the current debate cannot account for ignorance in all Gettier and lottery-style cases, and neither is it a necessary condition for knowledge. I conclude from these troublesome examples that modal epistemologists ought to embrace a much more simple and non-reductive version of safety, according to which the notion of similarity between possible worlds that determines in which worlds the subject must believe truly is an epistemic notion that cannot be defined or reduced to notions independent of knowledge. The resulting view is shown to also lead to desirable results with respect to lottery cases, certain quantum phenomena, and a puzzling case involving a cautious brain-in-a-vat. (shrink)

The Epistemic Objection says that certain theories of time imply that it is impossible to know which time is absolutely present. Standard presentations of the Epistemic Objection are elliptical—and some of the most natural premises one might fill in to complete the argument end up leading to radical skepticism. But there is a way of filling in the details which avoids this problem, using epistemic safety. The new version has two interesting upshots. First, while Ross Cameron alleges that the (...) Epistemic Objection applies to presentism as much as to theories like the growing block, the safety version does not overgeneralize this way. Second, the Epistemic Objection does generalize in a different, overlooked way. The safety objection is a serious problem for a widely held combination of views: “propositional temporalism” together with “metaphysical eternalism”. (shrink)

Modal knowledge accounts that are based on standards possible-worlds semantics face well-known problems when it comes to knowledge of necessities. Beliefs in necessities are trivially sensitive and safe and, therefore, trivially constitute knowledge according to these accounts. In this paper, I will first argue that existing solutions to this necessity problem, which accept standard possible-worlds semantics, are unsatisfactory. In order to solve the necessity problem, I will utilize an unorthodox account of counterfactuals, as proposed by Nolan, on which we also (...) consider impossible worlds. Nolan’s account for counterpossibles delivers the intuitively correct result for sensitivity i.e. S’s belief is sensitive in intuitive cases of knowledge of necessities and insensitive in intuitive cases of knowledge failure. However, we acquire the same plausible result for safety only if we reject his strangeness of impossibility condition and accept the modal closeness of impossible worlds. In this case, the necessity problem can be analogously solved for sensitivity and safety. For some, such non-moderate accounts might come at too high a cost. In this respect, sensitivity is better off than safety when it comes to knowing necessities. (shrink)

Recent research has identified a tension between the Safety principle that knowledge is belief without risk of error, and the Closure principle that knowledge is preserved by competent deduction. Timothy Williamson reconciles Safety and Closure by proposing that when an agent deduces a conclusion from some premises, the agent’s method for believing the conclusion includes their method for believing each premise. We argue that this theory is untenable because it implies problematically easy epistemic access to one’s methods. Several (...) possible solutions are explored and rejected. (shrink)

An account of the nature of knowledge must explain the value of knowledge. I argue that modal conditions, such as safety and sensitivity, do not confer value on a belief and so any account of knowledge that posits a modal condition as a fundamental constituent cannot vindicate widely held claims about the value of knowledge. I explain the implications of this for epistemology: We must either eschew modal conditions as a fundamental constituent of knowledge, or retain the modal conditions (...) but concede that knowledge is not more valuable than that which falls short of knowledge. This second horn—concluding that knowledge has no distinctive value—is unappealing since it renders puzzling why so much epistemological theorising focuses on knowledge, and why knowledge seems so important. (shrink)

ABSTRACTIn a recent paper, Michael Pardo argues that the epistemic property that is legally relevant is the one called Safety, rather than Sensitivity. In the process, he argues against our Sensitivity-related account of statistical evidence. Here we revisit these issues, partly in order to respond to Pardo, and partly in order to make general claims about legal epistemology. We clarify our account, we show how it adequately deals with counterexamples and other worries, we raise suspicions about Safety's value (...) here, and we revisit our general skepticism about the role that epistemological considerations should play in determining legal policy. (shrink)

This paper argues for several related theses. First, the epistemological position that knowledge requires safe belief can be motivated by views in the philosophy of science, according to which good explanations show that their explananda are robust. This motivation goes via the idea—recently defended on both conceptual and empirical grounds—that knowledge attributions play a crucial role in explaining successful action. Second, motivating the safety requirement in this way creates a choice point—depending on how we understand robustness, we'll end up (...) with different conceptions of safety in epistemology. Lastly, and most controversially, there's an attractive choice at this point that will not vindicate some of the most influential applications of the safety-theoretic framework in epistemology, e.g., Williamson's arguments against the KK principle, and luminosity. (shrink)

In this paper I will offer a comprehensive defense of the safety account of knowledge against counterexamples that have been recently put forward. In Sect. 2, I will discuss different versions of safety, arguing that a specific variant of method-relativized safety is the most plausible. I will then use this specific version of safety to respond to counterexamples in the recent literature. In Sect. 3, I will address alleged examples of safe beliefs that still constitute Gettier (...) cases. In Sect. 4, I will discuss alleged examples of unsafe knowledge. In Sect. 5, I will address alleged cases of safe belief that do not constitute knowledge for non-Gettier reasons. My overall goal is to show that there are no successful counterexamples to robust anti-luck epistemology and to highlight some major presuppositions of my reply. (shrink)

According to the safety condition, a subject knows that p only if she would believe that p only if p was true. The safety condition has been a very popular necessary condition for knowledge of late. However, it is well documented that the safety condition is trivially satisfied in cases where the subject believes in a necessary truth. This is for the simple reason that a necessary truth is true in all possible worlds, and therefore it is (...) true in all possible worlds where it is believed. But clearly, all beliefs concerning necessary truths do not amount to knowledge. The safety theorists have attempted to deal with the problem caused by necessary truths by restricting the safety condition to purely contingent truths and by globalizing the safety condition to a set of propositions. Both of these solutions are problematic. The principal aim of this paper is to develop a version of the safety condition that is able to deal with cases featuring necessary truths. (shrink)

It has been argued that an advantage of the safety account over the sensitivity account is that the safety account preserves epistemic closure, while the sensitivity account implies epistemic closure failure. However, the argument fails to take the method-relativity of the modal conditions on knowledge, viz., sensitivity and safety, into account. In this paper, I argue that the sensitivity account and the safety account are on a par with respect to epistemic closure once the method-relativity of (...) the modal conditions is taken into account. Therefore, epistemic closure is no longer an arbiter in the debate. (shrink)

In an essay recently published in this journal (“Is Safety in Danger?”), Fernando Broncano-Berrocal defends the safety condition on knowledge from a counterexample proposed by Tomas Bogardus (Philosophy and Phenomenological Research, 2012). In this paper, we will define the safety condition, briefly explain the proposed counterexample, and outline Broncano-Berrocal’s defense of the safety condition. We will then raise four objections to Broncano-Berrocal’s defense, four implausible implications of his central claim. In the end, we conclude that Broncano-Berrocal’s (...) defense of the safety condition is unsuccessful, and that the safety condition on knowledge should be rejected. (shrink)

Knowledge demands more than accuracy: epistemologists are broadly agreed that those who know are non-accidentally right, satisfying some kind of safety condition. However, it is hard to formulate any adequate account of safety, and harder still to explain exactly why we care about it. This paper approaches the problem by looking at a concrete human cognitive capacity, face recognition, to see where epistemic safety shows up in it. Drawing on new models in artificial intelligence, and making a (...) case that human face recognition is relevantly similar, I argue that safety is a natural feature of successful generalization. The concluding section of the paper applies this lesson to the problem of our intuitive recognition of knowledge. (shrink)

There are a number of important links and similarities between public health and safety. In this extended essay, Gregg D. Caruso defends and expands his public health-quarantine model, which is a non-retributive alternative for addressing criminal behavior that draws on the public health framework and prioritizes prevention and social justice. In developing his account, he explores the relationship between public health and safety, focusing on how social inequalities and systemic injustices affect health outcomes and crime rates, how poverty (...) affects brain development, how offenders often have pre-existing medical conditions (especially mental health issues), how involvement in the criminal justice system itself can lead to or worsen health and cognitive problems, how treatment and rehabilitation methods can best be employed to reduce recidivism and reintegrate offenders back into society, and how a public health approach could be successfully applied within the criminal justice system. Caruso's approach draws on research from the health sciences, social sciences, public policy, law, psychiatry, medical ethics, neuroscience, and philosophy, and he delivers a set of ethically defensible and practically workable proposals for implementing the public health-quarantine model. The essay begins by discussing recent empirical findings in psychology, neuroscience, and the social sciences that provide us with an increased understanding of the social and neurological determinants of health and criminal behavior. It then turns to Caruso's public health-quarantine model and argues that the model provides the most justified, humane, and effective approach for addressing criminal behavior. Caruso concludes by proposing a capability approach to social justice grounded in six key features of human well-being. He argues that we cannot successfully address concerns over public health and safety without simultaneously addressing issues of social justice—including the social determinants of health (SDH) and the social determinants of criminal behavior (SDCB)—and he recommends eight general policy proposals consistent with his model. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

Nominalists are confronted with a grave difficulty: if abstract objects do not exist, what explains the success of theories that invoke them? In this paper, I make headway on this problem. I develop a formal language in which certain platonistic claims about properties and certain nominalistic claims can be expressed, develop a formal language in which only certain nominalistic claims can be expressed, describe a function mapping sentences of the first language to sentences of the second language, and prove some (...) facts about that function and facts about some sound logics for those languages. In doing so, I prove that, given some plausible metaphysical assumptions, a large class of sentences about properties of concrete objects are “safe” on nominalistic grounds. Whenever some true sentences about concrete objects and some sentences belonging to this class that are true according to platonists collectively entail a conclusion about concrete objects, some nominalistically acceptable sentences are true and entail the same conclusion. Because the proof can itself be formulated without abstract objects, it provides a nominalistic explanation of the success of theories that invoke properties of concrete objects. (shrink)

In the preface paradox the posited author is supposed to know both that every sentence in a book is true and that not every sentence in that book is true. But, this result is paradoxically contradictory. The paradoxicality exhibited in such cases arises chiefly out of the recognition that large-scale and difficult tasks like verifying the truth of large sets of sentences typically involve errors even given our best efforts to be epistemically diligent. This paper introduces an argument designed to (...) resolve the preface paradox so understood by appeal to the safety condition on knowledge. (shrink)

The safety condition is supposed to be a necessary condition on knowledge which helps to eliminate epistemic luck. It has been argued that the condition should be globalized to a set of propositions rather than the target proposition believed to account for why not all beliefs in necessary truths are safe. A remaining issue is which propositions are relevant when evaluating whether the target belief is safe or not. In the literature, solutions have been proposed to determine the relevance (...) of propositions. This paper examines a case of luckily true belief—thus a case of ignorance—and a case of knowledge. It argues that no solution in the literature offers a correct verdict in either case. Therefore, the strategy to globalize safety remains unsatisfactory. (shrink)

This article is devoted to the study of directions of financial safety of Ukrainian agricultural enterprises through the assessment of indicators economic activity and analysis of the export potential of agricultural products. The financial indicators of economic activity of Ukrainian agricultural enterprises, which affect the ensuring of financial safety, are determined. The activity of large Ukrainian agricultural enterprises in terms of their capitalization and formation of own capital are studied. Analyzed the commodity structure of exports agricultural products of (...) Ukrainian agricultural enterprises and determined the amount of foreign exchange earnings from EU countries. Due to economic-statistical and mathematical tools, a study of the dependence of GDP and the euro on foreign exchange earnings from exports of agricultural products of Ukrainian agricultural enterprises to the EU countries. Offered the scheme of directions of maintenance of financial safety of the agricultural enterprises of Ukraine in the context of internal environment of activity of economic entities and stabilization of macroeconomic indicators of the country. (shrink)

Imagine you fly home from vacation with your one-and-a-half-year-old son who is traveling for free as a “lap child.” In the airport parking lot, you put him into his forward-facing car seat, where he sits much more contentedly than he did in the rear-facing one that was mandatory until his first birthday. After he falls asleep on the way home, you transfer him to his crib without waking him, lowering the side rail so you can lift him in more easily. (...) -/- Many parts of this idyllic parenting picture are deemed unacceptably risky according to recent child safety proposals. While these proposals all aim to improve child safety, their possible impact is unclear because there has been little discussion of the absolute risk and risk reduction involved in each. And while precise figures are lacking, rough estimates indicate that the magnitudes are quite small. I will argue that this risk and benefit data raises important questions about the proposals, including whether parents might reasonably believe that the small absolute risk reduction offered by the proposed changes does not justify the attendant burdens. This possibility—termed the “prevention paradox” in other contexts—highlights ethical and theoretical challenges in this area of public health. (shrink)

Phenomenology gives rise to certain ontological considerations that have far-reaching implications for standard conceptions of patient autonomy in medical ethics, and, as a result, the obligations of and to patients in clinical decision-making contexts. One such consideration is the phenomenological reduction in classical phenomenology, a core feature of which is the characterisation of our primary experiences as immediately and inherently meaningful. This paper builds on and extends the analyses of the phenomenological reduction in the works of Husserl, Heidegger, and (...) Merleau-Ponty in order to identify and explain its implications for our current understanding of the principle of respect for patient autonomy and the norms of clinical decision making. (shrink)

A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in a (...) decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are. (shrink)

In contemporary bioethics, the autonomy of the patient has assumed considerable importance. Progressing from a more limited notion of informed consent, shared decision making calls upon patients to voice the desires and preferences of their authentic self, engaging in choice among alternatives as a way to exercise deeply held values. One influential opinion in Jewish bioethics holds that Jewish law, in contradistinction to secular bioethics, limits the patient's exercise of autonomy only in those instances in which treatment choices (...) are sensitive to preferences. Here, we analyze a discussion in the Mishna, a foundational text of rabbinic Judaism, regarding patient autonomy in the setting of religiously mandated fasting, and commentaries in the Babylonian and Palestinian Talmuds, finding both a more expansive notion of such autonomy and a potential metaphysical grounding for it in the importance of patient self-knowledge. (shrink)

It is common to distinguish moral rules, reasons, or values that are agent-relative from those that are agent-neutral. One can also distinguish moral rules, reasons, or values that are moment-relative from those that are moment-neutral. In this article, I introduce a third distinction that stands alongside these two distinctions—the distinction between moral rules, reasons, or values that are patient-relative and those that are patient-neutral. I then show how patient-relativity plays an important role in several moral theories, gives (...) us a better understanding of agent-relativity and moment-relativity, and provides a novel objection to Derek Parfit’s “appeal to full relativity” argument. (shrink)

Safety, as discussed in contemporary epistemology, is a feature of true beliefs. Safe beliefs, when formed by the same method, remain true in close-by possible worlds. I argue that our beliefs being safely true serves no recognisable epistemic interest and, thus, that this notion of safety should play no role in epistemology. Epistemologists have been misled by failing to distinguish between a feature of beliefs — being safely true — and a feature of believers, namely being safe from (...) error. The latter is central to our epistemic endeavours: we want to be able to get right answers, whatever they are, to questions of interest. I argue that we are sufficiently safe from error (in some relevant domain) by being sufficiently sensitive (to relevant distinctions). (shrink)