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)

A growing literature has recognized the importance of mental simulation (e.g., imagining alternatives to reality) in sparking creativity. In this chapter, we examine how counterfactual thinking, or imagining alternatives to past outcomes, affects group creativity. We explore these effects by articulating a model that considers the influence of counterfactual thinking on both the cognitive and social processes known to impact group creative performance. With this framework, we aim to stimulate research on group creativity from a counterfactual perspective.

This study investigates how e-business capabilities and digital marketing strategies jointly influence business performance in the e-commerce industry, which has experienced unprecedented growth driven by technological advancements and changing consumer behavior. E-business capabilities encompass the use of technology and digital infrastructure, while digital marketing strategies are employed to attract and retain online customers. The study examines the effect of e-business capabilities through digital marketing strategies on the customer satisfaction and loyalty of UAE e-commerce industry. The research is descriptive and explanatory, (...) and uses a structured 5-scale Likert questionnaire to collect data from the HR managers of 135 e-commerce companies based in UAE. The statistical analysis is performed using structural equation modeling. The findings highlight the significant relationship of the study variables. Consequently, the results of this study provide valuable insights for e-commerce businesses, elucidating the need to invest in robust e-business capabilities to support effective digital marketing efforts. Additionally, the research underscores the significance of tailoring digital marketing strategies to align with specific business objectives and customer segments. The study also contributes to the literature on digital transformation, by demonstrating how e-business capabilities and digital marketing strategies can enable e-commerce firms to adapt and thrive in the dynamic and competitive digital environment. (shrink)

Critical notice of Christoph Kelp and Mona Simion's _Sharing Knowledge: A Functionalist Account of Assertion_.

Davis called for “extreme caution” in the use of non-invasive brain stimulation to treat neurological disorders in children, due to gaps in scientific knowledge. We are sympathetic to his position. However, we must also address the ethical implications of applying this technology to minors. Compensatory trade-offs associated with NIBS present a challenge to its use in children, insofar as these trade-offs have the effect of limiting the child’s future options. The distinction between treatment and enhancement has some normative force here. (...) As the intervention moves away from being a treatment toward being an enhancement—and thus toward a more uncertain weighing of the benefits, risks, and costs—considerations of the child’s best interests diminish, and the need to protect the child’s autonomy looms larger. NIBS for enhancement involving trade-offs should therefore be delayed, if possible, until the child reaches a state of maturity and can make an informed, personal decision. NIBS for treatment, by contrast, is permissible insofar as it can be shown to be at least as safe and effective as currently approved treatments, which are themselves justified on a best interests standard. (shrink)

There seems a potential tension between Hume’s naturalistic project and his normative ambitions. Hume adopts what I call a methodological naturalism: that is, the methodology of providing explanations for various phenomena based on natural properties and causes. This methodology takes the form of introducing ‘the experimental method of reasoning into moral subjects’, as stated in the subtitle of the Treatise; this ‘experimental method’ seems a paradigmatically descriptive one, and it remains unclear how Hume derives genuinely normative prescriptions from this methodology. (...) -/- In resolving this problem, I will argue that Hume’s naturalistic methodology – that is, his ‘experimental philosophy’ (THN Intro 7), or what has come to be known as his experimental method – consists of the systematisation of phenomena pertaining to human nature. In applying his experimental method to normative subjects, Hume systematises our normative judgments, deriving general principles of normative justification; he then reflexively applies these principles to the pre-philosophical judgments from which they derive, dismissing and/or correcting those that do not accord with his systematised account. I will argue that Hume’s experimental method, far from being wholly descriptive, is in fact thoroughly infused with normativity; furthermore, the very application of this methodology to our normative judgments reveals Hume’s normative ambitions. (shrink)

Deep brain stimulation has been of considerable interest to bioethicists, in large part because of the effects that the intervention can occasionally have on central features of the recipient’s personality. These effects raise questions regarding the philosophical concept of authenticity. In this article, we expand on our earlier work on the concept of authenticity in the context of deep brain stimulation by developing a diachronic, value-based account of authenticity. Our account draws on both existentialist and essentialist approaches to authenticity, and (...) Laura Waddell Ekstrom’s coherentist approach to personal autonomy. In developing our account, we respond to Sven Nyholm and Elizabeth O’Neill’s synchronic approach to authenticity, and explain how the diachronic approach we defend can have practical utility, contrary to Alexandre Erler and Tony Hope’s criticism of autonomy-based approaches to authenticity. Having drawn a distinction between the authenticity of an individual’s traits and the authenticity of that person’s values, we consider how our conception of authenticity applies to the context of anorexia nervosa in comparison to other prominent accounts of authenticity. We conclude with some reflections on the prudential value of authenticity, and by highlighting how the language of authenticity can be invoked to justify covert forms of paternalism that run contrary to the value of individuality that seems to be at the heart of authenticity. (shrink)

People’s beliefs about normality play an important role in many aspects of cognition and life (e.g., causal cognition, linguistic semantics, cooperative behavior). But how do people determine what sorts of things are normal in the first place? Past research has studied both people’s representations of statistical norms (e.g., the average) and their representations of prescriptive norms (e.g., the ideal). Four studies suggest that people’s notion of normality incorporates both of these types of norms. In particular, people’s representations of what is (...) normal were found to be influenced both by what they believed to be descriptively average and by what they believed to be prescriptively ideal. This is shown across three domains: people’s use of the word ‘‘normal” (Study 1), their use of gradable adjectives (Study 2), and their judgments of concept prototypicality (Study 3). A final study investigated the learning of normality for a novel category, showing that people actively combine statistical and prescriptive information they have learned into an undifferentiated notion of what is normal (Study 4). Taken together, these findings may help to explain how moral norms impact the acquisition of normality and, conversely, how normality impacts the acquisition of moral norms. (shrink)

The ills of psychiatry are currently diagnoses with the aid of deficient etiologies. The currently proposed prescriptions for psychiatry are practically impossible. The defective part of the profession is its leadership which in its very defensiveness sticks to the status quo, thereby owning the worst defects and impeding all possible cure. The current discussions of the matter are pretentious and thus woolly. The minimal requirement from the profession as a whole and from each of its individual members is that they (...) be not defensive and clear. In this vein I offer here preliminary discussions of propriety, of responsibility and of science. (shrink)

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of changes that (...) OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study.We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c)characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one’s abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research. (shrink)

We whole-heartedly agree with Mecacci and Haselager(2014) on the need to investigate the psychosocial effects of deep brain stimulation (DBS), and particularly to find out how to prevent adverse psychosocial effects. We also agree with the authors on the value of an embodied, embedded, enactive approach (EEC) to the self and the mind–brain problem. However, we do not think this value primarily lies in dissolving a so-called “maladaptation” of patients to their DBS device. In this comment, we challenge three central (...) claims of the authors on the basis of our direct experience with psychosocial effects of DBS in 45 obsessive- compulsive disorder (OCD) patients treated at the AMC in Amsterdam, The Netherlands, and our indepth qualitative interviews with 18 of them (de Haan et al. 2013). We end our comment by sketching out our perspective on the practical merits of an EEC approach to DBS. (shrink)

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and exercise (...) scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

Morally speaking, what should one do when one is morally uncertain? Call this the Moral Uncertainty Question. In this paper, I argue that a non-ideal moral theory provides the best answer to the Moral Uncertainty Question. I begin by arguing for a strong ought-implies-can principle---morally ought implies agentially can---and use that principle to clarify the structure of a compelling non-ideal moral theory. I then describe the ways in which one's moral uncertainty affects one's moral prescriptions: moral uncertainty constrains the set (...) of moral prescriptions one is subject to, and at the same time generates new non-ideal moral reasons for action. I end by surveying the problems that plague alternative answers to the Moral Uncertainty Question, and show that my preferred answer avoids most of those problems. (shrink)

Stimulants have been shown to be safe and effective for reduction of the symptoms of attention deficit hyperactivity disorder. Despite much debate, however, there has been little empirical evidence as to whether stimulants affect authenticity and moral agency in children. Singh presents evidence that stimulants do not undercut children's' sense of self and increase their experience of agency. These findings are consistent with laboratory evidence that stimulant drugs in therapeutic doses improve cognitive control over thought and behavior.

In this paper, we engage in dialogue with Jonathan Pugh, Hannah Maslen, and Julian Savulescu about how to best interpret the potential impacts of deep brain stimulation on the self. We consider whether ordinary people’s convictions about the true self should be interpreted in essentialist or existentialist ways. Like Pugh et al., we argue that it is useful to understand the notion of the true self as having both essentialist and existentialist components. We also consider two ideas from existentialist philosophy (...) – Jean-Paul Sartre and Simone de Beauvoir’s ideas about “bad faith” and “ambiguity” – to argue that there can be value to patients in regarding themselves as having a certain amount of freedom to choose what aspects of themselves should be considered representative of their true selves. Lastly, we consider the case of an anorexia nervosa-patient who shifts between conflicting mind-sets. We argue that mind-sets in which it is easier for the patient and his or her family to share values can plausibly be considered to be more representative of the patient’s true self, if this promotes a well-functioning relationship between the patient and the family. However, we also argue that families are well-advised to give patients room to figure out what such shared values mean to them, since it can be alienating for patients if they feel that others try to impose values on them from the outside. (shrink)

Prescription Drug Monitoring Programs (PDMPs) contain detailed information about which controlled medications physicians prescribe individuals, including where, when, how much, by whom, and more. The programs allow physicians to glimpse into the life of each patient that visits them — sometimes before a single word is exchanged between them. Every state has a PDMP, and almost all states share the data they collect through it. In this paper, I argue that informed consent should be required for recording of prescriptions (...) related to addiction management into the PDMP. (shrink)

Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.

In this article, the Golden Rule, a central ethical value to both Judaism and Confucianism, is evaluated in its prescriptive and proscriptive sentential formulations. Contrary to the positively worded, prescriptive formulation – “Love others as oneself” – the prohibitive formulation, which forms the injunction, “Do not harm others, as one would not harm oneself,” is shown to be the more prevalent Judaic and Confucian presentation of the Golden Rule. After establishing this point, the remainder of the article is dedicated to (...) an inquiry into why this preference between the two Golden-Rule-formulations occurs. In doing so, this article discovers four main benefits to the proscriptive formulations: I) harm-doing, as opposed to generalizable moral goodness, is easier for individuals to subjectively comprehend II) the prevention of harm-doing is the most fundamental ethical priority III) the proscriptive formulation preserves self-directed discovery of what is good, thus preserving moral autonomy IV) individuals are psychologically pre-disposed toward responding to prohibitions rather than counsels of goodness. (shrink)

The purpose of this essay is to make the case that the ethical issues raised by the current U.S. practice of direct-to-consumer prescription drug advertising are worthy of study in philosophy courses, and to provide instructors with some ideas for how they might approach teaching the topic, despite the current relative scarcity of philosophical literature published on it. This topic presents a unique opportunity to cover ground in ethics, critical thinking, and scientific literacy simultaneously. As a case study, the (...) practice of DTC advertising is both theoretically rich and universally relevant to students’ lives. The nature of these ads—numerous, diverse, visually and thematically entertaining—makes them delicious fodder for in-class activities, small group work, discussion-based learning, creative projects, and customizable essay topics. I offer a set of suggestions for approaching the study of DTC drug ads that is informed by my own experience doing so in bioethics courses. Ultimately, including this topic on your syllabus not only contributes to students’ philosophical skills and knowledge, but also helps them become better informed as citizens and potential “consumers” of health care. (shrink)

Bunge (2000) distinguishes two main methodological approaches of holism and individualism, and associates with them policy prescriptions of centralism and laissez-faire. He identifies systemism as a superior approach to both the study and management of society. The present paper, seeking to correct and develop this line of thought, suggests a more complex relation between policy and methodology. There are two possible methodological underpinnings for laissez-faire: while writers such as Friedman and Lucas fit Bunge’s pattern, more sophisticated advocates of laissez-faire, such (...) as Smith and Hayek, base their policy prescription in a methodology quite divergent from the individualism Bunge describes. (shrink)

This paper distinguishes between five different approaches to social discount rates in climate change economics, criticizes two of these, and explains how the other three are to some degree mutually compatible. It aims to shed some new light on a longstanding debate in climate change economics between so-called “descriptivists” and “prescriptivists” about social discounting. The ultimate goal is to offer a sketch of the conceptual landscape that makes visible some important facets of the debate that very often go unacknowledged.

People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10 percent of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). Deep brain stimulation involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. (...) It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioural measures of the severity of the symptoms. In this article we aim to capture the changes in the patients’ phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients’ experience of the world. We propose to specify the patients’ world in terms of a field of affordances, with the three dimensions of broadness of scope (‘width’ of the field), temporal horizon (‘depth’), and relevance of the perceived affordances (‘height’). The second aspect is the person-side of the interaction, that is, the patients’ self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take towards the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment. (shrink)

Exactly how do the sign/symbol/token systems of endo- and exo-biosemiosis differ from those of cognitive semiosis? Do the biological messages that integrate metabolism have conceptual meaning? Semantic information has two subsets: Descriptive and Prescriptive. Prescriptive information instructs or directly produces nontrivial function. In cognitive semiosis, prescriptive information requires anticipation and “choice with intent” at bona fide decision nodes. Prescriptive information either tells us what choices to make, or it is a recordation of wise choices already made. Symbol systems allow recordation (...) of deliberate choices and the transmission of linear digital prescriptive information. Formal symbol selection can be instantiated into physicality using physical symbol vehicles (tokens). Material symbol systems (MSS) formally assign representational meaning to physical objects. Even verbal semiosis instantiates meaning into physical sound waves using an MSS. Formal function can also be incorporated into physicality through the use of dynamically-inert (dynamically-incoherent or -decoupled) configurable switch-settings in conceptual circuits. This paper examines the degree to which biosemiosis conforms to the essential formal criteria of prescriptive semiosis and cybernetic management. (shrink)

We argue that the universal recommendations against “off-label” pediatric use of approved COVID-19 issued by the FDA, CDC, and AAP are overbroad. Especially for higher-risk children, vaccination can be ethically justified even before FDA authorization or approval – and similar reasoning is relevant for even younger patients. Legal risks can also be managed, although the FDA, CDC, and Department of Health and Human Services (HHS) should move quickly to provide clarity.

The aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. Regarding (...) (1), I argue that the pattern theory of self can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves. (shrink)

Deep Brain Stimulation is currently being investigated as an experimental treatment for patients suffering from treatment-refractory AN, with an increasing number of case reports and small-scale trials published. Although still at an exploratory and experimental stage, initial results have been promising. Despite the risks associated with an invasive neurosurgical procedure and the long-term implantation of a foreign body, DBS has a number of advantageous features for patients with SE-AN. Stimulation can be fine-tuned to the specific needs of the particular patient, (...) is relatively reversible, and the technique also allows for the crucial issue of investigating and comparing the effects of different neural targets. However, at a time when DBS is emerging as a promising investigational treatment modality for AN, lesioning procedures in psychiatry are having a renaissance. Of concern it has been argued that the two kinds of interventions should instead be understood as rivaling, yet “mutually enriching paradigms” despite the fact that lesioning the brain is irreversible and there is no evidence base for an effective target in AN. We argue that lesioning procedures in AN are unethical at this stage of knowledge and seriously problematic for this patient group, for whom self-control is particularly central to wellbeing. They pose a greater risk of major harms that cannot justify ethical equipoise, despite the apparent superiority in reduced short term surgical harms and lower cost. (shrink)

Advocates of moral enhancement through pharmacological, genetic, or other direct interventions sometimes explicitly argue, or assume without argument, that traditional moral education and development is insufficient to bring about moral enhancement. Traditional moral education grounded in a Kohlbergian theory of moral development is indeed unsuitable for that task; however, the psychology of moral development and education has come a long way since then. Recent studies support the view that moral cognition is a higher-order process, unified at a functional level, and (...) that a specific moral faculty does not exist. It is more likely that moral cognition involves a number of different mechanisms, each connected to other cognitive and affective processes. Taking this evidence into account, we propose a novel, empirically informed approach to moral development and education, in children and adults, which is based on a cognitive-affective approach to moral dispositions. This is an interpretative approach that derives from the cognitive-affective personality system (Mischel and Shoda, 1995). This conception individuates moral dispositions by reference to the cognitive and affective processes that realise them. Conceived of in this way, moral dispositions influence an agent's behaviour when they interact with situational factors, such as mood or social context. Understanding moral dispositions in this way lays the groundwork for proposing a range of indirect methods of moral enhancement, techniques that promise similar results as direct interventions whilst posing fewer risks. (shrink)

Everything and every word about spirituality have already been said but the practical utility of spiritual wisdom in day to day life to achieve success and live a blissful life is lacking. Spiritual wisdom not only shows us the path of salvation and freedom but also helps us to figure out the solutions for every problem in all walks of human life and civilization. Spirituality is a well-defined, scientific way to get any goal in life whether it is for justified (...) worldly desires or to fulfil the urge of salvation with a blissful route. The book is an important read for the present generation, i.e. our youth as well as the persons those who want to touch the divinity within. Due to the universal nature of Spiritual Wisdom, it is bound to be on the shelves of the coming generation as spiritual science is not something that can be restricted to any one generation. The book itself contains the aura of mysticism and a touch of the great teaching taken from the scriptures. The book will teach how spiritual wisdom may change a person’s life. (shrink)

After coining the term “philopsychy” to describe a “soul-loving” approach to philosophical practice, especially when it welcomes a creative synthesis of philosophy and psychology, this article identifies a system of geometrical figures (or “maps”) that can be used to stimulate reflection on various types of perspectival differences. The maps are part of the author’s previously established mapping methodology, known as the Geometry of Logic. As an illustration of how philosophy can influence the development of psychology, Immanuel Kant’s table of twelve (...) categories and Carl Jung’s theory of psychological types are shown to share a common logical structure. Just as Kant proposes four basic categories, each expressed in terms of three subordinate categories, Jung proposes four basic personality functions, each having three possible manifestations. The concluding section presents four scenarios illustrating how such maps can be used in philosophical counseling sessions to stimulate philopsychic insight. (shrink)

Deep Brain Stimulation (DBS) is an invasive therapeutic method involving the implantation of electrodes and the electrical stimulation of specific areas of the brain to modulate their activity. DBS brings therapeutic benefits, but can also have adverse side effects. Recently, neuroethicists have recognized that DBS poses a threat to the very fabric of human existence, namely, to the selves of patients. This article provides a review of the neuroethical literature examining this issue, and identifies the crucial dimensions related to the (...) self which DBS may endanger—personal identity, authenticity, and autonomy. The most influential theories accounting for these dimensions are analyzed herein, and it is argued that most of these theories require further refinement. This paper also demonstrates the interrelation between personal identity, authenticity, and autonomy, and concludes that one can only fully understand the impact of DBS on the self when all of these factors are taken into account. (shrink)

A central debate in philosophy and neuroscience pertains to whether PFC activity plays an essential role in the neural basis of consciousness. Neuroimaging and electrophysiology studies have revealed that the contents of conscious perceptual experience can be successfully decoded from PFC activity, but these findings might be confounded by post- perceptual cognitive processes, such as thinking, reasoning, and decision-making, that are not necessary for con- sciousness. To clarify the involvement of the PFC in consciousness, we present a synthesis of research (...) that has used intracranial electrical stimulation (iES) for the causal modulation of neural activity in the human PFC. This research provides compelling evidence that iES of only certain prefrontal regions (i.e., orbitofrontal cortex and anterior cingu- late cortex) reliably perturbs conscious experience. Conversely, stimulation of anterolateral prefrontal sites, often con- sidered crucial in higher-order and global workspace theories of consciousness, seldom elicits any reportable alterations in consciousness. Furthermore, the wide variety of iES-elicited effects in the PFC (e.g., emotions, thoughts, and olfactory and visual hallucinations) exhibits no clear relation to the immediate environment. Therefore, there is no evidence for the kinds of alterations in ongoing perceptual experience that would be predicted by higher-order or global workspace theories. Nevertheless, effects in the orbitofrontal and anterior cingulate cortices suggest a specific role for these PFC subregions in supporting emotional aspects of conscious experience. Overall, this evidence presents a challenge for higher-order and global workspace theories, which commonly point to the PFC as the basis for con- scious perception based on correlative and possibly confounded information. (shrink)

Case reports about patients undergoing Deep Brain Stimulation (DBS) for various motor and psychiatric disorders - including Parkinson’s Disease, Obsessive Compulsive Disorder, and Treatment Resistant Depression - have sparked a vast literature in neuroethics. Questions about whether and how DBS changes the self have been at the fore. The present chapter brings these neuroethical debates into conversation with recent research in moral psychology. We begin in Section 1 by reviewing the recent clinical literature on DBS. In Section 2, we consider (...) whether DBS poses a threat to personal identity. In Section 3 we argue for engagement with recent empirical work examining judgements of when identity changes. We conclude in Section 4 by highlighting a range of ethical issues raised by DBS, including various cross-cultural considerations. (shrink)

Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public views (...) or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p = .001) and in relation to AMR specifically (p = .006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society. (shrink)

This research article was championed as a way of providing discourses pertaining to the concept of "Critical Realism (CR)" approach, which is amongst many othe forms of competing postmodern philosophical concepts for the engagement of dialogical discourses in the area of established econonetric methodologies for effective policy prescription in the economic science discipline. On the the whole, there is no doubt surrounding the value of empirical endeavours in econometrics to address real world economic problems, but equally so, the heavy (...) weighted use and reliance on mathematical contents as a way of justifying its scientific base seemed to be loosing traction of the intended focus of economics when it comes to confronting real world problems in the domain of social interaction. In this vein, the construction of mixed methods discourse(s), which favour that of CR philosophy is hereby suggested in this article as a way forward in confronting with issues raised by critics of mainstream economics and other professionals in the postmodern era. (shrink)

Ethical analyses of the effects of neural interventions commonly focus on changes to personality and behavior, interpreting these changes in terms of authenticity and identity. These phenomena have led to debate among ethicists about the meaning of these terms for ethical analysis of such interventions. While these theoretical approaches have different criteria for ethical significance, they agree that patients’ reports are concerning because a sense of self is valuable. In this paper, I question this assumption. I propose that the Buddhist (...) theory of no‐self offers a novel approach to making ethical sense of patients’ claims following deep brain stimulation. This alternative approach is based on the value of insight into patterns of cause and effect among mental states and actions. (shrink)

Leading prescriptions for addressing the spread of fake news, misinformation, and other forms of epistemically toxic content online target either the platform or platform users as a single site for intervention. Neither approach attends to the intense feedback between people, posts, and platforms. Leading prescriptions boil down to the suggestion that we make social media more like traditional media, whether by making platforms take active roles as gatekeepers, or by exhorting individuals to behave more like media professionals. Both approaches are (...) impracticable and wrong. (shrink)

Family members can provide crucial support to individuals participating in clinical trials. In research on the “newest frontier” of Deep Brain Stimulation (DBS)—the use of DBS for psychiatric conditions—family member support is frequently listed as a criterion for trial enrollment. Despite the significance of family members, qualitative ethics research on DBS for psychiatric conditions has focused almost exclusively on the perspectives and experiences of DBS recipients. This qualitative study is one of the first to include both DBS recipients and their (...) family members as interview participants. Using dyadic thematic analysis—an approach that takes both the individuals and the relationship as units of analyses—this study analyzes the complex ways in which family relationships can affect DBS trial participation, and how DBS trial participation in turn influences family relationships. Based on these findings, we propose ways to improve study designs to better take family relationships into account, and better support family members in taking on the complex, essential roles that they play in DBS trials for psychiatric conditions. (shrink)

In this paper I distinguish between two kinds of meta-hypotheses, or hypotheses about science, at issue in the scientific realism debate. The first are descriptive empirical hypotheses regarding the nature of scientific inquiry. The second are epistemological theories about what individuals should / can justifiably believe about scientific theories. Favoring the realist Type-D meta-hypotheses, I argue that a particular set of realist and non-realist efforts in the debate over Type-E’s have been valuable in the quest to describe and understand the (...) nature of scientific inquiry. For the realism debate itself has inadvertently and indirectly laid the foundations for an important kind of Type-D meta-hypothesis, one regarding creativity in the history of science—which, in turn, is relevant to refining our descriptions of inference. After illustrating this result with regard to the historical argument against realism, I suggest that these empirically attained meta-hypotheses pertaining to scientific creativity can, in turn, be made methodologically prescriptive. (shrink)

Plato’s Phaedrus, perhaps his most enigmatic and structurally convoluted dialogue, could easily be said to inaugurate a pointed critique of mass media that persists to the present day. Indeed, in certain corners of media theory, the origin myth of writing furnished in the Phaedrus (in which the Egyptian god Theuth presents writing as a gift to King Thamus) has in turn come to serve as a kind of origin myth for media theory: a primaeval pharmacopoeia of media effects. And yet, (...) this is an origin myth that can only underwrite not only its own non-originarity and non-truth, insofar as its very status as a written text ensures that it will never meet the criteria that it itself establishes for a reasoned account of things (logos). It remains perpetually orphaned, unable to defend itself, irrevocably cut off from its ‘father’, the speaking subject, and thus from the vitality of living discourse. But this paradox, I argue, is not a failing of the dialogue, but is a device intended to encourage the reader’s active involvement in the text’s status as medium. The Phaedrus is not just diagnostic, but therapeutic. (shrink)

Despite analgesic and emetogenic benefits, cannabis has been banned from prescription in a number of western countries. Although some benefits are shared by drugs already available, the options of prescription are limited to the physician. The negative side-effects of cannabis do not justify this limitation on freedom and autonomy. Recreational use warrants limitations, as the search for euphoria is regularly believed to be a non-autonomous behavior. Medical prescriptions serve an analgesic and emetogenic purpose comparable to other prescribed drugs. (...) This vindicates the right for a physician to prescribe cannabis to qualified patients. For a patient to be considered qualified, they must be an adult that does not drive often, is not pregnant, and not at risk of schizophrenia or cardiovascular disease. If possible, cannabis should be eaten in an effort to avoid smoke irritation in the lungs and aerodigestive tract. In the end, the question is not whether cannabis use is efficable, but rather is the limitation of medical treatments to patients in need ethical? In light of the medical benefits, the banning of cannabis is simply immoral. Keywords: cannabis, banned substance, prescription, analgesic, emetogenic Note. Authors did not receive any external funding, nor display conflict of interest. (shrink)

An examination of two recent documents of Catholic Social Doctrine, Caritas in Veritate and Vocation of the Business Leader, is undertaken to uncover their assessment of our current cultural and moral crisis, of which our present economic distress is but one aspect, and their proposal for cultural renewal including a return to sound economic decision making. The intellectual commitments of molders of the modern mind such as Bacon, Descartes, and Hobbes severed morality at its metaphysical roots. Destroying the anthropological underpinnings (...) of ethics catapults the contemporary world into a state of nihilism. In such a condition economic disorder is inevitable. The human person is crushed in a regime that searches for more relentlessly. The demand for metaphysical and moral reconstruction is met by Pope Benedict XVI with his insistence on receptivity to what is. Contemplation of an ultimate reality given to us takes us to the Person of Jesus Christ. The Christian faith is the context of authentic integral human development. Being made in the image of God gives every human person an inviolable dignity and makes every person subject to transcendent moral norms. A truth-filled love informs the conduct of enterprise. Goods that are truly goods and services that truly serve are produced or supplied. Promotional efforts are conducive to the pursuit of wisdom. People are given meaningful work that utilizes and develops their higher faculties and are let in on the financial success of the venture. The environment is respected as a home place ought to be. The Christian business leader can have a transformative effect on the business world through the power of grace. (shrink)

This essay is part of a larger project aimed at making sense of rational thought and agency as part of the natural world. It provides a semantic framework for thinking about the contents of: 1) descriptive thoughts and sentences having a representational or mind-to-world direction of fit, and which manifest our capacity for theoretical rationality; and 2) prescriptive and intentional sentences having an expressive or world-to-mind direction of fit, and which manifest our capacity for practical rationality. I use a modified (...) version of Allan Gibbard’s hyperstate semantics, employing both maximally determinate possible worlds and maximally determinate plans of action, as a basis for providing a unified understanding of moral judgments and expressions of individual and collective intentionality – they one and all give voice to our ability as rational agents to adopt the perspectives of various individuals within a community and consider how we would behave were we in their positions. In the course of spelling out the view I draw on and criticize ideas that Wilfrid Sellars advanced in the middle of the 20th century, while employing the tools of contemporary modal logic and model-theoretic semantics to give perspicuous formulation to his thought that the moral judgment ‘one ought to do A’ should be understood in terms of the collective intention ‘we shall do A’, where the pronoun denotes the unrestricted class of rational agents and the ‘ought’ is in some sense unconditionally binding. (shrink)

The paper proposes an empirical method to investigate linguistic prescriptions as inherent corrective behaviors. The behaviors in question may but need not necessarily be supported by any explicit knowledge of rules. It is possible to gain insight into them, for example by extracting information about corrections from revision histories of texts (or by analyzing speech corpora where users correct themselves or one another). One easily available source of such information is the revision history of Wikipedia. As is shown, the most (...) frequent and short corrections are limited to linguistic errors such as typos (and editorial conventions adopted in Wikipedia). By perusing an automatically generated revision corpus, one gains insight into the prescriptive nature of language empirically. At the same time, the prescriptions offered are not reducible to descriptions of the most frequent linguistic use. (shrink)

In a world of partially overlapping and partially conflicting interests there is good reason to doubt that self-seeking behaviour at the micro-level will spontaneously lead to desirable social outcomes at the macro-level. Nevertheless, some sophisticated economic writers advocating a laissez-faire policy prescription have proposed various 'invisible hand' mechanisms which can supposedly be relied upon to 'educe good from ill'. Smith defended the 'simple system of natural liberty' as giving the greatest scope to the unfolding of God's will and the (...) working out of 'natural' providential processes free of interference by 'artificial' state intervention - the expression not of divine order but of fallible human reason. Hayek, adopting a similar policy stance, based it in an evolutionary process in which those institutional forms best adapted to reconciling individual interests would, he believed, spontaneously be selected for in the inter-group struggle for survival. Keynes shares the holistic approach of Smith and Hayek, but without their reliance on invisible hand mechanisms. If spontaneous processes cannot be relied upon to generate desirable social outcomes then we have to take responsibility for achieving this ourselves by establishing the appropriate institutional framework. Keynes takes a historical view of the role of capitalism and analyses its pathology as rooted in what we would now refer to as a multi-player prisoners' dilemma. The paper draws out the significance of his methodological standpoint here. Keynes's policy standpoint assigns a critical role to his own class, the 'educated bourgeoisie' in the reform process he maps out. A distinction, but also an intimate connection, is highlighted between, on the one hand, micro-level individualism (the 'Manchester System, and, on the other, the macro-level collective action ('planning') required to preserve it. Finally Keynes is considered in relation to the themes of laissez-faire, holism, reductionism, providentialism and the invisible hand. (shrink)

This thesis modifies the wording of William Clifford’s 1877 evidence principle (that ‘it is wrong always, everywhere, and for anyone, to believe anything upon insufficient evidence’) to propose an explicitly moral principle, restricted to descriptive beliefs (about what is or is not the case) and excluding prescriptive beliefs (about what ought or ought not to be the case). It considers potential counter-examples, particularly William James’s 1896 defence of religious belief; and concludes that the modified principle survives unscathed. It then searches (...) for suitable criteria for ‘sufficient’ and ‘insufficient’ evidence, first within a Bayesian framework enriched by pragmatic considerations, and finally by returning to Clifford’s conception of our shared responsibilities to our shared epistemic asset. Combined with elements of Edward Craig’s (1990, 1999) ‘state-of-nature’ theory of knowledge this gets us to a minimum threshold to avoid insufficient evidence and an aspirational criterion of sufficient evidence. (shrink)

Transcranial magnetic stimulation is used to make inferences about relationships between brain areas and their functions because, in contrast to neuroimaging tools, it modulates neuronal activity. The central aim of this article is to critically evaluate to what extent it is possible to draw causal inferences from repetitive TMS data. To that end, we describe the logical limitations of inferences based on rTMS experiments. The presented analysis suggests that rTMS alone does not provide the sort of premises that are sufficient (...) to warrant strong inferences about the direct causal properties of targeted brain structures. Overcoming these limitations demands a close look at the designs of rTMS studies, especially the methodological and theoretical conditions which are necessary for the functional decomposition of the relations between brain areas and cognitive functions. The main points of this article are that TMS-based inferences are limited in that stimulation-related causal effects are not equivalent to structure-related causal effects due to TMS side effects, the electric field distribution, and the sensitivity of neuroimaging and behavioral methods in detecting structure-related effects and disentangling them from confounds. Moreover, the postulated causal effects can be based on indirect effects. A few suggestions on how to manage some of these limitations are presented. We discuss the benefits of combining rTMS with neuroimaging in experimental reasoning and we address the restrictions and requirements of rTMS control conditions. The use of neuroimaging and control conditions allows stronger inferences to be gained, but the strength of the inferences that can be drawn depends on the individual experiment’s designs. Moreover, in some cases, TMS might not be an appropriate method of answering causality-related questions or the hypotheses have to account for the limitations of this technique. We hope this summary and formalization of the reasoning behind rTMS research can be of use not only for scientists and clinicians who intend to interpret rTMS results causally but also for philosophers interested in causal inferences based on brain stimulation research. (shrink)

We provide empirical evidence that people who believe in dualism are more likely to be uncomfortable with Deep Brain Stimulation (DBS) and to view it as threatening to their identity, humanity, or self. It is (neurocentric) materialists—who think the mind just is the brain—that are less inclined to fear DBS or to see it as threatening. We suggest various possible reasons for this connection. The inspiration for this brief report is a target article that addresses this issue from a theoretical (...) perspective. (shrink)