The research program Spit For Science was launched at Virginia Commonwealth University (VCU) in 2011. Since then, more than 10,000 freshmen have been enrolled in the program, filling out extensive questionnaires about their drinking, general substance use, and related behaviors, and also contributing saliva for genotyping. The goals of the program, as initially stated by the investigators, were to find the genes underlying the heritability of alcohol use and related behaviors, and in addition to put genetic knowledge to work in (...) ways that might aid university administrators and mental health professionals in the prevention and treatment of substance abuse. We review every empirical paper involving genetic data that has emerged from the program, and reach a surprising conclusion: the study has never identified a single genetic effect of more than trivial magnitude. Although the quantitative results of the studies were reported transparently, the theoretical ramifications of the negligible results have never been acknowledged. To the contrary, most of the papers ignore the tiny effects, reaching optimistic conclusions about the prospects for future genetic explanations of alcohol use. We explore the implications of these results for the broader prospects of applied psychiatric genetics. (shrink)

In this analysis I apply a Foucauldian approach to ethics to examine the politically prescribed moral and ethical character required of carers of aged persons at home in Australia and the role of nurses in shaping these behaviours. The work that spousal carers provide, although often founded on love and/or obligation, has been formalized through a variety of policy initiatives and technologies that serve to construct the moral approach they must adopt. This shaping of conduct at the most personal level (...) takes place through the application of codes of behaviour policed largely by nurses. These codes redefine the mode of coexistence between an aged husband and wife and propose a new form of relationship that is derived from and supports policies of the deinstitutionalization of care services for elderly persons. In this way modern carer policy has drawn on knowledge and governance of the self to produce a morality of caring that is both authoritative and scientific. (shrink)

Whole genome sequencing is quickly becoming more affordable and accessible, with the prospect of personal genome sequencing for under $1,000 now widely said to be in sight. The ethical issues raised by the use of this technology in the research context have received some significant attention, but little has been written on its use in the clinical context, and most of this analysis has been futuristic forecasting. This is problematic, given the speed with which whole genome sequencing technology is likely (...) to be incorporated into clinical care. This paper explores one particular subset of these issues: the implications of adopting this technology in the prenatal context without a good understanding of when and how it is useful. Prenatal whole genome sequencing differs from current prenatal genetic testing practice in a number of ethically relevant ways. Most notably, whole genome sequencing would radically increase the volume and scope of available prenatal genetic data. The wealth of new data could enhance reproductive decision‐making, promoting parents' freedom to make well‐informed reproductive decisions. We argue, however, that there is potential for prenatal whole genome sequencing to alter clinical practice in undesirable ways, especially in the short term. We are concerned that the technology could (1) change the norms and expectations of pregnancy in ways that complicate parental autonomy and informed decision‐making, (2) exacerbate the deleterious role that genetic determinism plays in child rearing, and (3) undermine children's future autonomy by removing the option of not knowing their genetic information without appropriate justification. (shrink)

The Ethics of Need: Agency, Dignity, and Obligation argues for the philosophical importance of the notion of need and for an ethical framework through which we can determine which needs have moral significance. In the volume, Sarah Clark Miller synthesizes insights from Kantian and feminist care ethics to establish that our mutual and inevitable interdependence gives rise to a duty to care for the needs of others. Further, she argues that we are obligated not merely to meet others’ needs (...) but to do so in a manner that expresses "dignifying care," a concept that captures how human interactions can grant or deny equal moral standing and inclusion in a moral community. She illuminates these theoretical developments by examining two cases where urgent needs require a caring and dignifying response: the needs of the elderly and the needs of global strangers. Those working in the areas of feminist theory, women’s studies, aging studies, bioethics, and global studies should find this volume of interest. (shrink)

This paper considers the justifications for adhering to a principle of confidentiality within medical practice. These are found to derive chiefly from respect for individual autonomy, the doctor/patient contract, and social utility. It is suggested that these will benefit more certainly if secrecy is rejected and the principle of confidentiality is removed from the area of health care.

An assessment of America's preference for "extra-large" shares examples ranging from mega churches and breast augmentation to landfills and mega-malls, in a cautionary report that reveals some of the consequences of these choices.

In this chapter, we critique a concept of resilience that has emerged from contemporary positive psychology and its application to health education. We argue that the present popularity of “resilience” as a strategy for managing mental health discourages educational institutions from providing students with the mental health services they need. Using the tools of American pragmatism, especially the work of John Dewey, we criticize the paradigm of resilience and identify several concrete reformulations of disability studies which would make concrete differences (...) in the lives of those with mental disability. (shrink)

Traditional philosophical discussions of knowledge have focused on the epistemic status of full beliefs. In this book, Moss argues that in addition to full beliefs, credences can constitute knowledge. For instance, your .4 credence that it is raining outside can constitute knowledge, in just the same way that your full beliefs can. In addition, you can know that it might be raining, and that if it is raining then it is probably cloudy, where this knowledge is not knowledge of propositions, (...) but of probabilistic contents. -/- The notion of probabilistic content introduced in this book plays a central role not only in epistemology, but in the philosophy of mind and language as well. Just as tradition holds that you believe and assert propositions, you can believe and assert probabilistic contents. Accepting that we can believe, assert, and know probabilistic contents has significant consequences for many philosophical debates, including debates about the relationship between full belief and credence, the semantics of epistemic modals and conditionals, the contents of perceptual experience, peer disagreement, pragmatic encroachment, perceptual dogmatism, and transformative experience. In addition, accepting probabilistic knowledge can help us discredit negative evaluations of female speech, explain why merely statistical evidence is insufficient for legal proof, and identify epistemic norms violated by acts of racial profiling. Hence the central theses of this book not only help us better understand the nature of our own mental states, but also help us better understand the nature of our responsibilities to each other. (shrink)

Costs at the end of life disproportionately contribute to health care costs in the United States. Addressing these costs will therefore be an important component in making the U.S. health care system more financially sustainable. In this paper, we explore the moral justifications for having discussions of end-of-life costs in the doctor-patient encounter as part of an effort to control costs. As health care costs are partly shared through pooled resources, such as insurance and taxation, and partly borne by individuals (...) through out-of-pocket expenses, we separate our defense for, and approach to, discussing both pooled and individual aspects of cost. We argue that there needs to be a shift away from formulating the options as a dichotomous choice of paying attention to end-of-life costs versus ignoring such costs. The question should be how personal costs will be managed and how societal expenditures should be allocated. These are issues that we believe patients care about and need to have addressed in a manner with which they are comfortable. Conversations about how money will be spent at the end of life should begin before the end is near. We propose discussing costs from the onset of chronic illness and incorporating financial issues in advance care planning. Through these approaches one can avoid abruptly and insensitively introducing financial issues at the very conclusion of a person's life when one would prefer to address the painful and important issues of spiritual and existential loss that are appropriately the focus when a person is dying. (shrink)

The cost of health care at the end of life accounts for a high proportion of total health care costs in the United States. The percentage of Medicare payments attributable to patients in their last year of life was 28.3% in 1978 and has remained substantially the same at 25.1% in 2006. This indicates how little progress has been made in containing these costs, though doing so will be important to promote a financially sustainable health care system. These expenditures also (...) highlight the prospect that efforts to reduce health care costs overall are likely to disproportionately affect the care patients receive at the end of life. (shrink)

This paper develops a precise understanding of the thesis of moral encroachment, which states that the epistemic status of an opinion can depend on its moral features. In addition, I raise objections to existing accounts of moral encroachment. For instance, many accounts fail to give sufficient attention to moral encroachment on credences. Also, many accounts focus on moral features that fail to support standard analogies between pragmatic and moral encroachment. Throughout the paper, I discuss racial profiling as a case study, (...) arguing that moral encroachment can help us identify one respect in which racial profiling is epistemically problematic. (shrink)

Introduction: The humanities enrich and transform the practice of medicine. What remains to be seen, however, is how best to integrate humanities into the medical curriculum to optimize both educational and patient-related outcomes. The present study considers the structure of an innovative student-driven humanities curriculum and seeks to understand its strengths and limitations, as well as make recommendations for improvement. Methods: The Penn State College of Medicine, University Park Regional Campus uses an inquiry-based approach to education, whereby students are responsible (...) for creating learning objectives in four core pillars of exploration: Foundational Science, Clinical Science, Health Systems Science, and Health Humanities. This study explores student-derived humanities learning objectives (HLO) across four years of the curriculum. Results: 420 HLOs met criteria for analysis and were coded as instrumental (developing direct clinical skill), non-instrumental (non-skill based), or both. Of these, 125 (30%) were instrumental, 239 (57%) were non-instrumental, and 56 (13%) were coded as both. Most instrumental HLO centered around communication skills. Non-instrumental HLO most commonly focused on bearing witness and critiquing a particular experience within a social and/or political context. Conclusions: Findings from this study contribute to the development of a humanities curriculum in a student-directed learning program. Non-instrumental HLO lacked a theoretical framework to guide student’s investigations to a deeper level of analysis. Student-directed learning offers many strengths, but can be enhanced through external direction from humanities trained faculty, particularly given that many medical students have a limited humanities background. (shrink)

Generic generalizations such as ‘mosquitoes carry the West Nile virus’ or ‘sharks attack bathers’ are often accepted by speakers despite the fact that very few members of the kinds in question have the predicated property. Previous work suggests that such low-prevalence generalizations may be accepted when the properties in question are dangerous, harmful, or appalling. This paper argues that the study of such generic generalizations sheds light on a particular class of prejudiced social beliefs, and points to new ways in (...) which those beliefs might be undermined and combatted. (shrink)

Contemporary discourses surrounding adoption have a normative tone and are critical of the ways in which international adoption is power based and exploitative. These discourses have a significant influence on adoptive parents, structuring their actions and opening the door for scrutiny of individual adopters' motives and ethics. As an internationally adoptive parent, I reflect, in this article, on my experience and use it as a vantage point from which to consider alternative perspectives on the ethical debates in the extant adoption (...) literature. The insights gained from my experience can inform adoption practices and the development of more nuanced, less polarized perspectives on the ethics of international adoption and inspire new avenues of research that explore the ways in which adoptive parents navigate their socio-political contexts in ways that are ethically sensitive and workable for them. (shrink)

Existing discussions of legal proof address a host of apparently disparate questions: What does it take to prove a fact beyond a reasonable doubt? Why is the reasonable doubt standard notoriously elusive, sometimes considered by courts to be impossible to define? Can the standard of proof by a preponderance of the evidence be defined in terms of probability thresholds? Why is statistical evidence often insufficient to meet the burden of proof? -/- This paper defends an account of proof that addresses (...) each of these questions. Where existing theories take a piecemeal approach to these puzzles, my theory develops an insight that unifies them—namely, the thesis that legal proof requires knowledge. Although this thesis may seem radical at first, I answer several common objections to it, and I argue that it does better than several competing accounts when it comes to making sense of our intuitions about what legal proof requires. (shrink)

This paper motivates and develops a novel semantics for several epistemic expressions, including possibility modals and indicative conditionals. The semantics I defend constitutes an alternative to standard truth conditional theories, as it assigns sets of probability spaces as sentential semantic values. I argue that what my theory lacks in conservatism is made up for by its strength. In particular, my semantics accounts for the distinctive behavior of nested epistemic modals, indicative conditionals embedded under probability operators, and instances of constructive dilemma (...) containing epistemic vocabulary. (shrink)

This chapter defines and defends time-slice epistemology, according to which there are no essentially diachronic norms of rationality. The chapter begins by distinguishing two notions of time-slice epistemology, and ends by defending time-slice theories of action under indeterminacy, i.e. theories about how you should act when the outcome of your decision depends on some indeterminate claim. In a recent chapter, J. Robert G. Williams defends a theory of action under indeterminacy which is subject to several objections. An alternative theory is (...) proposed in its place. The resulting discussion highlights a more general moral about action under indeterminacy, namely that time-slice theories are supported by strong analogies with ethical theories. In particular, our understanding of agents torn between interpretations of a decision situation should be guided by our theories of agents torn between incommensurable values. (shrink)

Recently, there have been a number of lawsuits in the United States in which families objected to performance of apnoea testing for determination of brain death. The courts reached conflicting determinations in these cases. We discuss the medicolegal complications associated with apnoea testing that are highlighted by these cases and our position that the decision to perform apnoea testing should be made by clinicians, not families, judges, or juries.

This paper argues that just as full beliefs can constitute knowledge, so can properties of your credence distribution. The resulting notion of probabilistic knowledge helps us give a natural account of knowledge ascriptions embedding language of subjective uncertainty, and a simple diagnosis of probabilistic analogs of Gettier cases. Just like propositional knowledge, probabilistic knowledge is factive, safe, and sensitive. And it helps us build knowledge-based norms of action without accepting implausible semantic assumptions or endorsing the claim that knowledge is interest-relative.

"One of the most careful and intensive among the introductory texts that can be used with a wide range of students. It builds remarkably sophisticated technical skills, a good sense of the nature of a formal system, and a solid and extensive background for more advanced work in logic.... The emphasis throughout is on natural deduction derivations, and the text's deductive systems are its greatest strength. Lemmon's unusual procedure of presenting derivations before truth tables is very effective." --Sarah Stebbins, (...) The Journal of Symbolic Logic. (shrink)

Aristotle connects modality and time in ways strange and perplexing to modern readers. In this book the author proposes a new solution to this exegetical problem. Although primarily expository, this work explores topics of central concern for current investigations into causality, time, and change.

This paper defends an account of full belief, including an account of its relationship to credence. Along the way, I address several familiar and difficult questions about belief. Does fully believing a proposition require having maximal confidence in it? Are rational beliefs closed under entailment, or does the preface paradox show that rational agents can believe inconsistent propositions? Does whether you believe a proposition depend partly on your practical interests? My account of belief resolves the tension between conflicting answers to (...) these questions that have been defended in the literature. In addition, my account complements fruitful probabilistic theories of assertion and knowledge. (shrink)

Ducks lay eggs' is a true sentence, and `ducks are female' is a false one. Similarly, `mosquitoes carry the West Nile virus' is obviously true, whereas `mosquitoes don't carry the West Nile virus' is patently false. This is so despite the egg-laying ducks' being a subset of the female ones and despite the number of mosquitoes that don't carry the virus being ninety-nine times the number that do. Puzzling facts such as these have made generic sentences defy adequate semantic treatment. (...) However complex the truth conditions of generics appear to be, though, young children grasp generics more quickly and readily than seemingly simpler quantifiers such as `all' and `some'. I present an account of generics that not only illuminates the strange truth conditions of generics, but also explains how young children find them so comparatively easy to acquire. I then argue that generics give voice to our most cognitively primitive generalizations and that this hypothesis accounts for a variety of facts ranging from acquisition patterns to cross-linguistic data concerning the phonological articulation of operators. I go on to develop an account of the nature of these cognitively fundamental generalizations and argue that this account explains the strange truth-conditional behavior of generics. (shrink)

An investigation into Aristotle's metaphysics of nature as expounded in the Physics. It focuses in particular his conception of change, a concept which is shown to possess a unique metaphysical structure, with implications that should engage the attention of contemporary analysis. First published in hardback in 1982, the book is now available for the first time in paperback. 'A powerful and appealing explanatory scheme which succeeds on the whole in drawing together a great many seemingly disparate elements in the Physics (...) into a neat unitary stucture.' Canadian Philosophical Review. (shrink)

This article reports the findings of a qualitative study that explored the organizational influences on moral distress for health professionals working in pediatric intensive care units across Canada. Participants were recruited to the study from PICUs across Canada. The PICU is a high-tech, fast-paced, high-pressure environment where caregivers frequently face conflict and ethical tension in the care of critically ill children. A number of themes including relationships with management, organizational structure and processes, workload and resources, and team dynamics were identified. (...) This study provides a rare and important multi-disciplinary perspective on this topic and the findings have implications for administrators and leaders who seek to improve the moral climate of healthcare delivery. (shrink)

One of the main themes that has emerged from behavioral decision research during the past three decades is the view that people's preferences are often constructed in the process of elicitation. This idea is derived from studies demonstrating that normatively equivalent methods of elicitation (e.g., choice and pricing) give rise to systematically different responses. These preference reversals violate the principle of procedure invariance that is fundamental to all theories of rational choice. If different elicitation procedures produce different orderings of options, (...) how can preferences be defined and in what sense do they exist? This book shows not only the historical roots of preference construction but also the blossoming of the concept within psychology, law, marketing, philosophy, environmental policy, and economics. Decision making is now understood to be a highly contingent form of information processing, sensitive to task complexity, time pressure, response mode, framing, reference points, and other contextual factors. (shrink)

Recently, von Fintel (2001) and Gillies (2007) have argued that certain sequences of counterfactuals, namely reverse Sobel sequences, should motivate us to abandon standard truth conditional theories of counterfactuals for dynamic semantic theories. I argue that we can give a pragmatic account of our judgments about counterfactuals without giving up the standard semantics. In particular, I introduce a pragmatic principle governing assertability, and I use this principle to explain a variety of subtle data concerning reverse Sobel sequences.

Recently many have argued that agents must sometimes have credences that are imprecise, represented by a set of probability measures. But opponents claim that fans of imprecise credences cannot provide a decision theory that protects agents who follow it from foregoing sure money. In particular, agents with imprecise credences appear doomed to act irrationally in diachronic cases, where they are called to make decisions at earlier and later times. I respond to this claim on behalf of imprecise credence fans. Once (...) we appreciate the complexity of our intuitions about rational decision making, we can see that diachronic cases are in fact evidence for the essential claims motivating imprecise credence models. I argue that our decision theory for imprecise agents should mirror our decision theory for agents in moral dilemmas, and I develop permissive norms that explain our intuitions about both sorts of agents. (shrink)

Traditionally, discussions of moral participation – and in particular moral agency – have focused on fully formed human actors. There has been some interest in the development of morality in humans, as well as interest in cultural differences when it comes to moral practices, commitments, and actions. However, until relatively recently, there has been little focus on the possibility that nonhuman animals have any role to play in morality, save being the objects of moral concern. Moreover, when nonhuman cases are (...) considered as evidence of moral agency or subjecthood, there has been an anthropocentric tendency to focus on those behaviors that inform our attributions of moral agency to humans. For example, some argue that the ability to evaluate the principles upon which a moral norm is grounded is required for full moral agency. Certainly, if a moral agent must understand what makes an action right or wrong, then most nonhuman animals would not qualify (and perhaps some humans too). However, if we are to understand the evolution of moral psychology and moral practice, we need to turn our attention to the foundations of full moral agency. We must first pay attention to the more broadly normative practices of other animals. Here, we begin that project by considering evidence that great apes and cetaceans participate in normative practices. (shrink)

This paper discusses three potential varieties of update: updates to the common ground, structuring updates, and updates that introduce discourse referents. These different types of update are used to model different aspects of natural language phenomena. Not-at-issue information directly updates the common ground. The illocutionary mood of a sentence structures the context. Other updates introduce discourse referents of various types, including propositional discourse referents for at-issue information. Distinguishing these types of update allows a unified treatment of a broad range of (...) phenomena, including the grammatical evidentials found in Cheyenne (Algonquian) as well as English evidential parentheticals, appositives, and mood marking. An update semantics that can formalize all of these varieties of update is given, integrating the different kinds of semantic contributions into a single representation of meaning. (shrink)

Many languages grammatically mark evidentiality, i.e., the source of information. In assertions, evidentials indicate the source of information of the speaker while in questions they indicate the expected source of information of the addressee. This dissertation examines the semantics and pragmatics of evidentiality and illocutionary mood, set within formal theories of meaning and discourse. The empirical focus is the evidential system of Cheyenne (Algonquian: Montana), which is analyzed based on several years of fieldwork by the author.

It is commonly assumed that when we assign different credences to a proposition, a perfect compromise between our opinions simply ‘splits the difference’ between our credences. I introduce and defend an alternative account, namely that a perfect compromise maximizes the average of the expected epistemic values that we each assign to alternative credences in the disputed proposition. I compare the compromise strategy I introduce with the traditional strategy of compromising by splitting the difference, and I argue that my strategy is (...) a reasonable characterization of epistemic compromise. (shrink)

This article unravels the complex set of financial dealings that are at the heart of the Enron story and follows the story through the highs and lows of Enron share prices. The key players are identified and their roles described. Apart from the financial and accounting issues, the Enron story also raises a wide range of ethical issues including corporate governance, organisational culture and ethical leadership and scrutiny. These are discussed in the article. It might be argued that Enron could (...) never have got away with some of its practices if it had been operating in Europe. The article concludes that this view may be naïve, particularly in the light of recent media disclosures of the UK Labour government's continuing flirtation with business donations. The Enron story raises serious considerations in a whole host of financial, economic, political and ethical areas. As the Enron story continues to unfold, an article of this type can only begin to scratch the surface of some of these issues and to lay them out for further investigation. (shrink)

For centuries, the British royal family has been the subject of books, articles, broadcast media, and digital communication. The addition of social media platforms has further increased the attention of the royals. Each of the family’s official social media sites have large numbers of followers around the world. The present study uses Goffman’s Presentation of Self to qualitatively examine how the current British royal family portrays itself visually via its official Instagram account. An analysis of two years of posts on (...) the social platform provides a glimpse of how the family works to maintain its image through a highly popular social media platform. Results indicated the presence of three main themes: Queen as the Head of the Monarchy, Honoring the Past, and The Working Royalty. This study offers a means of understanding the importance of visuals in conveying the royal family. (shrink)

Collaboration requires agents to coordinate their behavior on the fly, sometimes cooperating to solve a single task together and other times dividing it up into sub‐tasks to work on in parallel. Underlying the human ability to collaborate is theory‐of‐mind (ToM), the ability to infer the hidden mental states that drive others to act. Here, we develop Bayesian Delegation, a decentralized multi‐agent learning mechanism with these abilities. Bayesian Delegation enables agents to rapidly infer the hidden intentions of others by inverse planning. (...) We test Bayesian Delegation in a suite of multi‐agent Markov decision processes inspired by cooking problems. On these tasks, agents with Bayesian Delegation coordinate both their high‐level plans (e.g., what sub‐task they should work on) and their low‐level actions (e.g., avoiding getting in each other's way). When matched with partners that act using the same algorithm, Bayesian Delegation outperforms alternatives. Bayesian Delegation is also a capable ad hoc collaborator and successfully coordinates with other agent types even in the absence of prior experience. Finally, in a behavioral experiment, we show that Bayesian Delegation makes inferences similar to human observers about the intent of others. Together, these results argue for the centrality of ToM for successful decentralized multi‐agent collaboration. (shrink)

The concept of "nature as inner principle of change" is fundamental to Aristotle's theory of the physical world; it is the object of the present thesis to substantiate this claim by tracing the effects of this idea in Aristotle's rejection of materialism, in his doctrine of "natural places", in his definition of change and process in general, and in his notion of agency in general and the supreme Unmoved Mover in particular ). Aristotle elucidates "natural" by. contrast with "artificial" - (...) ), holding that natural substances not merely collectively - ) but as individuals each possess an 'innate impulse of change'. But this must be explained so as to allow for the fact that no change is entirely independent of external conditions - ). If, however, change were totally dependent on external conditions, its occurrence would be inexplicable - ), and the very concept of "change" would be incoherent. This latter conclusion emerges from an examination of the ancient paradox of becoming and Aristotle's treatment of it - ). The paradox is expounded -). Aristotle answers it by showing that language assumes a continuing subject of change - ). But this assumption meets the problem only if the metaphysical category of substance is also assumed, and along with it some distinction between substance-constitutive and non-substance-constitutive characteristics - ). The former mark off their subject as a thing of a certain causal type; thus change, in presupposing a substantial subject, presupposes one that makes some causal contribution to its own changes - ). But Aristotle means more than this by 'nature as inner principle'. He holds a natural substance to be the autonomous determinant of certain changes; these therefore are "natural", as manifesting the substantial nature - ). This problematic notion is taken for granted by Aristotle in the Vhys-ics - ), but can be seen to rest on his metaphysic of substance. It is a consequence of this that the natural change of a given substance be of one kind and display a unitary pattern reflecting the unity of the substance ). This view cripples scientific method as we understand it ), but Aristotle's idea of substance anyway cuts him off from the approaches successfully operated in later mechanics and chemistry - ). A summary of the ground so far covered ) introduces a further sense in which Aristotle's natures are "inner" principles of change: the subject of change is not external to the being which is the source of change - ). (shrink)