BackgroundPalliative sedation and analgesia are employed in patients with refractory and intractable symptoms at the end of life to reduce their suffering by lowering their level of consciousness. The doctrine of double effect, a philosophical principle that justifies doing a “good action” with a potentially “bad effect,” is frequently employed to provide an ethical justification for this practice. Main textWe argue that palliative sedation and analgesia do not fulfill the conditions required to apply the doctrine of double effect, and therefore (...) its use in this domain is inappropriate. Furthermore, we argue that the frequent application of the doctrine of double effect to palliative sedation and analgesia reflects physicians’ discomfort with the complex moral, intentional, and causal aspects of end-of-life care. ConclusionsWe are concerned that this misapplication of the doctrine of double effect can consequently impair physicians’ ethical reasoning and relationships with patients at the end of life. (shrink)

Despite their best efforts, scientists may be unable to construct models that simultaneously exemplify every theoretical virtue. One explanation for this is the existence of tradeoffs: relationships of attenuation that constrain the extent to which models can have such desirable qualities. In this paper, we characterize three types of tradeoffs theorists may confront. These characterizations are then used to examine the relationships between parameter precision and two types of generality. We show that several of these relationships exhibit tradeoffs and discuss (...) what consequences those tradeoffs have for theoretical practice. (shrink)

We defend a view of the distinction between the normal and the pathological according to which that distinction has an objective, biological component. We accept that there is a normative component to the concept of disease, especially as applied to human beings. Nevertheless, an organism cannot be in a pathological state unless something has gone wrong for that organism from a purely biological point of view. Biology, we argue, recognises two sources of biological normativity, which jointly generate four “ways of (...) going wrong” from a biological perspective. These findings show why previous attempts to provide objective criteria for pathology have fallen short: Biological science recognizes a broader range of ways in which living things can do better or worse than has previously been recognized in the philosophy of medicine. (shrink)

This article argues that Hannah Arendt’s controversial essay “Reflections on Little Rock,” when situated within her analysis of Jewish assimilation, has an astute insight: racial integration and the decrease of the racial gaps in material inequality, without taking seriously the political project of building a world in common, only intensify racism in racist polities. This occurs because attempts to extend formal equality to the racially dominated give rise to the rule of racial common sense, a result of a clash between (...) the political structures of equality and the racial inequality practiced in quotidian interracial exchanges occurring in civil society. Though Arendt’s work on racism echoes criticisms of racial integration leveled by racial realist and pessimistic accounts of the Civil Rights struggle, her work points to a more expansive practice of “the political” that calls for the institutional design of formal politics as an important strategy against racism. (shrink)

For over four decades, knowledge that symptoms of some inherited diseases can be prevented or reduced via early detection and treatment in newborns has underpinned state-funded screening programs in most developed countries. Conditions for which newborn screening is now a recognized preventative public health initiative include phenylketonuria, congenital hypothyroidism, and, more recently, cystic fibrosis and sickle cell disorder. The use of tandem mass spectrometry to detect conditions such as amino-acidopathies and fatty-acid oxidation defects is also becoming increasingly prevalent. a.

Most of Terence Penelhum’s essays collected in his Themes in Hume are already recognized as classics in Hume scholarship. Bringing them together only reinforces their strengths: clarity and sensitivity in exposition combined with charity and acuity in criticism. Penelhum wrote them over a course of almost fifty years, and we can see in them the evolution in his attitude towards Hume. In the earliest essay — the 1955 ‘Hume on Personal Identity’ — Penelhum offers a quick and local diagnosis of (...) Hume’s errors: he has mistakenly assumed that an object must be unchanging for it to be identical through time. But in the later essays, especially the three new ones, Penelhum recognizes that his earlier local insights must be balanced by a wider reading of Hume. After all, he does not, for example, talk about the self only to say that it is a bundle of perceptions; it is also crucial to his treatment of the passions, especially the indirect, person-oriented passions, and is an essential component in his explanation of sympathy, the ultimate source of our moral judgments. Moreover, as Penelhum notes, seeing the self as constituted out of its perceptions, rather than standing over them so as to judge their legitimacy as guides to action or knowledge, is what allows Hume to attempt a ‘science of man’ — a quasi-Newtonian project of discovering the principles governing the perceptions in the mind-bundle. (shrink)

Modeling metastasis in animal systems has been an important focus for developing cancer therapeutics. Xenopus laevis is a well‐established model, known for its use in identifying genetic mechanisms underlying diseases and disorders in humans. Prior literature has suggested that the drug, ivermectin, can be used in Xenopus to induce melanocytes to convert into a metastatic melanoma‐like state, and thus could be ideal for testing possible melanoma therapies in vivo. However, there are notable inconsistencies between ivermectin studies in Xenopus and the (...) application of ivermectin in mammalian systems, that are relevant to cancer and melanoma research. In this review, we examine the ivermectin‐induced phenotypes in Xenopus, and we explore the current uses of ivermectin in human research. We conclude that while ivermectin may be a useful drug for many biomedical purposes, it is not ideal to induce a metastatic melanocyte phenotype in Xenopus for testing the effects of potential melanoma therapeutics. (shrink)

This article is about the role of abstraction in mechanistic explanations. Abstraction is widely recognised as a necessary concession to the practicalities of scientific work, but some mechanist philosophers argue that it is also a positive explanatory feature in its own right. I claim that in as much as these arguments are based on the idea that mechanistic explanation exhibits a trade-off between fine-grained detail and generality, they are unsuccessful. Detail and generality both appear to be important sources of explanatory (...) power, but investigators do not need to make a choice between these desiderata, at least when an explanation incorporates further detail through the decomposition of the mechanism's parts. (shrink)

Natural selection comes in degrees. Some biological traits are subjected to stronger selective force than others, selection on particular traits waxes and wanes over time, and some groups can only undergo an attenuated kind of selective process. This has downstream consequences for any notions that are standardly treated as binary but depend on natural selection. For instance, the proper function of a biological structure can be defined as what caused that structure to be retained by natural selection in the past. (...) We usually think of proper functions in binary terms: storing bile is a function of the gall bladder, but making stones is not. However, if functions arise through natural selection, and natural selection comes in degrees, then a binary approach to proper functions is in tension with the biological facts. In order to resolve this tension, we need to revise our standard accounts of proper function. In particular, we may have to seriously consider the possibility that functions themselves come in degrees, in spite of the ramifications this will have for the way we speak about functions and related concepts such as dysfunction, disease, and teleosemantic content. (shrink)

This paper argues, on the basis of data from St'át'imcets (Lillooet Salish), for a theory of wide-scope indefinites which is similar, though not identical, to that proposed by Kratzer (1998). I show that a subset of S'át'imcets indefinites takes obligatory wide scope with respect to if-clauses, negation, and modals, and is unable to be distributed over by quantificational phrases. These wide-scope effects cannot be accounted for by movement, but require an analysis involving choice functions (Reinhart 1995, 1997). However, Reinhart's particular (...) choice function analysis is unable to account for the St'át'imcets data. A Kratzer-style theory, on the other hand, accounts not only for the wide-scope effects, but also for the emergence of narrower-than-widest interpretations for indefinites which contain bound variables. I depart from Kratzer's analysis in claiming that St'át'imcets choice function indefinites are not 'specific'; the discourse context does not provide a value for the function variable. Therefore, I utilize wide- scope existential closure over choice functions rather than leaving the variables free. However, my analysis provides support for Kratzer's claim that English indefinites are ambiguous between a choice function interpretation and a quantificational interpretation, since St'át'imcets determiners overtly encode the English ambiguity. I conclude by suggesting that the proposed analysis of wide-scope indefinites may be universally valid. (shrink)

This paper presents an account of the biological populations that can undergo paradigmatic natural selection. I argue for, and develop Peter Godfrey-Smith’s claim that reproductive competition is a core attribute of such populations. However, as Godfrey-Smith notes, it is not the only important attribute. I suggest what the missing element is, co-opting elements of Alan Templeton’s notion of exchangeability. The final framework is then compared to two recent discussions regarding biological populations proposed by Roberta Millstein and Jacob Stegenga.

In his 1966 paper “The Strategy of model-building in Population Biology”, Richard Levins argues that no single model in population biology can be maximally realistic, precise and general at the same time. This is because these desirable model properties trade-off against one another. Recently, philosophers have developed Levins’ claims, arguing that trade-offs between these desiderata are generated by practical limitations on scientists, or due to formal aspects of models and how they represent the world. However this project is not complete. (...) The trade-offs discussed by Levins had a noticeable effect on modelling in population biology, but not on other sciences. This raises questions regarding why such a difference holds. I claim that in order to explain this finding, we must pay due attention to the properties of the systems, or targets modelled by the different branches of science.Keywords: Trade-offs; Population biology; Scientific models; Generality; Precision. (shrink)

The standard analysis of quantification says that determiner quantifiers (such as every) take an NP predicate and create a generalized quantifier. The goal of this paper is to subject these beliefs to crosslinguistic scrutiny. I begin by showing that in St'á'imcets (Lillooet Salish), quantifiers always require sisters of argumental type, and the creation of a generalized quantifier from an NP predicate always proceeds in two steps rather than one. I then explicitly adopt the strong null hypothesis that the denotations of (...) quantifiers should be crosslinguistically uniform. Since the Salish data cannot be captured by the usual analysis of English, I pursue the idea that English is reducible to the Salish pattern. Reanalysis of many English constructions is required. I argue that the reanalysis has advantages over the standard analysis for partitives, as well as for non-partitive all- and most-phrases, which I analyze as containing bare plurals of argumental type. Even where the new analysis faces some challenges (for example, with every), the attempt still leads to fruitful results. It forces us to view familiar constructions in a new light, and to redefine, I believe correctly, which quantificational constructions are ‘basic’ and which stand in need of further explanation. (shrink)

This paper contributes to the debate about ‘tenseless languages’ by defending a tensed analysis of a superficially tenseless language. The language investigated is St’át’imcets (Lillooet Salish). I argue that although St’át’imcets lacks overt tense morphology, every finite clause in the language possesses a phonologically covert tense morpheme; this tense morpheme restricts the reference time to being non-future. Future interpretations, as well as ‘past future’ would-readings, are obtained by the combination of covert tense with an operator analogous to Abusch’s (1985) WOLL. (...) I offer St’át’imcets-internal evidence (of a kind not previously adduced) that the WOLL-like operator is modal in nature. It follows from the analysis presented here that there are only two (probably related) differences between St’át’imcets and English in the area of tense. The first is that St’át’imcets lacks tense morphemes which are pronounced. The second is that the St’át’imcets tense morpheme is semantically underspecified compared to English ones. In each of these respects, the St’át’imcets tense morpheme displays similar properties to pronouns, which may be covert and which may fail to distinguish person, number or gender. Along the way, I point out several striking and subtle similarities in the interpretive possibilities of St’át’imcets and English. I suggest that these similarities may reveal non-accidental properties of tense systems in natural language. I conclude with discussion of the implications of the analysis for cross-linguistic variation, learnability and the possible existence of tenseless languages. (shrink)

This essay is part of a special issue celebrating 50 years of Political Theory. The ambition of the editors was to mark this half century not with a retrospective but with a confabulation of futures. Contributors were asked: What will political theory look and sound like in the next century and beyond? What claims might political theorists or their descendants be making in ten, twenty-five, fifty, a hundred years’ time? How might they vindicate those claims in their future contexts? How (...) will the consistent concerns of political theorists evolve into the questions critical for people decades or centuries from now? What new problems will engage the political theorists (or their rough equivalents) of the future? What forms might those take? What follows is one of the many confabulations published in response to these queries. (shrink)

This paper is about mechanisms and models, and how they interact. In part, it is a response to recent discussion in philosophy of biology regarding whether natural selection is a mechanism. We suggest that this debate is indicative of a more general problem that occurs when scientists produce mechanistic models of populations and their behaviour. We can make sense of claims that there are mechanisms that drive population-level phenomena such as macroeconomics, natural selection, ecology, and epidemiology. But talk of mechanisms (...) and mechanistic explanation evokes objects with well-defined and localisable parts which interact in discrete ways, while models of populations include parts and interactions that are neither local nor discrete in any actual populations. This apparent tension can be resolved by carefully distinguishing between the properties of a model and those of the system it represents. To this end, we provide an analysis that recognises the flexible relationship between a mechanistic model and its target system. In turn, this reveals a surprising feature of mechanistic representation and explanation: it can occur even when there is a mismatch between the mechanism of the model and that of its target. Our analysis reframes the debate, providing an alternative way to interpret scientists’ mechanism-talk , which initially motivated the issue. We suggest that the relevant question is not whether any population-level phenomenon such as natural selection is a mechanism, but whether it can be usefully modelled as though it were a particular type of mechanism. (shrink)

Some ‘naturalist’ accounts of disease employ a biostatistical account of dysfunction, whilst others use a ‘selected effect’ account. Several recent authors have argued that the biostatistical account offers the best hope for a naturalist account of disease. We show that the selected effect account survives the criticisms levelled by these authors relatively unscathed, and has significant advantages over the BST. Moreover, unlike the BST, it has a strong theoretical rationale and can provide substantive reasons to decide difficult cases. This is (...) illustrated by showing how life-history theory clarifies the status of so-called diseases of old age. The selected effect account of function deserves a more prominent place in the philosophy of medicine than it currently occupies. _1_ Introduction _2_ Biostatistical and Selected Effect Accounts of Function _3_ Objections to the Selected Effect Account _3.1_ Boorse _3.2_ Kingma _3.3_ Hausman _3.4_ Murphy and Woolfolk _4_ Problems for the Biostatistical Account _4.1_ Schwartz _5_ Analysis versus Explication _6_ Explicating Dysfunction: Life History Theory and Senescence _7_ Conclusion. (shrink)

Modals in St’át’imcets (Lillooet Salish) show two differences from their counterparts in English. First, they have variable quantificational force, systematically allowing both possibility and necessity interpretations; and second, they lexically restrict the conversational background, distinguishing for example between deontic and (several kinds of) epistemic modality. We provide an analysis of the St’át’imcets modals according to which they are akin to specific indefinites in the nominal domain. They introduce choice function variables which select a subset of the accessible worlds. Following Klinedinst, (...) we assume distributivity over the resulting set of worlds. St’át’imcets modals thus receive a uniform interpretation as (distributive) pluralities. The appearance of variability in modal force arises because the choice function can select a larger or smaller subset of accessible worlds. Finally, we discuss the implications of our analysis for the investigation of modal systems in other languages. (shrink)

The law often calls on the concept of public interest for assistance. Privacy law makes use of this concept in several ways, including to justify consent waivers for secondary research on health information. Because the law sees information privacy as a means for individuals to control their personal information, consent can only be set aside in special circumstances. Ballantyne and Schaefer argue that only public interest, and only a broad conception of public interest, can do the special ‘normative justificatory work’ (...) to override consent requirements. Other, similar-sounding concepts, such as public benefit, public good and social value, also provide useful services. But none more so than public interest. In fact, they argue, public interest is the superior concept precisely because it can capture those concepts as well as a range of other interests. Our response focuses on this claim. We argue their strategy is not as promising as it might first seem. Ballantyne and Schaefer construe the important role that public interest plays in this context as their endpoint. They claim that unless the concept is open and content-rich, it will lose some of its importance. But by refusing to place limits around it, their inquiry leads us back to a catch-all concept that lacks clear focus or meaning. In reply, we argue that, for practically minded theorists, a narrow conception of public interest is more useful. Further, the narrowing of public interest in this context can be achieved by first analysing it in its legal, rather than ethical, sense. (shrink)

Clinical ethics committees (CECs) in the United Kingdom (UK) have developed significantly over the past 15 years. The issue of access to and participation in clinical ethics consultation by patients and family members has, however, gone largely unrecognized. There are various dimensions to this kind of contact, including patient notification, consent and participation. This study reports the first specific investigation of patient contact with UK CECs. A questionnaire study was carried out with representatives from UK CECs. Results suggest that patient (...) participation in clinical ethics consultation is low and unlikely to change significantly in the near future. Attitudes towards patients having a role in clinical ethics consultation are mixed, with a variety of reasons put forward both for and against patient participation. These results are discussed in the light of common themes in the literature and the practical and political context of clinical ethics support in the UK. (shrink)

This target article considers the ethical implications of providing prenatal diagnosis (PND) and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe abortion (...) for these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms. (shrink)

This article surveys the state of the art in the field of semantic universals. We examine potential semantic universals in three areas: (i) the lexicon, (ii) semantic “glue” (functional morphemes and composition principles), and (iii) pragmatics. At the level of the lexicon, we find remarkably few convincing semantic universals. At the level of functional morphemes and composition principles, we discuss a number of promising constraints, most of which require further empirical testing and/or refinement. In the realm of pragmatics, we predict (...) that Gricean mechanisms are universal, but suggest that the precise nature of presuppositions may be subject to cross-linguistic variation. Finally, we follow E.L. Keenan in concluding that the overarching universal of effability or translatability between languages cannot be upheld in its strongest form. A recurring theme throughout this survey is how much work still remains to be done in the relatively young field of cross-linguistic formal semantics. (shrink)

Empirical evidence suggests that some health professionals believe consent procedures for the emerging technology of non-invasive prenatal diagnosis (NIPD) should become less rigorous than those currently used for invasive prenatal testing. In this paper, we consider the importance of informed consent and informed choice procedures for protecting autonomy in those prenatal tests which will give rise to a definitive result. We consider whether there is anything special about NIPD that could sanction a change to consent procedures for prenatal diagnosis or (...) otherwise render informed decision-making less important. We accept the claim that the absence of risk of miscarriage to some extent lessens the gravity of the decision to test compared with invasive methods of testing. However, we also claim that the definitive nature of the information received, and the fact that the information can lead to decisions of great significance, makes NIPD an important choice. This choice should only be made by means of a rigorous and appropriately supported decision-making process (assuming that this is what the pregnant woman wants). We conclude that, on balance, consent procedures for NIPD should mirror those for invasive testing, albeit without the need to emphasise procedure-related risk. (shrink)

Multiple studies show that periodic reanalysis of genomic test results held by clinical laboratories delivers significant increases in overall diagnostic yield. However, while there is a widespread consensus that implementing routine reanalysis procedures is highly desirable, there is an equally widespread understanding that routine reanalysis of individual patient results is not presently feasible to perform for all patients. Instead, researchers, geneticists and ethicists are beginning to turn their attention to one part of reanalysis—reinterpretation of previously classified variants—as a means of (...) achieving similar ends to large-scale individual reanalysis but in a more sustainable manner. This has led some to ask whether the responsible implementation of genomics in healthcare requires that diagnostic laboratories routinely reinterpret their genomic variant classifications and reissue patient reports in the case of materially relevant changes. In this paper, we set out the nature and scope of any such obligation, and analyse some of the main ethical considerations pertaining to a putative duty to reinterpret. We discern and assess three potential outcomes of reinterpretation—upgrades, downgrades and regrades—in light of ongoing duties of care, systemic error risks and diagnostic equity. We argue against the existence of any general duty to reinterpret genomic variant classifications, yet we contend that a suitably restricted duty to reinterpret ought to be recognised, and that the responsible implementation of genomics into healthcare must take this into account. (shrink)

Recent scientific advances mean the widespread introduction of non-invasive prenatal diagnosis (NIPD) for chromosomal aneuploidies may be close at hand, raising the question of how NIPD should be introduced as part of antenatal care pathways for pregnant women. In this paper, the authors examine the ethical implications of three hypothetical models for using NIPD for aneuploidy in state-funded healthcare systems and assess which model is ethically preferable. In comparing the models, the authors consider their respective timings; how each model would (...) fit with current screening and diagnostic tests offered to pregnant women; the implications of offering NIPD at different stages of pregnancy; and the potential for each model to support reproductive autonomy and informed decision-making. The authors conclude by favouring a model that would be offered at 11–13 weeks gestation, alongside existing combined screening, provided that this is accompanied by measures to maximise informed decision-making, for example, provision of adequate pretest and post-test counselling. (shrink)

In a recent article in this journal, Zachary Ardern criticizes our view that the most promising candidate for a naturalized criterion of disease is the "selected effects" account of biological function and dysfunction. Here we reply to Ardern’s criticisms and, more generally, clarify the relationship between adaptation and dysfunction in the evolution of health and disease.

The use of genomic testing in pregnancy is increasing, giving rise to questions over how the information that is generated should be offered and returned in clinical practice. While these tests provide important information for prenatal decision-making, they can also generate information of uncertain significance. This paper critically examines three models for approaching the disclosure of variants of uncertain significance (VUS), which can arise from forms of genomic testing such as prenatal chromosomal microarray analysis (CMA). Contrary to prevailing arguments, we (...) argue that respect for reproductive autonomy does not justify adopting a model on which an offer to disclose VUS is a routine part of genetic counselling. Instead, we contend that a commitment both to solidarity between healthcare providers and pregnant women and to the acceptance of a novel principle of caution under normative uncertainty means that we should instead adopt a model of VUS disclosure that imposes a strong presumption against offering to disclose VUS. The upshot of this is that it should be standard practice to only offer to disclose VUS when this is requested by the woman undergoing CMA. We defend our position against claims that arise from an alleged right to such information and that a presumption against an offer will lead to inequity. (shrink)

We provide an account of mechanistic representation and explanation that has several advantages over previous proposals. In our view, explaining mechanistically is not simply giving an explanation of a mechanism. Rather, an explanation is mechanistic because of particular relations that hold between a mechanical representation, or model, and the target of explanation. Under this interpretation, mechanistic explanation is possible even when the explanatory target is not a mechanism. We argue that taking this view is not only coherent and plausible, it (...) gives a more sophisticated view of the relationship between mechanical models and their targets. This allows us to address some ambiguities within the mechanist framework, and delivers a more intuitive way to interpret scientists' use of the term "mechanism". (shrink)

Merit has very little to do with the increasing dominance of men in the modern Liberal Party. Yet Liberal women continue to defend it. Until now. ON MERIT explores this imbalance, its implications for the party's future, and how a pair of red shoes may spark a rebellion against the merit myth.

This volume brings together papers that discuss methodological issues in conducting elicitation on semantic topics in a fieldwork situation. Each author pairs explicit methodological proposals with concrete examples of their use in the field. The range of languages discussed span 11 language families and four continents.

The concept of autonomy plays a central role in bioethics,1 but there is no consensus as to how we should understand it beyond a general notion of self-determination. The conception of autonomy deployed in applied ethics2 can have crucial ramifications when it is applied in real-world scenarios, so it is important to be clear. However, this clarity is often lacking when autonomy is discussed in the bioethics literature. In this paper we outline three different conceptions of autonomy, and argue that (...) a substantive, perfectionist approach meets the theoretical requirements for an account of autonomy and also provides practical guidance. As Rebecca Walker argues, bioethics requires a more conceptually adequate account... (shrink)

Although the concept of intelligence is difficult to define, research has provided evidence for a significant genetic component. Attempts are now being made to use molecular genetic approaches to identify genes contributing to intelligence, and to determine the ways in which they interact with environmental variables. This research is then likely to determine the developmental pathways of intelligence, in an effort to understand mental handicap and learning disorders and develop new treatment strategies. This paper reviews research on the genetic basis (...) of intelligence, and discusses the ethical concerns, including the role of genetic information, the value we place on intelligence and the allocation of resources. It will be argued that the objections raised are problematic, and that because of the value of this knowledge and the prospect of improving lives, this research is morally required. We will then provide a brief analysis of the issues raised by enhancement of intelligence using genetic technology, and will argue that there is no intrinsic difference between this and other means of optimising intelligence. (shrink)

It is unarguable that the implementation and use of noninvasive prenatal testing (NIPT) should be critical and appropriate. After all, decisions that influence when and how to have children have ut...