As a preliminary step to beginning to assess the usefulness of clinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and third year students at the University of Toronto as part of another examination. The students were asked to list the issues presented by the (...) patient problem. Responses from 281 students were obtained. These students identified an average of 2.72 ethical issues per vignette. Each response was classified under the domains of autonomy, beneficence and justice. Comparisons were made between classes and between vignettes. There was considerable variation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects of ethical sensitivity in medical students but more study is required to clarify exactly what is being measured. (shrink)

An instrument to assess 'ethical sensitivity' has been developed. The instrument presents four clinical vignettes and the respondent is asked to list the ethical issues related to each vignette. The responses are classified, post hoc, into the domains of autonomy, beneficence and justice. This instrument was used in 1990 to assess the ethical sensitivity of students in all four medical classes at the University of Toronto. Ethical sensitivity, as measured by this instrument, is not related to age or grade-point average. (...) Sensitivity increases between the 1st and 2nd year and then decreases throughout the rest of undergraduate medical training, such that the 4th-year students identify fewer issues than those entering medical school. Students expressing a career choice of family medicine identify more issues than their peers. Several problems with the use of the instrument and the interpretation of the data were found. Nonetheless, these findings, if reproducible, are important and their meaning needs further discussion. (shrink)

The purpose of the work was to produce a framework to guide the development of meritorious clinical trial proposals. The framework consists of essential features of rigourous methodology, ethical acceptability, and a component referred to as "community context". These three domains were woven together in a checklist format under the headings of general, scientific and ethical considerations. Since texts concerning clinical trial methodology do not integrate ethics criteria and ethics guidelines do not provide detailed scientific criteria in obvious and practical (...) ways, we outline a more contemporary and comprehensive set of guidelines. (shrink)

Biobanks are increasingly being created specifically for research purposes. Concomitantly, we are seeing significant and evolving shifts in research ethics in relation to biobanking. Three discrete shifts are identified in this article. The first extends the ethical focus beyond the protection of human subjects to the promotion of broader community benefits of research utilizing biobanked resources, and an expectation that these benefits will be shared. The second involves the evolution of the traditional consent paradigm for future research uses of biobanks (...) resources that are not in contemplation at the time of donation. The third involves a move away from single project management to more dynamic governance accountability to research participants and the public. These shifts may take different local and institutional forms but share common recognizable elements. (shrink)

Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)

For nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethical principles for deliberating about moral problems in medicine and research, referred to in the pejorative sense as “principlism”, has come under scrutiny. In this paper we argue that (...) these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that (1) principles should be understood as heuristics that can be “specified” as described by DeGrazia (1992), and (2) that the principle‐based approach should be supplemented by formally incorporating “sensitivity to context” into the evaluation of clinical trials. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ethical, Legal, and Social Implications Research Program at the National Human Genome Research InstituteEric M. Meslin (bio), Elizabeth J. Thomson (bio), and Joy T. Boyer (bio)Organizers of the Human Genome Project (HGP) understood from the beginning that the scientific activities of mapping and sequencing the human genome would raise ethical, legal, and social issues that would require careful attention by scientists, health care professionals, government officials, and (...) the public. The establishment of the ELSI (ethical, legal, and social implications) programs at the National Human Genome Research Institute (NHGRI) and the Department of Energy (DOE) was thought to be vital to the success of the HGP in the United States. It also provided a novel approach to the simultaneous study of ethical, legal, and social issues and basic scientific issues. Eric Juengst, the first director of the ELSI program, described its origins in a previous issue of the Kennedy Institute of Ethics Journal (Juengst 1991). Now in its seventh year, the ELSI program has accomplished much. This article summarizes the evolution and goals of the ELSI program at NHGRI, outlines the program’s current research priorities with examples of activities within each priority area, and provides a look to the future, including the initiation of a strategic planning process.Evolution and Goals of the ELSI Research ProgramThe HGP’s “genomic” goals are unique: to map and sequence the entire human genome—some 3 billion base pairs that make up approximately 80–100,000 genes—and the genomes of related model organisms by the year 2005. This goal was particularly ambitious since, when it was proposed, the technologies for mapping and sequencing had yet to be developed. When the HGP was first established, its organizers also elaborated a set of ELSI goals, which they saw as vital to the success of the genome project. The original ELSI goals were: (1) to anticipate and address the implications of the HGP for individuals and society and (2) to examine the ELSI consequences of mapping and sequencing the human genome in order to stimulate public discussion. To meet these goals, the NHGRI created its ELSI research program in 1990. Along with mapping, sequencing, [End Page 291] and mammalian genetics, ELSI was one of four original branches in the NHGRI Division of Extramural Research that funded research in those areas. Although the individual “branches” no longer exist, the mechanisms for funding research remain much the same. While the overall goals of the program have not changed, the specific ways of achieving the goals have continued to evolve. The importance of the ELSI program lies not in the collection of a full set of data that will be valuable in and of itself, but in the value of using and interpreting this new set of information.Early on, the NHGRI described a set of somewhat more specific goals: (1) to develop a program to help understand the ethical, legal, and social implications of the human genome project and (2) to identify and define the major issues of concern and develop policy options to address them. These more specific goals have been largely met. As the most recent biennial NHGRI Progress Report notes, “a robust ELSI research and education program has been established, many of the most urgent ELSI issues have been identified, and many policy options to address these issues have been proposed” (NCHGR 1995, p. 21). Between 1990 and 1996, ELSI provided more than $32.5 million in funding through 128 research and education grants in more than 30 states and in Canada (Table 1). The ELSI research budget is unique in that when originally created, it was specifically tied to the amount of money provided for the overall NHGRI budget. The NHGRI originally devoted 3 percent of its extramural budget to fund ELSI projects, but in FY 1991, it increased the ELSI budget to 5 percent, a figure that remains today. Table 2 lists the expenditures for each fiscal year since 1990 and the cumulative expenditures to date. The ELSI research budget at NHGRI this year will be about $7 million. When other sources of funding—e.g., co-funding arrangements with other institutes and agencies and the funding of ELSI... (shrink)

The author presents and defends three theses: (1) "the first is that it is not profitable for us at present to do moral philosophy; that should be laid aside at any rate until we have an adequate philosophy of psychology." (2) "the second is that the concepts of obligation, And duty... And of what is morally right and wrong, And of the moral sense of 'ought', Ought to be jettisoned if this is psychologically possible...." (3) "the third thesis is that (...) the differences between the well-Known english writers on moral philosophy from sidgwick to the present day are of little importance." (staff). (shrink)

For nearly two decades, the process of reviewing the ethical merit of research involving human subjects has been based on the application of principles initially described in the U.S. National Commission's Belmont Report, and later articulated more fully by Beauchamp and Childress in their Principles of Biomedical Ethics. Recently, the use of ethical principles for deliberating about moral problems in medicine and research, referred to in the pejorative sense as “principlism”, has come under scrutiny. In this paper we argue that (...) these principles can provide a foundation for the source of ethical appraisal of human research, but are not themselves wholly adequate for this purpose. Therefore, we further propose that principles should be understood as heuristics that can be “specified” as described by DeGrazia , and that the principle‐based approach should be supplemented by formally incorporating “sensitivity to context” into the evaluation of clinical trials. (shrink)

With increased visibility of trans people comes increased philosophical interest in gendered language. This chapter aims to look at the research on gendered language in analytic philosophy of language so far, which has focused on two concerns: (1) determining how to define gender terms like ‘man’ and ‘woman’ such that they are trans inclusive and (2) if, or to what extent, we should use gendered language at all. We argue that the literature has focused too heavily on how gendered language (...) can harm trans people, and has not considered how trans people use gendered language to create meaning and joy for ourselves. Pulling from the literature in sociolinguistics, we look at examples of how trans people use language to make their lives better by gaining recognition, playing with gendered language, finding joy in gendered language, and taking control of definitional power, concluding that debates about gendered language need to consider not only how such language harms trans people but also how trans people use it for our own liberation. (shrink)

Niko Čavčavaże -- Tʻamaz Buačʻiże -- Zurab Kakabaże -- Eduard Kodua.

There is a curious phenomenon where people from marginalized populations are taken to be arrogant when they show no signs of superiority. In effect, their actions are misconstrued, and their attitudes are rendered unintelligible. Given that arrogance is standardly taken to be a flaw in one’s moral character, understanding such misattributions should give us insight into the affective marginalization many people face. This talk aims to give a thorough exploration of arrogance under oppression. I argue that arrogance is a kind (...) of self-preoccupation that involves projecting one’s values, goals, and concerns onto others as if they were objective values, goals, and concerns. When the affectively marginalized communicate their self-respect through things like protest, people mistake that self-respect as self-preoccupation given how the affectively marginalized are constructed. Furthermore, given how affective marginalization not only inhibits how the marginalized are understood by others, but inhibits their own affective lives, I argue that taking up an arrogant attitude is not always morally vicious, but can be a beautiful form of political resistance but all things considered good. (shrink)

The avant-garde has been popular for some time, but its popularity has tended to fly under the radar. This ¿popular avant-garde,¿ conceived as the meeting ground of the avant-garde and popular, avoids the divorce of art and praxis of which the avant-garde has been accused. The Popular Avant-Garde takes stock of the debates about both the ¿historical¿ (¿modernist¿) and posterior avant-gardes, and sets them in relation to popular culture and art forms. With a critical introduction that examines the concepts of (...) ¿the avant-garde,¿ ¿the popular,¿ and ¿the popular avant-garde,¿ the series of essays analyzes the way in which the avant-garde employs popular genres for political purposes, as well as how the popular acquires a critical function with respect to the avant-garde. Each of the volume¿s three sections considers a different aspect of the productive exchange between the avant-garde and popular: the popular avant-garde as a culturally hybrid and cross-border phenomenon; the play between the popular avant-garde and developments in media and technology; and the popular avant-garde¿s upending of conventional ideas about ¿the people¿ and ¿the popular.¿ The Popular Avant-Garde takes a fresh look at the now canonical Dadaist, Futurist, and Surrealist movements from the perspectives of gender and sexuality, and cultural and critical theory, while at the same time exploring less well-known avant-garde work in literature, film, television, music, photography, dance, sculpture, and the graphic arts. This volume¿s coverage of the American and Afro-American, Luso-Brazilian and Latin-American, East-European, and Scandinavian avant-gardes, in addition to the vanguards of Spain and other parts of Western Europe, will appeal to all those interested in avant-garde and popular art forms. (shrink)

Philosophers of race and other writers in the Black and Latinx intellectual traditions have remarked on what it is like to live under “the racial gaze,” to be shaped and limited by the way whites perceive us. However, little work has been spent developing how the racial gaze functions in whites’, and other racially privileged people’s, moral psychology. I argue in this paper that there is a morally objectionable way of perceiving people of color. This claim builds on an insight (...) from Iris Murdoch that our perception can be morally evaluable and extends it to issues of race. I articulate how racial stereotypes and misvaluing distort one’s perception of people of color and that these distortions are organizing around a dominant conception for race that plays an important role in the oppression of people of color. I believe understanding racist perception lays a foundation for understanding the moral dimensions of interpersonal (as opposed to structural) racism. (shrink)

Given the tremendous burst of activity in the philosophy of science during the last quarter century, the number of books by trained philosophers dealing with the logic of biology is surprisingly small. Simon’s book resembles Morton Beckner’s The Biological Way of Thought in its comprehensive ambitions: "trying to discover what, if anything, is distinctive about biological science, its concepts, and its mode of explaining." The most obvious difference of the two books is Simon’s long central chapter on "Theories, Models, and (...) the Concept of the Gene," which deals with the history of genetics from Mendel’s predecessors to the successors of Watson and Crick. Beckner paid little explicit attention to the history of biology. Another difference lies in Beckner’s dogged assessment of all problems in the logic of biology from the perspective of what he called the Humean Pattern of Explanation—a detailed and difficult variant of the approach of Hempel, Oppenheim, and Nagel. Simon’s philosophical position is more flexible than Beckner’s. He provides an acceptable review of the literature of the last decade and a half; some of his conclusions are most interesting—even when incompletely supported by his arguments; and the utility of his book is insured by the fact that it is necessary to go back over twelve years to find another with which it can be compared. The first chapter contains a very effective critique of J. J. C. Smart’s thesis that biology is no more an autonomous science than is electrical engineering, but is merely applied physics and chemistry. Smart had argued from the grounds that all biological generalizations implicitly refer to terrestrial evolution and are not truly universal, and Simon demonstrates the general lack of success of all efforts to demonstrate a difference in kind between so-called laws of nature and empirical generalizations of the sort found in biology. The second chapter continues in this same vein, drawing an interesting contrast between phylogenetic explanation in biology and the explanation of individual events in human history, and claiming that ‘explanatory’ status may be granted to accounts which do not meet the requirements of the deductive-nomological model, as in the case of Darwin’s theories of the geographical distribution of plants and animals and the persistence of rudimentary organs. The author’s negative reaction to much of the recent philosophical literature concerning the role of functional analysis in biology seems particularly well placed. Following Hempel, most philosophers writing in the past ten years have regarded the occurrence of the item whose function is in question as the event to be explained. Simon correctly points out that in the biological literature, statements indicating the presence of this item are part of the explanans, usually one component in an explanation of the normal functioning of the organism. He also insists that functional or teleological statements cannot effectively be replaced by nonteleological ones. A functional account is one that relates an entity to the role it plays in an organized system. In the first of several serene non-sequiturs which mar the latter half of this book, Simon insists that the above account shows that the notion of function is essentially an "extrinsic" one and that teleological principles generally cannot be used to account for experience. No better argument than an appeal to Kant’s authority backs up this conclusion. The third chapter deals with the recent history of genetics; its summary makes the claim that "at no time during this history was it correct to say that one model was replaced by another one; rather, the development appears to have been one involving successive correction and refining of earlier conceptions. There has been no revolution: geneticists have always succeeded in either repelling or accommodating critical attacks on the model." The evidence presented earlier in the chapter confers some plausibility on this conclusion, but no more: Simon takes no notice of the controversy surrounding Kuhn and the notion of scientific revolutions, and provides no criteria by which to distinguish "revolutions" from "accommodations." The precise nature of the methodological continuity to be found in the history of genetics is crucial for the view that "biology, or at least genetics, must be regarded as incapable of yielding a complete explanation of the phenomena that come within its purview; if the ultimate principles appealed to are not those of chemistry and physics and hence essentially nonbiological, the explanation cannot be regarded as complete." The text does not clearly indicate the extent to which the author agrees with the statement just quoted; perhaps he only attributes it to "many biologists" impressed by the successes of molecular genetics. It is clear the Simon regards something he calls the "Cartesian attitude" as pervasive in biology. "Biologists are committed to attempting to explain the phenomena of life in terms of the nonliving... The property of being alive or being associated with a living system is simply not treated as a logical primitive within biological science." But this seems to take us back full circle—to the position of Smart, that biology is no more than applied physics and chemistry. Simon disagrees with Smart. How does he stand vis-a-vis this last statement of the Cartesian spirit he finds so pervasive in biology? I think he disagrees with it, but it is very hard to tell. Perhaps the answer is that the resolution of the issue of the autonomy of biology is a pragmatic matter, relative to a complex set of needs and commitments: the sorts of things that determine life styles, political attitudes, and religious points of view, as well as the growth of scientific understanding. The question of the precise configuration of Simon’s pragmatism remains very vague indeed—a consequence of his over use of the style of impersonal attribution rather than direct assertion. Simon says generally sane and familiar things about Biology and the Idea of Progress and about Biology and Ethics. The really startling assertion of the penultimate chapter, that "consciousness" is neither a biological nor a behavioral predicate, and that its foundations are essentially moral and legal, is unfortunately supported by no argument whatsoever. Instead, the reader is urged to examine two of the author’s previous articles.—E. M. (shrink)

Is God's foreknowledge compatible with human freedom? One of the most attractive attempts to reconcile the two is the Ockhamistic view, which subscribes not only to human freedom and divine omniscience, but retains our most fundamental intuitions concerning God and time: that the past is immutable, that God exists and acts in time, and that there is no backward causation. In order to achieve all that, Ockhamists distinguish ‘hard facts’ about the past which cannot possibly be altered from ‘soft facts’ (...) about the past which are alterable, and argue that God's prior beliefs about human actions are soft facts about the past. (shrink)

In this article, I examine the moral dimensions of gender affirmation. I argue that the moral value of gender affirmation is rooted in what Iris Murdoch called loving attention. Loving attention is central to the moral value of gender affirmation because such affirmation is otherwise too fragile or insincere to have such value. Moral reasons to engage in acts that gender affirm derive from the commitment to give and express loving attention to trans people as a way of challenging their (...) marginalization. In the latter part of the paper, I will discuss how my arguments bear on recent arguments by Robin Dembroff and Daniel Wodak (2018) on the use of gender-neutral language. They argue that we have a duty not to use gender-specific pronouns for anyone. Their conclusion turns, in part, on a rejection of gender affirmation as a moral duty. The value of gender affirmation, rooted in our moral perception of trans people, should make us skeptical of this conclusion, in favor of a more nuanced and pluralistic approach to the ethics of gendering. (shrink)

There are two aims of this paper: (1) to explore the affective dimensions of moral shock and how it relates to normative marginalization of those furthest from dominant society, but also, more specifically; (2) to articulate the trans experience of constantly being under moral attack because the dominant “world” normatively defines you out of existence. Toward these ends, I build on Katie Stockdale’s recent work on moral shock, arguing that moral shock needs to be contextualized to “worlds” of sense to (...) understand how marginalized people affectively experience shocking events. My focus is the trans experience of moral shock due to the way trans people are positioned outside of dominant society, creating the conditions to experience cyclical, chronic shock. These affective conditions point to a collective responsibility to ease the affective stress that the most marginalized experience. (shrink)

Rescher has presented a proof that a completed science is logically impossible; not every truth can be known. I show that the proof is valid only if it is read de re. One of its premises, however, is an obvious truth only on a de dicto reading; read de re it is false. What the proof shows, therefore, is that science has no limits and any true proposition can be known. We can, however, know it only in the meagre de (...) re, and not in the informationally rich de dicto, sense of 'know'. (shrink)

Student nurses are confronted by many ethical challenges in clinical practice. The aim of the study was to explore Malawian students’ experiences of ethical problems during their clinical placement. A phenomenological hermeneutic design comprising interviews and qualitative content analysis was used. Ten students were interviewed. Three main themes emerged: 1) Conflict between patient rights and the guardians’ presence in the hospital; 2) Conflict between violation of professional values and patient rights caused by unethical behaviour; and 3) Conflict between moral awareness (...) and the ideal course of action. The students had difficulties ensuring patient rights and acting in accordance with western norms and values which are not always appropriate in the Malawian context. The students require role models who demonstrate professional attitudes towards patients’ rights and values. There is a need to create pedagogical strategies in which a caring attitude and ethical reflection can be learned and cultivated in clinical practice. (shrink)

While several tests and strategies are recommended for colorectal cancer (CRC) screening, studies suggest that primary care providers often recommend colonoscopy without providing information about its risks or alternatives. These observations raise concerns about the quality of informed consent for screening colonoscopy.

I believe that the world is a totality of things: there are no properties, or relations, or sets, or states of affairs, or facts, or events; there are only particular things. I also believe that all true statements can be expressed in a canonical language which includes names of things and logical terms only: there will be no predicates in this language. For what is a predicate? Some say that predicates are names of universals which individual things exemplify, or names (...) of sets of which individual things are members. If this is so, it is obvious that a nominalist's canonical language cannot have any predicates. Others say that predicates name nothing, but are satisfied by particular things. What, however, is satisfaction, and how is it different from naming? Semantic relations such as satisfaction, we are told, are not ‘in’ the world. But then a nominalist has no use for them. (shrink)

In [3] F. P. Ramsey proved as a theorem of Zermelo-Fraenkel set theory (ZF) with the Axiom of Choice (AC) the following result:(1) Theorem. Let A be an infinite class. For each integer n and partition {X, Y} of the size n subsets of A, there exists an infinite subclass of A all of whose size n subsets are contained in only one of X or Y.