BackgroundDespite five decades of increasingly elegant studies aimed at advancing the pathophysiology and treatment of mental illness, the results have not met expectations. Diagnoses are still based on observation, the clinical history, and an outmoded diagnostic system that stresses the historic goal of disease specificity. Psychotropic drugs are still based on molecular targets developed decades ago, with no increase in efficacy. Numerous biomarkers have been proposed, but none have the requisite degree of sensitivity and specificity, and therefore have no usefulness (...) in the clinic. The obvious lack of progress in psychiatry needs exploration.MethodsThe historical goals of psychiatry are reviewed, including parity with medicine, a focus on diagnostic reliability rather than validity, and an emphasis on reductionism at the expense of socioeconomic issues. Data are used from Thomas Picketty and others to argue that our failure to advance clinical care may rest in part on the rise in social and economic inequality that began in the 1970s, and in part on our inability to move beyond the medical model of specificity of disease and treatment.ResultsIt is demonstrated herein that the historical goal of specificity of disease and treatment has not only impeded the advance of diagnosis and treatment of mental illness, but, in combination with a rapid increase in socioeconomic inequality, has led to poorer outcomes and rising mortality rates in a number of disorders, including schizophrenia, anxiety, and depression.ConclusionsIt is proposed that Psychiatry should recognize the fact of socioeconomic inequality and its effects on mental disorders. The medical model, with its emphasis on diagnostic and treatment specificity, may not be appropriate for investigation of the brain, given its complexity. The rise of scientific inequality, with billions allocated to connectomics and genetics, may shift attention away from the need for improvements in clinical care. Unfortunately, the future prospects of those suffering from mental illness appear dim. (shrink)

ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not reporting and (2) not obtaining consent.MethodsSurvey of primary trial reports, published 2014–2019, identified using an electronic search filter for pragmatic trials implemented in MEDLINE, and registered in ClinicalTrials.gov.ResultsAmong 1988 trials, 132 (6.6%) did not include a statement about participant consent, 1691 (85.0%) reported consent had been obtained, 139 (7.0%) reported a (...) waiver and 26 (1.3%) reported consent for one aspect (eg, data collection) but a waiver for another (eg, intervention). Of the 165 trials reporting a waiver, 76 (46.1%) provided a justification. Few (53, 2.9%) explicitly reported use of alternative approaches to consent. In multivariable logistic regression analyses, lower journal impact factor (p=0.001) and cluster randomisation (p<0.0001) were significantly associated with not reporting on consent, while trial recency, cluster randomisation, higher-income country settings, health services research and explicit labelling as pragmatic were significantly associated with not obtaining consent (all p<0.0001).DiscussionNot obtaining consent seems to be increasing and is associated with the use of cluster randomisation and pragmatic aims, but neither cluster randomisation nor pragmatism are currently accepted justifications for waivers of consent. Rather than considering either standard written informed consent or waivers of consent, researchers and research ethics committees could consider alternative consent approaches that may facilitate the conduct of pragmatic trials while preserving patient autonomy and the public’s trust in research. (shrink)

Memory, funerals, and the communion of the saints: growing old and practices of remembering / M. Therese Lysaught -- God bends over backward to accommodate humankind...while the Civil Rights Acts and the Americans with Disabilities Act require [only] minimum effort / Mary Jo Iozzio -- Radical solidarity: migration as challenge ofr contemporary Christian ethics / Kristin E. Heyer -- Catholic lesbian feminist theology / Mary E. Hunt -- Theology of whose body? Sexual conplementarity, intersex conditions, and La Virgen de Guadalupe (...) / Katie M. Grimes -- Social conscience and politics in the United States of America: reflections / Mary Jo Bane -- Pope Francis, women, and the church for the poor / Lisa A. Fullam -- Floodwaters and the ticking clock: the systematic oppression and stigmatization of poor, single mothers in American and Christian theological responses / Julie A. Mavity Maddalena --What causes inequity? / Dean Baker -- Engaging the U.S. Bishops' pastoral on crime and criminal justice: from atomism to community justice / Robert DeFina and Lance Hannon -- Reconstructing the moral claim of racially unjust mass incarceration / Alison Benders -- The systemic erasure of the Black/dark-skinned body in Catholic ethics / Bryan Massingale -- Anti-blackness and white supremacy in the making of American Catholicism / M. Shawn Copeland -- White privilege / Charles E. Curran -- The Black Lives Matter Movement: justice and health equity / Michael P. Jaycox -- Mujerista theology: a challenge to traditional theology / Ada María Isasi-Díaz -- Faith of our mothers; Catholic womanist God-talk / Diana L. Hayes. (shrink)

Quality and service improvement (QSI) research employs a broad range of methods to enhance the efficiency of healthcare delivery. QSI research differs from traditional healthcare research and poses unique ethical questions. Since QSI research aims to generate knowledge to enhance quality improvement efforts, should it be considered research for regulatory purposes? Is review by a research ethics committee required? Should healthcare providers be considered research participants? If participation in QSI research entails no more than minimal risk, is consent required? The (...) lack of consensus on answers to these questions highlights the need for ethical guidance. Three distinct approaches to classifying QSI research in accordance with existing ethical principles and regulations can be found in the literature. In the first approach, QSI research is viewed as distinct from other types of healthcare research and does not require regulation. In the second approach, QSI research falls within regulatory guidelines but is exempt from research ethics committee review. In the third approach, QSI research is deemed to be part of the learning healthcare system and, as such, is subject to a different set of ethical principles entirely. In this paper, we critically assess each of these views. While none of these approaches is entirely satisfactory, we argue that use of the ethical principles governing research provides the best means of addressing the numerous questions posed by QSI research. (shrink)

Pragmatic randomized controlled trials are designed to evaluate the effectiveness of interventions in real-world clinical conditions. However, these studies raise ethical issues for researchers and regulators. Our objective is to identify a list of key ethical issues in pragmatic RCTs and highlight gaps in the ethics literature. We conducted a scoping review of articles addressing ethical aspects of pragmatic RCTs. After applying the search strategy and eligibility criteria, 36 articles were included and reviewed using content analysis. Our review identified four (...) major themes: 1) the research-practice distinction; 2) the need for consent; 3) elements that must be disclosed in the consent process; and 4) appropriate oversight by research ethics committees. 1) Most authors reject the need for a research-practice distinction in pragmatic RCTs. They argue that the distinction rests on the presumptions that research participation offers patients less benefit and greater risk than clinical practice, but neither is true in the case of pragmatic RCTs. 2) Most authors further conclude that pragmatic RCTs may proceed without informed consent or with simplified consent procedures when risks are low and consent is infeasible. 3) Authors who endorse the need for consent assert that information need only be disclosed when research participation poses incremental risks compared to clinical practice. Authors disagree as to whether randomization must be disclosed. 4) Finally, all authors view regulatory oversight as burdensome and a practical impediment to the conduct of pragmatic RCTs, and argue that oversight procedures ought to be streamlined when risks to participants are low. The current ethical discussion is framed by the assumption that the function of research oversight is to protect participants from risk. As pragmatic RCTs commonly involve usual care interventions, the risks may be minimal. This leads many to reject the research-practice distinction and question the need for informed consent. But the function of oversight should be understood broadly as protecting the liberty and welfare interest of participants and promoting public trust in research. This understanding, we suggest, will focus discussion on questions about appropriate ethical review for pragmatic RCTs. (shrink)

Pragmatic comparative effectiveness randomized controlled trials evaluate the effectiveness of one interventions under real-world clinical conditions. The results of ceRCTs are often directly generalizable to everyday clinical practice, providing information critical to decision-making by patients, clinicians, and healthcare policymakers. The PRECIS-2 framework identifies nine domains that serve to score a trial on a continuum between very explanatory to very pragmatic. According to the framework, pragmatic trials may have one or more of the following features: there are fewer eligibility criteria for (...) participants, in an... (shrink)

The ethics of the Flexibility In duty hour Requirements for Surgical Trainees trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trials of policy interventions involving healthcare professionals. In what follows, we have three objectives. First, we critically review the FIRST trial controversy, finding that commentators have failed to sufficiently identify and address many of the (...) relevant ethical issues. The 2012 Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials provides researchers and research ethics committees with specific guidance for the ethical design and conduct of CRTs. Second, we aim to demonstrate how the Ottawa Statement provides much-needed clarity to the ethical issues in the FIRST trial, including: research participant identification; consent requirements; gatekeeper roles; benefit-harm analysis and identification of vulnerable participants. We nonetheless also find that the FIRST trial raises ethical issues not adequately addressed by the Ottawa Statement. Hence, third and finally, we raise important questions requiring further ethical analysis and guidance, including: Does clinical equipoise apply to policy interventions with little or no evidence-base? Do healthcare providers have an obligation to participate in research? Does the power-differential in certain healthcare settings render healthcare providers vulnerable to duress and coercion to participant in research? If so, what safeguards might be implemented to protect providers, while allowing important research to proceed? (shrink)

Background Pragmatic randomized controlled trials are designed to evaluate the effectiveness of interventions in real-world clinical conditions. However, these studies raise ethical issues for researchers and regulators. Our objective is to identify a list of key ethical issues in pragmatic RCTs and highlight gaps in the ethics literature. Methods We conducted a scoping review of articles addressing ethical aspects of pragmatic RCTs. After applying the search strategy and eligibility criteria, 36 articles were included and reviewed using content analysis. Results Our (...) review identified four major themes: 1) the research-practice distinction; 2) the need for consent; 3) elements that must be disclosed in the consent process; and 4) appropriate oversight by research ethics committees. 1) Most authors reject the need for a research-practice distinction in pragmatic RCTs. They argue that the distinction rests on the presumptions that research participation offers patients less benefit and greater risk than clinical practice, but neither is true in the case of pragmatic RCTs. 2) Most authors further conclude that pragmatic RCTs may proceed without informed consent or with simplified consent procedures when risks are low and consent is infeasible. 3) Authors who endorse the need for consent assert that information need only be disclosed when research participation poses incremental risks compared to clinical practice. Authors disagree as to whether randomization must be disclosed. 4) Finally, all authors view regulatory oversight as burdensome and a practical impediment to the conduct of pragmatic RCTs, and argue that oversight procedures ought to be streamlined when risks to participants are low. Conclusion The current ethical discussion is framed by the assumption that the function of research oversight is to protect participants from risk. As pragmatic RCTs commonly involve usual care interventions, the risks may be minimal. This leads many to reject the research-practice distinction and question the need for informed consent. But the function of oversight should be understood broadly as protecting the liberty and welfare interest of participants and promoting public trust in research. This understanding, we suggest, will focus discussion on questions about appropriate ethical review for pragmatic RCTs. (shrink)

This handbook presents a comprehensive introduction to the core areas of philosophy of education combined with an up-to-date selection of the central themes. It includes 95 newly commissioned articles that focus on and advance key arguments; each essay incorporates essential background material serving to clarify the history and logic of the relevant topic, examining the status quo of the discipline with respect to the topic, and discussing the possible futures of the field. The book provides a state-of-the-art overview of philosophy (...) of education, covering a range of topics: Voices from the present and the past deals with 36 major figures that philosophers of education rely on; Schools of thought addresses 14 stances including Eastern, Indigenous, and African philosophies of education as well as religiously inspired philosophies of education such as Jewish and Islamic; Revisiting enduring educational debates scrutinizes 25 issues heavily debated in the past and the present, for example care and justice, democracy, and the curriculum; New areas and developments addresses 17 emerging issues that have garnered considerable attention like neuroscience, videogames, and radicalization. The collection is relevant for lecturers teaching undergraduate and graduate courses in philosophy of education as well as for colleagues in teacher training. Moreover, it helps junior researchers in philosophy of education to situate the problems they are addressing within the wider field of philosophy of education and offers a valuable update for experienced scholars dealing with issues in the sub-discipline. Combined with different conceptions of the purpose of philosophy, it discusses various aspects, using diverse perspectives to do so. Contributing Editors: Section 1: Voices from the Present and the Past: Nuraan Davids Section 2: Schools of Thought: Christiane Thompson and Joris Vlieghe Section 3: Revisiting Enduring Debates: Ann Chinnery, Naomi Hodgson, and Viktor Johansson Section 4: New Areas and Developments: Kai Horsthemke, Dirk Willem Postma, and Claudia Ruitenberg. (shrink)

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

This study used a partial least squares structural equation modelling (PLS-SEM) to estimate curriculum management's direct and indirect effects on university graduate programmes' viability. The study also examined the role of institutional effectiveness in mediating the nexus between the predictor and response variables. This is a correlational study with a factorial research design. The study's participants comprised 149 higher education administrators (23 Faculty Deans and 126 HODs) from two public universities in Nigeria. A structured questionnaire designed by the researchers was (...) used for data collection. The questionnaire was duly validated with an acceptable scale and item content validity indices. The dimensionality of the instrument was determined using exploratory factor analysis (EFA). Convergent validity was based on Average Variance Extracted (AVE), whereas discriminant validity was based on Fornell-Lacker criteria and the Hetero-Trait Mono-Trait (HTMT) ratio. Acceptable composite reliability estimates of internal consistency were reached for the three sub-scales. Following ethical practices, the questionnaire was physically administered to respondents and retrieved afterwards. Smart PLS (version 3.2.9) and SPSS (version 26.0) programs were used for all the statistical analyses. This study uncovered significant direct and indirect effects of curriculum management on the viability of graduate programmes. Institutional effectiveness significantly impacted graduate programmes’ viability while mediating the nexus between curriculum management and graduate programmes’ viability. Curriculum management and institutional effectiveness jointly explained a significant proportion of graduate programmes’ viability variance. The result of this study proved that graduate programmes’ viability depends, to a great extent, on how much curriculum is managed and how effective institutions are with their services. The result of this study can enable institutions seeking to run viable graduate programmes to re-evaluate their curriculum management practices and the effectiveness of their services. (shrink)

Uses interviews with one hundred twenty-five leading male executives to determine how companies can be managed both profitably and ethically.

Larmore aims to recover three forms of moral complexity that have often been neglected by moral and political philosophers. First, he argues that virtue is not simply the conscientious adherence to principle. Rather, the exercise of virtue apply. He argues - and this is the second pattern of complexity - that recognizing the value of constitutive ties with shared forms of life does not undermine the liberal ideal of political neutrality toward differing ideals of the good life. Finally Larmore agrues (...) for what he calls the heterogeneity of morality. Moral thinking need not be exclusively deontological or consequentialist, and we should recognize that the ultimate sources of moral value are diverse. The arguments presented here do not attack the possibility of moral theory. But in addressing some of the central issues of moral and political thinking today thay attempt to restore to that thinking greater flexibility and a necessary sensitivity to our common experience. (shrink)

A new understanding of political philosophy from one of its leading thinkers What is political philosophy? What are its fundamental problems? And how should it be distinguished from moral philosophy? In this book, Charles Larmore redefines the distinctive aims of political philosophy, reformulating in this light the basis of a liberal understanding of politics. Because political life is characterized by deep and enduring conflict between rival interests and differing moral ideals, the core problems of political philosophy are the regulation (...) of conflict and the conditions under which the members of society may thus be made subject to political authority. We cannot assume that reason will lead to unanimity about these matters because individuals hold different moral convictions. Larmore therefore analyzes the concept of reasonable disagreement and investigates the ways we can adjudicate conflicts among people who reasonably disagree about the nature of the human good and the proper basis of political society. Challenging both the classical liberalism of Locke, Kant, and Mill, and more recent theories of political realism proposed by Bernard Williams and others, Larmore argues for a version of political liberalism that is centered on political legitimacy rather than on social justice, and that aims to be well suited to our times rather than universally valid. Forceful and thorough yet concise, What Is Political Philosophy? proposes a new definition of political philosophy and demonstrates the profound implications of that definition. The result is a compelling and distinctive intervention from a major political philosopher. (shrink)

The essays collected in this volume all explore the problem of the relation between moral philosophy and modernity. Charles Larmore addresses this problem by attempting to define the way distinctive forms of modern experience should orientate our moral thinking. Charles Larmore wonders whether the dominant forms of modern philosophy have not become blind to important dimensions of the moral life. The book argues against recent attempts to return to the virtue-centered perspective of ancient Greek ethics. As well as (...) exploring the differences between ancient and modern ethics, the author examines such topics as the roles of reason and history in our moral understanding, the inadequacy of philsophical naturalism, and the foundations of modern liberalism. There are also extended discussions of a number of leading contemporary philosophers: Rawls, Habermas, Williams and Rorty. (shrink)

An examination of split-brain syndrome, and whether split-brain patients have two minds.

In this book, Charles Larmore develops an account of morality, freedom, and reason that rejects the naturalistic metaphysics shaping much of modern thought. Reason, Larmore argues, is responsiveness to reasons, and reasons themselves are essentially normative in character, consisting in the way that physical and psychological facts - facts about the world of nature - count in favor of possibilities of thought and action that we can take up. Moral judgments are true or false in virtue of the moral (...) reasons there are. We need therefore a more comprehensive metaphysics that recognizes a normative dimension to reality as well. Though taking its point of departure in the analysis of moral judgment, this book branches widely into related topics such as freedom and the causal order of the world, textual interpretation, the nature of the self, self-knowledge, and the concept of duties to ourselves. (shrink)

"... stimulating and insightful... a thoroughly researched and timely contribution to the secondary literature of ethics... " —Library Journal "His important new work establishes Scott... as one of the foremost interpreters of the Continental philosophical tradition of the US.... Necessary for anyone working in ethics or the Continental tradition." —Choice "... a provocative discourse on the consequences of the ethical in the thought of Nietzsche, Foucault, and Heidegger." —The Journal of Religion Charles E. Scott's challenging book advances the broad (...) claim that ethics as a way of judging and thinking has come into question as philosophers have confronted suffering and conflicts that arise from our traditional systems of value. (shrink)

During the past few decades, engineering ethics has been oriented towards protecting the public from professional misconduct by engineers and from the harmful effects of technology. This “preventive ethics” project has been accomplished primarily by means of the promulgation of negative rules. However, some aspects of engineering professionalism, such as (1) sensitivity to risk (2) awareness of the social context of technology, (3) respect for nature, and (4) commitment to the public good, cannot be adequately accounted for in terms of (...) rules, certainly not negative rules. Virtue ethics is a more appropriate vehicle for expressing these aspects of engineering professionalism. Some of the unique features of virtue ethics are the greater place it gives for discretion and judgment and also for inner motivation and commitment. Four of the many professional virtues that are important for engineers correspond to the four aspects of engineering professionalism listed above. Finally, the importance of the humanities and social sciences in promoting these virtues suggests that these disciplines are crucial in the professional education of engineers. (shrink)

We address how the leaders of a Catholic business school can articulate and assess how well their schools implement the following six principles drawn from Catholic social teaching : produce goods and services that are authentically good; foster solidarity with the poor by serving deprived and marginalized populations; advance the dignity of human work as a calling; exercise subsidiarity; promote responsible stewardship over resources; and acquire and allocate resources justly. We first discuss how the CST principles give substantive content and (...) meaning to the Good Goods, Good Work, and Good Wealth framework in The Vocation of the Business Leader and then discuss their congruencies and tensions with the UNGC and UNPRME principles. Next, we describe the Catholic Identity Matrix, an assessment tool that provides a quantitative and qualitative portrait of how well a Catholic business school integrates, within the scope of its mission and capacities, the three goods and related CST principles in its strategies, policies, activities, and processes. The concluding section discusses implications for ongoing UNGC and UNPRME assessment, reporting, and development efforts, and addresses the generalizability of our approach to business schools who draw their inspiration and moral principles from other faith-based or secular traditions. (shrink)

This paper explores the notions of hope and how individual patient autonomy can trump carefully reasoned ethical concerns and policies intended to regulate stem cell transplants. We argue that the same limits of knowledge that inform arguments to restrain and regulate unproven treatments might also undermine our ability to comprehensively dismiss or condemn them. Incautiously or indiscriminately reasoned policies and attitudes may drive critical information and data underground, impel patients away from working with clinical researchers, and tread needlessly on hope, (...) the essential motivator of patients, advocates and researchers alike. We offer recommendations to clinicians and health care providers to help balance the discourse with individuals seeking treatment while guarding against fraud, misconception, and patient harm. (shrink)

Sartre as guide -- Bad faith and sincerity -- The example of Stendhal -- Reflection and being like another -- Being natural -- The ubiquity of convention -- Being like another -- Authenticity and the democratic age -- Mimetism and equality -- Being oneself amid conventions -- Authenticity and the nature of the self -- Foundations of a theory of cognitive reflection -- Psychological interpretation -- The structure of cognitive self-reflection -- The self in cognitive reflection -- Representing and reasoning (...) -- A critique of autonomy -- Obligations and avowals -- A defense of first-person authority -- The persistence of the cartesian model -- The key to the mystery -- A final problem -- Ways of being oneself -- The domain of authenticity -- The instability of practical reflection -- Authenticity and conversion -- How to be virtuous -- The ends of reflection -- Reflection and its problems -- The self and time -- The importance of unexpected goods -- Socrates' mistake -- The limits of prudence -- Wisdom. (shrink)

One of the major intellectual figures of the twentieth century, Paul Ricoeur has influenced a generation of thinkers.

In a number of important works, Jerry Fodor has wrestled with the problem of how mental representation can be accounted for within a physicalist framework. His favored response has attempted to identify nonintentional conditions for intentionality, relying on a nexus of casual relations between symbols and what they represent. I examine Fodor's theory and argue that it fails to meet its own conditions for adequacy insofar as it presupposes the very phenomenon that it purports to account for. I conclude, however, (...) that the ontological commitments of intentional psychology survive within a broader conception of naturalism than the one adopted by Fodor. (shrink)

In his book The rediscovery of the mind John Searle claims that unconscious mental states (1) have first-person "aspectual shape", but (2) that their ontology is purely third-person. He attempts to eliminate the obvious inconsistency by arguing that the aspectual shape of unconscious mental states consists in their ability to cause conscious first-person states. However, I show that this attempted solution fails insofar as it covertly acknowledges that unconscious states lack the aspectual shape required for them to play a role (...) in psychological explanation. (shrink)

In theCompanion to Heidegger's Contributions to Philosophyan international group of fourteen Heidegger scholars shares strategies for reading and understanding this challenging work.