Background: Emergency exception to informed consent regulation was introduced to provide a venue to perform research on subjects in emergency situations before obtaining informed consent. For a study to proceed, institutional review boards need to determine if the regulations have been met.Aim: To determine IRB members’ experience reviewing research protocols using emergency exception to informed consent.Methods: This qualitative research used semistructured telephone interviews of 10 selected IRB members from around the US in the fall of 2003. IRB members were chosen (...) as little is known about their views of exception to consent, and part of their mandate is the protection of human subjects in research. Interview questions focused on the length of review process, ethical and legal considerations, training provided to IRB members on the regulations, and experience using community consultation and notification. Content analysis was performed on the transcripts of interviews. To ensure validity, data analysis was performed by individuals with varying backgrounds: three emergency physicians, an IRB member and a layperson.Results: Respondents noted that: emergency exception to informed consent studies require lengthy review; community consultation and notification regulations are vague and hard to implement; current regulations, if applied correctly, protect human subjects; legal counsel is an important aspect of reviewing exception to informed-consent protocols; and IRB members have had little or no formal training in these regulations, but are able to access materials needed to review such protocols.Conclusions: This preliminary study suggests that IRB members find emergency exception to informed consent studies take longer to review than other protocols, and that community consultation and community notification are the most difficult aspect of the regulations with which to comply but that they adequately protect human subjects. (shrink)

Palliative care seeks to improve the quality of life for patients suffering from the impact of life‐limiting illnesses. Palliative care encompasses but is more than end‐of‐life care, which is defined as care during the final hours/days/weeks of life. Although palliative care policies increasingly require all healthcare professionals to have at least basic or non‐specialist skills in palliative care, international evidence suggests there are difficulties in realising such policies. This study reports on an action research project aimed at developing respiratory nursing (...) practice to address the palliative care needs of patients with advanced chronic obstructive pulmonary disease (COPD). The findings suggest that interlevel dynamics at individual, team, interdepartmental and organisational levels are an important factor in the capacity of respiratory nurses to embed non‐specialist palliative care in their practice. At best, current efforts to embed palliative care in everyday practice may improve end‐of‐life care in the final hours/days/weeks of life. However, embedding palliative care in everyday practice requires a more fundamental shift in the organisation of care. (shrink)

The author takes up a provocative question poised by Charles Taylor about the relationship between our commitments to a good such as neighbor love and the possibilities of achieving and sustaining social justice. Taylor's concern is not only that we make such a commitment but that we make it in such a way that we avoid its ability to lead us towards injustice rather than justice. After articulating conceptions of love, justice, and injustice, the author turns to Charles Dickens's treatment (...) of love and injustice in Bleak House, to explore more fully how love can lead to injustice, and also its potential role in promoting justice. Dickens's view, profoundly shaped by his own sense of Christian virtues, helps us see the inner workings of love, justice, and injustice, so that we can appreciate their interconnectedness anew and understand better the urgency of Taylor's question for our time. (shrink)

Recent discussions of emergence in physics have focussed on the use of limiting relations, and often particularly on singular or asymptotic limits. We discuss a putative example of emergence that does not fit into this narrative: the case of phonons. These quasi-particles have some claim to be emergent, not least because the way in which they relate to the underlying crystal is almost precisely analogous to the way in which quantum particles relate to the underlying quantum field theory. But there (...) is no need to take a limit when moving from a crystal lattice based description to the phonon description. Not only does this demonstrate that we can have emergence without limits, but also provides a way of understanding cases that do involve limits. (shrink)

This indispensible collection brings together feminist theory and cultural studies, looking at issues such as pop culture and the media, science and technology, ...

It is shown that stochastic observables defined by an instrument need not, and generally do not, commute.

A predominant ethical view holds that physician‐investigators should conduct their research with therapeutic intent. And since a physician offering a therapy wouldn't prescribe second‐rate treatments, the experimental intervention and the best proven therapy should appear equally effective. "Clinical equipoise" is necessary. But this perspective is flawed. The ethics of research and of therapy are fundamentally different, and clinical equipoise should be abandoned.

Scientists, philosophers, and policymakers disagree about how to define microaggression. Here, we offer a taxonomy of existing definitions, clustering around (a) the psychological motives of perpetrators, (b) the experience of victims, and (c) the functional role of microaggression in oppressive social structures. We consider conceptual and epistemic challenges to each and suggest that progress may come from developing novel hybrid accounts of microaggression, combining empirically tractable features with sensitivity to the testimony of victims.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 27.2 (2003) 304-317 [Access article in PDF] Sovereign Love and Atomism in Racine's Bérénice Ellen Mcclure ALTHOUGH CRITICS HAVE NOTED links between the new science of the seventeenth century and the works of La Fontaine and Molière, 1 a similar influence of Epicureanism or even Cartesianism upon French classical tragedy is harder to trace. No two areas of seventeenth-century cultural life would seem farther apart (...) than the emerging science, with its rejection of Aristotelian categories as inadequate to experienced reality, and classical French tragedy, with its antimaterialism and claims to universal truth often bolstered by references to none other than Aristotle himself. Yet René Pintard reminds us that the 1660s and 1670s—the period when many of the tragedies we regard as "classical" were written—saw a strong renewal of interest in the philosophies articulated in the first half of the century. 2 So widespread was this interest that Pierre Gassendi's friend and follower Bernier was able to publish an edition and translation of the philosopher's works in 1674-1675 which proved to be a resounding success. It is hard to believe that the much-discussed new science somehow missed writers of tragedies, especially given the extensive contacts between Molière, La Fontaine and Racine.In this article, I demonstrate this influence by positing that Racine's play Bérénice, ostensibly a reworking of a well-known love story that Corneille was also producing on the Paris stage at the same time, is in part a reflection on the pressing question of what holds the universe together. Through his exploration of the possibility of satisfactory love between two independent sovereigns, Racine explores issues that the revival of Epicureanism had brought into the philosophical foreground. This reading of the play brings into focus the incredibly [End Page 304] important, yet too-often neglected, 3 role of Antiochus, the character whom Racine invented for his version of the play. I will show that his tragic in-betweenness offers a necessary alternative to Titus' and Bérénice's valorization of self-contained sovereignty. I Before embarking on a close reading of the play itself, however, I would like to offer a brief survey of the debate to which I believe Racine refers. Both Michel Foucault and Timothy Reiss have identified the seventeenth century as a transitional period between the age of correspondences exemplified in Aristotelian philosophy and the age of representation and quantification that characterized eighteenth-century thought. 4 This transition, however, was far from smooth, as philosophers sought to articulate a universe whose separate and radically de-hierarchized elements remained somehow joined together.For most seventeenth-century philosophers, the sacrifice of Aristotelian categories and scholasticism in no way lessened the imperative for a sense of divine order and causation. Gassendi's often self-contradictory efforts to reconcile Epicurus and Christianity provide perhaps the most striking example of this transitional struggle. The atomism posited by Epicurus through Lucretius posed particular difficulties for a Christian worldview. A world governed by the chance interactions of atoms eliminates any sense that things happen for a purpose; God cannot be the benevolent author and overseer of the universe. Gassendi's equal respect for atomism and for Christianity should be read as evidence of the profound struggle between separateness and interconnection (or, as Gassendi would call it, harmony) taking place during this period. 5 For, as Bloch points out, although Gassendi partially reconciled the demands of the two systems by situating atoms in an uncreated, infinite, and contiguous space and time, he continued to hold to the profoundly troubling existence of the void in the universe. Once again, the chief objection to the void implicit in atomism was religious, since if God is everywhere, the void cannot exist, and likewise, God cannot create nothing. The revival of stoicism supplied instead a vision of the universe ultimately comprised and held together by an ethereal pneuma that some neo-Stoics did not hesitate to identify as a sort of divine presence. 6 Descartes himself made heroic attempts, in his Principes... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President’s Council on Bioethics*Franklin G. Miller** (bio) and Robert D. Truog (bio)Traditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes (...) in the second half of the twentieth century prompted calls for a new, or at least expanded, definition of death: the development of intensive care medicine, especially the use of mechanical ventilators, and the advent of successful transplantation of vital organs. Patients with profound neurological damage, leaving them incapable of breathing on their own and in an irreversible coma, could be maintained for some period of time with the aid of mechanical ventilation. The situation of these patients posed two ethical questions. Is it appropriate to stop life-sustaining treatment? If so, is it acceptable to retrieve vital organs for transplantation to save the lives of others before stopping treatment?In 1968, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed that death could be determined on the basis of neurological criteria, thus providing a positive answer to these two questions (Ad Hoc Committee 1968). According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation. [End Page 185] Because they are dead, it is appropriate, indeed imperative, to stop mechanical ventilation. And because they are dead, it becomes ethical to procure vital organs for transplantation before stopping what otherwise would be life-sustaining treatment. Remarkably, this innovative neurological determination of death became, with little debate or controversy, the established position in medical ethics and the law throughout the United States.The Harvard Committee articulated the diagnosis of “irreversible coma,” but merely asserted that this condition constituted death. No explanatory rationale was provided. It fell to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research to provide an authoritative rationale in its 1981 report, Defining Death. The second paragraph of the report set the stage as follows: “The question addressed here is not inherently difficult or complicated. Simply, it is whether the law ought to recognize new means for establishing that the death of a human being has occurred” (President’s Commission 1981, p. 3). The Commission claimed that “death is a unitary phenomenon” (p. 7) and that the determination of death by neurological criteria, in terms of the absence of all brain function, is consistent with the traditional conception of death as the cessation of vital functioning of the organism as a whole. The key issue is the integrative functioning of the human organism, which ceases to exist, according to the Commission, when the whole brain, including higher cortical areas and the brain stem, fails to function. Although “brain-dead” patients do not appear to be dead—i.e., the reality of their death is “masked” by the activity of mechanical ventilation—the patient’s body has irreversibly lost all capacity for integrative functioning. In the words of the Commission: “When artificial means of support mask this loss of integration as measured by the old methods [cessation of respiration and heart beat], brain-oriented criteria and tests provide a new window on the same phenomenon” (p. 33). The President’s Commission was instrumental in developing and establishing “The Uniform Definition of Death Act”: “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead” (p. 2).Although the question posed by the President’s Commission was easy to articulate, the answer, over time, has proved complicated and controversial. The coherence and cogency of determining death by neurological criteria has been challenged. Various experts have demonstrated that “brain-dead” patients maintained on mechanical ventilation display a range of vital, integrative, functioning, which conflicts with the judgment that they are dead (Truog and... (shrink)

Prevailing ethical thinking about informed consent to clinical research is characterized by theoretical confidence and practical disquiet. On the one hand, bioethicists are confident that informed consent is a fundamental norm. And, for the most part, they are confident that what makes consent to research valid is that it constitutes an autonomous authorization by the research participant. On the other hand, bioethicists are uneasy about the quality of consent in practice. One major source of this disquiet is substantial evidence of (...) the “therapeutic misconception”—the tendency of patient-subjects in clinical trials to confuse participating in research with receiving personalized medical care. This .. (shrink)

Review of James Franklin, The Science of Conjecture: Evidence and Probability Before Pascal (Johns Hopkins University Press, 2001).

That bad things happen to good people was as true in early China as it is today. Franklin Perkins uses this observation as the thread by which to trace the effort by Chinese thinkers of the Warring States Period, a time of great conflict and division, to seek reconciliation between humankind and the world. Perkins provides rich new readings of classical Chinese texts and reflects on their significance for Western philosophical discourse.

The current study examines patterns of attachment/self-protective strategies and rates of unresolved loss/trauma in children and adolescents presenting to a multidisciplinary gender service. Fifty-seven children and adolescents (8.42–15.92 years; 24 birth-assigned males and 33 birth-assigned females) presenting with gender dysphoria participated in structured attachment interviews coded using dynamic-maturational model (DMM) discourse analysis. The children with gender dysphoria were compared to age- and sex-matched children from the community (non-clinical group) and a group of school-age children with mixed psychiatric disorders (mixed psychiatric (...) group). Information about adverse childhood experiences (ACEs), mental health diagnoses, and global level of functioning was also collected. In contrast to children in the non-clinical group, who were classified primarily into the normative attachment patterns (A1-2, B1-5, and C1-2) and who had low rates of unresolved loss/trauma, children with gender dysphoria were mostly classified into the high-risk attachment patterns (A3-4, A5-6, C3-4, C5-6, and A/C) (χ2= 52.66;p< 0.001) and had a high rate of unresolved loss/trauma (χ2= 18.64;p< 0.001). Comorbid psychiatric diagnoses (n= 50; 87.7%) and a history of self-harm, suicidal ideation, or symptoms of distress were also common. Global level of functioning was impaired (range 25–95/100; mean = 54.88;SD= 15.40; median = 55.00). There were no differences between children with gender dysphoria and children with mixed psychiatric disorders on attachment patterns (χ2= 2.43;p= 0.30) and rates of unresolved loss and trauma (χ2= 0.70;p= 0.40).Post hocanalyses showed that lower SES, family constellation (a non-traditional family unit), ACEs—including maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence)—increased the likelihood of the child being classified into a high risk attachment pattern. Akin to children with other forms of psychological distress, children with gender dysphoria present in the context of multiple interacting risk factors that include at-risk attachment, unresolved loss/trauma, family conflict and loss of family cohesion, and exposure to multiple ACEs. (shrink)

ABSTRACTAccording to difference-based models of causal judgement, the epistemic state of the agent should not affect judgements of cause. Four experiments examined opportunity chains in which a physical event enabled a subsequent proximal cause to produce an outcome. All four experiments showed that when the proximal cause was a human action, it was judged as more causal if the agent was aware of his opportunity than if he was not or if the proximal cause was a physical event. The first (...) two experiments showed that these preferences could not be explained in terms of differences in perceived conditional probability, social controllability or perceptions of the causal sequence as forming a single unit. The third experiment showed that awareness affected the perceived deliberateness with which the action brought the outcome about but not its perceived voluntariness. The fourth experiment showed that... (shrink)

The use of brain imaging technology as a common tool of research has spawned concern and debate over how investigators should respond to incidental fndings discovered in the course of research. In this article, we argue that investigators have an obligation to respond to incidental fndings in view of their entering into a professional relationship with research participants in which they are granted privileged access to private information with potential relevance to participants' health. We discuss the scope and limits of (...) this professional obligation to respond to incidental fndings, bearing in mind that the relationship between investigators and research participants differs fundamentally from the doctor-patient relationship. (shrink)

Microaggressions are seemingly negligible slights that can cause significant damage to frequently targeted members of marginalized groups. Recently, Scott O. Lilienfeld challenged a key platform of the microaggression research project: what’s aggressive about microaggressions? To answer this challenge, Derald Wing Sue, the psychologist who has spearheaded the research on microaggressions, needs to theorize a spectrum of aggression that ranges from intentional assault to unintentional microaggressions. I suggest turning to Bonnie Mann’s “Creepers, Flirts, Heroes and Allies” for inspiration. Building from Mann’s (...) richer theoretical framework will allow Sue to answer Lilienfeld’s objection and defend the legitimacy of the concept, ‘microaggression’. (shrink)

In this paper I offer a new interpretation of the philosophical method of the "Meno." In the opening discussion of the dialogue, Plato introduces a restriction on answers in dialectical inquiry, which I call the Dialectical Requirement (DR). The DR is applied twice in the "Meno," in different ways (75d5-7, 79d1-3). In the first section of the paper, I argue that the two applications of the DR represent the beginning and end of dialectic. This shows that dialectical inquiry starts from (...) our linguistic competence with the name of the property we investigate, and ends only when we have an account saying what is common to and explanatory of the bearers of that property. Dialectic begins in our ordinary ability to speak and think about the world, and ends in genuine grasp of the underlying causes of nature. In the second section, I describe the resources of linguistic competence, and their role in dialectical progress. Our linguistic competence with the name of a property enables us to make a wide variety of statements about the property and its bearers in ordinary discourse. In dialectic, these ordinary statements act as a portfolio in which the property under investigation is presented to us writ large, through its instances, types, species, etc. We seek to develop an account that says what is common to, and explanatory of the phenomena in the portfolio. When an account is inconsistent with one of the things we tend to say, this demands revision either in the account, or in the portfolio of statements. In this way, the process by which we develop our account also helps to organize and revise the statements in our portfolio so that they and the account ultimately form a coherent, explanatory body of statements. (shrink)

Its critics to the contrary, the “gift of life” metaphor is not to be blamed for the indebtedness and guilt that organ recipients often experience. It is certainly misused, however, both by post‐transplant caregivers, who exploit it to manipulate recipients' behavior, and by the organ procurement system, which has failed to understand that the decision to give the gift of life must be approached communally.

: Bioethicists have failed to understand the pervasively paternalistic character of research ethics. Not only is the overall structure of research review and regulation paternalistic in some sense; even the way informed consent is sought may imply paternalism. Paternalism has limits, however. Getting clear on the paternalism of research ethics may mean some kinds of prohibited research should be reassessed.

Explains Aristotle's views on the possibility of continuous variation between biological species. While the Porphyrean/Linnean classification of species by a tree suggests species are distributed discretely, Aristotle admitted continuous variation between species among lower life forms.

Why was Leibniz so fascinated by Chinese philosophy and culture? What specific forms did his interest take? How did his interest compare with the relative indifference of his philosophical contemporaries and near-contemporaries such as Spinoza and Locke? In this highly original book, Franklin Perkins examines Leibniz's voluminous writings on the subject and suggests that his interest was founded in his own philosophy: the nature of his metaphysical and theological views required him to take Chinese thought seriously. Leibniz was unusual (...) in holding enlightened views about the intellectual profitability of cultural exchange, and in a broad-ranging discussion Perkins charts these views, their historical context, and their social and philosophical ramifications. The result is an illuminating philosophical study which also raises wider questions about the perils and rewards of trying to understand and learn from a different culture. (shrink)

At first glance, hate speech and microaggressions seem to have little overlap beyond being communicated verbally or in written form. Hate speech seems clearly macro-aggressive: an intentional, obviously harmful act lacking the ambiguity (and plausible deniability) of microaggressions. If we look back at historical discussions of hate speech, however, many of these assumed differences turn out to be points of similarity. The harmfulness of hate speech only became widely acknowledged after a concerted effort by critical race theorists, feminists, and other (...) activists. Before the 1990s, slurs were widely considered socially acceptable behavior: mere jokes that weren’t intended to be harmful. Authors like Richard Delgado, Mari Matsuda, and Charles Lawrence pushed back against this dismissal. In this chapter, I show that their arguments for the serious harmfulness of hate speech prefigure and provide support for current debates about the serious harmfulness of microaggressions. Exploring resonances with the 1980s hate speech debate will allow us to explain why microaggressions fall below the cutoff for legal liability but remain apt targets for moral blame. (shrink)

Accepted medical practice already violates the dead donor rule. Explicitly jettisoning the rule—allowing vital organs to be extracted, under certain conditions, from living patients—is a radical change only at the conceptual level. But it would expand the pools of eligible organ donors.

The consistency of a second-order version of Morley’s Theorem on the number of countable models was proved in [EHMT23] with the aid of large cardinals. We here dispense with them.

“Free Will” is a philosophical term of art for a particular sort of capacity of rational agents to choose a course of action from among various alternatives. Which sort is the free will sort is what all the fuss is about. (And what a fuss it has been: philosophers have debated this question for over two millenia, and just about every major philosopher has had something to say about it.) Most philosophers suppose that the concept of free will is very (...) closely connected to the concept of moral responsibility. Acting with free will, on such views, is just to satisfy the metaphysical requirement on being responsible for one's action. (Clearly, there will also be epistemic conditions on responsibility as well, such as being aware—or failing that, being culpably unaware—of relevant alternatives to one's action and of the alternatives' moral significance.) But the significance of free will is not exhausted by its connection to moral responsibility. Free will also appears to be a condition on desert for one's accomplishments (why sustained effort and creative work are praiseworthy); on the autonomy and dignity of persons; and on the value we accord to love and friendship. (See Kane 1996, 81ff. and Clarke 2003, Ch.1.). (shrink)