Patients have received experimental pharmaceuticals outside of clinical trials for decades. There are no industry-wide best practices, and many companies that have granted compassionate use, or ‘preapproval’, access to their investigational products have done so without fanfare and without divulging the process or grounds on which decisions were made. The number of compassionate use requests has increased over time. Driving the demand are new treatments for serious unmet medical needs; patient advocacy groups pressing for access to emerging treatments; internet platforms (...) enabling broad awareness of compelling cases or novel drugs and a lack of trust among some that the pharmaceutical industry and/or the FDA have patients’ best interests in mind. High-profile cases in the media have highlighted the gap between patient expectations for compassionate use and company utilisation of fair processes to adjudicate requests. With many pharmaceutical manufacturers, patient groups, healthcare providers and policy analysts unhappy with the inequities of the status quo, fairer and more ethical management of compassionate use requests was needed. This paper reports on a novel collaboration between a pharmaceutical company and an academic medical ethics department that led to the formation of the Compassionate Use Advisory Committee. Comprising medical experts, bioethicists and patient representatives, CompAC established an ethical framework for the allocation of a scarce investigational oncology agent to single patients requesting non-trial access. This is the first account of how the committee was formed and how it built an ethical framework and put it into practice. (shrink)

Traditional pharmacy education emphasizes the biological processes of diseases and their pharmacological treatments. While the intense focus on biomedical aspects of disease is vital to educating pharmacy students, this focus is often insufficient in conveying what patients experience. The humanities, however, offer powerful characterizations of the disease experience for individuals as well as its impact on the human condition more generally. In this essay, I describe how using literary texts with pharmacy students provides them with a fuller appreciation of what (...) patients face with their diseases. The goal of this endeavor is to make students more effective as pharmacists in detecting and responding to their patients’ problems and needs by connecting their biomedical knowledge to depictions and meanings of illness experiences. (shrink)

Health care costs have been rising steadily in most industrialized countries. These increases are driven primarily by technological advances and, to a lesser degree, by aging of the population. Many factors make it unlikely that market forces alone will limit increases in the costs of health care. These unremitting increases make health care rationing appear both necessary and inevitable.One of the least controversial mechanisms for rationing could be to allow patients to make their own choices as to which kinds of (...) care they would be willing to forgo. This is appealing because it preserves individual freedom of choice regarding health care in a way that other rationing mechanisms often do not. Rationing by patient choice, however, can only happen if patients recognize that resources are limited and need to be conserved, and are willing to forgo marginal benefits. (shrink)

The present study was designed to explore the relationship between self-reported dissociative experiences and performance in tasks eliciting right-hemisphere processing load. Thirty-four participants performed a vigilance task in two conditions: with task-irrelevant negative-arousing pictures and task-irrelevant neutral pictures. Dissociation was assessed with the Dissociative Experience Scale. Consistent with theories positing right-hemisphere deregulation in high non-clinical dissociators, dissociative experiences correlated with greater vigilance decrement only in the negative picture condition. As both the vigilance task and negative picture processing are right lateralized, (...) this result provides support for a right-hemisphere dysfunction in high dissociators, at least in negative conditions. (shrink)

Though academic debate over gender-inclusive God-talk seems to have fizzled, the issue is a pressing one within many Christiandenominations today—both within and outside the Church—and for that reason deserves to be briefly revisited. Accordingly, althoughin this essay we approach the issue as professional philosophers, our focus is on the life of the Church—more specifically, those no doubt sizable segments of the Church for which a personal God and Satan exist and evangelism matters. Running an elimination argument, we contend that if (...) a certain sort of feminist concern about traditional God-talk is well-directed, the best response is to speak of not only God but also Satan in both masculine and feminine terms. And in closing, we address the possible worry that this response to the God-talk problem would not be Christian enough. (shrink)

A well-known term in eighteenth-century literature and philosophy, the “beautiful soul” (die schöne Seele) has resurfaced in recent years. Deleuze refers to the beautiful soul’s “religiosity” and argues that aggressive “selection” is necessary as its antidote. However, in volatile contexts of social destabilization, such selection risks recoiling into reactionary violence. After first developing in more detail the beautiful soul’s background as a discursive figure, I argue that understanding Deleuze’s selection within a context of spiritual experience is necessary to mitigate this (...) worry. Exploration of this experience is pursued through juxtaposition of Deleuze’s thought with Nishida Kitarō’s investigation of the ontological structure of religious consciousness. The comparative resonances I develop suggest an ontological objectivity to the problems and structuring of the logos of religious consciousness and show how a more explicitly spiritual rendering of “selection,” developed through the Deleuze/Nishida encounter, intervenes into the broader beautiful soul problematic. (shrink)

This new edition of Law and Medical Ethics continues to chart the ever-widening field that the topics cover. The interplay between the health caring professions and the public during the period intervening since the last edition has, perhaps, been mainly dominated by wide-ranging changes in the administration of the National Health Service and of the professions themselves but these have been paralleled by important developments in medical jurisprudence.

ABSTRACTThe article explores the connection between James's “radical empiricism” and Deleuze's “transcendental empiricism” with a particular focus on the concept of “pure experience.” It argues for the substantial nature of this connection in terms of both philosophical motivations and formal innovations. Both thinkers are motivated to construct “better” empiricisms that do not complacently accept conventional conceptual representations as exhaustive of the real. Moreover, radical empiricism develops a latent critique of representational models of consciousness that is accomplished through a turn to (...) events or processes as ontologically primary. These innovations are further developed by Deleuze in his treatment of the problem of individuation. Taken together, they help to specify the metaphysical reasons for the experimental pluralism that both James and Deleuze affirm, showing how these reasons are inextricable from the radical empiricist impulse to be maximally inclusive of modalities of real experience, including the felt, the vague, and the affective. Emphasizing the metaphysical dimensions of these alternative empiricisms brings into clearer focus the stakes of philosophical thought as part of the open-ended and ongoing relational processes by which the universe continues to unfold. (shrink)

The article explores the connection between James's " radical empiricism " and Deleuze's " transcendental empiricism " with a particular focus on the concept of " pure experience. " It argues for the substantial nature of this connection in terms of both philosophical motivations and formal innovations. Both thinkers are motivated to construct " better " empiricisms that do not complacently accept conventional conceptual representations as exhaustive of the real. Moreover, radical empiricism develops a latent critique of representational models of (...) consciousness that is accomplished through a turn to events or processes as ontologically primary. These innovations are further developed by Deleuze in his treatment of the problem of individuation. Taken together, they help to specify the metaphysical reasons for the experimental pluralism that both James and Deleuze affirm, showing how these reasons are inextricable from the radical empiricist impulse to be maximally inclusive of modalities of real experience, including the felt, the vague, and the affective. Emphasizing the metaphysical dimensions of these alternative empiricisms brings into clearer focus the stakes of philosophical thought as part of the open-ended and ongoing relational processes by which the universe continues to unfold. (shrink)

In this paper, I focus on an internal tension within James’s Principles and suggest that its formal structure provides useful insight into James’s subsequent evolution. Specifically, through a close reading of James’s account of ‘conceptions’ in the Principles, I examine the tension between these ‘conceptions’ construed as discrete and self-identical and James’s famous phenomenological description of consciousness as a continuous stream. Such a tension primarily involves the intersection of an epistemic need (or condition of possibility) with a quasi-metaphysical intuition or (...) postulate (continuity). Importantly, this tension is intensified by the methodological constraints of bracketing metaphysical questions which James sets for himself in the Principles. James’s decision to deny the cogency of this methodological bracketing can therefore be read as his response to the tension I examine and his speculative turn to “radical empiricism” as an attempt to resolve epistemological difficulties by going more radical ontologically. Doing so raises questions about the status of speculative metaphysics in intersection with empirical inquiry. (shrink)

This paper studies “environmental personhood” legislation as a transitional concept. A transitional concept is one whose originating context sets parameters for its pragmatic functioning even as the eventual coherence of this functioning entails deep change in this originating context. By more explicitly thematizing environmental personhood as a transitional concept, we can acknowledge worries about its entanglement with a rights paradigm emphasizing private property and human exceptionalism while still exploring how it might contribute towards deeper ecological transformation. The paper introduces Nuu-chah-nuulth (...) philosopher E. Richard Atleo’s notion of ‘phase connectors’ as a heuristic for thinking transitional tensions in environmental personhood especially in terms of the gap between its present operative strategy and possible future effects on wider imaginaries. Indeed, this gap indicates how environmental personhood’s transitional potential is entangled with challenging dominant presuppositions in what Anna Grear calls ‘law’s onto-epistemic imaginary’. Using Atleo’s heuristic and drawing on a range of sources, the paper thinks through some of the prominent fault lines and volatile dynamics of environmental personhood as a transitional concept. After establishing these critical tensions, it considers how its conceptualization in domains beyond legislative or academic articulations may or may not help induce ethico-phenomenological changes in constitutive imaginaries. Though such popular presentations are frequently reductive, understanding why and how is important if theorists can contribute to the construction of creative alternatives. (shrink)

Deleuze’s “transcendental empiricism” and the “empirical side” of Whitehead’s metaphysics are paradoxical unless placed in the context of their unorthodox readings of empiricism. I explore this context focusing on their engagements with Hume. Both subvert presumptions of a categorical gap between external nature and internal human experience and open possibilities for a speculative empiricism that is non-reductive while still affirming experience as source for philosophical thinking. Deleuze and Whitehead follow Hume in beginning with events of sensation as primary but do (...) not presume the logic of (human) subjects and objects (of nature) as necessary structuring polarities for their interpretation. This challenges a basic distinction (between inner and outer or between self and world) that seems inherent in the ordinary concept of experience, thus earning the moniker speculative. The speculative empiricist studies how these abstractions arise from events of experience prior to their consolidation in representation. This includes a critical component: to what extent do unexamined assumptions about conceptual abstraction hinder, block, or prefigure experiential attention? This critical component has existential implications for how we attend to the affective, intuitive, and preconceptual. (shrink)

This commentary considers Wahl’s 1942 “Poetry as Spiritual Exercise” in the context of his interests in radical empiricism and process metaphysics. In doing so, it raises appreciation for the complexity of his thought, identifies specific notes of influence on Gilles Deleuze, and responds to worries that Wahl’s notion of spiritual exercise is predominantly a form of withdrawal, quietism, or retreat from the horrors of World War Two. For Wahl, rather than passive contemplation of a determinate artifact, poetry is a mode (...) of experience that, to speak with Whitehead and James, is a making. This experience of poetry develops affordances of thought that strengthen existential capacity for remaining open to uncertainty, fragility, and vulnerability. (shrink)

This paper explores one means of connection between Whitehead and Deleuze through an investigation into the figure of the ‘beautiful soul’. I first examine Deleuze’s claim that a philosophy of difference risks a ‘new’ version of the beautiful soul, situating this figure in its historical context in Hegel. I then consider why Whitehead may initially appear to fall into the trap of the beautiful soul before arguing that this is not the case. Seeing how brings Whitehead and Deleuze closer together (...) by showing that their respective insistences on the risks, dangers, and adventures integral to speculative thinking highlight the importance of the intersection between the existential and the metaphysical. (shrink)

This paper explores one means of connection between Whitehead and Deleuze through an investigation into the figure of the ‘beautiful soul’. I first examine Deleuze's claim that a philosophy of difference risks a ‘new’ version of the beautiful soul, situating this figure in its historical context in Hegel. I then consider why Whitehead may initially appear to fall into the trap of the beautiful soul before arguing that this is not the case. Seeing how brings Whitehead and Deleuze closer together (...) by showing that their respective insistences on the risks, dangers, and adventures integral to speculative thinking highlight the importance of the intersection between the existential and the metaphysical. (shrink)

ABSTRACTJason Wirth's Mountains, Rivers, and the Great Earth: Reading Gary Snyder and Dōgen in an Age of Ecological Crisis challenges complacency in two significant ways. First, it performs a commitment to philosophy as creative and capacious practice in contrast to orthodoxies or technical provincialisms. Second, it disrupts unreflective usages of “wealth” and “development” as inherently economic in developing a compelling argument about the way that spiritual poverty informs contemporary ecological pathology. In this review, I present six key claims in Wirth's (...) text and offer unfolding thoughts in response. (shrink)

Michela Bella’s Ontology after Philosophical Psychology: The Continuity of Consciousness in William James’s Philosophy of Mind offers a detailed survey of James’s thought using “continuity” as its focal lens. Because the book presumes significant familiarity with James and frequently includes dense exegesis of his work’s most technical aspects, it is primarily for specialists. It will particularly interest James scholars studying the entanglement of the metaphysical with the psychological and epistemological.Combining “historical” and “theoretical” points of view, Bella tracks “James’s gradual translation (...) of psychological experimental observations of the continuity of thought into an ontological perspective... (shrink)

Rorty's aversion to metaphysics is well known, so the extent of his early work on Whitehead might come as a surprise. This article examines the young Rorty's critical assessment of Whitehead to show how it demonstrates the consequences of diverging metaphilosophical orientations. It argues that Rorty's insistence on judging Whitehead's work through an exclusively epistemological frame causes him to miss its more radical existential and epistemic implications. After examining how Rorty and Whitehead operate with different cost-benefit analyses as to the (...) risks and benefits of speculative philosophy, it suggests that closer attention to the fuller stakes of Whitehead's project shows that his metaphysics are not opposed to the “poeticized” culture that Rorty calls for, one where the distinction between making and finding is no longer metaphysically foundational. (shrink)

This paper investigates the relationship between James’ radical empiricism and Deleuze’s study of the genesis of sense without a transcendental subject as necessary condition. It shows that James’ concept of pure experience changes the form of relation between mind and world. Considering how to conceptualize experience without a fixed metaphysical or transcendental subject destabilizes ontological identity, leads to a founding conceptual divergence from traditional phenomenology, and motivates Deleuze’s efforts towards transcendental empiricism. The paper reads Deleuze’s work on the genesis of (...) sense in this context, arguing that one important result is an ontological pluralism. Such pluralism is crucial in considering how meaning can be made between and across differences and is in keeping with radical empiricism’s openness to life’s complexity. (shrink)

The paper critically explores tensions inherent in speculative thinking in the context of climate change. It argues that speculative thinking is not a supererogatory luxury or idle pastime, but rather an essential necessity, especially in the context of climate change. Understanding this requires becoming more aware of operative tensions of speculative practice. In particular, the paper focusses on how climate discourses intersect and engage our variable affective economies through the affect of fear and proposes two practical virtues to be cultivated (...) towards a responsible practice of speculative thought in this context. (shrink)