This book proposes an alternative to the consent model which is currently at the heart of patient self-determination and which is shown here to have fundamental flaws that constrain its effectiveness. The proposed model is a property model in which the patient’s bodily integrity is protected from unauthorised invasion, and their legitimate expectation to be provided with the relevant information to make an informed decision is taken to be a proprietary right. This model enables the courts to overcome the requirement (...) to prove causation in consent cases and offers a complementary approach to patient self-determination. (shrink)

Applied Christian Ethics addresses selected themes in Christian social ethics. Part one shows the roots of contributors in the realist school; part two focuses on different levels of the significance of economics for social justice; and part three deals with both existential experience and government policy in war and peace issues.

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

An increasing number of research teams are investigating the efficacy of brain-computer interface (BCI)-mediated interventions for promoting motor recovery following stroke. A growing body of evidence suggests that of the various BCI designs, most effective are those that deliver functional electrical stimulation (FES) of upper extremity (UE) muscles contingent on movement intent. More specifically, BCI-FES interventions utilize algorithms that isolate motor signals—user-generated intent-to-move neural activity recorded from cerebral cortical motor areas—to drive electrical stimulation of individual muscles or muscle synergies. BCI-FES (...) interventions aim to recover sensorimotor function of an impaired extremity by facilitating and/or inducing long-term motor learning-related neuroplastic changes in appropriate control circuitry. We developed a non-invasive, electroencephalogram (EEG)-based BCI-FES system that delivers closed-loop neural activity-triggered electrical stimulation of targeted distal muscles while providing the user with multimodal sensory feedback. This BCI-FES system consists of three components: (1) EEG acquisition and signal processing to extract real-time volitional and task-dependent neural command signals from cerebral cortical motor areas, (2) FES of muscles of the impaired hand contingent on the motor cortical neural command signals, and (3) multimodal sensory feedback associated with performance of the behavioral task, including visual information, linked activation of somatosensory afferents through intact sensorimotor circuits, and electro-tactile stimulation of the tongue. In this report, we describe device parameters and intervention protocols of our BCI-FES system which, combined with standard physical rehabilitation approaches, has proven efficacious in treating UE motor impairment in stroke survivors, regardless of level of impairment and chronicity. (shrink)

Returning genomic research results to family members raises complex questions. Genomic research on life-limiting conditions such as cancer, and research involving storage and reanalysis of data and specimens long into the future, makes these questions pressing. This author group, funded by an NIH grant, published consensus recommendations presenting a framework. This follow-up paper offers concrete guidance and tools for implementation. The group collected and analyzed relevant documents and guidance, including tools from the Clinical Sequencing Exploratory Research Consortium. The authors then (...) negotiated a consensus toolkit of processes and documents. That toolkit offers sample consent and notification documents plus decision flow-charts to address return of results to family of living and deceased participants, in adult and pediatric research. Core concerns are eliciting participant preferences on sharing results with family and on choice of a representative to make decisions about sharing after participant death. (shrink)

An empirical exploration of the effects on legislative structure, distribution of influence, power, and decision outcomes, of recent changes in the Congress and state legislatures. The book focuses on changes in rules, parties, and committees and the impact or lack of impact of these changes on subsequent activity. Originally published in 1978 by D.C. Heath and Company. Co-published with the Policy Studies Organization.

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.3 (2004) vii-viii [Access article in PDF] John C. Fletcher 1931-2004 John Fletcher was one of the pioneers in the still-young field of bioethics. In this short tribute, I can only hope to highlight a few of the many contributions he made to the field.For many of us, our first introduction to John occurred in October 1971. At an international symposium sponsored by the (...) Kennedy Foundation, the film "Who Should Survive?" depicted the dramatic case of an infant with Down syndrome and an intestinal blockage. The parents of the infant refused surgery to relieve the obstruction, and the healthcare providers for the infant decided not to pursue a court order permitting the surgery. During a period of approximately two weeks the infant was allowed to die.In the second part of "Who Should Survive?" John was one of several panelists invited to discuss the decisions made in this case. After acknowledging how troubling the infant's death was to him, John nonetheless sought to be empathic with the parents. He pointed out that in the re-enactment of the case the faces of the parents were never seen, and he worried that the film did not permit the parents to discuss the reasons for the choice they had made. John realized that his position would not be shared by most other panelists. Yet he had the courage to take an unpopular stand and to challenge other panelists—and the audience—not to reach premature closure on complex ethical dilemmas.Already in 1967, John had begun contributing to the literature of bioethics. His essay "Human Experimentation: Ethics in the Consent Situation," appeared in Law and Contemporary Problems. At the time, John was deeply immersed in studying the ethical dimensions of research with human subjects at the NIH Clinical Center. Paul Ramsey cited John's work with appreciation in his 1970 book, The Patient as Person. By the time he completed his dissertation at Union Theological Seminary in 1969, John was arguably one of the best trained bioethicists in the world—before there was a field of bioethics.After serving as chaplain, teaching at Virginia Theological Seminary, and founding and leading a seminary without walls in Washington, DC, John became the chief of the ethics program at the NIH Clinical Center in 1977. There he had the unenviable task of providing a second review for all clinical protocols emerging from the intramural programs of the NIH institutes. John discovered that in some cases the institutional review boards of the institutes had overlooked important ethical questions. This role also [End Page vii] required courage. At times John found it necessary to challenge senior NIH researchers, even institute directors, and to request protocol revisions that in his view were required for the protection of human subjects.In 1980, after Martin Cline had performed an unauthorized gene transfer experiment involving thalassemia patients, John joined with physician W. French Anderson to write an essay entitled "Gene Therapy in Human Beings: When Is It Ethical to Begin?" [New England Journal of Medicine 303: 1293-97]. Not only did this essay help to defuse a potentially explosive problem for NIH, which had funded Cline's research. It also provided a set of guidelines for the conduct of human gene transfer research that is of continuing relevance today.At times John disagreed with federal policies on research, for example, conservative policies on human embryo research. He also chafed at the idea of subjecting his publications to prior NIH review, both for accuracy and for political correctness. Thus, he welcomed the opportunity to move to the University of Virginia in 1987. There his academic career flowered, and he enjoyed some of his most productive years of research and writing.Among his many contributions during these later years, John participated as Committee co-chair in an effort to "redress the wrongs of Tuskegee." The Tuskegee Syphilis Study Legacy Committee proposed in May 1996 that President Clinton apologize to the participants in the Tuskegee study on behalf of the federal government. In May 1997, the President did in... (shrink)

Opening address, by C.W. Morris.--Address of the chairman, H.W. Chase.--Spinoza: his personality and his doctrine of perfection, by E.L. Schaub.--Spinoza's political and moral philosophy, by T.V. Smith.--Spinoza and religion, by S.B. Freehof.

"Une expérience qui réussit dans l'air ne réussit pas toujours dans le vide. C'est ainsi que s'achève le dialogue qui clôt l'Enquête sur les principes de la morale (1751). Dans cette oeuvre que Hume jugeait être le meilleur de tous ses écrits, le philosophe écossais. fidèle à sa méthode empirique et à son "scepticisme mitigé", part en quête des indices susceptibles de révéler L'origine de la morale. N'agissons-nous que par intérêt? L'approbation morale peut-elle faire abstraction de nos préférences? À suivre (...) les hommes dans leurs choix pour en dégager la constance, on ne peut qu'être frappé par la diversité des moeurs et des coutumes. La conclusion alors révèle la subtilité du détective: la morale de Hume joint l'utile à l'agréable et l'Enquête ne se fait pas faute de rappeler, dans sa forme même, que l'exercice philosophique doit lui aussi être un plaisir. (shrink)

Le rôle de David Hume dans la philosophie moderne, par A. L. Leroy.--The enlightenment of David Hume, by E. C. Mossner.--Hume and Jurieu: possible Calvinist origins of Hume's theory of belief, by R. H. Popkin.--Hume: philosopher or psychologist? A problem of exegesis, by T. E. Jessop.--L'astrazione nella filosofia di Hume, di M. Dal Pra.--Infinite divisibility in Hume's "Treatise," by A. Flew.--Note a "La rgola del gusto," di E. Migliorini.--Kant, Hamann-Jacobi and Schelling on Hume, by P. Merlan.--Bibliografia humiana dal 1937 (...) al 1966, di E. Ronchetti. (shrink)

Le syntagme « philosophie de la danse » fait surgir une tension aporétique : soit le philosophe esthéticien évince le _danser_ pour réduire la danse à la réception de son spectacle, soit il assimile la danse à une pensée ou un langage – ce qui est bien mal connaître l’absentement du concept en danse, supplanté par autant d’intuitions locomotrices. À titre alternatif, je soutiendrai que la pratique de la danse est révélatrice des dimensions non conceptuelles de la vérité, qualifiables d’ (...) « intuitions claires et évidentes » et posées comme condition même de toute connaissance par Descartes ; ou « vérités du cœur » de même valeur que les connaissances rationnelles selon Pascal. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 269 severally through hearing, tasting, and smelling, so that we should have on our hands five spatially unrelated spaces. He can find no reason for abandoning the spontaneous commonsense conviction that the puffing I hear is that of the locomotive I am looking at, that the chocolate I am tasting is the one I have put in my mouth, that what I am smelling is the rose (...) I am seeing and also perhaps holding; and, to return to Berkeley, that I perceive the surface I am seeing to be the very one that I am touching with my finger. Mr. Armstrong seems to be laying down the basis of a general theory of perception, that no given perception can be reduced to the datum proper to the sense-organ used plus an associate, a guess, or an inference. To turn this negative statement into a positive one, to say what the activity is that grasps more than the presumed datum, and what makes it reliable, is, as the history of the theory of perception makes plain, desperately hard. Far from grumbling at Mr. Armstrong for not having gone forward to this task, I am grateful for his having given us a book that is so intelligent, acute, clear, stimulating, and blessedly concise--one that deserves to be read by anyone interested in Berkeley, or the theory of vision, or the theory of perception generally. T. E. Jzssov Hull, England Studies in the Philosophy of David Hume. A new edition. By Charles W. Hendel. (Indianapolis, New York: The Bobbs-Merrill Co., 1963. 14 x 21. Pp. li + 516.) Cette nouvelle 6dition des Studies a subi d'importants changements non seulement dans sa pr6sentation, mais aussi dans son esprit. Elle nous prouve combien la pens6e d'un homme se d6veloppe sans cesse et s'enrichit. L'interpr&ation d'un philosophe et la pens& m~me du philosophe ont connu et connaissent encore ces transformations. La pens& humaine ne consid~re jamais sa t$che comme achev&. C'est pourquoi nous ne devons jamais cesser d'ftendre le champ de nos &udes philosophiques pour provoquer la naissance de nouvelles comparaisons f&ondes. Nous y passons certes beaucoup de temps, en retour, nous discernons mieux les complexit6s de la nature humaine. Nous savions d6jh qu'il y avait plusieurs Platon, car le progr& de l'homme se poursuivait de dialogue en dialogue; nous savons maintenant qu'il y a plusieurs David Hume, et que le Hume de Kant ou le Hume du dernier siecle, ne peuvent plus 6tre les n6tres. Comme le remarque Charles Hendel, dans son introduction, vingt-cinq annfes ont suffi h renouveler l'interpr&ation que nous donnions de Hume. Aujourd'hui c'est l'imagination qui se forme l'habitude de repr&enter par un seul mot une collection d'id&s semblables et qui nous sugg~re d'user de l'id& de causalit~ pour interpr&er le retour de cons&utions analogues. C'est aussi l'imagination, plus que la raison, qui nous r&~le la probabilit~ d'un &6nement donn6. Hendel nous rapelle aussi que Buder pourrait bien avoir inspir6 ~t Hume l'importance morale de la sympathie, et que l'Alciphron de Berkeley aurait sugg6r6 le Cl~anthe des Dialogues sur la Religion Naturelle. Hendel a 6galement raison d'insister sur l'importance des interpr&ations de Norman Kemp Smith. Cette nouvelle et si 6rudite &ude de Hendel nous fait mieux comprendre ~ la fois les variations des pens6es de Hume, de Kemp Smith et de Hendel lui-m~me. Nous sommes ainsi mieux avertis des difficult6s de l'histoire de la philosophie, dues non seulement au d6veloppement des sciences, mais aussi du progr&s moral et spirituel, sujet h tant de fluctuations dans l'histoire et m~me, ~t une m~me epoque, d'homme h homme. Aussi cette nouvelle ~dition ne manquera pas d'apporter de nouvelles dart& h nombre de ses lecteurs. ANDV.a~ Lotas LEROY Sorbonne... (shrink)

Part of the Philosophes series, this very useful introduction to Locke opens with a little ceremony which really does seem necessary in order to assure French readers of the relevance of foreign thinkers. It takes the form here of Voltaire's praise of Locke in his thirteenth Lettre philosophique. Voltaire's consecration however does serve to cast some eighteenth century light on Locke, which is an excellent way to begin the subject. There follows an outline of Locke's life and philosophy, with brief (...) considerations of the Letter on Tolerance and Two Treatises on Government, and an extended treatment of the four books of the Essay Concerning Human Understanding. Leroy uses a method of paraphrase with very limited commentary, a good device for getting inside a subject but one which involves a sacrifice in perspective. Some sixty pages of excerpts from the Essay are well chosen, indexed, and provided with topic headings. A minimal bibliography follows.--C. M. R. (shrink)

De Interpretatione is among Aristotle's most influential and widely read writings; C. W. A. Whitaker presents the first systematic study of this work, and offers a radical new view of its aims, its structure, and its place in Aristotle's system. He shows that De Interpretatione is not a disjointed essay on ill-connected subjects, as traditionally thought, but a highly organized and systematic treatise on logic, argument, and dialectic.

The last quarter of the twentieth century has given rise to reproductive technologies and arrangements that in the earlier part of the century could only be dreamed of by the authors of science fiction. We stand in the middle of this reproductive revolution, trying to cope with the developments that have already occurred but with an uneasy sense that the future may be even more complicated ethically than the past and the present. In this brief essay, I will survey recent (...) ethical and public-policy discussions of two reproductive techniques (assisted insemination and in vitro fertilization) and one reproductive arrangement (surrogate motherhood). After distinguishing three phases in the normative debate, I will briefly comment on some of the characteristics of, and continuing ambiguities in, the ethical debate of the past 25 years. At the conclusion of the essay, I will attempt to anticipate three future issues in ethics and reproduction. (shrink)