BackgroundMost end-of-life decisions are made by family members. Current ethical guidelines for family decision making are based on a hierarchical model that emphasizes the patient’s wishes over his or her best interests. Evidence suggests that the model poorly reflects the strategies and priorities of many families.MethodsResearchers observed and recorded 26 decision-making meetings between hospital staff and family members. Semi-structured follow-up interviews were conducted. Transcriptions were analyzed using qualitative techniques.ResultsFor both staff and families, consideration of a patient’s best interests generally took (...) priority over the patient’s wishes. Staff generally introduced discussion of the patient’s wishes for rhetorical purposes, such as persuasion. Competing moral frameworks, which de-emphasized the salience of patients’ autonomy and “right to choose,” played a role in family decision making.ConclusionsThe priority given to the patients’ wishes in the hierarchical model does not reflect the priorities of staff and families in making decisions about end-of-life care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Testimony of Sense: Empiricism and the Essay from Hume to Hazlitt by Tim MilnesMargaret WatkinsTim Milnes. The Testimony of Sense: Empiricism and the Essay from Hume to Hazlitt. Oxford: Oxford University Press, 2019. Pp. viii + 278. Hardback. ISBN: 9780198812739. $91.00.In his brief autobiography, “My Own Life,” Hume reports that “almost all [his] life has been spent in literary pursuits and occupations” (E-MOL: xxxi). This is one (...) of at least ten places in this brief work in which he associates himself with “letters” or “literature”—as compared to at most four associations with philosophy. The moral to be inferred is not that Hume considered himself not to be a philosopher. Rather, he conceived of philosophy as a kind of literature. The Treatise was itself a “literary attempt.” Indeed, opposition between the “literary” and “philosophical” aspects of a text would have been foreign to Hume and his contemporaries—a notion for a later age, despite his occasional loose distinction between the relevant genres, as in his list of writings “historical, philosophical, or literary” in “My Own Life” (E-MOL: xxxvi).Yet despite Hume’s own understanding of the continuity between philosophy and literature, broadly conceived, it is still common for contemporary philosophers to ignore literary questions in their examination of Hume’s work, or to presume that one can easily distinguish the “philosophical” parts from the “literary” ones. Tim Milnes’s The Testimony of Sense is therefore a welcome addition to the Hume literature (pun intended). With a particular focus on the essay—a genre of great importance to Hume—Milnes contributes to the small set of engagements with Hume from the disciplinary perspective of English literature. With training in both philosophy and literature, as well as established expertise on Romanticism and its own essays, Milnes is well-qualified for the task. The Testimony of Sense includes sustained engagement with Hume’s contemporaries and successors, but for the purposes of this review, I engage the book primarily as a Hume scholar for Hume scholars.Milnes’s story plays out in three acts. The first establishes the need for public trust created by a skeptical crisis, itself a product of Hume’s criticism of the epistemic program of thinkers in the Cartesian and Lockean traditions. The second explains how the essays of the long eighteenth century constitute a response to that need in various ways. The third reveals in detail how the Romantic essayists, particularly William Hazlitt and Charles Lamb, both respond to and deviate from the “neoclassical” essayists, typified by Hume and Samuel Johnson.The first chapter, “Self and Intersubjectivity,” lays the groundwork by articulating how Hume, Adam Smith, Thomas Reid, and Dugald Stewart identify the need for what we now call intersubjectivity. Milnes describes the common thread as a kind of “natural transcendentalism.” In what sense are these thinkers properly understood as [End Page 175] transcendentalists? The central idea seems to be that all posit things other than reason as “conditions of meaningful thought” (72). For Hume, it is the social, linguistic experience of a community of virtuous judges. The intricate relations between self and other essential to such a community get “internalized within the specular drama of the impartial spectator” (72) in Smith’s writing, which itself takes part in the drama through his “halting, qualified syntax” that mimics “everyday speech” (44). Reid posits a “prescience” of trust, which grounds our reliance on both human testimony and the uniformity of nature, itself undergirded by the design of a benevolent God. Stewart, who posits axiomatic truths that help constitute the “stamina of intellect,” goes furthest, actually calling these truths transcendental (55). This chapter also puts these eighteenth-century thinkers in conversation with twentieth-century theorists, including Habermas, Davidson, and Rorty.Chapter 2, “The Subject of Trust,” deepens the analysis by situating these “natural transcendentalisms” in the broader enlightenment context. In contrast to Descartes, Bacon, and Locke, who were suspicious of our reliance on the opinions of others, the eighteenth-century thinkers understand trust as prior to reason in various ways—though not prior to solidarity. The particulars in each case depend on their responses to skepticism and their accounts of the relation between... (shrink)

For those open to the possibility that philosophical thought can improve life, David Hume's Essays: Moral, Political, and Literary have something to say. In the first comprehensive study of the Essays, Margaret Watkins engages closely with these neglected texts and shows how they provide important insights into Hume's perspective on the breadth and depth of human life, arguing that the Essays reveal his continued commitment to philosophy as a discipline that can promote both social and individual progress. Addressing topics (...) such as politics, war, slavery, the priesthood, the development of industry, aesthetics, emotional disorders, egoism, friendship, sexuality, gender relations, and the nature of philosophy itself, the volume examines Hume's purposes and aims against the backdrop of the eighteenth century society in which he lived. It will be of interest to scholars of modern thought in philosophy, politics, history, and economics. (shrink)

Eyal et al have recently argued that researchers should consider conducting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human challenge studies to hasten vaccine development. We have conducted (J. L.) and overseen (L. D.) human challenge studies and agree that they can be useful in developing anti-infective agents. We also agree that adults can autonomously choose to undergo risks with no prospect of direct benefit to themselves. However, we disagree that SARS-CoV-2 challenge studies are ethically appropriate at this time, for (...) 3 reasons: (1) current scientific knowledge of SARS-CoV-2 infection is insufficient to manage risks; (2) autonomous decision making, while necessary, does not override concerns about risk; and (3) undertaking challenge studies now would imperil confidence in the research enterprise, potentially undermining the global response to the coronavirus disease 2019 (COVID-19) pandemic. (shrink)

En este trabajo discuto los criterios que se han postulado para establecer una distinción entre los estados doxásticos y los subdoxásticos; a saber: accesibilidad a la conciencia, integración inferencial y conceptualización. Esta discusión se realiza a través del análisis de los argumentos propuestos por Davies. Mi tesis es que si bien habría una distinción intuitiva entre ciertas clases de estados mentales, estos criterios, según las dos lecturas posibles de lo que el mismo Davies propone para que un criterio constituya una (...) distinción de principio, no parecen establecer la distinción deseada. /// In this paper I discuss the criteria that have been postulated for a principled distinction between doxastic states and subdoxastic states, namely: accesibility to consciousness, inferential integration, and conceptualization. The discussion set off from the analysis of the arguments put forward by Davies. My claim is that although there would be an intuitive distinction among certain kinds of mental states, according to two plausible readings of what Davies himself proposes as a principled criterion, such criteria do not seem to establish it. (shrink)

There is little information about the content of ethics consultations in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance (...) in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is need.. (shrink)

Difficult Atheism shows how contemporary French philosophy is rethinking the legacy of the death of God in ways that take the debate beyond the narrow confines of atheism into the much broader domain of post-theological thinking. Christopher Watkin argues that Alain Badiou, Jean-Luc Nancy and Quentin Meillassoux each elaborate a distinctive approach to the post-theological, but that each approach still struggles to do justice to the death of God.

Genomic sequencing is becoming more common both in clinical practice and as a routine aspect of much research. Over the last 15 years there has been ongoing discussion about the implications of gen...

This article argues that Hume's brief essay, "Of the Delicacy of Taste and Passion," offers resources for three claims: (1) Delicate taste correlates with self-sufficiency and thus with a particularly Humean form of Magnanimity -- greatness of mind; (2) Delicate taste improves the capacity for profound friendships, characterized by mutual admiration and true compassion; and (3) magnanimity and compassion are thus not necessarily in tension with one another and may even proceed from and support harmony of character. These claims, in (...) turn, provide reasons to take seriously Hume's view that moral character depends, in part, on aesthetic character. (shrink)

This paper attempts to shed light on Kant’s notion of autonomy in his moral philosophy by considering the extent to which he presents a similar doctrine in his theoretical philosophy, where he strikingly claims (e.g., in the Prolegomena) that the understanding prescribes laws to nature. It argues that even though there are important points of difference between the cases of theoretical legislation of the laws of nature and autonomy in moral philosophy, their extensive parallels make a strong, even if not (...) definitive case in favor of the Prolegomena forming at least an important part of the explanation of the emergence of autonomy in the Groundwork. In addition, the comparison proves instructive insofar as it reveals deep structural parallels between Kant’s theoretical and practical philosophy regarding his conception of laws. (shrink)

Volume 19, Issue 10, October 2019, Page 97-98.

As medicine and science advance, new ethical questions emerge. Over time, deliberation and analysis result in a somewhat settled approach to a problem. Often the settled approach is based on group...

As part of the regulatory review process, both the Food and Drug Administration and Office for Human Research Protections (U.S. Department of Health and Human Services [HHS]...

This case is about a study of burn patients that included a request to the IRB for a waiver of consent for perianal specimen collection–a request which ultimately was not approved by a reviewing IR...

I show that the common reading of Thomson, that she argues by analogy for the conclusion that abortion is permissible, is mistaken. The correct reading of Thomson is that she argues by counterexample, showing that arguments against abortion are unsound. The remainder of the paper highlights the lessons learned from Thomson once we read her aright.

Volume 20, Issue 10, October 2020, Page 82-83.

Volume 20, Issue 4, May 2020, Page 111-113.

This article studies the conceptions of social justice of women active in transnational migrant politics over a period of roughly 20 years in the Netherlands. The novel focus on migrant women reveals that transnational politics is almost completely male-dominated and -directed. Two of the exceptions found in this article include a leftist and a Kurdish women organization supporting the communist cause in the 1980s and the Kurdish struggle in the 1990s in Turkey, respectively. In both organizations gender equality was subordinated (...) to broader ideologies of political parties in their homeland. Leftist activists in the cold war era supported a narrow definition of the "politics of redistribution," while and Kurdish activists, combined classical features of the latter with those of traditional identity politics. (shrink)

We report on the deliberations of an interdisciplinary group of experts in science, law, and philosophy who convened to discuss novel ethical and policy challenges in stem cell research. In this report we discuss the ethical and policy implications of safety concerns in the transition from basic laboratory research to clinical applications of cell-based therapies derived from stem cells. Although many features of this transition from lab to clinic are common to other therapies, three aspects of stem cell biology pose (...) unique challenges. First, tension regarding the use of human embryos may complicate the scientific development of safe and effective cell lines. Second, because human stem cells were not developed in the laboratory until 1998, few safety questions relating to human applications have been addressed in animal research. Third, preclinical and clinical testing of biologic agents, particularly those as inherently complex as mammalian cells, present formidable challenges, such as the need to develop suitable standardized assays and the difficulty of selecting appropriate patient populations for early phase trials. We recommend that scientists, policy makers, and the public discuss these issues responsibly, and further, that a national advisory committee to oversee human trials of cell therapies be established. **NB we did not reccommend a NAC, we think it might be appropriate**. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

Volume 19, Issue 11, November 2019, Page 39-41.

According to the “adequacy-for-purpose” view of data evaluation, data should be evaluated as better or worse relative to a given research purpose and corresponding research context. In this paper, I apply the adequacy-for-purpose view to a novel case study—concerning the use of paleoecological data to make predictions about coral reef response to contemporary climate change—and then use the case study to suggest two extensions to the adequacy-for-purpose view. First, I argue that we can evaluate research purposes according to their productivity (...) (how well these research purposes serve other, more ultimate purposes). Second, I argue that we can also evaluate research purposes according to their plausibility (including whether we have access to data that are adequate for these research purposes). The relationship between data evaluation and purpose setting should be seen as an iterative one, in which both data and purposes are refined in concert over time. (shrink)

Dans les stations de tourisme de montagne, les intersaisons correspondent à des creux d’activité durant lesquels les offres d’emploi alternatives sont peu nombreuses. Les saisonniers se trouvent donc confrontés à une période de chômage cyclique. Cette situation « intermédiaire », réunissant une forme d’incertitude de la relation d’emploi ainsi qu’une relative prévisibilité des périodes de recrutement n’est pas sans susciter certaines controverses. Dans ce contexte, comment sont vécues les phases de chômage saisonnier dans ces territoires? Ces séquences temporelles correspondent-elles à (...) un « temps mort » ou à un temps pluriel? Comment se négocie le temps pour soi dans le cadre d’embauches à contre-rythmes des temps sociaux dominants? Dans le cadre de cette forme d’emploi intermittente, le temps de chômage peut-il être conçu comme un temps de construction de la carrière professionnelle? Cet article s’intéresse aux formes d’adaptation aux rythmes d’emploi et de chômage des saisonniers en montagne et montre comment ces périodes hors-emploi participent de l’intériorisation de rythmicités spécifiques. (shrink)

This essay looks at Norplant qua technology and uses analytic frameworks from the social construction of technology to explain the trajectory of its brief history. The author contend that there were multiple uses of Norplant, in terms of rhetorical strategies, symbolic representations, and contraceptive intentions, constructed by reproductive scientists, population control advocates, pharmaceutical manufacturers, doctors, birth control clinic staffers, government regulators, legislators, judges, women’s health activists, potential users, and actual users. However, while relevant social groups shaped the discourse surrounding Norplant (...) in the 1990s, its ultimate fate was determined by choices made by potential users. At the ‘‘consumption junction’’ of the late twentieth-century contraceptive marketplace, American women ignored the meanings constructed for Norplant by developers, producers, providers, and policy makers and made their decisions based on what Norplant meant to them. Individuals’ decisions to choose other methods of preventing pregnancy coalesced into a collective rejection of this contraceptive technology. (shrink)

Informed Consent: What Must Be Disclosed and What Must Be Understood seeks to challenge the “standard view” of consent. It seeks to do so by segregating the “disclosure function” from the “understa...

This research examined choice behaviour and probability judgement in a counterintuitive reasoning problem called the Monty Hall problem (MHP). In Experiments 1 and 2 we examined whether learning from a simulated card game similar to the MHP affected how people solved the MHP. Results indicated that the experience with the card game affected participants' choice behaviour, in that participants selected to switch in the MHP. However, it did not affect their understanding of the objective probabilities. This suggests that there is (...) dissociation between implicit knowledge gained from the task and the explicit understanding as to why switching was the best strategy. In Experiment 3, the number of prizes and doors were manipulated to examine how participants construed the problem space of the MHP. Results revealed that participants partition the probability judgement to reflect the number of prizes over the number of unopened doors. (shrink)

In this paper Grice's requirements for assertability are imposed on the disjunction of Classical Logic. Defining material implication in terms of negation and disjunction supplemented by assertability conditions, results in the disappearance of the most important paradoxes of material implication. The resulting consequence relation displays a very strong resemblance to Schurz's conclusion-relevant consequence relation.

Hornsby defiende una interpretación muy particular de la distinción personal-subpersonal tal como fue propuesta por Dennett y de la doctrina filosófica en la que está enraizada esta distinción. Según Hornsby de la aceptación de la distinción y la doctrina se sigue una defensa de la autonomía explicativa del nivel personal. Esta defensa nos compromete con un nivel personal genuino de explicación y la idea de que los hechos subpersonales no explican hechos personales. Hornsby sostiene, además, que mientras que en Dennett (...) se defiende la autonomía del nivel explicativo personal, en Dennett post-1969 al modificarse la doctrina de base cambia la manera de entender la distinción y con ello se reniega de ambos compromisos, de lo cual se sigue un abandono de la tesis de la autonomía del nivel explicativo personal. La tesis que vamos a sostener en este trabajo es que si bien la distinción de Dennett nos compromete con , no nos compromete con . Dado que una defensa de la autonomía explicativa del nivel personal, tal como Hornsby la entiende, abarca ambos compromisos, se sigue que no hay tal defensa. En consecuencia, si bien hay algunas cuestiones que en Dennett no se plantean de manera tan explícita y clara como en Dennett post-1969, no hay un cambio sustancial en su concepción de la distinción.According to Hornsby , Dennett's personal-subpersonal distinction has as one of its consequences a defense of the autonomy of personal level explanation, and this defense is based on two commitments: the personal level is a genuine level of explanation, and subpersonal facts do not explain personal facts. Moreover, Hornsby argues that Dennett post-1969 rejects both commitments, and that he consequently abandons the autonomy thesis. In this paper we shall argue that, although Dennett's distinction is committed to , it is not committed to . Given that a defense of the autonomy, as Hornsby understands it, presupposes both commitments, it follows that there is no such defense. We hold that there is no substantial change in Dennett's conception of the distinction, although some of these issues are not as clear and explicit in Dennett 1969 as in Dennett post-1969. (shrink)

Narrative has proven itself a continuous as well as adaptable means for environmentally oriented expression. Its role goes beyond the mediation of pre-existing knowledge imported into the realm of storytelling from other domains; rather, influential models of the natural world tend to circulate as storyworlds. This special issue of SubStance proceeds from the premise that narratives are not only a sequence of signs encoding a story but also “invisible, elusive representations that exist only in the mind”. Narrative forms generate and (...) transfer environmental knowledge; moreover, any specifically narrative concerns are important contributing factors to the models of agency, change... (shrink)

Emergency nurses apply specialist knowledge to the practice of emergency care. This paper discusses the ways in which three emergency nurses understand the nature of their care from their own frames of reference and experiences and presents some of the data collected in a larger study. Various discourses, which compete to inform emergency nurses' understandings of practice, are linked with the notion of nurses as subjects; that is, each discourse may inform, shape and constitute the practice of the nurse and, (...) in turn, the ways in which the patient comes to be known and understood. I will examine the ways in which emergency nurses come to experience or position themselves vis‐à‐vis extant forms of knowledge of emergency care and the extent to which they articulate new or distinctive formulations of emergency care. This paper illuminates the commonalities that constitute the discourses of emergency nursing care, and also analyse nurses' language which demonstrates that within each discourse variations, contradictions and resistances exist. Emergency nursing care occurs in a context of a biomedical discourse that dominates, or tends to dominate, the work of the emergency setting and so to determine acceptable or possible practices. Nevertheless, nurses contest in various ways the ‘truths' that they understand to underpin their practice. Challenges to biomedical discourses are revealed, to some extent, by drawing attention to specific situations and particular struggles encountered in emergency nurses' everyday practice. (shrink)