Proper conduct of an AIDS vaccine trial in Africa must be informed not only by the epidemiology and biology of HIV infection in African settings, but also by the ethical norms and cultural constraints prevailing in African settings.

Mass drug screening offers a deceptively simple solution to the problem of drug use among workers. Even a very effective test is subject to error. In any given group of tested individuals, some will unavoidably be falsely accused. Even though scientific tests appear to provide efficient solutions to social and legal problems, these tests should not be accepted unless they also meet our standards for fair dealing.

In the expanding repertoire of practices designed to increase the supply of organs for transplantation, non-heart-beating cadaver organ donation has generated an ongoing debate in the literature. The continuing stream of articles is disquieting in part because it documents a troubling "trial-and-error ethics" approach to the formulation of organ procurement policy, and because it raises serious questions about the reasons that the development of this policy is being mediated by published communication. In the light of concerns about the implicit support (...) and credibility that professional publications give to organ procurement policies, restraint in publishing articles about non-heart-beating organ donation as well as in devising such policies is strongly advocated. (shrink)

Comprehensive resource for indispensability research.

BackgroundFollowing several landmark rulings and increasing public support for physician-assisted death, in 2016, Canada became one of a handful of countries legalising medical assistance in dying (MAiD) with Bill C-14. However, the revised Bill C-7 proposes the specific exclusion of MAiD where a mental disorder is the sole underlying medical condition (MAiD MD-SUMC).AimThis review explores how some persons with serious and persistent mental illness (SPMI) could meet sensible and just criteria for MAiD under the Canadian legislative framework.MethodsWe review the proposed (...) Bill C-7 criteria (capacity, voluntariness, irremediability and suffering) as well as the nuances involved in separating a well-reasoned request for assisted suicide from what might be solely a manifestation of a SPMI.FindingsIn this paper, we argue against the absolute exclusion of patients with SPMIs from accessing MAiD. Instead, we propose that in some circumstances, MAiD MD-SUMC may be justifiable while remaining the last resort. Conducting MAiD eligibility assessments removes the need to introduce diagnosis-specific language into MAiD legislation. Competent psychiatric patients who request MAiD should not be treated any differently from other eligible candidates. Many individuals with psychiatric disorders will be incapable of consenting to MAiD. The only ethical option is to assess eligibility for MAiD on an individual basis and include as legitimate candidates those who suffer solely from psychiatric illness who have the decisional capacity to consent to MAiD. (shrink)

This article offers a critical discussion in the form of debate among experts in the fields of networks, human behaviour, and social analysis about key issues that arguably affect the human nature and society in the digital age. Based on the responses of Nicholas Christakis to an interview given to the authors, some key questions, applications, and limitations regarding the research on digital networks are discussed, together with hot issues related to the nature of digital data and experimentation (...) in contemporary social science. Finally, current and future prospects are presented in relation to data science and society in the light of the Fourth Industrial Revolution. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Unduly Iterative Ethical Review?”Franklin G. MillerMadam:Renée C. Fox and Nicholas A. Christakis have written a provocative article, “Perish and Publish: Non-Heart-Beating Organ Donation and Unduly Iterative Ethical Review” (KIEJ, December 1995). The language of their argument and some of the implicit assumptions on which it rests deserve critical scrutiny. They describe the articles presenting and commenting on the University of Pittsburgh protocol as “disquieting” because the display (...) “trial-and-error ethics.” To dismiss “trial-and-error ethics” implies that we antecedently possess all the moral knowledge we need to evaluate and regulate developments in medicine. Should we summarily reject experimentation in ethics, particularly with respect to complex issues involving scientific and technological changes? For if we need to reconsider and possibly revise what counts as moral knowledge, the proposing an experimental approach to the ethics of a novel practice, which is presented publicly and made open to revision, as in the Pittsburgh protocol, may be precisely the best way to proceed.Fox and Christakis resort to invidious insinuation in their criticism of ethicists who have written, and journals that have published, articles about non-heart-beating organ donation. Publication on this issue has given ethicists the opportunity of “adding numerous items to their vitae.” Their appraisal of the vitae-boosting behavior represents an interesting rhetorical specimen: “Although there is nothing inherently dishonorable about this it does create tension between two motives: conviction about the importance of perfecting ethical conduct, on the one hand, and the desire to advance one’s professional career, on the other” (p. 340). I am not sure what the authors mean by “perfecting ethical conduct.” Yet they suggest that a group of reputable scholars, who have taken diverse positions on the ethics of non-heart-beating organ donation, have come perilously close to venality.Finally, in order to avoid further legitimating what they consider to be an ethically objectionable practice, the authors advocate that journals exercise “restraint” in publishing articles about this topic. Perhaps in a future pronouncement they will enlighten us about how enforcing a publication policy that avoids the vice of “unduly iterative ethical review” might work without compromising freedom of discussion. Moral dogmatism and censorship have a long history of association.Franklin G. MillerCenter for Biomedical Ethics University of Virginia Charlottesville, VACopyright © 1996 The Johns Hopkins University Press... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Unduly Iterative Ethical Review?”Franklin G. MillerMadam:Renée C. Fox and Nicholas A. Christakis have written a provocative article, “Perish and Publish: Non-Heart-Beating Organ Donation and Unduly Iterative Ethical Review” (KIEJ, December 1995). The language of their argument and some of the implicit assumptions on which it rests deserve critical scrutiny. They describe the articles presenting and commenting on the University of Pittsburgh protocol as “disquieting” because the display (...) “trial-and-error ethics.” To dismiss “trial-and-error ethics” implies that we antecedently possess all the moral knowledge we need to evaluate and regulate developments in medicine. Should we summarily reject experimentation in ethics, particularly with respect to complex issues involving scientific and technological changes? For if we need to reconsider and possibly revise what counts as moral knowledge, the proposing an experimental approach to the ethics of a novel practice, which is presented publicly and made open to revision, as in the Pittsburgh protocol, may be precisely the best way to proceed.Fox and Christakis resort to invidious insinuation in their criticism of ethicists who have written, and journals that have published, articles about non-heart-beating organ donation. Publication on this issue has given ethicists the opportunity of “adding numerous items to their vitae.” Their appraisal of the vitae-boosting behavior represents an interesting rhetorical specimen: “Although there is nothing inherently dishonorable about this it does create tension between two motives: conviction about the importance of perfecting ethical conduct, on the one hand, and the desire to advance one’s professional career, on the other” (p. 340). I am not sure what the authors mean by “perfecting ethical conduct.” Yet they suggest that a group of reputable scholars, who have taken diverse positions on the ethics of non-heart-beating organ donation, have come perilously close to venality.Finally, in order to avoid further legitimating what they consider to be an ethically objectionable practice, the authors advocate that journals exercise “restraint” in publishing articles about this topic. Perhaps in a future pronouncement they will enlighten us about how enforcing a publication policy that avoids the vice of “unduly iterative ethical review” might work without compromising freedom of discussion. Moral dogmatism and censorship have a long history of association.Franklin G. MillerCenter for Biomedical Ethics University of Virginia Charlottesville, VACopyright © 1996 The Johns Hopkins University Press... (shrink)

The two great philosophical figures at the culminating point of the Enlightenment are Thomas Reid in Scotland and Immanuel Kant in Germany. Reid was by far the most influential across Europe and the United States well into the nineteenth century. Since that time his fame and influence have been eclipsed by his German contemporary. This important book by one of today's leading philosophers of knowledge and religion will do much to reestablish the significance of Reid for philosophy today. Nicholas (...) Wolterstorff has produced the first systematic account of Reid's epistemology. Relating Reid's philosophy to present-day epistemological discussions the author demonstrates how they are at once remarkably timely, relevant, and provocative. No other book both uncovers the deep pattern of Reid's thought and relates it to contemporary philosophical debate. This book should be read by historians of philosophy as well as all philosophers concerned with epistemology and the philosophy of mind. (shrink)

Nicholas Wolterstorff discusses the ethics of belief which Locke developed in Book IV of his Essay Concerning Human Understanding, where Locke finally argued his overarching aim: how we ought to govern our belief, especially on matters of religion and morality. Wolterstorff shows that this concern was instigated by the collapse, in Locke's day, of a once-unified moral and religious tradition in Europe into warring factions. His was thus a culturally and socially engaged epistemology. This view of Locke invites a (...) new interpretation of the origins of modern philosophy. He maintained that instead of following tradition we ought to let 'reason be our guide.' Accordingly, after discussing Hume's powerful attack on Locke's recommended practice, Wolterstorff argues for Locke's originality and emphasizes his contribution to the 'modernity' of post-sixteenth-century philosophy. (shrink)

Human beings engage works of the arts in many different ways: they sing songs while working, they kiss icons, they create and dedicate memorials. Yet almost all philosophers of art of the modern period have ignored this variety and focused entirely on just one mode of engagement, namely, disinterested attention. Nicholas Wolterstorff asks why this might be, and proposes that almost all philosophers have accepted the grand narrative concerning art in the modern world. It is generally agreed that in (...) the early modern period, members of the middle class in Western Europe increasingly engaged works of the arts as objects of disinterested attention. The grand narrative claims that this change represented the arts coming into their own, and that works of art, so engaged, are socially other and transcendent. Wolterstorff rejects this claim, and offers an alternative framework for thinking about the arts. Central to his alternative framework are the idea of the arts as social practices and the idea of works of the arts as having different meaning in different practices. (shrink)

Prominent in the canonical texts and traditions of Judaism, Christianity, and Islam is the claim that God speaks. Nicholas Wolterstorff argues that contemporary speech-action theory, when appropriately expanded, offers us a fascinating way of interpreting this claim and showing its intelligibility. He develops an innovative theory of double-hermeneutics - along the way opposing the current near-consensus led by Ricoeur and Derrida that there is something wrong-headed about interpreting a text to find out what its author said. Wolterstorff argues that (...) at least some of us are entitled to believe that God has spoken. Philosophers have never before, in any sustained fashion, reflected on these matters, mainly because they have mistakenly treated speech as revelation. (shrink)

In this brief history, philosopher Nicholas White reviews 2,500 years of philosophical thought about happiness. Addresses key questions such as: What is happiness? Should happiness play such a dominant role in our lives? How can we deal with conflicts between the various things that make us happy? Considers the ways in which major thinkers from antiquity to the modern day have treated happiness: from Plato’s notion of the harmony of the soul, through to Nietzsche’s championing of conflict over harmony. (...) Relates questions about happiness to ethics and to practical philosophy. (shrink)

"A complete and unified account of Plato's epistemology... scholarly, historically sensitive, and philosophically sophisticated. Above all it is sensible.... White's strength is that he places Plato's preoccupation in careful historical perspective, without belittling the intrinsic difficulties of the problems he tackled.... White's project is to find a continuous argument running through Plato's various attacks on epistemological problems. No summary can do justice to his remarkable success." --Ronald B. De Sousa, University of Toronto, in Phoenix.

A step by step, passage by passage analysis of the complete Republic. White shows how the argument of the book is articulated, the important interconnections among its elements, and the coherent and carefully developed train of though which motivates its complex philosophical reasoning. In his extensive introduction, White describes Plato's aims, introduces the argument, and discusses the major philosophical and ethical theories embodied in the Republic. He then summarizes each of its ten books and provides substantial explanatory and interpretive notes.

This volume brings together Nicholas Wolterstorff's essays on epistemology written between 1983 and 2008.

Participation in religious liturgies and rituals is a pervasive and complex human activity. This book discusses the nature of liturgical activity and the various dimensions of such activity. Nicholas Wolterstorff focuses on understanding what liturgical agents actually do and shows religious practice as a rich area for philosophical reflection.

This volume presents influential work by Nicholas Wolterstorff at the intersection between political philosophy and religion, alongside nine new essays on the nature of liberal democracy, human rights, and political authority. These novel essays offer an attractive alternative to the public reason liberalism defended by thinkers such as John Rawls.

Scientific revolution is a widely known concept. But does revolution really occur in science? Change through revolution means that present thinking does not retain anything from the past, because everything is thrown away due to the revolution. Does this pattern of change really correspond to the history of science? There is another pattern which is called evolution. This writing will show that process of evolution rather than revolution presents the real situation of scientific change. According to this concept, science grows (...) as an organic species grows in certain environment. An organism is different from its every former stage, yet it remains the same organism throughout its life. In the same way, we will find both change and continuity in scientific growth. (shrink)

For a century or more political theology has been in decline. Recent years, however, have seen increasing interest not only in how church and state should be related, but in the relation between divine authority and political authority, and in what religion has to say about the limits of state authority and the grounds of political obedience. In this book, Nicholas Wolterstorff addresses this whole complex of issues. He takes account of traditional answers to these questions, but on every (...) point stakes out new positions. Wolterstorff offers a fresh theological defense of liberal democracy, argues that the traditional doctrine of 'two rules' should be rejected and offers a fresh exegesis of Romans 13, the canonical biblical passage for the tradition of Christian political theology. This book provides useful discussion for scholars and students of political theology, law and religion, philosophy of religion and social ethics. (shrink)

Three thoughts strongly influence recent work on sensory imagination, often without explicit articulation. The image thought says that all mental states involving a mental image are imaginative. The attitude thought says that, if there is a distinctive imaginative attitude, it is a single, monolithic attitude. The function thought says that the functions of sensory imagination are identical or akin to functions of other mental states such as judgment or belief. Taken together, these thoughts create a theoretical context within which eliminativism (...) appears attractive. Eliminativism is the idea that we needn’t refer to a distinctive attitude in order to characterize sensory imagination: the attitudes involved in other states provide all the resources we need. Peter Langland-Hassan’s account of sensory imagination provides an example of such eliminativism. Via close examination of this account, I make manifest the three thoughts and their collective tendency to support eliminativism. I argue that all three are dubious, and that we should reject eliminativism; we need a distinctive imaginative attitude if we are to adequately explicate sensory imagination. (shrink)

In “Artistic Worth and Personal Taste,” Jerrold Levinson develops a problem for those who think we should strive to be “ideal critics” in our aesthetic lives. He then offers several solutions to this problem. I argue that his solutions miss the mark and that the problem he characterizes may not be genuine after all.

White opposes the long-standing view that ancient Greek ethics is fundamentally different from modern ethical views. He examines the ways in which Greek ethics has been interpreted since the 18th century, and traces the history in Greek ethical thought of the idea of conflict among human aims, in particular the conflict between conformity to ethical standards and one's own happiness.

In lieu of an abstract, here is a brief excerpt of the content:Minding Brain Injury, Consciousness, and Ethics: Discourse and DeliberationsJoseph J. Fins (bio) and James Giordano (bio)The annual John Collins Harvey Lecture at the Georgetown University’s Pellegrino Center for Clinical Bioethics is a forum for addressing contemporary topics at the intersection of medicine and bioethics. This year, in marking the decadal anniversary of the launch of the Brain Research through Advancing Innovative Neurotechnology (BRAIN) Initiative, the Harvey Lecture provided an (...) interactive discussion with renowned clinician, researcher, scholar, and author, Joseph J. Fins, MD—who is the E. William Davis, Jr., MD Professor of Medical Ethics, Chief of the Division of Medical Ethics, and a Professor of Medicine at Weill Cornell Medical College—conducted by James Giordano, PhD, MPhil—who is a Professor of Neurology and Biochemistry, and Chief of the Pellegrino Center’s Neuroethics Studies Program at the Georgetown University Medical Center. The discourse focused upon the topic of covert consciousness, and the ways in which current and developing brain science technologies, together with revised practices of medicine, in general, may afford new opportunities in patient care, but may also give rise to issues, questions, challenges, and opportunities for neuroethics.Prof. James GIORDANO:Prof. Fins, your most recent book, Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness (Fins 2015), addresses your ongoing work to employ current and emerging neurological approaches to reveal conscious functions in patients with profound brain injury and disease. To be sure, the destination—if you will—is to talk about covert consciousness. But in commencing this discussion, I’d like to propose a route, which traces your professional journey to this point in your career, and how it led you on your search to reveal consciousness in those patients who lack expressive capability. You went into palliative care first, and that brought you to where you are today. [End Page 227]Prof. Joseph J. FINS:First, let me thank you and the Pellegrino Center for the honor of giving the John Harvey Collins Lecture in such an interactive manner. The forefront of neurological care—and the neuroethical issues and methods focal to such practice—wasn’t what I initially intended to do professionally, but I think that therein is a good lesson for young people’s career aspirations. Simply put, one doesn’t always know where they’ll end up at the beginning of the journey, and as Kierkegaard said, life is lived forward, but is understood backwards (Kierkegaard 1843).In the nineties and the early 2000s, I was trying to help improve the quality of care of people at the end of life, and I wrote a book, entitled The Palliative Ethic of Care: Clinical Wisdom at Life’s End (Fins 2006), in which I addressed notions of phronesis—practical wisdom—in integrating theory and practice toward improving how people die. I became interested in the Quinlan case (Quinlan 1976), and the right to die, and around the same time, I ran into a colleague of mine at Cornell: Dr. Nicholas D. Schiff. Dr. Schiff is a neurologist, who was a protégé of Fred Plum, who was the originator of the concept of the vegetative state with Bryan Jennett, back in 1972. Fred was both of our teachers here at Cornell. Niko (Dr. Schiff) was interested in patients with disorders of consciousness, and was beginning to envision doing work—that ultimately, we did—using deep brain stimulation (DBS) to try to treat patients in the minimally conscious state, a category that was subsequently codified in 2002.I realized that a whole population of people—with these disorders of consciousness—had been somewhat marginalized, and their neglect essentially devolves back to the considerations of the right to die. The right to die was established in the Quinlan case because Judge Hughes—the presiding chief judge of the New Jersey Supreme Court—talked about Ms. Quinlan’s loss of a cognitive, sapient state as being the moral warrant for her right to die, given the fact that it was viewed as a futile situation. I recognized, over the ensuing years—from my background in palliative and end-of-life care—[1] that we had over-generalized notions of futility... (shrink)

This case looks at the question of how to consider obligations of confidentiality by a mental health professional who works for an institution and learns that a student has been using a drug intended for an animal research project. Dr. Paul Appelbaum, MD, a psychiatrist at Columbia University, examines the issue of the limits of confidentiality. Nicholas Steneck, PhD, a scholar in research misconduct at the University of Michigan, explores the obligations to report research misconduct. Walter Limehouse, MD, an (...) ethicist at the Medical University of South Carolina, considers the systems issues raised by this case and offers some suggestions that might change the institutional environment. (shrink)

Reflectance physicalists define reflectance as the intrinsic disposition of a surface to reflect finite-duration light pulses at a given efficiency per wavelength. I criticize the received view of dispositional reflectance (David R. Hilbert’s) for failing to account for what I call “harmonic dispersion,” the inverse relationship of a light pulse's duration to its bandwidth. I argue that harmonic dispersion renders reflectance defined in terms of light pulses an extrinsic disposition. Reflectance defined as the per-wavelength efficiency to reflect the superimposed, infinite-duration, (...) Fourier harmonics of pulses can be an intrinsic disposition of surfaces. This conclusion raises questions about mathematical realism, about which I nevertheless remain neutral. (shrink)