Background In earlier work, we found important selection biases when we tried to obtain consent for participation in a national stroke registry. Recognizing that not all registries will be exempt from requiring consent for participation, we examine here in greater depth the reasons for the poor accrual of patients from a systems perspective with a view to obtaining as representative sample as possible. Methods We determined the percent of eligible patients who were approached to participate and, among those approached, the (...) percent who actually consented to participate. In addition we examined the reasons why people were not approached or did not consent and the variation across sites in the percent of patients approached and consented. We also considered site variation in restrictions on the accrual and data collection process imposed by either the local research ethics board or the hospital. Results Seventy percent of stroke patients were approached, with wide variations in approach rates across sites (from: 41% to 86%), and considerable inter-site variation in hospital policies governing patient accrual. Chief reasons for not approaching were discharge or death before being approached for consent. Seventeen percent of those approached refused to participate (range: 5% to 75%). Finally, 11% of those approached did not participate due to language or communication difficulties. Conclusion We found wide variation in approach and agree rates across sites that were accounted for, in part, by different approaches to accrual and idiosyncratic policies of the hospitals. This wide variation in approach and agree rates raises important challenges for research ethics boards and data protection authorities in determining when to waive consent requirements, when to press for increased quality control, when to permit local adaptation of the consent process, and when to permit alternatives to individual express consent. We offer several suggestions for those registries that require consent for participation. (shrink)

It describes and explains the patient-centered model examining and evaluating qualitative and quantitative research. It comprehensively covers the evolution and the six interactive components of the patient-centered clinical method, taking the reader through the relationships between the patient and doctor and the patient and clinician. All the editors are professors in the Department of Family Medicine at the University of Western Ontario, London, Canada.

This extremely accessible textbook provides a wide-ranging analysis of the relations between philosophy and feminist thought. Examining not only feminist critiques of philosophical ideas, Gatens also looks at the ways in which feminist theory can be informed by philosophical analysis and debates. Gatens adopts an historical approach, beginning with an analysis of Mary Wollstonecraft's critique of Rousseau. She then examines attempts by Harriet Taylor and J. S. Mill to extend liberal principles to women's situation. Other chapters discuss the work of (...) more recent philosophers, including Simone de Beauvoir, Luce Irigaray, Mary Daly and Dale Spender. Gatens concludes with a discussion of current debates in the politics of sexual difference. (shrink)

Preface Giambattista Vico (1668-1744) was throughout his mature years professor of Latin Eloquence at the University of Naples. His works, first written in ...

What is the relation between a reason and an action when the reason explains the action by giving the agent's reason for doing what he did? We may call such explanations rationalizations, and say that the reason rationalizes the action. In this paper I want to defend the ancient - and common-sense - position that rationalization is a species of ordinary causal explanation. The defense no doubt requires some redeployment, but not more or less complete abandonment of the position, as (...) urged by many recent writers. (shrink)

Did George Eliot’s work as translator of the critical writings on religion of Ludwig Feuerbach and Benedict Spinoza influence her work as a novelist? Did she hold a comprehensive philosophy of religion? Through an examination of her non-fictional and fictional writings this chapter argues that we should take seriously Eliot’s claim that her novels are ‘experiments in life’. Building on the critiques of religion offered by Spinoza and Feuerbach, Eliot’s novels address the philosophical question: is morality possible in a godless (...) world? The capacities necessary to a moral life are imagination, sympathy, and reflection. Her fiction contributes to the reformation of moral consciousness by experimenting with the interplay between these capacities. (shrink)

Modern, or continental, rationalism refers to the works of the seventeenth‐century philosophers René Descartes, Baruch Spinoza, and Gottfried Leibniz. While there is much to mark each philosopher off from the others, there are nevertheless several shared fundamental assumptions that warrant the common title of “rationalist.” Each philosopher believed that mathematics and geometry were appropriate models on which to base philosophical methodology. Each, whilst critical of founding knowledge on mere faith – which they believed could only lead to skepticism – nevertheless (...) relied on theological arguments at various points in their philosophies. All three philosophers share a distrust of the notion that sensation, emotion (passion), and the body are capable of providing knowledge. Reason alone, on all three philosophers' accounts, is the a priori faculty which can provide secure foundations for human knowledge. It is Descartes' philosophy that has received most critical attention from feminist theorists. Spinoza has received less attention and Leibniz is all but ignored. At the end of this article, some attempt will be made to explain this uneven treatment of the modern rationalists. (shrink)

"Davidson begins by harking back to an early interest in the classics, and an even earlier engagement with the workings of grammar. In the pleasures of diagramming sentences in grade school, he locates his first glimpse into the mechanics of how we conduct the most important activities in our life - such as declaring love, asking directions, issuing orders, and telling stories. Davidson connects these essential questions with the most basic and yet hard to understand mysteries of language use - (...) how we connect noun to verb. This is a problem that Plato and Aristotle wrestled with, and Davidson draws on their thinking to show how an understanding of linguistic behavior is critical to the formulating of a workable concept of truth. Against a whole army of contemporary philosophers, Davidson argues that the concept of truth is not ambiguous.". (shrink)

Institutional Review Boards are confronted with new challenges in the face of expanding technologies while fulfll-ing their existing regulatory mandate to ensure that plans are in place to protect subjects and to inform them of risks and benefts of research participation. Existing regulations and guidance do not address the issue of incidental fndings , thus leaving awareness of the issue and the application of ethical principles to IRB judgment alone. In order to assure that researchers are aware of the potential (...) for IFs, IRBs must identify which studies are likely to identify IFs and establish what plans should be put into place prior to study initiation to assure the subjects are appropriately informed of the likelihood of IFs, how IFs will be communicated to subjects, and whether the burden of follow-up falls on the researchers or is the subject's responsibility. (shrink)

With rapidly expanding technological capacity, research has outpaced the existing infrastructure of ethical and regulatory guidance. In the area of incidental findings, this is particularly true.The regulations under which most Institutional Review Boards operate were established over 25 years ago and have not been substantially altered in the intervening years. The technology available today that creates the opportunity for IFs was not conceived of, or considered, in the crafting of those regulations. Therefore, little guidance can be derived directly from these (...) regulations. Rather, aspects of existing ethical guidance and regulations can be adapted to assist IRBs and researchers in dealing with issues surrounding IFs. (shrink)

Clarke, Moira On the East coast of America, every 13 or 17 years, billions of red-eyed magicicadas emerge from underground. For the next few weeks every tree resounds with a near-deafening symphony, a courting ritual that has been measured at 94 decibels. Finally, the resulting offspring burrow back into the earth, there to remain inactive for the exact same duration, 13 or 17 years.

It has typically been assumed that affective and social components of disagreement, such as trust and fair treatment, can be handled separately from substantive components, such as beliefs and logical principles. This has freed us to count as “deep” disagreements only those which persist even between people who have no animosity towards each other, feel equal to one another, and are willing to argue indefinitely in search of truth. A reliance on such ideal participants diverts us from the question of (...) whether we have swept away the opportunity for some real arguers to have their voices heard, and for those voices to determine the real substance of the disagreement. If affective and social issues need to be assessed side by side with belief differences and reasoning paradigms, investigating trust may assist us to understand and make progress on the affective and social components that are involved in disagreement. (shrink)

For individuals pursuing medically assisted gender transition, gender-affirming surgical treatments, such as oophorectomy (removal of the ovaries) and orchiectomy (removal of the testicles), cause sterility, and gender-affirming hormone treatment with medications (i.e., testosterone and estrogen) may negatively impact infertility. The major United States (US) medical associations already endorse fertility preservation (FP) through cryopreservation (i.e., “freezing” egg and sperm) for transgender individuals. Despite these endorsements from the relevant medical societies, medical insurance coverage for FP remains very limited in the US. Given (...) the high out-of-pocket costs for FP services, fertility preservation remains financially out of reach for many transgender individuals who may desire it. We present an ethical justification for universal FP coverage for all transgender and gender diverse (TGD) individuals who request this option during medically assisted gender transition. First, we argue that gender-affirming medical care is analogous to other medical interventions and treatment regimens that compromise fertility, such as cancer care, and that both types of interventions need to be afforded the same medical benefits and assistance in pursuing fertility goals. Second, we argue that the lack of FP for transgender individuals contributes to the ongoing and profound transphobia and anti-trans bias that has been exacerbated in the past several years across the healthcare landscape in the United States. We argue that the provision of FP coverage for transgender individuals is necessary for clinicians and third-party payers to state their unequivocal support for TGD patients and their healthcare needs. (shrink)

Moira Howes and Catherine Hundleby ABSTRACT: While anger can derail argumentation, it can also help arguers and audiences to reason together in argumentation. Anger can provide information about premises, biases, goals, discussants, and depth of disagreement that people might otherwise fail to recognize or prematurely dismiss. Anger can also enhance the salience of certain premises...

Debates about female genital mutilation/cutting have polarized opinion between those who see it as an abuse of women’s health and human rights, to be ‘eradicated’, and those who may or may not oppose the practice, but see a double standard on the part of western campaigners who fail to challenge other unnecessary surgical interventions — such as male circumcision or cosmetic surgery — in their own communities and cultures. This article interrogates these debates about FGM/c in the context of measures (...) to reduce it in the UK over recent decades. It does not suggest that FGM/c is a legitimate practice, seeing it, rather, as an abuse of women’s and children’s rights that should be combated using a combination of measures. However, it argues that reduction strategies are undermined by inconsistencies in the law and the failure to back up the law with research and education. (shrink)

While anger can derail argumentation, it can also help arguers and audiences to reason together in argumentation. Anger can provide information about premises, biases, goals, discussants, and depth of disagreement that people might otherwise fail to recognize or prematurely dismiss. Anger can also enhance the salience of certain premises and underscore the importance of related inferences. For these reasons, we claim that anger can serve as an epistemic resource in argumentation.

Students in critical thinking courses are often instructed to "read carefully" as a prerequisite to thinking critically. This instruction, which seems like a simple preliminary caution, in fact reveals controversial assumptions about how readers read, and whether critical thinking instruction presupposes the reading skill it purports to teach.

Sets out Catholic teaching on hotly debated issues such as stem cell research, reproductive technologies, euthanasia and much more.

In the Treatise of Human Nature , Hume argues that, because we have adequate ideas of the smallest parts of space, we can infer that space itself must conform to our representations of it. The paper examines two challenges to this argument based on Descartes's and Locke's treatments of adequate ideas, ideas that fully capture the objects they represent. The first challenge, posed by Arnauld in his Objections to the Meditations , asks how we can know that an idea is (...) adequate. The second challenge, implicit in Locke's Essay , asks how an empiricist can characterize an idea as inadequate, as both picking out an object and yet failing to capture it fully. In showing how Hume responds to these challenges, his theory of perceptual representation is explained and his treatment of space is related to his scepticism. His conclusion is shown not to be a characterization of space as it exists wholly apart from our powers of conception. Instead, in an adumbration of Kant, his claim is restricted to space as it appears to us. (shrink)

Moira Gatens investigates the ways in which differently sexed bodies can occupy the same social or political space. Representations of sexual difference have unacknowledged philosophical roots which cannot be dismissed as a superficial bias on the part of the philosopher, nor removed without destroying the coherence of the philosophical system concerned. The deep structural bias against women extends beyond metaphysics and its effects are felt in epistemology, moral, social and political theory. The idea of sexual difference is contextualised in (...) _Imaginary Bodies_ and traced through the history of philosophy. Using her work on Spinoza, Gatens develops alternative conceptions of power, new ways of conceiving women's embodiment and their legal, political and ethical status. (shrink)

There is more than one way to say that composition is identity. Yi has distinguished the Weak Composition thesis from the Strong Composition thesis and attributed the former to David Lewis while noting that Lewis associates something like the latter with me. Weak Composition is the thesis that the relation between the parts collectively and their whole is closely analogous to identity. Strong Composition is the thesis that the relation between the parts collectively and their whole is identity. Yi is (...) right that Strong Composition does not fully reflect my view. We must recognize further what, borrowing Lewis's characterization, could be called the "stronger, and stranger" Composition thesis, or what I'll call the Stronger Composition thesis for short. On Strong Composition, it is only collectively that the parts are identical with the whole. On Stronger Composition, they are individually identical with it as well. I will explain and motivate this thesis. (shrink)

Different sectors have expressed the need to address the different notions of pluralism that characterize modern society, as well as their difficulties. The article provides a critical reading of three significantly different approaches to the issue: Chantal Mouffe's On the Political, John Rawls' Political Liberalism, and William E. Connolly's Pluralism. It discusses their strengths and weaknesses, as well as the possibilities they provide to understand pluralism and take their theoretical contributions to the field of practice.

Desde diversos ámbitos se ha señalado la necesidad de abordar las nociones y difi-cultades del pluralismo que caracteriza a la sociedad actual. Se busca aportar una lectura crítica de tres abordajes considerablemente diferentes del tema: En torno a lo político (2005) de Chantal Mouffe, Political Liberalism (1996) de John Rawls y Pluralism (2005) de William E. Connolly. Se sopesan sus fortalezas y debilidades, así como las posibilidades que brindan para comprender el pluralismo y llevar los aportes teóricos a la esfera (...) práctica. (shrink)

The paper applies the theoretical frameworks of epistemic injustice and narrativist philosophy of history to read the process of re-signification of an event that took place in a prison in the city of Buenos Aires, Argentina, in 1978, called “Massacre in the Seventh Ward” or “Mutiny of the Mattresses”. By looking into this case, we explore the exercise of epistemic resistance through category expansion, drawing on the most recent developments on hermeneutical injustice as a deficiency in the application (and not (...) only in the content) of the available concepts. This allows us to identify the selected case as an example of hermeneutical injustice, and to highlight some characteristics of such injustice that remain under-analysed in the specialised literature, linked to agency, temporality, and the concrete forms adopted by resistance. Among the latter, we highlight the role that can be played by the exercise of what in philosophy of history has been called the “practical past”: an intervention in the dispute of meanings about the past, born out of an explicit commitment to the present. Finally, the conclusions present some caveats to be considered in the study of epistemic injustice in the context of institutions such as prisons. (shrink)

Phronesis is often described as a ‘practical wisdom’ adapted to the matters of everyday human life. Phronesis enables one to judge what is at stake in a situation and what means are required to bring about a good outcome. In medicine, phronesis tends to be called upon to deal with ethical issues and to offer a critique of clinical practice as a straightforward instrumental application of scientific knowledge. There is, however, a paucity of empirical studies of phronesis, including in medicine. (...) Using a hermeneutic and phenomenological approach, this inquiry explores how phronesis is manifest in the stories of clinical practice of eleven exemplary physicians. The findings highlight five overarching themes: ethos (or character) of the physician, clinical habitus revealed in physician know-how, encountering the patient with attentiveness, modes of reasoning amidst complexity, and embodied perceptions (such as intuitions or gut feeling). The findings open a discussion about the contingent nature of clinical situations, a hermeneutic mode of clinical thinking, tacit dimensions of being and doing in clinical practice, the centrality of caring relations with patients, and the elusive quality of some aspects of practice. This study deepens understandings of the nature of phronesis within clinical settings and proposes ‘Clinical phronesis’ as a descriptor for its appearance and role in the daily practice of (exemplary) physicians. (shrink)