Thus far, little work in bioethics has specifically focused on global health research priority-setting. Yet features of global health research priority-setting raise ethical considerations and concerns related to health justice. For example, such processes are often exclusively disease-driven, meaning they rely heavily on burden of disease considerations. They, therefore, tend to undervalue non-biomedical research topics, which have been identified as essential to helping reduce health disparities. In recognition of these ethical concerns and the limited scholarship and dialogue addressing them, we (...) convened an international workshop in September 2015. The workshop aimed to initiate discussion on the appropriate relationship between global and national levels of health research priority-setting and to begin exploring what might be ethically required for priority-setting at each of those levels. This paper comprises our reflections following the workshop. Its main objective is to launch a research agenda for the ethics of global health research priority-setting. We identify three domains of global health research priority-setting—scope, underlying values and substantive requirements, and procedural considerations. For each domain, specific research questions are highlighted and why they need to be explored is explained. Some preliminary thoughts and normative arguments as to how the research questions might be answered are also offered. For example, we provide initial ideas about the appropriate relationship between different priority-setting levels and what values and substantive considerations should guide or underpin global health research priority-setting as a matter of justice. We anticipate that framing a new research agenda for the ethics of global health research priority-setting will spur ethicists, researchers, and policymakers to refocus their efforts on developing more rigorous and ethically sound approaches to priority-setting. (shrink)

In recent years, the case has been made for special attention to be paid to a branch of research in the field of bioethics called ‘translational bioethics’. In this paper, we start by considering some of the assumptions that those advancing translational approaches to bioethics make about bioethics and compare them to the reality of bioethics as an academic field. We move on to explain how those who make this case, implicitly or explicitly, for translational bioethics go awry because of (...) how they understand the ‘gap’ between bioethical inquiry and practical settings that requires bridging. We consider three interpretations of this ‘translation gap’ in bioethics: (i) the gap between theory and practice, (ii) the gap between the force of normative claims and practical contextual realities and (iii) the gap between relevance or applicability to practice and actual application or implementation in practice. In each case, we show how a proper understanding of the nature of the academic field of bioethics undermines how these gaps have been formulated, and how any need for talk of ‘translational bioethics’ is removed. (shrink)

Many research institutions and funders have recently stated their commitment to actively support and promote ‘Equality, Diversity and Inclusion’ (EDI) in various aspects of health research including Patient and Public Involvement (PPI). However, translating this commitment into specific research projects presents significant challenges that existing approaches, practical guidelines and initiatives have not adequately addressed. In this paper, we explore how the lack of clear justifications for the EDI commitment in existing guidelines inadvertently complicates the work of those involved with PPI (...) and we stress the need for conceptual clarity for any EDI effort to yield meaningful results. Our focus centres on the first principle of the EDI discourse, ‘equality’, particularly in the form of ‘equality of opportunity’ as outlined in current guidance provided by the National Institute of Health Research in the United Kingdom. We examine challenges related to justifying and implementing a general, unspecified commitment to equality of opportunity and explain that this reflects a lack of consensus regarding the moral value of PPI in research – a profound problem that remains unaddressed. We then discuss how the presence of several opposing moral perspectives on PPI, makes determining the most appropriate way of addressing barriers to involvement complex and controversial, raising ethical implications for the work of health researchers, PPI specialists and coordinators. Finally we make suggestions on how future research can enrich the concept of ‘equality of opportunity’ in PPI and improve practice. While our primary focus is on the NIHR, a strong advocate of PPI in research, this analysis will point to normative and ethical considerations that may be relevant to other research institutions and funding organisations aiming to promote equality of opportunity in their public and patient involvement strategies. (shrink)

Data platforms represent a new paradigm for carrying out health research. In the platform model, datasets are pooled for remote access and analysis, so novel insights for developing better stratified and/or personalised medicine approaches can be derived from their integration. If the integration of diverse datasets enables development of more accurate risk indicators, prognostic factors, or better treatments and interventions, this obviates the need for the sharing and reuse of data; and a platform-based approach is an appropriate model for facilitating (...) this. Platform-based approaches thus require new thinking about consent. Here we defend an approach to meeting this challenge within the data platform model, grounded in: the notion of ‘reasonable expectations’ for the reuse of data; Waldron’s account of ‘integrity’ as a heuristic for managing disagreement about the ethical permissibility of the approach; and the element of the social contract that emphasises the importance of public engagement in embedding new norms of research consistent with changing technological realities. While a social contract approach may sound appealing, however, it is incoherent in the context at hand. We defend a way forward guided by that part of the social contract which requires public approval for the proposal and argue that we have moral reasons to endorse a wider presumption of data reuse. However, we show that the relationship in question is not recognisably contractual and that the social contract approach is therefore misleading in this context. We conclude stating four requirements on which the legitimacy of our proposal rests. (shrink)

Research involving adults who lack capacity to consent relies on proxy (or surrogate) decision making. Proxy decisions about participation are ethically complex, with a disparity between normative accounts and empirical evidence. Concerns about the accuracy of proxies’ decisions arise, in part, from the lack of an ethical framework which takes account of the complex and morally pluralistic world in which proxy decisions are situated. This qualitative study explored the experiences of family members who have acted as a research proxy in (...) order to develop an understanding of the ethical concepts involved, and the interactions between those concepts. Proxies described a complex process of respecting the wishes and preferences of the person they represented, whist integrating preferences with what they viewed as being in the interests of the person. They aimed to make a decision that was ‘best’ for the person and protected them from harm; they also aimed to make the ‘right’ decision, viewed as being authentic to the person’s values and life. Decisions were underpinned by the relationship between the person and their proxy, in which both trust and trustworthiness were key. Proxies’ decisions, based both on respect for the person and the need to protect their interests, arose out of their dual role as both proxy and carer. The findings raise questions about accounts which rely on existing normative assumptions with a focus on accuracy and discrepancy, and which fail to take account of the requirement for proxies to make authentic decisions that arise out of their caring obligations. (shrink)

Currently, research ethics committees in the UK meet behind closed doors—their workings and most of the content of their decisions are unavailable to the general public. There is a significant tension between this current practice and a broader societal presumption of openness. As a form of public institution, the REC system exists to oversee research from the perspective of society generally.An important part of this tension turns on the kind of justification that might be offered for the REC system. In (...) this paper I adapt Daniels and Sabin’s accountability for reasonableness model for just resource allocation to the research ethics context to provide some structural legitimacy and to enable progress on the question of openness. After considering the consequences of adopting this model for open REC meetings, I then examine some reasons that might be offered against open meetings. These arguments do not overwhelm the core intuitions behind the presumption of openness but they do, I suggest, give us reason to retreat from fully public meetings. I conclude that there should be important adjustments to the system towards public accountability and that there are grounds for stopping short of fully public meetings. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 67.4 (2006) 561-569 MuseSearchJournalsThis JournalContents[Access article in PDF]Introduction: Thinking about Idols in Early Modern EuropeJonathan Sheehan University of MichiganAbstractThis essay is an introduction to a collection of six articles on early modern debates about idolatry. If the debates started in religion, however, they quickly generated political, philosophical, anthropological, and even scientific corollaries. These may appear to be abstract and theoretical questions, but (...) they produced a complex set of answers with important consequences for many people. To see what was at stake, we need look no further than the New World and its missions. If the most frequently cited texts in the collection of articles are Bartolomé de las Casas and José de Acosta, it is because the New World forced the reality of idolatry onto the wider European stage.When does an image become a god? The early Christian apologist Minucius Felix had an answer. A log "is cut, is hewn, is planed," and is still no god. A stone "is sculptured, and is polished by some abandoned man" and still is no god. A sculpture "is set up, and even yet it is not a god." But, "lo, it is adorned, it is consecrated, it is prayed to—then at length it is a god, when man has chosen it to be so, and for the purpose has dedicated it." 1If only it were that easy. Felix offered just half of the story as David Freedberg has argued. Veneration does not produce that unhealthy power that idols exert over the attentive viewer. Rather, the opposite is true: idols are venerated because they exert this power. All images seem to contain at least traces of it. They draw our eye with ineluctable command, and force themselves on our attention. The image is just a representation, of course. It has been made by humans and can only ever gesture to an absent presence. And yet, images are also effective. Their ability to move us depends on "the possibility of fusion" between image and prototype. The crucifix is always only wood or stone, but its power comes from what might be called, with Freedberg, a "sacred contagion" that penetrates from behind the veil of representation. Indeed, its value as a religious object depends on this [End Page 561] contagion. Worshipers know that those tears shed by the Virgin in anguish at Christ's broken body are, in reality, just paint over mute stone and wood. Nevertheless, they are moved by those specks of material. If not, why have a statue in the first place? "The miraculous object has an effectiveness that proceeds as if the original body were present," Freedberg notes, "but the difficulty lies in cognitively grasping that 'as if.'" 2 Men do not choose to invest images with power over their imaginations and intellects. Even before images are prayed to, before they are consecrated, they already have that power.Whatever one thinks of the phenomenology of images, there is no doubt that this super-human power of idols obsessed many people in the early modern period. An object that had no power to inspire attention and devotion was hardly a threat, after all. The enormous waves of iconoclasm that swept across Europe—Germany in the 1520s, Scotland in the late 1550s, the Netherlands in the 1560s, England in the 1640s—were not directed at decorative tiles, pews, or doorstops. They were directed exactly at those things that made the devout feel the presence of the divine. And no one was quicker to identify these powerful images than the breakers themselves, who, in their extreme acts of rage, confirmed the effects that these supposedly dead bits of wood and stone exerted over them. The man in Ulm in 1534 who defecated into "the mouth of an effigy of Christ" demonstrated his extreme revulsion at what was, in reality, merely a lump of brute material. 3 Perhaps, if asked, he would have insisted that his scatological exuberance was designed to show definitively the impotence of the... (shrink)

For the past 3 years, since acquiring formal training in healthcare ethics and philosophy, I have been one of those physicians who “does” ethics. I teach medical students and residents, write articles, speak at conferences, chair an ethics committee, and informally consult with colleagues on cases where they request advice related to ethical issues in the care of patients. These activities have been a rewarding and challenging part of my practice. There has also been a fair amount of frustration. Unfortunately, (...) both in teaching and patient care, it has been a frequent experience to finish a discussion with physicians only to be told that what I said was nice but had no bearing in the real world. In the words of a medical resident: 'You know, this ethics stuff is really a lot of crap, isn't it?'. (shrink)

"Dissecting Bioethics," edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics. The section is dedicated to the idea that words defined by bioethicists and others should not be allowed to imprison people's actual concerns, emotions, and thoughts. Papers that expose the many meanings of a concept, describe the different readings of a moral doctrine, or provide an alternative angle to seemingly self-evident issues are therefore particularly appreciated. The themes covered in the section (...) so far include dignity, naturalness, public interest, community, disability, autonomy, parity of reasoning, symbolic appeals, and toleration. (shrink)

have recently provided a compelling demonstration of enhanced attentional control under post-hypnotic suggestion. Using the classic color-word interference paradigm, in which the task is to ignore a word and to name the color in which it is printed (e.g., RED in green, say ''green''), they gave a post-hypnotic instruction to participants that they would be unable to read. This eliminated Stroop interference in high suggestibility participants but did not alter interference in low suggestibility participants. replicated this pattern and further demonstrated (...) that it is not due to a visual strategy (such as blurring or looking at a different location). As a historical footnote, we describe a ''case study'' from 18 years ago in which we observed the same result using a hypnotic instruction to a single highly suggestible individual that he could not read. The elimination of Stroop interference has important implications for both the study of attention and the study of hypnosis. (shrink)

In the Early Modern era of encyclopedias, the Bible functioned as a tool for managing and organizing the superabundance of information. From Johann Alsted to Johann Scheuchzer, this paper traces the use of the Biblical encyclopedia and the ways that the Bible was deployed to control the data that flooded the world of Early Modern scholarship. In a variety of contexts, the Bible served as a structure for generating meaningful statements from informational noise. In turn, the use of the Bible (...) as a principle of organization would have profound implications for the status of the Bible in Early Modern scholarly culture. (shrink)

This essay is an attempt to think through some of the problems of idolatry and sacrifice for the early modern period and more generally, for the constitution of religious and political community. In particular, it argues that the altars of the idols condensed two problems: first, the problem of communion, and specifically the Protestant ability to communicate with God; and second, the problem of distinction. At a time when the nature of the religious polity was in question, the analysis of (...) idolatry and sacrifice produced a conceptual structure for understanding, in anthropological fashion, the very constitution of religious and political community. In fact, this essay will suggest, this structure lives on, alive and well, among modern theorists seeking to diagnose the ailments of modernity. (shrink)

ABSTRACT The Gorgias presents us with a mystery and an enigma: Who was Callicles? And, what was Plato trying to accomplish in this dialogue? While searching for the identity of Callicles, we gain a better understanding of Plato's purpose for this dialogue, which is to use justice as a means for staking out the boundaries of four types of rhetoric. This article argues that Plato uses the Gorgias to reveal the deficiencies of sophistic nomos-centered rhetorics and an unjust sophistic phusis-centered (...) rhetoric, opening the door for a “true” rhetoric that he articulates in the Phaedrus and a universal justice based on virtue that he describes in the Republic. (shrink)

The language of ethics expertise has become particularly important in bioethics in light of efforts to establish the value of the clinical ethics consultation, to specify who is qualified to function as a clinical ethics consultant, and to characterize how one should evaluate whether or not a person is so qualified. Supporters and skeptics about the possibility of ethics expertise use the language of ethics expertise in ways that reflect competing views about what ethics expertise entails. We argue for clarity (...) in understanding the nature of expertise and ethics expertise. To be an ethics expert, we argue, is to be an expert in knowing what ought to be done. Any attempt to articulate expertise with respect to knowing what ought to be done must include an account of ethics that specifies the nature of moral truth and the means by which we access this truth or a theoretical account of ethics such that expertise in another domain is linked to knowing or being better at judging what ought to be done and the standards by which this “knowing” or “being better at judging” is determined. We conclude with a discussion of the implications of our analysis for the literature on ethics expertise in CEC. We do think that there are clear domains in which a clinical ethics consultant might be expert but we are skeptical about the possibility that this includes ethics expertise. Clinical ethics consultants should not be referred to as ethics experts. (shrink)

As the COVID-19 pandemic impacts on health service delivery, health providers are modifying care pathways and staffing models in ways that require health professionals to be reallocated to work in critical care settings. Many of the roles that staff are being allocated to in the intensive care unit and emergency department pose additional risks to themselves, and new policies for staff reallocation are causing distress and uncertainty to the professionals concerned. In this paper, we analyse a range of ethical issues (...) associated with changes to staff allocation processes in the face of COVID-19. In line with a dominant view in the medical ethics literature, we claim, first, that no individual health professional has a specific, positive obligation to treat a patient when doing so places that professional at risk of harm, and so there is a clear ethical tension in any reallocation process in this context. Next, we argue that the changing asymmetries of health needs in hospitals means that careful consideration needs to be given to a stepwise process for deallocating staff from their usual duties. We conclude by considering how a justifiable process of reallocating professionals to high-risk clinical roles should be configured once those who are ‘fit for reallocation’ have been identified. We claim that this process needs to attend to three questions that we consider in detail: (1) how the choice to make reallocation decisions is made, (2) what justifiable models for reallocation might look like and (3) what is owed to those who are reallocated. (shrink)

This interdisciplinary book considers the relationship between language and thought from a philosophical perspective, drawing both on the philosophical study of language and the purely formal study of grammar, and arguing that the two should align. The claim is that grammar provides homo sapiens with the ability to think in certain grammatical ways and that this in turn explains the vast cognitive powers of human beings. Evidence is considered from biology, the evolution of language, language disorders, and linguistic phenomena.

We read with great interest Garland, Morain and Sugarman’s manuscript on the obligations of clinicians to participate in pragmatic clinical trials (PCTs) (Garland, Morain and Sugarman 2023). We bel...

The concept of a Liberal Proviso introduced in “Neutrality and Perfectionism in Public Health” provides some ideas on how to limit excessive or unjustified interventions from...

In 1885, during initial discussions of J. C. Maxwell's celebrated thermodynamic demon, Whiting(1) observed that the demon-like velocity selection of molecules can occur in a gravitationally bound gas. Recently, a gravitational Maxwell demon has been proposed which makes use of this observation [D. P. Sheehan, J. Glick, and J. D. Means, Found. Phys. 30, 1227 (2000)]. Here we report on numerical simulations that detail its microscopic phase space structure. Results verify the previously hypothesized mechanism of its paradoxical behavior. This (...) system appears to be the only example of a fully classical mechanical Maxwell demon that has not been resolved in favor of the second law of thermodynamics. (shrink)

Tragic choices arise during the COVID-19 pandemic when the limited resources made available in acute medical settings cannot be accessed by all patients who need them. In these circumstances, healthcare rationing is unavoidable. It is important in any healthcare rationing process that the interests of the community are recognised, and that decision-making upholds these interests through a fair and consistent process of decision-making. Responding to recent calls to safeguard individuals’ legal rights in decision-making in intensive care, and for new authoritative (...) national guidance for decision-making, this paper seeks to clarify what consistency and fairness demand in healthcare rationing during the COVID-19 pandemic, from both a legal and ethical standpoint. The paper begins with a brief review of UK law concerning healthcare resource allocation, considering how community interests and individual rights have been marshalled in judicial deliberation about the use of limited health resources within the National Health Service. It is then argued that an important distinction needs to be drawn between procedural and outcome consistency, and that a procedurally consistent decision-making process ought to be favoured. Congruent with the position that UK courts have adopted for resource allocation decision-making in the NHS more generally, specific requirements for a procedural framework and substantive triage criteria to be applied within that framework during the COVID-19 pandemic are considered in detail. (shrink)

Participants in some clinical trials are at risk of being harmed and sometimes are seriously harmed as a result of not being provided with available, relevant risk information. We argue that this situation is unacceptable and that there is a moral duty to disclose all adverse clinical trial results to participants in clinical trials. This duty is grounded in the human right not to be placed at risk of harm without informed consent. We consider objections to disclosure grounded in considerations (...) of commercial interest, and we argue that these concerns are insufficient to override the moral duty to disclose adverse clinical trial results. However, we also develop a proposal that enables commercial interests to be protected, while promoting the duty to disclose adverse clinical trial results. (shrink)

This title considers whether any generalisations can be made about word order in language. The chapters, written by international scholars, draw on data from several 'disharmonic' and typologically distinct languages, including Mandarin Chinese, Basque, French, English, Hixkaryana (a Cariban language), Khalkha Mongolian, Uyghur Turkic, and Afrikaans.

Adolescent risk-taking behaviour has potentially serious injury consequences and school-based behaviour change programmes provide potential for reducing such harm. A well-designed programme is likely to be theory-based and ecologically valid; however, it is rare that the operationalisation process of theories is described. The aim of this paper is to outline how the theory of planned behaviour and cognitive behavioural therapy informed intervention design in a school setting. Teacher interviews provided insights into strategies that might be implemented within the curriculum and (...) provided detail used to operationalise theory constructs. Benefits and challenges in applying both theories are described with examples from an injury prevention programme, Skills for Preventing Injury in Youth. (shrink)

The New Yearbook for Phenomenology and Phenomenological Philosophy provides an annual international forum for phenomenological research in the spirit of Husserl's groundbreaking work and the extension of this work by such figures as Scheler, Heidegger, Sartre, Levinas, Merleau-Ponty and Gadamer.

The New Yearbook for Phenomenology and Phenomenological Philosophy provides an annual international forum for phenomenological research in the spirit of Husserl's groundbreaking work and the extension of this work by such figures as Scheler, Heidegger, Sartre, Levinas, Merleau-Ponty and Gadamer.

This important book opens a new path in Heidegger research that will stimulate dialogue within Heidegger studies, as well as with philosophers outside the phenomenological tradition and scholars in theology, literary criticism, and existential psychiatry.

In biobanks, a broader model of consent is often used and justified by a range of different strategies that make reference to the potential benefits brought by the research it will facilitate combined with the low level of risk involved (provided adequate measures are in place to protect privacy and confidentiality) or a questioning of the centrality of the notion of informed consent. Against this, it has been suggested that the lack of specific information about particular uses of the samples (...) means that such consent cannot be fully autonomous and so is unethical. My answer to the title question is a definite ‘yes’. Broad consent can be informed consent and is justified by appeal to the principle of respect for autonomy. Indeed, I will suggest that the distinction between the various kinds of consent is not a distinction between kinds of consent but between the kinds of choice a person makes. When an individual makes a choice (of any kind) it is important that they do so according to the standards of informed consent and consistent with the choice that they are making. (shrink)

When it comes to using patient data from the National Health Service for research, we are often told that it is a matter of trust: we need to trust, we need to build trust, we need to restore trust. Various policy papers and reports articulate and develop these ideas and make very important contributions to public dialogue on the trustworthiness of our research institutions. But these documents and policies are apparently constructed with little sustained reflection on the nature of trust (...) and trustworthiness, and therefore are missing important features that matter for how we manage concerns related to trust. We suggest that what we mean by ‘trust’ and ‘trustworthiness’ matters and should affect the policies and guidance that govern data sharing in the NHS. We offer a number of initial, general reflections on the way in which some of these features might affect our approach to principles, policies and strategies that are related to sharing patient data for research. This paper is the outcome of a ‘public ethics’ coproduction activity which involved members of the public and two academic ethicists. Our task was to consider collectively the accounts of trust developed by philosophers as they applied in the context of the NHS and to coproduce an argumentative position relevant to this context. (shrink)

For your students, celebrating this day is a source of rare and pure joy. The only way we can be adequate to this occasion is to let the gratitude that we owe you become the fundamental mood suffusing everything from beginning to end. In keeping with a beautiful tradition, today on this celebratory occasion we offer you as our gift this slender volume of a few short essays. In no way could this ever be an adequate return for all that (...) you, our teacher, have lavished upon us, and awakened and nourished in us. In the coming days many will try to survey your work in philosophy and to evaluate its impact and effect on various scales. In so doing, they will bring to mind many things that we should not forget. However, that way of parceling out a person's intellectual impact and of calculating the influence of his writings fails to grasp the essential matter for which we owe you our thanks. That essential element will not be found by considering how fruitful your teaching career has been. Surely such effectiveness will continue to be the prerogative and good fortune of every professor as long as German university escapes the doom of getting turned into a mind-numbing trade school. No, the essence of your leadership consists in something else, namely that the content and style of your questioning immediately forces each of us into an intense, critical dialogue, and it demands that we always be ready to reverse or even abandon our position. There is no guarantee, of course, that any of us will find our way to the one thing that, so unpretentously, your work sought to lead us to: that releasement in which one is seasoned and ready for the problems.2 So too the works we present to you are mere witnesses to the fact that we wanted to follow your guidance, not proof that we succeeded in becoming your disciples.3 But there is one thing we will retain as a lasting possession: Each of us who had the privilege of following in your footsteps was confronted by you, our esteemed teacher, with the option either of becoming the steward of essential matters or of working against them. On this celebratory occasion, as we view your philosophical existence in this light, we also acquire secure points of reference for giving a true assessment of the value of your work in philosophy. Does it consist in the fact that some decades ago a new movement emerged in philosophy and gained influence among the then-dominant trends? Or that a new method was added to the list of previous ones? Or that long-forgotten problem-areas got reworked.. (shrink)

A masterful survey of the history of Marxist philosophy of science. Now with a new afterword. Skillfully deploying a large cast of characters, Sheehan retraces the development of Marxist philosophy of science through detailed and highly readable accounts of the debates that have characterized it. Approaching Marxism from the perspective of the philosophy of science, Sheehan shows how Marx's and Engel's ideas on the development and structure of natural science had a crucial impact on the work of early (...) twentieth-century natural philosophers, historians of science, and natural scientists. From the ideas of Marx and Engels, those of the Marxist theoreticians of the Second International to the debates within Russian Marxism up to World War II, Sheehan masterfully surveys the history of marxist philosophy of science, concluding with a close analysis of the development of the debate among non-Soviet Marxists, placing particular emphasis on the contributions of leading British Marxists in the 1930s. (shrink)