The solution structures of several small proteins have recently been determined from high‐resolution nuclear magnetic resonance data. The principal features of the methods available to do this are outlined here, together with the advantages, limitations and future prospects of the technique.

Early last year, the GenEthics Consortium (GEC) of the Washington Metropolitan Area convened at George Washington University to consider a complex case about genetic testing for Alzheimer disease (AD). The GEC consists of scientists, bioethicists, lawyers, genetic counselors, and consumers from a variety of institutions and affiliations. Four of the 8 co-authors of this paper delivered presentations on the case. Supplemented by additional ethical and legal observations, these presentations form the basis for the following discussion.

Accessing BRCA1/2 data facilitates the detection of disease-associated variants, which is critical to informing clinical management of risks. BRCA1/2 data sharing is complex and many practices exist. We describe current BRCA1/2 data-sharing practices, in the United States and globally, and discuss obstacles and incentives to sharing, based on 28 interviews with personnel at U.S. and non-U.S. clinical laboratories and databases. Our examination of the BRCA1/2 data-sharing landscape demonstrates strong support for and robust sharing of BRCA1/2 data around the world, increasing (...) global accesses to diverse data sets. (shrink)

A 2011 National Academies of Sciences report called for an “Information Commons” and a “Knowledge Network” to revolutionize biomedical research and clinical care. We interviewed 41 expert stakeholders to examine governance, access, data collection, and privacy in the context of a medical information commons. Stakeholders' attitudes about MICs align with the NAS vision of an Information Commons; however, differences of opinion regarding clinical use and access warrant further research to explore policy and technological solutions.

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

Different types of consent are used to obtain human biospecimens for future research. This variation has resulted in confusion regarding what research is permitted, inadvertent constraints on future research, and research proceeding without consent. The National Institutes of Health Clinical Center's Department of Bioethics held a workshop to consider the ethical acceptability of addressing these concerns by using broad consent for future research on stored biospecimens. Multiple bioethics scholars, who have written on these issues, discussed the reasons for consent, the (...) range of consent strategies, and gaps in our understanding, and concluded with a proposal for broad initial consent coupled with oversight and, when feasible, ongoing provision of information to donors. This article describes areas of agreement and areas that need more research and dialogue. Given recent proposed changes to the Common Rule, and new guidance regarding storing and sharing data and samples, this is an important and tim.. (shrink)

Understanding the clinical significance of variants associated with hereditary cancer risk requires access to a pooled data resource or network of resources—a “cancer gene variant commons”—incorporating representative, well-characterized genetic data, metadata, and, for some purposes, pathways to case-level data. Several initiatives have invested significant resources into collecting and sharing cancer gene variant data, but further progress hinges on identifying and addressing unresolved policy issues. This commentary provides insights from a modified policy Delphi process involving experts from a range of stakeholder (...) groups involved in the data-sharing ecosystem. In particular, we describe policy issues and options generated by Delphi participants in five domains critical to the development of an effective cancer gene variant commons: incentives, financial sustainability, privacy and security, equity, and data quality. Our intention is to stimulate wider discussion and lay a foundation for further work evaluating policy options more in-depth and mapping them to those who have the power to bring about change. Addressing issues in these five domains will contribute to a cancer gene variant commons that supports better care for at-risk and affected patients, empowers patient communities, and advances research on hereditary cancers. (shrink)

This book shows that the repeated announcements of the death of Hegel's philosophical system have been premature. Hegel's Philosophy of Freedom, Reality, and God brings to light accomplishments for which Hegel is seldom given credit: unique arguments for the reality of freedom, for the reality of knowledge, for the irrationality of egoism, and for the compatibility of key insights from traditional theism and naturalistic atheism. The book responds in a systematic manner to many of the major criticisms leveled at Hegel's (...) system, from Feuerbach and Kierkegaard to Heidegger and Charles Taylor. It provides detailed interpretations of Hegel's Philosophy of Spirit, large parts of his indispensable Science of Logic, and important parts of his Philosophy of Nature and Philosophy of Right. Unlike many academic books on Hegel, this one treats him very much as a 'live' thinker, whom we can learn from today. (shrink)

Essays on Philosophy and Economic Methodology By Daniel M. Hausman Cambridge University Press, 1992. Pp. 259. ISBN 0?521?41740?6. £35.00. Le Fondement de la morale: Essai d'éthiquephilosophique By André Léonard Cerf, 1991. Pp. 381. ISBN not available. FF240. The Philosophy of Time Edited By Robin Le Poidevin and Murray MacBeath Oxford University Press, 1993. Pp. 230. ISBN 0?19?823998?X. £27.50. The Ethics and Politics of Human Experimentation By Paul M. McNeill Cambridge University Press, 1993. Pp. 315. ISBN 0?521?41627?2. £35.00. Modern Conditions, Postmodern (...) Controversies By Barry Smart Routledge, 1991. Pp. 241. ISBN 0?415?06952. £10.99. Religion in Relation. Method, Application and Moral Location By Ivan Strenski Macmillan, 1993. Pp. ix + 257. ISBN 0?333?53469?7. £45.00. Robert Nozick: Property, Justice and the Minimal State By Jonathan Wolff Polity Press, 1991. Pp. ix + 168. ISBN 0?7456?0603?2. £8.95 pbk. (shrink)

Assesses the ethical problems that doctors face every day and advocates a more universal code of medical ethics, one that draws on the traditions of religion and philosophy.

_Plato's Dialectical Ethics,_ Gadamer's earliest work, has now been translated into English for the first time. This classic book, published in 1931 and reprinted in 1967 and 1982, is still important today. It is one of the most extensive and imaginative interpretations of Plato's _Philebus_ and an ideal introduction to Gadamer's thinking. It shows how his influential hermeneutics emerged from the application of his teacher Martin Heidegger's phenomenological method to classical texts and problems. The work consists of two chapters. The (...) first, which puts Socratic/Platonic dialectics and ethics in the context of Gadamer's thinking about how we come to shared understanding through conversation, helps to clarify the intentions and trajectory of all Gadamer's subsequent work. The second chapter, on the _Philebus, _will interest everyone who is concerned with the connection between Plato's discussions of ethics and those of Aristotle, and with the substantive issues of the relation between pleasure and reason that Plato explores and Gadamer interprets. This edition includes a new and useful introduction by the translator, Robert M. Wallace. (shrink)

The right to refuse medical intervention is well established, but it remains unclear how best to respect and exercise this right in life support. Contemporary ethical guidelines for critical care give ambiguous advice, largely because they focus on the moral equivalence of withdrawing and withholding care without confronting the very real differences regarding who is aware and informed of intervention options and how patient values are communicated and enacted. In withholding care, doctors typically withhold information about interventions judged too futile (...) to offer. They thus retain greater decision-making burden and face weaker obligations to secure consent from patients or proxies. In withdrawing care, there is a clearer imperative for the doctor to include patients in decisions, share information and secure consent, even when continued life support is deemed futile. How decisions to withhold and withdraw life support differ ethically in their implications for positive versus negative interpretations of patient autonomy, imperatives for consent, definitions of futility and the subjective evaluation of benefits and burdens of life support in critical care settings are explored. Professional reflection is required to respond to trends favouring a more positive interpretation of patient autonomy in the context of life support decisions in critical care. Both the bioethics and critical care communities should investigate the possibilities and limits of growing pressure for doctors to disclose their reasoning or seek patient consent when decisions to withhold life support are made. (shrink)

One of our great behavioral scientists, the bestselling author of Behave, plumbs the depths of the science and philosophy of decision-making to mount a devastating case against free will, an argument with profound consequences Robert Sapolsky's Behave, his now classic account of why humans do good and why they do bad, pointed toward an unsettling conclusion: We may not grasp the precise marriage of nature and nurture that creates the physics and chemistry at the base of human behavior, but (...) that doesn't mean it doesn't exist. Now, in Determined, Sapolsky takes his argument all the way, mounting a brilliant (and in his inimitable way, delightful) full-frontal assault on the pleasant fantasy that there is some separate self telling our biology what to do. Determined offers a marvelous synthesis of what we know about how consciousness works-the tight weave between reason and emotion and between stimulus and response in the moment and over a life. One by one, Sapolsky tackles all the major arguments for free will and takes them out, cutting a path through the thickets of chaos and complexity science and quantum physics, as well as touching ground on some of the wilder shores of philosophy. He shows us that the history of medicine is in no small part the history of learning that fewer and fewer things are somebody's "fault"; for example, for centuries we thought seizures were a sign of demonic possession. Yet, as he acknowledges, it's very hard, and at times impossible, to uncouple from our zeal to judge others and to judge ourselves. Sapolsky applies the new understanding of life beyond free will to some of our most essential questions around punishment, morality, and living well together. By the end, Sapolsky argues that while living our daily lives recognizing that we have no free will is going to be monumentally difficult, doing so is not going to result in anarchy, pointlessness, and existential malaise. Instead, it will make for a much more humane world. (shrink)

Many readers have suspected that Hegel---in arguing against Kant’s individualistic and critical way of approaching ethics and favoring instead an “ethical life” he associates with custom and habit---is in effect eliminating both individual judgment and any basis for criticism of corrupt or unjust communities. Most specialists reject this view of Hegel’s ethical theory, but they haven’t explained precisely how, on the contrary, ethical life preserves individual judgment and criticism within a new way of thinking about ethics. The goal of this (...) paper is to do that. (shrink)

Many readers have suspected that Hegel---in arguing against Kant’s individualistic and critical way of approaching ethics and favoring instead an “ethical life” he associates with custom and habit---is in effect eliminating both individual judgment and any basis for criticism of corrupt or unjust communities. Most specialists reject this view of Hegel’s ethical theory, but they haven’t explained precisely how, on the contrary, ethical life preserves individual judgment and criticism within a new way of thinking about ethics. The goal of this (...) paper is to do that. (shrink)

This major work by the German philosopher Hans Blumenberg is a monumental rethinking of the significance of the Copernican revolution for our understanding of modernity. It provides an important corrective to the view of science as an autonomous enterprise and presents a new account of the history of interpretations of the significance of the heavens for man.Hans Blumenberg is Professor of Philosophy, emeritus, at the University of Munster in West Germany. This book is included in the series Studies in Contemporary (...) German Social Thought, edited by Thomas McCarthy. (shrink)

Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the (...) circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (shrink)

An ascent routine (AR) allows a speaker to self-ascribe a given propositional attitude (PA) by redeploying the process that generates a corresponding lower level utterance. Thus, we may report on our beliefs about the weather by reporting (under certain constraints) on the weather. The chief criticism of my AR account of self-ascription, by Alvin Goldman and others, is that it covers few if any PA’s other than belief and offers no account of how we can attain reliability in identifying our (...) attitude as belief, desire, hope, etc., without presupposing some sort of recognition process. The criticism can be answered, but only by giving up a tacit—and wholly unnecessary—assumption that has influenced discussions of ascent routines. Abandoning the assumption allows a different account of ARs that avoids the criticism and even provides an algorithm for finding a corresponding lower level utterance for any PA. The account I give is supported by research on children’s first uses of a propositional attitude vocabulary. (shrink)