Objectives: To report the attitudes and opinions of subjects in US clinical trials about whether or not, and why, they should receive post-trial access (PTA) to the trial drug, care and information. Design: Focus groups, short self-administered questionnaires. Setting: Boston, Dallas, Detroit, Oklahoma City. Participants: Current and recent subjects in clinical trials, primarily for chronic diseases. Results: 93 individuals participated in 10 focus groups. Many thought researchers, sponsors, health insurers and others share obligations to facilitate PTA to the trial drug, (...) if it benefited the subject, or to a therapeutic equivalent. Some thought PTA obligations include providing transition care (referrals to non-trial physicians or other trials, limited follow-up, short-term drug supply) or care for long-term adverse events. Others held, in contrast, that there are no PTA obligations regarding drugs or care. However, there was agreement that former subjects should receive information (drug name, dosage received, market approval date, long-term adverse effects, trial results). Participants frequently appealed to health need, cost, relationships, reciprocity, free choice and sponsor self-interest to support their views. Many of their reasons overlapped with those commonly discussed by bioethicists. Conclusion: Many participants in US trials for chronic conditions thought there are obligations to facilitate PTA to the trial drug at a “fair” price; these views were less demanding than those of non-US subjects in other studies. However, our participants’ views about informational obligations were broader than those of other subjects and many bioethicists. Our results suggest that the PTA debate should expand beyond the trial drug and aggregate results. (shrink)

In recent years, scholars have begun to lay the groundwork to justify a distinct application of ethics to the field of public health. They have highlighted important features that differentiate public health ethics from bioethics, especially public health’s emphasis on population health rather than issues of individual health. Articulations of public health ethics also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the field of public health ethics is (...) developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of public health ethics may well be global health ethics, focusing on issues of global justice. As public health ethics evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and scholars will need to develop useful tools that practitioners may employ for identifying and tackling these ethical challenges. (shrink)

Trabajo intelectual y trabajo manual -- La historia de la filosofía en la enseñanza de la filosofía -- Sobre el estoicismo -- La concepción de tiempo en el libro XI de las Confesiones de San Agustín -- Sobre la muerte.

Einstein, in his “Zur Elektrodynamik bewegter Körper”, gave a physical (operational) meaning to “time” of a remote event in describing “motion” by introducing the concept of “synchronous stationary clocks located at different places”. But with regard to “place” in describing motion, he assumed without analysis the concept of a system of co-ordinates.In the present paper, we propose a way of giving physical (operational) meaning to the concepts of “place” and “co-ordinate system”, and show how the observer can define both the (...) place and time of a remote event. Following Einstein, we consider another system “in uniform motion of translation relatively to the former”. Without assuming “the properties of homogeneity which we attribute to space and time”, we show that the definitions of space and time in the two systems are linearly related. We deduce some novel consequences of our approach regarding faster-than-light observers and particles, “one-way” and “two-way” velocities of light, symmetry, the “group property” of inertial reference frames, length contraction and time dilatation, and the “twin paradox”. Finally, we point out a flaw in Einstein’s argument in the “Electrodynamical Part” of his paper and show that the Lorentz force formula and Einstein’s formula for transformation of field quantities are mutually consistent. We show that for faster-than-light bodies, a simple modification of Planck’s formula for mass suffices. (Except for the reference to Planck’s formula, we restrict ourselves to Physics of 1905.). (shrink)

A recent exchange on Benatar’s book Better never to have been between Doyal and Benatar discusses Benatar’s bold claim that people should not be brought into existence. Here, I expand the discussion of original position that the exchange focused on. I also discuss the asymmetries, between benefit and harm and between existence and non-existence, upon which Benatar’s bold claim rests. In both discussions, I show how Benatar’s bold claim can be rejected.

The relationship between place and remembering has been a long-standing matter of phenomenological concern. The role of the 'lived body' in mediating acts of remembering in context is clearly crucial. In this paper we contribute to an 'expanded view of memory' by describing how remembering difficult or problematic events -- 'vital memories' -- draws upon inter-subjective and inter-objective relations. We discuss two conceptual tools that provide an analytic framework -- the concept of 'life space' drawn from Kurt Lewin and the (...) idea of the 'setting specificity' of remembering. From this perspective we can see that the 'lived body' does not constitute a singular unity but rather a 'plurality' of potential bodies that have 'operative solidarity' with the material relations in which they are constituted. Drawing on the work of Eduardo Viveiros de Castro, we argue that 'body memories' need to be analysed from within the embodied material-relational perspective wherein they are afforded. (shrink)

Geoffrey Rose’s prevention paradox points to a tension between two prima facie plausible moral principles: that we should save the greater number and that weshould save the most at risk. This paper argues that a novel moral theory, ex-ante contractualism, captures our intuitions in many prevention paradox cases, regardless of our interpretation of probability claims. However, it goes on to show that it might be impossible to square ex-ante contractualism with all of our moral intuitions. It concludes that even if (...) ex-ante contractualism cannot furnish an entire ethics of risk, it does identify important considerations for any such theory. (shrink)

Geoffrey Rose’s prevention paradox points to a tension between two prima facie plausible moral principles: that we should save the greater number and that weshould save the most at risk. This paper argues that a novel moral theory, ex-ante contractualism, captures our intuitions in many prevention paradox cases, regardless of our interpretation of probability claims. However, it goes on to show that it might be impossible to square ex-ante contractualism with all of our moral intuitions. It concludes that even if (...) ex-ante contractualism cannot furnish an entire ethics of risk, it does identify important considerations for any such theory. (shrink)

This article addresses the aesthetic status of gargoyles in medieval Gothic architecture. Irreducible to the grotesque yet manifestly discrepant with the core of cathedral and monastic buildings, the gargoyle serves as an entry point for an exploration of the stylistic relations comprising the Gothic and reflecting the cultural duality of the ecclesiastic sites of its historical emergence. The relation between gargoyles and the bulk of Gothic structures and ornamentation is discussed in terms of an “aesthetics of contrast.”.

FEATURED IN EVENTAL AESTHETICS RETROSPECTIVE 1. LOOKING BACK AT 10 ISSUES OF EVENTAL AESTHETICS. This article addresses the aesthetic status of gargoyles in medieval Gothic architecture. Irreducible to the grotesque yet manifestly discrepant with the core of cathedral and monastic buildings, the gargoyle serves as an entry point for an exploration of the stylistic relations comprising the Gothic and reflecting the cultural duality of the ecclesiastic sites of its historical emergence. The relation between gargoyles and the bulk of Gothic structures (...) and ornamentation is discussed in terms of an “aesthetics of contrast.”. (shrink)

I.Carl Schmitt's The Concept of the Political (1927; revised 1932 and 1933) has come to be widely recognized as a work of rare insight into the formative logic of the state. Much less apparent is that implicit within this theoretical distillation is a new type of political history. There is every indication—given the philosophical, theological, and aesthetic aspects of Schmitt's writings, no less than his overtly personal beliefs in this regard—that a history of the political relative to the modern state, (...) which is the focus of his historical interest, would entail more than the mere rarefaction of traditional, pragmatic…. (shrink)

This article begins from the assumption that what was once an integral dimension of progress—the development of literature and of art more generally—now lies outside its scope. The essay falls into three parts that juxtapose French with German intellectual history. The first part examines the notion of literary progress developed by Charles Perrault and Fontenelle, as well as the opposition to it by Boileau and other antiquarians, during the querelle des Anciens et des Modernes in the later seventeenth century. The (...) second part treats the reception of those arguments during the eighteenth century by J. C. Gottsched, J. J. Bodmer, and J. J. Breitinger. Special attention is given to the paradox that Gottsched, the leader of the German antiquarians, and Bodmer, the leader of the German progressives, were equally devoted to the Leibnizian-Wolffian philosophical system and thus that German Romanticism, heavily indebted to Bodmer's poetics, had roots in rationalist philosophy. The essay's third part discusses ideas of literary progress in the writings of the early Romantics J. G. Herder and Friedrich Schlegel. As these discussions show, the conception of general progress was formed in a field that has since dissociated itself from progress's march. (shrink)

Joseph C. Pitt, based on his understanding of trust and of technology, makes the provocative argument that trusting technology is actually a matter of trusting people. I agree with Pitt’s conclusion but differ with him on the nature of trust. I contend, nonetheless, that my understanding of trust actually reinforces Pitt’s characterization of technology as “humanity at work.”.

Since the middle of the 20th century there has been a significant debate about the attribution of capacities of living systems, particularly humans, to technological artefacts, especially computers—from Turing’s opening gambit, to subsequent considerations of artificial intelligence, to recent claims about artificial life. Some now argue that the capacities of future technologies will ultimately make it impossible to draw any meaningful distinctions between humans and machines. Such issues center on what sense, if any, it makes to claim that gadgets can (...) actually think, feel, act, live, etc. I outline this debate and offer a critique of its persistent polarization. I characterize two of the debate’s major camps (associated roughly with Turing and Searle); argue that the debate’s structure (including key assumptions inherent to each camp) precludes resolution; and, contend that some central clashes within the debate actually stem from an inadequately drawn distinction between claims about the capacities of artifacts and claims about the proper criteria for assessing such attributions. I offer a different perspective in which I: challenge some central elements of the debate that contribute to its perennially irresolvable state; hold that the debate needs to be placed more squarely in sync with how we in fact treat the attribution of such capacities to humans themselves; and, offer (unlike the other two camps) a foothold for making moral assessments of such proposed technologies. (shrink)

Since the middle of the 20th century there has been a significant debate about the attribution of capacities of living systems, particularly humans, to technological artefacts, especially computers—from Turing’s opening gambit, to subsequent considerations of artificial intelligence, to recent claims about artificial life. Some now argue that the capacities of future technologies will ultimately make it impossible to draw any meaningful distinctions between humans and machines. Such issues center on what sense, if any, it makes to claim that gadgets can (...) actually think, feel, act, live, etc. I outline this debate and offer a critique of its persistent polarization. I characterize two of the debate’s major camps (associated roughly with Turing and Searle); argue that the debate’s structure (including key assumptions inherent to each camp) precludes resolution; and, contend that some central clashes within the debate actually stem from an inadequately drawn distinction between claims about the capacities of artifacts and claims about the proper criteria for assessing such attributions. I offer a different perspective in which I: challenge some central elements of the debate that contribute to its perennially irresolvable state; hold that the debate needs to be placed more squarely in sync with how we in fact treat the attribution of such capacities to humans themselves; and, offer (unlike the other two camps) a foothold for making moral assessments of such proposed technologies. (shrink)

The practice of prenatal screening for disability is sometimes objected to because of the hurt and offence such practices may cause to people currently living with disabilities. This objection is commonly termed “the expressivist objection”. In response to the objection it is standardly claimed that disabilities are analogous to illnesses. And just as it would be implausible to suppose reduction of the incidence of illnesses such as flu sends a negative message to ill people, so it is not plausible to (...) suppose prevention of disability sends a negative message to disabled people. The expressivist objection hinges, however, upon a view of the relationship between disability and self identity which sees disability as part of the identity of the disabled person, in a way in which illnesses such as flu cannot be. This possibility is generally not considered in critiques of the expressivist objection. In this paper, an “identity claim” to the effect that disabilities can be identity constituting is accepted and the force of the expressivist argument is reconsidered in the light of its acceptance. It is concluded that even when such an identity claim is accepted, the expressivist objection is still not morally compelling. (shrink)

Persistence theories of causation – such as transference theory, conserved-quantity theory, and Douglas Ehring's theory – attempt to analyzecausation in terms of some persisting entityconnecting cause and effect. While mostpersistence accounts are intended as empiricaltheories, this article develops a persistenceanalysis of the concept of causation. The basic idea is that the central concept ofdirect causation can be analyzed in terms ofproperty acquisition. The analysis cohereswith our ordinary causal judgments andprovides a straightforward explanation of thedirection of causation. It also explains whybackwards (...) causation is conceptually problematic. (shrink)

In this article we examine ethical aspects of the involvement of children in clinical research, specifically those who are incapable of giving informed consent to participate. The topic is, of course, not a new one in medical ethics but there are some tensions in current guidelines that, in our view, need to be made explicit and which need to be responded to by the relevant official bodies. In particular, we focus on tensions between the World Medical Association Declaration of Helsinki, (...) and the guidance offered by the British Medical Association, the Royal College of Paediatrics and Child Health , and the Council for International Organizations of Medical Sciences. We conclude with a call for these organisations to make their guidance explicit in relation to the World Medical Association Declaration. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Consciousness and Machines:A Commentary Drawing on Japanese PhilosophyS. D. Noam Cook (bio)Viewed from within the great unity of consciousness, thinking is a wave on the surface of a great intuition.Kitarō NishidaIntroductionRecent developments in AI have made the long-standing debate about what computers can and can't do a major public concern. What we understand the properties of such machines to be, and consequently how we design [End Page 305] and (...) deploy them, will increasingly shape how we live and how we understand ourselves. Thus, there is an urgent need for better understanding of these issues.Susan Schneider, in her book Artificial You: AI and the Future of Your Mind, offers an exceptionally careful and insightful examination of key issues entailed in how we understand AI and ourselves. One of her central concerns is how we might test for machine consciousness. Given the variations in design and function among current and projected AIs, Schneider sees no likely one-size-fits-all test. So, she offers a battery of different tests that she believes together will make such testing more reliable. This seems a wise approach, and reflects the conceptual and pragmatic care Schneider takes throughout the book.Similarly, it seems to me that the question of machine consciousness should also include various understandings of consciousness itself. What consciousness is taken to be has varied widely both historically and culturally. No commonly accepted single understanding has emerged, and may never emerge. Just as having a battery of tests might help us better assess possible machine consciousness, having different understandings of consciousness might give us a better understanding of what we are testing for. The two should work in tandem, each gauging and shaping the other.Like the development of computers themselves, the predominant thinking about AI has been shaped, in part, by key presuppositions of a scientific worldview, with its origins in Western thought and culture. Among these presuppositions are materialism, reductionism, and a primary focus on objective behavior. These are reflected in the common concern with observable behavior of physical aspects of the brain in efforts to understand human consciousness, which in turn has become a familiar model for work on machine consciousness. All this is important and valuable work. But, in the spirit of Schneider's cautions, it should not be taken as one-size-fits-all. Accordingly, I offer one view of consciousness from a different perspective.In what follows, I sketch out an understanding of consciousness that draws on Japanese philosophy, particularly that of the highly influential early twentieth-century Japanese philosopher Kitarō Nishida (1870–1945). I then explore how the tests for machine consciousness that Schneider proposes might be viewed from that perspective.Consciousness: A Perspective from Japanese PhilosophyConsciousness was a central concern for Nishida, whose philosophy is deeply informed by Japanese culture and by Zen theory and practice. As one might expect from such a philosopher, Nishida's exploration of consciousness is not concerned with properties of the brain, but with what we might discern through disciplined reflection on the experience of our own consciousness. Ultimately, he views consciousness as an organic whole [End Page 306] of systemically organized interrelationships of activities and sensations within our subjective experience. This may be understood by first considering 'nothingness'.For Nishida, nothingness does not suggest an ultimate and absolute vacuity, as is often understandably assumed. In Nishida's sense, it is a singular "place" that mirrors the multifaceted world of our common experience. In understanding this, I am told by native Japanese speakers that the English word 'nothingness' has an advantage over the Japanese equivalent, 'mu', in that 'nothingness' can usefully be broken down as 'nothing-ness'. This suggests that nothingness is a state of consciousness where what we commonly experience as distinct (self, other, world, blue, ache, joy, etc.) is indistinct, a state of unified experience. This is consciousness without our finding or discriminating in it the myriad "things" of common experience, but rather a "pure experience" of a singular whole. Nishida introduces his concept of "pure experience" as follows:To experience means to know facts just as they are, to know in accordance with facts by completely relinquishing one... (shrink)

The very idea of informative analysis gives rise to a well-known paradox. Yet a parallel puzzle, herein called the paradox of synonymy, arises for statements which do not express analyses. The paradox of synonymy has a straightforward metalinguistic solution: certain words are referring to themselves. Likewise, the paradox of analysis can be solved by recognizing that certain expressions in an analysis statement are referring to their own semantic structures.

This paper examines one particular justification for the screening and termination of embryos/fetuses which possess genetic features known to cause disability. The particular case is that put forward in several places by John Harris. He argues that the obligation to prevent needless suffering justifies the prevention of the births of disabled neonates. The paper begins by rehearsing Harris's case. Then, drawing upon claims advanced in a recent paper in the Journal of Medical Ethics, it is subjected to critical scrutiny, focusing (...) on Harris's “suffering claim” .1 It is argued that the suffering claim must be false if understood as an empirical claim. And, even if understood as a conceptual truth, it mistakenly assimilates the concepts of harm and suffering. Finally, again focusing on Harris's recent work in this area, his characterisation of disability as a “harmed condition” is shown not to apply in the case of at least some moderate forms of intellectual disability. (shrink)

In this paper the coherence of the precautionary principle as a guide to public health policy is considered. Two conditions that any account of the principle must meet are outlined, a condition of practicality and a condition of publicity. The principle is interpreted in terms of a tripartite division of the outcomes of action . Such a division of outcomes can be justified on either “consequentialist” or “deontological” grounds. In the second half of the paper, it is argued that the (...) precautionary principle is not necessarily opposed to risk–cost–benefit analysis, but, rather, should be interpreted as suggesting a lowering of our epistemic standards for assessing evidence that there is a link between some policy and “special bad” outcomes. This suggestion is defended against the claim that it mistakes the nature of statistical testing and against the charge that it is unscientific or antiscientific, and therefore irrational. (shrink)

Background: Despite potential benefits of the return of research results to research participants, the TriCouncil Policy Statement , which reflects Canadian regulatory ethical requirements, does not require this. The policies of Canadian research ethics boards are unknown.Objectives: To examine the policies of Canadian university based REBs regarding returning results to research participants, and to ascertain if the presence/absence of a policy may be influenced by REB member composition.Design: Email survey of the coordinators of Canadian university based REBs to determine the (...) presence/absence of a policy on return of research results to research participants both during an ongoing study and at conclusion. REB coordinators were asked to return a copy of the policy or guidelines and to describe the member composition of their REB.Findings: Of 50 REBs that were contacted 34 responded and 22 met the inclusion criteria. Two had a policy that governed the return of research results while on a study, and seven following the completion of a study. Presence of an ethicist or a lawyer on the REB did not influence the presence/absence of such policies. No REBs had specific guidelines describing how participants should be informed of results.Conclusions: Most REBs did not require researchers to disclose study results to research participants either during or following a study. Thus this study identifies an ethical shortcoming in the conduct of human research in Canada. It has also demonstrated that there are no clear recommendations by REBs to facilitate the return of results to participants following research projects. (shrink)

While there is significant consensus that undergraduate medical education should include bioethics training, there is widespread debate about how to teach bioethics to medical students. Educators disagree about course methods and approaches, the topics that should be covered, and the effectiveness and metrics for UME ethics training. One issue that has received scant attention is the timing of bioethics education during medical training. The existing literature suggests that most medical ethics education occurs in the pre-clinical years. Follow-up studies indicate that (...) medical students in their clinical rotations have little recall or ability to apply ethics concepts that were learned in their pre-clinical training. Trainees also report a desire for medical ethics to be taught in the context of practical application, which would suggest that the timing of pre-clinical ethics education is flawed. However, moving bioethics training to the clinical years should not be assumed to be the solution to the problems of recall and theory application. We argue that the effectiveness of timing bioethics education will depend on when medical students witness or experience particular categories of ethical dilemmas during their training. Our overarching hypothesis is that ethics education will be most effective when the bioethics training on a particular topic correlates to experiential exposure to that ethical issue. The purpose of our current study was to describe medical students exposure to particular categories of ethical conflicts, dilemmas, or issues. Our results may help bioethics educators better strategize about the most effective timing of medical ethics training in UME. (shrink)