It has often been argued that if a clinician cannot decide which of two treatments to offer, a trial may be ethical, but it is unethical if she/he has a preference. Since individual clinicians usually have a preference, most trials could be judged unethical according to this line of argument. A recent important article in the New England Journal of Medicine argued that individual preferences are not as important as the collective uncertainty of informed clinicians. If clinicians are equally divided, (...) there is a state of collective equipoise and a trial is ethical. However, clinicians will seldom be exactly equally divided. We conducted an ethometric study to find out how much collective equipoise can be disturbed before the potential subjects in a trial think that it is unethical. Half of our subjects perceived a trial as unethical when equipoise was disturbed beyond 70:30. In other words, when 70 per cent of experts favour one treatment, 50 per cent of subjects would prefer that treatment to be administered rather than subjected to critical assessment. When equipoise is disturbed beyond 80:20, less than 3 per cent of subjects would consider human trials morally justifiable. (shrink)

Explores the nature and types of mystical experience and discusses the value of mysticism for humanity.

In the Transcendental Aesthetic (TA), Kant is typically held to make negative assertations about “things in themselves,” namely that they are not spatial or temporal. These negative assertions stand behind the “neglected alternative” problem for Kant’s transcendental idealism. According to this problem, Kant may be entitled to assert that spatio-temporality is a subjective element of our cognition, but he cannot rule out that it may also be a feature of the objective world. In this paper, I show in a new (...) way how Kant’s view (focusing on his conclusions about space) is not subject to this objection, by showing that he does not make the denial about mind-independent reality that he is typically held to make. The argument develops consequences of a new reading of Kant’s expression “an sich selbst” (‘in itself’; ‘in themselves’). I argue that “an sich selbst” or “per se” has a special, judgment-level role, so that this expression does not form new noun-terms adjectivally. It follows that the conceptual unit of Kant’s “Conclusions” in the TA is simply “things” (Dinge), since “things in themselves” is not a nominal expression; Kant adopts the Wolffian ontological use of “thing” as the basic kind-term for any existent. The arguments that things per se are not in space are arguments that space cannot be a necessary property or relations of things as a kind. I show that this does not involve the positive claim about mind-independent reality that inspires the neglected alternative objection. (shrink)

In this paper we elaborate on the question how to bridge the gap between contemporary (New) music and the tradition of the past, often called ‘classical’ music. First we analyze the notion of tradition (in classical music) as being distinct from traditional music, nationalism and traditionalism. A central role in this paper is dedicated to the role of counterpoint education following J.J. Fux’s Gradus ad Parnassum in the development of Central-European classical music between the late Renaissance and late Romantic periods. (...) The developments in the 20th century New Music reveal several important trend breaks. The controversies raised during the early Renaissance, regarding the practice of polyphonic singing, are discussed with respect to their impact on music development in later ages. From these controversies and the re-discovery of Nicholas de Cusa’s view on mysticism, the experience of the non-experience in polyphonic music is elucidated. Herewith, an illuminative heuristic is found in the enfolding-unfolding paradigm both in music and pictural arts, from the Renaissance till the present. (shrink)

This paper explores difficulties around consent in the context of organ retention and return. It addresses the proposals of the Independent Review Group in Scotland on the Retention of Organs at Post Mortem to speak of authorisation rather than consent. Practical problems about whose consent determines disputes in relation to organ retention are explored. If a young child dies and his mother refuses consent but his father agrees what should ensue? Should the expressed wishes of a deceased adult override the (...) objections of surviving relatives? The paper suggests much broader understanding of the issues embedded in organ retention is needed to provide solutions which truly meet families' and society's needs. (shrink)

Some cognitive processes appear to have “phenomenal” properties that are directly revealed to the subject and not determined by physical properties. I suggest that the source of this appearance is the method by which our brain processes sensory information. The appearance is an illusion. Nonetheless, we are not mistaken when we judge that people sometimes fee lpain.

Thomas Kuhn's shadow hangs over almost every field of intellectual inquiry. His book The Structure of Scientific Revolutions has become a modern classic. His influence on philosophy, social science, historiography, feminism, theology, and (of course) the natural sciences themselves is unparalleled. His epoch-making concepts of 'new paradigm' and 'scientific revolution' make him probably the most influential scholar of the twentieth century. Sharrock and Read take the reader through Kuhn's work in a careful and accessible way, emphasizing Kuhn's detailed studies of (...) the history of science, which often assist the understanding of his more abstract philosophical work. These historical studies provide vital insight into what Kuhn was actually trying to achieve in his The Structure of Scientific Revolutions: an endeavour far less extreme than either his 'foes' or his 'fans' claim. In the book's second half, Sharrock and Read provide excellent explications, defences and, where appropriate, criticisms of Kuhn's central concept of 'incommensurability', and tackle head on the crucial issue of whether Kuhn's insights concerning the natural sciences can be extrapolated to other disciplines, such as the social sciences. This is the first comprehensive introduction to the work of Kuhn and it will be of particular interest to students and scholars in philosophy, theory of science, management science and anthropology. (shrink)

Prolonging neonatal lifeThe paradox that medicine’s success breeds medicine’s problems is well known to readers of the Journal of Medical Ethics. Advances in neonatal medicine have worked wonders. Not long ago, extremely premature birth babies, or those born with very serious health problems, would inevitably have died. Today, neonatologists can resuscitate babies born at ever-earlier stages of gestation. And very ill babies also benefit from advances in neonatal intensive care. Infant lives can be prolonged. Unfortunately, several such babies will not (...) survive for long whatever is done for them. Others will live to leave hospital, but face severe health problems. Doctors have gained the ability to prolong neonatal life. But should they always do so? This question is central to the recent report of the Nuffield Council on Bioethics, Critical care decisions in fetal and neonatal medicine.1 In many quarters, the report received a very positive response, commended in The Lancet as “thoughtful, sensitive and sensible” and welcomed by the premature baby charity BLISS. Critics attacked on both flanks. The report goes too far—ushering in a culture of “throw away babies”. Or it does not go far enough—failing to endorse the Dutch precedent to sanction active neonatal euthanasia.TOO FAR?One of the key recommendations of the report is that guidelines be developed in relation to the institution of intensive neonatal care. It is these guidelines, which have been savaged by some parts of the media. The BMA called them “blanket rules” smothering clinical discretion. The guidelines on resuscitation at birth apply to babies born at the borderline of viability, that is, at or before a gestational age of 25 weeks 6 days. The earlier the baby is born, the lower are the chances that he/she will survive to leave hospital. Before 21 weeks 6 days, none of …. (shrink)

Exposome research is put forward as a major tool for solving the nature-versus-nurture debate because the exposome is said to represent “the nature of nurture.” Against this influential idea, we argue that the adoption of the nature-versus-nurture debate into the exposome research program is a mistake that needs to be undone to allow for a proper bioethical assessment of exposome research. We first argue that this adoption is originally based on an equivocation between the traditional nature-versus-nurture debate and a debate (...) about disease prediction/etiology. Second, due to this mistake, exposome research is pushed to adopt a limited conception of agential control that is harmful to one's thinking about the good that exposome research can do for human health and wellbeing. To fully excise the nature-versus-nurture debate from exposome research, we argue that exposome researchers and bioethicists need to think about the exposome afresh from the perspective of actionability. We define the concept of actionability and related concepts and show how these can be used to analyze the ethical aspects of the exposome. In particular, we focus on refuting the popular “gun analogy” in exposome research, returning results to study participants and risk-taking in the context of a well-lived life. (shrink)

The Human Tissue Act 2004 is designed to regulate the storage and use of organs and tissues from the living, and the removal, storage and use of the same material from the deceased. It repeals much criticized legislation, including the Human Tissue Act 1961, and establishes a Human Tissue Authority to ensure compliance with the Act via a licensing and monitoring regime. When the Act comes into force, probably in April 2006, it will be a criminal offence not to comply (...) with certain provisions of the Act, and a new offence of DNA 'theft' will be introduced. Importantly, the Act places consent at the centre of the system, both from the living and from or on behalf of the deceased. (shrink)

Radical changes are taking place in the United Kingdom in relation to the classification of, and access to, medicines. More and more medicines are being made available over the counter both in local pharmacies and in supermarkets. The provision of more open access to medicines may be hailed as a triumph for patient autonomy. This paper examines whether such a claim is real or illusory. It explores the ethical and legal implications of deregulating medicines. Do patients benefit? What is the (...) impact on pharmacists? Are the true beneficiaries of change largely the pharmaceutical industries? (shrink)

Appearing in English for the first time, Schelling’s 1842 lectures develop the idea that many philosophical concepts are born of religious-mythological notions.

The companion piece to this article, “Situating Moral Justification,” challenges the idea that moral epistemology's mission is to establish a single, all‐purpose reasoning strategy for moral justification because no reasoning practice can be expected to deliver authoritative moral conclusions in all social contexts. The present article argues that rethinking the mission of moral epistemology requires rethinking its method as well. Philosophers cannot learn which reasoning practices are suitable to use in particular contexts exclusively by exploring logical relations among concepts. Instead, (...) in order to understand which reasoning practices are capable of justifying moral claims in different types of contexts, we need to study empirically the relationships between reasoning practices and the contexts in which they are used. The article proposes that philosophers investigate case studies of real‐world moral disputes in which people lack shared cultural assumptions and/or are unequal in social power. It motivates and explains the proposed case study method and illustrates the philosophical value of this method through a case study. (shrink)

Witnessing in merging biological, social and algorithmic realities is crucial to trust, as modelled in the YUTPA framework. Being witness and bearing witness is fundamental to human interaction. System participation in human communities of practice challenges the notion of witnessing and therefore the ability to build trust. Nevertheless, through trial and error, people in a variety of practices have found ways to establish the presence and develop trust in merging realities. This paper presents the results of 20 in-depth interviews with (...) professionals from a variety of disciplines and nations. The conclusion of cumulative analysis is that systems do not witness themselves, but their output deeply affects the mental maps that human beings make of each other, the world around them and their own self. Essential qualities human beings seek when being involved with other beings are defined by granularity and reciprocity in the design of time (duration of engagement, synchronizing performance, integrating rhythms and moments to signify), place (body sense, material interaction, emotional space and situated agency), relation (shared meaning, engagement, reputation and use) and action (tuning, reciprocity, negotiation and quality of deeds). By designing granular interaction in 4 dimensions, reciprocity in witnessing obtains significance and the basis for establishing trust in a variety of presences emerges while human agency acquires potential. (shrink)

This chapter reaches the following conclusions about laws that enhance punishment for criminal conduct prompted by group hatred or bias:Hatred should not be either a necessary or a sufficient condition for enhanced punishment.Enhanced punishment is justifiable when bias crimes display greater culpability, express disrespect for the victim’s group, or cause either greater psychic harm to the victim or group-specific outrage in the victim’s community.Properly designed bias crime laws do not improperly punish for thoughts or character.Such laws are more defensible if (...) they require that the actor’s primary motive was animus toward the disfavored group.There is no principled reason to require that such laws merely enhance punishment for an already existing parallel crime.Increasing punishment significantly because of bias may violate principles of proportionality. (shrink)

Asperó and Schindler have completely solved the Axiom [Formula: see text] vs. [Formula: see text] problem. They have proved that if [Formula: see text] holds then Axiom [Formula: see text] holds, with no additional assumptions. The key question now concerns the relationship between [Formula: see text] and Axiom [Formula: see text]. This is because the foundational issues raised by the problem of Axiom [Formula: see text] vs. [Formula: see text] arguably persist in the problem of Axiom [Formula: see text] vs. (...) [Formula: see text]. The first of our two main theorems is that Axiom [Formula: see text] is equivalent to Axiom [Formula: see text], and as a corollary we show that Axiom [Formula: see text] fails in all the known models of [Formula: see text]. This suggests that [Formula: see text] actually refutes Axiom [Formula: see text]. Our second main theorem is that the [Formula: see text] Conjecture holds assuming [Formula: see text]. This is the strongest partial result known on this conjecture which is one of the central open problems of [Formula: see text]-theory and [Formula: see text]-logic. These results identify a fundamental asymmetry between the Continuum Hypothesis and any axiom which is both [Formula: see text]-expressible and which implies [Formula: see text], on the basis of generic absoluteness for the simplest of the nontrivial sentences of Third-Order Number Theory. These are the [Formula: see text]-sentences with no parameters. Such sentences are those which simply assert the existence of a set [Formula: see text] for which some property involving only quantification over [Formula: see text] holds. (shrink)

Moral philosophers agree that welfare matters. But they disagree about what it is, or how much it matters. In this vital new work, Wayne Sumner presents an original theory of welfare, investigating its nature and discussing its importance. He considers and rejects all notable theories of welfare, both objective and subjective, including hedonism and theories founded on desire or preference. His own theory connects welfare closely with happiness or life satisfaction. Reacting against the value pluralism that currently dominates moral philosophy, (...) he advances welfare as the only basic ethical value. He concludes by discussing the implications of this thesis for ethical and political theory. Written in clear, non-technical language, and including a definitive survey of other work in this area, Sumner's book is essential reading for moral philosophers, political theorists, and welfare economists. (shrink)

We wish to describe and acknowledge the exceptional contributions to medical ethics, both in the UK and internationally, made by Edward Shotter1 who died at home on 3 July 2019. He was founder of the London Medical Group2 3 and instigator of similar student-led medical ethics groups throughout the UK; founder of the Institute of Medical Ethics4 and founder of the Journal of Medical Ethics. Ted Shotter transformed the study of medical ethics in the UK in the interests of patients (...) and professionals alike. In 1963, he established the pioneering ‘Medical Group’ model, an innovative bottom-up method whereby students in the health professions could gain a grounding in ethics that had previously been denied to the profession.5 It was with these Medical Groups that many of the leading figures in contemporary UK medical ethics and law began their careers in the subject including Sir Kenneth Calman, Sir Ian Kennedy, Professor Margaret Brazier OBE, Professor John Harris and Professor Sir Jonathan Montgomery to name but …. (shrink)

Manchester's multi-disciplinary approach to medical ethics combines established methods and new initiatives. There is a longstanding Medical Group and also, plans are evolving for the inclusion of medical ethics teaching in the undergraduate curriculum, the start of an MA in Health Care Ethics in October 1987 and the establishment of the Centre for Social Ethics and Policy to act as a focus within the university for research and study in a wider context.

This masterful work on Kant's Religion within the Boundaries of Mere Reason explores Kant's treatment of the Idea of God, his views concerning evil, and the moral grounds for faith in God. Kant and Religion works to deepen our understanding of religion's place and meaning within the history of human culture, touching on Kant's philosophical stance regarding theoretical, moral, political, and religious matters. Wood's breadth of knowledge of Kant's corpus, philosophical sharpness, and depth of reflection sheds light not only on (...) Kant, but also on the fate of religion and its relation to philosophy in the modern world. (shrink)

Developing a simple test to identify swiftly neonates with sepsis who carry the genetic variant which means that one dose of the recommended antibiotic, gentamicin, will cause the child to become profoundly deaf looks like an admirable objective. The baby needs antibiotics and needs them within 1 hour of admission to the neonatal intensive care unit. Conventional genetic tests take much longer to yield results. The test being trialled produces results in 25 min; a baby who carries the variant can (...) be treated with a different antibiotic. All the test requires is a gentle swab of the baby’s inner cheek. Babies can be treated for potentially fatal sepsis without the risk that the drugs designed to save their lives will cost them their hearing. Parents and healthcare staff are relieved of worry—a great idea? PALOH is not a trial of the safety or efficacy of the test, only to assess how feasible it will be to carry out this test in a busy NICU, without disrupting the care of the baby. A tiny painless ‘scrape’ will take a sample of DNA—what’s the fuss about? Several other invasive and painful procedures will be carried out without a fuss.1 The problem is DNA. Genetic information must be safeguarded from falling into the wrong hands. In section 45 of Human Tissue Act 2004, Parliament legislated to prohibit non-consensual DNA testing.1 It fits uncomfortably in a statute designed to regulate retention and uses of human material, after revelations that organs and tissue from the …. (shrink)

This paper will attempt to assess the primary differences between what I take to be the two primary philosophical "traditions" in contemporary French philosophy, using Derrida (transcendence) and Deleuze (immanence) as exemplary representatives. The body of the paper will examine the use of these terms in three different areas of philosophy on which Derrida and Deleuze have both written: subjectivity, ontology, and epistemology. (1) In the field of subjectivity, the notion of the subject has been critiqued in two manners, either (...) by appealing either to the transcendence of the other (Levinas, Derrida) or to the immanent jlux of experience itself, in relation to which the Ego itself is trancendent (Deleuze, Foucault, Sartre, James). (2) In the field of ontology, a purely "immanent" ontology would be an ontology in which there is neither a "beyond" or an "otherwise" Being, nor "interruptions" in Being, both of which would require an appeal to a formal element of transcendence (Deleuze). Such a "transcendent" and aporetic structure, which can never appear or be present as such within Being, is what lies at the basis of the project of deconstruction, with its attendant aporias (Derrida). (3) This distinction, finally, finds parallels in Kant's epistemology, for whom the possible experience is conditioned by purely immanent criteria (Deleuze), whereas what goes beyond the limits of possible experience is transcendent (Derrida). Drawing on these three thread of analysis, the paper concludes with an assessment of what is at stake in the ethical differences between the two traditions. The question of "transcendence" is "What mast I do?", which is the question of morality (a duty or obligation that is beyond being, an "ought" beyond the "is"). The question of "immanence" is "What can I do?" (my power or capacity as an existing individual within being). For Levinas and Derrida, ethics precedes ontology because it is derived from an element of transcendence (the Other); for Deleuze, ethics is ontology because it is derived from the immanent relation of beings to Being at the level of their existence (Spinoza). (shrink)

The purpose of this cross-sectional study was to examine whether psychosocial working conditions may be a mediator between indoor physical working conditions and the type of vague general health symptoms included in the diagnosis of sick building syndrome (SBS). The study was based on survey data from 1505 British white-collar workers from 20 different organizations. A path analysis revealed that there was a significant direct relation between physical working conditions and vague symptoms and also psychosocial job strain (Effort-Reward Imbalance ratio), (...) which in turn also strongly related to the vague symptoms. The findings thus suggested a mediating role between physical working conditions and symptoms for psychosocial job strain. Due to the cross-sectional study design no conclusions on causality can be drawn. (shrink)

Paracelsus was a transmutational alchemist: For most of his career, he believed that one metal could be turned into another. In an alchemical text, the De renovatione et restauratione, he explored the theoretical foundations of transmutation and hinted at recipes for bringing it about. He proposed that from plants, gems, metals, and minerals might be prepared a class of marvelous medicaments, which he called prima entia (first entities). Each primum ens had particular uses, but the entia were all supposed to (...) be able to revitalize the human body and cleanse it of disease. Certain entia could also transmute metals. The De renovatione et restauratione affirmed the metaphysical centrality, in goldmaking and medicine alike, not just of purification or alteration but of renewal and transformation. It expressed the author’s eschatological excitement at God’s works of wonder, whether within or above nature. (shrink)

This book provides a collection of sources, many of them fragmentary and previously scattered and hard to access, for the development of Peripatetic philosophy in the later Hellenistic period and the early Roman Empire. It also supplies the background against which the first commentator on Aristotle from whom extensive material survives, Alexander of Aphrodisias (fl. c. AD 200), developed his interpretations which continue to be influential even today. Many of the passages are here translated into English for the first time, (...) including the whole of the summary of Peripatetic ethics attributed to 'Arius Didymus'. (shrink)

Formulated by Aquinas, commented on by post-Copernican philosophers and theologians, analysed in depth by C.S. Lewis, and deliberated by some contemporary writers, the question of multiple incarnations either within humanity or amongst extra-terrestrial sentient species is all too intermittently examined: ‘Can the Christ be incarnated more than once in our reality, or somewhere else in the universe, or another reality?’ In this paper, we examine the debate and the conclusions: that is, Lewis’s position within his philosophical theology and his analogical (...) narratives; also, some contemporary philosophers of religion and theologians (Karl Rahner, with Christopher L. Fisher and David Fergusson; Sjoerd L. Bonting and William B. Drees; E.L. Mascall and Brian Hebblethwaite; Oliver Crisp and Keith Ward). How do they relate to Aquinas’s handling of the question and how do they compare with Lewis’s approach based on a theology of the imagination (grounded in Augustine and Alice Meynell)? Can Lewis resolve the argument? Could alien species have witnessed wholly different acts, equally unique, costly to God, and necessary to the process of salvation? Any answer or explanation relates to the function and purpose of the incarnation: the Fall, original sin—therefore, how we define the boundaries, limits, of atonement. (shrink)

"A potent source of inspiration for anyone interested in the therapeutic potential of Buddhism. David Brazier writes with clarity and authority about the Zen way."—Mark Epstein, M.D. author of Thoughts Without a Thinker: Psychotherapy from a Buddhist Perspective. "Comprehensive and readable... should appeal to anyone broadly interested in Buddhism."—Helen Sieroda psychosynthesis psychotherapist. In this book, psychotherapist David Brazier offers readers in the West a fresh perspective on Buddhist psychology and demonstrates how Zen Buddhist techniques are integrated into psychotherapy. (...) Writing from the viewpoint of a Western psychotherapist, Dr. Brazier successfully demystifies Buddhist psychology, explains the conceptual foundations of Buddhist thought, and with the help of vivid case studies, clearly demonstrates how a Buddhist approach can provide a practical path to personal growth. (shrink)

Modern medicine is built on a long history of medical experimentation. Experiments in the past often exploited more vulnerable patients. Questionable ethics litter the history of medicine. Without such experiments, however, millions of lives would be forfeited. This paper asks whether all the ``unethical'' experiments of the past were unjustifiable, and do we still exploit the poorer members of the community today? It concludes by wondering if Harris is right in his advocacy of a moral duty to participate in medical (...) research. (shrink)