In lieu of an abstract, here is a brief excerpt of the content:Conflicts—and Consensus—about Conflicts of Interest in MedicineMatthew K. Wynia and Bette–Jane Crigger*This fascinating collection of essays about individual experiences of conflict of interest leaves little doubt that physicians remain divided about the importance, impact and meaning of conflicts of interest in their work. These essays offer differing views about what conflicts of interest look and feel like “on the ground” and about whether specific conflicts of (...) interest are bad, just a fact of life, or maybe even good.Conflict, Conflict EverywhereThese essays situate conflict of interest in a variety of contexts: the treatment recommendations a physician makes for an individual patient; the relationship between teaching physician and medical student or practicing physician and health care organization; the interaction between academic researchers and industry collaborators or professional bodies and industry supporters. In this, the narratives taken together reflect the scope of concern about conflict of interest in medicine familiar in the literature. In his classic 1993 essay, Dennis Thompson noted that concerns about conflict of interest encompass issues of physician self–referral, risk sharing between physicians and health care institutions, gifts from industry, hospital purchasing practices, as well as sponsored research and research with patients (Thompson 1993). To that list have subsequently been added relationships with industry in medical education at all levels, physicians’ service as consultants to industry or members of industry speakers bureau, and development of clinical practice guidelines (Lo & Fields 2009).That almost none of these essays draw attention to some widely publicized situations of conflict of interest—for example, gifts to physicians or the provision of drug samples—should, we think, be seen more as an artifact of the authors’ varied individual experiences than as a failure by the authors to engage key concerns in the ongoing professional and public debate. It could also be that the authors, asked to submit personal stories, assumed that yet another essay about the ‘traditional’ issues in the conflicts of interest literature would be seen as redundant, routine or even boring. Or, there is the tantalizing possibility that the absence of some of the more familiar conflicts from these narratives is the early fruit of efforts to address these traditional issues through policies governing interactions between physicians and industry promulgated by academic medical centers and health systems, medical specialty societies, and industry.One significant area of concern that has emerged in recent years is conflict of interest in the development of clinical practice guidelines. E.g., Choudry et al. 2002; Sniderrman & Furberg 2009; Guyatt et al. 2010. Although none of the essays in this [End Page 101] collection address it head on, Perlmutter touches on several key issues. His depiction of how an FDA committee process limited the input he was able to provide as an expert, undermined his potential to contribute to the professional dialogue, and raised concerns about the objectivity of the drug approval process echoes concerns about objectivity, the role of expert opinion, and the presence on guideline development panels of individuals with financial interests in the recommendations to be developed that have been explored at some length in the literature, most recently by the Institute of Medicine in reports on evidentiary standards (Eden et al 2011) and principles for guideline development (Graham et al. 2011).Conflict of Interest or Dual Agency?Several essays set out physicians’ experience in navigating situations of diverging expectations. Bierut, for example, reflects on the disjunction between the goals and products of academic researchers and commercial sponsors. She saw herself advancing basic knowledge and was forced to grapple with the reality of sponsors’ goals to advance commercial ends as well. Nagldinne and Mikulec each recall struggles to reconcile their obligation to exercise professional judgment on behalf of patients with the demands of health care organizations focussed also on the bottom line. Cruz–Flores attests to the challenge of making recommendations for care when one is both a practicing clinician and a clinical investigator engaged in research that might offer benefit to a patient for whom there are limited options.Thompson defined conflicts of interest as “a set of conditions in which professional judgment concerning a primary interest (such as a patient’s welfare or the validity of... (shrink)

Ethics consultation at the bedside has been hailed as a better way than courts and ethics committees to empower patients and make explicit the value components of treatment decisions. But close examination of the practice of ethics consultation reveals that it in fact risks subverting those ends by interpolating a third (expert) party into the doctor-patient encounter. In addition, the practice of bioethics through consultation does the broader cultural work of fashioning a shared moral order in the face of manifestly (...) plural individual commitments. In doing so, however, bioethics furthers medicine's position as a privileged domain of public moral discourse in contemporary American society. (shrink)

Anne Barnhill focuses her article in this issue on the American Medical Association's ethics policy governing clinical use of placebos, but the implications of her analysis are deeper, touching on how physicians should make judgments about which interventions to offer patients in the process of shared decision‐making. The bottom line is that, even if an undisclosed placebo might be marginally more effective for a particular patient in the short term, over the long haul the integrity of the patient‐physician relationship relies (...) on doctors being honest with their patients. Even when it comes to placebos, honesty remains the best policy. (shrink)

Although many physicians have been using the internet for both clinical and social purposes for years, recently concerns have been raised regarding blurred boundaries of the profession as a whole. In both the news media and medical literature, physicians have noted there are unanswered questions in these areas, and that professional self-regulation is needed. This report discusses the ethical implications of physicians’ nonclinical use of the internet, including the use of social networking sites, blogs, and other means to post content (...) online. It does not address the clinical use of the internet, such as telemedicine, e-prescribing, online clinical consultations, health-related websites, use of electronic media for clinical collaboration, and e-mailing patients (some of which are already covered in the AMA’s Code of Medical Ethics). (shrink)

The Council on Ethical and Judicial Affairs of the American Medical Association examines physicians’ professional ethical responsibility in the event that the security of patients’ electronic records is breached.

Beginning Bioethics introduces students to the language of philosophical ethics before leading them in Part Two through six major issues in bioethics. The author gives clear explanations of all sides of a given issue and engages with several major contributions to the debate. This book can stand alone, but was written also to accompany the third edition of Bette-Jane Crigger's Cases in Bioethics, providing the philosophical counterpart to cases discussed there by US medical practitioners. Both books originate (...) with St Martin's Press in the United States. (shrink)

For Pleasure argues that aesthetic pleasure and formal experimentalism hold the twinned capacity to maintain a global racial order and also to undo it.

This paper explores the role of generics in social cognition. First, we explore the nature and effects of the most common form of generics about social kinds. Second, we discuss the nature and effects of a less common but equally important form of generics about social kinds. Finally, we consider the implications of this discussion for how we ought to use language about the social world.

Recent philosophy of mind has had a mistaken conception of the nature of psychological concepts. It has assumed too much similarity between psychological judgments and those of natural science and has thus overlooked the fact that other people are not just objects whose thoughts we may try to predict and control but fellow creatures with whom we talk and co-operate. In this collection of essays, Jane Heal argues that central to our ability to arrive at views about others' thoughts (...) is not knowledge of some theory of the mind but rather an ability to imagine alternative worlds and how things appear from another person's point of view. She then applies this view to questions of how we represent others' thoughts, the shape of psychological concepts, the nature of rationality and the possibility of first person authority. This book should appeal to students and professionals in philosophy of mind and language. (shrink)

English translation by Kneller and Losonsky of Klaus Reich, Die Vollständigkeit der Kantischen Urteilstafel -/- "This classic of Kant scholarship, whose first edition appeared in 1932, deals with one of the most controversial and difficult topics in the Critique of Pure Reason: Kant's table of judgments and their connection to the table of categories. Kant's attempt to derive the latter from the former is called the "Metaphysical Deduction," and it paves the way for the Transcendental Deduction that is universally recognized (...) as the heart of the Critique." "Many commentators have passed over the Metaphysical Deduction in silence, as if embarrassed by Kant's fatuity, and his critics are almost unanimous in finding its premise ungrounded, its argument incorrect, and its conclusion false. At the heart of the failure of the Metaphysical Deduction, it is alleged, is Kant's inability to justify the table of the forms of judgment. Critics argue that Kant simply took these forms of judgment from the logic textbooks of his day and doctored them so as to yield the required categories. Such objections were current even in Kant's time; they were repeated by Hegel, and are commonplaces of Kant criticism today." "This book is the fullest and most systematic evaluation ever made of the Metaphysical Deduction. Reich argues that its principal conclusion is correct even though Kant failed to establish it in the Metaphysical Deduction proper, and he defends the conclusion by using Kant material far removed from the text of the Metaphysical Deduction, notes by Kant that only became available in the 1920's and that remain even now untranslated into English. With the publication of this translation for English-speaking Kant scholars, a neglected and impugned part of the Critique of Pure Reason can finally receive the attention it deserves."--BOOK JACKET.Title Summary field provided by Blackwell North America, Inc. All Rights Reserved. (shrink)

The cornerstone of contemporary nursing practice is the provision of individualised nursing care. Sustaining and nourishing the stream of research frameworks that inform individualised care are the findings from qualitative research. At the centre of much qualitative research practice, however, is an assumption that experiential understanding can be delivered through a thematisation of meaning which, it will be argued, can lead the researcher to make unsustainable assumptions about the relations of language and meaning‐making to experience. We will show that an (...) uncritical subscription to such assumptions can undermine the researcher's capacity to represent experience at the high level of abstraction consistent with experience itself and to thus inform genuinely individualised care. Instead, using qualia as a touchstone for the possibilities of understanding and representing experience, we trace the ‘designative’ and ‘expressive’ distinction to language in order to raise critical questions concerning both these assumptions and common practices within qualitative research. Following the ‘expressive’ account of language, we foreground in particular the hermeneutic work of Gadamer through which we explore the possibilities for a qualitative research approach that would better seek the mot juste of individual experience and illuminate qualia in order to better inform genuinely individualised care. (shrink)

In the past decade, numerous ethical frameworks have been developed to support public health decision‐making in challenging areas. Before the COVID‐19 pandemic began, members of the authorship team were involved in research programmes, in which the development of ethical frameworks was planned, to guide (a) the use of new technologies for emerging infectious disease surveillance; and (b) the allocation of scarce supplies of pandemic influenza vaccine. However, as the pandemic evolved, significant practical challenges emerged that led to our questioning the (...) value of these frameworks. We now believe that a normative instrument, such as a framework, cannot adequately or reliably provide the ethical guidance that needs to be incorporated into public health decision‐making during natural disasters or infectious disease emergencies. Recently it has been suggested that there are potentially more dynamic, flexible, and effective ways to navigate decisions involving complex considerations entailed in policies and practices during a public health emergency. In this paper, we first outline the key functions of a public health ethics framework, before describing why we believe it would not be fit for purpose during a crisis. We end by considering whether proposed alternative methods to promote ethical public health decision‐making goals have the potential to meet these objectives. (shrink)

Informed by Critical Race Theory, this quantitative study supports civic educators in understanding the role of classroom climate and racial identity in students’ civic engagement during a statewide middle school civics mandate (n = 4707). Findings reveal that students of color experience higher civic engagement and lower civic attitude scores than white-identifying peers, after controlling for school, classroom, and affluence indicators. Students’ perception of whiteness (or perhaps majority status) appeared to correlate with positive civic knowledge and civic attitude, but relative (...) civic inaction. These findings suggest differences in civic outcomes as early as middle school between white-identifying students and students of color. Such differences offer implications for civic education interventions that address not only effective instruction, but civic inequities, students’ perceived agency, and curricular content. (shrink)

The recently revised Common Rule requires that donors of biospecimens for research be informed if their specimens might be used for commercial profit. The Common Rule, however, does not apply to sharing or selling de-identified biospecimens that are “leftover” from clinical uses. As a result, many medical researchers remain uncertain of their legal and ethical obligations when a commercial entity expresses interest in these specimens.

A century ago, John Dewey remarked that when home changes radically, school must change as well. With home, family, and gender roles dramatically altered in recent years, we are faced with a difficult problem: in the lives of more and more American children, no one is home. The Schoolhome proposes a solution. Drawing selectively from reform movements of the past and relating them to the unique needs of today's parents and children, Jane Martin presents a philosophy of education that (...) is responsive to America's changed and changing realities. As more and more parents enter the workforce, the historic role of the domestic sphere in the education and development of children is drastically reduced. Consequently, Martin advocates removing the barriers between the school and the home--making school a metaphorical "home," a safe and nuturant environment that provides children with the experience of affection and connection otherwise missing or inconsistent in their lives. In this proposition, the traditional schoolhouse where children are drilled in the three Rs is transformed into a "schoolhome" where learning is animated by an ethic of social awareness. At a time when many school reformers are calling for a return to basics and lobbying for skills education and quick-fix initiatives, Martin urges us to reconsider the distinctive legacies of Dewey and Montessori and to conceive of a school that integrates the values of the home with those of social responsibility. With cultural diversity and gender equality among its explicit goals, the schoolhome expands upon Dewey's edict to educate the "whole child," seeking instead to educate all children in the culture's whole heritage. Martin eloquently challenges reformers to reclaim the founding fathers' vision of the nation as a domestic realm, and to imagine a learning environment whose curriculum and classroom practice reflect not merely an economic but a moral investment in the future of our children. More than a summons to action, this remarkable book is a call to rethink the assumptions we bring to the educational enterprise, and so, to act wisely. (shrink)