Edmund D. Pellegrino, John Collins Harvey, Kevin T. Fitzgerald, SJ; Must the Church be Mute Lest Its Truths be Distorted? A Response to Engelhardt, Christian bi.

BackgroundAlthough patient advocates have developed templates for standard consent forms, evaluating patient preferences for first in human (FIH) and window of opportunity (Window) trial consent forms is critical due to their unique risks. FIH trials are the initial use of a novel compound in study participants. In contrast, Window trials give an investigational agent over a fixed duration to treatment naïve patients in the time between diagnosis and standard of care (SOC) surgery. Our goal was to determine the patient-preferred presentation (...) of important information in consent forms for these trials.MethodsThe study consisted of two phases: (1) analyses of oncology FIH and Window consents; (2) interviews of trial participants. FIH consent forms were analyzed for the location(s) of information stating that the study drug has not been tested in humans (FIH information); Window consents were analyzed for the location(s) of information stating the trial may delay SOC surgery (delay information). Participants were asked about their preferred placement of the information in their own trial’s consent form. The location of information in the consent forms was compared to the participants’ suggestions for placement. Results34 [17 FIH; 17 Window] of 42(81%) cancer patients approached participated. 25 consents [20 FIH; 5 Window] were analyzed. 19/20 FIH consent forms included FIH information, and 4/5 Window consent forms included delay information. 19/20(95%) FIH consent forms contained FIH information in the risks section 12/17(71%) patients preferred the same. Fourteen (82%) patients wanted FIH information in the purpose, but only 5(25%) consents mentioned it there. 9/17(53%) Window patients preferred delay information to be located early in the consent, before the “Risks” section. 3/5(60%) consents did this.ConclusionsDesigning consents that reflect patient preferences more accurately is essential for ethical informed consent; however, a one-size fits all approach will not accurately capture patient preferences. We found that preferences differed for FIH and Window trial consents, though for both, patients preferred key risk information early in the consent. Next steps include determining if FIH and Window consent templates improve understanding. (shrink)

In many research studies, tumor biopsies are an unavoidable requirement for achieving key scientific aims. Yet some commentators view mandatory research biopsies as coercive and suggest they should be optional, or at least optional until further data are obtained regarding their scientific usefulness. Further complicating the ethical picture is the fact that some research biopsies offer a potential for clinical benefit to trial participants. We interviewed and surveyed a convenience sample of participants in phase I clinical trials at a single (...) institution. Our primary aim was to describe phase I participants’ understanding of whether a research biopsy offered them the prospect of medical benefit. We also endeavored to describe participants’ views about biopsies—specifically, the benefits of biopsies, if any, and whether biopsies were acceptable, risky, or discouraged trial participation. Finally, we collected data on demographics and attitudes to see if any strong correlations with misunderstanding, acceptability, or riskiness existed. Overall, the respondents tended to view research biopsies as acceptable, though they did not succeed in identifying the lack of benefit of a research biopsy. These findings call for renewed efforts in consent conversations and documents to carefully describe the benefits, or lack thereof, of research biopsies. (shrink)

Attention and disruptive behavior disorders present considerable challenges for children and their parents. These challenges have led to the development of parenting programs; however, there is a paucity of literature that discusses the ethical dilemmas parent training researchers face. This article reviews ethical principles and professional standards relevant to parent training research and provides case material to illustrate the challenge of balancing ethical adherence and empirical rigor using three ethical issues that commonly arise in parent training research. In particular, this (...) article focuses on ethical issues surrounding confidentiality in a group setting, use of control groups, and limiting changes in medication/treatment status outside of the treatment protocol. (shrink)

The notion that the metric field in general relativity can be understood as a property of space-time rests on a feature of the theory sometimes called universal coupling—the claim that rods and clocks “measure” the metric in a way that is independent of their constitution. It is pointed out that this feature is not strictly a consequence of the central dynamical tenets of the theory, and argued that the metric field would better be regarded as a field in space-time, rather (...) than as the very fabric of space-time itself. (shrink)

This paper questions the dogmatic stance of the domestic courts toward mandatory orders for treatment, arguing that this has the potential to subjugate patients' interests to clinical discretion, and proposing a via media to accommodate the legitimate concerns of all parties.

Although workplace bullying is common and has universally harmful effects on employees’ outcomes, little is known about workplace bullies. To address this gap in knowledge, we draw from the tenets of social exchange and displaced aggression theories in order to develop and test a model of workplace bullying that incorporates the effects of employees’ individual differences, perceptions of their work environments, and perceptions of supervisory treatment on their tendencies to bully coworkers. The results of mediated moderation analyses that examine responses (...) from two samples of working adults support our hypotheses. Specifically, we find evidence of an indirect relationship between entitlement and coworker bullying through perceptions of abusive supervision that is stronger for employees who report lower levels of felt accountability than employees who report higher levels of felt accountability. This study makes important theoretical and practical contributions to abusive supervision research, bullying research, and organizational efforts to promote ethical work environments devoid of interpersonal mistreatment by providing novel insight into how employees’ entitlement and felt accountability combine to influence their tendencies to perceive themselves as victims of abusive supervision and culprits of coworker bullying. (shrink)

An examination of crucial questions about the relationship between rationality and femininity.

CATHOLIC PERSPECTIVES AND CONTEMPORARY MEDICAL MORALS A Catholic perspective on medical morals antedates the current world wide interest in medical and biomedical ethics by many centuries[5]. Discussions about the moral status of the fetus, abortion, contraception, and sterilization can be found in the writings of the Fathers and Doctors of the Church. Teachings on various aspects of medical morals were scattered throughout the penitential books of the early medieval church and later in more formal treatises when moral theology became recog (...) nized as a distinct discipline. Still later, medical morality was incorpor ated into the many pastoral works on medicine. Finally, in the contemporary period, works that strictly focus on medical ethics are produced by Catholic moral theologians who have special interests in matters medical. Moreover, this long tradition of teaching has been put into practice in the medical moral directives governing the operation of hospitals under Catholic sponsorship. Catholic hospitals were monitored by Ethics Committees long before such committees were recommended by the New Jersey Court in the Karen Ann Quinlan case or by the President's Commission in 1983 ([8, 9]). Underlying the Catholic moral tradition was the use of the casuistic method, which since the 17th and 18th centuries was employed by Catholic moralists to study and resolve concrete clinical ethical dilem mas. The history of casuistry is of renewed interest today when the case method has become so widely used in the current revival of interest in medical ethics[ll]. (shrink)

This book is a collection of secondary essays on America's most important philosophic thinkers—statesmen, judges, writers, educators, and activists—from the colonial period to the present. Each essay is a comprehensive introduction to the thought of a noted American on the fundamental meaning of the American regime.

We consider the implications of trends in the number of U.S. farmers and food imports on the question of what role U.S. farmers have in an increasingly global agrifood system. Our discussion stems from the argument some scholars have made that American consumers can import their food more cheaply from other countries than it can produce it. We consider the distinction between U.S. farmers and agriculture and the effect of the U.S. food footprint on developing nations to argue there might (...) be an important role for U.S. farmers, even if it appears Americans don’t need them. For instance, we may need to protect U.S. farmland and, by implication, U.S. farmers, for future food security needs both domestic and international. We also explore the role of U.S. farmers by considering the question of whether food is a privilege or a right. Although Americans seem to accept that food is a privilege, many scholars and commentators argue that, at least on a global scale, food is a right, particularly for the world’s poor and hungry. If this is the case, then U.S. farmers might have a role in meeting the associated obligation to ensure that the poor of the world have enough food to eat. We look at the consequences of determining that food is a right versus a privilege and the implications of that decision for agricultural subsidies as well as U.S. agriculture and nutrition policies. (shrink)

Human clinical research has become a huge economic enterprise (Morin et al. 2002; Noah 2002). Because the human subject at the center can be so easily marginalized, many commentators recommend spec...

For half a century, Ernest Fortin's scholarship has charmed and educated theologians and philosophers with its intellectual search for the best way to live. Written by friends, colleagues, and students of Fortin, this book pays tribute to a remarkable thinker in a series of essays that bear eloquent testimony to Fortin's influence and his legacy. A formidable commentator on Catholic philosophical and political thought, Ernest Fortin inspired others with his restless inquiries beyond the boundaries of conventional scholarship. With essays on (...) subjects ranging across philosophy, political science, literature, and theology Gladly to Learn and Gladly to Teach reflects the astonishing depth and breadth of Fortin's contribution to contemporary thought. (shrink)

For half a century, Ernest Fortin's scholarship has charmed and educated theologians and philosophers with its intellectual search for the best way to live. Written by friends, colleagues, and students of Fortin, this book pays tribute to a remarkable thinker in a series of essays that bear eloquent testimony to Fortin's influence and his legacy. A formidable commentator on Catholic philosophical and political thought, Ernest Fortin inspired others with his restless inquiries beyond the boundaries of conventional scholarship. With essays on (...) subjects ranging across philosophy, political science, literature, and theology Gladly to Learn and Gladly to Teach reflects the astonishing depth and breadth of Fortin's contribution to contemporary thought. (shrink)

Robert Aumann presents his Agreement Theorem as the key conditional: “if two people have the same priors and their posteriors for an event A are common knowledge, then these posteriors are equal” (Aumann, 1976, p. 1236). This paper focuses on four assumptions which are used in Aumann’s proof but are not explicit in the key conditional: (1) that agents commonly know, of some prior μ, that it is the common prior; (2) that agents commonly know that each of them updates (...) on the prior by conditionalization; (3) that agents commonly know that if an agent knows a proposition, she knows that she knows that proposition (the “K K” principle); (4) that agents commonly know that they each update only on true propositions. It is shown that natural weakenings of any one of these strong assumptions can lead to countermodels to Aumann’s key conditional. Examples are given in which agents who have a common prior and commonly know what probability they each assign to a proposition nevertheless assign that proposition unequal probabilities. To alter Aumann’s famous slogan: people can “agree to disagree”, even if they share a common prior. The epistemological significance of these examples is presented in terms of their role in a defense of the Uniqueness Thesis: If an agent whose total evidence is E is fully rational in taking doxastic attitude D to P, then necessarily, any subject with total evidence E who takes a different attitude to P is less than fully rational. (shrink)