A Decent Proposal: Ethical Review of Clinical Research Donald Evans and Martyn Evans Centre for Philosophy and Health Care University of Wales Swansea, UK The investigation and development of modern medicines and medical technology can create numerous ethical dilemmas both for clinical researchers and research ethics committees. A Decent Proposal: Ethical Review of Clinical Research seeks to facilitate and encourage good clinical research by exploring the concerns, responsibilities, general issues and particular pitfalls associated with ethical aspects of research. It (...) provides practical guidelines for researchers on how to improve the quality of research design, while for those appointed to scrutinise research proposals it offers advice on how to apply consistent, careful and critical reasoning to the process of assessing ethical standards. As such, it will provide invaluable assistance to clinical researchers and ethics committees alike in understanding the moral challenges posed by modern health care. (shrink)

The notion of patients’ duties has received periodic scholarly attention but remains overwhelmed by attention to the duties of healthcare professionals. In a previous paper the author argued that patients in publicly funded healthcare systems have a duty to participate in clinical research, arising from their debt to previous patients. Here the author proposes a greatly extended range of patients’ duties grounding their moral force distinctively in the interests of contemporary and future patients, since medical treatment offered to one patient (...) is always liable to be an opportunity cost in terms of medical treatment needed by other patients. This generates both negative and positive duties. Ten duties—enjoining obligations ranging from participation in healthcare schemes to promoting one’s own earliest recovery from illness—are proposed. The characteristics of these duties, including their basis, moral force, extent and enforceability, are considered. They are tested against a range of objections—principled, societal, epistemological and practical—and found to survive. Finally, the paper suggests that these duties could be thought to reinforce a regrettably adversarial characteristic, shared with rights-based approaches, and that a preferable alternative might be sought through the notion of a “virtuous patient” contributing to a problem-solving partnership with the clinician. However, in defining and giving content to that partnership, there is a clear role for most, if not all, of the proposed duties; their value thus extends beyond the adversarial context in which they might first be thought to arise. (shrink)

Discussions of moral weakness in recent and even not so recent ethics have generally neglected large areas of the moral life. In some cases, it may be argued, such neglect has been accidental in that the philosopher or philosophers concerned have set out to examine problems thrown up by a class or classes of actions without purporting to present an exhaustive account of moral weakness. In other cases such neglect is pernicious in that if not designed to protect a certain (...) philosophical position it has by the doctrinaire delimitation of the range of examples considered had precisely that effect. This delimitation has often arisen out of unexamined presuppositions as to the nature of moral weakness. They are embodied in the following general framework suggested as an account not of some cases of weakness but of all cases: In a case of weakness a man does something that he knows or believes he should not do, or fails to do something that he knows or believes he should do, when the occasion and the opportunity for acting or refraining is present, and when it is in his power, in some significant sense, to act in accordance with his knowledge or belief. (shrink)

An ω-categorical supersimple group is finite-by-abelian-by-finite, and has finite SU-rank. Every definable subgroup is commensurable with an acl( $\emptyset$ )-definable subgroup. Every finitely based regular type in a CM-trivial ω-categorical simple theory is non-orthogonal to a type of SU-rank 1. In particular, a supersimple ω-categorical CM-trivial theory has finite SU-rank.

Patients participating in the shared benefits of publicly funded health care enjoy the benefits of treatments tested on previous patients. Future patients similarly depend on treatments tested on present patients. Since properly designed research assumes that the treatments being studied are—so far as is known at the outset—equivalent in therapeutic value, no one is clinically disadvantaged merely by taking part in research, provided the research involves administering active treatments to all participants. This paper argues that, because no other practical or (...) moral considerations count decisively against so doing, we could and should oblige patients to agree to receive indicated treatment within the terms of any concurrent research protocols. This ensures their treatment will benefit not only themselves but also future patients through contributing to new knowledge. By analogy with the paying of income tax, patients should not be allowed to “veto” their social responsibility to take part in clinical research. (shrink)

Some philosophers such as Ninian Smart have claimed that mystics from different religious traditions may sometimes have the same experience , while nevertheless giving different and tradition-bound descriptive reports of that experience. In two important essays, Steven Katz has challenged such a claim. Mystics from different religious traditions do not have the same experience.

Across the world, healthcare providers must wrestle with the twin ogres of finite resources and infinite demand. Successful healthcare delivery creates its own legacy of need. For example, a renal failure patient may now be given a greatly extended life by means of dialysis or organ transplantation. In the process, the healthcare provider has created a permanent demand for services during that extended life. It has been estimated that the recurrent cost of maintaining a patient on hemodialysis for 1 year (...) in the United Kingdom is in the region of £20,000. (shrink)

Using a fictional but representative general practice consultation, involving the diagnosis of irritable bowel syndrome in a patient who is anxious for some relief from the discomfort his condition entails, this paper argues that when both a drug fails to out-perform placebo and the condition in question is a functional illness with no demonstrable underlying pathology, then the action of the drug is not only no better than placebo, and it is also no different from it either. The paper also (...) argues that, in the circumstances of the consultation described, it is striking that current governance deems it ethical for a practitioner to prescribe either a drug or a placebo, both of which appear to rely for their effectiveness on a measure of concealment on the part of the doctor, yet deems it unethical for a practitioner openly to prescribe a harmless and enjoyable substance which is likely to be no less effective than either drug or placebo and is also likely to be better-tolerated and cheaper than the drug. (shrink)

Presents a collection of alphabetically-arranged entries that provide information on a wide range of topics related to philosophy, including ethics, religion, history, aesthetics, logic, metaphysics, from Aristotle and the Greek Academy, to modern concepts of feminist theory and philosophy of the mind.

There is a tension between the preservation of academic freedom and the economic context in which the university currently finds itself. This tension embodies serious threats to global health as a result of three overlapping phenomena which impede the production and diffusion of valuable knowledge about health. These phenomena, the privatisation, commercialisation and instrumentalisation of knowledge are identified and examined in this paper in relation to human rights and international morality.

Let us consider Flew’s main contention, that the onus of proof lies on the theist. The “proof” which is required of the theist involves showing that his concept of God is such that the existence of God is theoretically possible and providing sufficient reasons, though not necessarily a demonstration, to warrant believing that God exists. The “onus” which is on the theist does not preclude the possibility of a theistic proof. It is similar to the “onus” which is on the (...) prosecutor in an English court: it is up to the prosecutor to prove guilt, but such proof is possible. And just as the prosecutor does not have to drop his personal conviction—if he has one—that the defendant is guilty, the theist does not have to drop his own theistic belief. What Flew is asking the theist to do is to accept a procedure. Like the affirmative side in a debate, the theist is asked to concede that if he has not provided grounds for what he affirms, he has lost the debate— whether or not the opposition says anything. If a theist moves, “Resolved that this house affirms the existence of God”, the presumption in the debate is atheistic; the theist has to prove his claim or lose the debate. He is like a prosecutor in a court where the procedural rule is that innocence is presumed; the prosecutor must prove guilt or lose his case. Flew holds that the presumption of atheism is a better procedure than the presumption of theism, where the atheist would affirm, “Resolved that this house affirms the non-existence of God”, and the atheist would have to prove his claim or lose the argument. (shrink)

This book is for people who find themselves beset by arguments: persuasions open and hidden, put forward in books or on buses, blown up onto hoardings or piped right into the home by television and radio. Such arguments may need to be critically weighed and cautiously assessed, if the arguee is not to be taken for a ride. For such analysis, some introduction to logic is required. This book explains how to decide which arguments are sound and what makes the (...) bad ones bad. (shrink)

Written by a leading proponent of the philosophy and ethics of healthcare, this volume, filled with thought-provoking and frequently controversial ideas and arguments provides readers with a contribution to the literature on medical ethics.

Concept definitions applicable to human and non-human animals should be usable for both. Awareness is a state during which concepts of environment, self, and self in relation to environment result from complex brain analysis of sensory stimuli or constructs based on memory. There are several proposed categories of awareness. The widespread usage of the term conscious is 'not unconscious' so a conscious individual is an individual that has the capability to perceive and respond to sensory stimuli. It is confusing and (...) scientifically undesirable if conscious is also used to mean aware. Hence it is proposed that conscious should be used only as above. Fully functioning and adequately developed humans and members of many other animal species are sentient. Sentience means having the capacity, the level of awareness and cognitive ability, necessary to have feelings. The welfare of an individual is its state as regards its attempts to cope with its environment. This includes feelings, which are important coping mechanisms, and health. Since feelings involve awareness, there is overlap between welfare assessment and awareness assessment. Methods for assessing awareness, consciousness, sentience, and welfare and links to morality are briefly discussed. (shrink)

Human attitudes to animals have changed as non-humans have become more widely incorporated in the category of moral agents who deserve some respect. Parallels between the functioning of humans and non-humans have been made for thousands of years but the idea that the animals that we keep can suffer has spread recently. An improved understanding of motivation, cognition and the complexity of social behaviour in animals has led in the last 30 years to the rapid development of animal welfare science. (...) Early attempts to define welfare referred to individuals being in harmony with nature but the first usable definition incorporated feelings and health as part of attempts to cope with the environment. Others considered that welfare is only about feelings but it is argued that as feelings are mechanisms that have evolved they are a part of welfare rather than all of it. Most reviews of welfare now start with listing the needs of the animal, including needs to show certain behaviours. This approach has used sophisticated studies of what is important to animals and has replaced the earlier general guidelines described as freedoms. Many measures of welfare are now used and indicate how good or how poor the welfare is. Naturalness is not a part of the definition of welfare but explains why some needs exist. In recent years, welfare has become established as one of various criteria used to decide on whether a system is sustainable because members of the public will not accept systems that cause poor welfare. The study of welfare has become part of the scientific basis upon which important political decisions are made. (shrink)

While there may be a place in some contexts for high handed, “blanket” legislative prohibitions on dissenting views of what constitutes death, the paper under consideration does not describe such a contextThis stimulating and provocative paper by Professor Appel, Defining death: when physicians and families differ, asks us to consider “whether patients’ families should be permitted to opt out of widely accepted definitions of death in favour of their own standards”. This is a striking question in many ways. It reminds (...) us that, as a simple description of fact, there are indeed different standards for human death in so far as different groups or communities have accepted and continue to accept varying notions of what constitutes human death. The question’s reference to “opting out” suggests, perhaps reasonably, that it seems prima facie odd to think of adopting a definition of death as being a matter of individual choice. The reference to “permission” invites us to suppose limitations, primarily legal, upon the extent to which such a choice could be tolerated. Also, the question ascribes to certain “definitions of death” the authority of being widely accepted. The definitions thus favoured are, we learn, the various formulations of death referring to the state of the brain, chief among them “whole brain death” although the author is troublingly vague over whether all such formulations are morally, legally, or conceptually equivalent; and the relevant communities of acceptance turn out to consist of many—but, as the author admits, not all—physicians labouring under varying and inconsistent jurisdictions in the United States.My preface to the criticisms that follow is a …. (shrink)

In _The Body in Late-Capitalist USA_, Donald M. Lowe explores the varied social practices that code and construct the body. Arguing that our bodily lives are shaped by a complex of daily and ongoing practices—how we work, what we buy and consume—Lowe contends that as a result of the commodification of these and other social practices in the late-twentieth century, what we often understand to be the needs of the body are in fact means for capital accumulation. Moving beyond (...) studies of representations and images of the body, Lowe focuses on the intersection of body practices, language, and the Social to describe concretely the reality of a lived body. His strongly synthetic work brings together Marxist critique, semiotics, Foucaultian discourse analysis, and systems and communications theory to examine those practices that construct the body under late capitalism: habits of work and consumption, the ways we give birth and raise children, socialization, mental and physical healing, reconstructions and contestations of sexuality and gender. Lowe draws upon a wide range of sources, including government and labor studies and statistics, diagnostic and statistical manuals on mental illness, computer manuals, self-help books, and guides to work-related stress disorders, to illustrate the transformation of the body into a nexus of exchange value in postmodern society. (shrink)

This paper sets out to give sufficient detail to the notion of mental simulation to allow an appraisal of its contribution to ‘mindreading’ in the context of the ‘false-belief tasks’ used in developmental psychology. We first describe the reasoning strategy of ‘modified derivation’, which supports counterfactual reasoning. We then give an analysis of the logical structure of the standard false-belief tasks. We then show how modified derivation can be used in a hybrid strategy for mindreading in these tasks. We then (...) formulate the hypothesis that children become able (around the age of 4 years) to pass these tasks when they acquire the counterfactual reasoning ability required in this strategy. We find this to be consistent with various empirical findings. We then discuss the implications for the theory/simulation debate, meta-representation and pretence. (shrink)

Donald Broom argues that morality and the central components of religion are of great value, and presents two central ideas. He asserts that morality has a biological foundation and has evolved as a consequence of natural selection, and that religions are essentially the structures supporting morality. Many philosophers and theologians write about morality and its origins without reference to biological processes such as evolution. Likewise, biologists discuss phenomena of importance to human morality and religion without taking account of the (...) thoughts of others on these subjects. (shrink)