Patients have received experimental pharmaceuticals outside of clinical trials for decades. There are no industry-wide best practices, and many companies that have granted compassionate use, or ‘preapproval’, access to their investigational products have done so without fanfare and without divulging the process or grounds on which decisions were made. The number of compassionate use requests has increased over time. Driving the demand are new treatments for serious unmet medical needs; patient advocacy groups pressing for access to emerging treatments; internet platforms (...) enabling broad awareness of compelling cases or novel drugs and a lack of trust among some that the pharmaceutical industry and/or the FDA have patients’ best interests in mind. High-profile cases in the media have highlighted the gap between patient expectations for compassionate use and company utilisation of fair processes to adjudicate requests. With many pharmaceutical manufacturers, patient groups, healthcare providers and policy analysts unhappy with the inequities of the status quo, fairer and more ethical management of compassionate use requests was needed. This paper reports on a novel collaboration between a pharmaceutical company and an academic medical ethics department that led to the formation of the Compassionate Use Advisory Committee. Comprising medical experts, bioethicists and patient representatives, CompAC established an ethical framework for the allocation of a scarce investigational oncology agent to single patients requesting non-trial access. This is the first account of how the committee was formed and how it built an ethical framework and put it into practice. (shrink)

Health care costs have been rising steadily in most industrialized countries. These increases are driven primarily by technological advances and, to a lesser degree, by aging of the population. Many factors make it unlikely that market forces alone will limit increases in the costs of health care. These unremitting increases make health care rationing appear both necessary and inevitable.One of the least controversial mechanisms for rationing could be to allow patients to make their own choices as to which kinds of (...) care they would be willing to forgo. This is appealing because it preserves individual freedom of choice regarding health care in a way that other rationing mechanisms often do not. Rationing by patient choice, however, can only happen if patients recognize that resources are limited and need to be conserved, and are willing to forgo marginal benefits. (shrink)

Traditional pharmacy education emphasizes the biological processes of diseases and their pharmacological treatments. While the intense focus on biomedical aspects of disease is vital to educating pharmacy students, this focus is often insufficient in conveying what patients experience. The humanities, however, offer powerful characterizations of the disease experience for individuals as well as its impact on the human condition more generally. In this essay, I describe how using literary texts with pharmacy students provides them with a fuller appreciation of what (...) patients face with their diseases. The goal of this endeavor is to make students more effective as pharmacists in detecting and responding to their patients’ problems and needs by connecting their biomedical knowledge to depictions and meanings of illness experiences. (shrink)

The present study was designed to explore the relationship between self-reported dissociative experiences and performance in tasks eliciting right-hemisphere processing load. Thirty-four participants performed a vigilance task in two conditions: with task-irrelevant negative-arousing pictures and task-irrelevant neutral pictures. Dissociation was assessed with the Dissociative Experience Scale. Consistent with theories positing right-hemisphere deregulation in high non-clinical dissociators, dissociative experiences correlated with greater vigilance decrement only in the negative picture condition. As both the vigilance task and negative picture processing are right lateralized, (...) this result provides support for a right-hemisphere dysfunction in high dissociators, at least in negative conditions. (shrink)

This paper explores one means of connection between Whitehead and Deleuze through an investigation into the figure of the ‘beautiful soul’. I first examine Deleuze’s claim that a philosophy of difference risks a ‘new’ version of the beautiful soul, situating this figure in its historical context in Hegel. I then consider why Whitehead may initially appear to fall into the trap of the beautiful soul before arguing that this is not the case. Seeing how brings Whitehead and Deleuze closer together (...) by showing that their respective insistences on the risks, dangers, and adventures integral to speculative thinking highlight the importance of the intersection between the existential and the metaphysical. (shrink)

Michela Bella’s Ontology after Philosophical Psychology: The Continuity of Consciousness in William James’s Philosophy of Mind offers a detailed survey of James’s thought using “continuity” as its focal lens. Because the book presumes significant familiarity with James and frequently includes dense exegesis of his work’s most technical aspects, it is primarily for specialists. It will particularly interest James scholars studying the entanglement of the metaphysical with the psychological and epistemological.Combining “historical” and “theoretical” points of view, Bella tracks “James’s gradual translation (...) of psychological experimental observations of the continuity of thought into an ontological perspective... (shrink)

Norman Kretzmann's recent analysis of the natural lawslogan ``lex iniusta non est lex'' (an unjust law is nota law) demonstrates the coherence of the slogan andmakes a case for its practical value, but I shallargue that it also ends up showing that the sloganfails to mark any interesting conceptual or practicaldivision between natural law and legal positivistviews about the nature of law. I argue that this is ahappy result. The non-est-lex slogan has been used toexaggerate the extent of disagreement about (...) the natureof law and has diverted critics of natural law theoryfrom recognizing that the main disagreement betweennatural lawyers and legal positivists centres ontheories of practical reason and how they affect ourunderstanding of the relationship between law andmorality. This extends the debate about the nature oflaw somewhat beyond the traditional boundaries ofphilosophy of law, but these boundaries are due inpart to the diversion created by debate over thenon-est-lex slogan. Recognizing that the non-est-lexslogan fails on its own to mark any interestingpractical or conceptual division between natural lawtheories and legal positivism should therefore focusand encourage debate on matters of genuine substancebetween these outlooks. The disagreement, however, mayturn out to be primarily metaphysical and explanatoryand not normative in nature. (shrink)

In this paper we examine how the use of robots in caring for elders can impact the meaningfulness of elders’ lives. We present a framework for understanding ‘meaningfulness in life’, and then apply that framework in discussing ways in which the use of robots to assist in activities of daily living can preserve, enhance or undermine the meaningfulness of elders’ lives. We conclude with a discussion of if and how having false beliefs about companion robots can affect meaningfulness in the (...) life of the person having those false beliefs. (shrink)

This paper argues that human psychological resilience is a central virtue in sport and in human life generally. Despite its importance, it is an overlooked virtue in philosophy of sport and classical and contemporary virtue theory. The phenomenon of human resilience has received a great deal of attention recently in other quarters, however. There is a large and instructive empirical psychological literature on resilience, but connections to virtue theory are rarely drawn and there is no agreement about what the concept (...) refers to. This paper attempts to clarify the concept of resilience and explain how it fits into and supports a traditional Aristotelian conception of virtue. It shows how resilience figures centrally in sport and can extend and enrich our understanding of virtue and success in sport and of sport's internal values. The investigations into the nature of resilience in sport can also help us to understand better sport's contributions to human culture and well-being. (shrink)

The Earth agglomerates and heats. Convection cells within the planetary interior expedite the cooling process. Volcanoes evolve steam, carbon dioxide, sulfur dioxide and pyrophosphate. An acidulous Hadean ocean condenses from the carbon dioxide atmosphere. Dusts and stratospheric sulfurous smogs absorb a proportion of the Sun’s rays. The cooled ocean leaks into the stressed crust and also convects. High temperature acid springs, coupled to magmatic plumes and spreading centers, emit iron, manganese, zinc, cobalt and nickel ions to the ocean. Away from (...) the spreading centers cooler alkaline spring waters emanate from the ocean floor. These bear hydrogen, formate, ammonia, hydrosulfide and minor methane thiol. The thermal potential begins to be dissipated but the chemical potential is dammed. The exhaling alkaline solutions are frustrated in their further attempt to mix thoroughly with their oceanic source by the spontaneous precipitation of biomorphic barriers of colloidal iron compounds and other minerals. It is here we surmise that organic molecules are synthesized, filtered, concentrated and adsorbed, while acetate and methane—separate products of the precursor to the reductive acetyl-coenzyme-A pathway—are exhaled as waste. Reactions in mineral compartments produce acetate, amino acids, and the components of nucleosides. Short peptides, condensed from the simple amino acids, sequester ‘ready-made’ iron sulfide clusters to form protoferredoxins, and also bind phosphates. Nucleotides are assembled from amino acids, simple phosphates carbon dioxide and ribose phosphate upon nanocrystalline mineral surfaces. The side chains of particular amino acids register to fitting nucleotide triplet clefts. Keyed in, the amino acids are polymerized, through acid–base catalysis, to alpha chains. Peptides, the tenuous outer-most filaments of the nanocrysts, continually peel away from bound RNA. The polymers are concentrated at cooler regions of the mineral compartments through thermophoresis. RNA is reproduced through a convective polymerase chain reaction operating between 40 and 100°C. The coded peptides produce true ferredoxins, the ubiquitous proteins with the longest evolutionary pedigree. They take over the role of catalyst and electron transfer agent from the iron sulfides. Other iron–nickel sulfide clusters, sequestered now by cysteine residues as CO-dehydrogenase and acetyl-coenzyme-A synthase, promote further chemosynthesis and support the hatchery—the electrochemical reactor—from which they sprang. Reactions and interactions fall into step as further pathways are negotiated. This hydrothermal circuitry offers a continuous supply of material and chemical energy, as well as electricity and proticity at a potential appropriate for the onset of life in the dark, a rapidly emerging kinetic structure born to persist, evolve and generate entropy while the sun shines. (shrink)

This paper argues that human psychological resilience is a central virtue in sport and in human life generally. Despite its importance, it is an overlooked virtue in philosophy of sport and classical and contemporary virtue theory. The phenomenon of human resilience has received a great deal of attention recently in other quarters, however. There is a large and instructive empirical psychological literature on resilience, but connections to virtue theory are rarely drawn and there is no agreement about what the concept (...) refers to. This paper attempts to clarify the concept of resilience and explain how it fits into and supports a traditional Aristotelian conception of virtue. It shows how resilience figures centrally in sport and can extend and enrich our understanding of virtue and success in sport and of sport's internal values. The investigations into the nature of resilience in sport can also help us to understand better sport's contributions to human culture and well-being. (shrink)

This essay argues that defences of strategic fouling in sport are enriched and supported by better recognizing the role of play in sport. A common characteristic of play is its disengagement from the everyday, in particular its moral disengagement. If sport in its best manifestations is a species of play, then we should expect to find some moral disengagement there. And indeed we do in a variety of ways. Strategic fouling affords a useful example to illustrate and support this claim (...) and to examine the limits of that sort of disengagement. It is argued that while strategic fouling is morally problematic, it can be a sort of playful ‘competitive shenanigan’ that should be tolerated at times for the way it adds to the challenge and drama of sport. This allows us to better recognize the complexity and depth of sport and the way it reflects fundamental human values. Like everyday life, sport challenges us to weigh morality, perfection, and play against each other in ways that give each sphere of value its due and that contribute to rewarding and meaningful activities and lives. (shrink)

A well-known term in eighteenth-century literature and philosophy, the “beautiful soul” (die schöne Seele) has resurfaced in recent years. Deleuze refers to the beautiful soul’s “religiosity” and argues that aggressive “selection” is necessary as its antidote. However, in volatile contexts of social destabilization, such selection risks recoiling into reactionary violence. After first developing in more detail the beautiful soul’s background as a discursive figure, I argue that understanding Deleuze’s selection within a context of spiritual experience is necessary to mitigate this (...) worry. Exploration of this experience is pursued through juxtaposition of Deleuze’s thought with Nishida Kitarō’s investigation of the ontological structure of religious consciousness. The comparative resonances I develop suggest an ontological objectivity to the problems and structuring of the logos of religious consciousness and show how a more explicitly spiritual rendering of “selection,” developed through the Deleuze/Nishida encounter, intervenes into the broader beautiful soul problematic. (shrink)

Philosophical Studies Vol. 2, No. 2, p. 163, l. 24 for ‘Pocreon’ read “Creon’ and p. 165, l.4 for “Nereus” read “Nessus”, l. 16 for “Corrolate” read “Correlate” and l. 27 for “ Trachinae ” read “ Trachiniae ”. Proffessor Mackinnon should also have been described as Norris-Hulse Professor of Divinity in the University of Cambridge and Fellow of Corpus Christi College.