Malaria is a disease of developing countries whose local health services do not have the time, resources or personnel to mount studies of drugs or vaccines without the collaboration and technology of western investigators. This investigative collaboration requires a unique bridging of cultural differences with respect to human investigation. The following debate, sponsored by The Institute of Medicine and The American Society of Tropical Medicine and Hygiene, raises questions concerning the conduct of trans-cultural clinical malaria research. Specific questions are raised (...) about the difficulties of informed consent in different cultural settings and whether there is any role for community involvement. Discussants debate whether drug and vaccine trials not approved in an industrialised country are ever defensible if performed in a third-world setting. Potential conflicting priorities between investigators are discussed and ideas regarding conflict resolution are offered. (shrink)

The importance of communities in strengthening the ethics of international collaborative research is increasingly highlighted, but there has been much debate about the meaning of the term ‘community’ and its specific normative contribution. We argue that ‘community’ is a contingent concept that plays an important normative role in research through the existence of morally significant interplay between notions of community and individuality. We draw on experience of community engagement in rural Kenya to illustrate two aspects of this interplay: (i) that (...) taking individual informed consent seriously involves understanding and addressing the influence of communities in which individuals’ lives are embedded; (ii) that individual participation can generate risks and benefits for communities as part of the wider implications of research. We further argue that the contingent nature of a community means that defining boundaries is generally a normative process itself, with ethical implications. Community engagement supports the enactment of normative roles; building mutual understanding and trust between researchers and community members have been important goals in Kilifi, requiring a broad range of approaches. Ethical dilemmas are continuously generated as part of these engagement activities, including the risks of perverse outcomes related to existing social relations in communities and conditions of ‘half knowing’ intrinsic to processes of developing new understandings. (shrink)

BackgroundThe potential contribution of community engagement to addressing ethical challenges for international biomedical research is well described, but there is relatively little documented experience of community engagement to inform its development in practice. This paper draws on experiences around community engagement and informed consent during a genetic cohort study in Kenya to contribute to understanding the strengths and challenges of community engagement in supporting ethical research practice, focusing on issues of communication, the role of field workers in 'doing ethics' on (...) the ground and the challenges of community consultation.MethodsThe findings are based on action research methods, including analysis of community engagement documentation and the observations of the authors closely involved in their development and implementation. Qualitative and quantitative content analysis has been used for documentation of staff meetings and trainings, a meeting with 24 community leaders, and 40 large public and 70 small community group meetings. Meeting minutes from a purposive sample of six community representative groups have been analysed using a thematic framework approach.ResultsField workers described challenges around misunderstandings about research, perceived pressure for recruitment and challenges in explaining the study. During consultation, leaders expressed support for the study and screening for sickle cell disease. In community meetings, there was a common interpretation of research as medical care. Concerns centred on unfamiliar procedures. After explanations of study procedures to leaders and community members, few questions were asked about export of samples or the archiving of samples for future research.ConclusionsCommunity engagement enabled researchers to take account of staff and community opinions and issues during the study and adapt messages and methods to address emerging ethical challenges. Field workers conducting informed consent faced complex issues and their understanding, attitudes and communication skills were key influences on ethical practice. Community consultation was a challenging concept to put into practice, illustrating the complexity of assessing information needs and levels of deliberation that are appropriate to a given study. (shrink)

There is wide agreement that community engagement is important for many research types and settings, often including interaction with ‘representatives’ of communities. There is relatively little published experience of community engagement in international research settings, with available information focusing on Community Advisory Boards or Groups (CAB/CAGs), or variants of these, where CAB/G members often advise researchers on behalf of the communities they represent. In this paper we describe a network of community members (‘KEMRI Community Representatives’, or ‘KCRs’) linked to a (...) large multi-disciplinary research programme on the Kenyan Coast. Unlike many CAB/Gs, the intention with the KCR network has evolved to be for members to represent the geographical areas in which a diverse range of health studies are conducted through being typical of those communities. We draw on routine reports, self-administered questionnaires and interviews to: 1) document how typical KCR members are of the local communities in terms of basic characteristics, and 2) explore KCR's perceptions of their roles, and of the benefits and challenges of undertaking these roles. We conclude that this evolving network is a potentially valuable way of strengthening interactions between a research institution and a local geographic community, through contributing to meeting intrinsic ethical values such as showing respect, and instrumental values such as improving consent processes. However, there are numerous challenges involved. Other ways of interacting with members of local communities, including community leaders, and the most vulnerable groups least likely to be vocal in representative groups, have always been, and remain, essential. (shrink)

Benefit sharing in health research has been the focus of international debates for many years, particularly in developing countries. Whilst increasing attention is being given to frameworks that can guide researchers to determine levels of benefits to participants, there is little empirical research from developing countries on the practical application of these frameworks, including in situations of extreme poverty and vulnerability. In addition, the voices of those who often negotiate and face issues related to benefits in practice - frontline researchers (...) and fieldworkers - are rarely included in these debates. Against this background, this paper reports on experiences of negotiating research participation and benefits as described by fieldworkers, research participants and researchers in two community based studies. (shrink)

Fieldworkers (FWs) are community members employed by research teams to support access to participants, address language barriers, and advise on culturally appropriate research conduct. The critical role that FWs play in studies, and the range of practical and ethical dilemmas associated with their involvement, is increasingly recognised. In this paper, we draw on qualitative observation and interview data collected alongside a six month basic science study which involved a team of FWs regularly visiting 47 participating households in their homes. The (...) qualitative study documented how relationships between field workers and research participants were initiated, developed and evolved over the course of the study, the shifting dilemmas FWs faced and how they handled them. Even in this one case study, we see how the complex and evolving relationships between fieldworkers and study participants had important implications for consent processes, access to benefits and mutual understanding and trust. While the precise issues that FWs face are likely to depend on the type of research and the context in which that research is being conducted, we argue that appropriate support for field workers is a key requirement to strengthen ethical research practice and for the long term sustainability of research programmes. (shrink)

Background: There is general consensus internationally that unfair distribution of the benefits of research is exploitative and should be avoided or reduced. However, what constitutes fair benefits, and the exact nature of the benefits and their mode of provision can be strongly contested. Empirical studies have the potential to contribute viewpoints and experiences to debates and guidelines, but few have been conducted. We conducted a study to support the development of guidelines on benefits and payments for studies conducted by the (...) KEMRI-Wellcome Trust programme in Kilifi, Kenya. Methods: Following an initial broad based survey of cash, health services and other items being offered during research by all programme studies (n = 38 studies), interviews were held with research managers (n = 9), and with research staff involved in 8 purposively selected case studies (n = 30 interviewees). Interviews explored how these ‘benefits’ were selected and communicated, experiences with their administration, and recommendations for future guidelines. Data fed into a consultative workshop attended by 48 research staff and health managers, which was facilitated by an external ethicist.FindingsThe most commonly provided benefits were medical care (for example free care, and strengthened quality of care), and lunch or snacks. Most cash given to participants was reimbursement of transport costs (for example to meet appointments or facilitate use of services when unexpectedly sick), but these payments were often described by research participants as benefits. Challenges included: tensions within households and communities resulting from lack of clarity and agreement on who is eligible for benefits; suspicion regarding motivation for their provision; and confusion caused by differences between studies in types and levels of benefits. Conclusions: Research staff differed in their views on how benefits should be approached. Echoing elements of international benefit sharing and ancillary care debates, some research staff saw research as based on goodwill and partnership, and aimed to avoid costs to participants and a commercial relationship; while others sought to maximise participant benefits given the relative wealth of the institution and the multiple community needs. An emerging middle position was to strengthen collateral or indirect medical benefits to communities through collaborations with the Ministry of Health to support sustainability. (shrink)

BackgroundCarefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/aids, without increasing burdens. Such studies, however, must navigate a ‘vulnerability paradox’, since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/aids (ALH) in Kenya, we develop an account of researchers’ responsibilities towards young people, incorporating concepts of vulnerability, resilience, and agency (...) as ‘interacting layers’.MethodsUsing a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders’ perspectives on vulnerability and resilience of young people living with HIV/aids, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna’s layered account of vulnerability.ResultsALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences.ConclusionsThe most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabilities, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interpersonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers’ responsibilities to work within multi-sectoral partnerships to plan and implement studies involving ALH, share findings in a timely way and contribute to policies addressing known causes of vulnerabilities. (shrink)

Objectives: Bronchoalveolar lavage obtained at bronchoscopy is useful for research on pulmonary defence mechanisms. Bronchoscopy involves some discomfort and risk to subjects. We audited the process of consent, experienced adverse effects and reasons for participation among research bronchoscopy volunteers.Design: 100 consecutive volunteer research subjects attending for bronchoscopy, repeat bronchoscopy or routine recruitment clinic were interviewed. Information was gathered about volunteer motivation, perception of the consent process and adverse effects of bronchoscopy. Suggestions for improvement were requested. Responses were themed by a (...) second investigator prior to data analysis.Results: 81 bronchoscopy-experienced subjects and 19 new volunteers were interviewed. 19 subjects reported adverse symptoms during or after bronchoscopy, but no symptoms were of sufficient severity that they would not repeat the procedure. The frequency of symptoms was not related to gender, the quality of the lavage or the HIV status of the subject. 76 subjects reported that the information given pre-procedure was useful and adequate but 43 had further questions mostly relating to their own results. The reasons given for research participation were access to health assessment , access to treatment when ill , desire to participate in research and remuneration . 7 subjects complained that the remuneration was inadequate.Conclusions: The main incentive to participation in research bronchoscopy was access to healthcare. Informed consent and procedure technique were adequate but subjects would value more feedback about individual and project results. (shrink)

A correspondência entre J. Locke e W. Molyneux é conhecida principalmente como a fonte da famosa questão relativa ao que pode ser aprendido por um homem cego de nascença e que depois ganha a visão. Curiosamente, a correspondência oferece muito pouco esclarecimento sobre a questão. Outros tópicos importantes, entretanto, são apontados e explorados: entusiasmo pela obra de Malebranche, liberdade e responsabilidade, identidade pessoal, etc. Além disso, a correspondência oferece um conhecimento profundo da recepção histórica do Ensaio de Locke, como (...) estes dois correspondentes, que tinham obviamente muita simpatia um para com o outro, discutem a tradução da obra de Locke, suas futuras edições, e as críticas feitas a ela por Synge, King, Sergeant, Stllingfleet, Leibniz, etc. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bishop Berkeley Exorcises the Infinite: Fuzzy Consequences of Strict Finitism1 David M. Levy Introduction It all began simply enough when Molyneux asked the wonderful question whether a person born blind, now able to see, would recognize by sight what he knew by touch (Davis 1960). After George Berkeley elaborated an answer, that we learn to perceive by heuristics, the foundations ofcontemporarymathematics wereinruin. Contemporary mathematicians waved their hands and (...) changed the subject.2 Berkeley's answer received a much more positive response from economists. Adam Smith,in particular, seizedupon Berkeley's doctrine that welearn to perceive distance tobuild anelaborate system in which one learns to perceive one's self-interest.3 Perhaps because older histories of mathematics are a positive hindrance in helping us understand the importance of Berkeley's argument against infinitesimals,4 its consequences for economics have passed unnoticed. If infinitesimal numbers are ruled out, and we wish to maintain an algebra, then we rule out infinite numbers. This implication of Berkeley's argumenthas a dramatic implication for our understanding ofthe history ofideas about rule-directed action. Let me motivate this claim with a well-known historical problem. The social doctrine set forth by John Locke outside the Two Treatises depends critically upon individual belief about possible states of infinite pain or pleasure. The critical issue for the intolerance of atheism in Locke's system is his claim that without beUefin the infinite bliss of heaven forgone by a criminal, there is no reason to think a calculating individual will avoid crime.5 Locke's discussion is so different from the discussion of religion by David Hume and Smith. Here, questions of the substance of belief—the infinite worth of Heaven—have largely vanished.6 What happened between Locke and Hume-Smith? One answer is Pierre Bayle and Bernard Mandeville. Berkeley's doctrine that only the finite is perceived is, I think, a better answer. Out of sight, out ofmind. In this paper I propose to give a close look at the content and consequences ofBishop Berkeley's once famous Towards a New Theory ofVision. While there are other aspects ofBerkeley's work that attract Volume XVIII Number 2 511 DAVID M. LEVY attention from historians ofeconomics,7 1 shall claim that Berkeley's insight into human perception in the Theory of Vision is central to Adam Smith's attempt to found economic behaviour on the self-awareness of systematic illusion. There is no doubt that Smith finds that much ofhuman behaviour is characterized by illusion.8 The difficulty arises, or so it seems to me, from modern unwilUngness to beheve that illusion can be systematic. There are four pieces to my argument. First, we consider Berkeley's statementofwhat we shall call his doctrine ofstrict finitism in perception.9 Berkeley puts forward two postulates: 1) there exists some minimum perceptible quantity, and 2) distance is not perceived directly but by experience. Second, we define strict finitism and demonstrate that it translates into the claim that perception is fuzzy in a technical sense. If Berkeleian perception is fuzzy, then some modern criticism of Berkeley's strict finitism is based upon a simple misunderstandingofthe propertiesoffuzzyrelations. Thisis quite easy to set right. (Getting right the doctrine of those who implicitly take perception to be fuzzy—Adam Smith is my prime candidate—will be muchharder.)Third, wereconsiderBerkeley's dispute withMandeville on the role ofinfinite gain in choice. Here, we find Mandeville putting forward the Berkeleian position that if infinite amounts mattered, people would not behave as they do. Berkeley's position against Mandeville, however, seems to depend upon the supposition that infinite distance is sensible.10 Earlier, however, the position that Mandeville argued for was defended by Berkeley. Fourth, we ask why all this isn't well known. The debate between Berkeley and Mandeville has been well studied, as has been the link between Berkeley and the Scots. In fact, our work focuses on one aspect of Berkeley's work that led to his challenge of the contemporary foundations of the calculus. If sense is a matter of perception, and infinitesimals cannot be perceived, then they are quite literally nonsense. Armed with this insight, Berkeley refuted contemporary mathematics. Nevertheless, the calculus was too... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bishop Berkeley Exorcises the Infinite: Fuzzy Consequences of Strict Finitism1 David M. Levy Introduction It all began simply enough when Molyneux asked the wonderful question whether a person born blind, now able to see, would recognize by sight what he knew by touch (Davis 1960). After George Berkeley elaborated an answer, that we learn to perceive by heuristics, the foundations ofcontemporarymathematics wereinruin. Contemporary mathematicians waved their hands and (...) changed the subject.2 Berkeley's answer received a much more positive response from economists. Adam Smith,in particular, seizedupon Berkeley's doctrine that welearn to perceive distance tobuild anelaborate system in which one learns to perceive one's self-interest.3 Perhaps because older histories of mathematics are a positive hindrance in helping us understand the importance of Berkeley's argument against infinitesimals,4 its consequences for economics have passed unnoticed. If infinitesimal numbers are ruled out, and we wish to maintain an algebra, then we rule out infinite numbers. This implication of Berkeley's argumenthas a dramatic implication for our understanding ofthe history ofideas about rule-directed action. Let me motivate this claim with a well-known historical problem. The social doctrine set forth by John Locke outside the Two Treatises depends critically upon individual belief about possible states of infinite pain or pleasure. The critical issue for the intolerance of atheism in Locke's system is his claim that without beUefin the infinite bliss of heaven forgone by a criminal, there is no reason to think a calculating individual will avoid crime.5 Locke's discussion is so different from the discussion of religion by David Hume and Smith. Here, questions of the substance of belief—the infinite worth of Heaven—have largely vanished.6 What happened between Locke and Hume-Smith? One answer is Pierre Bayle and Bernard Mandeville. Berkeley's doctrine that only the finite is perceived is, I think, a better answer. Out of sight, out ofmind. In this paper I propose to give a close look at the content and consequences ofBishop Berkeley's once famous Towards a New Theory ofVision. While there are other aspects ofBerkeley's work that attract Volume XVIII Number 2 511 DAVID M. LEVY attention from historians ofeconomics,7 1 shall claim that Berkeley's insight into human perception in the Theory of Vision is central to Adam Smith's attempt to found economic behaviour on the self-awareness of systematic illusion. There is no doubt that Smith finds that much ofhuman behaviour is characterized by illusion.8 The difficulty arises, or so it seems to me, from modern unwilUngness to beheve that illusion can be systematic. There are four pieces to my argument. First, we consider Berkeley's statementofwhat we shall call his doctrine ofstrict finitism in perception.9 Berkeley puts forward two postulates: 1) there exists some minimum perceptible quantity, and 2) distance is not perceived directly but by experience. Second, we define strict finitism and demonstrate that it translates into the claim that perception is fuzzy in a technical sense. If Berkeleian perception is fuzzy, then some modern criticism of Berkeley's strict finitism is based upon a simple misunderstandingofthe propertiesoffuzzyrelations. Thisis quite easy to set right. (Getting right the doctrine of those who implicitly take perception to be fuzzy—Adam Smith is my prime candidate—will be muchharder.)Third, wereconsiderBerkeley's dispute withMandeville on the role ofinfinite gain in choice. Here, we find Mandeville putting forward the Berkeleian position that if infinite amounts mattered, people would not behave as they do. Berkeley's position against Mandeville, however, seems to depend upon the supposition that infinite distance is sensible.10 Earlier, however, the position that Mandeville argued for was defended by Berkeley. Fourth, we ask why all this isn't well known. The debate between Berkeley and Mandeville has been well studied, as has been the link between Berkeley and the Scots. In fact, our work focuses on one aspect of Berkeley's work that led to his challenge of the contemporary foundations of the calculus. If sense is a matter of perception, and infinitesimals cannot be perceived, then they are quite literally nonsense. Armed with this insight, Berkeley refuted contemporary mathematics. Nevertheless, the calculus was too... (shrink)

Most of the New Theory of Vision is an argument for a negative answer to Molyneux's question.// re primacy of vision in spatial perception: "most rational philosopher on this topic is Berkeley, whose New Theory of Vision presents in cogent detail the argument" (from Bennett 1966, p. 30, in note cites 41ff.).// Berkeley's criticisms of Locke: "If we really abstract from colour and hardness and all that 'belongs to sensation', so far from being left with 'pure' notions of extension (...) and figure, we are left with nothing but words emptied of meaning" (from Strawson 1966, p. 61). (shrink)

Is it possible to establish a line of research that brings Gabriel Marcel and Jean-Paul Sartre closer together? With this article, we will positively support this idea, by distancing ourselves from the overly rigid interpretations that exclusively focus on antinomic elements sliding into a reductionist and nowadays “canonical” presentation of the relationship between these philosophers. Beyond the undeniable and, fortunately, unmediated differences between the two philosophers, this article aims to investigate their positions regarding the concept of “relationship”. In doing so, (...) we will highlight how Gabriel Marcel’s “coesse” and Jean-Paul Sartre’s “being-for-others” have numerous points of contact that place both philosophers, beyond their personal positions in the religious sphere, within the common ground of “existentialism”. (shrink)

Reference is a central topic in philosophy of language, and has been the main focus of discussion about how language relates to the world. R. M. Sainsbury sets out a new approach to the concept, which promises to bring to an end some long-standing debates in semantic theory.There is a single category of referring expressions, all of which deserve essentially the same kind of semantic treatment. Included in this category are both singular and plural referring expressions, complex and non-complex referring (...) expressions, and empty and non-empty referring expressions. Referring expressions are to be described semantically by a reference condition, rather than by being associated with a referent. In arguing for these theses, Sainsbury's book promises to end the fruitless oscillation between Millian and descriptivist views. Millian views insist that every name has a referent, and find it hard to give a good account of names which appear not to have referents, or at least are not known to do so, like ones introduced through error, ones where it is disputed whether they have a bearer and ones used in fiction. Descriptivist theories require that each name be associated with some body of information. These theories fly in the face of the fact names are useful precisely because there is often no overlap of information among speakers and hearers. The alternative position for which the book argues is firmly non-descriptivist, though it also does not require a referent. A much broader view can be taken of which expressions are referring expressions: not just names and pronouns used demonstratively, but also some complex expressions and some anaphoric uses of pronouns.Sainsbury's approach brings reference into line with truth: no one would think that a semantic theory should associate a sentence with a truth value, but it is commonly held that a semantic theory should associate a sentence with a truth condition, a condition which an arbitrary state of the world would have to satisfy in order to make the sentence true. The right analogy is that a semantic theory should associate a referring expression with a reference condition, a condition which an arbitrary object would have to satisfy in order to be the expression's referent.Lucid and accessible, and written with a minimum of technicality, Sainsbury's book also includes a useful historical survey. It will be of interest to those working in logic, mind, and metaphysics as well as essential reading for philosophers of language. (shrink)

Obiettivo di questo articolo sarà presentare l’analisi fenomenologica e teoretica che Sartre propone del concetto di malafede, a partire dal romanzo La Nausea fino all’opera L’essere e il nulla. Ricostruendo il procedimento sartriano, che dall’atteggiamento interrogativo dell’uomo di fronte all’essere porta alla posizione del non-essere, giungeremo alla libertà e all’angoscia, quali caratteri costitutivi dell’essenza umana. Il tentativo di fuggire dalla libertà, a cui per Sartre siamo condannati, e dall’angoscia che da essa deriva, condurrà l’uomo sartriano all’autoinganno, ad una vita inautentica… (...) alla malafede. (shrink)

This book presents state of the art philosophical work on conspiracy theory research that brings in sharp focus on central and important insights concerning the supposed irrationality of conspiracy theory and conspiracy theory belief, while also proposing several novel solutions to long standing issues in the broader academic debate on these things called ‘conspiracy theories’. -/- It features a critical history of conspiracy theory theory, emphasising the role of the ‘first generation’ of philosophers in conspiracy theory research. This book also (...) includes discussions of a range of key issues such as: -/- What counts as conspiracy theory? Who counts as a conspiracy theorist? How are these terms variously understood by academics and the wider public, and Are conspiracy theories automatically suspect, and is it ever reasonable to be a conspiracy theorist? The book then builds upon that work by looking at how people’s political views affect both the conspiracy theories they believe and their beliefs about conspiracy theories; how we might defend conspiracy theorising without endorsing mad, bad or dangerous conspiracy theories; and contains several proposals for unifying conspiracy theory research under one theoretical framework: particularism. -/- This volume will be a key resource for philosophers and social scientists interested in recent work on the philosophy of conspiracy theory theory and its implications for conspiracy theory research. It will also appeal to members of the public, who want to know what, if anything, is wrong with these things called “conspiracy theories”. It was originally published as a special issue of Social Epistemology. (shrink)

Zhizneopisanie -- Kniga znanii︠a︡ -- Ukazanii︠a︡ i nastavlenii︠a︡ -- Kniga o dushe.

This book analyzes for the first time in English the ethical theory that underpins Qur’anic legislation by providing a classification of specific verses in which Islam’s holy book discusses moral issues. The principal purpose of this book is to demonstrate the ways in which the Qur’an theoretically and practically provides the moral code to which Muslims around the world adhere. The author divides his analysis into a survey of Qur’anic attitudes towards the basic ethical issues of obligation and responsibility, issues (...) of moral psychology such as motivation and intention, as well as matters of social ethics such as the function of law in society. He then explores the meanings of individual morality, morality within the family and civil society, and the relationship of morality to the idea of the state. (shrink)

On September 1, 2023, Texas made important revisions to it its decades‐old statute granting legal safe harbor immunity to physicians who withhold or withdraw life‐sustaining treatment over the objection of critically ill patients’ surrogate decision‐makers. However, lawmakers left untouched glaring flaws in a key safeguard for patients—the transfer option. The transfer option is ethically important because, when no hospital is willing to accept the patient in transfer, that fact is taken as strong evidence that the surrogates’ treatment requests fall outside (...) accepted medical practice. But there are serious shortcomings in how the transfer option is carried out in Texas and many other states, which undermines the ethical usefulness of the process. We identify these shortcomings and recommend revisions to state statutes and professional guidelines to overcome them. (shrink)

According to the standard analysis of degree questions, the logical form of a degree question contains a variable that ranges over individual degrees and is bound by the degree question operator how. In contrast with this, we claim that the variable bound by the degree question operator how does not range over individual degrees but over intervals of degrees, by analogy with Schwarzschild and Wilkinson's proposal regarding the semantics of comparative clauses. Not only does the interval-based semantics predict the existence (...) of certain readings that are not predicted under the standard view, it is also able, together with other natural assumptions, to account for the sensitivity of degree questions to negative islands, as well as for the fact, uncovered by Fox and Hackl, that negative islands can be obviated by some properly placed modals. Like Fox and Hackl, we characterize negative island effects as arising from the fact that the relevant question, due to its meaning alone, can never have a maximally informative answer. Contrary to Fox and Hackl, however, we do not need to assume that scales are universally dense, nor that the notion of maximal informativity responsible for negative islands is blind to contextual parameters. (shrink)