The dominant account of welfare in medicine is an objective one; welfare consists of certain favoured health states, or in having needs satisfied, or in certain capabilities and functionings. By contrast, I present a subjective account of welfare, suggested initially by LW Sumner and called “authentic happiness”. The adoption of such an account of welfare within medicine offers several advantages over other subjective and objective accounts, and systematises several intuitions about patient-centredness and autonomy. Subjective accounts of welfare are unpopular because (...) of their implications for justice and the autonomy of the healthcare professional. This account of welfare, however, seems to have the resources to resist these criticisms. (shrink)

"Six Metaphysical Meditations" by René Descartes (translated by William Molyneux). Published by Good Press. Good Press publishes a wide range of titles that encompasses every genre. From well-known classics & literary fiction and non-fiction to forgotten−or yet undiscovered gems−of world literature, we issue the books that need to be read. Each Good Press edition has been meticulously edited and formatted to boost readability for all e-readers and devices. Our goal is to produce eBooks that are user-friendly and accessible to (...) everyone in a high-quality digital format. (shrink)

Eighty one years on, the Russian Revolution remains an event of unique significance for socialists, Marxists and historical materialists. It is the only occasion to date of which it can plausibly be claimed that the working class itself overthrew the capitalist state, established its own power and maintained it on a national scale for a significant period of time. Discount the Russian Revolution and we are left only with heroic but local and short-lived attempts and near-misses such as the Paris (...) Commune, the Hungarian Revolution of 1919, the Munich Soviet and Barcelona 1936, or the long list of seizures of power, usually by armed forces of one sort or another, in the name of the working class or Marxism. (shrink)

I show that the recursive structure of Leibniz's Law requires agents to perform infinitely many operations to psychologically identify the referents of phenomenal and physical concepts, even though the referents of ordinary concepts (e.g. Hesperus and Phosphorus) can be identified in a finite number of steps. The resulting problem resembles the hard problem of consciousness in the fact that it appears (and indeed is) unsolvable by anyone for whom it arises, and in the fact that it invites dualist and eliminativist (...) responses. Moreover, if this is the hard problem then we can predict that regardless of the strength of the argument for physicalism, and regardless of physicalism's truth, an ineliminable dissatisfaction is bound to accompany any physicalist theory of consciousness. Accordingly, I suggest that this is the hard problem of consciousness, and therefore that the hard problem arises from a recursively degenerate application of Leibniz's Law. (shrink)

According to orthodox views of philosophical methodology, when philosophers appeal to intuitions, they treat them as evidence for their contents. Call this “descriptive evidentialism.” Descriptive evidentialism is assumed both by those who defend the epistemic status of intuitions and by those, including many experimental philosophers, who criticize it. This article shows, however, that the idea that philosophers treat intuitions as evidence struggles to account for the way philosophers treat intuitions in a variety of philosophical contexts. In particular, it cannot account (...) for philosophers' treatment of a priori intuitions, for nonpropositional uses of intuition, and for philosophers' failure to use intuition to exclude the counterintuitive. The article concludes that alternatives to descriptive evidentialism (some of which are sketched) must be developed, and that much of the recent debate between traditionalists and skeptics from, for example, experimental philosophy is probably based on a false presupposition. (shrink)

BackgroundVerbal autopsy is a pragmatic approach for generating cause-of-death data in contexts without well-functioning civil registration and vital statistics systems. It has primarily been conducted in health and demographic surveillance systems (HDSS) in Africa and Asia. Although significant resources have been invested to develop the technical aspects of verbal autopsy, ethical issues have received little attention. We explored the benefits and burdens of verbal autopsy in HDSS settings and identified potential strategies to respond to the ethical issues identified.MethodsThis research was (...) based on a case study approach centred on two contrasting HDSS in Kenya and followed the Mapping-Framing-Shaping Framework for empirical bioethics research. Data were collected through individual interviews, focus group discussions, document reviews and non-participant observations. 115 participants were involved, including 86 community members (HDSS residents and community representatives), and 29 research staff (HDSS managers, researchers, census field workers and verbal autopsy interviewers).ResultsThe use of verbal autopsy data for research and public health was described as the most common potential benefit of verbal autopsy in HDSS. Community members mentioned the potential uses of verbal autopsy data in addressing immediate public health problems for the local population while research staff emphasized the benefits of verbal autopsy to research and the wider public. The most prominent burden associated with the verbal autopsy was emotional distress for verbal autopsy interviewers and respondents. Moral events linked to the interview, such as being unsure of the right thing to do (moral uncertainty) or knowing the right thing to do and being constrained from acting (moral constraint), emerged as key causes of emotional distress for verbal autopsy interviewers.ConclusionsThe collection of cause-of-death data through verbal autopsy in HDSS settings presents important ethical and emotional challenges for verbal autopsy interviewers and respondents. These challenges include emotional distress for respondents and moral distress for interviewers. This empirical ethics study provides detailed accounts of the distress caused by verbal autopsy and highlights ethical tensions between potential population benefits and risks to individuals. It includes recommendations for policy and practice to address emotional and moral distress in verbal autopsy. (shrink)

Williamson (2000) [Knowledge and its Limits, Oxford: Oxford University Press] argues that attempts to substitute narrow mental states or narrow/environmental composites for broad and factive mental states will result in poorer explanations of behavior. I resist Williamson.

The transparency argument concludes that we're directly aware of external properties and not directly aware of the properties of experience. Focusing on the presentation used by Michael Tye (2002) I contend that the argument requires experience to have content that it cannot plausibly have. I attribute the failure to a faulty account of the transparency phenomenon and conclude by suggesting an alternative understanding that is independently plausible, is not an error-theory and yet renders the transparency of experience compatible with mental-paint (...) style views. (shrink)

Advocates of the use of intuitions in philosophy argue that they are treated as evidence because they are evidential. Their opponents agree that they are treated as evidence, but argue that they should not be so used, since they are the wrong kinds of things. In contrast to both, we argue that, despite appearances, intuitions are not treated as evidence in philosophy whether or not they should be. Our positive account is that intuitions are a subclass of inclinations to believe. (...) Our thesis explains why intuitions play a role in persuasion and inquiry, without conceding that they are evidential. The account also makes predictions about the structure of intuitions that are confirmed by independent arguments. (shrink)

There is a growing interest in the ethics of Health Policy and Systems Research, and especially in areas that have particular ethical salience across HPSR. Hyder et al provide an initial framework to consider this, and call for more conceptual and empirical work. In this paper, we respond by examining the ethical issues that arose for researchers over the course of conducting three HPSR studies in Kenya in which health managers and providers were key participants. All three studies involved qualitative (...) work including observations and individual and group interviews. Many of the ethical dilemmas researchers faced only emerged over the course of the fieldwork, or on completion, and were related to interactions and relationships between individuals operating at different levels or positions in health/research systems. The dilemmas reveal significant ethical challenges for these forms of HPSR, and show that potential ‘solutions’ to dilemmas often lead to new issues and complications. Our experiences support the value of research ethics frameworks, and suggest that these can be enriched by incorporating careful consideration of context embedded social relations into research planning and conduct. Many of these essential relational elements of ethical practice, and of producing quality data, are given stronger emphasis in social science research ethics than in epidemiological, clinical or biomedical research ethics, and are particularly relevant where health systems are understood as social and political constructs. We conclude with practical and research implications. (shrink)

In recent years, there has been an increase in the establishment of biobanks for genetic and genomic studies around the globe. One example of this is the Human Heredity and Health in Africa Initiative (H3Africa), which has established biobanks in the sub‐region to facilitate future indigenous genomic studies. The concept of ‘broad consent’ has been proposed as a mechanism to enable potential research participants in biobanks to give permission for their samples to be used in future research studies. However, questions (...) remain about the acceptability of this model of consent. Drawing on findings from empirical research about the role of trust in decision‐making, we argue that an account of entrustment may be an appropriate way of addressing current challenges of seeking consent for biobank research in Africa. We propose a set of key points to consider that can support the proposed entrustment framework. (shrink)

I show how a robot with what looks like a hard problem of consciousness might emerge from the earnest attempt to make a robot that is smart and self-reflective. This problem arises independently of any assumption to the effect that the robot is conscious, but deserves to be thought of as related to the human problem in virtue of the fact that (1) the problem is one the robot encounters when it tries to naturalistically reduce its own subjective states (2) (...) it seems incredibly difficult from the robot’s own naturalist perspective and, most importantly, (3) it invites the robot to engage in the exact same metaphysical responses as humans offer to the problem of consciousness. Despite the fact that it invites the robot to consider extravagant metaphysical solutions, the problem I explore is purely algorithmic. The robot cannot complete its naturalist physicalist reduction as a matter of algorithmic fact, whether or not the naturalist physicalist reduction would be correct as a matter of metaphysical fact. It is hoped that by reproducing the familiar seeming problem in an artificial context, a greater understanding of the human problem of consciousness can be achieved. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 31-33, August 2011.

From the assumption that the presence of consciousness is detectable, in the first instance, only from behavioral indicators, I offer a proof to the effect that, with respect to any theory T that states that some particular state or process is the neural correlate of consciousness, there are always rival neural correlates that, from T’s perspective, can never be empirically ruled out. That's because, with respect to these states, the means of detecting consciousness is disrupted along with the empirical test. (...) Possible responses are discussed. (shrink)

For many decades, access to human biological samples, such as cells, tissues, organs, blood, and sub-cellular materials such as DNA, for use in biomedical research, has been central in understanding the nature and transmission of diseases across the globe. However, the limitations of current ethical and regulatory frameworks in sub-Saharan Africa to govern the collection, export, storage and reuse of these samples have resulted in inconsistencies in practice and a number of ethical concerns for sample donors, researchers and research ethics (...) committees. This paper examines stakeholders’ perspectives of and responses to the ethical issues arising from these research practices. (shrink)

We develop an approach to the problem of de se belief usually expressed with the question, what does the shopper with the leaky sugar bag have to learn to know that s/he is the one making the mess. Where one might have thought that some special kind of “de se” belief explains the triggering of action, we maintain that this gets the order of explanation wrong. We sketch a very simple cognitive architecture that yields de se-like behavior on which the (...) action-triggering functionality of the belief-state is what counts it as de se rather than some prior property of being “de se” explaining the triggering of action. This functionality shows that action-triggering change in belief-state also undergirds a correlative change in the objective involved in the triggered action. This model is far too simple to have any claim to showing how the de se works for humans, but it shows, by illustration, that nothing mysteriously “subjective”” need be involved in this aspect of self-conception. While our exposition is very different from those of Perry and Recanati, all three of us are developing the same kind of view. (shrink)

quidnam homines putarent, si turn occisus esset, cum tu ilium in foro inspectante populo Romano gladio insecutus es negotiumque transegisses, nisi se ille in scalas tabernae librariae coniecisset iisque oppilatis impetum tuum compressisset?

Many philosophers claim that intuitions are evidential. Yet it is hard to see how introspecting one's mental states could provide evidence for such synthetic truths as those concerning, for example, the abstract and the counterfactual. Such considerations have sometimes been taken to lead to mentalism---the view that philosophy must concern itself only with matters of concept application or other mind-dependent topics suited to a contemplative approach---but this provides us with a poor account of what it is that philosophers take themselves (...) to be doing, for many of them are concerned with the extra-mental facts about the universe. Evidentialism therefore gestates a disaster for philosophy, for it ultimately demands an epistemology for the investigation into such matter as the abstract and the modal that simply will not be forthcoming. We make a different suggestion: That intuitions are inclinations to believe. Hence, according to us, a philosophical argument does well, as a socio-rhetorical matter of fact, when it is founded on premises philosophers are generally inclined to believe, whether or not those inclinations to believe connect appropriately to the extra-mental facts. Accordingly, the role of intuitions (inclinations to believe) in philosophical methodology is non-evidential, and the question of how they could be used as evidence falls away. (shrink)

BackgroundThere 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.MethodsFollowing 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.ConclusionsResearch 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)

As generally interpreted this line leaves much to be desired because of its unwieldy construction. It is true that est ut plus a form of possum is a common periphrasis in Lucretius . Quite common also is Lucretius' use of the infinitive as a nominative substantive . But the combination of fieri mirarier with the already periphrastic erat ut posset results in ‘a very clumsy phrase.… The line should be regarded as one which Lucretius might have improved on revision’.

Respect for autonomy is an important moral principle within medical ethics. However, the question of whether the normative importance of respect for autonomy is derived from other moral principles (such as welfare) or has independent moral value is debatable. In this paper it is argued that the normative importance of autonomy is derived from both welfare and non-welfare considerations. Welfare considerations provide two types of reason to respect autonomy, one related to the role of autonomy in creating welfare and one (...) related to its role in constituting welfare. In addition, autonomy seems to have normative importance that is unrelated to welfare considerations. This type of normative role is difficult to defend within medical ethics, because most non-welfare justifications of autonomy work for only a proportion of the autonomous decisions that patients make and give no clear guidance on how to respond to autonomous yet welfare-reducing treatment requests. A recent account of autonomy (Stephen Darwall’s “demand” account) provides a nuanced defence of autonomy that does not rely on welfare considerations. Darwall’s approach seems to work well within medical ethics and provides a principled explanation of how to respond to autonomous patient requests for treatment options that may not be in their best medical interests. It is argued that to fully respect autonomy within a medical consultation, practitioners must consider non-welfare autonomy as well as instrumental and intrinsic welfare-related autonomy. (shrink)

This open access edited book provides new thinking on scientific identity formation. It thoroughly interrogates the concepts of community and identity, including both historical and contemporaneous analyses of several scientific fields. Chapters examine whether, and how, today’s scientific identities and communities are subject to fundamental changes, reacting to tangible shifts in research funding as well as more intangible transformations in our society’s understanding and expectations of technoscience. In so doing, this book reinvigorates the concept of scientific community. Readers will discover (...) empirical analyses of newly emerging fields such as synthetic biology, systems biology and nanotechnology, and accounts of the evolution of theoretical conceptions of scientific identity and community. With inspiring examples of technoscientific identity work and community constellations, along with thought-provoking hypotheses and discussion, the work has a broad appeal. Those involved in science governance will benefit particularly from this book, and it has much to offer those in scholarly fields including sociology of science, science studies, philosophy of science and history of science, as well as teachers of science and scientists themselves. (shrink)

"This is an extremely interesting and innovative collection with unusual empirical richness, with ethical and epistemological discussions cutting across ...

Increasing adoption of electronic health records in hospitals provides new opportunities for patient data to support public health advances. Such learning healthcare models have generated ethical debate in high-income countries, including on the role of patient and public consent and engagement. Increasing use of electronic health records in low-middle income countries offers important potential to fast-track healthcare improvements in these settings, where a disproportionate burden of global morbidity occurs. Core ethical issues have been raised around the role and form of (...) information sharing processes for learning healthcare systems, including individual consent and individual and public general notification processes, but little research has focused on this perspective in low-middle income countries. We conducted a qualitative study on the role of information sharing and governance processes for inpatient data re-use, using in-depth interviews with 34 health stakeholders at two public hospitals on the Kenyan coast, including health managers, providers and researchers. Data were collected between March and July 2016 and analysed using a framework approach, with Nvivo 10 software to support data management. Most forms of clinical data re-use were seen as an important public health good. Individual consent and general notification processes were often argued as important, but contingent on interrelated influences of the type of data, use and secondary user. Underlying concerns were linked to issues of patient privacy and autonomy; perceived risks to trust in health systems; and fairness in how data would be used, particularly for non-public sector re-users. Support for engagement often turned on the anticipated outcomes of information-sharing processes, as building or undermining trust in healthcare systems. As reported in high income countries, learning healthcare systems in low-middle counties may generate a core ethical tension between supporting a public good and respecting patient autonomy and privacy, with the maintenance of public trust acting as a core requirement. While more evidence is needed on patient and public perspectives on learning healthcare activities, greater collaboration between public health and research governance systems is likely to support the development of efficient and locally responsive learning healthcare activities in LMICs. (shrink)

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)

BackgroundHealth service delivery should ensure ethical principles are observed at all levels of healthcare. Working towards this goal requires understanding the ethics-related priorities and concerns in the day-to-day activities among different health practitioners. These practitioners include community health workers (CHWs) who are involved in healthcare delivery in communities in many low-and middle-income countries such as Uganda. In this study, we used photovoice, an innovative community based participatory research method that uses photography, to examine CHWs' perspectives on ethical concerns in their (...) work.MethodsWe explored perspectives of 10 CHWs (5 females and 5 males) on ethical dimensions of their work for 5 months using photovoice in a rural community in Wakiso district, Uganda. As part of the study, we: 1. Oriented CHWs on photovoice research and ethics; 2. Asked CHWs to take photographs of key ethical dimensions of their work; 3. Held monthly meetings to discuss and reflect on the photos; and 4. Disseminated the findings. The discussions from the monthly meetings were audio recorded, transcribed, and emerging data analysed using conventional content analysis with the help of Atlas ti version 6.0.15.ResultsCHWs were aware of and highly concerned about the need to observe ethical principles while carrying out their roles. The ethical principles CHWs were aware of and endeavoured to observe during their work were: maintaining professional integrity and abiding by ethical principles of practice; ethical responsibility in patient care; maintaining confidentiality while handling clients; respect for persons and communities; and enhancing their knowledge and skills for better practice. However, CHWs also identified challenges concerning their observance of ethical principles including: low commitment to their work due to other obligations; availability of some reference materials and guidelines in English yet majority could only read in the local language; and minimal avenues for knowledge enhancement such as trainings.ConclusionsCHWs were aware of and keen to discuss ethical issues in their work. However, there is need to address the challenges they face so as to facilitate observing ethical principles during the course of their work in communities. (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)