Fecal microbiota transplantation has demonstrated efficacy and is increasingly being used in the treatment of patients with recurrent Clostridium difficile infection. Despite a lack of high-quality trials to provide more information on the long-term effects of FMT, there has been great enthusiasm about the potential for expanding its applications. However, FMT presents many serious ethical and social challenges that must be addressed as part of a successful regulatory policy response. In this article, we draw on a sample of the scientific (...) and bioethics literatures to examine clusters of ethical and social issues arising in five main areas: informed consent and the vulnerability of patients; determining what a “suitable healthy donor” is; safety and risk; commercialization and potential exploitation of vulnerable patients; and public health implications. We find that these issues are complex and worthy of careful consideration by health care professionals. Desperation of a patient should not be the basis for selecting treatment with FMT, and the patient's interests should always be of paramount concern. Authorities must prioritize development of appropriate and effective regulation of FMT to safeguard patients and donors, promote further research into safety and efficacy, and avoid abuse of the treatment. (shrink)

In a world surrounded by smart objects from sensors to automated medical devices, the ubiquity of ‘smart’ seems matched only by its lack of clarity. In this article, we use our discussions with expert stakeholders working in areas of implantable medical devices such as cochlear implants, implantable cardiac defibrillators, deep brain stimulators and in vivo biosensors to interrogate the difference facets of smart in ‘implantable smart technologies’, considering also whether regulation needs to respond to the autonomy that such artefacts carry (...) within them. We discover that when smart technology is deconstructed it is a slippery and multi-layered concept. A device’s ability to sense and transmit data and automate medicine can be associated with the ‘sting’ of autonomy being disassociated from human control as well as affecting individual, group, and social environments. (shrink)

In its governance activities for genetic resources, the international community has adopted various approaches to their ownership, including: free access; common heritage of mankind; intellectual property rights; and state sovereign rights. They have also created systems which combine elements of these approaches. While governance of plant and animal genetic resources is well-established internationally, there has not yet been a clear approach selected for human genetic resources. Based on assessment of the goals which international governance of human genetic resources ought to (...) serve, and the implications for how they will be accessed and utilised, it is argued that common heritage of mankind will be the most appropriate approach to adopt to their ownership/control. It does this with the aim of stimulating discussion in this area and providing a starting point for deeper consideration of how a common heritage of mankind, or similar, regime for human genetic resources would function and be implemented. (shrink)

There are several good reasons for the UK Department of Health to recommend the appraisal of bevacizumab for the treatment of eye conditions by the National Institute for Health and Clinical Excellence. These reasons will extend to other drugs when similar situations arise in the future.

Genetic resources are a key resource for much biomedical research. Pathogenic genetic resources are of value in the identification, surveillance, understanding, and development of vaccines, treatments, and other responses to major public threats such as pandemic influenza outbreaks. Significant attempts have been made to improve the international governance of infectious disease over the last decade, but the handling of pathogenic genetic resources remains contentious and problematic. The need to address the deficiencies in current arrangements (e.g., the World Health Organization's Pandemic (...) Influenza Preparedness Framework) is urgent because future outbreaks are likely to revert to the past situation in which developed states secured vaccine supplies for their own populations while leaving developing countries vulnerable to the pandemic. Thereby, the collaboration of developed countries with vital international systems such as the Global Influenza Surveillance and Response System is disincentivized. The current international approach to pathogenic genetic resources is based on the sovereign rights of states and access and benefit-sharing arrangements that stem from those rights. While this approach is consistent with international rules on other types of genetic resources, herein I argue that this is an inappropriate approach to pathogens on both political (serving public health goals) and ethical grounds (e.g., equity and justice). Instead I argue for a (modified) common heritage approach to pathogenic genetic resources, based on their intrinsic qualities (e.g., rapid mutation, easy transmissibility) and their value to global efforts to respond to disease outbreaks. I will further argue for de-linking access to these resources from benefit-sharing requirements; explaining that while there are strong justifications for both, their linkage (particularly for pathogenic genetic resources) is problematic and detrimental to the achievement of its intended goals (i.e., ensuring equitable benefit-sharing in return for access being granted). (shrink)

Introduction: Platonic dramatology -- The political and philosophical problems. Using pre-Socratic philosophy to support political reform: the Athenian stranger ; Plato's Parmenides: Parmenides' critique of Socrates and Plato's critique of Parmenides ; Becoming Socrates ; Socrates interrogates his contemporaries about the noble and good -- Paradigms of philosophy. Socrates' positive teaching ; Timaeus-Critias: completing or challenging Socratic political philosophy? ; Socratic practice -- The trial and death of Socrates. The limits of human intelligence ; The Eleatic challenge ; The trial (...) and death of Socrates -- Conclusion: Why Plato made Socrates his hero. (shrink)

This landmark study examines the role played by the rediscovery of the writings of the ancient atomists, Epicurus and Lucretius, in the articulation of the major philosophical systems of the seventeenth century, and, more broadly, their influence on the evolution of natural science and moral and political philosophy. The target of sustained and trenchant philosophical criticism by Cicero, and of opprobrium by the Christian Fathers of the early Church, for its unflinching commitment to the absence of divine supervision and the (...) finitude of life, the Epicurean philosophy surfaced again in the period of the Scientific Revolution, when it displaced scholastic Aristotelianism. Both modern social contract theory and utilitarianism in ethics were grounded in its tenets. Catherine Wilson shows how the distinctive Epicurean image of the natural and social worlds took hold in philosophy, and how it is an acknowledged, and often unacknowledged presence in the writings of Descartes, Gassendi, Hobbes, Boyle, Locke, Leibniz, Berkeley. With chapters devoted to Epicurean physics and cosmology, the corpuscularian or "mechanical" philosophy, the question of the mortality of the soul, the grounds of political authority, the contested nature of the experimental philosophy, sensuality, curiosity, and the role of pleasure and utility in ethics, the author makes a persuasive case for the significance of materialism in seventeenth-century philosophy without underestimating the depth and significance of the opposition to it, and for its continued importance in the contemporary world. Lucretius's great poem, On the Nature of Things, supplies the frame of reference for this deeply-researched inquiry into the origins of modern philosophy. (shrink)

Cognitive psychologists have recently identified alterations in perception and reasoning that contribute to the formation and maintenance of beliefs that happen to be delusional. Clinically significant delusions, however, are often deeply unusual. An account of their formation and maintenance must explain not merely how someone can come to hold false or uncommon beliefs, but also how someone can arrive at beliefs that seem profoundly improbable and even bizarre. This paper uses the philosophical concepts of the Bedrock and the Background to (...) provide an account of that foundational, nonrepresentational, non–rule-governed, dispositional structure of everyday understanding that underpins both our perception and our reasoning. The central claim is that the formation and maintenance of delusions becomes intelligible once they are seen to reflect disturbances to this foundational dispositional structure. Different dimensions of the Background are described along with the delusions that might follow from distortions to these dimensions. We challenge the assumption of much recent cognitive psychological theorizing that delusions can be understood as explanations of unusual experiences or as the product of hasty reasoning. Finally, the implications of the theory for the therapy of the delusional patient are briefly discussed. (shrink)

Science relies on models and idealizations that are known not to be true. Even so, science is epistemically reputable. To accommodate science, epistemology should focus on understanding rather than knowledge and should recognize that the understanding of a topic need not be factive. This requires reconfiguring the norms of epistemic acceptability. If epistemology has the resources to accommodate science, it will also have the resources to show that art too advances understanding.

Over the past 15 years, medical schools have paid some attention to the importance of developing students' communication skills as part of their medical education. Over the past decade, medical ethics has been added to the curriculum of most U.S. medical schools, at least on paper. More recently, there has been growing discussion of the importance of professionalism in medical education. Yet, the nature and content of these fields and their relationship to one another remains confused and vague, and that (...) lack of clarity, in turn, impairs the effectiveness of medical education. This ambiguity invites serious contention over who should design and teach the curriculum as well as when, where, and how it should be taught. (shrink)

Because the process of moving from moral principles and facts to action-guiding moral conclusions has not been articulated clearly enough to be useful in a practical way, we designed a systematic approach to aid learners and clinicians in their application of ethical principles to the resolution of clinical dilemmas. Our model for clinical moral reasoning is intended to provide a clear and replicable structure that makes the thought process involved in reasoning about clinical cases explicit. In this paper we present (...) the model and demonstrate how it can be used in three clinical cases. (shrink)

Traditional moral theories of rights and principles have dominated medical ethics discussions for decades. Appeals to utilitarian consequences, as well as the principles of respect for autonomy, beneficence, and justice, have provided the standard vocabulary and filled the literature of the field.Recently on the bioethics scene, however, there has been some discussion of virtue, and, particularly within the nursing ethics literature, appeals are being made to the feminist ethics of care. This intimation of a shift in the wind may have (...) to do with postmodern doubt, or it may be attributable to the claim that virtue theory and the ethics of care are more appropriate to private interaction; theories of rights and justice are best applied to the political domain of public policy. (shrink)

This paper reports on a survey of auditors in New Zealand which investigates the nature of the moral judgements they make on a series of problems with ethical dimensions. The framework adopted for this purpose is developed from earlier work which identifies a range of ethical principles which may be involved in business ethical decision‐making. Auditors responded to a questionnaire which posed, firstly, several questions about the context of their ethical decision‐making, and secondly, a series of vignettes elaborating problematical dilemmas (...) which required the selection of one of four possible responses. Data was analysed to determine whether or not it confirmed previous findings in suggesting a predominant ethical orientation for auditors. The results were correlated with demographic variables in order to determine whether or not age, gender, position in firm and size of employee firm were significantly correlated to ethical response. The survey results, on the whole, confirmed the ethical orientation suggested by previous findings, but there were some unexpected results in three out of the ten vignettes examined. Although some correlations were found between the demographic variables and subject responses, the evidence of this survey does not strongly suggest a consistent significant correlation. (shrink)

Through a number of studies recently published in the psychology literature, T.D. Wilson, D.T. Gilbert, and others have demonstrated that our judgments about what our future mental states will be are contaminated by various distortions. Their studies distinguish a variety of different distortions, but they refer to them all with the generic term “affective forecasting.” The findings of their studies on normal volunteers are remarkably robust and, therefore, demonstrate that we are all vulnerable to the distortions of affective forecasting. a.

This paper articulates a conception of organizational justice based on the promise of a mode of organizing that does not violate the particularity of each and every other person. It argues that the decisive condition for such a form of justice resides in the realities of the cultural practices of an organization as they are apparent in the conduct of people in relation to multiple others. These are practices that can only seek justification in the primary right of each person (...) to be regarded with absolute alterity. It also argues that a degree of violence is unavoidable within any practical ordering of justice and that any consideration of ethics and justice in organizations must account for such violence and seek to negotiate its existence on ethical terms. The organizational justice that is referred to is one sensitive to the exercise of its own power and authority in the context of its unavoidable violation of its basis in ethics. This is a justice that is ethically necessary, but is never sure of itself. (shrink)

The development of genomics has dramatically expanded the scope of genetic research, and collections of genetic biosamples have proliferated in countries with active genomics research programs. In this essay, we consider a particular kind of collection, national biobanks. National biobanks are often presented by advocates as an economic ‘‘resource’’ that will be used by both basic researchers and academic biologists, as well as by pharmaceutical diagnostic and clinical genomics companies. Although national biobanks have been the subject of intense interest in (...) recent social science literature, most prior work on this topic focuses either on bioethical issues related to biobanks, such as the question of informed consent, or on the possibilities for scientific citizenship that they make possible. We emphasize, by contrast, the economic aspect of biobanks, focusing specifically on the way in which national biobanks create biovalue. Our emphasis on the economic aspect of biobanks allows us to recognize the importance of what we call clinical labor—that is, the regularized, embodied work that members of the national population are expected to perform in their role as biobank participants—in the creation of biovalue through biobanks. Moreover, it allows us to understand how the technical way in which national biobanks link clinical labor to databases alters both medical and popular understandings of risk for common diseases and conditions. (shrink)

Confronting fundamentalism: the dangerous God of "control and condemn" -- 1967: What the cake said -- God-talk 101: The art that is Christianity -- The Copernican turn of Christian humanism -- Quantum theology: the symbolic character of God-talk -- Theological weirdness (1): the symbolic claim that God is a person -- Poets as theologians: the moral imagination of Christian Humanist tradition -- Moses debates with a burning bush -- I AM v. I WILL BE: translation and the authority of theologians (...) -- Theological weirdness (2): the symbolic claim that God is necessarily impersonal -- What, then, can be said about God? (shrink)

a This paper is a revised and shortened version of my chapter, “Justice in Allocations for Terrorism, Biological Warfare, and Public Health” in Public Health Ethics, edited by Michael Boylan, Kluwer; 2004. Portions of this material were presented at the International Bioethics Retreat, Pavia, Italy, June 2003, and at the meetings of the Association for Politics and the Life Sciences, Philadelphia, September 2003.

Professor Rhodes, with Professor Lewis, has collected the evidence for decrees through which the states of the ancient Greek world were governed, and uses the evidence to study the decision-making procedures and the extent to which the citizens were actively involved.

Contemporary research ethics policies started with reflection on the atrocities perpetrated upoconcentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of (...) this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)

Network analysis is increasingly appreciated as a methodology in the social sciences. In recent years, it is also receiving attention among historians of science. History of economics is no exception in that researchers have begun to use network analysis to study a variety of topics, including collaborations and interactions in scientific communities, the spread of economic theories within and across fields, or the formation of new specialties in the discipline of economics. Against this backdrop, a debate is emerging about how (...) network analysis can help address questions that are pertinent to the history of economics. With this paper, we want to push this debate one step forward by offering and discussing five reasons why network analysis should have a future in the history of economics. (shrink)

Name der Zeitschrift: Apeiron Jahrgang: 50 Heft: 4 Seiten: 483-510.

In this unconventional article, Sarah Banet-Weiser, Rosalind Gill and Catherine Rottenberg conduct a three-way ‘conversation’ in which they all take turns outlining how they understand the relationship among postfeminism, popular feminism and neoliberal feminism. It begins with a short introduction, and then Ros, Sarah and Catherine each define the term they have become associated with. This is followed by another round in which they discuss the overlaps, similarities and disjunctures among the terms, and the article ends with how (...) each one understands the current mediated feminist landscape. (shrink)

The rapid growth of next-generation genetic sequencing has prompted debate about the responsibilities of researchers toward genetic incidental findings. Assuming there is a duty to disclose significant incidental findings, might there be an obligation for researchers to actively look for these findings? We present an ethical framework for analyzing whether there is a positive duty to look for genetic incidental findings. Using the ancillary care framework as a guide, we identify three main criteria that must be present to give rise (...) to an obligation to look: high benefit to participants, lack of alternative access for participants, and reasonable burden on researchers. Our analysis indicates that there is no obligation to look for incidental findings today, but during the ongoing translation of genomic analysis from research to clinical care, this obligation may arise. (shrink)

The essay is an analysis of John of Damascus’ justification for venerating the icons. Under the subtitle ‘reasoning for venerating the icons’ the essay conducts the analysis in three parts. First, John's definition of ‘veneration’ is presented and examined. Second, the OT ‘veneration’ passages he cites are critically evaluated. Third, the apparent incoherence of John's case is demonstrated from the Eastern Orthodox notion of scripture. This is a follow-up study to a previous essay (i.e., ‘Handmade: a critical analysis of John (...) of Damascus’ reasoning for making icons’) which analyzes a problem in Orthodox aesthetics closely related to the one I examine here. (shrink)