Community engagement is increasingly emphasized in biomedical research, as a right in itself, and to strengthen ethical practice. We draw on interviews and observations to consider the practical and ethical implications of involving Community Health Workers (CHWs) as part of a community engagement strategy for a vaccine trial on the Kenyan Coast. CHWs were initially engaged as an important network to be informed about the trial. However over time, and in response to community advice, they became involved in trial information (...) sharing and identifying potential participants; thereby taking on roles that overlapped with those of employed fieldworkers (FWs). While CHWs involvement was generally perceived as positive and appreciated, there were challenges in their relations with FWs and other community members, partly related to levels and forms of remuneration. Specifically, payment of CHWs was not as high as for FWs and was based on ‘performance’. This extrinsic motivation had the potential to crowd out CHWs intrinsic motivation to perform their pre-existing community roles. CHWs remuneration potentially also contributed to CHWs distorting trial information to encourage community members to participate; and to researchers encouraging CHWs to utilize their social connections and status to increase the numbers of people who attended information giving sessions. Individual consent processes were protected in this trial through final information sharing and consent being conducted by trained clinical staff who were not embedded in study communities. However, our experiences suggest that roles and remuneration of all front line staff and volunteers involved in trials need careful consideration from the outset, and monitoring and discussion over time. (shrink)

In this chapter, Marie Collins Swabey critiques naturalism and defends a rationalistic conception of knowledge.

In this article, Grace Andrus de Laguna develops a view of human freedom, one according to which it is made possible by the uniqueness of human individuals and the cultural worlds in which they live.

_Encountering Bigotry_ examines the occurrence of emotionally fraught and socially provocative expressions, such as racism, sexism, homophobia, anti-Semitism, classism, and other forms of hatred of outgroups or others, in everyday experience. The editors categorize such remarks as projections, particular forms of perceiving oneself and others in the world. This projection allows the person to perceive emotional intensity without owning the feeling or experiencing anxiety-producing emotions. Such projections are not pathological, they observe, but rather "faulty" and not beyond repair. Utilizing experiences (...) gathered from various people and settings, and deriving theory from common psychoanalytic and Gestalt therapy, the observations and conclusions found in _Encountering Bigotry_ are as applicable in any social context as they are in the therapeutic relationship. (shrink)

"This reviewer had to be restrained from stopping people in the street to urge them to read it: They would learn something of the way science is done,...

The continuing spread and development of electronic data interchange in health care settings is fuelling a significant global debate about the practicality, ethics, and legality of such a practice. The uncertainties implicit in this debate are particularly acute in the context of disease or population groups for whom multidisciplinary, multipleagency teamworking has become acknowledged as the “best practice” for providing effective and timely care or support. The greying of the population is a demographic phenomenon that will have a profound impact (...) on the health care system, social care agencies, and caregivers, and will require a greater degree of service coordination in order to meet the complex care needs of both care-receiver and caregiver. (shrink)

This paper provides a methodological schema for interpreting Hume's Dialogues concerning Natural Religion that supports the traditional thesis that Philo represents Hume's views on religious belief. To understand the complexity of Hume's ‘naturalism’ and his assessment of religious belief, it is essential to grasp the manner in which Philo articulates a consistently Humean position in the Dialogues.

What did it mean to keep a secret in early medieval England? It was a period during which the experience of secrecy was intensely bound to the belief that God knew all human secrets, yet the secrets of God remained unknowable to human beings. In Bonds of Secrecy, Benjamin A. Saltzman argues that this double-edged conception of secrecy and divinity profoundly affected the way believers acted and thought as subjects under the law, as the devout within monasteries, and as (...) readers before books. One crucial way it did so was by forming an ethical relationship between the self and the world that was fundamentally different from its modern reflex. Whereas today the bearers of secrets might be judged for the consequences of their reticence or disclosure, Saltzman observes, in the early Middle Ages a person attempting to conceal a secret was judged for believing he or she could conceal it from God. In other words, to attempt to hide from God was to become ensnared in a serious sin, but to hide from the world while deliberately and humbly submitting to God's constant observation was often a hallmark of spiritual virtue. Looking to law codes and religious architecture, hagiographies and riddles, Bonds of Secrecy shows how legal and monastic institutions harnessed the pervasive and complex belief in God's omniscience to produce an intense culture of scrutiny and a radical ethics of secrecy founded on the individual's belief that nothing could be hidden from God. According to Saltzman, this ethics of secrecy not only informed early medieval notions of mental activity and ideas about the mind but also profoundly shaped the practices of literary interpretation in ways that can inform our own contemporary approaches to reading texts from the past. (shrink)

Initial writings and moral distress research focused on nursing, however, it soon became clear that others in healthcare also experienced moral distress. The narratives discussed in this commentary show this variation not only in the authors’ multiplicity of disciplines (psychologists, nurses, an ethicist, and physicians), but also in their workplace environments (prisons, hospitals, and homecare) and their roles, from students to well accomplished professionals. In other words no one is immune. By looking through the lens of time the author shows (...) that the experience of moral distress is not isolated in time, but in fact continues to be lived over time. Other important themes drawn out here are: isolation, powerlessness, failure, regret, undermined potential and the way feelings are experienced. It is also noted that despite the pain and angst, there is a sense of gratitude in these stories. They touch our own woundedness, remind us of our own resiliency and give us hope for the redemptive power of the experience and reflection. (shrink)

Book synopsis: Vagueness is currently the subject of vigorous debate in the philosophy of logic and language. Vague terms-such as "tall", "red", "bald", and "tadpole"—have borderline cases ; and they lack well-defined extensions. The phenomenon of vagueness poses a fundamental challenge to classical logic and semantics, which assumes that propositions are either true or false and that extensions are determinate. Another striking problem to which vagueness gives rise is the sorites paradox. If you remove one grain from a heap of (...) sand, surely you must be left with a heap. Yet apply this principle repeatedly as you remove grains one by one, and you end up, absurdly, with a solitary grain that counts as a heap. This anthology collects papers in the field. After an introduction that surveys the field, the essays form four groups, starting with some historically notable pieces. The 1970s saw an explosion of interest in vagueness, and the second group of essays reprints classic papers from this period. The following group of papers represent current work on the logic and semantics of vagueness. The essays in the final group are contributions to the continuing debate about vague objects and vague identity. (shrink)

Benedict Spinoza is feted as the philosopher par excellence of the popular democratic multitude by Antonio Negri and others. But Spinoza himself expresses a marked ambivalence about the multitude in brief asides, and as for his thoughts on what he calls “the rule of multitude,” that is, democracy, these exist only as meager fragments in his unfinished Tractatus Politicus or Political Treatise. This essay addresses the problem of Spinoza’s multitude. First, I reconstruct a vision of power that is found in (...) the Ethics but that tends to be overlooked in the scholarly literature: power is not just sheer efficacy or imposition of will, but rather involves a capacity for being-affected; I call this the conception of power as sensitivity. The second part of my argument shows how, given Spinoza’s emphatic political naturalism, the conception of power as sensitivity can be extended to his political philosophy to shed light on what Spinoza calls potentia multitudinis, or “the power of the multitude”—a term found solely in the Political Treatise and nowhere else in his oeuvre. This juxtaposition reveals significant qualifications to the liberatory potential of the multitude currently claimed in the scholarly literature. (shrink)

There has been a long debate on whether demonstratives are directly referential as Kaplan originally argued, or indirectly referential like a definite description. I propose a new analysis of demonstratives that combines intuitions from both direct and indirect approaches. The demonstrative is analyzed as an indirectly referential expression with a binary maximality operator that takes two arguments, where the second argument can be a deictic pointing, an anaphoric index, or a relative clause. Direct reference is encoded not in the meaning (...) of the demonstrative but in the meaning contributed by the pointing gesture, thus capturing both direct and indirect uses. I further propose that some pronouns in English function as demonstratives, realizing the binary structure and competing with the demonstrative. The main advantages of this proposal include (a) deriving the distribution of pronominal and adnominal demonstratives systematically; (b) capturing the unique interaction that demonstratives have with a pointing gesture; and (c) locating English demonstratives against a larger, cross-linguistic picture. (shrink)

In a number of influential articles published since 1972, Dorothy Grover has developed the prosentential theory of truth. Brought together and published with a new introduction, these essays are even more impressive as a group than they were as single contributions to philosophy and linguistics. Denying that truth has an explanatory role, the prosentential theory does not address traditional truth issues like belief, meaning, and justification. Instead, it focuses on the grammatical role of the truth predicate and asserts that (...) “it is true” is a prosentence, functioning much as a pronoun does. Grover defends the theory by indicating how it can handle notorious paradoxes like the Liar, as well as by analyzing some English truth-usages. The introduction to the volume surveys traditional theories of truth, including correspondence, pragmatic, and coherence theories. It discusses the essays to come and, finally, considers the implications of the prosentential theory for other theories. Despite the fact that the prosentential theory dismisses the “nature of truth” as a red herring, Grover shows that there are important aspects of traditional truth theories that prosentential theorists have the option of endorsing. (shrink)

It has often been said that the Zhuangzi 莊子 advocates political abstention, and that its putative skepticism prevents it from contributing in any meaningful way to political thinking: at best the Zhuangzi espouses a sort of anarchism, at worst it is “the night in which all cows are black,” a stance that one scholar has charged is ultimately immoral. This article tracks possible political allusions within the text, and, by reading these against details of social, political, and historical context, sheds (...) light on another strand of the Zhuangzi—one that questions prevailing normative values because it is fiercely critical of scholarly complicity with violent imperial territorial consolidation. (shrink)