Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its purpose. Intervention (...) participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (shrink)

Television medical dramas frequently depict the practice of medicine and bioethical issues in a strikingly realistic but sometimes inaccurate fashion. Because these shows depict medicine so vividly and are so relevant to the career interests of medical and nursing students, they may affect these students' beliefs, attitudes, and perceptions regarding the practice of medicine and bioethical issues. We conducted a web-based survey of medical and nursing students to determine the medical drama viewing habits and impressions of bioethical issues depicted in (...) them. More than 80% of medical and nursing students watch television medical dramas. Students with more clinical experience tended to have impressions that were more negative than those of students without clinical experience. Furthermore, viewing of television medical dramas is a social event and many students discuss the bioethical issues they observe with friends and family. Television medical dramas may stimulate students to think about and discuss bioethical issues. (shrink)

Book reviewed in this article: Wrong Medicine. By Lawrence J. Schneiderman and Nancy S. Jecker.

Pragmatic clinical trials offer important benefits, such as generating evidence that is suited to inform real-world health care decisions and increasing research efficiency. However, PCTs also present ethical challenges. One such challenge involves the management of information that emerges in a PCT that is unrelated to the primary research question, yet may have implications for the individual patients, clinicians, or health care systems from whom or within which research data were collected. We term these findings as?pragmatic clinical trial collateral findings,? (...) or?PCT-CFs?. In this article, we explore the ethical considerations associated with the identification, assessment, and management of PCT-CFs, and how these considerations may vary based upon the attributes of a specific PCT. Our purpose is to map the terrain of PCT-CFs to serve as a foundation for future scholarship as well as policy-making and to facilitate careful deliberation about actual cases as they occur in practice. (shrink)

This paper argues that Sulmasy and Sugarman have not succeeded in showing a moral difference between withholding and withdrawing treatment. In particular, they have misunderstood historical entitlement theory, which does not automatically prefer a first occupant by just acquisition.

A history of injustices to diverse groups of human subjects in medical research has resulted in concerted efforts by U.S. policymakers in the second half of the twentieth century to provide greater protection for future subjects. However, in the context of patient populations demanding better therapies, potential medical advances, and greater attention to issues of social justice, Kahn, Mastroianni, and Sugarman set out to reconceptualize the principle of justice in human subjects research to address these urgent concerns. In BeyondConsent, Kahn (...) and colleagues advance a framework of justice in terms of access to participation in research, instead of protection. Their worthy cause, developed out of collaboration on the White House Advisory Committee on Human Radiation Experiments, aims to demonstrate how previously unaddressed notions of justice now require greater consideration in research. Specifically, they emphasize how fairness requires a greater distribution of risks and benefits, and that The volume does not report new research findings but rather draws on multidisciplinary approaches, including law, medicine, philosophy, history, and health policy, to argue that justice must go beyond informed consent. The editors posit that this challenge to protectionism is necessary given the heightened urgency for patients to benefit from investigational therapies although they incur increased risks. (shrink)

In contemporary forms of psychoanalysis, particularly intersubjective systems theory, the turn towards contextualism has permitted the development of new ways of thinking and practicing that have dispensed with the notion of isolated individuality. For many who embrace this "post-subjectivist" way of thinking and practicing, the recognition that all human experience is fundamentally immersed in the world makes the question of individuality seem confusing, even anachronistic. Yet the challenge of individuality remains an important and pressing issue for contemporary theory and practice; (...) many clinicians are left to wonder about the role of "individual" experience and how to approach it conceptually or clinically. This volume of original essays gives the problem of individuality its due, without losing sight of the importance of contextualized experience. Drawing on a variety of disciplinary backgrounds - philosophical, developmental, biological, and neuroscientific - the contributors address the tension that exists between individuality and the emergence of contextualism as a dominant mode of psychoanalytic theory and practice, thereby providing unique insights into the role and place of individuality both in and out of the clinical setting. Ultimately, these essays demonstrate that individuality, no matter how it may be defined, always occurs within a contextual web that forms the basis of human experience. _Contributors:_ William J. Coburn, Philip Cushman, James L. Fosshage, Roger Frie, Frank M. Lachmann, Jack Martin, Donna Orange, Robert D. Stolorow, Jeff Sugarman. (shrink)

The editors of this book set out to provide an overview of the various disciplines and methods of inquiry that contribute to medical ethics. The question “what is medical ethics?” is an important and topical one, especially in countries such as the UK where medical ethics has become established as a subject of academic inquiry relatively recently compared to the United States. Sugarman and Sulmasy argue that medical ethics is a single field of inquiry which is shared by several disciplines, (...) each of which bring their own disciplinary methods to the subject of the normative aspects of health care. The first chapter is used to explain this definition of medical ethics and to consider the interplay between normative and descriptive (or empirical) …. (shrink)

Following an initial discussion of the general nature of interpretation in contemporary psychology, and social and natural science, relevant views of Charles Taylor and Thomas Kuhn are considered in some detail. Although both Taylor and Kuhn agree that interpretation in the social or human sciences differs in some ways from interpretation in the natural sciences, they disagree about the nature and origins of such difference. Our own analysis follows, in which we consider differences in interpretation between the natural and social (...) sciences in terms of Ian Hacking's use of Elizabeth Anscombe's conceptualization of actions as intentional acts under particular descriptions. We conclude that both Taylor and Kuhn are correct to point to differences in interpretation between the natural and social sciences. We also argue that in psychology, such interpretive differences, contra Kuhn and pro Taylor, are qualitative rather than quantitative. They arise from the nature of persons as self-interpretive, reactive beings who act under socioculturally sanctioned, linguistic descriptions. The actions of psychological persons may display qualitative differences over time and across contexts as these descriptions, including social scientific and psychological findings and interpretations, change. In contrast, even when descriptions in natural science change, such changes do not spawn changes in the self-interpretations and intentional actions of the focal phenomena of natural science. We also make the point that much current confusion surrounding interpretation in science arises from the unwarranted tendency of some commentators to treat interpretation as subjective, in ways that ignore the objective grounding of interpretation within regulated social practices, including scientific practices sanctioned by scientific communities. (shrink)

Of all the developments in twentieth century physics, none has given rise to more heated debates than the changes in our understanding of science precipitated by the quantum revolution''. In this revolution, Niels Bohr's dramatically non-classical theory of the atom proved to be the springboard from which the new atomic physics drew it's momentum. Furthermore, Bohr's contribution was crucial not only because his interpretation of quantum mechanics became the most widely accepted view but also because in his role as educator (...) and spokesman for atomic physics Bohr was very much the patron spirit of the entire quantum revolution. The conceptual framework which he proposed to provide a new viewpoint for understanding the quantum theoretical description of atomic systems became for most of this century the dominant outlook of countless productive experimental and theoretical physicists. He called this new framework complementarity''. (shrink)

Trope theory is a leading metaphysical theory in analytic ontology. One of its classic statements is found in the work of Donald C. Williams who argued that tropes qua abstract particulars are the very alphabet of being. The concept of an abstract particular has been repeatedly attacked in the literature. Opponents and proponents of trope theory alike have levelled their criticisms at the abstractness of tropes and the associated act of abstraction. In this paper I defend the concept of a (...) trope qua abstract particular by rejecting arguments that purport to show that tropes should not be understood as abstract and by arguing that the abstractness of tropes plays an indispensable role in one of our more promising trope-theoretic analyses of universals and of concrete objects. (shrink)

v. 1. Nicomachean ethics. Politics. The Athenian Constitution. Rhetoric. On Poetics.--v. 2. Logic.--v. 3. Physics. Metaphysics. On the soul. Short physical treaties.--v. 4. On the heavens. On generation and corruption. Meteorology. Biological treatises.

In Working Virtue: Virtue Ethics and Contemporary Moral Problems, leading figures in the fields of virtue ethics and ethics come together to present the first ...

The concept of instantiation is realized differently across a variety of metaphysical theories. A certain realization of the concept in a given theory depends on what roles are specified and associated with the concept and its corresponding term as well as what entities are suited to fill those roles. In this paper, the classic realization of the concept of instantiation in a one-category ontology of abstract particulars or tropes is articulated in a novel way and defended against unaddressed objections.

Fifteen essays addressing conceptions of individualism and holism as they emerged in Chinese literature and philosophy from the time of Confucius and Chuang-tzu to the present.

Human languages vary in many ways but also show striking cross-linguistic universals. Why do these universals exist? Recent theoretical results demonstrate that Bayesian learners transmitting language to each other through iterated learning will converge on a distribution of languages that depends only on their prior biases about language and the quantity of data transmitted at each point; the structure of the world being communicated about plays no role (Griffiths & Kalish, , ). We revisit these findings and show that when (...) certain assumptions about the relationship between language and the world are abandoned, learners will converge to languages that depend on the structure of the world as well as their prior biases. These theoretical results are supported with a series of experiments showing that when human learners acquire language through iterated learning, the ultimate structure of those languages is shaped by the structure of the meanings to be communicated. (shrink)

For over 40 years, J. I. Packer's classic has been an important tool to help Christians around the world discover the wonder, the glory and the joy of knowing God. Explaining both who God is and how we can relate to him, this thought-provoking work seeks to transform and enrich the Christian understanding of God.

In management research, theory testing confronts a paradox described by Meehl in which designing studies with greater methodological rigor puts theories at less risk of falsification. This paradox exists because most management theories make predictions that are merely directional, such as stating that two variables will be positively or negatively related. As methodological rigor increases, the probability that an estimated effect will differ from zero likewise increases, and the likelihood of finding support for a directional prediction boils down to a (...) coin toss. This paradox can be resolved by developing theories with greater precision, such that their propositions predict something more meaningful than deviations from zero. This article evaluates the precision of theories in management research, offers guidelines for making theories more precise, and discusses ways to overcome barriers to the pursuit of theoretical precision. (shrink)

Rooted in the field of cathedral studies, this paper draws into dialogue three bodies of knowledge: Edward Bailey’s notion of implicit religion that, among other things, highlights the continuing traction of the Christian tradition and Christian practice within secular societies; David Walker’s notion of the multiple ways through which in secular societies people may relate to the Christian tradition as embodied within the Anglican Church and John Fisher’s notion of spiritual wellbeing as conceptualised in relational terms. Against this conceptual background, (...) this paper draws on data provided by 1234 participants attending one of the Christmas Eve carol services in Liverpool Cathedral to explore the perceived impact of attendance on the spiritual health of people who do not believe in God and yet feel that Liverpool Cathedral is their cathedral, and it is this sense of belonging that brings them back at Christmas time.Contribution: Situated within the science of cathedral studies, this paper links in an original way three fields of discourse: Edward Bailey’s notion of implicit religion, David Walker’s notion of the four ways of belonging to God facilitated by the Anglican Church and John Fisher’s conceptualisation and operationalisation of the notion of spiritual wellbeing. The hypothesis developed from this original integration of theoretical perspectives is then tested empirically on data provided by 404 participants at carol services who do not believe in God. (shrink)

Semantic Scholar extracted view of "Animal Welfare and Rights: V. Zoos and Zoological Parks" by J. Dunlap et al.

This article has two objectives. First, and in particular, it seeks to reinterpret the ostracism procedure of early democratic Athens. Since Aristotle, this has been understood as a rational, political weapon of collective defense, intended to expel from Athens a disproportionately powerful individual. In this article, by putting emphasis on themateriality, gestures, and location of ostraka-casting, I propose instead that the institution can more fruitfully be understood as a ritual enactment of civic unity. Second, and more generally, I hope to (...) explore the frames within which early Athenian democracy is placed: while Greek kingship and tyranny (i.e. “primitive” polities) have been very successfully explored through anthropological and cross-cultural comparison, Greek democracy for the most part has remained in the domains of the institutional historian and political theorist. Taking a phenomenological and comparative approach, this article asks how the citizens of early democratic Athens experienced and comprehended their new sovereignty and the invented procedures of mass decision-making through which it was expressed. (shrink)

I INTRODUCTION: RESPECT, EQUALITY AND THE AUTONOMY OF MORALITY We often invoke a notion of respect to express our sense of human equality. ...

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

The mechanistic theory of life.--Criticism of the mechanistic theory.--Biology and the physical sciences.--Personality.

This book is unified by three broad concerns: the rationality of belief in God, the relation between religion and morality, and the explication of the concept of God. The essays are, however, marked by diversity. Some focus on historical figures, such as Aquinas and Locke; others bring recent epistemological and metaphysical developments to bear on problems of religious belief. Some of the papers explore neglected issues central to religious practice, such as the question of how total devotion to God can (...) permit other deep commitments; others apply philosophical distinctions from within a religious tradition, for example, in setting out a Christian approach to the problem of evil. (shrink)

The continuing power of racist ideology threatens liberal democracy, for racism is more than a personal bias or a social construction. It is an ideological framework that reduces human beings to an existence along a color-coded spectrum, with people designated as “white” at the top of the hierarchy and people designated as “black” at the bottom. One has to see this ideology clearly in order to choose a proper response and then act accordingly. First, the reality of “race” has been (...) exposed as unscientific and illusory, and as based not on biology or genetics, but on a legacy of empowerment for some and enslavement for others. Second, this racist ideology, part of our disenchanted, secular age, is exposed as a continuing form of enchantment in its manner of seeing the world, opening the possibility for a spiritual response. Third, dismantling this racist ideology requires a reimagining of “blackness” as a source of life and spirituality, as a way of countering and rewriting the dominant racist narrative. Fourth, a postsecular spiritualty, based on the work of Pope Francis—that emphasizes the importance of protecting our common human dignity, of caring for each other, and of “walking together”—can be engaged as a path for action in the battle against racism. (shrink)

Two conceptual strands of research within the field of cathedral studies have theorised the capacity of Anglican cathedrals to engage more successfully than parish churches with the wider non-churchgoing community. One strand has explored mobilising cathedral metaphors, and the other strand has explored the notion of implicit religion. Both strands illuminate the power of events and installations to soften the boundaries between common ground and sacred space. Drawing on a quantitative survey among 978 people who attended the pre-Christmas son et (...) lumiere at Liverpool Cathedral during December 2022, the present study analyses the qualitative responses of 123 participants who never attend church services. Three categories of themes emerged from these data, concerning the Cathedral itself, the installation, and discordant experience.Contribution: Situated within the science of cathedral studies, this article draws on original qualitative data to illuminate the experiences of participants who never attend church services when engaging with the pre-Christmas son et lumiere at a major cathedral. Conceptualised within the framework of implicit religion, these data confirmed how the son et lumiere succeeded in softening boundaries between the sacred and the secular and provided a deeply moving experience. As one participant said, ‘I am not religious, but I had the best experience ever’. (shrink)

The problem of stability in population dynamics concerns many domains of application in demography, biology, mechanics and mathematics. The problem is highly generic and independent of the population considered (human, animals, molecules,…). We give in this paper some examples of population dynamics concerning nucleic acids interacting through direct nucleic binding with small or cyclic RNAs acting on mRNAs or tRNAs as translation factors or through protein complexes expressed by genes and linked to DNA as transcription factors. The networks made of (...) these interactions between nucleic acids (considered respectively as edges and nodes of their interaction graph) are complex, but exhibit simple emergent asymptotic behaviours, when time tends to infinity, called attractors. We show that the quantity called attractor entropy plays a crucial role in the study of the stability and robustness of such genetic networks. (shrink)

Prize offered for most innovative web publication A t present, the Journal of Medical Ethics appears in duplicate: one version on the web, one version in paper. There has been little difference between these two copies. But the web and paper publishing offer different opportunities for the reader. A bound conventional paper copy of a journal offers a compact, transportable, easily readable, discrete collection of knowledge. It ….