Research Ethics Committees (RECs) play a critical gatekeeping role in clinical trials. This role is meant to ensure that only those trials that meet certain ethical thresholds proceed through their gate. Two of these thresholds are that the potential benefits of trials are reasonable in relation to risks and that trials are capable of producing a requisite amount of social value. While one ought not expect perfect execution by RECs of their gatekeeping role, one should expect routine success in it. (...) This article reviews a range of evidence showing that substantial numbers of ethically tainted trials are receiving REC approvals. Many of the trials are early phase trials that evidence shows have benefits that may not be reasonable compared with their risks and many others are later trials that evidence shows may lack sufficient social value. The evidence pertains to such matters as methodologically inadequate preclinical studies incapable of supporting the inferences that REC members must make about the prospects for potential benefit needed to offset the risks in early phase trials and sponsorship bias that can cause improperly designed, conducted, analysed and reported later phase trials. The analysis of the evidence makes clear that REC practices need to be strengthened if they are to adequately fulfil their gatekeeping role. The article also explores options that RECs could use in order to improve their gatekeeping function. (shrink)

Few early debates in bioethics invigorated the field to the same extent as the one concerning whether or not young children could be used in nontherapeutic research. Though some of the issues in the debate were never fully settled, a consensus emerged, reflected in the Common Rule—that surrogates could consent to use children in such research, although once the level of risk rises above minimal, additional stipulations are required. Nontherapeutic research on cognitively impaired elderly people raises equally complex ethical issues, (...) but there has been a dearth of debate in the literature about whether such research is ethically permissible. Instead, there have been many published recommendations regarding the circumstances under which such research can occur. (shrink)

Volume 20, Issue 7, July 2020, Page 101-103.

Commentators tout the societal benefits of research to conclude that people have a civic duty to participate in it. A review of several problems in research demonstrate the contrary and reveal why claims we are duty-bound to participate in research deter urgently needed efforts to tackle multiple entrenched deficiencies in it.

:Academic Medical Centers offer patient care and perform research. Increasingly, AMCs advertise to the public in order to garner income that can support these dual missions. In what follows, we raise concerns about the ways that advertising blurs important distinctions between them. Such blurring is detrimental to AMC efforts to fulfill critically important ethical responsibilities pertaining both to science communication and clinical research, because marketing campaigns can employ hype that weakens research integrity and contributes to therapeutic misconception and misestimation, undermining (...) the informed consent process that is essential to the ethical conduct of research. We offer ethical analysis of common advertising practices that justify these concerns. We also suggest the need for a deliberative body convened by the Association of American Medical Colleges and others to develop a set of voluntary guidelines that AMCs can use to avoid in the future, the problems found in many current AMC advertising practices. (shrink)

Any humane society needs a just and compassionate way to care for those who are sick, and should be vigilant in identifying and eliminating barriers that frustrate efforts to adequately care for the sick. Some current insurance underwriting practices constitute effective barriers to access to healthcare and serve to diminish the place of freedom and justice in our healthcare system.

There is substantial published evidence showing that countless people enroll each year in ethically deficient clinical trials. Many of the trials are problematic because the quality of the science used to justify their launch may not be sufficiently vetted while many other trials may lack requisite social value. This poses the question: why do people volunteer for them? The answer resides in large part in the fact that informed consent practices have historically masked, rather than disclosed, the information that would (...) alert research candidates to the ethically problematic nature of the trials. The “reasonable person” and “key information” provisions in the revised US Common Rule create the opportunity to correct this historical shortcoming. Two sources are employed to shed light on what the “key information” is that should be disclosed to a “reasonable person”: the original disclosure aims of the Nuremberg Code, as well as an extensive body of meta-research evidence. Those sources jointly support a range of new disclosures in the informed consent process that would unmask the heretofore undisclosed information. The resulting proposed new disclosures pertain to the overall success prospects of clinical trials, the quality of the prior research that both forms the basis of clinical trials and informs assessment of their risks and benefits, the potential social value of clinical trials, and the commercial purposes of clinical trials. (shrink)

A recent editorial in this journal calls for more philosophical work in the areas of philosophy of medical science and research methodology [1]. The purpose of the present paper is to bring to light and discuss some obstacles and opportunities for development in these areas. In section I, barriers to increased philosophical work in medicine outside ethics are discussed. In sections II and III, additional areas in medicine ripe for philosophical work are identified and discussed: (a) improving the epistemic fitness (...) of much current clinical reasoning, (b) defining the conditions under which greater epistemic fitness can be achieved, and (c) technology assessment. (shrink)

The thesis of the paper is that For Profit Hospitals are morally inappropriate health care delivery institutions. The thesis is established first by elaborating on the beneficent nature of medicine, hospitals, and the physician/patient relationship. The primary obligation of the physician, who draws on the resources of medicine and the hospitals, is to restore personal autonomy that is diminished by illness and suffering within the constraints of the canon of loyalty that frames the physician patient relationship. Hospitals have historically played (...) the role of facilitator enhancing a physician's ability to administer treatment. Next it is argued that For Profit Hospitals may neglect the role of facilitator. This neglect may occur given the institutions' motivations to return a profit to investors by exploiting the patient/physician relationship. This exploitation is clearly shown to be contrary to the canon of loyalty that ought to exist between the patient and physician. (shrink)

The popular view of non-directive genetic counseling limits the counselor's role to providing information to clients and assisting families in making decisions in a morally neutral fashion. This view of non-directive genetic counseling is shown to be incomplete. A fuller understanding of what it means to respect autonomy shows that merely respecting client choices does not exhaust the duty. Moreover, the genetic counselor/client relationship should also be governed by the counselor's commitment to the principle of beneficience. When non-directive counseling is (...) reexamined in light of both these principles, it becomes clear that there are cases in which counselors should attempt to persuade clients to reconsider their decisions. Such attempts are consistent with non-directive counseling because, while respecting the clients' decision-making authority, they insure that clients act with full knowledge of the moral consequences of their decisions. (shrink)

Like many trained in philosophy, we greatly value the work of those scholars with the courage to espouse contrarian views, particularly when the ideas in dispute lie at the very heart of entrenched...

Metaphors used to describe new technologies mediate public understanding of the innovations. Analyzing the linguistic, rhetorical, and affective aspects of these metaphors opens the range of issues available for bioethical scrutiny and increases public accountability. This article shows how such a multidisciplinary approach can be useful by looking at a set of texts about one issue, the use of a newly developed technique for genetic modification, CRISPRcas9.

Academic medical centers and drug manufacturers have traditionally occupied very distinct positions with regard to public trust. As collaborations among medical researchers and pharmaceutical companies expand, however, worries about the aggressive pursuit of profit that has tarnished the reputation of the pharmaceutical industry may be transferred to medical institutions and clinical investigators, suggesting to some that biomedical research is more about increasing profit than promoting public health. Consequently, when medical institutions forge research collaborations with industry they should be mindful of (...) the potential for these relationships to erode public confidence in the integrity of clinical research.Recent events have heightened concerns about the financing of clinical research. These include the widely publicized deaths of several research volunteers, scandals at the nation's largest funder of biomedical research, and evidence of fabricated research findings in prominent medical journals. These unfortunate events have prompted many to re-examine strategies for managing industry relationships and the financial conflicts of interest they may create. (shrink)

For all humans, sexual orientation and gender identity are essential elements of identity, informing how we plan and live our lives. The historic invisibility of sexual minorities in medicine has meant that these important aspects of their identities as patients have been ignored, with the result that these patients have been denied respect, culturally competent services, and proper treatment. Likely due to historic rejection and mistreatment, there is evidence of reluctance on the part of LGBT patients to disclose their sexual (...) orientation (SO) or gender identity (GI) to their health care providers. There is some perception of risk in sharing SO and GI for many patients who have had bad prior experiences. Despite these risks, we argue that we can improve the quality of care provided this population only by encouraging them to self‐identify and then using that information to improve quality of care.One strategy both to prompt patient self‐identification and to store and use SO and GI data to improve care centers on the use of electronic health records. However, gathering SO and GI data in the EHR requires a workforce that knows both how to obtain and how to use that information. To develop these competencies, educational programs for health professionals must prepare students and educators to elicit and to use sexual orientation and gender identity information to improve care while simultaneously ensuring the safety of patients, trainees, and staff and faculty members as SO and GI become openly discussed and integral parts of ongoing medical discussion and care. As determination of SO and GI demographics becomes more common in health research, we will more fully understand the health risks for all the LGBTIQQ populations. (shrink)

On the basis of careful textual exegesis and philosophical analysis, and contrary to the received view, Mark R. Wheeler demonstrates that Aristotle presents and systematically explicates his definition of the essence of the truth in the Metaphysics. Aristotle states the nominal definitions of the terms "truth" and "falsehood" as part of his arguments in defense of the logical axioms. These nominal definitions express conceptions of truth and falsehood his philosophical opponents would have recognized and accepted in the context of (...) dialectical argument. On the basis of these nominal definitions, Aristotle develops his definitions of the essences of truth and falsehood--his "real" definitions of truth and falsehood. Aristotle's methodical exposition of his essential definitions of truth and falsehood in the Metaphysics serves as a well-developed example of how his philosophical inquiry starts with nominal definitions and ends with real definitions. Wheeler also argues for the novel claim that Aristotle defines the most fundamental kind of truth in terms of accurate measurement. Aristotle's metrical conception of truth serves as the theoretical basis for specifying the truth conditions of various assertions, for identifying the sorts of beings implicated in these truth conditions, and for explaining the nature of approximate truth and falsehood. Far from offering us a minimal account of truth, Wheeler shows how Aristotle offers us a sophisticated and metrical theory of truth. (shrink)

Prologue, invitation to thinking about God In the Hebrew Bible? -- Part I, questions about God? -- Why does God in the Bible have a body? -- What do God's body parts in the Bible mean? -- Why is God angry in the Bible? -- Does God in the Bible have gender or sexuality? -- Part II, questions about God in the world? -- What can creation tell us about God? -- Who-or what-is the Satan? -- Why do people suffer (...) according to the Hebrew Bible? -- Epilogue, God in the Bible and beyond. (shrink)

Hume's Reception in Early America: Expanded Edition brings together the original American responses to one of Britain's greatest men of letters, David Hume. Now available as a single volume paperback, this new edition includes updated further readings suggestions and dozens of additional primary sources gathered together in a completely new concluding section. From complete pamphlets and booklets, to poems, reviews, and letters, to extracts from newspapers, religious magazines and literary and political journals, this book's contents come from a wide variety (...) of sources published in colonial America and the early United States between 1758 and 1850. As well as classics by Thomas Jefferson, John Adams and Alexander Hamilton, it contains scores of unknown and hard-to-locate items, many of which have not been reprinted since their original publication. These responses are divided into four parts covering Hume's Essays; his Philosophical Writings; his History of England; and his Character and Death. Each of those parts has a separate introductory essay, and every selection is introduced by a short headnote that sets the piece in its historical context and provides bibliographical references. Packed with new insights into Hume and American thought and culture, Hume's Reception in Early America reveals the relevance and impact of Hume on American political, philosophical, historical, religious, and aesthetic debates. (shrink)

This book initiates a conversation between the two traditions showing how concepts and tools drawn from one philosophical tradition can help solve problems ...

It is time to bring the rich resources of these traditions into the contemporary debate about the nature of self. This volume is the first of its kind.

Animal rights and moral theories -- Arguing for one's species -- Utilitarianism and animals : Peter Singer's case for animal liberation -- Tom Regan : animal rights as natural rights -- Virtue ethics and animals -- Contractarianism and animal rights -- Animal minds.

Epistemology -- Power I -- Power II -- Subjectivity -- Resistance -- Critique -- Ethics.

A revelatory new theory of consciousness that returns emotions to the center of mental life. For Mark Solms, one of the boldest thinkers in contemporary neuroscience, discovering how consciousness comes about has been a lifetime's quest. Scientists consider it the "hard problem" because it seems an impossible task to understand why we feel a subjective sense of self and how it arises in the brain. Venturing into the elementary physics of life, Solms has now arrived at an astonishing answer. (...) In The Hidden Spring, he brings forward his discovery in accessible language and graspable analogies. Solms is a frank and fearless guide on an extraordinary voyage from the dawn of neuropsychology and psychoanalysis to the cutting edge of contemporary neuroscience, adhering to the medically provable. But he goes beyond other neuroscientists by paying close attention to the subjective experiences of hundreds of neurological patients, many of whom he treated, whose uncanny conversations expose much about the brain's obscure reaches. Most importantly, you will be able to recognize the workings of your own mind for what they really are, including every stray thought, pulse of emotion, and shift of attention. The Hidden Spring will profoundly alter your understanding of your own subjective experience. (shrink)

Welche Bedeutung haben Eigennamen wie "Kurt Gödel", Artnamen wie "Tiger" oder Indexikalia wie "ich"? Auf welche Weise beziehen sich solche Ausdrücke auf etwas? In den letzten Jahren hat sich eine intensive Diskussion über diese Fragen entwickelt, die nicht nur für Sprachphilosophen von Interesse ist: Die in der Debatte vorgebrachten Argumente haben z. B. zu heteodoxen erkenntnistheoretischen Positionen und zu einer Erneuerung des philosophischen Interesses an essentiellen Eigenschaften geführt. In diesem Band sind Arbeiten - größtenteils erstmals in deutscher Übersetzung - zusammengestellt, (...) die den Grundgedanken der Neuen Theorien entwickeln und einzelne Folgeprobleme für diese Neuen Theorien zu lösen versuchen. (shrink)

This book explores how the processes and practices of politics shape political values, such as liberty, justice, equality, and democracy.

Fitting Attitudes accounts of value analogize or equate being good with being desirable, on the premise that ‘desirable’ means not, ‘able to be desired’, as Mill has been accused of mistakenly assuming, but ‘ought to be desired’, or something similar. The appeal of this idea is visible in the critical reaction to Mill, which generally goes along with his equation of ‘good’ with ‘desirable’ and only balks at the second step, and it crosses broad boundaries in terms of philosophers’ other (...) commitments. For example, Fitting Attitudes accounts play a central role both in T.M. Scanlon’s [1998] case against teleology, and in Michael Smith [2003], [unpublished] and Doug Portmore’s [2007] cases for it. And of course they have a long and distinguished history. (shrink)

This chapter sets out to distinguish the sorts of claims have been advanced under the rubric of “moral particularism,” and to sort through the insights and costs of each. In particular, it distinguishes those who are animated by suspicion of theory itself from those who aim to reconfigure — sometimes radically — the nature of theory. It defends as key the particularist insight that exceptions to substantive moral explanations are ubiquitous. It argues that the lesson of this insight is not (...) to abandon moral generalizations, but to change the picture of what they must look like to do their work. (shrink)

MacIntyre and the plurality of traditions -- Charles Taylor : strong evaluation and the hermenutics of the modern social imaginary -- Hannah Arendt on reasoning without banisters -- Seyla Benhabib : thinking with Arendt and Habermas against Arendt and Habermas -- Foucault and the art of telling the truth of ourselves -- Connolly and the practice of deep pluralism -- Reasoning through baggage in a global polity.

Mark Vernon links the resources of the philosophical tradition with numerous illustrations from modern culture to ask what friendship is and how it relates to sex, work, politics and spirituality. Unusually, he argues that Plato and Nietzsche, as much as Aristotle and Aelred, should be put center stage. Their penetrating and occasionally tough insights are invaluable if friendship is to be a full, not merely sentimental, way of life for today.

Testifying as an expert ethics witness raises a number of important issues. These include: the prospect of generating adverse publicity for oneself and one's institution, avoiding bias, giving testimony that is at odds with testimony given by colleagues, potential conflicts of interest introduced by reimbursement, the need of those who hear the testimony of bioethicists to appreciate the nature of moral expertise, the difficulty of assessing the quality of legal evidence which emerges from adversarial legal proceedings, and the need to (...) consider what weight should be assigned to expert ethics testimony. Along with these issues, what might constitute sexual misconduct is addressed in the essay so that readers can review the decision-making of the author in two cases. (shrink)

Batterman and Rice ([2014]) argue that minimal models possess explanatory power that cannot be captured by what they call ‘common features’ approaches to explanation. Minimal models are explanatory, according to Batterman and Rice, not in virtue of accurately representing relevant features, but in virtue of answering three questions that provide a ‘story about why large classes of features are irrelevant to the explanandum phenomenon’ ([2014], p. 356). In this article, I argue, first, that a method (the renormalization group) they propose (...) to answer the three questions cannot answer them, at least not by itself. Second, I argue that answers to the three questions are unnecessary to account for the explanatoriness of their minimal models. Finally, I argue that a common features account, what I call the ‘generalized ontic conception of explanation’, can capture the explanatoriness of minimal models. (shrink)

We usually consider literary thinking to be peripheral and dispensable, an activity for specialists: poets, prophets, lunatics, and babysitters. Certainly we do not think it is the basis of the mind. We think of stories and parables from Aesop's Fables or The Thousand and One Nights, for example, as exotic tales set in strange lands, with spectacular images, talking animals, and fantastic plots--wonderful entertainments, often insightful, but well removed from logic and science, and entirely foreign to the world of everyday (...) thought. But Mark Turner argues that this common wisdom is wrong. The literary mind--the mind of stories and parables--is not peripheral but basic to thought. Story is the central principle of our experience and knowledge. Parable--the projection of story to give meaning to new encounters--is the indispensable tool of everyday reason. Literary thought makes everyday thought possible. This book makes the revolutionary claim that the basic issue for cognitive science is the nature of literary thinking. In The Literary Mind, Turner ranges from the tools of modern linguistics, to the recent work of neuroscientists such as Antonio Damasio and Gerald Edelman, to literary masterpieces by Homer, Dante, Shakespeare, and Proust, as he explains how story and projection--and their powerful combination in parable--are fundamental to everyday thought. In simple and traditional English, he reveals how we use parable to understand space and time, to grasp what it means to be located in space and time, and to conceive of ourselves, other selves, other lives, and other viewpoints. He explains the role of parable in reasoning, in categorizing, and in solving problems. He develops a powerful model of conceptual construction and, in a far-reaching final chapter, extends it to a new conception of the origin of language that contradicts proposals by such thinkers as Noam Chomsky and Steven Pinker. Turner argues that story, projection, and parable precede grammar, that language follows from these mental capacities as a consequence. Language, he concludes, is the child of the literary mind. Offering major revisions to our understanding of thought, conceptual activity, and the origin and nature of language, The Literary Mind presents a unified theory of central problems in cognitive science, linguistics, neuroscience, psychology, and philosophy. It gives new and unexpected answers to classic questions about knowledge, creativity, understanding, reason, and invention. (shrink)

Offers managers new tools to deal with the tough problems businesses face today. Reveals how analyzing the ethical dimensions of problems actually offers competitive advantages. Offers illustrative case examples from internally recognized companies showing that high ethics and high profits go hand in hand--and identifies the factors responsible for these companies' success.

In Republic 8–9, Socrates describes four main kinds of vicious people, all of whose souls are “ruled” by an element other than reason, and in some of whom reason is said to be “enslaved.” What role does reason play in such souls? In this paper, I argue, based on Republic 8–9 and related passages, and in contrast to some common alternative views, that for Plato the “enslavement” of reason consists in this: instead of determining for itself what is good, reason (...) is forced to desire and pursue as good a goal determined by the soul’s ruler. (shrink)

Using path-breaking discoveries of cognitive science, Mark Johnson argues that humans are fundamentally imaginative moral animals, challenging the view that morality is simply a system of universal laws dictated by reason. According to the Western moral tradition, we make ethical decisions by applying universal laws to concrete situations. But Johnson shows how research in cognitive science undermines this view and reveals that imagination has an essential role in ethical deliberation. Expanding his innovative studies of human reason in Metaphors We (...) Live By and The Body in the Mind, Johnson provides the tools for more practical, realistic, and constructive moral reflection. (shrink)

An account of distinctively mathematical explanation (DME) should satisfy three desiderata: it should account for the modal import of some DMEs; it should distinguish uses of mathematics in explanation that are distinctively mathematical from those that are not (Baron [2016]); and it should also account for the directionality of DMEs (Craver and Povich [2017]). Baron’s (forthcoming) deductive-mathematical account, because it is modelled on the deductive-nomological account, is unlikely to satisfy these desiderata. I provide a counterfactual account of DME, the Narrow (...) Ontic Counterfactual Account (NOCA), that can satisfy all three desiderata. NOCA appeals to ontic considerations to account for explanatory asymmetry and ground the relevant counterfactuals. NOCA provides a unification of the causal and the non-causal, the ontic and the modal, by identifying a common core that all explanations share and in virtue of which they are explanatory. (shrink)

Philosophers have tended to construe friendship as an intimate relationship involving mutual love, and have focused their discussions on this ‘true’ form of friendship. However, everyone recognizes that we use the word ‘friend’ and its cognates to refer, non-ironically, to those with whom we share various relationships that are not terribly intimate or which do not involve mutual love. I argue that there exists no general reason to restrict our philosophical focus to ‘true’ friendships, and allege that we can gain (...) important insights if we broaden our perspective to include lesser friends. I contend that friendships, in the broad sense (encompassing both ‘true’ and lesser forms), are necessarily relationships that are the product of significant collaborative norm manipulation. And I argue that understanding friendship in this way helps explain important features, including the difference between friendships and familiar relations, the non-fungibility of friends, and why friendships are often in flux. (shrink)

The first film adaptation of the story of the unmasking of the insatiable Transylvanian vampire, Count Dracula. The tale unfolds with an awesome eeriness unequalled in later versions.

forthcoming in reisner and steglich-peterson, eds., Reasons for Belief If I believe, for no good reason, that P and I infer (correctly) from this that Q, I don’t think we want to say that I ‘have’ P as evidence for Q. Only things that I believe (or could believe) rationally, or perhaps, with justification, count as part of the evidence that I have. It seems to me that this is a good reason to include an epistemic acceptability constraint on evidence (...) possessed…1 It is a truism that adopting an unjustified belief does not put you in a better evidential position with respect to believing its consequences. This truism has led many philosophers to assume that there must, at a minimum, be a justification condition (and perhaps even a knowledge condition) on what it takes to count as having evidence. This is the best (or only) possible explanation of the truism, these philosophers have believed. This paper explores an alternative explanation for the truism. According to the alternative explanation that I will offer, unjustified beliefs do not put you in a better evidential position with respect to believing their consequences because any evidence you have in virtue of having an unjustified belief is guaranteed to be defeated. Since the lack of justification for a belief guarantees its defeat, I will suggest, we don't need to postulate a special justification condition (much less a knowledge condition) on what it takes to count as having evidence. Why is this important? It is important because the assumption that there must be a justification condition (or perhaps a knowledge condition) on what it takes to count as having evidence places a high bar on what it takes to have evidence - such a high bar that it is difficult to see how this bar could be met in the case of basic, perceptually justified beliefs. As a result, the high bar set by this condition plays a fundamental role, I will claim, in central features of a core dialectic from the epistemology of basic perceptual belief which plays a central role in the debates between internalism and externalism, foundationalism and coherentism, and rationalism and empiricism.. (shrink)