Laudato si’, with its articulation of a familial ecology reflecting Francis’s Latin American context, expands the subject of solidarity in Catholic social teaching and thought. Yet, this ecological vision of family fails to attend to the problem of gender subordination latent in Catholic social teaching, including in its approaches to ecology. A vision of solidarity that eradicates gender and ecological subordination must elaborate a familial ecology characterized by both mercy and equality.

Miguel A. De La Torre rejects hope as the ethical basis for a politically effective and truly liberative form of solidarity. Kelly Brown Douglas, on the other hand, articulates a critical retrieval of hope emphasizing the interpretive relationship between the cross, the lynching tree, and the resurrection. Reading De La Torre and Douglas’s works through Natalie Carnes’s theological aesthetics suggests that their respective works can be engaged as “iconoclasms of fidelity,” or the salutary breaking of idolatrous images toward recovering faithful (...) ones. Examining #SprayTheirNames murals that were created in response to state violence against Black people in the United States, I argue that Carnes’s aesthetics framework holds the violence of the crucifixion and promise of resurrection in visual tension, thus decrying violent oppression while offering a beautiful and dangerous memory that catalyzes hope-filled movement in defense of Black lives. (shrink)

Solidarity is a key virtue in Christian family ethics. Emphasizing the institutional and practical dimensions of this principle, this essay claims that inter- and intrafamily solidarity are critical aspects of a Christian family ethics emanating from Latina/o theological anthropology and family practices. Interfamily solidarity, exemplified by the Latina/o family practice of extended communal family, emphasizes the integral dynamic between family solidarity and the common good. Intrafamily solidarity simultaneously critiques abusive dynamics in Latina/o families while asserting the necessary dialectic between individual (...) and familial flourishing. This articulation of family solidarity asserts a robust role for extended communal families in fostering cooperation across difference in civic life. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Theology from the Trenches: Reflections on Urban Ministry by Roger J. GenchNichole M. FloresTheology from the Trenches: Reflections on Urban Ministry Roger J. Gench LOUISVILLE, KY: WESTMINSTER JOHN KNOX PRESS, 2014. 151 PP. $17.00Beginning from reflections on his own lived experience of pastoral ministry in Baltimore and Washington, DC, Roger Gench engages both the theological and practical dimensions of community organizing, especially as this work relates to the (...) orienting principles of the Industrial Areas Foundation (IAF). Gench first asserts the necessity of continual articulation of theological reasons for public engagement before elaborating some crucial theological aspects of the IAF's core principles. Gench's commitment to theological justification for IAF principles is especially evident in his treatment of the theme of self-interest as underpinning for organizing in religious communities. He interprets self-interest within the practical and theological context of relationship. Within the IAF worldview, individuals come to greater self-understanding only in conversation with others. Gench uncovers the relational demands of self-interest based on the practical dimensions of uncovering self-interest.Gench offers several rich images that illuminate his theological vision for urban ministry. The first is the "cruciform covenant," which springs forth from brokenness and devastation while moving toward justice and restoration. Cruciformity draws attention to abuses of power in the urban environment and underscores God's promise of personal and social redemption. Thus, the cruciform covenant gestures to the ways that God reaches out to humans amid brokenness rather than an assertion of God's wrathful judgment on humanity. Another helpful theological image in this text is the "three-legged stool"—the integration of mind, will, and heart—which offers an accessible theological anthropology of human wholeness and flourishing as a resource in the struggle for justice. Gench contends that a justice-oriented ministry requires engagement of multidimensional personhood, an anthropology crucial for forging public dialogue and fostering effective community organizing.Gench's text excels at knitting together ethics and practical reflection within the context of the urban parish. The author's relatable and authentic voice gives the text the feel of a narrative, one that keeps the pages turning and keeps the reader involved in the outcome of the various campaigns. One might even walk away from the text convinced of the necessity of urban parishes to become involved in local campaigns for justice. Gench's perspective is deeply and [End Page 197] authentically Reformed but with an eye toward ecumenical and interreligious cooperation in campaigns based on self-interest and oriented toward the common good. The text sometimes struggles to gain critical distance from the IAF model even as it acknowledges human sin, finitude, and the risks associated with the exercise of self-interested politics. Still, its ecumenical methodology makes it an attractive option for a broad range of Christian communities seeking to organize around social justice issues.Gench writes in an accessible manner, reflecting on his own experiences of pastoral ministry in two different urban contexts. For this reason, his work will be of particular interest to those engaged in, preparing for, or studying community organizing in an ecclesial setting. The questions and practical meditations at the end of each chapter make this an engaging text for seminary students, congregations, and religious organizers seeking to situate political engagement within a Reformed theological framework. The text will also be of great interest to religious and theological ethicists examining grassroots organizing practices and theological approaches to themes of solidarity, participation, justice, and workers' rights.Nichole M. FloresUniversity of VirginiaCopyright © 2017 Society of Christian Ethics... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Theology from the Trenches: Reflections on Urban Ministry by Roger J. GenchNichole M. FloresTheology from the Trenches: Reflections on Urban Ministry Roger J. Gench LOUISVILLE, KY: WESTMINSTER JOHN KNOX PRESS, 2014. 151 PP. $17.00Beginning from reflections on his own lived experience of pastoral ministry in Baltimore and Washington, DC, Roger Gench engages both the theological and practical dimensions of community organizing, especially as this work relates to the (...) orienting principles of the Industrial Areas Foundation (IAF). Gench first asserts the necessity of continual articulation of theological reasons for public engagement before elaborating some crucial theological aspects of the IAF's core principles. Gench's commitment to theological justification for IAF principles is especially evident in his treatment of the theme of self-interest as underpinning for organizing in religious communities. He interprets self-interest within the practical and theological context of relationship. Within the IAF worldview, individuals come to greater self-understanding only in conversation with others. Gench uncovers the relational demands of self-interest based on the practical dimensions of uncovering self-interest.Gench offers several rich images that illuminate his theological vision for urban ministry. The first is the "cruciform covenant," which springs forth from brokenness and devastation while moving toward justice and restoration. Cruciformity draws attention to abuses of power in the urban environment and underscores God's promise of personal and social redemption. Thus, the cruciform covenant gestures to the ways that God reaches out to humans amid brokenness rather than an assertion of God's wrathful judgment on humanity. Another helpful theological image in this text is the "three-legged stool"—the integration of mind, will, and heart—which offers an accessible theological anthropology of human wholeness and flourishing as a resource in the struggle for justice. Gench contends that a justice-oriented ministry requires engagement of multidimensional personhood, an anthropology crucial for forging public dialogue and fostering effective community organizing.Gench's text excels at knitting together ethics and practical reflection within the context of the urban parish. The author's relatable and authentic voice gives the text the feel of a narrative, one that keeps the pages turning and keeps the reader involved in the outcome of the various campaigns. One might even walk away from the text convinced of the necessity of urban parishes to become involved in local campaigns for justice. Gench's perspective is deeply and [End Page 197] authentically Reformed but with an eye toward ecumenical and interreligious cooperation in campaigns based on self-interest and oriented toward the common good. The text sometimes struggles to gain critical distance from the IAF model even as it acknowledges human sin, finitude, and the risks associated with the exercise of self-interested politics. Still, its ecumenical methodology makes it an attractive option for a broad range of Christian communities seeking to organize around social justice issues.Gench writes in an accessible manner, reflecting on his own experiences of pastoral ministry in two different urban contexts. For this reason, his work will be of particular interest to those engaged in, preparing for, or studying community organizing in an ecclesial setting. The questions and practical meditations at the end of each chapter make this an engaging text for seminary students, congregations, and religious organizers seeking to situate political engagement within a Reformed theological framework. The text will also be of great interest to religious and theological ethicists examining grassroots organizing practices and theological approaches to themes of solidarity, participation, justice, and workers' rights.Nichole M. FloresUniversity of VirginiaCopyright © 2017 Society of Christian Ethics... (shrink)

The text serves as an education program handbook for understanding the complexities of student engagement and providing access, equity, and justice for learners, with an emphasis on students with diverse backgrounds. The book examines current research and best practices on engagement for these learners and explores educational issues through social, cultural, and racial lenses.

The administration of pro re nata medications is the responsibility of the nurse. However, ethical uncertainties often happen due to the inability of incapacitated patients to collaborate with the nurse in the process of decision making for pro re nata medication administration. There is a lack of integrative knowledge and insufficient understanding regarding ethical considerations surrounding the administration of pro re nata medications to incapacitated patients. Therefore, they have been discussed in this paper and practical strategies to avoid unethical practices (...) have been suggested. The complicated caring situation surrounding the administration of pro re nata medications is intertwined with ethical issues affecting the consideration of the patient's wishes and interventions that override them. The patient's right of autonomy and treatment refusal, surrogacy role, paternalism, and coercion are the main ethos of ethical pro re nata medication administration. Education and training can help nurses avoid legal and ethical issues in pro re nata medicines management and improve the quality and safety of healthcare. Empirical research is needed to improve our understanding of this phenomenon in the multidisciplinary environment of medicines management. (shrink)

A disturbing economic reality confronts consumers today: thousands of farm workers are enslaved in U.S. agricultural fields, forced to work without pay amid deplorable conditions and under the constant threat of violence. If structural economic injustices perpetuate modern‐day agricultural slavery, then it is necessary to promote consumer practices that resist these abusive dynamics. But a consumption‐oriented strategy does not necessarily restore either personal agency or communal relations damaged by agricultural trafficking. This essay proposes a framework for aesthetic solidarity that cultivates (...) affective bonds necessary for building communities of resistance characterized by mutuality, equality, and participation. (shrink)

James F. Keenan defines mercy as “the willingness to enter the chaos of another.” Mercy thus defined, he argues, is the distinctive characteristic of Christian morality. This essay asserts that mercy is, in fact, a public virtue, one that can be affirmed across a broad range of religious and moral traditions. As a public virtue, mercy ought to shape both affective and effective responses to the Syrian refugee crisis in the United States.

In this paper we propose to argue for two claims. The first is that a sizeable group of epistemological projects – a group which includes much of what has been done in epistemology in the analytic tradition – would be seriously undermined if one or more of a cluster of empirical hypotheses about epistemic intuitions turns out to be true. The basis for this claim will be set out in Section 2. The second claim is that, while the jury is (...) still out, there is now a substantial body of evidence suggesting that some of those empirical hypotheses are true. Much of this evidence derives from an ongoing series of experimental studies of epistemic intuitions that we have been conducting. A preliminary report on these studies will be presented in Section 3. In light of these studies, we think it is incumbent on those who pursue the epistemological projects in question to either explain why the truth of the hypotheses does not undermine their projects, or to say why, in light of the evidence we will present, they nonetheless assume that the hypotheses are false. In Section 4, which is devoted to Objections and Replies, we’ll consider some of the ways in which defenders of the projects we are criticizing might reply to our challenge. Our goal, in all of this, is not to offer a conclusive argument demonstrating that the epistemological projects we will be criticizing are untenable. Rather, our aim is to shift the burden of argument. (shrink)

Bibliography of works in experimental philosophy.

Throughout the 20th century, an enormous amount of intellectual fuel was spent debating the merits of a class of skeptical arguments which purport to show that knowledge of the external world is not possible. These arguments, whose origins can be traced back to Descartes, played an important role in the work of some of the leading philosophers of the 20th century, including Russell, Moore and Wittgenstein, and they continue to engage the interest of contemporary philosophers. (e.g., Cohen 1999, DeRose 1995, (...) Hill 1996, Klein 1981, Lewis 1996, McGinn 1993, Nozick 1981, Schiffer 1996, Unger 1975, Williams 1996) Typically, these arguments make use of one or more premises which the philosophers proposing them take to be intuitively obvious. Beyond an appeal to intuition, little or no defense is offered, and in many cases it is hard to see what else could be said in support of these premises. A number of authors have suggested that the intuitions undergirding these skeptical arguments are universal – shared by everyone (or almost everyone) who thinks reflectively about knowledge. In this paper we will offer some evidence indicating that they are far from universal. Rather, the evidence suggests that many of the intuitions epistemologists invoke vary with the cultural background, socioeconomic status and educational background of the person offering the intuition. And this, we will argue, is bad news for the skeptical arguments that rely on those intuitions. The evidence may also be bad news for skepticism itself – not because it shows that skepticism is false, but rather because, if we accept one prominent account of the link between epistemic intuitions and epistemic concepts, it indicates that skepticism may be much less interesting and much less worrisome than philosophers have taken it to be. (shrink)

Research in instrumental stakeholder theory often discusses the benefits of a stakeholder strategy that balances all stakeholders’ interests as if the firm’s managers were not constrained much in choosing a strategy. Yet, through their value appropriation behavior, stakeholders with high bargaining power can significantly constrain managers’ choices. Our objective is, therefore, to understand when powerful stakeholders give managers the latitude to balance all stakeholders’ interests, rather than forcing them to satisfy primarily their own interests. Building on enlightened self-interest and the (...) justice literature, we identify five motivational drivers that help explain powerful stakeholders’ value appropriation behavior. We next explore the endogenous relationship between the stakeholder strategy adopted by the firm and its effect on powerful stakeholders’ value appropriation behavior. This article complements instrumental stakeholder theory by looking at powerful stakeholders’ motivation to exercise their bargaining power, and in so doing brings powerful stakeholders’ moral responsibility in the treatment of weak stakeholders to the forefront. (shrink)

The debate over off-line simulation has largely focussed on the capacity to predict behavior, but the basic idea of off-line simulation can be cast in a much broader framework. The central claim of the off-line account of behavior prediction is that the practical reasoning mechanism is taken off-line and used for predicting behavior. However, there's no reason to suppose that the idea of off-line simulation can't be extended to mechanisms other than the practical reasoning system. In principle, any cognitive component (...) can be taken off-line and used to perform some other function. On this view of off-line simulation, such accounts differ radically from traditional information-based accounts of cognitive capacities. And cognitive penetrability provides a wedge for empirically determining whether a capacity requires an information-based account or an off-line simulation account. Stich and Nichols (1992) argued that the simulation theory of behavior prediction was inadequate because behavior prediction seemed to be cognitively penetrable. We present empirical evidence that supports the claim that the behavior prediction is cognitively penetrable. As a result, the simulation account of behavior prediction still seems unpromising. However, off-line simulation might provide accounts of other cognitive capacities. Indeed, off- line simulation accounts have recently been offered for a strikingly diverse set of capacities including counterfactual reasoning, empathy and mental imagery. Goldman, for instance, maintains that counterfactual reasoning and empathy clearly demand off-line simulation accounts. We argue that there are alternative information-based explanations of these phenomena. Nonetheless, the off-line accounts of these phenomena are interesting and clearly worthy of further exploration. (shrink)

The aim of this chapter is to address the role of memory in past-life convictions. Although it is commonly accepted in the modern media - and popular western culture more generally - that people believe they have lived before because the memory contains detailed verifiable facts, little is known about how people actually reason about the veracity of their previous existence. To our knowledge, the current project is the most extensive research that probes the role of memory in past life (...) convictions. More specifically, we explore two questions. First, to what extent does memory lead to past-life belief, and is this conviction based on external validation or via the episodic sense of personal identity contained in the memory? Second, what is the conception of self on which one's current self is taken to be the same as the past-life self? -/- In what follows, we propose that memory plays an important role in convincing people that they have lived before. Fundamentally, this memory is episodic insofar as it represents the event as happened to the encoder. This memory contrasts with semantic memory - memory of facts...Further, we contend that it is the episodic sense of personal identity (rather than external validation) that typically contributes to the belief in a past life. Finally, we argue that the conception of self implicated in past-life belief is the non-trait conception. Of course, this fits naturally with the idea that the belief in a past life issues partly from the episodic sense of identity, since it is the non-trait conception of self that is implicated in the episodic sense of identity... -/- Our proposal in this chapter can be construed as a psychological extension of Reid's point in the context of past-life belief. People assume that they are the same person as someone in earlier times, despite large variations in the traits between those individuals, and they think this partly because of the testimony of their episodic memory. If our account is correct, then it makes the belief in a past life less bizarre, at least psychologically. For we are suggesting that the episodic sense of personal identity that led to your conviction that you existed at the time of your sixteenth birthday celebrations some decades ago, is also involved in other people's convictions that they existed 200 years ago. This proposal is also situated in recent cognitive approaches to the study of religion and religious experiences, which suggests that extraordinary convictions are often underpinned by the ordinary processes of social cognition (e.g. see Barrett 2000; Barrett 2007; Boyer 2001; Lawson and McCauley 1990; for reincarnation, see White Forthcoming-a,-b). (shrink)

Neither prevention nor preemption can have any moral standing in the abstract, since it is the circumstances, not the concepts, that inform their qualities as strategies. The question, rather, is whether the decision to engage in a new war against the Iraqi regime is just.

IntroductionCardiology is characterized by its state-of-the-art biomedical technology and the predominance of Evidence-Based Medicine. This predominance makes it difficult for healthcare professionals to deal with the ethical dilemmas that emerge in this subspecialty. This paper is a first endeavor to empirically investigate the axiological foundations of the healthcare professionals in a cardiology hospital. Our pilot study selected, as the target population, cardiology personnel not only because of their difficult ethical deliberations but also because of the stringent conditions in which they (...) have to make them. Therefore, there is an urgent need to reconsider clinical ethics and Value-Based Medicine. This study proposes a qualitative analysis of the values and the virtues of healthcare professionals in a cardiology hospital in order to establish how the former impact upon the medical and ethical decisions made by the latter.ResultsWe point out the need for strengthening the roles of healthcare personnel as educators and guidance counselors in order to meet the ends of medicine, as well as the need for an ethical discernment that is compatible with our results, namely, that the ethical values developed by healthcare professionals stem from their life history as well as their professional education.ConclusionWe establish the kind of actions, communication skills and empathy that are required to build a stronger patient-healthcare professional relationship, which at the same time improves prognosis, treatment efficiency and therapeutic adhesion. (shrink)

Obesity is a particularly vexing public health challenge, since it not only underlies much disease and health spending but also largely stems from repeated personal behavioral choices. The newly enacted comprehensive health reform law contains a number of provisions to address obesity. For example, insurance companies are required to provide coverage for preventive-health services, which include obesity screening and nutritional counseling. In addition, employers will soon be able to offer premium discounts to workers who participate in wellness programs that emphasize (...) behavioral choices. These policies presume that government intervention to reduce obesity is necessary and justified. Some people, however, argue that individuals have a compelling interest to pursue their own health and happiness as they see fit, and therefore any government intervention in these areas is an unwarranted intrusion into privacy and one's freedom to eat, drink, and exercise as much or as little as one wants. This paper clarifies the overlapping individual, employer, and social interest in each person's health generally to avoid obesity and its myriad costs in particular. The paper also explores recent evidence on the impact of government interventions on obesity through case studies on food labeling and employer-based anti-obesity interventions. Our analysis suggests a positive role for government intervention to reduce and prevent obesity. At the same time, we discuss criteria that can be used to draw lines between government, employer, and individual responsibility for health, and to derive principles that should guide and limit government interventions on obesity as health reform's various elements (e.g., exchanges, insurance market reforms) are implemented in the coming years. (shrink)

The obesity epidemic is not only impairing the health of millions of Americans but also giving rise to billions of added dollars in health care spending. Climbing rates of obesity over the past decades are one of the predominant determinants behind the surging progression of health care expenses in the United States. Moreover, the less fit and less productive U.S. workforce has gradually eroded the nation’s industrial competitiveness. Since the early 1970s, adult obesity rates have doubled and childhood obesity rates (...) have more than tripled, while health expenditures have risen two percentage points faster than the Gross Domestic Product, burgeoning from 8.8 percent in 1980 to a projected 17.9 percent in 2011. Studies analyze that greater than a quarter of America’s health care expenses are attributed to obesity. The stunning growth in obesity has been imputed for 20 to 30 percent of the increase in health care costs since the late 1970s. If the proportion of obese population had stayed unchanged, then health care expenditures in America would be approximately 10 percent less on a per capita average than they are today. (shrink)

Teaching students to ask and answer questions is critically important if they are to engage in reasoned argumentation, problem-solving, and learning. This study involved 35 groups of grade 6 children from 18 classrooms in three conditions (cognitive questioning condition, community of inquiry condition, and the comparison condition) who were videotaped as they worked on specific inquiry-based science tasks. The study also involved the teachers in these classrooms who were audio-taped as they interacted with the children during these tasks. The results (...) show that while there were no significant differences in the children's explanatory behaviour across the two time periods, there were significant differences in the total verbal interactions between the children in the cognitive questioning condition and their peers in the community of inquiry and comparison conditions. Furthermore, the children in the cognitive questioning condition obtained higher reasoning and problem-solving scores than peers in the other conditions. Interestingly, while there were no significant differences between the teachers’ basic and extended mediating behaviours in the three conditions at Times 1 and 2, there was a significant difference in extended mediation behaviours with the teachers demonstrating nearly three times more extended mediation to promote students’ learning at Time 2 than they did at Time 1. Teacher intervention in providing guidance in how to interact during cooperative, inquiry-based science appears to be critical to helping students engage in higher-level thinking and learning. (shrink)

Corruption presents an assurance problem to businesses: all businesses are best off if none act corruptly but in the event that corruption occurs are better off if they act corruptly than if they do not, and because there is no assurance that other actors are not cheating a business does not know how to act. The usual solution to an assurance problem – criminal sanctions imposed on cheaters – does not work in a corrupt system. Integrative Social Contract Theory suggests (...) a solution to the assurance problem. Application of Integrative Social Contract Theory to corruption demonstrates that in the case of corruption it has advantages over international law, and that the theory's elegance lies in its recognition of norms generated by multiple communities. (shrink)

La tendencia natural de identificar complejidad con algo complicado y confuso, es una forma también natural de simplificar las redes complejas del fenómeno del conocimiento y de los saberes. En este artículo se presentan las orientaciones y puntos de partida del pensamiento complejo en la perspectiv..

This book presents a collection of contemporary discourses that reconsider the relationship of democracy as a political ideology and American ideal and education as the foundation of preparing democratic citizens in America.

In lieu of an abstract, here is a brief excerpt of the content:Narrative Symposium:Conflicting Interests in MedicineLaura Jean Bierut, Sal Cruz-Flores, Laura E. Hodges, Anthony A. Mikulec, Govind K. Nagaldinne, Erine L. Bakanas, John F. Peppin, Joel S. Perlmutter, William H. Seitz Jr., Edward Diao, Andre N. Sofair, and David M. Zientek• To Recruit or Not to Recruit for a Clinical Trial• An Unexpected Lesson• Am I on call for the entire Midwest?• Why is Medicare Wasting Away?• The Downside (...) of the Informed Consent Juggernaut• Expert Testimony at the Food and Drug Administration: Who Wants the Truth?• Crossroads: The Intersection of Personal, Professional Society, and Industry Relationships• A Change of Heart• The Evolution of Conflicts of Interest in a New Subspecialty: A Case Study of the Development of Interventional CardiologyCopyright © 2011 The Johns Hopkins University Press... (shrink)

Adaptation to right-shifting prisms improves left neglect for mental number line bisection. This study examined whether adaptation affects the mental number line in normal participants. Thirty-six participants completed a mental number line task before and after adaptation to either: left-shifting prisms, right-shifting prisms or control spectacles that did not shift the visual scene. Participants viewed number triplets (e.g. 16, 36, 55) and determined whether the numerical distance was greater on the left or right side of the inner number. Participants demonstrated (...) a leftward bias (i.e. overestimated the length occupied by numbers located on the left side of the number line) that was consistent with the effect of pseudoneglect. The leftward bias was corrected by a short period of visuomotor adaptation to left-shifting prisms, but remained unaffected by adaptation to right-shifting prisms and control spectacles. The findings demonstrate that a simple visuomotor task alters the representation of space on the mental number line in normal participants. (shrink)

Prior studies note that gender- and race-based discrimination routinely inhibit women’s advancement in medical fields. Yet few studies have examined how gendered displays of deference and demeanor are interpreted by college-educated and professional Latinas/os who are making inroads into prestigious and masculinized nontraditional fields such as medicine. In this article, we elucidate how gender shapes perceptions of authority and competence among the same pan-ethnic group, and we use deference and demeanor as an analytical tool to examine these processes. Our analysis (...) underscores three main points of difference: gendered cultural taxation; microaggressions from women nurses and staff and; the questioning of authority and competence to elucidate how gendered racism manifests for Latina/o doctors. Taking demonstrations of gendered deference and demeanors are vital to transforming medical schools and creating more inclusive spaces for all physicians and patients. Conclusions are based on experiences reported in interviews with 48 Latina/o physicians and observation in their places of work in Southern California. (shrink)

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

The intensity of the opposition to health reform in the United States continues to shock and perplex proponents of the Patient Protection and Affordable Care Act. The emotion and the apocalyptic rhetoric, render civil and evidence-based debate over the implications and alternatives to specific provisions in the law difficult if not problematic. The public debate has largely barreled down two non-parallel yet non-intersecting paths: opponents focus on their fear of government expansion in the future if PPACA is implemented now, while (...) proponents focus on the urgency and specifics of our health care market problems and the limited number of tools we have to address them. Frustration on both sides has led opponents to deny the seriousness of our health system’s problems and proponents to ignore the risk of governmental overreach. These non-intersecting lines of argument are not moving us closer to a desired and necessary resolution. (shrink)