Drug companies are moving their research from academic medical centers to physicians’ private offices. The shift brings in more subjects, and could mean faster and better results. It also changes the physician's relationship to patients, dangles monetary lures in front of physicians, and could produce subjects who don't understand what they're participating in and results that are unreliable.

Two articles in this issue of the Hastings Center Report address the continuing controversy over the Surfactant, Positive Pressure, and Oxygenation Randomized Trial (SUPPORT). This controversy is part of a larger discussion about the appropriate regulatory framework for protecting human research participants in comparative effectiveness research (CER), a group of studies that aims to compare two “usual” or “standard” treatments in order to provide evidence of which treatment is most effective.

If the practice of maternal‐fetal medicine sometimes results in abortion, can a physician strongly opposed to abortion maintain his own integrity and still practice in this field?

The question of legalizing physician-assisted suicide has become a serious public debate. Growing interest in assisted suicide reflects a public increasingly fearful of the process of dying, particularly the prospect of dying a painful, protracted, or undignified death. PAS has been proposed as a compassionate response to unrelievable suffering, designed to give terminally or incurably ill individuals direct control over the timing, manner, and circumstances of their death. Although the American Medical Association remains firmly opposed to legalizing PAS, many physicians (...) have begun to express support for the practice, and some have acknowledged that they have helped patients commit suicide despite the existing legal ban.As support for PAS grows, it becomes increasingly likely that the practice will be legalized in at least some states in the not-too-distant future. In 1994, Oregon voters approved a referendum legalizing PAS for competent, terminally ill patients; a federal court injunction preventing the referendum from going into effect is currently on appeal, and it is widely expected that the injunction will be lifted. (shrink)

The question of legalizing physician-assisted suicide has become a serious public debate. Growing interest in assisted suicide reflects a public increasingly fearful of the process of dying, particularly the prospect of dying a painful, protracted, or undignified death. PAS has been proposed as a compassionate response to unrelievable suffering, designed to give terminally or incurably ill individuals direct control over the timing, manner, and circumstances of their death. Although the American Medical Association remains firmly opposed to legalizing PAS, many physicians (...) have begun to express support for the practice, and some have acknowledged that they have helped patients commit suicide despite the existing legal ban.As support for PAS grows, it becomes increasingly likely that the practice will be legalized in at least some states in the not-too-distant future. In 1994, Oregon voters approved a referendum legalizing PAS for competent, terminally ill patients; a federal court injunction preventing the referendum from going into effect is currently on appeal, and it is widely expected that the injunction will be lifted. (shrink)

: Urban bioethics seeks to broaden the traditional focus of bioethics to encompass questions about the interplay of individuals with family, group, community, and society. Urban bioethics will need to deal with cultural diversity, issues of equity, and the conflict between individual rights and the public good. Encouraging a multicultural ethical discernment, fostering an appreciation of the political, economic, sociological, and psychological issues that inform the question of urban moral choice, urban bioethics is essentially a multi-disciplinary, synthesizing enterprise. Several theoretical (...) models including social contract, rule utilitarian, communitarian, and feminist paradigms offer complementary conceptual frameworks. This paper is offered as a proposal, a road map for future study to place current bioethical analysis into a broader context. (shrink)

Urban bioethics seeks to broaden the traditional focus of bioethics to encompass questions about the interplay of individuals with family, group, community, and society. Urban bioethics will need to deal with cultural diversity, issues of equity, and the conflict between individual rights and the public good. Encouraging a multicultural ethical discernment, fostering an appreciation of the political, economic, sociological, and psychological issues that inform the question of urban moral choice, urban bioethics is essentially a multi-disciplinary, synthesizing enterprise. Several theoretical models (...) including social contract, rule utilitarian, communitarian, and feminist paradigms offer complementary conceptual frameworks. This paper is offered as a proposal, a road map for future study to place current bioethical analysis into a broader context. (shrink)

Pragmatism established a philosophical presence over a century ago through the work of Charles Peirce, William James and John Dewey, and has enjoyed an unprecedented revival in recent years owing to the pioneering efforts of Richard Rorty and Hilary Putnam. The essays in this volume explore the history and themes of classic pragmatism, discuss the revival of pragmatism and show how it engages with a range of areas of inquiry including politics, law, education, aesthetics, religion and feminism. Together they provide (...) readers with an overview of the richness and vitality of pragmatist thinking and the influence that it continues to exert both in philosophy and other disciplines. The volume will be of interest to students and scholars of pragmatism, American philosophy and political theory. (shrink)

There has been a longstanding and acrimonious debate in the human sciences over the role played by classic texts. Advocates of the classic insist its value is timeless and rests on the intrinsic superiority of its cognitive insights and aesthetic virtues. Critics, by contrast, argue that the respect accorded the classic is spurious because it conceals the ideological assumptions, tensions and discontinuities of tradition. This paper seeks a solution through the account of ‘the classical’ brought by Hans-Georg Gadamer in Truth (...) and Method, which acknowledges a text’s ‘eminence’ as well as its ‘historicity’. Following the introduction, the paper divides into four sections. Section one, notes that the hermeneutic account of tradition describes it as being open to challenge rather than closed and unchangeable, and that the classic, as grounded in tradition, will conserve difficulty as readily as comfortable certainty. Section two focuses on the idea that in the classic we find matter ‘properly portrayed’, while section three notes the importance of ‘application’ for an understanding of classic texts. It is noted that both ‘proper portrayal’ and ‘application’ depend on recognising the role of the fusion of historical horizons in generating classic texts. The final section challenges the criticism that the classic is no more than a reflection of the institutional power wielded by the canon, arguing instead that the classic and the canon are different entities, and conflating them in favour of the latter, misleadingly reduces classic-ness to being no more than an effect of canonicity. (shrink)

In 'Philosophy and the Mirror of Nature' Richard Rorty presented his provocation and influential vision of the post-philosophical culture, calling upon professional philosophers to accept that epistemology is dead, that the analytic method is a myth, and that philosophy and science are merely forms of literature.

The truthmaker objection to presentism (the view that only what exists now exists simpliciter) is that it lacks sufficient metaphysical resources to ground truths about the past. In this paper I identify five constraints that an adequate presentist response must satisfy. In light of these constraints, I examine and reject responses by Bigelow, Keller, Crisp, and Bourne. Consideration of how these responses fail, however, points toward a proposal that works; one that posits God’s memories as truthmakers for truths about the (...) past. I conclude that presentists have, in the truthmaker objection, considerable incentive to endorse theism. (shrink)

Discussions of the evidential argument from evil generally pay little attention to how different models of divine providence constrain the theist's options for response. After describing four models of providence and general theistic strategies for engaging the evidential argument, I articulate and defend a definition of 'gratuitous evil' that renders the theological premise of the argument uncontroversial for theists. This forces theists to focus their fire on the evidential premise, enabling us to compare models of providence with respect to how (...) plausibly they can resist it. I then assess the four models, concluding that theists are better off vis-à-vis the evidential argument if they reject meticulous providence. (shrink)

This essay examines and compares two paradigms of technology, nature, and social life, and their associated environmental impacts. I explore moving from technocratic paradigms to the emerging ecological paradigms of planetary person ecosophies. The dominant technocratic philosophy's guiding policy and technological power is mechanistic. It conceptualizes nature as a resource to be controlled for human ends. Its global practices are drastically altering the integrity of the planet's ecosystems. In contrast, the organic, planetary person approaches respect the intrinsic values of all (...) beings. Deep ecology movement principles give priority to community and ecosystem integrity. These deep ecology movement principles guide the design and applications of technology by principles following from ecological understanding. I describe this shift in philosophical paradigms and how it affects our perceptions, values, and actions. (shrink)

This manuscript reviews the background of Radio Frequency Identification (RFID) as well as the ethical foundations of individual privacy. This includes a historical perspective on personal privacy, a review of the United States Constitutional privacy interpretations, the United Nations Declaration of Human Rights, European Union Regulations, as well as the positions of industry and advocacy groups. A brief review of the information technology ethics literature is also included. The RFID privacy concerns are three-fold: pre-sales activities, sales transaction activities, and post-sales (...) uses. A proposal to address these privacy concerns is detailed, generally based on past philosophical frameworks and specifically on the Fair Information Practices that the Federal Trade Commission has outlined for the electronic marketplace (e-commerce). It is proposed that by application of these Fair Information Practices, the major privacy issues of RFID can be addressed. (shrink)

Bioethics as politics -- Bioethics and the politics of expectations -- Engendering consent : bioethics and biobanks -- Missing the big picture : bioethics and stem cell research -- Testing times : bioethics and "do-it-yourself" genetics -- Governing uncertainty : the politics of nanoethics -- Beyond bioethics.

Richard Rorty is notorious for contending that the traditional, foundation-building and truth-seeking ambitions of systematic philosophy should be set aside in favour of a more pragmatic, conversational, hermeneutically guided project. This challenge has not only struck at the heart of philosophy but has ricocheted across other disciplines, both contesting their received self-images and opening up new avenues of inquiry in the process. Alan Malachowski provides an authoritative overview of Rorty's considerable body of work and a general assessment of his (...) impact both within philosophy and in the humanities more broadly. He begins by explaining the genesis of Rorty's central ideas, tracking their development from suggestions in his early papers through their crystallization in his groundbreaking book, "Philosophy and the Mirror of Nature". Malachowski evaluates some of the common criticisms of Rorty's position and his ensuing pragmatism. The book examines the subsequent evolution of his ideas, focusing particularly on the main themes of his second major work, Contingency, Irony, and Solidarity. The political and cultural impact of Rorty's writings on such diverse fields as feminism, cultural and literary theory, and international relations are also considered, and the author explores why Rorty's work has generally found its warmest reception in these areas rather than among mainstream philosophers. (shrink)

There is currently no consensus from the relevant stakeholders regarding the operational and construct definitions of child assent for research. As such, the requirements for assent are often construed in different ways, institutionally disparate, and often conflated with those of parental consent. Development of a standardized operational definition of assent would thus be important to ensure that investigators, institutional review boards, and policy makers consider the assent process in the same way. To this end, we describe a Delphi study that (...) provided consensus from a panel of expert stakeholders regarding the definitions of child assent for research. Based on current guidelines, a preliminary definition of assent was generated and sent out for review to a Delphi panel including pediatric bioethicists and researchers, Institutional Review Board members, parents, and individuals with regulatory/legal expertise. For each subsequent review, the process of summarizing and revising responses was repeated until consensus was achieved. Panelists were also required to rank order elements of assent that they believed were most important in defining the underlying constructs of the assent process. In providing these rankings, panelists were asked to frame their responses in the contexts of younger and adolescents/older children in non-therapeutic and therapeutic trials. Summary rankings of the most important identified elements were then used to generate written construct definitions which were sent out for iterative reviews by the expert panel. Consensus regarding the operational definition was reached by 14/18 of the panel members. Seventeen panelists agreed with the definitions of capacity for assent, elements of disclosure for younger children, and the requirements for meaningful assent, respectively. Fifteen members agreed with the elements of disclosure for adolescents/older children. It is hoped that this study will positively inform and effect change in the way investigators, regulators, and IRBs operationalize the assent process, respect children’s developing autonomy, and in concert with parental permission, ensure the protection of children who participate in research. (shrink)

'The New Pragmatism' explains what it is about Pragmatism that makes it such an attractive prospect to so many thinkers, even in previously hostile traditions. This work sets out the guiding thoughts behind the Pragmatist approach to philosophy & shows how these thoughts have faired in the hands of those responsible for the revival.

Parents can benefit their offspring by conserving resources that the offspring stand to inherit. Thus, inheritance of resources should promote the evolution of propensities to conserve. But inheritance also has another, less obvious effect: it can reduce the fertility of the conserver’s grandchildren, thus reducing the expected number of great-grandchildren. Consequently, inheritance of resources promotes the evolution of conservation less than might be supposed.

The goal of this paper is to facilitate ongoing dialogue between open and non-open theists. First, I try to make precise what open theism is by distinguishing the core commitments of the position from other secondary and optional commitments. The result is a characterization of ‘generic open theism’, the minimal set of commitments that any open theist, qua open theist, must affirm. Second, within the framework of generic open theism, I distinguish three important variants and discuss challenges distinctive to each. (...) The significance of this approach is that it helps avoid conflating arguments bearing on specific versions of open theism with arguments pertaining to open theism simpliciter. (shrink)

In this paper I examine the interconnections between two paradigms of technology, nature, and social life, and their associated environmental impacts. The dominant technocratic philosophy which now guides policy and technological power is mechanistic. It conceptualizes nature as a resource to be controlled fully for human ends and it threatens drastically to alter the integrity of the planet’s ecosystems. Incontrast, the organic, person-planetary paradigm conceptualizes intrinsic value in all beings. Deep ecology gives priority to community and ecosystem integrity and seeks (...) to guide the design and applications of technology according to principles which follow from ecological understanding. I describe this shift in paradigms and how it affects our perceptions, values, and actions. (shrink)

Mr. T. H. Mcpherson has given, in a recent article in PHILOSOPHY , various reasons for supposing that there was a development in Butler's ethics from the Sermons to the Analogy . He argues that Butler was in the Sermons a “rational egoist” or “Ethical Eudaemonist,” and in the Analogy an Intuitionist. By “Ethical Eudaemonism” he seems1 to mean that “the ground or criterion of rightness is conduciveness to the agent's interest” or that “it is the happiness-producing character of acts (...) that makes them right” . I shall use the phrase “McPherson's view” to denote the theory that this was Butler's view in the Sermons. (shrink)