People with learning disability sometimes display challenging behaviour. This can be managed by use of antipsychotic medication or behavioural therapy or both. There is no solid evidence, however, that these therapies are safe and effective. A randomised controlled trial of antipsychotic medication has been proposed to deliver such evidence. However, this presents difficult issues in the ethics of research with learning disabled people. In particular, is a trial the most efficient and fairest way to evaluate practice in this area? This (...) paper reviews the clinical situation, gives the rationale for the trial, and analyses the ethical arguments for and against such a trial. (shrink)

A major feature of post-colonial theory has been its ability to analyse historical developments of culture: expressions of anti-colonial nationalism; the paradoxical dissolution of the idea of nation along with the continuous persistence of national concerns; the question of language and appropriation; of the transformation of literary genres; the question of ethnicity and its relation to the state. But the broader question for this century concerns the way in which postcolonial theory is positioned to approach the continuing issues of global (...) power, global interaction and cultural difference in the coming century. One answer to this has been a growing, and now well-established, interest in cultural and ethnic mobility, of diaspora, of transnational and cosmopolitan interactions. This article goes beyond this to analyse modernity using the tools of postcolonial theory to argue for the multiplicity of modernities. Modernities proceed in various ways, but the process of transformation demonstrated by the literary model can be adapted to examine the proliferation of alternative and multiple modernities. Special attention shall be given to India and China as alternative modernities to help to re-think the nature of modernity itself. (shrink)

fusion theory challenges efforts to see theory as inhibiting by presenting an approach that is innovative, eclectic, and subtle in order to draw out competing and constellating ideas and opinions. This collected volume of essays examines fusion theory and demonstrates how the theory can be applied to the reading of various works of Indian English novelists.

Early modern empiricists thought that the nature of perceptual experience is given by citing the object presented to the mind in that experience. Hallucination and illusion suggest that this requires untenable mind-dependent objects. Current orthodoxy replaces the appeal to direct objects with the claim that perceptual experience is characterized instead by its representational content. This paper argues that the move to content is problematic, and reclaims the early modern empiricist insight as perfectly consistent, even in cases of illusion, with the (...) realist contention that these direct objects of perception are the persisting mind-independent physical objects we all know and love. (shrink)

Introduction -- What is journalism for? -- Truth: the first and most confusing principle -- Who journalists work for -- Journalism of verification -- Independence from faction -- Monitor power and offer voice to the voiceless -- Journalism as a public forum -- Engagement and relevance -- Make the news comprehensive and proportional -- Journalists have a responsibility to conscience -- The rights and responsibilities of citizens.

The question how to account for illusion has had a prominent role in shaping theories of perception throughout the history of philosophy. Prevailing philosophical wisdom today has it that phenomena of illusion force us to choose between the following two options. First, reject altogether the early modern empiricist idea that the core subjective character of perceptual experience is to be given simply by citing the object presented in that experience. Instead we must characterize perceptual experience entirely in terms of its (...) representational content. Second, retain the early modern idea that the core subjective character of experience is simply constituted by the identity of its direct objects, but admit that these must be mind-dependent entities, distinct from the mind-independent physical objects we all know and love. I argue here that the early modern empiricists had an indispensable insight. The idea that the core subjective character of perceptual experience is to be given simply by citing the object presented in that experience is more fundamental than any appeal to perceptual content, and can account for illusion, and indeed hallucination, without resorting to the problematic postulation of any such mind-dependent objects. (shrink)

Bioethics has been subject to considerable social criticism in recent years. One criticism that has caused particular discomfort in the bioethics community is that bioethicists, because of the way their work is funded, are involved in profound conflicts of interest that undermine their title to be considered independent moral commentators on developments in biomedicine and biotechnology. This criticism draws its force from the assumption that bioethics is, or ought to be, a type of normative social criticism. Versions of this criticism (...) come from both the political left and right. For instance, such criticisms include allegations that bioethics is inherently socially conservative, that it is inherently “pro-technology”, that it lays spurious claims to moral and social authority and expertise, that its focus on autonomy links it to neoliberal theories of choice, and that it is an ideological mystification of real social relationships and political power. This commentary paper analyses the problem of bioethical conflict of interest, and argues that the types of conflict of interest facing bioethics are inherent to the role of “public intellectual” that bioethicists generally wish to assume. The paper defends this conception of the role of the bioethicist, arguing that bioethicists should be interested and openly so. (shrink)

Evidence based medicine has been a topic of considerable controversy in medical and health care circles over its short lifetime, because of the claims made by its exponents about the criteria used to assess the evidence for or against the effectiveness of medical interventions. The central epistemological debates underpinning the debates about evidence based medicine are reviewed by this paper, and some areas are suggested where further work remains to be done. In particular, further work is needed on the theory (...) of evidence and inference; causation and correlation; clinical judgment and collective knowledge; the structure of medical theory; and the nature of clinical effectiveness. (shrink)

Regulation and governance of medical research is frequently criticised by researchers. In this paper, we draw on Everett Hughes’ concepts of professional licence and professional mandate, and on contemporary sociological theory on risk regulation, to explain the emergence of research governance and the kinds of criticism it receives. We offer explanations for researcher criticism of the rules and practices of research governance, suggesting that these are perceived as interference in their mandate. We argue that, in spite of their complaints, researchers (...) benefit from the institutions of governance and regulation, in particular by the ways in which regulation secures the social licence for research. While it is difficult to answer questions such as: “Is medical research over-regulated?” and “Does the regulation of medical research successfully protect patients or promote ethical conduct?”, a close analysis of the social functions of research governance and its relationship to risk, trust, and confidence permits us to pose these questions in a more illuminating way. (shrink)

Bill Brewer presents an original view of the role of conscious experience in the acquisition of empirical knowledge. He argues that perceptual experiences must provide reasons for empirical beliefs if there are to be any determinate beliefs at all about particular objects in the world. This fresh approach to epistemology turns away from the search for necessary and sufficient conditions for knowledge and works instead from a theory of understanding in a particular area.

The surge of interest in Jean-Francois Lyotard's writings has pushed him into the centre of debate on the postmodern.

What is the role of conscious experience in the epistemology of perceptual knowledge: how should we characterise what is going on in seeing that o is F in order to illuminate the contribution of seeing o to their status as cases of knowing that o is F? My proposal is that seeing o involves conscious acquaintance with o itself, the concrete worldly source of the truth that o is F, in a way that may make it evident to the subject (...) that o is an instance of ‘x is F’ as she understands this, and hence evident that o is F. Seeing that o is F is thus a way of its being evident that o is F and is therefore a way of knowing that o is F. (shrink)

The phenomenon of multimodality is central to our everyday interaction. 'Hybrid' modes of communication that combine traditional uses of language with imagery, tagging, hashtags and voice-recognition tools have become the norm. Bringing together concepts of meaning and communication across a range of subject areas, including education, media studies, cultural studies, design and architecture, the authors uncover a multimodal grammar that moves away from rigid and language-centered understandings of meaning. They present the first framework for describing and analysing different forms of (...) meaning across text, image, space, body, sound and speech. Succinct summaries of the main thinkers in the fields of language, communications and semiotics are provided alongside rich examples to illustrate the key arguments. A history of media including the genesis of digital media, Unicode, Emoji, XML and HTML, MP3 and more is covered. This book will stimulate new thinking about the nature of meaning, and life itself, and will serve practitioners and theorists alike. (shrink)

In this review of Leon Kass’s Life, liberty and the defense of dignity and Deryck Beyleveld and Roger Brownsword’s Human dignity in bioethics and biolaw. I consider the prospects for a theory of dignity as a basis for bioethics research. I argue that dignity theories are worth exploring in more detail, but that research needs to consider both “antitheory” accounts of the language of bioethics, and to give more weight to accounts of dignity as an outcome of holding positive liberties (...) and as something that has a psychological dimension. (shrink)

The editors of the symposium hope it will provide a balanced appraisal of evidence based medicine.This symposium is devoted to evidence based medicine and the ethical issues it raises. Since Sir Archie Cochrane’s seminal Nuffield Provincial Hospitals Trust lectures in 1972 and their publication as the Rock Carling monograph for that year, Effectiveness and Efficiency: Random Reflections on Health Services, the idea that medical interventions and health services should be evaluated and selected on the basis of the most reliable evidence (...) available for their effectiveness and cost effectiveness has become very widely accepted.1,2 This widespread acceptance has not been complete, and it sometimes seems that there are as many critics of EBM as advocates. Whereas the importance of randomised trial evidence, critical appraisal, meta-analysis, and systematic review …. (shrink)

Francis Fukuyama, in his Our Posthuman Future, and Gregory Stock, in his Redesigning Humans, present competing versions of the biomedical future of human beings, and debate the merits of more or less stringent regimes of regulation for biomedical innovation. In this article, these positions are shown to depend on a shared discourse of market liberalism, which limits both the range of ends for such innovation discussed by the authors, and the scope of their policy analyses and proposals. A proper evaluation (...) of the human significance and policy imperatives for biomedical innovation needs to be both more utopian in its imagination, and more sophisticated in its political economy. In essence, the Fukuyama/Stock debate tells us more about current US political ideology than it does about the morality of human genetic and biopsychological engineering. (shrink)

I take it for granted that sense experiential states provide reasons for empirical beliefs; indeed this claim forms the first premise of my central argument for (CC). 1 The subsequent stages of the argument are intended to establish that a person has such a reason for believing something about the way things are in the world around him only if he is in some mental state or other with a conceptual content: a conceptual state. Thus, given that sense experiential states (...) do provide reasons for empirical beliefs, they must have conceptual content. (shrink)

Clinical trials and other forms of evaluation of medical treatment are held to give an objective assessment of the 'clinical effectiveness' of the medical treatments under evaluation. This kind of evaluation is central to the evidence-based medicine movement, as it provides a basis for the rational selection of treatment. The ethical status of randomised clinical trials is widely agreed to depend crucially upon the state of equipoise regarding which of two treatments is more effective in a defined population. However, the (...) meaning and nature of 'clinical effectiveness' are unclear. in this paper, I discuss the proposals to define clinical effectiveness as a relational property and as an intrinsic property, and the way effectiveness may supervene upon more fundamental physical properties of treatments. I discuss whether effectiveness is a single property or a family of properties; the types of outcome which can be explained by effectiveness properties; and the relationship between 'objective' and 'preference' outcomes. This paper suggests that while it may be possible to put clinical effectiveness on a proper metaphysical footing, in practice the language of clinical effectiveness is more properly a topic of the human sciences than of the natural sciences. (shrink)

It is close to current orthodoxy that perceptual experience is to be characterized, at least in part, by its representational content, roughly, by the way it represents things as being in the world around the perceiver. Call this basic idea the content view.

A timely new edition of the classic journalism guide, now featuring updated material on the importance of reporting in the age of media mistrust and fake news--and how journalists can use technology while also navigating its challenges. More than two decades ago, the Committee of Concerned Journalists gathered some of America's most influential newspeople to ask the question "What is journalism for?" Through exhaustive research, surveys, interviews, and public forums, they identified the essential elements that define journalism and its role (...) in our society. The result is one of the most important books on the media ever written, winner of the Goldsmith Book Prize from Harvard, the Society of Professional Journalists Award, and the Bart Richards Award from Penn State University. Updated with new material covering the ways journalists can deftly leverage technology to their advantage, especially given the shifting revenue architecture--with "clickbait" fading away and consumers paying a higher premium for quality reporting--this fourth edition of The Elements of Journalism is an essential read for journalists, students, and anybody hoping to stay informed in contentious times. (shrink)

Over the past ten years, we have worked in a collaboration between educators and computer scientists at the University of Illinois to imagine futures for education in the context of what is loosely called “artificial intelligence.” Unhappy with the first generation of digital learning environments, our agenda has been to design alternatives and research their implementation. Our starting point has been to ask, what is the nature of machine intelligence, and what are its limits and potentials in education? This paper (...) offers some tentative answers, first conceptually, and then practically in an overview of the results of a number of experimental implementations documented in greater detail elsewhere. Our key finding is that artificial intelligence—in the context of the practices of electronic computing developing over the past three quarters of a century—will never in any sense “take over” the role of teacher, because how it works and what it does are so profoundly different from human intelligence. However, within the limits that we describe in this paper, it offers the potential to transform education in ways that—counterintuitively perhaps—make education more human, not less. (shrink)

When denial of medical treatment is being used as a lever to move people out of the country, ethicists and healthcare professionals should speak out.An ugly feature of political life throughout the Western world, and beyond, is the suspicion towards, and maltreatment of, migrants from poor to rich countries. People who would otherwise be horrified at being labelled racist nevertheless find it acceptable to support practices which can range from stigmatisation to confinement in brutalising conditions in “reception” and “removal” centres.1–5An (...) hour spent searching through government and NGO websites concerned with the treatment of asylum seekers and refugees in developed world countries is an hour well spent – but profoundly depressing. This is not only because of the frankly Orwellian language used by the governments of the UK and Australia , or because of the conditions and treatment meted out, but also because of the apparent support these practices have among the voting public. In the pointedly optimistic reports of Her Majesty’s Inspector of Prisons, for example, one can find praise for the fact …. (shrink)

In this paper I examine the ways in which the concept of “public interest” is used in biomedical policymaking to justify the preemption or overruling of decisions made by individuals about their own, their family's, or group interests in the field of healthcare. I discuss six variants of public-interest justification, before going on to consider a concrete example, the use of personal health data in health services management and medical research. I distinguish between the global public interest and particular public (...) interests and consider critically how the global public interest can be said to arise from private interests. I show that there is always room for the private individual to defeat appeals to public interest on moral grounds, and hence that public interest cannot have overriding moral force. Hence, public-interest claims need to be considered as political appeals about competing claims and conceptions of justice, rather than as shortcuts to defining the universal solidary interest. (shrink)

Professor Robertson sketches an elegant framework for policy evaluation and regulation of the use of preimplantation genetic diagnosis for various medical, medical related, and non-medical purposes. In criticism of his position, I argue that the distinction between policy and ethics upon which his argument relies is highly unstable, and the approach taken to ethical evaluation of particular parental interests leaves open many issues which the policy approach would hope to exclude. In conclusion I argue that while his position ultimately fails, (...) the onus is on his critics to come up with a viable and satisfying alternative. (shrink)

Since the inception of the Human Genome Project, human genetics has frequently been conducted through big science projects, combining academic, state and industrial methods, interests and resources. The legitimacy of such projects has been linked to national prestige and images of the nation, the purity of scientific endeavour, the entrepreneurial spirit, medical progress and the public health. A key complication in these discourses is that large-scale genetic research has yet to show major results when considered in terms of the objectives (...) used to legitimate investment and social support for these projects. The main area showing promise at present is the developing field of pharmacogenetics, which is now attracting major industry and government investment. Sociological, ethical and philosophical study of human genetic sample-based research and pharmacogenetics has developed in parallel with inquiry in the biological and biomedical sciences. This paper introduces a symposium on the ethical and social aspects of this field of biomedical research. (shrink)

Teaching medical ethics and law to medical students has been a requirement for all medical schools in the United Kingdom since the General Medical Council’s Tomorrow’s Doctors guidance on medical curricular reform of 1992. All United Kingdom medical schools now have at least some medical ethics and law in their curricula and most have a person appointed primarily to be responsible for this teaching. Since the publication in the Journal of Medical Ethics in 1998, volume 24, pages188–192, of a consensus (...) statement on a core curriculum in medical ethics and law for medical students, most medical schools have gradually come to conform to this as the benchmark for the content of such teaching. There remains, however, a great diversity in the approaches taken to ensuring that learning this content takes place. A wide range of strategies have …. (shrink)

" _On Friendship_, with its total of one hundred sayings, is the perfect gift for friends."—Feng Yingjing, renowned scholar and civic official, 1601 Matteo Ricci is best known as the Italian Jesuit missionary who brought Christianity to China. He also published a landmark text on friendship—the first book to be written in Chinese by a European—that instantly became a late Ming best seller. _On Friendship_ distilled the best ideas on friendship from Renaissance Latin texts into one hundred pure and provocative (...) Chinese maxims. Written in a masterful classical style, Ricci's sayings established his reputation as a great sage and the sentiments still ring true. Available for the first time in English, _On Friendship_ matches a carefully edited Chinese text with a facing-page English translation and includes notes on sources and biographical, historical, and cultural information. Still admired in China for its sophistication and inspirational wisdom, _On Friendship_ is a delightful cross-cultural work by a crucial and fascinating historical figure. It is also an excellent tool for learning Chinese, pairing a superb model of the classical language with an accessible and accurate translation. (shrink)

Physical objects are such things as stones, tables, trees, people and other animals: the persisting macroscopic constituents of the world we live in. therefore expresses a commonsense commitment to physical realism: the persisting macroscopic constituents of the world we live in exist, and are as they are, quite independently of anyone.

Background Policies to use financial incentives to encourage healthy behaviour are controversial. Much of this controversy is played out in the mass media, both reflecting and shaping public opinion. Objective To describe UK mass media coverage of incentive schemes, comparing schemes targeted at different client groups and assessing the relative prominence of the views of different interest groups. Design Thematic content analysis. Subjects National and local news coverage in newspapers, news media targeted at health-care providers and popular websites between January (...) 2005 and February 2010. Setting UK mass media. Results The study included 210 articles. Fifteen separate arguments favourable towards schemes, and 19 unfavourable, were identified. Overall, coverage was more favourable than unfavourable, although most articles reported a mix of views. Arguments about the prevalence and seriousness of the health problems targeted by incentive schemes were uncontested. Moral and ethical objections to such schemes were common, focused in particular on recipients such as drug users or the overweight who were already stereotyped as morally deficient, and these arguments were largely uncontested. Arguments about the effectiveness of schemes and their potential for benefit or harm were areas of greater contestation. Government, public health and other health-care provider interests dominated favourable coverage; oppo- sition came from rival politicians, taxpayersÕ representatives, certain charities and from some journalists themselves. Conclusions Those promoting incentive schemes for people who might be regarded as ÔundeservingÕ should plan a media strategy that anticipates their public reception. (shrink)

Charles Foster and Jonathan Herring are to be congratulated on their useful presentation of the roles played by concepts of personhood and identity in English medical law. 1 However, I fear that the project they have undertaken here is misconceived. It is an interesting and important misconception, which is widely shared in the literature on medical law and ethics; but a misconception it remains. The problem is this. What we call ‘the Law’ is in fact a complex assemblage of institutions, (...) rules, accredited persons, practices and systems. What it is not is a self-sufficient, integrated and self-interpreting system of doctrine. As such it does not have a clear structure which we can excavate and the idea that we can find concepts which explain and unify that structure at some deep level is thus quixotic. To approach ‘the Law’ in that way is to pursue a chimaera. We should instead... (shrink)

Evaluation of the potential of a cocaine vaccine requires a detailed understanding of the intended and unintended social consequences of its use. Prospective technology assessment is always difficult, but in the case of treatment and prevention of cocaine addiction we need to understand not only the neuroscience and pharmacology of cocaine addiction, but also social attitudes to drug use and addiction, the social context of drug use, and the factors which make drug use a rational strategy for an addict and (...) make treatment seeking or relapse more or less likely. By considering different scenarios related to differing levels of effectiveness of the vaccine, the authors argue that vaccination will be at best a useful adjunct to existing methods of treatment, rather than a substitute for them. (shrink)

In The Varieties of Reference (1982), Gareth Evans claims that considerations having to do with certain basic ways we have of gaining knowledge of our own physical states and properties provide "the most powerful antidote to a Cartesian conception of the self" (220). In this chapter, I start with a discussion and evaluation of Evans' own argument, which is, I think, in the end unconvincing. Then I raise the possibility of a more direct application of similar considerations in defence of (...) common sense anti-Cartesianism. Progress in this direction depends upon a far more psychologically informed understanding of normal and abnormal bodily awareness than is generally found in philosophical discussions of these issues. In the context of my attempt at some such understanding, I go on to assess the potential of this more direct line of argument. (shrink)

It is widely maintained that a clinical trial is ethical only if some form of equipoise between the treatments being compared obtains. To be in equipoise between two treatments A and B is to be cognitively indifferent between the statement ‘A is strictly more effective than B’ and its negation. It is natural to claim that equipoise regarding A and B is necessary for randomised assignment to treatments A and B to be beneficent and non‐maleficent and is sufficient for such (...) an assignment to be fair. Cashing this out precisely is difficult, and various forms of equipoise have been discussed which consider whose equipoise is relevant to the decision. This is to make judgement of equipoise something to be managed socially, while its prima facie significance is supposedly cognitive. Recent reconstructions of equipoise‐like concepts in epistemology give clues about how to understand equipoise cognitively. In this paper I examine some of this work and discuss how successful it has been. I suggest that while this work is promising, it still has far to go, and that while equipoise remains the best theory we have of the cognitive justification for clinical trials, it is nonetheless incoherent. (shrink)

Queen Mary, University of London, School of Law, Mile End Road, London E1 4NS, UK. Tel: +442078825126, Fax: +442089818733, Email: r.ashcroft{at}qmul.ac.uk ' + u + '@' + d + ' '//--> Abstract Recent doctrine in both national and international organisations concerned with public health planning and resource allocation has it that direct ethical justification of substantive decisions is so difficult as to be impossible. Instead, we should agree on criteria of procedural justice and reach decisions whose justification lies in (...) how they are arrived at, rather than any direct ethical justification on the ground of substantive moral principles. In this polemical article, I argue that this amounts to a serious dereliction of intellectual duty on the part of the bioethics community. Our role in these settings is to produce and defend the best substantive arguments we can. Failing to do this makes bioethicists at best redundant and at worst leads us to seriously defective conclusions. The argument is illustrated by analysis of the ethical frameworks for resource allocation under the UNAIDS ‘3 by 5’ programme and for pandemic influenza planning. CiteULike Connotea Del.icio.us What's this? (shrink)

Over the past ten years, we have worked in a collaboration between educators and computer scientists at the University of Illinois to imagine futures for education in the context of what is loosely called “artificial intelligence.” Unhappy with the first generation of digital learning environments, our agenda has been to design alternatives and research their implementation. Our starting point has been to ask, what is the nature of machine intelligence, and what are its limits and potentials in education? This paper (...) offers some tentative answers, first conceptually, and then practically in an overview of the results of a number of experimental implementations documented in greater detail elsewhere. Our key finding is that artificial intelligence—in the context of the practices of electronic computing developing over the past three quarters of a century—will never in any sense “take over” the role of teacher, because how it works and what it does are so profoundly different from human intelligence. However, within the limits that we describe in this paper, it offers the potential to transform education in ways that—counterintuitively perhaps—make education more human, not less. (shrink)

ABSTRACT Medicines that are vital for the saving and preserving of life in conditions of public health emergency or endemic serious disease are known as essential medicines. In many developing world settings such medicines may be unavailable, or unaffordably expensive for the majority of those in need of them. Furthermore, for many serious diseases (such as HIV/aids and tuberculosis) these essential medicines are protected by patents that permit the patent‐holder to operate a monopoly on their manufacture and supply, and to (...) price these medicines well above marginal cost. Recent international legal doctrine has placed great stress on the need to globalise intellectual property rights protections, and on the rights of intellectual property rights holders to have their property rights enforced. Although international intellectual property rights law does permit compulsory licensing of protected inventions in the interests of public health, the use of this right by sovereign states has proved highly controversial. In this paper I give an argument in support of states’ sovereign right to expropriate private intellectual property in conditions of public health emergency. This argument turns on a social contract argument for the legitimacy of states. The argument shows, further, that under some circumstances states are not merely permitted compulsory to license inventions, but are actually obliged to do so, on pain of failure of their legitimacy as sovereign states. The argument draws freely on a loose interpretation of Thomas Hobbes's arguments in his Leviathan, and on an analogy between his state of War and the situation of public health disasters. (shrink)

Frances Kamm's characteristically subtle paper in response to Michael Sandel is an intriguing intervention in the long-standing and increasingly frustrating debate over the morality of enhancement...