In his article ‘The case against ethics review in the social sciences’, Schrag asserts that the social sciences should not be subject to ethical review. He recounts a number of examples where ethical review has seemingly failed. He further suggests some alternative models for dealing with ethical review in the social sciences. Finally, he concludes, and we concur, that there is a lack of empirical evidence as to the benefit of research ethics review.

ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not reporting and (2) not obtaining consent.MethodsSurvey of primary trial reports, published 2014–2019, identified using an electronic search filter for pragmatic trials implemented in MEDLINE, and registered in ClinicalTrials.gov.ResultsAmong 1988 trials, 132 (6.6%) did not include a statement about participant consent, 1691 (85.0%) reported consent had been obtained, 139 (7.0%) reported a (...) waiver and 26 (1.3%) reported consent for one aspect (eg, data collection) but a waiver for another (eg, intervention). Of the 165 trials reporting a waiver, 76 (46.1%) provided a justification. Few (53, 2.9%) explicitly reported use of alternative approaches to consent. In multivariable logistic regression analyses, lower journal impact factor (p=0.001) and cluster randomisation (p<0.0001) were significantly associated with not reporting on consent, while trial recency, cluster randomisation, higher-income country settings, health services research and explicit labelling as pragmatic were significantly associated with not obtaining consent (all p<0.0001).DiscussionNot obtaining consent seems to be increasing and is associated with the use of cluster randomisation and pragmatic aims, but neither cluster randomisation nor pragmatism are currently accepted justifications for waivers of consent. Rather than considering either standard written informed consent or waivers of consent, researchers and research ethics committees could consider alternative consent approaches that may facilitate the conduct of pragmatic trials while preserving patient autonomy and the public’s trust in research. (shrink)

Pragmatic comparative effectiveness randomized controlled trials evaluate the effectiveness of one interventions under real-world clinical conditions. The results of ceRCTs are often directly generalizable to everyday clinical practice, providing information critical to decision-making by patients, clinicians, and healthcare policymakers. The PRECIS-2 framework identifies nine domains that serve to score a trial on a continuum between very explanatory to very pragmatic. According to the framework, pragmatic trials may have one or more of the following features: there are fewer eligibility criteria for (...) participants, in an... (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 ethics of the Flexibility In duty hour Requirements for Surgical Trainees trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trials of policy interventions involving healthcare professionals. In what follows, we have three objectives. First, we critically review the FIRST trial controversy, finding that commentators have failed to sufficiently identify and address many of the (...) relevant ethical issues. The 2012 Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials provides researchers and research ethics committees with specific guidance for the ethical design and conduct of CRTs. Second, we aim to demonstrate how the Ottawa Statement provides much-needed clarity to the ethical issues in the FIRST trial, including: research participant identification; consent requirements; gatekeeper roles; benefit-harm analysis and identification of vulnerable participants. We nonetheless also find that the FIRST trial raises ethical issues not adequately addressed by the Ottawa Statement. Hence, third and finally, we raise important questions requiring further ethical analysis and guidance, including: Does clinical equipoise apply to policy interventions with little or no evidence-base? Do healthcare providers have an obligation to participate in research? Does the power-differential in certain healthcare settings render healthcare providers vulnerable to duress and coercion to participant in research? If so, what safeguards might be implemented to protect providers, while allowing important research to proceed? (shrink)

Quality and service improvement (QSI) research employs a broad range of methods to enhance the efficiency of healthcare delivery. QSI research differs from traditional healthcare research and poses unique ethical questions. Since QSI research aims to generate knowledge to enhance quality improvement efforts, should it be considered research for regulatory purposes? Is review by a research ethics committee required? Should healthcare providers be considered research participants? If participation in QSI research entails no more than minimal risk, is consent required? The (...) lack of consensus on answers to these questions highlights the need for ethical guidance. Three distinct approaches to classifying QSI research in accordance with existing ethical principles and regulations can be found in the literature. In the first approach, QSI research is viewed as distinct from other types of healthcare research and does not require regulation. In the second approach, QSI research falls within regulatory guidelines but is exempt from research ethics committee review. In the third approach, QSI research is deemed to be part of the learning healthcare system and, as such, is subject to a different set of ethical principles entirely. In this paper, we critically assess each of these views. While none of these approaches is entirely satisfactory, we argue that use of the ethical principles governing research provides the best means of addressing the numerous questions posed by QSI research. (shrink)

Newborn bloodspot screening programs are some of the longest running population screening programs internationally. Debate continues regarding the need for parents to give consent to having their child screened. Little attention has been paid to how meanings of consent-related terminology vary among stakeholders and the implications of this for practice. We undertook semi-structured interviews with parents, healthcare professionals and policy decision makers in two Canadian provinces. Conceptions of consent-related terms revolved around seven factors within two broad domains, decision-making and information (...) attainment. Decision-making comprised: parent decision authority; voluntariness; parent engagement with decision-making; and the process of enacting choice. Information ascertainment comprised: professional responsibilities ; parent responsibilities; and the need for discussion and understanding prior to a decision. Our findings indicate that consent-related terms are variously understood, with substantive implications for practice. We suggest that consent procedures should be explained descriptively, regardless of approach, so there are clear indications of what is expected of parents and healthcare professionals. Support systems are required both to meet the educational needs of parents and families and to support healthcare professionals in delivering information in a manner in keeping with parent needs. (shrink)

Background Pragmatic randomized controlled trials are designed to evaluate the effectiveness of interventions in real-world clinical conditions. However, these studies raise ethical issues for researchers and regulators. Our objective is to identify a list of key ethical issues in pragmatic RCTs and highlight gaps in the ethics literature. Methods We conducted a scoping review of articles addressing ethical aspects of pragmatic RCTs. After applying the search strategy and eligibility criteria, 36 articles were included and reviewed using content analysis. Results Our (...) review identified four major themes: 1) the research-practice distinction; 2) the need for consent; 3) elements that must be disclosed in the consent process; and 4) appropriate oversight by research ethics committees. 1) Most authors reject the need for a research-practice distinction in pragmatic RCTs. They argue that the distinction rests on the presumptions that research participation offers patients less benefit and greater risk than clinical practice, but neither is true in the case of pragmatic RCTs. 2) Most authors further conclude that pragmatic RCTs may proceed without informed consent or with simplified consent procedures when risks are low and consent is infeasible. 3) Authors who endorse the need for consent assert that information need only be disclosed when research participation poses incremental risks compared to clinical practice. Authors disagree as to whether randomization must be disclosed. 4) Finally, all authors view regulatory oversight as burdensome and a practical impediment to the conduct of pragmatic RCTs, and argue that oversight procedures ought to be streamlined when risks to participants are low. Conclusion The current ethical discussion is framed by the assumption that the function of research oversight is to protect participants from risk. As pragmatic RCTs commonly involve usual care interventions, the risks may be minimal. This leads many to reject the research-practice distinction and question the need for informed consent. But the function of oversight should be understood broadly as protecting the liberty and welfare interest of participants and promoting public trust in research. This understanding, we suggest, will focus discussion on questions about appropriate ethical review for pragmatic RCTs. (shrink)

Objective Cluster randomised trial (CRT) investigators face challenges in seeking informed consent from individual patients (cluster members). This study examined associations between reporting of patient consent in healthcare CRTs and characteristics of these trials. Study design Consent practices and study characteristics were abstracted from a random sample of 160 CRTs performed in primary or hospital care settings that were published from 2000 to 2008. Multivariable logistic regression was used to examine associations between reporting of patient consent and methodological characteristics, as (...) well as publication features such as date and journal of publication. Results 82 (53.8%) of 160 studies reported obtaining informed consent from individual patients. Reporting of patient consent was independently and positively associated with: smaller cluster size, the evaluation of experimental interventions targeted at patients, data collection from individual patients, publication later than 2004 and publication in higher-impact journals. Conclusions Reporting of consent practices in published CRTs should be improved. Consent practices in published CRTs appear to be related to the type of interventions under study, as well as journal impact and trends in research ethics practices. These findings will inform best practices in trial conduct and ethics review, remediation of errors in consent practices and ethics review and the development of regulatory guidance for CRTs. (shrink)

Pragmatic randomized controlled trials are designed to evaluate the effectiveness of interventions in real-world clinical conditions. However, these studies raise ethical issues for researchers and regulators. Our objective is to identify a list of key ethical issues in pragmatic RCTs and highlight gaps in the ethics literature. We conducted a scoping review of articles addressing ethical aspects of pragmatic RCTs. After applying the search strategy and eligibility criteria, 36 articles were included and reviewed using content analysis. Our review identified four (...) major themes: 1) the research-practice distinction; 2) the need for consent; 3) elements that must be disclosed in the consent process; and 4) appropriate oversight by research ethics committees. 1) Most authors reject the need for a research-practice distinction in pragmatic RCTs. They argue that the distinction rests on the presumptions that research participation offers patients less benefit and greater risk than clinical practice, but neither is true in the case of pragmatic RCTs. 2) Most authors further conclude that pragmatic RCTs may proceed without informed consent or with simplified consent procedures when risks are low and consent is infeasible. 3) Authors who endorse the need for consent assert that information need only be disclosed when research participation poses incremental risks compared to clinical practice. Authors disagree as to whether randomization must be disclosed. 4) Finally, all authors view regulatory oversight as burdensome and a practical impediment to the conduct of pragmatic RCTs, and argue that oversight procedures ought to be streamlined when risks to participants are low. The current ethical discussion is framed by the assumption that the function of research oversight is to protect participants from risk. As pragmatic RCTs commonly involve usual care interventions, the risks may be minimal. This leads many to reject the research-practice distinction and question the need for informed consent. But the function of oversight should be understood broadly as protecting the liberty and welfare interest of participants and promoting public trust in research. This understanding, we suggest, will focus discussion on questions about appropriate ethical review for pragmatic RCTs. (shrink)

There was a methodological revolution in the mathematics of the nineteenth century, and philosophers have, for the most part, failed to notice.2 My objective in this chapter is to convince you of this, and further to convince you of the following points. The philosophy of mathematics has been informed by an inaccurately narrow picture of the emergence of rigour and logical foundations in the nineteenth century. This blinkered vision encourages a picture of philosophical and logical foundations as essentially disengaged from (...) ongoing mathematical practice. Frege is a telling example: we have misunderstood much of what Frege was trying to do, and missed the intended significance of much of what he wrote, because our received stories underestimate the complexity of nineteenth-century mathematics and mislocate Frege’s work within that context. Given Frege’s perceived status as a paradigmatic analytic philosopher, this mislocation translates into an unduly narrow vision of the relation between mathematics and philosophy. This chapter surveys one part of a larger project that takes Frege as a benchmark to fix some of the broader interest and philosophical significance of nineteenth-century developments. To keep this contribution to a manageable.. (shrink)

In this work, Jamie Mayerfeld undertakes a careful inquiry into the meaning and moral significance of suffering. Understanding suffering in hedonistic terms as an affliction of feeling, he claims that it is an objective psychological condition, amenable to measurement and interpersonal comparison, although its accurate assessment is never easy. Mayerfeld goes on to examine the content of the duty to prevent suffering and the weight it has relative to other moral considerations. He argues that the prevention of suffering is (...) morally more important than the promotion of happiness, and that the duty to relieve suffering is much stronger than most of us acknowledge. (shrink)

In this article, I consider how the epistemic problem of religious disagreement has been viewed within the Islamic tradition. Specifically, I consider two religious epistemological trends within the tradition: Islamic Rationalism and Islamic Traditionalism. In examining the approaches of both trends toward addressing the epistemic problem, I suggest that neither is wholly adequate. Nonetheless, I argue that both approaches offer insights that might be relevant to building a more adequate response. So, I attempt to combine insights from both by drawing (...) a distinction between inferential and noninferential reflective responsibility. Given this distinction, I argue that it may be possible for a theist to remain steadfast in upholding their tradition-specific theistic belief, without having to hold that belief by way of inference; but nevertheless, having to be sufficiently reflectively responsible in forming their theistic belief noninferentially. (shrink)

A cluster of recent papers on Frege have urged variations on the themethat Frege’s conception of logic is in some crucial way incompatible with‘metatheoretic’ investigation. From this observation, significant consequencesfor our interpretation of Frege’s understanding of his enterprise are taken tofollow. This chapter aims to critically examine this view, and to isolate whatI take to be the core of truth in it. However, I will also argue that once wehave isolated the defensible kernel, the sense in which Frege was committedto (...) rejecting ‘metatheory’ is too narrow and uninteresting to support the con-clusions drawn from the thesis by its proponents. (shrink)

In reference to the philosophical theology of medieval Islamic theologian Ibn Taymiyya, this paper outlines a parallel between Taymiyyan thought and Alvin Plantinga’s thesis of ‘Reformed Epistemology’. In critiquing a previous attempt to build an account of ‘Islamic externalism’, the Taymiyyan model offers an account that can be seen as wholly ‘Plantingan’.

Amongst intellectuals and activists, neoliberalism has become a potent signifier for the kind of free-market thinking that has dominated politics for the past three decades. Forever associated with the conviction politics of Ronald Reagan and Margaret Thatcher, the free-market project has since become synonymous with the 'Washington consensus' on international development policy and the phenomenon of corporate globalization, where it has come to mean privatization, deregulation, and the opening up of new markets. But beyond its utility as a protest slogan (...) or buzzword as shorthand for the political-economic Zeitgeist, what do we know about where neoliberalism came from and how it spread? Who are the neoliberals, and why do they studiously avoid the label? Constructions of Neoliberal Reason presents a radical critique of the free-market project, from its origins in the first half of the 20th Century through to the recent global economic crisis, from the utopian dreams of Friedrich von Hayek through the dogmatic theories of the Chicago School to the hope and hubris of Obamanomics. The book traces how neoliberalism went from crank science to common sense in the period between the Great Depression and the age of Obama. Constructions of Neoliberal Reason dramatizes the rise of neoliberalism and its uneven spread as an intellectual, political, and cultural project, combining genealogical analysis with situated case studies of formative moments throughout the world, like New York City's bankruptcy, Hurricane Katrina, and the Wall Street crisis of 2008. The book names and tracks some of neoliberalism's key protagonists, as well as some of the less visible bit-part players. It explores how this adaptive regime of market rule was produced and reproduced, its logics and limits, its faults and its fate. (shrink)

How can researchers use race, as they do now, to conduct health-care studies when its very definition is in question? The belief that race is a social construct without “biological authenticity” though widely shared across disciplines in social science is not subscribed to by traditional science. Yet with an interdisciplinary approach, the two horns of the social construct/genetics dilemma of race are not mutually exclusive. We can use traditional science to provide a rigorous framework and use a social-science approach so (...) that “invisible” factors are used to adjust the design of studies on an as-needed basis. One approach is to first observe health-care outcomes and then categorize the outcomes, thus removing genetic differences as racial proxies from the design of the study. From the outcomes, we can then determine if there is a pattern of conceivable racial categories. If needed, we can apply dynamic notions of race to acknowledge bias without prejudice. We can use them constructively to improve outcomes and reduce racial disparities. Another approach is nearly identical but considers race not at all: While analyzing outcomes, we can determine if there are biological differences significant enough to identify classifications of humans. That is, we look for genetic patterns in the outcomes and classify only those patterns. There is no attempt to link those patterns to race. (shrink)

This investigation is motivated by the lack of scholarship examining the content of what firms are communicating to various stakeholders about their commitment to socially responsible behaviors. To address this query, a qualitative study of the legal, ethical and moral statements available on the websites of Forbes Magazine''s top 50 U.S. and top 50 multinational firms of non-U.S. origin were analyzed within the context of stakeholder theory. The results are presented thematically, and the close provides implications for social responsibility among (...) managers of global organizations as well as researchers interested in business ethics. (shrink)

Despite the prominence of person‐centred care (PCC) in nursing, there is no general agreement on the assumptions and the meaning of PCC. We sympathize with the work of others who rethink PCC towards relational, embedded, and temporal selfhood rather than individual personhood. Our perspective addresses criticism of humanist assumptions in PCC using critical posthumanism as a diffraction from dominant values We highlight the problematic realities that might be produced in healthcare, leading to some people being more likely to be disenfranchised (...) from healthcare than others. We point to the colonial, homo‐ and transphobic, racist, ableist, and ageist consequences of humanist traditions that have influenced the development of PCC. We describe the deep rooted conditions that structurally uphold inequality and undermine nursing practice that PCC reproduces. We advocate for the self‐determination of patients and emphasize that we support the fundamental mechanisms of PCC enabling patients' choice; however, without critical introspection, these are limited to a portion of humans. Last, we present limitations of our perspective based on our white*‐cisheteropatriarchy** positionality. We point to the fact that any reimagining of models such as PCC should be carefully done by listening, following, and ceding power to people with diversity dimensions*** and the lived experience or expertise that exists from diverse perspectives. We point towards Black, queer feminism, and critical disabilities studies to contextualize our point of critique with humanism and PCC to amplify equity for all people and communities. Theory and philosophy are useful to understand restrictive factors in healthcare delivery and to inform systematic strategies to improve the quality of care so as not to perpetuate the oppression of groups of people with diversity dimensions. *We purposely capitalize Black and use lower case for white to decentre whiteness and as an intentional act of antiracism (see White Homework a podcast series by Tori W. Douglas). **Cisheteropatriarchy describes people with intersecting identities of dominant social groups; cisgender is the gender identity that aligns with the gender you were assigned at birth, hetero means heterosexual, and patriarchy refers to structural systems of power based on maleness where women are often excluded and hold less power. ***With diversity dimensions, we refer to subjective lived experience and material realities of people that exist outside the ‘dominant minorities' of white‐cisheteropatriarchy, meaning groups of people in society who historically and currently hold more power and through this, structurally dominate the norms and possibilities of living for other people. (shrink)

This paper offers a defence of the distinction between agent-neutral and agent-relative reasons for action from scepticism aired by Toni Rønnow-Rasmussen. In response it is argued that the Nagelian notion of an agent-neutral reason is not incomprehensible, and that agent-neutral reasons can indeed be understood as obtaining states of affairs that count in favour of anyone and everyone performing the action they favour. Furthermore, I argue that a distinction drawn between agent-neutral and agent-relative reason-statements that express the salient features of (...) reason-constitutive states of affairs is neither reductive in the sense of reducing normative reasons to the propositional content of an agent’s mental state, nor trivial in the sense of locating the distinction merely in an agent’s description of the world. (shrink)

This thesis examines the hogbacks and hammerhead crosses of Viking Age Strathclyde and Northumbria. Both are Insular forms of carved stone sculpture often found in Christian contexts. This thesis aims to highlight the significance of these carved stones within a contemporary landscape dominated by a complex historical and archaeological narrative, with the overall aim of ascribing them functions, beyond those of funerary. The approach this thesis takes is theoretical in its construct, both methodologically and analytically, and is grounded in the (...) phenomenological principles of Maurice Merleau-Ponty. It is hoped that this thesis will break down the perceived barrier imposed on research by the modern Scotland-England border, thus potentially alleviate the implied disconnect between Viking Age Strathclyde and Northumbria. While acknowledging the current art-historical work, this thesis archaeologically reappraises hogbacks and provides an original and detailed archaeological treatise of hammerhead crosses. Additionally, this thesis espouses a conceptual framework for approaching, analysing and interpreting carved stones, which considers the idea of what makes space become a place. This framework involves the adoption of a reflexive phenomenological approach to the recording of carved stone monuments in the landscape, and, in approaching material, the adoption and adaption of the concepts of hybrid practice, supervenience, Deleuzian difference, common difference, the third space, and art and agency. In integrating these approaches and concepts, the idea of place-making emerges, discerned via non-dialectical interrelationships between people, material, and space. It is conceptualised here in abstract form as the person/object/place framework. In applying this framework to postulate the functions of hogbacks and hammerhead crosses in the landscape, the following, non-mutually exclusive, themes are considered: commemorative space, economic space, biblical space, mythological space, political space, and sacred space. Considering these themes in the application of the conceptual framework to approaching notable carved stones gives rise to the concept of functional landscapes. These abstract landscapes emerge and are understood through a network of functional places, developing out of particular carved stone monuments inhabiting specific spaces. Ascribing functions to Viking Age carved stones allows for interpretation beyond the traditional and uncritical narrative that hogbacks and hammerhead crosses are simply Viking ‘calling cards’ or gravestones. Furthermore, in considering the Christian context and syncretic nature of many hogbacks, this thesis challenges the common idea that their origins and models often lie solely in Scandinavian paganism and culture. (shrink)

The essays gathered here recommend the work of Ernest Bloch as a challenge to older models of historical materialism and utopian emancipation and give specific examples of how Bloch's work can contribute to current debates about utopia, nationalism, collective memory, and the complex relationship between ideology and everyday life.

Ethicists, policy-makers, and the general public have questioned whether artificial entities such as robots warrant rights or other forms of moral consideration. There is little synthesis of the research on this topic so far. We identify 294 relevant research or discussion items in our literature review of this topic. There is widespread agreement among scholars that some artificial entities could warrant moral consideration in the future, if not also the present. The reasoning varies, such as concern for the effects on (...) artificial entities and concern for the effects on human society. Beyond the conventional consequentialist, deontological, and virtue ethicist ethical frameworks, some scholars encourage “information ethics” and “social-relational” approaches, though there are opportunities for more in-depth ethical research on the nuances of moral consideration of artificial entities. There is limited relevant empirical data collection, primarily in a few psychological studies on current moral and social attitudes of humans towards robots and other artificial entities. This suggests an important gap for psychological, sociological, economic, and organizational research on how artificial entities will be integrated into society and the factors that will determine how the interests of artificial entities are considered. (shrink)

Recent philosophical literature has turned its attention towards assessments of how to judge scientific proposals as worthy of further inquiry. Previous work, as well as papers contained within this special issue, propose criteria for pursuitworthiness (Achinstein, 1993; Whitt, 1992; DiMarco & Khalifa, 2019; Laudan, 1977; Shan, 2020; Šešelja et al., 2012). The purpose of this paper is to assess the grounds on which pursuitworthiness demands can be legitimately made. To do this, I propose a challenge to the possibility of even (...) minimal criteria of pursuitworthiness, inspired by Paul Feyerabend. I go on to provide a framework for identifying the contexts in which pursuitworthiness criteria may promote the efficiency of scientific inquiry. I then spell out some implications this framework has for values and pursuit. (shrink)

Formation of branching epithelial trees from unbranched precursors is a common process in animal organogenesis. In humans, for example, this process gives rise to the airways of the lungs, the urine‐collecting ducts of the kidneys and the excretory epithelia of the mammary, prostate and salivary glands. Branching in these different organs, and in different animal classes and phyla, is morphologically similar enough to suggest that they might use a conserved developmental programme, while being dissimilar enough not to make it obviously (...) certain that they do. In this article, I review recent discoveries about the molecular regulation of branching morphogenesis in the best‐studied systems, and present evidence for and against the idea of there being a highly conserved mechanism. Overall, I come to the tentative conclusion that key mechanisms are highly conserved, at least within vertebrates, but acknowledge that more work needs to be done before the case is proved beyond reasonable doubt. BioEssays 24:937–948, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

The Vitruvian Man is a metaphor for the “ideal man” by feminist posthuman philosopher Rosi Braidotti (2013) as a proxy for eurocentric humanist ideals. The first half of this paper extends Braidotti's concept by thinking about the metaphor of the “ideal nurse” (Vitruvian nurse) and how this metaphor contributes to racism, oppression, and burnout in nursing and might restrict the professionalization of nursing. The Vitruvian nurse is an idealized and perfected form of a nurse with self‐sacrificial language (re)producing self‐sacrificing expectations. (...) The second half of this paper looks at how regulatory frameworks (using the example of UK's Nursing and Midwifery Council Code of Conduct) institutionalize the conditions of possibility through collective imaginations. The domineering expectations found within the Vitruvian nurse metaphor and further codified by regulatory frameworks give rise to boredom and burnout. The paper ends by suggesting possible ways to diffract regulatory frameworks to practice with affirmative ethics and reduce feelings of self‐sacrifice and exhaustion among nurses. (shrink)

Words associated with perceptually salient, highly imageable concepts are learned earlier in life, more accurately recalled, and more rapidly named than abstract words (R. W. Brown, 1976; Walker & Hulme, 1999). Theories accounting for this concreteness effect have focused exclusively on semantic properties of word referents. A novel possibility is that word structure may also contribute to the effect. We report a corpus-based analysis of the phonological and morphological structures of a large set of nouns with imageability ratings (N = (...) 2,023). High- and low-imageability nouns differed by length, etymology, prosody, affixation, phonological neighborhood density, and rates of consonant clustering. On average, nouns denoting abstract concepts were longer, more derivationally complex, and emerged in English from a different distribution of languages than did concrete nouns. We address implications for interactivity of word form and meaning as pertain to theories of word concreteness, lexical acquisition, and word processing. (shrink)

The most public-facing forms of contemporary Darwinism happily promote its worldview ambitions. Popular works, by the likes of Richard Dawkins, deflect associations with eugenics and social Darwinism, but also extend the reach of Darwinism beyond biology into social policy, politics, and ethics. Critics of the enterprise fall into two categories. Advocates of Intelligent Design and secular philosophers (like Mary Midgley and Thomas Nagel) recognise it as a worldview and argue against its implications. Scholars in the rhetoric of science or science (...) communication, however, typically take the view that Darwinism isn't a worldview, but a scientific theory, which has been improperly embellished by some; they uphold the distinction between is and ought and argue that science is restricted to the former. This prompts an is–ought problem on another level. I catalogue the ways in which Darwinism plainly is a worldview and why commentators' beliefs that it ought not to be distorts their analysis. Hence, it is their own worldview that precludes them from accepting Darwinism's worldview implications. (shrink)

I have two aims in this article. The first is to break the deadlocked exchange between John Skorupski and John Broome concerning how best to understand Thomas Nagel's distinction between agent-neutral and agent-relative reasons for action. The second is to provide a reformulation of the distinction which captures an uncontroversial distinction between those reason-giving considerations which encapsulate an indexical relationship between an agent and an object of moral concern, and those which do not. The resolution of this exchange, and subsequent (...) reformulation of the dichotomy, has two important ramifications for contemporary debates in moral philosophy. First and foremost, it reveals the true, pre-theoretical nature of the distinction between agent-neutral and agent-relative reasons for action, and how the notion of agent-relativity cannot be utilized to underwrite the existence of deontic constraints. And, second, it provides definitive support for Skorupski's claim that agent-relative reasons are not the defining feature of deontological ethics. (shrink)

The provider–patient relationship is typically regarded as an expert-to-novice relationship, and with good reason. Providers have extensive education and experience that have developed in them the competence to treat conditions better and with fewer harms than anyone else. However, some researchers argue that many patients with long-term conditions (LTCs), such as arthritis and chronic pain, have become “experts” at managing their LTC. Unfortunately, there is no generally agreed-upon conception of “patient expertise” or what it implies for the provider–patient relationship. I (...) review three prominent accounts of patient expertise and argue that all face serious objections. I contend, however, that a plausible account of patient expertise is available and that it provides a framework both for further empirical studies and for enhancing the provider–patient relationship. (shrink)

In an age were artificial intelligence can do everything for us why should we do things for ourselves? What is at stake is the intrinsic value of doing things for ourselves, our relationship to the world, and the sense of personal identity that springs forth from our actions. An age were automated machines do everything for us, threatens to de-skill our perceptions and to turn the individual into a passive observer rather than an active participant in the world. Therefore, this (...) paper draws upon the phenomenology of skilled perception and the Aristotelian concept of Aretê to argue for the importance of doing high-quality work for its own sake and how such domains of activity are central to our personal identities. What is required to live authentically is the targeted automation of routinized work and to enable the individual to freely choose their own practical identities based on its potential to provide an engaging perceptual niche. AI may either enhance or diminish our authenticity in three salient ways; it can either be used to liberate us from disengaging work, to facilitate psychologically engaging work, or to annihilate engaging perceptual niches and to close off corners of reality from mankind forever. (shrink)

Epithelia can be defined morphologically as tissues that line surfaces, and ultrastructurally with reference to their cells' apico‐basal polarity and possession of specific cell‐cell junctions. Defining the epithelial phenotype at a molecular level is more problematic ‐ while it is easy to name proteins (e.g. keratins) expressed by a “typical” epithelium, no known molecules are expressed by every epithelium but by no other tissues. Cells can differentiate to and from the epithelial state as part of normal development, as a response (...) to disease or when manipulated in culture. Many factors (matrix components, adhesion molecules, growth factors, transcription factors) have been identified that can trigger these transitions of phenotype in specific cases, but to date no general master regulators of the epithelial state have been found. The epithelial state may therefore be controlled by multiple regulatory genes so that there is no single molecule responsible for all of the diverse types of epithelium that exist in higher animals. (shrink)

United in Hate analyzes the Left's contemporary romance with militant Islam as a continuation of the Left's love affair with communist totalitarianism in the ...

Keirkegaard's Metaphors offers an explaination of a more accessible way to understand Kierkegarrd by analyzing his persistent use of metaphors.