In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

The legal requirements and justifications for collecting patient-identifiable data without patient consent were examined. The impetus for this arose from legal and ethical issues raised during the development of a population-based disease register. Numerous commentaries and case studies have been discussing the impact of the Data Protection Act 1998 and Caldicott principles of good practice on the uses of personal data. But uncertainty still remains about the legal requirements for processing patient-identifiable data without patient consent for research purposes. This is (...) largely owing to ignorance, or misunderstandings of the implications of the common law duty of confidentiality and section 60 of the Health and Social Care Act 2001. The common law duty of confidentiality states that patient-identifiable data should not be provided to third parties, regardless of compliance with the DPA1998. It is an obligation derived from case law, and is open to interpretation. Compliance with section 60 ensures that collection of patient-identifiable data without patient consent is lawful despite the duty of confidentiality. Fears regarding the duty of confidentiality have resulted in a common misconception that section 60 must be complied with. Although this is not the case, section 60 support does provide the most secure basis in law for collecting such data. Using our own experience in developing a disease register as a backdrop, this article will clarify the procedures, risks and potential costs of applying for section 60 support. (shrink)

Robust technology infrastructure is needed to enable learning health care systems to improve quality, access, and cost. Such infrastructure relies on the trust and confidence of individuals to share their health data for healthcare and research. Few studies have addressed consumers’ views on electronic data sharing and fewer still have explored the dual purposes of healthcare and research together. The objective of the study is to explore factors that affect consumers’ willingness to share electronic health information for healthcare and research. (...) This study involved a random-digit dial telephone survey of 800 adult Californians conducted in English and Spanish. Logistic regression was performed using backward selection to test for significant associations of each explanatory variable with the outcome variable. The odds of consent for electronic data sharing for healthcare decreased as Likert scale ratings for EHR impact on privacy worsened, odds ratio = 0.74, 95% CI [0.60, 0.90]; security, OR = 0.80, 95% CI [0.66, 0.98]; and quality, OR = 0.59, 95% CI [0.46–0.75]. The odds of consent for sharing for research was greater for those who think EHR will improve research quality, OR = 11.26, 95% CI [4.13, 30.73]; those who value research benefit over privacy OR = 2.72, 95% CI [1.55, 4.78]; and those who value control over research benefit OR = 0.49, 95% CI [0.26, 0.94]. Consumers’ choices about electronically sharing health information are affected by their attitudes toward EHRs as well as beliefs about research benefit and individual control. Design of person-centered interventions utilizing electronically collected health information, and policies regarding data sharing should address these values of importance to people. Understanding of these perspectives is critical for leveraging health data to support learning health care systems. (shrink)

Michael A. PetersBeijing Normal UniversityMy deepest condolences to Pepe, Dom and Marcus and to Jim’s grandchildren. Tina and I spent a lot of time at the Marshall family home, often attending dinn...

A CHOICE Outstanding Academic Title 2012! Contemporary picturebooks open up spaces for philosophical dialogues between people of all ages. As works of art, picturebooks offer unique opportunities to explore ideas and to create meaning collaboratively. This book considers censorship of certain well-known picturebooks, challenging the assumptions on which this censorship is based. Through a lively exploration of children's responses to these same picturebooks the authors paint a way of working philosophically based on respectful listening and creative and authentic interactions, rather (...) than scripted lessons. This dialogical process challenges much current practice in education. The authors propose that a courageous and critical practice of listening is central to the facilitation of mutually educative dialogue. This book will be of interest to scholars and students of education studies, philosophy of education, literacy teaching and learning, children's literature, childhood and pedagogy. (shrink)

This fully revised second edition suggests ways in which you can introduce philosophical enquiry to your Personal, Social and Health Education and Citizenship teaching and across the curriculum.

Bakhtin and the Visual Arts is the first book to assess the relevance of Mikhail Bakhtin's ideas as they relate to painting and sculpture. First published in the 1960s, Bakhtin's writings introduced the concepts of carnival and dialogue or dialogism, which have had significant impact in such diverse fields as literature and literary theory, philosophy, theology, biology, and psychology. In his four early aesthetic essays, written between 1919 and 1926, and before he began to focus on linguistic and literary categories, (...) Bakhtin worked on a larger philosophy of creativity, which was never completed. Deborah Haynes's in-depth study of his aesthetics, especially his theory of creativity, analyses its applicability to contemporary art theory and criticism. The author argues that Bakhtin, with such categories as answerability, outsideness and unfinalisability, offers a conceptual basis for interpreting the moral dimensions of creative activity. (shrink)

New brain imaging technology has emerged that might make it possible to read a person's thoughts directly from their brain activity. This novel approach is referred to as “brain reading” or the “decoding of mental states.” This article provides a general outline of the field and discusses its limitations, potential applications, and also certain ethical issues that brain reading raises. The measurement of brain activity and brain structure has made considerable progress in recent decades. The mapping from brain activity patterns (...) to thoughts is learned for each specific subject using brute force statistical pattern recognition techniques. It discusses the degree to which polygraphy and brain-based lie detection can be manipulated by trained subjects. A future application of brain reading technology, “neuromarketing,” has received tremendous interest and there are repeated attempts to optimize marketing campaigns by adding brain-based sources of information. (shrink)

Written specifically for education studies students, this accessible text offers a clear introduction to philosophy of education. It skilfully guides readers through this challenging and sometimes complex area bringing key philosophical ideas and questions to life in the context and practice of education. Considering the implications of educational trends and movements through a variety of philosophical lenses such as Marxism, feminism, ethics and democracy, the book explores enduring themes in philosophy of education. Features include: individual tasks and group activities to (...) promote discussion case studies notes boxes to highlight further reading; chapter overviews and summaries Drawing on readers' own experiences of education, the book reveals the connections between philosophical ideas and educational policy and practice. Part of the Foundations in Education Studies series, this timely textbook is essential reading for students coming to the study of philosophy of education for the first time. (shrink)

There have long been calls from industry for guidance in implementing strategies for sustainable development. The Circular Economy represents the most recent attempt to conceptualize the integration of economic activity and environmental wellbeing in a sustainable way. This set of ideas has been adopted by China as the basis of their economic development, escalating the concept in minds of western policymakers and NGOs. This paper traces the conceptualisations and origins of the Circular Economy, tracing its meanings, and exploring its antecedents (...) in economics and ecology, and discusses how the Circular Economy has been operationalized in business and policy. The paper finds that while the Circular Economy places emphasis on the redesign of processes and cycling of materials, which may contribute to more sustainable business models, it also encapsulates tensions and limitations. These include an absence of the social dimension inherent in sustainable development that limits its ethical dimensions, and some unintended consequences. This leads us to propose a revised definition of the Circular Economy as “an economic model wherein planning, resourcing, procurement, production and reprocessing are designed and managed, as both process and output, to maximize ecosystem functioning and human well-being”. (shrink)

We examine corruption across three Central and Eastern Europe countries through a social psychology framework which integrates social identity theory, social cognitive theory and moral disengagement mechanisms. We illustrate how various social identities influence individual and collective action in terms of ethical behavior and corruption, thereby creating, maintaining and perpetuating petty, grand and systemic public/private corruption through triadic co-determination via cognition, behavior and the environment. Despite growing research on corruption normalization, less is known about the cognitive and behavioral mechanisms in (...) ethical decision making, the cognitive workings of how individuals reconcile unethical behavior and the social psychological processes behind corruption in society and organizations. Expert interviews reveal internally conflicted multi-layered social identities perpetuating corruption, some embedded in nationalistic history and others tied to the European Union, which supports the divergent paths of CEE countries since the fall of communism. Some moral disengagement mechanisms are common across all three countries, while others are linked to specific circumstances. Social identity mechanisms feed into moral disengagement, which individuals draw upon to reconcile the conflict between unethical behavior and moral codes. Patterns of moral disengagement aggregate to the country level and explain normalization of corruption in CEE society and organizations. (shrink)

Still the Heart of Darkness analyzes Richard Preston's best-selling account of an Ebola virus outbreak in Reston, Virginia in 1989. Through a textual examination of The Hot Zone, this essay demonstrates how Preston grounds his narrative about the threat of rare emerging viruses from the third world in terms of the colonialist discourse about Africa as the white man's grave, most notably Joseph Conrad's Heart of Darkness. By foregrounding previous outbreaks in Africa, Preston simultaneously darkens its landscape and inscribes the (...) Ebola filovirus as an external biological threat to Americans in a post-Cold War world with porous borders. (shrink)

Sartre's experimentation in February 1935 with the drug mescalin has been well documented by Simone de Beauvoir in her book The Prime of Life. 1 She recalls that Sartre experienced under the influence of the drug not exactly hallucinations, ‘but the objects he looked at changed their appearance in the most horrifying manner:’ [POL 209]. The residual effects of this nightmarish experience left Sartre, not only for several days ‘in a state of deep depression’ [POL 210], but also produced moods (...) that ‘recalled those that had been induced by mescalin.’. (shrink)

Western theology struggles with the rise of secularism and postmodernism. The Radical Orthodoxy sensibility asserts that the ancient principles of methexis (participation) and theosis (deification) presents an alternative metaphysical narrative to the narrative of secularism and the onto-theological tradition. This article addresses the problems of the onto-theological metaphysical tradition in Western theology by analyzing Radical Orthodoxy's rediscovery of the philosophical and theological principles of participation and theosis as articulated in the patristic tradition and in the thought of Thomas Aquinas. Using (...) historical and analytical methods, this article will survey the biblical and patristic literature on theosis, as well as John Milbank's understanding of methexis and theosis in Thomas Aquinas. The result of this study will be to offer theosis, rooted in participation in God, as not only a soteriological model to reclaim for the West, but also a core metaphysical principle for Christian ethics that contravenes both onto-theology and the materialistic reduction of ontology in secularism. (shrink)

Serious threats to global order are said to emanate from Al Qaeda, exemplified by bombings and multiple deaths in, inter alia, Bali, Dar es Salaam, Istanbul, Nairobi, New York and Madrid. These outrages raise the question about the ideological assumptions and goals of Al Qaeda ? given that the majority of the dead were not Jews or Christians, but Muslims. What were the bombers trying to achieve? What were their ideological assumptions and goals? This article argues that Al Qaeda first (...) emerged in the late 1980s to challenge the incumbency and authority of rulers in various Middle Eastern countries, including Saudi Arabia, with the objective of replacing them with more plausibly Islamic leaders. Due to a lack of success in this regard, Al Qaeda's attention shifted from the domestic to the global: a war against ?the West? utilising the weapons of terror to achieve ideological goals relating to both specific religious concerns, as well as a wider concern with a global balance of power between the West and the world of Islam. (shrink)

This chapter contains sections titled: Notes.

This chapter contains sections titled: Notes.

This chapter contains sections titled: Notes.

Games may seem like a waste of time, where we struggle under artificial rules for arbitrary goals. The author suggests that the rules and goals of games are not arbitrary at all. They are a way of specifying particular modes of agency. This is what make games a distinctive art form. Game designers designate goals and abilities for the player; they shape the agential skeleton which the player will inhabit during the game. Game designers work in the medium of agency. (...) Game-playing, then, illuminates a distinctive human capacity. We can take on ends temporarily for the sake of the experience of pursuing them. Game play shows that our agency is significantly more modular and more fluid than we might have thought. It also demonstrates our capacity to take on an inverted motivational structure. Sometimes we can take on an end for the sake of the activity of pursuing that end. (shrink)

The business corporation is at the centre of the modern global economy but does it act in the general interest? This paper explores Joel Bakan's film and book critique of the corporation which suggests that it is characterised by a 'pathological pursuit of power and profit'. It seeks to extend Bakan's argument by reconsidering the ethical position of those who run corporations; the question of how far competition constrains their actions; and the extent to which the modern state can control (...) corporations or is itself subject to similar pressures. (shrink)