Patients have received experimental pharmaceuticals outside of clinical trials for decades. There are no industry-wide best practices, and many companies that have granted compassionate use, or ‘preapproval’, access to their investigational products have done so without fanfare and without divulging the process or grounds on which decisions were made. The number of compassionate use requests has increased over time. Driving the demand are new treatments for serious unmet medical needs; patient advocacy groups pressing for access to emerging treatments; internet platforms (...) enabling broad awareness of compelling cases or novel drugs and a lack of trust among some that the pharmaceutical industry and/or the FDA have patients’ best interests in mind. High-profile cases in the media have highlighted the gap between patient expectations for compassionate use and company utilisation of fair processes to adjudicate requests. With many pharmaceutical manufacturers, patient groups, healthcare providers and policy analysts unhappy with the inequities of the status quo, fairer and more ethical management of compassionate use requests was needed. This paper reports on a novel collaboration between a pharmaceutical company and an academic medical ethics department that led to the formation of the Compassionate Use Advisory Committee. Comprising medical experts, bioethicists and patient representatives, CompAC established an ethical framework for the allocation of a scarce investigational oncology agent to single patients requesting non-trial access. This is the first account of how the committee was formed and how it built an ethical framework and put it into practice. (shrink)

Traditional pharmacy education emphasizes the biological processes of diseases and their pharmacological treatments. While the intense focus on biomedical aspects of disease is vital to educating pharmacy students, this focus is often insufficient in conveying what patients experience. The humanities, however, offer powerful characterizations of the disease experience for individuals as well as its impact on the human condition more generally. In this essay, I describe how using literary texts with pharmacy students provides them with a fuller appreciation of what (...) patients face with their diseases. The goal of this endeavor is to make students more effective as pharmacists in detecting and responding to their patients’ problems and needs by connecting their biomedical knowledge to depictions and meanings of illness experiences. (shrink)

Health care costs have been rising steadily in most industrialized countries. These increases are driven primarily by technological advances and, to a lesser degree, by aging of the population. Many factors make it unlikely that market forces alone will limit increases in the costs of health care. These unremitting increases make health care rationing appear both necessary and inevitable.One of the least controversial mechanisms for rationing could be to allow patients to make their own choices as to which kinds of (...) care they would be willing to forgo. This is appealing because it preserves individual freedom of choice regarding health care in a way that other rationing mechanisms often do not. Rationing by patient choice, however, can only happen if patients recognize that resources are limited and need to be conserved, and are willing to forgo marginal benefits. (shrink)

The philosophical literature on sport and games has had little to say about boredom beyond presuming that sports and games can be important ways of overcoming or preventing it. But boredom is an interesting and often misunderstood phenomenon with overlooked implications in this context. Boredom has significant human value and motivates play in ways that contribute to well-being and culture, often through encouraging engaged agency and exploration of novelty. Understanding boredom can also help to clarify problems and tendencies in sports (...) and games that qualify them as havens from boredom. (shrink)

This collection of 21 essays explores the creative interaction among the cognitive neurosciences, philosophy, and theology. It is the result of an international research conference co-sponsored by the Vatican Observatory, Rome, and the Center for Theology and the Natural Sciences, Berkeley.

The present study was designed to explore the relationship between self-reported dissociative experiences and performance in tasks eliciting right-hemisphere processing load. Thirty-four participants performed a vigilance task in two conditions: with task-irrelevant negative-arousing pictures and task-irrelevant neutral pictures. Dissociation was assessed with the Dissociative Experience Scale. Consistent with theories positing right-hemisphere deregulation in high non-clinical dissociators, dissociative experiences correlated with greater vigilance decrement only in the negative picture condition. As both the vigilance task and negative picture processing are right lateralized, (...) this result provides support for a right-hemisphere dysfunction in high dissociators, at least in negative conditions. (shrink)

In this book, the authors present current research in the study of the philosophy of the mind. Topics discussed in this compilation include the concepts of hope and belief; how consciousness builds the subject through relating and human behaviour; analysing the neurophysiological mechanism of qigong on the mind and brain activity; the conscious and unconscious mind and implications for society, religion, and disease; how the mind is shaped by culture; and the power of computational mathematics to explore some of the (...) universal ways by which each human mind builds its image of the world. (shrink)

Over 40 years ago, Daniel Bell made the provocative claim that ideological polarization was diminishing in Western democracies, but new ideologies were emerging and driving politics in developing nations. This article tests the EndofIdeology thesis with a new wave of public opinion data from the World Values Survey (WVS) that covers over 70 nations representing more than 80 per cent of the world's population. We find that polarization along the Left/Right dimension is substantially greater in the less affluent and less (...) democratic societies than in advanced industrial democracies. The correlates of Left/Right orientations also vary systematically across regions. The twin pillars of economic and religious cleavages remain important in European states; cultural values and nationalism provide stronger bases of ideology in Asia and the Middle East. As Bell suggested, social modernization does seem to transform the extent and bases of ideological polarization within contemporary societies. (shrink)

We add texture to the conclusion of Duchon and Drake (Journal of Business Ethics, 85, 2009, 301) that extreme narcissism is associated with unethical conduct. We argue that the special features possessed by financial accounting facilitate extreme narcissism in susceptible CEOs. In particular, we propose that extremely narcissistic CEOs are key players in a recurring discourse cycle facilitated by financial accounting language and measures. Such CEOs project themselves as the corporation they lead, construct a narrative about the corporation and themselves (...) using financial accounting measures, and then reflect on how their accounting-constructed performance is perceived by stakeholders. We do not present empirical evidence about whether the use of accounting language and measures leads to unethical behaviour by extreme narcissistic CEOs — although the conclusions of Duchon and Drake (2009) suggest empirical support is probable. Rather, we focus on developing alertness to the potential for accounting, when engaged by an extremely narcissistic CEO, to be a precursor or implement of unethical behaviour. (shrink)

A well-known term in eighteenth-century literature and philosophy, the “beautiful soul” (die schöne Seele) has resurfaced in recent years. Deleuze refers to the beautiful soul’s “religiosity” and argues that aggressive “selection” is necessary as its antidote. However, in volatile contexts of social destabilization, such selection risks recoiling into reactionary violence. After first developing in more detail the beautiful soul’s background as a discursive figure, I argue that understanding Deleuze’s selection within a context of spiritual experience is necessary to mitigate this (...) worry. Exploration of this experience is pursued through juxtaposition of Deleuze’s thought with Nishida Kitarō’s investigation of the ontological structure of religious consciousness. The comparative resonances I develop suggest an ontological objectivity to the problems and structuring of the logos of religious consciousness and show how a more explicitly spiritual rendering of “selection,” developed through the Deleuze/Nishida encounter, intervenes into the broader beautiful soul problematic. (shrink)

This paper reviews the development of socially responsible investment (SRI) over recent years and highlights the prospects for an increasingly strong connection with the practice of corporate social responsibility. The paper argues that not only has SRI grown significantly, it has also matured. In particular, it has become an investment philosophy adopted by a growing proportion of large investment institutions. This shift in SRI from margin to mainstream and the position in which institutional investors find themselves is leading to a (...) new form of SRI shareholder pressure. Although this bears some resemblance to lobbying campaigns which might take advantage of shareholder rights, we seek to distinguish it as an important phenomenon in its own right — one to which corporate executives are likely to be paying increasing attention in the years to come. We further argue that this approach potentially meets some of the earlier ethical criticisms of certain forms of SRI but, ironically, probably owes its existence to those pioneering approaches. We conclude with some suggestions for further research to inform discussion of the issues highlighted in the paper. (shrink)

Melatonin, the chief hormone of the pineal gland, is produced and secreted into the blood in a circadian manner with maximal production always occurring during the dark phase of the light dark cycle. Whereas the 24h rhythm of melatonin production is very robust in young animals including humans, the cycle deteriorates during ageing. The rhythm of melatonin can be substantially preserved during ageing by restricting the food intake of experimental animals; this same treatment increases the life span of the animals. (...) The exogenous administration of melatonin to non‐food restricted animals also reportedly increases their survival. Moreover, melatonin has been shown to have immunoenhancing effects and oncostatic properties. The implication of these studies is that melatonin may have both direct and indirect beneficial effects in delaying ageing processes or it may retard the development of processes (e.g., immunodeficiency and tumor growth) which contribute to a reduced life span. (shrink)

According to deontic justice theory, individuals often feel principled moral obligations to uphold norms of justice. That is, standards of justice can be valued for their own sake, even apart from serving self-interested goals. While a growing body of evidence in business ethics supports the notion of deontic justice, skepticism remains. This hesitation results, at least in part, from the absence of a coherent framework for explaining how individuals produce and experience deontic justice. To address this need, we argue that (...) a compelling, yet still missing, step is to gain further understanding into the underlying neural and psychological mechanisms of deontic justice. Here, we advance a theoretical model that disentangles three key processes of deontic justice: The use of justice rules to assess events, cognitive empathy, and affective empathy. Together with reviewing neural systems supporting these processes, broader implications of our model for business ethics scholarship are discussed. (shrink)

In this paper we examine how the use of robots in caring for elders can impact the meaningfulness of elders’ lives. We present a framework for understanding ‘meaningfulness in life’, and then apply that framework in discussing ways in which the use of robots to assist in activities of daily living can preserve, enhance or undermine the meaningfulness of elders’ lives. We conclude with a discussion of if and how having false beliefs about companion robots can affect meaningfulness in the (...) life of the person having those false beliefs. (shrink)

Two types of conception of a Way of Life are important for a consideration of the question of the forming and testing of ideals of conduct, and consequently for a consideration of our questions regarding the relation of ideals to practice. The one type is more, the other type less general. The one has reference to man as man, the other to particular classes of man, with relation to their specific function in society. The former issues in the idea of (...) a universal ethic, the latter in the idea of a professional code. Thus the former has a wider generality, the latter has a greater concreteness. Ethical progress seems to me to require that both types should be kept in view, and used to guide man's efforts. (shrink)