This indispensible collection brings together feminist theory and cultural studies, looking at issues such as pop culture and the media, science and technology, ...

It is shown that stochastic observables defined by an instrument need not, and generally do not, commute.

A predominant ethical view holds that physician‐investigators should conduct their research with therapeutic intent. And since a physician offering a therapy wouldn't prescribe second‐rate treatments, the experimental intervention and the best proven therapy should appear equally effective. "Clinical equipoise" is necessary. But this perspective is flawed. The ethics of research and of therapy are fundamentally different, and clinical equipoise should be abandoned.

In lieu of an abstract, here is a brief excerpt of the content:The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President’s Council on Bioethics*Franklin G. Miller** (bio) and Robert D. Truog (bio)Traditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes in (...) the second half of the twentieth century prompted calls for a new, or at least expanded, definition of death: the development of intensive care medicine, especially the use of mechanical ventilators, and the advent of successful transplantation of vital organs. Patients with profound neurological damage, leaving them incapable of breathing on their own and in an irreversible coma, could be maintained for some period of time with the aid of mechanical ventilation. The situation of these patients posed two ethical questions. Is it appropriate to stop life-sustaining treatment? If so, is it acceptable to retrieve vital organs for transplantation to save the lives of others before stopping treatment?In 1968, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed that death could be determined on the basis of neurological criteria, thus providing a positive answer to these two questions (Ad Hoc Committee 1968). According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation. [End Page 185] Because they are dead, it is appropriate, indeed imperative, to stop mechanical ventilation. And because they are dead, it becomes ethical to procure vital organs for transplantation before stopping what otherwise would be life-sustaining treatment. Remarkably, this innovative neurological determination of death became, with little debate or controversy, the established position in medical ethics and the law throughout the United States.The Harvard Committee articulated the diagnosis of “irreversible coma,” but merely asserted that this condition constituted death. No explanatory rationale was provided. It fell to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research to provide an authoritative rationale in its 1981 report, Defining Death. The second paragraph of the report set the stage as follows: “The question addressed here is not inherently difficult or complicated. Simply, it is whether the law ought to recognize new means for establishing that the death of a human being has occurred” (President’s Commission 1981, p. 3). The Commission claimed that “death is a unitary phenomenon” (p. 7) and that the determination of death by neurological criteria, in terms of the absence of all brain function, is consistent with the traditional conception of death as the cessation of vital functioning of the organism as a whole. The key issue is the integrative functioning of the human organism, which ceases to exist, according to the Commission, when the whole brain, including higher cortical areas and the brain stem, fails to function. Although “brain-dead” patients do not appear to be dead—i.e., the reality of their death is “masked” by the activity of mechanical ventilation—the patient’s body has irreversibly lost all capacity for integrative functioning. In the words of the Commission: “When artificial means of support mask this loss of integration as measured by the old methods [cessation of respiration and heart beat], brain-oriented criteria and tests provide a new window on the same phenomenon” (p. 33). The President’s Commission was instrumental in developing and establishing “The Uniform Definition of Death Act”: “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead” (p. 2).Although the question posed by the President’s Commission was easy to articulate, the answer, over time, has proved complicated and controversial. The coherence and cogency of determining death by neurological criteria has been challenged. Various experts have demonstrated that “brain-dead” patients maintained on mechanical ventilation display a range of vital, integrative, functioning, which conflicts with the judgment that they are dead (Truog and... (shrink)

That bad things happen to good people was as true in early China as it is today. Franklin Perkins uses this observation as the thread by which to trace the effort by Chinese thinkers of the Warring States Period, a time of great conflict and division, to seek reconciliation between humankind and the world. Perkins provides rich new readings of classical Chinese texts and reflects on their significance for Western philosophical discourse.

Prevailing ethical thinking about informed consent to clinical research is characterized by theoretical confidence and practical disquiet. On the one hand, bioethicists are confident that informed consent is a fundamental norm. And, for the most part, they are confident that what makes consent to research valid is that it constitutes an autonomous authorization by the research participant. On the other hand, bioethicists are uneasy about the quality of consent in practice. One major source of this disquiet is substantial evidence of (...) the “therapeutic misconception”—the tendency of patient-subjects in clinical trials to confuse participating in research with receiving personalized medical care. This .. (shrink)

Review of James Franklin, The Science of Conjecture: Evidence and Probability Before Pascal (Johns Hopkins University Press, 2001).

The use of brain imaging technology as a common tool of research has spawned concern and debate over how investigators should respond to incidental fndings discovered in the course of research. In this article, we argue that investigators have an obligation to respond to incidental fndings in view of their entering into a professional relationship with research participants in which they are granted privileged access to private information with potential relevance to participants' health. We discuss the scope and limits of (...) this professional obligation to respond to incidental fndings, bearing in mind that the relationship between investigators and research participants differs fundamentally from the doctor-patient relationship. (shrink)

: Bioethicists have failed to understand the pervasively paternalistic character of research ethics. Not only is the overall structure of research review and regulation paternalistic in some sense; even the way informed consent is sought may imply paternalism. Paternalism has limits, however. Getting clear on the paternalism of research ethics may mean some kinds of prohibited research should be reassessed.

Why was Leibniz so fascinated by Chinese philosophy and culture? What specific forms did his interest take? How did his interest compare with the relative indifference of his philosophical contemporaries and near-contemporaries such as Spinoza and Locke? In this highly original book, Franklin Perkins examines Leibniz's voluminous writings on the subject and suggests that his interest was founded in his own philosophy: the nature of his metaphysical and theological views required him to take Chinese thought seriously. Leibniz was unusual in (...) holding enlightened views about the intellectual profitability of cultural exchange, and in a broad-ranging discussion Perkins charts these views, their historical context, and their social and philosophical ramifications. The result is an illuminating philosophical study which also raises wider questions about the perils and rewards of trying to understand and learn from a different culture. (shrink)

Accepted medical practice already violates the dead donor rule. Explicitly jettisoning the rule—allowing vital organs to be extracted, under certain conditions, from living patients—is a radical change only at the conceptual level. But it would expand the pools of eligible organ donors.

“Free Will” is a philosophical term of art for a particular sort of capacity of rational agents to choose a course of action from among various alternatives. Which sort is the free will sort is what all the fuss is about. (And what a fuss it has been: philosophers have debated this question for over two millenia, and just about every major philosopher has had something to say about it.) Most philosophers suppose that the concept of free will is very (...) closely connected to the concept of moral responsibility. Acting with free will, on such views, is just to satisfy the metaphysical requirement on being responsible for one's action. (Clearly, there will also be epistemic conditions on responsibility as well, such as being aware—or failing that, being culpably unaware—of relevant alternatives to one's action and of the alternatives' moral significance.) But the significance of free will is not exhausted by its connection to moral responsibility. Free will also appears to be a condition on desert for one's accomplishments (why sustained effort and creative work are praiseworthy); on the autonomy and dignity of persons; and on the value we accord to love and friendship. (See Kane 1996, 81ff. and Clarke 2003, Ch.1.). (shrink)

The consistency of a second-order version of Morley’s Theorem on the number of countable models was proved in [EHMT23] with the aid of large cardinals. We here dispense with them.

This book assembles the contributions of a distinguished group of scholars concerning the ethics of consent in theory and practice.

Conventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life-sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life-sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of medication. We argue that the differential moral assessment of these two practices (...) is based on a series of moral fictions – motivated false beliefs that erroneously characterize withdrawing life-sustaining treatment in order to bring accepted end-of-life practices in line with the prevailing moral norm that doctors must never kill patients. When these moral fictions are exposed, it becomes apparent that conventional medical ethics relating to end-of-life decisions is radically mistaken. (shrink)

Explains Aristotle's views on the possibility of continuous variation between biological species. While the Porphyrean/Linnean classification of species by a tree suggests species are distributed discretely, Aristotle admitted continuous variation between species among lower life forms.

The leading ethical position on placebo-controlled clinical trials is that whenever proven effective treatment exists for a given condition, it is unethical to test a new treatment for that condition against placebo. Invoking the principle of clinical equipoise, opponents of placebo-controlled trials in the face of proven effective treatment argue that they (1) violate the therapeutic obligation of physicians to offer optimal medical care and (2) lack both scientific and clinical merit. We contend that both of these arguments are mistaken. (...) Clinical equipoise provides erroneous ethical guidance in the case of placebo-controlled trials, because it ignores the ethically relevant distinction between clinical trials and treatment in the context of clinical medicine and the methodological limitations of active-controlled trials. Placebo controls are ethically justifiable when they are supported by sound methodological considerations and their use does not expose research participants to excessive risks of harm. (shrink)

Comparative valuation of different policy interventions often requires interpersonal comparability of benefit. In the field of health economics, the metric commonly used for such comparison, quality adjusted life years (QALYs) gained, has been criticized for failing to respect the equality of all persons’ intrinsic worth, including particularly those with disabilities. A methodology is proposed that interprets ‘full quality of life’ as the best health prospect that is achievable for the particular individual within the relevant budget constraint. This calibration is challenging (...) both conceptually and operationally as it shifts dramatically when technology or budget developments alter what can be achieved for incapacitated individuals. The proposal nevertheless ensures that the maximal achievable satisfaction of one person’s preferences can carry no more intrinsic value than that of another. This approach, which can be applied to other domains of social valuation, thus prevents implicit discrimination against the elderly and those with irremediable incapacities. (shrink)

Presentism has received much scrutiny of late, yet little has been said of its definition. Many assume that it means simply that all that exists, exists at present. However, this definition will not do. It is defective in a multiplicity of ways. I consider and reject each of a number of intuitive ways in which to amend it. Each carries us a bit closer to our goal, but not until the end do we reach a definition that is wholly satisfactory. (...) The final definition has this remarkable feature: it has us posit abstracta of two kinds, namely, times and haecceities. (shrink)

It has been presumed within bioethics that the benefits and risks of treatments can be assessed independently of information disclosure to patients as part of the informed consent process. Research on placebo and nocebo effects indicates that this is not true for symptomatic treatments. The benefits and risks that patients experience from symptomatic treatments can be shaped powerfully by information about these treatments provided by clinicians. In this paper we discuss the implications of placebo and nocebo research for risk–benefit assessment (...) and informed consent. (shrink)

Engaging in a dialogue with such major representatives of the dominant consensus as Kant, Habermas, and Rawls, and informed by the philosophical writings of ...

Both children and adults predict the content of upcoming language, suggesting that prediction is useful for learning as well as processing. We present an alternative model which can explain prediction behaviour as a by-product of language learning. We suggest that a consideration of language acquisition places important constraints on Pickering & Garrod's (P&G's) theory.

Physicians commonly recommend ?placebo treatments?, which are not believed to have specific efficacy for the patient's condition. Motivations for placebo treatments include complying with patient expectations and promoting a placebo effect. In this article, we focus on two key empirical questions that must be addressed in order to assess the ethical legitimacy of placebo treatments in clinical practice: 1) do placebo treatments have the potential to produce clinically significant benefit? and 2) can placebo treatments be effective in promoting a therapeutic (...) placebo response without the use of deception? We examine evidence from clinical trials and laboratory experiments bearing on these two questions. The conclusion is reached that based on currently available evidence, it is premature to judge whether placebo treatments are ethically justifiable, with the possible exception of acupuncture for pain relief. (shrink)

The ability to combine words into novel sentences has been used to argue that humans have symbolic language production abilities. Critiques of connectionist models of language often center on the inability of these models to generalize symbolically (Fodor & Pylyshyn, 1988; Marcus, 1998). To address these issues, a connectionist model of sentence production was developed. The model had variables (role‐concept bindings) that were inspired by spatial representations (Landau & Jackendoff, 1993). In order to take advantage of these variables, a novel (...) dual‐pathway architecture with event semantics is proposed and shown to be better at symbolic generalization than several variants. This architecture has one pathway for mapping message content to words and a separate pathway that enforces sequencing constraints. Analysis of the model's hidden units demonstrated that the model learned different types of information in each pathway, and that the model's compositional behavior arose from the combination of these two pathways. The model's ability to balance symbolic and statistical behavior in syntax acquisition and to model aphasic double dissociations provided independent support for the dual‐pathway architecture. (shrink)

ABSTRACTThe major credit rating agencies contributed substantially to the sub‐prime mortgage crisis by giving their highest rating to most of the collateralized debt obligations securities that were backed by these sub‐prime mortgages. Because the rating agencies are compensated by the issuers whose CDO bonds they rate, this relationship creates a prima facie conflict of interest, one that is compounded when the rating agency also consults for the issuers on designing the CDOs. While Congress and the Securities Exchange Commission investigate possible (...) wrongdoing, various reforms have been proposed. This article analyzes these conflicts of interest and the cognate corporate governance issues. It then categorizes and critiques several of the reform proposals—which range in severity from requiring more disclosure to the suspension of the rating agency's license. (shrink)

The Death of the Past argues that critical problems in the philosophy of history, such as the the truth of historical texts, how texts relate to the past that they are about, and the nature of historical explanation, can be successfully investigated if we accept the claim that historical writing is historicist--perspectival (from the standpoint of the historian) rather than purporting to be like an eyewitness account (as in the first-person "presentist" views critiqued by Enzo Traverso). This approach admits all (...) relevant evidence as subject to analysis in order to determine the widest point of view, as opposed to the biased "eyewitness" approach, which observes only partially. The link between the past itself and historical knowledge is radically broken, giving the latter the wisdom of hindsight across a broader temporal field from the events examined up to the present. The truth about the past is only accessible from a later point in time; "the past" itself is not a reality for the historian; it no longer exists. Frank Ankersmit offers a surprising foundation for the historicist notion of history: Leibniz' monadological universe, in which each monad or substance has its own point of view. There is no deeper ontology to which they owe their status--just an infinity of monads and a corresponding infinity of points of view on other monads. So with historical representations, statements about the past that can be either true or false but not depictions of the past itself. In striking contrast to Hayden White's view, Ankersmit insists that historical writing is no less rational than the sciences-- mathematical and scientific writing has its counterpart in the writing of history. (shrink)

The purpose of Parts and Places, say Casati and Varzi in their introduction, is to construct “a theory of our spatial competence,” a theory that will lay bare how we conceive of space and the things that lie within it. Its purpose, then, is psychological, not metaphysical. Its object of study is not space. It is not the things that lie within it. Rather its object of study is us. In this regard, Parts and Places is at best a mixed (...) success. (shrink)

The doctrine of clinical equipoise is appealing because it appears to permit physicians to maintain their therapeutic obligation to offer optimal medical care to patients while conducting randomized controlled trials (RCTs). The appearance, however, is deceptive. In this article we argue that clinical equipoise is defective and incoherent in multiple ways. First, it conflates the sound methodological principle that RCTs should begin with an honest null hypothesis with the questionable ethical norm that participants in these trials should never be randomized (...) to an intervention known to be inferior to standard treatment. Second, the claim that RCTs preserve the therapeutic obligation of physicians misrepresents the patient-centered orientation of medical care. Third, the appeal to clinical equipoise as a basic principle of risk-benefit assessment for RCTs is incoherent. Finally, the difficulties with clinical equipoise cannot be resolved by viewing it as a presumptive principle subject to exceptions. In the final sections of the article, we elaborate on the non-exploitation framework for the ethics clinical research and indicate issues that warrant further inquiry. (shrink)

A basic question of medical ethics is whether the norms governing medical practice should be understood as the application of principles and rules of the common morality to medicine or whether some of these norms are internal or proper to medicine. In this article we describe and defend an evolutionary perspective on the internal morality of medicine that is defined in terms of the goals of clinical medicine and a set of duties that constrain medical practice in pursuit of these (...) goals. This perspective is developed by means of a critical examination of the essentialist conception of the internal morality of medicine advocated by Edmund Pellegrino and the critique of internal morality approaches by Robert Veatch and Tom Beauchamp. (shrink)

¿Perdonar es un deber? No, si significa la simple liberación de las deudas o debidas sanciones. En cambio, si perdonar se refiere a forjar un carácter indulgente, orientado a la cancelación de odios y rencores para con quienes nos han agraviado, entonces es posible que el sistema moral kantiano pueda justificarlo como deber. En el marco de la "Metafísica de las costumbres", perdonar podría considerarse un deber imperfecto. En ese sentido, sería a la vez compatible con otros deberes, perfectos e (...) imperfectos, como hacer cumplir la justicia o colaborar para que esta se cumpla. Distinguir entre perdón e impunidad constituye una tarea fundamental en contextos de justicia transicional. El artículo sostiene que perdonar es un deber y que este no contradice a la justicia. (shrink)