In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

In this article I examine several criticisms of the concept of vulnerability. Rather than rejecting the concept, however, I argue that a sufficiently rich understanding of vulnerability is essential to bioethics. The challenges of international research in developing countries require an understanding of how new vulnerabilities arise from conditions of economic, social and political exclusion. A serious shortcoming of current conceptions of vulnerability in research ethics is the tendency to treat vulnerability as a label fixed on a particular subpopulation. My (...) paper examines the role of this “label” metaphor in current statements of research ethics. In contrast to this prevailing “label” metaphor, my own positive account of vulnerability develops a dynamic way of understanding the structure of the concept of vulnerability based on the idea of “layers of vulnerability.” I examine several cases involving women, as they are sometimes labeled as a vulnerable population and sometimes not. My analysis demonstrates the essential role of this revised concept of vulnerability in bioethics and research ethics. (shrink)

“Vulnerability” is a key concept for research ethics and public health ethics. This term can be discussed from either a conceptual or a practical perspective. I previously proposed the metaphor of layers to understand how this concept functions from the conceptual perspective in human research. In this paper I will clarify how my analysis includes other definitions of vulnerability. Then, I will take the practical‐ethical perspective, rejecting the usefulness of taxonomies to analyze vulnerabilities. My proposal specifies two steps and provides (...) a procedural guide to help rank layers. I introduce the notion of cascade vulnerability and outline the dispositional nature of layers of vulnerability to underscore the importance of identifying their stimulus condition. In addition, I identify three kinds of obligations and some strategies to implement them. This strategy outlines the normative force of harmful layers of vulnerability. It offers concrete guidance. It contributes substantial content to the practical sphere but it does not simplify or idealize research subjects, research context or public health challenges. (shrink)

What has the past reaction to the COVID-19 pandemic taught us? We have seen that many low and middle-income countries (LMICs) still lack access to vaccines, and it seems little progress has been made in the last few months and year. This article discusses whether the current strategies, most notably, vaccine donations by the international community and the COVID-19 global access facility COVAX, offer meaningful solutions to tackle the problem. At the centre of our analysis, we compare the concepts of (...) “donations” and “charity” with “vaccine equity” and the “empowerment” of poorer countries. We suggest that the achievement of fair global vaccine production requires that our global approach is supportive of the idea of empowerment. We, therefore, need structural reforms, which would most importantly include capacity building, to positively impact this goal and to take the interests of the global poor seriously. (shrink)

What has the past reaction to the COVID-19 pandemic taught us? We have seen that many low and middle-income countries (LMICs) still lack access to vaccines, and it seems little progress has been made in the last few months and year. This article discusses whether the current strategies, most notably, vaccine donations by the international community and the COVID-19 global access facility COVAX, offer meaningful solutions to tackle the problem. At the centre of our analysis, we compare the concepts of (...) “donations” and “charity” with “vaccine equity” and the “empowerment” of poorer countries. We suggest that the achievement of fair global vaccine production requires that our global approach is supportive of the idea of empowerment. We, therefore, need structural reforms, which would most importantly include capacity building, to positively impact this goal and to take the interests of the global poor seriously. (shrink)

A common argument in support of a beginning of the universe used by advocates of the kalām cosmological argument (KCA) is the argument against the possibility of an actual infinite, or the “Infinity Argument”. However, it turns out that the Infinity Argument loses some of its force when compared with the achievements of set theory and it brings into question the view that God predetermined an endless future. We therefore defend a new formal argument, based on the nature of time (...) (just as geometrical reasoning is based on the nature of space), which addresses more directly the question of beginningless time. (shrink)

COVID-19 vaccines are likely to be scarce for years to come. Many countries, from India to the U.K., have demonstrated vaccine nationalism. What are the ethical limits to this vaccine nationalism? Neither extreme nationalism nor extreme cosmopolitanism is ethically justifiable. Instead, we propose the fair priority for residents framework, in which governments can retain COVID-19 vaccine doses for their residents only to the extent that they are needed to maintain a noncrisis level of mortality while they are implementing reasonable public (...) health interventions. Practically, a noncrisis level of mortality is that experienced during a bad influenza season, which society considers an acceptable background risk. Governments take action to limit mortality from influenza, but there is no emergency that includes severe lockdowns. This “flu-risk standard” is a nonarbitrary and generally accepted heuristic. Mortality above the flu-risk standard justifies greater governmental interventions, including retaining vaccines for a country's own citizens over global need. The precise level of vaccination needed to meet the flu-risk standard will depend upon empirical factors related to the pandemic. This links the ethical principles to the scientific data emerging from the emergency. Thus, the FPR framework recognizes that governments should prioritize procuring vaccines for their country when doing so is necessary to reduce mortality to noncrisis flu-like levels. But after that, a government is obligated to do its part to share vaccines to reduce risks of mortality for people in other countries. We consider and reject objections to the FPR framework based on a country: having developed a vaccine, raising taxes to pay for vaccine research and purchase, wanting to eliminate economic and social burdens, and being ineffective in combating COVID-19 through public health interventions. (shrink)

The strong law of large numbers and considerations concerning additional information strongly suggest that Beauty upon awakening has probability 1/3 to be in a heads-awakening but should still believe the probability that the coin landed heads in the Sunday toss to be 1/2. The problem is that she is in a heads-awakening if and only if the coin landed heads. So, how can she rationally assign different probabilities or credences to propositions she knows imply each other? This is the problem (...) I address in this article. I suggest that ‘p whenever q and vice versa’ may be consistent with p and q having different probabilities if one of them refers to a sample space containing ordinary possible worlds and the other to a sample space containing centred possible worlds, because such spaces may fail to combine into one composite probability space and, as a consequence, ‘whenever’ may not be well defined; such is the main contribution of this article. 1The Sleeping Beauty Game2Groisman’s and Peter Lewis’s Approaches3Discussing Beauty’s Credences4The Principle of Equivalence's Failure5Making Sense of the Principle of Equivalence's Failure6Elga’s and Lewis’s Approaches7ConclusionAppendix. (shrink)

The concept of vulnerability is widely used in bioethics, particularly in research ethics and public health ethics. The traditional approach construes vulnerability as inherent in individuals or the groups to which they belong and views vulnerability as requiring special protections. Florencia Luna and other bioethicists continue to challenge traditional ways of conceptualizing and applying the term. Luna began proposing a layered approach to this concept and recently extended this proposal to offer two new concepts to analyze the concept of vulnerability, (...) namely understanding external conditions that trigger vulnerability and layers of vulnerability with cascading effects. Luna's conception of vulnerability is useful, which we demonstrate by applying her layered view and the new analyses in multiple contexts. We begin by outlining Luna's view and we use vignettes from healthcare involving transgender patients, the care of patients in psychiatric contexts, and research involving prisoners to illustrate how each part of Luna's concept elucidates important moral issues. (shrink)

Amidst broad debates about the “New Green Revolution” in Africa, input-intensive agriculture is on the rise in some parts of Africa. This paper examines the underlying drivers of the recent and rapid adoption of herbicides and genetically modified seeds in the Burkina Faso cotton sector. Drawing on 8 months of ethnographic fieldwork in the Houndé region, this article contends that economic and cultural dynamics—often considered separately in analyses of technology adoption—have co-produced a self-reinforcing technological treadmill. On the one hand, male (...) farmers seek to increase cotton production in response to an economic squeeze. At the same time, broader cultural shifts toward individualism have created labor shortages as a result of families splitting apart, parents putting their children in school, and some women and young men refusing to provide free labor. Male cotton farmers thus increase production by turning to labor-saving inputs like herbicides, but these inputs create more debt, further locking farmers into intensive production. This article thus expands on the classic concept of the technological treadmill, demonstrating how economic and cultural processes intersect within a process of agrarian change to drive labor-saving agricultural technology adoption in the Burkinabè cotton sector. This expanded treadmill concept illuminates the complex dynamics compelling farmers’ choices to opt into input-intensive agriculture, and also helps explain rising farmer differentiation, as poorer farmers struggle to stay afloat and wealthier farmers expand. (shrink)

Black Feminist Sociology offers new writings by established and emerging scholars working in a Black feminist tradition. The book centers Black feminist sociology within the sociology canon and widens is to feature Black feminist sociologists both outside the U.S. and the academy. Inspired by a BFS lens, the essays are critical, personal, political and oriented toward social justice. Key themes include the origins of Black feminist sociology, expositions of BFS orientations to research that extend disciplinary norms, and contradictions of the (...) pleasures and costs of such an approach both academically and personally. Authors explore their own sociological legacy of intellectual development to raise critical questions of intellectual thought and self-reflexivity. The book highlights the dynamism of BFS so future generations of scholars can expand upon and beyond the book's key themes. (shrink)

This paper challenges the traditional account of vulnerability in healthcare which conceptualizes vulnerability as a list of identifiable subpopulations. This list of ‘usual suspects’, focusing on groups from lower resource settings, is a narrow account of vulnerability. In this article we argue that in certain circumstances middle-class individuals can be also rendered vulnerable. We propose a relational and layered account of vulnerability and explore this concept using the case study of cord blood (CB) banking. In the first section, two different (...) approaches to ‘vulnerability’ are contrasted: categorical versus layered. In the second section, we describe CB banking and present a case study of CB banking in Argentina. We examine the types of pressure that middle-class pregnant women feel when considering CB collection and storage. In section three, we use the CB banking case study to critique the categorical approach to vulnerability: this model is unable to account for the ways in which these women are vulnerable. A layered account of vulnerability identifies several ways in which middle-class women are vulnerable. Finally, by utilizing the layered approach, this paper suggests how public health policies could be designed to overcome vulnerabilities. (shrink)

Traditional accounts of vulnerability tend to label entire populations as vulnerable. This approach is of limited utility. Instead, this article utilizes a layered approach to vulnerability, identifying multiple vulnerabilities that older people experience. It focuses on distinguishing the different layers of vulnerability that may be experienced by the elderly in middle-income countries of Latin America. In doing so, I show how the layered approach to vulnerability functions, and demonstrate why it is more interesting and useful than the traditional approach. The (...) article achieves three things. First, it unwraps the different potential layers of vulnerability that develop in old age and the multidimensionality aspects of aging. Second, it reestablishes the usefulness of the concept of vulnerability and explains its functioning. Finally, it shows how different policies can be designed in order to address each vulnerability layer. The layered account promotes a multifaceted approach to public policy analyses and design. In this sense, the layered concept of vulnerability is an appealing concept to consider in public health ethics. (shrink)

This target article considers the ethical implications of providing prenatal diagnosis (PND) and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe abortion (...) for these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms. (shrink)

Previous studies making use of indirect processing measures have shown that perceptual grouping can occur outside the focus of attention. However, no previous study has examined the possibility of subliminal processing of perceptual grouping. The present work steps forward in the study of perceptual organization, reporting direct evidence of subliminal processing of Gestalt patterns. In two masked priming experiments, Gestalt patterns grouped by proximity or similarity that induced either a horizontal or vertical global orientation of the stimuli were presented as (...) masked primes and followed by visible targets that could be congruent or incongruent with the orientation of the primes. The results showed a reliable priming effect in the complete absence of prime awareness for both proximity and similarity grouping principles. These findings suggest that a phenomenal report of the Gestalt pattern is not mandatory to observe an effect on the response based on the global properties of Gestalt stimuli. (shrink)

In this article, the authors focus on Argentina's activity in the developing field of regenerative medicine, specifically stem cell research. They take as a starting point a recent article by Shawn Harmon (published in this journal) who argues that attempts to regulate the practice in Argentina are morally incoherent. The authors try to show first, that there is no such ‘attempt to legislate’ on stem cell research in Argentina and this is due to a number of reasons that they explain. (...) Second, by examining the role played by different values, conflicting legal and moral views, and the influence of various actors, they attempt to show that the legislative silence regarding stem cell research may not necessarily be a manifestation of a legal/moral disconnection but rather a survival strategy for navigating the long and heated battle on the moral status of the embryo and the kind of treatment it deserves. (shrink)

Cantor’s proof that the powerset of the set of all natural numbers is uncountable yields a version of Richard’s paradox when restricted to the full definable universe, that is, to the universe containing all objects that can be defined not just in one formal language but by means of the full expressive power of natural language: this universe seems to be countable on one account and uncountable on another. We argue that the claim that definitional contexts impose restrictions on the (...) scope of quantifiers reveals a natural way out. (shrink)

Research on the U.S. women’s movement has documented the difficulties of cross-racial work between White women and women of racial/ethnic minorities. Less understood is how racial/ethnic minorities do cross-racial work among themselves to construct a collective identity of “women of color” that encourages solidarity across race, class, and other statuses. Drawing on research from the reproductive justice movement, I examine how women of color organizations that strive for intersectional praxis negotiate sameness and difference. I identify two different logics at work (...) within women of color organizations: the first relies on a presumption of “same difference” that emphasizes similar experiences of gender and race oppression; the second accords greater recognition to the “difference-in-sameness” that structures constituents’ lived experiences. While the former can reproduce precisely those forms of silencing and exclusion that women of color organizations seek to challenge, the second remains a ongoing process. The article concludes that women of color organizations must strive continuously to actively negotiate, rather than assume, commonality if they are to avoid reproducing various forms of marginalization and inequality. (shrink)

Non-communicable diseases are no longer largely limited to high-income countries and the elderly. The burden of non-communicable diseases is rising across all country income categories, in part because these diseases have been relatively overlooked on the global health agenda. Historically, communicable diseases have been prioritized in many countries as they were perceived to constitute the greatest disease burden, especially among vulnerable and poor populations, and strategies for prevention and treatment, which had been successful in high-income settings, were considered feasible and (...) often affordable in low-income settings. This prioritization has reduced the communicable diseases burden globally but has left non-communicable diseases largely neglected. A new approach is urgently needed to tackle non-communicable diseases. Based on an analysis of potential features which may have underlain the different approaches to non-communicable diseases and communicable diseases until now, including acuity of disease, potential for control or cure, cost, infectiousness, blaming of individuals and logistical barriers, little ethical or rational justification can be found to support continued neglect of non-communicable diseases. Justice demands access to quality and affordable care for all. An equitable approach to non-communicable diseases is therefore strongly mandated on medical, ethical, economic, and public health grounds. Funding must not however be diverted away from communicable diseases, which continue to require attention—but concomitantly, funding for non-communicable diseases must be increased. International and multi-sectoral action is required to accelerate progress towards true universal health coverage and towards achievement of all of the sustainable development goals, such that prevention and access to care for non-communicable disease can become a global reality. (shrink)

BackgroundInformed consent is a key element of ethical clinical research. Addicted population may be at risk for impaired consent capacity. However, very little research has focused on their comprehension of consent forms. The aim of this study is to assess the capacity of addicted individuals to provide consent to research.Methods53 subjects with DSM-5 diagnoses of a Substance Use Disorder and 50 non psychiatric comparison subjects participated in the survey from December 2014 to March 2015. This cross-sectional study was carried out (...) at a community-based Outpatient Treatment Center and at an urban-located Health Centre in Spain. A binary judgment of capacity/incapacity was made guided by the MacArthur Competence Assessment Tool for Clinical Research and a clinical interview. Demographics and clinical characteristics were assessed by cases notes and the Mini-Mental State Examination, the Global Assessment Functional Scale and the Clinical Global Impression Scale.ResultsNPCs performed the best on the MacCAT–CR, and patients with SUD had the worst performance, particularly on the Understanding and Appreciation subscales. 32.7 % SUD people lacked research-related decisional capacity. There were no statistically significant differences between the groups in terms of capacity to consent to research.ConclusionsThe findings of our study provide evidence that a large proportion of individuals with SUD had decisional capacity for consent to research. It is therefore inappropriate to draw conclusions about capacity to make research decisions on the basis of a SUD diagnosis. In the absence of advanced cognitive impairment, acute withdrawal or intoxication, we should assume that addicted persons possess decision-making capacity. Thus, the view that people with SUD would ipso facto lose decision-making power for research consent is flawed and stigmatizing. (shrink)

Este número de acceso abierto tiene como objetivo resaltar los puntos de vista de los países latinoamericanos sobre la justicia en un contexto de pandemia y contribuir al diálogo entre estos y con la comunidad científica global. Explora los desafíos globales de la pandemia de COVID-19, las diferencias relevantes entre las medidas de salud pública y su impacto en los países de ingresos altos versus los países de ingresos bajos o medios, y cómo la injusticia global se profundizó debido a (...) la pandemia de COVID-19. También llama la atención sobre las experiencias, los resultados y las respuestas del norte global a la pandemia con respecto a poblaciones vulnerables y trayectorias de exposición que se reproducen en América Latina. (shrink)

We use two logical resources, namely, the notion of recursively defined function and the Benardete-Yablo paradox, together with some inherent features of causality and time, as usually conceived, to derive two results: that no ungrounded causal chain exists and that time has a beginning.

This open-access issue aims to highlight views about justice in a pandemic context from Latin American countries and to contribute to the dialogue between them as well as with the global scientific community. It explores the global challenges of the COVID-19 pandemic, relevant differences between public health measures and their impact on high-income countries versus low- or middle-income countries, and how global injustice deepened because of the COVID-19 pandemic. It also draws attention to experiences, outcomes, and responses to the pandemic (...) from the global north regarding vulnerable populations and exposure paths that are also present in Latin America. (shrink)

This book presents some of the challenges bioethics in Latin America faces today. It considers them through the lenses of vulnerable populations, those incapable of protecting their own interests, such as the illiterate, women in societies disrespectful of their reproductive rights, and research subjects in contexts where resources are scarce.

ABSTRACT This paper focuses on poverty and inequality in the world today. First, it points out how this topic is a main concern for the IAB. Second, it proposes ‘new’ theoretical tools in order to analyze global justice and our obligations towards the needy. I present John Rawls's denial that the egalitarian principle can be applied to the global sphere, his proposed weak duty of assistance, and his consideration of endemic poverty as essentially homegrown. In opposition, I focus on Thomas (...) Pogge as representative of a cosmopolitan view who also holds a critical position towards the international systems which allow and cause poverty. I endorse the general normative proposal that defends every human being as an ultimate unit of moral concern, as well as the strategy of moving away from the charity model of bilateral aid to the realm of rights and duties. These ideas should redesign and broaden the normative and practical roles of institutions, and should also help provide a new approach on bioethical issues such as drug patenting or the imbalance in global research and neglected diseases. (shrink)

The structure of Yablo’s paradox is analysed and generalised in order to show that beginningless step-by-step determination processes can be used to provoke antinomies, more concretely, to make our logical and our on-tological intuitions clash. The flow of time and the flow of causality are usually conceived of as intimately intertwined, so that temporal causation is the very paradigm of a step-by-step determination process. As a conse-quence, the paradoxical nature of beginningless step-by-step determina-tion processes concerns time and causality as usually (...) conceived. (shrink)

This short article is a commentary to ‘Vulnerability in Research Ethics: A way forward’ from Margaret Meek Lange, Wendy Rogers and Susan Dodds. In their article they describe and accept my criticisms of the subpopulation approach to vulnerability and my analysis of vulnerability based on layers, but they suggest going beyond it using a taxonomy to classify layers of vulnerabilty. I argue that a) we do not need a taxonomy to classify vulnerabilities, b) the authors do not provide an adequate (...) or successful taxonomy, and c) they are unable to link their taxonomy to specific obligations. Thus I propose avoiding an approach that requires taxonomies, and suggest instead using some characteristics of layers of vulnerability. (shrink)

In this article I examine some proposals for modification of ethical documents regulating research, particularly, the problems that introducing certain economic clauses may pose. I evaluate suggestions that reject the notion of providing the ‘best proven diagnostic and therapeutic method’ in favor of ‘the highest attainable therapeutic method’ or ‘the proven effective prophylactic, diagnostic and therapeutic methods’. I analyze the plausibility and problems of introducing a double standard and the consequences it may have in developing countries. Finally I highlight the (...) impact these changes may imply for these countries. (shrink)

We model infinite regress structures — not arguments — by means of ungrounded recursively defined functions in order to show that no such structure can perform the task of providing determination to the items composing it, that is, that no determination process containing an infinite regress structure is successful.

The concept of vulnerability has been hotly debated in research ethics literature. Some critics considered it a useless concept. In 2009—against some of those criticisms—I defended the importance of understanding this concept in terms of layers instead of applying it as a label given to certain subpopulations. In this paper, I present some of the limits of this analysis and I also explore the similarities and differences this approach has when compared to using a taxonomy as another answer on how (...) to assess vulnerability. I present the notion of cascade vulnerability and underscore the dispositional character of layers and their relevance to identify and evaluate layers of vulnerability. Finally, I show how this layered account has been incorporated in important documents such as the new 2016 CIOMS-WHO Guidelines. (shrink)

Following an idea from Gödel and Carnap we show how we can speak with absolute generality even if we cannot quantify with absolute generality.

In response to Bhupinder Singh Anand''s article CAN WE REALLY FALSIFY TRUTH BY DICTAT? in THE REASONER II, 1, January 2008,that denies the existence of nonstandard models of Peano Arithmetic, we prove from Compactness the existence of such models.

This volume deals with the rapports among the extant Greek commentaries on Aristotle's _Metaphysics_: Alexander of Aphrodisias, Syrianus, Asclepius, Ps. Alexander. It traces the precise map of these texts and provides a starting point for any future research in the field.

Despite "progressive" legislative changes concerning the LGBT collective and assisted reproductive technologies (ARTs) in Argentina, women and their sexual and reproductive rights have been overlooked. This article presents a critical perspective of some of these legislative modifications in the country. It addresses why some legislators and society are prepared to challenge a conservative or traditional approach for certain groups while ignoring others. Several factors are at play. There is no all-inclusive explanation. I stress that a striking double standard prevails in (...) Argentina with respect to women and their sexual and reproductive rights. I also contend that powerful discrimination exists, in particular against poor women, who continue to suffer and are "punished" by the criminalization of abortion. (shrink)

In this article I focus on two issues concerning bioethics in Argentina: reproductive health and ethics in research. Although these topics are quite dissimilar, they share a particular feature: their special relationship with context.

Throughout this essay, I will consider an argument frequently used to justify paternalistic behavior toward a specific class of persons: illiterate people. The argument states that illiterate people are uneducated, lack information and understanding, and are thus unable to make decisions. Therefore, it is argued, paternalism in their case is justified. The conclusion is that illiterate persons cannot be autonomous. The justification for this view is based on an a priori attitude: since it is impossible to communicate, physicians should decide (...) which kind of treatment the illiterate patient should receive. This argument is frequently used even though its proponents may not be aware of its implications. Given the importance and uncritical acceptance this argument has in Argentina, and also in other Latin American countries, I think it is relevant to analyze carefully what it means. I propose a thorough analysis of this argument, of its implications and an evaluation of whether it is acceptable. (shrink)

Throughout this essay, I will consider an argument frequently used to justify paternalistic behavior toward a specific class of persons: illiterate people. The argument states that illiterate people are uneducated, lack information and understanding, and are thus unable to make decisions. Therefore, it is argued, paternalism in their case is justified. The conclusion is that illiterate persons cannot be autonomous. The justification for this view is based on an a priori attitude: since it is impossible to communicate, physicians should decide (...) which kind of treatment the illiterate patient should receive. This argument is frequently used even though its proponents may not be aware of its implications. Given the importance and uncritical acceptance this argument has in Argentina, and also in other Latin American countries, I think it is relevant to analyze carefully what it means. I propose a thorough analysis of this argument, of its implications and an evaluation of whether it is acceptable. (shrink)

This article addresses the dilemma facing an editor when he or she has to decide whether or not to publish a manuscript that describes unethical research. I will explore three options the editor may follow: a) publish the unethical research; b) publish it with an explicit condemnation of the methods used; c) reject the article on moral grounds. I will consider the importance of deterring unethical research, why the deterrence argument has been overlooked and the relevance it has in developing (...) countries which seem to be more exposed to morally tainted experiments. I will suggest a combined policy. For cases in which the ethical problems are serious — where basic human rights are not respected, where consent has been given without complete or proper information or voluntary participation by subjects, or where deceit has been practised — I would support the strong policy of rejecting the article on moral grounds. For dubious cases, where the risk assessment can be doubted or where there are suspicions of ethical problems, I argue for a policy under which the article is published along with a serious discussion of the ethical problems suspected, allowing a rebuttal by the authors. In this way, while maintaining a strong deterrent policy, we recognize that sometimes it is not so clear if a research project was unethical, and only in such cases (where the ethical problems are dubious), the article may be published with an editorial. (shrink)

OBJECTIVES: To analyse the attitudes of medical personnel towards terminally ill patients and their right to be fully informed. DESIGN: Self-administered questionnaire composed of 56 closed questions. SETTING: Three general hospitals and eleven health centres in Granada (Spain). The sample comprised 168 doctors and 207 nurses. RESULTS: A high percentage of medical personnel (24.1%) do not think that informing the terminally ill would help them face their illness with greater serenity. Eighty-four per cent think the patient's own home is the (...) best place to die: 8.9% of the subjects questioned state that the would not like to be informed of an incurable illness. CONCLUSION: In our opinion any information given should depend on the patient's personality, the stage of the illness and family circumstances. Our study confirms that a hospital is not the ideal environment for attending to the needs of the terminally ill and their families. (shrink)

Poincaré in a 1909 lecture in Göttingen proposed a solution to the apparent incompatibility of two results as viewed from a definitionist perspective: on the one hand, Richard’s proof that the definitions of real numbers form a countable set and, on the other, Cantor’s proof that the real numbers make up an uncountable class. Poincaré argues that, Richard’s result notwithstanding, there is no enumeration of all definable real numbers. We apply previous research by Luna and Taylor on Richard’s paradox, indefinite (...) extensibility and unrestricted quantification to evaluate Poincaré’s proposal. We emphasize that Poincaré’s solution involves an early recourse to indefinite extensibility and argue that his proposal, if it is to completely avoid Richard’s paradox, requires rejecting absolutely unrestricted quantification: Richard’s paradox provides a context in which paradox seems inescapable if unrestricted quantification is possible. In proposing his solution to the apparent conflict between Richard’s and Cantor’s results, Poincaré employs temporal expressions whose exact meaning he does not clarify. We suggest an interpretation of these expressions in terms of order of availability and briefly discuss its explanatory power in topics like paradoxes, limitation theorems and indefinite extensibility. (shrink)

The Monist’s call for papers for this issue ended: “if formalism is true, then it must be possible in principle to mechanize meaning in a conscious thinking and language-using machine; if intentionalism is true, no such project is intelligible”. We use the Grelling-Nelson paradox to show that natural language is indefinitely extensible, which has two important consequences: it cannot be formalized and model theoretic semantics, standard for formal languages, is not suitable for it. We also point out that object-object mapping (...) theories of semantics, the usual account for the possibility of non intentional semantics, doesn’t seem able to account for the indefinitely extensible productivity of natural language. (shrink)

Computationalism is the claim that all possible thoughts are computations, i.e. executions of algorithms. The aim of the paper is to show that if intentionality is semantically clear, in a way defined in the paper, then computationalism must be false. Using a convenient version of the phenomenological relation of intentionality and a diagonalization device inspired by Thomson's theorem of 1962, we show there exists a thought that canno be a computation.

This article examines the problems that research ethics confronts in developing countries and the impact that research in developing countries has had on research ethics. In order to show this it analyzes the first paradigmatic cases that gave rise to the ‘classic’ analysis of research ethics. Hence, in this article, many of the ethical concerns apply wherever research is conducted and are not particular to developing countries. Secondly, the article describes the complex process of research by analyzing different research actors (...) and their interests in the current research process. Thirdly, it sketches some of the recent cases that have prompted fierce ethical debate surrounding research in developing countries. (shrink)

We develop an argument sketched by Luna (2011) based on the Pinocchio paradox, which was proposed by Eldridge-Smith and Eldridge- Smith (2010). We show that, upon plausible assumptions, the claim that mental states supervene on bodily states leads to the conclusion that some proposition is both paradoxical and not paradoxical. In order to show how the presence of paradoxes can be harnessed for philosophical argumentation, we present as well a couple of related arguments.

We model infinite regress structures -not arguments- by means of ungrounded recursively defined functions in order to show that no such structure can perform the task of providing determination to the items composing it, that is, that no determination process containing an infinite regress structure is successful.

Background: Sharing information with relatives of elderly patients in primary care and in hospital has to fit into the complex set of obligations, justifications and pressures concerning the provision of information, and the results of some studies point to the need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day-to-day care of older people.Objectives: To know the frequency with which “capable” patients over 65 years of age receive information when admitted to hospital, the (...) information offered to the families concerned, the person who gives consent for medical intervention, and the degree of satisfaction with the information received and the healthcare provided.Method: A descriptive questionnaire given to 200 patients and 200 relatives during the patients’ stay in hospital.Results: Only 5% of patients confirmed that they had been asked whether information could be given to their relatives. A significantly higher proportion of relatives received information on the successive stages of the care offered than did patients themselves. As the age of the patients increased, so the number who were given information, understood the information and were asked for their consent for complementary tests decreased. The degree of satisfaction with the information offered was high for both patients and relatives , despite the irregularities observed.Conclusions: The capacity of elderly patients to participate in the decision-making process is frequently doubted simply because they have reached a certain age and it is thought that relatives should act as their representatives. In Spain, the opinion of the family and doctors appears to play a larger role in making decisions than does the concept of patient autonomy. (shrink)