John McMillan's article raises numerous important points about the ethics of surgical castration of sex offenders.1 In this commentary, we focus solely on and argue against the claim that the offer of release from detention conditional upon surgical castration is a coercive offer that compromises the validity of the offender's consent. We take no view on the question as to whether castration for sex offenders is ethically permissible. But, we reject the claim that it is ethically permissible only if competing (...) ethical considerations outweigh worries about coercion. For in the situation described, the proposal is not coercive at all.McMillan states that if offenders agree to castration because they fear long-term detention, then ‘it seems, intuitively, as if agreeing to be castrated under these conditions makes the decision coerced in some way.’1 He adds that if castration is ‘the only way that they will be released back into the community, the status of this decision as a genuine expression of their autonomy is questionable.’1 In defence of his claim, he uses two analogies that he borrows from Joel Feinberg. First, if a governor offers to commute a death sentence if the prisoner agrees to participate in a medical experiment, then ‘it's clear that the governor is coercing the prisoner.’1 Second, if a millionaire offers to give a woman $1 000 000 …. (shrink)

Intended as an introduction to ethics, this book examines four main problems: obligation, moral value, intrinsic goods and the justification of moral judgments. Frankena's approach to each problem is to examine critically the main types of theory and then develop his own position. Of particular interest is his discussion of the meaning and justification of moral judgments; while joining recent English thought in holding that a non-descriptivist position does not imply the impossibility of sensible discussion of normative problems, Frankena suggests (...) that this need not necessitate even an ultimate relativism, since broad standards of rationality may be applied in cases of conflict. By approaching ethics through types of ethical theory rather than concrete examples, and because of the great variety of subjects discussed within this brief compass, a necessary over-simplification and superficiality results which may inhibit the beginning student from developing his own thinking. A more selective approach might have been both less confusing and more stimulating.--A. F. G. (shrink)

Risk–benefit assessment is a routine requirement for research ethics committees that review and oversee biomedical research with human subjects. Nevertheless, it remains unclear how to weigh and balance risks to research participants against the social benefits that flow from generating biomedical knowledge. In this article, we address the question of whether there are any reasonable criteria for defining the limit of permissible risks to individuals who provide informed consent for research participation. We argue against any a priori limit to permissible (...) research risks. However, attention to the uncertainty of potential social benefit that can be derived from any particular study warrants caution in exposing prospective research participants to a substantial likelihood of serious harm. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

IntroductionTourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered.Methods and ResultsWe discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a tic reduction of (...) more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects.DiscussionSpecific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication.ConclusionClinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

Data taken by the Mark II detector at the PEP storage ring was used to measure the rate of dilepton production in multihadronic events produced by e+e- annihilation at √s=29 GeV. We determine the probability that a hadron initially containing a b quark decays to a positive lepton to be 0.17-0.08+0.15, with 90% confidence level limits of 0.06 and 0.38. © 1990.

The Phenomenology of Spirit was Hegel's grandest experiment, changing our vision of the world and the very nature of philosophical enterprise. In this book, Solomon captures the bold and exhilarating spirit, presenting the Phenomenology as a thoroughly personal as well as philosophical work. He begins with a historical introduction, which lays the groundwork for a section-by-section analysis of the Phenomenology. Both the initiated and readers unacquainted with the intricacies of German idealism will find this to be an accessible and exciting (...) introduction to this great philosopher's monumental work. (shrink)

Using twelve modern philosophers as moments in a rather contrived dialectic, Kiley examines man's relation to himself and to the world. While showing the many "possibilities of human existence," he suggests that "human completion" can only be achieved through the religious experience.—A. F. G.

This collection of Kant's writings on the philosophy of history includes, besides the well-known "What is Enlightenment?" and "Perpetual Peace," several other essays from his critical period. Most are newly translated. Together they give a reasonably complete picture of Kant's views on history, which he never presented in systematic form. The result is valuable in showing how widely Kant applied some of the central principles of the Critiques, as well as the close relationship of his ideas to other Enlightenment thinkers. (...) The editor provides a useful introduction.--A. F. G. (shrink)

Five essays concerned primarily with Dewey's philosophy of education and its influence. Taking up half of the volume is Williams Brickman's thoroughly documented study of the rise and decline of Dewey's sympathies with the Soviet Union and the varying treatment his educational theories received there. George Axtelle surveys Dewey's philosophy, which he sees as expressing "the genius of American civilization" and showing directions for its future development. Dewey's reliance on the "civilizational functions" of education as the major tool for developing (...) a sound democratic society is emphasized by John Childs. Brief essays on Dewey's influence on American educators and an early proposal to teach psychology in high school fill out the collection.—A. F. G. (shrink)

This volume contains the Dialogues, The Natural History of Religion, and several short essays and selections from other works. The selection is a good one, but the editor's introduction does little to explicate the principles upon which Hume's writings on religion are based or to connect them with his other philosophical work.—A. F. G.

Friedman characterizes modern man as alienated and problematic, an exile and a rebel. The Modern Promethean and the Modern Job are the typical responses to this situation. These categories are central to Friedman's "depth-image" of modern man and he attempts to give them concrete meaning through intensive examination of the writings of Melville, Dostoievsky, Kafka and Camus. The analysis tends to be repetitious and often too detailed to have clear relevance to the author's main theme.—A. F. G.

This study centers on Hume's discussion of the relation of reason and the passions in Book III, Part I, section I of the Treatise and related passages. Hume's central arguments are carefully laid out and are found to rest on unwarranted premisses. Making use of the distinctions suggested by Baier, Ryle, and other modern writers, Broiles questions Hume's thesis that reason plays no direct role in ethics, and further suggests that a failure to distinguish explanatory or exciting reasons from justifying (...) reasons leads Hume to an incorrect conception of the nature of motives. Hume's relation to the earlier British moralists is also treated, and the famous "is-ought" passage is given a fresh interpretation.—A. F. G. (shrink)

This collection of Kant's writings on the philosophy of history includes, besides the well-known "What is Enlightenment?" and "Perpetual Peace," several other essays from his critical period. Most are newly translated. Together they give a reasonably complete picture of Kant's views on history, which he never presented in systematic form. The result is valuable in showing how widely Kant applied some of the central principles of the Critiques, as well as the close relationship of his ideas to other Enlightenment thinkers. (...) The editor provides a useful introduction.--A. F. G. (shrink)

This volume contains the Dialogues, The Natural History of Religion, and several short essays and selections from other works. The selection is a good one, but the editor's introduction does little to explicate the principles upon which Hume's writings on religion are based or to connect them with his other philosophical work.—A. F. G.

This volume forms a part of the Great American Thinkers Series and is intended for the general reader. It is largely devoted to a highly readable biography of Jefferson in which main emphasis is placed on his political activities and ideas, and their influence upon the development of the United States. A separate essay at the end gives the outlines of Jefferson's thought, relating it to the contemporary ideas of the enlightenment, and tracing its sources to those thinkers whom Jefferson (...) most admired, Bacon, Newton, Locke, and Epicurus. In discussing these figures, the author exhibits an unfortunate tendency towards facile and occasionally incorrect generalizations.—A. F. G. (shrink)

Cassirer rejects Burckhardt's thesis that there is a radical separation between the theory and practice of the Renaissance, and that Renaissance philosophy is merely a survival of the Middle Ages, containing none of the new tendencies of the period. Nor does he see a sharp break between Renaissance and medieval thought. Instead, Cassirer traces the "close interplay between religion, philosophy, and humanism" in Renaissance thought, and the gradual emergence of a new view of man. Underlying the astonishing variety of philosophies (...) in this period, he uncovers certain common tendencies. Starting with Cusanus, the key transition figure in the shift from medieval patterns of thought, Cassirer traces the rise of new conceptions of knowledge, science, freedom and humanity.--A. F. G. (shrink)

Objective: To evaluate feasibility of the guidelines of the Groupe Francophone de Réanimation et Urgence Pédiatriques for limitation of treatments in the paediatric intensive care unit .Design: A 2-year prospective survey.Setting: A 12-bed PICU at the Hôpital Jeanne de Flandre, Lille, France.Patients: Were included when limitation of treatments was expected.Results: Of 967 children admitted, 55 were included with a 2-day median delay. They were younger than others , had a higher paediatric risk of mortality score , and a higher paediatric (...) overall performance category score at admission ; all p<0.002. 34 children died. A limitation decision was made without meeting for 7 children who died: 6 received do-not-resuscitate orders and 1 received withholding decision. Decision-making meetings were organised for 31 children, and the following decisions were made: 12 DNROs , 4 withholding , with 14 withdrawing and 1 continuing treatment . After limitation, 21 children died and 10 survived . 13 procedures were interrupted because of death and 11 because of clinical improvement . Parents’ opinions were obtained after 4 family conferences , 3 days after inclusion. The first meeting was planned for 6 days after inclusion and held on the 7th day after inclusion; 80% of parents were immediately informed of the decision, which was implemented after half a day.Conclusions: GFRUPs procedure was applicable in most cases. The main difficulties were anticipating the correct date for the meeting and involving nurses in the procedure. Children for whom the procedure was interrupted because of clinical improvement and who survived in poor condition without a formal decision pointed out the need for medical criteria for questioning, which should systematically lead to a formal decision-making process. (shrink)

The Phenomenology of Spirit was Hegel's grandest experiement, changing our vision of the world and the very nature of philosophical enterprise. In this book, Solomon captures the bold and exhilarating spirit, presenting the Phenomenology as a thoroughly personal as well as philosophical work. He begins with a historical introduction, which lays the groundwork for a section-by-section analysis of the Phenomenology. Both the initiated as well as readers unacquainted with the intricacies of German idealism will find this to be an accessible (...) and exciting introduction to this great philosopher's monumental work. (shrink)

IntroductionTourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered.Methods and ResultsWe discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a tic reduction of (...) more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects.DiscussionSpecific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication.ConclusionClinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

Objective To assess parental permission for a neonate's research participation using the MacArthur competence assessment tool for clinical research (MacCAT-CR), specifically testing the components of understanding, appreciation, reasoning and choice. Study Design Quantitative interviews using study-specific MacCAT-CR tools. Hypothesis Parents of critically ill newborns would produce comparable MacCAT-CR scores to healthy adult controls despite the emotional stress of an infant with critical heart disease or the urgency of surgery. Parents of infants diagnosed prenatally would have higher MacCAT-CR scores than parents (...) of infants diagnosed postnatally. There would be no difference in MacCAT-CR scores between parents with respect to gender or whether they did or did not permit research participation. Participants Parents of neonates undergoing cardiac surgery who had made decisions about research participation before their neonate's surgery. Methods The MacCAT-CR. Results 35 parents (18 mothers; 17 fathers) of 24 neonates completed 55 interviews for one or more of three studies. Total scores: magnetic resonance imaging (mean 36.6, SD 7.71), genetics (mean 38.8, SD 3.44), heart rate variability (mean 37.7, SD 3.30). Parents generally scored higher than published subject populations and were comparable to published control populations with some exceptions. Conclusions The MacCAT-CR can be used to assess parental permission for neonatal research participation. Despite the stress of a critically ill neonate requiring surgery, parents were able to understand study-specific information and make informed decisions to permit their neonate's participation. (shrink)

We use data from the Mark II experiment at PEP to search for the process B→h0X for mh0 between 50 and 210 MeV/c2. No evidence for the Higgs boson is seen in this mass range. The limit obtained rules out the standard Higgs boson for masses between 70 and 210 MeV/c2 and significantly constrains extensions of the Higgs sector. © 1989.