The first book to be devoted to the logic behind the application of ethical theories, this collection of essays explores the question of how many different moral traditions (utilitarianism, natural rights theory, Marxism, Christian moral theology, and Kantianism among others) view the relation between theory and concrete judgments. By considering many applications of moral theory in medical ethics the authors illustrate their point.

In recent years, bioethics has increasingly become an international area of inquiry with major contributions being made not only in North America but also in Europe and in the Pacific Rim countries. This general observation is particularly true for research ethics. Little attention has been paid, however, to this internationalization of bioethics in general and research ethics in particular, and there are few studies comparing what has emerged in the different countries.

Restraint as an intervention in the management of acute mental distress has a long history that predates the existence of psychiatry. However, it remains a source of controversy with an ongoing debate as to its role. This article critically explores what to date has seemingly been only implicit in the debate surrounding the role of restraint: how should the concept of validity be interpreted when applied to restraint as an intervention? The practice of restraint in mental health is critically examined (...) using two post-positivist constructions of validity, the pragmatic and the psychopolitical, by means of a critical examination of the literature. The current literature provides only weak support for the pragmatic validity of restraint as an intervention and no support to date for its psychopolitical validity. Judgements regarding the validity of any intervention that is coercive must include reference to the psychopolitical dimensions of both practice and policy. (shrink)

The focus of this paper is the syntax of inverse scope in Hungarian, a language that largely disambiguates quantifier scope at spell-out. Inverse scope is attributed to alternate orderings of potentially large chunks of structure, but with appeal to base-generation, as opposed to nonfeature-driven movement as in Kayne 1998. The proposal is developed within mirror theory and conforms to the assumption that structures are antisymmetrical. The paper also develops a matching notion of scope in terms of featural domination, as opposed (...) to c-command, and applies it to otherwise problematic cases of pied piping. Finally, the interaction of different quantifier types is examined and the patterns are explained invoking morphological considerations on one hand and A-bar reconstruction on the other. (shrink)

Among those who criticize the concept of a common refrain is that we really have no idea what futility means. For example, physicians seem to disagree on whether a treatment being futile means that it has a less than 5% chance of working or a 20% chance of working. If the concept is so unclear, then it seems a thin reed upon which to base a momentous ethical decision—namely, that the physician's judgment should be allowed to override the wishes of (...) the competent patient or the patient's duly appointed surrogate. (shrink)

Research on ethical issues within food systems is often human-centric. As a consequence, animal-centric policy debates where regulatory decisions about food are being made tend to be overlooked by food scholars and activists. This absence was notable in the recent debates around Australia’s animal live export industry. Using Foucault’s tools, we explore how ‘food security’ is conceptualised and governed within animal cruelty policy debates about the live export trade. The problem of food security produced in these debates shaped Indonesians as (...) ‘victims’ of food insecurity due to the nation’s inability to produce sufficient quantities of protein. This understanding of the problem reproduced the dominant framing of food security as a problem for developing countries addressed by increasing global food production. The underlying premise uncritically accepted in Australia’s debates on live export trade was that intensive animal agriculture, and Australia’s live export trade specifically, were essential to alleviating global food insecurity. Drawing on our findings, we show how dominant representations of ‘food security’, and related regulatory and technological trajectories, flourish where alliances between animal and food activists, scholarship, and movements are weak. Accordingly, we argue for agri-food scholars to take up opportunities to contribute to the policy discussions about the treatment of animals to effectively expand the kinds of problems, solutions, and strategies of resistance produced in the discourses surrounding food system issues. (shrink)

All treatments, even those labeled as supportive, have burdens as well as benefits. Patients and their surrogates have the right to finally decide whether the offered treatment's cost-benefit calculation is acceptable.

An individual's health, genetic, or environmental-exposure data, placed in an online repository, creates a valuable shared resource that can accelerate biomedical research and even open opportunities for crowd-sourcing discoveries by members of the public. But these data become “immortalized” in ways that may create lasting risk as well as benefit. Once shared on the Internet, the data are difficult or impossible to redact, and identities may be revealed by a process called data linkage, in which online data sets are matched (...) to each other. Reidentification, the process of associating an individual's name with data that were considered deidentified, poses risks such as insurance or employment discrimination, social stigma, and breach of the promises often made in informed-consent documents. At the same time, re-ID poses risks to researchers and indeed to the future of science, should re-ID end up undermining the trust and participation of potential research participants. The ethical challenges of online data sharing are heightened as so-called big data becomes an increasingly important research tool and driver of new research structures. Big data is shifting research to include large numbers of researchers and institutions as well as large numbers of participants providing diverse types of data, so the participants’ consent relationship is no longer with a person or even a research institution. In addition, consent is further transformed because big data analysis often begins with descriptive inquiry and generation of a hypothesis, and the research questions cannot be clearly defined at the outset and may be unforeseeable over the long term. In this article, we consider how expanded data sharing poses new challenges, illustrated by genomics and the transition to new models of consent. We draw on the experiences of participants in an open data platform—the Personal Genome Project—to allow study participants to contribute their voices to inform ethical consent practices and protocol reviews for big-data research. (shrink)

The human labor and animal inputs required to manufacture meat products are kept physically and symbolically distanced from the consumer. Recently however, meatpacking plants received significant news media attention when they emerged as hotpots for COVID-19 — threatening workers’ health, requiring plants to slow production, and forcing farmers to euthanize livestock. In light of these disruptions, this research asks: how did news media frame the impact of COVID-19 on the meat industry, and to what extent is a process of _defetishization_ (...) observed? Examining a sample of 230 news articles from coverage of US meatpacking plants and COVID-19 in 2020, I find that news media largely attributes the cause for the spread of COVID-19 in meatpacking plants to the history of exploitative working conditions and business practices of the meat industry. By contrast, the solutions offered to address these problems aim at alleviating the immediate obstacles posed by the pandemic and returning to, rather than challenging, the status quo. These short-run solutions for complex issues demonstrate the constraints in imagining alternatives to a problem rooted in capitalism. Furthermore, my analysis shows that animals are only made visible in the production process when their bodies become a waste product. (shrink)

The Patient Self Determination Act of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient’s preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity. In general, patients are presumed to have DMC. A patient’s DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. (...) Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders. (shrink)

In this paper, I defend the view that the identity of indiscernibles could serve as an adequate basis for a general theory of identity. I then show how a theory of essentialism forces one to modify that general theory. In light of both the original and modified theory, I offer a new resolution of some of the classical and contemporary problems of personal identity.

Tversky and Koehler's support theory attempts to explain why probability judgments are affected by the manner in which formally similar events are described. Support theory suggests that as the explicitness of a description increases, an event will be judged to be more likely. In the present experiment, experienced decision-makers from large, international accounting firms were given case-specific information about an audit client and asked to provide a series of judgments regarding the perceived likelihood of events. Unpacking a hypothesis into four (...) formally equivalent hypotheses more than doubled its perceived likelihood. These results are largely consistent with support theory, extending its generalizability to applied contexts involving business professionals. Further, the paper finds that task-specific factors, a previously untested area, can also affect support theory interpretations. (shrink)

I am grateful to Drs. Richard Bukata and Jerome Hoffman and the staff of Primary Care Medicals for retrieving and analyzing some of the references used in this paper.

A social study of "An essay concerning human understanding." Includes bibliographical references and index.

For many years the damages available to an employee in a wrongful dismissal action have been somewhat limited. A conservative approach to the question of measure of damages has prevailed and the recoverable heads of damage have been restricted. In particular, damages for injury to feelings and reputation have not been available. The House of Lords decision in Malik v BCCI [1998] AC 20, where the plaintiffs were held to be entitled to compensation for the damage the dismissals caused to (...) future employment prospects, has resulted in a significant change in the law. The decision in Malik comes at a time when the law of the employment contract is undergoing significant change. Perhaps the most notable instance of this has been the emergence of the implied obligation of mutual trust and confidence; that obligation being central to the plaintiffs case in Malik. Against that background this article considers whether further reform of the damages available in a wrongful dismissal action might usefully take place. It is argued that, for reasons of public policy, the law should aim to compensate fully an employee who has been wrongfully dismissed. This would involve a radical re-thinking on the approach to measure of damages. It would also require a change in the position on compensation for injury to feelings. (shrink)

Last night I dived my beggar armDays deep in her breast that wore no heartFor me alone but only a rocked drumTelling the heart I broke of a good habitThat her loving, unfriendly limbsWould plunge my betrayal from sheet to skySo the betrayed might learn in the sun beamsOf the death in a bed in another country.1This poem, as far as I have been able to determine, has never been the object of any published critical commentary. The only help that (...) I have had in my reading of it has come from groups of students to whom I have regularly assigned it as a midterm paper, largely because I knew in advance that they would have to confront it entirely on their own. My interest in this text stems from its unique status as a poem.. (shrink)

BACKGROUND: Many published accounts of clinical trials report no differences between the treatment arms, while being underpowered to find differences. This study determined how the authors of these reports interpreted their findings. STUDY DESIGN: We examined 54 reports of surgical trials chosen randomly from a database of 110 influential trials conducted in 2008. Seven that reported having adequate statistical power were excluded from further analysis, as were the 32 that reported significant differences between the treatment arms. We examined the remaining (...) 15 to see whether the authors interpreted their negative findings appropriately. Appropriate interpretations discussed the lack of power and/or called for larger studies. RESULTS: Three of the 7 trials that did not report an a priori power calculation offered inappropriate interpretations, as did 3 of the 8 trials that reported an a priori power < 0.90. However, we examined only a modest number of trial reports from 1 year. CONCLUSIONS: Negative findings in underpowered trials were often interpreted as showing the equivalence of the treatment arms with no discussion of the issue of being underpowered. This may lead clinicians to accept new treatments that have not been validated. (shrink)

It has been argued that neither the biological or the moral justifications commonly given for adoption of brain-death criteria are adequate; and that the only argument that succeeds is an ontological justification based on the fact that one's personal identity terminates with the death of one's brain. But a more satisfactory ontological approach analyzes brain death in terms of the existence of a person in connection with a body, not personal identity. The personal-existence justification does not supplant the usual biological (...) and moral arguments, but acts in concert with them. (shrink)

In 1979, James S. and Jean M. Goodwin and Albert V. Vogel published the first of what became a series of articles that studied current patterns of placebo use. They surveyed 60 house officers and 37 nurses in a New Mexico teaching hospital. Only five of the 1900 patients hospitalized during the study period had received a placebo. Their subjects underestimated the pain relief provided by placebos and believed that a positive placebo response showed that the pain was psychogenic and (...) not “real.” The few patients who were prescribed placebos tended to be those whom the staff most disliked. A few other studies published during the 1980s showed similar results.Fast forward now to 2010.... (shrink)

This scarce antiquarian book is a facsimile reprint of the original. Due to its age, it may contain imperfections such as marks, notations, marginalia and flawed pages. Because we believe this work is culturally important, we have made it available as part of our commitment for protecting, preserving, and promoting the world's literature in affordable, high quality, modern editions that are true to the original work.

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)

Baruch Brody contends that the fundamental assumption on which the tradition is based is erroneous and that once this assumption is shown to be in error, all philosophical problems in this area have to be rethought. Originally published in 1980. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and (...) hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

Smith, Glass, and Miller have reported a meta-analysis of over 500 studies comparing some form of psychological therapy with a control condition. They report that when averaged over all dependent measures of outcome, psychological therapy is. 85 standard deviations better than the control treatment. We examined the subset of studies included in the Smith et al. metaanalysis that contained a psychotherapy and a placebo treatment. The median of the mean effect sizes for these 32 studies was. 15. There was a (...) nonsignificant inverse relationship between mean outcome and the following: sample size, duration of therapy, use of measures of outcome other than undisguised self-report, measurement of outcome at follow-up, and use of real patients rather than subjects solicited for the purposes of participation in a research study. A qualitative analysis of the studies in terms of the type of patient involved indicates that those using psychiatric outpatients had essentially zero effect sizes and that none using psychiatric inpaticnts provide convincing evidence for psychotherapeutic effectiveness. The onty studies clearly demonstrating significant effects of psychotherapy were the ones that did not use real patients. For the most part, these studies involved small samples of subjects and brief treatments, occasionally described in quasibeliavioristic language. It was concluded that for real patients there is no evidence that the benefits of psychotherapy are greater than those of placebo treatment. (shrink)

Cosmetic surgery is a fast-growing medical practice. In 1997 surgeons in the United States performed the four most common cosmetic procedures443,728 times, an increase of 150% over the comparable total for 1992. Estimated total expenditures for cosmetic surgery range from $1 to $2 billion. As managed care cuts into physicians' income and autonomy, cosmetic surgery, which is not covered by health insurance, offers a financially attractive medical specialty.