Quality improvement (QI) is fundamental to maintaining high standards of health care. Significant debate exists concerning the necessity for an ethical approval system for those QI projects that push the boundaries, appearing more similar to research than QI. The authors discuss this issue identifying the core ethical issues in family medicine (FM), drawing upon the fundamental principles of medical ethics, including principles of autonomy, utility, justice and non-maleficence. Recent debate concerning the application of QI ethics boards is discussed with relevance (...) to primary care and issues such as general practitioner (GP) intentions, the impact of QI on patients and the use of confidential patient data and the impact of dissemination. The authors conclude that a system of QI ethical approval leaves many issues unresolved and potentially creates several barriers to implementing QI. To ensure ethical QI work is generated within FM it is essential for GPs to learn about and engage in more ethical reflection so that they can better judge and resolve these issues. (shrink)

This paper has three main aims. The first is to provide a critical assessment of two rival concepts of suffering, that proposed by Cassell and that proposed in this journal by van Hooft. The second aim of the paper is to sketch a more plausible concept of suffering, one which derives from a Wittgensteinian view of linguistic meaning. This more plausible concept is labeled an ‘intuitive concept’. The third aim is to assess the prospects for scientific understanding of suffering.

This paper aims to show that Sartre’s later work represents a valuable resource for feminist scholarship that remains relatively untapped. It analyses Sartre’s discussions of women’s attitude towards their situation from the 1940s, 1960s, and 1970s, alongside Beauvoir’s account of women’s situation in The Second Sex, to trace the development of Sartre’s thought on the structure of gendered experience. It argues that Sartre transitions from reducing psychological oppression to self-deception in Being and Nothingness to construing women as ‘survivors’ of it (...) in The Family Idiot. Then, it underlines the potential for Sartre’s mature existentialism to contribute to current debates in feminist philosophy by illuminating the role of the imagination in women’s psychological oppression. (shrink)

Jansen and Wall suggest a new way of defending hard paternalism in clinical research. They argue that non-therapeutic research exposing people to more than minimal risk should be banned on egalitarian grounds: in preventing poor decision-makers from making bad decisions, we will promote equality of welfare. We argue that their proposal is flawed for four reasons.First, the idea of poor decision-makers is much more problematic than Jansen and Wall allow. Second, pace Jansen and Wall, it may be practicable for regulators (...) to uncover the values that a potential research participant holds when agreeing to enter a research project, so their claim that we must ban such research projects for all if we are to ban them for poor decision-makers looks to be unmotivated. Third, there seem to be cases where the liberty to enter the sort of research project Jansen and Wall discuss is morally weighty, and arguably should outweigh concerns of egalitarian distribution. Fourth, banning certain types of research, which seem on the face of it to offer an unfavourable risk-benefit ratio, would have unwelcome consequences for all clinical research, which Jansen and Wall do not recognize. (shrink)

Psychology has benefited from an enormous wealth of knowledge about processes of cognition in relation to how the brain organizes information. Within the categorization literature, this behavior is often explained through theories of memory construction called exemplar theory and prototype theory which are typically based on similarity or rule functions as explanations of how categories emerge. Although these theories work well at modeling highly controlled stimuli in laboratory settings, they often perform less well outside of these settings, such as explaining (...) the emergence of background knowledge processes. In order to explain background knowledge, we present a non-similarity-based post-Skinnerian theory of human language called Relational Frame Theory which is rooted in a philosophical world view called functional contextualism. This theory offers a very different interpretation of how categories emerge through the functions of behavior and through contextual cues, which may be of some benefit to existing categorization theories. Specifically, RFT may be able to offer a novel explanation of how background knowledge arises, and we provide some mathematical considerations in order to identify a formal model. Finally, we discuss much of this work within the broader context of general semantic knowledge and artificial intelligence research. (shrink)

In this paper I assess whether truth pluralism can account for the normativity of truth. This is a key issue, as accommodating the idea that truth is normative is often presented as a main advantage that truth pluralism has over deflationism. The basis of the discussion is Engel’s critique of truth pluralism, which questions the view’s ability to account for the normativity of truth. I develop the ways truth pluralists of different sorts can respond to Engel’s critique, and explore the (...) accounts of the normativity of truth that emerge. (shrink)

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be (...) preserved, reproduced, and made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

ABSTRACT Many people argue that disagreements and inconsistencies between Research Ethics Committees are morally problematic and there has been much effort to ‘harmonise’ their judgements. Some inconsistencies are bad because they are due to irrationality, or carelessness, or the operation of conflicting interests, and so should be reduced or removed. Other inconsistencies, we argue, are not bad and should be left or even encouraged. In this paper we examine three arguments to reject the view that we should strive for complete (...) consistency between committees. The first argument is that differences in judgement are not necessarily incompatible with ideas of justice for patients who are potential participants of research reviewed by different committees. We call this ‘the justice argument.’ The second argument is that such committees do not have access to a single moral truth, to which their judgement is supposed to correspond. We call this the ‘moral pluralism argument.’ The third argument is that the process of ethics committee review is also morally relevant and not solely the outcome. We call this the ‘due process argument.’ While we fall short of establishing exactly how much variation and on what substantive issues would be ethically permissible, we show that it is largely inevitable and that a certain amount of variation could be seen as a desirable part of the institution of medical research. (shrink)

In popular articles that play down the genetical differences among human populations, it is often stated that about 85% of the total genetical variation is due to individual differences within populations and only 15% to differences between populations or ethnic groups. It has therefore been proposed that the division of Homo sapiens into these groups is not justified by the genetic data. This conclusion, due to R.C. Lewontin in 1972, is unwarranted because the argument ignores the fact that most of (...) the information that distinguishes populations is hidden in the correlation structure of the data and not simply in the variation of the individual factors. The underlying logic, which was discussed in the early years of the last century, is here discussed using a simple genetical example. (shrink)

The research was generally motivated by a dearth of studies on joy, and particularly inspired by a book of joy celebrating the inter-spiritual dialogue between the Dalai Lama and Desmond Tutu. Its aim was to investigate whether the direct contemplation of joy would be associated with improvements in psychophysiological coherence, spirituality and various positive emotions and feelings. Integrative quantitative and qualitative findings emerging from a small pilot study, including a convenience sample of six participants with a mean age of 42 (...) years and age range of 25-69 years, supported the research hypothesis. Significant quantitative increases in psychophysiological coherence, spirituality and positive feelings were coherently and consistently supported by participants' individual and collective experiences. Integrative discussion amplified the paradoxical theme of joy through suffering in human emotional and spiritual life. (shrink)

Alfandre et al. helpfully outlines the case for attending to contingency planning as well as to crisis measures during a pandemic. The authors provides a helpful framework for reflecting on...

In these replies I develop responses to the fascinating issues raised in the commentaries on my book The Metaphysics of Truth from Matti Eklund, Gila Sher, Crispin Wright, and Jeremy Wyatt. I focus on four main areas where there seemed to be a degree of convergence amongst the critics: (1) the viability and use of the sparse/abundant property distinction; (2) truth, dependence, and superassertibility; (3) correspondence, realism, and anti—realism; and (4) my ‘globalizing’ argument against deflationism.

What is truth? What precisely is it that truths have that falsehoods lack? Pluralists about truth (or “alethic pluralists”) tend to answer these questions by saying that there is more than one way for a proposition, sentence, belief—or any chosen truth-bearer—to be true. In this paper, I argue that two of the most influential formations of alethic pluralism, those of Wright (1992, 2003a) and Lynch (2009), are subject to serious problems. I outline a new formulation, which I call “simple determination (...) pluralism,” that I claim offers better prospects for alethic pluralism, with the potential to have applications for pluralist theories beyond truth. (shrink)

This article traces the development of Sartre's metaphysics with three interrelated aims in mind. The first is to situate Sartre's metaphysical views in relation to those of his predecessors, his contemporaries, and current continental philosophy. The second is to show that Sartre's project informs some of the key changes he makes to his existentialism during his career. The third is to bring Sartre the metaphysician into dialogue with key thinkers in the current realism/antirealism debate in Continental philosophy by showing that (...) the defense of materialism he offers in his later work preserves many hard-won insights of phenomenology and has significant advantages over many contemporary articulations of realism. (shrink)

Most ethics committees which review research protocols insist that potential research participants reserve unconditional or absolute ‘right’ of withdrawal at any time and without giving any reason. In this paper, I examine what consent means for research participation and a sense of commitment in relation to this right to withdraw. I suggest that, once consent has been given (and here I am excluding incompetent minors and adults), participants should not necessarily have unconditional or absolute rights to withdraw.This does not imply (...) that that there should be a complete absence of rights, or, indeed, an abandonment of the right to withdraw. The point of this paper is to show that the supposed unconditional or absolute nature of these rights may be self‐defeating and so fail to respect the autonomy of participants. In addition, and on a more positive note, I suggest that, attaching certain conditions on the right to withdraw, may better respect the autonomy of these participants by underlining the idea that autonomy is more than mere whim or indifference to the fate of others. On the contrary, research staff are currently unable to ‘push’ participants, who may merely have logistical difficulties unrelated to the research itself, but who really want to stay the course, for fear of coercing them. Furthermore, researchers now try to ‘screen out’ people they think may be unreliable to protect the science of the study and so groups at risk of dropping out may be unfairly denied access to research treatments. I conclude that on‐going negotiation between the relevant parties could be on balance the only truly acceptable way forward but concede certain important limitations to take into account. (shrink)

In his classic 1936 paper Tarski sought to motivate his definition of logical consequence by appeal to the inference form: P(0), P(1), . . ., P(n), . . . therefore ∀nP(n). This is prima facie puzzling because these inferences are seemingly first-order and Tarski knew that Gödel had shown first-order proof methods to be complete, and because ∀nP(n) is not a logical consequence of P(0), P(1), . . ., P(n), . . . by Taski's proposed definition. An attempt to resolve (...) the puzzle due to Etchemendy is considered and rejected. A second attempt due to Gómez-Torrente is accepted as far as it goes, but it is argued that it raises a further puzzle of its own: it takes the plausibility of Tarski's claim that his definition captures our common concept of logical consequence to depend upon our common concept being a reductive conception. A further interpretation of what Tarski had in mind when he offered the example is proposed, using materials well known to Tarski at the time. It is argued that this interpretation makes the motivating example independent of reductive definitions which take natural numbers to be higher-order set theoretic entities, and it also explains why he did not regard the distinction between defined and primitive terms as pressing, as was the distinction between logical and nonlogical terms. (shrink)

Within Kant scholarship, there is an entrenched tendency to distinguish, on Kant’s behalf, between pure and ‘schematized’ categories. There is also a widespread tendency to view the schematized categories as conceptually richer than the pure categories. I argue that this reading of the distinction, which I call the standard view, should be rejected. In its place, I draw on a neglected part of Kant’s theory of marks – namely, his account of ‘synthetic attributes’ – to propose an account of the (...) distinction that preserves a strict identity between pure and schematized categories at the level of analysable content. (shrink)

Volume 20, Issue 9, September 2020, Page 39-41.

Clinical research under the usual regulatory constraints may be difficult or even impossible in a public health emergency. Regulators must seek to strike a good balance in granting as wide therapeutic access to new drugs as possible at the same time as gathering sound evidence of safety and effectiveness. To inform current policy, I reexamine the philosophical rationale for restricting new medicines to clinical trials, at any stage and for any population of patients (which resides in the precautionary principle), to (...) show that its objective to protect public health, now or in the future, could soon be defeated in a pandemic. Providing wider therapeutic access and coordinating observations and natural experiments, including service delivery by cluster (wedged cluster trials), may provide such a balance. However, there are important questions of fairness to resolve before any such research can proceed. (shrink)

The ethics of care still appeals to many in spite of penetrating criticisms of it which have been presented over the past 15 years or so. This paper tries to offer an explanation for this, and then to critically engage with three versions of an ethics of care. The explanation consists firstly in the close affinities between nursing and care. The three versions identified below are by Gilligan (1982 ), a second by Tronto (1993 ), and a third by Gastmans (...) (2006 ), see also Little (1998 ). Each version is described and then subjected to criticism. It is concluded that where the ethics of care is presented in a distinctive way, it is at its least plausible; where it is stated in more plausible forms, it is not sufficiently distinct from nor superior to at least one other common approach to nursing ethics, namely the much-maligned 'four principles' approach. What is added by this paper to what is already known: as the article tries to explain, in spite of its being subjected to sustained criticism the ethics of care retains its appeal to many scholars. The paper tries to explain why, partly by distinguishing three different versions of an ethics of care. It is also shown that all three versions are beset with problems the least serious of which is distinctiveness from other approaches to moral problems in health care. (shrink)

Much time has been spent arguing about the soundness of But in the philosophical literature there is no single such principle; there are many harm principles. And many objections pressed against are objections to only some of these principles. The first half of this paper draws a number of distinctions between harm principles. It then argues that each harm principle is compatible with many other principles that impose limits on the law, including but not limited to other harm principles. The (...) second half of the paper applies the lessons of the first to a number of prominent objections to That principle has been accused of a) being underinclusive; b) misrepresenting the reasons why many act-types ought to be legally proscribed; c) permitting lawmakers to treat people as mere means of achieving their ends; and d) being overinclusive. The paper argues that one harm principle survives all four objections. (shrink)

The broad topic of this paper is the relationship between the theoretical notion of a concept and familiar types of cognitive structures (prototypes, exemplars, causal models, etc.) The discussion is organized around different ways that theorists about concepts can attempt to accommodate what has been dubbed the Heterogeneity Hypothesis (roughly: the claim that various types of structures with which concepts have been identified co-exist and form a heterogeneous class). The most general goal of the paper is to clarify the dialectical (...) geography when it comes to different ways of construing the relationship between concepts and familiar cognitive structures. A more focussed and more polemical goal of the paper is to raise problems for so-called pluralist approaches to concepts. This paper will not offer a comprehensive defense of any particular view about the relationship between concepts and cognitive structures, but the discussion will be a convenient venue in which to highlight some virtues of what I will call Higher-Level Unity approaches to concepts. (shrink)

Indirect complaint sequences are examined in a corpus of everyday domestic telephone conversations. The analysis focuses on how a speaker/complainer displays and manages their subjective investment in the complaint. Four features are picked out: announcements, in which an upcoming complaint is projected in ways that signal the complainer’s stance or attitude; laughter accompanying the complaint announcement, and its delivery and receipt; displacement, where the speaker complains about something incidental to what would be expected to be the main offence; and uses (...) of lexical descriptions such as ‘moan’ and ‘whinge’ that formulate subjectivity, investment, and a disposition to complain, and are generally used to counter a complaint’s evidential basis or objectivity. Laughter and irony provide complaint recipients with response cues, and are used in ways that can strengthen as well as undermine a complaint’s factual basis and seriousness. (shrink)

Is truth itself natural? This is an important question for both those working on truth and those working on naturalism. For theorists of truth, answering the question of whether truth is natural will tell us more about the nature of truth (or lack of it), and the relations between truth and other properties of interest. For those working on naturalism who wish to have truth as part of the natural order, answering this question is of paramount importance. In this chapter, (...) we focus primarily on the kinds of theory of truth that occupy the central positions in current debates about truth, namely correspondence theories, deflationary theories, epistemic theories, and pluralist theories, and aim to discern the extent to which truth is a natural property on each view. (shrink)

In this paper the need for valid evidence of the cost-effectiveness of treatments that have not been properly evaluated, yet are already available, albeit in short supply, are examined. Such treatments cannot be withdrawn, pending proper evaluation, nor can they be made more widely available until they have been shown to be cost-effective. As a solution to this impasse the argument put forward recently by Toroyan et al is discussed. They say that randomised controlled trials of such resources could be (...) done but only if resources are randomly allocated independently of a research context. Relevant outcome data could then be collected for research, given this opportunity. We agree. We disagree with Toroyan et al on a number of points. First, they claim that no ethical issue relating to equipoise arises. We disagree and this disagreement depends on our showing that equipoise should be maintained in a relationship that they do not consider. Secondly, they say that consent to data collection is always needed. Again we disagree. Thirdly, they claim that the previous two issues are the only possible ethical issues that could arise. We argue, instead, that there is a further conflict of interests that has ethical import. (shrink)

The distinction between work and play is a defining feature of the modern world. But the border between them has been a site of major political contestation, giving rise to new forms of authority. I turn to the work of Michael Oakeshott to examine the distinction between work and play and how it relates to the idea of authority. I argue that reading Oakeshott on work, play, conduct, and authority can give us important insights into key questions of democratic theory (...) at a time when socio-economic and technological changes are once again transforming the border of work and play. (shrink)