Contemporary hormonal therapy for the menopause has its conceptual origins in the ancient tradition of organotherapy. The popular but pharmacologically inactive precursors of hormonal therapy were developed as part of a resurgence of interest in organotherapy in the 19th century, which coincided with increasing medicalization of the menopause and the view that the ovaries were responsible for the ‘feminine’ identity and wellbeing of women. The subsequent chemical identification of oestrogens allowed the development of pharmacologically active hormonal therapy for the menopause, (...) which was probably first used clinically in the late 1920s. Around this time, emphasis shifted from the ovaries to oestrogen as being responsible for femininity and health, with the menopause and ageing increasingly defined as oestrogen deficiency diseases. Hormonal therapy for the menopause was first used predominantly for women who had a premature menopause. In the 1960s, universal prescription was increasingly promoted as a way of preventing diseases of later life and the perceived ‘defeminization’ of women by menopause. Scientific evidence regarding the risks and benefits of hormonal therapy for the menopause has been accruing over the last 70 years; its interpretation has been affected by background beliefs regarding the effects of oestrogen and the menopause on women. (shrink)

Between 2013 and 2016, West Africa experienced the largest ever outbreak of Ebola Virus Disease. In the absence of registered treatments or vaccines to control this lethal disease, the World Health Organization coordinated and supported research to expedite identification of interventions that could control the outbreak and improve future control efforts. Consequently, the World Health Organization Research Ethics Review Committee was heavily involved in reviews and ethics discussions. It reviewed 24 new and 22 amended protocols for research studies including interventional (...) and observational studies. WHO-ERC provided the reviews within on average 6 working days. The WHO-ERC often could not provide immediate approval of protocols for reasons which were not Ebola Virus Disease specific but related to protocol inconsistencies, missing information and complex informed consents. WHO-ERC considerations on Ebola Virus Disease specific issues are presented. To accelerate study approval in future public health emergencies, we recommend: internally consistent and complete submissions with information documents in language participants are likely to understand, close collaboration between local and international researchers from research inception, generation of template agreements for data and sample sharing and use during the ongoing global consultations on bio-banks, formation of Joint Scientific Advisory and Data Safety Review Committees for all studies linked to a particular intervention or group of interventions, formation of a Joint Ethics Review Committee with representatives of the Ethics Committees of all institutions and countries involved to strengthen reviews through the different perspectives provided without the ‘opportunity costs’ for time to final approval of multiple, independent reviews, direct information exchange between the chairs of advisory, safety review and ethics committees, more Ethics Committee support for investigators than is standard and a global consultation on criteria for inclusion of pregnant women and children in interventional studies for conditions which put them at particularly high risk of mortality or other irreversible adverse outcomes under standard-of-care. (shrink)

Background Between 2013 and 2016, West Africa experienced the largest ever outbreak of Ebola Virus Disease. In the absence of registered treatments or vaccines to control this lethal disease, the World Health Organization coordinated and supported research to expedite identification of interventions that could control the outbreak and improve future control efforts. Consequently, the World Health Organization Research Ethics Review Committee was heavily involved in reviews and ethics discussions. It reviewed 24 new and 22 amended protocols for research studies including (...) interventional and observational studies. WHO-ERC reviews WHO-ERC provided the reviews within on average 6 working days. The WHO-ERC often could not provide immediate approval of protocols for reasons which were not Ebola Virus Disease specific but related to protocol inconsistencies, missing information and complex informed consents. WHO-ERC considerations on Ebola Virus Disease specific issues are presented. Conclusions To accelerate study approval in future public health emergencies, we recommend: internally consistent and complete submissions with information documents in language participants are likely to understand, close collaboration between local and international researchers from research inception, generation of template agreements for data and sample sharing and use during the ongoing global consultations on bio-banks, formation of Joint Scientific Advisory and Data Safety Review Committees for all studies linked to a particular intervention or group of interventions, formation of a Joint Ethics Review Committee with representatives of the Ethics Committees of all institutions and countries involved to strengthen reviews through the different perspectives provided without the ‘opportunity costs’ for time to final approval of multiple, independent reviews, direct information exchange between the chairs of advisory, safety review and ethics committees, more Ethics Committee support for investigators than is standard and a global consultation on criteria for inclusion of pregnant women and children in interventional studies for conditions which put them at particularly high risk of mortality or other irreversible adverse outcomes under standard-of-care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Re-examining Empirical Data on Conflicts of Interest Through the Lens of Personal NarrativesEmily E. Anderson and Elena M. KrausIntroductionThe personal stories submitted by physicians and researchers for this symposium add much–needed dimension to conversations on conflicts of interest in medicine and research. Narratives from individuals living with conflicts of interest can serve as a unique lens through which to consider psychological and economic theories and survey data on physician (...) and patient views. In our reading of these personal narratives, we identified four primary themes that will serve as springboards for our commentary. We aim to triangulate clusters of meaning drawn from the narratives with relevant data from published empirical studies and identify gaps in knowledge where more research is needed. These themes are: the unique environments of medicine and research; weighing the potential benefits of conflicts of interest against the risks; conflict of interest management; and the roles and responsibilities of diverse stakeholder groups.The Unique Challenges of the Medical and Research EnvironmentsThe reflections of the narrative authors draw attention to many of the unique environmental aspects of medicine and medical research that make physicians and researchers especially vulnerable to conflicts of interest. Conflicts of interest may be more ubiquitous in medicine than in any other industry (Kassirer, 2006). As the narratives demonstrate, conflicts of interest emerge across a range of health care delivery and research activities. Surveys have shown that 94 percent of physicians have some kind of relationship with industry (Campbell, Gruen, Mountford, et al., 2007). There is also evidence that physician interactions with medical industry begin early and are a regular part of a physician’s professional practice along the career continuum (Wazana, 2000).Medicine as a profession is distinct from banking or law. It is often said that medicine is an art; in treating patients, creative individualized solutions and gut instinct are as (if not more) important than the application of scientific knowledge. Uncertainty surrounds medical decision making. There is limited precision with respect to diagnoses and prognoses, limited data regarding the effectiveness of many treatments, and a range of patient values and preferences. Because of this uncertainty, rules about practice standards, especially with respect to avoidance and management of conflicts of interest, cannot be as explicit as they are in law or business. As demonstrated by the story presented by Sal Cruz–Flores, research and practice often intersect. And, there is no system in greater need of reform—and no system about which there are more divergent opinions as to what shape that reform should take—than the United States health care [End Page 91] system. The narratives of Tony Mikulec, Govind Nagaldinne, and David M. Zientek demonstrate how various aspects of the structure of healthcare service provision and third–party payer arrangements have the potential to harm patients. Conflicts of interest comprise more than relationships with pharmaceutical and medical device manufacturers.The narratives of Laura Jean Bierut and David M. Zientek also discuss examples of conflicts of interest that arise from factors beyond relationships with industry or the direct potential for financial gain. This may be somewhat unique to the medical milieu. Non-financial conflicts such as a desire for the prestige bestowed upon scientists who make key discoveries, a requirement to publish for tenure and promotion, the need to maintain one’s license or other privileges, or simply the pressure of a competitive environment can influence physician and researcher behavior. As noted by Bierut, more research on how to identify and manage non-financial conflicts is needed.The Potential Benefits and Harms of Conflicts of InterestConflicts of interest are usually presented in a negative light, particularly those that involve physician relationships with the pharmaceutical industry. To “have a conflict of interest” is to be in a situation or role where there is potential for personal interests to be prioritized over professional responsibilities. However, in terms of public perception, it seems that conflicts of interest have become almost synonymous with wrongdoing. Perhaps this is due to the barrage of media reports during the last decade on significant harms caused by financial conflicts of interest in business, journalism, and sports as well as in medicine (Steinbrook, 2004). Amidst... (shrink)

This article seeks to explain the variable implementation of gender mainstreaming as a `policy frame' over time and across various international organisations (I.O.s). In the years since the U.N. Fourth World Women's Conference in Beijing (1995),mainstreaming has been endorsed and adopted by a wide range of international organisations, and we compare the adoption and implementation of mainstreaming in four specific I.O.s: the World Bank, the United Nations Development Programme, the Organisation for Security and Cooperation in Europe, and the European Union. (...) The rhetorical acceptance of mainstreaming by various international organisations, however, obscures considerable variation in both the timing and the nature of the mainstreaming process within and among organisations. This variation, in turn, can be explained in terms of the categories of political opportunity, mobilising structures and strategic framing, which have been put forward by social movement theorists. (shrink)

Escalating demands for limited food supplies at America’s food banks and pantries during the COVID-19 pandemic have raised ethical concerns underlying “first-come, first-served” distributions strategies. A series of model ethical principles are designed to guide ethical allocations of these resources to assure greater access among persons facing food insecurity.

The third edition of this popular book has been updated to take account of the latest developments in policy and social work practice. It includes new sections on radical/emancipatory and postmodern approaches to ethics, analysis of the latest codes of ethics from over 30 different countries, additional case studies of ethical problems and dilemmas, practical exercises, and annotated further reading lists at the end of each chapter.

The book revives the neutral monism of Mach, James, and Russell and applies the updated view to the problem of redefining physicalism, explaining the origins of sensation, and the problem of deriving extended physical objects and systems from an ontology of events.

Because idealizations frequently advance scientific understanding, many claim that falsehoods play an epistemic role. In this paper, we argue that these positions greatly overstate idealiza...

Under what conditions does machine learning (ML) model opacity inhibit the possibility of explaining and understanding phenomena? In this article, I argue that nonepistemic values give shape to the ML opacity problem even if we keep researcher interests fixed. Treating ML models as an instance of doing model-based science to explain and understand phenomena reveals that there is (i) an external opacity problem, where the presence of inductive risk imposes higher standards on externally validating models, and (ii) an internal opacity (...) problem, where greater inductive risk demands a higher level of transparency regarding the inferences the model makes. (shrink)

A consideration of Mach's elements, his philosophy of neutral monism, and philosophy of physics, especially space and time, much of it based on unpublished writings from the Nachlass and other original sources. The historical connection between Mach and logical positivism is shown to be superficial at best, and Mach's elements are shown to be mind independent natural qualities (world-elements) with dynamic force, not limited to human sensations.

Viewed this way, the texts yield striking examples of language and notation that are irreducibly ambiguous and productive because they are ambiguous.

The domain of professional ethics -- Virtue, ethics, and professional life -- Virtues, vices, and situations -- Professional wisdom -- Care -- Respectfulness -- Trustworthiness -- Justice -- Courage -- Integrity.

This book explores the far-reaching ethical implications of recent changes in the organization and practice of the social professions, including social work, community and youth work. Drawing on moral philosophy, professional ethics and new empirical research, the author explores such questions as: * Can any occupation justifiably claim a special set of ethics? * What is the impact of the new 'ethics of distrust' on the autonomy discretion and creativity of practitioners? * How does inter-professional working challenge conceptions of professional (...) identities and roles? * Do 'professional ethics' act as an obstruction to constructive developments? Combing interviews with practitioners with developments in ethical theory, Ethics, Accountability and the Social Professions shows the complexity and range of issues at stake. (shrink)

Payment to recruit research subjects is a common practice but raises ethical concerns relating to the potential for coercion or undue influence. We conducted the first national study of IRB members and human subjects protection professionals to explore attitudes as to whether and why payment of research participants constitutes coercion or undue influence. Upon critical evaluation of the cogency of ethical concerns regarding payment, as reflected in our survey results, we found expansive or inconsistent views about coercion and undue influence (...) that may interfere with valuable research. In particular, respondents appear to believe that coercion and undue influence lie on a continuum; by contrast, we argue that they are wholly distinct: whereas undue influence is a cognitive distortion relating to assessment of risks and benefits, coercion is a threat of harm. Because payment is an offer, rather than a threat, payment is never coercive. (shrink)

We argued in a recent issue of this journal that if abortion is restricted,1 then there are parallel obligations for parents to donate body parts to their children. The strength of this obligation to donate is proportional to the strength of the abortion restrictions. If abortion is never permissible, then a parent must always donate any organ if they are a match. If abortion is sometimes permissible and sometimes not, then organ donation is sometimes obligatory and sometimes not. Our argument (...) was based on the following ideas: (a) that a fetus has full moral status, (b) that parents have special obligations to their offspring, fetus or not, and (c) that this special obligation is to protect them. The result is the conclusion that abortion restrictivists cannot also consistently deny that organ donation should be compulsory. (shrink)

It's well-known that Kant believed that intuition was central to an account of mathematical knowledge. What that role is and how Kant argues for it are, however, still open to debate. There are, broadly speaking, two tendencies in interpreting Kant's account of intuition in mathematics, each emphasizing different aspects of Kant's general doctrine of intuition. On one view, most recently put forward by Michael Friedman, this central role for intuition is a direct result of the limitations of the syllogistic logic (...) available to Kant. On this view, Kant's reasons for introducing intuition are taken to be logical or mathematical, rather than philosophical. The other tendency, which I shall try to develop here, emphasizes an epistemological or phenomenological role for intuition in mathematics arising out of what may loosely be called Kant's ‘antiformalism.’This paper, which focuses specifically on the case of geometry, falls into two parts. First, I consider Kant's discussion of intuition in the Metaphysical Exposition of the concept of space. (shrink)

In this chapter, we address the roles that exemplars might play in a comprehensive response to epistemic injustice. Fricker defines epistemic injustices as harms people suffer specifically in their capacity as (potential) knowers. We focus on testimonial epistemic injustice, which occurs when someone’s assertoric speech acts are systematically met with either too little or too much credence by a biased audience. Fricker recommends a virtue­theoretic response: people who do not suffer from biases should try to maintain their disposition towards naive (...) testimonial justice, and those who find themselves already biased should cultivate corrective testimonial justice by systematically adjusting their credence in testimony up or down depending on whether they are hearing from someone whom they may be biased against or in favor of. We doubt that the prominent admiration­emulation model of exemplarism will be much use in this connection, so we propose two ways of learning from negative exemplars to better conduct one’s epistemic affairs. In the admiration­emulation model, both the identification of what a virtue is and the cultivation of virtues identified thusly proceed through the admiration of virtuous exemplars. We show that this model has serious flaws and argue for two alternatives: the envy­agonism model and the ambivalence­avoidance model. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kant on the Method of MathematicsEmily Carson1. INTRODUCTIONThis paper will touch on three very general but closely related questions about Kant’s philosophy. First, on the role of mathematics as a paradigm of knowledge in the development of Kant’s Critical philosophy; second, on the nature of Kant’s opposition to his Leibnizean predecessors and its role in the development of the Critical philosophy; and finally, on the specific role of intuition (...) in Kant’s philosophy of mathematics. One of the points that I want to make is that recognizing the importance of these first two issues is essential to giving an adequate account of the third. That is, only by appreciating how Kant uses the example of mathematical knowledge, and in particular the objections he had to previous accounts of such knowledge, can we understand the philosophical role that he ascribes to intuition in his own account of mathematics.I don’t propose to explain the details of Kant’s philosophy of mathematics, but rather to compare his views on mathematics in the pre-Critical Prize Essay of 1764 to those of the Critique of Pure Reason, with the aim of showing how Kant’s doctrine of construction in pure intuition arises out of a combination of two factors: first, his attempt to ground the distinction between the respective methods of mathematics and philosophy, and second, his concern to defend the reality of mathematical knowledge against the views of those he called ‘the metaphysicians.’ The first factor demands an account of the certainty of mathematics, the second requires an account of its content. I shall argue that there is a possible conflict between Kant’s accounts of these features in the Prize Essay, a possibility which is finally ruled out only by means of the Critical doctrine of pure intuition. So I hope to show that there is a significant philosophical role for intuition in Kant’s account of mathematical knowledge (over and above the more logical role attributed to it on readings [End Page 629] such as those of Friedman, Beth, and Hintikka1) in reconciling the content of mathematics and its certainty.2. THE MATHEMATICIANS VS. THE METAPHYSICIANSThroughout his early writings, Kant appealed to the evidence and certainty of mathematics; his attitude towards metaphysics, however, underwent a dramatic shift. In the Physical Monadology of 1756, Kant asked how metaphysics and geometry can be united,[f] or the former peremptorily denies that space is infinitely divisible, while the latter, with its usual certainty, asserts that it is infinitely divisible. Geometry contends that empty space is necessary for free motion, while metaphysics hisses the idea off the stage. Geometry holds universal attraction or gravitation to be hardly explicable by mechanical causes but shows that it derives from the forces which are inherent in bodies at rest and which act at a distance, whereas metaphysics dismisses the notion as an empty delusion of the imagination [1:475–6].2He attempted in this work to reconcile the respective positions of metaphysics and geometry regarding infinite divisibility, thereby demonstrating that “it is neither the case that the geometer is mistaken nor that the opinion to be found among metaphysicians deviates from the truth” [1:480]. But in a series of works from 1762–3, Kant reveals a markedly different attitude towards metaphysics. For example, in “The only possible argument in support of a demonstration of the existence of God,” Kant says:the mania for method and the imitation of the mathematician, who advances with a sure step along a well-surfaced road, have occasioned a large number of such mishaps on the slippery ground of metaphysics. These mishaps are constantly before one’s eyes, but there is little hope that people will be warned by them, or that they will learn to be more circumspect as a result [2:71].In contrast, Kant describes the geometer as uncovering “with the greatest certainty” the most secret properties of that which is extended [2:70]. But the less conciliatory attitude to metaphysics comes out most clearly in Kant’s actual procedure in “The only possible argument.” In the Seventh Reflection, he presents an attempt to explain the origin of... (shrink)

Trust makes cooperation possible. It enables us to learn from others and at a distance. It makes democratic deliberation possible. But it also makes us vulnerable: when we place our trust in another’s word, we are liable to be deceived—sometimes intentionally, sometimes unintentionally. Our evolved mechanisms for deciding whom to trust and whom to distrust mostly rely on face-to-face interactions with people whose reputation we can both access and influence. Online, these mechanisms are largely useless, and the institutions that might (...) supplant them need to have their own trustworthiness verified. Currently, those institutions are mostly corporations such as Facebook and Twitter, which have checkered track records at best. To make matters worse, the social media sector is a natural monopoly, and companies like Facebook have shown that they are willing to use their market power unscrupulously. For these reasons, we argue that social media should be treated like other natural monopolies: it should either be nationalized, highly regulated, or broken up through antitrust legal actions. (shrink)

For years, _Multicultural Education_ has served as an essential resource for education professionals, featuring scholarly articles written by industry leaders and topics, following current trends in education instruction today. The text helps educators understand the concepts, paradigms, and explanations necessary for becoming effective practitioners in the ever-evolving classroom environment, highlighting cultural, raocial and language-focused topics. Each chapter now incorporates new theoretical, conceptual, and research developments within the field, providing an adaptable approach to classroom techniques. With growing classroom diversity, the text (...) also features a chapter that focuses on lesbian, gay, bisexual and transgender issues. Statistical tables, figures and charts have been updated to present the most current information. (shrink)

This book draws its inspiration from Hilbert, Wittgenstein, Cavaillès and Lakatos and is designed to reconfigure contemporary philosophy of mathematics by making the growth of knowledge rather than its foundations central to the study of mathematical rationality, and by analyzing the notion of growth in historical as well as logical terms. Not a mere compendium of opinions, it is organised in dialogical forms, with each philosophical thesis answered by one or more historical case studies designed to support, complicate or question (...) it. The first part of the book examines the role of scientific theory and empirical fact in the growth of mathematical knowledge. The second examines the role of abstraction, analysis and axiomatization. The third raises the question of whether the growth of mathematical knowledge constitutes progress, and how progress may be understood. Readership: Students and scholars concerned with the history and philosophy of mathematics and the formal sciences. (shrink)

Demystifying Legal Reasoning defends the proposition that there are no special forms of reasoning peculiar to law. Legal decision makers engage in the same modes of reasoning that all actors use in deciding what to do: open-ended moral reasoning, empirical reasoning, and deduction from authoritative rules. This book addresses common law reasoning when prior judicial decisions determine the law, and interpretation of texts. In both areas, the popular view that legal decision makers practise special forms of reasoning is false.

What do humility, intellectual humility, and open-mindedness mean in the context of inter-group conflict? We spend most of our time with ingroup members, such as family, friends, and colleagues. Yet our biggest disagreements —— about practical, moral, and epistemic matters —— are likely to be with those who do not belong to our ingroup. An attitude of humility towards the former might be difficult to integrate with a corresponding attitude of humility towards the latter, leading to smug tribalism that masquerades (...) as genuine virtue. These potentially conflicting priorities have recently come to the fore because “tribal epistemology” has so thoroughly infected political and social discourse. Most research on these dispositions focuses on individual traits and dyadic peer-disagreement, with little attention to group membership or inter-group conflict. In this chapter, we dilate the social scale to address this pressing philosophical and social problem. (shrink)

This article contributes to a growing conversation about the role of numbers in promoting gendered agendas in potentially contradictory ways. Drawing from interviews with gender advisors—the professionals tasked with mainstreaming gender in development projects—in an East African country, I begin from the paradox that gender advisors articulate a strong preference for qualitative data to best capture the lives of the women they aim to assist while voicing a need for quantitative metrics. I demonstrate that gender advisors come to imagine metrics (...) as expeditious bureaucratic tools able to inspire cooperation from otherwise reluctant coworkers. I argue that development organizations are gendered in ways—acutely seen in how advisors struggle, are sidelined, and attempt to advance their goals with numbers—that lead to the utility of valuing quantitative metrics over qualitative ones. I establish two theoretical contributions: Gendered organizations theory is essential to understanding the adoption and globalization of performance metrics, and in an age of evidence-based decision making, the utility of quantified data to garner resources is heightened, rewarding those who adopt quantified knowledge production. I coin the term “the paradox of quantified utility” to describe how these material advantages encourage even skeptics to value quantitative metrics. (shrink)

Exploring the intimate tie between body movement and space and time, Lee begins with the position that body movement generates space and time and explores the ethical implications of this responsibility for the situations one’s body movements generate. Whiteness theory has come to recognize the ethical responsibility for situations not of one’s own making and hence accountability for the results of more than one’s immediate personal conscious decisions. Because of our specific history, whites have developed a particular embodiment and body (...) movement that generates places that can only be characterized as more comfortable and more enabling to whites. (shrink)

To ensure that the information resulting from research is relevant to patients, the Patient‐Centered Outcomes Research Institute eschews the “traditional health research” paradigm, in which investigators drive all aspects of research, in favor of one in which patients assume the role of research partner. If we accept the premise that patient engagement can offer fresh perspectives that shape research in valuable ways, then at least two important sets of questions present themselves. First, how are patients being engaged—and how should they (...) be engaged? Second, which patients are being engaged—and which patients should be? This set has received relatively less attention, and the neglect is surprising, given that the “who” question is conceptually prior to the question of “how.”This article focuses attention on the “who” of patient engagement in research. First, we provide background on the rationale for patient engagement, underscoring the importance of ensuring the representativeness of engaged patients. Second, we present what little is known about patients engaged in PCORI‐funded research. Third, we identify and discuss the ethical implications of ways in which current practices of patient identification and recruitment may lead to a lack of representativeness. These practices include reliance on the well‐connected and well‐informed, reliance on patients who are not well trained or well‐informed, and reliance on patient advocacy organizations. Finally, we consider several strategies for addressing these pitfalls in order to maximize the positive goals of patient engagement. Patient engagement is intended to address the inability of researchers, funders, and others to fully represent patient views and priorities, but without sufficient attention, the patients selected for this role may still leave important gaps. (shrink)

This essay explores how the distinctively anthropological concept of culture provides uniquely valuable insights into the workings of science in its cultural context. Recent efforts by anthropologists to dislodge the traditional notion of culture as a homogenous, stable whole have opened up a variety of ways of imagining culture that place power differentials, flux, and contradiction at its center. Including attention to a wide variety of social domains outside the laboratory, attending to the ways nonscientists actively engage with scientific knowledge, (...) and focusing on the complex interactions that flow both into and out of research laboratories are ways the activities of both scientists and nonscientists can be situated in the heterogeneous matrtx of culture. Three images—the citadel, the rhizome, and the string figure—allow us to picture the discontinuous ways science both permeates and is permeated by cultural life. (shrink)

Madison Kilbride recently argued that insurance ) should cover in vitro fertilisation with preimplantation genetic testing services for couples at high risk of having a child affected with a genetic condition. She argues that IVF-PGT meets CMS’s definition of ‘medically necessary care’, where such care includes ‘services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms’. Kilbride argues that IVF-PGT satisfies this definition in two ways: as a diagnostic tool and as a treatment. Contradicting (...) Kilbride, however, I argue that IVF-PGT provides neither diagnosis nor treatment under CMS’s definition. Thus, as long as we accept CMS’s definition of medically necessary care—which Kilbride does, explicitly—it follows that IVF-PGT does not count as medically necessary care. Still, there may be other reasons to conclude that IVF-Preimplantation genetic testing should be covered, and so, it would be a mistake to reject Kilbride’s conclusion altogether. The problem is simply that Kilbride’s argument—that the procedure should be covered because it is medically necessary per CMS’s definition—is not sound. I conclude by discussing a number of other genetic services that are not currently being covered despite the fact that they do seem to satisfy CMS’s definition of ‘medically necessary diagnosis or treatment’. These services, I argue, should be provided under CMS before we consider expanding coverage to include elective procedures such as IVF-PGT. (shrink)

The Cartesian method, construed as a way of organizing domains of knowledge according to the "order of reasons," was a powerful reductive tool. Descartes made significant strides in mathematics, physics, and metaphysics by relating certain complex items and problems back to more simple elements that served as starting points for his inquiries. But his reductive method also impoverished these domains in important ways, for it tended to restrict geometry to the study of straight line segments, physics to the study of (...) ambiguously constituted bits of matter in motion, and metaphysics to the study of the isolated, incorporeal knower. This book examines in detail the negative and positive impact of Descartes's method on his scientific and philosophical enterprises, exemplified by the Geometry, the Principles, the Treatise of Man, and the Meditations. (shrink)

The healthcare systems of the United States and United Kingdom are vastly different. The former relies primarily on private sector incentives and market forces to allocate medical care services, while the latter is a centrally planned system funded almost entirely by the public sector. Therefore, each nation represents divergent views on the relative efficacy of the market or government in achieving social objectives in the area of medical care policy. Since its inception in 1948, the National Health Services of the (...) United Kingdom has consistently emphasized equity in the allocation of medical services. It has done so by creating a system whereby services are universally free of charge at the point of entry. Conversely, the United States has relied upon the evolution of a perplexing array of public and private sector insurance schemes centered more around consumer choice than equity in allocation. (shrink)

In Physics 2.4–6, Aristotle offers an account of things that happen “by luck” and “spontaneously”. Many of these things are what we might think of as “lucky breaks”: cases where things go well for us, even though we don’t expect them to. In Physics 2.5, Aristotle illustrates this idea with the case of a man who goes to the market for some reason unrelated to collecting a debt he is owed. While he is there, this man just so happens to (...) run into his debtor and get his money back—which is what he “wanted” all along. This case has a number of features that have proved puzzling. Most notably, Aristotle seems to think that while “it happened accidentally to him to come and to do this for the sake of getting the money”, nevertheless the man “did not come for the sake of this”—though he “would have”. What must such a proceeding be like to be described in these ways? Physics 2.4–6 makes several important moves towards answering this question. One of them—among the earliest and seemingly a foundational one—is the claim that “for the sake of something are as many things as could be done by thought and by nature”. The aim of this paper is to identify the role that this claim plays in Aristotle’s account of spontaneous proceedings. It defends two main claims. First, Aristotle’s suggestion that spontaneous proceedings could be done by nature and by thought is the product of a more general strategy. His approach is to sketch an intuitive pattern of explanation for proceedings that happen for the sake of something in the ordinary—non-spontaneous—way, and then to try to extend that model to the case of things that do so spontaneously, preserving as much of it as possible. Applying this strategy reveals that whereas nature and thought in fact function as efficient causes of ordinary proceedings that are for the sake of something, this cannot be the case in spontaneous ones. Instead, nature and thought could function as their causes. Second, I argue that Aristotle’s implementation of this strategy is rooted in his account of causation and especially Physics 2.3’s list of “modes” of causes. When he claims that spontaneous proceedings “could” be done by nature and by thought, he is saying that nature and thought are their efficient causes in capacity. In the practical case, spontaneous proceedings are caused by agents who have certain capacities, connected with their desires and abilities. In the right circumstances, these agents would actively exercise those capacities in acting for the sake of a given end. (shrink)

In this issue of the Hastings Center Report, James Sabin and his colleagues ask what responsibility investigators in a learning health organization have to patients when research—particularly research of which patients might be unaware—illuminates problematic aspects of the patients' care. Sabin and his colleagues were confronted by this question in the midst of designing a randomized controlled trial that sought to determine if an educational intervention targeted at patients with atrial fibrillation and their clinicians reduces underuse of oral anticoagulants. Worried (...) about harm that might befall patients in the control group and fearing that they would be negligent bystanders if they knew these patients were at risk and did nothing, the investigators adopted a “workaround.” But the “workaround,” I suggest, was not a solution to the negligent bystander problem. Nor was it a solution to the problem as I would alternatively frame it—how to address instances of suboptimal patient care identified through research within learning health organizations. (shrink)

The equality provision in section 15 of the Canadian Charter of Rights and Freedoms 1982 was drafted with a vision of promoting substantive equality. Following challenges to this vision during the 1990s by a group of conservative Supreme Court judges, the recent judgment of Iacobucci J in Law v Canada (1999) has been welcomed for reasserting section 15's substantive ideal. But despite the effective manner in which the provision was drafted, and despite the recent guidelines set out in Law, interpretations (...) of section 15 must continue to explore the complexities of intersectional inequalities and clarify any reliance on the ambiguous call to ‘human dignity’ if they are to maintain Canada's position near the forefront of progressive approaches to equality law. (shrink)