How does talk work, and can we engage the public in a dialogue about the scientific study of talk? This article presents a history, critical evaluation and empirical illustration of the public science of talk. We chart the public ethos of conversation analysis that treats talk as an inherently public phenomenon and its transcribed recordings as public data. We examine the inherent contradictions that conversation analysis is simultaneously obscure yet highly cited; it studies an object that people understand intuitively, yet (...) routinely produces counter-intuitive findings about talk. We describe a novel methodology for engaging the public in a science exhibition event and show how our ‘conversational rollercoaster’ used live recording, transcription and public-led analysis to address the challenge of demonstrating how talk can become an informative object of scientific research. We conclude by encouraging researchers not only to engage in a public dialogue but also to find ways to actively engage people in taking a scientific approach to talk as a pervasive, structural feature of their everyday lives. (shrink)

Ugandan smallholder farmers need to feed a growing population, but their efforts are hampered by declining soil fertility rates. Agricultural extension can facilitate farmers’ access to new practices and technologies, yet farmers are understandably often hesitant to adopt new behaviors. New knowledge assimilation is an important component of behavior change that is often overlooked or poorly addressed by current extension efforts. We implemented a Fertility Management Education Program in central Uganda to investigate smallholder farmers’ existing soil knowledge and their assimilation (...) of new scientific concepts into their knowledge framework. Qualitative data were collected through participant observation, farmer interviews, and focus groups, and coded for using a priori and emergent themes. Our exploration revealed some notable similarities between farmers’ soil knowledge and scientific concepts, particularly in regards to soil health concepts, a discovery that could facilitate communication between extension agents and farmers. However, certain scientific concepts are either unknown to farmers or discordant with existing soil knowledge; these concepts are unlikely to be assimilated by farmers without convincing and concerted extension efforts. Importantly, we found that the combination of new scientific knowledge and hands-on experimentation with novel practices gave farmers far greater confidence in implementing improved soil management practices. Our study provides evidence that extension programs should engage directly with farmers’ existing soil knowledge to develop their understanding of key biological concepts and confidence in implementing improved practices. (shrink)

Pharmaceutical companies routinely engage physicians, particularly those with prestigious academic credentials, to deliver “educational” talks to groups of physicians in the community to help market the company's brand-name drugs.Although presented as educational, and even though they provide educational content, these events are intended to influence decisions about drug selection in ways that are not based on the suitability and effectiveness of the product, but on the prestige and persuasiveness of the speaker. A number of state legislatures and most academic medical (...) centers have attempted to restrict physician participation in pharmaceutical marketing activities, though most restrictions are not absolute and have proven difficult to enforce. This article reviews the literature on why Speakers' Bureaus have become a lightning rod for academic/industry conflicts of interest and examines the arguments of those who defend physician participation. It considers whether the restrictions on Speakers' Bureaus are consistent with principles of academic freedom and concludes with the legal and institutional efforts to manage industry speaking. (shrink)

Pharmaceutical companies routinely engage physicians, particularly those with prestigious academic credentials, to deliver educational talks to groups of physicians in the community to help market the company's brand-name drugs. These speakers receive substantial compensation to lecture at events sponsored by pharmaceutical companies, a practice that has garnered attention, controversy, and scrutiny in recent years from legislators, professional associations, researchers, and ethicists on the issue of whether it is appropriate for academic physicians to serve in a promotional role. These relationships have (...) become so contentious that three years ago the pharmaceutical industry trade association, the Pharmaceutical Research and Manufacturers of America, adopted voluntary guidelines stating that drug companies should stop giving doctors free pens, calendars, sports bags, or tickets to entertainment events. Further, numerous medical associations, such as the Association of American Medical Colleges, the American Board of Internal Medicine and the Institute on Medicine as a Profession, and government bodies such as the Institute of Medicine have recommended that medical schools and teaching hospitals prohibit or strongly discourage faculty from participating in so-called industry Speakers Bureaus — promotional events designed solely to market pharmaceutical products. (shrink)

Dispositional forgiveness is positively associated with many facets of wellbeing and has protective implications against depression and anxiety in adolescents. However, little work has been done to examine neurobiological aspects of forgiveness as they relate to clinical symptoms. In order to better understand the neural mechanisms supporting the protective role of forgiveness in adolescents, the current study examined the middle frontal gyrus, which comprises the majority of the dorsolateral prefrontal cortex and is associated with cognitive regulation, and its relationship to (...) forgiveness and clinical symptoms in a sample of healthy adolescents. In this cross-sectional study, larger MFG volume was significantly associated with higher self-reported dispositional forgiveness scores and lower levels of depressive and anxiety symptoms. Forgiveness mediated the relationship between MFG volume and both depressive and anxiety symptom levels. The mediating role of forgiveness in the relationship between MFG volume and clinical symptoms suggests that one way that cognitive regulation strategies supported by this brain region may improve adolescent mental health is via increasing a capacity for forgiveness. The present study highlights the relevance of forgiveness to neurobiology and their relevance to emotional health in adolescents. Future longitudinal studies should focus on the predictive quality of the relationship between forgiveness, brain volume and clinical symptoms and the effects of forgiveness interventions on these relationships. (shrink)

BackgroundThe evolution of the female orgasm in humans and its role in romantic relationships is poorly understood. Whereas the male orgasm is inherently linked to reproduction, the female orgasm is not linked to obvious reproductive or survival benefits. It also occurs less consistently during penetrative sex than does the male orgasm. Mate-choice hypotheses posit that the wide variation in female orgasm frequency reflects a discriminatory mechanism designed to select high-quality mates.ObjectiveWe aimed to determine whether women report that their orgasm frequency (...) varies between partners, whether this variation reflects mates' personal characteristics, and whether this variation reflects own and partner sexual behaviour during intercourse.DesignWe collected survey data from 103 women who rated the extent to which their orgasm frequency varied between partners, the characteristics of previous sexual partners who induced high-orgasm frequency and those who induced low-orgasm frequency,... (shrink)

Aesthetics plays an important role in environmental conservation. In this paper, I pin down two key concepts for understanding this role, aesthetic character and aesthetic integrity. Aesthetic character describes the particularity of an environment based on its aesthetic and nonaesthetic qualities. In the first part, I give an account of aesthetic character through a discussion of its subjective and objective bases, and I argue for an awareness of the dynamic nature of this character. In the second part, I consider aesthetic (...) character in a conservation context. I develop the diachronic concept of aesthetic integrity to guide decisions about how to manage change to aesthetic character. My argument is illustrated with a case study of the proposal for a superquarry on the remote isle of Harris in Scotland. (shrink)

Aesthetics plays an important role in environmental conservation. In this paper, I pin down two key concepts for understanding this role, aesthetic character and aesthetic integrity. Aesthetic character describes the particularity of an environment based on its aesthetic and nonaesthetic qualities. In the first part, I give an account of aesthetic character through a discussion of its subjective and objective bases, and I argue for an awareness of the dynamic nature of this character. In the second part, I consider aesthetic (...) character in a conservation context. I develop the diachronic concept of aesthetic integrity to guide decisions about how to manage change to aesthetic character. My argument is illustrated with a case study of the proposal for a superquarry on the remote isle of Harris in Scotland. (shrink)

Literature is recognised as having significantly influenced the development of modern psychoanalytic thought. In recent years psychoanalysis has drawn increasingly on the literary and artistic traditions of western culture and moved away from its original medical–scientific context. Originally published in 1991 _The Chamber of Maiden Thought _ is an original and revealing exploration of the seminal role of literature in forming the modern psychoanalytic model of the mind. The crux of the 'post-Kleinian' psychoanalytic view of personality development lies in the (...) internal relations between the self and the mind's 'objects'. Meg Harris Williams and Margot Waddell show that these relations have their origins in the drama of identifications which we can see played out metaphorically and figuratively in literature, which presents the self-creative process in aesthetic terms. They argue that psychoanalysis is a true child of literature rather than merely the interpreter or explainer of literature, illustrating this with some examples from clinical experience, but drawing above all on close scrutiny of the dynamic mental processes presented in the work of Shakespeare, Milton, the Romantic poets, Emily Bronte and George Eliot. _The Chamber of Maiden Thought_ will encourage psychoanalytic workers to respond to the influence of literature in exploring symbolic mental processes. By bringing psychoanalysis into creative conjunction with the arts, it enables practitioners to tap a cultural potential whose insights into the human mind are of immense value. (shrink)

Literature is recognised as having significantly influenced the development of modern psychoanalytic thought. In recent years psychoanalysis has drawn increasingly on the literary and artistic traditions of western culture and moved away from its original medical–scientific context. Originally published in 1991 _The Chamber of Maiden Thought _ is an original and revealing exploration of the seminal role of literature in forming the modern psychoanalytic model of the mind. The crux of the 'post-Kleinian' psychoanalytic view of personality development lies in the (...) internal relations between the self and the mind's 'objects'. Meg Harris Williams and Margot Waddell show that these relations have their origins in the drama of identifications which we can see played out metaphorically and figuratively in literature, which presents the self-creative process in aesthetic terms. They argue that psychoanalysis is a true child of literature rather than merely the interpreter or explainer of literature, illustrating this with some examples from clinical experience, but drawing above all on close scrutiny of the dynamic mental processes presented in the work of Shakespeare, Milton, the Romantic poets, Emily Bronte and George Eliot. _The Chamber of Maiden Thought_ will encourage psychoanalytic workers to respond to the influence of literature in exploring symbolic mental processes. By bringing psychoanalysis into creative conjunction with the arts, it enables practitioners to tap a cultural potential whose insights into the human mind are of immense value. (shrink)

This introductory article to the thematic section on “Spiritual Intelligence” sets out the ways in which spiritual intelligence is currently conceptualized. Most prominently, spiritual intelligence is understood as an adaptive intelligence which enables people to develop their values, vision, and capacity for meaning. Questions arise as to whether spiritual intelligence is a distinct form of intelligence, and how to frame it if it is. It is questionable whether psychometric approaches justify concluding there is a distinct spiritual intelligence, and the authors (...) reject any notion of a God spot in the brain specifically dedicated to spiritual intelligence, which is a much more broadly embodied phenomenon. The authors suggest that spiritual intelligence most likely makes use of existing cognitive architecture, though applied in a distinctive way. This article finishes with a brief introduction to the four main articles in this thematic section, which present spiritual intelligence as a kind of participation in transcendent being. The four articles approach the cognitive, embodied, meditative, and ritual aspects of spiritual intelligence as participation. (shrink)

This article explores three aspects of Masterman's language work and applies them to questions of spiritual intelligence: metaphor, coherence, and ambiguity. First, metaphor, which is ubiquitous in ordinary language, both leads and misleads in religious and scientific understanding. Masterman's case for a “dual-approach” to thinking, both speculative and critical, is explored and tied to concepts of moral-spiritual development per Pierre Hadot and Hannah Arendt. Second, Masterman's work on machine translation presents semantic disambiguation as an emerging coherence wherein one gradually hones (...) in on meaning through features of ordinary language (like redundancy and repetition). This is applied to the problem of comprehending difficult spiritual language, and tied to spiritual stretching and spiritual cartography. Third, Masterman's work with thesauri, rather than relying on words as having fixed meanings, appeals to a concept of semantic spaces, nebulae of variously interconnected meanings. This is constructed into an exhortation to reambiguate overfamiliar religious language, to reinvest one's quotidian surroundings with spiritual meaning through defamilarization. (shrink)

An argument that moral functioning is immeasurably complex, mediated by biology but not determined by it. Throughout history, humanity has been seen as being in need of improvement, most pressingly in need of moral improvement. Today, in what has been called the beginnings of “the golden age of neuroscience,” laboratory findings claim to offer insights into how the brain “does” morality, even suggesting that it is possible to make people more moral by manipulating their biology. Can “moral bioenhancement”—using technological or (...) pharmaceutical means to boost the morally desirable and remove the morally problematic—bring about a morally improved humanity? In The Myth of the Moral Brain, Harris Wiseman argues that moral functioning is immeasurably complex, mediated by biology but not determined by it. Morality cannot be engineered; there is no such thing as a “moral brain.” Wiseman takes a distinctively interdisciplinary approach, drawing on insights from philosophy, biology, theology, and clinical psychology. He considers philosophical rationales for moral enhancement, and the practical realities they come up against; recent empirical work, including studies of the cognitive and behavioral effects of oxytocin, serotonin, and dopamine; and traditional moral education, in particular the influence of religious thought, belief, and practice. Arguing that morality involves many interacting elements, Wiseman proposes an integrated bio-psycho-social approach to the consideration of moral enhancement. Such an approach would show that, by virtue of their sheer numbers, social and environmental factors are more important in shaping moral functioning than the neurobiological factors with which they are interwoven. (shrink)

Selective serotonin reuptake inhibitors (SSRIs) have gained a degree of prominence across recent moral enhancement literature as a possible intervention for dealing with antisocial and aggressive impulses. This is due to serotonin's purported capacity to modulate persons’ averseness to harm. The aim of this article is to argue that the use of SSRIs is not something worth getting particularly excited about as a practicable intervention for moral enhancement purposes, and that the generally uncritical enthusiasm over serotonin's potential as a moral (...) enhancer is a consequence of the paucity of viable options for envisaging practicable moral enhancement interventions. While there are many conceptual issues raised by the idea of moral enhancement generally, and by the idea of serotonin as a morally affective agent, the aim here is to look at practical concerns. It is argued that SSRIs do not, nor cannot in the reasonably foreseeable future, be made to work as a reliably safe or reliably effective means for moral enhancement, even within the very limited remit of treating “reactive” aggression. SSRIs might be effective as a limited and partial mental health intervention (even this is questionable), but not as a generally effective moral enhancement technology. (shrink)

There is a popular and widely accepted version of the precautionary principle which may be expressed thus: “If you are in a hole—stop digging!”. Tom Baldwin, as Deputy Chair of the Human Fertilisation and Embryology Authority , may be excused for rushing to the defence of the indefensible,1 the HFEA’s sex selection report,2 but not surely for recklessly abandoning so prudent a principle. Baldwin has many complaints about my misrepresenting the HFEA and about my supposed elitist contempt for public opinion; (...) readers of this exchange will decide for themselves.REDRAFTING THE REPORTBaldwin begins with a piece of wishful thinking:"Harris objects that in this recommendation “an absurdly high standard of caution is employed”, since a theoretical risk is associated with almost all medical procedures. This objection is misplaced: as paragraph 142 of the report indicates, the phrase “theoretical risk” is to be understood here in the light of the earlier discussion of the risks arising from the fact that flow cytometry exposes sperm to laser energy, a procedure which is known to be liable to damage DNA."Paragraph 142 does not make that clear. It does indeed refer back to a set of earlier paragraphs but these give, if anything, an upbeat assessment of the safety of flow cytometry. Paragraph 121 states: “However whilst potentially less intrusive, and with potentially lower risk to the health of patients, flow cytometry …” .2 But even if the overall burden of the report does indicate unresolved fears, the standard is still absurdly high. However, so far from endorsing the report’s judgement that flow cytometry has “potentially lower risk to the health of patients”, Baldwin now regards the risk of flow cytometry as “serious”1:"Since the application of flow cytometry to humans is a new procedure, the risk of … ". (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 article explores an aspect of spiritual intelligence characterized as a lifelong search for meaning. Slow knowing involves wrestling with perplexity. Periods of such tarrying gradually facilitate an unfolding of meaning. More than just the content of one's knowledge, it is the relationship, the how or manner of one's relationship with meaning that grounds the spiritual generativity of the seeking. Slow knowing is presented as an existential orientation, a lifelong process akin to ongoing conversion. Part 1 distinguishes such slow knowing (...) from other senses of slow in current discourse (Kahneman's fast/slow thinking framework, and meditative concepts of slow mind). Part 2 explores slow knowing through the lenses of lectio divina and the use of metaphor in religious language. Slow knowing is characterized as having both individual and social dimensions. The article concludes with the concern that the conditions needed for slow knowing—and thus for spiritual intelligence—are undermined by the hasty pace of contemporary life. (shrink)

The article explores the interaction of verbal and nonverbal semantic levels in the performance of Christian ritual. The article maps the distinction between theoretical and performative knowledge onto Barnard and Teasdale's Interacting Cognitive Systems model to give a (partial) account of how meaning emerges in ritual participation. With Christian ritual, both know-how and know-that are needed. Above all, it is their interaction that generate the richness of meaning in ritual performance. Three core claims are made. First, many contemporary concepts of (...) ritual have at least one flaw in that they do not grasp the relationality between verbal and nonverbal, wherein both dimensions have a semantic integrity of their own. Second, there is an ideological valuation of the semantic levels. The experiential level is not only meaningful in its own right, but the fundamental ground of spiritual knowing. Third, combining learning styles and kinds of attention can be valuable for eliciting the full semantic richness of ritual participation. (shrink)

:The term “moral bioenhancement” conceals a diverse plurality encompassing much potential, some elements of which are desirable, some of which are disturbing, and some of which are simply bland. This article invites readers to take a better differentiated approach to discriminating between elements of the debate rather than talking of moral bioenhancement “per se,” or coming to any global value judgments about the idea as an abstract whole. Readers are then invited to consider the benefits and distortions that come from (...) the usual dichotomies framing the various debates, concluding with an additional distinction for further clarifying this discourse qua explicit/implicit moral bioenhancement. (shrink)

the philebus is a puzzling dialogue, both for the substantive views it puts forward,1 and for the unexpected twists and turns of the discussion. Commentators frequently complain about the dialogue's lack of unity, due to its many apparently unnecessary digressions and interruptions.2 The discussion of the so-called 'divine method' seems to be one of the worst offenders on this score, for it is described and exemplified at length, only to be set aside as unnecessary shortly afterwards.I argue that the divine (...) method plays a vital role in the subsequent examination and evaluation of pleasure and knowledge. I focus in particular on the application of the divine method to pleasure, since the method is... (shrink)

Some individuals facing dementia contemplate hastening their own death: weighing the possibility of living longer with dementia against the alternative of dying sooner but avoiding the later stages of cognitive and functional impairment. This weighing resonates with an ethical and legal consensus in the United States that individuals can voluntarily choose to forgo life‐sustaining interventions and also that medical professionals can support these choices even when they will result in an earlier death. For these reasons, whether and how a terminally (...) ill individual can choose to control the timing of their death is a topic that cannot be avoided when considering the dementia trajectory. With a focus on the U.S. context, this landscape review considers the status of provisions that would legally permit people facing dementia to hasten death with appropriate support from medical professionals. This review can be used to plan and guide clinical and legal practitioner discussion and policy development concerning evolving questions not fully covered by existing medical decision‐making provisions. (shrink)

ArgumentMost social scientists today think of data sharing as an ethical imperative essential to making social science more transparent, verifiable, and replicable. But what moved the architects of some of the U.S.’s first university-based social scientific research institutions, the University of Michigan’s Institute for Social Research, and its spin-off, the Inter-university Consortium for Political and Social Research, to share their data? Relying primarily on archived records, unpublished personal papers, and oral histories, I show that Angus Campbell, Warren Miller, Philip Converse, (...) and others understood sharing data not as an ethical imperative intrinsic to social science but as a useful means to the diverse ends of financial stability, scholarly and institutional autonomy, and epistemological reproduction. I conclude that data sharing must be evaluated not only on the basis of the scientific ideals its supporters affirm, but also on the professional objectives it serves. (shrink)

The panic occasioned by the birth of Dolly sent international and national bodies and their representatives scurrying for principles with which to allay imagined public anxiety. It is instructive to note that principles are things of which such people and bodies so often seem to be bereft. The search for appropriate principles turned out to be difficult since so many aspects of the Dolly case were unprecedented. In the end, some fascinating examples of more or less plausible candidates for the (...) status of moral principles were identified; central to many of them is the idea of human dignity and how it might be affected by human mitotic reproduction. (shrink)

This paper argues that the HFEA’s recent report on sex selection abdicates its responsibility to give its own authentic advice on the matters within its remit, that it accepts arguments and conclusions that are implausible on the face of it and where they depend on empirical claims, produces no empirical evidence whatsoever, but relies on reckless speculation as to what the “facts” are likely to be. Finally, having committed itself to what I call the “democratic presumption”, that human freedom will (...) not be constrained unless very good and powerful reasons can be produced to justify such infringement of liberty, the HFEA simply reformulates the democratic presumption as saying the opposite—namely that freedom may only be exercised if powerful justifications are produced for any exercise of liberty. (shrink)

Most research on the corporate philanthropy of organizations has focused on the external benefits of such initiatives for firms, such as benefits for firm reputation and opportunities. However, many firms justify their giving, in part, due to the positive impact it has on their employees. Little is known about the effectiveness of such efforts, or how they can be managed strategically to maximize impact. We hypothesize a main effect of office-level corporate philanthropy on average employee attitudes in that office, but (...) also investigate three strategies that offices may use to enhance this impact. Testing our hypotheses with 3 years of data on attitudes of an average of 14,577 employees in 53 offices we find support for the main effect, but mixed support for the specific strategies used to enhance impact. (shrink)

With the normative demand to attend to social difference and an absence of universal evaluative terms with which to do so, recent theory has increasingly turned to the study of the affective rather than epistemological conditions of ethical encounter. This I call a “dispositional ethics” that construes responsibility as responsiveness. Recent articulations of such an ethics, notably in the most current work of Judith Butler, James Tully, Jade Larissa Schiff, and Ella Myers, highlight its connection to situated practices of concrete (...) bodies-in-relation, but often stop short of developing an account of what such embodied practices might be. Based on interviews with thirteen experts who take the body as their primary vocational and intellectual field and characterize their practice as an art of listening, I distinguish three dimensions of a dispositional ethics in practice and some of the specific strategies available to cultivate the conditions for responsiveness in political life. (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)

Today, DIY -- do-it-yourself -- describes more than self-taught carpentry. Social media enables DIY citizens to organize and protest in new ways and to repurpose corporate content in order to offer political counternarratives. This book examines the usefulness and limits of DIY citizenship, exploring the diverse forms of political participation and "critical making" that have emerged in recent years. The authors and artists in this collection describe DIY citizens whose activities range from activist fan blogging and video production to knitting (...) and the creation of community gardens. Contributors examine DIY activism, describing new modes of civic engagement that include Harry Potter fan activism and the activities of the Yes Men. They consider DIY making in learning, culture, hacking, and the arts, including do-it-yourself media production and collaborative documentary making. They discuss DIY and design and how citizens can unlock the black box of technological infrastructures to engage and innovate open and participatory critical making. And they explore DIY and media, describing activists' efforts to remake and reimagine media and the public sphere. As these chapters make clear, DIY is characterized by its emphasis on "doing" and making rather than passive consumption. DIY citizens assume active roles as interventionists, makers, hackers, modders, and tinkerers, in pursuit of new forms of engaged and participatory democracy. _Contributors_Mike Ananny, Chris Atton, Alexandra Bal, Megan Boler, Catherine Burwell, Red Chidgey, Andrew Clement, Negin Dahya, Suzanne de Castell, Carl DiSalvo, Kevin Driscoll, Christina Dunbar-Hester, Joseph Ferenbok, Stephanie Fisher, Miki Foster, Stephen Gilbert, Henry Jenkins, Jennifer Jenson, Yasmin B. Kafai, Ann Light, Steve Mann, Joel McKim, Brenda McPhail, Owen McSwiney, Joshua McVeigh-Schultz, Graham Meikle, Emily Rose Michaud, Kate Milberry, Michael Murphy, Jason Nolan, Kate Orton-Johnson, Kylie A. Peppler, David J. Phillips, Karen Pollock, Matt Ratto, Ian Reilly, Rosa Reitsamer, Mandy Rose, Daniela K. Rosner, Yukari Seko, Karen Louise Smith, Lana Swartz, Alex Tichine, Jennette Weber, Elke Zobl. (shrink)

A retired manager and university teacher reflects on global ethics, on the purpose of life, and on the challenges facing global ethics in a contemporary world where there is no certainty about shared belief or shared values. The future lies, he concludes, with process and with a deeper understanding of one another.

Correspondence to: John Harris The Centre for Social Ethics and Policy, Institute of Medicine Law and Bioethics, School of Law, University of Manchester, Williamson Building, Oxford Road, Manchester M13 0JH, UK; john.m.harris@man.ac.ukClaxton and Culyer1 have written an interesting and considered response, as people intimately connected to the National Institute for Health and Clinical Excellence , to the two editorials that I wrote on recent NICE decisions. Before commenting on their response, I would like to consider a point they (...) made, which echoes a point already made by Rawlins and Dillon,2 about the tone of my editorials. Claxton and Culyer accuse me of making “personally abusive charges”. In my original editorial, I criticised an institution, NICE, in robust terms, but in doing so I was continuing a long and respected tradition in English philosophy. Consider the following extract from Jeremy Bentham:" In English law, fiction is a syphilis, which runs in every vein, and carries into every part of the system the principle of rottenness...Fiction of use to justice? Exactly as swindling is to trade...It affords presumptive and conclusive evidence of moral turpitude in those by whom it was invented and first employed.3"My remarks were not an ad hominem criticism of anyone but directed at the published, but anonymous statements of an institution—a body corporate. In robustly criticising NICE, I no more attacked any individual associated with NICE than I attacked Tony Blair or the various ministers of state who are ultimately responsible for NICE. And, contra Claxton and Culyer’s claims, I have not denigrated the views of people who beg to differ from me.i If the apologists for NICE, whether they are Tony Culyer or Tony Blair, choose to identify themselves with criticism of NICE, that is entirely a matter for them. The only ad hominem remarks in this entire exchange have been made by Rawlins and Dillon, and Claxton and Culyer. The idea that criticism of the anonymously authored publications of …. (shrink)

NICE must not say people are not worth treatingThe National Institute for Health and Clinical Excellence has proposed that drugs for the treatment of dementia be banned to National Health Service patients on the grounds that their cost is too high and “outside the range of cost effectiveness that might be considered appropriate for the NHS”i.1This is despite NICE’s admission that these drugs are effective in the treatment of Alzheimer’s disease and despite NICE having approved even more expensive treatments. The (...) effect is that thousands of Alzheimer’s patients will be denied the only treatment available. It is difficult to think of this as anything but wickedness or folly or more likely both. At the same time, and with no apparent sense of irony, NICE has launched a public consultation document3 on its guidelines on social value judgments. As we shall see these guidelines are ethically illiterate as well as socially divisive.Assuming permanently scarce resources it is clearly crucial that such healthcare resources as are available are not wasted. This point is often made in terms of cost effectiveness and it is argued, not implausibly, that to talk of cost effectiveness implies that we are able to measure just how cost effective each treatment is. To do so of course we need a standard of measurement. NICE has adopted the ubiquitous, but justly infamous QALY, the Quality Adjusted Life Year.The QALY combines life expectancy after treatment with measures of the expected quality of that life. There are two ways in which QALYS can be used. They might be used to determine which of rival therapies to give to a particular patient or which procedure to use to treat a particular condition, in short which of two different treatments is the more …. (shrink)