The authors are members of the British Association Committee on Social Concern and Biological Advances. Following earlier discussions of legal and social problems arising from certain medical advances, they undertook, independently, to examine the Law Commission's study.

In his famous 1982 paper, Allen Newell [22, 23] introduced the notion of knowledge level to indicate a level of analysis, and prediction, of the rational behavior of a cognitive arti cial agent. This analysis concerns the investigation about the availability of the agent knowledge, in order to pursue its own goals, and is based on the so-called Rationality Principle (an assumption according to which "an agent will use the knowledge it has of its environment to achieve its goals" [22, (...) p. 17]. By using the Newell's own words: "To treat a system at the knowledge level is to treat it as having some knowledge, some goals, and believing it will do whatever is within its power to attain its goals, in so far as its knowledge indicates" [22, p. 13]. In the last decades, the importance of the knowledge level has been historically and system- atically downsized by the research area in cognitive architectures (CAs), whose interests have been mainly focused on the analysis and the development of mechanisms and the processes governing human and (arti cial) cognition. The knowledge level in CAs, however, represents a crucial level of analysis for the development of such arti cial general systems and therefore deserves greater research attention [17]. In the following, we will discuss areas of broad agree- ment and outline the main problematic aspects that should be faced within a Common Model of Cognition [12]. Such aspects, departing from an analysis at the knowledge level, also clearly impact both lower (e.g. representational) and higher (e.g. social) levels. (shrink)

Reconstructive allografts using Vascularized Composite Allotransplantation are providing individuals living with upper limb loss and facial disfigurement with new opportunities for a sensate, esthetically acceptable, and functional alternative to current treatment strategies. Important research attention is being paid to how best to assess and screen candidates for VCA, measure optimal patient outcomes, and support patient adherence to lifelong behaviors and medical regimens. Far less attention, however, has been dedicated to the team science required for these complex VCA teams to form, (...) prepare, and provide the highest quality clinical and psychosocial care to those receiving VCA. VCA teams are unique in that they require specialized team members whose scope of practice may not otherwise overlap. The team also needs to constantly negotiate balancing patient safety with multiple risks throughout the transplant process. This study aimed to elucidate the team science needed for this highly innovative and complex area of medicine. Using in-depth qualitative interviews with 14 VCA team members and observations at team meetings, we found that careful consideration of team composition, team structure, and organizational commitment influences team performance and patient outcomes, but that to be efficient and truly effective, teams need to commit to developing processes that foster collaboration. These processes are action-oriented, strategic and interpersonal. Dedication and commitment to team science allows teams to manage conflict under stress and exercise ways to leverage strengths to provide optimal performance or patient psychosocial and clinical outcomes. This study can provide insight into quality improvement efforts for VCA teams and guidance for other transplant programs that wish to consider expansion into VCA. (shrink)

Heterogeneity within MDD has hampered identification of biological markers (e.g., intermediate phenotypes, IPs) that might increase risk for the disorder or reflect closer links to the genes underlying the disease process. The newer characterizations of dimensions of MDD within Research Domain Criteria (RDoC) domains may align well with the goal of defining IPs. We compare a sample of 25 individuals with MDD compared to 29 age and education matched controls in multimodal assessment. The multimodal RDoC assessment included the primary IP (...) biomarker, positron emission tomography (PET) with a selective radiotracer for 5-HT1A ([11C]WAY-100635), as well as event-related functional MRI with a Go/No-go task targeting the Cognitive Control network, neuropsychological assessment of affective perception, negative memory bias and Cognitive Control domains. There was also an exploratory genetic analysis with the serotonin transporter (5-HTTLPR) and monamine oxidase A (MAO-A) genes. In regression analyses, lower 5-HT1A binding potential (BP) in the MDD group was related to diminished engagement of the Cognitive Control network, slowed resolution of interfering cognitive stimuli, one element of Cognitive Control. In contrast, higher/normative levels of 5-HT1A BP in MDD (only) was related to a substantial memory bias toward negative information, but intact resolution of interfering cognitive stimuli and greater engagement of Cognitive Control circuitry. The serotonin transporter risk allele was associated with lower 1a BP and the corresponding imaging and cognitive IPs in MDD. Lowered 5HT 1a BP was present in half of the MDD group relative to the control group. Lowered 5HT 1a BP may represent a subtype including decreased engagement of Cognitive Control network and impaired resolution of interfering cognitive stimuli. Future investigations might link lowered 1a BP to neurobiological pathways and markers, as well as probing subtype-specific treatment targets. (shrink)

ObjectiveTo compare techniques for computing clustering and switching scores in terms of agreement, correlation, and empirical value as predictors of incident cognitive impairment.MethodsWe transcribed animal and letter F fluency recordings on 640 cases of ICI and matched controls from a national epidemiological study, amending each transcription with word timings. We then calculated clustering and switching scores, as well as scores indexing speed of responses, using techniques described in the literature. We evaluated agreement among the techniques with Cohen’s κ and calculated (...) correlations among the scores. After fitting a base model with raw scores, repetitions, and intrusions, we fit a series of Bayesian logistic regression models adding either clustering and switching scores or speed scores, comparing the models in terms of several metrics. We partitioned the ICI cases into acute and progressive cases and repeated the regression analysis for each group.ResultsFor animal fluency, we found that models with speed scores derived using the slope difference algorithm achieved the best values of the Watanabe–Akaike Information Criterion, but with good net reclassification improvement only for the progressive group. For letter fluency, different models excelled for prediction of acute and progressive cases. For acute cases, NRI was best for speed scores derived from a network model, while for progressive cases, the best model used clustering and switching scores derived from the same network model. Combining variables from the best animal and letter F models led to marginal improvements in model fit and NRI only for the all-cases and acute-cases analyses.ConclusionSpeed scores improve a base model for predicting progressive cognitive impairment from animal fluency. Letter fluency scores may provide complementary information. (shrink)

This Element takes a deep dive into Gödel's 1931 paper giving the first presentation of the Incompleteness Theorems, opening up completely passages in it that might possibly puzzle the student, such as the mysterious footnote 48a. It considers the main ingredients of Gödel's proof: arithmetization, strong representability, and the Fixed Point Theorem in a layered fashion, returning to their various aspects: semantic, syntactic, computational, philosophical and mathematical, as the topic arises. It samples some of the most important proofs of the (...) Incompleteness Theorems, e.g. due to Kuratowski, Smullyan and Robinson, as well as newer proofs, also of other independent statements, due to H. Friedman, Weiermann and Paris-Harrington. It examines the question whether the incompleteness of e.g. Peano Arithmetic gives immediately the undecidability of the Entscheidungsproblem, as Kripke has recently argued. It considers set-theoretical incompleteness, and finally considers some of the philosophical consequences considered in the literature. (shrink)

This collection, the first of its kind, brings together specially commissioned academic essays to mark fifty years since the death of John Kennedy Toole.

This article argues that children represent one vanguard of an emergent shift in Western subjectivity, and that adult-child dialogue, especially in the context of schooling, is a key locus for the epistemological change that implies. Following Herbert Marcuse's invocation of a ‘new sensibility’, the author argues that the evolutionary phenomenon of neoteny—the long formative period of human childhood and the pedomorphic character of humans across the life cycle—makes of the adult-collective of school a primary site for the reconstruction of belief. (...) After exploring child-adult dialogue more broadly as a form of dialectical interaction between what Dewey called ‘impulse’ and ‘habit’, three key dimensions of dialogic schooling are identified, all of which are grounded in a fourth: the form of dialogical group discourse called community of philosophical inquiry (CPI), which is based on the problematisation and reconstruction of concepts through critical argumentation. As a discourse-model, CPI grounds practice in all of the dialogic school's emergent curricular spaces, whether science, mathematics, literature, art, or philosophy. Second, it opens a functional space for shared decision-making and collaborative governance, making of school an exemplary model of direct democracy. Finally, CPI as a site for critical interrogation of concepts encountered in the curriculum (e.g. ‘alive’, ‘justice’, ‘system’, ‘biosphere’) and as a site for democratic governance leads naturally to expression in activist projects that model an emergent ‘new reality principle’ through concrete solutions to practical problems on local and global levels. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Books ReceivedThe Ambitions of Curiosity: Understanding the World in Ancient Greece and China. By G.E.R. Lloyd. Cambridge: Cambridge University Press, 2002. Pp. xvi + 175. Price not given.The Art of the Han Essay: Wang Fu's Ch'ien-Fu Lun. By Anne Behnke Kinney. Tempe: Center for Asian Studies, Arizona State University, 1990. Pp. xi + 154. Paper $10.00.The Autobiography of Jamgön Kongtrul: A Gem of Many Colors. By Jamgön Kongtrul Lodrön (...) Thayé and translated by Richard Barron (Chökyi Nyima). Ithaca, New York: Snow Lion Publications, 2003. Pp. xxii + 549. Price not given.Awesome Nightfall: The Life, Times, and Poetry of Saigyō. By William R. LaFleur. Boston: Wisdom Publications, 2003. Pp. xiii + 173. Paper $14.95.Becoming the Compassion Buddha: Tantric Mahamudra for Everyday Life. By Lama Thubten Yeshe, edited by Robina Courtin, and foreword by Geshe Lhundub Sopa. Boston: Wisdom Publications, 2003. Pp. xi + 194. Paper $14.95.Between Two Worlds East and West: An Autobiography. By J. N. Mohanty. New Delhi: Oxford University Press, 2002. Pp. ix + 134. Hardcover RS 525.00.The Chinese Face of Jesus Christ. Edited by Roman Malek, S.V.D. Sankt Augustin, Germany: Institut Monumenta Serica and China-Zentrum; and Nettetal, Germany: Steyler Verlag, 2002. Pp. 391. EUR 40.00.Chinese Medicine in Contemporary China: Plurality and Synthesis. By Volker Scheid. Durham and London: Duke University Press, 2002. Pp. xiv + 407. Hardcover $69.95. Paper $23.95.Confucian Feminist: Memoirs of Zeng Baosun (1893-1978). Translated and adapted by Thomas L. Kennedy. Philadelphia: American Philosophical Society, 2002. Pp. xxi + 170. Price not given.Consciousness Studies: Cross-Cultural Perspectives. By K. Ramakrishna Rao. Jefferson (North Carolina) and London: McFarland and Company, 2002. Pp. 367. Hardcover $65.00.Constituting Communities: Theravāda Buddhism and the Religious Cultures of South and Southeast Asia. Edited by John Clifford Holt, Jacob N. Kinnard, and Jonathan S. Walters. Albany: State University of New York Press, 2003. Pp. viii + 224. Hardcover $65.50. Paper $21.95.Developments in Indian Philosophy from Eighteenth Century Onwards: Classical and Western. By Daya Krishna. Volume X Part 1 of History of Science, Philosophy and Culture in Indian Civilization, edited by D. P. Chattopadhyaya. New [End Page 110] Delhi: Centre for Studies in Civilizations, 2001. Pp. xxiii + 417. Hardcover RS 1200.East and West: Identità e dialogo interculturale. By Giangiorgio Pasqualotto. Venezia: Marsilo Editori, 2003. Pp. 210. EUR 16.00.Effortless Action: Wu-wei as Conceptual Metaphor and Spiritual Ideal in Early China. By Edward Slingerland. New York: Oxford University Press, 2003. Pp. xii + 352. Price not given.Encountering Kā lī: In the Margins, at the Center, in the West. Edited by Rachel Fell McDermott and Jeffrey J. Kripal. Berkeley and Los Angeles: University of California Press, 2003. Pp. xviii + 321. Hardcover $55.00, £37.95. Paper $21.95, £15.95.Encyclopedia of Chinese Philosophy. Edited by Antonio S. Cua. New York and London: Routledge, 2003. Pp. xx + 1020. Hardcover $150.00.Essays on Indian Philosophy. By J. N. Mohanty and edited by Purushottama Bilimoria. New Delhi: Oxford University Press, 2002. Pp. xxxvii + 347. Paper RS 525.00.Faith, Humor, and Paradox. By Ignacio L. Götz. Westport, Connecticut: Praeger Publishers, 2002. Pp. 136. Hardcover $61.95.Four Illusions: Candrakīrti's Advice for Travelers on the Bodhisattva Path. Translated by Karen C. Lang. New York: Oxford University Press, 2003. Pp. xv + 240. Price not given.The Great Awakening: A Buddhist Social Theory. By David R. Loy. Boston: Wisdom Publications, 2003. Pp. 223. Paper $16.95.The Hidden History of The Tibetan Book of the Dead. By Bryan J. Cuevas. New York: Oxford University Press, 2003. Pp. xi + 328. Price not given.Huang Di nei jing su wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. By Paul U. Unschuld. Berkeley and Los Angeles: University of California Press, 2003. Pp. xii + 520. Hardcover $75.00, £52.00.In Dewey's Wake: Unfinished Work of Pragmatic Reconstruction. Edited by William J. Gavin. Albany: State University of New York Press, 2003. Pp. vi + 249. Hardcover $71.50. Paper $23.95.Knowledge and Freedom in Indian Philosophy. By Tara Chatterjea. Lanham, Maryland: Lexington Books, 2002. Pp. xvi + 159. Hardcover... (shrink)

Moral enhancement is an ostensibly laudable project. Who wouldn’t want people to become more moral? Still, the project’s approach is crucial. We can distinguish between two approaches for moral enhancement: direct and indirect. Direct moral enhancements aim at bringing about particular ideas, motives or behaviors. Indirect moral enhancements, by contrast, aim at making people more reliably produce the morally correct ideas, motives or behaviors without committing to the content of those ideas, motives and/or actions. I will argue, on Millian grounds, (...) that the value of disagreement puts serious pressure on proposals for relatively widespread direct moral enhancement. A more acceptable path would be to focus instead on indirect moral enhancements while staying neutral, for the most part, on a wide range of substantive moral claims. I will outline what such indirect moral enhancement might look like, and why we should expect it to lead to general moral improvement. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President’s Council on Bioethics*Franklin G. Miller** (bio) and Robert D. Truog (bio)Traditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes in (...) the second half of the twentieth century prompted calls for a new, or at least expanded, definition of death: the development of intensive care medicine, especially the use of mechanical ventilators, and the advent of successful transplantation of vital organs. Patients with profound neurological damage, leaving them incapable of breathing on their own and in an irreversible coma, could be maintained for some period of time with the aid of mechanical ventilation. The situation of these patients posed two ethical questions. Is it appropriate to stop life-sustaining treatment? If so, is it acceptable to retrieve vital organs for transplantation to save the lives of others before stopping treatment?In 1968, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed that death could be determined on the basis of neurological criteria, thus providing a positive answer to these two questions (Ad Hoc Committee 1968). According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation. [End Page 185] Because they are dead, it is appropriate, indeed imperative, to stop mechanical ventilation. And because they are dead, it becomes ethical to procure vital organs for transplantation before stopping what otherwise would be life-sustaining treatment. Remarkably, this innovative neurological determination of death became, with little debate or controversy, the established position in medical ethics and the law throughout the United States.The Harvard Committee articulated the diagnosis of “irreversible coma,” but merely asserted that this condition constituted death. No explanatory rationale was provided. It fell to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research to provide an authoritative rationale in its 1981 report, Defining Death. The second paragraph of the report set the stage as follows: “The question addressed here is not inherently difficult or complicated. Simply, it is whether the law ought to recognize new means for establishing that the death of a human being has occurred” (President’s Commission 1981, p. 3). The Commission claimed that “death is a unitary phenomenon” (p. 7) and that the determination of death by neurological criteria, in terms of the absence of all brain function, is consistent with the traditional conception of death as the cessation of vital functioning of the organism as a whole. The key issue is the integrative functioning of the human organism, which ceases to exist, according to the Commission, when the whole brain, including higher cortical areas and the brain stem, fails to function. Although “brain-dead” patients do not appear to be dead—i.e., the reality of their death is “masked” by the activity of mechanical ventilation—the patient’s body has irreversibly lost all capacity for integrative functioning. In the words of the Commission: “When artificial means of support mask this loss of integration as measured by the old methods [cessation of respiration and heart beat], brain-oriented criteria and tests provide a new window on the same phenomenon” (p. 33). The President’s Commission was instrumental in developing and establishing “The Uniform Definition of Death Act”: “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead” (p. 2).Although the question posed by the President’s Commission was easy to articulate, the answer, over time, has proved complicated and controversial. The coherence and cogency of determining death by neurological criteria has been challenged. Various experts have demonstrated that “brain-dead” patients maintained on mechanical ventilation display a range of vital, integrative, functioning, which conflicts with the judgment that they are dead (Truog and... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A THEORY OF BASIC GOODS: STRUCTURE AND HIERARCHY* I. FTEN, PERHAPS ALWAYS, moral theory emerges from particular problems. Just how is obscure. The logic of discovery is elusive; and it is harder to explain how we have come to see matters rightly than to recognize that we do, in fact, see them rightly. What counts as a theory, moreover, calls for explication as much as does a theory's emergence. (...) When we have in mind a theory that shapes our social vision, there is a progression from a central set of propositions, keyed to a range of paradigm cases and seen as a logical structure, to a " way of thinking " widely enough embraced to have political significance, at least for a given oommunity. In this essay I want to explore some fundamental questions raised by Germain Grisez's theory of natural law ethics.1 These questions are chiefly conceptual. But neither they nor Grisez's theory should be seen in a vacuum. Rather, I would begin by suggesting that the importance of his work, its emergence in some Catholic circles, is linked with two specific moral and political problems. The first is abortion; the second is the superpowers' policy of nuclear deterrence. *I thank David Blake, Robert Gordh, Carroll Kearley, Gary Mar. Martin Woods, and Linda Zagzebski for their comments on an earlier version of this essay. 1 For the theory's fullest presentation, see Germain Grisez, The Way of the Lord Jesus, vol. one, Ohristian Moral Principles, with the help of Joseph M. Boyle, Jr., Basil Cole, O.P., John Finnis, John A. Geinzer, Robert G. Kennedy, Patrick Lee, William E. May, and Russell Shaw (Chicago: Franciscan Herald Press, 1983). Especially critical are chapters two through twelve. 221 JAMES G. HANINK As a point of chronology, Grisez's early study of rubortion was the context for one of the first formulations of his natural law ethics.2 But why should this have been so? And why should abortion so engage Catholic thinkers, some of whom had felt a distance from explicitly Catholic positions, that Grisez's work should become pivotal? Answers to such questions must be tentative, but they include the following considerations. In a brief period, no more than a decade, legal abortion in the West became entrenched social policy.8 It was a policy, too, supported by dominant intellectual forces. But the new policy, defended in terms of individual freedom and a right to privacy, struck many Catholicsand non-Catholics-as vicious and tragic. It was vicious in that it made expendable the weakest and most vulnerable human beings. Human rights somehow became restricted to the strong and self-sufficient. The policy was tragic in its denial of human community. We are not, however much radical individualism supposes, merely a collection of separate egos. l/Ve are, rather, a community tied to a past and pledged to a future, so pledged, in part, by the children we bear and nurture.4 For in hearing and nurturing children we carry on the love of parents who have done as much for us; and we carry ourselves into a future where we hope our own love will be thus extended. But abortion, and surely unrestricted abortion, betrays this community of trust. Still, a policy so vicious and tragic can make us look for a fresh moral vision. And, of course, to the extent that we have contributed to,a climate in which abortion could become entrenched -either by our failures to support women in need or 2 Germain Grisez, Abortion: The Myths, the Realities, and the Arguments (New York and Cleveland: Corpus Books, 1970). a A milepost, of course, was the United States Supreme Court decision, Roe v. Wade, in 1973. Recent U.S. Government figures indicate that there are now well over a million legal abortions annually in this country. 4 For a provocative discussion of this theme, see Stanley Hauerwas's " The Moral Value of the Family " in his A Commimity of Character (Notre Dame: University of Notre Dame Press, 1981). A THEORY OF BASIC GOODS: STRUCTURE & HIERARCHY 223 by an acquiescence in our culture's individualism-the call for theoretical reconstruction is all the more urgent... (shrink)

The right to withdraw from participation in research is recognized in virtually all national and international guidelines for research on human subjects. It is therefore surprising that there has been little justification for that right in the literature. We argue that the right to withdraw should protect research participants from information imbalance, inability to hedge, inherent uncertainty, and untoward bodily invasion, and it serves to bolster public trust in the research enterprise. Although this argument is not radical, it provides a (...) useful way to determine how the right should be applied in various cases. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President’s Council on Bioethics*Franklin G. Miller** (bio) and Robert D. Truog (bio)Traditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes in (...) the second half of the twentieth century prompted calls for a new, or at least expanded, definition of death: the development of intensive care medicine, especially the use of mechanical ventilators, and the advent of successful transplantation of vital organs. Patients with profound neurological damage, leaving them incapable of breathing on their own and in an irreversible coma, could be maintained for some period of time with the aid of mechanical ventilation. The situation of these patients posed two ethical questions. Is it appropriate to stop life-sustaining treatment? If so, is it acceptable to retrieve vital organs for transplantation to save the lives of others before stopping treatment?In 1968, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed that death could be determined on the basis of neurological criteria, thus providing a positive answer to these two questions (Ad Hoc Committee 1968). According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation. [End Page 185] Because they are dead, it is appropriate, indeed imperative, to stop mechanical ventilation. And because they are dead, it becomes ethical to procure vital organs for transplantation before stopping what otherwise would be life-sustaining treatment. Remarkably, this innovative neurological determination of death became, with little debate or controversy, the established position in medical ethics and the law throughout the United States.The Harvard Committee articulated the diagnosis of “irreversible coma,” but merely asserted that this condition constituted death. No explanatory rationale was provided. It fell to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research to provide an authoritative rationale in its 1981 report, Defining Death. The second paragraph of the report set the stage as follows: “The question addressed here is not inherently difficult or complicated. Simply, it is whether the law ought to recognize new means for establishing that the death of a human being has occurred” (President’s Commission 1981, p. 3). The Commission claimed that “death is a unitary phenomenon” (p. 7) and that the determination of death by neurological criteria, in terms of the absence of all brain function, is consistent with the traditional conception of death as the cessation of vital functioning of the organism as a whole. The key issue is the integrative functioning of the human organism, which ceases to exist, according to the Commission, when the whole brain, including higher cortical areas and the brain stem, fails to function. Although “brain-dead” patients do not appear to be dead—i.e., the reality of their death is “masked” by the activity of mechanical ventilation—the patient’s body has irreversibly lost all capacity for integrative functioning. In the words of the Commission: “When artificial means of support mask this loss of integration as measured by the old methods [cessation of respiration and heart beat], brain-oriented criteria and tests provide a new window on the same phenomenon” (p. 33). The President’s Commission was instrumental in developing and establishing “The Uniform Definition of Death Act”: “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead” (p. 2).Although the question posed by the President’s Commission was easy to articulate, the answer, over time, has proved complicated and controversial. The coherence and cogency of determining death by neurological criteria has been challenged. Various experts have demonstrated that “brain-dead” patients maintained on mechanical ventilation display a range of vital, integrative, functioning, which conflicts with the judgment that they are dead (Truog and... (shrink)

: Recent controversial decisions to terminate several large clinical trials have called attention to the need for developing a sound ethical framework to determine when trials should be stopped in light of emerging efficacy data. Currently, the fundamental rationale for stopping trials early is based on the principle that equipoise has been disturbed. We present an analysis of the ethical and practical problems with the "equipoise disturbed" position and describe an alternative ethical framework based on the principle of nonexploitation. This (...) framework acknowledges the need for balancing the dual ethical obligations of clinical research, the protection of human subjects and the generation of new medical knowledge. Based on this framework, we put forward a proposal to make early stopping guidelines more stringent under specified conditions. The temporary withholding of apparent benefits in certain circumstances is justified by achieving a fair contract with the research participants, one that protects them from undue harm and exploitation while reducing the many uncertainties surrounding new investigational treatments that arise when trials are stopped prematurely. (shrink)

Doctor–patient communication is a crucial component in any therapeutic encounter. Physicians use words to formulate diagnoses and prognoses, to disclose the risks and benefits of medical interventions, and to explain why, how, and when a therapy will be administered to a patient. Likewise, patients communicate to describe their symptoms, to make sense of their conditions, to report side effects, to explore other therapeutic options, and to share their feelings. Throughout the history of medicine, the ethics of the doctor–patient communication has (...) been traditionally grounded on considerations of paternalistic beneficence and nonmaleficence. In this respect, it was no different from the ethics regulating.. (shrink)

The right to withdraw from participation in research is recognized in virtually all national and international guidelines for research on human subjects. It is therefore surprising that there has been little justification for that right in the literature. We argue that the right to withdraw should protect research participants from information imbalance, inability to hedge, inherent uncertainty, and untoward bodily invasion, and it serves to bolster public trust in the research enterprise. Although this argument is not radical, it provides a (...) useful way to determine how the right should be applied in various cases. (shrink)

In the debates surrounding the ethical dimensions of interventions in the human genome, much attention is paid to determining whether—and if so, how—market access to these technologies ought to be managed in order to maximize social benefit. There are those who advocate a “laissez-faire” free-market approach to the development and use of genetic and genomic interventions. We are sympathetic to this view insofar as we understand the workings of the market stimulus effect. We use the term “market stimulus effect” to (...) refer to the outcome of a set of mechanisms whereby early adoption of a new technology by wealthy consumers promotes the development of versions of this product that are cheaper to produce, or are simply .. (shrink)

: The "difference position" holds that clinical research and therapeutic medical practice are sufficiently distinct activities to require different ethical rules and principles. The "similarity position" holds instead that clinical investigators ought to be bound by the same fundamental principles that govern therapeutic medicine—specifically, a duty to provide the optimal therapeutic benefit to each patient or subject. Some defenders of the similarity position defend it because of the overlap between the role of attending physician and the role of investigator in (...) a research trial. This overlap is maximal when the same physician occupies both roles with respect to a particular patient-subject. We address the ethical tensions inherent in that role conflict and argue that the tensions are real but manageable. The difference position provides a sound ethical framework within which to manage those tensions, while the similarity position is unsatisfactory because it seeks to deny the existence of the tensions. (shrink)

: This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in (...) moral problem solving are discussed. (shrink)

The "four-wave mixer", a laser technique for reversing the motion direction of light waves so that they can be turned around and returned to their point of origin was the subject of my last Alternate View column (ANALOG, June-1985). In this AV column I want to go one step further by examining a hypothetical kind of time-reversed light wave which should actually go backward in time. As we shall see, such backward waves could be used to send information from the (...) present to the past, resulting in a sort of "poor man's" time travel. Recent science fiction novels like Jim Hogan's Thrice in Time and Greg Benford's Timescape have been based on backwards-in-time communication and the situations that might arise from it. In both books a world disaster is averted by sending a message to the past. In Timescape a side-effect of the signalling prevents Lee Harvey Oswald from assassinating President Kennedy, irreversibly altering the course of events after 1963. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 15.2 (2005) 199-210 [Access article in PDF] Conflict-of-Interest Policy at the National Institutes of Health: The Pendulum Swings Wildly* Evan G. DeRenzo **This article addresses the National Institutes of Health (NIH) employee conflict-of-interest (COI) policy that went into effect February 2005. It is not, however, merely an account of another poorly crafted government policy that cries out for revision. Instead, it is also (...) a story about one of our nation's most important and prestigious institutions and its struggles to navigate the crosscurrents of scientific aspirations, power politics, public ambivalence toward capitalist economics in the biosciences, and the media's inclination to exaggerate problems and under report complicated facts. It is also a tale of greed, politics, purgatory, and redemption. The dramatic and abrupt change in the NIH COI policy demonstrates the difficulty of balancing the production of cutting-edge science with the demands for transparency resulting from work performed in the public interest on the public tab. It is an unhappy chapter in the life of a government agency that is also a national treasure. And, one hopes, it will be an example of how harmful and ill-conceived law can be revised and amended to advance national health and well-being. What is the New NIH COI Policy? The new NIH COI employee policy, more accurately referred to as the Interim Final Rule (Federal Register 2005), is a sweeping set of prohibitions on activities and holdings to reduce the possibility that NIH employees will have any actual [End Page 199] or apparent conflicts of interest. For the most part, the prohibitions are applied across-the-board—i.e., without distinction to employee category or function. The new policy includes prohibitions on outside activities, stock holdings, and awards. It prohibits all NIH employees from engaging in any compensated or uncompensated employment, including consulting, serving on advisory or other such boards, and compensated teaching, speaking, writing, or editing with certain kinds of entities. The first class of such entities is referred to as substantially affected organizations, defined as biotechnology, pharmaceutical, medical device companies, and others with similar interests. But these are not the only entities included in the prohibitions. Other organizations from which NIH employees now are cut off are hospitals, clinics, and other health care institutions; health, science, or health research-related professional associations and consumer and advocacy groups. Included also are educational institutions and not-for-profit independent research institutes that are, or were, recent NIH funding applicants, grantees, contractors, or cooperative research and development agreement (CRADA) partners. The only exemptions appear to be for health care institutions at which NIH employees provide clinical care and some forms of writing—e.g., an NIH physician who moonlights at her/his local hospital's emergency room or submits a manuscript to a peer-reviewed journal that receives only unrestricted funding from a prohibited entity. Prohibited and/or restricted holdings include stock in biotechnology, pharmaceutical, and medical device companies and others in research, development, or manufacture of medical devices, equipment, preparations, treatments, or products. The prohibitions apply to senior NIH employees; restrictions in the amount of such holdings apply to all remaining employees. Both apply to the spouses and minor children of NIH employees. If an NIH employee wins an award, the monetary allowance in most cases is limited to $200. In sum, the scope of this policy is vast, too vast to be reasonable. Too many employees are restricted in too many ways. Where appropriate restrictions have been placed on senior NIH employees, even these constructive aspects of the policy are overshadowed by the unfairness and destructiveness of other aspects. This policy far exceeds anything that could be considered sound. Fortunately, the policy has a built-in assessment process to begin at the end of the policy's first year of implementation. One can only hope that a fair and open evaluation will be conducted, the results of which surely must result in major revisions to what is now bad regulation. Why the Policy... (shrink)

The Fitzgerald-Lorentz contraction hypothesis, proposed as an explanation of the Michelson-Morley result, fails to account for the Kennedy-Thorndike result. Hence, Grünbaum argues, the hypothesis has been falsified. However, the contraction hypothesis as formulated by Lorentz is false for the very fundamental reason that it entails a contradiction, namely, the consequence that light waves must have a variable velocity along what by definition is taken to be a rest length. Furthermore, the attempt to resolve this contradiction by coupling the Fitzgerald-Lorentz (...) contraction with the hypothesis that clock rates are a function of velocity, is open to a sound, methodological objection. The Michelson-Morley result is fully satisfied, provided only that the lengths of the interferometer arms, in the longitudinal and transverse positions, are thought to be related to one another in a certain ratio, and this ratio may be interpreted as a contraction in both arms. Since this twofold contraction hypothesis suffices to explain both the Michelson-Morley and the Kennedy-Thorndike results, and since it entails no contradiction, there is no need to correct both the length of rods and the rate of clocks. Therefore, the combined clock-rod hypothesis, and with it the Fitzgerald-Lorentz contraction hypothesis, must be rejected. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 10.4 (2000) 283-286 [Access article in PDF] Introduction This Issue of the Kennedy Institute of Ethics Journal focuses on "Aristotelianism in Contemporary Bioethics." It is an unusual topic for this journal as it is seemingly very theoretical. But, I assure the reader that the theoretical topics explored are of the most practical and pressing kind. The questions addressed concern what kind of (...) knowledge and skill there can be in deliberating about particular cases and issues, whether this knowledge is culturally relative, and how bioethics can balance the rights of the individual in making health care decisions with responsibilities to the community.Authors in bioethics, especially those working in clinical ethics, have long sought to address particular problems with the fewest theoretical commitments possible so as to make broad consensus more plausible. Since theoretical foundations are often disputed, keeping the discussion pragmatic has seemed the more likely road to agreement. Similarly, our American heritage has lent the rhetoric of the rights of the individual to the scholarly dialogue in bioethics. Although no one wishes to do away with such language completely, it sometimes has seemed inadequate to the moral phenomena. To address these concerns, the philosophy of Aristotle has been recruited. Aristotelianism in contemporary bioethics has become identified with two claims: (1) there is such a thing as the ability to reason wisely about particular problems and cases, and (2) there is a need to supplement the American emphasis on the individual with a richer notion of the person or a concept of the common good. Both of these claims address concerns arising from the doctrine of informed consent, the fundamental framework of medical decision making.Contemporary American biomedical ethics is now more than 25 years old. It has been marked by some important successes. For instance, it has evolved an ethical and legal consensus that the doctrine of informed consent is the primary way to make operational the value of respect for the patient. And this doctrine extends to all areas of medical treatment and biomedical research. The doctrine is minimalist in that it relies simply on [End Page 283] the right of a competent patient to refuse unwanted interventions. This approach naturally raises questions concerning whether it can adequately settle the more difficult moral questions society faces without recourse to a grander philosophical theory. Similarly, the doctrine of informed consent places the rights of the individual front and center, and this causes us to ask whether bioethics is intrinsically individualistic. Although some might find individualism unobjectionable, many claim that such individualism does not capture the moral phenomenon of the family's role in ethical medical decision making (Nelson and Nelson 1995) or the need to see particular choices in light of the health care schema we wish for society (Callahan 1990).Aristotelianism has not presented itself as just another competing theory among other approaches to bioethics. Through the notions of practical wisdom and the common good, Aristotelianism can be seen as a metaethical way of tying together the methodological progress in bioethics that has resulted from a rich debate among various methods. For instance, bioethics has seen the flourishing of two important methods: the principles approach and casuistry. Virtue theory has also received much attention. The representatives of each have often argued that the philosophical concepts and principles behind ethical decision making in medicine are minimal.Whether one is talking about the four principles approach of Beauchamp and Childress (1994), the case-based approach (casuistry) of Jonsen and Toulmin (1988), or the virtue theory of Pellegrino and Thomasma (1993), one immediately notices that each method is fairly dependent on the judgment or practical wisdom of a competent practitioner of the method in order to be effective. The four principles approach depends upon someone being able to balance or to specify its mid-level principles in difficult cases; casuistry requires the discrimination of a person of practical wisdom to identify relevant features of cases and reason analogically between paradigm cases and their less clear particular instances, and virtue theory places the competent practitioner of the clinical art at the center of its method and makes... (shrink)

*This is a project I hope to come back to one day. It stalled, a bit, on the absence of a positive theory of update I could be satisfied with* When should we believe a indicative conditional, and how much confidence in it should we have? Here’s one proposal: one supposes actual the antecedent; and sees under that supposition what credence attaches to the consequent. Thus we suppose that Oswald did not shot Kennedy; and note that under this assumption, (...) Kennedy was assassinated by someone other than Oswald. Thus we are highly confident in the indicative: if Oswald did not kill Kennedy, someone else did. (shrink)

Prevailing ethical thinking about informed consent to clinical research is characterized by theoretical confidence and practical disquiet. On the one hand, bioethicists are confident that informed consent is a fundamental norm. And, for the most part, they are confident that what makes consent to research valid is that it constitutes an autonomous authorization by the research participant. On the other hand, bioethicists are uneasy about the quality of consent in practice. One major source of this disquiet is substantial evidence of (...) the “therapeutic misconception”—the tendency of patient-subjects in clinical trials to confuse participating in research with receiving personalized medical care. This .. (shrink)

The only test theory used by workers in the field of testing special relativity to analyze the significance of their experiments is the proof by H. P. Robertson [Rev. Mod. Phys. 21, 378 (1949)] of the Lorentz transformations from the results of the experimental evidence. Some researchers would argue that the proof contains an unwarranted assumption disguised as a convention about synchronization procedures. Others would say that alternative conventions are possible. In the present paper, no convention is used, but the (...) Lorentz transformations are still obtained using only the results of the experiments in Robertson's proof, namely the Michelson-Morley, Kennedy-Thorndike, and Ives-Stilwell experiments. Thus the revised proof is a valid test theory which is independent of any conventions, since one appeals only to the experimental evidence. The analysis of that evidence shows the directions in which efforts to test special relativity should go. Finally it is shown how the resulting test theory still has to be improved for consistency in the analysis of experiments with complicated experimental setups, how it can be simplified for expediency as to what should be tested, and how it should be completed for a missing step not considered by Robertson. (shrink)

This paper examines the case of Lawrence v. Texas to bring out the philosophical commitments of Justices Anthony Kennedy and Antonin Scalia. It is proposed that Justices Kennedy and Scalia, while both Catholics, represent fundamentally different visions of the “ends and reasons” of democratic law. A close reading of the Justices’ opinions in Lawrence indicates that Justice Scalia belongs to the tradition of the “ancients” and Justice Kennedy to the tradition of the “moderns.” The paper focuses in (...) particular on the Justices’ interpretations of the Due Process Clause of the Fourteenth Amendment. It is claimed that the interpretation of this clause turns on a philosophical commitment regarding the ends and reasons that the Constitution should be understood to serve, and thus that justices cannot help acting as “philosopher kings” here. Which of the two Justices is more consistent with the Catholic tradition is proposed as a question for another day. (shrink)

Bioethics has been an interdisciplinary field since its inception. From the founding of the Hastings Center in 1969 and the Kennedy Institute of Ethics in 1971, scholars from many disciplines have come together to create a field of study strengthened by its interdisciplinarity. In this special issue of Perspectives in Biology and Medicine, we celebrate the interdisciplinary character of bioethics by means of essays by eight distinguished bioethics scholars hailing from backgrounds in philosophy, law, medicine, nursing, public health, history, (...) sociology, and narrative methods. Each contributor offers a personal perspective on their journey into bioethics from a particular disciplinary background... (shrink)

Debriefing is a standard ethical requirement for human research involving the use of deception. Little systematic attention, however, has been devoted to explaining the ethical significance of debriefing and the specific ethical functions that it serves. In this article, we develop an account of debriefing as a tool of moral accountability for the prima facie wrong of deception. Specifically, we contend that debriefing should include a responsibility to promote transparency by explaining the deception and its rationale, to provide an apology (...) to subjects for infringing the principle of respect for persons, and to offer subjects an opportunity to withdraw their data. We also present recommendations concerning the discussion of deception in scientific articles reporting the results of research using deception. (shrink)