In November 2016, the Council for International Organizations of Medical Sciences published its revised International Ethical Guidelines for Health-related Research Involving Humans. In relation to earlier versions, the scope of the new guidelines has been expanded to include public-health research. While successful to some extent, the document does not take into sufficient account the differences between public-health research and other types of health research. It is silent on some issues of importance to public-health research, such as its definition, health inequities (...) and novel research methodologies. Its treatment of some other issues, including the need for researchethics committee approval, consent, community involvement and dissemination of research results, are deficient in some respects. The guidelines that are particularly applicable to and useful for public-health research deal with social value, the health needs of communities and populations, community engagement, disasters and disease outbreaks, cluster randomised trials and data sharing. Much further development of the foundations and applications of public-health research ethics is needed to inform future revisions of the guidelines and of other international and national research-ethics documents. (shrink)

The purpose of this note is to defend the following reading, offered by a minority of manuscripts, at Sat. 6.6. Even if the evidence of the manuscripts showed merely that egregius… senes was an eleventh-century conjecture which gained a very moderate degree of acceptance, the reading would still have much to commend it.

This article studies a series of provocative references to Spinoza by Jacques Derrida and Giorgio Agamben. For both contemporary philosophers, the context is discussions of eating, a subject matter that turns out to involve such central issues as subjectivity, nature, ethics, and teleology. Each situates Spinoza in a counter-history of philosophy and suggests that Spinoza constitutes an important resource for contemporary reflections. Through an analysis of the three philosophers' texts about eating, nutrition, and being metabolized, I argue that Spinoza's nonteleological, (...) nonhumanistic conception of nature remains a radical possibility, even in the face of contemporary attempts to think outside the canonical discourses of transcendental subjectivity, technological reason, and teleological ethics. Spinoza's position is, in the end, more uncompromising than that of Derrida or Agamben. (shrink)

It seems to me certain that the perception of foreign bodies of a certain sort, although a necessary, is not the only, part of the basis of our belief in other persons. The greatest disagreement with this view that I know of has been expressed by Professor Aaron in a paper published in Philosophy , XIX, 72. He claims that, since one does not really know “what it means to be a mind in one's own case,” the question whether we (...) can be certain that there are other minds is meaningless except as reducible to the question whether such propositions as “Robinson exists” are propositions which we can be certain about. And he tries to show that no more is involved in the analysis of “Robinson exists” than would be involved in the analysis of propositions of whose truth we can be perceptually certain, such as “That table over there exists” or “The Eiffel Tower exists.” My assurance that Robinson exists is not the assurance that something called Robinson's mind exists. It is the perfectly ordinary perceptual assurance that ‘the person over there’ exists. “You ask me how I am certain that Robinson exists and I answer, ‘Well, look, there he is.’ It would be absurd for anyone to say that he does not exist when I see him here before me and hear him talk and watch him move that chair.”. (shrink)

There are many challenges to be met when writing an introductory treatise on an academic topic. The subject matter must be presented in a simple but not oversimplified manner. Enough theory must be included to ground the discussion of specific issues but not so much as to overwhelm or bore the readers. The text should be long enough to do justice to the subject matter but short enough to be readily accessible, especially for readers such as healthcare professionals, whose primary (...) concerns lie elsewhere.There are additional challenges in a relatively novel interdisciplinary field such as bioethics. The scope and methodology of bioethics are matters of great controversy, as are its relations with related subjects such as professionalism and human rights. The field is so broad that a single author cannot claim expertise on all topics. Rivalries between law and ethics and among medicine, other health professions, and disciplines such as philosophy complicate efforts to produce a broadly acceptable text. Finally, national and cultural differences pose major challenges to anyone trying to write for a truly international readership.The difficulty of meeting all these challenges in producing the WMA Medical Ethics Manual provides ample opportunity for criticism, especially from bioethics experts. The three expert reviewers of the manual in this issue of the journal are remarkably restrained in pointing out its shortcomings.1–3 I am grateful for both their positive evaluations and their constructive criticism. In what follows, I will respond to each of them in turn, focusing in particular on their suggestions as to how the Manual could have been improved.Before addressing these suggestions, I wish to clarify a matter raised by Søren Holm, namely, to what degree the manual …. (shrink)

On April 26, 1995, the United States Supreme Court limited the reach of the preemption provision of ERISA in New York State Conference of Blue Cross & Blue Shield Plans v. Tavelers Insurance Co. ). In Travelers, the Supreme Court upheld the validity of a New York statute requiring hospitals to collect surcharges from patients covered by commercial insurers and requiring health maintenance organizations to pay a surcharge to the state's general fund that varies depending on the number of Medicaid-eligible (...) HMO members enrolled. Neither patients insured by Blue Cross/Blue Shield plans nor the plans themselves are similarly charged under the statute. Several commercial insurers and HMOs claimed the surcharges should be preempted under ERISA because they are levied on patients whose insurance or HMO membership premiums are purchased by an ERISA plan.The ERISA preemption clause means that federal regulation, or lack thereof, supersedes state regulation that is related to employee pension and benefit plans. This preemption clause prevents states from changing health care and benefit law for a significant portion of state residents. (shrink)

The Christian conviction about Divine Providence encourages a novel account of the moral content of health and authority in the heath care context. While health can be understood as the disposition of a living body to be able to proceed in the world well, as a species of freedom it is informed by the particular projects and concerns that Christians hold deepest. This is due to the fact that health acquires content, and thus becomes desirable as a particular type of (...) good, only in relation to judgments about the good life. Aquinas' reflections concerning the good of health and its partial slavery to fortune reveal a Christian past that dwelt on the intrinsic and instrumental good of health. A rich Christian tradition in which health as intrinsically good, a good of the body, is ordained to the interests of right Christian virtue. Each of these factors affects the character of the health to be pursued and the authority of the physician as determining the ends and means of medicine. (shrink)

Biologically, pain is neither intrinsically good nor bad, but is a communication mechanism designed to serve organismal ends. Pain for any given person at any given time should be evaluated on the basis of “success” (or not) in serving those purposes. Yet, the physiological, psychological, and cultural complexity of the experience makes moral consideration of pain complicated. This is especially the case with infants in pain. The competence of the infant as a “decision maker” cannot, of course, be assumed. Even (...) if the child “thinks” about pain, an epistemological barrier exists in that the child cannot clearly communicate about the pain experience. Furthermore, any expressions of pain from the child may be necessary for diagnosis. Just coercion criteria provide a means of evaluating when and to what extent pain in infants should be controlled under the authority of surrogate decision makers. (shrink)