Lavoie and Talwar examine the phenomenon of prosocial lie telling: lying with the intention to benefit others. They investigate how well children aged 4 to 11 are able to conceal information about a surprise gift from their parents based on these children’s responses to their parents’ questions. Lavoie and Talwar conclude that, as children’s theory of mind abilities and working memory improve, their ability to conceal information from others also develops.

Concealing information requires that adolescents manage the information that they share, which requires cognitive skills, for example, theory of mind. This study explored motivations for concealment that early adolescents endorsed concealing or disclosing to friends and parents, in relation to their theory of mind. We found that adolescents broadly endorsed disclosure to both parents and friends, even when it might mean they would face consequences, be impolite, or face negative identity-related emotions. We found that ToM ability was associated with a (...) tendency to endorse being forthcoming and sharing information with both friends and parents. These findings provide new insight into how the relation between ToM and concealment may change with age, specifically how in early adolescence it may foster open communication rather than concealment as is the case in early and middle childhood. (shrink)

Within the research community, it is generally accepted that consent processes for research should be culturally appropriate and tailored to the context, yet researchers continue to grapple with what valid consent means within specific stakeholder groups. In this study, we explored the consent practices and attitudes regarding essential information required for the consent process within hospital-based trial communities from four referral hospitals in Vietnam. We collected surveys from and conducted semi-structured interviews with study physicians, study nurses, ethics committee members, and (...) study participants and family members regarding their experiences of participating in research, their perspectives toward research, and their views about various elements of the consent process. In our findings, we describe three interrelated themes related to the consent process: words and regulation; reimbursement, suspicions, and joining; and responsibilities. In general, stakeholders had highly varied perspectives of nghiên cứu and researchers used varying levels of detail regarding all aspects of the study in the consent process to build trust with and/or promote potential research participants’ choices about taking part in research. Findings additionally highlight how researchers felt that offering financial reimbursements in a hospital setting, where payment for services was routine, would be unfamiliar to participants and could raise suspicions about the research. Participants, however, focused their discussions on reimbursement or alternative reasons for joining the study, such as health related benefits or altruism. Finally, participants often relied on their physician to help them decide about joining a study or not. Further research is needed to understand how researchers and participants make sense of and practice consent, and how that impacts participants’ decision-making about research participation. To promote valid consent within this context, it is important to engage with hospital-based trial communities as a whole. The data from this study will inform future research on consent, guide the revisions of consent related policies within our research sites and point to several larger issues surrounding researcher-participant expectations, communication, and trust. (shrink)

Community engagement has been recognised as an important aspect of the ethical conduct of biomedical research, especially when research is focused on ethnically or culturally distinct populations. While this is a generally accepted tenet of biomedical research, it is unclear what components are necessary for effective community engagement, particularly in the context of genomic research in Africa.

Emotion recognition skills and the ability to understand the mental states of others are crucial for normal social functioning. Conversely, delays and impairments in these processes can have a profound impact on capability to engage in, maintain, and effectively regulate social interactions. Therefore, this study aimed to compare the performance of 42 autistic children, 45 unaffected siblings, and 41 typically developing controls on the Affect Recognition and Theory of Mind subtests of the Developmental Neuropsychological Assessment Battery. There were no significant (...) differences between siblings and TD controls. Autistic children showed significantly poorer performance on AR when compared to TD controls and on TOM when compared to both TD controls and unaffected siblings. An additional comparison of ASD, unaffected sibling and TD control subsamples, matched on full-scale IQ, revealed no group differences for either AR or TOM. AR and TOM processes have received less research attention in siblings of autistic children and remain less well characterized. Therefore, despite limitations, findings reported here contribute to our growing understanding of AR and TOM abilities in siblings of autistic children and highlight important future research directions. (shrink)

Co-authored letter to the APA to take a lead role in the recognition of teaching in the classroom, based on the participation in an interdisciplinary Conference on the Role of Advocacy in the Classroom back in 1995. At the time of this writing, the late Myles Brand was the President of Indiana University and a member of the IU Department of Philosophy.

Background Achieving meaningful consent can be challenging, particularly in contexts of diminished literacy, yet is a vital part of participant protection in global health research. Method We explored the challenges and potential solutions of achieving meaningful consent through a qualitative study in a predominantly hill tribe ethnic minority population in northern Thailand, a culturally distinctive population with low literacy. Semi-structured interviews were conducted with 37 respondents who had participated in scrub typhus clinical research, their family members, researchers and other key (...) informants. A thematic analysis was conducted. Results Our analysis identified four interrelated themes surrounding participants’ ability to give consent: varying degrees of research understanding, limitations of using informal translators, issues impacting decisions to join research, and voluntariness of consent. Suggestions for achieving more meaningful consent included the use of formal translators and community engagement with research populations. Conclusions Participant’s agency in decision making to join research should be supported, but research information needs to be communicated to potential participants in a way that they can understand. We found that improved understanding about the study and its potential benefits and harms goes beyond literacy or translation and requires attention to social and cultural factors. (shrink)

This July 2020 issue of JME introduces a new section, “COVID-19 Current Controversies,” which will be a recurring section in each issue for the foreseeable future. This issue reflects on some of the most pressing ethical issues that have arisen roughly 6 months into the pandemic. Kathleen Liddell and colleagues examine important legal considerations at play in ventilator allocation decisions raised by the pandemic.1 They point out that ethics-based triage protocols that argue from the principle of “saving the most lives” (...) by withholding or withdrawing ventilators from certain patients could violate the law (U.K. and elsewhere). Patients’ legal rights are not suspended during this crisis, they remind us. The mere action of ventilator removal (extubation and proning) may constitute battery without consent, for example. Moreover, there may be problems with “evidentiary weakness” in some of the prognostic models used to inform such decisions. And, decisions that are inconsistent, subjective, and/or discriminatory may be deemed illegal. Those developing policies need to consider and consult various areas of law including criminal law (eg, murder, battery, negligence, manslaughter), human rights law, civil law (eg, battery, negligence, duty of care, consent), public and administrative law (eg, discrimination, case law), law on decision-making for incapacitated adults, professional regulations, and derogations from current law (eg, immunities and indemnities). Liddell et al offer 10 concrete, legally informed recommendations for those developing triage-policies to consider. Michael Parker and colleagues take on the issue of contact tracing using mobile apps and point out that such apps can enable people to emerge more safely from lockdowns, which provides a strong autonomy-based argument in favour …. (shrink)

The last thirty years have seen a resurgence of interest in virtue among philosophers, psychologists, and educators. This co-authored book brings an interdisciplinary response to the study of virtue: it not only provides a framework for quantifying virtues, but also explores how we can understand virtue in a philosophically-informed way that is compatible with the best current thinking in personality psychology. The volume presents a major contribution to theemerging science of virtue and character measurement.

1. Lying -- 2. The problem of what is said -- 3. What is said -- 4. Is lying worse than merely misleading? -- 5. Some interesting cases.

This essay explores the speech act of dogwhistling (sometimes referred to as ‘using coded language’). Dogwhistles may be overt or covert, and within each of these categories may be intentional or unintentional. Dogwhistles are a powerful form of political speech, allowing people to be manipulated in ways they would resist if the manipulation was carried outmore openly—often drawing on racist attitudes that are consciously rejected. If philosophers focus only on content expressed or otherwise consciously conveyed they may miss what is (...) most powerful and pernicious in the speech of political culture. This essay is a call to start paying attention to these more covert speech acts, and a first attempt at beginning to theorize them. It argues that dogwhistles present a complex and interesting case for the philosopher of language, and explores their implications for democratic politics. (shrink)

Skepticism about the epistemic value of intuition in theoretical and philosophical inquiry has recently been bolstered by empirical research suggesting that people’s concrete-case intuitions are vulnerable to irrational biases (e.g., the order effect). What is more, skeptics argue that we have no way to ‘‘calibrate” our intuitions against these biases and no way of anticipating intuitional instability. This paper challenges the skeptical position, introducing data from two studies that suggest not only that people’s concrete-case intuitions are often stable, but also (...) that people have introspective awareness of this stability, providing a promising means by which to assess the epistemic value of our intuitions. (shrink)

Recent scholarship (Goodwin & Darley, 2008) on the meta-ethical debate between objectivism and relativism has found people to be mixed: they are objectivists about some issues, but relativists about others. The studies discussed here sought to explore this further. Study 1 explored whether giving people the ability to identify moral issues for themselves would reveal them to be more globally objectivist. Study 2 explored people's meta-ethical commitments more deeply, asking them to provide verbal explanations for their judgments. This revealed that (...) while people think they are relativists, this may not always be the case. The explanations people gave were sometimes rated by outside (blind) coders as being objective, even when given a relativist response. Nonetheless, people remained meta-ethical pluralists. Why this might be is discussed. (shrink)

Against recent work by Haslanger and Leslie, I argue that we do not yet have good reason to think that we should single out generics about social groups out as peculiarly destructive, or that we should strive to eradicate them from our usage. Indeed, I suggest they continue to serve a very valuable purpose and we should not rush to condemn them.

Moral abolitionists claim that morality ought to be abolished. According to one of their most prominent arguments, this is because making moral judgments renders people significantly less tolerant toward anyone who holds divergent views. In this paper we investigate the hypothesis that morality’s tolerance-decreasing effect only occurs if people are realists about moral issues, i.e., they interpret these issues as objectively grounded. We found support for this hypothesis (Studies 1 and 2). Yet, it also turned out that the intolerance associated (...) with realism is mediated by moral conviction and perceived consensus. People tend to feel more strongly about those moral issues they ground objectively and, in doing so, are more prone to display the vice of moral smugness toward those who disagree with them. The remedy for this that has been recommended is humility which we found (Study 3) is indeed related to reduced intolerance, in part by predicting a reduction in realism, but also in part through a direct connection to intolerance. These results put pressure on abolitionists’ “argument from intolerance.”. (shrink)

Abstract: Recent experimental research on the 'Knobe effect' suggests, somewhat surprisingly, that there is a bi-directional relation between attributions of intentional action and evaluative considerations. We defend a novel account of this phenomenon that exploits two factors: (i) an intuitive asymmetry in judgments of responsibility (e.g. praise/blame) and (ii) the fact that intentionality commonly connects the evaluative status of actions to the responsibility of actors. We present the results of several new studies that provide empirical evidence in support of this (...) account while disconfirming various currently prominent alternative accounts. We end by discussing some implications of this account for folk psychology. (shrink)

The rise to power of Donald Trump has been shocking in many ways. One of these was that it disrupted the preexisting consensus that overt racism would be death to a national political campaign. In this paper, I argue that Trump made use of what I call “racial figleaves”—additional utterances that provide just enough cover to give reassurance to voters who are racially resentful but don’t wish to see themselves as racist. These figleaves also, I argue, play a key role (...) in shifting our norms about what counts as racist: they bring it about that something which would previously have been seen as revealing obvious racism is now seen as the sort of thing that a nonracist might say. This gives them tremendous power to corrupt not just our political discourse but our culture more broadly. (shrink)

Dispositionality is a modal notion of a certain sort. When an object is said to have a disposition, we typically understand this to mean that under certain circumstances, the object would behave in a certain way. For instance, a fragile object is disposed to break when dropped onto a concrete surface. It need not actually break - its being fragile has implications that, so to speak, point beyond the actual world. According to dispositionalism, all modal features of the world may (...) be accounted for in terms of its dispositional features. My aim in this paper is to assess the prospects for dispositionalism by examining the most promising theories. Sections 1 and 2 clarify the assumptions and desiderata of a successful dispositionalist theory of modality. Section 3 introduces the principles governing the dispositionalist theories that apparently meet the desiderata. Sections 4 through 6 show that dispositionalism nonetheless faces three problems: while dispositions help account for modal features of the world that are local, diachronic, or gradable, they cannot account for certain modal features of the world that are global, synchronic, or absolute. I end by discussing the costs of preserving dispositionalism. (shrink)

True to his longstanding bias against grand unifying theories, Hacking chooses to pursue these questions by focusing on a specific case of memory-thinking: the history of multiple personality. His excavation of the contemporary terrain leads him, however, to the surprisingly grand conclusion that the various sciences of memory—including neurological studies of localization, experimental studies of recall, and studies in the psychodynamics of memory—all emerged in connection with attempts to “scientize the soul,” as a result of which spiritual battles have been (...) recast as scientific controversies “where we suppose there is such a thing as knowledge to be had”. (shrink)

Background Few studies have been conducted to assess the quality of orientation practices for ethics advisory committees that conduct ethics consultation. This survey study focused on several Harvard teaching hospitals, exploring orientation quality and committee members’ self-evaluation in the American Society of Bioethics and Humanities ethics consultation competencies. Methods We conducted a survey study that involved 116 members and 16 chairs of ethics advisory committees, respectively. Predictor variables included professional demographics, duration on committees and level of training. Outcome variables included (...) familiarity with and preparedness in the ASBH competencies and satisfaction with orientations. We hypothesised that responses would be associated with both the aforementioned predictors and whether or not participants had encountered the ASBH competencies in training. Results A majority of respondents found their orientation curricula to be helpful, although a significant portion of respondents did not receive any orientation or were unsatisfied with their orientation. Familiarity with ASBH competencies was a statistically significant predictor of respondents’ self-evaluation in particular categories. Standard educational materials were reported as offered during orientation, such as readings and case studies ; different medium resources were less evidenced such as videos on ethics consultation. Conclusions Institutions should re-evaluate orientation practices for ethics committee members that perform ethics consultation. Integrating ASBH competencies and useful methods into a resourceful pedagogy will help improve both member satisfaction with orientation and preparation in consultation. (shrink)

There is a puzzle concerning the essences of fundamental entities that arises from considerations about essence, on one hand, and fundamentality, on the other. The Essence-Dependence Link (EDL) says that if x figures in the essence of y, then y is dependent upon x. EDL is prima facie plausible in many cases, especially those involving derivative entities. But consider the property negative charge. A negatively charged object exhibits certain behaviors that a positively charged object does not: it moves away from (...) other negatively charged objects, towards positively charged objects, etc. It is commonly thought that negative charge disposes its bearer to move away from other negatively charged objects, towards positively charged objects, etc. But if negative charge is fundamental, then no other entities—including the property positive charge—can figure in its essence. We thus have a prima facie puzzle: How can we say anything interesting about the essences of fundamental entities without running afoul of EDL? In this paper, I present and discuss the consequences of EDL for the debate between causal essentialists and quidditists about properties, and propose solutions to the puzzle. (shrink)

[First Paragraph] Unlike so many other distinctions in philosophy, H P Grice's distinction between what is said and what is implicated has an immediate appeal: undergraduate students readily grasp that one who says 'someone shot my parents' has merely implicated rather than said that he was not the shooter [2]. It seems to capture things that we all really pay attention to in everyday conversation'this is why there are so many people whose entire sense of humour consists of deliberately ignoring (...) implicatures. ('Can you pass the salt?' 'Yes.') Unsurprisingly, it was quickly picked up and put to a wide variety of uses in not only in philosophy but also in linguistics and psychology. What is surprising, however, is that upon close inspection Grice's conception of implicature turns out to be very different from those at work in the literature which has grown out of his original discussion. This would not be much of a criticism of this literature were it not for the fact that discussions of implicature explicitly claim to be using Grice's notion, not some other one inspired by him (generally going so far as to quote one of Grice's characterisations of implicature). This still would not be terribly interesting if the notion Grice was actually carving out had little theoretical or practical utility. But I will argue here that Grice's own notion of implicature, one quite different from the ones most of us have come to work with, is in fact far more interesting and subtle than that which has been attributed to him. (shrink)

Sally Haslanger’s ‘What Good Are Our Intuitions? Philosophical Analysis and Social Kinds’ is, among other things, a part of the theoretical underpinning for analyses of race and gender concepts that she discusses far more fully elsewhere. My reply focuses on these analyses of race and gender concepts, exploring the ways in which the theoretical work done in this paper and others can or cannot be used to defend these analyses against certain objections. I argue that the problems faced by Haslanger’s (...) analyses are in some ways less serious, and in some ways more serious, than they may at first appear. Along the way, I suggest that ordinary speakers may not in fact have race and gender concepts and I explore the ramifications of this claim. (shrink)

BackgroundArtificial intelligence has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: (...) What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective?MethodsEight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed.ResultsUpon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries.ConclusionsThe ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere. (shrink)

Recent, well-publicized scandals, involving unethical conduct have rekindled interest in academic misconduct. Prior studies of academic misconduct have focussed exclusively on situational factors (e.g., integrity culture, honor codes), demographic variables or personality constructs. We contend that it is important to also examine how␣these classes of variables interact to influence perceptions of and intentions relating to academic misconduct. In a sample of 217 business students, we examined how integrity culture interacts with Prudence and Adjustment to explain variance in estimated frequency of (...) cheating, suspicions of cheating, considering cheating and reporting cheating. Age, integrity culture, and personality variables were significantly related to different criteria. Overall, personality variables explained the most unique variance in academic misconduct, and Adjustment interacted with integrity culture, such that integrity culture had more influence on intentions to cheat for less well-adjusted individuals. Implications for practice are discussed and future research directions are offered. (shrink)

Catharine MacKinnon has claimed that pornography is the subordination of women. Rae Langton has defended the plausibility and coherence of this claim by drawing on speech act theory. I argue that considering the role of context in speech acts poses serious problems for Langton's defence of MacKinnon. Langton's account can be altered in order to accommodate the role of context. Once this is done, however, her defence of MacKinnon no longer looks so plausible. Finally, I argue that the speech act (...) approach (adapted to account for context) offers an appealing way to make sense of disagreements over pornography; but also that this will probably not be so appealing to most proponents of the speech acts approach. (shrink)

Much has been published about the ethical issues encountered by clinicians in genetics/genomics, but those experienced by clinical laboratory scientists are less well described. Clinical laboratory scientists now frequently face navigating ethical problems in their work, but how they should be best supported to do this is underexplored. This lack of attention is also reflected in the ethics tools available to clinical laboratory scientists such as guidance and deliberative ethics forums, developed primarily to manage issues arising within the clinic.We explore (...) what ethical issues are being experienced by clinical scientists, how they think such issues could be best analysed and managed, and whether their practice might be enhanced by more situated approaches to ethics deliberation and practice such as ethical preparedness. From thematic analysis of cases presented by clinical scientists at a specially convened meeting of the UK Genethics Forum, we derived three main ethical themes: (1) the redistribution of labour and responsibilities resulting from the practice of genomic medicine; (2) the interpretation and certainty of results and (3) the proposal that better standardisation and consistency of ethical approaches (for example, more guidelines and policy) could resolve some of the challenges arising.We argue that although standardisation is important for promoting shared understandings of good (including ethical) practice, supplementary approaches to enhance and sustain ethical preparedness will be important to help clinical scientists and others in the recently expanded genetic/genomic medicine environment foster quality ethical thinking. (shrink)

The view that lying is morally worse than merely misleading is a very natural one, which has had many prominent defenders. Nonetheless, here I will argue that it is misguided: holding all else fixed, acts of mere misleading are not morally preferable to acts of lying, and successful lying is not morally worse than merely deliberately misleading. In fact, except in certain very special contexts, I will suggest that – when faced with a felt need to deceive – we might (...) as well just go ahead and lie. (shrink)

Substitution and simple sentences -- Simple sentences and semantics -- Simple sentences and implicatures -- The enlightenment problem and a common assumption -- Abandoning (EOI) -- Beyond matching propositions -- App. A : extending the account -- App. B : belief reporting.

The new field of experimental philosophy has emerged as the methods of psychological science have been brought to bear on traditional philosophical issues. Oxford Studies in Experimental Philosophy will be the place to go to see outstanding new work in the field. It will feature papers by philosophers, papers by psychologists, and papers co-authored by people in both disciplines. The series heralds the emergence of a truly interdisciplinary field in which people from different disciplines are working together to address a (...) shared set of questions. The inaugural volume is roughly structured into four sections. The first three papers focus on recent developments in moral psychology, a topic that has seen lively debate and a great deal of progress over the last decade. The second section highlights three contributions that bring new methods to moral psychology: formal modeling and special populations. The third section brings together four papers that adopt an experimental philosophy approach to novel topics, including intuitive dualism, generics, joint action, and happiness. And the last two papers provide critical and historical context to the development of experimental philosophy. (shrink)

College cheating is prevalent, with rates ranging widely from 9 to 95%. Research has been exclusively conducted with enrolled college students. This study examined the prevalence of cheating in a sample of college alumni, who risk less in disclosing academic dishonesty than current students. A total of 273 alumni reported on their prevalence and perceived severity of 19 cheating behaviors. The vast majority of participants report having engaged in some form of cheating during their undergraduate career. The most common forms (...) of cheating were “copying from another student's assignment” and “allowing others to copy from your assignment.” More students reported cheating in classes for their major than other classes. Males and females cheated at the same rates in classes for their major, and males reported higher rates of cheating than females in nonmajor classes. Respondents reported that their top reasons for cheating were “lack of time” and “to help a friend.”. (shrink)

Scientific cognitivists argue formalist aesthetics of nature are (i) inadequate for appreciating the full range of nature’s aesthetic values and (ii) too subjective to be useful for defending nature conservation. I argue that (i) is false because moderate formalists can appreciate nature for its performances, not merely objects and vistas. I argue (ii) is false because moderate formalists can argue that appreciation of beauty (including natural beauty) is a constitutive good of human flourishing, whose realization relies on access to a (...) rich and diverse array of aesthetically rewarding experiences throughout a lifetime. On these grounds, moderate formalists (among others) can justify conserving distinctive natural entities and environs for our own and future generations’ good. (shrink)

One of the most important aspects of Grice’s theory of conversation is the drawing of a borderline between what is said and what is implic- ated. Grice’s views concerning this borderline have been strongly and influentially criticised by relevance theorists. In particular, it has become increasingly widely accepted that Grice’s notion of what is said is too lim- ited, and that pragmatics has a far larger role to play in determining what is said than Grice would have allowed. (See for (...) example Bezuidenhuit 1996; Blakemore 1987; Carston 1991; Recanati 1991, 1993, 2001; Sperber and Wilson 1986; Wilson and Sperber 1981.) In this paper, I argue that the rejection of Grice has moved too swiftly, as a key line of objection which has led to this rejection is flawed. The flaw, we will see, is that relevance theorists rely on a misunderstanding of Grice’s project in his theory of conversation. I am not arguing that Grice’s versions of saying and implicating are right in all details, but simply that certain widespread reasons for rejecting his theory are based on misconceptions. (shrink)

Aristotle’s requirement that virtuous actions be chosen for themselves is typically interpreted, in Kantian terms, as taking virtuous action to have intrinsic rather than consequentialist value. This raises problems about how to reconcile Aristotle’s requirement with (a) the fact that virtuous actions typically aim at ends beyond themselves (usually benefits to others); and (b) Aristotle’s apparent requirement that everything (including virtuous action) be chosen for the sake of eudaimonia. I offer an alternative interpretation, based on Aristotle’s account of loving a (...) friend for herself, according to which choosing a virtuous action for itself involves choosing it on account of those features of it that make it the kind of action it is, where these features include its intended consequences (such as the benefits it seeks to provide to others). I then suggest that Aristotle may take these consequences (including benefits to others) as contributing (and contributing non-instrumentally) to the agent’s own eudaimonia, and that there is no conflict here with Aristotle’s view that eudaimonia is an activity of the soul. For just as my activity of teaching is actualized in my students (provided they learn from me), so too my virtuous activity can be actualized in its beneficiaries. If this is right, then Aristotle’s view is far from the Stoic (and proto-Kantian) view often attributed to him. (shrink)

Modal primitivists hold that some modal truths are primitively true. They thus seem to face a special epistemological problem: how can primitive modal truths be known? The epistemological objection has not been adequately developed in the literature. I undertake to develop the objection, and then to argue that the best formulation of the epistemological objection targets all realists about modality, rather than the primitivist alone. Furthermore, the moves available to reductionists in response to the objection are also available to primitivists. (...) I conclude by suggesting that extant theories of the epistemology of modality are not sensitive to the question of primitivism versus reductionism. (shrink)

ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not reporting and (2) not obtaining consent.MethodsSurvey of primary trial reports, published 2014–2019, identified using an electronic search filter for pragmatic trials implemented in MEDLINE, and registered in ClinicalTrials.gov.ResultsAmong 1988 trials, 132 (6.6%) did not include a statement about participant consent, 1691 (85.0%) reported consent had been obtained, 139 (7.0%) reported a (...) waiver and 26 (1.3%) reported consent for one aspect (eg, data collection) but a waiver for another (eg, intervention). Of the 165 trials reporting a waiver, 76 (46.1%) provided a justification. Few (53, 2.9%) explicitly reported use of alternative approaches to consent. In multivariable logistic regression analyses, lower journal impact factor (p=0.001) and cluster randomisation (p<0.0001) were significantly associated with not reporting on consent, while trial recency, cluster randomisation, higher-income country settings, health services research and explicit labelling as pragmatic were significantly associated with not obtaining consent (all p<0.0001).DiscussionNot obtaining consent seems to be increasing and is associated with the use of cluster randomisation and pragmatic aims, but neither cluster randomisation nor pragmatism are currently accepted justifications for waivers of consent. Rather than considering either standard written informed consent or waivers of consent, researchers and research ethics committees could consider alternative consent approaches that may facilitate the conduct of pragmatic trials while preserving patient autonomy and the public’s trust in research. (shrink)