Placebo-controlled trials are held by many, including regulators at agencies like the United States Food and Drug Administration, to be the gold standard in the assessment of new medical interventions. Yet the use of placebo controls in clinical trials has been the focus of considerable controversy. In this two-part article, we challenge a number of common beliefs concerning the value of placebo controls. Part I critiques statistical and other scientific justifications for the use of placebo controls in clinical research. The (...) continued use of placebo controls in clinical trials on diseases for which accepted treatment exists raises equally important ethical, legal, and regulatory issues for which various justifications have been given. Defense of this practice relies on normative as well as empirical myths.In their attack on the prevailing use of placebo controls, Kenneth Rothman and Karin Michels emphasize that this practice stands in violation of the World Medical Association's guidelines on the ethics of human experimentation, most commonly known as the Helsinki Declaration. (shrink)

The use of statistics in medical research has been compared to a religion: it has its high priests, supplicants, and orthodoxy. Although the comparison may be more unfair to religion than to research, a useful lesson can nonetheless be drawn: the practice of clinical research may benefit—as does the spirit—from critical self-examination. Arguably, no aspect of the conduct of clinical trials is currently more controversial—and thus in as dire need of critical examination—than the use of placebo controls. The ethical and (...) scientific controversies associated with placebo-controlled trials, never far below the surface, have once again seized public attention. Clearly, concern about these issues within the professional community runs deep and wide, as evidenced by the volume of response generated by Kenneth Rothman and Karin Michels's recent Critique. Criticisms of the use of placebo controls in clinical research are scattered through the literatureo; our objective is to present the case against placebos in a compendious form that takes account of scientific and statistical as well as normative issues. (shrink)

The use of statistics in medical research has been compared to a religion: it has its high priests, supplicants, and orthodoxy. Although the comparison may be more unfair to religion than to research, a useful lesson can nonetheless be drawn: the practice of clinical research may benefit—as does the spirit—from critical self-examination. Arguably, no aspect of the conduct of clinical trials is currently more controversial—and thus in as dire need of critical examination—than the use of placebo controls. The ethical and (...) scientific controversies associated with placebo-controlled trials, never far below the surface, have once again seized public attention. Clearly, concern about these issues within the professional community runs deep and wide, as evidenced by the volume of response generated by Kenneth Rothman and Karin Michels's recent Critique. Criticisms of the use of placebo controls in clinical research are scattered through the literatureo; our objective is to present the case against placebos in a compendious form that takes account of scientific and statistical as well as normative issues. (shrink)

Worldwide, the literature reports that many residents in long‐term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations (...) with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add‐on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

© 2015, Springer-Verlag Berlin Heidelberg.Genetic studies have identified single nucleotide polymorphisms associated with the risk of prostate cancer. It remains unclear whether such genetic variants are associated with disease aggressiveness. The NCI-SPORE Genetics Working Group retrospectively collected clinicopathologic information and genotype data for 36 SNPs which at the time had been validated to be associated with PC risk from 25,674 cases with PC. Cases were grouped according to race, Gleason score and aggressiveness. Statistical analyses were used to compare the frequency (...) of the SNPs between different disease cohorts. After adjusting for multiple testing, only PC-risk SNP rs2735839 was significantly and inversely associated with aggressive and high-grade disease in European men. Similar associations with aggressive and high-grade disease were documented in African-American subjects. The G allele of rs2735839 was associated with disease aggressiveness even at low PSA levels in both European and African-American men. Our results provide further support that a PC-risk SNP rs2735839 near the KLK3 gene on chromosome 19q13 may be associated with aggressive and high-grade PC. Future prospectively designed, case-case GWAS are needed to identify additional SNPs associated with PC aggressiveness. (shrink)

One model for creating artificial consciousness is replicating every fine detail of the brain on computers and setting the model in motion. Consciousness has been experimentally demonstrated to be a much more fragmented experience than we think it to be, perhaps we only need snippets of ourselves to feel conscious. Perhaps consciousness is nothing less and nothing more than story, and all we need do to continue to feel conscious is maintain identity through computer‐based narrative. Applied nanotechnology has generated uncountable (...) applications in electronics, pharmacology, and materials engineering. The best approach to life extension and consciousness expansion might lie in our own marvelously complex and entire bodies, meshed with and augmented by tiny bionan machines that become a part of us, rather than the opposite vision of humans migrating into a machine substrate. (shrink)

Palliative Care Nursing: Caring for Suffering Patients explores the concept of suffering as it relates to nursing practice. This text helps practicing nurses and students define and recognize various aspects of suffering across the lifespan and within various patient populations while providing guidance in alleviating suffering. In addition, it examines spiritual and ethical perspectives on suffering and discusses how witnessing suffering impacts nurses' ability to assume the professional role. Further, the authors discuss ways nurses as witnesses to suffering can optimize (...) their own coping skills and facilitate personal growth. Rich in case studies, pictures, and reflections on nursing practice and life experiences, Palliative Care Nursing: Caring for Suffering Patients delves into key topics such as how to identify when a patient is suffering, whether they are coping, sources of coping facades, what to do to ease suffering, and how to convey the extent of suffering to members of the health care team.Palliative Care Nursing: Caring for Suffering Patients helps practicing nurses and students define and recognize various aspects of suffering across the lifespan and within various patient populations while providing guidance in alleviating suffering. (shrink)

Hardly anyone disputes that discrimination can be a grave moral wrong. Yet this consensus masks fundamental disagreements about what makes something discrimination, as well as precisely why acts of discrimination are wrong. Benjamin Eidelson develops systematic answers to those two questions. He claims that discrimination is a form of differential treatment distinguished by its special connection to the differential ascription of some property to different people, and goes on to argue that what makes some cases of discrimination intrinsically wrongful (...) is that they manifest an attitude of disrespect for the personhood of those who are disfavored. He endeavors to specify what this attitude consists in, and to demonstrate how attending to its character can help us to better understand the moral dimensions of different forms of wrongful discrimination. The book concludes with an extended discussion of racial profiling in law enforcement. (shrink)

Teilhard's words divided into a "Book of Hours" of eight days, according to Dawn, Day, Dusk, and Dark.

Kiesewetter defends the normativity of rationality by presenting a new solution to the problems that arise from the common assumption that we ought to be rational. He provides a defence of a reason-response conception of rationality, an evidence-relative account of reason, and an explanation of structural irrationality in relation to these accounts.

One of the reasons for the disappearance of beauty in the artistic ideology of the late twentieth century has been the seeming similarity of beauty to certain kinds of kitsch. Beauty has also been associated with flawlessness and with glamour. I will content that the flawless and the glamorous are actually categories of kitsch, and that the dominance of these images in marketing has contributed to our societal tendency to confuse them with beauty. The quests for flawlessness and glamour are (...) both self-sabotaging, a premise on which the marketing of beauty depends. These false paradigms of beauty have ob cured the fact that human beauty manifests an ideal of balance and health that is neither self-conscious nor a consequence of deliberate effort. I will defend the relevance of this ideal to beauty to our personal and cultural well-being. (shrink)

Sometimes our intentions and beliefs exhibit a structure that proves us to be irrational. This dissertation is concerned with the question of whether we ought (or have at least good reason) to avoid such irrationality. The thesis defends the normativity of rationality by presenting a new solution to the problems that arise from the common assumption that we ought to be rational. The argument touches upon many other topics in the theory of normativity, such as the form and the content (...) of rational standards or requirements, the preconditions of criti¬cism, and the function of reasons in deliberation and advice. Over and above an exten¬sive assessment of the problems discussed in the literature, the thesis provides a detailed defence of a reason-response conception of rationality, a novel, evidence-relative account of reasons, and an explanation of structural irrationality in terms of these accounts. (shrink)

This paper aims at presenting a horizontal approach to the design of communication for joint action in human-robot interaction. According to this approach, social robotics must focus on different parameters of the whole joint action including context, the embedded situation and human psychological profile during the design and test process. Such an approach aims at complementing the standard building-block model that represents the state-of-the-art in robotic communication. Moreover, we provide some general ideas of how the model can facilitate the use (...) of available communicative strategies for creating more efficient culturally sustainable robots in contexts of joint action. (shrink)

Scientists depend on complex computational systems that are often ineliminably opaque, to the detriment of our ability to give scientific explanations and detect artifacts. Some philosophers have s...

This article examines the relationship between an aspect of a firm’s corporate social responsibility, corporate community programs, and the effectiveness of its corporate political activity. Developing a conceptual model based on resource-based view of the firm, the authors argue that the mechanism linking a firm’s CCP to CPA mechanism is the effect of CCPs on the development of firm level resources. Specifically, the intensity of a firm’s CCPs enhances a firm’s human capital, organizational capital, and geographic resources, which in turn (...) improve the effectiveness of two key aspects of CPA: information and constituency-building political strategies. This linkage of CCPs to CPA effectiveness may be particularly relevant when the firm faces unfavorable political markets. (shrink)

Consider the following 'principles':2(Norm of Belief Schema) Necessarily, a belief of is correct (relative to some scenario) if and only if p (at that scenario) — where 'p' has the aforementioned content .(Generalized Norm of Belief) Necessarily, for all propositions , a belief of is correct (relative to some scenario) if and only if is true (at that scenario).Both 'principles' appear to capture the aim(s) of belief. (NBS) particularizes the aims to beliefs of distinct content-types. (GNB) generalizes these aims of (...) beliefs as truth. Properly understood, the instances of (NBS) appear to be at least approximately true as does (GNB). Of course, one might harbor concerns about whether these are mere .. (shrink)

According to a widely held view, epistemic reasons are normative reasons for belief – much like prudential or moral reasons are normative reasons for action. In recent years, however, an increasing number of authors have questioned the assumption that epistemic reasons are normative. In this article, I discuss an important challenge for anti-normativism about epistemic reasons and present a number of arguments in support of normativism. The challenge for anti-normativism is to say what kind of reasons epistemic reasons are if (...) they are not normative reasons. I discuss various answers to this challenge and find them all wanting. The arguments for normativism each stress a certain analogy between epistemic reasons and normative reasons for action. Just like normative reasons for action, epistemic reasons provide partial justification; they provide premises for correct reasoning; they constitute good bases for the responses they are reasons for; and they are reasons for which agents can show these responses without committing a mistake. In each case, I argue that the relevant condition is plausibly sufficient for the normativity of a reason, and that normativism is in any case in a much better position to explain the analogy than anti-normativism. (shrink)

A popular approach to defining fictive utterance says that, necessarily, it is intended to produce imagining. I shall argue that this is not falsified by the fact that some fictive utterances are intended to be believed, or are non-accidentally true. That this is so becomes apparent given a proper understanding of the relation of what one imagines to one's belief set. In light of this understanding, I shall then argue that being intended to produce imagining is sufficient for fictive utterance (...) as well. (shrink)

This volume examines the motives behind rejections of beauty often found within contemporary art practice, where much critically acclaimed art is deliberately ugly and alienating. It reflects on the nature and value of beauty, asking whether beauty still has a future in art and what role it can play in our lives generally. The volume discusses the possible “end of art,” what art is, and the relation between art and beauty beyond their historically Western horizons to include perspectives from Asia. (...) The individual chapters address a number of interrelated issues, including: art, beauty and the sacred; beauty as a source of joy and consolation; beauty as a bridge between the natural and the human; beauty and the human form; the role of curatorial practice in defining art; order and creativity; and the distinction between art and craft. The volume offers a valuable addition to cross-cultural dialogue and, in particular, to the sparse literature on art and beauty in comparative context. It demonstrates the relevance of the rich tradition of Asian aesthetics and the vibrant practices of contemporary art in Asia to Western discussions about the future of art and the role of beauty. (shrink)

According to an attractive and widely held view, all practical reasons are explained in terms of the (instrumental or final) value of the action supported by the reason. I argue that this theory is incompatible with plausible assumptions about the practical reasons that correspond to certain moral rights, including the right to a promised action and the right to an exclusive use of one’s property. The argument is an explanatory rather than extensional one: while the actions supported by the relevant (...) reasons (e.g. keeping a valid promise or respecting property) can be argued to have a certain kind of value, I argue that this value presupposes a moral right, and therefore cannot explain the reason. Reflection on such cases suggest the conclusion that reasons that are subject to normative powers are generally not value-based. This also has important implications for the dialectic between ‘value-first’ and ‘reasons-first’ approaches to normativity. (shrink)

An increasing number of regulations propose the notion of ‘AI audits’ as an enforcement mechanism for achieving transparency and accountability for artificial intelligence (AI) systems. Despite some converging norms around various forms of AI auditing, auditing for the purpose of compliance and assurance currently have little to no agreed upon practices, procedures, taxonomies, and standards. We propose the ‘criterion audit’ as an operationalizable compliance and assurance external audit framework. We model elements of this approach after financial auditing practices, and argue (...) that AI audits should similarly provide assurance to their stakeholders about AI organizations’ ability to govern their algorithms in ways that mitigate harms and uphold human values. We discuss the necessary conditions for the criterion audit, and provide a procedural blueprint for performing an audit engagement in practice. We illustrate how this framework can be adapted to current regulations by deriving the criteria on which ‘bias audits’ for hiring algorithms can be performed, as required by the recently effective New York City Local Law 144 of 2021. We conclude by offering critical discussion on the benefits, inherent limitations, and implementation challenges of applying practices of the more mature financial auditing industry to AI auditing where robust guardrails against quality assurance issues are only starting to emerge. Our discussion as informed by experiences in performing these audits in practice highlights the critical role that an audit ecosystem plays in ensuring the effectiveness of such methodology. (shrink)

If you ought to perform a certain act, and some other action is a necessary means for you to perform that act, then you ought to perform that other action as well – or so it seems plausible to say. This transmission principle is of both practical and theoretical significance. The aim of this paper is to defend this principle against a number of recent objections, which (as I show) are all based on core assumptions of the view called actualism. (...) I reject actualism, provide an alternative explanation of its plausible features, and present an independent argument for the transmission principle. (shrink)

The concept of a relational self has been prominent in feminism, communitarianism, narrative self theories, and social network theories, and has been important to theorizing about practical dimensions of selfhood. However, it has been largely ignored in traditional philosophical theories of personal identity, which have been dominated by psychological and animal theories of the self. This book offers a systematic treatment of the notion of the self as constituted by social, cultural, political, and biological relations. The author's account incorporates practical (...) concerns and addresses how a relational self has agency, autonomy, responsibility, and continuity through time in the face of change and impairments. This cumulative network model of the self incorporates concepts from work in the American pragmatist and naturalist tradition. The ultimate aim of the book is to bridge traditions that are often disconnected from one another--feminism, personal identity theory, and pragmatism--to develop a unified theory of the self. (shrink)

This entry considers the question “What is objectification?” After preliminary remarks about different methodological approaches, several possible answers, or groups of answers, are introduced, separated out in terms of broad themes. Each is situated in relation to historical and more contemporary authors. These themes are: objectification as instrumentalization; objectification as reduction to the body; objectification as negation of subjectivity or agency; objectification as naturalization. Objectification is considered in relation to both sexual and racial contexts. Finally, these themes are discussed in (...) relation to the wider category of “mind suppression,” and its relation to objectification in the familiar context of imagery. (shrink)

The tremendous recent growth of the women's movement as a political force has been accompanied by an event of equal import to the academic world--the development of the discipline of women's studies. Colleges across the nation are establishing programs in this area. Women's Studies is a classroom anthology designed for use in these newly-introduced courses.

Medical Professionals: Conflicts and Quandaries in Medical Practice offers a fresh approach to understanding the role-related conflicts and quandaries that pervade contemporary medical practice. While a focus on professional conflicts is not new in the literature, what is missing is a volume that delves into medical professionals' own experience of the conflicts and quandaries they face, often as a result of inhabiting multiple roles. The volume explores the ways in which these conflicts and quandaries are exacerbated by broader societal forces, (...) including changing scientific and technological paradigms, commercialization, and strengthened consumer movements, which simultaneously expand the scope of roles and responsibilities that medical professionals are expected to fulfill, and make it more difficult to do so. Several empirical chapters analyze data from qualitative interview studies with clinicians and other stakeholders. The studies highlight the burdens on clinicians who are expected to make informed and justified judgments and decisions in the midst of competing pressures; authors describe the methods that clinicians use to address the associated tensions within specific contexts. Two conceptual chapters follow and offer some innovative ways to think about the challenges facing medical professionals as they strive to make sense of the changing landscape within healthcare. The first reflects on the challenges to clinical practice in the midst of shifting and often competing definitions of disease and associated ideologies of care. The second reflects more broadly on the utility of value pluralism as a framework for conceptualizing and working through moral and professional quandaries. The book concludes with a chapter containing suggestions for how members of the medical profession might reframe their thinking about their roles, responsibilities, and decision-making in the midst of inevitable quandaries such as those presented here. This book will be of vital reading for academics, researchers, educators, postgraduate students, and interested health care practitioners and administrators. (shrink)

This article examines the complaint that arbitrary algorithmic decisions wrong those whom they affect. It makes three contributions. First, it provides an analysis of what arbitrariness means in this context. Second, it argues that arbitrariness is not of moral concern except when special circumstances apply. However, when the same algorithm or different algorithms based on the same data are used in multiple contexts, a person may be arbitrarily excluded from a broad range of opportunities. The third contribution is to explain (...) why this systemic exclusion is of moral concern and to offer a solution to address it. (shrink)