This paper raises questions about the epistemological foundations of evidence-based medicine . We argue that EBM is based upon reliabilist epistemological assumptions, and that this is appropriate - we should focus on identifying the most reliable processes for generating and collecting medical knowledge. However, we note that this should not be reduced to narrow questions about which research methodologies are the best for gathering evidence. Reliable processes for generating medical evidence might lie outside of formal research methods. We also question (...) the notion of the knower that is assumed by EBM. We argue that EBM assumes an enlightenment conception of knowers as autonomous, substitutable individuals. This conception is troubled by the way that clinicians learn the role of anecdote in health care and the role of patient choice, all of which bring into play features of clinicians and patients as situated individuals with particular backgrounds and experiences. EBM's enlightenment conception of the knower is also troubled by aspects of the way evidence is produced. Given these limitations, we argue that EBM should retain its reliabilist bent, but should look beyond formal research methodologies in identifying processes that yield reliable evidence for clinical practice. We suggest looking to feminist epistemology, with its focus on the standpoints of individual situated knowers, and the role of social context in determining what counts as knowledge. (shrink)

Patient or public involvement in health research is increasingly expected as a matter of policy. In theory, PPI can contribute both to the epistemic aims intrinsic to research, and to extrinsically valued features of research such as social inclusion and transparency. In practice, the aims of PPI have not always been clear, although there has been a tendency to encourage the involvement of so-called ordinary people who are regarded as representative of an assumed patient perspective. In this paper we focus (...) on the epistemic potential of PPI, using theoretical work in epistemology to develop a nuanced account of patients’ experiential knowledge and how this might contribute directly to conceptual development, hypothesis generation and data interpretation. We also consider how some features of health research pose barriers to this kind of epistemic contribution. Drawing on Miranda Fricker’s idea of testimonial injustice, we explore how disciplinary indicators of credibility in clinical and academic health research contexts might be wrongly applied to those involved in PPI, undermining their potential to contribute. Finally we argue for a range of strategies to maximize opportunities for patients to engage with research teams and make epistemologically significant contributions to research. (shrink)

OBJECTIVES: This article presents an original definition of surgical innovation and a practical tool for identifying planned innovations. These will support the responsible introduction of surgical innovations. BACKGROUND: Frameworks developed for the safer introduction of surgical innovations rely upon identifying cases of innovation; oversight cannot occur unless innovations are identified. However, there is no consensus among surgeons about which interventions they consider innovative; existing definitions are vague and impractical. METHODS: Using conceptual analysis, this article synthesizes findings from relevant literature, and (...) from qualitative research with surgeons, to develop an original definition of surgical innovation and a tool for prospectively identifying planned surgical innovations. The tool has been developed in light of feedback from health care professionals, surgeons, and policy makers. RESULTS: This definition of innovation distinguishes between variations, introduction of established interventions, and innovations in surgical techniques or use of devices. It can be applied easily and consistently, is sensitive to the key features of innovation, is prospective, and focuses on features relevant to safety and evaluation. The accompanying tool is deliberately broad so that appropriate supports may, if necessary, be provided each time that a surgeon does something "new". CONCLUSIONS: The definition presented in this article overcomes a number of practical challenges. The definition and tool will be of value in supporting responsible surgical innovation, in particular, through the prospective identification of planned innovations. (shrink)

This paper draws attention to gendered dimensions of surgical device failure, focusing on two case studies—hernia repair mesh for pelvic organ prolapse, and metal-on-metal hip implants. We explore possible reasons for higher rates of harms to women, including systematic biases in health research and device regulation. Given that these factors are readily identifiable, we look to feminist scholarship to understand what might maintain them, including the role of cultural factors within surgery, such as gendered communication patterns and sexism. We then (...) canvas potential measures to mitigate the increased risk of harms faced by women who use implanted devices. (shrink)

As the price of pharmaceuticals and biologicals rises so does the number of patients who cannot afford them. In this article, we argue that physicians have a moral duty to help patients access affordable medicines. We offer three grounds to support our argument: (i) the aim of prescribing is to improve health and well-being which can only be realized with secure access to treatment; (ii) there is no morally significant difference between medicines being unavailable and medicines being unaffordable, so the (...) steps physicians are willing to take in the first case should extend to the second; and (iii) as the primary stakeholder with a duty to put the individual patient’s interests first, the medical professional has a duty to address cost-barriers to patient care. In articulating this duty, we take account of important epistemic and control conditions that must be met for the attribution of this duty to be justified. (shrink)

Placebo-controlled surgical trials can provide important information about the efficacy of surgical interventions. However, they are ethically contentious as placebo surgery entails the risk of harms to recipients, such as pain, scarring or anaesthetic misadventure. This has led to claims that placebo-controlled surgical trials are inherently unethical. On the other hand, without placebo-controlled surgical trials, it may be impossible to know whether an apparent benefit from surgery is due to the intervention itself or to the placebo effect.

Surgical advances can provide great benefits to patients but can come at a cost. The successes are often matched by failures that cause harm to patients. The risks of surgery create a strong ethical imperative for research to establish the safety and efficacy of new treatments. Surgical research is, however, challenging for a number of reasons including the lack of a clear boundary between variations in practice, innovation and research, its irreversible nature, the difficulty of performing placebo-controlled randomised trials, confounding (...) factors such as surgeon learning curves and conflicts of interest. In this chapter the ethical issues raised by surgical innovation are explored with the use of a case study based on the uptake of vaginal mesh to treat vaginal prolapse to highlight these issues (Sects. 12.1 and 12.2). In Sect. 12.3 the argument for the value of a structured approach to introducing innovations, such as that developed by the IDEAL Collaboration, which clarifies both ethical and methodological issues at each stage of research is proposed. This chapter recognises that ethical challenges extend beyond adequate ethical evaluation of the innovation in the care of individual patients to include broader issues such as justice in access to any new interventions. (shrink)

Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide (...) advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: impacts on healthcare costs, the outsourcing of expertise and issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries. (shrink)

Volume 19, Issue 6, June 2019, Page 28-29.

The development and deployment of medical devices, along with most areas of healthcare, has been significantly impacted by the COVID-19 pandemic. This has had variable ethical implications, two of which we will focus on here. First, medical device regulations have been rapidly amended to expedite approvals of devices ranging from face masks to ventilators. Although some regulators have issued cessation dates, there is inadequate discussion of triggers for exiting these crisis standards, and evidence that this may not be feasible. Given (...) the relatively low evidence standards currently required for regulatory approval of devices, this further indefinite reduction in standards raises serious ethical issues. Second, the pandemic has disrupted the usual operations of device representatives in hospitals, providing an opportunity to examine and refine this potentially ethically problematic practice. In this paper we explain and critically analyse the ethical implications of these two pandemic-related impacts on medical devices and propose suggestions for their management. These include an endpoint for pandemic-related adjustments to device regulation or a mechanism for continued refinement over time, together with a review of device research conducted under crisis conditions, support for the removal and replacement of emergency approved devices, and a review of device representative credentialling. (shrink)

For over a decade, we have watched the state affairs/practitioner constituency within the American Psychological Association move steadily to become the single largest group—clearly a majority—within the membership ranks of the association. Over the same period of time and as the obverse of related demographic phenomena, the research/academic constituency has shrunk to around 30% of the membership. Since power over the affairs of and the destiny of APA has traditionally resided in the hands of the latter, it probably would have (...) been too much to hope that the visionaries in the research/academic community would have made way gracefully for new leadership to be seated in the positions of authority in the association, a leadership more attuned to the needs of APA's majority. So it is not surprising that an orderly transfer of power has not taken place. 2012 APA, all rights reserved). (shrink)

This case deals with the corporate response to a crisis and the successful evacuation of approximately 900 hotel guests, staff, and family members of staff whowere stranded in the Fairmont New Orleans hotel by Hurricane Katrina. This rescue effort, spearheaded by managers at the sister Fairmont hotel in Dallas, Texas, was completed shortly after 12 a.m. on Friday, September 2, 2005, when the last bus with evacuees pulled into the Dallas Fairmont after making a round trip of more than (...) 1000 miles — and about 64 hours after planning began. This case is particularly significant for lessons that may be derived about crisis management and leadership, and it also raises several interesting ethical issues. The case, which relies on field research plus secondary sources, is appropriate for business ethics and business strategy courses. (shrink)

The goal of this paper is to examine the impact of leadership and promotion regulatory focus on employees’ willingness to engage in unethical pro-organizational behavior . Building from a person–situation interactionist perspective, we investigate the interaction of leadership style and how leaders frame messages, as well as test a three-way interaction with promotion focus. Using an experimental design, we found that inspirational and charismatic transformational leaders elicited higher levels of UPB than transactional leaders when the leaders used loss framing, but (...) not gain framing. Furthermore, followers’ promotion regulatory focus moderated this relationship such that the effect held for followers with low promotion focus, but not for individuals with high promotion focus. Our findings extend the understanding of UPB, offer theoretical mechanisms to explain when this behavior occurs, and contribute to leadership theory and research on ethical decision making. (shrink)

Introduction: Conversion and the practice of transformation -- The philosophical structure of Jonathan Edwards's religious affections -- Habit, habit change, and conversion in C.S. Peirce -- Reconstructing faith : religious overcoming in Dewey's pragmatism -- Transforming obligation in William James -- Dwelling in absence: the reflective origin of conversion -- Creative transformation : the work of conversion -- The evasion of conversion in recent American philosophy.

In this first-ever history of contemporary liberal theory, Forrester shows how liberal egalitarianism--a set of ideas about justice, equality, obligation, and the state--became dominant, and traces its emergence from the political and ideological context of the postwar United States and Britain.d Britain.

The paper distinguishes between weak and strong epistemic possibility and argues that the notion of strong epistemic possibility is the key to solving some of the most vexing puzzles about the semantics of epistemic modality.

In this chapter, Sifferd analyzes the grounds for moral and legal desert. She bridges the gap between compatibilist accounts of our moral and legal responsibility, and she argues that neither moral nor criminal responsibility demand impossible or superhuman abilities. Sifferd’s capacitarian view of agency embraces our mechanistic natures yet can still ground robust mental causation, a key requirement for criminal culpability. She also notes the ways in which the capacity for reasons-responsiveness is developed and maintained over time, and she claims (...) that diachronic agency can instantiate meaningful self-control and self-formation with moral and legal rules in mind. Sifferd concludes that rapists do in some cases deserve criminal punishment. Her ultimate position is that basic desert is necessary but not sufficient for criminal punishment of rape. (shrink)

In May 2011, more than a decade after the International Association of Athletics Federations (IAAF) and the International Olympic Committee (IOC) abandoned sex testing, they devised new policies in response to the IAAF's treatment of Caster Semenya, the South African runner whose sex was challenged because of her spectacular win and powerful physique that fueled an international frenzy questioning her sex and legitimacy to compete as female. These policies claim that atypically high levels of endogenous testosterone in women (caused by (...) various medical conditions) create an unfair advantage and must be regulated. Against the backdrop of Semenya's case and the scientific and historical complexity of ?gender verification? in elite sports, we question the new policies on three grounds: (1) the underlying scientific assumptions; (2) the policymaking process; and (3) the potential to achieve fairness for female athletes. We find the policies in each of these domains significantly flawed and therefore argue they should be withdrawn. (shrink)

Not all probability ascriptions that appear in scientific theories describe chances. There is a question about whether probability ascriptions in non-fundamental sciences, such as those found in evolutionary biology and statistical mechanics, describe chances in deterministic worlds and about whether there could be any chances in deterministic worlds. Recent debate over whether chance is compatible with determinism has unearthed two strategies for arguing about whether a probability ascription describes chance—that is, to speak metaphorically, two different strategies for figuring out where (...) the chances are: find the chances by focusing on chance’s explanatory role or find the chances by focusing on chance’s predictive role. These two strategies tend to yield conflicting results about where the chances are, and debate over which strategy is appropriate tends to end in stalemate. After discussing these two strategies, I consider a new view of chance’s explanatory role. I argue that one theoretical advantage of this new view is that allows us to make progress on the question of where the chances are by providing a principled way of determining which probability ascriptions describe chances. From the vantage of this new view, the correct application of both strategies involves figuring out where the chances are by figuring out where the probabilistic scientific explanations are and what those explanations are like. (shrink)

This paper proposes a preliminary infrastructure for future philosophical discourse on the virtual, interactive, visual, top layer of the Internet. The paper begins by introducing thoughts on such words as real, virtual, reality, knowledge, and truth. Next, news summaries are provided illustrating some effects from the “real world” on the virtual part of the Internet, and vice versa. Subsequently, nine major categories of Internet variables are identified. Finally, over one hundred questions about the philosophical nature of the virtual part of (...) the Internet are listed and are organized into fourteen categories. (shrink)

This paper proposes a preliminary infrastructure for future philosophical discourse on the virtual, interactive, visual, top layer of the Internet. The paper begins by introducing thoughts on such words as real, virtual, reality, knowledge, and truth. Next, news summaries are provided illustrating some effects from the “real world” on the virtual part of the Internet, and vice versa. Subsequently, nine major categories of Internet variables are identified. Finally, over one hundred questions about the philosophical nature of the virtual part of (...) the Internet are listed and are organized into fourteen categories. (shrink)

Does smoke cause fire or does fire cause smoke? James Woodward’s “Flagpoles anyone? Causal and explanatory asymmetries” argues that various statistical independence relations not only help us to uncover the directions of causal and explanatory relations in our world, but also are the worldly basis of causal and explanatory directions. We raise questions about Woodward’s envisioned epistemology, but our primary focus is on his metaphysics. We argue that any alleged connection between statistical dependence and causal/explanatory direction is contingent, at best. (...) The directions of causal/explanatory relations in our world seem not to depend on the statistical dependence relations in our world. Thus, we doubt that statistical dependence relations are the worldly basis of causal and explanatory directions. (shrink)

Translator's Preface LA LOGIQUE DE HUSSERL, etude sur "Logique for- melle et logique transcendentale" the original of the present translation, was published ...

In light of recent interest among political theorists in the idea of political realism, Judith Shklar’s liberalism of fear has come to be associated with anti-Rawlsian thought. This paper seeks to show that, on the contrary, Shklar’s specific formulation of political realism, unlike more recent variations, was not motivated by a critique of Rawls. This paper will address three concerns: first, it will show what exactly Shklar’s initial realism was responding to; second, it will consider the implications of this realism (...) for thinking about liberal democracies; third, it will attempt, briefly, in light of this, to make sense of her relationship with Rawls and, in turn, through a comparison with Bernard Williams’s thought, her relationship to anti-Rawlsian political realism. (shrink)

Professional sport in the United States has widely adopted biometric technologies, dramatically expanding the monitoring of players’ biodata. These technologies have the potential to prevent injuries, improve performance, and extend athletes’ careers; they also risk compromising players’ privacy and autonomy, the confidentiality of their data, and their careers. The use of these technologies in professional sport and the consumer sector remains largely unregulated and unexamined. We seek to provide guidance for their adoption by examining five areas of concern: validity and (...) interpretation of data; increased surveillance and threats to privacy; risks to confidentiality and concerns regarding data security; conflicts of interest; and coercion. Our analysis uses professional sport as a case study; however, these concerns extend to other domains where their use is expanding, including the consumer sector, collegiate and high school sport, the military, and commercial sectors where monitori... (shrink)

In April 2018, the International Association of Athletics Federations released new regulations placing a ceiling on women athletes’ natural testosterone levels to “ensure fair and meaningful competition.” The regulations revise previous ones with the same intent. They require women with higher natural levels of testosterone and androgen sensitivity who compete in a set of “restricted” events to lower their testosterone levels to below a designated threshold. If they do not lower their testosterone, women may compete in the male category, in (...) an intersex category, at the national level, or in unrestricted events. Women may also challenge the regulation, whether or not they have lowered their testosterone, or quit sport. Irrespective of IAAF’s stated aims, the options forced by the new regulations are impossible choices. They violate dignity, threaten privacy, and mete out both suspicion and judgement on the sex and gender identity of the athletes regulated. (shrink)

Argues that the only way to understand the Confucian vision of the consummate moral life is to take the tradition on its own terms.

The Peterloo Massacre was more than just a Manchester event. The attendees, on whom Manchester industry depended, came from a large spread of the wider textile regions. The large demonstrations that followed in the autumn of 1819, protesting against the actions of the authorities, were pan-regional and national. The reaction to Peterloo established the massacre as firmly part of the radical canon of martyrdom in the story of popular protest for democracy. This article argues for the significance of Peterloo in (...) fostering a sense of regional and northern identities in England. Demonstrators expressed an alternative patriotism to the anti-radical loyalism as defined by the authorities and other opponents of mass collective action. (shrink)

Background: The current study was designed to examine whether ethnic-racial identity moderated the relationship between disordered eating and primary ethnic identification.Methods: Three hundred and ninety-eight undergraduate women were recruited from a large university in Hawai‘i. Participants completed the Eating Disorder Examination Questionnaire, the ERI measure, and reported their primary ethnicity as an index of ethnicity.Results: There was a significant correlation between eating concerns and centrality, r = 0.127, p < 0.05. Moderation analyses indicated that only ERI centrality moderated the predictive (...) effect of ethnicity on the importance of eating concerns, b = 0.05, t = 2.37, p = 0.018.Conclusions: The results suggest that the relationship between self-reported primary ethnicity and EDEQ scores is greater when ethnicity is more central to the individual's identity or when the in-group affect is important to an individual. Findings underscore the need for further research on the underlying mechanisms that account for the differing ways that ERI may affect eating concerns. (shrink)

Philosophical Perspectives, Volume 35, Issue 1, Page 170-188, December 2021.

Does neo-Rawlsian political philosophy offer an adequate account of the social conditions of capitalism? In this paper, I present two arguments for thinking that it does not. First, I develop a historicist critique of liberal egalitarianism, arguing that it provides a vision of social reality that is intimately connected to the historical and ideological constellation that I call postwar liberalism, and as such cannot account for social reality since the neoliberal revolutions of the late twentieth century. Second, I explore arguments (...) in Marxist and critical social theory that cast liberal egalitarianism as partial, on account of its inadequate portrait of capitalist society. In surveying responses to these critiques, I argue that merely extending liberal egalitarianism into new domains to account for how contemporary circumstances have changed since the mid-twentieth century cannot address the problem of its partial view of the social world. Taking seriously the insights of critical social theory and the study of capitalism should lead to a challenge to liberal egalitarianism, not an extension of it. (shrink)

Does smoke cause fire or does fire cause smoke? James Woodward’s “Flagpoles anyone? Causal and explanatory asymmetries” argues that various statistical independence relations not only help us to uncover the directions of causal and explanatory relations in our world, but also are the worldly basis of causal and explanatory directions. We raise questions about Woodward’s envisioned epistemology, but our primary focus is on his metaphysics. We argue that any alleged connection between statistical (in)dependence and causal/explanatory direction is contingent, at best. (...) The directions of causal/explanatory relations in our world seem not to depend on the statistical (in)dependence relations in our world (conceived of either as frequency patterns or as relations among chances). Thus, we doubt that statistical (in)dependence relations are the worldly basis of causal and explanatory directions. (shrink)

According to David Lewis’s Principal Principle, our beliefs about the objective chances of outcomes determine our rational credences in those outcomes. Lewis influentially argues that any adequate metaphysics of objective chance must explain why the Principal Principle holds. Since no theory of chance is widely agreed to have met this burden, I suggest we change tack. On the view I develop, a central aspect of the Principal Principle holds not because of what objective chances are but rather because of the (...) explanatory role that objective chances play for the rational agents who believe in them. (shrink)

Connects the work of Merleau-Ponty to environmental studies.

_Philosophically explores the topic of emotional depth._.

The psychological literature now differentiates between two types of psychopath:successful (with little or no criminal record) and unsuccessful (with a criminal record). Recent research indicates that earlier findings of reduced autonomic activity, reduced prefrontal grey matter, and compromised executive activity may only be true of unsuccessful psychopaths. In contrast, successful psychopaths actually show autonomic and executive function that exceeds that of normals, while having no difference in prefrontal volume from normals. We argue that many successful psychopaths are legally responsible for (...) their actions, as they have the executive capacity to choose not to harm (and thus are legally rational). However, many unsuccessful psychopaths have a lack of executive function that should at least partially excuse them from criminal culpability. Although a successful psychopath's increased executive function may occur in conflict with, rather than in consonance with their increased autonomic activity - producing a cognitive style characterized by self deception and articulate-sounding, but unsound reasoning - they may be capable of recognizing and correcting their lack of autonomic data, and thus can be held responsible. (shrink)

Certain anaphoric forms are widely supposed to give rise to ‘de se’ interpretations. Castanteda (1966a/b, 1967) argues that intensive reflexive anaphors such as ‘he himself’ and ‘she herself’ act as devices for the indirect report of essentially ‘first person’ contents when they occur with singular antecedents. In this paper, I argue that first and third person pronouns that occur as anaphors on c-commanding quantified antecedents (so-called ‘bound variable pronouns’) also give rise to de se interpretations. I draw out a problem (...) that this observation raises for a well-accepted account according to which bound pronouns occur as featureless variables. I argue that the best way to account for de se interpretations of bound first and third person pronouns is to abandon the view that pronouns lack features when bound. I offer a new account of bound pronominal anaphora which assigns the features of pronouns a crucial role in deriving bound readings. (shrink)

"In recent years, we have grown accustomed to philosophical language that is intensely self-conscious and rhetorically thick, often tragic in tone. It is enlivening to read Bergson, who exerts so little rhetorical pressure while exacting such a substantial effort of thought.... Bergson's texts teach the reader to let go of entrenched intellectual habits and to begin to think differently—to think in time.... Too much and too little have been said about Bergson. Too much, because of the various appropriations of his (...) thought. Too little, because the work itself has not been carefully studied in recent decades."—from Thinking in Time Henri Bergson, whose philosophical works emphasized motion, time, and change, won the Nobel Prize for Literature in 1927. His work remains influential, particularly in the realms of philosophy, cultural studies, and new media studies. In Thinking in Time, Suzanne Guerlac provides readers with the conceptual and contextual tools necessary for informed appreciation of Bergson's work. Guerlac's straightforward philosophical expositions of two Bergson texts, Time and Free Will and Matter and Memory, focus on the notions of duration and memory—concepts that are central to the philosopher's work. Thinking in Time makes plain that it is well worth learning how to read Bergson effectively: his era and our own share important concerns. Bergson's insistence on the opposition between the automatic and the voluntary and his engagement with the notions of "the living," affect, and embodiment are especially germane to discussions of electronic culture. (shrink)