The physician-researcher conflict of interest has thus far eluded satisfactory solution. Most attempts to deal with it focus on improving informed consent. But those attempts are not successful and may even make things worse. Research subjects are already voluntarily undertaking the risks of research — we should not ask them to go it alone — to undergo medical “treatment” without medical “care.” The only effective solution is that in much clinical research, each research subject should have a doctor independent from (...) the research study. (shrink)

The physician-researcher conflict of interest, a long-standing and widely recognized ethical challenge of clinical research, has thus far eluded satisfactory solution. The conflict is fairly straightforward. Medical research and medical therapy are distinct pursuits; the former is aimed at producing generalizable knowledge for the benefit of future patients, whereas the latter is aimed at addressing the individualized medical needs of a particular patient. When the physician-researcher combines these pursuits, he or she serves two masters and cannot — no matter how (...) well-intentioned — avoid the risk of compromising the duties owed in one of the professional roles assumed. Because of the necessary rigidity of a research protocol, the more demanding of the two masters is frequently the research.The problem of the physician-researcher conflict has been evident since the first attempts to regulate human research in the United States. Otto E. Guttentag, a physician at the University of California School of Medicine in San Francisco, addressed the conflict in a 1953Sciencemagazine article. (shrink)

Ann Margaret Sharp, American philosopher of education, believed that friends could, in fact, be quite critical of one another. Writing in her essay, “What is a Community of Inquiry,” she states,... but children know that the group has taken on a great significance for them: each one’s happiness means as much to each of them as their own. They truly care for each other as persons, and this care enables them to converse in ways they never have before. They (...) can engage in inquiry without fear of rebuff or humiliation. They can try out ideas that they never would have thought of expressing before just to see what happens.I am grateful to the friends of Sharp who spent time in pursuit of understanding her work and its... (shrink)

Virginia Woolf, in A Room of One’s Own, asked why there were no women writers before 1800. If she had been thinking about philosophers instead of writers in the traditional women’s areas of plays and fiction, she might have asked why there were no women philosophers at all, for I suspect that most people would find it very hard to name a woman philosopher before the present day. To help her in answering her question, she invented a fictional character, Judith (...) Shakespeare, a sister to William Shakespeare. The conditions of Judith’s life made it impossible for her to write, and so Woolf speculated that the women who would have been writers did not lead the kinds of lives that permitted them to realize their talents. Woolf’s image of Judith Shakespeare is a very powerful one but her speculation is only half right. There undoubtedly were many women in the past who would have been talented writers or philosophers if their lives had been different, but Judith Shakespeare’s image can also blot out our knowledge of women who, contrary to Woolf’s speculation, did exist and did write. Indeed, we know now there were even women who wrote philosophy. These women were in many ways exceptional, for Woolf is quite right that most women did not live either with enough privacy or with enough income to allow them to write. Often, they were members of the aristocracy, whose position enabled them to behave eccentrically, sometimes to be able to demand privacy, and sometimes to be able to invite contacts with leading intellectuals. Quite often, these women were childless, which in an age before birth control made them exceptions to the general rule, and at a time when many women were bearing their last child in their forties, was the only thing that could have given them private time. Nevertheless, research in the last ten or fifteen years has uncovered the work of quite a number of these women: for example, Princess Elizabeth of Bohemia, the Electress Sophie, Queen Christina of Sweden, Queen Sophie Charlotte of Prussia, Anne, Lady Conway, Mary Astell, Damaris, Lady Masham, Catharine Trotter Cockburn, Emilie du Chatelet, Catherine Macaulay, Lady Mary Shepherd, and many more. Woolf’s question then comes up again in a slightly different form. Why is it that the work of these women was for so long unknown? Why do so many people even today remain ignorant of the existence of women philosophers before the present day? I am not going to answer this question directly; in fact, I suspect it has multiple answers. Instead, I am going to present a case study from amongst all the cases of all of these women. I hope by considering the history of this woman, and, in particular, considering the way in which she was read, it will be possible to gain some insights into the ways in which women have failed to be incorporated into philosophical history. The woman I am going to discuss is Lady Mary Shepherd. Mary Shepherd actually falls outside of Woolf’s target date of 1800, since she flourished in the first half of the nineteenth century, but this merely reflects my point about the greater ignorance that prevails about women in philosophy. (shrink)

In this article, we offer a perspective into howCanadian doctoral nursing students’ writing capacity is mentored and, as a result, we argue is disciplined. We do this by sharing our own disciplinary and interdisciplinary experiences of writing with, for and about nurses. We locate our experiences within a broader discourse that suggests doctoral (nursing) students be prepared as stewards of the (nursing) discipline. We draw attention to tensions and effects of writing within (nursing) disciplinary boundaries. We argue that traditional approaches (...) to developing nurses’ writing capacity in doctoral programs both shepherds and excludes emerging scholarly voices, and we present some examples to illustrate this dual role. We ask our nurse colleagues to consider for whom nurses write, offering an argument that nurses’ writing must ultimately improve patient care and thus would benefit from multiple voices in writing. (shrink)

In 1827, Lady Mary Shepherd published Essays on the Perception of an External Universe, which offers both an argument for the existence of a world of external bodies existing outside our minds and a criticism of Berkeley's argument for idealism in A Treatise Concerning the Principles of Human Knowledge. In this paper, I evaluate Margaret Atherton's criticisms of Shepherd's case against Berkeley, and provide reasons for thinking that, although Shepherd's particular criticisms of Berkeley do not succeed, (...) she correctly identifies an important problem to which Berkeley's reasoning is subject. (shrink)

This chapter examines the epistemologies of Margaret Cavendish, Mary Astell, and Mary Shepherd. Cavendish argues that minds come to have knowledge via two routes: sensory perception and reason. For Cavendish, these two faculties of knowledge differ not in kind but in degree: they work to produce ideas in the same way, but ideas that come from reason are less trustworthy than those from the senses. While Astell also acknowledges a distinction between sense perception and reason as faculties of (...) cognition, she claims that ideas that come from the senses cannot properly be called knowledge. In contrast, reason traffics in ideas that are wholly non-sensory and allow for a level of certainty that counts as knowledge in the strict sense. Shepherd locates a position that lies in between that of Cavendish and Astell. Like Astell, Shepherd argues that we have limited knowledge from sense perception, and we have absolutely certain knowledge of some things through a non-sensory faculty of reason – for example, that changes in a body cannot occur without a cause, and that things cannot be annihilated or come from nothing. However, for Shepherd, the scope of human knowledge is quite limited. (shrink)

For those open to the possibility that philosophical thought can improve life, David Hume's Essays: Moral, Political, and Literary have something to say. In the first comprehensive study of the Essays, Margaret Watkins engages closely with these neglected texts and shows how they provide important insights into Hume's perspective on the breadth and depth of human life, arguing that the Essays reveal his continued commitment to philosophy as a discipline that can promote both social and individual progress. Addressing topics (...) such as politics, war, slavery, the priesthood, the development of industry, aesthetics, emotional disorders, egoism, friendship, sexuality, gender relations, and the nature of philosophy itself, the volume examines Hume's purposes and aims against the backdrop of the eighteenth century society in which he lived. It will be of interest to scholars of modern thought in philosophy, politics, history, and economics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Testimony of Sense: Empiricism and the Essay from Hume to Hazlitt by Tim MilnesMargaret WatkinsTim Milnes. The Testimony of Sense: Empiricism and the Essay from Hume to Hazlitt. Oxford: Oxford University Press, 2019. Pp. viii + 278. Hardback. ISBN: 9780198812739. $91.00.In his brief autobiography, “My Own Life,” Hume reports that “almost all [his] life has been spent in literary pursuits and occupations” (E-MOL: xxxi). This is one (...) of at least ten places in this brief work in which he associates himself with “letters” or “literature”—as compared to at most four associations with philosophy. The moral to be inferred is not that Hume considered himself not to be a philosopher. Rather, he conceived of philosophy as a kind of literature. The Treatise was itself a “literary attempt.” Indeed, opposition between the “literary” and “philosophical” aspects of a text would have been foreign to Hume and his contemporaries—a notion for a later age, despite his occasional loose distinction between the relevant genres, as in his list of writings “historical, philosophical, or literary” in “My Own Life” (E-MOL: xxxvi).Yet despite Hume’s own understanding of the continuity between philosophy and literature, broadly conceived, it is still common for contemporary philosophers to ignore literary questions in their examination of Hume’s work, or to presume that one can easily distinguish the “philosophical” parts from the “literary” ones. Tim Milnes’s The Testimony of Sense is therefore a welcome addition to the Hume literature (pun intended). With a particular focus on the essay—a genre of great importance to Hume—Milnes contributes to the small set of engagements with Hume from the disciplinary perspective of English literature. With training in both philosophy and literature, as well as established expertise on Romanticism and its own essays, Milnes is well-qualified for the task. The Testimony of Sense includes sustained engagement with Hume’s contemporaries and successors, but for the purposes of this review, I engage the book primarily as a Hume scholar for Hume scholars.Milnes’s story plays out in three acts. The first establishes the need for public trust created by a skeptical crisis, itself a product of Hume’s criticism of the epistemic program of thinkers in the Cartesian and Lockean traditions. The second explains how the essays of the long eighteenth century constitute a response to that need in various ways. The third reveals in detail how the Romantic essayists, particularly William Hazlitt and Charles Lamb, both respond to and deviate from the “neoclassical” essayists, typified by Hume and Samuel Johnson.The first chapter, “Self and Intersubjectivity,” lays the groundwork by articulating how Hume, Adam Smith, Thomas Reid, and Dugald Stewart identify the need for what we now call intersubjectivity. Milnes describes the common thread as a kind of “natural transcendentalism.” In what sense are these thinkers properly understood as [End Page 175] transcendentalists? The central idea seems to be that all posit things other than reason as “conditions of meaningful thought” (72). For Hume, it is the social, linguistic experience of a community of virtuous judges. The intricate relations between self and other essential to such a community get “internalized within the specular drama of the impartial spectator” (72) in Smith’s writing, which itself takes part in the drama through his “halting, qualified syntax” that mimics “everyday speech” (44). Reid posits a “prescience” of trust, which grounds our reliance on both human testimony and the uniformity of nature, itself undergirded by the design of a benevolent God. Stewart, who posits axiomatic truths that help constitute the “stamina of intellect,” goes furthest, actually calling these truths transcendental (55). This chapter also puts these eighteenth-century thinkers in conversation with twentieth-century theorists, including Habermas, Davidson, and Rorty.Chapter 2, “The Subject of Trust,” deepens the analysis by situating these “natural transcendentalisms” in the broader enlightenment context. In contrast to Descartes, Bacon, and Locke, who were suspicious of our reliance on the opinions of others, the eighteenth-century thinkers understand trust as prior to reason in various ways—though not prior to solidarity. The particulars in each case depend on their responses to skepticism and their accounts of the relation between... (shrink)

For more than sixty years, surgeons have used bioethical strategies to promote patient self‐determination, many of these now collectively described as “informed consent.” Yet the core framework—understanding, risks, benefits, and alternatives—fails to support patients in deliberation about treatment. We find that surgeons translate this framework into an overly complicated technical explanation of disease and treatment and an overly simplified narrative that surgery will “fix” the problem. They omit critical information about the goals and downsides of surgery and present untenable options (...) as a matter of patient choice. We propose a novel framework called “better conversations.” Herein, surgeons provide context about clinical norms, establish the goals of surgery, and comprehensively delineate the downsides of surgery to generate a deliberative space for patients to consider whether surgery is right for them. This paradigm shift meets the standards for informed consent, supports deliberation, and allows patients to anticipate and prepare for the experience of treatment. (shrink)

The provenance of “naturalized epistemology,” so called, is too recent for the hand of Quine not to be still heavily upon it. But like its older relative, “naturalism,” it is an idea rich enough to be coveted, and protean enough to be claimed, by diverse comers with different things in mind. While Quine's version of naturalized epistemology of science inevitably furnishes the backdrop for current discussion of naturalizing moral epistemology, it is important to pause over what “naturalized epistemology” can and (...) should mean in ethics. To what extent is Quine's example of an epistemologyofscience that helps itselfto sciencethe model for understanding knowledge of and in morality? Does it require a view of moral knowledge as reducible to, or in a fundamental way furnished by, science? Or a view of moral theory as sciencelike in some way? I argue that the appropriate analogy is instead a holistic and reflexive epistemology of morality that helps itself to moral judgments and standards seen as answerable to the experience of the kinds of shared lives they make possible and necessary. This approach neither privileges nor rejects wholesale what scientific inquiries might have to say. (shrink)

The central problem of social theory is 'structure and agency'. How do the objective features of society influence human agents? Determinism is not the answer, nor is conditioning as currently conceptualised. It accentuates the way structure and culture shape the social context in which individuals operate, but it neglects our personal capacity to define what we care about most and to establish a modus vivendi expressive of our concerns. Through inner dialogue, 'the internal conversation', individuals reflect upon their social situation (...) in the light of current concerns and projects. On the basis of a series of unique, in-depth interviews, Archer identifies three distinctive forms of internal conversation. These govern agents' responses to social conditioning, their individual patterns of social mobility and whether or not they contribute to social stability or change. Thus the internal conversation is seen as being the missing link between society and the individual, structure and agency. (shrink)

Background Researchers are required to determine whether a person has capacity to consent to a research study before they are able to participate. The Mental Capacity Act and accompanying Code of Practice for England and Wales provide some guidance on this process, but researchers have identified that it can be difficult to determine capacity to consent when a person has complex cognitive or communication needs. This study aimed to understand the experiences and opinions of researchers who recruit people with dementia (...) to research projects, to inform the future development of training resources. Methods A mixed method, cross-sectional, electronic survey was circulated via social media and research networks in England and Wales. The survey remained open for ten weeks and included open and closed questions exploring respondents’ confidence in determining capacity in the context of recruiting people with dementia to consent, their views on training and support they have experienced and their suggestions for future training and support needs. Results 60 respondents completed the survey from across England and Wales. Although 75% of respondents had experience of determining capacity to consent with people with dementia to research, only 13% rated themselves as feeling ‘very confident’ in this. Qualitative content analysis of open responses led to the generation of six themes, explaining researchers’ confidence, competence and future training needs in this area: (1) Researcher uncertainties, (2) Lack of time, (3) Balancing information complexity with accessibility, (4) Gatekeepers, (5) Existing enablers and (6) Envisioning future training. Conclusions Researchers would benefit from specific training in undertaking conversations around consent with people with dementia. People with dementia may have fluctuating capacity, and despite support from caregivers, researchers have little practical guidance on methods of determining a person’s ability to understand or appreciate the information they have provided during the consent process. Given the development of large complex trials within dementia research, there is an urgency to develop specific and practical guidance and training for researchers working with people with dementia and their families. (shrink)

Moral epistemology investigates sources and patterns of moral understanding. Its questions include: To what extent does morality consist in or depend on knowledge, and of what kind(s)? What makes possible moral knowledge, and how is such knowledge grounded or justified? What is the relation between philosophical claims about morality and the moral understanding any of us has, that is, what has ethics – the philosophical representation of morality – to do with morality itself? Feminist moral epistemology asks how social divisions (...) of labor, opportunity, power, and recognition which reproduce gender and other hierarchies affect both the ways these questions have in fact been answered, and the ways they might be. (shrink)

The claim that Spinoza has a conception of animal mentality and consciousness that is superior to Descartes's is criticized. It is also argued that Spinoza fails to provide a coherent way of establishing what he considers to be our morally unconstrained “rights” with regard to brutes. Despite Spinoza's claim that brutes “feel,” i.e., are capable of sentience, his view that we are nonetheless entitled to treat animals in any way convenient to us is criticized. Questions are also raised as to (...) whether Spinoza is entitled to distinguish human from bestial nature on the basis of the possession of reason. (shrink)

First published in 1998. Routledge is an imprint of Taylor & Francis, an informa company.

'The Patient as Victim and Vector' is jointly written by four authors at the University of Utah with expertise in bioethics health law, and both clinical practice and public health policy concerning infectious disease.

At least some of these commentators have then, rather naturally, taken a step which it will be the business of this essay to criticize. They have suggested that Leibniz’s "counter-part theory" can be understood as providing an interpretation of counter-factuals and certain forms of modal discourse within his system. For example, Mondadori writes.

Sarah Angelina Acland is one of the most important photographers of the late Victorian and early Edwardian periods. Daughter of the Regius Professor of Medicine at Oxford, she was photographed by Lewis Carroll as a child, along with her close friend Ina Liddell, sister of Alice of Wonderland fame. The critic John Ruskin taught her art and she also knew many of the Pre-Raphaelites, holding Rossetti's palette for him as he painted the Oxford Union murals. At the age of nineteen (...) she met the photographer Julia Margaret Cameron, whose influence is evident in her early work.Following in the footsteps of Cameron and Carroll Miss Acland first came to attention as a portraitist, photographing the illustrious visitors to her Oxford home. In 1899 she then turned to the challenge of colour photography, becoming, through work with the 'Sanger Shepherd process', the leading colour photographer of the day. Her colour photographs were regarded as the finest that had ever been seen by her contemporaries, several years before the release of the Lumière Autochrome system, which she also practised.This volume provides an introduction to Miss Acland's photography, illustrating more than 200 examples of her work, from portraits to picturesque views of the landscape and gardens of Madeira. Some fifty specimens of the photographic art and science of her peers from Bodleian collections are also reproduced for the first time, including four unrecorded child portraits by Carroll. Detailed descriptions accompany the images, explaining their interest and significance. The photographs not only shed important light on the history of photography in the period, but also offer a fascinating insight into the lives of a pre-eminent English family and their circle of friends. (shrink)

Margaret Cavendish's 1668 edition of Observations upon Experimental Philosophy, presented here in its first modern edition, holds a unique position in early modern philosophy. Cavendish rejects the Aristotelianism which was taught in the universities in the seventeenth century, and the picture of nature as a grand machine which was propounded by Hobbes, Descartes and members of the Royal Society of London, such as Boyle. She also rejects the views of nature which make reference to immaterial spirits. Instead she develops (...) an original system of organicist materialism, and draws on the doctrines of ancient Stoicism to attack the tenets of seventeenth-century mechanical philosophy. Her treatise is a document of major importance in the history of women's contributions to philosophy and science. (shrink)

Theoretical variables : an overview -- Limited and unlimited law -- Legal materialism and social existence -- A new legal materialism -- Inner and outer space -- Scales of law -- Subjects and perspective -- Imagining law -- Pathfinding -- Conclusion.

In Culture and Agency, I distinguished between the ‘Cultural System', namely all items logged into the universal cultural archive, and ‘Socio-Cultural' interaction, na...

This book, the last volume in the Social Morphogenesis series, examines whether or not a Morphogenic society can foster new modes of human relations that could exercise a form of 'relational steering', protecting and promoting a nuanced version of the good life for all. It analyses the way in which the intensification of morphogenesis and the diminishing of morphostasis impact upon human flourishing. The book links intensified morphogenesis to promoting human flourishing based on the assumption that new opportunities open up (...) novel experiences, skills, and modes of communication that appeal to talents previously lacking any outlet or recognition. It proposes that equality of opportunity would increase as ascribed characteristics diminished in importance, and it could be maintained as the notion of achievement continued to diversify. Digitalization has opened the cultural 'archive' for more to explore and, as it expands exponentially, so do new complementary compatibilities whose development foster yet further opportunities. If more people can do more of what they do best, these represent stepping stones towards the 'good life' for more of them. (shrink)

The English translation of Habermas's The Structural Transformation of the Public Sphere converges with the revival of the "political culture concept" in the social sciences. Surprisingly, Habermas's account of the Western bourgeois public sphere has much in common with the original political culture concept associated with Parsonian modernization theory in the 1950s and 1960s. In both cases, the concept of political culture is used in a way that is neither political nor cultural. Explaining this peculiarity is the central problem addressed (...) in this article and its companion piece, which appeared in Sociological Theory, volume 3, number 2 (1995). I hypothesize that this is the case because the concept itself is embedded in an historically constituted political culture (here called a conceptual network)-a structured web of conceptual relationships that combine into Anglo-American citizenship theory. The method of an historical sociology of concept formation is used to analyze historically and empirically the internal constraints and dynamics of this conceptual network. The method draws from new work in cultural history and sociology, social studies, and network, narrative, and institutional analysis. This research yields three empirical findings: this conceptual network has a narrative structure, here called the Anglo-American citizenship story; this narrative is grafted onto an epistemology of social naturalism; and these elements combine in a metanarrative that continues to constrain empirical research in political sociology. (shrink)

Background:The right of children to have their voice heard has been accepted by researchers, and there are increasing numbers of qualitative health studies involving children. The ethical and methodological issues of including children in research have caused worldwide concerns, and many researchers have published articles sharing their own experiences.Objectives:To systematically review and synthesise experts’ opinions and experiences about ethical and methodological issues of including children in research, as well as related solution strategies.Research design:The research design was a systematic review of (...) opinion-based evidence, based on the guidelines by Joanna Briggs Institute.Methods:A search of five computerised databases has been conducted in April 2014 and 2271 articles were found. After screening the titles, abstracts, full texts and appraising the quality, 30 articles were finally included in the review. A meta-aggregative approach was applied in the data analysis and synthesis process.Ethical considerations:Ethical approval is not needed as it is a systematic review of published literature.Results:Six themes were identified, including evaluating potential risks and benefits, gaining access, obtaining informed consent/assent, protecting confidentiality and privacy, building rapport and collecting rich data. The similarities and differences between research involving children and that involving adults were indicated.Conclusion:All potential incentives should be justified when designing the study. Further studies need to research how to evaluate individual capacity of children and how to balance protecting children’s right to participate and their interests in the research. Cultural differences related to researching children in different regions should also be studied. (shrink)

First published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

Policies promoted and adopted for allocating ventilators during the COVID-19 pandemic have often prioritised healthcare workers or other essential workers. While the need for such policies has so far been largely averted, renewed stress on health systems from continuing surges, as well as the experience of allocating another scarce resource—vaccination—counsel revisiting the justifications for such prioritisation. Prioritising healthcare workers may have intuitive appeal, but the ethical justifications for doing so and the potential harms that could follow require careful analysis. Ethical (...) justifications commonly offered for healthcare worker prioritisation for ventilators rest on two social value criteria: instrumental value, also known as the ‘multiplier effect’, which may preserve the ability of healthcare workers to help others, and reciprocity, which rewards past usefulness or sacrifice. We argue that these justifications are insufficient to over-ride the common moral commitment to value each person’s life equally. Institutional policies prioritising healthcare workers over other patients also violate other ethical norms of the healthcare professions, including the commitment to put patients first. Furthermore, policy decisions to prioritise healthcare workers for ventilators could engender or deepen existing distrust of the clinicians, hospitals and health systems where those policies exist, even if they are never invoked. (shrink)

Governments in New Zealand have legislated a large number of settlements extinguishing many hundreds of claims taken by Māori against the Crown for breaches of the country’s founding document, Te Tiriti o Waitangi. They portray settlements as a great success for Māori and the Crown. Māori disagree. Settlements are government-determined and imposed on Māori using a smoke and mirrors approach that masks successive governments’ true intentions: to claw back Māori legal rights; to extinguish all claims; and to maintain White control (...) over Māori. In short, to uphold the Doctrine of Discovery in further breach of Te Tiriti o Waitangi. Māori claimants and negotiators report being enticed into the process by false promises only to become traumatised and disenchanted. Yet many take a pragmatic stance and sign settlements, making the best they can out of a bad deal that goes nowhere near compensating for their actual loss. They know that despite what legislation may say, the settlements are not full, not fair and not final and that, like all previous settlements, they will be revisited. They also know that unless fundamental changes are made to the constitutional makeup of the country, there is no prospect of justice and reconciliation for Māori. (shrink)

The essence of artefacts is typically taken to be their function: they are defined in terms of the goals or aims of the artisans that make them. In this paper, an alternative theory is proposed tha...

Theories of perception are at the core of many of the most renowned seventeenth and eighteenth century European philosophical systems. Work on perception is less common in the writings of women philosophers of this period, and yet, like their male peers, early modern women philosophers are responsible for innovative accounts of our perceptual relation with the natural world. With special attention to the work of Margaret Cavendish and Mary Shepherd, this essay explores some notable features of theories of (...) perception developed by women between the mid-seventeenth and the early nineteenth centuries with the aim of elucidating how women’s contributions to this cardinal area of early modern study expanded the diversity of views on offer. (shrink)

Throughout Latin America during the past 15 years, new democratic or postwar governments have faced demands for transitional justice following the end of authoritarian rule or the conclusion of internal armed conflicts.