Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

The study of landscape and place has become an increasingly fertile realm of inquiry in the humanities and social sciences. In this new book of essays, selected from presentations at the first annual meeting of the Society for Philosophy and Geography, scholars investigate the experiences and meanings that inscribe urban and suburban landscapes. Gary Backhaus and John Murungi bring philosophy and geography into a dialogue with a host of other disciplines to explore a fundamental dialectic: while our collective and personal (...) activity modifies the landscape, in turn, the landscape modifies human identities, and social and environmental relations. Whether proposing a peripatetic politics, conducting a sociological analysis of building security systems, or critically examining the formation of New York City's municipal parks, each essay sheds distinctive light on this fascinating and engaging aspect of contemporary environmental studies. (shrink)

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

It is widely assumed that informing prospective subjects about the risks and possible benefits of research not only protects their rights as autonomous decisionmakers, but also empowers them to protect their own interests. Yet interviews with patient‐subjects conducted under the auspices of the Advisory Committee on Human Radiation Experiments suggest this is not always the case. Patient‐subjects often trust their physician to guide them through decisions on research participation. Clinicians, investigators, and IRBs must assure that such trust is not misplaced.

Response to Emily A. Largent, Franklin G. Miller and Steven Joffe, A Prescription for Ethical Learning, Hastings Center Report, 43, s1, (S28-S29), (2013).

In the past ten years, there has been growing interest in and concern about protecting the privacy of personal medical information. Insofar as medical records increasingly are stored electronically, and electronic information can be shared easily and widely, there have been legislative efforts as well as scholarly analyses calling for greater privacy protections to ensure that patients can feel safe disclosing personal information to their health-care providers. At the same time, the volume of biomedical research conducted in this country continues (...) to grow. The budget of the National Institutes of Health, for example, was $20,298 million in 2001, having more than doubled from a budget of $9,218 million 10 years before. This growing body of research includes increased efforts to use stored medical records as a source of data for health services, epidemiologic, and clinical studies. (shrink)

In the past ten years, there has been growing interest in and concern about protecting the privacy of personal medical information. Insofar as medical records increasingly are stored electronically, and electronic information can be shared easily and widely, there have been legislative efforts as well as scholarly analyses calling for greater privacy protections to ensure that patients can feel safe disclosing personal information to their health-care providers. At the same time, the volume of biomedical research conducted in this country continues (...) to grow. The budget of the National Institutes of Health, for example, was $20,298 million in 2001, having more than doubled from a budget of $9,218 million 10 years before. This growing body of research includes increased efforts to use stored medical records as a source of data for health services, epidemiologic, and clinical studies. (shrink)

Hastings Center Report, Volume 52, Issue 3, Page 29-31, May–June 2022.

Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with (...) the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors—biological, behavioral, social, and environmental—in developing effective interventions. (shrink)

Aim: Streamlining consent for low-risk comparative effectiveness research (CER) could facilitate research, while safeguarding patients' rights. Materials & methods: 2618 adults were randomized to one of seven consent approaches (six streamlined and one traditional) for a hypothetical, low-risk CER study. A survey measured understanding, voluntariness, and feelings of respect. Results: Participants in all arms had a high understanding of the trial and positive attitudes toward the consent interaction. Highest satisfaction was with a streamlined approach showing a video before the medical (...) appointment. Participants in streamlined were more likely to mistakenly think a signature was required. Conclusion: Streamlined consent was no less acceptable than traditional, signed consent. Streamlined and traditional approaches achieved similar levels of understanding, voluntariness and a feeling that the doctor–patient interaction was respectful. (shrink)

As concerns about the negative health effects of unhealthy eating, overweight and obesity have increased, so too have policy efforts to promote healthy eating. Federal, state, and local governments have proposed and implemented a variety of healthy eating policies. Many of these policies are controversial, facing objections that range from the practical (e.g., the policy won’t succeed at improving people’s diets) to the ethical (e.g., the policy is paternalistic or inequitable). Especially controversial have been policies limiting the options offered in (...) the marketplace, limiting access to certain options, or providing disincentives for the purchase of certain options. Examples of such policies include proposed .. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

As interest in comparative effectiveness research grows, questions have emerged regarding whether it is ever acceptable to alter informed consent requirements for research when patients are randomly assigned to widely-used therapies. This paper reports on interviews with Institutional Review Board members and researchers and on focus groups with patients from Geisinger and Johns Hopkins health systems. The objective was to elicit participants' views of the acceptability of four different disclosure and authorization models for low-risk pragmatic comparative effectiveness trials of widely-used (...) therapies. Results suggest that although participants valued autonomous choice, many also believed that it was acceptable to streamline information disclosure and to use an opt-out process for eligible individuals who would prefer not to participate. This provides some preliminary evidence that relevant stakeholders find alternatives to traditional informed consent acceptable for low-risk pragmatic comparative effectiveness trials of widely-used therapies as long as a sufficient amount of choice is preserved. (shrink)

This book provides practical and research-based chapters that offer greater clarity about the particular kinds of teacher reflection that matter and avoids talking about teacher reflection generically, which implies that all kinds of reflection are of equal value.

Strengthening the abilities of smallholder farmers in developing countries, particularly women farmers, to produce for both home and the market is currently a development priority. In many contexts, ownership of assets is strongly gendered, reflecting existing gender norms and limiting women’s ability to invest in more profitable livelihood strategies such as market-oriented agriculture. Yet the intersection between women’s asset endowments and their ability to participate in and benefit from agricultural interventions receives minimal attention. This paper explores changes in gender relations (...) and women’s assets in four agricultural interventions that promoted high value agriculture with different degrees of market-orientation. Findings suggest that these dairy and horticulture projects can successfully involve women and increase production, income and the stock of household assets. In some cases, women were able to increase their control over production, income and assets; however in most cases men’s incomes increased more than women’s and the gender-asset gap did not decrease. Gender- and asset-based barriers to participation in projects as well as gender norms that limit women’s ability to accumulate and retain control over assets both contributed to the results. Comparing experiences across the four projects, especially where projects implemented adaptive measures to encourage gender-equitable outcomes, provides lessons for gender-responsive projects targeting existing and emerging value chains for high value products. Other targeted support to women farmers may also be needed to promote their acquisition of the physical assets required to expand production or enter other nodes of the value chain. (shrink)

Pragmatic clinical trials (PCTs) serve an important function in the modern research landscape: studying interventions in an environment that reflects real-world conditions, rather than the relative...

In _Feminist Interpretations of John Rawls_, Ruth Abbey collects eight essays responding to the work of John Rawls from a feminist perspective. An impressive introduction by the editor provides a chronological overview of English-language feminist engagements with Rawls from his Theory of Justice onwards. She surveys the range of issues canvassed by feminist readers of Rawls, as well as critics’ wide disagreement about the value of Rawls’s corpus for feminist purposes. The eight essays that follow testify to the continuing (...) ambivalence among feminist readers of Rawls. From the perspectives of political theory and moral, social, and political philosophy, the essayists address particular aspects of Rawls’s work and apply it to a variety of worldly practices relating to gender inequality and the family, to the construction of disability, to justice in everyday relationships, and to human rights on an international level. The overall effect is to give a sense of the broad spectrum of possible feminist critical responses to Rawls, ranging from rejection to adoption. Aside from the editor, the contributors are Amy R. Baehr, Eileen Hunt Botting, Elizabeth Brake, Clare Chambers, Nancy J. Hirschmann, Anthony Simon Laden, Janice Richardson, and Lisa H. Schwartzman. (shrink)

“There is no longer any world,” wrote the late philosopher Jean-Luc Nancy in 1993, and in this paper, the sense of this loss of world is analysed in terms of the modal notions of necessity, impossibility, and possibility. Modal differentiation can illuminate what constitutes the sense of actuality in a world, and hence, what it is that has been lost regarding this actuality of being in a world. Modal thinking does not rely on knowledge of the true state of (...) affairs, nor on having a constant grasp on necessity: modal thinking enables us to discern the actual by way of the relations between necessity, possibility, and impossibility. It is on the basis of these relations that a mode of rethinking actuality is suggested. In order to pursue this line of thought, I rely on Jacques Lacan’s understanding of modalities as writing operations, concentrating mostly on certain sections from his Seminar XXI, wherein he refers to Aristotelian modal logic and mentions the analytic philosopher Jaakko Hintikka. This ternary relation between Aristotle, Hintikka, and Lacan suggests a different outlook on the actual being-such of a world. The being-such of a world, its actuality, is understood as a contingency, a possibility emerging from the relation between what is declared necessary and what is impossible. The paper shows the implications of such a modal understanding of actuality, as demonstrated in Lacan’s view of human sexuality and sexual difference. (shrink)

RÉSUMÉLe goût, en tant que faculté d'appréciation esthétique, implique un individu, et pourtant suppose une communauté. Dans cet article, nous constatons qu'une disposition singulière à l’égard des objets de goût est conditionnée par le consentement d'autrui et par l’être-avec autrui. De cette façon, une communauté esthétique est établie. Cette idée de communauté esthétique remonte au sensus communis de Kant et à la notion de préservation de Heidegger : dans les deux cas, c'est la présence d'une communauté qui conditionne l'expérience esthétique.

This paper is the introduction to the volume. It gives an argumentative view of the philosophical landscape concerning incommensurability and incomparability. It argues that incomparability, not incommensurability, is the important phenomenon on which philosophers should be focusing and that the arguments for the existence of incomparability are so far not compelling.

Can quite different values be rationally weighed against one another? Can the value of one thing always be ranked as greater than, equal to, or less than the value of something else? If the answer to these questions is no, then in what areas do we find commensurability and comparability unavailable? And what are the implications for moral and legal decision making? This book struggles with these questions, and arrives at distinctly different answers.".

One of the strongest strands in Nancy's philosophy is an attempt to rethink community and the very idea of the social in a way that does not ground these ideas in some individual subject or subjectivity. The fundamental argument of this book is that being is always 'being with', that 'I' is not prior to 'we', that existence is essentially co-existence. He thinks this being together, not as a comfortable enclosure in a pre-existing group, but as a mutual abandonment (...) and exposure to each other, one that would preserve the 'I' and its freedom in a mode of imagining community as neither a 'society of spectacle' nor via some form of 'authenticity'. (shrink)

What does it mean to think critically about politics at a time when inequality is increasing worldwide, when struggles for the recognition of difference are eclipsing struggles for social equality, and when we lack any credible vision of an alternative to the present order? Philosopher Nancy Fraser claims that the key is to overcome the false oppositions of "postsocialist" commonsense. Refuting the view that we must choose between "the politics of recognition" and the "politics of redistribution," Fraser argues for (...) an integrative approach that encompasses the best aspects of both. (shrink)

The last and most poignant of these essays is The Intruder, Nancys philosophical meditation on his heart transplant.

What sorts of consideration can be normative reasons for action? If we systematize the wide variety of considerations that can be cited as normative reasons, do we find that there is a single kind of consideration that can always be a reason? Desire-based theorists think that the fact that you want something or would want it under certain evaluatively neutral conditions can always be your normative reason for action. Value-based theorists, by contrast, think that what plays that role are evaluative (...) facts (or the facts that subvene them) about what you want, such as the fact that having it would be good in some way. This paper argues that value-based theorists are wrong; if we try to find a single kind of consideration that can always be normative reason, we find that sometimes our reason is the fact that we want something and not any corresponding evaluative fact. (shrink)

The central aim of this book is to answer two questions: Are alternatives for choice ever incomparable? and, In what ways can items be compared? The arguments offered suggest that alternatives for choice no matter how different are never incomparable, and that the ways in which items can be compared are richer and more varied than commonly supposed. This work is the first book length treatment of the topics of incomparability, value, and practical reason.

" Biosemantics " was the title of a paper on mental representation originally printed in The Journal of Philosophy in 1989. It contained a much abbreviated version of the work on mental representation in Language Thought and Other Biological Categories. There I had presented a naturalist theory of intentional signs generally, including linguistic representations, graphs, charts and diagrams, road sign symbols, animal communications, the "chemical signals" that regulate the function of glands, and so forth. But the term " biosemantics " (...) has usually been applied only to the theory of mental representation. Let me first characterize a more general class of theories called "teleological theories of mental content" of which biosemantics is an example. Then I will discuss the details that distinguish biosemantics from other naturalistic teleological theories. (shrink)

What, normatively speaking, are the grounds of rational choice? This paper defends ‘comparativism’, the view that a comparative fact grounds rational choice. It examines three of the most serious challenges to comparativism: 1) that sometimes what grounds rational choice is an exclusionary-type relation among alternatives; 2) that an absolute fact such as that it’s your duty or conforms to the Categorial Imperative grounds rational choice; and 3) that rational choice between incomparables is possible, and in particular, all that is needed (...) for the possibility of rational choice is that one alternative is not worse than the others. Each challenge is questioned. If comparativism is correct, then no matter what normative theory you favor, your answer to the question, ‘What makes my choice rational?’ must be comparative in form. In this way, comparativism provides a framework for normative theorizing. (shrink)

A leading scholar in the psychology of thinking and reasoning argues that the counterfactual imagination—the creation of "if only" alternatives to ...

This work examines the concept of trust in the light of virtue theory, and takes our responsibility to be trustworthy as central. Rather than thinking of trust as risk-taking, Potter views it as equally a matter of responsibility-taking. Her work illustrates that relations of trust are never independent from considerations of power, and that asking ourselves what we can do to be trustworthy allows us to move beyond adversarial trust relationships and toward a more democratic, just, and peaceful society.

A Managerial Philosophy of Technology offers a unique combination of a review of academic work in the philosophy of technology with practical methodologies for business management of technology strategy.

The history of the interpretations of The Merchant of Venice, both on the stage and in critical comment, and of the reactions it has evoked in its readers or viewers, is surely unique in the Shakespeare canon. Interpretations of Hamlet are numberless, but the contentions expend themselves within the intellectual realm. The Merchant of Venice reaches down into deep emotional levels, involving commitments and shrouded reticences of the soul. When conscience and the play come together, a drama takes place. Sigurd (...) Burckhardt has clearly perceived the problem, without exploring it. “Audiences,” he writes, “persist in feeling distressed by Shylock's final treatment, and no amount of historical explanation helps them over their unease.” We cannot join unreservedly in the joyful harmonies of the last act. “Shylock spooks in the background, an unappeased ghost.”. (shrink)

Targeting injustices that cut across borders, they are making the scale of justice an object of explicit struggle.Inspired by these efforts, Nancy Fraser asks: ...

This collection, by one of the most challenging of contemporary thinkers, asks the question: why are there several arts and not just one? This question focuses on the point of maximal tension between the philosophical tradition and contemporary thinking about the arts: the relation between the plurality of the human senses and sense or meaning in general. Throughout the five essays, Nancy's argument hinges on the culminating formulation of this relation in Hegel's Aesthetics and The Phenomenology of Spirit - (...) art as the sensible presentation of the Idea. He considers the emergence of art as presentation rather than representation and looks at the contemporary situation of art, and the question of whether art today is still art. Other essays provide intricate and compelling readings of Caravaggio's Death of the Virgin and an analysis of a traced hand in the grotto of Lascaux as the essential mimetic gesture. (shrink)

: This article considers what contribution the work of John Rawls can make to questions about animal ethics. It argues that there are more normative resources in A Theory of Justice for a concern with animal welfare than some of Rawls's critics acknowledge. However, the move from A Theory of Justice to Political Liberalism sees a depletion of normative resources in Rawlsian thought for addressing animal ethics. The article concludes by endorsing the implication of A Theory of Justice that we (...) look for ways other than rights discourse to respect and protect the well-being of animals. (shrink)