BackgroundThe boundaries between health-related research and practice have become blurred as initiatives traditionally considered to be practice increasingly use the same methodology as research. Further, the application of different ethical requirements based on this distinction raises concerns because many initiatives commonly labelled as “non-research” are associated with risks to patients, participants, and other stakeholders, yet may not be subject to any ethical oversight. Accordingly, we sought to develop a tool to facilitate the systematic identification of risks to human participants and (...) determination of risk level across a broad range of projects and health-related contexts. This paper describes the development of the Public Health Ontario Risk Screening Tool.MethodDevelopment of the PHO Risk Screening Tool included: preparation of a draft risk tool ; expert appraisal; internal stakeholder validation; external validation; pilot testing and evalution of the draft tool; and revision after 1 year of testing.ResultsA risk screening tool was generated consisting of 20 items organized into five risk domains: Sensitivity; Participant Selection, Recruitment and Consent; Data/Sample Collection; Identifiability and Privacy Risk; and Commercial Interests. The PHO Risk Screening Tool is an electronic tool, designed to identify potential project-associated risks to participants and communities and to determine what level of ethics review is required, if any. The tool features an easy to use checklist format that generates a risk score associated with a suggested level of ethics review once all items have been completed. The final score is based on a threshold approach to ensure that the final score represents the highest level of risk identified in any of the domains of the tool.ConclusionsThe PHO Risk Screening Tool offers a practical solution to the problem of how to maintain accountability and appropriate risk oversight that transcends the boundaries of research and practice. We hope that the PHO Risk Screening Tool will prove useful in minimizing the problems of over and under protection across a wide range of disciplines and jurisdictions. (shrink)

The generation of evidence is integral to the work of public health and health service providers. Traditionally, ethics has been addressed differently in research projects, compared with other forms of evidence generation, such as quality improvement, program evaluation, and surveillance, with review of non-research activities falling outside the purview of the research ethics board. However, the boundaries between research and these other evaluative activities are not distinct. Efforts to delineate a boundary – whether on grounds of primary purpose, temporality, underlying (...) legal authority, departure from usual practice, or direct benefits to participants – have been unsatisfactory. (shrink)

This study examined the quality of children's assent to a clinical trial. In subjects younger than 9 years of age, understanding of most aspects of the study was found to be poor to non-existent. Understanding of procedures was poor in almost all subjects. In addition, voluntariness may have been compromised in many subjects by their belief that failure to complete the study would displease others. If the fact that a child's assent has been obtained is used to justify the exposure (...) of that child to the potential harm of a non-therapeutic blood sample, the assent must be meaningful. In the nutrition study observed here, the quality of the assent of children younger than 9 years of age was very poor. The assent therefore did not provide a valid justification for requesting a blood sample from these children. This study indicates that most children younger than 9 years of age cannot be expected to consent or assent to clinical research in a meaningful way. The current age of 7 years for initiating assent (in addition to parental consent) is possibly not appropriate and should be reconsidered. (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: ...

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

Bioethics needs an expanded moral vision. It is now time for bioethics to take full account of the problems of health disparities and structural injustice that are made newly urgent by the COVID-19 pandemic and the effects of climate change. Nancy M. P. King, Gail E. Henderson, and Larry R. Churchill make the case for a more social understanding and application of justice, a deeper humility in assessing expertise in bioethics consulting, a broader and more relevant research agenda, and (...) greater appreciation of the profound health implications of global warming. (shrink)

How fixed are the happenings in Nature and how are they fixed? One - very orthodox - account teaches that the sciences offer general truths that we combine with local facts to derive our expectations about what will happen, either naturally or when we build a device to design, be it a laser, a washing machine, an anti-malarial bed net, or an auction for the airwavse. Nancy Cartwright offers a different picture, one in which neither we nor Nature have (...) such nice rules to go by. This volume includes her Paul Carus Lectures plus four additional papers that further develop some of the central ideas. Cartwright offers an original view on the age-old question of scientific realism in which our knowledge is genuine, yet our scientific principles are neither true nor false but are, rather, templates for building good models. (shrink)

Charlemagne's monogram -- Introduction -- The problem of consciousness -- The earliest vision -- Truth, being, and mind -- The Kehre -- The essence of truth -- The later Heidegger -- Reading Heidegger after Heidegger -- Being not a soul but the unmediated discovery of being.

Why mediation? -- What makes bioethics mediation unique? -- Before you begin a bioethics mediation program -- The stages of bioethics mediation -- Techniques for mediating bioethics disputes -- How to write a bioethics mediation chart note -- Mediation with a competent patient : Mr. Samuels's case -- Mediation with a dysfunctional family : Mrs. Bates's case -- A complex mediation with a large and involved family : Mrs. Leonari's case -- Discharge planning for a dying patient : a role-play (...) -- An at-risk pregnancy : a role-play -- HIV and postsurgical complications in the ICU : a role-play -- Treating the dying adolescent : a role-play -- She didn't mean it : a role-play -- Don't tell mama : a role-play -- An at-risk pregnancy : a role-play transcript -- HIV and postsurgical complications in the ICU : a role-play transcript -- She didn't mean it: a role-play transcript -- Don't tell mama : a role-play transcript. (shrink)

This paper opens a critical conversation about the ethics of international bioethics conferencing and proposes principles that commit to being anti-discriminatory, global, and inclusive. We launch this conversation in the Section, Case Study, with a case example involving the International Association of Bioethics’ (IAB’s) selection of Qatar to host the 2024 World Congress of Bioethics. IAB’s choice of Qatar sparked controversy. We believe it also may reveal deeper issues of Islamophobia in bioethics. The Section, Principles for International Bioethics Conferencing, sets (...) forth and defends proposed principles for international bioethics conferencing. The Section, Applying Principles to Site Selection applies the proposed principles to the case example. The Section, Applying Principles Beyond Site Selection addresses other applications of the proposed principles. The Section, Objections responds to objections. We close (in the Section, Conclusion) by calling for a wider discussion of our proposed principles.One-Sentence Capsule Summary: How should bioethicists navigate the ethics of global bioethics conferencing? (shrink)

We lay groundwork for applying ethnographic methods in philosophy of science. We frame our analysis in terms of two tasks: to identify the benefits of an ethnographic approach in philosophy of science and to structure an ethnographic approach for philosophical investigation best adapted to provide information relevant to philosophical interests and epistemic values. To this end, we advocate for a purpose-guided form of cognitive ethnography that mediates between the explanatory and normative interests of philosophy of science, while maintaining openness and (...) independence when framing such an investigation to achieve robust unbiased results. (shrink)

This chapter addresses the close association between withholding and withdrawing futile life-sustaining medical treatments and assisting patients with hastening ending their lives. Section 12.2 sets forth a definition of medical futility and places this concept in the broader context of bioethical principles of autonomy, beneficence, nonmaleficence and justice. Section 12.3 draws out futility’s ethical implications and considers the view that physicians are ethically permitted to refrain from medically futile treatments, should be encouraged to refrain, or have a duty to refrain. (...) Section 12.4 examines ethical arguments that physicians also have a positive duty to assist patients with terminal conditions who are imminently dying to end their lives. It explores ethical arguments for assisted dying that appeal to the physicians’ significant responsibility and relationship with patients, the claimed moral equivalence of actions and omissions, and the medical goal of helping patients have a peaceful and dignified death. (shrink)

A cognitive ethnography of how bioengineering scientists create innovative modeling methods. In this first full-scale, long-term cognitive ethnography by a philosopher of science, Nancy J. Nersessian offers an account of how scientists at the interdisciplinary frontiers of bioengineering create novel problem-solving methods. Bioengineering scientists model complex dynamical biological systems using concepts, methods, materials, and other resources drawn primarily from engineering. They aim to understand these systems sufficiently to control or intervene in them. What Nersessian examines here is how cutting-edge (...) bioengineering scientists integrate the cognitive, social, material, and cultural dimensions of practice. Her findings and conclusions have broad implications for researchers in philosophy, science studies, cognitive science, and interdisciplinary studies, as well as scientists, educators, policy makers, and funding agencies. In studying the epistemic practices of scientists, Nersessian pushes the boundaries of the philosophy of science and cognitive science into areas not ventured before. She recounts a decades-long, wide-ranging, and richly detailed investigation of the innovative interdisciplinary modeling practices of bioengineering researchers in four university laboratories. She argues and demonstrates that the methods of cognitive ethnography and qualitative data analysis, placed in the framework of distributed cognition, provide the tools for a philosophical analysis of how scientific discoveries arise from complex systems in which the cognitive, social, material, and cultural dimensions of problem-solving are integrated into the epistemic practices of scientists. Specifically, she looks at how interdisciplinary environments shape problem-solving. Although Nersessian’s case material is drawn from the bioengineering sciences, her analytic framework and methodological approach are directly applicable to scientific research in a broader, more general sense, as well. (shrink)

This chapter contains sections titled: Getting Under Her Skin Revolutionary Politics and Feminist Body Consciousness Homosociality Skinship Bonding, and Corporeal Feminism Meeting Narrative Needs Pricks as Needles Odd Girls Out ‘By the Father's Hand’: The Tattoo Taboo, Public Anxiety, and India(n) Ink The Skin She's In: Keeping Tattooing Personal and Political.

Ego Sum proposes a provocative and unprecedented reading of Descartes. By paying attention to mode of presentation of Descartes's philosophy, Nancy challenges our common understanding of the Cogito and shows how Descartes's ego is not the self-certain, self-transparent Subject of metaphysics but a mouth that opens to utter: ego sum.

Medical error is a leading problem of health care in the United States. Each year, more patients die as a result of medical mistakes than are killed by motor vehicle accidents, breast cancer, or AIDS. While most government and regulatory efforts are directed toward reducing and preventing errors, the actions that should follow the injury or death of a patient are still hotly debated. According to Nancy Berlinger, conversations on patient safety are missing several important components: religious voices, traditions, (...) and models. In After Harm, Berlinger draws on sources in theology, ethics, religion, and culture to create a practical and comprehensive approach to addressing the needs of patients, families, and clinicians affected by medical error. She emphasizes the importance of acknowledging fallibility, telling the truth, confronting feelings of guilt and shame, and providing just compensation. After Harm adds important human dimensions to an issue that has profound consequences for patients and health care providers. (shrink)

This is the first English translation published of Jean-Luc Nancy's acclaimed consideration of the law's most pervasive principles in the context of actual systems and contemporary institutions, power, norms, laws.

Jean-Luc Nancy provides an analysis of the anti-Semitic aspects of Heidegger's recently published Black Notebooks. Nancy refers to a philosophical or "historial" anti-Semitism marked, nonetheless, by the "banality" of ordinary anti-Semitism pervading Europe. Heidegger's thought is placed in the broader context of the European (especially Christian) impulse toward new beginnings.

A topic of special importance when it comes to responsibility and implicit bias is responsibility for knowledge. Are there strategies for becoming more responsible and respectful knowers? How might we work together, not just as individuals but members of collectives, to reduce the negative effects of bias on what we see and believe, as well as the wrongs associated with epistemic injustice? To explore these questions, Chapter 9 introduces the concept of epistemic responsibility, a set of practices developed through the (...) cultivation of basic epistemic virtues, such as open-mindedness, epistemic humility, and diligence that help knowers seek information about themselves, others, and the world. (shrink)

Racial Climates, Ecological Indifference offers a powerful intervention to the field of climate justice scholarship by addressing a neglected aspect of the field of climate justice, namely systemic racisms. Building on the work of Black feminist theorists, the work develops an ecointersectional approach designed to reveal the depth and complexities of racial climates overlooked even in the environmental justice literature. The book’s conception of ecological indifference underscores the disposition of seeing the environment as a resource for human consumption and enjoyment, (...) a resource that is usable, fungible, disposable, and without intrinsic worth or standing. The many examples in the book offer new insights demonstrating that systemic racisms emerge out of and give rise to environmental degradation; that is, they are often mutually constitutive. The ecointersectional analyses provided throughout the book reveal that ecological indifference and climate injustice are two sides of the same coin. Three distinctive but interrelated domains in which the intersections between systemic racisms and ecological indifference are manifest are identified: (1) differential distribution of harms/benefits due to systemic racisms, (2) racist institutions and practices fueling or causing environmental degradation, and (3) the basic social structures that generate environmental degradation being the same ones that generate systemic oppression of certain groups of people. One of the aims of Racial Climates, Ecological Indifference is to underscore that any effort to protect the environment must also be a fight against systemic racisms and other forms of systemic inequity. (shrink)

Questions of whether anything exceeds reasonable sense and meaning have persisted throughout the history of philosophy. These questions have even continued in postmodern thought as well as in liberatory philosophies in which many kinds of events and lineages are experienced and seen as beyond philosophy. In this cowritten text, distinguished philosophers Nancy Tuana and Charles Scott pay particular attention to lineages and their dynamism as they develop the idea of things beyond philosophy, beyond norms. This is not a history (...) of philosophy or a critical study of a particular philosopher but a way to engage experience around dimensions of events that are beyond measuring, counting, meaning, and value. These attunements, they assert, are vitally important for the ways people orient themselves in the world and comport themselves in it. Tuana and Scott build on the alternatives to normative ethics that they find in the work of Nietzsche, Foucault, and Anzaldúa. They urge attunement to the world as a way to speak about what is impossible to give voice to, to live in the spaces between speech and the unspeakable, and to conceptualize and articulate the boundaries of rational sensibility. (shrink)

Nancy Fraser’s powerful new book documents the “movements of feminism” and the shifts in the feminist imaginary since the 1970s. Fraser follows the history of feminism from the ferment of the New Left, during which “Second Wave” feminism emerged as a struggle for women’s liberation alongside other social movements, to its emersion in identity politics following the decline of its initial utopian energies. Alongside this detailed history, Fraser recognizes the need for a reinvigorated feminist radicalism to respond to the (...) crisis in neoliberalism. She argues for a feminism that could join other egalitarian movements in struggles aimed at subjecting capitalism to democratic control, while retrieving the core utopian insights of feminism’s earlier phases. (shrink)

This Commentary critiques an extremely relational view of robot moral status, drawing out its practical implications for ethics and law. It also suggests next steps for AI ethics if extremely relational reasoning is compelling. Section I introduces the topic, distinguishing an ‘extremely relational’ view from more moderate relational views. Section II illustrates extremely relational views using the example of embodiment. Section III explores practical implications of extremely relational views for ethics and law. Section IV offers possible responses to extreme relationism. (...) Section V concludes by suggesting next steps for AI ethics. (shrink)

In “How the Neuroscience of Decision Making Informs Our Conception of Autonomy,” Gidon Felsen and Peter Reiner (2011) argue that decisions typically regarded as rational and autonomous are in fact...

We present an analysis of ethical argumentation and rhetorical elements in an article on the debate about growing genetically modified food (GMF), an issue of current interest in environmental ethics. Ethical argumentation is argumentation that a certain action is permissible, forbidden, or obligatory in terms of ethical intuitions, principles, or theories. Based on analysis of argumentation in the article, we propose several argumentation schemes for descriptive modeling of utilitarian arguments as an alternative to using more general schemes such as practical (...) reasoning and argument from consequences. We also show how the article promoted its pro-GMF stance using rhetorical elements such as quotation, argument from expert opinion, and ad hominem attacks. Pedagogical and computational implications of the analysis of argumentation and rhetoric are discussed. (shrink)

The future of public philosophy is already being practiced, developed, molded, and critiqued on the ground through the act of doing and writing about public philosophy. Thus, given the astute framings of the future of public philosophy in prior chapters, the author's contribution is going to engage two shifts that she want to emphasize: Increasing the inclusivity of who counts as a public philosopher and providing more experience‐building in public philosophy through educating and mentoring philosophers in public philosophy practice. The (...) future of public philosophy is also dependent upon experience‐building in public philosophy. Engaging in experience‐building in public philosophy with students, faculty, and the broader public has the potential to mitigate the harms that could occur. (shrink)

This chapter sets forth an interpretation of public reason that appeals to our central capabilities as human beings. I argue that appealing to central human capabilities and to the related idea of respect for threshold capabilities is the best way to understand public reason. My defense of this position advances stepwise: first, I consider a central alternative to a capability account, which regards public reason as a matter of contracting; next, I describe central concerns with contract views and show how (...) a capability view can avoid them; lastly, I consider extending public reason beyond national borders and test the two views in this context. (shrink)

Désirer, qu’est-ce que c’est? Quelle différence entre désirer, vouloir ou avoir besoin? Jean-Luc Nancy, auteur fidèle de la collection, s’attache à percevoir comment le désir travaille en nous, et comment nous vivons avec cette force toujours à l’oeuvre, quels que soient nos âges et nos situations.