Acting for the good of the patient is the most fundamental and universally acknowledged principle of medical ethics. However, given the complexity of modern medicine as well as the moral fragmentation of contemporary society, determining the good is far from simple. In his philosophy of medicine, Edmund Pellegrino develops a conception of the good that is derived from the internal morality of medicine via the physician-patient relationship. It is through this healing relationship that rights, duties, and privileges are defined for (...) both physicians and patients. Moreover, this relationship determines the characteristics or virtues that are necessary to engage in the medical telos. This paper addresses the role of the moral virtues in clinical medicine and the physician-patient relationship. First, it provides a brief background of the Aristotelian foundations of virtue-ethics. Second, it delves into Pellegrino’s philosophy of medicine understood as a practice oriented towards a teleological goal. Third, it relates the telos of medicine to the notion of the medical community as a fundamentally moral community. Finally, it concludes with a section that creates a dialogue between virtue ethics and principlism. (shrink)

This paper is a personal account of the events associated with the author’s work at the University of Toronto’s Hospital for Sick Children on a drug, deferiprone, for the treatment of thalassaemia. Trials of the drug were sponsored by the Canadian Medical Research Council and a drug company which would have been able, had the trials been successful, to seek regulatory approval to market the drug. When evidence emerged that deferiprone might be inadequately effective in a substantial proportion of patients, (...) the drug company issued legal threats when the author proposed informing her patients and the scientific community. Until protests were made by international authorities in her field of research, the hospital and university did not adequately support the author’s academic freedom and responsibilities as a medical practitioner. It is argued that underlying cause of this, and of other similar cases, is the political philosophy which is driving the commercialisation of universities and bringing about the deregulation of drug approval procedures. Together these changes constitute a serious threat to the public good. (shrink)

Persuasive technologies are interactive systems designed to change and shape users’ behaviours towards specific goals. By discussing the case of screen-time management applications, this paper explores how persuasive systems transform self-awareness and the self’s cognitive architecture. Drawing on the notion of tectonoetic awareness, I will illustrate how artefacts enable the transition from the temporal bounded experience characterizing first-person perspective (noetic awareness) to the ability of reflecting on oneself from a third person and temporally extended perspective (autonoetic awareness). I will argue (...) that persuasive systems make possible new modalities of self-recognition and self-projection while they simultaneously affect the sense of agency by interfering with users’ actions and intentions. (shrink)

1. Une polémique historique En matière de syntaxe, la notion de corpus fut très controversée et reste encore problématique. Avant Chomsky, les structuralistes utilisaient des corpus, mais le terme désignait alors un échantillon représentatif et homogène d’un aspect syntaxique particulier ou d’une langue donnée et était utilisé dans une perspective behaviouriste exlusivement empiriste et taxinomique. C’est contre ce type de « corpus » que Chomsky s’est prononcé lorsqu’il a commencé à développe...

In this paper we propose an extension of Defeasible Logic to represent and compute different concepts of defeasible permission. In particular, we discuss some types of explicit permissive norms that work as exceptions to opposite obligations or encode permissive rights. Moreover, we show how strong permissions can be represented both with, and without introducing a new consequence relation for inferring conclusions from explicit permissive norms. Finally, we illustrate how a preference operator applicable to contrary-to-duty obligations can be combined with a (...) new operator representing ordered sequences of strong permissions. The logical system is studied from a computational standpoint and is shown to have linear computational complexity. (shrink)

1. A long-standing controversy The notion of corpus represents a long-standing and controversial matter in syntax. Before Chomsky, structuralists exploited corpora however these were considered as representative and homogeneous samples of a particular syntactic phenomenon or of a given language. This type of corpus was thus used within a behaviourist approach exclusively with empiricist and taxonomic aims. Then, as soon as Chomsky started to develop generative grammar in the 1950s, it is prec..

1. Une polémique historique En matière de syntaxe, la notion de corpus fut très controversée et reste encore problématique. Avant Chomsky, les structuralistes utilisaient des corpus, mais le terme désignait alors un échantillon représentatif et homogène d’un aspect syntaxique particulier ou d’une langue donnée et était utilisé dans une perspective behaviouriste exlusivement empiriste et taxinomique. C’est contre ce type de « corpus » que Chomsky s’est prononcé lorsqu’il a commencé à développe..

This paper shows the state of the art regarding the possibilities of intervention for the economic and social inclusion of young people Not engaged in Employment, Education, or Training through Massive Open Online Courses in the countries of the European Union, in order to identify and compare good practices and didactic models aimed to contrast the social and economic vulnerabilities of young people. The systematic review, carried out on both generalist and more properly educational databases, has revealed the poor relationship (...) between the two topics in literature, each one moreover only recently made the subject of articulated research. The field of study is therefore open and invites further reflection on its possible developments. Matching NEETs’ needs and business companies’ requirements, students’ motivation during the learning path, keeping balance between e-learning and face-to-face lectures, tutors’ involvement along the course, and relationships with stakeholders remain the main issues identified in the various papers reviewed. (shrink)

Alors que toutes les langues romanes connaissent les deux types de topicalisation à gauche : le topique suspendu (HT, dans les propositions principales) et la dislocation gauche (LD, dans les propositions principales et les subordonnées), quelques dialectes occitans (et peut-être quelques dialectes italiens) se distinguent en présentant aussi un topique suspendu enchâssé. Cet article met en évidence les difficultés soulevées par les analyses antérieures, notamment celle de Sauzet (1989) qui suppose qu’un rôle prédicatif spécifique légitime ce type de topique et (...) celle de Lahne (2005) qui postule que le topique n’est pas enchâssé. Nous montrons que, en Occitan, la tête fonctionnelle la plus à gauche (FORCE° de Rizzi 1997) porte un trait (déclaratif) fort qui attire le DP topicalisé dans la périphérie gauche de la proposition. La force de ce trait est ainsi paramétrée, ce qui permet de faire des prédictions typologiques intéressantes. (shrink)

We formally introduce a novel, yet ubiquitous, category of norms: norms of instrumentality. Norms of this category describe which actions are obligatory, or prohibited, as instruments for certain purposes. We propose the Logic of Agency and Norms (LAN) that enables reasoning about actions, instrumentality, and normative principles in a multi-agent setting. Leveraging LAN , we formalize norms of instrumentality and compare them to two prevalent norm categories: norms to be and norms to do. Last, we pose principles relating the three (...) categories and evaluate their validity vis-à-vis notions of deliberative acting. On a technical note, the logic will be shown decidable via the finite model property. (shrink)

In her reply to Baylis the author takes the opportunity to “clarify, and in some cases to correct, some facts”I am pleased to see Dr Baylis’s article relating to the Olivieri case at the Hospital for Sick Children and the University of Toronto. I thank her for the many facets of that case that she has articulated. Nonetheless, as the bioethicist most closely connected with the case at the clinical level I would like to take this opportunity to clarify, (...) and in some cases to correct, some facts.Dr Baylis entitles her section on the role of bioethics as “Stories of silence”. I differ from this view. Perhaps the stories are less stories of silence than stories to which others have not listened.I wish to make it quite clear that I have always supported Dr Olivieri and her colleagues in their actions with respect to the research that is at the centre of this case. I have been public in my support and I continue to be so.My departure from the Hospital for Sick Children was in no way caused by the Olivieri case. I was offered a challenging position at another Ontario …. (shrink)

All Canadian bioethicists need to reflect on the meaning and value of their work, to see more clearly how the ethics of bioethics is being undermined from within. In the case involving Dr Olivieri, the Hospital for Sick Children, the University of Toronto, and Apotex Inc, there were countless opportunities for bioethical heroism. And yet, no bioethics heroes emerged from this case. Much has been written about the hospital’s and the university’s failures in this case. But what about the (...) deafening silence from the Canadian bioethics community? Given the duty of bioethicists to “speak truth to power”, this silence is troubling. To date, nothing has been written about the silence. This article is intended as a partial remedy. As well, the article pays tribute to heretofore unsung heroes among Dr Olivieri’s research colleagues. (shrink)

The case of Dr. Nancy Olivieri, the Hospital for Sick Children, the University of Toronto, and Apotex Inc. vividly illustrates many of the issues central to contemporary health research and the safety of research participants. First, it exemplifies the financial and health stakes in such research. Second, it shows deficits in the ways in which research is governed. Finally, it was and remains relevant not only in Toronto but in communities across Canada and well beyond its borders because, absent (...) appropriate policies, what happened in Toronto could have happened (and could well still happen) elsewhere. In Part One of this paper, we review the facts of the Olivieri case relevant to the issues we wish to highlight: first, the right of participants in a clinical trial to be informed of a risk that an investigator had identified during the course of the trial and the obligation of the investigator to inform participants (both her own and those of other investigators); and second, the obligation of institutions to protect and promote the well-being of research participants as well as academic freedom and research integrity, the obligations of research sponsors to inform participants, research regulators, and others about unforeseen risks, and the obligations of research regulators to ensure that participants are informed of unforeseen risks and to otherwise protect and promote research integrity. In Part Two, we relate these facts and issues to New Zealand and Australia. We also make detailed recommendations for changes to the various instruments used for the governance of research involving humans in Australasia. (shrink)

Adrian Viens, Guest Editor of this Olivieri symposium, and Julian Savulescu, the Editor of JME, set the scene for the symposium."In failing...[her] when she needed them most, it is now clear that some members of the University’s Faculty of Medicine heard her muffled cries of academic freedom from the back room, yet their response was to serve another round of drinks and turn the music up louder. With the bombshell revelations in the...affair, the plug may have been pulled on (...) this business sponsored party, and hopefully a sober re-examination of the university’s neglected role and responsibility toward independent inquiry and academic freedom can begin.1" "These guys don’t get one thing—we’re not going away. This isn’t a personal vendetta. This is something I want patients to be protected from when I’m dead, fifty years from now.2" "[The Olivieri affair is] not a mystery novel, but instead the latest skulduggery at Toronto’s Hospital for Sick Children.1" "The legal assaults which you have endured in your battle against the drug company, and in your battle against the medical establishment appear to have been fought with the type of uncommon bravery that is rarely seen. It is for this reason that our trustees have unanimously chosen to recognise you for this most prestigious award.3" "[The Olivieri affair resulted from] a fundamental misreading of the issue as a mere contractual and scientific dispute...[it is] Canada’s worst academic and research scandal in decades...[Since 1998, Olivieri has been] demoted, then restored, then harassed. She has been smeared with allegations attacking her competence, integrity, sanity and personality....4"The Olivieri affair is one of the most important events to occur in research ethics. From its dominance in the Canadian and international news media, to changes in the governance of public health, academic medicine, …. (shrink)

ABSTRACT Dr. Nancy Olivieri has become an icon of research integrity for her insistence on publishing adverse data about a drug she was investigating. She has been celebrated world‐wide as a hero of biomedical ethics for her bravery in disclosing potential dangers to research subjects, in the face of both drug company threats and coercive pressures from her hospital and university. Like so many other ‘whistle‐blowers’ however, she now faces both personal vilification and disturbing accusations of scientific error. The (...) case against Olivieri is assessed and found to be baseless. (shrink)

No discussion of academic freedom, research integrity, and patient safety could begin with a more disquieting pair of case studies than those of Nancy Olivieri and David Healy. The cumulative impact of the Olivieri and Healy affairs has caused serious self examination within the biomedical research community. The first part of the essay analyses these recent academic scandals. The two case studies are then placed in their historical context—that context being the transformation of the norms of science through (...) increasingly close ties between research universities and the corporate world. After a literature survey of the ways in which corporate sponsorship has biased the results of clinical drug trials, two different strategies to mitigate this problem are identified and assessed: a regulatory approach, which focuses on managing risks associated with industry funding of university research, and a more radical approach, the sequestration thesis, which counsels the outright elimination of corporate sponsorship. The reformist approach is criticised and the radical approach defended. (shrink)

The Canadian Bioethics Society has taken some constructive steps in its attempt to learn from the Olivieri caseWe would like to thank the authors and editors of the JME’s minisymposium on the Olivieri case in the February 2004 issue of the journal for continuing and extending the dialogue about this important challenge to the North American bioethics community.This minisymposium is of special interest to us as members of the Canadian Bioethics Society’s working group on employment standards for bioethics. (...) We are members of this working group precisely because we believe that most of us in the Canadian bioethics community ought to do more to respond to situations such as the Olivieri/Apotex affair. We welcome the opportunity to continue to learn from the case and …. (shrink)

The Toronto experience suggests that there may be several general lessons for academic health sciences complexes to learn from the Olivieri/Apotex affair regarding the ethics, independence, and integrity of clinical research sponsored by for profit enterprises. From a local perspective, the OAA occurred when there already was a focus on the complex and changing relationships among the University of Toronto, its medical school, the fully affiliated teaching hospitals, and off campus faculty because of intertwined interests and responsibilities. The OAA (...) became a catalyst that accelerated various systemic reforms, particularly concerning academic/industry relations. In this article, the evolving governance framework for the Toronto academic health sciences complex is reviewed and these policy and process reforms discussed. These reforms have created collaborative activity among research ethics boards and contract research offices of the partner institutions, and allowed the joint university/hospital ethics centre to play a role in governance and policy, while respecting the missions and mandates of the involved institutions. Although few of the policies are dramatically innovative, what is arguably novel is the elaboration of an overarching governance framework that aims to move ethics to a central focus in the academic complex. Time alone will tell how sustainable and effective these changes are. (shrink)

The Toronto experience suggests that there may be several general lessons for academic health sciences complexes to learn from the Olivieri/Apotex affair regarding the ethics, independence, and integrity of clinical research sponsored by for profit enterprises. From a local perspective, the OAA occurred when there already was a focus on the complex and changing relationships among the University of Toronto, its medical school, the fully affiliated teaching hospitals, and off campus faculty because of intertwined interests and responsibilities. The OAA (...) became a catalyst that accelerated various systemic reforms, particularly concerning academic/industry relations. In this article, the evolving governance framework for the Toronto academic health sciences complex is reviewed and these policy and process reforms discussed. These reforms have created collaborative activity among research ethics boards and contract research offices of the partner institutions, and allowed the joint university/hospital ethics centre to play a role in governance and policy, while respecting the missions and mandates of the involved institutions. Although few of the policies are dramatically innovative, what is arguably novel is the elaboration of an overarching governance framework that aims to move ethics to a central focus in the academic complex. Time alone will tell how sustainable and effective these changes are. (shrink)

The Olivieri symposium offers an opportunity to reflect on the Canadian regulatory climate and public governance. Baylis’s paper raises a concern about the Canadian bio-ethics community’s collective silence and stewardship regarding the Olivieri case.1 A similar collective silence greeted the recent McDonald report2 on research governance in Canada. The McDonald report assessed the integrity and effectiveness of research governance arrangements and concluded that serious reform was required.Curiously, although the McDonald report was recently referred to in a Canadian Medical (...) Association Journal editorial as an example of Canadian leadership,3 it has never received an editorial commentary in the CMAJ. Nor has any article in the CMAJ ever addressed the McDonald report. Yet the CMAJ created an ethics editorship and a senior Canadian bioethicist was chosen for the position in light of the growing importance of ethics in public policy.4 A chapter of the McDonald report also focused on the mandate of the Canadian Medical …. (shrink)

A recent study by Olivieri et al, published in PLOS ONE, reports that between 2009 and 2015 a third of patients with thalassaemia in Canada’s largest hospital were switched from first-line licensed drugs to regimens of deferiprone, an unlicensed drug of unproven safety and efficacy. Based on retrospective data from patient records, the PLOS Study reports that patients treated with deferiprone, either as monotherapy or in combination with first-line drugs, suffered serious adverse effects. The data reported by Olivieri (...) et al give rise to a number of ethical issues. These ethical issues are identified, placed in historical context and analysed. For purposes of this analysis, reliance is placed on two core principles of research ethics, harm minimisation and informed consent, and also on the hospital’s mission statement. Then a mystery is explored: How and why did it happen that Toronto’s University Health Network treated large numbers of patients with an unlicensed drug over a period of many years? ‘Institutional conflict of interest’ is considered as a possible explanatory hypothesis. (shrink)

Although medical centres have established boards, special committees, and offices for the review and redress of breaches in ethical behaviour, these mechanisms repeatedly prove themselves ineffective in addressing research misconduct within the institutions of academic medicine. As the authors see it, institutional design: systematically ignores serious ethical problems, makes whistleblowers into institutional enemies and punishes them, and thereby fails to provide an ethical environment.The authors present and discuss cases of academic medicine failing to address unethical behaviour in academic science and, (...) thereby, illustrate the scope and seriousness of the problem. The Olivieri/Apotex affair is just another instance of academic medicine’s dereliction in a case of scientific fraud and misconduct. Instead of vigorously supporting their faculty member in her efforts to honestly communicate her findings and to protect patients from the risks associated with the use of the study drug, the University of Toronto collaborated with the Apotex company’s “stalling tactics,” closed down Dr Olivieri’s laboratory, harassed her, and ultimately dismissed her.The authors argue that the incentives for addressing problematic behaviour have to be revised in order to effect a change in the current pattern of response that occurs in academic medicine. An externally imposed realignment of incentives could convert the perception of the whistleblower, from their present caste as the enemy within, into a new position, as valued friend of the institution. The authors explain how such a correction could encourage appropriate reactions to scientific misconduct from academic medicine. (shrink)