Evidence-based medicine has beendefined as the conscientious and judicious useof current best evidence in making clinicaldecisions. This paper will attempt to explicatethe terms ``conscientious'''' and ``judicious''''within the evidence-based medicine definition.It will be argued that ``conscientious'''' and``judicious'''' represent virtue terms derived fromvirtue ethics and virtue epistemology. Theidentification of explicit virtue components inthe definition and therefore conception ofevidence-based medicine presents an importantstarting point in the connection between virtuetheories and medicine itself. In addition, aunification of virtue theories andevidence-based medicine will illustrate theneed (...) for future research in order to combinethe fields of virtue-based approaches andclinical practice. (shrink)

Background: Patient autonomy has been promoted as the most important principle to guide difficult clinical decisions. To examine whether practising physicians indeed value patient autonomy above other considerations, physicians were asked to weight patient autonomy against three other criteria that often influence doctors’ decisions. Associations between physicians’ religious characteristics and their weighting of the criteria were also examined. Methods: Mailed survey in 2007 of a stratified random sample of 1000 US primary care physicians, selected from the American Medical Association masterfile. (...) Physicians were asked how much weight should be given to the following: (1) the patient’s expressed wishes and values, (2) the physician’s own judgment about what is in the patient’s best interest, (3) standards and recommendations from professional medical bodies and (4) moral guidelines from religious traditions. Results: Response rate 51% (446/879). Half of physicians (55%) gave the patient’s expressed wishes and values “the highest possible weight”. In comparative analysis, 40% gave patient wishes more weight than the other three factors, and 13% ranked patient wishes behind some other factor. Religious doctors tended to give less weight to the patient’s expressed wishes. For example, 47% of doctors with high intrinsic religious motivation gave patient wishes the “highest possible weight”, versus 67% of those with low (OR 0.5; 95% CI 0.3 to 0.8). Conclusions: Doctors believe patient wishes and values are important, but other considerations are often equally or more important. This suggests that patient autonomy does not guide physicians’ decisions as much as is often recommended in the ethics literature. (shrink)

G. E. Moore's ‘A Defence of Common Sense’ has generated the kind of interest and contrariety which often accompany what is new, provocative, and even important in philosophy. Moore himself reportedly agreed with Wittgenstein's estimate that this was his best article, while C. D. Broad has lamented its very great but largely unfortunate influence. Although the essay inspired Wittgenstein to explore the basis of Moore's claim to know many propositions of common sense to be true, A. J. Ayer judges (...) its enduring value to lie in provoking a more sophisticated conception of the very type of metaphysics which disputes any such unqualified claim of certainty. (shrink)

The first chapter discusses the association of the English word ‘or’ in reasoning. “Or” is descended from the Anglo-Saxon word meaning second, a form which survives in such expressions as “every other day.” If logical theory had not introduced the vocabulary of disjunction, we could not formulate the question. The truth-functional character of ‘or’ and ‘and’, if they have such a character in their natural language habitat, is a character that is derived as a consequence of their playing a certain (...) role in discourse, one best described as punctuation, or in a specialized sense of the word adverbial. In many cases, the transformation of a sentence embedding an or-list to an equivalent or joined pair of sentences cannot plausibly be called disjunctive distribution. ‘Or’-words derive from additive rather than from subtractive ancestors. (shrink)

Evaluation of the potential of a cocaine vaccine requires a detailed understanding of the intended and unintended social consequences of its use. Prospective technology assessment is always difficult, but in the case of treatment and prevention of cocaine addiction we need to understand not only the neuroscience and pharmacology of cocaine addiction, but also social attitudes to drug use and addiction, the social context of drug use, and the factors which make drug use a rational strategy for an addict and (...) make treatment seeking or relapse more or less likely. By considering different scenarios related to differing levels of effectiveness of the vaccine, the authors argue that vaccination will be at best a useful adjunct to existing methods of treatment, rather than a substitute for them. (shrink)

Public health ethics is a relatively new academic field. Crucially, it is distinguished from traditional medical ethics by its focus on populations rather than individuals. Still, the ethics of public health cannot be perceived completely detached from the ethics of individuals, as populations are made up of individuals. One issue that clearly falls within the intersection of a population- and an individual based perspective on ethics is resource allocation. Resource allocation takes place at various stages within the organisation of healthcare, (...) i.e. at the micro-, meso- and macro level [3]. Resources are almost always limited, with the consequence that some healthcare is prioritised while other care is rationed. In this manner, resource allocation creates winners and losers; those who get the best care available, those who do not receive the best care and those who do not receive care at all. It seems prudent to assume that any adequate public health ethics involved in population-based decision-making will have to address all ethical aspects of resource allocation, all the way from the macrolevel policy-making process to the micro-level implementation where it affects specific and identifiable individuals. More specifically, such an ethics must be able to deal with the ethical tensions arising between population-based concerns framing the policy design process, and individual concerns in the realisation of the resource allocations. In the following, I will identify an inherent ethical tension involved in ‘legitimate resource allocation’, which is related to the challenge of meeting the ethical requirements from a population- and an individual based perspective at the same time. (shrink)

Medicine is not merely a job that requires technical expertise, but a profession concerned with making the best decisions and recommendations with reference to, and in consultation with, the patient. This means that the skill set required for healthcare professionals in order to provide good care is a combination of scientific knowledge, technical aptitude, and affective qualities or virtues such as compassion and empathy.

This volume contains papers from a 1962 Symposium in the Philosophy of Mind held at Wayne State University. There are seven essays, each accompanied by lengthy and usually quite astute comments, and followed by a shorter rejoinder. Chisholm contributes a refinement of his much discussed criteria for intentional connectives: "On Some Psychological Concepts and the 'Logic' of Intentionality." The scare quotes are well-placed around "Logic," as it is Chisholm's intuitive rather than formal logical perspicacity which carries the weight of the (...) argument. Ayer's paper, "The Concept of a Person," has already been published in his book of the same name. The most deliberate exercise in epistemic logic is Castañeda's paper, "Consciousness and Behavior: Their Basic Connections." This essay deserves close scrutiny, as it represents a disciplined attempt to rehabilitate more traditional conceptions of consciousness and, particularly, self-consciousness. Putnam has some more to say about minds and machines in "The Mental Life of Some Machines." In what is possibly the best paper in the volume, Sellars develops the dialectic that runs from phenomenalism, through various forms of realism, to a critical scientific realism mediated by a Kantian-style phenomenalism. Aune's comments on the paper are very illuminating. Alston, owing to the delay in publication of the Symposium, joins a bit late the list of those who are criticizing and rejecting the logical barrier between reasons and causes that has been erected by Melden et al. Finally, Firth tries to delimit our concept of seeing by arguing in a manner more suggestive than definitive for causal criteria for the use of the term. The general tone of the volume is exploratory.—E. A. R. (shrink)

The book is designed as an introductory text in the history of pre-Christian religion. The religions are examined in their socio-historical context and are treated as religions in the broad sense in which they provided total frameworks of meaning for a particular culture. The religions treated are the standard ones: Sumerian, Babylonian, Egyptian, Hebraic, and Greek. Loew's technique is to examine in detail the literature of each culture and to reconstruct from it the sacred space in which the people of (...) that culture must have moved. His categories of myth, sacred history, and philosophy are meant to be more or less adequate characterizations of the shape of the expression of the sacred in the Sumero-Babylonian and Egyptian, Hebraic, and Greek cultures respectively. Of course there is overlap, e.g., the obviously mythic roots of Greek literature. Loew is best on the Sumero-Babylonian and Egyptian religions. When he comes to the Hebraic religions he oversimplifies the picture to a considerable degree, as is the case also with his treatment of the Greeks. But this is perhaps a justifiable procedure in an introductory text. Each chapter concludes with a brief but helpfully annotated bibliography.--E. A. R. (shrink)

The pituitary hormone prolactin (PRL) is best known for its role in the regulation of lactation. Recent evidence furthermore indicates PRL is required for normal reproduction in rodents. Here, we report on the insertion of two transposon-like DNA sequences in the human prolactin gene, which together function as an alternative promoter directing extrapituitary PRL expression. Indeed, the transposable elements contain transcription factor binding sites that have been shown to mediate PRL transcription in human uterine decidualised endometrial cells and lymphocytes. (...) We hypothesize that the transposon insertion event has resulted in divergent (pituitary versus extrapituitary) expression of prolactin in primates, and in differential actions of pituitary versus extrapituitary prolactin in lactation versus pregnancy respectively. Importantly, the TE insertion might provide a context for some of the conflicting results obtained in studies of PRL function in mice and man. (shrink)

There is limited knowledge about cancer patients' experiences of uncertainty while waiting for genome sequencing results, and whether prolonged uncertainty contributes to psychological factors in this context. To investigate uncertainty in patients with a cancer of likely hereditary origin while waiting for genome sequencing results, we collected questionnaire and interview data at baseline, and at three and 12 months follow up. Participants had negative attitudes towards uncertainty at baseline, and low levels of uncertainty at three and 12 months. Uncertainty about (...) genome sequencing did not change significantly over time [t = 0.660, p = 0.510]. Greater perceived susceptibility for cancer [r = 0.14, p < 0.01], fear of cancer recurrence [r = 0.19, p < 0.01], perceived importance of genome sequencing [r = 0.24, p < 0.01], intention to change behavior if a gene variant indicating risk is found [r = 0.29, p < 0.01], perceived ability to cope with results [r = 0.36, p < 0.01], and satisfaction with decision to have genome sequencing [r = 0.52, p < 0.01] were significantly correlated with negative attitudes towards uncertainty at baseline. Multiple primary cancer diagnoses [B = −2.364 [−4.238, −0.491], p = 0.014], lower perceived ability to cope with results [B = −0.1.881 [−3.403, −0.359], p = 0.016] at baseline, greater anxiety about genome sequencing [B = 0.347 [0.148, 0.546], p = 0.0012] at 3 months, and greater perceived uncertainty about genome sequencing [B = 0.494 [0.267, 0.721] p = 0.000] at 3 months significantly predicted greater perceived uncertainty about genome sequencing at 12 months. Greater perceived uncertainty about genome sequencing at 3 months significantly predicted greater anxiety about genome sequencing at 12 months [B = 0.291 [0.072, 0.509], p = 0.009]. Semi-structured interviews revealed that while participants were motivated to pursue genome sequencing as a strategy to reduce their illness and risk uncertainty, genome sequencing generated additional practical, scientific and personal uncertainties. Some uncertainties were consistently discussed over the 12 months, while others emerged over time. Similarly, some uncertainty coping strategies were consistent over time, while others emerged while patients waited for their genome sequencing results. This study demonstrates the complexity of uncertainty generated by genome sequencing for cancer patients and provides further support for the inter-relationship between uncertainty and anxiety. Helping patients manage their uncertainty may ameliorate psychological morbidity. (shrink)

Despite the growing body of literature on training in the responsible conduct of research, few studies have examined the effectiveness of delivery formats used in ethics courses. The present effort sought to address this gap in the literature through a meta-analytic review of 66 empirical studies, representing 106 ethics courses and 10,069 participants. The frequency and effectiveness of 67 instructional and process-based content areas were also assessed for each delivery format. Process-based contents were best delivered face-to-face, whereas contents delivered (...) online were most effective when restricted to compliance-based instructional contents. Overall, hybrid courses were found to be most effective, suggesting that ethics courses are best delivered using a blend of formats and content areas. Implications and recommendations for future development of ethics education courses in the sciences are discussed. (shrink)

Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the (...) living donor evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation. (shrink)

Aim To study the views of people in a largely Muslim country, Kuwait, of the acceptability of a life-ending action such as physician-assisted suicide (PAS). Method 330 Kuwaiti university students judged the acceptability of PAS in 36 scenarios composed of all combinations of four factors: the patient's age (35, 60 or 85 years); the level of incurability of the illness (completely incurable vs extremely difficult to cure); the type of suffering (extreme physical pain or complete dependence) and the extent to (...) which the patient requests a life-ending procedure, euthanasia or PAS (no request, some form of request, repeated requests). In all scenarios, the patients were women who were receiving the best possible care. The ratings were subjected to cluster analysis and analyses of variance. Results Five clusters were found. For 44%, PAS was always very unacceptable, no matter what the circumstances. For 23%, it was unacceptable, but less so if the patient was older or requested it repeatedly. For 16%, it was unacceptable if the patient was young but was acceptable if the patient was elderly. For 5%, it was unacceptable if the patient had extreme pain but was acceptable if completely dependent. For 11%, it was unacceptable if the patient did not request it but acceptable if she did. Conclusion The majority of the Kuwaiti university students opposed PAS either categorically or with a slight variation according to circumstances. Nonetheless, a minority approved of PAS in some cases, particularly when the patient was elderly. (shrink)

Although removed from immediate clinical practice, decisions about the design of hospitals eventually impact on patient care and treatment. Any decision which affects a patient’s treatment is an ethical decision and should be guided by the principles of medical ethics. If we apply these principles to healthcare facilities, it would seem that providers have a duty to design hospitals which best reduce the possibility that a patient may come to unnecessary harm during their treatment and improve a patient’s experience, (...) privacy and dignity. Evidence suggests that hospitals designed with 100% single-occupancy rooms are best equipped to achieve these aims.The prevalence of hospital acquired infections is still increasing. Currently, they are thought to affect around 9% of hospital patients in the UK and contribute to around 90 000 deaths per year in Europe.1 A hospital design which is able to decrease the prevalence of hospital acquired infection would help to reduce the amount of harm a patient may experience in hospital. Studies have shown that adapting the hospital design to incorporate 100% single-occupancy …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Picking Up the Pieces of a Shattered Culture:Abandoning Sartre for AquinasR. E. HouserI expect to die in my bed, my successor will die in prison, and his successor will die a martyr in the public square. Then his successor will pick up the shards of a ruined society and slowly help rebuild civilization, as the Church has done so often in human history.—Francis Cardinal George (2010)Here I propose to (...) present a feature of the ethics of Thomas Aquinas, his ethical doctrine of virtue, concentrating on the four cardinal virtues—justice, prudence or good practical judgment, courage, and temperance. Plato first selected them as the four premier virtues, but they go back at least to Homer, for whom wily Odysseus exemplified prudence, warlike Achilles courage, old Nestor justice, Penelope and Telemachus, Odysseus' wife and son, temperance. And I offer them as central to living the morally good life required to "rebuild civilization" in an America that so fair and judicious a man as Cardinal George could call a "ruined society." To see the need for Thomas's solution, we must begin with the problem. Now, all societies depend upon the deep and fundamental ideas of the most important thinkers, prophets and sages, saints, and yes, even philosophers. Their ideas "trickle down" to influence regular folk, like you and me, those who whose hard work actually makes a society thrive, or die. And when those fundamental ideas change, the moral principles of those who embrace those ideas change, and consequently their actions change, and as a result the wider society in which they live changes, for better or worse. Such effects can now be felt across America [End Page 135] by all; but most of us are unaware of the primary intellectual agents of these changes, since they operate at the level of fundamental ideas, not politics or business or day-to-day life. And often their originators have died before the ideas reach full cultural force. So, ignorance of history makes it difficult to deal with present problems caused by those ideas.My first conclusion will be that a major cause of the current coarsening of our culture is the group of ideas of the French philosopher Jean Paul Sartre, even though most Americans have never heard of him, and most of those who recognize his name have not read his works carefully enough to see the connection. Why Sartre? In the honors program at my university, I had a bright young lady of Muslim heritage who had gone to a lycée, one of France's elite classical secondary schools. "Did you read the classics?" "Yes." Expecting Montaigne or Pascal, I asked, "Who?" Her answer: "Sartre." So let us begin with the theory and practice of Sartre and his long-time lover Simone Beauvoir, whose book The Second Sex was an intellectual spark for the women's liberation movement. Then we turn to some real-life examples of Sartrean influence on ourselves and American culture. Finally, for the best remedy for non-Christian and Christian alike, I recommend Aquinas's doctrine of virtue, when taken in its full scope.Sartre's Ethics of Absolute FreedomIn 1946, the year I was born, Sartre gave a lecture to a meeting of French librarians, which became his most popular book, Existentialism is a Humanism. There he laid out the core of his thought about God, humans, and their ethical behavior. Here I arrange his main ideas in an order that facilitates comparison with Aquinas, beginning with his view of human ontology and proceeding to its impact on the four cardinal virtues.Human OntologySartre turned his back on the traditional metaphysical view that every creature is an individual substance defined by a nature or essence it has in common with all other things of that type. In his "first principle of existentialism," Sartre skips over other animate things, plants and animals, and compares humans to inanimate objects:Let us consider... a book or a paper-cutter: here is an object made by an artisan whose inspiration came from a concept.... One cannot postulate a man who makes a paper-cutter but does not know what it is... (shrink)

Quality and service improvement (QSI) research employs a broad range of methods to enhance the efficiency of healthcare delivery. QSI research differs from traditional healthcare research and poses unique ethical questions. Since QSI research aims to generate knowledge to enhance quality improvement efforts, should it be considered research for regulatory purposes? Is review by a research ethics committee required? Should healthcare providers be considered research participants? If participation in QSI research entails no more than minimal risk, is consent required? The (...) lack of consensus on answers to these questions highlights the need for ethical guidance. Three distinct approaches to classifying QSI research in accordance with existing ethical principles and regulations can be found in the literature. In the first approach, QSI research is viewed as distinct from other types of healthcare research and does not require regulation. In the second approach, QSI research falls within regulatory guidelines but is exempt from research ethics committee review. In the third approach, QSI research is deemed to be part of the learning healthcare system and, as such, is subject to a different set of ethical principles entirely. In this paper, we critically assess each of these views. While none of these approaches is entirely satisfactory, we argue that use of the ethical principles governing research provides the best means of addressing the numerous questions posed by QSI research. (shrink)

Twenty essays by fifteen British and American writers representing some of the best anglo-american Platonic scholarship dating, chiefly, from the fifties but with essays by Cherniss, Ryle, Vlastos, and Hackforth dating from the thirties. The later dialogues are the focus with nine of the essays treating the Theory of Forms explicitly. Included are essays by Ryle and Runciman on the Parmenides, and also the Vlastos-Geach exchange on the Third Man Argument. The Timaeus is covered by Cherniss' "On the Relation (...) of the Timaeus to Plato's Later Dialogues," and also by Vlastos' "The Disorderly Motion in the Timaeus" and Morrow's "Necessity and Persuasion in Plato's Timaeus." In all, a welcome collection.—E. A. R. (shrink)

Determining appropriate authorship recognition in student-faculty collaborative research is a complex task. In this quantitative study, responses from 1346 students and faculty in education and some social science disciplines at 36 research-intensive institutions in the United States were analyzed to provide a description of current and recommended practices for authorship in student-faculty collaborative research. The responses revealed practices and perceptions that are not aligned with ethical guidelines and a lack of consensus among respondents about appropriate practice. Faculty and student respondents (...) agreed that students deserve more authorship recognition than they get in common practice but they did not agree on the appropriate authorship arrangement for several of the collaborative scenarios described in the study or on the relative value of various contributions to research projects. The misalignment with ethical codes and lack of consensus among the respondents is problematic because student-faculty collaborative research is common and authored publications are powerful indicators of research competency. With these detailed results, students and faculty can better anticipate areas where their perspectives are likely to differ and faculty can work to clarify ambiguous expectations. (shrink)

A non-technical review of the state of various of the life sciences—biology, genetics, ethology-as they provide data upon which to erect a philosophy of life. The philosophical problems taken up include emergence, the mind-body relation, and the relevance of evolutionary theory to questions in ethics. Thorpe is at his best when he is operating within the field of scientific biology, not so much as one reporting the results of specific research, but as one making an attempt to see some (...) unity in the total enterprise and results of the life sciences. From this perspective Thorpe finds organicism an hypothesis that is supported much more heavily than any form of reductivism, even at the level of molecular biology where Thorpe questions the mechanistic model that has been imposed, via information theory, on such elemental biological phenomena as gene structure and the working of DNA. Thorpe's philosophizing, however, though often suggestive, never takes the form of sustained argument, and one is sometimes hard put to draw the line between it and bits of biological speculation. Provocative and summative rather than definitive or original, but still quite worthwhile.—E. A. R. (shrink)

Thirty-one essays by thirty psychologists and philosophers, treating, roughly, methodological, systematic, and miscellaneous "issues." Some of the psychologists and—alas—too many of the philosophers simply put in an appearance; but there is some excellent material. Piaget's "Psychology and Philosophy" points out the priority of the symbolic abstraction from action rather than language in the learning process of the child, a fact which should have consequences for certain philosophical theories of meaning. Bertocci ably defends a "Personalistic Psychology," while, in the best (...) of the philosophers' contributions, R. S. Peters distinguishes between active and passive emotions—between wanting and wishing—using Freud as both a source and exemplum. Pribram argues philosophically and neurophysiologically for what he terms a "Structural Pragmatism"; a similar view is developed very suggestively by Razran in his essay, "Evolutionary Psychology: Levels of Learning—and Perception and Thinking." The holistic as opposed to the atomistic approach in psychology gets in the final word in Wolman's "Principles of Monistic Transitionism." The editor provides an excellent, annotated bibliography of books on philosophical psychology.—E. A. R. (shrink)

Ferm's expanded Christian Theology makes Christianity scarcely distinguishable from the best of all possible ethical systems—and nothing more. But Christianity has always claimed to be much more, as have most religions. This claim can be challenged of course, but not by Ferm's uncritical and outdated use of biblical scholarship and criticism. He is careful to state that most of what he says about the historical status of Christianity is his opinion, and we can leave it at that.—E. A. R.

Along with other complete selections this volume contains the complete text of the Praise of Folly, The Handbook of the Militant Christian, and The Complaint of Peace. Dolan's translation achieves a freshness that recaptures the spirit that Erasmus' original texts must have had when he first published them. The commentary by Dolan is sympathetic and scholarly. This is by far the best inexpensive introduction to the thought of Erasmus.—E. A. R.

This volume is designed as an anthology of shorter texts centered around some of the standard problems in natural theology. The first section contains readings pertaining to the theistic proofs; the section on the Ontological argument is particularly well-organized here. The inclusion of Braithwaite's paper, "Religious Statements as Ethically but not Factually Significant" and Hick's own paper on "Eschatological Verification" makes these papers available in an inexpensive form for the first time. Hick's own conviction that religion can at best (...) assume an attitude of indifference or armed neutrality towards philosophy is reflected in his introduction.—E. A. R. (shrink)

The third volume of Bréhier's seven volume history to be translated, and, like the previous two volumes, it is handsomely put together. Bréhier is perhaps at his best on the Medieval period in the history of philosophy, and, therefore, this volume will still be of value for serious students. As with the other volumes, the bibliographies have been updated.—E. A. R.

Edelstein's death in 1965 came when he had completed only four of eight projected chapters on the idea of progress in antiquity, and these four chapters in the history of this idea take us from Xenophanes to the start of the Augustan Age. What the book is best in is scholarship of the footnote sort. Edelstein's major thesis is that the ancients exhibited something more than an isolated or peripheral interest in progress, and that, consequently, the supposed antithesis between (...) the pagan, cyclic notion of time and the Christian, linear and progressive notion of time is a misguided oversimplification. But in his introduction, in which he discusses the notion of progress in general, Edelstein has failed to give an account of the relation of the notion of progress to the notion of historical time which would provide the critically justified ground for saying that emphasis on progress requires similar conceptions of time. Progressivism, after all, is, and in antiquity often was, compatible with catastrophism; and the latter is, at least in its ancient garb, out of step with the eschatological notion of history which finds expression in the Judaeo-Christian tradition. What Edelstein has done is to draw our attention to the polymorphous and detailed thought on progress in antiquity—often despite his own attempts to force a unity or organicism on the phenomena where there appears to be none. But when we go in search of the wider context, the conviction persists that the repeated forms and instances of progressivism in antiquity strain at but do not break free from the hegemony of moira and eternal return—even though it be not eternal return of the same.—E. A. R. (shrink)

The translation here of Chenu's by now classic work is a slightly revised form of the original 1950 French edition, Introduction à l'étude de saint Thomas d'Aquin. The bibliography has been brought up to date and the translators have added two helpful indexes, one giving abbreviations used in the citations and a table of the Aquinian texts referred to, the other giving a list of Latin and Greek technical terms and the places where they occur and are defined or explained (...) in Chenu's text. Chenu's book has been a handbook in the best sense of the word since the time of its first appearance and English-language students of St. Thomas can be extremely grateful for this translation.—E. A. R. (shrink)

The Genetic Information Nondiscrimination Act of 2008 was passed to encourage patients to seek genetic testing that could improve health outcomes and provide opportunities for preventive measures. GINA protects individuals from discrimination based upon genetic information, but not upon manifested diseases and conditions. Because the manifestation of a disease establishes a threshold of protection for individuals under GINA, the definition of manifestation is crucial to understanding the scope of the bill. This paper examines the range of possible legal definitions of (...) disease manifestation and explores the historical struggle that courts have faced when trying to apply these different definitions. Specifically, the paper examines three frameworks that courts have used in the past to interpret the manifestation of a disease; “manifestation as apparent symptoms,”“manifestation as patient action,” and “manifestation as physician action.” We argue that the “manifestation as physician action” is the best framework to utilize in this law generally, but that the definition of manifestation should be read in the light most favorable to a plaintiff in order to achieve the underlying goals of GINA. (shrink)

Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in (...) the informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

Over the past decade, there has been an extensive debate about whether researchers have an obligation to disclose genetic research findings, including primary and secondary findings. There appears to be an emerging (but disputed) view that researchers have some obligation to disclose some genetic findings to some research participants. The contours of this obligation, however, remain unclear. -/- As this paper will explore, much of this confusion is definitional or conceptual in nature. The extent of a researcher’s obligation to return (...) secondary and other research findings is often limited by reference to terms and concepts like “incidental,” “analytic validity,” “clinical validity,” “clinical relevance,” “clinical utility,” “clinical significance,” “actionability,” and “desirability.” These terms are used in different ways by different writers to describe obligations in different sorts of cases. -/- Underneath this definitional confusion is a general notion, supported by much of the literature, that findings only need to be disclosed when they surpass certain presumably objective or measureable thresholds, such as medical importance or scientific reproducibility. The problem is that there is significant variability in the way that these terms and concepts are used in the literature and, as such, in defining the scope of an obligation to return findings that surpasses the relevant thresholds. -/- The goal of this paper is to analyze the definitional muddle underlying the debate about returning genetic research findings, with the hope of answering a few questions. First, what is the range of definitions being used in this debate? Based on an extensive literature review, Part 1 will lay out a range of articulated definitions for each relevant term, with the goal of categorizing them into a handful of distinct types. Part 2 explains the definitional redundancy and confusion in the current literature, and, drawing from the terminological patterns identified in Part 1, outlines more cohesive building blocks to inform the development of future disclosure frameworks.Our minimum goal in articulating these conceptual building blocks is to promote clearer articulations of, and distinctions between, future disclosure frameworks. More ambitiously, we suggest which definitions and conceptualizations we consider most appropriate to use in future disclosure frameworks. Here, we seek to balance benefits to participants through the disclosure of important information with the minimization of undue burdens on individual researchers and the research enterprise more generally. -/- Our analysis builds upon the central philosophical distinction between concepts and conceptions. The basic idea is that the “concept” of X refers to the general (and relatively uncontroversial) structure/shape of X, while various “conceptions” of X are more particular, filled out, and controversial elaborations of the concept. In other words, “concepts” of X will be formal representations of X, while “conceptions” of X will be substantive interpretations of the key elements and relationships operating within that formal framework. (Implicit in this distinction is an important point about the nature of disagreement – namely, that in order for two or more parties to “disagree” about X as opposed to simply talk past one another, there must be at least enough shared agreement about X to know that the parties are referring to the same thing. A concept of X provides this point of common agreement, while competing conceptions of X mark the areas where disagreement arises.) In this paper, we will employ this distinction in a fundamental way to clarify exactly where the primary disagreements arise in the debate over disclosing genetic research findings. -/- We propose that, underlying all the seeming confusion and disagreement, there are three central and widely agreed upon concepts at work in this debate—validity, value, and volition. The first two concepts concern the nature of the information itself. An obligation to disclose only exists when findings are valid and have value but there are competing conceptions of how to determine or define validity and valuableness. The third concept—volition—pertains not to the information but rather to the person to whom it will be disclosed. Does that person want or not want the information, and what is the best way of determining this? Here, too, competing conceptions arise. Our key point, though, is that almost all of the ethical disagreement arises because of competing conceptions of these three concepts. Understanding and appreciating this key point can help to refocus the substantive debate by providing some common ground to start from in determining how best to interpret these shared concepts. This refocusing can, ideally, produce more productive debate and facilitate some progress in resolving it. (shrink)

The most prevalent approach to understanding recreation experiences in resource management has been a motivational research program that views satisfaction as an appropriate indicator of experience quality. This research explores a different approach to studying the quality of recreation experiences. Rather than viewing recreation experiences as a linear sequence of events beginning with expectations and ending with outcomes that are then cognitively compared to determine experience quality, this alternative approach views recreation as an emergent experience motivated by the not very (...) well-defined goal of acquiring stories that ultimately enrich one's life. Further, it assumes that the nature of human experience is best characterized by situated freedom in which the environment sets boundaries that constrain the nature of the experience, but that within those boundaries recreationists are free to experience the world in unique and variable ways. Therefore this alternative approach seeks a more context specific description of the setting/experience relationship that is intended to complement more general management frameworks (e.g., the Recreation Opportunity Spectrum) developed in conjunction with the motivational research program. (shrink)

Much epistemological theorizing is the attempt to specify what makes for meritorious cognition, but epistemologists have not, despite meritorious effort, achieved unity when it comes to picking out the feature and principles that are distinctive of epistemic normativity. In this essay we explain why this is the inevitable outcome. We isolate important but overlooked variations in the link between epistemological theorizing and the idea of epistemic unification, and then argue that much epistemological theorizing is misguided because it aims toward complete (...) epistemic unification when only partial epistemic unification, at best, is possible. But our arguments — based on work in moral epistemology and philosophical psychology — stop short of epistemological eliminativism, and thus we stake out a middle ground between philosophers such as Descartes, the earlier Alston, Audi, and the earlier BonJour on one hand and Rorty, Fish, and Patricia Churchland on the other. (shrink)

This slim volume can best be characterized as a condensed reworking of the theme of The Phenomenon of Man. Of course, as more and more of Teilhard's work becomes available, it becomes clear that everything he wrote is an earlier transcription or later reworking of the themes of "corpusculization," "biogenesis," "noogenesis," in short, Teilhard's dominantly stated theme of "anthropogenesis." To these teleologically generated levels of emergence of the primordial unity of spirit and matter-categoreally expressed in terms of the internal (...) relatedness of "inner" and "outer"—the theologian, and indeed Teilhard, would want to add Christogenesis—what St. Paul terms "the filling out of Christ's body." It seems hopeless to expect that Teilhard's sweeping synthesis will ever be able to meet the logical tests required by even the broad consensus in contemporary philosophy of science. Perhaps this consensus will have to be adjusted. But insofar as Teilhard claims to have presented a scientific theory, some criteria of meaning and truth will have to be met. But this is a challenge, not a rebuttal.—E. A. R. (shrink)

Intelligence analysts, like other professionals, form norms that define standards of tradecraft excellence. These norms, however, have evolved in an idiosyncratic manner that reflects the influence of prominent insiders who had keen psychological insights but little appreciation for how to translate those insights into testable hypotheses. The net result is that the prevailing tradecraft norms of best practice are only loosely grounded in the science of judgment and decision-making. The “common sense” of prestigious opinion leaders inside the intelligence community (...) has pre-empted systematic validity testing of the training techniques and judgment aids endorsed by those opinion leaders. Drawing on the scientific literature, we advance hypotheses about how current best practices could well be reducing rather than increasing the quality of analytic products. One set of hypotheses pertain to the failure of tradecraft training to recognize the most basic threat to accuracy: measurement error in the interpretation of the same data and in the communication of interpretations. Another set of hypotheses focuses on the insensitivity of tradecraft training to the risk that issuing broad-brush, one-directional warnings against bias (e.g., over-confidence) will be less likely to encourage self-critical, deliberative cognition than simple response-threshold shifting that yields the mirror-image bias (e.g., under-confidence). Given the magnitude of the consequences of better and worse intelligence analysis flowing to policy-makers, we see a compelling case for greater funding of efforts to test what actually works. (shrink)

Human beings persist in an extraordinary range of ecological settings, in the process exhibiting enormous behavioural diversity, both within and between populations. People vary in their social, mating and parental behaviour and have diverse and elaborate beliefs, traditions, norms and institutions. The aim of this theme issue is to ask whether, and how, evolutionary theory can help us to understand this diversity. In this introductory article, we provide a background to the debate surrounding how best to understand behavioural diversity (...) using evolutionary models of human behaviour. In particular, we examine how diversity has been viewed by the main subdisciplines within the human evolutionary behavioural sciences, focusing in particular on the human behavioural ecology, evolutionary psychology and cultural evolution approaches. In addition to differences in focus and methodology, these subdisciplines have traditionally varied in the emphasis placed on human universals, ecological factors and socially learned behaviour, and on how they have addressed the issue of genetic variation. We reaffirm that evolutionary theory provides an essential framework for understanding behavioural diversity within and between human populations, but argue that greater integration between the subfields is critical to developing a satisfactory understanding of diversity. (shrink)

Responding to Randall and Gibson''s (1990) call for more rigorous methodologies in empirically-based ethics research, this paper develops propositions — based on both previous ethics research as well as the larger organizational behavior literature — examining the impact of attitudes, leadership, presence/absence of ethical codes and organizational size on corporate ethical behavior. The results, which come from a mail survey of 149 companies in a major U.S. service industry, indicate that attitudes and organizational size are the best predictors of (...) ethical behavior. Leadership and ethical codes contribute little to predicting ethical behavior. The paper concludes with an assessment of the relevant propositions, as well as a delineation of future research needs. (shrink)

Elsasser outlines in an informal but meticulous fashion an organismic biology which promises, in his opinion, to combine the best features of epigenetic vitalism and preformationist mechanism. Mechanistic reductionism is for Elsasser an unverifiable metaphysical hypothesis; i.e., if the postulate of infinite homogenous classes is dropped from the axiomatics of Van Neumann's proof that the state of any system is, in principle, Quantum Mechanically determinable, it becomes combinatorically obvious that biological systems and classes are radically inhomogenous [[sic]], a fact (...) which operationally bars the way to any complete reductionism. The door is thus opened to an open-ended theoretical biology in which all questions do not have a truth-functional equivalent answer according to the axioms and laws of the science, and prediction in the science becomes statistical in a nonabsolute way. Elsasser is a physicist with more than a casual acquaintance with biology and his argument benefits by his obvious expertise in both of these areas. Philosophically, however, he is a lightweight and relies, in particular, too much on the ontological ice that might be cut by operationalism. Theories are not verified in the stringent operational sense; they are confirmed in a way which is not logically tied to the requirement that all laws be inductively established. Elsasser, however, has so much to say on the problem of reductionism in biology that is of obvious value that the book is easily recommended over these caveats.—E. A. R. (shrink)

In the Preface, Kargon states the two objectives of this monograph in the history of science: "First, I wish to bring to the attention of historians of science the existence and importance of two circles of natural philosophers which played an important role in the history of atomism. Secondly, I wish to trace the evolution of atomism and illustrate the mechanism of its establishment in England in the latter seventeenth century. In doing so, I will re-evaluate the contributions of four (...) major figures and many minor ones, including Walter Charleton, the Duke and Duchess of Newcastle, William Petty, Charles Cavendish, and John Pell". Kargon turns in cash on both promissory notes with a careful yet highly readable piece of scholarship. Some obscurities remain, however, in particular his attempt to link the Northumberland and Newcastle groups with the suggestion that Hobbes' atomism might have been influenced through his connection with John Pell. Concurrence rather than influence was more likely the case. It is also suggested that there might have been a link between Bacon's early atomism and that of Hariot's Northumberland group. But once again the arguments in favor of such a connection are inconclusive at best. Of great importance for the history of atomism is the influence maintained to have been exerted by the 1653 publication of Bacon's atomistic works; this influence was felt by the Newcastle group and the Royal Society. Most interesting, however, is the securely attested influence of the Baconian method on Barrow, Newton, and the Royal Society in general.—E. A. R. (shrink)

Dedicated to Philipp Frank and containing introductory greetings to Frank by some of his more illustrious pupils and colleagues, the essays in this volume cover the proceedings of the Boston Colloquium for the Philosophy of Science, 1962-1964. The essays deal with most of the important problems in the philosophy of science from physics to the biological sciences and psychology, and include approaches from diverse traditions: Whiteheadian, Scientific Realism, Thomistic, Phenomenological, as well as historical approaches. High points were McMullin's "From Matter (...) to Mass," which contained a highly sensitive analysis of the Aristotelian doctrine of prime matter; Sellars's "The Identity Approach to the Mind-Body Problem"; Capek's "The Myth of Frozen Passage," which very ably took to task some historical and theoretical overextensions of Relativity Theory and spatializations of time which have resulted in the Block-Universe theory: the fact that Donald Williams commented on Capek's paper made it all the more interesting as it was William's theory in particular that was under attack. The best part of the book, however, was an approximately one hundred page exchange on the nature of scientific explanation which included a lead paper by J. J. C. Smart and lengthy commentaries by Sellars, Putnam, and Feyerabend. The issue, in part, was the radical-replaceability-of-frameworks theory of Feyerabend versus the gradual-replacement theory of Sellars.—E. A. R. (shrink)

In these three Riddell Memorial Lectures for 1965 Ramsey views religious discourse as an instrument for expressing or stimulating "cosmic disclosure." RD must invariably work through the medium of "models," systems of concepts drawn from human experience and applied only by way of metaphor to the presumably transcendent object of RD. No single model is wholly adequate to exhaust a cosmic disclosure, and the danger lies in interpreting them in too literal a fashion and creating the false, and eventually inconsistent, (...) idea that all or most of the elements of the model are isomorphic with the reality of the object of the disclosure. This danger was succumbed to in the past, according to Ramsey, by most explanations of the doctrine of Atonement. Love, Ramsey concludes, is the best model upon which to express Atonement, and the model of the person is most appropriately used to express the disclosure of God. Having detailed this theory of RD, Ramsey attempts to show how it can be used successfully in resolving some of the difficulties raised in the "Honest to God" debate.—E. A. R. (shrink)

This volume contains papers from a 1962 Symposium in the Philosophy of Mind held at Wayne State University. There are seven essays, each accompanied by lengthy and usually quite astute comments, and followed by a shorter rejoinder. Chisholm contributes a refinement of his much discussed criteria for intentional connectives: "On Some Psychological Concepts and the 'Logic' of Intentionality." The scare quotes are well-placed around "Logic," as it is Chisholm's intuitive rather than formal logical perspicacity which carries the weight of the (...) argument. Ayer's paper, "The Concept of a Person," has already been published in his book of the same name. The most deliberate exercise in epistemic logic is Castañeda's paper, "Consciousness and Behavior: Their Basic Connections." This essay deserves close scrutiny, as it represents a disciplined attempt to rehabilitate more traditional conceptions of consciousness and, particularly, self-consciousness. Putnam has some more to say about minds and machines in "The Mental Life of Some Machines." In what is possibly the best paper in the volume, Sellars develops the dialectic that runs from phenomenalism, through various forms of realism, to a critical scientific realism mediated by a Kantian-style phenomenalism. Aune's comments on the paper are very illuminating. Alston, owing to the delay in publication of the Symposium, joins a bit late the list of those who are criticizing and rejecting the logical barrier between reasons and causes that has been erected by Melden et al. Finally, Firth tries to delimit our concept of seeing by arguing in a manner more suggestive than definitive for causal criteria for the use of the term. The general tone of the volume is exploratory.—E. A. R. (shrink)

This is a competent and sympathetic introduction to the life and thought of Leibniz. It reads, on the surface, like an encyclopedia article or a chapter in a critical history of philosophy. But there is a meta-critical strain governing the exposition. Within a limited space, Van Peursen has molded a presentation which manages to balance considerations of what was central to Leibniz' philosophy from Leibniz' point of view with issues which have special relevance for contemporary philosophy. For example, Van Peursen (...) devotes his longest chapter, "The Logic of an Optimal World: Truth, Freedom, God," to the teleological and ethical roots of Leibniz' ontology. Leibniz preferred to stress the nature/grace and best-of-all-possible-worlds aspects of this teleological ontology. But contemporary philosophy has difficulty relating to this way of expressing the Platonic notion of the primacy of the good over the true. So Van Peursen, while not neglecting Leibniz' focus, also draws attention to a modern reworking of this point: the idea, familiar to contemporary semiotic, that syntactics must ultimately be grounded in pragmatics. Beginning students will find this introduction readable and genuinely helpful. Teachers of philosophy will benefit from the author's historical acuity as well as the clarity of exposition. An index and a brief bibliography are included.--E. A. R. (shrink)