Patient or public involvement in health research is increasingly expected as a matter of policy. In theory, PPI can contribute both to the epistemic aims intrinsic to research, and to extrinsically valued features of research such as social inclusion and transparency. In practice, the aims of PPI have not always been clear, although there has been a tendency to encourage the involvement of so-called ordinary people who are regarded as representative of an assumed patient perspective. In this paper we focus (...) on the epistemic potential of PPI, using theoretical work in epistemology to develop a nuanced account of patients’ experiential knowledge and how this might contribute directly to conceptual development, hypothesis generation and data interpretation. We also consider how some features of health research pose barriers to this kind of epistemic contribution. Drawing on Miranda Fricker’s idea of testimonial injustice, we explore how disciplinary indicators of credibility in clinical and academic health research contexts might be wrongly applied to those involved in PPI, undermining their potential to contribute. Finally we argue for a range of strategies to maximize opportunities for patients to engage with research teams and make epistemologically significant contributions to research. (shrink)

This paper raises questions about the epistemological foundations of evidence-based medicine . We argue that EBM is based upon reliabilist epistemological assumptions, and that this is appropriate - we should focus on identifying the most reliable processes for generating and collecting medical knowledge. However, we note that this should not be reduced to narrow questions about which research methodologies are the best for gathering evidence. Reliable processes for generating medical evidence might lie outside of formal research methods. We also question (...) the notion of the knower that is assumed by EBM. We argue that EBM assumes an enlightenment conception of knowers as autonomous, substitutable individuals. This conception is troubled by the way that clinicians learn the role of anecdote in health care and the role of patient choice, all of which bring into play features of clinicians and patients as situated individuals with particular backgrounds and experiences. EBM's enlightenment conception of the knower is also troubled by aspects of the way evidence is produced. Given these limitations, we argue that EBM should retain its reliabilist bent, but should look beyond formal research methodologies in identifying processes that yield reliable evidence for clinical practice. We suggest looking to feminist epistemology, with its focus on the standpoints of individual situated knowers, and the role of social context in determining what counts as knowledge. (shrink)

Placebo-controlled surgical trials can provide important information about the efficacy of surgical interventions. However, they are ethically contentious as placebo surgery entails the risk of harms to recipients, such as pain, scarring or anaesthetic misadventure. This has led to claims that placebo-controlled surgical trials are inherently unethical. On the other hand, without placebo-controlled surgical trials, it may be impossible to know whether an apparent benefit from surgery is due to the intervention itself or to the placebo effect.

OBJECTIVES: This article presents an original definition of surgical innovation and a practical tool for identifying planned innovations. These will support the responsible introduction of surgical innovations. BACKGROUND: Frameworks developed for the safer introduction of surgical innovations rely upon identifying cases of innovation; oversight cannot occur unless innovations are identified. However, there is no consensus among surgeons about which interventions they consider innovative; existing definitions are vague and impractical. METHODS: Using conceptual analysis, this article synthesizes findings from relevant literature, and (...) from qualitative research with surgeons, to develop an original definition of surgical innovation and a tool for prospectively identifying planned surgical innovations. The tool has been developed in light of feedback from health care professionals, surgeons, and policy makers. RESULTS: This definition of innovation distinguishes between variations, introduction of established interventions, and innovations in surgical techniques or use of devices. It can be applied easily and consistently, is sensitive to the key features of innovation, is prospective, and focuses on features relevant to safety and evaluation. The accompanying tool is deliberately broad so that appropriate supports may, if necessary, be provided each time that a surgeon does something "new". CONCLUSIONS: The definition presented in this article overcomes a number of practical challenges. The definition and tool will be of value in supporting responsible surgical innovation, in particular, through the prospective identification of planned innovations. (shrink)

As the price of pharmaceuticals and biologicals rises so does the number of patients who cannot afford them. In this article, we argue that physicians have a moral duty to help patients access affordable medicines. We offer three grounds to support our argument: (i) the aim of prescribing is to improve health and well-being which can only be realized with secure access to treatment; (ii) there is no morally significant difference between medicines being unavailable and medicines being unaffordable, so the (...) steps physicians are willing to take in the first case should extend to the second; and (iii) as the primary stakeholder with a duty to put the individual patient’s interests first, the medical professional has a duty to address cost-barriers to patient care. In articulating this duty, we take account of important epistemic and control conditions that must be met for the attribution of this duty to be justified. (shrink)

Surgical advances can provide great benefits to patients but can come at a cost. The successes are often matched by failures that cause harm to patients. The risks of surgery create a strong ethical imperative for research to establish the safety and efficacy of new treatments. Surgical research is, however, challenging for a number of reasons including the lack of a clear boundary between variations in practice, innovation and research, its irreversible nature, the difficulty of performing placebo-controlled randomised trials, confounding (...) factors such as surgeon learning curves and conflicts of interest. In this chapter the ethical issues raised by surgical innovation are explored with the use of a case study based on the uptake of vaginal mesh to treat vaginal prolapse to highlight these issues (Sects. 12.1 and 12.2). In Sect. 12.3 the argument for the value of a structured approach to introducing innovations, such as that developed by the IDEAL Collaboration, which clarifies both ethical and methodological issues at each stage of research is proposed. This chapter recognises that ethical challenges extend beyond adequate ethical evaluation of the innovation in the care of individual patients to include broader issues such as justice in access to any new interventions. (shrink)

Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide (...) advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: impacts on healthcare costs, the outsourcing of expertise and issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries. (shrink)

A beautifully illustrated reminder that God paints his love on every face he creates.

This paper draws attention to gendered dimensions of surgical device failure, focusing on two case studies—hernia repair mesh for pelvic organ prolapse, and metal-on-metal hip implants. We explore possible reasons for higher rates of harms to women, including systematic biases in health research and device regulation. Given that these factors are readily identifiable, we look to feminist scholarship to understand what might maintain them, including the role of cultural factors within surgery, such as gendered communication patterns and sexism. We then (...) canvas potential measures to mitigate the increased risk of harms faced by women who use implanted devices. (shrink)

Volume 19, Issue 6, June 2019, Page 28-29.

The development and deployment of medical devices, along with most areas of healthcare, has been significantly impacted by the COVID-19 pandemic. This has had variable ethical implications, two of which we will focus on here. First, medical device regulations have been rapidly amended to expedite approvals of devices ranging from face masks to ventilators. Although some regulators have issued cessation dates, there is inadequate discussion of triggers for exiting these crisis standards, and evidence that this may not be feasible. Given (...) the relatively low evidence standards currently required for regulatory approval of devices, this further indefinite reduction in standards raises serious ethical issues. Second, the pandemic has disrupted the usual operations of device representatives in hospitals, providing an opportunity to examine and refine this potentially ethically problematic practice. In this paper we explain and critically analyse the ethical implications of these two pandemic-related impacts on medical devices and propose suggestions for their management. These include an endpoint for pandemic-related adjustments to device regulation or a mechanism for continued refinement over time, together with a review of device research conducted under crisis conditions, support for the removal and replacement of emergency approved devices, and a review of device representative credentialling. (shrink)

The article presents the author's perspectives regarding the book "The Significance and Basic Postulates of Economic Theory," by Terence Wilmot Hutchison. He emphasizes two important general themes that emerge from the symposium in total, the great breadth of Hutchison's contribution to economic methodology and a brief introduction on the four individual papers. He mentions some people including Roger Backhouse, John Hart and Ross Emmett as well as the comments of each about Hutchison's works.

We examined unconscious priming in a stem-completion task with both identity and form-related primes. Participants were given exclusion instructions to avoid completing a stem with a briefly flashed masked word . In Experiment 1, priming of around 7% occurred for both identity and form-based primes at a 33 ms exposure duration. When examining only trials in which the participants failed to identify the prime, this effect increased to 12% for identity primes, but remained the same for form-based primes. In Experiment (...) 2, priming without prime identification was 9% for identity primes, 4% for homophone primes, and 3% for orthographic control primes. Although identity priming was greater than form priming in both experiments, regression analyses revealed that orthographic and phonological overlap alone between the flashed primes and targets could completely account for unconscious identity priming. Hence, we conclude that masked words may only activate their sublexical orthographic and phonological representations and not their lexical representations. (shrink)

Introduction: Conversion and the practice of transformation -- The philosophical structure of Jonathan Edwards's religious affections -- Habit, habit change, and conversion in C.S. Peirce -- Reconstructing faith : religious overcoming in Dewey's pragmatism -- Transforming obligation in William James -- Dwelling in absence: the reflective origin of conversion -- Creative transformation : the work of conversion -- The evasion of conversion in recent American philosophy.

Argues that the only way to understand the Confucian vision of the consummate moral life is to take the tradition on its own terms.

One of the clear targets of Thomason’s paper is the Feyerabendian portrait of Galileo as epistemic opportunist, hastening to substitute rhetoric for reason. Thomason reveals that Feyerabend has fallen into that awkward trap all critics must fear: when we claim to detect blemishes of logic, the defect may well be in our own grasp of the argument. Yet in making this very point, Thomason is already defending one of Feyerabend’s favourite claims — the reasoning processes used by great scientists are (...) remarkably untidy and do not readily compress themselves into neat philosophic formulation. (shrink)

This article examines the public significance of emotions, most specifically their role in constituting identity and community in the wake of political violence and trauma. It offers a conceptual engagement with processes of healing and reconciliation, showing that emotions are central to how societies experience and work through the legacy of catastrophe. In many instances, political actors deal with the legacy of trauma in restorative ways, by re-imposing the order that has been violated. Emotions can in this way be directed (...) by elites who are concerned with reinstating political stability and social control. Healing often becomes more about retribution and revenge, rather than a long-term project begetting peace, collaboration and emotional catharsis. The emotions triggered by trauma thus tend to perpetuate existing antagonisms, further entrenching the disingenuous perceptions of identity that may have created violence in the first place. Surveying this process, this article suggests that scholars of politics and reconciliation need to be more attentive to the role emotion plays in shaping particular forms of community. Doing so requires a systematic understanding not only of the feelings associated with first-hand experiences of trauma, but also of the manner in which these affective reactions can spread and generate collective emotions, thus producing new forms of antagonism. Addressing this challenge, the authors explore how a more conscious and active appreciation of the whole spectrum of emotions — not only anger and fear, for instance, but also empathy, compassion and wonder — may facilitate more lasting and ingenuous forms of social healing and reconciliation. (shrink)

This paper argues for two theses: that degrees of belief are context sensitive; that outright belief is belief to degree 1. The latter thesis is rejected quickly in most discussions of the relationship between credence and belief, but the former thesis undermines the usual reasons for doing so. Furthermore, identifying belief with credence 1 allows nice solutions to a number of problems for the most widely-held view of the relationship between credence and belief, the threshold view. I provide a sketch (...) of a formal framework on which both theses are true. This is a modified Bayesian framework; I argue that despite making credences context-sensitive, the framework lets Bayesians hold on to their signature explanatory successes. The sort of context-sensitivity claimed for credences here mirrors the sort of context-sensitivity I have elsewhere claimed for outright belief: one's credences depend, in part, on the space of alternative possibilities one takes seriously in a context. (shrink)

The earliest Analects yet discovered, this work provides us with a new perspective on the central canonical text that has defined Chinese culture--and clearly illuminates the spirit and values of Confucius.

The essays in this volume open up reflection on the implications of social inequality for theorizing about moral responsibility. Collectively, they focus attention on the relevance of the social context, and of structural and epistemic injustice, stereotyping and implicit bias, for critically analyzing our moral responsibility practices.

In Reasons and the Good Roger Crisp answers some of the oldest questions in moral philosophy. Fundamental to ethics, he claims, is the idea of ultimate reasons for action; and he argues controversially that these reasons do not depend on moral concepts. He investigates the nature of reasons themselves, and how we come to know them. He defends a hedonistic theory of well-being and an account of practical reason according to which we can give some, though not overriding, priority (...) to our own good over that of others. (shrink)

This is a three-part exchange on the relationship between belief and credence. It begins with an opening essay by Roger Clarke that argues for the claim that the notion of credence generalizes the notion of belief. Julia Staffel argues in her reply that we need to distinguish between mental states and models representing them, and that this helps us explain what it could mean that belief is a special case of credence. Roger Clarke's final essay reflects on the (...) compatibility of the previously discussed views with dualist and monist interpretations of our mental states and our ways of modeling them. (shrink)

This paper defends moral testimony pessimism, the view that there is something morally or epistemically regrettable about relying on the moral testimony of others, against several arguments in Lillehammer. One central such argument is that reliance on testimony is inconsistent with the exercise of true practical wisdom. Lillehammer doubts whether such reliance is always objectionable, but it is important to note that moral testimony pessimism is best understood as a view about the pro tanto, rather than the overall, badness of (...) relying on testimony. One must also be clear about what counts as genuine moral testimony: there will be morally charged occasions when a virtuous person will properly rely on the views of others. It can also plausibly be argued that relying on moral testimony may constitute a lack of full autonomy. After discussing some remaining issues concerning the definition of moral testimony, a possible analogy between lying and relying on testimony, and the implications of untrustworthiness for the truth of moral testimony pessimism, the paper ends with a return to the case against relying on moral testimony, grounded on a conception of the role of knowledge and understanding in virtue. (shrink)

Introduction -- Anselm's classical theism -- The Augustinian legacy -- The purpose, definition, and structure of free choice -- Alternative possibilities and primary agency -- The causes of sin and the intelligibility problem -- Creaturely freedom and God as Creator Omnium -- Grace and free will -- Foreknowledge, freedom, and eternity : part I, the problem and historical background -- Foreknowledge, freedom, and eternity : part II, Anselm's solution -- The freedom of God.

Despite its place in the humanities, the career prospects and numbers of women in philosophy much more closely resemble those found in the sciences and engineering. This book collects a series of critical essays by female philosophers pursuing the question of why philosophy continues to be inhospitable to women and what can be done to change it. By examining the social and institutional conditions of contemporary academic philosophy in the Anglophone world as well as its methods, culture, and characteristic commitments, (...) the volume provides a case study in interpretation of one academic discipline in which women's progress seems to have stalled since initial gains made in the 1980s. Some contributors make use of concepts developed in other contexts to explain women's under-representation, including the effects of unconscious biases, stereotype threat, and micro-inequities. Other chapters draw on the resources of feminist philosophy to challenge everyday understandings of time, communication, authority and merit, as these shape effective but often unrecognized forms of discrimination and exclusion. Often it is assumed that women need to change to fit existing institutions. This book instead offers concrete reflections on the way in which philosophy needs to change, in order to accommodate and benefit from the important contribution women's full participation makes to the discipline. (shrink)