In clinical trials, it is common practice to follow up significant interactions between the factors under investigation with subgroup analyses. Such analyses pose at least two analytical and interpretational challenges. The first challenge is that performing multiple subgroup analyses increases the likelihood of obtaining spuriously significant results. This has been acknowledged and relevant guidance exists in the medical literature. The second challenge is that the effects that are obtained at the level of subgroup are composite. This has yet to be (...) fully acknowledged and discussed in the context of medical research. This paper aims to fill this lacuna. Using a simple additive model, we use recent findings from the CHARISMA trial on the efficacy of clopidogrel in addition to aspirin in the treatment of patients at risk for atherothrombotic events to demonstrate quantitatively the composition of effects at the level of subgroups. In the simplest case of a design involving an interaction (two crossed factors, with two levels each, i.e. a 2 x 2 design), effects at the level of subgroup consist of influences that stem (i) from the incidence of the measured outcome in the study population as a whole; (ii) from the factor of interest (e.g. treatment vs. placebo); (iii) from the second factor (e.g. patient group membership); (iv) from the interaction between the two factors; and (v) from random error in the measured outcome. The value of the approach illustrated here is that it is generalizable to any research design irrespective of its complexity and that it prompts clinicians to consider the multiple causality underlying medical research findings. (shrink)

Common morality has been the touchstone of medical ethics since the publication of Beauchamp and Childress's Principles of Biomedical Ethics in 1979. Rosamond Rhodes challenges this dominant view by presenting an original and novel account of the ethics of medicine, one deeply rooted in the actual experience of medical professionals. She argues that common morality accounts of medical ethics are unsuitable for the profession, and inadequate for responding to the particular issues that arise in medical practice. Instead, Rhodes argues (...) that medicine's distinctive ethics should be explained in terms of the trust that society allows to the profession. Trust is the core and starting point of Rhodes' moral framework, which states that the most basic duty of doctors0is to "seek trust and be trustworthy." 0Building from this foundation, Rhodes explicates the sixteen specific duties that doctors take on when they join the profession, and demonstrates how her view of these duties is largely consistent with the codes of medical ethics of medical societies around the world. She then explains why it is critical for physicians to develop the attitudes or "doctorly" virtues that comprise the character of trustworthy doctors and buttress physicians' efforts to fulfil their professional obligations. Her book's presentation of physicians' duties and the elements that comprise a doctorly character, together add up to a cohesive and comprehensive description of what medical professionalism really entails. Rhodes's analysis provides a clear understanding of medical professionalism as well as a guide for doctors navigating the ethically challenging situations that arise in clinical practice. (shrink)

I heartily agree with Sam Doernberg and Robert Troug’s claims that there are important differences between “general morality” and medical ethics, and that in some instances they issue contradictory...

This sourcebook, a corrected reprint of the University of South Carolina Press edition of 1972, contains a complete English translation of the sophist material collected in the critical edition of Diels-Krantz, as well as Euthydemus and a completely re-edited Antiphon.

Human microbiome research has revealed that legions of bacteria, viruses, and fungi live on our skin and within the cavities of our bodies. New knowledge from these recent studies shows that humans are superorganisms and that the microbiome is indispensible to our lives and our health. This volume explores some of the science on the human microbiome and considers the ethical, legal, and social concerns that are raised by this research.

I compare Rosamond’s relationship with her husband in Middlemarch with Rosamond’s marital relationship in L.A.G. Strong’s short story “The Seal.” I interpret the latter fiction as addressing the unpleasant question: what sort of decent man can suppress Rosamond?

The need for organs to transplant is clear. Due to the lack of transplants, people suffer, they die, and the cost of taking care of them until they die is huge. There is general agreement that it would be good to increase the supply of organs in order to meet the demand for organ transplantation.

Because medicine can preserve and restore health and function, it is widely acknowledged as a basic good that a just society owes its members. Yet there is controversy over the scope of what should be provided, to whom, how, when and why. This comprehensive and authoritative book - by well-known philosophers, doctors, lawyers, political scientists, and economists - lays a theoretical foundation for understanding the debate, assesses how health care is distributed in different countries and to various social groups, and (...) analyzes practical issues in constructing a socially just health care system. (shrink)

THE phenomenon of sleep is of course of interest to Aristotle as a student of animals, and his biological works contain quite detailed accounts of what he takes to be the physiology of sleep. But sleep has also, for Aristotle, what might be called a metaphysical interest, and it is on this I wish to focus. My purpose is to make some small contribution to the philosophical study of Aristotle’s biology.

The human microbiome is the bacteria, viruses, and fungi that cover our skin, line our intestines, and flourish in our body cavities. Work on the human microbiome is new, but it is quickly becoming a leading area of biomedical research. What scientists are learning about humans and our microbiomes could change medical practice by introducing new treatment modalities. This new knowledge redefines us as superorganisms comprised of the human body and the collection of microbes that inhabit it and reveals how (...) much we are a part of our environment. The understanding that microbes are not only beneficial but sometimes necessary for survival recasts our interaction with microbes from adversarial to neighborly. This volume explores some of the science that makes human microbiome research possible. It then considers ethical, legal, and social concerns raised by microbiome research. Chapters explore issues related to personal identity, property rights, and privacy. The authors reflect on how human microbiome research challenges reigning views on public health and research ethics. They also address the need for thoughtful policies and procedures to guide the use of the biobanked human samples required for advancing this new domain of research. In the course of these explorations, they introduce examples from the history of biomedical science and recent legal cases that shed light on the issues and inform the policy recommendations they offer at the end of each topic's discussion.This volume is the product of an NIH Human Microbiome Project grant. It represents three years of conversations focused on consensus formation by the twenty-seven members of the interdisciplinary Microbiome Working Group. (shrink)

Because the process of moving from moral principles and facts to action-guiding moral conclusions has not been articulated clearly enough to be useful in a practical way, we designed a systematic approach to aid learners and clinicians in their application of ethical principles to the resolution of clinical dilemmas. Our model for clinical moral reasoning is intended to provide a clear and replicable structure that makes the thought process involved in reasoning about clinical cases explicit. In this paper we present (...) the model and demonstrate how it can be used in three clinical cases. (shrink)

Over the past 15 years, medical schools have paid some attention to the importance of developing students' communication skills as part of their medical education. Over the past decade, medical ethics has been added to the curriculum of most U.S. medical schools, at least on paper. More recently, there has been growing discussion of the importance of professionalism in medical education. Yet, the nature and content of these fields and their relationship to one another remains confused and vague, and that (...) lack of clarity, in turn, impairs the effectiveness of medical education. This ambiguity invites serious contention over who should design and teach the curriculum as well as when, where, and how it should be taught. (shrink)

Medicine needs our trust. We need to be able to rely on individual clinicians and researchers, and we need to be able to have confidence in hospitals and clinics. Yet the organization of our healthcare institutions is not designed to promote that trust. In fact, the structure of our medical institutions seems to undermine our faith.

The primary aim of this work on Hobbes is to present a new construction of his moral and political views. I argue for a reading of the text which dramatically recasts his theory as a deontological contractarianism rather than a consequentialist contractarianism. This reading of the text pays serious attention to Hobbes's usually neglected rejection of prudential calculation and his commitment to the method of Reason which he explains as what we would now call analytical deduction from the meaning of (...) words. ;I argue for the centrality of three theses: that obligation arises from assent, that there is always an obligation to obey the Laws of Nature, and that one is obliged to obey one's sovereign. In explicating Hobbes's theory I present a more complex picture of the authorization of the sovereign than is standardly given in the accounts that characterize the sovereign as the third party beneficiary of a contract between individuals in the State of Nature. Instead, my complex account depicts the sovereign as a duty bound contractor with obligations to the commonwealth. Furthermore, I contend that Hobbes's distinction between the natural and the artificial can be seen to organize and explain important elements in his view. ;Parts 3 and 4 of Leviathan, where Hobbes discusses the obligation of Christian citizens to their civil sovereign and the supposed powers of the Kingdom of Darkness, are then used as a test for verifying the coherence and validity of my novel interpretation. Because my reading of the first two parts of Leviathan conforms with the ideas and method presented in parts 3 and 4, I conclude that the deontic reading, and not the egoist reading, best captures Hobbes's intended meaning. I then go on to defend my interpretation against today's most prominant advocates of the egoist readings, Gauthier, Hampton and Kavka. ;In the final chapter of this work I present three arguments on currently important moral questions: benevolence, infidelity, and abortion. These arguments, which all employ what I have shown to be the Hobbesian approach, show the usefulness of Hobbes's theory in addressing contemporary questions of ethics. (shrink)

Through a number of studies recently published in the psychology literature, T.D. Wilson, D.T. Gilbert, and others have demonstrated that our judgments about what our future mental states will be are contaminated by various distortions. Their studies distinguish a variety of different distortions, but they refer to them all with the generic term “affective forecasting.” The findings of their studies on normal volunteers are remarkably robust and, therefore, demonstrate that we are all vulnerable to the distortions of affective forecasting. a.

Traditional moral theories of rights and principles have dominated medical ethics discussions for decades. Appeals to utilitarian consequences, as well as the principles of respect for autonomy, beneficence, and justice, have provided the standard vocabulary and filled the literature of the field.Recently on the bioethics scene, however, there has been some discussion of virtue, and, particularly within the nursing ethics literature, appeals are being made to the feminist ethics of care. This intimation of a shift in the wind may have (...) to do with postmodern doubt, or it may be attributable to the claim that virtue theory and the ethics of care are more appropriate to private interaction; theories of rights and justice are best applied to the political domain of public policy. (shrink)