Objectives: To report the attitudes and opinions of subjects in US clinical trials about whether or not, and why, they should receive post-trial access (PTA) to the trial drug, care and information. Design: Focus groups, short self-administered questionnaires. Setting: Boston, Dallas, Detroit, Oklahoma City. Participants: Current and recent subjects in clinical trials, primarily for chronic diseases. Results: 93 individuals participated in 10 focus groups. Many thought researchers, sponsors, health insurers and others share obligations to facilitate PTA to the trial drug, (...) if it benefited the subject, or to a therapeutic equivalent. Some thought PTA obligations include providing transition care (referrals to non-trial physicians or other trials, limited follow-up, short-term drug supply) or care for long-term adverse events. Others held, in contrast, that there are no PTA obligations regarding drugs or care. However, there was agreement that former subjects should receive information (drug name, dosage received, market approval date, long-term adverse effects, trial results). Participants frequently appealed to health need, cost, relationships, reciprocity, free choice and sponsor self-interest to support their views. Many of their reasons overlapped with those commonly discussed by bioethicists. Conclusion: Many participants in US trials for chronic conditions thought there are obligations to facilitate PTA to the trial drug at a “fair” price; these views were less demanding than those of non-US subjects in other studies. However, our participants’ views about informational obligations were broader than those of other subjects and many bioethicists. Our results suggest that the PTA debate should expand beyond the trial drug and aggregate results. (shrink)

In recent years, scholars have begun to lay the groundwork to justify a distinct application of ethics to the field of public health. They have highlighted important features that differentiate public health ethics from bioethics, especially public health’s emphasis on population health rather than issues of individual health. Articulations of public health ethics also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the field of public health ethics is (...) developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of public health ethics may well be global health ethics, focusing on issues of global justice. As public health ethics evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and scholars will need to develop useful tools that practitioners may employ for identifying and tackling these ethical challenges. (shrink)

This paper discusses the predicament of Oscar Pistorius. He is a Paralympic gold medallist who wishes to participate in the Olympics in Beijing in 2008. Following a brief introductory section, the paper discusses the arguments that could be, and have been, deployed against his participation in the Olympics, should he make the qualifying time for his chosen event (400m). The next section discusses a more hypothetical argument based upon a specific understanding of the fair opportunity rule. According to this, there (...) may be a case for allowing Pistorius to compete even if he should fail to make the official qualifying time. The final part of the paper reviews the situation at the time of writing and offers some assessment of the strategy of the IAAF in responding to it. It is argued below that the proper focus for assessment of Pistorius's eligibility to compete should not be on whether his blades lead to his having an unfair advantage over his competitors, but instead should focus on whether what he does counts as running. (shrink)

Published within weeks of Charles Darwin's Origin of Species, Isabelle Duncan's Pre-Adamite Man (1860) is the first full-length treatment of preadamism by an evangelical. Intended as a reconciliation of Genesis and geology, Duncan's work gained immediacy when it was published shortly after the September 1859 revelations that men had walked among the mammoths. Written in the tradition of evangelical 'Christian philosophy', Pre-Adamite Man deploys innovative biblical hermeneutics and recent trends in geology to set out both a biblical preadamite theory, and (...) an unorthodox angelology. Duncan responded to contemporary secular interpretations of geology by pushing evangelical concordist strategies to new frontiers, filling out an acceptance of an ancient earth with new biblically informed catastrophist proposals and extensions of salvation history, while simultaneously retaining a firm commitment to plenary inspiration. The product is a highly readable book that operates both as an accessible treatment of geology and a theological discourse. Running through six printings between 1860 and 1866, the book was reviewed by many of the period's leading journals and created a minor controversy among evangelicals. This study both brings to life this previously neglected episode in scriptural geology, and adds to recent work on Victorian popular science writing. (shrink)

Soon after its publication, Readings in Ancient Greek Philosophy was hailed as the favourite to become "the 'standard' text for survey courses in ancient philosophy. Over twenty years later that prediction has been borne out: Readings in Ancient Greek Philosophy still stands as the leading anthology of its kind. It is now stronger than ever: This 5th Edition features a completely revised Aristotle unit, with new translations, as well as a newly revised glossary. The Plato unit offers new translations of (...) the Meno and Republic. In the latter, indirect dialogue is cast into direct dialogue for greater readability. The Presocratics unit has been re-edited and streamlined, and the pages of every unit have been completely reset. (shrink)

Geoffrey Rose’s prevention paradox points to a tension between two prima facie plausible moral principles: that we should save the greater number and that weshould save the most at risk. This paper argues that a novel moral theory, ex-ante contractualism, captures our intuitions in many prevention paradox cases, regardless of our interpretation of probability claims. However, it goes on to show that it might be impossible to square ex-ante contractualism with all of our moral intuitions. It concludes that even if (...) ex-ante contractualism cannot furnish an entire ethics of risk, it does identify important considerations for any such theory. (shrink)

Thirty years after the conference that gave rise to The Structure of Scientific Theories, there is renewed interest in the nature of theories and models. However, certain crucial issues from thirty years ago are reprised in current discussions; specifically: whether the diversity of models in the science can be captured by some unitary account; and whether the temporal dimension of scientific practice can be represented by such an account. After reviewing recent developments we suggest that these issues can be accommodated (...) within the partial structures formulation of the semantic or model-theoretic approach. (shrink)

Geoffrey Rose’s prevention paradox points to a tension between two prima facie plausible moral principles: that we should save the greater number and that weshould save the most at risk. This paper argues that a novel moral theory, ex-ante contractualism, captures our intuitions in many prevention paradox cases, regardless of our interpretation of probability claims. However, it goes on to show that it might be impossible to square ex-ante contractualism with all of our moral intuitions. It concludes that even if (...) ex-ante contractualism cannot furnish an entire ethics of risk, it does identify important considerations for any such theory. (shrink)

This article discusses the question of whether, as is often claimed, nursing is properly described as an art. Following critical remarks on the claims of Carper, Chinn and Watson, and Johnson, the account of art provided by RG Collingwood is described, with particular reference to his influential distinction between art and craft. The question of whether nursing is best described as an art or a craft is then discussed. The conclusion is advanced that nursing cannot properly be described as an (...) art, given acceptance of Collingwood’s influential definition of art. Moreover, it is shown that, due to difficulties inherent in specifying the ‘ends’ of nursing, nursing is only problematically described as a craft. (shrink)

This “current controversies” contribution describes the recent case of a severely disabled six year old girl who has been subjected to a range of medical interventions at the request of her parents and with the permission of a hospital clinical ethics committee. The interventions prescribed have become known as “the Ashley treatment” and involve the performance of invasive medical procedures (eg, hysterectomy) and oestrogen treatment. A central aim of the treatment is to restrict the growth of the child and thus (...) make it easier for her parents to care for her at home. The paper below discusses the main objections to the treatment. It concludes that the most serious concern raised by the case is that it may set a worrying precedent if the moral principle employed in justification of the treatment is applied again to endorse it in similar circumstances. Finally, it raises the possibility that that same moral principle may even be invoked to justify more radical interventions than those that were actually performed in the Ashley treatment. (shrink)

In this paper the coherence of the precautionary principle as a guide to public health policy is considered. Two conditions that any account of the principle must meet are outlined, a condition of practicality and a condition of publicity. The principle is interpreted in terms of a tripartite division of the outcomes of action . Such a division of outcomes can be justified on either “consequentialist” or “deontological” grounds. In the second half of the paper, it is argued that the (...) precautionary principle is not necessarily opposed to risk–cost–benefit analysis, but, rather, should be interpreted as suggesting a lowering of our epistemic standards for assessing evidence that there is a link between some policy and “special bad” outcomes. This suggestion is defended against the claim that it mistakes the nature of statistical testing and against the charge that it is unscientific or antiscientific, and therefore irrational. (shrink)

Background: Despite potential benefits of the return of research results to research participants, the TriCouncil Policy Statement , which reflects Canadian regulatory ethical requirements, does not require this. The policies of Canadian research ethics boards are unknown.Objectives: To examine the policies of Canadian university based REBs regarding returning results to research participants, and to ascertain if the presence/absence of a policy may be influenced by REB member composition.Design: Email survey of the coordinators of Canadian university based REBs to determine the (...) presence/absence of a policy on return of research results to research participants both during an ongoing study and at conclusion. REB coordinators were asked to return a copy of the policy or guidelines and to describe the member composition of their REB.Findings: Of 50 REBs that were contacted 34 responded and 22 met the inclusion criteria. Two had a policy that governed the return of research results while on a study, and seven following the completion of a study. Presence of an ethicist or a lawyer on the REB did not influence the presence/absence of such policies. No REBs had specific guidelines describing how participants should be informed of results.Conclusions: Most REBs did not require researchers to disclose study results to research participants either during or following a study. Thus this study identifies an ethical shortcoming in the conduct of human research in Canada. It has also demonstrated that there are no clear recommendations by REBs to facilitate the return of results to participants following research projects. (shrink)

The interaction of the organism with the environment requires not only reactive, but also active behavior which helps subject to meet the challenge of the uncertainty of the environment. A positive feedback between active behavior and immune system makes the selection process effective.

Seeking parallels among disciplines can have both risks and benefits. Finding parallels may be a vacuous exercise in categorization, generating no new insights. And pointing to analogous functions may cause us to treat them as homologous. Hull et al. have provided a basis for the generation of insights in different selectionist areas, without confusing analogy with homology.

The relationship between place and remembering has been a long-standing matter of phenomenological concern. The role of the 'lived body' in mediating acts of remembering in context is clearly crucial. In this paper we contribute to an 'expanded view of memory' by describing how remembering difficult or problematic events -- 'vital memories' -- draws upon inter-subjective and inter-objective relations. We discuss two conceptual tools that provide an analytic framework -- the concept of 'life space' drawn from Kurt Lewin and the (...) idea of the 'setting specificity' of remembering. From this perspective we can see that the 'lived body' does not constitute a singular unity but rather a 'plurality' of potential bodies that have 'operative solidarity' with the material relations in which they are constituted. Drawing on the work of Eduardo Viveiros de Castro, we argue that 'body memories' need to be analysed from within the embodied material-relational perspective wherein they are afforded. (shrink)

Shepherdson [14] showed that for a discrete ordered ring I, I is a model of IOpen iff I is an integer part of a real closed ordered field. In this paper, we consider integer parts satisfying PA. We show that if a real closed ordered field R has an integer part I that is a nonstandard model of PA (or even IΣ₄), then R must be recursively saturated. In particular, the real closure of I, RC (I), is recursively saturated. We (...) also show that if R is a countable recursively saturated real closed ordered field, then there is an integer part I such that R = RC(I) and I is a nonstandard model of PA. (shrink)