In this issue of the Hastings Center Report, James Sabin and his colleagues ask what responsibility investigators in a learning health organization have to patients when research—particularly research of which patients might be unaware—illuminates problematic aspects of the patients' care. Sabin and his colleagues were confronted by this question in the midst of designing a randomized controlled trial that sought to determine if an educational intervention targeted at patients with atrial fibrillation and their clinicians reduces underuse of oral anticoagulants. Worried (...) about harm that might befall patients in the control group and fearing that they would be negligent bystanders if they knew these patients were at risk and did nothing, the investigators adopted a “workaround.” But the “workaround,” I suggest, was not a solution to the negligent bystander problem. Nor was it a solution to the problem as I would alternatively frame it—how to address instances of suboptimal patient care identified through research within learning health organizations. (shrink)

the philebus is a puzzling dialogue, both for the substantive views it puts forward,1 and for the unexpected twists and turns of the discussion. Commentators frequently complain about the dialogue's lack of unity, due to its many apparently unnecessary digressions and interruptions.2 The discussion of the so-called 'divine method' seems to be one of the worst offenders on this score, for it is described and exemplified at length, only to be set aside as unnecessary shortly afterwards.I argue that the divine (...) method plays a vital role in the subsequent examination and evaluation of pleasure and knowledge. I focus in particular on the application of the divine method to pleasure, since the method is... (shrink)

ArgumentMost social scientists today think of data sharing as an ethical imperative essential to making social science more transparent, verifiable, and replicable. But what moved the architects of some of the U.S.’s first university-based social scientific research institutions, the University of Michigan’s Institute for Social Research, and its spin-off, the Inter-university Consortium for Political and Social Research, to share their data? Relying primarily on archived records, unpublished personal papers, and oral histories, I show that Angus Campbell, Warren Miller, Philip Converse, (...) and others understood sharing data not as an ethical imperative intrinsic to social science but as a useful means to the diverse ends of financial stability, scholarly and institutional autonomy, and epistemological reproduction. I conclude that data sharing must be evaluated not only on the basis of the scientific ideals its supporters affirm, but also on the professional objectives it serves. (shrink)

Some individuals facing dementia contemplate hastening their own death: weighing the possibility of living longer with dementia against the alternative of dying sooner but avoiding the later stages of cognitive and functional impairment. This weighing resonates with an ethical and legal consensus in the United States that individuals can voluntarily choose to forgo life‐sustaining interventions and also that medical professionals can support these choices even when they will result in an earlier death. For these reasons, whether and how a terminally (...) ill individual can choose to control the timing of their death is a topic that cannot be avoided when considering the dementia trajectory. With a focus on the U.S. context, this landscape review considers the status of provisions that would legally permit people facing dementia to hasten death with appropriate support from medical professionals. This review can be used to plan and guide clinical and legal practitioner discussion and policy development concerning evolving questions not fully covered by existing medical decision‐making provisions. (shrink)

Most research on the corporate philanthropy of organizations has focused on the external benefits of such initiatives for firms, such as benefits for firm reputation and opportunities. However, many firms justify their giving, in part, due to the positive impact it has on their employees. Little is known about the effectiveness of such efforts, or how they can be managed strategically to maximize impact. We hypothesize a main effect of office-level corporate philanthropy on average employee attitudes in that office, but (...) also investigate three strategies that offices may use to enhance this impact. Testing our hypotheses with 3 years of data on attitudes of an average of 14,577 employees in 53 offices we find support for the main effect, but mixed support for the specific strategies used to enhance impact. (shrink)

With the normative demand to attend to social difference and an absence of universal evaluative terms with which to do so, recent theory has increasingly turned to the study of the affective rather than epistemological conditions of ethical encounter. This I call a “dispositional ethics” that construes responsibility as responsiveness. Recent articulations of such an ethics, notably in the most current work of Judith Butler, James Tully, Jade Larissa Schiff, and Ella Myers, highlight its connection to situated practices of concrete (...) bodies-in-relation, but often stop short of developing an account of what such embodied practices might be. Based on interviews with thirteen experts who take the body as their primary vocational and intellectual field and characterize their practice as an art of listening, I distinguish three dimensions of a dispositional ethics in practice and some of the specific strategies available to cultivate the conditions for responsiveness in political life. (shrink)

This book draws its inspiration from Hilbert, Wittgenstein, Cavaillès and Lakatos and is designed to reconfigure contemporary philosophy of mathematics by making the growth of knowledge rather than its foundations central to the study of mathematical rationality, and by analyzing the notion of growth in historical as well as logical terms. Not a mere compendium of opinions, it is organised in dialogical forms, with each philosophical thesis answered by one or more historical case studies designed to support, complicate or question (...) it. The first part of the book examines the role of scientific theory and empirical fact in the growth of mathematical knowledge. The second examines the role of abstraction, analysis and axiomatization. The third raises the question of whether the growth of mathematical knowledge constitutes progress, and how progress may be understood. Readership: Students and scholars concerned with the history and philosophy of mathematics and the formal sciences. (shrink)

Despite legislation and public education, racism and sexism are alive and well. Though pre‐conceptive gender selection may enhance procreative liberty, this technology presents two disturbing questions. First, does sex selection represent underlying parental sexism? Second, by performing gender selection, do medical professionals perpetuate sexism? It will be maintained that pre‐conceptive sex selection is sexist as it reflects parental anticipation of stereotypical gender based behavior. Perhaps even more incriminating, sex selection forces parents to prefer one sex over another, to place a (...) value on gender. This emphasis on sex conflicts with societal goals which urge, and often legally require, individuals to ignore gender. We will assert that pre‐conceptive gender selection exemplifies sexism in its purest most blatant form as prior to conception, before parents can possibly know anything about their child, gender dominates the calculus of a child’s worth. We will also emphasize that physicians, by facilitating sex selection, legitimize the motivations of their patients and provide de facto support of sexism. In a similar vein, arguments against pre‐conceptive race selection will be made. (shrink)

Long histories and entrenched habits of inattention among advantaged groups mean that even minor challenge and concession can provoke subjective perceptions of victimization. How, in such conditions, might claims of structural injustice break through? Drawing on field work with practitioners across conflict mediation, therapy, education, and performance – four sectors that facilitate listening in fraught contexts yet are undertheorized in politics – this article makes the case that among the most overlooked and powerful resources for cultivating receptivity and responsiveness among (...) advantaged groups are the arts of listening. Practices of engagement across these sectors establish listening as potent rather than passive, given the extent to which it constitutes the field of encounter and shapes what emerges within it, both in terms of expression and, more significantly in this context, receptivity of those to whom one listens. Yet this also means that how one listens is a pivotal consideration – particularly when listening might serve to reinforce and normalize unjustly dominant positions. In contrast to progressive politics’ emphasis on finding more forceful forms of voice and conventional reliance on direct communicative practices, this article explores how specific comedic, theatrical, and embodied tactics can generate ‘oblique forms of listening’ potentially useful to social justice struggles. (shrink)

Bioethics, Volume 36, Issue 3, Page 298-304, March 2022.

To ensure that the information resulting from research is relevant to patients, the Patient‐Centered Outcomes Research Institute eschews the “traditional health research” paradigm, in which investigators drive all aspects of research, in favor of one in which patients assume the role of research partner. If we accept the premise that patient engagement can offer fresh perspectives that shape research in valuable ways, then at least two important sets of questions present themselves. First, how are patients being engaged—and how should they (...) be engaged? Second, which patients are being engaged—and which patients should be? This set has received relatively less attention, and the neglect is surprising, given that the “who” question is conceptually prior to the question of “how.”This article focuses attention on the “who” of patient engagement in research. First, we provide background on the rationale for patient engagement, underscoring the importance of ensuring the representativeness of engaged patients. Second, we present what little is known about patients engaged in PCORI‐funded research. Third, we identify and discuss the ethical implications of ways in which current practices of patient identification and recruitment may lead to a lack of representativeness. These practices include reliance on the well‐connected and well‐informed, reliance on patients who are not well trained or well‐informed, and reliance on patient advocacy organizations. Finally, we consider several strategies for addressing these pitfalls in order to maximize the positive goals of patient engagement. Patient engagement is intended to address the inability of researchers, funders, and others to fully represent patient views and priorities, but without sufficient attention, the patients selected for this role may still leave important gaps. (shrink)

In the 1930s, the Bengali philosopher K. C. Bhattacharyya proposed a new theory of rasa, or aesthetic emotion, according to which aesthetic emotions are feelings that have other feelings as their intentional objects. This paper articulates how Bhattacharyya’s theory offers a novel solution to the puzzle of how it is both possible and rational to enjoy the kind of negative emotions that are inspired by tragic and sorrowful tales. The new solution is distinct from the conversion and compensation views that (...) dominate the existing literature, and it derives its significance from how it ties aesthetic experience to self-awareness. (shrink)

Frege argues that number is so unlike the things we accept as properties of external objects that it cannot be such a property. In particular, (1) number is arbitrary in a way that qualities are not, and (2) number is not predicated of its subjects in the way that qualities are. Most Aristotle scholars suppose either that Frege has refuted Aristotle's number theory or that Aristotle avoids Frege's objections by not making numbers properties of external objects. This has led some (...) to conclude that Aristotle's accounts of arithmetical and geometrical objects differ substantially. I close this supposed gap by showing that Aristotle's arithmetical objects, like geometrical objects, are just certain sensible things qua certain properties they in fact possess. Specifically, numbers are pluralities qua quantitative or relational properties like ten units or ten. I show that this view is resistant to the Fregean concerns about arbitrariness and numerical predication. (shrink)

Interest in the use of medical data for health research is increasing. Yet, as Elizabeth Ford and colleagues rightly note, there are open questions about the suitability of existing ethical and regulatory oversight frameworks for these research approaches. In their feature article, ‘Should free text data in electronic medical records be shared for research? A citizen’s jury study in the United Kingdom’, Ford et al report the results of a deliberative engagement study in which 18 members of the public were (...) asked whether and under what conditions free text data from medical records should be shared for research purposes. The authors’ explicit aim was to inform national policy on sharing medical text. Public attitudes—stated otherwise, the attitudes of patients whose medical information will ultimately be used under any data sharing policy—are a necessary input into ethical and regulatory decision-making about use of medical data for health research. Though public attitudes will rarely be determinative, they must be weighed in order to uphold the ethical principle of respect for persons.1 Ford et al ’s article is, therefore, an important contribution to …. (shrink)

In the article “Nudging and Informed Consent”, Cohen argues that the use of “nudging” by physicians in the clinical encounter may be ethically warranted because it results in an informed consent where obligations for beneficence and respect for autonomy are both met. However, the author's overenthusiastic support for nudging and his quick dismissal of shared decision-making leads him to assume that “soft” manipulation is un-problematic and that “wisdom” on the side of medical professionals will suffice to guard against abuse. Opposing (...) this view, we propose that: 1) patient preferences and values should not be boiled down to rational or irrational decisions based on cognitive reasoning alone, 2) potential threats to the physician-patient must be mitigated and could be minimized by employing alternative strategies that acknowledge the impact of cognitive heuristics in shaping decision-making but maintain transparency and trust, and 3) patient preferences and values can be legitimately influenced only under specific circumstances. The latter include: (1) exhaustion of other means; (2) evidence that nudging is effective in a specific context; (3) evidence of clear and active public misinformation (e.g., industry promoting smoking); (4) explicit pubic dialogue between various stakeholders including medical professional societies about nudging; (5) upholding shared decision-making as a preferred approach; and (6) a rich understanding of clinical reality beyond the simple dichotomy of beneficence-autonomy. (shrink)

There is a long tradition, in the history and philosophy of science, of studying Kant’s philosophy of mathematics, but recently philosophers have begun to examine the way in which Kant’s reflections on mathematics play a role in his philosophy more generally, and in its development. For example, in the Critique of Pure Reason , Kant outlines the method of philosophy in general by contrasting it with the method of mathematics; in the Critique of Practical Reason , Kant compares the Formula (...) of Universal Law, central to his theory of moral judgement, to a mathematical postulate; in the Critique of Judgement , where he considers aesthetic judgment, Kant distinguishes the mathematical sublime from the dynamical sublime. This last point rests on the distinction that shapes the Transcendental Analytic of Concepts at the heart of Kant’s Critical philosophy, that between the mathematical and the dynamical categories. These examples make it clear that Kant's transcendental philosophy is strongly influenced by the importance and special status of mathematics. The contributions to this book explore this theme of the centrality of mathematics to Kant’s philosophy as a whole. This book was originally published as a special issue of the Canadian Journal of Philosophy. (shrink)

The continuum between nature and artefact is occupied by objects and environments that embody a relationship between natural processes and human activity. In this paper, I explore the relationship that emerges through human interaction with the land in the generation and aesthetic appreciation of industrial farming in contrast to more traditional agricultural practices. I consider the concept of a dialectical relationship and develop it in order to characterise the distinctive synthesising activity of humans and nature which underlies cultivated environments. I (...) argue that a more harmonious relationship, and greater aesthetic value, may be located within traditional farming landscapes. This position is supported and illustrated through a discussion of two agricultural practices in the UK, hedge-laying and stonewalling. (shrink)

This paper explores factors shaping perceptions of Greenhouse Gas Removal (GGR) amongst a range of informed stakeholders, with a particular focus on their role in future social and political systems. We find considerable ambivalence regarding the role of climate targets and incumbent interests in relation to GGR. Our results suggest that GGR is symbolic of a fundamental debate - occurring not only between separate people, but sometimes within the minds of individuals themselves - over whether technological solutions represent a pragmatic (...) or an unethical strategy. We present the idea of a 'Monsanto effect', whereby an entirely separate debate taps into deeper narratives and becomes so pervasive that it spills over into a new topic area. Our findings have significant implications for extant and emergent climate policy as they suggest that, in addition to the considerable practical challenges facing large-scale GGR deployment, there is a deeper psychological challenge in that actors are themselves conflicted about the fundamental desirability of GGR. (shrink)

We argued last year in this journal that extensive integration of research and care is a worthy goal of health system design, and we second the call from Ruth Faden and colleagues to move toward learning health care systems. As they recognize, learning health care systems demand the coordination of research and medical ethics—two sets of normative commitments that have long been considered distinct. In offering a novel ethics framework for such systems, Faden et al. advance the scholarly debate about (...) how best to do this and challenge us to think more deeply about its practical implications. However, we believe that at least three issues they raise require additional attention. First, the research‐care distinction has more normative bite than they are willing to concede. Second, the role for independent oversight requires clarification. Finally, they neglect the concept of stewardship as a guiding obligation of learning health care systems. (shrink)

An evaluation of a health condition-specific hope scale adapted from the more general dispositional Hope Scale (Snyder et al., 1991) is provided. Participants (N = 202) with a rare, debilitating, and potentially stigmatising health condition were recruited from readers of the Anal Fissure Self Help Page. Data were gathered anonymously using an online survey linked to the website. Consistent with hope theory, this new measure yielded a pathways factor (perceived capacity to find ways to achieve desired goals) and an (...) agency factor (perceived motivation to pursue goals energetically). Respondents with stronger pathways thoughts reported greater benefits from website information for understanding and generating strategies for managing anal fissures. Stronger agency beliefs were related to more frequent website visits, more rereading of first-hand patient accounts, and shorter duration of fissure symptoms. Results offer preliminary support for validity of this scale and for using web-based methodologies to study conditions, such as anal fissure. (shrink)

A woman's body found, afternoon, 27 December 1994, in Belfast Lough at Seapark near Holywood, 50–70 years old. Wore a grey tweed coat with a British Legion badge in the lapel and a necklace bearing the name of Vera.

In 1940, John and Morag Aitkenhead set up Kilquhanity School in rural Galloway, inspired by the writings of A.S. Neill and the practices at Summerhill School. In 1962, Aitkenhead wrote that he had swallowed ‘hook, line and sinker’ Neill's theories and that ‘but for him and his example, there could never have been this free school in Scotland’. Historians and commentators have tended to share his view, for example, describing Aitkenhead as a ‘disciple’ of Neill and Kilquhanity as an ‘approximate’ (...) of Summerhill with its weekly meeting, informality of relations between adults and children and a valuing of freedom and happiness over academic achievement.However, this article, drawing on primary research with ex-pupils and staff, uncovers significant differences of philosophy and practice between the two schools, particularly in relation to pupils’ contribution to the Kilquhanity School community through the daily practice of ‘useful work’. These differences raise questions about the positioning of Kilquhanity as simply a less well-known and less radical ‘Summerhill in Scotland’ and expose an often neglected fault line within the progressive and radical movements with which both schools are associated. (shrink)

Despite the Swan River Colony of Western Australia being founded as the first, experimental, and free colony on the Australian continent, crime and punishment were intertwined with colonisation. It can be demonstrated that Jeremy Bentham’s writings on punishment and reform, specifically through the panopticon, had a significant influence on the punishment of prisoners in the Swan River Colony. Most notably, this occurred through the construction of Fremantle Gaol. Indeed, in the emerging port town of Fremantle, the jail was designed by (...) Henry Willey Reveley, a known associate of Bentham, and it incorporates crucial elements of the panopticon into its architecture and operations. Whilst it should be noted that the prison does not conform to the entirety of the panopticon design, it can be viewed as a practical response to the model in a colonial setting with limited resources. Deviations from the methods of discipline and punishment outlined by Bentham through the panopticon and other writings are attributable to the increased need for the perception of control over a disgruntled settler population who felt that they had been misled regarding the potential of the colony, and an Indigenous population who sought to defend their homeland against invasion. Thus, the jail provides an interesting insight into the state of crime, society and penal trends that emerged in the formative years of the Swan River Colony between 1831-1841. Through analysis of the surviving records, this paper will examine Fremantle Gaol as an example of Bentham’s panopticon, in particular how its architecture and operations mirrored the model. (shrink)

The Editor-in-Chief would like to thank the following colleagues who have helped maintain ….