This text reconstructs the Kohlberg/Gilligan controversy between a male ethics of justice and a female ethics of care. Using Karl-Otto Apel's transcendental pragmatics, the author argues for a mediation between both models in terms of a reciprocal co-responsibility. Against this backdrop, she defends the circular procedure of an exclusively argumentative-reflexive justification of a normative ethics. From this it follows for feminist ethics that it cannot do without either of the two types of ethics. The goal is to assure the evaluative (...) variety of different types of an ethics of the good without endangering the normative boundaries of a deontological discourse ethics. (shrink)

The Ethics of Need: Agency, Dignity, and Obligation argues for the philosophical importance of the notion of need and for an ethical framework through which we can determine which needs have moral significance. In the volume, Sarah Clark Miller synthesizes insights from Kantian and feminist care ethics to establish that our mutual and inevitable interdependence gives rise to a duty to care for the needs of others. Further, she argues that we are obligated not merely to meet (...) others’ needs but to do so in a manner that expresses "dignifying care," a concept that captures how human interactions can grant or deny equal moral standing and inclusion in a moral community. She illuminates these theoretical developments by examining two cases where urgent needs require a caring and dignifying response: the needs of the elderly and the needs of global strangers. Those working in the areas of feminist theory, women’s studies, aging studies, bioethics, and global studies should find this volume of interest. (shrink)

_The Ethics of Need: Agency, Dignity, and Obligation_ argues for the philosophical importance of the notion of need and for an ethical framework through which we can determine which needs have moral significance. In the volume, Sarah Clark Miller synthesizes insights from Kantian and feminist care ethics to establish that our mutual and inevitable interdependence gives rise to a duty to care for the needs of others. Further, she argues that we are obligated not merely to meet (...) others’ needs but to do so in a manner that expresses "dignifying care," a concept that captures how human interactions can grant or deny equal moral standing and inclusion in a moral community. She illuminates these theoretical developments by examining two cases where urgent needs require a caring and dignifying response: the needs of the elderly and the needs of global strangers. Those working in the areas of feminist theory, women’s studies, aging studies, bioethics, and global studies should find this volume of interest. (shrink)

The Ethics of Need: Agency, Dignity, and Obligation argues for the philosophical importance of the notion of need and for an ethical framework through which we can determine which needs have moral significance. In the volume, Sarah Clark Miller synthesizes insights from Kantian and feminist care ethics to establish that our mutual and inevitable interdependence gives rise to a duty to care for the needs of others. Further, she argues that we are obligated not merely to meet (...) others’ needs but to do so in a manner that expresses "dignifying care," a concept that captures how human interactions can grant or deny equal moral standing and inclusion in a moral community. She illuminates these theoretical developments by examining two cases where urgent needs require a caring and dignifying response: the needs of the elderly and the needs of global strangers. Those working in the areas of feminist theory, women’s studies, aging studies, bioethics, and global studies should find this volume of interest. (shrink)

I develop the foundation for cosmopolitan care, an underexplored variety of moral cosmopolitanism. I begin by offering a characterization of contemporary cosmopolitanism from the justice tradition. Rather than discussing the political, economic or cultural aspects of cosmopolitanism, I instead address its moral dimensions. I then employ a feminist philosophical perspective to provide a critical evaluation of the moral foundations of cosmopolitan justice, with an eye toward demonstrating the need for an alternative account of moral cosmopolitanism as cosmopolitan care. After providing (...) an explanation of how care ethics in connection with Kantian ethics generates a duty to care, I consider one main feature of cosmopolitan care, namely the theory of obligation it endorses. In developing this account, I place special emphasis on the practical ramifications of the theory by using it to analyze gender violence in conflict zones. (shrink)

In this article, I seek to address an aspect of the general inattention to miscarriage by examining a pressing topic: the moral meanings of pregnancy loss. I focus primarily on the import of such meanings for women in their ethical relationship with themselves, while also finding significant the meaning of miscarriage in community, that is, for our shared moral lives. Exploring miscarriage as a moral phenomenon is critical for figuring out miscarriage’s impact on our ethical self-conception—on how we understand ourselves (...) as moral agents—and in forming and deforming how we understand one another in the broader context of our moral communities—in intimate realms, in public realms, and in various realms in between. -/- I begin by articulating the need for a dedicated perinatal ethics, then developing an overview of this approach. It is against this backdrop that miscarriage’s complex moral meaning can best emerge. I then consider a few promising yet problematic concepts for comprehending the moral meanings of miscarriage, including moral agency, reactive attitudes (in this case, betrayal and guilt), moral responsibility, and moral standing. (shrink)

The ethics of care addresses aspects of the human condition that other moral theories overlook—our vulnerability to injury, inevitable dependencies, and ubiquitous needs. In the grip of these experiences, we require care from others to survive and flourish. The precarious nature of human existence represents a related experience, one less thoroughly explored within care ethics. Through examination of these occasions for care, this article offers two contributions: First, a map of the conceptual relations between care ethics’ four key concepts: need, (...) vulnerability, dependency, and precariousness. As a subset of these efforts, I investigate the relevance of precariousness and precarity for care ethics by asking what they require of caring relations that vulnerability does not. Second, a more precise articulation of care ethics’ normative foundations and accompanying elucidation of the alternative vision of moral responsibility care ethics advances. Examining need, vulnerability, dependency, and precariousness through the lenses of finitude and embodiment exposes two common forms of conflation: between precarity and vulnerability and between dependency and vulnerability. Analysis of the moral significance of the body as a site for care reveals a novel portrayal of the normative foundations of care ethics and the reasons why we care for one another ethically. (shrink)

All humans experience needs. At times needs cut deep, inhibiting persons’ abilities to act as agents in the world, to live in distinctly human ways, or to achieve life goals of significance to them. In considering such potentialities, several questions arise: Are any needs morally important, meaning that they operate as morally relevant details of a situation? What is the correct moral stance to take with regard to situations of need? Are moral agents ever required to tend to others’ well-being (...) by meeting their needs? What justification or foundation, if any, can be given for requiring moral agents to respond to others’ needs? (shrink)

Rather than focusing on the legal and political questions that surround genocidal rape, in this paper I treat a vital area of inquiry that has received much less attention: the moral significance of genocidal rape. My aim is to augment existing moral accounts of rape in order to address the specific contexts of genocidal rape. I move beyond understanding rape primarily as a violation of an individual's interests or agential abilities. The account I offer builds on these approaches (as well (...) as on a pluralist approach), by arguing that rape, as a moral injury, negatively affects the very human dignity of victims. My account also emphasizes the relational harm that marks genocidal rape. (shrink)

The ethics of care addresses aspects of the human condition that other moral theories overlook—our vulnerability to injury, inevitable dependencies, and ubiquitous needs. In the grip of these experiences, we require care from others to survive and flourish. The precarious nature of human existence represents a related experience, one less thoroughly explored within care ethics. Through examination of these occasions for care, this article offers two contributions: First, a map of the conceptual relations between care ethics’ four key concepts: need, (...) vulnerability, dependency, and precariousness. As a subset of these efforts, I investigate the relevance of precariousness and precarity for care ethics by asking what they require of caring relations that vulnerability does not. Second, a more precise articulation of care ethics’ normative foundations and accompanying elucidation of the alternative vision of moral responsibility care ethics advances. Examining need, vulnerability, dependency, and precariousness through the lenses of finitude and embodiment exposes two common forms of conflation: between precarity and vulnerability and between dependency and vulnerability. Analysis of the moral significance of the body as a site for care reveals a novel portrayal of the normative foundations of care ethics and the reasons why we care for one another ethically. (shrink)

The primary aim of this essay is to investigate modalities of resistance to sexual violence. It begins from the observation that the nature of what we understand ourselves to be resisting—that is, how we define the scope, content, and causes of sexual violence—will have profound implications for how we are able to resist. I critically engage one model of resistance to sexual violence: feminist philosophical scholarship on self-defense, highlighting several shortcomings in how the feminist self-defense discourse inadvertently frames sexual violence. (...) Holding these criticisms in mind, I expand the landscape of resistance to sexual violence by considering the new possibilities that empathy might offer. The work of two contemporary women of color feminists—Roxane Gay and Tarana Burke—launches further exploration of empathy’s alternative modes of resistance. By focusing on empathy between survivors of sexual violence, we can expand our understanding of the possibilities of resistance by redistributing and broadening our attention in three main ways: from action to affect and attitude, from a spatially and temporally limited event to something more expansive, and from the individual through the interpersonal to the structural. (shrink)

Contemporary ethical and political discourses frequently refer to the moral force of needs as justifying access to resources and rights to goods. Can needs make normative claims on anyone, and if so, how? What obligations do moral agents have to respond to the needs of other people? As finite creatures, humans inevitably experience need. Certain kinds of needs, namely fundamental needs, must be met if individuals are to avoid the harm of compromised agency. Fundamental needs involve agency-threatening events or circumstances (...) to which another must respond in order to cultivate, sustain or restore the agency of the one in need. I establish that fundamental needs have moral significance through an argument demonstrating the good of agency. I develop a robust account of agency, one that moves beyond the traditional identification of agency with rational capacities, to incorporate both emotional and relational abilities. Following the Kantian duty of beneficence, I then argue that our mutual and inevitable interdependence gives rise to a duty to care for the fundamental needs of others. Next, drawing upon care ethics, I suggest that moral agents are obligated not only to meet fundamental needs present in others, but also to do so in a manner indebted to forms of dignifying care. It is not enough that we meet the needs of others. How we do so carries with it the conferral or denial of dignity and inclusion in a moral community. Finally, I demonstrate the applied ethical import of the foregoing theoretical account by discussing practices of caring for the fundamental needs of elderly individuals, who are often relegated to the margins of agency. Specifically, I consider two cases: recommended rationing of healthcare resources for the elderly and filial obligation. (shrink)

My aim in this paper is to move toward a relational moral theory of harm through examination of a common yet underexplored form of child maltreatment: childhood psychological abuse. I draw on relational theory to consider agential, intrapersonal, and interpersonal ways in which relational harms develop and evolve both in intimate relationships and in conditions of oppression. I set forth three distinctive yet interconnected forms of relational harm that childhood psychological abuse causes: harm to the relational agency of individuals, harm (...) to the relationships individuals hold with themselves, especially with regard to how they respect, know, and trust themselves, and harm to interpersonal relationships of both a direct and indirect nature in present and future timeframes. I close by noting that while relationships can be the site of human brutality that destroys the relational self, paradoxically and promisingly, they also can be a primary means of the relational reconstitution of the self. Ultimately, relational analyses of the harms of childhood psychological abuse reveal several key elements of a relational theory of harm and demonstrate the significance of relational harms for moral philosophy. (shrink)

Do adult children have a particular duty, or set of duties, to their aging parents? What might the normative source and content of filial obligation be? This chapter examines Kant’s duty of beneficence in The Doctrine of Virtue and the Groundwork, suggesting that at its core, performance of filial duty occurs in response to the needs of aging parents. The duty of beneficence accounts for inevitable vulnerabilities that befall human rational beings and reveals moral agents as situated in communities of (...) dependence and mutual aid. Other accounts of filial obligation, such as those based on a notion of gratitude, virtue, or friendship, generate various difficulties and fail to adequately address and emphasize four morally significant features of the adult child/ aging parent relationship. First, the relationship between adult children and their aging parents is one of dependency created by the increasing frailty and need of those parents. Second, the obligations that adult children have to aging parents take place in the context of a relationship not voluntarily assumed, but not coerced. Third, given a cultural tendency toward paternalistic care of elderly individuals, the content of filial obligation should safeguard against such treatment. Fourth, because dependency relations between adult children and aging parents can involve an immense degree of sacrifice on the part of the caretaker, an acknowledgment of duties should be accompanied by a concurrent acknowledgment of the necessary limitation of duties. Addressing these four issues is essential in offering a coherent account of the normative source, content, nature, and scope of adult children’s duty to care for their aging parents. This essay demonstrates that the Kantian duty of beneficence, when functioning as the philosophical foundation of filial obligation, allows for ample light to be shed upon and for proper analysis to take place of these four issues. (shrink)

A shocking number of people worldwide currently suffer from malnutrition, disease, violence, and poverty. Their difficult lives evidence the intractability and pervasiveness of global need. In this paper I draw on recent developments in metaethical and normative theory to reframe one aspect of the conversation regarding whether moral agents are required to respond to the needs of distant strangers. In contrast with recent treatments of the issue of global poverty, as found in the work of Peter Singer (1972 and 2002), (...) who employs a broadly consequentialist framework focusing on suffering, and Thomas Pogge (2002), who inventively reframes the issue in terms of a negative duty not to harm, I explore this issue through an alternative approach: a social view of deontic moral reasons that features the idea of relational normativity. I address whether moral agents must respond to needy others by considering how the needs of distant strangers make implicit claims on those able to help them. Ultimately, I demonstrate why indifference in the face of global need is morally unacceptable, hence supporting the idea of an obligation that requires response to others’ basic needs. (shrink)

In this article I engage Susan Brison’s “What’s Consent Got to Do with It?” by offering multiple contributions regarding the limitations of the language and culture of consent. I begin by briefly appreciating what consent reveals to us morally about the harms of nonconsensual sex. I then offer five points regarding the language and culture of consent: (1) Conceptualizing rape as nonconsensual sex hides from view the moral harm of having one’s will subjugated by another. (2) The framework of consent (...) renders women’s desires insignificant and invisible. (3) Epistemic gaslighting represents one major and underappreciated form of epistemic injustice that consent-based views of rape propagate. (4) Consent-centered accounts of sexual violence impede our ability to imagine better sexual futures. And (5) consent not only functions to normalize gender-based violence but also to normalize other forms of violence, such as those that erupt in light of race, ability, nationality, weight, and age. (shrink)

Rather than focusing on political and legal debates surrounding attempts to determine if and when genocidal rape has taken place in a particular setting, this essay turns instead to a crucial, yet neglected area of inquiry: the moral significance of genocidal rape, and more specifically, the nature of the harms that constitute the culpable wrongdoing that genocidal rape represents. In contrast to standard philosophical accounts, which tend to employ an individualistic framework, this essay offers a situated understanding of harm that (...) features the importance of interdependence and relationality and that conceptualizes harms as embodied and contextual. The paper ultimately reveals what is distinctive about this particular crime of sexual violence by exploring the logic of genocidal rape: genocidal rape involves the harm of forced self-betrayal unleashed relationally, causing victims as representatives of their group to participate inadvertently in the destruction of that group. (shrink)

I reconsider the concept of dignity in several ways in this article. My primary aim is to move dignity in a more relational direction, drawing on care ethics to do so. After analyzing the power and perils of dignity and tracing its rhetorical, academic, and historical influence, I discuss three interventions that care ethics can make into the dignity discourse. The first intervention involves an understanding of the ways in which care can be dignifying. The second intervention examines whether the (...) capacity to care should be considered a distinguishing moral power – as rationality often is – in light of which humans have dignity. In the third intervention, I cast dignity as a fundamentally relational concept and argue that relationality is constitutive not only of dignity but also of the wider enterprise of normativity. I understand relationality as the condition of connection in which all human beings stand with some other human beings. A thought experiment involving the last person on earth helps to reframe the normative significance of human relatedness. Dignity emerges as fundamentally grounded in relationality. (shrink)

In this essay, I develop the duty to care. I argue that certain needs do require a moral response. Under the duty to care, moral individuals must act so as to bolster and safeguard the agency of those in need. Substantively, the duty to care features five qualities. It endorses a wide variety of forms of care. It does not demand that caretakers feel certain emotions for their charges. It places limits on the extent of self-sacrifice involved in meeting others’’ (...) needs. It is action oriented. Finally, it is nonpaternalistic. I take a unique approach to develop the duty to care, bringing Kantian ethics and feminist care ethics into conversation with one another in order to highlight the exciting contributions that both have to offer this account. I propose that building on the Kantian duty of beneficence, one can articulate a duty that explains why we are obligated to respond to certain needs found in others. Although the Kantian duty of beneficence provides some resources to use in developing this explanation, I also employ a care ethics perspective to offer an important angle of critique through which one can see both moments when Kant’s account fails (which I consider in a series of four objections) and why care ethics must be incorporated into any worthwhile discussion of meeting needs. Thus the duty to care, while drawing upon the duty of beneficence for its foundation, moves beyond it. Demonstrated through the duty to care’s responsiveness to perceptive objections that care ethicists might raise, the duty to care emerges as a distinctive duty in its own right, one sensitive to the moral concerns of agency, need, and care. (shrink)

This essay demonstrates that Beauvoir's La Vieillesse is a phenomenological study of old age indebted to Husserl's phenomenology of the body. Beauvoir's depiction of the doubling in the lived experience of the elderly--a division between outsiders' awareness of the elderly's decline and the elderly's own inner understanding of old age--serves as a specific illustration of Beauvoir's particular method of description and analysis.

It is fairly easy to charge intergenerational justice accounts that recommend a distribution of healthcare resources favoring the young as being ageist. Clearly, such policies strongly privilege the interests of one age group over those of another. In a time of tight resources, the elderly are to get the short end of the stick, though for reasons that some theorists believe are ethically justifiable. What is not as immediately clear, however, is the sexist nature of rationing healthcare resources for the (...) elderly. In this essay, I contend that perspectives capitalizing on justice, fairness, or equity between age groups do not readily reveal, and perhaps even obstruct, a clear view of such sexist dimensions. (shrink)

Interventional cardiologists are commonly faced with patients who prefer percutaneous coronary intervention (PCI) rather than coronary artery bypass surgery (CABG). Many prefer PCI even when CABG is recommended. Doctors may wonder whether (as the cardiac surgeons suspect) they consciously or unconsciously influence patients to choose PCI. We consider reasons why patient preferences in this context are not irrational.

Contemporary philosophical discourse on global responsibility has sustained a nearly unwavering focus on justice. In response, I investigate an underrepresented element in global justice discussions: insights from feminist philosophy, and more specifically, from the ethics of care. I assess current theories of cosmopolitanism, criticizing the shortcomings of cosmopolitan justice from the perspective of cosmopolitan care. Through the concepts of dependence, vulnerability, and need, I develop a feminist global obligation--the global duty to care--and explore the distinctive vision it offers as the (...) ground and content of a feminist theory of global responsibility. (shrink)

An overview of relational approaches to ethics, which contrast with individualist and holist ones, particularly as they feature in the Confucian, African, and feminist/care traditions.

As the usual regulatory framework did not fit well during the last Ebola outbreak, innovative thinking still needed. In the absence of an outbreak, randomised controlled trials of clinical efficacy in humans cannot be done, while during an outbreak such trials will continue to face significant practical, philosophical, and ethical challenges. This article argues that researchers should also test the safety and effectiveness of novel vaccines in wild apes by employing a pluralistic approach to evidence. There are three reasons to (...) test vaccines in wild populations of apes: i) protect apes; ii) reduce Ebola transmission from wild animals to humans; and iii) accelerate vaccine development and licensing for humans. Data obtained from studies of vaccines among wild apes and chimpanzees may even be considered sufficient for licensing new vaccines for humans. This strategy will serve to benefit both wild apes and humans. (shrink)

The theory of boundary organizations was developed to address an important group of institutions in American society neglected by scholarship in science studies and political science. The long-term stability of scientific and political institutions in the United States has enabled a new class of institutions to grow and thrive as mediators between the two. As originally developed, this structural feature of these new institutions—that is, their location on the boundary between science and politics—dominated theoretical frame-works for explaining their behavior. Applying (...) the theory of boundary organizations to international society requires a refocusing of some of the theory’s central features, however. In this article, I introduce a new framework—hybrid management—to explain the activities of boundary organizations in the more complex, contingent, and contested settings of global politics. I develop the framework of hybrid management using the specific example of the U.N. Framework Convention on Climate Change’s Subsidiary Body for Scientific and Technological Advice. (shrink)

After offering an opening consideration of the hazards of neoliberalism, I address the general shape of the crisis of care that has evolved under its auspices. Two aspects of this crisis require greater attention: the moral precarity of caregivers and the relational harms of neoliberal capitalism. Thus, I first consider the moral precarity that caregivers experience by drawing on a concept that originates in scholarly work on the experiences of healthcare workers and combat veterans, namely, moral injury. Through this concept, (...) we can see how caregivers in late-stage capitalism face a seemingly unavoidable violation of their own significant moral beliefs. Second, I examine how the crisis of care results not only in individual harms of moral injury but also in harms to relationships themselves, as I continue to track the impact of moral injury on our intrapersonal and interpersonal lives. Ultimately, I argue that an important facet of the crisis of care is how it operates as a crisis of relationality in which our intrapersonal and interpersonal connections are placed under practical and moral strain. In taking a broader view, we can see how the fraying of particular intrapersonal and interpersonal connections can accumulate, resulting in the unraveling of wider webs of interdependency, just when we need them most. Throughout the paper, I zero in on the moral implications of the crisis of care driven by neoliberalism, featuring the damages that caregivers and their relationships sustain when situated in morally precarious ways. In doing so, I drive home the point that the crisis of care under neoliberalism is as much a moral and relational crisis as it is a political and economic one. (shrink)

While the subject of framing has achieved considerable recognition recently among social scientists and policy analysts, less attention has been given to how societies arrive at stable, collective frames of meaning for environmental values and policy. This paper proposes four models of societal processes by which framing occurs: narration, modelling, canonisation and normalisation. These four models are developed, compared, and explored in detail through a case study of the framing of the impacts of climate change on human societies in US (...) science policy from the 1960s through the 1990s. I conclude by offering a number of potentially fruitful avenues for further research into the dynamics of framing. (shrink)

This volume examines some of the most contentious social justice issues present in the corpus of Augustine's writings. Whether one is concerned with human trafficking and the contemporary slave trade, the global economy, or endless wars, these essays further the conversation on social justice as informed by the writings of Augustine of Hippo.

This chapter begins by discussing what feminist ethics is and does through examination of a specific example of the spheres into which our lives are separated: the public and the private. After demonstrating how feminist ethicists critique, complicate, and expand the content and experiences of such categories, I characterize the overarching aims of feminist ethics as (1) critical and (2) creative. I then turn to major themes in feminist ethics, exploring four of them in depth: oppression, vulnerability and dependency, relationality, (...) and the nonideal. Having provided an overview of the ethical themes that matter to feminists, I also depict three different varieties of feminist ethics—liberal, care, and transnational—before concluding. (shrink)

There are many ways to understand the meanings of the #MeToo movement. Analyses of its significance have proliferated in popular media; some academic analyses have also recently appeared. Commentary on the philosophical and epistemic significance of the #MeToo movement has been less plentiful. The specific moment of the #MeToo movement in which Dr. Christine Blasey Ford’s testimony garnered a widespread social media response from sexual violence survivors highlighted the power of a particular form of epistemic response, what I call ‘epistemic (...) refusal.’ In breaking our silence, those of us who are sexual violence survivors have used this strategy to refuse the dominant epistemic structures that have kept us tightly in check. Mass informal disclosure of survivor status represented in conjunction with hashtags such as #MeToo, #WhyIDidntReport, and #BelieveHer creates space for epistemic, ethical, and political community between survivors of sexual violence by denying hegemonic epistemic discourses of contemporary rape culture. Regarding Dr. Blasey Ford’s testimony and the social media response it garnered, analysis of three main elements proves particularly illuminating: the nature of mass informal disclosure of sexual violence, what the hashtag #WhyIDidntReport reveals about refusing silence, and what the hashtags #BelieveHer and #BelieveSurvivors can show us about what it takes to begin to overcome epistemic gaslighting. (shrink)

The European Legacy, Volume 17, Issue 3, Page 405, June 2012.

The concept of social license to operate was forged in the crucible between globalization—which has radically decentralized the ability of organizations to operate wherever they choose—and the rise of oppositional social movements, newly empowered to confront global actors infringing on their communities. This article reviews the central dilemma posed by social license to operate: whether it is business practice, sociological reality, or emerging form of governance, drawing on the insights and findings of the articles in this special issue. It then (...) suggests three lines of future research for the critical social sciences. The article concludes that the principle shortcomings of the concept of social license to operate is the inevitability of the boundaries it draws between organizations and the communities they inhabit and the failure of the concept to acknowledge that transformation, not just operation, is almost always at stake in these encounters. (shrink)

In the original publication, funding information was missing: Andy Clark was supported by ERC Advanced Grant 692739.

The Practices of Global Ethics takes a unique look at global ethics: not as mere written statements but as a set of practices undertaken by thousands of organisations and hundreds of thousands of people to shape the normative trajectory of human affairs. It looks at statements of global ethical principles including The Universal Declaration of Human Rights, the Earth Charter and the Rio Documents and positions them as the outcomes and expression of ongoing practices. Offering innovative, critical and thoughtful analyses (...) of ethical practices since World War II, the book examines efforts to promote human rights; foster ecological responsibility; end genocide; reduce global poverty; encourage responsible and sustainable international business practices; cultivate understanding and collaboration amongst the world's religions among other worldwide endeavours. (shrink)

Importance Informed consent is essential to ethical, rigorous research and is important to recruitment and retention in cancer trials.Objective To examine cancer clinical trial (CCT) participants’ perceptions of informed consent processes and variations in perceptions by cancer type.Design and Setting and Participants Cross-sectional survey from mixed-methods study at National Cancer Institute–designated Northeast comprehensive cancer center. Open-ended and forced-choice items addressed: (1) enrollment and informed consent experiences and (2) decision-making processes, including risk-benefit assessment. Eligibility: CCT participant with gastro-intestinal or genitourinary, hematologic-lymphatic (...) malignancies, lung cancer, and breast or gynecological cancer (N = 334).Main Outcome Measures Percentages satisfied with consent process and information provided; and assessing participation’s perceptions of risks/benefits. Multivariable logistic or ordinal regression examined differences by cancer type.Results Most patient-participants felt well informed by the consent process (more than 90% overall and by cancer type) and. most (87.4%) reported that the consent form provided all the information they wanted, although nearly half (44.8%) reported that they read the form somewhat carefully or less. More than half (57.9%) said that talking to research staff (i.e., the consent process) had a greater impact on participation decisions than reading the consent form (2.1%). A third (31.1%) were very sure of joining in research studies before the informed consent process (almost half of lung cancer patients did—47.1%). Most patients personally assessed the risks and benefits before consenting. However, trust in physicians played an important role in the decision to enroll in CCT.Conclusions and Relevance Cancer patients rely less on written features of the informed consent process than on information obtained from the research staff and their own physicians. Research should focus on information and communication strategies that support informed consent from referring physicians, researchers, and others to improve patient risk-benefit assessment and decision-making. (shrink)

Being and Nothingness: An Essay in Phenomenological Ontology, by SartreJean-Paul, translated by Sarah Richmond. Abingdon: Routledge, 2018. Pp. xlvii + 848.