The World Medical Association’s revised Declaration of Helsinki endorses the view that all trial participants in every country are entitled to the worldwide best standard of care. In this paper the authors show that this requirement has been rejected by every national and international committee that has examined this issue. They argue that the consensus view now holds that it is ethically permissible, in some circumstances, to provide research participants less than the worldwide best care. Finally, the authors show that (...) there is also consensus regarding the broad conditions under which this is acceptable. (shrink)

The current study uses a two-wave longitudinal survey to explores the influence mechanism of the family environment on adolescents’ academic achievement. The family environment is measured by parents and children’s reports, including family atmosphere, parent–child interaction, and family rules, to reveal the mediating effect of adolescents’ positive or negative peers between the family environment and academic achievement, and whether the gap between self- and parental educational expectation plays a moderating effect. This study uses the data of the China Education Panel (...) Study ; the survey samples include 9,449 eighth-grade students, establishing a multilevel moderated mediating effect model. The results showed the family environment and peer interaction quality can positively predict adolescents’ academic achievement. Using the KHB test, peer interaction quality plays a partial mediating role in the process of family environment positively affecting academic achievement, and the mediating ratio is 27.5%. The educational expectation gap moderates the effect of the family environment on academic achievement and also on peer interaction quality. Therefore, from the perspective of environment and important others, to correctly grasp the academic achievement of junior high school students in the process of socialization, it is necessary to recognize that the family environment, peer interaction quality, and educational expectation gap play an important role. (shrink)

This book, edited by a team of leading European bioethicists, is in all respects an innovative publication.

Decision analysts sometimes use the results of clinical trials in order to evaluate treatment alternatives. I discuss some problems associated with this, and in particular I point out that it is not valid to use the estimates from clinical trials as the probabilities of events which are needed for decision analysis. I also attempt to show that an approach based on objective statistical theory may have advantages over commonly used methods based on decision theory. These advantages include the recognition of (...) uncertain data, the introduction of a third alternative, namely suspension of judgement, and the possibility of modifying the choice of probabilities based on a clinical trial with reference to other available knowledge. I have not, however, shown in detail how this modification is done, but I think the concept is sufficiently promising to be applied to an actual clinical decision problem. (shrink)

This paper analyses Steven Vogel's claim that his account of a post-natural environmental philosophy solves the dualism problem within the field. Through what I will call a novel critique of social constructionism, this paper examines whether Vogel's attempt succeeds or whether it reinforces the problem he wants to solve. Could the ontological foundations of social constructivism themselves be in conflict with Vogel's stated aim of overcoming the human/nature dualism? The last part of the paper focuses on the significance and role (...) of a post-natural environmental philosophy for the field of environmental philosophy in general. (shrink)

Du silex à l'internet l'Homme dans toute sa complexité.

With a specific example from Norway and inspiration from Sara Ahmed’s The Promise of Happiness, this article demonstrates how today’s educational rhetoric lacks the language and will to recognise a key pedagogical dimension in education: what happens when the normative ambitions of education and students meet. At best, teaching students life skills to mitigate their mental health issues is naive. Inspired by Ahmed, such an initiative might actually work against its purpose. At a time when educational outcomes are emphasised in (...) local and international political contexts, I argue that the task of philosophy of education should be 1) to reclaim the significance of the pedagogical dimension in education and 2) to philosophise on what negative emotions such as unhappiness require of education. (shrink)

This article explores possibilities for establishing dialogues between feminism and constructivism in the field of technology studies. Based on an overview of Norwegian feminist debates about technology, it indicates several points where feminism and constructivism meet and can mutually benefit from each other. The article critically examines feminist studies questioning the problems of technological determinism, social deternacnism, and essentialism. It criticizes constructivism for a lack of concern for gender and politics but holds that it is still possible to use theoretical (...) tools from constructivism in feminist analyses. Fruitful dialogues require the application of the principle of symmetry to the dcalogues and sharing some common ground and mutual recognation of each other's strengths and weaknesses. (shrink)

All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities. We review explicit priority setting efforts in Norway, Sweden, Israel, the Netherlands, Denmark, New Zealand, the United Kingdom and the (...) state of Oregon in the US. The approaches used can be divided into those centered on outlining principles versus those that define practices. In order to establish the main lessons from their experiences we consider the process each country used, criteria to judge the success of these efforts, which approaches seem to have met these criteria, and using their successes and failures as a guide, how to proceed in setting priorities. We demonstrate that there is little evidence that establishment of a values framework for priority setting has had any effect on health policy, nor is there evidence that priority setting exercises have led to the envisaged ideal of an open and participatory public involvement in decision making. (shrink)

ArgumentDuring the 1950s it became apparent that antibiotics could not conquer all microbes, and a series of tests were developed to assess the susceptibility of microbes to antibiotics. This article explores the development and standardization of one such testing procedure which became dominant in the Nordic region, and how the project eventually failed in the late 1970s. The standardization procedures amounted to a comprehensive scheme, standardizing not only the materials used, but also the methods and the interpretation of the results. (...) Focusing on Sweden and Norway in particular, the article shows how this comprehensive standardization procedure accounted for several co-dependent factors and demanded collaboration within and across laboratories. Whereas literature on standardization has focused mostly on how facts and artefacts move within and across laboratories, I argue for the importance of also attending to regions and territories. More particularly, while arguing that the practices, ideals, and politics related to what have been called the “Nordic welfare state” were contributing to the design of the standardized procedure in the laboratory, I also argue that Scandinavia was drawn together as a unified region with and by these very same practices. (shrink)

In this issue, Alex London and Kevin Zollman provide an analysis of an influential approach to the ethics of international research, known as the “fair benefits” approach. According to them, the fair benefits approach suffers from a fatal flaw: it is either too vague to be useful, or worse, is internally inconsistent. The fair benefits approach was developed based on a presentation I gave at a workshop organized in Malawi in March 2001 by the National Institutes of Health Clinical Center’s (...) Department of Bioethics. In this presentation, I made what I still think is a valid point, which was accepted by the diverse group of participants and formed the basis of the subsequent publications: One should not .. (shrink)

In this paper, the author argues that the requirement to conduct randomised clinical trials to inform policy in cases where one wants to identify a cheaper alternative to known effective but expensive interventions raises an important ethical issue. This situation will eventually arise whenever there are resource constraints, and a policy decision has been made not to fund an intervention on cost effectiveness grounds. It has been thought that this is an issue only in extremely resource poor settings. This paper (...) gives an example from the United Kingdom illustrating that this is also a problem faced by richer countries. (shrink)

The article analyses the debate on egg donation in Norway using source material from the parliamentary debate of amendments to the Biotechnology Law. In both policy documents on bioethics and the Biotechnology Law, gender is not a spoken issue, but bringing egg and sperm directly to the fore highlights how gender is implicated in bioethics debates. Gender perceptions affect the understanding of `what egg and sperm may do' at the same time as the debate sets established perceptions of gender in (...) motion. In Norway, gender equality is a valid and important premise within the general political debate. It is, however, contested as a valid argument in the context of egg donation, which therefore becomes a field of negotiations about the limits of equal opportunities. The article analyses the egg donation debate as a process of cultural co-production and asks how the Norwegian emphasis on gender equality influences the debate on egg donation and, vice versa, how debates of assisted reproductive technology reopen debates on gender in relation to reproduction and parenthood. (shrink)

Background: Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees should evaluate the risks of comparative effectiveness research. Main text: We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when “nothing is known” about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. (...) Rather, we should focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative. We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. Conclusion: We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation. (shrink)

Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees should evaluate the risks of comparative effectiveness research. We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when “nothing is known” about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. Rather, we should (...) focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative. We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation. (shrink)

Philosophers on Education offers us the most comprehensive available history of philosopher's views and impacts on the directions of education. As Amelie Rorty explains, in describing a history of education, we are essentially describing and gaining the clearest understanding of the issues that presently concern and divide us. The essays in this stellar collection are written by some of the finest comtemporary philosophers. Those interested in history of philosophy, epistemology, moral psychology and education, and political theory will find Philosophers on (...) Education to be both an engaging and fascinating read. (shrink)

The new reproductive technologies affect several of our conceptual distinctions, and most basically the one between nature and culture. This includes the understanding of reproduction as natural, biological processes and of the body as a product of nature. Nature and culture has been a basic conceptual distinction in western culture and it is paralleled in the division between sex, understood as nature, and gender, understood as culture. The process of reproduction is central to the understanding of sexual difference, in the (...) sense that the abilities to conceive and give birth to children are generally considered to be features that distinguish woman from man. Therefore changes in this process provide us with empirical material for exploring changes in people's understanding of sex and gender. The article explores reproductive technology as a provider of new cultural models for understanding the relationship between nature and culture and thereby the distinction of sex/nature and gender/culture. (shrink)

This article explores the relations between autobiography, fiction and history in the recent texts of Hélène Cixous. It examines the uses and limits of a range of generic categorizations in accounting for these relations. We suggest that most categorizations tend to rely on an underlying oppositionary and exclusive dynamic between autobiography and fiction in which one or the other may be privileged. Our contention is that Cixous's work should rather be understood within an inclusive dynamic in which all three elements, (...) the fictional, autobiographical and the historical coexist in a complex relation which cannot be disentangled. This inclusive dynamic, we suggest, is not only central to an understanding of the texts’ generic dimensions, but also to the specifics of the pact which Cixous establishes with her readers, as well as to the ethical thinking which underlies her oeuvre. (shrink)

This article presents a case study from the history of cardiology, namely, the development towards the acceptance of the coronary theory of angina pectoris. I show that the arguments which were considered decisive against the theory were not answered at the time the theory was accepted. I also point out that the experimental and practical success of the theory cannot be used to support the initial choice because, in the subsequent development, the field researchers became preoccupied with new questions and (...) problems. In spite of this, there is a sense in which the field of angina research has progressed, but it remains a challenge to exactly characterise in what sense this is the case. (shrink)