This paper compares tracking and phenomenal intentionality theories of intentionality with respect to the issue of naturalism. Tracking theories explicitly aim to naturalize intentionality, while phenomenal intentionality theories generally do not. It might seem that considerations of naturalism count in favor of tracking theories. We survey key considerations relevant to this claim, including some motivations for and objections to the two kinds of theories. We conclude by suggesting that naturalistic considerations may in fact support phenomenal intentionality theories over tracking theories.

The predominant view is that a study using health data is observational research and should require individual consent unless it can be shown that gaining consent is impractical. But recent arguments have been made that citizens have an ethical obligation to share their health information for research purposes. In our view, this obligation is sufficient ground to expand the circumstances where secondary use research with identifiable health information is permitted without explicit subject consent. As such, for some studies the Institutional (...) Review Board/Research Ethics Committee review process should not assess the practicality of gaining consent for data use. Instead the review process should focus on assessing the public good of the research, public engagement and transparency. (shrink)

According to intentionalism, phenomenal properties are identical to, supervenient on, or determined by representational properties. Intentionalism faces a special challenge when it comes to accounting for the phenomenal character of moods. First, it seems that no intentionalist treatment of moods can capture their apparently undirected phenomenology. Second, it seems that even if we can come up with a viable intentionalist account of moods, we would not be able to motivate it in some of the same kinds of ways that intentionalism (...) about other kinds of states can be motivated. In this article, I respond to both challenges: First, I propose a novel intentionalist treatment of moods on which they represent unbound affective properties. Then, I argue that this view is indirectly supported by the same kinds of considerations that directly support intentionalism about other mental states. (shrink)

Over the past few decades, the dominant approach to explaining intentionality has been a naturalistic approach, one appealing only to non-mental ingredients condoned by the natural sciences. Karen Neander’s A Mark of the Mental (2017) is the latest installment in the naturalist project, proposing a detailed and systematic theory of intentionality that combines aspects of several naturalistic approaches, invoking causal relations, teleological functions, and relations of second-order similarity. In this paper, we consider the case of perceptual representations of colors, which (...) is a challenging case for Neander’s theory. This case will brings out a general methodological concern with Neander’s and other naturalistic theories: these theories generally rest on the assumption that the mental intentionality we are acquainted with in everyday life—the phenomenon exhibited by desires for cups of coffee, perceptual experiences of dogs playing in yards, and thoughts about the weather—is the very same kind of phenomenon that cognitive science studies under labels such as “mental representation” and, in some cases, “information processing.” This assumption is dubious, as the case of Neander’s theory illustrates. (shrink)

This volume presents the first Italian translation with commentary of the Doric Pseudo-Pythagorean texts, which are ascribed to Archytas and Brontinus and deal with metaphysical, logical, and epistemological questions. These texts probably date from the 1st century BCE and are the product of a re-emerging dogmatic interpretation of Plato's dialogues.

This paper contends that a research ethics approach to the regulation of health data research is unhelpful in the era of population‐level research and big data because it results in a primary focus on consent (meta‐, broad, dynamic and/or specific consent). Two recent guidelines – the 2016 WMA Declaration of Taipei on ethical considerations regarding health databases and biobanks and the revised CIOMS International ethical guidelines for health‐related research involving humans – both focus on the growing reliance on health data (...) for research. But as research ethics documents, they remain (to varying degrees) focused on consent and individual control of data use. Many current and future uses of health data make individual consent impractical, if not impossible. Many of the risks of secondary data use apply to communities and stakeholders rather than individual data subjects. Shifting from a research ethics perspective to a public health lens brings a different set of issues into view: how are the benefits and burdens of data use distributed, how can data research empower communities, who has legitimate decision‐making capacity? I propose that a public health ethics framework – based on public benefit, proportionality, equity, trust and accountability – provides more appropriate tools for assessing the ethical uses of health data. The main advantage of a public health approach for data research is that it is more likely to foster debate about power, justice and equity and to highlight the complexity of deciding when data use is in the public interest. (shrink)

Public-private partnerships are established to specifically harness the potential of Big Data in healthcare and can include partners working across the data chain—producing health data, analysing data, using research results or creating value from data. This domain paper will illustrate the challenges that arise when partners from the public and private sector collaborate to share, analyse and use biomedical Big Data. We discuss three specific challenges for PPPs: working within the social licence, public antipathy to the commercialisation of public sector (...) health data, and questions of ownership, both of the data and any resulting intellectual property or products. As a specific example we consider the case of the UK National Health Service providing patient data to Google’s DeepMind AI program to develop a diagnostic app for kidney disease. This article is an application of the framework presented in this issue of ABR. Please refer to that article for more information on how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end. We use four specific values to help analysis these issues: public benefit, stewardship, transparency and engagement. We demonstrate how the Deliberative Framework can support ethical governance of PPPs involving biomedical big data. (shrink)

There is an alleged tension between undue inducement and exploitation in research trials. This paper considers claims that increasing the benefits to research subjects enrolled in international, externally-sponsored clinical trials should be avoided on the grounds that it may result in the undue inducement of research subjects. This article contributes to the debate about exploitation versus undue inducement by introducing an analysis of the available empirical research into research participants' motivations and the influence of payments on research subjects' behaviour and (...) risk assessment. Admittedly, the available research in this field is limited, but the research that has been conducted suggests that financial rewards do not distort research subjects' behaviour or blind them to the risks involved with research. Therefore, I conclude that research sponsors should prioritise the prevention of exploitation in international research by providing greater benefits to research participants. (edited). (shrink)

In 2004 Emanuel et al. published an influential account of exploitation in international research, which has become known as the 'fair benefits account'. In this paper I argue that the thin definition of fairness presented by Emanuel et al, and subsequently endorsed by Gbadegesin and Wendler, does not provide a notion of fairness that is adequately robust to support a fair benefits account of exploitation. The authors present a procedural notion of fairness – the fair distribution of the benefits of (...) research is to be determined on a case-by-case basis by the parties involved in each study. The fairness of the distribution of benefits is not assessed against an independent normative standard. Emanuel et al.'s account of fairness provides a framework for objecting only to transactions that occur without the fully informed consent of the weaker party. As a result, a debate about exploitation collapses into a debate about consent. This is problematic because, as the proponents of the fair benefits framework acknowledge, neither the trial participants' consent nor the host community's consent preclude exploitation. Attempts to stipulate normative standards of fairness to protect research subjects in developing countries have been controversial and divisive, and it is therefore understandable that bioethicists would be tempted to develop accounts of exploitation that are independent of such prescriptive principles. I conclude, however, that the utility of the fair benefits model of exploitation as a policy tool will ultimately depend on whether a substantive principle of fairness can be developed to underpin it. (shrink)

Throughout March and April 2020, debate raged about how best to allocate limited intensive care unit (ICU) resources in the face of a growing COVID-19 pandemic. The debate was dominated by utility-based arguments for saving the most lives or life-years. These arguments were tempered by equity-based concerns that triage based solely on prognosis would exacerbate existing health inequities, leaving disadvantaged patients worse off. Central to this debate was the assumption that ICU admission is a valuable but scarce resource in the (...) pandemic context.In this paper, we argue that the concern about achieving equity in ICU triage is problematic for two reasons. First, ICU can be futile and prolong or exacerbate suffering rather than ameliorate it. This may be especially true in patients with COVID-19 with emerging data showing that most who receive access to a ventilator will still die. There is no value in admitting patients with poor prognostic indicators to ICU to meet an equity target when intensive critical care is contrary to their best interests. Second, the focus on ICU admission shifts focus away from important aspects of COVID-19 care where there is greater opportunity for mitigating suffering and enhancing equitable care.We propose that the focus on equity concerns during the pandemic should broaden to include providing all people who need it with access to the highest possible standard of end-of-life care. This requires attention to culturally safe care in the following interlinked areas: palliative care, communication and decision support and advanced care planning. (shrink)

Making data broadly accessible is essential to creating a medical information commons. Transparency about data-sharing practices can cultivate trust among prospective and existing MIC participants. We present an analysis of 34 initiatives sharing DNA-derived data based on public information. We describe data-sharing practices captured, including practices related to consent, privacy and security, data access, oversight, and participant engagement. Our results reveal that data-sharing initiatives have some distance to go in achieving transparency.

Advances in technologies and biomedical informatics have expanded capacity to generate and share biomedical data. With a lens on genomic data, we present a typology characterizing the data-sharing landscape in biomedical research to advance understanding of the key stakeholders and existing data-sharing practices. The typology highlights the diversity of data-sharing efforts and facilitators and reveals how novel data-sharing efforts are challenging existing norms regarding the role of individuals whom the data describe.

Notions of care for humans and more-than-humans appear at the margins of the sustainability transformations debate. This paper explores the merits of an ethics of care approach to sustainability tr...

Concerns about exploitation pervade the literature on commercial cross-border reproductive care, particularly egg selling and surrogacy. But what constitutes exploitation, and what moral weight does it have? I consider the relationship between vulnerability, limited choice, consent, and mutually advantageous exploitation. To elucidate the difference between limited choice and consent, I draw on an account of relational autonomy. In the absence of a normative principle of fair distribution, it is unclear whether the providers of reproductive goods and services are treated fairly (...) in such contracts, and therefore whether they have been exploited. I finish with some pragmatic recommendations for minimizing risks and empowering egg sellers and surrogates. (shrink)

There is increasing global pressure to ensure that pregnant women are responsibly and safely included in clinical research in order to improve the evidence base that underpins healthcare delivery during pregnancy. One supposed barrier to inclusion is the assumption that pregnant women will be reluctant to participate in research. There is however very little empirical research investigating the views of pregnant women. Their perspective on the benefits, burdens and risks of research is a crucial component to ensuring effective recruitment. The (...) Research In Pregnancy Ethics study set out to ascertain the views of pregnant women about research participation using an inductive thematic analysis. We conducted semi-structured interviews with 20 women who had participated in a double-blind randomised placebo controlled trial in Wellington while pregnant. Our results show that at least some pregnant women recognise the value and importance of research during pregnancy. The women we interviewed were deeply invested in the research process and outcomes. Key motivations for participating were altruism, playing a valuable civic role and the importance of research. The main perceived burdens related to inconvenience and time commitment. For some women, possible randomization to the placebo arm was regarded as a burden or disadvantage. (shrink)

In this commentary, we take up Yearby’s call for racism-sensitive research and apply this to the discourse regarding race and diversity in COVID vaccine research. We consider whether efforts...

As the demand for human eggs for stem cell research increases, debate about appropriate standards for recruitment and compensation of women intensifies. In the majority of cases, the source of eggs for research is women undergoing fertility treatment requiring ovarian stimulation and egg retrieval. The principle of "just participant selection" requires that research subjects be selected from the population that stands to benefit from the research. Based on this principle, infertile women should be actively recruited to donate eggs for fertility-related (...) research only. It is unethical to exclusively or predominantly recruit infertile women to donate eggs for stem cell research that concerns general medical conditions. It is preferable to recruit women from the general population to donate eggs for such research, and these women should be viewed as healthy volunteers. To avoid exploitation, these donors should receive compensation for both the direct and indirect costs associated with their donation. (shrink)

This article examines Leon Kass's contention that a choice for physician-assisted suicide is “undignified.” Although Kass is Jewish rather than Christian, he argues for positions that most Christians share, and he argues for these positions without presupposing the truth of specific religious claims. I argue that although Kass has some important intuitions, he too readily assumes that these intuitions will be shared by his audience, and that this assumption diminishes the force of his argument. An examination of the limitations of (...) Kass's argument is helpful insofar as it illustrates the real challenge faced by religious believers who wish to defend their beliefs in the “public forum.” For it illustrates that what needs to be made “accessible” is the Judeo-Christian understanding of man and his place in the world. While I do not wish to claim that this task is impossible, I do think that it is far more difficult than most realize. Like all important tasks, however, unless we wrestle with the difficulties it raises, our arguments will strike many as unconvincing. (shrink)

In The Metaphysics of Sensory Experience, David Papineau offers some metaphysical reasons for rejecting representationalism. This paper overviews these reasons, arguing that while some of his arguments against some versions of representationalism succeed, there are versions of phenomenal intentionalism that escape his criticisms. Still, once we consider some of the contents of perceptual experiences, such as their perspectival contents, it is clear that perceptual experience does not present us with the world as we take it to be. This leads to (...) a rather attenuated form of representationalism, perhaps one that even Papineau could come close to agreeing with. (shrink)

This introduction describes the origins and rationale behind the papers that comprise this special issue of Studies in Christian Ethics. These papers represent several recent contributions to scholarship on the theology of character.

Earp et al. (2024) sketch a thought-provoking potential use of generative AI to enhance supported decision-making for adults who have lost capacity/competence to make their own medical decisions. T...

Lawyers in many jurisdictions are ageing, and yet there is little information concerning the age profile of the legal profession. This paper presents the first consideration of the age profile of lawyers outside of the US, showing that Australian lawyers are ageing and delaying retirement. These findings have serious implications. Problems associated with a growing proportion of older lawyers include an increasing risk of lawyers suffering from age-related cognitive and physical impairment, and the related rise of complaints and malpractice claims (...) against older lawyers. It is also clear that the Australian legal profession is unprepared to address these problems. The legal profession has ignored important gender-specific implications of ageing, such as female lawyers experiencing menopause and the lower savings of female lawyers moving into retirement. Regulatory regimes have not considered the impact of the profession's ageing profile, and there is no mandatory reporting of lawyers suffering from age-related impairment or provisions should a lawyer die. The profession also has not provided strategies to positively transition lawyers into retirement, and there is a lack of flexible working arrangements and succession planning, especially in firms located outside urban centres. (shrink)

En este artículo se analiza la importancia del trabajo textil realizado por las mujeres en la Grecia antigua. Se presentarán algunos pasajes homéricos para guiar el reconocimiento del concepto de unas manos pensantes en el que una actividad teórico-práctica es capaz de transmitir poderosos mensajes no hablados desde la vulnerabilidad de lo femenino que, al contrario de lo que tradicionalmente podría pensarse, tienen una dimensión política. Para ello se procederá en tres apartados. En el primero, se indicará el modo en (...) que el trabajo manual puede ser comprendido como ejercicio intelectual en el mundo griego; en el segundo, se revisará cómo el tejido se entiende desde lo humano y la manera en la que Atenea es símbolo de la textilidad que reviste a lo humano, y en el tercero se afirma que la práctica del tejido es una forma idónea de reivindicación de la figura femenina. Finalmente, la conclusión muestra cómo esta práctica sigue vigente hoy. (shrink)

This essay seeks to establish that Catholic community pharmacists should refuse to verify, dispense, and counsel on hormonal medications used for contraception on the grounds of professional and personal beliefs as these services constitute immoral immediate material cooperation. In this controversial area of patient care, pharmacists are more frequently being called upon to facilitate medication use for contraceptive purposes. Contraceptive acts are believed by some healthcare providers to be morally harmful to a patient’s well-being. Pharmacists who hold beliefs that contraception (...) does not promote positive patient outcomes are professionally bound to refuse immediate cooperation through providing pharmaceutical services related to contraception. (shrink)

This target article considers the ethical implications of providing prenatal diagnosis and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe abortion for (...) these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms. (shrink)

(2010). Response to Open Peer Commentaries on “How to Do Research Fairly in an Unjust World”. The American Journal of Bioethics: Vol. 10, No. 6, pp. W4-W6.

Somatic or inherited mutations in the adenomatous polyposis coli (APC) gene are a frequent cause of colorectal cancer in humans. APC protein has an important tumor suppression function to reduce cellular levels of the signaling protein β‐catenin and, thereby, inhibit β‐catenin and T‐cell‐factor‐mediated gene expression. In addition, APC protein binds to microtubules in vertebrate cells and localizes to actin‐rich adherens junctions in epithelial cells of the fruit fly Drosophila (Fig. 1). Very little is known, however, about the function of these (...) cytoskeletal associations. Recently, Hamada and Bienz have described a potential role for Drosophila E‐APC in cellular adhesion,1 which offers new clues to APC function in embryonic development, and potentially colorectal adenoma formation and tumor progression in humans. BioEssays 24:771–774, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

Community-level legal and policy innovations or “experiments” can be important levers to improve health. States and localities are empowered through the 10th Amendment of the United States Constitution to use their police powers to protect the health and welfare of the public. Many legal and policy tools are available, including: the power to tax and spend; regulation; mandated education or disclosure of information, modifying the environment — whether built or natural ; and indirect regulation. These legal and policy interventions can (...) be targeted to specific needs at the community level and are often relatively low-cost, but high impact interventions. As every community is different, effective laws and policies will vary. This freedom allows states and localities to, as Justice Louis Brandeis argued, truly serve as “laboratories of democracy.”. (shrink)

The Centers for Disease Control and Prevention’s goal is to develop a surveillance system of public health laws that would both support research and analysis among policymakers and legislators, and support the scientific basis for public health law. This session was convened, in part, to discuss the value of creating an electronic system to track public health legal information. Public health surveillance is the “ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public (...) health action to reduce morbidity and mortality and to improve health. Data disseminated by a public health surveillance system can be used for immediate public health action, program planning and evaluation, and formulating research hypotheses.” There is currently no system available that meets the goals of this definition of “surveillance” for public health laws. (shrink)

Starting from Hans Jonas’ works, this essay researches the bases of human responsibility and its reasoning is made up of four points. 1. He was aware of how his experience had influenced his thought and he questioned what means reflecting starting from extreme situations: «The apocalyptic state of things, the threatening collapse of a world, the climatic crisis of civilization, the proximity of death, the stark nakedness to which all the issues of life were stripped, all these were ground enough (...) to take a new look at the very foundations of our being and to review the principles by which we guide our thinking on them». 2. Faced with these situations he rediscovered the richness of the Ancients’ thought. For example, the Stoics inherited and transformed the illuminating aspects of the theory that conceived of the ‘being’ as contemplation of the whole, which had permeated Greek natural philosophy and scientific speculation. They took it on as the capacity to identify one’s own most internal principle with the principle of the whole, in a more religious sense. The discovery in the whole of what is felt to be the highest and noblest in human beings – like reason, order, and form - makes our orientation towards a super-regulating end a liberating wisdom. 3. Jonas considers that starting from XVII century the two aspects, here distinct as external and internal, remain at the core of the issue so far as the problem of freedom is concerned. Moreover, theoretical efforts now move in the direction of rendering, of discovering a conception of freedom which is logically compatible with causal determinism, while in the history of philosophy, the problem of freedom was not born in the sphere of logic. So it is necessary to rethink Modernity and how it is possible to found human freedom and responsibility nowadays. (shrink)

The advent of sales over the Internet has led to interesting developments in sales tax policy as states attempt to monitor, control, and collect revenue from illusive Internet tobacco vendors. Tobacco sales have been successfully monitored and regulated, to some extent, in convenience stores, grocery stores, and smoke shops, and in most cases sales taxes are collected. The Internet, however, is extremely difficult to regulate. States could use their regulatory powers to ban the sale of products such as tobacco and (...) alcohol over the Internet, but enforcement would be nearly impossible.The issue of enforcement of Internet sales is extremely difficult. Keeping the products out of the wrong hands, under aged children for example, is difficult. Also, it is difficult in terms of tax policy. (shrink)

Thank you so much for the invitation to be here with you. It is always a pleasure to be with people who understand, believe in, and know the importance of public health. Those of us who work in the legislative arena know how infrequent it is to have dialogue and conversation with people who really have a good, tangible, hands-on working knowledge of health care, and particularly of public health.The notion of public health is an interesting one. It will range—if (...) you talk to people in the legislature or out of the legislature—from just complete ignorance to total unawareness of what we mean by the words “public health.” When you talk to individuals like us in this room, we find a mixture of definitions, a mixture of understandings, and a mixture of appreciation as to what public health really is. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Medical MishapAngela MooreIn western society we live in an environment where image is valued and sought after. Acquiring Spastic Cerebral Palsy through no fault of one’s own directly challenges and contradicts this. We tend to base our judgments of other people on the way they “look” before we even speak to them or get to know them. For many centuries western society has valued and aspired to having (...) the “perfect” image and body shape. The children’s nursery rhyme “Humpty Dumpty” illustrates that as far back as the 1600’s when something was broken people felt there was a “need” to correct the damage and fix the problem. Maybe “Humpty Dumpty” was an obese person who fell off the wall, maybe he was an intoxicated soldier, maybe it was a name of a large cannon that was sitting on the wall of Colchester (Wright, 2008) which was set up to protect the city. No matter what the situation, the reader is left with a feeling that whenever there was something wrong with Humpty Dumpty, there was a need to correct the error and fix what was broken. Because he was “different” or “not normal” in one way or another he was not valued for his role by members of his local community. The reader is left to form his or her own opinion. Society continues to hold those views to this very day.I am a secondary emergency teacher, have completed a Masters in Special Needs along with having a permanent acquired physical disability, Spastic Cerebral Palsy, affecting my four limbs. This was caused after an initial medical examination was “botched” by an unsupervised intern—the specialist left the theatre during the procedure when I was 14 weeks of age, over forty years ago. Further medical testing was arranged because there was a belief that I may have had hydrocephalus—swelling and excess fluid buildup around my brain causing it to be unnecessarily enlarge for my age. In my family’s case this seems to be an hereditary trait that has passed from my father who has a large head. It’s interesting to note that an obstetrician made a comment to my sister on the size of her toddler’s head. [End Page 213]Since 1970 I have had a range of both positive and negative medical experiences. As a child who wasn’t able to comprehend what and why things were happening I was very frightened and often very upset. As an adult I am able to understand what and why something is going on and I ask questions when needed.“Normal” has always been completing the same things but in a different way to other people while intending to reach the same outcome of “success.” There are many ways to skin a cat and “normal” is a term that has a very broad definition which is dependent upon the individual and the situation at hand. What is “normal” for me will be “different” for someone else. What is “normal” for another person will be “different” for me. It’s the differences between individuals that we come to value later on in life. That I cope in a different manner from others has clearly been aided by being able to make use of information technology—laptop, mobile phones, printers, etc.—along with a feeling that the acquired physical disability that I have is a small part of the overall person that I am. Before I became a person with an acquired disability I was a normal, happy, healthy baby and even now although I will always have a disability I have excellent health and choose not to be defined by having acquired a disability. Unlike some other people I consider myself to be a person who “acquired” a disability instead of being a “disabled” person. Having an acquired physical disability is a small part of the person I am. The manner in which I acquired a severe physical disability is what I have come to value along with the fact that I have done well in many areas of life while having such a severe condition.Unlike people who had disabilities in the 19... (shrink)