Quality and service improvement (QSI) research employs a broad range of methods to enhance the efficiency of healthcare delivery. QSI research differs from traditional healthcare research and poses unique ethical questions. Since QSI research aims to generate knowledge to enhance quality improvement efforts, should it be considered research for regulatory purposes? Is review by a research ethics committee required? Should healthcare providers be considered research participants? If participation in QSI research entails no more than minimal risk, is consent required? The (...) lack of consensus on answers to these questions highlights the need for ethical guidance. Three distinct approaches to classifying QSI research in accordance with existing ethical principles and regulations can be found in the literature. In the first approach, QSI research is viewed as distinct from other types of healthcare research and does not require regulation. In the second approach, QSI research falls within regulatory guidelines but is exempt from research ethics committee review. In the third approach, QSI research is deemed to be part of the learning healthcare system and, as such, is subject to a different set of ethical principles entirely. In this paper, we critically assess each of these views. While none of these approaches is entirely satisfactory, we argue that use of the ethical principles governing research provides the best means of addressing the numerous questions posed by QSI research. (shrink)

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

Religion and Community: Adam Smith on the Virtues of Liberty CHARLES L. GRISWOLD, JR. The good temper and moderation of con- tending factions seems to be the most es- gential circumstance in the publick morals of a free people. Adam Smith' THE ARCHITECTS of what one might call "classical" or "Enlightenment" liberal- ism saw themselves as committed to refuting the claims to political sovereignty by organized religion. ~ The arguments against the legitimacy of a state- supported religion, and, in (...) the extreme case, of a religious monopoly, are so integral a part of the Enlightenment's effort to put politics on a stable and just foundation as to constitute one of the controlling themes of the period. Lib- eral politics requires toleration, or better, liberty of religious belief. And this in turn requires that religious institutions be privatized, as it were, and that just politics be secularized in that legitimate rule is to lie in the consent of the ruled rather than in the laws of God as interpreted by his ministers on earth. Differ- ' Wealth of Nations V.i.f.4o. My references to The Wealth of Nations are to the two-volume R. H. Campbell and A. S. Skinner edition . 2 The list of thinkers in the "classical liberal" tradition simply reads as the list of key Enlighten- ment figures: Bayle, Hobbes, Locke, Spinoza, Hume, Smith, Voltaire, and Kant, to name a few. Consider the role that religious freedom plays in Kant's. (shrink)

Most philosophical explorations of responsibility discuss the topic solely in terms of metaphysics and the "free will" problem. By contrast, these essays by leading philosophers view responsibility from a variety of perspectives -- metaphysics, ethics, action theory, and the philosophy of law. After a broad, framing introduction by the volume's editors, the contributors consider such subjects as responsibility as it relates to the "free will" problem; the relation between responsibility and knowledge or ignorance; the relation between causal and moral responsibility; (...) the difference, if any, between responsibility for actions and responsibility for omissions; the metaphysical requirements for making sense of "collective" responsibility; and the relation between moral and legal responsibility. The contributors include such distinguished authors as Alfred R. Mele, John Martin Fischer, George Sher, and Frances Kamm, as well as important rising scholars. Taken together, the essays in _Action, Ethics, and Responsibility_ offer a breadth of perspectives that is unmatched by other treatments of the topic. Contributors: Joseph Keim Campbell, David Chan, Randolph Clarke, E.J. Coffman, John Martin Fischer, Helen Frowe, Todd Jones, Frances Kamm, Antti Kauppinen, Alfred R. Mele, Michael O'Rourke, Paul Russell, Robert F. Schopp, George Sher, Harry S. Silverstein, Saul Smilansky, Donald Smith, Charles T. Wolfe The hardcover edition does not include a dust jacket. (shrink)

Human rights have become one of the most important moral concepts in global political life over the last 60 years. Charles Beitz, one of the world's leading philosophers, offers a compelling new examination of the idea of a human right.

Professor Flathman's main aim in this interesting paper is to set forth what we might call the “moderation thesis.” It holds that there may be occasions when the best thing to do, all things considered, is to violate a right – at least if the violation takes the form of what Flathman calls “civil encroachment” or “civil non-enforcement.” Moreover, it would be desirable, in a society whose practices include rights, for this belief to be generally accepted, so that those who (...) engaged with good reason in “civil encroachment” would receive the sympathetic support of the community. Let me begin by trying to explain the source of the problem to which this thesis is a response. As Flathman notes, rights have a discretionary character: if I have a right to do or to have something, it is up to me whether to do it or to have it. Having a right, I am entitled to make a choice. Since we cannot say, in advance, what choice I will make, we cannot say, in advance, what will be the state of the world after I make it. But since it seems plain that some states of the world are more desirable than others, it will always be possible that the consequences of my choice will be worse, on the whole, than the consequences of some other choice that I might have made but did not. To moderate rights is apparently to act in ways that redress or compensate for the undesirable results of their exercise. (shrink)

The collapse of historicism was not merely the demise of an academic tradition but signified a shift in the understanding of hermeneutics and metaphysics. Whereas earlier books have explored the rise and dominance of historicism within academic history, this is the first to trace its collapse and to show how it was shaped by larger philosophical and scientific concerns. Charles R. Bambach's lucid account of the demise of historicism within the context of German metaphysics provides a rich new perspective (...) on the development of the young Heidegger's concept of "historicity" and on the origins of postmodern thought. Bambach reconstructs the methodological debates arising from a pervasive sense of crisis among German philosophers in the late nineteenth century. He details the divergent attempts by the Neo-Kantians, Nietzsche, and Dilthey to overcome the limitations of historical relativism. Heidegger's view of "historicity," Bambach shows, radically transforms the problematic of historicism into a discourse concerning the crisis of philosophical modernity. (shrink)

_A concise history of “just price,” from Aristotle to the present day_ The question of what constitutes a fair price has been at the center of market interactions since the time of Aristotle. Should a seller sell to the highest bidder, or is there some other standard, such as a morally defined price, to be applied? Charles R. Geisst traces the ways that philosophers, religious leaders, and economists have sought to answer that question, from antiquity through the modern era. (...) Aristotle’s thinking on usury influenced the idea of pricing well into the Renaissance. In his view, money was barren and should not be used to beget more money. As trade became more extensive, the strictures placed on pricing by Aristotelian thinking began to fall away, replaced by Roman and common-law conceptions of value and interest. Geisst’s book follows the evolution of that thought—influenced along the way by figures such as Copernicus, Fibonacci, Adam Smith, Marx, Cassel, and Keynes—and charts parallel developments in European and Islamic notions of fair pricing. Today, pricing is seen as an economic inevitability, dictated by the laws of supply and demand. But this has not always been the case. As Geisst argues, the idea of a just price was once a moral concept, long before it was an economic one. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:To Be or Not to Be:Waiving Informed Consent in Emergency ResearchCharles R. McCarthy (bio)The requirements for prior, legally authorized informed consent constitute a necessary condition for recruiting subjects into biomedical or behavioral research. However, informed consent requirements pose a serious problem for most research conducted in emergency care settings. For this reason, the Food and Drug Administration's (FDA) regulations governing investigational devices and the Department of Health and Human (...) Services' (HHS) regulations for the protection of human subjects allow narrow exceptions to the general requirements of informed consent. In a joint effort to clarify the applicability of the current FDA regulations and to better understand the intent of the HHS regulations as they apply to emergency research, the FDA and the National Institutes of Health (NIH) cosponsored a public forum on the ethical conduct of emergency research in January 1995.Although the forum was not designed as a consensus conference and participants vigorously disagreed on some of the details, a broad consensus emerged on several major points: (1) both HHS and FDA regulations should, in the immediate future, be interpreted to allow for randomized clinical trials in emergency situations so long as the subjects are carefully protected; and (2) consideration should be given to producing new, closely harmonized regulations from both agencies that will provide greater clarity concerning what kinds of emergency research may be allowed without obtaining prior informed consent.The FDA-NIH forum in January was occasioned primarily by controversy about the hypothermia research protocol described below, but it is obvious that many other kinds of emergency research also await the outcome of deliberations concerning waiver of informed consent in emergency situations. These include research into the care and treatment of: occlusive stroke; subarachnoid hemorrhage due to intracranial aneurysm; metabolic coma; status epilepticus; cardiac arrest; myocardial infarction; cardiac arrhythmia; hemorrhagic shock; pulmonary embolism; acute asthmatic attack; and poisoning. All of these conditions [End Page 155] are encountered in emergency settings where obtaining informed consent from the patient-subjects to participate in research is seldom possible, and obtaining consent from legally authorized representatives of the subjects is either not feasible, or, if obtained, is of doubtful validity.The Hypothermia Research Case and HHS RegulationsA $7.2 million grant for research on the use of hypothermia in the treatment of severe head trauma, the largest award ever made to the University of Texas Health Sciences Center at Houston, is in danger of expiring before the study is completed. The protocol, which involves the use of cooling blankets to induce hypothermia in patients suffering from severe head injuries, is designed to test the hypothesis that: "Early lowering of the body temperature of patients suffering from severe head trauma to approximately 91 degrees Fahrenheit will slow patients' metabolism and will/will not, as a consequence, reduce the rates of both morbidity and mortality in these patients." The protocol was approved by seven Institutional Review Boards (IRBs), each of which waived the requirement to obtain informed consent from research subjects in accordance with Sec. 46. 116(d) of the HHS Regulations for the Protection of Human Subjects.1However, NIH's Office for Protection from Research Risks (OPRR), which is responsible for assuring compliance with the HHS regulations, has taken a controversial regulatory position by requiring informed consent from a legally authorized representative of each subject to be entered in the hypothermia trial. Because the obtaining of surrogate consent has proved to be very difficult, OPRR's position has slowed the research to a point where it may have to be terminated.At issue in the controversy is a fundamental question of ethics and public policy. Is it ever permissible to involve incompetent subjects in research without either their consent, or the consent of their legally authorized representatives? Pertinent HHS regulations for the protection of human subjects seem to answer the question affirmatively by allowing local IRBs to waive some or all of the elements of informed consent under carefully limited circumstances (45 CFR 46 116(d)). Nevertheless, OPRR has signalled the research community that use of the informed consent waiver provision for the Houston hypothermia study is not permitted under the regulations. OPRR judged that the risks... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Wilhelm Dilthey, Selected Works, Volume IV: Hermeneutics and the Study of History ed. by Rudolf A. Makkreel, Frithjof RodiCharles BambachRudolf A. Makkreel and Frithjof Rodi, editors. Wilhelm Dilthey, Selected Works, Volume IV: Hermeneutics and the Study of History. Princeton: Princeton University Press, 1996. Pp. xii + 409. Cloth, $59.50.Contemporary hermeneutics has been dominated by the work of Heidegger and Gadamer. Their phenomenological approach to the human world has (...) exerted such a powerful influence in recent years that one can hardly enter a discussion about the philosophical meaning of hermeneutics that is not already framed in the terms of their discourse. At the same time, there is less familiarity with the origins and sources of the hermeneutic method or with the thought of Wilhelm Dilthey. The editors of Dilthey’s Selected Works, Rudolf Makkreel and Frithjof Rodi, have set about trying to rectify this situation. They have sought to provide a richer context for the study of hermeneutics by bringing out a six-volume collection of writings from one of the major hermeneutical philosophers in the Western tradition. The publication of Volume Four in this series helps to accomplish this task by offering new translations of important Dilthey texts covering both the history and genesis of hermeneutics and a genealogical account of Dilthey’s own hermeneutical approach to history. Only one short essay in this volume, “The Rise of Hermeneutics” (1900), has been published before, and even this older translation has been revised and supplemented by material from the Nachlass. But what is the significance of this material and how does it help to achieve a fuller understanding of hermeneutics and its history?The selections in Volume Four cover the period from 1860 to 1903 with a heavy emphasis on the period from 1860 to 1868 (over two-thirds of the book focuses on Dilthey’s 1860 Preisschrift on “Schleiermacher’s Hermeneutical System in Relation to Earlier Protestant Hermeneutics,” notes from his 1867–68 lectures “On Understanding and Hermeneutics,” and three reviews from 1862 on historical literature from Buckle, Burckhardt, and F.C. Schlosser). The remaining essays from 1900–1903 provide a sense of Dilthey’s later reflections on hermeneutics and on the meaning of the eighteenth century for historiography and as a philosophical approach to history. The editors of this collection have chosen these texts carefully; the selections in Volume Four are organized around a specific theme. By culling significant early texts about hermeneutics and history and juxtaposing them with a number of later texts on the same topics, they hope to show the genesis of Dilthey’s own path of thought. What emerges from an attentive reading of these sources—especially when carried out within the context of the editors’ own principle of selection—is a highly persuasive view of Dilthey and his work. In the texts themselves we see Dilthey moving from his earlier role as the chronicler and historian of Protestant thought (who conceives of hermeneutics as an ancillary method of textual exegesis) to his later position as the philosopher of the historical world (who views hermeneutics as the epistemological method for the grounding of the human sciences). What we see here is a developmental account of Dilthey’s thought path: from the traditional scholar who conceives of hermeneutics as a method for interpreting texts to the philosopher who understands it as the fundamental science for interpreting historical life. This shift within Dilthey’s work from a hermeneutics of textuality to a hermeneutics of historicity marks an important turning point in the history of the hermeneutical [End Page 641] tradition, a turning point that helped to form the basis of all later philosophical hermeneutics.The five essays from Part Two—“Interpretations of History”—offer a smattering of Dilthey’s own writings on historiography, the theory of history, and the role of the eighteenth-century German tradition in forging an historicist understanding of “human affairs” (373) whose “organic nexus” and “inner purposiveness as a whole” opened up a radically new conception of historical being. Most contemporary continental philosophers will get lost in the textured details of Dilthey’s analyses because what passes for “philosophy” in our epoch pales by comparison with the rich... (shrink)

This book is meant to help resolve a couple of uncertainties.

Nihilism, Nietzsche and the Doppelganger Problem Was Nietzsche a nihilist? Yes, because, like J. L. Mackie, he was an error-theorist about morality, including the elitist morality to which he himself subscribed. But he was variously a diagnostician, an opponent and a survivor of certain other kinds of nihilism. Schacht argues that Nietzsche cannot have been an error theorist, since meta-ethical nihilism is inconsistent with the moral commitment that Nietzsche displayed. Schacht’s exegetical argument parallels the substantive argument (advocated in recent years (...) by Wright and Blackburn) that Mackie’s error theory can’t be true because if it were, we would have to give up morality or give up moralizing. I answer this argument with a little bit of help from Nietzsche. I then pose a problem, the Doppelganger Problem, for the meta-ethical nihilism that I attribute to Mackie and Nietzsche. (If A is a moral proposition then not-A is a moral proposition: hence not all moral propositions can be false.) I solve the problem by reformulating the error theory and also deal with a variant of the problem, the Reinforced Doppelganger, glancing at a famous paper of Ronald Dworkin’s. Thus, whatever its demerits, the error theory, is not self-refuting, nor does it require us to give up morality. (shrink)

In this revised edition of his 1979 classic Political Theory and International Relations, Charles Beitz rejects two highly influential conceptions of international theory as empirically inaccurate and theoretically misleading. In one, international relations is a Hobbesian state of nature in which moral judgments are entirely inappropriate, and in the other, states are analogous to persons in domestic society in having rights of autonomy that insulate them from external moral assessment and political interference. Beitz postulates that a theory of international (...) politics should include a revised principle of state autonomy based on the justice of a state’s domestic institutions, and a principle of international distributive justice to establish a fair division of resources and wealth among persons situated in diverse national societies. (shrink)

Are conspiracy theorists epistemically vicious? That is the conventional wisdom. It has distinguished supporters, including Quassim Cassam, Cass Sunstein and Adrian Vermeule. For me, a trait is an epistemic virtue if leads to the discovery of salient truths and the avoidance of pernicious falsehoods, and an epistemic vice the contrary. As such epistemic virtues and vices are role‐relative, context‐relative and end‐relative. I argue that that it is not necessarily or even usually vicious to be a conspiracy theorist, even if we (...) restrict the conspiracies in question to conspiracies on the part of Western government agencies, the reason being that many such theories are now known to be true. Finally I contend that the policy suggested by some polemicists of systematic skepticism towards conspiracy theories would be intellectually suicidal and hence vicious. (shrink)

Global economic and political inequalities are in most respects greater today than they have been for decades. From one point of view inequality is a bad thing simply because it involves a deviation from equality, which is thought to have value for its own sake. But it is controversial whether this position can be defended, and if it can, whether the egalitarian ideal on which the defense may depend applies at the global level as in individual societies. Setting aside directly (...) egalitarian reasons for concern about global inequality, this paper explores several reasons for concern that derive from nonegalitarian values – primarily those associated with poverty and material deprivation, humiliation, the impact of inequality on the capacity for self‐control and self‐government, and the unfairness of political decision‐making procedures with large economic inequalities in the background. (shrink)

Part of our fascination with the Maya can be attributed to the fact that they were literate . . . that is, the Classic Maya possessed a visible language that consisted of letters and a grammar, and one of the products of their literacy was the book. (Aveni 1992b, p.3).

The myth of the homeland -- The Nietzschean self-assertion of the German University -- The geo-politics of Heidegger's Mitteleuropa -- Heidegger's Greeks and the myth of autochthony -- Heidegger's "Nietzsche".

Philosophical attention to problems about global justice is flourishing in a way it has not in any time in memory. This paper considers some reasons for the rise of interest in the subject and reflects on some dilemmas about the meaning of the idea of the cosmopolitan in reasoning about social institutions, concentrating on the two principal dimensions of global justice, the economic and the political.

Beatrice Han has argued that the theories of subjection (determinism: structure) and subjectivation (freedom: agency) are the “the blind spot[s] of Foucault's work.” Furthermore, she continues, as historical and transcendental theories, respectively, Foucault left them in a state of irresolvable conflict. In the Scientific Temptation I have shown that, as a practicing researcher, Foucault encourages us to situate the theories of the subject in the context of his un-thematized search for a metaphysics of realism, the purpose of which was to (...) ground his complementary reach for a possibility of naturalism. In Returning to Kant I now argue that it is this fundamental feature of “Foucault's Foucault” that drives his returns to Kant, the purpose of which was to resolve the conflicting theories of the subject and thereby solve his Giddensian problem of structure and creativity. Locating the returns and their purpose in the context of my own arguments for the recovery of human agency, I argue that Foucault's attempts to solve his Giddensian problem led to two unfortunate solutions. In the first return, his resort to Baudelaire's aesthetic subject is a regression to a pre-noumenal conception of the Kantian subject. With the second return, the reinstatement of the Kantian subject as causally empowered, minus the noumenalism, is nothing more than a reclamation of Kant's conception. I argue that only a reconstruction of Foucault's scientific realism permits us to understand that he could have moved beyond mere reclamation to the actual recovery of human agency. (shrink)