orbit and far beyond it. Indeed, the immense, painstaking, indefatigable and ever-improving effort of Husserl to find ever-deeper and more reliable foundations for the philosophical enterprise (as well as his constant critical re-thinking and perfecting of the approach and so called "method" in order to perform this task and thus cover in this source-excavation an ever more far-reaching groundwork) stands out and maintains itself as an inepuisable reservoir for philosophical reflec tion in which all the above-mentioned work has either its (...) core or its source. In fact, in his undertaking to re-think the entire philosophical enterprise as such and to recreate philosophy upon what he sought to be at least a satisfactorily legitimated basis, Husserl, through his already systematised and "authorized" work, and his courses, and later on in his spontaneous reflection (which did not find its way into a definitive corpus but was nevertheless sufficiently coherent with his previously established body of thought to be considered a continuation of it), uncovers perspectives upon the universe of man and projects their new philosophical thematisation that brings together all the attempts by philosophers (e. g., Merleau-Ponty, who drew upon this material and found there his own inspiration) who succeeded him with foundational intentions; it also gives a core of philosophical ideas and insights for the youngergenerationofphilosophers today. (shrink)

This collection is the final volume of a four book survey of the state of phenomenology fifty years after the death of Edmund Husserl. Its publication represents a landmark in the comprehensive treatment of contemporary phenomenology in all its vastness and richness. The diversity of the issues raised here is dazzling, but the main themes of Husserl's thought are all either explicitly treated, or else they underlie the ingenious approaches found here. Time, historicity, intentionality, eidos, meaning, possibility/reality, and teleology (...) are the main concerns of this collection devoted to studies in aesthetics, metaphysics and literary interpretation, written by such authors as, among others, R. Cobb-Stevens, C. Moreno Marquez, J. Swiecimski, Sitansu Ray and M. Kronegger. These original studies of phenomenological aesthetics and literary theory by scholars from all parts of the world were gathered by the World Institute for Advanced Phenomenological Research and Learn ing during the year 1988/89 during its assessment of the phenomeno logical movement, fifty years after Husserl's death. IX A -T. Tymieniecka (ed.), Analecta Husserliana, Vol. XXXVII, ix. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.1 (2003) 51-52 [Access article in PDF] Congress Considers Incentives for Organ Procurement Alexander S. Curtis [Tables]During the 108th Congressional session, several bills pertaining to ethical incentives for organ donation likely will be introduced. In some cases, they will be similar to bills before the 107th Congress (see Table 1). Bills in both the House of Representatives and the Senate address the establishment and (...) maintenance of donor registries, financial reimbursements for medical and nonmedical expenses incurred by qualifying donors, the presentation of commemorative medals, and tax credits.A bill entitled "Gift of Life Congressional Medal Act" (introduced last year by Senate majority leader Bill Frist (R-TN) as Senate Bill 325), and its corresponding bill of the same title (passed in the House of Representatives last year as H.R. 708), would establish a congressional commemorative medal honoring "any organ donor, or the family or family member of any organ donor." The medal is to be designed and struck with "suitable emblems, devices, and inscriptions" by the Secretary of the Treasury. The eligible donor or donor's family member would be presented with the medal by the Secretary of Health and Human Services. This bill would establish qualifying donations as those of human kidneys, livers, hearts, lungs, pancreases, or any other organ, but excludes corneas and eyes.Another bill, introduced by Representative Michael Bilirakis (R-FL) entitled "Organ Donation Improvement Act" (H.R. 624), would award grants or contracts to states, transplant centers, and qualified organ procurement organizations for the purpose of providing travel, subsistence, and incidental nonmedical expenses to individuals who make living donations. In order to receive reimbursement, the donating individuals must reside in states other than the states in which the intended recipients reside and the annual income of those receiving the organs cannot exceed $35,000. The bill also would appropriate $15,000,000 to make grants to states and public and nonprofit entities for the purpose of carrying out studies, public education demonstrations, and outreach activities "designed to increase the number of organ donors within the state." The bill would be effective from time of enactment through 2005. [End Page 51]Two other bills proposed within the House of Representatives in 2002 called for amendment to the Internal Revenue Code. The "Gift of Life Tax Credit Act (introduced as H.R. 1872 by Representative James Hansen (R-UT)) and the "Help Organ Procurement Expand Act" (introduced as H.R. 2090 by Representative Chris Smith (R-NJ)) present a refundable credit to individuals or to the estates of those who agree either to be living donors or to donate their organs upon death. The "Gift of Life Tax Credit Act" refunds $10,000 to the estates of eligible individuals "for the taxable year which includes the date of the individual's death." The "Help Organ Procurement Expand Act" offers a refund of $2,500 to qualified persons. Donations of kidneys, livers, pancreases, islet cells, lungs, and intestines are accepted, however several conditions restrict permissible donors. The "Gift of Life Tax Credit Act" requires that the legally competent individual's death not be due to a suicide and that the intention to donate was clearly declared. The "Help Organ Procurement Expand Act" prohibits donations from individuals who were killed with physician assistance, died as a result of a suicide, have been indicted or convicted of a felony or a misdemeanor offense, or are actively under criminal investigation for a possible felony offense. The "Help Organ Procurement Expand Act" also restricts procuring organs from unborn children or human fetuses and under circumstances in which the living donor would be subject to "unacceptable levels of medical risk of death or permanent debilitation." Alexander S. Curtis is a research assistant at the Kennedy Institute of Ethics, Georgetown University, Washington, DC. He received his bachelor's degree from Miami University.... (shrink)

In 1994, Congress established more than sixty new capital crimes with wide public support. Davis argues that, if the U.S. is ever to join the majority of the world in abolishing capital punishment, opponents of the death penalty must make a stronger philosophical case against it. He systematically dissects the arguments in favor of capital punishment and demonstrates why they are philosophically superior to opposing arguments. By connecting the death penalty to a general theory of punishment in which (...) penalties are retributive in proportion to the crime, Davis shows why we must reconceive the entire criminal justice system and address violent crime more successfully before the death penalty can be successfully opposed. (shrink)

The word ‘dignity’ is a staple of contemporary American medical ethics, where it often follows the words ‘death with’. People unfamiliar with this usage might expect it to apply to one’s manner of dying—for example, a stately exit involving ceremonial farewells. Instead, conventional usage generally holds that “death with dignity” ends or prevents life without dignity, by which is meant life marked not by buffoonery, but by illness and disability. Popular examples of dignity-depleters include dementia, incontinence, and being (...) “dependent on machines”—provided the machines are respirators rather than furnaces, refrigerators, and computers. (shrink)

It is not the purpose of the present paper to chronicle transformations in the recent history of dance but rather to demonstrate that an art in which the materiality of the body and the localizability of space are critical has nevertheless been engaged in a struggle between sign and image. This struggle cannot be understood without attending to the tensions between the visceral and the virtual, between site specific spatiality and cyberspace. Exploring changes in dance, an art not generally discussed (...) in this context, may help to illuminate the conceptual underpinnings of structuralism understood as a theory of signs and the shift to a poststructuralist culture of images. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:diacritics 35.1 (2005) 71-98MuseSearchJournalsThis JournalContents[Access article in PDF]Hospitality after the Death of GodTracy McNultyPierre Klossowski's fiction has been only sporadically published in English, and largely dismissed as perverse erotica or soft-core porn. When his 1965 trilogy Les lois de l'hospitalité was partially translated in English (under the title Roberte, ce soir & The Revocation of the Edict of Nantes), its Library of Congress classification characterized it simply as (...) "erotic fiction—French." Even in France, Klossowski has become the very signifier of perversion. His artwork graces the cover of Serge André's L'imposture perverse and of numerous erotic novels, he has been "diagnosed" as a pervert by writers on both sides of the Atlantic, and unironic readers of his Sade mon prochain hail him as Sade's disciple and heir.1Admittedly, the larger stakes of Klossowski's work are easily obscured by its free adaptation of the stock themes of libertine literature. His fictional works, like his visual compositions (essentially representations of rape scenes, often on historical themes—Diana and Actaeon, the Rape of Lucretia), explore the conflict between a woman's chaste moral attitude and her gradual surrender to an assailant's advances. The Laws of Hospitality concerns the erotic awakening of "hospitality" in a woman, which exposes a contradiction within her moral character and reveals her symbolic identity to be without foundation. Its protagonist Octave, who bears more than a passing resemblance to his creator, is a collector of artworks that eroticize the moment of moral hesitation experienced by women submitting to the sexual advances of a chance stranger—or even a "spiritual" apparition. His "laws of hospitality" are the fruit of his desire to experience this operation firsthand; they name a practice wherein the master of the house "offers" his wife to fortuitous guests, in order to savor the moment of her surrender.However, the stakes of Klossowski's "perverse" meditations are very different from the Sadeian project of uprooting religious morality. Sade challenges the patriarchal and religious authorities of his day by demonstrating that the paternal signifier on which their laws are based is without foundation. In proving that the law cannot hold [End Page 71] up against the repeated assaults of libertinage, he mounts a systematic deconstruction of the symbolic order of language by the real of jouissance. But although Klossowski may share Sade's perverse drive to "humiliate the law with the object,"2 his target is not the signifier as such, but rather the imaginary consistency afforded by what he calls the "grammatical fiction of the 'I,'" the illusion of autonomous personhood. The "object" he confronts it with is not the natural "truth" of jouissance, but rather the feminine object who disrupts the identity of the "master" who offers her.Klossowski's reflections on the special status of femininity in Enlightenment culture—at once marginal and singularly "extimate"—have never been fully appreciated, despite their enormous interest for the study of culture. In a way unique among contemporary authors, Klossowski sheds light on Jacques Lacan's enigmatic insight that the cultural importance of the feminine object consists in its sublimated status as an "object raised to the dignity of the Thing" [Lacan 112]. His fiction underscores the close ties between the feminine and what Freud called das Ding, the Thing uncannily internal to subjectivity that Lacan later identified with the function of the Nebenmensch, as the apotheosis of the Christian idea of the prochain, or neighbor [Lacan 151–52].Although Klossowski's erotic scenario invites comparisons with Sade's and Fourier's utopian calls to dissolve the privative boundaries between subjects, what he understands by "hospitality" is not the abolition of personal identity, but rather the staging of its internal contradiction.Hospitality, at the Limits of the LawThe act of hospitality—whose theological and philosophical origins this former Dominican novice and Latin scholar was intimately acquainted with—concerns a very particular tension. Etymologically, the host is the "master," the one who "eminently personifies" identity: not only his own identity, but also that of the group in whose... (shrink)

This paper discusses the notions of impermanence and death as treated in the Chinese and Japanese philosophical traditions, particularly in connection with the Buddhist concept of emptiness and void and the original Daoist answers to the problem. Methodological problems are mentioned and two ways of approaching the theme are proposed: the logically discursive and the meditative mystical one, with the two symbols of each, Uroboros and the open circle. The switch of consciousness is suggested as an essential condition for (...) liberation of the Ego and its illusions. Rational logic as well as the sophisticated meditative ways of selflessness and detachment are suggested when treating the Chinese and Japanese philosophical notions, and examples of the discussed topics from the texts given. The instructive seventh chapter of the classical Daoist work, Lie Zi, is analyzed in detail and put into contrast with the answers given to that problem in the Greco-Judeo-Christian tradition. (shrink)

The advancement in the field of medical science and technology has made the issue of euthanasia more relevant and important for the present day society to discuss. Life saving machines and drugs are helping the patients who become incapable of leading their lives independently and to live artificially with thehelp of these life prolonging machines and medicines. But today it is possible to prolong their life, which may be full of pain and suffering. This suffering of the 'person' forces us (...) to think as to how far we are morally justified to help such patients to go on living a useless, helpless and painful life. Isn't it obligatory on us to relieve them of their pain? Such issues have made the concept of ‘euthanasia’, which involves 'good death', an important one. One should take a utilitarianpoint of view in analyzing the concept of euthanasia. One should keep the interests and benefit of people in mind. When one decides that a particular case is a case of euthanasia, then not only the 'net benefit' of the patient should be borne in mind, but also the 'general benefit of the society and individuals looking after the patient should be taken into consideration. (shrink)

Lucretius points out a puzzling asymmetry in our attitudes towards our prenatal non-existence and our post-mortem non-existence. Normally, we view birth as a happy occasion, and death as a sad event. Some philosophers argue that these asymmetry in our attitude is justified by the A-theory of Time, which reflects the common sense way of thinking about time, and so they discredit the B-theory of Time. In this paper I critically examine these claims and argue that this belief is false. (...) Our attitude is neither justified nor discredited by anything which is in debate between the A-Theory and the B-theory of time. Thus the existence of this asymmetry does not favor one theory over the other, and the dispute between the two theories will have to be settled on other grounds. (shrink)

Fifty years after the death of Edmund Husserl, the main founder of the phenomenological current of thought, we present to the public a four book collection showing in an unprecedented way how Husserl's aspiration to inspire the entire universe of knowledge and scholarship has now been realized. These volumes display for the first time the astounding expansion of phenomenological philosophy throughout the world and the enormous wealth and variety of ideas, insights, and approaches it has inspired. The basic commitment (...) to phenomenological concerns found in all this variety makes this collection a most signifi cant historical document. This second volume of the collection bears witness to a deliberate shift of attention from the earlier to the later phase of Husserl's reflections. We see how his issues - intersubjectivity, ethics, human encounter, the societal world, empathy, the sphere of the self, and the surpassing of dichotomies (bodylpsyche, etc.) - are now at the center of attention in the human sciences. Among the authors are H. Tellenbach, A. Rigobello, C. Balzer, C. Bjurvill, V. Molchanov, E. Syristova, O. Balaban, R. Boehm, M. Sancipriano, O. M. Anwar, Y. Okamoto, B. Holyst, T. Sodeika, and M. De Negri. The studies were gathered at the programs held by The World Institute for Advanced Phenomenological Research and Learning in the commemorative year 1988/1989, chiefly at the First World Congress of Phenomenology at Santiago de Compos tela, Spain, with the aim of assessing the current state of phenomenology. A-T. T. (shrink)

I examine the ways in which our cultural expectations with respect to death may be transformed by the legalization of assisted suicide. I suggest the inadequacy of the philosophical framework currently taken as the basis for discussing the advantages as well as the dangers of legalizing assisted suicide. I do not believe that individual autonomy is any sort of possibility for dying patients, regardless of the social policies that surround death in a society, insofar as our individual agency (...) in this situation is necessarily intertwined with that of various relevant others. By means of a theory of agency relations, I attempt to show the dynamic ways in which we may all adjust to the option of assisted suicide as a preferred end-of-life option. My theory of agency relations does not deny individual choice; rather it explains the qualitative complexity of individual choice, as well as its dynamic social process of evolving. (shrink)

The philosophy of our proposal are as follows: (1) Various ideas of life and death, including that of objecting to brain death as human death, should be guaranteed. We would like to maintain the idea of pluralism of human death; and (2) We should respect a child’s view of life and death. We should provide him/her with an opportunity to think and express their own ideas about life and death.

There is no notion of postmortem Heaven and Hell in both ancient Israeli and Confucian traditions, and the two traditions also share quite a number of similarities about the idea of immortal life after death. Therefore, a comparison of the commonness in this field, e.g. the Jewish Levirate Marriage custom and the Confucian custom of adopting one’s son as heir; the idea of name surviving death in Biblical Judaism and that of glorifying one’s parents by making one’s name (...) famous in future ages in Confucianism, can help us reveal the common pursuit in the two traditions: the postmortem fulfillment of an individual is realized in the form of the continuation of one’s family/ tribe/ nation of which they were, and forever remain, a generational link. In addition, this can help clarify a long faulted Confucian dogma of “Having no male heir being the gravest of the three cardinal offences against filial piety”. (shrink)

Part of the bafflement over expressions like “contemporary” and “postmodern” in philosophy can be traced to a flood of nineteenth-century historians of philosophy who dubbed the so-called “post-medieval” era from Bacon and Descartes to Mill and Nietzsche the “Philosophie der Neuzeit,” “L’époque moderne,” and “modern philosophy.” Even the philosophers mentioned suffice to indicate that these labels are often only placeholders for views of thinkers linked by little more than a birth after the onset of the Reformation and a death (...) before the Curies’ discovery of polonium. Nevertheless, philosophers in the twentieth century and their historians were faced with the dilemma of either subsuming their work under this broadly conceived moniker, thereby signaling nolens volens a lack of significant innovation, or coming up with some appropriately distinctive term. (shrink)

The distinction between killing and letting die has been a controversial element in arguments about the morality of euthanasia and physician-assisted suicide. The killing/letting die distinction is based on causation of death. However, a number of causal factors come into play in any death; it is impossible to state a complete cause of death. I argue that John Mackie’s analysis of causation in terms of ‘inus factors,’ insufficient but nonredundant parts of unnecessary but sufficient conditions, helps us (...) to see that moral responsibility for death cannot rest on causation alone. In specifying the cause of death, some factors can be considered alternatively as either causal factors or merely parts of the presupposed background conditions. If a factor is moved from the background field into the causal field, the result is a changed background field. Comparisons of cases of killing and letting die often do just this; hence, the cases depend on different presuppositions and the causation cannot be directly compared. Moral judgments determine how to apportion factors to the causal and background fields. (shrink)

TRANSCENDENTAL THOUGHT IN HENRY OF GHENT JAN A. AERTSEN (K6LN) 1. Introduction: Henry as a "transcendental" philosopher (J. Paulus) "If it is proper to an...

This paper begins with an explanation of the "life sequence of value," which is defined by the formula Life->Means of Life->More Life. The analysis then contrasts this general sequence of value to the "money sequence of value," which is shown to have three autonomous forms not before distinguished: Money->Means of Life->More Money ; Money->Means of Life Destruction->More Money ; Money->More Money->More Money. I explain how the first money sequence of value, analyzed by Marx in his classical formula of industrial capital, (...) has mutated so that the standard sequence of assumed by economists has, in fact, been increasingly displaced by sequences and. The argument shows that these sequences of economic "growth" increasingly dismantle environmental and civil life-fabrics, but remain unproblematic to the dominant economic paradigm whose measures of value do not register life-losses in their value accounts. It is concluded that a regrounding of economic understanding in the life sequence of value is required to avoid a cumulative breakdown in the conditions of social and planetary existence. (shrink)

After the death of Prophet Muhammad (p.b.u.h), one of the most significant debated topics of Muslims was the institution of caliphate. This institution caused crucial argumentations through the ages from Abu Bakr to Abd-al-Majid who was the hundreth khalifa. Some prominent issues in that regard as follows: How khalifa comes to power, who becomes khalifa, whether he is descended from Quraysh or not, which kind of traits khalifa should have, and how khalifa should behave in certain circumstances. While these (...) arguments were going on, caliphate was maintained based on the reign under some certain dynasties’ responsibilities after the Rashidun (rightly guided) Caliphs. Umayyads, Abbasids and Ottoman Dynasties were the most well-known ones of these dynasties. Throughout history, even though caliphate passed in one another’s hands among aforementioned dynasties, none of them did attempt to abolish this position. However, Turkish Muslims who became defeated with European occupation of non-western territories decided to abolish caliphate for the sake of modernization activities within the period of transition from imperialism to nation state. This decision brought about a trauma, which was much more critical than former argumentation around the position in Muslim world. Many congresses were organized in Islamic world in order to recover from this trauma. While this kind of quests were continuing, Muhammad Hamīdullah proposed “High Caliphate Council” in relation to rearrangement of caliphate in accordance with the conditions of Islamic countries. This proposal offers an applicable model to today’s modern nation states by establishing unity among them and leaving aside their conflicts and differences. This proposal offers a resolution of much-discussed matters of the position within the limits of principals. It also draws attention by showing a possibility of Islamic union in contemporary Islamic thought. Summary: The matters of who undertakes the management of societies, how rulers come to power and in what manners the rulers maintain the management have been discussed throughout history. It is seen that rulers adopted kingdom as regime before the period of the Prophet Muhammad (p.b.u.h). There was also two-person management. The discussions about this matter were also seen around khalifas who were the rulers of Muslims after the death of Prophet Muhammad (p.b.u.h). Some debated issues in that regards as follows: Who becomes khalifa, how he is elected, which traits he should possess, and so on. Caliphate continued its existence despite the discussions until the first quarter of the 14th Hijra era. Abolition of caliphate was a trauma for Muslims undoubtedly. From Anatolia to Egypt and from India to the Balkans, many attempts were carried out to recover from this trauma. However, this matter was oversimplified in the conditions of that period since it became a topic which was hushed over in just congresses and conventions. One of the people who wrote on this topic, which maintains its vitality even today was Muhammad Hamīdullah. He was an important Islamic scholar, a lawyer and a historian in Indian geography. Hamīdullah did deal caliphate by indicating its history broadly. The distinctive feature of Hamīdullah from others who wrote on this topic is that he also presented a considerable offer to solve the matter. In this sense, Hamīdullah experienced the trauma in his own life as all muslims did it with the abolition of caliphate. Hence he mentioned this matter in his writings in the mood of care and dignity of a scientist and also in feeling of a heartbroken muslim. Hamīdullah made clear that the method of election of the ruler differed throughout history. Indeed, the verses of Holy Qur’ān, the applications of the Prophet Muhammad (p.b.u.h) and the differences of Four Great Chaliphs on coming to power testified this claim. According to Hamīdullah, it is quite normal that the method of regime can vary according to the conditions of societies. He recommended acting based on timeless rules rather than the changes that vary according to conditions and places. He also stated that the regime which Islam approves is a combination of kingdom and democracy in his lines dealing with methods of regime. To him, kingdom is the method of regime of empire. Empire is the regime in which various nationalities live together with all their differences and interact with one another intensely and in which the rulers rule over wide borders. On the other hand, Islamic world lost its edges of empire, changed its regime and divided to nation states after the decline of the Ottoman Empire and Mughal Empire which were established by Muslims. On the contrary, westerners attempted to establish a head empire several times after building nation states in Europe. Some of them are UN, NATO, EU, to name but a few. In our opinion, in the transition process of Muslim rulers from empire to nation state, Hamīdullah made an offer to accomodate Islamic law in state law, Islamic politic and administrative principles in politics and administration practices, Islamic education system in education system, and principles of Islamic economics in economic decisions of government using the Prophet Muhammed’s life as a base. He also explained to Muslims that the method of regime can be changed and the essential matter is to apply Islamic management principles in such a new situation. He played a role in clearing the way for Muslims by indicating that the method of Islamic regime can be changed according to conditions but the principles of Islam are unalterable. To the writer of these lines, Hamīdullah intimates that it is not so true to stick to the form of the process in Muslim territories in which a compulsory transition from the empires or multinational social structures to the nation state structures have been experienced for the last two ages. However, the first matter to dwell on should be whether the ruler of the government behaves in accoradance with the principles of Islam or not. To Hamīdullah, the second matter is that even though Muslim countries had to enter in the process of becoming nation states, Muslims should make an effort to establish supra-state associations as required by Islam. In this respect, Hamīdullah’s proposal is “High Caliphate Council”. This council is a considerable offer presented to Muslim countries in the age when a universal caliphate is not possible and Muslims head towards a unified state form all over the world. Today, this offer recommends countries of which great majority is Muslims and in which Muslims are minority to meet on a common ground rather than conflict because of differences among them. The High Caliphate Council is an institute consists of presidents or hereditary administrators as leading and regular members and so it avoids regional competition. It is established by Muslim presidents who shares the chair alternately. Based on this, all Muslim presidents play a role altogether in this council without need to be Sunni, Shia, or from Quraysh. The High Caliphate Council is a reflection of a dream, which started a century and half a century ago but is required more today. It is also a reflection of the discourse of “Islamic Union” in Contemporary Islamic Thought. The Caliphate Council and International Islamic Legists’ Association, which is the first practical step of the council can be seen as the theory of a new world order based on the unity principle of Islam. Hamīdullah does not consider this order not only in the range of belief but also with the aim of institutionalizing ‘ijmā (consensus of Islamic legists) and qiyās(legal analogy). He stated that International Islamic Legists’ Association, which is a scientific institution could not be established beforetime by Muslims spread on three continents due to lacking of communication among them. However, thanks to today’s possibilities, the establishment of such association is easier today. Hamīdullah found dynamic solutions such these two institutions for the realization of caliphate, which is a religious necessity. He marked an era for Muslims in the period of time when they are on a quest. (shrink)

During the last congress of the International Association of Bioethics in Beijing, there was a special session on human enhancement. John Harris, pioneer in the discussions on the ethics of enhancement,1 summarised this session, describing the focus of different panelists.2 This session included: Biopsychological enhancements The possibility of regulating emotions through pharmacological means Biases that may affect our judgments against human enhancement Health care inequalities that will follow from the adoption of genetic technology Social impact and costs of adopting the (...) new technology A discussion on women enhancing their physical strength as men through genetic modification .The Beijing panel did not address women’s involvement in the enhancement scenario. Of course, not every aspect of a topic can be covered in one session of a congress and some aspects may remain unaddressed; mainly, because these sessions draw from the research interests of the presenters. However, neither John Harris nor Julian Savulescu has yet addressed women’s crucial involvement in the enhancement scenario. It is the aim of this paper to draw attention to the invisibility of the ‘vessel’ in these discussions. Enhancement may be justified; but clearly, it will also affect women. In this scenario, will women be worse off?LATE ONSET DISEASES AND ENHANCEMENTFirstly, I would like to point out that I believe that enhancement may be a necessary step in the future of human evolution. As I have explained elsewhere,3 health care systems in the developed world are near to collapse under the pressure of late onset chronic diseases. Largely successful in preventing early deaths in the last century, health care systems have prompted a new plague, recognised lately by the World Health Organization as a new pandemic …. (shrink)

Torture used to be incompatible with American values. Our Bill of Rights forbids cruel and unusual punishment, and that has come to include all forms of corporal punishment except prison and death by methods purported to be painless. Americans and our government have historically condemned states that torture; we have granted asylum or refuge to those who fear it. The Senate ratified the Convention Against Torture, Congress enacted antitorture legislation, and judicial opinions spoke of "the dastardly and totally inhuman (...) act of torture.” Then came September 11. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 10.2 (2000) 171-174 [Access article in PDF] Bioethics Inside the Beltway The Oversight of Human Gene Transfer Research LeRoy Walters Jesse Gelsinger's death last September in a gene transfer study being conducted at the University of Pennsylvania has helped to spark a national debate. In part, this debate parallels the broader discussion of how human subjects research should be reviewed and regulated in (...) the United States. However, human gene transfer research is one of a handful of biomedical technologies that seem to deserve special attention, at least in the early years of their development.The major participants in the national debate on human gene transfer include the National Institutes of Health (NIH), the Food and Drug Administration (FDA), the National Bioethics Advisory Commission, members of Congress, biotechnology and pharmaceutical companies, disease-oriented advocacy groups, reporters, and academics. At the December 1999 meeting of the NIH Recombinant DNA Advisory Committee (RAC), the protocol that involved Jesse Gelsinger was a central focus of discussion, but other topics emerged as well. One ad hoc panel reviewed adverse events that had occurred in other research protocols using adenovirus vectors, while a second proposed changes in the general system for reporting adverse events to NIH and the RAC.During the first several months of the year 2000, the United States Congress also became involved in the human gene transfer debate. In February, Senator Bill Frist (R-TN) convened a hearing to which Jesse Gelsinger's father, representatives of NIH and FDA, and several other witnesses were invited. At approximately the same time, the House Commerce Committee and its Subcommittee on Oversight and Investigations initiated their own inquiries, asking the Office of Inspector General at the Department of Health and Human Services to review the oversight roles of NIH and FDA. In March and April, the House committee also wrote directly to the NIH Director, the FDA Commissioner, and the President of the University of Pennsylvania, requesting extensive documentation on gene transfer, in general, and the trial in which Jesse Gelsinger was involved, in particular. Congressman Henry Waxman (D-CA) and Senator Edward Kennedy (D-MA) have also raised questions and proposed solutions in multiple letters to the NIH Director and the Secretary of Health and Human Services. [End Page 171]The major general questions that have emerged from this discussion are the following:(1) What kinds of information about adverse events should be reported by researchers or sponsors during the course of human gene transfer trials?(2) To what group or groups should adverse-event information be reported? How often and in what ways should the information be analyzed?(3) Should the information about adverse events remain confidential, or should it be discussed publicly?(4) How can the disclosure and consent process in gene transfer trials be improved?(5) Which federal agency should have primary responsibility for overseeing human gene transfer research, and how can it best fulfill its oversight role?How these questions are answered will have immediate relevance to the field of human gene transfer research as it enters into its next phase. At the same time, the models that are created for this important cutting-edge field also may be useful in other complex or controversial arenas of biomedical research, for example, xenotransplantation or human embryonic stem-cell research. In addition, the lessons learned from this one important area of human subjects research may suggest ways to improve protections for all the volunteers who make clinical research--and medical progress--possible.In the remainder of this article, I will turn from reporting, in as objective a way as possible, on the status of the public policy debate about human gene transfer research to suggesting measures for improving the current oversight system for such research. My initial general recommendation is that we should not expect a single regulatory agency to be solely responsible for a field as large and dynamic as human gene transfer research. Rather, there should be some helpful redundancy or, to change the metaphor, checks and balances in the public oversight of this field. Thus, an... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Patient Self-Determination ActElizabeth Leibold McCloskey (bio)What are the ethics of extending the length of life? We know that we cannot artificially end life (Thou Shalt not Kill), but how about artificially extending life? Is that always good, sometimes good?... In ethics, is keeping people alive the highest good? Should our priority be to keep people breathing?... What does basic religious ethics say about this?(John C. Danforth, letter to (...) the author, 19 August 1989)The Patient Self-Determination Act, signed into law as part of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) last November, marks the first time that Congress has passed legislation concerning the ethics of life-sustaining medical treatment. The bill was spearheaded by Senator John C. Danforth (RMO), who has a special interest in this area. An Episcopal priest, Danforth was formerly an assistant chaplain at New York's Memorial Sloan-Kettering Cancer Center and now sits as a senior member of the Senate Finance Committee, which oversees Medicare and Medicaid. Although Senator Danforth's legislative initiative was not a result of the Cruzan case, it was in his state of Missouri that the U.S. Supreme Court case involving removal of Nancy Cruzan's feeding tube arose (Cruzan v. Director of Missouri Department of Health, U.S. Supreme Court, 58 LW 4916, 26 June 1990). From his unique vantage point, he felt it was time to craft a legislative response to some of the difficult issues surrounding prolongation of life.The short answer to Senator Danforth's questions about when to artificially extend life is simple enough: people must be free to determine that for themselves. Common law and common sense dictate such a conclusion; living will and health care proxy statutes, enacted in almost every state, codify that right. The Catholic moral tradition teaches that one is not morally obligated to use extraordinary means to prolong life, a tradition shared both by the mainline Protestant and the reform and conservative Jewish community. Yet most people are unaware of their fundamental legal right to make such decisions, and as court cases from Quinlan (In re Quinlin, 137 N.J. Super. 227, 1975) to Cruzan demonstrate, few know [End Page 163] how to make arrangements for this right to be exercised if they become incapacitated.Meanwhile, health care practices are often driven by a denial of death. When Senator Danforth and Senator Daniel Patrick Moynihan (D-NY) introduced the bill on October 17, 1989, Senator Danforth said:More and more it is arguable that we play God by subjecting people to unwanted and sometimes unnecessary treatment, treatment that unnaturally prolongs the dying process. Our health care system has become obsessed with extending life, at times neglecting the caring component of medicine and trampling on the rights of patients.(Congressional Record 1989, 135:5.13566)The American Hospital Association estimates that 70 percent of deaths now occur after a determination to withhold or withdraw medical treatment. Many of those decisions are made without the benefit of an incapacitated patient's views, yet a Harvard study revealed that 95 percent of the population would like to prepare in advance for such decisions. Only 4 percent of hospitals have a systematic method of asking patients if they have an advance directive. Family members confront painful choices in the face of uncertainty about their loved one's wishes and it can be even more painful when a family knows the patient's desires but providers and the courts act otherwise because clear evidence is lacking.The Patient Self-Determination Act is rooted in the belief that people should be given information that enables them to specify the extent of medical treatment they wish to receive should they become incapacitated. The public should be educated about applicable state laws that protect the individual's right to make such choices through the use of an advance directive.The Act moves toward that goal by promoting knowledge of state laws. It requires every hospital, nursing home, home health agency, hospice, and health maintenance organization that participates in Medicaid or Medicare to routinely give all adult patients information about advance directives. Patients will also be given information on the... (shrink)

Despite being ‘one of the most notable leaders of the German Communist movement’, Ernst Meyer remains relatively unknown. Prior to the online publication of the author’s PhD dissertation – an extensive 666-page biography of Meyer – there existed beyond two short biographies – an informative political autobiography from Meyer’s wife Rosa Meyer-Leviné and an essay by Hermann Weber published in 1968 – and some recent texts from the author, no other publications dealing closely with his life and work. Of these, (...) only Meyer-Leviné’s biography has been published in English. Meyer played a major role in the left wing of the German labour movement, beginning in 1908 when he joined the German Social-Democratic Party until his death over twenty years later. A friend and collaborator of Rosa Luxemburg, he was also one of the founding and leading members of the International Group and its successor, the Spartacus League, in which the radical, anti-war wing of Social Democracy organised itself after the outbreak of World War i. He represented both of these groups as a delegate to the international conferences of anti-war socialists at Zimmerwald and Kienthal. Elected to the kpd’s Zentrale at the party’s founding conference, Meyer remained a member of the leadership almost continuously in the years to come, occupying various leading positions. He also represented the party at the Second and Fourth World-Congresses of the Communist International. (shrink)

For a long time now there have been different interpretations of the philosophical category "one divides into two." The debate that took place in scholarly circles in 1964 over "one divides into two" and "two combine into one" began with the question of how to interpret this category. At first this was a very lively and widespread scholarly debate. But later, because those "authorities on theory" who had at that time taken over the reigns of intellectual leadership within the Party (...) created contemporary superstitions that inhibited thought, the tone and boundaries of this debate became arbitrarily fixed and circumscribed so that this scholarly question became a political issue resulting in the criticism and trial of comrades such as Yang Xianzhen and the premature death of this debate. Today, in accordance with the spirit of the Third Session of the Eleventh Congress of the Central Committee of the Party, with an attitude of really searching for the truth, we must undertake a new and correct evaluation of this debate. Politically, we must overturn the false charges which were wrongly leveled at Comrade Yang Xianzhen and others, and intellectually, we must uphold the policy of "let a hundred schools contend, let a hundred flowers bloom." We must encourage the free discussion of different points of view, and we must avoid issuing hasty conclusions. All of us comrades who participated in this debate should accept the valuable experience and lessons learned from it. We want the debate on this question to truly become a widespread intellectual debate which will once again develop and move forward healthily. In this article I would simply like to talk about a few of my own views concerning the problem of how to correctly interpret "one divides into two.". (shrink)

Over the past decades the mortality rate in the United States has decreased and life expectancy has increased. Yet a number of recent studies have drawn Americans attention to the fact that racial and ethnic disparities persist in health care. It is clear that the U.S. health care system is not only flawed for many reasons including basic injustices, but may be the cause of both injury and death for members of racial and ethnic minorities.In 2002, an Institute of (...) Medicine report requested by Congress listed more than 100 studies documenting a wide range of disparities in the United States health care system. This report found that people belonging to racial and ethnic minorities often receive lower quality of health care than do people of European descent, even when their medical insurance coverage and income levels are the same as that of the latter. (shrink)

This paper undertakes two tasks. It will endeavour, first of all, to establish that there is a difficult discipline called Absolute-theory - Aristotle called it First Philosophy or Theology - which builds itself around the concept of a unique something which exists in an unqualified and necessary manner, and to which everything not itself attaches, or from which it in one manner or another derives. We shall try to distinguish the different strands or strata in the conception of an Absolute, (...) and shall then consider the alternative ways in which such a concept can be developed. For though, if there is or can be anything Absolute, it is one and unique and without rivals or alternatives, there are for us a large number of alternative ways of conceiving of what is absolute, some of which are arguably better and less exposed to antinomy than others. And of course there is always for us the alternative of not conceiving or not believing in any Absolute at all. And we shall briefly glance at the great historical dynasty of Absolutes: the infinitely arbitrary, anthropomorphic, of the Judaic-Christian-Islamic tradition, the less arbitrary Aristotelian-Neoplatonic Absolute of Thomas Aquinas, the Substantial Absolute of Spinoza, the Leibnizian-Wolffian Absolute of which Kant made his Ideal of Pure Reason, the Upanishadic Absolute of Shanaracharya, the infinitely vacuous Absolute of Mahayana Buddhism, the Deistic and Materialistic Absolutes of the Eighteenth Century Enlightenment, the absolute Space-Time of modern physicists, the Aussersein of Alexius Meinong and the Logical Space of Ludwig Wittgenstein. If the construction of Absolutes is an unrewarding language-and thought-game, it is none the less one which practically all the more intense thinkers have tried to play. I shall next, in the second part of my paper, try to establish that Hegel is by far the subtlest and the most successful of all the Absolute-theorists. His whole philosophy may be regarded as an essay in Absolute-theory, in that it throughout does nothing but try out, modify or discard categories of thought and forms of being because they fail to measure up to an adequate conception of an Absolute. And in his vast rehearsal of categories and forms of being Hegel arguably works up to a conception of the Absolute which takes account of a far wider and richer array of issues, and forestalls a more varied assemblage of objections than any other exercise in Absolute-theory. Sometimes Hegel anticipates thought-moves that will occur long after his death: the moves, e.g., of John Stuart Mill regarding the Syllogism’s being a Petitio Principii, and inductive reasoning’s being really an inference from particulars to particulars. And it will be our contention, finally, that Hegel is by far the most successful of Absolutists, in that he, and he alone, has worked out a many-sided Logic which, whatever its imperfections, is the only sort of instrument with which Absolute-theory can be tackled. In arguing in this manner I shall be contributing to the main theme of this Congress, the nature of the Universe, for the Universe, I believe, is a very vague and degenerate sort of Absolute. (shrink)

This guide accompanies the following article(s): ‘Full Disclosure of the “Raw Data” of Research on Humans: Citizens’ Rights, Product Manufacturer’s Obligations and the Quality of the Scientific Database.’Philosophy Compass 6/2 (2011): 90–99. doi: 10.1111/j.1747‐9991.2010.00376.x Author’s Introduction Securing consent (and informed consent) from patients and research study participants is a key concern in patient care and research on humans. Yet, the legal doctrines of consent and informed consent differ in their applications. In patient care, the judicial doctrines of consent and informed (...) consent are disclosure doctrines based on the obligation of physicians to inform their patients of the following types of information: the nature of the procedure the physician is recommending in the patent’s care (P), the alternatives to the physician‐recommendation (A), and the risks of procedure and its alternatives (R). In addition, the physician must provide truthful answers to the patient’s questions (Q) to the best of the physician’s abilities. In research on humans, the onus of disclosure by study sponsors and principal investigators is much greater than in patient care precisely because the purpose of research is not patient care. The purpose of research is the identification and development of new generalizable knowledge. Thus, participation in a research study or trial may not benefit the study volunteer at all. In addition, the participant may carry a heavy risk burden in relationship to any testing of a newly designed drug or device as part of their experiences in the research study. Presently, despite the risks borne by the research study participant, the raw data collected from volunteers in research trials are treated by courts as if they were the private property of the study sponsor rather than generally owed to the public as would be expected by an effort like research participation aimed at contributing to the development of generalizable knowledge. This paper reviews the obligations that study sponsors owe to their study participants based on the very definition of research as a systematic activity whose purpose is to develop generalizable knowledge to help all humans. Author Recommends Court cases Canterbury v. Spence, United States Court of Appeals, District of Columbia Circuit 464 F.2d 772 (1972). (Federal appellate decision heard in the District of Columbia, USA) Reibl v. Hughes, 2 S.C.R. 880 (1980). (Supreme Court of Canada) Rogers v. Whitaker, 175 C.L. R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Canterbury v. Spence is the landmark Federal informed consent case in the United States heard in the District of Columbia. In this case, Judge Spottswood Robinson articulated the reasonable person standard of informed consent. This standard was subsequently adopted by the Supreme Court of Canada (Reibl v. Hughes, 2 S.C.R. 880 (1980)) and the High Court of Australia (Rogers v. Whitaker, 175 C.L. R. 479 (1992)). The House of Lords rejected the reasonable person standard in England in Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985). Book Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. This book is a detailed guide for the review of scientific and ethical aspects of research on humans contained in the research study protocols and research informed consent forms which need to be submitted by study sponsors and principal investigators to institutional review boards (IRBs) for IRB review before a research study can receive approval to be conducted within a human study population in those institutions over which the IRB has authority. It also presents basic definitions in the area of research on humans and basic approaches to help conduct a deep review of the underlying scientific and ethical issues that are present within a research study protocol and its accompanying research informed consent form. Report National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). This U.S. National Commission in the Belmont Report argued for the necessity of a reasonable volunteer standard in research on humans in the United States. Arguing that the professional standard and the reasonable person standard of consent and informed consent were insufficient to base a disclosure standard in research on humans, this National Commission developed the reasonable volunteer standard where a study participant is to be approached in research informed consent with that information that a reasonable volunteer would want to know. Online Materials Belmont Report: Syllabus Topics for Lecture and Discussion Week I: Introduction and Overview Readings: Rogers v. Whitaker, 175 C.L.R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week II: The Different Standards of Consent and Informed Consent Readings: Canterbury v. Spence, 464 F.2d 772 (1972). (Federal appellate opinion heard in the District of Columbia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week III: Definition of Research Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 2 and 3) Week IV: How to Review a Research Study Protocol and Research Informed Consent Form Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 4–6, 10, and 12–14) Week V: Obligations in Research of Humans Versus Patient Care Reading: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). Focus Questions • How do the judicial doctrines of consent in England and Australia compare to the judicial doctrines of informed consent in the United States and Canada? • How does a professional standard of disclosure differ from a reasonable person standard of disclosure? • What is the definition of research? • How is a research study (study proposal and research informed consent form) reviewed from scientific and ethical bases for considerations of approval by an IRB? • How do the obligations of a study sponsor, a principal investigator, and a research team conducting a research trial on human study participants differ from the obligations of a physician caring for a patient? • Should all raw data of research derived from humans be made available to the public for use in developing generalizable knowledge to help others, or should raw data be considered the private property of the study sponsors (for example, prescription drug manufacturers), who fund the research trials? Seminar/project Idea Draw a timeline of the development of the basic concepts of consent and informed consent in patient care and in patient research. On this timeline, first place the dates of the key court cases in England, the United States, Canada, and Australia on consent and informed consent. Then place the date of the development of the Belmont Report. Why do differences exist between these four countries in terms of the legal requirements of informedness of a patient (in medical care) and a study participant (in medical research)? What roles if any do the concepts of self‐determination and self‐decision have in consent and informed consent in patient care and in informed consent in research on humans among the four countries of interest? What are the realities of research on human participants that require a new standard of informed consent, the reasonable volunteer standard, to be developed beyond the two standards in patient care, the professional standard, and the reasonable person standard? Counterpoint Arguments The following are counterpoint arguments that need to be appreciated to more fully understand the concepts that impact the thesis that ‘raw data’ should be open to the public to allow the opportunity of checking of the results of its associated scientific paper and for further analysis. De‐Identified (Anonymized) Raw Data A current approach to identifying (anonymizinig) raw data is based on the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L.104‐191). HIPAA was enacted by the U.S. Congress in 1996 to keep a person’s medical information private. In a research study, a person’s private medical information can become research data. HIPAA’s Privacy Rule allows a covered entity to de‐identify data by removing all 18 elements that could be used to identify the individual or the individual’s relatives, employers, or household members; these elements are enumerated in the Privacy Rule. The covered entity must also have no actual knowledge that the remaining information could be used alone or in combination with other information to identify the individual who is the subject of the information. Under this method, the identifiers that must be removed are the following: 1 Names. 2 All geographic subdivisions smaller than a state, including street address, city, county, precinct, ZIP Code, and their equivalent geographical codes, except for the initial three digits of a ZIP Code if, according to the current publicly available data from the Bureau of the Census: 2a. The geographic unit formed by combining all ZIP Codes with the same three initial digits contains more than 20,000 people. 2b. The initial three digits of a ZIP Code for all such geographic units containing 20,000 or fewer people are changed to 000. 3 All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, and date of death, and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older. 4 Telephone numbers. 5 Facsimile numbers. 6 Electronic mail addresses. 7 Social security numbers. 8 Medical record numbers. 9 Health plan beneficiary numbers. 10 Account numbers. 11 Certificate/license numbers. 12 Vehicle identifiers and serial numbers, including license plate numbers. 13 Device identifiers and serial numbers. 14 Web universal resource locators (URLs). 15 Internet protocol (IP) address numbers. 16 Biometric identifiers, including fingerprints and voiceprints. 17 Full‐face photographic images and any comparable images. 18 Any other unique identifying number, characteristic, or code, unless otherwise permitted by the Privacy Rule for re‐identification. Even though ‘raw data’ can be de‐identified (anonymized) so that there is no way to trace back the data to the study participant from which it was drawn, there are still questions whether the ‘de‐identified raw data’ can be given to other researchers or made public without the original study participant’s approval. It may be the case that this approval could be done at the start of any research study where the individual considering study participation would be counseled on what the process of de‐identification consists of and would be asked whether the participant would allow use of the data by other researchers or made available to the public in a de‐identified state. However, there may be questions of the study participants as to whether the data are truly de‐identified and untraceable back to the study participant since the participant would not be able to see the process actually being carried out in detail in all relevant circumstances. Using Raw Data in Context Simply being in possession of raw data is never enough to build on that data from a research perspective. Researchers need to understand the context of the scientific research study in which the data were collected. This research context includes (but is not limited to): (i) the scientific hypothesis of the research study, (ii) the inclusion and exclusion criteria selected by the research designers of the study to determine which study participants were included and which were excluded from the study, (iii) the methods used to collect the data and possibilities of errors in the data collection processes, and (iv) answers to questions regarding whether any data were excluded from the study data and why these data were excluded. Ownership Rights Over Data There are ownership rights over data. Ownership rights include court decision making related to the question which parties are to be considered as the owners of the data. Possible owners here include (but are not limited to) (i) the study sponsor whose only role was to fund that study, (ii) the principal investigator(s) who developed the scientific hypothesis, and (iii) individual study participants through special contracts made by individual participants who negotiate such contracts with study sponsors and principal investigators to share in the ownership of data. Examples of such data are participant sources of unique gene lines or unique cell lines to be used in future research. Objections to Data Sharing Finally, individual researchers may simply object to sharing data. A researcher’s arguments here may be simply stating that he or she has a right to fully analyze the data since the collection of the data was the researchers’ idea in the first place. These researchers may argue that they have the right to mine the data as fully as they can before deciding to make the data open to the public for others to analyze. Works Cited 1 Kaiser, J. ‘Making Clinical Data Widely Available.’Science 322.5899 (10 Oct. 2008): 217–8. 2 de Lusignan, S., J.F. Metsemakers, P. Houwink, V. Gunnarsdottir, and J. van der Lei. ‘Routinely Collected General Practice Data: Goldmines for Research? A Report of the European Federation for Medical Informatics Primary Care Informatics Working Group (EFMI PCIWG) from MIE2006, Maastricht, The Netherlands.’Informatics in Primary Care 14.3 (2006): 203–9. 3 Sim, I. ‘Human Studies Database Project’, CTSA Data Repositories Symposium (17 Oct. 2008). 23 Nov. 2010. 4 Sim, I., C.G. Chute, H. Lehmann, R. Nagarajan, M. Nahm, and R.H. Scheuermann. ‘Keeping Raw Data in Context.’Science 323.5915 (6 Feb. 2009): 713. 5 U.S. Department of Health and Human Services, National Institutes of Health, HIPAA Privacy Rule, Information for Researchers. 13 Nov. 2010. 6 Wilczynski, N.L., R.B. Haynes, and Hedges Team. ‘EMBASE Search Strategies for Identifying Methodologically Sound Diagnostic Studies for Use by Clinicians and Researchers.’BMC Medicine 29.3 (March 2005): 7. (shrink)

This guide accompanies the following article(s): ‘Full Disclosure of the “Raw Data” of Research on Humans: Citizens’ Rights, Product Manufacturer’s Obligations and the Quality of the Scientific Database.’Philosophy Compass 6/2 (2011): 90–99. doi: 10.1111/j.1747‐9991.2010.00376.x Author’s Introduction Securing consent (and informed consent) from patients and research study participants is a key concern in patient care and research on humans. Yet, the legal doctrines of consent and informed consent differ in their applications. In patient care, the judicial doctrines of consent and informed (...) consent are disclosure doctrines based on the obligation of physicians to inform their patients of the following types of information: the nature of the procedure the physician is recommending in the patent’s care (P), the alternatives to the physician‐recommendation (A), and the risks of procedure and its alternatives (R). In addition, the physician must provide truthful answers to the patient’s questions (Q) to the best of the physician’s abilities. In research on humans, the onus of disclosure by study sponsors and principal investigators is much greater than in patient care precisely because the purpose of research is not patient care. The purpose of research is the identification and development of new generalizable knowledge. Thus, participation in a research study or trial may not benefit the study volunteer at all. In addition, the participant may carry a heavy risk burden in relationship to any testing of a newly designed drug or device as part of their experiences in the research study. Presently, despite the risks borne by the research study participant, the raw data collected from volunteers in research trials are treated by courts as if they were the private property of the study sponsor rather than generally owed to the public as would be expected by an effort like research participation aimed at contributing to the development of generalizable knowledge. This paper reviews the obligations that study sponsors owe to their study participants based on the very definition of research as a systematic activity whose purpose is to develop generalizable knowledge to help all humans. Author Recommends Court cases Canterbury v. Spence, United States Court of Appeals, District of Columbia Circuit 464 F.2d 772 (1972). (Federal appellate decision heard in the District of Columbia, USA) Reibl v. Hughes, 2 S.C.R. 880 (1980). (Supreme Court of Canada) Rogers v. Whitaker, 175 C.L. R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Canterbury v. Spence is the landmark Federal informed consent case in the United States heard in the District of Columbia. In this case, Judge Spottswood Robinson articulated the reasonable person standard of informed consent. This standard was subsequently adopted by the Supreme Court of Canada (Reibl v. Hughes, 2 S.C.R. 880 (1980)) and the High Court of Australia (Rogers v. Whitaker, 175 C.L. R. 479 (1992)). The House of Lords rejected the reasonable person standard in England in Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985). Book Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. This book is a detailed guide for the review of scientific and ethical aspects of research on humans contained in the research study protocols and research informed consent forms which need to be submitted by study sponsors and principal investigators to institutional review boards (IRBs) for IRB review before a research study can receive approval to be conducted within a human study population in those institutions over which the IRB has authority. It also presents basic definitions in the area of research on humans and basic approaches to help conduct a deep review of the underlying scientific and ethical issues that are present within a research study protocol and its accompanying research informed consent form. Report National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). This U.S. National Commission in the Belmont Report argued for the necessity of a reasonable volunteer standard in research on humans in the United States. Arguing that the professional standard and the reasonable person standard of consent and informed consent were insufficient to base a disclosure standard in research on humans, this National Commission developed the reasonable volunteer standard where a study participant is to be approached in research informed consent with that information that a reasonable volunteer would want to know. Online Materials Belmont Report: Syllabus Topics for Lecture and Discussion Week I: Introduction and Overview Readings: Rogers v. Whitaker, 175 C.L.R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week II: The Different Standards of Consent and Informed Consent Readings: Canterbury v. Spence, 464 F.2d 772 (1972). (Federal appellate opinion heard in the District of Columbia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week III: Definition of Research Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 2 and 3) Week IV: How to Review a Research Study Protocol and Research Informed Consent Form Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 4–6, 10, and 12–14) Week V: Obligations in Research of Humans Versus Patient Care Reading: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). Focus Questions • How do the judicial doctrines of consent in England and Australia compare to the judicial doctrines of informed consent in the United States and Canada? • How does a professional standard of disclosure differ from a reasonable person standard of disclosure? • What is the definition of research? • How is a research study (study proposal and research informed consent form) reviewed from scientific and ethical bases for considerations of approval by an IRB? • How do the obligations of a study sponsor, a principal investigator, and a research team conducting a research trial on human study participants differ from the obligations of a physician caring for a patient? • Should all raw data of research derived from humans be made available to the public for use in developing generalizable knowledge to help others, or should raw data be considered the private property of the study sponsors (for example, prescription drug manufacturers), who fund the research trials? Seminar/project Idea Draw a timeline of the development of the basic concepts of consent and informed consent in patient care and in patient research. On this timeline, first place the dates of the key court cases in England, the United States, Canada, and Australia on consent and informed consent. Then place the date of the development of the Belmont Report. Why do differences exist between these four countries in terms of the legal requirements of informedness of a patient (in medical care) and a study participant (in medical research)? What roles if any do the concepts of self‐determination and self‐decision have in consent and informed consent in patient care and in informed consent in research on humans among the four countries of interest? What are the realities of research on human participants that require a new standard of informed consent, the reasonable volunteer standard, to be developed beyond the two standards in patient care, the professional standard, and the reasonable person standard? Counterpoint Arguments The following are counterpoint arguments that need to be appreciated to more fully understand the concepts that impact the thesis that ‘raw data’ should be open to the public to allow the opportunity of checking of the results of its associated scientific paper and for further analysis. De‐Identified (Anonymized) Raw Data A current approach to identifying (anonymizinig) raw data is based on the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L.104‐191). HIPAA was enacted by the U.S. Congress in 1996 to keep a person’s medical information private. In a research study, a person’s private medical information can become research data. HIPAA’s Privacy Rule allows a covered entity to de‐identify data by removing all 18 elements that could be used to identify the individual or the individual’s relatives, employers, or household members; these elements are enumerated in the Privacy Rule. The covered entity must also have no actual knowledge that the remaining information could be used alone or in combination with other information to identify the individual who is the subject of the information. Under this method, the identifiers that must be removed are the following: 1 Names. 2 All geographic subdivisions smaller than a state, including street address, city, county, precinct, ZIP Code, and their equivalent geographical codes, except for the initial three digits of a ZIP Code if, according to the current publicly available data from the Bureau of the Census: 2a. The geographic unit formed by combining all ZIP Codes with the same three initial digits contains more than 20,000 people. 2b. The initial three digits of a ZIP Code for all such geographic units containing 20,000 or fewer people are changed to 000. 3 All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, and date of death, and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older. 4 Telephone numbers. 5 Facsimile numbers. 6 Electronic mail addresses. 7 Social security numbers. 8 Medical record numbers. 9 Health plan beneficiary numbers. 10 Account numbers. 11 Certificate/license numbers. 12 Vehicle identifiers and serial numbers, including license plate numbers. 13 Device identifiers and serial numbers. 14 Web universal resource locators (URLs). 15 Internet protocol (IP) address numbers. 16 Biometric identifiers, including fingerprints and voiceprints. 17 Full‐face photographic images and any comparable images. 18 Any other unique identifying number, characteristic, or code, unless otherwise permitted by the Privacy Rule for re‐identification. Even though ‘raw data’ can be de‐identified (anonymized) so that there is no way to trace back the data to the study participant from which it was drawn, there are still questions whether the ‘de‐identified raw data’ can be given to other researchers or made public without the original study participant’s approval. It may be the case that this approval could be done at the start of any research study where the individual considering study participation would be counseled on what the process of de‐identification consists of and would be asked whether the participant would allow use of the data by other researchers or made available to the public in a de‐identified state. However, there may be questions of the study participants as to whether the data are truly de‐identified and untraceable back to the study participant since the participant would not be able to see the process actually being carried out in detail in all relevant circumstances. Using Raw Data in Context Simply being in possession of raw data is never enough to build on that data from a research perspective. Researchers need to understand the context of the scientific research study in which the data were collected. This research context includes (but is not limited to): (i) the scientific hypothesis of the research study, (ii) the inclusion and exclusion criteria selected by the research designers of the study to determine which study participants were included and which were excluded from the study, (iii) the methods used to collect the data and possibilities of errors in the data collection processes, and (iv) answers to questions regarding whether any data were excluded from the study data and why these data were excluded. Ownership Rights Over Data There are ownership rights over data. Ownership rights include court decision making related to the question which parties are to be considered as the owners of the data. Possible owners here include (but are not limited to) (i) the study sponsor whose only role was to fund that study, (ii) the principal investigator(s) who developed the scientific hypothesis, and (iii) individual study participants through special contracts made by individual participants who negotiate such contracts with study sponsors and principal investigators to share in the ownership of data. Examples of such data are participant sources of unique gene lines or unique cell lines to be used in future research. Objections to Data Sharing Finally, individual researchers may simply object to sharing data. A researcher’s arguments here may be simply stating that he or she has a right to fully analyze the data since the collection of the data was the researchers’ idea in the first place. These researchers may argue that they have the right to mine the data as fully as they can before deciding to make the data open to the public for others to analyze. Works Cited 1 Kaiser, J. ‘Making Clinical Data Widely Available.’Science 322.5899 (10 Oct. 2008): 217–8. 2 de Lusignan, S., J.F. Metsemakers, P. Houwink, V. Gunnarsdottir, and J. van der Lei. ‘Routinely Collected General Practice Data: Goldmines for Research? A Report of the European Federation for Medical Informatics Primary Care Informatics Working Group (EFMI PCIWG) from MIE2006, Maastricht, The Netherlands.’Informatics in Primary Care 14.3 (2006): 203–9. 3 Sim, I. ‘Human Studies Database Project’, CTSA Data Repositories Symposium (17 Oct. 2008). 23 Nov. 2010. 4 Sim, I., C.G. Chute, H. Lehmann, R. Nagarajan, M. Nahm, and R.H. Scheuermann. ‘Keeping Raw Data in Context.’Science 323.5915 (6 Feb. 2009): 713. 5 U.S. Department of Health and Human Services, National Institutes of Health, HIPAA Privacy Rule, Information for Researchers. 13 Nov. 2010. 6 Wilczynski, N.L., R.B. Haynes, and Hedges Team. ‘EMBASE Search Strategies for Identifying Methodologically Sound Diagnostic Studies for Use by Clinicians and Researchers.’BMC Medicine 29.3 (March 2005): 7. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ethics of Salomon Maimon (1753-1800) DAVID BAUMGARDT* SALOMON MAIMON is now generally considered the most acute mind among the earliest critics of Kant. Kant himself had praised his acumen,1 though later qualifying his regard decisively.2 Johann Gottfried Herder called * We have just learned of the death of the author. David Baumgardt, born in Germany on April 20, 1890, studied in Vienna and in Berlin and taught (...) philosophy at the University of Berlin from 1924 to 1935 as Privatdozent, Extraordinarius and Ordinarius, until he was forced by Germany's racial laws to resign, but after the end of the war the Free University of Berlin appointed him honorary professor. From 1935 to 1939 he taught at the University of Birmingham; after his arrival in the United States he first joined the staff of the Pendle Hill School and, from 1941 to 1954, he served with the Library of Congress as a consultant in the field of philosophy. In 1955-56 he was Visiting Professor of Philosophy at Columbia. After his retirement he continued to publish and at present there are five publications by him in the press. The number of books and articles written by him probably well exceeds two hundred. Just in the last months of his life he was presented with a Festschri[t (Horizons of a Philosopher), indicative of a wide range of friends, students, and fellow-scholars who wanted to express their appreciation of the man and his work. On the continent Baumgardt was perhaps best known for two books: Franz yon Baader (1927) and Der Kampf um den Lebenssinn unter den Vorliiufern der Modernen Ethik (1933). The former threw full light on an important but unduly neglected figure of the German romantic school of philosophy; the latter confronts Kant's rationalistic ethics with the irrationalism of a Herder, Hemsterhuis, and Jacobi. In the United States he published, among others, Bentham and the Ethics of Today (1952) and Great Western Mystics (1961), originally delivered as Matchette Lectures, but enriched, for publication, by voluminous notes containing a wealth of information on mystics, some of whom, especially Jewish ones, are familiar only to the expert. At the time of his death he was working on a book which would probably have become his opus magnum: an attempt to reconcile what he called the ethics of force with the ethics of love. Baumgardt described his own philosophic position as that of a Benthamian hedonist, asserting that only hedonism, when carried to its conclusions, would permit such a reconciliation. Systematic, ethical and religious problems underlay all his historic research; thus his loss will be felt keenly and widely. (PHILIP MERLAN) t See Kant's Gesammelte Schri[ten, ed. K6nig. Preuss. Akad. Wissenschaften, Vol. XI, Abt. II, Kant's Briefwechsel (1900), Vol. II, p. 49, letter to Marcus Herz, May 26, 1789: "Nicht allein" hat "niemand yon meinen Gegnern reich und die Hauptfrage so wohl verstanden, sondern nur wenige... mochten zu dergleichen tiefen Untersuchungen so viel Scharfsinn besitzen... als Hr. Maymon." 2See ibid., p. 476, letter to Carl Leonhard Reinhold, March 28, 1794: "Was aber z. B. ein Maimon mit seiner Nachbesserung der critischen Philosophie... eigentlich wolle," habe ich "nie recht fassen k6nnen." The noticeable change in Kant's judgment of Maimon's work is hardly due to the fact that his praising remarks were addressed to a Jewish friend and the disapproving ones to a gentile disciple. The reason for this shift in his evaluation of Maimon's later writings 099] 200 HISTORY OF PHILOSOPHY Maimon's Versuch iiber die Transzendentalphilosophie "profound" and "comprehensive.''~ Even Goethe and Schiller mentioned him with esteem in their correspondence;~ and Johann Gottlieb Fichte explicitly' warned that coming centuries would ridicule us bitterly for disregarding this "immensely great talent." It may, therefore, not be out of place if, even more than 150 years after Maimon's death, some attention is paid to his generally neglected criticism of Kant's categorical imperative. Maimon's acute critical observations on Kant's ethics may claim to be of interest even to the analysis of some basic issues of contemporary moral philosophy. In an autobiography, culturally of general interest, edited by the psychologist and esthetician Karl... (shrink)

Poe’s influence on the Symbolists has been traced on many occasions, though not in detail. The classical study in English is Eliot’s “From Poe to Valéry,” a Library of Congress lecture delivered three years after Valéry’s death.2 Eliot defines Poe as irresponsible and immature—irresponsible in style, immature in vision. He had, Eliot comments, “the intellect of a highly gifted young person before puberty”; “all of his ideas seem to be entertained rather than believed” . How, then, we ask, did (...) he hoax the sophisticated French? Although Eliot raises the issue of their relative ignorance of English, he prudently does not make much of it: after all, we know that Baudelaire spent seventeen years on the tales, Mallarmé still longer on the poems—thirty years for the definitive text; while Valéry, to whom Baudelaire and Mallarmé left little to translate, managed a version of the Marginalia. Each might have said, as Mallarmé did in 1885, that he had learned English for one sole reason: “to read Poe better.”3 In the matter of linguistic competence, then, Eliot is content to remark that the French poets “were not disturbed by weaknesses of which we are very much aware” . He underlines, however, that Poe showed different facets of himself to each of his readers who adopted him in various ways: Baudelaire focused on the Poète maudit, Mallarmé on the prosodist, and Valéry on the theoretician in whom he discovered “a method and an occupation—that of observing himself write” . So Poe had a diverse effect, which Eliot accepts more readily in respect of Baudelaire and Mallarmé than he does of Valéry. To explain this last case which intrigues him especially, he introduces a paradox: “with Poe and Valéry, extremes meet,” he writes, “the immature mind playing with ideas because it had not developed to the point of convictions, and the very adult mind playing with ideas because it was too skeptical to hold convictions” .Thus Eliot damns Poe with faint praise. The distance between cause and effect, master and disciples is so vast that it can only be thought the product of monstrous error. And yet “from Poet to Valéry” and the complementary studies in English or French of the past thirty-five years neglect some deeper factors that drew the Symbolists. Misreadings there were no doubt since such are in the nature of things, but these authors were sensitive to currents that others overlooked. They attempted to go to first principles, not only because Poe was “ce poète incomparable, ce philosophe non refute” 4 and, therefore, worthy of scrutiny, but because they held him to be vital to their future thought. In a period of great social and aesthetic change they found a figure of radical independence—classicist, visionary, logician supreme—whom they explained by convergent tropes of daemonic power. In this regard the newly published correspondence of Mallarmé and the massive Valéry notebooks have added to our knowledge. I would like, then, to consider the nature of Poe’s action, this submerged dialogue in time and successive rewriting by which—“à l’égal de nos maître les plus chers ou vénérés,” as Mallarmé put it5—he entered the mainstream of French poetry. 2. The lecture was later published in Hudson Review 2 : 335; all further references to this work, abbreviated “FPV,” will be included in the text.3. Mallarmé, “Autobiographie,” Oeuvres completes, p. 662.4. Baudelaire, “Le Poème du hachisch,” Oeuvres complètes, 1:427.5. Mallarmé, “Scolies,” Oeuvres completes, p. 223. James Lawler, Edward arson Waller Distinguished Service Professor of French at the University of Chicago, has written extensively on nineteenth- and twentieth-century French poetry. Among his books are Lecture de Valéry, The Language of French Symbolism, The Poet as Analyst, and René Char: The Myth and the Poem. He is currently completing a study of Buadelaire’s Les Fleurs du mal. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.1 (2003) 53-64 [Access article in PDF] Incentives for Providing Organs Patricia Milmoe McCarrick and Martina Darragh After a contentious debate at its 2002 annual meeting, the American Medical Association's House of Delegates voted to endorse the opinion of its Council on Ethical and Judicial Affairs that the impact of financial incentives on organ donation should be studied (Josefson 2002). The shortage of organs (...) for transplantation has been an ongoing problem for more than 20 years. In June1981, Representative Philip Crane (R-IL) introduced legislation in the U.S. House of Representatives proposing a $25,000 income tax deduction and a $25,000 estate tax exclusion for donating an organ (Tax Incentives 1981). Still the National Organ Transplant Act enacted in October 1984 prohibited the offering of any "valuable consideration" in return for organs (United States 1984).The developments of a legal market for tissues in the United States and a black market for organs around the world have raised the question of whether donation without compensation is the only ethically viable option. Some critics of the current system claim reliance on donation actually promotes a black market in organs (Kaserman and Barnett 2002, p. 38; Palmer 1999, p. 36). In addition, a new set of compensation issues has arisen as living kidney donor transplantations begin to rival those performed with cadaveric organs (United States 2001).As a result, current suggestions for incentives go far beyond the traditional death benefit payment to include such ideas as medals of honor for donors, reimbursement for funeral expenses, exchange programs for organ donation, and special medical insurance for living organ donors. Numerous bills introduced into the 107th Congress have proposed such incentives (Delmonico et al. 2002.) In October 2002, the U.S. Department of Health and Human Services awarded $5.2 million in grants to study both clinical and behavioral interventions for increasing organ donations that do not involve incentives. The inspiration for some of the funded proposals comes from the successes of Spain's social services and the United Kingdom's clinical administration of organ procurement programs (Robeznieks 2002). [End Page 53]With a nod to evidence-based medicine, the underlying concern expressed in much of the current literature is that no idea for increasing the supply of organs should be discounted before it is studied. This bibliography provides a short introduction to the range of opinions expressed on the issue of incentives for providing organs.al-Mousawi, M.; Samhan, M.; al-Mezairee I.; Razzak, M.A.; and Khawari, F. Cadaver Organ Procurement in Kuwait. Transplantation Proceedings 31 (8): 3375-76, 1999.The authors describe a protocol that significantly increased cadaveric organ donation and credit it with fostering the expansion of an organ sharing program among the Arab Gulf states. Developed by Kuwaiti neurologists and anesthetists after a continuing education course on transplantation, the protocol places a special emphasis on the role of local transplant coordinators who facilitate the investigation of brain death cases by neurologists.Arnold, Robert; Bartlett, Steven; Bernat, James; et al. [Ethics Committee of the American Society of Transplant Surgeons] Financial Incentives for Cadaver Organ Donation: an Ethical Reappraisal. Transplantation 73 (8): 1361-67, 27 April 2002.To prepare for proposed studies of financial incentives for organ donation, the American Society of Transplant Surgeons convened a panel to develop a methodology for evaluating the ethics of such research. Comprised of organ procurement organization executives, physicians, surgeons, and ethicists, the panel generated a list of nine criteria for use in judging any incentives proposal. While opposed to direct payment or tax incentives for organ donation, a majority of the members support funeral expense reimbursement or charitable contributions as incentives that would not violate or undermine the ideal of altruism.Cameron, J. Stewart, and Hoffenberg, Raymond. The Ethics of Organ Transplantation Reconsidered: Paid Organ Donation and the Use of Executed Prisoners as Donors. Kidney International 55 (2): 724-32, February 1999.After reviewing arguments for and against payment for organ procurement, the authors apply these arguments to the specific case of obtaining organs from executed... (shrink)

Artificial intelligence holds great promise for improved health‐care outcomes. But it also poses substantial new hazards, including algorithmic discrimination. For example, an algorithm used to identify candidates for beneficial “high risk care management” programs routinely failed to select racial minorities. Furthermore, some algorithms deliberately adjust for race in ways that divert resources away from minority patients. To illustrate, algorithms have underestimated African Americans’ risks of kidney stones and death from heart failure. Algorithmic discrimination can violate Title VI of the (...) Civil Rights Act and Section 1557 of the Affordable Care Act when it unjustifiably disadvantages underserved populations. This article urges that both legal and technical tools be deployed to promote AI fairness. Plaintiffs should be able to assert disparate impact claims in health‐care litigation, and Congress should enact an Algorithmic Accountability Act. In addition, fairness should be a key element in designing, implementing, validating, and employing AI. (shrink)

In 1992, the United States Supreme Court, in Planned Parenthood of Southeastern Pennsylvania v. Casey, upheld the ruling in Roe v. Wade, namely that women have a right “to choose to have an abortion before viability and to obtain it without undue interference from the State.”1 However, since this ruling, some states have imposed regulations that greatly limit this right by restricting access. Texas is a recent example of this. Two proposed restrictions in House Bill 2, which will be discussed (...) in detail below, will force all but eight clinics that are located in metropolitan areas to shut down. The U.S. Supreme Court put the proposed restrictions on hold in October 2014, allowing several clinics to remain open while the restrictions are being appealed in the U.S. Court of Appeals for the Fifth Circuit. If the restrictions are passed, however, those clinics will be forced to shut down and, as a result, many women in Texas will be required to travel more than 100 miles in order to access a safe and legal abortion. Much of the focus of these restrictions has been on women and rightly so. However, I want to turn the attention to physicians. The requirements exacerbate unfair treatment of abortion providers compared with other physicians. Abortion providers face threats from the public—some of which turn into violent attacks—and they are often ostracized by their fellow medical practitioners. There are so few abortion providers to begin with and the proposed requirements limit these physicians’ opportunities to practice the branch of medicine of their choosing. Although the HB 2 requirements may not result in an unconstitutional undue burden on physicians, the challenges created by the bill limit physicians’ abilities to provide abortions. As a result of these limits, HB 2 creates an unconstitutional undue burden for women seeking abortions by creating barriers directed at abortion providers and clinic staff who are willing and able to provide abortions. The first of the two controversial HB 2 requirements is the admitting privileges requirement: “A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced.”2 The second requirement is the ambulatory surgical center requirement: “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under [Texas Health & Safety Code] [...] for ambulatory surgical centres.”3 In order to meet these state-mandated obligations, some abortion clinics would have to spend more than $1 million in upgrades if they wish to remain open. The District Court decided that the ambulatory surgical center requirement places an unconstitutional undue burden on women, and that the two requirements together place an undue burden on women in Texas and especially in the Rio Grande Valley where the nearest clinic is a couple hundred miles away.4 Later, the U.S. Court of Appeals for the Fifth Circuit reversed the District Court’s decision and argued, “the admitting privileges requirement is constitutional on its face.”5 While the regulations are being appealed, the Supreme Court granted a stay of injunction, allowing about twelve abortion clinics to reopen until a final decision regarding the regulations is made. The District Court ruled that the purpose of the two regulations was to create a substantial obstacle for women seeking abortions in Texas. While the defendants argued that the regulations were designed to make abortions safer and reduce risk, the Court decided that this was not the case. An abortion, especially a first-term abortion, is a very safe procedure and is safer than many other routine surgical procedures. As stated in Planned Parenthood v. Casey, “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”6 The undue burden in this case is imposed, not through restricting women’s access directly, but by restricting physicians’ freedom to perform abortions. The admitting privileges requirement has reduced the number of physicians who can perform abortions and the ambulatory surgical center requirement has reduced the number of clinics where abortions can be performed. The American Medical Association states, “[t]he Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.”7 This means that physicians are not required to perform abortions, except in emergency situations, but can as long as the procedure is done safely and does not violate the law. The new Texas regulations, however, are so restrictive that few abortion providers, limited to only four urban areas, can legally perform abortions. Physicians do not have an absolute right to perform abortions as opposed to women who have an absolute right to have access to an abortion. Physicians do face many challenges that other professionals face in terms of obtaining qualifications and finding work. Abortion providers, however, face challenges that most other physicians do not. The restrictions imposed by these regulations exacerbate unfair treatment toward abortion providers and place further obstacles in their path in terms of providing the service they want and are qualified to provide. Both abortion clinics and abortion providers are being treated differently from other medical clinics and physicians. For instance, “grandfathering of existing facilities and the granting of waivers from specific requirements is prohibited for abortion providers, although other types of ambulatory surgical facilities are frequently granted waivers or are grandfathered.”8 Many abortion clinics cannot afford the necessary upgrades. Furthermore, it is extremely expensive to open a brand new clinic that complies with the ambulatory surgical center requirements. Being grandfathered in would be the only option available to abortion clinics that cannot afford the upgrade. However, unfair treatment of abortion clinics and providers is preventing those clinics from being grandfathered into the new system. As a result, many abortion clinics may be forced to close. Admitting privileges are proving difficult or impossible for physicians both to obtain and, for those who have already been granted privileges, to keep. Dr. Sherwood Lynn, an obstetrician-gynecologist who has performed abortions for decades, describes the process of obtaining admitting privileges and the difficulties abortion providers face. After sending in an application a physician must wait for the hospital to send them the required materials, “but if the address of the practice on the application is of an abortion provider or clinic, [the hospital] won’t send [them] the package of materials required. [They] simply can’t apply.”9 Dr. Lynn and several other physicians have surmised that hospitals are only withholding privileges from qualified physicians who perform abortions and that other physicians do not face this discriminatory treatment. Hospitals have also revoked privileges granted to physicians after learning that the physicians perform abortions. For instance, in Texas two doctors, “received notices [...] informing them that their admitting privileges to the University General Hospital of Dallas have been revoked, with the hospital’s CEO claiming the hospital was unaware they were providing abortion care and that the hospital believed such care would damage its reputation.”10 What is curious about this revocation is that, “federal and state laws [...] forbid hospitals from discriminating against doctors who perform abortions,” and yet hospitals are clearly doing just that.11 Dr. Pamela Richter, another abortion provider in Texas, had her temporary admitting privileges revoked with no explanation and because of this, the clinic where she performed abortions, Reproductive Services, can no longer provide abortions at all.12 As the hospital gave no reason for the revocation, it not clear Dr. Richter’s privileges were revoked because she performs abortions. Dr. Richter, however, has performed over 17,000 abortions and her privileges were revoked soon after HB 2 was introduced.13 According to the Texas Hospital Association, giving admitting privileges to doctors who do not work for the hospital is expensive and time-consuming but this does not account for the fact that hospitals are revoking previously granted privileges from physicians whom they learn are providing abortion services.14 As mentioned previously, the District Court found that the admitting privileges requirement and the ambulatory surgical center requirement do not further ensure the health and safety of women undergoing an abortion. Several physicians have testified to this fact. Dr. Lynn stated in an interview: The admitting privileges requirements are [...] absolutely unnecessary. If you have a number of patients waiting for procedures, and something happens and a patient needs to be transferred to a hospital, you’re not going to leave everyone else and go to the hospital. That makes no sense. You’re going to refer that person to a gynecologist at the hospital. There is no safety issue involved here. If a patient shows up with an emergency, every hospital is required to admit that patient. They have to by law.15 It is rare that complications will arise from an abortion performed in a clinic. Dr. Richter, for example, has performed more than 17,000 abortions and not once had to send a patient to a hospital because of complications resulting from the procedure. According to Dr. Lynn even if abortion providers were granted privileges to hospitals, it is unlikely that they will exercise them. In essence, having admitting privileges at a hospital does nothing to further ensure the safety of an already safe procedure. The only result of the admitting privileges requirement is to limit certain physicians’ ability to perform legal abortions. Not only do the HB 2 requirements fail to further ensure the health and safety of women, the HB 2 requirements may actually create more health risks to women who cannot access the eight remaining clinics. The first risk is that the remaining clinics would have an influx of patients that they may not be able to handle, forcing women to wait longer for an appointment. As stated by the District Court, “[e]ven assuming every woman in Texas who wants an abortion [...] could travel to one of the four metropolitan areas where abortions will still be available, the cumulative results of HB 2 are that, at most, eight providers would have to handle the abortion demand of the entire state.”16 Furthermore, “[t]hat the State suggests that these seven or eight providers could meet the demand of the entire state stretches credulity.”17 Abortion is a time sensitive procedure. It is safest when performed early in a pregnancy. The increase in patients to these remaining clinics, assuming all women in Texas can access them, will increase wait times and may force women to have abortions later in pregnancy. In the worst-case scenario, a woman would not see an abortion provider at all before viability. Such instances may be rare, but they are possible. In such cases, women’s access to legal abortions becomes impossible and thereby violate the ruling in Roe. Clinics may be able to avoid the aforementioned problems if they hire more physicians. However, there are two barriers to hiring more physicians. First, as mentioned previously, admitting privileges to Texas hospitals are difficult, if not impossible, for abortion providers to obtain. Second, given the negative treatment of abortion providers by anti-abortion groups, many physicians are not willing to perform abortions. The harassment abortion providers face is unique to those physicians and many physicians will not perform abortions for that reason. In an article published in the Austin Chronicle, anti- abortion activist Abby Johnson, “discusses how her group investigated appraisal district records to find the new location of where an Austin abortion physician plans to work.”18 Johnson states, “These abortionists are feeling the pressure from the pro-life movement in Texas. I think they feel like they’re on the run. And that’s how we want to keep it.”19 If the HB 2 requirements are passed and there remain at most eight abortion providers in Texas, these activists will concentrate on those clinics and, “the dangerous impact of their intimidation tactics will be exacerbated.”20 Even if the number of physicians needed to meet the demand in Texas can obtain admitting privileges and work at one of the remaining clinics, they may choose not to do such work because they are putting themselves at risk. The harm abortion providers face from such anti-abortion groups is not unique to Texas. There are stories from all over the country and from other countries where abortion is legal of physicians receiving death threats. Dr. George Tiller, an abortion provider in Kansas, was killed outside his church and had received numerous death threats prior to this. The HB 2 requirements are making it so that abortion providers either cannot provide their services any longer or will face increased threats and increased danger to themselves. Physicians are allowed to conscientiously object to providing medical interventions in certain circumstances for moral and religious reasons. However, there are limits on this right. According to the American Congress of Obstetricians and Gynecologists, “[w]hen conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal.”21 I would argue fear for one’s safety in the face of immediate threats is perhaps a stronger ground on which to refuse to provide care than a personal belief that abortion is immoral or against one’s religion. ACOG also states, “[p]roviders with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide.”22 This responsibility has been largely disputed by the medical community but in cases of rape, incest, and health risks to women, referrals must be made without exception. However, under the requirements of HB 2, working in proximity to an abortion provider may not be possible because they are so geographically limited. Referrals are supposed to be made within reason. Some areas of Texas, such as the Rio Grande Valley, are up to 200 miles away from the nearest clinic that would remain open if HB 2 is passed. Referrals may simply not be feasible given the geographical distances and the decreasing number of available physicians. As mentioned above, there are two risks to the health and safety of women as a result of HB 2. The second of these is that if a woman cannot access one of the remaining clinics, she may seek out a more convenient but illegal and unsafe abortion, which is far more likely to result in a dangerous complication. Dr. Lynn states, “[b]ecause of the restrictions lawmakers impose, women will seek abortions illegally, and we’re going to see a rise in septic abortions.”23 Some areas of Texas might effectively revert back to a pre-Roe era where abortions were performed in unsanitary conditions by unqualified people resulting in dangerous medical complications far more often than legal abortion procedures do now. Physicians like Dr. Lynn who want to prevent this from happening generally cannot do so without facing legal sanction. Physicians have a duty to provide safe medical care and if they cannot obtain admitting privileges, they cannot exercise this duty. ACOG released a statement expressing their objections to the new requirements. They state that HB 2 is, “plainly intended to restrict the reproductive rights of women in Texas through a series of requirements that improperly regulate medical practice and interfere with the patient-physician relationship.”24 Executive Vice-President of ACOG, Hal C. Lawrence III stated: The Texas bills set a dangerous precedent of a legislature telling doctors how to practice medicine and how to care for individual patients. ACOG opposes legislative interference, and strongly believes that decisions about medical care must be based on scientific evidence and made by licensed medical professionals, not the state or federal government.25 Abortion is one of only a few areas of medicine where the legislature imposes so many regulations restricting particular physicians’ ability to practice medicine. Not only are abortions providers being regulated by the state, they are also facing clear discrimination from others within the medical community. The state is closing down clinics that do not meet the ambulatory surgical center requirements and hospitals are denying physicians admitting privileges because they perform abortions. In summary, abortion providers are being discriminated against both by the legislature and other members of the medical community. Other physicians who do not perform abortions are not denied admitting privileges on discriminatory grounds. Clinics that cannot afford upgrades to become an ambulatory surgical center are being grandfathered in, while abortion clinics are being forced to close down. Ob-Gyns who conscientiously object to performing abortions and who are not located in close proximity to at least one abortion provider cannot effectively fulfill their duty to refer patients. Lastly, given the barriers these regulations will create, there will likely be a rise in complications resulting from abortions provided under grossly unsafe conditions. Physicians, whose duty it is to provide safe and effective medical care, are being denied the right to exercise this duty. While this denial may not be unconstitutional, it is certainly unjust and discriminatory and creates obstacles that other physicians do not face. Most importantly, these obstacles are creating an undue burden for women. The HB 2 requirements do not increase the health and safety of abortions; all they do is create substantial obstacles for women. In light of these observations, the requirements seem to me to be in clear violation of Casey, in which it was decided that, “[u]nnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on that right.”26 These regulations do just what Casey was meant to prohibit and this is accomplished through limiting physicians’ ability to practice safe abortions across the state of Texas. Therefore, the HB 2 requirements may not impose an undue burden on doctors but they do impose an undue burden on women. PDF available: Rachel Hill, "Texas HB 2," Voices in Bioethics. References: 1 Planned Parenthood of Southeastern Pennsylvania v. Casey, pg. 2. 2 Whole Women’s Health v. Lakey, pg. 2. 3 Ibid. 4 Ibid., 4. 5 Ibid., 2. 6 Planned Parenthood v. Casey, pg. 16 7 AMA Code of Medical Ethics, “Opinion 2.01 – Abortion,” American Medical Association. 8 Whole Women’s Health v. Lakey, pg. 10. 9 Dr. Sherwood Lynn, “A Texas Ob-Gyn Details the Horrific Consequences of Abortion Restrictions,” Cosmopolitan. 10 Feminist Newswire, “Texas Hospitals Revoke Admitting Privileges to Abortion Providers,” Feminist Majority Foundation Blog. 11 Ibid. 12 Ibid. 13 Ibid. 14 Glenn Hegar, “Texas Hospital Association’s Statement of Opposition to Section 2 of the Committee Substitute for Senate Bill 5,” Texas Hospital Association. 15 Dr. Lynn, “A Texas Ob-Gyn.” 16 Whole Women’s Health v. Lakey, pg. 10. 17 Ibid. 18 Mary Tuma, “Undercover Audio Reveals Anti-Abortion Tactics: Anti-abortion activists monitor and track providers, patients,” Austin Chronicle. 19 Ibid. 20 Ibid. 21 Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” The American Congress of Obstetricians and Gynecologists. 22 Ibid. 23 Dr. Lynn, “A Texas Ob-Gyn.” 24 “Ob-Gyns Denounce Texas Abortion Legislation: Senate Bill 1 and House Bill 2 Set Dangerous Precedent,” The American Congress of Obstetricians and Gynecologists. 25 Ibid. 26 Planned Parenthood v. Casey, pg. 16. (shrink)

Stem cell research represents the most promising field of investigation for treatment of many degenerative diseases. The veto against this research condemns millions of people to a life with little hope of cureO vous, les boutefeux, ô vous les bons apôtres, Mourez donc les premiers, nous vous cédons le pas, Mais de grâce, morbleu! laissez vivre les autres!Last year, Rome hosted the first meeting of the World Congress For Freedom of Scientific Research.The Congress was organised by the Luca Coscioni Association, (...) an organisation of scientists, patients and citizens committed to freedom of scientific research and the assertion of the rights of patients and disabled people.The Congress was exceptional for at least three reasons:First, the moving force of the whole congress, and of the many struggles for freedom conducted by the Luca Coscioni Association, has been Luca Coscioni himself, the President of the Association. Despite the severe degenerative illness that rendered Luca immobile and destined him to tragic and premature death, Luca remained committed to the ideals of freedom, and on the first day of the Congress, just days before his death, he eloquently expressed his appeal. This not only touched every one present, but also reminded us all that when we talk of scientific research, we talk of real people, who have real lives and real illnesses, and who are destined to die prematurely and in agony unless treatment is found—and hope for treatment for many degenerative diseases bears upon embryonic stem cell research. Luca reminded us that while the public discusses …. (shrink)

Volume Eight of the project documenting Thomas Jefferson's last years presents 591 documents dated from 1 October 1814 to 31 August 1815. Jefferson is overjoyed by American victories late in the War of 1812 and highly interested in the treaty negotiations that ultimately end the conflict. Following Congress's decision to purchase his library, he oversees the counting, packing, and transportation of his books to Washington. Jefferson uses most of the funds from the sale to pay old debts but spends some (...) of the proceeds on new titles. He resigns from the presidency of the American Philosophical Society, revises draft chapters of Louis H. Girardin's history of Virginia, and advises William Wirt on revolutionary-era Stamp Act resolutions. Jefferson criticizes those who discuss politics from the pulpit, and he drafts a bill to transform the Albemarle Academy into Central College. Monticello visitors Francis W. Gilmer, Francis C. Gray, and George Ticknor describe the mountaintop and its inhabitants, and Gray's visit leads to an exchange with Jefferson about how many generations of white interbreeding it takes to clear Negro blood. Finally, although death takes his nephew Peter Carr and brother Randolph Jefferson, the marriage of his grandson Thomas Jefferson Randolph is a continuing source of great happiness. Some images inside the book are unavailable due to digital copyright restrictions. (shrink)

In his 1622 work The Assayer, Galileo commented on the necessity of mathematics for understanding the natural world. "Philosophy is written in this very great book. . . . It is written in mathematical language and the characters are triangles, circles and other geometrical figures." More than 300 years later, debating math education at the 1958 International Congress of Mathematicians, French mathematician Jean Dieudonné interjected: "Down with Euclid! Death to triangles!".

Nietzsche's ideas were widely disseminated among and appropriated by the first Hebrew Zionist writers and leaders. It seems quite appropriate, then, that the first Zionist Congress was held in Basle, where Nietzsche spent several years as a professor of classical philology. This coincidence gains profound significance when we see Nietzsche's impact on the first Zionist leaders and writers in Europe as well as his presence in Palestine and, later, in the State of Israel.--from the Introduction The early Zionists were deeply (...) concerned with the authenticity of the modern Jew qua person and with the content and direction of the reawakening Hebrew culture. Nietzsche too was propagating his highest ideal of a personal authenticity. Yet the affinities in their thought, and the formative impact of Nietzsche on the first leaders and writers of the Zionist movement, have attracted very little attention from intellectual historians. Indeed, the antisemitic uses to which Nietzsche's thought was turned after his death have led most commentators to assume the philosopher's antipathy to Jewish aspirations. Jacob Golomb proposes a Nietzsche whose sympathies overturn such preconceptions and details for the first time how Nietzsche's philosophy inspired Zionist leaders, ideologues, and writers to create a modern Hebrew culture. Golomb cites Ahad Ha'am, Micha Josef Berdichevski, Martin Buber, Theodor Herzl, Max Nordau, and Hillel Zeitlin as examples of Zionists who dared to look into Nietzsche's abyss. This book tells us what they found. --Allan Arkush, author of Moses Mendelssohn and the Enlightenment "Jerusalem Post". (shrink)

The potato blight that struck Ireland in 1845 led to ineffable suffering that sent shockwaves throughout the Anglosphere. The Irish Famine is deemed to be the first national calamity to attract extensive help and support from all around the world. Even though the Irish did not receive adequate support from the British government, their ordeal was mitigated by private charity. Without the donations from a great number of individuals, the death toll among the famished Irishmen and Irishwomen would have (...) been definitely higher. The greatest and most generous amount of assistance came from the United States. In spite of the fact that the U.S. Congress did not decide to earmark any money for the support of famine-stricken Ireland, the horrors taking place in this part of the British Empire pulled at American citizens’ heartstrings and they contributed munificently to the help of the Irish people. Aiding Ireland was embraced by the American press, which, unlike major British newspapers, lauded private efforts to bring succour to the Irish. Such American newspapers as the Daily National Intelligencer, the New York Herald and the Liberator encouraged their readers to contribute to the relief of Ireland and applauded efforts to help the Irish. The aim of this essay is to argue that the American press, in general, played a significant role in encouraging private charity in the United States towards the Irish at the time of An Gorta Mór and, thus, helped to save many lives. (shrink)

Pessimism distilled: Happiness is possible, but evil; unhappiness is likely, but futile.Very little is known of the bastard called Zobel Blake. We know he is the only person of record, bastard or otherwise, ever to be called by that name, and that his primary claim to historical significance lies in the fact that he was the very last man to languish to his death in an American debtors' prison. That such a distinction should befall an otherwise obscure man is (...) not surprising; that this notable death took place in New Orleans, however, in the year 1867, more than two decades after debtors' prisons had been formally abolished both by the U.S. Congress and by the state of Louisiana, might well wrinkle one's brow.Most of... (shrink)

Those are the words of Pope John Paul II, speaking in March 2004 to an international congress held in Rome. The conference was on "Life-sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas," and it was organized by the World Federation of Catholic Medical Associations and the Pontifical Academy for Life. The pope was able to cut through all the ethical dilemmas. Although he acknowledged that a patient in a persistent vegetative state, or PVS, "shows no evident sign of (...) selfawareness or of awareness of the environment, and seems unable to interact with others or to react to specific stimuli," he said that they should be kept alive indefinitely. Such patients, he insisted, "retain their human dignity in all its fullness" and "the loving gaze of God the Father continues to fall upon them." For this reason, he said, it is obligatory to continue to provide them with food and water, even if this can only be done through a tube. The pope added that to withdraw the tube, knowing that it will lead to the death of the patient, is "euthanasia by omission.". (shrink)

In 1951–1952 a selected committee appointed by the US Congress investigated the circumstances of the so-called Katyn Crime. The reasons why the highest US legislative body undertook the issue hale to be sought in the international situation of the day, which was determined by the Korean War.The “Katyn Committee” was called up on September 18, 1951 by the House of Representatives of the 82nd Congress on the strength of Resolution 390. Sitting on it were Daniel L. Flood, Thaddeus M. Machrowicz, (...) George A. Dondero, Foster Furcolo, Alvin K. O’Konski, Timothy P. Sheenan and Ray J. Madden, who was also appointed its chairman. The committee began interrogating witnesses on October 11, 1951 and closed the interrogations on November 14, 1952. Simultaneously, the committee inspected 183 material exhibits pertaining to the Katyn event. In all the committee took down the testimonies of 81 main and about 200 secondary witnesses as well as about a hundred written testimonies and accounts.The committee’s final report to the House of Representatives clearly stated the responsibility of the Soviet NKVD for the 1940 massacre of around 15,000 Polish officers from POW camps in Kozielsk, Starobielsk and Ostaszków.In response to the committee’s proceedings the east bloc staged a propaganda campaign aimed at discrediting its work and upholding the so-called Katyn Lie—a 1943—originated false version of the events whereby the executions of the Polish officers had been carried out by the Germans in the latter half of 1941.The Soviet government took an official stand on the committee on February 29, 1952. It rejected all possibility of cooperation and underscored the Germans’ responsibility for the massacre. On March 1, 1952 the Polish government issued a statement condemning the committee and reiterating the false version of the Katyn incident. This statement appeared in the March 1 edition of the national daily Trybuna Ludu under the heading, The Polish nation indignantly condemns the cynical provocations of American imperialists, who are feeding on the tragic deaths of thousands of Polish citizens in Katyn.The main wave of attacks on the Madden Committee rolled through the Eastern European press in March, 1952. It was most intense in the Soviet Union and Poland, but also penetrated to other countries like Czechoslovakia and Bulgaria. In the USSR most of the related coverage was published in the communist party daily Pravda. In Poland articles attacking the Madden Committee and propagating the false version of the Katyn events appeared in all dailies and periodicals, including the party, military, youth, branch and satirical press. Especially avid in this respect were papers brought out by the Czytelnik publishers, notably Życie Warszawy. Also published was a deceitful book The Truth About Katyn by Boleslaw Wójcicki.Simultaneously to the press campaign against the Madden Committee the eastern countries launched broad scale repressions involving the prosecution, courts and intelligence services. (shrink)

No provision of the Patient Protection and Affordable Care Act has proven to be more contentious than the so-called “individual mandate.” Starting in 2014, the mandate will impose a penalty on non-exempt individuals who lack health insurance. According to Congress, the mandate is essential to ensuring near universal coverage. Without it, PPACA’s insurance reforms will lead healthy individuals to delay purchasing health insurance until they require medical care, resulting in risk pools with a disproportionate share of high-risk people. The price (...) of insurance will then climb, causing more and more not-so-sick people to forego health insurance. The resulting “death spiral” will make insurance unaffordable to many more Americans. (shrink)