Book reviewed in this article: Informed Consent in Medical Therapy and Research. By Bernard Barber.

sirAt a recent health authority meeting Professor Stacey, the NHSE Head of Research Ethics, was quoted as stating that for multicentre trials rapid responses were required ….

The title of this presentation may suggest that the subject is homocystinuria. It is not. Rather, the subject is how our epistemology influences our concept of disease, which in turn determines our ability to help patients.

Moral responsibility theorists and legal theorists both worry about what negligence is, and how it might be a ground of blameworthiness. In this paper I argue that negligence suitably understood, can be an appropriate grounds for mens rea in rape cases. I am interested in cases where someone continues with sex in the mistaken belief that the other person consents. Such a mistaken belief is often unreasonable: a wilfully blind agent, one who deliberately ignores evidence that there is no consent, (...) is clearly not exculpated by his ignorance. However, there may be circumstances in which a man’s mistaken belief in consent is reasonable in the circumstances, then he is not culpable. Thus it is important to be clear about what we mean by a reasonable mistake. Many critics (e.g. Duff, Baron and others) have argued that it is not possible to make a reasonable mistake about consent, that any such mistake must involve culpable carelessness. Consent is so important that we should always double check. Not to do so is reckless, and in that case there is clearly culpability. In this paper I argue that it is possible to make a mistake that is reasonable, at least in one sense. Someone in the grip of sexist ideology might not understand how important consent is, and not through carelessness, but through sexist ideology that they have non-culpably and non-voluntarily absorbed. In that case it is not obvious that the man is culpable. I go on to argue that so far as the law is concerned, there is good reason to hold that even those who have ‘reasonable’ beliefs culpable. Having a reasonable belief in consent may be, but is not always exculpatory. We usually think a reasonable mistake does not count as negligence because a reasonable mistake is not failing to know something that you should have known. I argue that we should understand negligence—not knowing something you should have known—in a moralized sense, so that people who are ignorant through being ideologically blinded can be held to have the mens rea requisite for rape conviction. -/- . (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

This work is, in large part, a series of refutations; it is also the author's Ph.D. thesis. First to be refuted is Russell's vicious circle principle as a general remedy for the solution of the paradoxes. The author rejects the classification of paradoxes into syntactic and semantic, since in his view there are no purely syntactic paradoxes. The distinction in logic between the uninterpreted syntactical aspect of a system and the system when given a determinate interpretation is held to be (...) untenable. Tarski's distinction between object-language and meta-language and his concept of semantically closed language are considered irrelevant for the solution of the Liar paradox. The author claims that the usual versions of the Liar paradox have the same structure as the Barber paradox, viz., [S ↔ ~S]. The author solves the Liar paradox by pointing out that it does not have a proper reference. Cantor's diagonal argument for the indenumerability [[sic]] of the real numbers is labeled as unsatisfactory. Since the diagonal number is dependent upon the real numbers in the constructed list, the author claims that this makes the diagonal number to be of a different nature and status than the real numbers in the list; thus we have what the author calls the dependence fallacy. The author also refuses to accept Cantor's nested interval proof of the indenumerability [[sic]] of the real numbers. Within the proof, two infinite sequences are constructed, each of which converges to a limit. Because the proof does not give a "definite rule of convergence," the author is not satisfied that the infinite sequences converge. Also rejected is Cantor's theorem. Other paradoxes analyzed are the Berry, Richard, heterological, "Richardian", Russell, Cantor, and Burali-Forti paradoxes.--T. G. N. (shrink)

sirFollowing Dr Barber's letter1 relating to the mechanism for approval of Local Research Ethics Committees , I have also had concerns over the intense pressure for a fast turn around for local approval. Projects may have been six months or more in the Multicentre Research Ethics Committe process and then arrive on my desk with multiple telephone calls requiring ….

Inspired by the work of intellectual historian J. G. A. Pocock, this 1993 collection explores the political ideologies of early modern Britain.

For Quine, a paradox is an apparently successful argument having as its conclusion a statement or proposition that seems obviously false or absurd. That conclusion he calls the proposition of the paradox in question. What is paradoxical is of course that if the argument is indeed successful as it seems to be, its conclusion must be true. On this view, to resolve the paradox is (1) to show either that (and why) despite appearances the conclusion is true after all, or (...) that the argument is fallacious, and (2) if the former, to explain away the deceptive appearances. Quine divides paradoxes into three groups. A veridical paradox is one whose proposition or conclusion is in fact true despite its air of absurdity. We decide that a paradox is veridical when we look carefully at the argument and it convinces us, i.e., it manages to show us how it is that the conclusion is true after all and appearances to the contrary were misleading. Quine’s two main examples of this are the puzzle of Frederic in The Pirates of Penzance (who has reachError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMaped the age of twenty-one after passing only five birthdays), and the Barber Paradox, which Quine considers simply a sound proof that there can be no such barber as is described.1 A falsidical paradox is one whose proposition or conclusion is indeed obviously false or self-contradictory, but which contains a fallacy that is detectably responsible for delivering the absurd conclusion. We decide that a paradox is falsidical when we look carefully at the argument and spot the fallacy. Quine’s leading example here is De Morgan’s trick argument for the proposition that 2 = 1. (shrink)

La educación cívica se encuentra en la misma base de la democracia . T odo sistema democrático que prescinda de esta necesidad acabará haciendo de s v anecerse la racionalidad democrática de sus instituciones. La democracia liberal es un buen ejemplo de este debilitamiento pr o g res i v o de las estructuras democráticas. Benjamin R. Barber no tarda en referirse a ella como "democracia débil". La democracia carece de plenitud sin ciudadanos fo r mados cívicamente. Educación y (...) democracia están indisol u b lemente unidas. P or eso, para este autor la r e generación de la democracia, con sus contenidos reales de pa r ticipación política, pasa necesariamente por la educación. Enseñar democracia es se r vir a la comuni dad. (shrink)

Dans quelles circonstances et pourquoi Robert K. Merton a-t-il rencontré l’idée de serendipity? Quelle place occupe-t-elle dans son œuvre? Cet article propose de reconstituer pas à pas l’histoire de cette rencontre, qui ne manque pas d’ironie ni de piquant. En elle-même « sérendipienne », la découverte accidentelle mais tellement féconde du mot serendipity ouvrit à Merton nombre de pistes de recherche au cours des années 1940. Le concept intrigant de la découverte fortuite qui – entre autres vertus – engendre des (...) résultats de nature à transformer la théorie promettait d’enrichir et de renouveler la connaissance objective. Mais la serendipity était plus qu’une recette heuristique à appliquer en science. Chez Merton, c’était aussi l’objet privilégié et « auto-exemplifiant » d’une sémantique sociologique des concepts, dont l’ambition est d’étudier les itinéraires des terminologies dans la culture. En retraçant la genèse de la recherche qu’il mena avec Elinor Barber sur l’histoire du mot et des significations parfois volatiles de la serendipity, on parviendra à saisir pourquoi ce thème revêtait pour Merton un double intérêt stratégique, à la fois épistémologique et autobiographique. On comprendra aussi pourquoi une nouvelle traduction en français du premier fragment d’article dans lequel le sociologue conceptualise la serendipity en 1948 est de bonne méthode sérendipienne. (shrink)

An engaging argument about what experimental music can tell us about being human. -/- In Experimenting the Human, G Douglas Barrett argues that experimental music speaks to the contemporary posthuman, a condition in which science and technology decenter human agency amid the uneven temporality of postwar global capitalism. Time moves forward for some during this period, while it seems to stand still or even move backward for others. Some say we’re already posthuman, while others endure the extended consequences of never (...) having been considered fully human in the first place. Experimental music reflects on this state, Barrett contends, through its interdisciplinary involvements in postwar science, technology, and art movements. -/- Rather than pursuing the human’s beyond, experimental music addresses the social and technological conditions that support such a pursuit. Barrett locates this tendency of experimentalism throughout its historical entanglements with cybernetics, and in his intimate analysis of Alvin Lucier’s neurofeedback music, Pamela Z’s BodySynth performances, Nam June Paik’s musical robotics, Pauline Oliveros’s experiments with radio astronomy, and work by Laetitia Sonami, Yasunao Tone, and Jerry Hunt. Through a unique meeting of music studies, media theory, and art history, Experimenting the Human provides fresh insights into what it means to be human. (shrink)

Plutarch, in his work,_ Peri __Deisidaimon_ia_ __,_ presents a striking portrayal of superstition in the First Century. The Philosopher who also served for decades as a priest of Apollo portrays the pernicious effects of some supposed religious practices as worse than the outcome of atheism. His position constitutes a forceful explanation to ostensibly controversial socio-religious behaviours. This article discusses some of the priest’s concerns as well as his rebuff of religious attitudes that are borne out of what he describes as (...) misrepresentation of the gods or superstition. Plutarch’s essay is seen as illustrating a reason for a socio-religious situation in Africa, a continent that shares a similar religious background with the world of the writer. Specifically, with the example of the hard fight against street begging in some parts of Nigeria, the article shows how social reform programmes could fail when effects of traditional African beliefs and cultural practices remain potent. __. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Vanities of the Eye: Vision in Early Modern European CultureDallas G. Denery IIStuart Clark. Vanities of the Eye: Vision in Early Modern European Culture. Oxford-New York: Oxford University Press, 2007. Pp. xi + 415. Cloth, $75.00.A popular and pervasive historical narrative links the Renaissance development of linear perspective with Europe’s transition from a pre-modern to an early modern society. Erwin Panofsky gave this narrative its definitive form early (...) in the twentieth century and William Ivins boiled it down to a simple idea that served as the title of his most famous book. According to Ivins, single-point perspective, the artistic technique championed by Alberti and perfected in the paintings of Masaccio and Piero della Francesca, allowed for “the rationalization of sight.” In other words, it provided a mathematically and geometrically grounded method for accurately representing the external world. It is a powerful and seductive claim, one that has shaped generations of scholarly work. It is also, Stuart Clark contends in this important new book, patently wrong. Far from exhibiting a renewed or reinvigorated confidence in the accuracy and reliability of vision, sixteenth- and seventeenth-century philosophers, artists, theologians, and doctors worried that sight was susceptible, perhaps permanently so, to all sorts of debilitating derangements, displacements, and delusions.Rather than relate a history of progress, Clark offers a history of exhaustion, failure, and, ultimately, of rejection. Early modern intellectuals inherited a comprehensive theory of vision and cognition from their medieval predecessors known as perspectivist optics. This theory sought to secure the accuracy of human sense perception through regularized causal processes that linked things in the world with our various cognitive faculties. While some fourteenth-century intellectuals, most notably Nicolas of Autrecourt and Nicole Oresme, recognized structural deficiencies in this theory, their critiques were mostly ignored or treated as anomalies. Over the course of the next two and a half centuries, Clark argues, the challenges to this theory multiplied until it collapsed under their weight (20).Clark’s argument is straightforward and, as his evidence mounts, thoroughly convincing. Throughout each of the eight engrossing chapters that form the core of the book, Clark outlines a different threat, a different set of challenges that pointed out problems with the assumption that vision is trustworthy. The range and depth of those challenges are truly amazing. Doctors worried that imbalances in our humoral system, and especially in the black bile that causes melancholy, could render our visual perceptions dubious at best (ch. 2). Theologians, wary of the dangers of witchcraft and eager to prosecute its practitioners, obsessed over the cognitive threats that devils and demons posed to good Christians (ch. 4), while Protestant reformers relegated the entire tradition of Catholic miracles to the counterfeit illusions of the antichrist (ch. 5). For their part, artists believed that perspective undermined vision, depending as it does on the assumption that what we see is always relative, dependent upon our point of view (ch. 3).Clark structures much of his argument around George Hakewill’s 1608 book, The vanitie of the eye, an exposition on the natural, artificial, and demonic sources that forever render visual knowledge suspect. He could just as well have organized it around the opening pages of Descartes’s Meditations, and in many ways Clark’s book serves as a superb rumination on the sources of Descartes’s skeptical arguments. Unlike Etienne Gilson and, more recently, Richard Popkin, both of whom have done so much to open up the scholastic and early modern sources of Descartes’s skeptical thought experiments, Clark does not limit himself to philosophical lineages. Rather, he considers sources of visual skepticism that developed across an entire culture—in natural philosophy, medicine, art, religion, and literature (especially in Shakespeare’s Macbeth). Not only does the sheer volume and variety of such [End Page 103] sources help to explain Descartes’s urgent desire to overturn everything he had learned and begin again from the foundations, but it also contextualizes the specific arguments he employs. None of Descartes’s skeptical arguments were new and most were well known in the Middle Ages. What had changed over the intervening centuries, Clark contends, was how these arguments drew from... (shrink)

Boldly focusing on sexuality as a crucial definer of social order, Being and Symptom argues that there is an "M theory" -- a master theory of theories -- not only in Quantum Physics, but also in Continental Philosophy, Psychoanalysis, and Sociology, disclosing how the ontological structure of the "fantastic four" ingredients of metaphysics (potentiality, impotentiality, actuality, completion) has recurred through time. Öğüt also seeks to turn Thomas Hobbes's political philosophy into a social theory within the fields of sexuality and sovereignty (...) and to locate parallels among Aristotle, Ibn Khaldun, Kant, Hegel, Heidegger, Foucault, Lacan, Agamben, Nash, Derrida, Girard, Kristeva, and Žižek, with a special emphasis on how Žižek has adapted Lacanian psychoanalysis into social theory. Öğüt conveys a highly original analysis of the unconscious of our social (sexual) relations, subjectivities, and politics. (shrink)