Name der Zeitschrift: Klio Jahrgang: 97 Heft: 1 Seiten: 7-31.

Most whistleblowers talk as if they never had a choice about whether to blow the whistle. This doesn't mean they acted suddenly, or impulsively, only that they believe they could not have done otherwise. Trying to make sense of this near universal answer to the question "Why did you do it?" the essay draws on narrative theory. Narrative theory distinguishes between actant and sender—that is, between actor and his or her values. This distinction helps to explain what it means to (...) face a difficult choice over something about which one feels one never had a choice. (shrink)

This volume covers a wide range of conceptual, epistemological and methodological issues in the philosophy of science raised by reflection upon medical science and practice.

The central dilemma concerning randomized clinical trials (RCTs) arises out of some simple facts about causal methodology (RCTs are the best way to generate the reliable causal knowledge necessary for optimally-informed action) and a prima facie plausible principle concerning how physicians should treat their patients (always do what it is most reasonable to believe will be best for the patient). A number of arguments related to this in the literature are considered. Attempts to avoid the dilemma fail. Appeals to informed (...) consent and mechanisms for minimizing the resulting harm are important for policy, but informed consent is problematic and mechanisms for minimization of harm do not address the dilemma. Appeals to some sort of contract model of justification are promising and illuminating. Keywords: randomized clinical trials, ethics CiteULike Connotea Del.icio.us What's this? (shrink)

It is often claimed that a clinical investigator may ethically participate (e.g., enroll patients) in a trial only if she is in equipoise (if she has no way to ground a preference for one arm of the study). But this is a serious problem, for as data accumulate, it can be expected that there will be a discernible trend favoring one of the treatments prior to the point where we achieve the trial's objective. In this paper, I critically evaluate Benjamin (...) Freedman's 'clinical equipoise' solution to this dilemma. I argue that Freedman actually puts forth at least two distinct contrasts - one in terms of community vs. individual equipoise, and another concerning clinical vs. theoretical equipoise - and that neither of them resolves the dilemma. I then make a proposal for a more adequate account of how to think about the circumstances under which entering subjects in trials would be justified - a 'sliding-scale equipoise' that arises out of a discussion of patients' values. (shrink)

Are there universal values of right and wrong, good and bad, shared by virtually every human? The tradition of natural law argues that there is. Drawing on the work of psychoanalyst Melanie Klein, whose analyses have touched upon issues related to original sin, trespass, guilt, and salvation through reparation, in this 2006 book C. Fred Alford adds an extra dimension to this argument: we know natural law to be true because we have hated before we have loved and have (...) wished to destroy before we have wanted to create. Natural law is built upon the desire to make reparation for the goodness we have destroyed, or have longed to destroy. Through reparation, we earn salvation from the most hateful part of ourselves, that which would destroy what we know to be good. (shrink)

A central idea in moral and political philosophy, 'autonomy' is generally understood as some form of self-governance or self-direction. Certain Stoics, modern philosophers such as Spinoza, and most importantly, Immanuel Kant, are among the great philosophers who have offered important insights on the concept. Some theorists analyze autonomy in terms of the self being moved by its higher-order desires. Others argue that autonomy must be understood in terms of acting from reason or from a sense of moral duty independent of (...) the passions. Autonomy seems closely related to the notion of freedom, but in what sense: freedom from coercion, freedom from psychological constraints, or freedom from material necessity? Various approaches to these and similar questions yield different implications for public policy. Is capitalism, social democracy or socialism more favorable to autonomy? The essays in this volume address these important questions. (shrink)

The modern theory of computability is based on the works of Church, Markov and Turing who, starting from quite different models of computation, arrived at the same class of computable functions. The purpose of this paper is the show how the main results of the Church-Markov-Turing theory of computable functions may quickly be derived and understood without recourse to the largely irrelevant theories of recursive functions, Markov algorithms, or Turing machines. We do this by ignoring the problem of what constitutes (...) a computable function and concentrating on the central feature of the Church-Markov-Turing theory: that the set of computable partial functions can be effectively enumerated. In this manner we are led directly to the heart of the theory of computability without having to fuss about what a computable function is.The spirit of this approach is similar to that of [RGRS]. A major difference is that we operate in the context of constructive mathematics in the sense of Bishop [BSH1], so all functions are computable by definition, and the phrase “you can find” implies “by a finite calculation.” In particular ifPis some property, then the statement “for eachmthere isnsuch thatP” means that we can construct a functionθsuch thatP)for allm. Church's thesis has a different flavor in an environment like this where the notion of a computable function is primitive.One point of such a treatment of Church's thesis is to make available to Bishopstyle constructivists the Markovian counterexamples of Russian constructivism and recursive function theory. The lack of serious candidates for computable functions other than recursive functions makes it quite implausible that a Bishopstyle constructivist could refute Church's thesis, or any consequence of Church's thesis. Hence counterexamples such as Specker's bounded increasing sequence of rational numbers that is eventually bounded away from any given real number [SPEC] may be used, as Brouwerian counterexamples are, as evidence of the unprovability of certain assertions. (shrink)

“We have to be willing to consider stimulants as an option because we are not correcting students' disadvantages in other, more traditional ways,” writes Ray (2016), pointing out how limited and in...

We consider notions of boundedness of subsets of the natural numbers ℕ that occur when doing mathematics in the context of intuitionistic logic. We obtain a new characterization of the notion of a pseudobounded subset and we formulate the closely related notion of a detachably finite subset. We establish metric equivalents for a subset of ℕ to be detachably finite and to satisfy the ascending chain condition. Following Ishihara, we spell out the relationship between detachable finiteness and sequential continuity. Most (...) of the results do not require countable choice. (shrink)

There have been significant changes in what economists include in the category of investment over the last six decades. The US government agency that compiles national income date, the Bureau of Economic Analysis, has tried to keep up with these changes, but it has not succeeded. The resulting tension between economic theory and official data can be overcome by adopting a different theoretical lens. Work on social reproduction and social investment suggests a more coherent definition of investment than that offered (...) by mainstream economists. The paper then contrasts the measurement of investment in the government data with a calculation of investment derived from this new approach. The results show that business investment is dwarfed by the combined investment made by government and households. This finding suggests that business investment is not the key engine that powers the economy. This has significant implications for economic and social policies. (shrink)

A very weak omniscience principle is formulated, related omniscience principlesare considered, and the theorem that a function of bounded variation is the difference of two increasing functions is shown to be equivalent to the omniscience principle WLPO. It is a so shown that an arbitrary function with located variation on an interval is the difference of two increasing functions.

The mortality and morbidity resulting from noncommunicable diseases including cancer in sub- Saharan Africa are predicted to overtake that of infectious diseases by the year 2030. Esophageal cancer is on the increase in Tanzania. This study estimates risk factors for esophageal cancer, ethical issues and the level of awareness of cancer related services among adults in rural Kilimanjaro. A cross sectional descriptive study was conducted of adults aged 18 years and above in three wards, namely, Kahe, mabogini and Arusha Chini, (...) Moshi Rural District, Kilimanjaro region. Face-to-face interviews were conducted with a total of 419 individuals. The mean age was 36.47 =13.49) years. Of those who participated, 211 were male and 60% reported to have completed primary education. A majority of participants were knowledgeable about esophageal cancer risk factors. Overall, 15% and 23% of the participants reported to have been smoking and drinking alcohol, respectively. Male respondents were almost three times more likely to be smokers as compared to female respondents. Moreover, people who were self-employed were about five times more likely to be smokers as compared to those who were unemployed.. Male respondents were almost two times more likely to be drinkers as compared to female respondents. Overall, the level of awareness of cancer related health services was about 70%. The study findings confirm that despite a good level of knowledge about risk factors for esophageal cancer, the practice of exposure to risk factors is alarmingly high. Awareness of where to seek cancer related health services was high with hospitals been mentioned by the majority though there was low understanding on modalities of treatment among adults in Rural Kilimanjaro. Intervention measures should aim at further increasing knowledge of cancer risk factors and reduce the practice of such risks. Ethical matters including truth telling, ageism and autonomy need to be addressed to improve the perception of cancer related health issues and health seeking behaviour. (shrink)

In this article, we argue that shaming interventions and messages during Covid-19 have drawn the relationship between public health and shame into a heightened state of contention, offering us a valuable opportunity to reconsider shame as a desired outcome of public health work, and to push back against the logics of individual responsibility and blame for illness and disease on which it sits. We begin by defining shame and demonstrating how it is conceptually and practically distinct from stigma. We then (...) set out evidence on the consequences of shame for social and relational health outcomes and assess the past and present dimensions of shame in the context of the Covid-19 pandemic, primarily through a corpus of international news stories on the shaming of people perceived to have transgressed public health directions or advice. Following a brief note on shame (and policymaking) in a cultural context, we turn to the concept and practice of ‘shame-sensitivity’ in order to theorise a set of practical and adaptable principles that could be used to assist policymakers in short- and medium-term decision-making on urgent, tenacious, and emerging issues within public health. Finally, we consider the longer consequences of pandemic shame, making a wider case for the acknowledgement of the emotion as a key determinant of health. (shrink)

In this collection, thirteen prominent philosophers and political scientists address the nature of liberalism, its origins, and its meaning and proper interpretation. Some essays examine the writings of liberalism's earliest defenders, like John Locke and Adam Smith, or the influence of classical liberalism on the American founders. Some focus on the Progressive movement and the rise of the administrative state, while others defend particular conceptions of liberalism or examine liberal theories of justice, including those of John Rawls and Robert Nozick. (...) Several essays discuss the U.S. Constitution, seeking to determine whether it is best viewed as empowering the federal government to achieve certain ends, or as strictly limiting its power to ensure the broadest freedom for individuals to pursue their own ends. Other essays address the limits of economic freedom or focus on the nature and extent of property rights and the government's power of eminent domain. (shrink)