BackgroundClinical trials should be as inclusive as possible to facilitate equitable access to research and better reflect the population towards which any intervention is aimed. Informed by the UK’s National Institute for Health and Care Research (NIHR) Innovations in Clinical Trial Design and Delivery for the Under-served (INCLUDE) guidance, we audited oncology trials conducted by the Clinical Trials and Statistics Unit at The Institute of Cancer Research, London (ICR-CTSU) to identify whether essential documents were overtly excluding any groups and whether (...) sufficient data were collected to assess diversity of trial participants from groups suggested by INCLUDE as under-served by research in the UK.MethodsThirty cancer clinical trials managed by ICR-CTSU and approved between 2011–2021 were audited. The first ethics approved version of each trial’s protocol, patient information sheet, and patient completed questionnaire, together with the first case report forms (CRFs) version were reviewed. A range of items aligned with the INCLUDE under-served groups were assessed, including age, sex and gender, socio-economic and health factors. The scope did not cover trial processes in participating hospitals.ResultsData relating to participants’ age, ethnic group and health status were well collected and no upper age limit was specified in any trials’ eligibility criteria. 23/30 (77%) information sheets used at least one gendered term to address patients. Most CRFs did not specify whether they were collecting sex or gender and only included male or female categories. The median reading age for information sheets was 15–16 years (IQR: 14–15 – 16–17). Socio-economic factors were not routinely collected and not commonly mentioned in trial protocols.ConclusionsNo systemic issues were identified in protocols which would explicitly prevent any under-served group from participating. Areas for improvement include reducing use of gendered words and improving readability of patient information. The challenge of fully assessing adequate inclusion of under-served populations remains, as socio-economic factors are not routinely collected because they fall beyond the data generally required for protocol-specified trial endpoint assessments. This audit has highlighted the need to agree and standardise demographic data collection to permit adequate monitoring of the under-served groups identified by the NIHR. (shrink)

Judith Suissa and Alice Sullivan’s 2021 paper ‘The Gender Wars, Academic Freedom and Education’ holds that activism associated with the slogan ‘trans women are women’ harms progress towards the goals of shared learning and knowledge production. They hold that shared learning and knowledge production ground the value of the university. In response, we point out that academic freedom is not absolute, and that its contribution to learning and knowledge production is only part of a host of academic goods. Given (...) the hostile environment faced by trans people in the UK, absolute academic freedom in relation to questions about sex, gender, and gender identity should not be taken for granted. The focus of this article is on the following: (1) academic freedom is not absolute and should be responsibly curtailed when it causes harm, or hinders other educational goods; (2) public perceptions of ‘gender debates’ in the UK cause harm and hinder other educational goods; (3) academic debates about sex, gender, and gender identity could contribute to this harm and hindrance and should be undertaken only with care. (shrink)

In a series of memorable exchanges, three eminent theorists engage in a dialogue on central questions of contemporary philosophy and politics.

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

The Cambridge Critical Guides series offers cutting-edge research volumes on some of the most important works of philosophy. Each volume presents newly-commissioned essays by an international team of contributors, and will appeal to a scholarly and graduate-level audience. One of the themes that this volume brings out is the endurance and contemporary relevance of some of Schopenhauer’s most pressing concerns. In a sense, he is right to be ahistorical: is it not this reaching out of its time that makes a (...) work a classic, eternal even? Principal among these concerns of course is the question of how to respond as plagues overwhelm us (which is Schopenhauer’s description of existence in a normal state, the plague of existence rather than a plague within existence). His famous answer involves the negation of the will, the ascetic denial and rejection of desire. Of course, this response is more striking than it is clear, and several of the essays tackle the question of what is meant, entailed, and achieved by negation of the will. (shrink)

Nietzsche's late works are brilliant and uncompromising, and stand as monuments to his lucidity, rigour, and style. This volume combines, for the first time in English, five of these works: The Antichrist, Ecce Homo, Twilight of the Idols, Nietzsche contra Wagner, and The Case of Wagner. Here, Nietzsche takes on some of his greatest adversaries: traditional religion, contemporary culture, and above all his one-time hero, the composer Richard Wagner. His writing is simultaneously critical and creative, putting into practice his alternative (...) philosophical vision, which, after more than a hundred years, still retains its startling novelty and audacity. These new translations aim to capture something of the style and rhythm of the original German, so that the reader can get a sense of Nietzsche as not just a philosopher but also a consummate artist, capable of 'dancing with his pen', and as untimely as he claims to be. (shrink)

Although children and parents often feature in philosophical literature on education, the nature of the parent–child relationship remains occluded by the language of rights, duties and entitlements. Likewise, talk of ‘parenting’ in popular literature and culture implies that being a parent is primarily about performing tasks. Drawing on popular literature, moral philosophy and philosophy of education, I make some suggestions towards articulating a richer philosophical conception of this relationship, and outline some of the implications, questions and problems this raises for (...) philosophers of education. (shrink)

Julia Kristeva attempts to expose the limits of Lacan's theory of language by revealing the semiotic dimension of language that it excludes. She argues that the semiotic potential of language is subversive, and describes the semiotic as a poetic-maternal linguistic practice that disrupts the symbolic, understood as culturally intelligible rule-governed speech. In the course of arguing that the semiotic contests the universality of the Symbolic, Kristeva makes several theoretical moves which end up consolidating the power of the Symbolic and paternal (...) authority generally. She defends a maternal instinct as a pre-discursive biological necessity, thereby naturalizing a specific cultural configuration of maternity. In her use of psychoanalytic theory, she ends up claiming the cultural unintelligibility of lesbianism. Her distinction between the semiotic and the Symbolic operates to foreclose a cultural investigation into the genesis of precisely those feminine principles for which she claims a pre-discursive, naturalistic ontology. Although she claims that the maternal aspects of language are repressed in Symbolic speech and provide a critical possibility of displacing the hegemony of the paternal/symbolic, her very descriptions of the maternal appear to accept rather than contest the inevitable hegemony of the Symbolic. In conclusion, this essay offers a genealogical critique of the maternal discourse in Kristeva and suggests that recourse to the maternal does not constitute a subversive strategy as Kristeva appears to assume. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Shame is Not an Effective Diet PlanJudith BrukThe stigma of being obese is so strong that it is assumed that anyone with the condition is (or should be) deeply ashamed. After all, it’s really easy to lose weight, right? Just cut out dessert and walk around the block three times a week. If you can’t even do that, then you are definitely a moral failure, have succumbed to Gluttony (...) and Sloth, and deserve to be shunned by society.The problem is that shame is not a very effective diet plan; quite the opposite. It’s no surprise that recent research shows that shame leads to depression that leads to isolation, which, in the morbidly obese, leads to a suicide rate twelve times that of healthy–weight people.Unfortunately, it is indeed true that many obese people feel a great deal of shame, even if we occasionally put on a façade of bravado or seeming shamelessness, e.g., the “large and in charge” sitcom staple trope. The bottom line is that our shame about our weight does keep us from engaging with other people, limits our willingness to participate in physical activities, and generally makes us reluctant to simply exist out in public. None of these are behaviors conducive to positive lifestyle changes.For years I engineered my life so I would only go out of my house when absolutely necessary: grocery shopping and the occasional meeting at work were pretty much it (I usually work from home). I went for years without going to a movie, shopping for clothes in a store, eating in a restaurant, gardening, or any of the other activities I once enjoyed. I was ashamed to be seen. And since I had tried and tried and tried and tried to lose weight for three decades and only ended up more overweight as the years went by, I finally, truly gave up. I convinced myself my psychological makeup was so flawed (or was missing whatever ingredient it was that made someone succeed at sustained weight loss) that I just hoped my inevitable heart attack would be instantaneously fatal. This thinking is irrational, or at least unhealthy. (I am an otherwise fairly smart person with an advanced degree and am professionally employed.) Yet, it is basically the path that both societal attitudes and medical treatment lead us down at this point in time.Here are a few examples that illustrate how the path to irrationality evolved for me.About twelve years ago, I decided to see a psychotherapist to get to the bottom of my subconscious psychological issue that was keeping me overweight. This therapist suggested I see a nutritionist who gave me a list of detailed thyroid tests to take to my doctor so she could order the labs and we could get a full profile of how my thyroid was functioning. Upon presenting the list to my doctor’s PA (my doctor was not available that day), she rolled her eyes, gave a very deep sigh and said to me, “Every fat woman wants to believe it’s because of her thyroid and it never, ever is.” I was so embarrassed for having even brought the subject up that in an effort to save face, I reacted to my shame by replying, “Yeah, I just assume my extreme lack of energy and excess weight is simply because I eat too much.” She said, “Right, so let’s not even bother running these tests.” It was at least ten years later that I finally had the thyroid panel run and found out it was very low functioning.After about a year of seeing that shrink, she declared me “cured” and sent me on my way, though I had not lost any weight. It was about this time I first began thinking that throwing in the towel [End Page 91] was a good option. That didn’t mean that I went out and ate pizza and ice cream every day. Not at all. In fact, given the fact that I had been vegetarian and general health–food freak beginning in my mid–twenties, I rarely had anything in the house that contained sugar... (shrink)

Over 20 unstable microsatellite repeats have been identified as the cause of neurological disease in humans. The repeat nucleotide sequences, their location within the genes, the ranges of normal and disease‐causing repeat length and the clinical outcomes differ. Unstable repeats can be located in the coding or the non‐coding region of a gene. Different pathogenic mechanisms that are hypothesised to underlie the diseases are discussed. Evidence is given both from studies in simple model systems and from studies on human material (...) and in animal models. Since somatic instability might affect the clinical outcome, this is briefly touched on. Available data and theories on the timing and mechanisms of the repeat instability itself are discussed, along with factors that have been observed to affect instability. Finally, the question of why the often harmful unstable repeats have been maintained throughout evolution is addressed. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

'Community' and 'justice' recur in anthropological, historical, and legal scholarship, yet as concepts they are notoriously slippery. Historians and lawyers look to anthropologists as 'community specialists', but anthropologists often avoid the concept through circumlocution: although much used by historians, legal thinkers, and political philosophers, the term remains strikingly indeterminate and often morally overdetermined. 'Justice', meanwhile, is elusive, alternately invoked as the goal of contemporary political theorizing, and wrapped in obscure philosophical controversy. A conceptual knot emerges in much legal and political (...) thought between law, justice, and community, but theories abound, without any agreement over concepts.The contributors to this volume use empirical case studies to unpick threads of this knot. Local codes from Anglo-Saxon England, north Africa, and medieval Armenia indicate disjunctions between community boundaries and the subjects of local rules and categories; processes of justice from early modern Europe to eastern Tibet suggest new ways of conceptualizing the relationship between law and justice; and practices of exile that recur throughout the world illustrate contingent formulations of community. In the first book in the series, Legalism: Anthropology and History, law was addressed through a focus on local legal categories as conceptual tools. Here this approach is extended to the ideas and ideals of justice and community. Rigorous cross-cultural comparison allows the contributors to avoid normative assumptions, while opening new avenues of inquiry for lawyers, anthropologists, and historians alike. (shrink)

In a time of globalization, Political Philosophy for the Global Age provides a theoretical basis for the convergence of human values in terms of legitimate conceptions of time, language, and notions of self. Sánchez Flores reviews what she considers to be the most important positions in the current debate on political theory (liberalism, communitarianism, feminism, and postcolonialism) and also proposes her own original contribution. Sánchez Flores’s unique approach is a critique of a type of morality formulated solely on the basis (...) of the Judeo-Christian view of reality. It is a theoretical construct that becomes an invitation to explore other notions of human morality and an inquiry into the need to produce a political philosophy that universalizes an ethics of caring and responsibility as well as provides a locus where diverse human cultures can meet. (shrink)

A striking visual essay captures the institutional landmarks of Chicago in a collection of full-color photographs of local schools, jails, and other landmarks of public life, including works by such renowned architects as Rem Koolhaas, Helmut Jahn, and Mies van der Rohe.

The recent arrest of Roman Polanski, the film director who fled to France from the United States in 1978 on the eve of sentencing for having unlawful sex with a 13-year-old girl, has caused an international ruckus. The French culture minister, Frédéric Mitterrand, and the French foreign minister, Bernard Kouchner, both issued statements of support for Mr. Polanski. But many others in France have expressed outrage at that support and said he should face justice for the crime.

Resumo (200 palavras) Podem-se encontrar diferentes conceitos na história da Ética. Esse artigo lida com a ideia que se deve identificar um conceito de Ética para se discutir sobre sua relação com Educação. Moral é um conceito que aparece quando se pensa sobre Ética. Por isso uma discussão sobre o conceito de Moral e sua relação com Ética é apresentado. Discutir Ética significa entender o conceito na sociedade porque Ética não pode acontecer a uma pessoa sozinha. Pessoas se relacionam na (...) sociedade e Ética é o fundamento básico da vida social. Antes que se possa observar Ética na sociedade como um conjunto, é possível descobrir que Ética começa na vida da família. A escola é o lugar específico na sociedade que ajuda a família a construir a relação entre Ética e Educação. Filósofos e educadores concordam sobre a importância de educar crianças para serem cidadãos éticos, mas os conceitos de Ética que eles possam usar são de algum modo diferente. Ética Relativa e Ética Universal são os principais grupos de conceitos encontrados na literatura. Concluímos que para se tornar inteiramente um ser humano, cada pessoa precisa se sentir integrada à humanidade e isto somente é possível por meio de conceitos universais de ética. Palavras chaves – ética – educação – moral – família - escola - sociedade (200 words) We can find different concepts in history of Ethics. This article deals with the idea that it is necessary to identify a concept of Ethics in order to discuss about its relation to Education. Moral is a concept that comes to mind when we think about Ethics. Because of this a discussion about this concept and its relation to Ethics is presented. To discuss Ethics means to understand it in society because it can’t happen to a person alone. People relate themselves in society and Ethics is the basic foundation to social life. Before we can observe Ethics in society as a whole it is possible to discover that Ethics begins in family life. School is the specific place in society that helps family to build the relation between Ethics and Education. Philosophers and educators agree about the importance of educating children to be ethical citizens but concepts of Ethics they may use are somehow different. Relative Ethics and Universal Ethics are the major groups of concepts that we can find in literature. We conclude that to become a whole human being each person needs to feel integrated to humankind and this is only possible through universal concepts of Ethics. Keywords – ethics – education – moral – family – school - society  . (shrink)

This article examines how tattoos may function as a way to deal with personal trauma. First, I examine a recent theory of how personal trauma cannot be fully experienced; thus, it calls for a return to the event in order to incorporate it into the psyche. Second, I look at how that return, often achieved symbolically, might include the process of acquiring a tattoo. Finally, I turn to various examples, taken from memoirs, film, and an interview, of trauma that has (...) been expressed through tattooed images that turn bodies into memory‐laden texts. (shrink)

The protagonist of Edith Wharton’s 1904 short story “The Descent of Man” is both scien­tist and satirist. The target of his satire-“false interpreters” of evolutionary theory-allows Wharton to combine analysis of genre with inquiry into the cultural controversy Darwin’s ideas inspired. Anthropocentric anxieties explain popular preference for soothing “pseudo-science” over unsparing accounts of natural selection; they likewise explain widespread obtuseness to Professor Linyard’s ridicule of hazy illogic posing as science. Motivated more strongly by fitness interests than by allegiance to scientific (...) truth, however, the professor becomes complicit in widespread misreading of his own text. He thereby encourages the ignorance he intended to dispel, and Wharton highlights the ironies inherent in this self-sabotage. She insists that susceptibility to evolved adaptations is universal, moreover, and that it often impedes the discovery and promulgation of truth. (shrink)

Research in the field of evolutionary psychology underlines the importance of masculine display in the mate-selection process. Men seek opportunities to exhibit qualities women find desirable; hence they invite inspection of their resources and status, their physical and mental prowess. They also advertise specialized skills and abilities, including artistic performance and creativity. Men seeking to impress potential mates hope to benefit not only from displaying survival-oriented skills as toolmakers or hunters but also from publishing adeptness in less utilitarian realms such (...) as storytelling, drumming, or carving.1 Exhibition of aesthetic achievement is relevant, therefore, to current inquiries into the... (shrink)

A closer look at recent reports of “modern slavery” in the Sahara, particularly the exploitation of sub-Saharan migrants in contemporary southern Libya, shows that they speak of other forms of captivity, such as debt bondage, forced prison labor, and hostage taking for ransom. Such forms of exploitation have an equally long history in the region but are more obviously enmeshed with contemporary phenomena: repressive migration policies, state incarceration, and the worldwide ranking of nationalities. This article seeks to understand them for (...) what they are, using fieldwork and historical examples. Understanding shifts the blame for the migrants’ plight from “local culture” to the international political economy and grants migrants a degree of agency that blanket condemnations of slavery often deny. It also opens up more general questions about links between labor, mobility, and captivity; the relationship between state and nonstate systems of political control, their boundaries and overlaps; and the different ways value is accorded to individual lives—or actively created, negotiated, or denied—in the Sahara and beyond. (shrink)

Cette étude consacrée à la dimension heuristique des métaphores cherche à comprendre le rôle qu’elles jouent dans l’activité générale de la pensée. Le rôle des métaphores est particulièrement visible à l’état naissant de la pensée connaissante, au point où son exploration trouve dans l’étoffe du langage les moyens de conceptualiser le nouveau. L’exemple de Savigny, de Bacon et de Kant montre comment l’intuition métaphorique et la reprise culturelle des schèmes métaphoriques ont une fonction intellectuelle féconde.

This article draws on the results of an inductive qualitative study on the microdynamics of framing corporate community involvement. Insight is provided into these dynamics by using the metaphor of a social movement and drawing on that literature’s framing perspective. Based on accounts of diverse organizational members, we identify several double edges in framing CCI as a strategic issue, and we develop a model that helps to understand why and how strategizing CCI may be controversial.

Bordo argues that the “theoretics of heterogeneity” taken too far prevents us from being able make generalizations or broadly conceptual statements about women. 1 argue that the political efficacy of feminism does not depend on the capacity to speak from the perspective of “women” and that the insistence on the heterogeneity of the category of women does not imply an opposition to abstraction but rather moves abstract thinking in a self-critical and democratizing direction.

I borrow this title from an English mystical text written at the end of the fourteenth century, The Veil of Unknowledge, which has long been part of my life. The explicit aim of the book is to tear away this veil of unknowledge, or to give us the means to do it ourselves. The image of the veil invites a reciprocal gesture of raising, tearing, piercing. The desire that motivates this act goes beyond the veil, toward Isis and the truth, (...) the naked figure we're endeavoring to know. Once we have cleared away the obstacles and gained a clear view of her, we—and she—are transformed. (shrink)