This case is about a study of burn patients that included a request to the IRB for a waiver of consent for perianal specimen collection–a request which ultimately was not approved by a reviewing IR...

The American Journal of Bioethics, Volume 12, Issue 6, Page 33-34, June 2012.

Emergency nurses apply specialist knowledge to the practice of emergency care. This paper discusses the ways in which three emergency nurses understand the nature of their care from their own frames of reference and experiences and presents some of the data collected in a larger study. Various discourses, which compete to inform emergency nurses' understandings of practice, are linked with the notion of nurses as subjects; that is, each discourse may inform, shape and constitute the practice of the nurse and, (...) in turn, the ways in which the patient comes to be known and understood. I will examine the ways in which emergency nurses come to experience or position themselves vis‐à‐vis extant forms of knowledge of emergency care and the extent to which they articulate new or distinctive formulations of emergency care. This paper illuminates the commonalities that constitute the discourses of emergency nursing care, and also analyse nurses' language which demonstrates that within each discourse variations, contradictions and resistances exist. Emergency nursing care occurs in a context of a biomedical discourse that dominates, or tends to dominate, the work of the emergency setting and so to determine acceptable or possible practices. Nevertheless, nurses contest in various ways the ‘truths' that they understand to underpin their practice. Challenges to biomedical discourses are revealed, to some extent, by drawing attention to specific situations and particular struggles encountered in emergency nurses' everyday practice. (shrink)

The purpose of this discussion is twofold. First, I want to shed some light on Kant's concept of personhood as rational agency, by situating it in the context of the first Critique's conception of the self as defined by its rational dispositions. I hope to suggest that this concept of personhood cannot be simply grafted onto an essentially Humean conception of the self that is inherently inimical to it, as I believe Rawls, Gewirth, and others have tried to do. Instead (...) I will try to show how deeply embedded this concept of personhood is in Kant's conception of the self as rationally unified consciousness. Second, I want to deploy this embedded concept of personhood as the basis for an analysis of the phenomenon of xenophobia. (shrink)

Skeptical theism seeks to defend theism against the problem of evil by invoking putatively reasonable skepticism concerning human epistemic limitations in order to establish that we have no epistemological basis from which to judge that apparently gratuitous evils are not in fact justified by morally sufficient reasons beyond our ken. This paper contributes to the set of distinctively practical criticisms of skeptical theism by arguing that religious believers who accept skeptical theism and take its practical implications seriously will be forced (...) into a position of paralysis or "aporia" when faced with a wide set of morally significant situations. It is argued that this consequence speaks strongly against the acceptance of skeptical theism insofar as such moral "aporia" is inconsistent with religious moral teaching and practice. In addition, a variety of arguments designed to show that accepting skeptical theism does not lead to this consequence are considered, and shown to be deficient. (shrink)

In crafting our paper on addressing the ethical challenges in HIV prevention research with people who inject drugs,1 we had hoped to stimulate further discussion and deliberation about the topic. We are pleased that three commentaries on our paper have begun this process.2 3 4 The commentaries rightly bring up important issues relating to community engagement and problems in translating research into practice in the fraught environments in which PWID face multiple risks. These risks include acquisition of HIV as well (...) as criminalisation, stigma and lack of access to needed healthcare, prevention and social services. We take this opportunity to respond to the excellent points raised by the commentators. All of the commentaries support our emphasis on robust community engagement with PWID and other stakeholders in designing and conducting HIV prevention research, but urge us to go farther. Wolfe highlights the difficulty of even engaging with community members in oppressive settings, where authorities severely restrict civil liberties of PWID so that even discussing issues related to drug use and enforcement may place individuals at risk. To overcome such limitations, he appropriately suggests interviewing confidentially those who have previously been detained in closed settings as part of the community engagement process. Similarly, Wolfe observes that critical issues can be overlooked with a narrow focus on study procedures if contextual factors before, during or after a study are ignored. For example, he cites the risk of overdose for study participants who have been abstinent during a study and subsequently resume injecting when the study concludes. These kinds of risks may not be obvious …. (shrink)

In the Philosophy of Cognitive Science, it is a common held view that the modularity hypothesis for cognitive mechanisms and the innateness hypothesis for mental contents are conceptually independent. In this paper I distinguish between substantial and deflationist modularity as well as between substantial and deflationist innatism, and I analyze whether the conceptual independence between substantial modularity and innatism holds. My conclusion will be that if what is taken into account are the essential properties of the substantial modules, i.e. domain (...) specificity and informational encapsulation, then it seems to be such independence. However, if what is taken into account is the function of the substantial modules, then it seems to be a conceptual connection from modularity to substantial innateness. (shrink)

Volume 19, Issue 11, November 2019, Page 39-41.

This paper is a contribution to the program of constructing formal representations of pragmatic aspects of human reasoning. We propose a formalization within the framework of Adaptive Logics of the exclusivity implicature governing the connective ‘or’.Keywords: exclusivity implicature, Adaptive Logics.

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

There is little information about the content of ethics consultations in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance (...) in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is need.. (shrink)

Volume 20, Issue 10, October 2020, Page 39-41.

This article seeks to advance ethical dialogue on choosing standards of prevention in clinical trials testing improved biomedical prevention methods for HIV. The stakes in this area of research are high, given the continued high rates of infection in many countries and the budget limitations that have constrained efforts to expand treatment for all who are currently HIV-infected. New prevention methods are still needed; at the same time, some existing prevention and treatment interventions have been proven effective but are not (...) yet widely available in the countries where they most urgently needed. The ethical tensions in this field of clinical research are well known and have been the subject of extensive debate. There is no single clinical trial design that can optimize all the ethically important goals and commitments involved in research. Several recent articles have described the current ethical difficulties in designing HIV prevention trials, especially in resource limited settings; however, there is no consensus on how to handle clinical trial design decisions, and existing international ethical guidelines offer conflicting advice. This article acknowledges these deep ethical dilemmas and moves beyond a simple descriptive approach to advance an organized method for considering what clinical trial designs will be ethically acceptable for HIV prevention trials, balancing the relevant criteria and providing justification for specific design decisions. (shrink)

Although the personal-subpersonal distinction was first proposed in 1969 by D. Dennett, it has been approximately in the last ten years that it has received in­creasing attention and has became a widely used distinction particularly in the philosophy of mind and cognitive psychology literature. While the distinction is ubiquitous there are a few recent proposals about the relationship between the levels, namely, inter alia, the mixed horizontal explanation (Bermúdez 2000), the semantic view of computation (Peacocke 1994), and interaction without reduction (...) (Davies 2000a, b). In this paper I will first describe the way of understanding the distinction shared by the proposals aforementioned. Second, I will show some of the difficulties facing each proposal. Finally, I will suggest what I consider are the misleading assumptions that are at the root of the proposed strategies of inter-level relations. (shrink)

We need modal imagination in order to extend our conception of reality - and, in particular, of human beings - beyond our immediate experience in the indexical present; and we need to do this in order to preserve the significance of human interaction. To make this leap of imagination successfully is to achieve not only insight but also an impartial perspective on our own and others' inner states. This perspective is a necessary condition of experiencing compassion for others. This is (...) the primary thesis I will try to defend in this discussion. (shrink)

I want to argue that self-deception is a species of a more general phenomenon, which I shall call pseudorationality, which in turn is necessitated by what I shall describe as our highest-order disposition to literal self-preservation. By "literal self-preservation," I mean preservation of the rational intelligibility of the self, in the face of recalcitrant facts that invariably threaten it.

Volume 20, Issue 4, May 2020, Page 111-113.

Genomic sequencing is becoming more common both in clinical practice and as a routine aspect of much research. Over the last 15 years there has been ongoing discussion about the implications of gen...

This chapter contains sections titled: Metaphysical Approaches Metaphysical Problems References.

Most moral theories share certain features in common with other theories. They consist of a set of propositions that are universal, general, and hence impartial. The propositions that constitute a typical moral theory are (1) universal, in that they apply to all subjects designated as within their scope. They are (2) general, in that they include no proper names or definite descriptions. They are therefore (3) impartial, in that they accord no special privilege to any particular agent's situation which cannot (...) be justified under (2) and (3). These three features do not distinguish moral theories from other theories, nor indeed from most general categorical propositions we assert. Yet, in recent years, these features of moral theories have been the target of a certain concerted and sustained criticism, namely, that to be committed to such a moral theory, or to aspire to act in accordance with its requirements, results in what has come to be known as moral alienation. Moral alienation, according to this criticism, consists in (i) viewing one's ground projects from an impersonal, "moral point of view" engendered by one's acceptance of the theory; (ii) being prepared to sacrifice these projects to the requirements of moral principle; and (iii) making such a sacrifice specifically and self-consciously in order to conform to these requirements. Moral alienation is said to manifest itself in one (or both) of two ways, depending on the nature of the project thus susceptible to sacrifice. One may be alienated from oneself, if the project consists of tastes, convictions, or aspirations that are centrally definitive of one's self. In this case one's commitment to the project can be at best conditional on its congruence with one's moral theory. It is claimed that this must make for a rather tepid and unenthusiastic commitment indeed. Alternatively, one may be alienated from others, if the project is an interpersonal relationship such as a friendship, marriage, or collegial relationship. In this case one's responses to the other are motivated by one's awareness of what one's moral theory requires. It is claimed that this obstructs a genuine and unmediated emotional response to the other as such. My aim here will be to argue that this very compelling criticism - call it the moral-alienation criticism - is nevertheless misdirected. The real culprit is not any particular moral theory, but rather a certain familiar personality type that may or may not adopt it. (shrink)

Kant identifies what are in fact Free Riders as the most noxious species of polemicists. Kant thinks polemic reduces the stature and authority of reason to a method of squabbling that destabilizes social equilibrium and portends disintegration into the Hobessian state of nature. In the first Critique, Kant proposes two textually related solutions to the Free Rider problem.

Volume 19, Issue 10, October 2019, Page 97-98.

Much of the discussion surrounding freedom of speech relates to the importance of promoting speech. On this approach, the more speech the better, both for individuals and for democratic society. This line of thought, typically associated with the work of J. S. Mill, has obvious merit. Yet unrestrained speech also poses perils to individuals and society. In this paper, we argue for two theses: (1) Examination of On Liberty shows that Mill in fact supported the notion that forbearance in public (...) speech is ethically justified (albeit not legally enforceable), and (2) Anyone supporting utilitarian principles should give serious consideration to the possibility that prudent forbearance in public speech is a civic virtue. In other words, a reasonable concern for free speech as an integral part of social well-functioning should lead us to temper our manners of expression in circumstances when this is appropriate, and when a policy of complete license in public expression would likely undermine both the well-functioning of the society of which we are a part and the free exchange of ideas that free speech principles were intended to foster in the first place. (shrink)

Mitnovetski and Nicol provide a stimulating and thorough discussion of patenting of medical methods of treatment— an area of law that interests patent lawyers, medical practitioners, and the public. However, a consideration of alternative perspectives to their account of the exclusion of medical methods of treatment from patentability undermines the rhetorical force of their conclusion that there are “strong ordre public and morality reasons and “generally convenient” reasons to justify the existence of such patents”. I set out below four counter (...) arguments to their claims that could lead to a more balanced consideration of whether medical methods should be patented.TWO EXAMPLESFirstly, the patentability of medical methods of treatment cannot be discussed in isolation from the larger current normative debate about the justice of patenting medical technologies. Although much of what the authors discuss is necessarily speculative because it involves patenting inventions that have not previously been patentable, two cases present concrete instances of the impact of granting patent rights on healthcare. The first is the example of Myriad Genetics Inc, Salt Lake City, UT, USA, which has patented the genetic diagnostic test for the BRCA1 and BRCA2 breast cancer mutations in the US and, to a lesser extent, in Europe. It is enforcing its patent rights to require national healthcare systems to pay its highly increased fee to conduct the test in Atlanta, when hospitals can perform the test locally much more cheaply and efficiently. Many, including the Curie Institute, which is spearheading opposition proceedings at the European Patent Office, argue that allowing such technologies to be patented undermines socialised healthcare regimes, inadvertently leading to privatisation and diminished access to healthcare. Many women have not been able to access the test due to its high cost.A second well known example concerns access in developing countries to life saving drugs …. (shrink)

A reconstruction of Kant's argument for why autonomy deserves respect.

An examination, in dialogue form, of one of the core weaknesses of the design argument for God's existence.

Ten commandments of philosophical writing.

The case (Dawson et al. 2024) raises tensions between the ethical demands of respect for patient autonomy, patients’ clinical needs, and research to improve clinical care. Given burn patients’ urge...

As part of the regulatory review process, both the Food and Drug Administration and Office for Human Research Protections (U.S. Department of Health and Human Services [HHS]...

Hornsby defiende una interpretación muy particular de la distinción personal-subpersonal tal como fue propuesta por Dennett y de la doctrina filosófica en la que está enraizada esta distinción. Según Hornsby de la aceptación de la distinción y la doctrina se sigue una defensa de la autonomía explicativa del nivel personal. Esta defensa nos compromete con un nivel personal genuino de explicación y la idea de que los hechos subpersonales no explican hechos personales. Hornsby sostiene, además, que mientras que en Dennett (...) se defiende la autonomía del nivel explicativo personal, en Dennett post-1969 al modificarse la doctrina de base cambia la manera de entender la distinción y con ello se reniega de ambos compromisos, de lo cual se sigue un abandono de la tesis de la autonomía del nivel explicativo personal. La tesis que vamos a sostener en este trabajo es que si bien la distinción de Dennett nos compromete con , no nos compromete con . Dado que una defensa de la autonomía explicativa del nivel personal, tal como Hornsby la entiende, abarca ambos compromisos, se sigue que no hay tal defensa. En consecuencia, si bien hay algunas cuestiones que en Dennett no se plantean de manera tan explícita y clara como en Dennett post-1969, no hay un cambio sustancial en su concepción de la distinción.According to Hornsby , Dennett's personal-subpersonal distinction has as one of its consequences a defense of the autonomy of personal level explanation, and this defense is based on two commitments: the personal level is a genuine level of explanation, and subpersonal facts do not explain personal facts. Moreover, Hornsby argues that Dennett post-1969 rejects both commitments, and that he consequently abandons the autonomy thesis. In this paper we shall argue that, although Dennett's distinction is committed to , it is not committed to . Given that a defense of the autonomy, as Hornsby understands it, presupposes both commitments, it follows that there is no such defense. We hold that there is no substantial change in Dennett's conception of the distinction, although some of these issues are not as clear and explicit in Dennett 1969 as in Dennett post-1969. (shrink)

Adrian Piper argues that the Humean conception can be made to work only if it is placed in the context of a wider and genuinely universal conception of the self, whose origins are to be found in Kant’s Critique of Pure Reason. This conception comprises the basic canons of classical logic, which provide both a model of motivation and a model of rationality. These supply necessary conditions both for the coherence and integrity of the self and also for unified (...) agency. The Kantian conception solves certain intractable problems in decision theory by integrating it into classical predicate logic, and provides answers to longstanding controversies in metaethics concerning moral motivation, rational final ends, and moral justification that the Humean conception engenders. In addition, it sheds light on certain kinds of moral behavior – for example, the whistleblower – that the Humean conception is at a loss to explain. (shrink)

The two kinds of discrimination I want to talk about are political discrimination and cognitive discrimination. By political discrimination, I mean what we ordinarily understand by the term "discrimination" in political contexts: A manifest attitude in which a particular property of a person which is irrelevant to judgments of that person's intrinsic value or competence, for example his race, gender, class, sexual orientation, or religious or ethnic affiliation, is seen as a source of disvalue or incompetence; in general, as a (...) source of inferiority.By cognitive discrimination, I mean what we ordinarily understand by the term "discrimination" in cognitive contexts: A manifest capacity to distinguish veridically between one property and another, and to respond appropriately to each. I want to explore the relation between these two kinds of discrimination, and to argue that the first type of discrimination depends upon a failure of the second. (shrink)