Randomised placebo-controlled trials (RPCTs) are the gold standard for evaluating novel treatments. However, this design is rarely used in the context of orthopaedic interventions where participants are assigned to a real or placebo surgery. The present study examines attitudes towards RPCTs for orthopaedic surgery among 687 orthopaedic surgeons across the USA. When presented with a vignette describing an RPCT for orthopaedic surgery, 52.3% of participants viewed it as ‘completely’ or ‘mostly’ unethical. Participants were also asked to rank-order the value of (...) five different types of evidence supporting the efficacy of a surgery, ranging from RPCT to an anecdotal report. Responses regarding RPCTs were polarised with 26.4% viewing it as theleastvaluable (even less valuable than an anecdote) and 35.7.% viewing it as themostvaluable. Where equipoise exists, if we want to subject orthopaedic surgeries to the highest standard of evidence (RPCTs) before they are implemented in clinical practice, it will be necessary to educate physicians on the value and ethics of placebo surgery control conditions. Otherwise, invasive procedures may be performed without any benefits beyond possible placebo effects. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Direct Nuclear Reprogramming: Response to Condic, Lee, and GeorgeGerard Magill, Ph.D. and William B. NeavesWe read with great interest the response of Maureen Condic, Patrick Lee, and Robert George (2009) to our essay, “Ontological and Ethical Implications of Direct Nuclear Reprogramming” in the March 2009 issue of the Kennedy Institute of Ethics Journal (Magill and Neaves 2009). Much of their response addressed issues that are not in (...) dispute: somatic cells are not zygotes, neurons and hepatocytes are different, growth-factor signals from the trophoblast influence development of the inner cell mass, membranes derived from the trophectoderm are critically required for embryonic survival, and stem cells cannot produce a fetus “on their own.”The crucial point of disagreement deals with the fact that iPS cells are not totipotent but zygotes are. Zygotes can generate their own placental structures while iPS cells must be given them through tetraploid complementation. Condic, Lee, and George consider totipotency to be crucial to natural potentiality. We present an alternative view in our essay (Magill and Neaves 2009, pp. 28–29). Placental structures make no lasting contribution to the postnatal organism, and the equivalency of iPS cells with the inner cell mass of the blastocyst is apparent from tetraploid complementation experiments.The respondents acknowledge the following:... somatic cells can be “converted” into zygotes by the process of somatic cell nuclear transfer (SCNT) or direct reprogramming in combination with tetraploid complementation—just as sperm and egg cells can be “converted” into a zygote by the process of natural fertilization—....(Condic, Lee, and George 2009, p. 35)As the respondents recognize, different ways of manipulating cells can lead to embryogenesis: sperm and egg cells in the process of natural fertilization, the enucleated egg and an ordinary body cell in the process of somatic cell nuclear transfer, and reprogrammed skin cells and a tetraploid blastocyst in the case of induced pluripotent stem (iPS) cells. In each case, different cells are manipulated—or “converted” in the respondents’ terminology—in a process that alters their biological fate within a supportive environment facilitating embryogenesis.The developmental potential that resides in the human genome does not unfold in isolation, not even in a zygote. In all cases, whether involving a zygote or an iPS cell, interaction with a supportive environment is required to express the developmental program residing in the genome. [End Page 201]This biological reality supports what we have described as “early cellular development along the continuum of natural potentiality that can result in the formation of a fetus” (Magill and Neaves 2009, p. 30), and it presents a significant challenge to the natural potentiality argument.Gerard MagillVernon F. Gallagher Chair for the Integration of Science, Theology, Philosophy, and Law, and Professor, Center for Healthcare Ethics Duquesne University Pittsburgh, PA.William B. NeavesPresident and CEO Stowers Institute for Medical Research and Professor of Basic Medical Science University of Missouri at Kansas City School of Medicine Kansas City, MOReferencesCondic, Maureen L.; Lee, Patrick; and George, Robert P. 2008. Ontological and Ethical Implications of Direct Nuclear Reprogramming: Response to Magill and Neaves. Kennedy Institute of Ethics Journal 19: 33–40. Google ScholarMagill, Gerard, and Neaves William B. 2009. Ontological and Ethical Implications of Direct Nuclear Reprogramming. Kennedy Institute of Ethics Journal 19: 23–32. Google ScholarCopyright © 2009 The Johns Hopkins University Press... (shrink)

Scientific breakthroughs rarely yield the potential to engage a foundational ethical question. Recent studies on direct reprogramming of human skin cells reported by the Yamanaka lab in Japan and the Thomson lab in Wisconsin suggest that scientists may have crossed both a scientific and an ethical threshold. The fascinating science of direct nuclear reprogramming highlights empirical data that may clarify the ontological status of cellular activity in the early stages of what could become a human fetus and justify ethical options (...) for research in this controversial field. The ontological and ethical implications that accrue here are connected with the biological or natural potentiality of these cells. (shrink)

Many of us agree that we ought not to wrong future people, but there remains disagreement about which of our actions can wrong them. Can we wrong individuals whose lives are worth living by taking actions that result in their very existence? The problem of justifying an answer to this question has come to be known as the non-identity problem.[1] While the literature contains an array of strategies for solving the problem,[2] in this paper I will take what I call (...) the harm-based approach, and I will defend an account of harming—which I call the existence account of harming—that can vindicate this approach. -/- Roughly put, the harm-based approach holds that, by acting in ways that result in the existence of individuals whose lives are worth living, we can harm and thereby wrong those individuals. An initially plausible way to try to justify this approach is to endorse the non-comparative account of harming, which holds that an event harms an individual just in case it causes her to be in a bad state, such that the state’s badness does not derive from a comparison between that state and some alternative state that the individual would or could have been in. However, many philosophers argue that the non-comparative account of harming is inadequate,[3] and one might be tempted to infer from this that any harm-based approach to the non-identity problem will fail. My proposal, which I call the existence account of harming, will show that this inference is faulty: we can vindicate the harm-based approach without relying on the non-comparative account of harming. (shrink)

Mollie Adams; The Concept of Physical Education II, Journal of Philosophy of Education, Volume 3, Issue 1, 30 May 2006, Pages 23–35, https://doi.org/10.1111/j.1.

There is an increasing need for quality in ethics consultations, though there have been significant achievements in the United States and Europe. However, fundamental concerns that place the profession in jeopardy are discussed from the perspective of the U.S. in a manner that will be helpful for other countries. The descriptive component of the essay (the first two points) explains the achievements in ethics quality (illustrated by the IntegratedEthics program of the Veterans Health Administration) and the progress on standards and (...) competencies for ethics consultations (represented by the Core Competencies of the American Society for Bioethics and Humanities). Based on these achievements, the analytical component of the essay (the final three points) identifies and seeks to resolve three fundamental concerns (with increasing levels of importance) that compromise quality in ethics consultations: standards of quality; professionalism; and credentialing. The analysis argues for clearer standards of quality in ethics consultation and urges further professionalism by explaining the need for the following: interpreting the ASBH core competencies in a normative manner, developing a Code of Ethics, and clarifying the meaning of best practices. However, the most serious concern that threatens quality in ethics consultations is the lack of a credentialing process. This concern can be resolved effectively by developing an independent Ethics Consultation Accreditation Council to accredit and standardize graduate degree programs, fellowship experiences, and qualifying examinations. This credentialing process is indispensable if we are to strategically enhance quality in ethics consultations. (shrink)

Critical pedagogy is an optimistic approach for achieving transformative agency, which remains an elusive and vital aspect of civic education. Therefore, the purpose of this study was to examine the pedagogical approach of three critically identifying teachers. Specifically, this study was interested in understanding participant teacher critically civic ontological postures. The posture implies an understanding of the power inherent to civic relation and pedagogy. Participant teachers uniquely demonstrated postures that allowed them to address conceptual, personal, and material aspects of civics (...) education. Participants achieved this first by making clear temporal connections between citizenship and disciplines; second, by incorporating student experiences; and lastly by utilizing a range of instructional approaches to negate traditional civic archetypes. Findings suggest that critical civic ontological postures are dynamic, contextual, and disciplinarily situated. Authentically critically civic ontological postures include developing intellectual solidarity with students and those in educational communities. (shrink)

Nursing education holds a history framed in white supremacy and whiteness. Efforts to employ antiracist strategies have been hindered, largely due to an inability for faculty to acknowledge and hold accountability for racialized harms that occur within nursing educational structures. A nurse–midwifery program in the Pacific Northwest United States uncovered harm that impacted students and identified a need to respond and hold accountability. Guided by the framework of Transformative Justice, a truth and reconciliation process was implemented as a first step (...) to better address racism within nursing and nurse–midwifery education. This paper describes the process to support other institutions in their work to address harms within nursing education. (shrink)

Some claim that consent requires common knowledge. For a doctor to obtain consent, a doctor must know that her patient has given her permission to perform surgery, and her patient must know the doctor knows that he has given this permission. Some claim that such common knowledge requires communication, and so consent requires communication: the patient must tell the doctor he consents for both to know consent took place, and for both to know the other knows consent took place. I (...) first defend the claim that consent requires common knowledge, responding to recent objections. I then argue that, though consent requires common knowledge, it does not always require communication. It does not require communication when the agent obtaining consent can infer common knowledge based on non-behavioral facts about the world. (shrink)

We report on an unpublished and previously unknown manuscript of John von Neumann and contextualize it within the development of the theory of shock waves and detonations during the nineteenth and twentieth centuries. Von Neumann studies bombs comprising a primary explosive charge along with explosive booster material. His goal is to calculate the minimal amount of booster needed to create a sustainable detonation, presumably because booster material is often more expensive and more volatile. In service of this goal, he formulates (...) and analyzes a partial differential equation-based model describing a moving shock wave at the interface of detonated and undetonated material. We provide a complete transcription of von Neumann’s work and give our own accompanying explanations and analyses, including the correction of two small errors in his calculations. Today, detonations are typically modeled using a combination of experimental results and numerical simulations particular to the shape and materials of the explosive, as the complex three dimensional dynamics of detonations are analytically intractable. Although von Neumann’s manuscript will not revolutionize our modern understanding of detonations, the document is a valuable historical record of the state of hydrodynamics research during and after World War II. (shrink)

Board oversight of community benefit constitutes an ethical imperative for nonprofit health care organizations. By "ethical imperative" we mean a health care organization's duty to fulfill value-based obligations that transcend compliance requirements in order to be consistent with its basic sense of purpose. We consider three points here: the existence of a distinctively ethical imperative for board oversight, the fact that the imperative is organizational in nature, and practical ways to fulfill its obligations. To explain the meaning of ethical imperative, (...) offer analytical clarification, and provide evidence-based guidelines we adopt an organizational ethics paradigm. Because community benefit for tax-exempt .. (shrink)

The author reviews Bucking the Artworld Tide: Reflections on Art, Pseudo Art, Art Education & Theory, a collection of essays on the visual arts by Michelle Marder Kamhi. In her view, Kamhi presents a compelling case against the modernist and postmodernist inventions that have come to dominate the artworld since the early twentieth century—from abstract work to “conceptual art.” Citing countless paintings, sculptures, and works of purported art, these essays offer sparkling nuggets of insight into what art is, what it (...) is not, and why. (shrink)

Midnight: The Tempest Essays, the second book in Molly Nesbit's 'Pre-Occupations' series, returns the question of pragmatism to the everyday critical practice of the art historian working in the late 20th century. These essays take their cues from the work of specific artists and writers, beginning in the late 1960s, a time when critical commentary found itself in a political and philosophical crisis. Illustrated case studies on Eugène Atget, Marcel Duchamp, Jean-Luc Godard, Cindy Sherman, Louise Lawler, Rachel Whiteread, Gabriel (...) Orozco, Rirkrit Tiravanija, Lawrence Weiner, Nancy Spero, Rem Koolhaas, Martha Rosler, Gerhard Richter, Matthew Barney and Richard Serra, among others, continue the legacy of a pragmatism that has endured while debates over postmodernism and French philosophy raged. (shrink)

In _The Excessive Subject: A New Theory of Social Change_, Molly Anne Rothenberg uncovers an innovative theory of social change implicit in the writings of radical social theorists, such as Pierre Bourdieu, Michel de Certeau, Judith Butler, Ernesto Laclau, and Slavoj?i?ek. Through case studies of these writers' work, Rothenberg illuminates how this new theory calls into question currently accepted views of social practices, subject formation, democratic interaction, hegemony, political solidarity, revolutionary acts, and the ethics of alterity. Finding a common (...) dissatisfaction with the dominant paradigms of social structures in the authors she discusses, Rothenberg goes on to show that each of these thinkers makes use of Lacan's investigations of the causality of subjectivity in an effort to find an alternative paradigm. Labeling this paradigm 'extimate causality', Rothenberg demonstrates how it produces a nondeterminacy, so that every subject bears some excess; paradoxically, this excess is what structures the social field itself. Whilst other theories of social change, subject formation, and political alliance invariably conceive of the elimination of this excess as necessary to their projects, the theory of extimate causality makes clear that it is ineradicable. To imagine otherwise is to be held hostage to a politics of fantasy. As she examines the importance as well as the limitations of theories that put extimate causality to work, Rothenberg reveals how the excess of the subject promises a new theory of social change. By bringing these prominent thinkers together for the first time in one volume, this landmark text will be sure to ignite debate among scholars in the field, as well as being an indispensable tool for students. (shrink)

Consider a duty of beneficence towards a particular individual, S, and call a reason that is grounded in that duty a “beneficence reason towards S.” Call a person who will be brought into existence by an act of procreation the “resultant person.” Is there ever a beneficence reason towards the resultant person for an agent to procreate? In this paper, I argue for such a reason by appealing to two main premises. First, we owe a pro tanto duty of beneficence (...) to future persons; and second, some of us can benefit some of those persons by procreating. In support of the first premise I reject the presentist account of time in favor of the view that future persons are just as real as presently existing persons. I then argue that future persons are like us in all the morally relevant ways, and since we owe duties of beneficence to each other, we also owe duties of beneficence to future persons. In support of the second premise I offer an account of benefiting according to which an individual can be benefited by an action even if it makes her no better off than she would have been, had the action not been performed. This account of benefiting solves what I call the “non-identity benefit problem.” Finally, I argue that having a life worth living is a benefit, and some of us can cause some persons that benefit by causing them to exist. (shrink)

The article criticises various interpretations of Epicurus's claim that belief in determinism is self-invalidating: -/- - 'The man who says that all things come to pass by necessity cannot criticise one who denies that all things come to pass by necessity, for he admits that this too happens of necessity.' - -/- especially Ted Honderich's argument that the real force of the Epicurean claim is that if belief acquisition is causally necessitated, we will be excluded from possible facts and inquiries (...) that might have produced new knowledge and might have shown some of what we take to be knowledge to be false. Honderich's argument fails to consider that undetermined inquirers might fail to make discoveries that determined inquirers could not fail to make. Determinism would not, therefore, put us in a worse position as seekers of knowledge than indeterminism. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Brit Milah for Eliezer Herschel ben Yonatan AryehMolly SinderbrandFor observant Jews, the choice to circumcise one's son is not a choice. Technically, it is a contractual obligation; the belief is that male circumcision is part of a holy covenant with God. The word for ritual circumcision, brit milah or bris, literally means "covenant [of circumcision]." Circumcision is a physical symbol of a relationship with the divine. It is (...) the commandment that encompasses all other commandments. It is, thankfully, only required of men (women, they say, are naturally closer to divinity). Circumcision is when a baby boy enters the Jewish community, eight days after birth, and when he gets his name. He becomes somebody. To choose otherwise— and some may choose otherwise—is to choose not to be part of the contract, and by extension, not be part of the Jewish community. And a community is one of the most valuable things a person can have.I was not always an observant Jew, though I was raised in a Jewish household. I essentially fell into observance over a period of 10 years, starting with studying ancient Hebrew with a language-loving rabbi in high school and eventually leading to weekly attendance at an orthodox shul, which I joined shortly after first tasting the vegan cholent at kiddush. It was much easier to make friends in [End Page 91] the Jewish community than in my competitive and mildly misogynist graduate program, and frankly, I liked them better. I received kindness and support when I needed it, and gave it back equally, especially around having children. Having children is difficult under any circumstance, but it is especially difficult in social settings where it is seen as abnormal, strange, or even selfish. The Jewish community normalized having children and created a respite from the judgment of the secular world. When I was pregnant at work, I got comments like "It looks like you're having twins!" and "Are you sure you don't have pre-eclampsia? You look awfully large"; at shul, I got pep talks, encouragement, and the traditional "b'sha'a tova"—"may it happen at a good time."Eventually, after having two kids in a two-bedroom rowhome, my husband and I moved to a mostly-Jewish suburb just outside the city. It is the kind of place where everyone says "Gut Shabbes" (a good Sabbath) to each other on Saturdays, but not one in which all the men wear black hats and study Torah all day (though some do). That is, folks live Jewish lives, but interact with the outside world as well. After a few months, it felt like home.This was the context in which I decided—or rather, did not have to decide—to circumcise my son. It was the natural result of the decision to be part of a community that places value (and even membership) on the ritual of circumcision. I made that decision years earlier and have been continuously reaffirming it since. Every day I wake up is a day I decide to be an observant Jew, and I decide to do so in order to be a member of an observant community. The decision to circumcise was yet another decision to be part of that community, which has given me so much joy, support, and meaning. Why would I deny my son—and myself—that community?In addition, not needing to make any decisions was itself a kind of relief. I have heard of mothers—including my own—off in a room crying, needing comfort, unable to be there for the circumcision. That did not happen for me. Despite a history of rather severe perinatal depression and anxiety, including suicidal ideation less than a week before the event, I was completely fine. Maybe my comfort came from the fact that I already had two children; this was not my first newborn, though it was my first bris. Maybe, after almost two years of COVID, circumcision did not seem like such a big deal. Maybe I was just glad someone else would hold the baby for a while. But I think at least part of it was the happiness that... (shrink)

The lack of gender parity in philosophy has garnered serious attention recently. Previous empirical work that aims to quantify what has come to be called “the gender gap” in philosophy focuses mainly on the absence of women in philosophy faculty and graduate programs. Our study looks at gender representation in philosophy among undergraduate students, undergraduate majors, graduate students, and faculty. Our findings are consistent with what other studies have found about women faculty in philosophy, but we were able to add (...) two pieces of new information. First, the biggest drop in the proportion of women in philosophy occurs between students enrolled in introductory philosophy classes and philosophy majors. Second, this drop is mitigated by the presence of more women philosophy faculty. (shrink)

Explore meditation and yoga poses designed to help you align with your truth, find your purpose, and walk through the fire until you transform, gaining a new sense of Self.

The argument between retributivists and consequentialists about what morally justifies the punishment of offenders is incoherent. If we were to discover that all of the contending justifications were mistaken, there is no realistic prospect that this would lead us to abandon legal punishment. Justification of words, beliefs and deeds, can only be intelligible on the assumption that if one's justification were found to be invalid and there were no alternative justification, one would be prepared to stop saying, believing or doing (...) what one has attempted to justify. Therefore, the moral standing or basis of our practices of punishing offenders can not rest on a justification of it. (shrink)

In the past few years, two new DNA topoisomerases have been discovered in bacteria, bringing the total number of DNA topoisomerases in E. coli to four. Two classes of topoisomerases, type 1 and type 2, are distinguishable by their amino acid homology and their apparent reaction mechanism. Of the four E. coli topoisomerases, there are two type 1 and two type 2 enzymes. In eukaryotes, the existence of multiple type 1 and type 2 enzymes has also become apparent. The existence (...) of these multiple enzymes provokes a question whose answer has both evolutionary and physiological implications: are these topoisomerases functionally redundant, or have they acquired sufficient specialization that they now perform unique biological reactions? In bacteria, there is evidence for both specialization and redundancy in the functions of topoisomerases. (shrink)

Molly Cochran offers an account of the development of normative theory in international relations over the past two decades. In particular, she analyzes the tensions between cosmopolitan and communitarian approaches to international ethics, paying attention to differences in their treatments of a concept of the person, the moral standing of states and the scope of moral arguments. The book draws connections between this debate and the tension between foundationalist and antifoundationalist thinking and offers an argument for a pragmatic approach (...) to international ethics. (shrink)

Incarcerated offenders are categorically high-risk patients who are disproportionately more likely to suffer from chronic illnesses than members of the general population. The conditions of confinement (e.g., overcrowding, poor nutrition, risky sexual practices) furthermore make them increasingly susceptible to acquiring an infectious disease. Past research has linked preventive care, including the early detection and treatment of such diseases, with better long-term health outcomes; however, such care is not universally provided to this population. The benefits and current availability of preventive care (...) for incarcerated offenders is discussed and several questions are raised for future discussion within a global context. In particular, these questions include whether or not incarcerated offenders should receive preventive care, the underlying reason for such provision, who should advocate for and for be responsible for their access to preventive care, and the mechanisms through which access could be attained. (shrink)

Contains concise summaries of 200 major works of philosophy arranged chronologically.