It is often supposed that the spectacular successes of our modern mathematical sciences support a lofty vision of a world completely ordered by one single elegant theory. In this book Nancy Cartwright argues to the contrary. When we draw our image of the world from the way modern science works - as empiricism teaches us we should - we end up with a world where some features are precisely ordered, others are given to rough regularity and still others behave (...) in their own diverse ways. This patchwork makes sense when we realise that laws are very special productions of nature, requiring very special arrangements for their generation. Combining classic and newly written essays on physics and economics, The Dappled World carries important philosophical consequences and offers serious lessons for both the natural and the social sciences. (shrink)

Der Körper hat Konjunktur. Als ausgestellter, verfüg- und verführbarer begegnet er uns täglichim Übermaß. Es war nur eine Frage der Zeit, bis im Spiel der sich in den Wissenschafteneinander ablösenden turns auch ein corporeal (oder body) turn ausgerufen würde. Dabeibleibt im genannten turn der Gegenstand der Untersuchung nicht selten reduziert auf das, wasman im deutschen Sprachgebrauch »Körper« nennt: ein physisches Substrat, das wie ein Dingunter Dingen beschreibbar ist. Gegen diese Verkürzung stellt der Begri des »Leibes«,spätestens seit Edmund Husserl, eine präzise (...) theoretische Intervention in die wissenschaftlicheund philosophische Diskussion um Körper und Körperlichkeit dar: Dem objektiv beobachtbaren Körper, den wir haben, wird der lebendige Leib, der wir sind, gegenübergestellt. Diesem »Leib«, seiner Geschichte, seinen Varianten und seinem Versprechen gehen dieAutoren der vorliegenden Beiträge nach. Inhaltsübersicht Emmanuel Alloa/Thomas Bedorf/Christian Grüny/Tobias Nikolaus Klass: Einleitung I. Der Leibbegriff in der Phänomenologie Emmanuel Alloa / Natalie Depraz: Edmund Husserl – „Ein merkwürdig unvollkommenkonstituiertes Ding“ – Stefan Kristensen: Maurice Merleau-Ponty I – Körperschema undleibliche Subjektivität – Emmanuel Alloa: Maurice Merleau-Ponty II – Fleisch und Dierenz – David Espinet: Martin Heidegger – Der leibliche Sinn von Sein – Thomas Bedorf: EmmanuelLevinas – Der Leib des Anderen – Karel Novotný: Körper, Leib, Aektivität in Jan Pato č kasPhänomenologie der natürlichen Welt – Julia Scheidegger: Michel Henry – TranszendentaleLeiblichkeit – Jörg Sternagel: Bernhard Waldenfels – Responsivität des Leibes – Kerstin Andermann: Hermann Schmitz – Leiblichkeit als kommunikatives Selbst- und Weltverhältnis II. Zur Geschichte des Leibbegris Emmanuel Alloa: Archaische Leiblichkeit. Die griechische Antike und die Entdeckung desKörpers – Theresia Heimerl: Der Leib Christi und der Körper des Christen: Körper und Leib alszentrale Problemzonen des Christentums – Marc Rölli: Philosophische Anthropologie im 19. Jahrhundert – Zwischen Leib und Körper – Tobias Nikolaus Klass: Friedrich Nietzsche – Denkenam „Leitfaden des Leibes“ – Andreas Cremonini: Sigmund Freud – Der gelebte vs. derphantasmatische Leib – Uta Noppeney: Kurt Goldstein und Frederik Buytendijk – Der Leib-Begri in der organismischen Biologie – Volker Schürmann: Max Scheler und Helmuth Plessner– Leiblichkeit in der Philosophischen Anthropologie – Marion Lauschke: Ernst Cassirer und AbyWarburg – Kulturanthropologie III. Grenzen und Kritik des Leibbegris Christian Grüny: Theodor W. Adorno – Soma und Sensorium – Ulrich Johannes Schneider: Michel Foucault – Der Körper und die Körper – Burkhard Liebsch: Paul Ricoeur – Das leiblicheSelbst begegnet dem Widerstand des Anderen – Mirjam Schaub: Gilles Deleuze – Was weiß ein„Körper ohne Organe“ vom Leib? – Kathrin Busch: Jean-Luc Nancy – Exposition und Berührung– Shaun Gallagher: Embodiment: Leiblichkeit in den Kognitionswissenschaften – Marie-Luise Angerer: Gender und Performance – Ist leibliche Identität ein Konstrukt? – Thomas Bedorf/Selin Gerlek: Praxistheorien – Leibkörperliche Praktiken im Vollzug. (shrink)

Philosophy for Children arose in the 1970s in the US as an educational programme. This programme, initiated by Matthew Lipman, was devoted to exploring the relationship between the notions ‘philosophy’ and ‘childhood’, with the implicit practical goal of establishing philosophy as a full-fledged ‘content area’ in public schools. Over 40 years, the programme has spread worldwide, and the theory and practice of doing philosophy for or with children and young people appears to be of growing interest in the field of (...) education and, by implication, in society as a whole. This article focuses on this growing interest by offering a survey of the main arguments and ideas that have given shape to the idea of philosophy for children in recent decades. This aim is twofold: first, to make more familiar an actual educational practice that is not at all well known in the field of academic philosophy itself; and second, to invite a re-thinking of the relationship between philosophy and the child ‘after Lipman’. (shrink)

Who, over the age of 20, hasn’t experienced a serendipitous event: unexpected information that yields some unintended but potential value later on? Sitting next to a stranger on a plane who becomes a business partner? Stumbling onto an article in a journal or newspaper that helps tackle a nagging problem? Creating a new drug by accident?

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

In this paper I want to analyse the meaning of education for democracy and thinking as this is generally understood by Philosophy for Children. Although we may be inclined to applaud Philosophy for Children's emphasis on children, critical thinking, autonomy and dialogue, there is reason for scepticism too. Since we are expected as a matter of course to subscribe to the basic assumptions of Philosophy for Children, we seem to become tied, as it were, to the whole package, without reservation. (...) Following ideas of Hannah Arendt, I draw attention to the instrumentalised nature of Philosophy for Children and the loss of originality that this instrumentalisation means. This does not mean that I wish to abandon Philosophy for Children. The point is rather that I want to examine whether or not another kind of philosophy for children is possible. (shrink)

Based on evidence from press articles covering 39 corporate fraud cases that went public during the period 1992-2005, the objective of this article is to examine the role of managers' behavior in the commitment of the fraud. This study integrates the fraud triangle (FT) and the theory of planned behavior (TPB) to gain a better understanding of fraud cases. The results of the analysis suggest that personality traits appear to be a major fraud-risk factor. The analysis was further validated through (...) a quantitative analysis of keywords which confirmed that keywords associated with the attitudes/rationalizations component of the integrated theory were predominately found in fraud firms as opposed to a sample of control firms. The results of the study suggest that auditors should evaluate the ethics of management through the components of the TPB: the assessment of attitude, subjective norms, perceived behavioral control and moral obligation. Therefore, it is potentially important that the professional standards that are related to fraud detection strengthen the emphasis on managers' behavior that may be associated with unethical behavior. (shrink)

Institutional review boards and investigators are used to talking about risks of harm. Both low risks of great harm and high risks of small harm must be disclosed to prospective subjects and should be explained and categorized in ways that help potential subjects to understand and weigh them appropriately. Everyone on an IRB has probably spent time at meetings arguing over whether a three-page bulleted list of risk description is helpful or overkill for prospective subjects. Yet only a small fraction (...) of all the time and attention lavished on risk disclosure has been devoted to discussing whether and when potential benefit to subjects can reasonably be claimed and, if so, how it should be described in the consent form and process.Traditionally, IRBs and regulators have worked to ensure that clear lines can be drawn between research that, by definition, carries no potential for direct benefit — because it uses healthy volunteers or because it is not foreseeably focused on the development of treatments — and research that does have the development of effective treatments as its goal. (shrink)

This paper sheds light on the incongruent findings concerning the relationship between family involvement and firms’ corporate social responsibility. While prior studies have mainly taken the perspective of families’ socioemotional wealth preservation, we approach this relationship from the perspective of behavioral agency theory, highlighting the important role played by CEOs’ family memberships. Specifically, we posit that family firms are more likely to invest in CSR when their CEOs are members of the controlling families. Furthermore, we examine how family firms can (...) employ long-term incentives to encourage non-family CEOs to act in the interests of the controlling families to preserve SEW and thus enhancing family firms’ CSR performance. We tested our hypotheses using hand-collected data of family firms included in the S&P 500 index, in the period of 2003–2010. The empirical findings support our hypotheses that family firms with family members as the CEOs have better CSR performance and family firms tend to provide a high level of long-term incentives to non-family than family CEOs. In addition, long-term incentives strongly motivate CEOs to improve firms’ CSR performance, regardless of their family memberships. (shrink)

While few soldiers may have read the works of Epictetus or Marcus Aurelius, it is undoubtedly true that the ancient philosophy known as Stoicism guides the actions of many in the military. Soldiers and seamen learn early in their training “to suck it up,” to endure, to put aside their feelings and to get on with the mission. This book explores what the Stoic philosophy actually is, the role it plays in the character of the military (both ancient and modern), (...) and its powerful value as a philosophy of life. Marshalling anecdotes from military history—ranging from ancient Greek wars to World War II, Vietnam, and Iraq—the book illuminates the military mind and uses it as a window on the virtues of the Stoic philosophy, which are far richer and more interesting than our popularized notions. The book explores the deep, lasting value that Stoicism can yield, in issues of military leadership and character; in the Stoic conception of anger and its control (does a warrior need anger to go to battle?); and in Stoic thinking about fear and resilience, grief and mourning, and the value of camaraderie and brotherhood. The book concludes by recommending a moderate Stoicism, where the task for the individual, both civilian and military, youth and adult, is to temper control with forgiveness, and warrior drive and achievement with humility and humor. (shrink)

Public health ethics in the future will be distinguished from public health ethics in the past by this new subfield being labeled as such, acknowledged, and called upon for service. Ethical dilemmas have been present throughout the history of public health. The question of whether to force Henning Jacobson to be immunized in 1905 in accordance with the 1902 Massachusetts smallpox vaccination law was one of ethics as well as law. How Thomas Parran, Surgeon General in 1936, chose to respond (...) to a raging syphilis epidemic in the United States in the early part of the 2W century raised considerable moral debate in determining the appropriate public health response for a government? More recently, questions have arisen concerning the appropriate reach of government in controlling HIV banning smoking, or promoting healthy lifestyles. Debates over government infringement, morality, and justice recur throughout the history of public health. (shrink)

This study is aimed to identify the relative effect of online review ratings and perceived crowding on purchase intentions of a consumer. Our study also investigated the contingent effect of gender and perceived crowding between the relationship of exogenous and endogenous variables. This study was conducted in the Malaysian restaurant industry. We applied the purposive sampling technique to identify respondents, the mall intercept survey method was used for data collection. Smart PLS software was applied for data analysis. This study demonstrates (...) through its results that online review ratings and perceived crowding have a positive effect on purchase intentions of a consumer. Moreover, if a consumer perceives crowding at a restaurant, this has a positive contingent effect on the relationship between review ratings and purchase intentions. This demonstrates that the consumer is more inclined to choose a restaurant with a high online review rating and has high perceived crowding at some unfamiliar place. Lastly, no evidence is found for the gender difference between review rating and purchase intentions; however, gender shows contingent effect and results confirmed that males preferred more crowded restaurants as compared to females. There are theoretical and practical implications for managers in the findings of this study. (shrink)

This study adapts the theory of reasoned action (Ajzen and Fishbein, 1980) to the behavior of fraudulent reporting on financial statements so as to examine the effects of moral reasoning and self-monitoring on intention to report fraudulently, using structural equation modeling. The paper seeks to investigate two of the red flags for financial statement fraud identified in Loebbecke et al.'s (1989) paper: client management displays a significant lack of moral fiber and client personnel exhibit strong personality anomalies. As expected, high (...) moral reasoners are more influenced than low moral reasoners by their own attitude towards the behavior. Contrary to prior research, low self-monitors are found to be more influenced than high self-monitors by subjective norms. Future research is recommended to investigate the counter-intuitive results for self-monitors, to consider the implications of group decision making as regards the promulgation of fraudulent financial statements, and to examine additional red flags for financial statement fraud. (shrink)

An advertising firm''s ethical culture (as defined by the firm''s managerial and peer ethical behaviors) may affect the employees'' comfort levels and ethical behaviors. In this research, scenarios were used to describe advertising firms with various ethical cultures. Respondents'' perceived comfort levels in working for the firms described in the scenarios and the respondents'' behavioral intentions when faced with various advertising situations were assessed. Results of the study indicate that peer ethical behavior exerts a strong influence on the comfort or (...) discomfort level and the ethical behavioral intentions of potential advertising employees. Further, the strong influence exerted by peers seems to transcend the ethical behavior of the manager and carry over to the attitude toward the entire corporate advertising environment. This study provides insights for firms and researchers interested in assessing the impact of an advertising firm''s ethical culture on potential employees. (shrink)

Should you wash your hands? -- Are workarounds ethical? -- Turfing, bending, and gaming -- Dirty hands and the semiclear conscience -- Problems of humanity -- Ethics without heroics : foreseeing moral problems in complex systems.

As a response to Le Fils, a film directed by the Dardenne brothers (), we explore the idea of speaking as an invitation and juxtapose it against ideas of speaking as a transactional, calculative, calibrated, activity. Speaking tends to be understood as a relatively straightforward matter: as a means of communication structured by such values as the reciprocal balancing of rights and obligations, of clear communication of information, of the gaining of insight into what is happening. Speaking, then, is a (...) means by which we explain, prove or pass judgement on something. Understood this way, it is easily associated with ideas of empowerment or of the mediation of information: one directs or commits oneself to a (shared) orientation—for example to what Jürgen Habermas refers to as ‘communicative reason’. It presupposes a particular attitude of the subject; speaking that addresses the listener and the speaker herself in the name of an orientation or particular expertise to which access is claimed. In this article, by contrast, we would like to explore a different avenue of thought whereby speaking appears rather as an abandoning or exposing of oneself. It is less an activity than a passivity or passion, through which one becomes present in the present, which is at once also a kind of invitation. In exploring this form of speaking, we take up some ideas of Martin Buber. Our discussion relates speaking to being inspiring and being inspired, revealing in the process the way that to be inspiring is at the same time to be inspired. Speaking as invitation, we conclude, is what education is about. (shrink)

Clinical gene transfer research has both a unique history and a complex and layered system of research oversight, featuring a unique review body, the Recombinant DNA Advisory Committee. This paper briefly describes the process of decision-making about clinical GTR, considers whether the questions, problems, and issues raised in clinical GTR are unique, and concludes by examining whether the RAC's oversight is a useful model that should be reproduced for other similar areas of clinical research.Clinical GTR is governed by the same (...) oversight system as most clinical trials, with a significant addition: the RAC. Like other research with human subjects, GTR, if it is affiliated with a federally funded institution, must be approved by an institutional review board whose activities are governed by the common rule, that is, the federal regulations for protection of human subjects in research. Like other research intended to produce a drug, device, or biologic to be marketed in the United States, GTR is also overseen by the Food and Drug Administration. (shrink)

Journal of Social Philosophy, EarlyView.

Approximately 20% of adult cancer patients are eligible to participate in a clinical trial, but only 2.5-9% do so. Accrual is even less for minority and medically underserved populations. As a result, critical life-saving treatments and quality of life services developed from research studies may not address their needs. This study questions the utility of the bioethical concern with therapeutic misconception (TM), a misconception that occurs when research subjects fail to distinguish between clinical research and ordinary treatment, and therefore attribute (...) therapeutic intent to research procedures in the safety net setting. This paper provides ethnographic insight into the ways in which research is discussed and related to standard treatment. (shrink)

The relationship between professional ethical reflection and corresponding moral behavior is an important theme of moral psychology in recent years. Following Schönegger and Wagner’s research in German-speaking countries, through a replication-extension of the original US-based research carried out by Schwitzgebel and Rust, we aim at examining their results in the Chinese context. The previous researchers have shown that ethical reflection generally has no positive effect on moral behavior. A cross validation of this result was conducted in Chinese mainland, and three (...) issues concerning Confucian virtues were added. Through reaching out to 4482 professors and collecting 368 responses altogether, we attempted to explore whether professional ethical reflection can influence normative attitude and the moral attitude-behavior consistency. Unfortunately, the results failed to show a statistically significant difference between ethicists and other professors on most of the moral issues, with the exception of paying academic membership fees and vegetarianism, wherein ethicists do express more stringent normative attitudes, and their moral attitude and self-reported behavior are statistically consistent. Notably, Chinese professors mainly expressed morally neutral attitudes toward the issue of eating meat, and they tended to believe that ethical reflection contributes to more and better moral behaviors. (shrink)

Prior research has documented the continued existence of an expectation gap, defined as the divergence between the public’s and the profession’s conceptions of auditor’s duties, despite the auditing profession’s attempt to adopt standards and practices to close this gap. In this paper, we consider one potential explanation for the persistence of the expectation gap: the role of media bias in shaping public opinion and views. We analyze press articles covering 40 U.S. corporate fraud cases discovered between 1992 and 2011. We (...) compare the auditor’s duties, described by the auditing standards, with the description of the fraud cases as found in the press articles. We draw upon prior research to identify three sources of the expectation gap: deficient performance, deficient standards, and unreasonable expectations. The results of our analysis provide evidence that the performance gap can be reduced by strengthening auditor’s willingness and ability to apply existing auditing standards concerning fraud detection; the standards gap can be narrowed by improving existing auditing standards; and unreasonable expectations, however, involve elements beyond the profession’s sphere of control. As a result, the expectation gap is unlikely to disappear given the media’s tendency to bias, with an overemphasis of unreasonable expectations in their coverage of frauds and press articles tending to reinforce the view that the auditor should take more responsibility for detecting fraud, irrespective of whether this is feasible at a reasonable cost. In addition to the primary role of the press in perpetuating the expectation gap, a second reason for continuation of the expectation gap is that the rational auditor will have difficulty in assessing subjective components of fraudulent behavior. (shrink)

When we think about Kantian virtue, what often comes to mind is the notion of respect. Respect is due to all persons merely in virtue of their status as rational agents. Indeed, on the Kantian view, specific virtues, such as duties of beneficence, gratitude, or self-perfection, are so many ways of respecting persons as free rational agents. To preserve and promote rational agency, to protect individuals from threats against rational agency, i.e., to respect persons, is at the core of virtue. (...) No doubt, part of the appeal of the Kantian notion of respect is that it offers an intuitive way of talking about the wrongness of manipulation and coercion, and in general, the wrongness of unfairly taking advantage of another. For to respect persons is to take seriously their status as persons, and to forswear, at some level, actions and attitudes that would compromise their dignity. Talking about respect has become shorthand for signaling deontological concerns. More formally, within recent Kantian exegesis, respect is viewed as yielding a more accessible and less contrived account of the Categorical Imperative than the more traditional criterion of universalizability and the contradictions tests applied to it. Within the Kantianinspired political theory of John Rawls, respect is also a core notion, representing a pervasive good, the bases of which, just states have an obligation to distribute to their members. Yet, for all its appeal, respect is an odd feature of Kantian ethics. For it is an emotion in a theory that prides itself in grounding morality in principles of reason alone. In this essay, I draw attention to the importance of respect in Kant's account in order to show just how he makes room for the emotions. Indeed, I shall argue that on Kant's account of full moral agency, we are emotional as well as rational creatures. Although Kant often portrays respect as an abstract emotional attitude mysteriously connected to our rationality, I argue that on a suitable revision, respect can be transformed into a more concrete attitude, cultivated and expressed alongside other emotions requisite for full virtue. (shrink)

The three important target articles make a strong case for regarding racism as a public health crisis. Each calls for advocacy by the bi...

Giving up the increasingly troubled distinction between “experiment” and “treatment” would make it easier to focus on informed consent and harder to beg questions about uncertainty and shared decisionmaking in medicine.

Informed consent in clinical research is widely regarded as broken, but essential nonetheless. The most recent attempt to reform it comes as part of the first revisions to the Common Rule since it became truly “common” in 1991. This change, the addition of a “key information” requirement for most consent forms, is intended to support and promote a reasoned decision-making process by potential subjects. The key information requirement is both promising and problematic. It is promising because it encourages clarity and (...) honesty about research participation, creativity in information disclosure, and mutual learning through the investigator-subject relationship. It is problematic because those goals — which have remained aspirational since the beginning — may be difficult to achieve in what has become an excessively compliance-oriented regulatory regime. (shrink)

AimTo investigate the status of positive mental characters and humanistic care ability among Chinese nursing students, and confirm the association between positive mental characters and humanistic care ability.MethodsA cross-sectional survey was conducted. Nine hundred eighty-one Chinese nursing students were recruited from hospitals and community healthcare services in Changsha, Hunan, China. Three different self-reported questionnaires were applied: The Demographic Characteristics Questionnaire, Humanistic care ability of Nursing Undergraduates Assessment Scale and Positive Mental Characters Scale for Chinese College Students. Pearson correlation analysis and (...) multiple liner regression analysis were performed to analyze the association between positive mental character and humanistic care ability for Chinese nursing students.ResultsThe mean scores of nursing students' humanistic care ability and positive mental character were 125.94 ± 21.19, 233.18 ± 38.59, respectively. The Pearson correlation results showed that positive mental character was significantly associated with humanistic care ability. Multiple liner regression analysis indicated that positive mental characters, four dimensions of courage, humanity, justice and transcendence in positive mental character, care from classmates were found to be independent predictors of humanistic care ability.ConclusionPositive mental characters are important considerations in the development, implementation and evaluation of humanistic care ability interventions. (shrink)

One of the reasons often cited for the renewed interest in Aristotelian virtue theory is its alleged sensitivity to the particular case. In addition to rules and procedures is attention to the variety of individual cases, and a reminder of the shortfalls of misplaced rigour. Often quoted are the passages from the Nicomachean Ethics in which Aristotle warns that we must seek only so much precision as is appropriate for the subject matter. Repeated, too, is the well-known phrase of the (...) Ethics, that “judgment rests in perception”. The spirit of these remarks, in essence, that “practical wisdom is not scientific understanding”, is contrasted with modern views which stress the sufficiency of algorithms for fully determining right action and deliberation based on deduction from rules. (shrink)

In recent years, while extensive researches on various networks properties have been proposed and accomplished, little has been proposed and done on network robustness and node vulnerability assessment under cascades in directed large-scale online community networks. In essential, an online directed social network is a group-centered and information spread-dominated online platform which is very different from the traditional undirected social network. Some further research studies have indicated that the online social network has high robustness to random removals of nodes but (...) fails to the intentional attacks, particularly to those attacks based on node betweenness or node directed coefficient. To explore on the robustness of directed social network, in this article, we have proposed two novel node centralities of ITG and I M p v. These two new centrality models are designed to capture this cascading effect in directed online social networks. Furthermore, we also propose a new and highly efficient computing method based on iterations for I M p v. Then, with the abundant experiments on the synthetic signed network and real-life networks derived from directed online social media and directed human mobile phone calling network, it has been proved that our ITG and I M p v based on directed social network robustness and node vulnerability assessment method is more accurate, efficient, and faster than several traditional centrality methods such as degree and betweenness. And we also have proposed the solid reasoning and proof process of iteration times k in computation of I M p v. To the best knowledge of us, our research has drawn some new light on the leading edge of robustness on the directed social network. (shrink)

Sherman presents a slightly revised definition of empathy, in which empathy is the cognitive ability to place oneself in the world of another, imagining all of the realities, feelings, and circumstances of that person in the context of their world.

What does it mean to say that this person at this time is 'the same' as that person at an earlier time? If the brain is damaged or the memory lost, how far does a person's identity continue? In this book two eminent philosophers develop very different approaches to the problem.

People who lack decision‐making capacity may be able to communicate preferences, which can and should inform surrogate decision‐making on their behalf. It is unclear whether making a further distinction about “capacity for preferences,” as Jason Wasserman and Mark Navin propose in this issue of the Hastings Center Report, would improve the process of surrogate decision‐making. Anyone who is regularly involved in surrogate decision‐making or who has worked to articulate decision‐making standards and processes can think of cases in which a patient's (...) voice was ignored or his or her preferences and ability to communicate them overlooked. However, we can also think of cases in which it was unclear whether information provided by a patient, recently or in the past, should have been characterized as a preference relevant to a medical decision that the patient lacked the capacity to make. We should also recognize that clear preferences of a patient who lacks decision‐making capacity may conflict with the limits of another person or of a family's resources such that these preferences cannot guide a surrogate's decision. This patient will not get what he wants. A situation in which preferences are known and make sense but cannot be applied in a feasible way demonstrates the limits of the medical decision‐making framework concerning care that is not covered by medical insurance. (shrink)

BackgroundCommunity engagement in research is valuable for instrumental and intrinsic reasons. Despite existing guidance on how to ensure meaningful CE, much of what it takes to achieve this goal differs across settings. Considering the emerging trend towards mandating CE in many research studies, this study aimed at documenting how CE is conceptualized and implemented, and then providing context-specific guidance on how researchers and research regulators in Uganda could think about and manage CE in research.MethodsWe conducted qualitative interviews and focus group (...) discussions involving forty-one respondents who were experienced in HIV/aids biomedical research involving CE. Thirty-eight of these were directly or indirectly associated with Uganda’s leading research institution in the field of HIV/aids. They included Principal Investigators, Community Liaisons Officers, Research Ethics Committee members and Community Advisory Board Members. Three respondents were from Uganda National Council for Science and Technology. Data were collected between August 2019 and August 2020, using audio-taped focus group discussions and key informant interviews, transcribed and analyzed manually to generate themes and subthemes.ResultsThree major themes emerged: goals or value of CE; the means of CE, and, the evaluation of CE. Goals or value of CE generated four subthemes representing the overarching goals of CE: Promote communities’ agency; Generate and sustain trust; Protect and promote communities’ rights and interests; and, Help studies optimize participation in the form of enrolment and retention of participants. What usually comes under the nomenclatures of methods, strategies, and approaches of CE, such as town-hall meetings, sports events, drama, and the like, should simply be understood as the means of CE, and it is not desirable to hold pre-conceived and fixed ideas about the best means to conduct CE in research since a lot depend on the context. Finally, the study found that despite CE’s critical importance, which suggests the need to track and evaluate it, CE is currently intermittently evaluated, and for inadequate motivations.ConclusionsExisting guidance on how to conduct robust CE in research is no substitute for creativity, flexibility, and reflexivity on the part of both researchers and research regulators. (shrink)