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)

In an increasingly global environment, managers face a dilemma when selecting and applying moral values to decisions in cross-cultural settings. While moral values may be similar across cultures (either in different countries or among people within a single country), their application (or ethics) to specific situations may vary. Ethics is the systematic application of moral principles to concrete problems.This paper addresses the cross-cultural ethical dilemma, proposes a tentative model for conceptualizing cross-cultural ethics, and suggests some ways in which the model (...) may be tested and operationalized. (shrink)

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)

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)

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)

It is widely assumed that informing prospective subjects about the risks and possible benefits of research not only protects their rights as autonomous decisionmakers, but also empowers them to protect their own interests. Yet interviews with patient‐subjects conducted under the auspices of the Advisory Committee on Human Radiation Experiments suggest this is not always the case. Patient‐subjects often trust their physician to guide them through decisions on research participation. Clinicians, investigators, and IRBs must assure that such trust is not misplaced.

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)

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)

In the past ten years, there has been growing interest in and concern about protecting the privacy of personal medical information. Insofar as medical records increasingly are stored electronically, and electronic information can be shared easily and widely, there have been legislative efforts as well as scholarly analyses calling for greater privacy protections to ensure that patients can feel safe disclosing personal information to their health-care providers. At the same time, the volume of biomedical research conducted in this country continues (...) to grow. The budget of the National Institutes of Health, for example, was $20,298 million in 2001, having more than doubled from a budget of $9,218 million 10 years before. This growing body of research includes increased efforts to use stored medical records as a source of data for health services, epidemiologic, and clinical studies. (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)

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.

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)

Hastings Center Report, Volume 52, Issue 3, Page 3-3, May–June 2022.

Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its purpose. Intervention (...) participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (shrink)

Genetic testing raises concerns that individuals will be denied health insurance (and thus, effectively, access to health care), or that employers will screen to eliminate potentially costly workers. Although we as a society do not yet concur on the degree to which private businesses have a responsibility to promote social justice, several different policy alternatives might allow us to weigh the interests of insurers, as businesses, against the interests of citizens in a responsible manner.

In accordance with Progressivism, Matthew Lipman, introduced an educational model for renewal and change by means of the child. With his Philosophy for Children programme he wished to offer an alternative for the intellectualistic oriented education which silenced children. The answer to the search for freedom and change, Lipman finds in the symbioses between ‘Philosophy’ and ‘Children’. Philosophy expressed in critical thinking and communication, was the basis to emancipate the child from the oppression of the adult and to cause change. (...) According to Lipman the main purpose of philosophy is to free every individual from determination. This plea is being elaborated by dialogue. The main issue of our paper concerns the question whether Lipman’s alternative ‘Philosophy for Children’ can fulfil the promise of change and freedom. To answer this question we will investigate thoroughly where dialogue and change in Philosophy for Children stand for. Finally we will propose another perspective of dialogue. A dialogue stressed on listening. Listening to how the world appears to us and how we appear to ourselves. (shrink)

This article arises from the thoughts of Hannah Arendt, and more especially from her idea that the essence of education is the renewal of the world. That idea forms the backdrop to a consideration of the current interest in education as the construction of one's own life. I argue that the will to construct one's own life is not a natural, biological given, but a product of a 'biopolitical machine'. In the first part of the article I challenge the contemporary (...) discourse of self-empowerment and expose the way that the will to construct one's own life, in its current manifestation, is an effect and an instrument of a (strategic) configuration that includes the construction of one's own life as a matter of public concern. Ironically, the foregrounding of 'public concern' in this way undermines a more meaningful realisation of the public realm. I see this, however, not primarily as a problem, but as an invitation to think again. In the second part I argue that what the 'biopolitical machine' has shown is precisely that thinking of childhood in terms of a becoming and a 'not yet' does not capture the essence of human being. Instead it should be conceived as a singular, historical experience emerging within a particular historical context. What this reveals is an opening onto a possibility of acting and thinking differently. I conclude with an alternative idea of education, one that is inspired by Arendt. However, this is not intended as a utopian turn, but rather as a means of exposing a dimension of education that has remained silenced or even largely excluded: a dimension that is an invitation to think and to put our thoughts at stake, which is something altogether different from utopia. (shrink)

This concluding essay offers reflections on core components of the faculty fellowship program, its outcomes and results, and program design and administration. Amid the current calls for reform in legal and other professional education, the lessons we learned and perspectives we gained during this fellowship program may be relevant to any faculty members and university administrations that are seeking to create more effective and engaged professional and graduate school programs, whatever may be their subject-matter discipline.

This article examines the functions performed by each of the “core” face processing regions: the fusiform face area, occipital face area, and superior temporal sulcus. It reviews the data from two complementary sources: functional imaging in healthy subjects and behavioral data from neurological subjects with damage to these regions. Data from functional neuroimaging allows for the determination of which regions are specifically engaged by which stimuli and which tasks; functional magnetic resonance imaging adaptation and pattern classification methods even allow for (...) the characterisation of the representations extracted in each. However, fMRI can only tell that a given region is sensitive to a particular stimulus property. fMRI cannot depict if the processing requires perceiving that property occurs in that area. In contrast, lesion data can answer the crucial question of whether a given brain region is necessary for a given computation. (shrink)

Mary Wollstonecraft was one of the most influential and controversial women of her age. No writer, except perhaps her political foe, Edmund Burke, and her fellow reformer, Thomas Paine, inspired more intense reactions. In her brief literary career before her untimely death in 1797, Wollstonecraft achieved remarkable success in an unusually wide range of genres: from education tracts and political polemics, to novels and travel writing. Just as impressive as her expansive range was the profound evolution of her thinking in (...) the decade when she flourished as an author. In this collection of essays, leading international scholars reveal the intricate biographical, critical, cultural, and historical context crucial for understanding Mary Wollstonecraft's oeuvre. Chapters on British radicalism and conservatism, French philosophes and English Dissenters, constitutional law and domestic law, sentimental literature, eighteenth-century periodicals and more elucidate Wollstonecraft's social and political thought, historical writings, moral tales for children, and novels. (shrink)

Girolamo Cardano's writings on medicine reflect both the complexity and diversity of the Renaissance medical world and the breadth of his own interests. This book draws on selected themes of in Cardano's medical writings to explore the relation between medicine and Renaissance.

“Tell me," Wittgenstein once asked a friend, "why do people always say, it was natural for man to assume that the sun went round the earth rather than that the earth was rotating?" His friend replied, "Well, obviously because it just looks as though the Sun is going round the Earth." Wittgenstein replied, "Well, what would it have looked like if it had looked as though the Earth was rotating?” What would it have looked like if we looked at all (...) sciences from the viewpoint of Wittgenstein’s philosophy? Wittgenstein is undoubtedly one of the most influential philosophers of the twentieth century. His complex body of work has been analysed by numerous scholars, from mathematicians and physicists, to philosophers, linguists, and beyond. This volume brings together some of his central perspectives as applied to the modern sciences and studies the influence they may have on the thought processes underlying science and on the world view it engenders. The contributions stem from leading scholars in philosophy, mathematics, physics, economics, psychology and human sciences; all of them have written in an accessible style that demands little specialist knowledge, whilst clearly portraying and discussing the deep issues at hand. (shrink)

This chapter draws upon ancient sources to develop a cognitivist account of emotions and indicate the sense in which they are candidates for the attribution of moral responsibility. Aristotle and the Stoics provide rich resources here, even if the Stoics themselves ultimately deny a place for ordinary emotions in the best moral life. In a selective engagement with the ancients, Kant aligns himself with the Stoic disparagement of the emotions while rejecting their cognitivist account. According to him, emotions are inclinations (...) distinct from the exercise of practical reason. But in his later moral writings, Kant urges a place for emotions in the fine and virtuous character. The chapter begins by reviewing considered intuitions about the moral significance of emotions. (shrink)