Many of the demands being voiced for a "humanizing" of health care center on the public's concern that they have some say In determining what happens to the individual in health care institutions. The essays in this volume address fundamental questions of conflicts of rights and autonomy as they affect four selected, controversial areas in health care ethics: the Limits of Professional Autonomy, Refusing! Withdrawing from Treatment, Electing "Heroic" Measures, and Advancing Reproductive Technology. Each of the topics is addressed in (...) such a way that it includes an examination of the locus of responsibility for ethical decision making. The topics are not intended to exhaustively review those areas of health care provision where conflicts of rights might be said to be an issue. Rather they constitute an examination of the difficulties so often encountered in these specific contexts that we hope will illuminate similar conflicts in other problem areas by raising the level of the reader's moral awareness. Many books in bioethics appeal only to a limited audience in spite of the fact that their subject matter is of deep personal concern to everyone. In part, this is true because they are frequently written from the perspective of a single discipline or a single profession. As a result, one is often left with the impression that such a book views the philosophical, historical, and! or theological problems as essentially indifferent to clinical, legal, and! or policy-making problems. (shrink)

In Setting Limits, Daniel Callahan advances the provocative thesis that age be a limiting factor in decisions to allocate certain kinds of health services to the elderly. However, when one looks at available data, one discovers that there are many more elderly women than there are elderly men, and these older women are poorer, more apt to live alone, and less likely to have informal social and personal supports than their male counterparts. Older women, therefore, will make the heaviest demand (...) on health care resources. If age were to become a limiting factor, as Dr. Callahan sug-gests it should, the limits that will be set are limits that will affect women more dras” tically than they affect men. This review essay examines the implications of Callahan's thesis for elderly women. (shrink)

A series of letters between a professor of philosophy and an eleven-year-old girl.

Review of Alastair V. Campbell: Medicine, Health and Justice: The Problem of Priorities.

Epistemologies have power. They have the power not only to transform worlds, but to create them. And the worlds that they create can be better or worse. For many people, the worlds they create are predictably and reliably deadly. Epistemologies can turn sacred land into ‘resources’ to be bought, sold, exploited, and exhausted. They can turn people into ‘labor’ in much the same way. They can not only disappear acts of violence but render them unnamable and unrecognizable within their conceptual (...) architectures. Settler systems of epistemic and conceptual resources and the relations among them are constructed to preclude certain forms of knowledge. This is not an accident; it is a central goal of colonial violence. Colonization and land dispossession would not be possible without the violent disruption of Indigenous knowledge systems and ongoing organized attempts to disrupt their survival. Violently disrupting the relationships of people to land is as much an epistemic project as it is a material one, and these two projects are inherently linked. The task of theorizing epistemic oppression is not only about epistemic oppression. Epistemic oppression is a story that gives language to a phenomenon in order to get past it, to carry on with the maintaining and reviving the forms of Indigenous and diasporic knowledge that colonialism has worked tirelessly to corrupt and silence. (shrink)

The increasing use of cluster randomised trials in low-resource settings raises unique ethical issues. TheOttawa Statement on the Ethical Design and Conduct of Cluster Randomised Trialsis the first international ethical guidance document specific to cluster trials, but it is unknown if it adequately addresses issues in low-resource settings. In this paper, we seek to identify any gaps in theOttawa Statementrelevant to cluster trials conducted in low-resource settings. Our method is (1) to analyse a prototypical cluster trial conducted in a low-resource (...) setting (PURE Malawi trial) with theOttawa Statement; (2) to identify ethical issues in the design or conduct of the trial not captured adequately and (3) to make recommendations for issues needing attention in forthcoming revisions to theOttawa Statement. Our analysis identified six ethical aspects of cluster randomised trials in low-resource settings that require further guidance. The forthcoming revision of theOttawa Statementshould provide additional guidance on these issues: (1) streamlining research ethics committee review for collaborating investigators who are affiliated with other institutions; (2) the classification of lay health workers who deliver study interventions as health providers or research participants; (3) the dilemma experienced by investigators when national standards seem to prohibit waivers of consent; (4) the timing of gatekeeper engagement, particularly when researchers face funding constraints; (5) providing ancillary care in health services or implementation trials when a routine care control arm is known to fall below national standards and (6) defining vulnerable participants needing protection in low-resource settings. (shrink)

I Norge har vi hatt kontroverser omkring regulering avhumanmedisinsk bioteknologi siden 1980-tallet. Denneartikkelen analyserer et lite utsnitt av disse reguleringsdebattene,nærmere bestemt kontroversen omkring forskningpå befruktede egg. Med utgangspunkt i skriftlig materialeknyttet til tre reguleringsrunder undersøker vi her hvordan ulike aktører arbeidet forå ramme inn denne kontroversen, bl.a. ved hjelp av ulikevitenskapelige og politiske representasjoner av det befruktedeegget.Vi finner at det i perioden 1987–2007 ble arbeidet medulike innramminger som utgangspunkt for retoriske ogpolitiske strategier: På den ene siden ser vi forsøk på (...) å innrammekontroversen i et risikorammeverk som først ogfremst fokuserte på de potensielle negative sidene vedhumanmedisinsk bioteknologi, og som spesielt vektlarespekten for det ufødte liv. På den andre siden ser vi atman arbeidet med en forventningsinnramming som lahovedvekten på håpet om nye behandlingsregimer foralvorlig syke mennesker.Forbudet mot forskning på befruktede egg som ble vedtatti 1987, ble opprettholdt i 1994 og 2003. Med lovendringeni 2008 fikk vi imidlertid et markant brudd i dennorske lovgivningspraksisen, da forskning på befruktedeegg ble tillatt på visse premisser. Vi argumenterer for at den viktigste årsaken til denne lovendringen var Mehmet-saken, en sak som medførtesåkalte «oversvømmelser» i begge innrammingsforsøkenesom er omtalt ovenfor. Mehmet-saken eksponerte samtidig et generelt demokratiskdilemma. Saken illustrerte hvor sårbare lovregler og etiske prinsippkan være for det som for allmennheten fremstår som helt urimelig, og dennesaken etterspør slik sett mer hybride måter å tenke forholdet mellom det universelleog det partikulære, mellom prinsipiell etikk og lekmannsskjønn, mellomfakta og verdier som utgangspunkt for politikkutforming.Nøkkelord: humanmedisinsk bioteknologi, forskning på befruktede egg,kontrovers, representasjoner, Mehmet-sakenEnglish abstract: Effective representations? Concerns and expectationsregarding research on fertilized eggsSince the 1980s, there have been several debates and controversies concerningthe regulation of medical biotechnology. In this article, we analyze three suchinstances in Norway, mainly the debates concerning research on fertilizedeggs. Analyzing the debates surrounding the regulations of 1994, 2003/2004and 2008, we investigate how different stakeholders strived to mobilize whatwe call different framings of the controversy, utilizing the different scientificand political representations of the fertilized egg.Framing involves creating baselines for rhetorical and political stratagems.Two framings appear more pronounced than others in the Norwegian debate.On one hand, we find attempts of framing the controversy in a risk centricframework, which mostly emphasizes the potential negative effects of medicalbiotechnology as it focuses on the universal reverence for the unborn life. Onthe other hand, we see attempts to mobilize a positive frame of expectationthat emphasizes on the hope of finding new and effective treatment options forthe severely ill.The ban against research on fertilized eggs that was passed in Norway in1987 was repeated in 1994 and 2003. However, with the changes introducedto the law in 2008, there was a noticeable shift in Norwegian legislation, asresearch on fertilized eggs became permissible if specific conditions were met.We argue that the turning point in this regulative change was the Mehmentcase, a particular case that entailed the so-called «overflowing» in both the negative and the positive frame. The Mehmet case exposed a moregeneral democratic and political dilemma. In our opinion, it illustrates howvulnerable can regulation that is based on general ethical principles be in theface of what appears to the laity as unreasonable. Thus, we argue that thisactualizes the need for more hybridized ways to view the relationship betweenthe universal and the particular, between principle-based ethics and theunderstandings of lay people, between facts, and values and actual cases inpolicy shaping and practice. (shrink)

[1] Elul. Yamim Noraʼim. Sukot -- [2] Pesaḥ. Shevuʻot. Galut u-geʼulot. Ḥanukah. Purim.

ha-R. ha-ḳ. R. Mosheh mi-Drogiṭshin -- ha-R. ha-ḳ. R. Avraham me-Ulinov -- ha-R. ha-ḳ. R. Shelomoh Leyb mi-Lenṭshna -- ha-R. ha-ḳ. R. Meʼir mi-Primishla -- ha-R. ha-ḳ. R. Avraham mi-Miḳalyov -- ha-R. ha-ḳ. R. Daṿid mi-Zovliṭov -- ha-R. ha-ḳ. R. Shmelḳe mi-Sasov -- ha-R. ha-ḳ. R. Yeshaʻy. Shor -- ha-R. ha-ḳ. R. Yeḥiʼel Mikhal.

[1] Pinḳas ha-ḳabalot -- [2] Talmidaṿ (2 v.) -- [3] ʻInyene Elul ṿe-Yamim Noraʼim -- [4] ʻInyene Ḥanukah u-Furim.

v. 1. Chugŭl ttae kkaji i kŏrŭm ŭro -- v. 2. kyŏul i manil ondamyŏn -- v. 3. pabosae ŭi norae.

ḳerekh rishon. ʻInyane Elul ṿe-Yamim noraʼim.

[1] Tseṭil ḳaṭan -- [2] Hanhagot ha-adam -- [3] Mikhtav ḳodesh -- [4] Liḳuṭim neʻimim -- [5] Igeret ha-ḳodesh -- [6] Kitve ḳodesh -- [7] Tefilah noraʼah -- [8] Noʻam Elimelekh -- [9] Yalḳuṭ Darkhe tsedeḳ.

In lieu of an abstract, here is a brief excerpt of the content:The Sources of MemoryJeffrey Andrew Barash“What does it mean to remember?” This question might seem commonplace when it is confined to the domain of events recalled in past individual experience; but even in this restricted sense, when memory recalls, for example, a first personal encounter with birth or with death, the singularity of the remembered image places the deeper possibilities of human understanding in relief. Such experiences punctuating everyday (...) life highlight the central place of memory as a source of human identity.With a few notable exceptions, such as Henri Bergson or Maurice Halb-wachs, this central role of memory was rarely a topic of interest in the theoretical orientations of our century. It played only a peripheral role in the different philosophical orientations and in the human sciences of this century until, very recently, new attempts have been made to comprehend the significance of memory, above all in the fields of intellectual history and philosophy. Without dealing exhaustively with the bibliography of works on memory, I will mention what seem to me to be the signs of a recent renewal of questioning in this area of interest to historians and philosophers alike. This will lead me to the specific problem I will address in the pages that follow.One of the chief sources of the historian’s recent interest in memory has been the historians’ conflict (Historikerstreit) of the 1980s concerning the interpretation of the German and European past since the rise to power of Nazism and in the aftermath of World War II. As the generations who lived through and—from a given perspective—remembered these events increasingly disappear, the question concerning their precise historical meaning has reemerged with a new urgency. In this vein, for example, as the relatively new periodical History and Memory: Studies in the Representation of the Past and the collection of essays Probing the Limits of Representation: Nazism and the “Final Solution,” edited by Saul Friedlander, amply attest, the relation of memory to historical narrative is as important as it is problematic: to the extent that eyewitness memory claims a status of objectivity beyond the fictional sphere of [End Page 707] the imagination, its role in informing historical narrative involves the very issue of objectivity itself. 1Independently of this query concerning the relation of memory and history in recent scholarship focusing on the twentieth century, a number of studies have attempted to place the idea of memory in historical perspective during premodern periods. In this regard, we may cite Janet Coleman’s recently published work, Ancient and Medieval Memories: Studies in the Reconstruction of the Past and Mary Carruthers’s treatment of the subject of memory in the medieval period in The Book of Memory: A Study of Memory in Medieval Culture. 2 A number of other recent works in the field of intellectual history have attempted to grapple with the intriguing problem of the historicity of the phenomenon of memory in the West. This idea of the historicity of memory has been inspired at least in part by Pierre Nora’s essay, “Between Memory and History,” which introduced the multi-volume series he directed, Les Lieux de mémoire. In this vein, Patrick H. Hutton’s History as an Art of Memory, Matt K. Matsuda’s The Memory of the Modern, and Richard Terdiman’s Present Past: Modernity and the Memory Crisis all center on the historical transforma-tions to which, according to the different perspectives of their works, “memory” has been subject. 3 Like Nora, they link this historicity of the social and cultural role of memory to the radical transformations that Western civilization has undergone in the modern period.In a philosophical perspective David Farrell Krell’s work, Of Memory, Reminiscence, and Writing: On the Verge, presents a very different idea of the phenomenon of memory. 4 Where the intellectual historians of modernity stress the mutations in the role of memory, Krell, following in the footsteps of Jacques Derrida, emphasizes one essential line of continuity that, to his mind, has tied [End Page 708] together the tradition of philosophical reflection on memory from Plato and Aristotle up until Freud: the metaphoric reference to memory as the faculty... (shrink)

The anti-realist argument from underconsideration focuses on the fact that, when scientists evaluate theories, they only ever consider a subset of the theories that can account for the available data. As a result, when scientists judge one theory to be superior to competitor theories, they are not warranted in drawing the conclusion that the superior theory is likely true with respect to what it says about unobservable entities and processes. I defend the argument from underconsideration from the objections of Peter (...) Lipton. I argue that the inconsistency that Lipton claims to find in the argument vanishes once we understand what the anti-realist means when she claims that scientists are reliable. I also argue that collapsing the distinction between relative and absolute evaluations, as Lipton recommends, has its costs. Finally, I briefly examine Richard Boyd's influential defence of realism. (shrink)

Van Fraassen believes our current best theories enable us to make accurate predictions because they have been subjected to a selection process similar to natural selection. His explanation for the predictive success of our best theories has been subjected to extensive criticism from realists. I aim to clarify the nature of van Fraassen’s selectionist explanation for the success of science. Contrary to what the critics claim, the selectionist can explain why it is that we have successful theories, as well as (...) why it is reasonable to expect past successful theories to be successful in the future. I also argue that the plausibility of the realists’ explanation rests on an inaccurate understanding of the nature of predictive success . The predictive success of our best theories is a relative success. (shrink)

I evaluate the extent to which we could learn something about how we should be conducting collaborative research in science from the research on groupthink. I argue that Solomon has set us in the wrong direction, failing to recognize that the consensus in scientific specialties is not the result of deliberation. But the attention to the structure of problem-solving that has emerged in the groupthink research conducted by psychologists can help us see when deliberation could lead to problems for a (...) research team. I argue that whenever we need to generate alternative solutions or proposals, groupthink is a genuine threat, and research teams would be wise to allow individuals opportunities to work alone. But the benefits of team work emerge when scientists seek to evaluate the various proposals generated, and determine a course of action. Then the group is less prone is groupthink, and the interaction of group members can be an epistemic asset. (shrink)

I examine the citation patterns to a revolutionary scientific paper, Hess’ “History of Ocean Basins”, which played a significant role in the plate tectonics revolution in the geosciences. I test two predictions made by the geoscientist Menard (in Science: growth and change. Harvard University Press, Cambridge, 1971): (1) that the peak year of citations for Hess’ article will be 1968; and (2) that the rate of citations to the article will then reach some lower level, continuing on accumulating citations at (...) some regular but unimpressive rate. Drawing on data covering the period from 1962 to 2019, I show that Menard was close with respect to the first prediction. But I also show that things are less clear with respect to the second prediction. I explain why the data are less clear with respect to the second prediction. (shrink)

Rejectionists argue that collective belief ascriptions are best understood as instances of collective acceptance rather than belief. Margaret Gilbert objects to rejectionist accounts of collective belief statements. She argues that rejectionists rely on a questionable methodology when they inquire into the nature of collective belief ascriptions, and make an erroneous inference when they are led to believe that collectives do not really have beliefs. Consequently, Gilbert claims that collective belief statements are best understood as instances of belief. I critically examine (...) Gilbert’s criticisms of rejectionism. I argue that rejectionism is still a viable account of collective belief ascriptions. I also argue that Gilbert’s most powerful criticism provides important insight into what really stands between her and the rejectionists. Gilbert and the rejectionists do not yet agree about what background assumptions can be made in developing an account of collective belief ascriptions. (shrink)

I examine the influence of James B. Conant on the writing of Kuhn’s Structure of Scientific Revolutions. By clarifying Conant’s influence on Kuhn, I also clarify the influence that others had on Kuhn’s thinking. And by identifying the various influences that Conant had on Kuhn’s view of science, I identify Kuhn’s most original contributions in Structure. On the one hand, I argue that much of the framework and many of the concepts that figure in Structure were part of Conant’s picture (...) of science, a picture that figured prominently in the general education natural science courses that Conant taught at Harvard. On the other hand, I show that Kuhn’s Structure contains important contributions that do not figure in Conant’s picture of science. I argue that the following three themes in Structure do not originate with Conant: (1) the concept of “normal science”; (2) “the problem of scientific revolutions,” that is, the apparent threat posed by radical changes of theory in science; and (3) Kuhn’s emphasis on the social dimensions of science, specifically the social structure of research communities. (shrink)

1-pu. Ttang ŭi soksagim -- 2-pu. Mul ŭi norae -- 3-pu. Pulkkot ch'ŏrŏm -- 4-pu. Param ŭi hŭnjŏk.

Social media applications such as Twitter, YouTube and Facebook have attained huge popularity, with more than three billion people and organizations predicted to have a social networking account by 2015. Social media offers a rapid avenue of communication with the public and has potential benefits for communicable disease control and surveillance. However, its application in everyday public health practice raises a number of important issues around confidentiality and autonomy. We report here a case from local level health protection where the (...) friend of an individual with meningococcal septicaemia used a social networking site to notify potential contacts. (shrink)

Between the 14 and 18 March 2016, the Institute for Ethics, History and Theory of Medicine, in cooperation with the Institute for Sociology at Ludwig-Maximilians-University, Munich, hosted an interdisciplinary workshop on migrant and refugee health in Germany and the UK. Fifteen participants from four countries met to discuss ethical issues surrounding the health of migrants and refugees in Europe, with particular emphasis on a comparison of the different approaches taken by Germany and the UK. This report provides an overview of (...) the structure and purpose of the workshop, an outline of the topics discussed, its outcomes, and its objectives moving forward. (shrink)