Les résultats quantitatifs que la psychologie et la physiologie n'ont cessé d'accumuler depuis le début du siecle à propos du sens tactile laissent apparaître aujourd'hui une certaine ambiguïteé. D'un côté en effet, la préoccupation de connaître les sensibilities cutanées spécifiques telles qu'elles se présentent de manière isolée à l'analyse objective des récepteurs stimulés: les sensations de chaud et de froid, de pression et de contact, de douleur, de vibration. D'un autre côté, le désir de sauvegarder l'unité fonctionnelle du sens tactile (...) c.a.d. sa spécificité propre par rapport aux quatre autres sens traditionnels. Ainsi, par exemple, une analyse neurophysiologique des récepteurs tactiles5 ne manque pas de mentionner plusieurs catégories fonctionnelles de la sensibilité cutanée: la douleur, comme signal d'un danger qui peut menacer l'existence de l'organisme; la perception des qualités d'un objet, comme intégration du toucher et de la kinesthésie au cours d'une exploration active de la main; les expériences somatiques complexes telles que le chatouillement et les sensations sexuelles. Pour le phénoménologue, un tel compromis s'apparente à une confusion et provient des positions épistémologiques qui ont animé l'orientation méthodologique des recherches, depuis la psychophysiologie mécaniste jusqu'à la psychologie cybernétique de l'information sensorielle. En cela, la domaine de la sensation tactile reste l'apanage de la psychophysique, et nous tenterons de clarifier pourquoi cette position ne peut aboutir qu'à des résultats problématiques. A partir d'une psychologie anthropologique du sens tactile,14 nous défendrons l'idée d'une psychologie comparée qui permettrait une investigation empirique, objective des comportements animaux, sur la base de prolégomènes phénoménologiques. (shrink)

The author discusses the ways in which she finds the University of Pittsburgh Medical Center protocol for procuring organs from "non-heart-beating cadaver donors" medically and morally questionable and irreverent. She also identifies some of the factors that contributed to the composition of this troubling protocol, and to its institutional approval.

To quote Yogi Berra, writing this editorial is a “déja vu all over again” experience for us. It entails not only collaborating once more as coauthors but also reiterating some of the criticisms and concerns that have figured prominently in virtually all our previous publications about bioethics—most recently in our book Observing Bioethics.

They have watched, as insiders, the first fumbling attempts to transplant kidneys, then hearts, then live‐donated lobes of liver and lung. Now the two sociologists most closely identified with organ transplantation have concluded that they must leave the field.

In the expanding repertoire of practices designed to increase the supply of organs for transplantation, non-heart-beating cadaver organ donation has generated an ongoing debate in the literature. The continuing stream of articles is disquieting in part because it documents a troubling "trial-and-error ethics" approach to the formulation of organ procurement policy, and because it raises serious questions about the reasons that the development of this policy is being mediated by published communication. In the light of concerns about the implicit support (...) and credibility that professional publications give to organ procurement policies, restraint in publishing articles about non-heart-beating organ donation as well as in devising such policies is strongly advocated. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Striving To Do Good:Well-Springs, Realities, and Paradoxes of Medical Humanitarian WorkRenée C. FoxThe voices that speak from the pages of these testimonial narratives are those of physicians who are engaged in medical humanitarian work. The preponderance of them are based in U.S. academic medical centers where they have clinical, teaching, and research responsibilities from which they regularly "commute" to care for patients in what the euphemistic language of "global (...) health" terms "resource-limited," rather than "poor" countries." This "hybrid life," as one of the physicians (Robert Riviello) refers to it, has transported them periodically to numerous African societies (to Algeria, Ethiopia, Gabon, Morocco, Rwanda, Sudan, Tanzania, and Uganda), to Haiti, to India and Nepal, and to Guatemala and Mexico. Three of the "stories" are written by physicians at work in the countries where they were born (Prasanta Tripathy in Eastern India, Sridevi Seetharam and colleagues in Southern India, and Paul Pierre, in Haiti).Only one group of physician-coauthors (Maricruz Merino, Jonathan Iralu, and Sonya Shin) write about their experiences in practicing medicine among poor and socially disadvantaged patients on the American mainland—in the setting of the Navajo Indian reservation in Gallup, New Mexico.All these physicians describe their involvement in humanitarian medicine as emanating from their commitment to "social justice," to "saving lives," and to "caring for the poor"; to their universalistic convictions about "human solidarity," and the non- otherness of others; to their indignation about the inequities and injustices of the world, particularly with regard to access to health care (in the words of Jeffrey Deal, "[They] deserve better. They all do"); and to their "passionate" desire, not just their "sense of duty," to help rectify these wrongs (Richard Keiden). I was struck by the fact that none of them uses the word "suffering" to describe the plight of the persons whom they feel they have been called to medically assist.Three of the physicians express the wellsprings of their motivation in religious terms. Richard Keiden refers to a "guiding principle of Judaism" on which his medical humanitarian work has been founded—"tzedakah"—which "translates as charity but actually means righteousness," is based on a "concept of social justice," and is "an obligation, not a choice." Robert Riveillo says that at the time of his graduation from high school he envisioned his "life's work as a long-term missionary surgeon"; he invokes "loving mercy," as well as justice, "in this work of solidarity" that he has undertaken; and he poignantly admits that "most days I still long to pack my things, my family, and our efforts and move to Africa for a life of direct service." What Jeffrey Deal writes is the most explicitly and ardently religious of all. He identifies his work as a physician in Sudan with Jesus's "desire for us to care [End Page 115] for the poor and downtrodden in His stead." He is haunted by his "failure" to deliver alive a "partially born" baby girl who for him incarnated "the least of the least" of whom Jesus "spoke passionately." And in touching "ever so briefly... [that] one, tiny being [he] encountered... [on ] that hot morning in Sudan," he attests, he "touched Jesus."Jeffrey Deal is not the only one who was so stricken by the death of a baby or a child. For a number of these physicians (Sadath Sayeed, Maneesh Batra, and for Sridevi Seetharam, Lisa Adams and their colleagues), it was a tragedy that they found hard to bear with "detached enlightenment" (Sayeed), or to accept. The most demonstrably heartbroken and morally outraged among them is Sadath Sayeed, who "wept uncontrollably" over the death of a baby boy, born "at home" in Haiti, "probably in one of the hundreds of make-shift tent cities." The baby was not breathing continuously, and was "handed" to him to care for. At the close of the "story " about this experience that he recounts, Sayeed lashes out with fury and angst at those who were likely to ask him, "How was it in Haiti?" Do you want to hear "my real answer?" he replies:... [L]et me summarize my last patient for you: Good luck Dad... (shrink)

In 1999, Médecins Sans Frontières set out to explore and demonstrate the feasibility of preventing and treating HIV/AIDS in a so-called resource-poor, economically and socially disadvantaged setting. The first MSF mission to incorporate antiretroviral treatment into its HIV-AIDS-oriented medical program was undertaken in Bangkok. The second project was launched in Khayelitsha where MSF has been providing ARV treatment for persons with HIV/AIDS since May 2001. Khayelitsha is an enclave of some 500,000 inhabitants, most of whom live in corrugated-iron shacks, without (...) running water or electricity. Unemployment is extremely high; crime and violence are rampant. The general prevalence of HIV/AIDS is 26%, measured among pregnant women. The tuberculosis incidence rate is one of the world's highest for open-space sites. Unsurprisingly, TB/HIV coinfection is very high too: 63% of those with TB are also infected with HIV. (shrink)

Twelve narratives written by surgeons on ethical decision-making are analyzed in this commentary. Several major themes in their narratives are discussed: the preponderance of end-of-life issues; the struggle to be inclusively empathetic, even under emotionally alienating circumstances; social justice; and the disagreement among colleagues about how to deal with patients in situations of medical uncertainty. The commentary not only discusses the areas of stress that the surgeons identify in their accounts. It also highlights phenomena and themes that are missing from (...) them, and calls for more work to be done gathering stories from surgeons to explore and explain the “gaps” in this narrative collection. (shrink)

In 1986, philosopher-bioethicist Samuel Gorovitz published an essay entitled “Baiting Bioethics,” in which he reported on various criticisms of bioethics that were “in print, or voiced in and around … the field” at that time, and set forth his assessment of their legitimacy. He gave detailed attention to what he judged to be the particularly fierce and “irresponsible attacks” on “the moral integrity” and soundness of bioethics contained in two papers: “Getting Ethics” by philosopher William Bennett and “Medical Morality Is (...) Not Bioethics,” coauthored by us. Gorovitz attributed some of the criticisms that bioethics was eliciting to the fact that this new, rapidly rising, and increasingly visible field had brought “scholars and practitioners together who otherwise would have little exposure to one another's disciplines. Their interactions are mutually enriching at times,” he declared, “but mutually baffling and even infuriating at other times.” In this latter regard, he suggested that “perhaps” Fox and Swazey's characterization of bioethics in the article he dissected “reflects a general revulsion at endeavors they see as inadequately like the social sciences or insufficiently respectful of them.” He went on to say that despite his objections to our “complaints” about bioethics—especially to our claim that “autonomy [had] been an unduly emphasized value” in the field—he had “a lingering sense” that there might be “a grain of truth” in them. Gorovitz ended his essay with an affirmation about the “benefit” that bioethics can derive from “responsible” and even from “irresponsible” criticism. “The unexamined discipline invites the philosopher's critical scrutiny no less than the unexamined life,” he aphoristically concluded. a. (shrink)

“Bioethics is not just Bioethics.” This is the aphoristic way in which I have recurrently expressed my historical and social perspective on the significance of bioethics, whose import I regard as extending beyond the emergence, development, and establishment of an intellectual field that is primarily concerned with advances in biology and medicine, their relationship to illness and health, and their ethical concomitants. In my view, although they are expressed through the medium of medicine, some of the value and belief questions (...) with which bioethics has been preoccupied since its inception are connected with broad and deep moral issues that are integral to what the illustrious French sociologist Émile Durkheim... (shrink)

Book reviewed in this article: The Puzzle People: Memoirs of a Transplant Surgeon. By Thomas E. Starzl.

Ownership rights influence thought and behavior in relation to the physical world and in relation to other people. We review recent research examining the nature of ownership rights, and how young children and adults conceive of them. This research examines issues such as the rights ownership is assumed to confer; whether ownership rights reflect principles specific to ownership or instead depend on more general moral principles; and whether ownership rights are inventions of law and culture, or whether they have a (...) more natural basis. (shrink)

This paper defends the Intention Account of Inquiry. On this account, inquiry is best understood by appeal to a ‘question-directed intention’ (QDI), an intention to answer a question broadly construed. This account’s core commitments help meet recent challenges plaguing extant approaches to characterizing inquiry. First, QDIs are the type of mental state central to inquiry, not attitudes like curiosity or wonder. Second, holding a QDI towards a question and acting in service of it constitutes the start of inquiry. Third, controversial (...) norms which mandate a rational inquirer's ignorance towards the answer to her question can be reformulated and defended by appeal to rational constraints on intention. Fourth, instrumental pressures inquirers face are the standard pressures of plan-rationality. In defending these theses, I show that the Intention Account provides compelling explanations to standing challenges, in ways competitors cannot. It does so by advancing understanding of how our epistemic and practical agency are intertwined. (shrink)

The coming of bioethics -- The coming of bioethicists -- "Choices on our conscience": the inauguration of the Kennedy Institute of Education -- "Hello, Dolly": bioethics in the media -- Celebrating bioethics and bioethicists -- Thinking socially and culturally in bioethics -- Reminiscences of observing participants -- Bioethics circles the globe -- Bioethics in France -- The development of bioethics in the Islamic Republic of Pakistan -- The coming of the culture wars to American bioethics.

Background: Treating medication-refractory freezing of gait in Parkinson’s disease remains challenging despite several trials reporting improvements in motor symptoms using subthalamic nucleus or globus pallidus internus deep brain stimulation. Pedunculopontine nucleus region DBS has been used for medication-refractory FoG, with mixed findings. FoG, as a paroxysmal phenomenon, provides an ideal framework for the possibility of closed-loop DBS.Methods: In this clinical trial, five subjects with medication-refractory FoG underwent bilateral GPi DBS implantation to address levodopa-responsive PD symptoms with open-loop stimulation. Additionally, PPN (...) DBS leads were implanted for CL-DBS to treat FoG. The primary outcome of the study was a 40% improvement in medication-refractory FoG in 60% of subjects at 6 months when “on” PPN CL-DBS. Secondary outcomes included device feasibility to gauge the recruitment potential of this four-lead DBS approach for a potentially larger clinical trial. Safety was judged based on adverse events and explantation rate.Findings: The feasibility of this approach was demonstrated as we recruited five subjects with both “on” and “off” medication freezing. The safety for this population of patients receiving four DBS leads was suboptimal and associated with a high explantation rate of 40%. The primary clinical outcome in three of the five subjects was achieved at 6 months. However, the group analysis of the primary clinical outcome did not reveal any benefit.Interpretation: This study of a human PPN CL-DBS trial in medication-refractory FoG showed feasibility in recruitment, suboptimal safety, and a heterogeneous clinical effect in FoG outcomes. (shrink)

Scientific disagreements are an important catalyst for scientific progress. But what happens when scientists disagree amidst times of crisis, when we need quick yet reliable policy guidance? In this paper we provide a normative account for how scientists facing disagreement in the context of ‘fast science’ should respond, and how policy makers should evaluate such disagreement. Starting from an argumentative, pragma-dialectic account of scientific controversies, we argue for the importance of ‘higher-order evidence’ (HOE) and we specify desiderata for scientifically relevant (...) HOE. We use our account to analyze the controversy about the aerosol transmission of COVID-19. (shrink)

What do we owe those with whom we inquire? Presumably, quite a bit. Anything beyond what is necessary to secure knowledge? Yes. In this paper, I argue for a class of ‘zetetic rights.’ These are rights distinctive to participants in group inquiry. Zetetic rights help protect important central interests of inquirers. These include a right to aid, a right against interference, and a right to exert influence over the course of inquiry. Building on arguments by Fricker (2015), I defend these (...) rights, and explore cases of their violation: zetetic wrongings. I argue that zetetic wrongings constitute a distinctive, ubiquitous, and significant form of injustice in our epistemic and zetetic lives. To improve our inquiries and avoid epistemic injustice, we need to contend with zetetic wronging. Making this case helps show that a complete picture of epistemic life must account for the deep influence of our cooperative ties to one another. (shrink)

In a full survey of the programme and reports produced by the Seventh Assembly of the World Council of Churches in Canberra, René Padilla notes that though the theme was the Holy Spirit, Pentecostalism continued to be under suspicion in ecumenical circles. The life of the Assembly also illustrated the fact that the WCC must address the limits of theological pluralism and can no longer afford to maintain a separation between its confessional basis and its programmes.