In clinical trials, it is common practice to follow up significant interactions between the factors under investigation with subgroup analyses. Such analyses pose at least two analytical and interpretational challenges. The first challenge is that performing multiple subgroup analyses increases the likelihood of obtaining spuriously significant results. This has been acknowledged and relevant guidance exists in the medical literature. The second challenge is that the effects that are obtained at the level of subgroup are composite. This has yet to be (...) fully acknowledged and discussed in the context of medical research. This paper aims to fill this lacuna. Using a simple additive model, we use recent findings from the CHARISMA trial on the efficacy of clopidogrel in addition to aspirin in the treatment of patients at risk for atherothrombotic events to demonstrate quantitatively the composition of effects at the level of subgroups. In the simplest case of a design involving an interaction (two crossed factors, with two levels each, i.e. a 2 x 2 design), effects at the level of subgroup consist of influences that stem (i) from the incidence of the measured outcome in the study population as a whole; (ii) from the factor of interest (e.g. treatment vs. placebo); (iii) from the second factor (e.g. patient group membership); (iv) from the interaction between the two factors; and (v) from random error in the measured outcome. The value of the approach illustrated here is that it is generalizable to any research design irrespective of its complexity and that it prompts clinicians to consider the multiple causality underlying medical research findings. (shrink)

This sourcebook, a corrected reprint of the University of South Carolina Press edition of 1972, contains a complete English translation of the sophist material collected in the critical edition of Diels-Krantz, as well as Euthydemus and a completely re-edited Antiphon.

This paper challenges the long-standing and widely accepted view that medical ethics is nothing more than common morality applied to clinical matters. It argues against Tom Beauchamp and James Childress’s four principles; Bernard Gert, K. Danner Clouser and Charles Culver’s ten rules; and Albert Jonsen, Mark Siegler, and William Winslade’s four topics approaches to medical ethics. First, a negative argument shows that common morality does not provide an account of medical ethics and then a positive argument demonstrates why the medical (...) profession requires its own distinctive ethics. The paper also provides a way to distinguish roles and professions and an account of the distinctive duties of medical ethics. It concludes by emphasizing ways in which the uncommon morality approach to medical ethics is markedly different from the common morality approach. (shrink)

This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today’s high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gertet al10-rule version is an adequate and appropriate guide for physicians’ actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from it, the (...) paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics. (shrink)

Common morality has been the touchstone of medical ethics since the publication of Beauchamp and Childress's Principles of Biomedical Ethics in 1979. Rosamond Rhodes challenges this dominant view by presenting an original and novel account of the ethics of medicine, one deeply rooted in the actual experience of medical professionals. She argues that common morality accounts of medical ethics are unsuitable for the profession, and inadequate for responding to the particular issues that arise in medical practice. Instead, Rhodes argues (...) that medicine's distinctive ethics should be explained in terms of the trust that society allows to the profession. Trust is the core and starting point of Rhodes' moral framework, which states that the most basic duty of doctors0is to "seek trust and be trustworthy." 0Building from this foundation, Rhodes explicates the sixteen specific duties that doctors take on when they join the profession, and demonstrates how her view of these duties is largely consistent with the codes of medical ethics of medical societies around the world. She then explains why it is critical for physicians to develop the attitudes or "doctorly" virtues that comprise the character of trustworthy doctors and buttress physicians' efforts to fulfil their professional obligations. Her book's presentation of physicians' duties and the elements that comprise a doctorly character, together add up to a cohesive and comprehensive description of what medical professionalism really entails. Rhodes's analysis provides a clear understanding of medical professionalism as well as a guide for doctors navigating the ethically challenging situations that arise in clinical practice. (shrink)

Currently, some of the most significant moral issues involving genetic links relate to genetic knowledge. In this paper, instead of looking at the frequently addressed issues of responsibilities professionals or institutions have to individuals, I take up the question of what responsibilities individuals have to one another with respect to genetic knowledge. I address the questions of whether individuals have a moral right to pursue their own goals without contributing to society's knowledge of population genetics, without adding to their family's (...) knowledge of its genetic history, and without discovering genetic information about themselves and their offspring. These questions lead to an examination of the presumed right to genetic ignorance and an exploration of a variety of social bonds. Analyzing cases in light of these considerations leads to a surprising conclusion about a widely accepted precept of genetic counseling, to some ethical insights into typical problems, and to some further unanswered questions about personal responsibility in the face of genetic knowledge. (shrink)

Contemporary research ethics policies started with reflection on the atrocities perpetrated upon concentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim (...) of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)

Conley et al. (2023) analyze the attempts at public engagement (PE) by five governance groups. These projects were conducted by organizations that endorse both the goals and values of PE. The autho...

In this article the authors reflect on regulations which have been developed to protect research subjects and data in research which uses human subjects. They suggest that regulations related to informed consent and privacy protection are burdensome in research which uses human subjects. They argue that a new category of research risk must be established which informs research subjects of the level of risk that they will be exposed to by participating in the research.

This article is an extended discussion from the recent opening presentation for the Annual Winchester Advanced ‘Philosophy for Children’ Seminar in Climate Change Education, Hope and Philosophy for Children. The presentation and text originate from Rosamonde Birch's (2019) Masters’ dissertation research discerning hope through an Education for Sustainable Development Philosophy for Children workshop.

I heartily agree with Sam Doernberg and Robert Troug’s claims that there are important differences between “general morality” and medical ethics, and that in some instances they issue contradictory...

What are the consequences of the tendency for ubiquitous online reputation calculation to lead not to more precise expressions of reputation capital but, rather, to greater reputational instability? This article contrasts two conceptions of online reputation, which enact opposing attitudes about the relation between reputation and the calculable. According to an early online reputation paradigm – reputation capital – users strove to achieve high scores, performing the presumption that reputation could be incrementally accumulated and consistently measured within relatively stable spheres (...) of value. Yet, ubiquitous calculation led not to more precise measurements of reputation, but rather to the increasing volatility of online reputation. Thus, a second online reputation paradigm – reputation warfare – has become increasingly prevalent, in which strategic actors indirectly capitalize on systemic volatility produced by reputation’s ubiquitous online calculation. Steve Bannon’s 2016 Trump campaign strategy, which mobilized trolls, exemplifies the indirect optimization of online reputation, placing an option on reputational volatility. (shrink)

Volume 20, Issue 7, July 2020, Page 163-166.

In their target article, Blumenthal-Barby et al. (2022) address the view that bioethics as a philosophical discipline is obsolete. Indeed, their discussion was prompted by a recent bioethics confer...

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Dialectic and Dialogue: Plato's Practice of Philosophical Inquiry (SPEP Studies in Historical Philosophy)Rosamond Kent SpragueFrancisco J. Gonzalez. Dialectic and Dialogue: Plato's Practice of Philosophical Inquiry (SPEP Studies in Historical Philosophy). Evanston, IL: Northwestern University Press, 1998. Pp. 418. Paper, $29.95.What this rich and independent-minded book asks us to do is to give serious consideration to the question, "What, in Plato's view, are we doing when we philosophize?" (...) (1) If we employ our own conceptions of philosophy as the models for formulating and discussing specific Platonic questions, we may be imposing upon him ways of thinking that are foreign to his thought. To do this is particularly distorting in the case of dialectic.Gonzalez has chosen to confine himself to the early and middle dialogues, so that his book is a direct challenge to the work of Richard Robinson. Of the important views that have more recently arisen, Gonzalez allies himself most nearly with the non-doctrinal approach, but not to the extent of embracing scepticism. There is much philosophical knowledge in the dialogues, but such knowledge is primarily non-propositional. As for the esotericist and the developmentalist, both are misguided in proceeding on the assumption that Plato is attempting to formulate definitions and to arrive at a systematic philosophy; they regard the dialogues as treatises, which they are not. As Gonzalez quite justly inquires, "can there be any form of writing less suited to presenting a systematic philosophy than Plato's dramatic dialogues?" (4)In contrast to Robinson, who relies on the analysis of passages taken out of context, Gonzalez focusses mainly on whole dialogues, taking them to be dramatic portrayals of dialectic at work. He begins with detailed studies of the Laches and Charmides. In both cases, Socrates starts with ordinary knowledge (in the persons of the title characters), but "clearly intends to transcend it" (20). Neither will he accept "the 'sophistic' understanding that attempts to substitute definitions for this experience" (21) on the part of Nicias and Critias. The knowledge sought by Socrates by means of the dialectical method is shown to thave three characteristics: it is "knowledge how," it is "self-knowledge," and it is "non-propositional" (61).The next chapters consider three presuppositions of Plato's dialectic: words (in the Cratylus), arguments (in the Euthydemus), and images (in Republic X). All three are necessary to the dialectical enterprise, but, like ordinary knowledge in the aporetic dialogues, are transcended.Gonzalez' confrontation with Robinson naturally requires that he address the topic [End Page 113] of the method of hypothesis in the Meno, Phaedo, and Republic. This is a method that does yield propositional results, but it remains at the level of poion ti and fails to provide similar knowledge of the ti. Gonzalez' interpretation of the divided line is of particular interest here: as he sees it, dialectic is not intended as simply an extension continuous with the method of hypothesis. To take it this way is, with Robinson, to collapse dialectic into mathematics, making the former as deductive as the latter. The good (which "is not for Plato an exclusively moral term" 216) is "already there before the inquiry as the ground of its possibility" (236); this is what "unhypothesized" means. The movement of thought is circular, but not with a vicious circularity; "reflexivity" is the term preferred.To my mind the most rewarding and most convincing section of the book is the concluding chapter on the philosophical digression in the Seventh Letter. (The issue of authenticity is not significant, since, if the Letter is a forgery, "this forger had a better understanding of Plato than many other scholars, both ancient and contemporary" (246). Although "the subject of this wisdom simply cannot be expressed in words" (252) (and here Gonzalez emphasizes that Plato means spoken as much as written words), there is no contradiction in being able to talk or write about it. If "our only means of attaining true knowledge of a thing have the defect of being unable to express this nature" (263), Plato suggests an up and down movement which transcends this defect. The nature of this movement he describes as tribein, a process... (shrink)

Contemporary research ethics policies started with reflection on the atrocities perpetrated upoconcentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of (...) this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)

In their paper, “Rationing, Responsibility, and Vaccination during Covid-19: A Conceptual Map,” Jim Park and Ben Davies (2024) do a fine job of synthesizing the justice literature on whether, when,...

Name der Zeitschrift: Paragrana Jahrgang: 25 Heft: 2 Seiten: 112-124.

Individuals each have their own unique conceptions of what is good. Nevertheless, because human beings have common needs, there is a significant overlap in their appreciation of what counts as good...

Policies for the allocation of COVID-19 vaccine were implemented in early 2021 as soon as vaccine became available. Those responsible for the planning and execution of COVID-19 vaccination had to make choices about who received vaccination first while numerous authors offered their own recommendations. This paper provides an account of how such decisions should be made by focusing on the specifics of the situation at hand. In that light, I offer an argument for prioritising those who are likely vectors of (...) the disease and a criticism of the victim-focused priority proposals put forward by the US Centers for Disease Control and Prevention, the National Academies of Sciences, Engineering, and Medicine, the UK National Health Service, and others. I also offer thoughts on how those authors may have gone astray. (shrink)

In this paper I argue for recognizing the moral duty to participate in research. I base my argument on the need for biomedical research and the fact that at some point studies require human participants, what I call collaborative necessity. In presenting my position, I argue against the widely accepted views of Han Jonas and all of those who have accepted his declarations without challenge. I go on to show why it is both just and fair to invite and encourage (...) people to participate in studies. It is just because research participation is the necessary means to achieve the broadly shared goals of preventing and curing disease and alleviating disease symptoms. Mutual love requires us to be willing to do for others what we would want them to do for us. It is fair because the approach treats similarly situated people in the same way. Research participation is morally required because failing to do one's part in the collaborative project of advancing biomedical science would be free-riding. People who exempt themselves from participation while eagerly accepting benefits from others doing their part are taking advantage of their compatriots and treating themselves as more deserving than others when they are not. (shrink)

To inform the ongoing discussion of whether claims of conscientious objection allow medical professionals to refuse to perform tasks that would otherwise be their duty, this paper begins with a review of the philosophical literature that describes conscience as either a moral sense or the dictate of reason. Even though authors have starkly different views on what conscience is, advocates of both approaches agree that conscience should be obeyed and that keeping promises is a conscience-given moral imperative. The paper then (...) considers exemplars of conscientious objection—Henry David Thoreau, Mohandas Gandhi, and Martin Luther King Jr.—to identify the critical feature of conscientious objection as willingness to bear the burdens of one’s convictions. It concludes by showing that medical professionals who put their own interests before their patients’ welfare violate their previous commitments and misappropriate the title “conscientious objector” because they are unwilling to bear the burdens of their choices and instead impose burdens on their patients and colleagues. (shrink)

Human microbiome research has revealed that legions of bacteria, viruses, and fungi live on our skin and within the cavities of our bodies. New knowledge from these recent studies shows that humans are superorganisms and that the microbiome is indispensible to our lives and our health. This volume explores some of the science on the human microbiome and considers the ethical, legal, and social concerns that are raised by this research.

Abstract:This article provides a critique of the monolithic accounts that define justice in terms of a single and often inappropriate goal. By providing an array of real examples, I argue that there is no simple definition of justice, because allocations that express justice are governed by a variety of reasons that reasonable people endorse for their saliency. In making difficult choices about ranking priorities, different considerations have different importance in different kinds of situations. In this sense,justice is a conclusionabout whether (...) an allocation reflects the human interests and priorities that are at stake. The article describes how several principles of justice have a legitimate place in medical allocations. To achieve justice within medical practice, professionals should focus on the human interests and compelling reasons for prioritizing specific principles within their specific medical domain. (shrink)

This article explores the ethics of world heritage (WH) through a cosmopolitan lens. It proposes that cosmopolitanism provides fertile ground for the study of WH, in particular if combined with sensitivity to distinct indigenous ethical and political claims. Underpinning my article is the question of whether the politics of WH, despite its peaceful and universalist intensions, obscures local disputes and subaltern voices. The empirical emphasis is placed on the WH site of Laponia in the North of Sweden – a location (...) of Sami indigenous communities and commercial mining interests. I provide a narrative analysis of the inconsistencies between the Swedish ‘good state’ narrative defined by support for human and indigenous rights globally and the protection ambition of WH and its generally favourable attitude towards mining, despite its potentially damaging effects on the WH site of Laponia and the cultural heritage and land rights of Sami people living there. My study also provides an analysis of Sami narratives on Laponia – storylines that are rarely included in the Swedish ‘good state’ narrative. The study seeks to contribute to scholarly understandings of indigenous peoples’ ability to lay claims to the cosmopolitan protection logic that prevails in WH. (shrink)

The use of organs obtained from executed prisoners in China has recently been condemned by every major transplant organization. The government of the People's Republic of China has also recently made it illegal to provide transplant organs from executed prisoners to foreigners transplant tourists. Nevertheless, the extreme shortage of transplant organs in the U.S. continues to make organ transplantation in China an appealing option for some patients with end-stage disease. Their choice of traveling to China for an organ leaves U.S. (...) transplant programs with decisions about how to respond to the needs of patients who return after transplantation. By discussing two cases that raised this dilemma, we argue for upholding medicine's commitments to traditional principles of beneficence and nonjudgmental regard in sorting out the policies that a transplant program should adopt. We also explain how position statements that aim for the high ground of moral purity fail to give appropriate weight to the needs and suffering of present and future patients in the U.S. and in China. (shrink)

The prelims comprise: Part I Part II Note.

The primary aim of this work on Hobbes is to present a new construction of his moral and political views. I argue for a reading of the text which dramatically recasts his theory as a deontological contractarianism rather than a consequentialist contractarianism. This reading of the text pays serious attention to Hobbes's usually neglected rejection of prudential calculation and his commitment to the method of Reason which he explains as what we would now call analytical deduction from the meaning of (...) words. ;I argue for the centrality of three theses: that obligation arises from assent, that there is always an obligation to obey the Laws of Nature, and that one is obliged to obey one's sovereign. In explicating Hobbes's theory I present a more complex picture of the authorization of the sovereign than is standardly given in the accounts that characterize the sovereign as the third party beneficiary of a contract between individuals in the State of Nature. Instead, my complex account depicts the sovereign as a duty bound contractor with obligations to the commonwealth. Furthermore, I contend that Hobbes's distinction between the natural and the artificial can be seen to organize and explain important elements in his view. ;Parts 3 and 4 of Leviathan, where Hobbes discusses the obligation of Christian citizens to their civil sovereign and the supposed powers of the Kingdom of Darkness, are then used as a test for verifying the coherence and validity of my novel interpretation. Because my reading of the first two parts of Leviathan conforms with the ideas and method presented in parts 3 and 4, I conclude that the deontic reading, and not the egoist reading, best captures Hobbes's intended meaning. I then go on to defend my interpretation against today's most prominant advocates of the egoist readings, Gauthier, Hampton and Kavka. ;In the final chapter of this work I present three arguments on currently important moral questions: benevolence, infidelity, and abortion. These arguments, which all employ what I have shown to be the Hobbesian approach, show the usefulness of Hobbes's theory in addressing contemporary questions of ethics. (shrink)

a This paper is a revised and shortened version of my chapter, “Justice in Allocations for Terrorism, Biological Warfare, and Public Health” in Public Health Ethics, edited by Michael Boylan, Kluwer; 2004. Portions of this material were presented at the International Bioethics Retreat, Pavia, Italy, June 2003, and at the meetings of the Association for Politics and the Life Sciences, Philadelphia, September 2003.