The aim of this study is to assess patients' recall of their previous research participation. Recall was established during interviews and compared with entries from clinical notes. Participants were 49 patients who had previously participated in different types of research. Of the 49 patients, 45 (92%) interviewees recalled 69 of 109 (63%) study participations. Level of recall varied according to the type of research, some participants clearly recalled the details of research aims, giving consent and research procedures. Others recalled procedures (...) (e.g. DNA testing) but were unclear about their purpose. There was no significant effect of time on recall. Some types of research participation (e.g. DNA testing) may be recalled as clinical care. We argue that such misunderstandings may have the potential to undermine participants' ongoing consent, particularly in ongoing/longitudinal studies. Valid consent may be best achieved by re-assessing the scope of consent and relating it to the nature of the interventions themselves rather than the reasons for undertaking them. (shrink)

Physics has been thought to truly represent reality since at least Galileo, and the foundations of physics are always established using philosophical ideas. In particular, the elegant naming of physical entities is usually very influential in the acceptance of physical theories. We here demonstrate (using current developments in thermodynamics as an example) that both the epistemology and the ontology of physics ultimately rest on poetic language. What we understand depends essentially on the language we use. We wish to establish our (...) knowledge securely, but strictly speaking this is impossible using only analytic language. Knowledge of the meanings of things must use a natural language designed to express meaning, that is, poetic language. Although the world is really there, and although we can indeed know it truly, this knowledge is never either complete or certain but ultimately must rest on intuition. Reading a recently discovered artefact with a palaeo-Hebrew inscription as from the first century, we demonstrate from it that this ontological understanding long predates the Hellenic period. Poetic language is primary, both logically and temporally. (shrink)

Over several decades, ethics and law have been applied to medical education and practice in a way that reflects the continuation during the twentieth century of the strong distinction between facts and values. We explain the development of applied ethics and applied medical law and report selected results that reflect this applied model from an empirical project examining doctors’ decisions on withdrawing/withholding treatment from patients who lack decision-making capacity. The model is critiqued, and an alternative “constitutive” model is supported on (...) the basis that medicine, medical law, and medical ethics exemplify the inevitable entanglement of facts and values. The model requires that ethics and law be taught across the medical education curriculum and integrated with the basic and clinical sciences and that they be perceived as an integral component of medical evidence and practice. Law, in particular, would rank as equal in normative authority to the relevant clinical scientific “facts” of the case, with graduating doctors having as strong a basic command of each category as the other. The normalization of legal knowledge as part of the clinician’s evidence base to be utilized in practice may provide adequate consolation for clinicians who may initially resent further perceived incursions on their traditional independence and discretion. (shrink)

Entscheidungen der Therapiebegrenzung und in der Betreuung am Lebensende sind häufig komplex und von ethischen Problemen begleitet. Im Mittelpunkt der Untersuchung steht die entscheidende Frage, wie hilfreich existierende „Ethik-Richtlinien“, die eine ethische Orientierung bei solchen Entscheidungen geben sollen, in der klinischen Praxis tatsächlich sind. Die Frage, welchen Nutzen „Ethik-Richtlinien“ bei der Entscheidungsfindung haben oder haben können, wird hier exemplarisch an einem klinischen Fallbeispiel aus einer Ethik-Kooperationsstudie in der Intensivmedizin analysiert. Vergleichend werden hierzu „Ethik-Richtlinien“ aus Deutschland, der Schweiz und aus Großbritannien (...) herangezogen, die Gegenstand eines internationalen Projekts zur Analyse von Richtlinien waren. Die Möglichkeiten und Grenzen einer ethischen Orientierung an „Ethik-Richtlinien“ bei Entscheidungsproblemen der Therapiebegrenzung und in der Betreuung am Lebensende werden anhand der Fallstudie diskutiert und illustriert. Abschließend werden Schlussfolgerungen für die Entwicklung ethischer Richtlinien für die klinische Praxis formuliert. (shrink)

A model is described for implementing a program in research ethics education in the face of federal and institutional mandates and current resource, disciplinary, and infrastructure limitations. Also discussed are the historical background, content and evaluation process of the workshop at the heart of the program, which reaches a diverse group of over 250 students per year—from first-year graduate students in basic research labs to clinical fellows. The workshop addresses central issues in both everyday laboratory ethics and in larger societal (...) questions. Goals include improving overall awareness of ethics guidelines and philosophy and enhancing skills in identifying and then analyzing the ethical components of situations. Pedagogies used and their effectiveness and that of the overall workshop and extended program are addressed. Programs like these have initiated a shift in the culture of basic research, which is a critical need given the current atmosphere. (shrink)

This paper introduces a new typology and associated measure of social and environmental mission integration by conceptually framing a feature of hybrid organizations—the degree of integration of their revenue model and social–environmental mission. The SEMI measure is illustrated using a hand-collected sample of 256 North American Certified B Corporations. We explore the heterogeneity of SEMI scores by identifying external-facing correlates and demonstrate non-congruence with Certified B Corporation’s audit results. Overall, our findings advance existing knowledge of these hybrid organizations and how (...) they balance their social–environmental missions with their economic objectives. (shrink)

This paper considers concerns that social care research may be stifled by health-focused ethical scrutiny under the Mental Capacity Act 2005 and the requirement for an ?appropriate body? to determine ethical approval for research involving people who are deemed to lack capacity under the Act to make decisions concerning their participation and consent in research. The current study comprised an online survey of current practice in university research ethics committees (URECs), and explored through semi-structured interviews the views of social researchers (...) engaged in or exploring work concerning people who may, under the Act, lack the capacity to make decisions to consent to participate in a research programme. The paper concludes that there was a lack of overt knowledge of and reference to the implications of the Act for research and some concerns that a restrictive focus on health-related scrutiny might prevent social care research from taking place. There was also a degree of creativity shown by social care researchers in responding to changing demands and a wish to assist people in making decisions to participate where possible. (shrink)

Little work has focused on resilience amongst older adults, and few factors have been identified that promote their resilience. Kalisch et al. suggest that socioenvironmental factors are distant influences. We argue, however, that community and societal influences are as important as individual ones. Further, an ecological framework explains why some older adults are resilient whilst others are not.

The European Biomedical Ethics Practitioner Education Project (EBEPE), funded by the BIOMED programme of the European Commission, is a five-nation partnership to produce open learning materials for healthcare ethics education. Papers and case studies from a series of twelve conferences throughout the European Union, reflecting the ‘burning issues’ in the participants' healthcare systems, have been collected by a team based at Imperial College, London, where they are now being edited into a series of seven activity-based workbooks for individual or group (...) study. These draft workbooks are now being read by a network of critical readers across Europe, whose comments will be incorporated into the final versions of the workbooks. The result will be the first European-wide and Europe-centred resource for teaching students, practitioners, and members of ethics committees. Topics covered include: • Resource allocation and rationing • The rights of children and young people • Long-term care of the elderly • Mental health and mental illness • Autonomy and patient choice • Decisions at the end of life • A study guide to using the workbooks The collaborative nature of the project has highlighted differentiated national approaches in medical ethics. Against the British and Dutch rights-orientated approach have emerged two other alternative models: the Nordic preference for administrative resolution of entitlement disputes, and the southern European emphasis on deontological codes. A genuinely European reconstruction of autonomy and rights, using hermeneutic, feminist and narrative approaches to counterbalance individualistic models, is emerging across the workbooks. The programme has also uncovered national differences in how ethics should be taught, with the workbooks' style being an experiential approach. Thus the EBEPE project is developing new models in both substantive and pedagogic senses, about both what should be taught and how it should be presented. (shrink)

: From 1902 onward, Peirce viewed esthetics, ethics, and logic as "normative sciences," interconnected spheres of philosophical inquiry that constitute his main work in value theory. The normative sciences provide the basis for a theoretical investigation of questions of value detached from practical interests. Because the normative sciences maintain Peirce's well-known insistence on realism, they set his pragmaticism apart from the more "nominalistic" pragmatism of James and Dewey. The paper aims to clarify Peirce's idea of the normative sciences, to show (...) how his realism applies in the sphere of value, and to explore his views on the proper relation between theory and practice. The concluding section suggests examples of how we might understand Peirce's rich and innovative concept of normative esthetics.Resumo: De 1902 em diante, Peirce considerava a estética, a ética e a lógica como "ciências normativas", esferas interconexas de inquirição filosófica que constituem seu principal trabalho em teoria do valor. As ciências normativas fornecem a base para uma investigação teorética de questões sobre valor independentes de interesses práticos. Porque as ciências normativas mantém a notória insistência de Peirce no realismo, elas colocam seu pragmaticismo à parte do pragmatismo mais "nominalista" de James e Dewey. O artigo almeja esclarecer a idéia de Peirce das ciências normativas, mostrar como seu realismo se aplica à esfera do valor, e explorar suas visões da própria relação entre ciência e prática. A seção concludente sugere exemplos de como podemos entender o rico e inovador conceito peirciano de estética normativa. (shrink)

The government of Ontario has adopted wind energy development as an alternative energy source. It enacted the Green Energy and Economy Act, May 2009, with the intention to fast track the approval process regarding industrial wind turbines. The Act legislated a centralized decision making process while removing local jurisdictional authority. Throughout this process, the government reassured the public of inexpensive and reliable electricity. This article explores the costs and benefits related to the renewable energy policy established in Ontario, Canada.

IntroductionDeep brain stimulation (DBS) is increasingly used to treat the symptoms of various neurologic and psychiatric conditions. People can undergo the procedure during reproductive years but the safety of DBS in pregnancy remains relatively unknown given the paucity of published cases. We thus conducted a review of the literature to determine the state of current knowledge about DBS in pregnancy and to determine how eligibility criteria are approached in clinical trials with respect to pregnancy and the potential for pregnancy.MethodsA literature (...) review was conducted in EMBASE to identify articles involving DBS and pregnancy. Two reviewers independently analyzed the articles to confirm inclusion. Data extracted for analysis included conditions treated, complications at all stages of pregnancy, neonatal/pediatric outcomes, and DBS target. A second search was then conducted using www.clinicaltrials.gov. The same two reviewers then assessed whether each trial excluded pregnant individuals, lactating individuals, or persons of childbearing age planning to conceive. Also assessed was whether contraception had to be deemed adequate prior to enrollment.ResultsThe literature search returned 681 articles. Following independent analysis and agreement of two reviewers, 8 pregnancy related DBS articles were included for analysis. These articles described 27 subjects, 29 pregnancies (2 with subsequent pregnancies), and 31 infants (2 twin pregnancies). There was 1 preterm birth at 35 weeks, and 3 patients who experienced discomfort from the DBS battery (i.e., impulse generator) placement site. All 27 patients had a DBS device implanted before they became pregnant, which remained in use throughout their pregnancy. There was exclusion of pregnant individuals from 68% of 135 interventional trials involving DBS. Approximately 44% of these trials excluded persons of childbearing age not on “adequate contraception” or wishing to conceive in the coming years. Finally, 22% excluded breastfeeding persons.ConclusionThe data from 29 pregnancies receiving DBS treatment during pregnancy was not associated with unexpected pregnancy or post-partum complication patterns. Many clinical trials have excluded pregnant individuals. Documentation of outcomes in larger numbers of pregnancies will help clarify the safety profile and will help guide study designs that will safely include pregnant patients. (shrink)

This paper seeks to clarify the process of ethical review primarily through a consideration of the lay member's role; it considers some of the conventional accounts of the role and portrays weaknesses in them. Its positive account places the ethical review service in a wide political context allowing the definition of lay member as a politically-positioned individual in the REC with the function of formally representing the public standards of morality in the medical research context.

Ian Parker has been a leading light in the fields of critical and discursive psychology for over 25 years. The Psychology After Critique series brings together for the first time his most important papers. Each volume in the series has been prepared by Ian Parker and presents a newly written introduction and focused overview of a key topic area. Psychology After the Unconscious is the fifth volume in the series and addresses three central questions: - Why is Freud's (...) concept of the unconscious important today? - Does language itself play a role in the creation of the unconscious? - How does Lacan radicalize Freud's notion of the unconscious in relation to cultural research? The book provides a clear explanation of Freudian and Lacanian accounts of the unconscious. It also highlights their role in offering a new way of describing, understanding and working with the human subject in clinical settings and in cultural research. Part One shows how the unconscious is elaborated in Freud's early case studies in Studies on Hysteria, while Part Two focuses on Lacan's re-working of the unconscious and its relationship to language and culture in his influential public seminars. The book also provides access to key debates currently occurring in Freudian and Lacanian psychoanalysis, exploring both the clinical dimension and the consequences for psychological and cultural research. Psychology After the Unconscious is essential reading for students and researchers in psychology, psychosocial studies, sociology, social anthropology and cultural studies, and to psychoanalysts of different traditions engaged in academic research. It will also introduce key ideas and debates within critical psychology to undergraduates and postgraduate students across the social sciences. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Beyond DisciplineOn the Status of Bodily Difference in PhilosophyEmily Anne ParkerMuch deserved attention has recently been directed to the fact that philosophy faculty are surprisingly homogeneous when compared to faculty in other fields, not only in the humanities and social sciences but also in the natural sciences (Alcoff 2011, 7–8). Perhaps it is as a result of this bodily homogeneity that sexual harassment and sexual assault in philosophy departments (...) are routine and that stories about such experiences, when they can be shared, are questioned or ignored. Certainly such experiences deserve attention. But they also deserve philosophical examination. Linda Martín Alcoff points out that a study of the relationship between percentages of (predominantly white, hetero, cisgendered, normatively abled) women in a department and the status of that department in Brian Leiter’s Philosophical Gourmet demonstrates a “reverse correlation, where the higher the percentages of women, the lower the rankings. Departments concerned about their Leiter rankings would be ‘rational,’ then to forego hiring too many women” (Alcoff 2011, 8). Alcoff suggests that instead of simply counting the nonwhite, cisgendered, heterosexual, normatively abled men in the field, we need to consider the connection between the “climate for women and the attitude toward feminist philosophy” and (as her own work elsewhere would suggest) the philosophy of race. Clearly Alcoff is right to suggest that we should not think of sexual harassment as the obstacle to participation of a very small sampling of bodily diversity in the field, but rather as a circular indicator and cause of a larger problem. [End Page 222]But what is the problem?I would like to suggest that the problem, still underdiscussed, is the implicit disciplining of what counts as philosophical. It is this quiet yet ubiquitous questioning that not only keeps philosophy homogeneous, but also prevents most critics of that homogeneity from doing more than reporting limited demographical information about the field. To be sure, when one wants to argue that there is something wrong with the culture of philosophy as a field, it seems necessary to marshal data. And yet it will always be the case that such studies can never answer questions about how a culture develops, what its assumptions, horizons, and cosmologies are. For this one needs (critical race, feminist, ability, queer, trans, economic, ecological) philosophy. And yet, circularly, disciplining what counts as philosophical sets limits to what questions can be explored.Kristie Dotson, Gayle Salamon, and Alexis Shotwell have each in separate contexts pointed out that what counts as “philosophy” should be recognized as the philosophical question that it itself apparently is (Dotson 2011, 2012; Salamon 2009; Shotwell 2010). This conversation about what counts as philosophy is directly related to the status not only of white hetero women in the field, but also the status of anyone who challenges the philosophical centrality of normatively raced-classed-abled-gendered bodies. In a recent paper, Dotson reflects on having been asked repeatedly, “How is this paper philosophy?” (Dotson 2012, 407). This question is extremely common, and as Shotwell points out, having to answer it is “a common experience for people who attempt to do work in philosophy while departing in archive and method from accepted norms” (117). Shotwell further suggests that it’s not just archive and method that make one suspect; it’s also the questions that one is willing to ask about oneself, about community, about world. Read together, Dotson and Shotwell make it clear not only that the question of whether one’s work is or is not philosophical is a common question, but that this is the case precisely because it is taken for granted what philosophy is, perhaps especially by those who ask whether X is or is not philosophy. Otherwise the question of how some project or other is philosophy simply wouldn’t be articulable as a question.For the moment I would like to take a widely common and implicit definition of philosophy seriously: “Philosophy” is whatever directs fundamental questions at itself. Perhaps this means that philosophy is the art of attempting to discern the creative within the wrongly presumed. We could then say that philosophy asks, What do we presuppose? Why, and... (shrink)

The concept of community is increasingly the focus of political argument in Britain, the United States and elsewhere around the world. The sense people have of belonging to coummunities provides a powerful motivation which continues to affecct the political and social face of the world. Recently, debate about the relationship between individuals and their communities has become central to the making of both, American and European social policy. In the United Kingdom this is especially apparent in the area of health (...) care, where ideas of community have informed recent legislation concerning community care, community health trusts and the Children Act among others. This volume explores the focus of interest in community and the emerging theoretical oppostion between communitarianism and liberalism, as well as the practical, theoretical and ethical issues relating to community in the health care professions, including a discussion of the health service as Civil Association, an analysis of liberal and communitarian views on the allocaiton of health care resources, an exploration of the use of genetic information and an examination of health care decision making for incapacitated elderly patients. (shrink)

The aim of the dissertation is to propose a new understanding of the philosophy of Charles S. Peirce. Peirce sought to construct a philosophical system applicable to all of human experience, but he never presented this system in a unified work. In the dissertation I attempt to present the strongest possible reconstruction of Peirce’s mature philosophy. My thesis is that Peirce’s philosophy is best understood as an extended exploration and application of his concept of mathematical continuity, which he called "the (...) master-key of philosophy." Many scholars have recognized that Peirce’s concept of continuity is important to his metaphysical theories. The bulk of the dissertation is devoted to examining this concept and explicating its importance throughout his philosophy. I argue that Peirce’s theory of semeiotic provides a general model of experience that elaborates the direct experience of continuity described in phenomenology. This model in turn serves as the basis for his metaphysics and evolutionary cosmology. Part I of the dissertation sketches Peirce’s response to Kant’s philosophy and presents an outline of his classification of the sciences. Part II presents Peirce’s technical conception of continuity, showing its origins in formal logic and in his revision of Cantor’s theory of transfinite sets. Part III examines the role of the continuity principle in phenomenology, esthetics, ethics, and semeiotic, which bridge the rather wide gap between mathematics and metaphysics in Peirce’s system. Part IV presents an overview of Peirce’s cosmology and metaphysics, with particular attention to their methodological dependence upon semeiotic. Part IV includes consideration of two issues that emerge as crucial to the assessment of Peirce’s thought. The first concerns the ontological status of extra-semeiotic entities, and is known as the problem of "semiotic idealism." I argue that Peirce is not a semiotic idealist. The second issue concerns the testability of Peirce’s metaphysical hypotheses.. (shrink)

This book offers a fresh framework for the historical understanding of revolutions and ideas about revolution.