Research that is initiated, designed or funded by sponsor agencies based in countries with relatively high social and economic development, and conducted in countries that are relatively less developed, gives rise to many important ethical challenges. Although clinical trials of HIV vaccines began ten years ago in the US and Europe, an increasing number of trials are now being conducted or planned in other countries, including several that are considered “developing” countries. Safeguarding the rights and welfare of individuals participating as (...) research subjects in developing countries is a priority. In September, 1997, the Joint United Nations Programme on HIV/AIDS embarked on a process of international consultation; its purpose was further to define the important ethical issues and to formulate guidance that might facilitate the ethical design and conduct of HIV vaccine trials in international contexts. This paper summarises the major outcomes of the UNAIDS consultative process. (shrink)

In this paper I seek to critically examine UCT’s and CCT’s and consider how a Levinasian ethics might offer normative guidelines to evaluate such aid programmes. Such an analysis will serve to both critique and supplement the traditional utilitarian analyses of such programmes. In so doing, this paper also hopes to contribute to the business ethics literature in which a Levinasian ethics may be brought to bear on real world problems. I proceed by enlisting Jordaan who argues that (...) a Levinasian ethical politics can be instantiated in institutional designs by allowing a more complex representation of the other’s alterity. Two UCT programmes are interrogated in light of this finding – the first, a UCT programme in a community in Vietnam; the second, a joint CCT/UCT programme targeting adolescent girls in Malawi, designed to test the efficacy of conditionality to achieve certain. (shrink)

The Pacific Islands are estimated to have among the highest global burdens of hearing loss, however, hearing health services are limited throughout this region. The provision of hearing aid is desirable, but should be delivered in accordance with WHO recommendations of appropriate and locally sustainable services. Large-scale hearing aid donation programmes to the Pacific Islands raise ethical questions that challenge these recommendations.The aim of this paper is to consider the ethical implications of large-scale hearing aid donation programmes to (...) Samoa, a nation of the Pacific Islands. Evaluation of both ‘Western’ and ‘Pacific Island’ perspectives reveals important cross-cultural differences regarding attitudes to donation programmes. We attempt to offer possible solutions that satisfy both ethical frameworks, and which should enable us to deliver an effective hearing health service for Samoa. These solutions may be translational and benefit other Pacific Island nations in a similar context. (shrink)

Philippe Fournier | : Le point de départ de ma proposition est que la responsabilité est un terme plus approprié que la vertu pour désigner les exhortations au devoir civique dans l’ère contemporaine. De même, à défaut de voir l’implication citoyenne comme l’expression de la rationalité individuelle ou de la conscience morale dans la sphère publique, je propose de comprendre la responsabilité comme une matrice discursive et gouvernementale qui perpétue des modèles comportementaux bien spécifiques. J’entends ainsi démontrer que la responsabilité (...) est devenue une modalité indispensable du « gouvernement de la conduite » au sein d’une rationalité néolibérale. En plus de constituer une série de dispositions morales qui remédierait aux failles et aux lacunes de l’individualisme libéral, la responsabilité se matérialise dans les incitations à une citoyenneté active et participe de ce fait à la rationalisation du retranchement de l’État de la sphère sociale. Comme l’illustrent des courants aussi divers que le néoconservatisme, le communautarisme et l’économie sociale, la responsabilité se présente moins comme une solution de rechange aux créneaux du néolibéralisme qu’une série de techniques et de standards comportementaux visant à compléter et renforcer l’application élargie d’une logique micro-économique. Je montrerai que le recours à la notion de responsabilité est particulièrement visible dans les politiques d’aide sociale et au sein des nouveaux partenariats entre l’État, le milieu communautaire et les communautés locales. En effet, l’aide étatique est de plus en plus conditionnelle à la démonstration de certaines dispositions morales et psychologiques comme la volonté, la ténacité et la probité. L’article se divise en quatre parties. La première s’attarde à définir brièvement la « gouvernementalité », concept initialement développé par Michel Foucault. La deuxième se penche sur des travaux plus contemporains, notamment ceux du sociologue britannique Nikolas Rose qui se préoccupe de la responsabilité en tant que modalité gouvernementale au sein du néolibéralisme. La troisième partie met en relief les particularités du néolibéralisme américain. En vue de cerner les pratiques et discours associés à la responsabilité de façon plus précise, la dernière partie examine l’un des principaux programmes d’aide sociale aux États-Unis, l’Aid to Families with Dependent Children, devenu le Temporary Assistance for Needy Families en 1996, des années 1980 jusqu’à aujourd’hui. | : Our point of departure is that responsibility is a more appropriate term than virtue to designate the contemporary exhortations to civic duty. Instead of seeing civic engagement as a means to express individual rationality or moral conscience in the public sphere, this paper suggests that we should understand responsability as a discursive and governmental matrix that perpetuates specific behavioral standards. More specifically, the article aims to show that responsability has become an indispensable instrument of rule within a neoliberal rationality of government. As well as pointing to a range of moral dispositions that can offset neoliberalism’s shortcomings, the notion of responsibility is mobilised in the repeated public calls to active citizenship and plays a strategic role in the discursive justification of the state’s withdrawal from the social sphere. As illustrated by strands of thought as diverse as neoconservatism, communitarianism and social economy, responsibility is less an alternative to neoliberal tenets than a series of techniques and behavioral standards that complement and reinforce the extension of a microeconomic logic to all spheres of human activity. The appeals to responsibility are particularly visible in contemporary social policies and in the strategic partnerships between the state, community organisations and local communities. Indeed, state assistance has become increasingly conditional on the demonstration of aptitudes and moral qualities like earnestness, tenacity and willpower. The article proceeds in four parts. The first part briefly defines governmentality, a concept initially developed by Michel Foucault. The second part explores Nikolas Rose’s work on advanced liberalism and takes a look at contemporary articulations of responsibility. The third part examines the specificities of American neoliberalism. In order to identify the practices and discourses linked to the notion of responsibility, the final part of the article looks at one of the main social programs in the United States, namely the Aid to Families with Dependent Children, renamed the Temporary Assistance for Needy Families in 1996, from the early 1980s to our day. (shrink)

Awareness, care and preventative action regarding HIV/aids, and those affected by it, is growing in the evangelical Christian Community in French-speaking Sub-Saharan Africa. Yet, even though the issues seem to be addressed through teaching and preaching in the churches, the real issues, questions and struggles of the people are not discussed. This article describes some of the most important outcomes of a qualitative research in this people group, looking at the values and beliefs around sexuality and community and what impact (...) they have on current HIV/aids prevention practices and strategies. This description highlights the seeming discrepancy between people’s values and their daily lives, the role community can play – as both a community of grace and a countercultural yet contextually relevant community, and the role of leaders, grass-root communities and partnership processes in strategy development. This article argues for a contextual relevant approach in which the specific evangelical worldview is encountered as a possible strength, rather than a problem. (shrink)

BackgroundAfrica continues to bear a disproportionate share of the global HIV/AIDS, tuberculosis (TB) and malaria burden. The development and distribution of safe, effective and affordable vaccines is critical to reduce these epidemics. However, conducting HIV/AIDS, TB, and/or malaria vaccine trials simultaneously in developing countries, or in populations affected by all three diseases, is likely to result in numerous ethical challenges.MethodsIn order to explore convergent ethical issues in HIV/AIDS, TB and malaria vaccine trials in Africa, the Ethics, Law and Human Rights (...) Collaborating Centre of the WHO/UNAIDS African AIDS Vaccine Programme hosted a consultation on the Convergent Ethical Issues in HIV/AIDS, TB and Malaria Vaccine Trials in Africa in Durban, South Africa on the 10-11 February 2009.ResultsKey cross cutting ethical issues were prioritized during the consultation as community engagement; ancillary care obligations; care and treatment; informed consent; and resource sharing.ConclusionThe consultation revealed that while there have been few attempts to find convergence on ethical issues between HIV/AIDS, TB and malaria vaccine trial fields to date, there is much common ground and scope for convergence work between stakeholders in the three fields. (shrink)

Since the first diagnosis of an HIV infection in 1956, the number of victims infected with the virus has dramatically increased to 40.3 million in 2005. The countries of sub-Saharan Africa carry the largest burden of HIV/AIDS worldwide. Various programs against the spread of the epidemic in this region have been promised. The objective of this article is to analyze to what extent these programs can achieve a sustainable effect. This article examines in detail the sustainability of thirteen programmes (...) initiated by large American and European pharmaceutical companies. It finds that none of the examined programs offers a fully sustainable solution. However, programs that were organized in cooperation with local authorities or organizations appear suitable to reach sustainable effects in high-prevalencecountries. As a result, cooperation seems to be an important prerequisite to implement the infrastructural measures necessary to guarantee sustainable effects in sub-Saharan Africa. (shrink)

Mark Evan Bonds’ recent book, Absolute Music, deepens considerably the historical context within which Eduard Hanslick’s famous treatise on musical beauty can be read. This paper argues that, with the aid of this expanded context, we can understand Hanslick’s treatise to have provided contemporary and subsequent audiences with a kind of meta-programme for listening to symphonic and other non-texted music. That is to say, Hanslick’s text arguably informed and directed the way audiences came to listen to instrumental music by furnishing (...) them with imaginative constructs which could then be applied to the practice of musical listening. In much the same way as the texts which supply the poetic scenarios of so-called programme music, Hanslick’s ‘meta-programme’ became indispensable to an expanding culture of musical listening in the second half of the 19th century and beyond beyond. My claim thus contradicts the well-known formalist tenets of Hanslick’s musical aesthetics. (shrink)

Background: The feeding modalities applied in countries with school meal programs are varied because these are shaped not only by the national commitments to alleviate food insecurity among children but also by resource availability from national and international agencies. In terms of financial resources, the USA plays a consistent role in providing donations, grants, loans, and loan guarantee programs to support global school feeding. The U.S. Department of Agriculture (USDA) oversees these funding sources for international school meal programs. Aim: This (...) study aims to examine the moderating effect of USDA funding on the relationship between supply purchasing methods and feeding modalities among countries implementing school meal programs. Methods: The Bayesian Mindsponge Framework, combining the reasoning strengths of Mindsponge Theory and inference advantages of Bayesian analysis, was employed on a dataset of 126 government representatives who manage large-scale school meal programs in 126 different countries. Results: The findings indicated that USDA funding has the potential to positively moderate the relationship between foreign supply purchases and the feeding modalities of school meal programs. However, the direct association between foreign purchases and feeding modalities was unclear. Conversely, while USDA funding was found to have a negative moderation effect on the relationship between domestic supply purchases and feeding modalities, it is these domestic purchases that show potential for positively influencing the feeding modalities. Conclusions: Findings underscore the importance of supporting the World Bank and World Food Programme’s recommendation to rely more on local resources and capacities for developing long-term and sustainable school meal programs. Further exploration of the impact of foreign supply purchases on feeding modalities is needed. Formulating strategic plans to better leverage USDA funding for enhancing domestic supply purchases is highly recommended. (shrink)

The present situation of the HIV/aids epidemic is very grim in China. The probability of China becoming a country with a high prevalence of HIV/aids cannot be excluded because there have been factors which promote the wide spread of HIV if we fail to take timely action to prevent it at the opportune moment. However, China's HIV prevention policy is inadequate. Health professionals and programmers believed that they could take a conventional public health approach to cope with the HIV epidemic. (...) They simply ignored the fact that HIV infection is an epidemic so special that their approach is not effective to deter the epidemic. Many health professionals and programmers bypassed ethical issues that had emerged in the prevention of the HIV epidemic. Even some health educators, sexologists and officials believe that `AIDS is the punishment for promiscuity', and this belief has led to discrimination and stigmatization of AIDS patients, HIV positive people, their family members and high risk groups. Although homosexuality is not illegal, the police can always find any reason to detain homosexuals. A difficult ethical issue is about the laws prohibiting prostitution and drug use in China which force prostitutes and intravenous drug users underground, giving them no chance to access information, education and the services needed to protect them. The dilemma facing China is whether to stay with a restrictive policy for the reason of ideology cleansing or to turn to a more supportive policy. It is necessary to have some change in the ethical framework to evaluate the action in HIV prevention. Tolerance should be the first ethical principle. (shrink)

Should philosophers speak about Aids? In this contribution, which is intended to open a forum for the readers of ‘Etica e politica’, it is argued that not only philosophers but all the responsible members of community have the duty to discuss the procedures which rules the funding of Aids research. The underlying idea is that scientific progress in this field is better guaranteed by supplying an adequate support to competing seriously proposed programmes of research.

The term Monte Carlo method indicates any computer-aided procedure for numerical estimation that combines mathematical calculations with randomly generated numerical input values. Today it is an important tool in high energy physics while physicists and philosophers also often consider it a sort of virtual experiment. The Monte Carlo method was developed in the 1940s, in the context of U.S. American nuclear weapons research, an event often regarded as the origin of both computer simulation and “artificial reality” (Galison 1997). The present (...) paper interrogates this strong claim by focusing on the emergence of Monte Carlo event generators in particle physics in the early 1960s. This historical case study shows how, as Monte Carlo computation became part of the toolbox of particle physicists around 1960, it was neither usually referred to as a “computer simulation” nor was it regarded as a surrogate for experimentation. In revising the history of this method, this paper asks, in what context did particle physicists of the 1960s decide to create FAKE, the first high-energy-physics Monte Carlo event simulator? What was their goal? And what epistemic role did FAKE play? In answering these questions, it is argued that Monte Carlo computations were not introduced into particle physics to simulate experiments, but rather they played the role of theoretical tools. The Monte Carlo method was able to do this thanks to its random component, a property which provided a means of modeling a specific phenomenon, so-called “(particle) resonances”. Indeed, in doing so, event generators even came to mutually assimilate and reshape the notions of particle and resonance, taking up an epistemic function which had previously been confined to physical-mathematical formulae: that of a medium which could express aspects of particle theory. (shrink)

Background: Confidentiality lies at the core of medical ethics and is the cornerstone for developing and keeping a trusting relationship between nurses and patients. In the wake of the HIV epidemic, there has been a heightened focus on confidentiality in healthcare contexts. Nurses’ follow-up of HIV-positive women and their susceptible HIV-exposed children has proved to be challenging in this regard, but the ethical dilemmas concerning confidentiality that emerge in the process of ensuring HIV-free survival of the third party – the (...) child – have attracted limited attention. Objective: The study explores challenges of confidentiality linked to a third party in nurse–patient relationships in a rural Tanzanian HIV/AIDS context. Study context: The study was carried out in rural and semi-urban settings of Tanzania where the population is largely agro-pastoral, the formal educational level is low and poverty is rife. The HIV prevalence of 1.5% is low compared to the national prevalence of 5.1%. Methods: Data were collected during 9 months of ethnographic fieldwork and consisted of participant observation in clinical settings and during home visits combined with in-depth interviews. The main categories of informants were nurses employed in prevention of mother-to-child transmission of HIV programmes and HIV-positive women enrolled in these programmes. Ethical considerations: Based on information about the study aims, all informants consented to participate. Ethical approval was granted by ethics review boards in Tanzania and Norway. Findings and discussion: The material indicates a delicate balance between the nurses’ attempt to secure the HIV-free survival of the babies and the mothers’ desire to preserve confidentiality. Profound confidentiality-related dilemmas emerged in actual practice, and indications of a lack of thorough consideration of the implication of a patient’s restricted disclosure came to light during follow-up of the HIV-positive women and the third party – the child who is at risk of HIV infection through mother’s milk. World Health Organization’s substantial focus on infant survival (Millennium Development Goal-4) and the strong calls for disclosure among the HIV-positive are reflected on in the discussion. (shrink)

Increasing international cooperation and interdependence are important features of the contemporary globalized world. In the present age, foreign aid is a very peculiar type of transaction in the sense that its focus is to satisfy the objectives of the donor and the recipient, which are not always the same. This paper attempts to analyse the situation of US and British aid to Pakistan’s education sector. The role of international donors in the development of the education sector in Pakistan cannot be (...) underestimated. They have been even more important for this developing country which has faced financial crises, particularly during the 1990s. These financial hardships faced by the country were mainly the outcome of the changed regional, political, as well as the geostrategic situation which also caused the change in the behaviour of international donors. It is especially true in the case of the USA and the UK where the aid to Pakistan was seriously affected by the changed situation in Afghanistan, political changes within the country, its nuclear programme and more recently the events of 9/11. This discussion reflects that the potential benefits of the aid were not reaped adequately due mainly to disruption and resumption of aid on the grounds of the geo‐political situation and strategic interests of donors. (shrink)

On 18 November 2014, the United Nations launched an urgent new campaign to end AIDS as a global health threat by 2030. With its proposed strategy, the UN follows leading scientists who had declared the failure of former prevention strategies and now were promoting a ‘Seek and Treat for Optimal Prevention’ (STOP) approach as the most cost‐effective response to the pandemic to meet the goal of ‘an AIDS‐free generation’. STOP combines antiretroviral therapy and routine HIV screening to find persons unaware (...) that they are HIV‐positive, because research has shown that people consistently change their behaviour (i.e. increase condom use, have fewer partners) after an HIV diagnosis. AIDS activists have broadly criticized this strategy on different levels. In this article, we go beyond these criticisms and try to analyse the political rationalities behind this ‘new’ strategy. We believe that it is necessary to put the rationale underpinning the STOP programme into the context of broader societal transformations that can best be captured as the development of advanced liberal societies and the new emphasis on self‐controlling or self‐responsibility rather than on disciplining behaviour. (shrink)

Self‐management programmes provide strategies to optimise health while educating and providing resources for living with enduring illnesses. The current paper describes the development of a community‐based programme that combines a transdiagnostic approach to self‐management with mindfulness to enhance psychological coping for older people with long‐term multimorbidity. The six steps of intervention mapping (IM) were used to develop the programme. From a needs assessment, the objectives of the programme were formulated; the theoretical underpinnings then aligned to the objectives, which informed (...) programme design, decisions on implementation, programme adoption and evaluation steps. Bandura's social cognitive theory informed the methods and practical strategies of delivery. Among the features addressed with participants are transdiagnostic dimensions such as fatigue, pain, breathlessness, sleep disturbances. The programme utilises mindfulness to aid coping and ameliorate the psychological distresses associated with chronicity. Findings from an initial feasibility study and subsequent pilot assisted in conceptualising our programme. In conclusion, applying IM gave the planners confidence the programme is robust and evidence‐based with clearly articulated links between the behavioural goals and design elements to obtain the desired outcomes. (shrink)

Like many African countries, Botswana is adversely affected by HIV and AIDS. However, from the onset of the epidemic there was an inimical expectation, both internally and externally, that the country would effectively address the problem. The paper posits that this expectation was a partial result of the halo effect emanating from Botswana's successful history on many social, economic, and political fronts. However, whilst the country's HIV and AIDS strategy is one of the success stories of the African continent insofar (...) as the state's commitment is concerned, it is afflicted by ethical impediments that continue to negatively impact the effectiveness of related policies and programmes. The paper examines the loopholes in the Botswana Government's HIV and AIDS response from the perspective of missed opportunities for addressing relevant ethical issues. These include anomalies regarding the lack of targeted sexual health and wellness programmes for prison inmates, sex workers, and sexual minorities. Strategies requiring urgent attention are concerned with provision of HIV prevention, treatment, and care for these populations. The authors contend that inclusive policies, legislation, and programmes to achieve a holistic and ethical response to the epidemic are urgently needed to harmonise the halo effect of Botswana's otherwise positive stance in relation to HIV and AIDS in Africa. (shrink)

This paper traces the development of policies dealing with HIV/AIDS in Botswana from their beginning in the late 1980s to the current programme to provide population-wide anti-retroviral therapy (ARV). Using a variety of source material, including long-term ethnographic research, it seeks to account for the failure of Western-inspired approaches in dealing with the pandemic. It does this by looking at the cultural and institutional features that have created resistance to the message and inhibited effective implementation. The negative response to the (...) first educational campaign stressing condom use is described and contextualized in terms of Tswana ideas of morality and illness. Nor, as was initially expected, did the introduction of free ARV therapy operate to break the silence and stigma that had developed around the disease. Take-up was very slow, and did not operate to encourage widespread testing. In 2003, key policymakers in Botswana began to argue for a break with the AIDS position, with its emphasis on voluntarism, confidentiality and the human rights of patients. This resulted in routine testing being introduced in 2004. This links to a major argument running through the paper which is that the failure of policy cannot be attributed solely to the nature of local populations. Western cultural assumptions about also require critical examination. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Closing the Gaps in Pediatric HIV/AIDS Care, One Step at a TimeLisa V. Adams, Helga Naburi, Goodluck Lyatuu, Paul Palumbo, and C. Fordham von ReynFatuma's* doctors were completely perplexed. It was 2003 and she had returned to the DARDAR clinic in her hometown of Dar es Salaam, Tanzania three times that week with vague complaints of various pains and aches. Her doctors were considering whether these symptoms were due (...) to the initiation of her recent treatment with antiretroviral medications for her HIV infection or related to the last administration of the investigational tuberculosis (TB) vaccine that the DARDAR Health Study was evaluating. Fatuma's doctor, Dr. Lillian Mtei, consulted with Dartmouth's chief of Infectious Disease, Dr. Ford von Reyn, who happened to be in Dar that week on a site visit. Neither physician could determine the basis for her symptoms. Dr. Mtei returned to the exam room once more and this time emerged with the answer: Fatuma had just learned that her three year old daughter was HIV-infected, likely contracted from Fatuma during or shortly after she gave birth to her daughter. Fatuma believed that her HIV diagnosis was a death sentence for her daughter since antiretroviral therapy was not widely available for children.Dr. von Reyn, Dartmouth's lead clinical researcher in Africa and a father, knew too well the harsh reality of inequities in a resource-limited country. He turned to Dr. Mtei and said decidedly, "we need to do something about this."Thus the DARDAR Pediatric Program was born.Pediatric HIV: A Neglected DiseaseThe need for HIV treatment among children in Tanzania, as in most of sub-Saharan Africa, is compelling. At the end of 2009, approximately 160,000 children aged zero to fourteen in Tanzania were living with HIV (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2011). Even with successful roll out of prevention of mother to child transmission programs in Tanzania, there were nearly 29,000 perinatal infections in 2009. As of December 2010, only 18% of these were enrolled in HIV treatment programs (UNAIDS, 2011; World Health Organization [WHO], 2011). Without antiretroviral therapy (ART), one-half of HIV-infected children will die before their second birthday. Since clinical research to determine efficacy and safety of new medical treatments is conducted almost exclusively in adults, provision of new medical treatments to [End Page 75] children always lags behind advances for adults. Furthermore, children are often underrepresented in programs for antiretroviral drugs for the following reasons: 1) they are not prioritized for care; 2) facilities lack infant diagnostic capabilities; 3) there is limited pediatric HIV training and consequently, a shortage of pediatric providers; and 4) pediatric antiretroviral formulations are frequently unavailable. The unacceptable delays in pediatric HIV drug development and treatment access led the international organization Drugs for Neglected Diseases initiative to publish an editorial in which they referred to pediatric HIV as a "neglected disease" (Lallemant, Chang, Cohen, & Pecoul, 2011).The Tip of the Iceberg: More than Just MedicinesWith a grant from the New York-based Foundation for the Treatment of Children with AIDS, the DARDAR Pediatric Program, a joint collaboration between Geisel School of Medicine at Dartmouth and Muhimbili University of Health and Allied Sciences, began seeing patients in May 2006. It was the first dedicated pediatric HIV Care and Treatment Center in Tanzania and operates in accordance with Tanzania's National AIDS Control Programme's guidance. Testing for both children and infants (the latter of which requires a more sophisticated assay) is available.The day the clinic opened we celebrated this collaborative effort that would provide HIV-infected children in Dar es Salaam access to antiretroviral treatment. One of our first patients was a six-year-old boy whose mother, like Fatuma, was a participant in our TB vaccine trial. She had been advised to bring her son to us for HIV screening. Her son looked healthy so she was surprised and understandably distraught when his test results indicated that not only was he HIV-infected, but his CD4 percentage was very low. His mother was reluctant to have him started on antiretrovirals given his general appearance and young age—and that he was... (shrink)

This article addresses the rise of faith-based emergency relief by examining the US President’s Emergency Plan for HIV/AIDS (PEPFAR), a public health intervention focused on the AIDS epidemic in sub-Saharan Africa. It argues that the theological turn in humanitarian aid serves to amplify ongoing dynamics in the domestic politics of sub-Saharan African states, where social services have assumed the form of chronic emergency relief and religious organizations have come to play an increasingly prominent role in the provision of such services. (...) In the context of an ongoing public health crisis, PEPFAR has institutionalized the social authority of the Pentecostal and charismatic churches, leading to a semantic confluence between the postcolonial politics of emergency and the Pentecostal/Pauline theology of kairos or event. Far from being confined to the space of foreign aid, however, the faith-based turn in humanitarianism is in keeping with ongoing reforms in domestic social policy in the United States. While on the one hand the sustained welfare programmes of the New Deal and Great Society have been dismantled in favour of a system of emergency relief, on the other hand the federal government has intensified its moral, pedagogical and punitive interventions into the lives of the poor. The wilful transfer of welfare services to overtly religious service providers has played a decisive role in this process. The article concludes with a critical appraisal of the links between African and North American Pentecostal-evangelical churches and questions the revolutionary mission ascribed to Pauline political theology in recent political theory. (shrink)

With the increasing number of people living with HIV/AIDS and the escalating costs of health care, there is an increasing demand for informal caregiving in the community. Currently, much emphasis is placed on individuals who are living with HIV/AIDS (in terms of the provision of social, psychological and economic support), but very little attention has been paid to the well-being and quality of life of informal caregivers. Lack of support and care for caregivers may have a negative impact on the (...) quality of care and effective services for individuals living with HIV/AIDS. This paper is based on findings from a qualitative study that explored major sources of stress associated with caregiving among informal caregivers in a village in the southern part of Botswana. The paper suggests that informal caregivers are an integral part of the continuum of care. As a result, they need to be nurtured and supported for the betterment of those both infected and affected by HIV/AIDS. The paper concludes by discussing the implications for further research, policy and programme development. (shrink)

The leadership development industry regularly claims to aid in developing effective, ethical leaders, using 360-degree psychometric assessments as key tools for so doing. This paper analyses the effects of such tools on those subjected to and subjectivised by them from a Foucauldian perspective. We argue that instead of encouraging ethical leadership such instruments inculcate practices and belief systems that perpetuate falsehoods, misrepresentations and inequalities. ‘Followers’ are presumed compliant, malleable beings needing leaders to determine what is in their interests. Such techniques (...) pursue productivity and profitability, rather than ethical leadership. We examine the Multifactor Leadership Questionnaire, a widely used 360-degree tool that measures transformational leadership, as an illustrative case study to substantiate these criticisms. (shrink)

Poverty in Africa has gained the attention of social activists, Non-Governmental Organizations, scholars from diverse fields, as well as governments. The contemporary reality of poverty, as revealed by various indices, shows that this problem has resisted the interventions so far. In view of the failures of earlier and current approaches to alleviating poverty in Africa, this paper explores the ethical and prudential approaches to setting anew, viable trajectory for poverty alleviation in twenty-first century Africa. It raises the fundamental question of (...) whether or not the affluent individuals in African societies on the one hand, and the wealthy Western nations on the other have any obligation towards the poor in Africa. On the basis of a critical consideration of some ethical theories in relation to the question of poverty, the paper contends that for the sake of stability and progress in the continent, it is necessary to develop programmes for the effectiveassistance of the poor on altruistic and prudential grounds. (shrink)

La théorie des catégories vaut tant par ses applications mathématiques que par les débats philosophiques qu’elle suscite. Elle sert à exprimer en topologie algébrique, à déduire en algèbre homologique et, en tant qu’alternative à la théorie des ensembles, à construire des objets en géométrie algébrique dans la conception de Grothendieck. La théorie des catégories est une discipline fondamentale en le sens de Christian Thiel, car elle traite d’opérations typiques de la mathématique de structures. Cette thèse est défendue à l’aide d’une (...) interprétation particulière du pragmatisme peircéen d’après laquelle la justification de la connaissance mathématique ne se fait pas par la réduction à des objets de base mais plutôt, à chaque niveau, par rapport au sens commun technique (les théories de niveau ultérieur ont pour objets les théories des objets originaux). (shrink)

Proof and Disproof in Formal Logic is a lively and entertaining introduction to formal logic providing an excellent insight into how a simple logic works. Formal logic allows you to check a logical claim without considering what the claim means. This highly abstracted idea is an essential and practical part of computer science. The idea of a formal system-a collection of rules and axioms, which define a universe of logical proofs-is what gives us programming languages and modern-day programming. This book (...) concentrates on using logic as a tool: making and using formal proofs and disproofs of particular logical claims. The logic it uses-natural deduction-is very small and very simple; working with it helps you see how large mathematical universes can be built on small foundations. The book is divided into four parts: Part I "Basics" gives an introduction to formal logic with a short history of logic and explanations of some technical words. Part II "Formal Syntactic Proof" show you how to do calculations in a formal system where you are guided by shapes and never need to think about meaning. Your experiments are aided by Jape, which can operate as both inquisitor and oracle. Part III "Formal Semantic Disproof" shows you how to construct mathematical counterexamples to shoe that proof is impossible. Jape can check the counterexamples you build. Part IV " Program Specification and Proof" describes how to apply your logical understanding to a real computer science problem, the accurate description and verification of programs. Jape helps, as far as arithmetic allows. Aimed at undergraduates and graduates in computer science, logic, mathematics and philosophy, the text includes reference to and exercises based on the computer software package Jape, an interactive teaching and research tool designed and hosted by the author that is freely available on the web. (shrink)

Originally published in 1987 to commemorate the 40 th anniversary of the Marshall Plan, this fascinating collection of essays, from an eminent ‘insider’ to the Marshall Plan, combines economics, politics and history to provide authoritative and personal insights into the creation of one of the greatest foreign aid programmes of the twentieth century. Any reader interested in the Marshall Plan itself, the inner workings of a major act of US foreign policy, and its many economic, political and historical facets (...) will welcome the reissue of this valuable book from one of America’s most distinguished economists. (shrink)

Le programme canadien d’aide médicale à mourir (AMM), qui repose sur une législation ambitieuse et des règlements détaillés, n’a pas réussi à fournir aux Canadiens suffisamment de preuves accessibles au public pour montrer qu’il fonctionne comme le prévoit les exigences de la loi, les règlements et les attentes de toutes les parties prenantes. La loi fédérale qui a été adoptée en 2016 a défini les critères d’éligibilité et mis en place un certain nombre de garanties qui devaient être satisfaites avant (...) de fournir une aide à mourir à une personne afin de ne pas transgresser le droit pénal. La responsabilité du contrôle du respect des critères d’éligibilité et des garanties procédurales a été confiée par le ministère fédéral de la santé (responsable de l’ensemble du contrôle) aux gouvernements provinciaux et territoriaux. Certains gouvernements ont publié des données statistiques concernant le programme, mais aucun n’a encore publié un rapport complet sur le respect des critères d’éligibilité et des garanties, comme l’exigent la loi et les règlements. Cet article explique le processus, explore les raisons possibles de cette lacune et propose quelques suggestions d’actions qui pourraient rectifier cet aspect du programme d’AMM. La responsabilité et la transparence font partie intégrante de la mise en oeuvre du programme d’AMM et les publications des rapports de suivi fédéraux et provinciaux/territoriaux obligatoires constituent une approche importante pour obtenir la confiance dans le programme. (shrink)

This is the first in a series of ‘diary reflections’ written, initially, from Vietnam where I work as an adviser to the Vietnam-Sweden Mountain Rural Development Programme (MRDP).1 This instalment will give the background to my work and highlight some of the areas I will cover in later entries. In doing so I will reflect on how my own philosophical work informs and is informed by my work on the practical management of natural resources and community development. The process will, (...) I hope, take in issues around the practical application of philosophical thinking — mainly to the environment and development. This reflection takes place in the context of work that involves a high degree of exchange across cultures, mainly Vietnamese (Kinh and several ethnic minorities), Swedish and British. The questions and challenges raised in this instalment may (or may not) be resolved over the remaining phase of my work with MRDP during 2001. In doing so I hope to provoke debate. Many of the issues raised within this programme are not unique but often occur within donor funded aid programmes in the natural resource and poverty alleviation arena. Later instalments will outline some practical matters and the theoretical issues raised by them. (shrink)

The epistemic terrain of humanitarian morality hasundergone a profound paradigmatic transformationin recent years. The turn towards “resilience” as a structuring principle in aid programmes has produced new modes of governance that challenge what I call the moral exceptionalism of humanitarianism’s mandate. This article traces the trajectory of moralism in humanitarian studies, exploring how the productive tension between contrapuntal readings of humanitarianism as moral intent or biopolitical care is transcended by the resilience paradigm’s ontological vision of an intrinsically fragileand vulnerable (...) world. Contrary to theoretical critiques of resilience as an extension of neoliberal tenets to global governance, I draw on the context of the Syrian refugee crisis in Jordan to argue that resilience humanitarianism has in fact prompted a return to state welfare as the final guarantor of refugee rights. (shrink)

Global GDP is more than 100 trillion dollars, yet 10 % of the world’s population still live in extreme poverty on less than $1.90 per day. No one should have to live like that: alleviating poverty is a minimal moral obligation implied by nearly every secular and religious moral system. Unfortunately, neither economic growth nor conventional international aid can be relied upon to fulfil this obligation. A global basic income programme that transferred $1 per day from the rich world to (...) each poor person would eliminate extreme poverty directly and at negligible cost. It is the least we should do. (shrink)

Since the introduction of drugs to prevent vertical transmission of HIV, the purpose of and approach to HIV testing of pregnant women has increasingly become an area of major controversy. In recent years, many strategies to increase the uptake of HIV testing have focused on offering HIV tests to women in pregnancy-related services. New global guidance issued by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) specifically notes these services as an entry point for (...) provider-initiated HIV testing and counseling (PITC). The guidance constitutes a useful first step towards a framework within which PITC sensitive to health, human rights and ethical concerns can be provided to pregnant women in health facilities. However, a number of issues will require further attention as implementation moves forward. It is incumbent on all those involved in the scale up of PITC to ensure that it promotes long-term connection with relevant health services and does not result simply in increased testing with no concrete benefits being accrued by the women being tested. Within health services, this will require significant attention to informed consent, pre- and post-test counseling, patient confidentiality, referrals and access to appropriate services, as well as reduction of stigma and discrimination. Beyond health services, efforts will be needed to address larger societal, legal, policy and contextual issues. The health and human rights of pregnant women must be a primary consideration in how HIV testing is implemented; they can benefit greatly from PITC but only if it is carried out appropriately. (shrink)

En este trabajo, el autor describe el Programa de sistemas de ayuda centrado en la persona que fue desarrollado para responder las demandas de las personas de la ciudad de Oporto, socialmente excluidas. Se describe el principio fundamental y los componentes del programa, junto con su proceso de realización. Finalmente, se ofrece una reflexión crítica de todo el programa y las expectativas de los futuros desarrollos.

Cet ouvrage vise à délimiter le champ d'investigation de la philosophie de l'esprit. Il comprend huit chapitres. Le premier, le plus général, se veut une première délimitation du champ d'investigation de la philosophie de l'esprit à l'aide de ses trois concepts clés: l'intentionnalité, la rationalité et la conscience. Le chapitre suivant se veut une réflexion plus générale sur les motivations philosophiques qui commandent des jugements si opposés sur le statut ontologique et épistémologique de la psychologie du sens commun. Le chapitre (...) IV dresse un tableau de ces différents programmes et des grands courants de la philosophie de l'esprit, en commençant par le behaviorisme, le physicalisme, le fonctionnalisme et le connexionnisme. Les trois chapitres suivants porteront sur les problèmes et débats liés à la naturalisation des trois propriétés principales de l'esprit, des trois problèmes principaux de la philosophie de l'esprit, soit les concepts d'intentionnalité, de rationalité et de conscience. Le chapitre V porte, d'une part, sur la nature de l'intentionnalité et les différents concepts de directionnalité (aboutness) que l'on retrouve actuellement en philosophie de l'esprit ; d'autre part, il s'agira pour nous de décrire et de classer les différents programmes de naturalisation de l'intentionnalité. Le chapitre six est ouvre de nouvelles perpectives en ce qu'il porte sur la nature de la rationalité et sur les différentes tentatives et arguments en faveur de sa naturalisation. Le chapitre VII s'attaque au problème central de la philosophie de l'esprit, à savoir la conscience. (shrink)

ABSTRACT I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments. INTRODUCTION In contrast to the classic model of randomized-control trials, often with a large number of (...) subjects enrolled, precision medicine attempts to optimize therapeutic outcomes by focusing on the individual.[i] A recent publication highlights the strengths and weakness of both traditional evidence-based medicine and precision medicine.[ii] Plus, it outlines a tension in the shift from evidence-based medicine’s inductive reasoning style (the collection of data to postulate general theories) to precision medicine’s abductive reasoning style (the generation of an idea from the limited data available).[iii] The paper’s main example is the application of precision medicine for the treatment of cancer.[iv] I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. As the name suggests, brain-computer interfaces are a significant advancement in neurotechnology that directly connects someone’s brain to external or implanted devices.[v] Among the various kinds of brain-computer interfaces, adaptive deep brain stimulation devices require numerous personalized adjustments to their settings during the implantation and computation stages in order to provide adequate relief to patients with treatment-resistant disorders. What makes these devices unique is how adaptive deep brain stimulation integrates a sensory component to initiate the stimulation. While not commonly at the level of sophistication as self-supervising or generative large language models,[vi] they currently allow for a semi-autonomous form of neuromodulation. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments.[vii] ANALYSIS I. The State of Precision Medicine in Oncology and the Epistemological Shift While a thorough overview of precision medicine for the treatment of cancer is beyond the scope of this article, its practice can be roughly summarized as identifying clinically significant characteristics a patient possesses (e.g., genetic traits) to land on a specialized treatment option that, theoretically, should benefit the patient the most.[viii] However, in such a practice of stratification patients fall into smaller and smaller populations and the quality of evidence that can be applied to anyone outside these decreases in turn.[ix] As inductive logic helps to articulate, the greater the number of patients that respond to a particular therapy the higher the probability of its efficacy. By straying from this logical framework, precision medicine opens the treatment of cancer to more uncertainty about the validity of these approaches to the resulting disease subcategories.[x] Thus, while contemporary medical practices explicitly describe some treatments as “personalized”, they ought not be viewed as inherently better founded than other therapies.[xi] A relevant contemporary case of precision medicine out of Norway focuses on the care of a patient with cancer between the ventricles of the heart and esophagus, which had failed to respond to the standard regimen of therapies over four years.[xii] In a last-ditch effort, the patient elected to pay out-of-pocket for an experimental immunotherapy (nivolumab) at a private hospital. He experienced marked improvements and a reduction in the size of the tumor. Understandably, the patient tried to pursue further rounds of nivolumab at a public hospital. However, the hospital initially declined to pay for it given the “lack of evidence from randomised clinical trials for this drug relating to this [patient’s] condition.”[xiii] In rebuttal to this claim, the patient countered that he was actually similar to a subpopulation of patients who responded in “open‐label, single arm, phase 2 studies on another immune therapy drug” (pembrolizumab).[xiv] Given this interpretation of the prior studies and the patient’s response, further rounds of nivolumab were approved. Had the patient not had improvements in the tumor’s size following a round of nivolumab, then pembrolizumab’s prior empirical evidence in isolation would have been insufficient, inductively speaking, to justify his continued use of nivolumab.[xv] The case demonstrates a shift in reasoning from the traditional induction to abduction. The phenomenon of ‘cancer improvement’ is considered causally linked to nivolumab and its underlying physiological mechanisms.[xvi] However, “the weakness of abductions is that there may always be some other better, unknown explanation for an effect. The patient may for example belong to a special subgroup that spontaneously improves, or the change may be a placebo effect. This does not mean, however, that abductive inferences cannot be strong or reasonable, in the sense that they can make a conclusion probable.”[xvii] To demonstrate the limitations of relying on the abductive standard in isolation, commentators have pointed out that side effects in precision medicine are hard to rule out as being related to the initial intervention itself unless trends from a group of patients are taken into consideration.[xviii] As artificial intelligence (AI) assists the development of precision medicine for oncology, this uncertainty ought to be taken into consideration. The implementation of AI has been crucial to the development of precision medicine by providing a way to combine large patient datasets or a single patient with a large number of unique variables with machine learning to recommend matches based on statistics and probability of success upon which practitioners can base medical recommendations.[xix] The AI is usually not establishing a causal relationship[xx] – it is predicting. So, as AI bleeds into medical devices, like brain-computer interfaces, the same cautions about using abductive reasoning alone should be carried over. II. Responsive Neurostimulation, AI, and Personalized Medicine Like precision medicine in cancer treatment, computer-brain interface technology similarly focuses on the individual patient through personalized settings. In order to properly expose the intersection of AI, precision medicine, abductive reasoning, and implantable neurotechnologies, the descriptions of adaptive deep brain stimulation systems need to deepen.[xxi] As a broad summary of adaptive deep brain stimulation, to provide a patient with the therapeutic stimulation, a neural signal, typically referred to as a local field potential,[xxii] must first be detected and then interpreted by the device. The main adaptive deep brain stimulation device with premarket approval, the NeuroPace Responsive Neurostimulation system, is used to treat epilepsy by detecting and storing “programmer-defined phenomena.”[xxiii] Providers can optimize the detection settings of the device to align with the patient’s unique electrographic seizures as well as personalize the reacting stimulation’s parameters.[xxiv] The provider adjusts the technology based on trial and error. One day machine learning algorithms will be able to regularly aid this process in myriad ways, such as by identifying the specific stimulation settings a patient may respond to ahead of time based on their electrophysiological signatures.[xxv] Either way, with AI or programmers, adaptive neurostimulation technologies are individualized and therefore operate in line with precision medicine rather than standard treatments based on large clinical trials. Contemporary neurostimulation devices are not usually sophisticated enough to be prominent in AI discussions where the topics of neural networks, deep learning, generative models, and self-attention dominate the conversation. However, implantable high-density electrocorticography arrays (a much more sensitive version than adaptive deep brain stimulation systems use) have been used in combination with neural networks to help patients with neurologic deficits from a prior stroke “speak” through a virtual avatar.[xxvi] In some experimental situations, algorithms are optimizing stimulation parameters with increasing levels of independence.[xxvii] An example of neurostimulation that is analogous to the use of nivolumab in Norway surrounds a patient in the United States who was experiencing both treatment-resistant OCD and temporal lobe epilepsy.[xxviii]Given the refractory nature of her epilepsy, implantation of an adaptive deep brain stimulation system was indicated. As a form of experimental therapy, her treatment-resistant OCD was also indicated for the off-label use of an adaptive deep brain stimulation set-up. Another deep brain stimulation lead, other than the one implanted for epilepsy, was placed in the patient’s right nucleus accumbens and ventral pallidum region given the correlation these nuclei had with OCD symptoms in prior research. Following this, the patient underwent “1) ambulatory, patient-initiated magnet-swipe storage of data during moments of obsessive thoughts; (2) lab-based, naturalistic provocation of OCD-related distress (naturalistic provocation task); and (3) lab-based, VR [virtual reality] provocation of OCD-related distress (VR provocation task).”[xxix] Such signals were used to identify when to deliver the therapeutic stimulation in order to counter the OCD symptoms. Thankfully, following the procedure and calibration the patient exhibited marked improvements in their OCD symptoms and recently shared her results publicly.[xxx] In both cases, there is a similar level of abductive justification for the efficacy of the delivered therapy. In the case study in which the patient was treated with adaptive deep brain stimulation, they at least had their neural activity tested in various settings to determine the optimum parameters for treatment to avoid them being based on guesswork. Additionally, the adaptive deep brain stimulation lead was already placed before the calibration trials were conducted, meaning that the patient had already taken on the bulk of the procedural risk before the efficacy could be determined. Such an efficacy test could have been replicated in the first patient’s cancer treatment, had it been biopsied and tested against the remaining immunotherapies in vitro. Yet, in the case of cancer with few options, one previous dose of a drug that appeared to work on the patient may justify further doses. However, as the Norwegian case presents, corroboration with known responses to a similar drug (from a clinical trial) could be helpful to validate the treatment strategy. (It should be noted that both patients were resigned to these last resort options regardless of the efficacy of treatment.) There are some elements of inductive logic seen with adaptive deep brain stimulation research in general. For example, abductively the focus could be that patient X’s stimulation parameters are different from patient Y’s and patient Z’s. In contrast, when grouped as subjects who obtained personalized stimulation, patients X, Y, and Z demonstrate an inductive aspect to this approach’s safety and/or efficacy. The OCD case holds plenty of abductive characteristics in line with precision medicine’s approach to treating cancer and as more individuals try the method, there will be additional data. With the gradual integration of AI into brain-computer interfaces in the name of efficacy, this reliance on abduction will continue, if not grow, over time. Moving forward, if a responsive deep brain stimulation treatment is novel and individualized (like the dose of nivolumab) and there is some other suggestion of efficacy (like clinical similarities to other patients in the literature), then it may justify insurance coverage for the investigative intervention, absent other unrelated reasons to deny it. III. Ethical Implications and Next Steps While AI’s use in oncology and neurology is not yet as prominent as its use in other fields (e.g., radiology), it appears to be on the horizon for both.[xxxi] AI can be found in both the functioning of the neurotechnologies as well as the implementation of precision medicine. The increasing use of AI may serve to further individualize both oncologic and neurological therapies. Given these implications and the handful of publications cited in this article, it is important to have a nuanced evaluation of how these treatments, which heavily rely on abductive justification, ought to be managed. The just use an abductive approach may be difficult as AI infused precision medicine is further pursued. At baseline, such technology relies on a level of advanced technology literacy among the general public and could exclude populations who lack access to basic technological infrastructure or know-how from participation.[xxxii] Even among nations with adequate infrastructure, as more patients seek out implantable neurotechnologies, which require robust healthcare resources, the market will favor patient populations that can afford this complex care.[xxxiii] If patients already have the means to pay for an initial dose/use of a precision medicine product out of pocket, should insurance providers be required to cover subsequent treatments?[xxxiv] That is, if a first dose of a cancer drug or a deep brain stimulator over its initial battery life is successful, patients may feel justified in having the costs of further treatments covered. The Norwegian patient’s experience implies there is a precedent for the idea that some public insurance companies ought to cover successful cancer therapies, however, insurance companies may not all see themselves as obligated to cover neurotechnologies that rely on personalized settings or that are based on precision/abductive research more than on clinical trials. CONCLUSION The fact that the cases outlined above rely on abductive style of reasoning implies that there may not be as strong a justification for coverage by insurance, as they are both experimental and individualized, when compared to the more traditional large clinical trials in which groups have the same or a standardized protocol (settings/doses). If a study is examining the efficacy of a treatment with a large cohort of patients or with different experimental groups/phases, insurance companies may conclude that the resulting symptom improvements are more likely to be coming from the devices themselves. A preference for inductive justification may take priority when ruling in favor of funding someone’s continued use of an implantable neurostimulator. There are further nuances to this discussion surrounding the classifications of these interventions as research versus clinical care that warrant future exploration, since such a distinction is more of a scale[xxxv] than binary and could have significant impacts on the “right-to-try” approach to experimental therapies in the United States.[xxxvi] Namely, given the inherent limitations of conducting large cohort trials for deep brain stimulation interventions on patients with neuropsychiatric disorders, surgically innovative frameworks that blend abductive and inductive methodologies, like with sham stimulation phases, have traditionally been used.[xxxvii] Similarly, for adaptive brain-computer interface systems, if there are no large clinical trials and instead only publications that demonstrate that something similar worked for someone else, then, in addition to the evidence that the first treatment/dose worked for the patient in question, the balance of reasoning would be valid and arguably justify insurance coverage. As precision approaches to neurotechnology become more common, frameworks for evaluating efficacy will be crucial both for insurance coverage and for clinical decision making. ACKNOWLEDGEMENT This article was originally written as an assignment for Dr. Francis Shen’s “Bioethics & AI” course at Harvard’s Center for Bioethics. I would like to thank Dr. Shen for his comments as well as my colleagues in the Lázaro-Muñoz Lab for their feedback. - [i] Jonathan Kimmelman and Ian Tannock, “The Paradox of Precision Medicine,” Nature Reviews. Clinical Oncology 15, no. 6 (June 2018): 341–42, https://doi.org/10.1038/s41571-018-0016-0. [ii] Henrik Vogt and Bjørn Hofmann, “How Precision Medicine Changes Medical Epistemology: A Formative Case from Norway,” Journal of Evaluation in Clinical Practice 28, no. 6 (December 2022): 1205–12, https://doi.org/10.1111/jep.13649. [iii] David Barrett and Ahtisham Younas, “Induction, Deduction and Abduction,” Evidence-Based Nursing 27, no. 1 (January 1, 2024): 6–7, https://doi.org/10.1136/ebnurs-2023-103873. [iv] Vogt and Hofmann, “How Precision Medicine Changes Medical Epistemology,” 1208. [v] Wireko Andrew Awuah et al., “Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications,” World Neurosurgery, May 22, 2024, S1878-8750(24)00867-2, https://doi.org/10.1016/j.wneu.2024.05.104. [vi] Mark Riedl, “A Very Gentle Introduction to Large Language Models without the Hype,” Medium (blog), May 25, 2023, https://mark-riedl.medium.com/a-very-gentle-introduction-to-large-language-models-without-the-hype-5 f67941fa59e. [vii] David E. Burdette and Barbara E. Swartz, “Chapter 4 - Responsive Neurostimulation,” in Neurostimulation for Epilepsy, ed. Vikram R. Rao (Academic Press, 2023), 97–132, https://doi.org/10.1016/B978-0-323-91702-5.00002-5. [viii] Kimmelman and Tannock, 2018. [ix] Kimmelman and Tannock, 2018. [x] Simon Lohse, “Mapping Uncertainty in Precision Medicine: A Systematic Scoping Review,” Journal of Evaluation in Clinical Practice 29, no. 3 (April 2023): 554–64, https://doi.org/10.1111/jep.13789. [xi] Kimmelman and Tannock, “The Paradox of Precision Medicine.” [xii] Vogt and Hofmann, 1206. [xiii] Vogt and Hofmann, 1206. [xiv] Vogt and Hofmann, 1206. [xv] Vogt and Hofmann, 1207. [xvi] Vogt and Hofmann, 1207. [xvii] Vogt and Hofmann, 1207. [xviii] Vogt and Hofmann, 1210. [xix] Mehar Sahu et al., “Chapter Three - Artificial Intelligence and Machine Learning in Precision Medicine: A Paradigm Shift in Big Data Analysis,” in Progress in Molecular Biology and Translational Science, ed. David B. Teplow, vol. 190, 1 vols., Precision Medicine (Academic Press, 2022), 57–100, https://doi.org/10.1016/bs.pmbts.2022.03.002. [xx] Stefan Feuerriegel et al., “Causal Machine Learning for Predicting Treatment Outcomes,” Nature Medicine 30, no. 4 (April 2024): 958–68, https://doi.org/10.1038/s41591-024-02902-1. [xxi] Sunderland Baker et al., “Ethical Considerations in Closed Loop Deep Brain Stimulation,” Deep Brain Stimulation 3 (October 1, 2023): 8–15, https://doi.org/10.1016/j.jdbs.2023.11.001. [xxii] David Haslacher et al., “AI for Brain-Computer Interfaces,” 2024, 7, https://doi.org/10.1016/bs.dnb.2024.02.003. [xxiii] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 103–4; “Premarket Approval (PMA),” https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P100026. [xxiv] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 104. [xxv] Burdette and Swartz, 126. [xxvi] Sean L. Metzger et al., “A High-Performance Neuroprosthesis for Speech Decoding and Avatar Control,” Nature 620, no. 7976 (August 2023): 1037–46, https://doi.org/10.1038/s41586-023-06443-4. [xxvii] Hao Fang and Yuxiao Yang, “Predictive Neuromodulation of Cingulo-Frontal Neural Dynamics in Major Depressive Disorder Using a Brain-Computer Interface System: A Simulation Study,” Frontiers in Computational Neuroscience 17 (March 6, 2023), https://doi.org/10.3389/fncom.2023.1119685; Mahsa Malekmohammadi et al., “Kinematic Adaptive Deep Brain Stimulation for Resting Tremor in Parkinson’s Disease,” Movement Disorders 31, no. 3 (2016): 426–28, https://doi.org/10.1002/mds.26482. [xxviii] Young-Hoon Nho et al., “Responsive Deep Brain Stimulation Guided by Ventral Striatal Electrophysiology of Obsession Durably Ameliorates Compulsion,” Neuron 0, no. 0 (October 20, 2023), https://doi.org/10.1016/j.neuron.2023.09.034. [xxix] Nho et al. [xxx] Nho et al.; Erik Robinson, “Brain Implant at OHSU Successfully Controls Both Seizures and OCD,” OHSU News, accessed March 3, 2024, https://news.ohsu.edu/2023/10/25/brain-implant-at-ohsu-successfully-controls-both-seizures-and-ocd. [xxxi] Awuah et al., “Bridging Minds and Machines”; Haslacher et al., “AI for Brain-Computer Interfaces.” [xxxii] Awuah et al., “Bridging Minds and Machines.” [xxxiii] Sara Green, Barbara Prainsack, and Maya Sabatello, “The Roots of (in)Equity in Precision Medicine: Gaps in the Discourse,” Personalized Medicine 21, no. 1 (January 2024): 5–9, https://doi.org/10.2217/pme-2023-0097. [xxxiv] Green, Prainsack, and Sabatello, 7. [xxxv] Robyn Bluhm and Kirstin Borgerson, “An Epistemic Argument for Research-Practice Integration in Medicine,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 43, no. 4 (July 9, 2018): 469–84, https://doi.org/10.1093/jmp/jhy009. [xxxvi] Vijay Mahant, “‘Right-to-Try’ Experimental Drugs: An Overview,” Journal of Translational Medicine 18 (June 23, 2020): 253, https://doi.org/10.1186/s12967-020-02427-4. [xxxvii] Michael S. Okun et al., “Deep Brain Stimulation in the Internal Capsule and Nucleus Accumbens Region: Responses Observed during Active and Sham Programming,” Journal of Neurology, Neurosurgery & Psychiatry 78, no. 3 (March 1, 2007): 310–14, https://doi.org/10.1136/jnnp.2006.095315. (shrink)

À l’aide d’une autobiographie professionnelle de soixante ans de recherche en formation continue des adultes, l’article explicite les références qui ont ancré philosophiquement la construction d’une problématique rythmoformatrice des apprentissages adultes tout au long et dans tous les secteurs de la vie. Cette construction s’est opérée sur trois périodes transatlantiques : une période initiale en Europe (1959-1969) d’entrée dans la vie adulte (20-30 ans) en recherche-formation laborieuse de sens à la vie ; une seconde au Québec (1969-1985) de conception, construction (...) et conduite de programmes de recherche en éducation permanente à la Faculté de l’éducation permanente de l’Université de Montréal (30-45 ans) ; et enfin une troisième comme professeur-chercheur à l’Université de Tours (1985-2007) en co-création de diplômes et de groupes de recherche-formation universitaire pour adultes (45- 67 ans). Deux ancrages philosophiques préscolaires – la caverne de Platon et l’Émile de Rousseau – et un ancrage postscolaire et transdisciplinaire d’une épistémologie dialectique systémique, apparaissent progressivement contribuer de façon dominante à la conceptualisation d’une problématique rythmoformatrice du cours de la vie adulte, en deux temps (expérientiel/formel) et trois mouvements (auto, socio et écoformation). (shrink)

Serge Daney is widely recognised in his homeland as the most important French film critic after André Bazin. In a career devoted to criticism for Cahiers du cinéma and later Libération, including a key period as editor during the transition from the journal’s PCF and then Maoist phase beginning in 1973, Daney also held a lecturing position for a spell at the University of Paris, Paris III, La Censure. He was a significant public intellectual and featured in several documentaries, including (...) Claire Denis’ film Jacques Rivette – Le veilleur. From 1985 to 1990 Daney presented a programme on cinema on the radio station France Culture. Following the publication of a book on Haitian politics in 1973 under the assumed name Raymond Sapène, Daney’s journalism was collected in several volumes. He left Libération in 1981 to establish Trafic, a journal which, since his death from Aids in 1992, has continued his legacy. The only book-length English translation of Daney’s writings to date – Postcards from the Cinema – is of the posthumously published Persévérances. (shrink)

This paper examines attention as a scientific concept, and argues that it has a patchwork structure. On this view, the concept of attention takes on different meanings, depending on the scientific context. I argue that these different meanings vary systematically along four dimensions, as a result of the epistemic goals of the scientific programme in question and the constraints imposed by the scientific context. Based on this, I argue that attention is a general reasoning strategy concept: it provides general, non-specific (...) guidance that aids scientific work. As well as shedding light on attention as a scientific concept, this theory has two wider consequences. First, it demonstrates that the patchwork approach is a fruitful way to think about psychological concepts. Second, it provides novel resources to resist eliminativism about attention. (shrink)

Cet ouvrage se propose de décrire la place et le sens de la responsabilité dans le monde contemporain. Depuis quelques années, la notion est en effet omniprésente dans les discussions sur l'éthique. On l'invoque à propos de l'écologie, de l'aide aux personnes dépendantes, de l'éducation, de l'intervention humanitaire et ainsi de suite. Pourtant, cet usage répandu, loin de traduire une large adhésion à ce qui irait de soi, témoigne plutôt que la responsabilité est devenue problématique : elle devient incertaine lorsque (...) les liens sociaux se réduisent à une série de relations ou d'échanges contractuels, sans autorité ou garants supra-individuels qui assignent à chacun une place ; lorsque les obligations entre les individus ne sont plus garanties par des rôles, des statuts et des appartenances, et que l'Etat, chargé d'y remédier par ses programmes et ses interventions, est lui-même affaibli par l'économie de marché. De l'ensemble des perspectives réunies ici, il apparaîtra que c'est devant l'imprévisible, le fragile ou le vulnérable que la responsabilité se déploie. Elle dénote un certain désir de l'engagement, la volonté d'entreprendre, le risque de se tromper et le courage d'assumer, mais aussi la conscience de nos propres insuffisances, de nos limites, lesquelles, à tort, pourraient nous y faire renoncer en plaidant l'irresponsabilité. Dans ce sens, la responsabilité est davantage une question posée à nous tous qu'une réponse toute faite fournie par les codes et les lois. (shrink)

Governments are investing in precision medicine with the aim of improving healthcare through the use of genomic analyses and data analytics to develop tailored treatment approaches for individual patients. The success of PM is contingent upon clear public communications that engender trust and secure the social licence to collect and share large population-wide data sets because specific consent for each data re-use is impractical. Variation in the terminology used by different programmes used to describe PM may hinder clear communication (...) and threaten trust. Language is used to create common understanding and expectations regarding precision medicine between researchers, clinicians and the volunteers. There is a need to better understand public interpretations of PM-related terminology. This paper reports on a qualitative study involving 24 focus group participants in the multi-lingual context of Singapore. The study explored how Singaporeans interpret and understand the terms ‘precision medicine’ and ‘personalised medicine’, and which term they felt more aptly communicates the concept and goals of PM. Results suggest that participants were unable to readily link the terms with this area of medicine and initially displayed preferences for the more familiar term of ‘personalised’. The use of visual aids to convey key concepts resonated with participants, some of whom then indicated preferences for the term ‘precision’ as being a more accurate description of PM research. These aids helped to facilitate dialogue around the ethical and social value, as well as the risks, of PM. Implications for programme developers and policy makers are discussed. (shrink)

Background: Studies have established that negative perceptions of people living with HIV/AIDS exist among nursing students throughout the world, perceptions which can be detrimental to the delivery of high-quality nursing care. Objectives: The purpose of this research was to explore socio-cultural influences on the perceptions of nursing students towards caring for people living with HIV/AIDS. Research design: The study was guided by stigma theory, a qualitative descriptive research approach was adopted. Data collected via semi-structured interviews were thematically analysed. Participants and (...) research context: Participants were 21 international and Australian undergraduate nursing students enrolled in a Bachelor of Nursing programme at an Australian university. Ethical considerations: Ethical approval was granted by the Social and Behavioural Research Ethics Committee at the study university. Participation was entirely voluntary; informed consent was obtained before the study commenced; confidentiality and anonymity were assured. Findings: Three major themes were found: blame, othering and values. Complex and interrelated factors constructed participant perceptions of people living with HIV/AIDS, perceptions underscored by the prevailing culturally construed blame and othering associated with HIV/AIDS. The study found discordance between the negative personal beliefs and perceptions some nursing students have towards people living with HIV/AIDS, and the professional values expected of them as Registered Nurses. Discussion: There was considerable commonality between this and previous studies on how homosexuality and illicit drug use were perceived and stigmatised, correlating with the blame directed towards people living with HIV/AIDS. These perceptions indicated some nursing students potentially risked not fulfilling the ethical and professional obligations the Registered Nurse. Conclusion: Nursing curriculum should be strengthened in relation to comprehending the meaning of being stigmatised by society. Educational institutions need to work towards enhancing strategies that assist nursing students to reconcile any incongruity between their personal beliefs and requisite professional nursing values. (shrink)

As new HIV prevention tools are developed, researchers face a number of ethical and logistic questions about how and when to include novel HIV prevention strategies and tools in the standard prevention package of ongoing and future HIV prevention trials. Current Joint United Nations Programme on HIV/AIDS /World Health Organization guidance recommends that participants in prevention trials receive ‘access to all state of the art HIV risk reduction methods’, and that decisions about adding new tools to the prevention package be (...) made in consultation with ‘all relevant stakeholders’. The guidance, however, leaves open questions of both process and implementation. In March 2009, the Global Campaign for Microbicides, UNAIDS and the Centers for Disease Control and Prevention convened a consultation to develop practical answers to these questions. Fifty-nine diverse participants, including researchers, ethicists, advocates and policymakers, worked to develop consensus criteria on when to include new HIV prevention tools in future trials. Participants developed a set of questions to guide decision-making, including: whether the method has been recommended by international bodies or adopted at a national level; the size of the effect and weight of the evidence; relevance to the trial population; whether the tool has been approved or introduced in the trial country; whether adding the tool might lead to trial futility; outstanding safety issues and status of the trial. Further work is needed to develop, implement and evaluate approaches to facilitate meaningful stakeholder participation in this deliberative process. (shrink)

La question directrice de cette étude est la suivante: comment est-il possible de comprendre la nécessité d’une entreprise pédagogique pour atteindre l’intelligible dans la République, tandis que l’âme accède à l’Idée sans l’aide d’un maître dans le Phédon? Ces deux voies épistémologiques, respectivement politique et morale, ne sont contradictoires qu’en apparence, car c’est toujours un naturel philosophe qui, programme éducatif ou non, peut avoir une intuition de l’Idée dans une expérience solitaire. Si le rôle de l’éducation est, dans la République, (...) de repérer un tel naturel, de le préserver d’une corruption politique , de le rendre redevable d’un engagement dans les affaires publiques et de faciliter la conversion eidétique de son regard, la philosophie - ou dialectique - reste, dans les deux dialogues, une aventure personnelle et solitaire. (shrink)

Professor Gostin is a leading authority on health law, whose writing and teaching are among the most authoritative in the United States, as exemplified by his recent work, Public Health Law: Power, Duty, Restraint. Gostin's article in this issue of the Journal of Law, Medicine & Ethics pays homage to Jonathan Mann by expressing the debt he feels toward this extraordinary doctor and public health official with whom he had collaborated on several projects.As many will remember, Mann held high-level positions (...) at the Centers for Disease Control and worked on AIDS research in Central Africa before setting up the World Health Organization's Global Programme on AIDS, which he ran from 1986 to 1990. Thanks to his profound commitment and consummate communication skills, he achieved the unprecedented feat of raising the budget within two years to almost $100 million from the initial set-up of “himself, a secretary, and one typewriter,” as described by Daniel Tarantola. (shrink)

This paper introduces this special issue which is focused on its target paper - The Natural Origins of Content. The target paper has had a robust and considered set of fifteen replies; a literal A to Z of papers. This extended introduction explains the background thinking and challenges that motivated the target article's proposed research programme. It also provides a sneak peak preview and navigational aid to the special issue’s contents. Brief highlights of each commentary are provided and they are (...) grouped together under broad headings. We do not attempt to give detailed replies to these suggestions or answer the various critiques at this stage of the proceedings: that is for future work. (shrink)

The boundary problem is related to the binding problem, part of a family of puzzles and phenomenal experiences that theories of consciousness (ToC) must either explain or eliminate. By comparison with the phenomenal binding problem, the boundary problem has received very little scholarly attention since first framed in detail by Rosengard in 1998, despite discussion by Chalmers in his widely cited 2016 work on the combination problem. However, any ToC that addresses the binding problem must also address the boundary problem. (...) The binding problem asks how a unified first person perspective (1PP) can bind experiences across multiple physically distinct activities, whether billions of individual neurons firing or some other underlying phenomenon. To a first approximation, the boundary problem asks why we experience hard boundaries around those unified 1PPs and why the boundaries operate at their apparent spatiotemporal scale. We review recent discussion of the boundary problem, identifying several promising avenues but none that yet address all aspects of the problem. We set out five specific boundary problems to aid precision in future efforts. We also examine electromagnetic (EM) field theories in detail, given their previous success with the binding problem, and introduce a feature with the necessary characteristics to address the boundary problem at a conceptual level. Topological segmentation can, in principle, create exactly the hard boundaries desired, enclosing holistic, frame-invariant units capable of effecting downward causality. The conclusion outlines a programme for testing this concept, describing how it might also differentiate between competing EM ToCs. (shrink)