Psychologists and neuroscientists often struggle to integrate findings in their respective domains, a problem due partly to implicitly and explicitly held philosophical positions on issues of reduction and autonomy across these domains. The present article reviews how reduction and autonomy have been used in philosophical arguments regarding how macro-scale findings relate to micro-scale findings across various scientific disciplines. The present article demonstrates how macro findings are indispensable to explanations of phenomena of interest by (a) providing information regarding higher levels of (...) organization in mechanisms, (b) including information not contained within certain micro explanations that (c) provides more general and stable causal explanations relative to micro explanations in certain situations. The purpose of presenting these analyses and recommendations is to disabuse psychologists and neuroscientists of pervasive assumptions that psychology is reducible to biology and that lower level phenomena (molecular) should be prioritized as somehow more explanatory than higher level phenomena (behavioral). The article concludes with 3 hypothetical scenarios from clinical psychology and psychiatry illustrating this critique and providing a pragmatic approach to clarify the relative roles, and importance, of biological and psychological data in service of general and stable explanations that are tailored to the kind of intervention desired. (shrink)

Special moral, regulatory, and scientific questions surround the inclusion of children in health-related research. These questions arise from a fundamental moral tension between the obligation to expose children to research participation to ensure that they share in the benefits that arise from it and the obligation to protect them from the harms associated with their inappropriate involvement in research. This tension is felt in the development of moral and regulatory frameworks for the protection of child research subjects and in the (...) implementation and interpretation of these frameworks by institutional review boards. (shrink)

Franklin G. Miller and colleagues have stimulated renewed interest in research ethics through their work criticizing clinical equipoise. Over three years and some twenty articles, they have also worked to articulate a positive alternative view on norms governing the conduct of clinical research. Shared presuppositions underlie the positive and critical dimensions of Miller and colleagues' work. However, recognizing that constructive contributions to the field ought to enjoy priority, we presently scrutinize the constructive dimension of their work. We argue (...) that it is wanting in several respects. (shrink)

: When may a physician legitimately offer enrollment in a randomized clinical trial (RCT) to her patient? Two answers to this question have had a profound impact on the research ethics literature. Equipoise, as originated by Charles Fried, which we term Fried's equipoise (FE), stipulates that a physician may offer trial enrollment to her patient only when the physician is genuinely uncertain as to the preferred treatment. Clinical equipoise (CE), originated by Benjamin Freedman, requires that there exist a state of (...) honest, professional disagreement in the community of expert practitioners as to the preferred treatment. FE and CE are widely understood as competing concepts. We argue that FE and CE offer separable and, in themselves, incomplete justifications for the conduct of clinical trials. FE articulates conditions under which the fiduciary duties of physician to patient may be upheld in the conduct of research. CE sets out a standard for the social approval of research by institutional review boards. Viewed in this way, FE and CE are not necessarily competing notions, but rather address complementary moral concerns. (shrink)

Heated debate surrounds the question whether the relationship between physician-researcher and patient-subject is governed by a duty of care. Miller and Weijer argue that fiduciary law provides a strong legal foundation for this duty, and for articulating the terms of the relationship between physician-researcher and patient-subject.

Bioethics is currently witnessing unprecedented debate over the moral and legal norms governing the conduct of clinical research. At the center of this debate is the duty of care in clinical research, and its most widely accepted specification, clinical equipoise. In recent work, we have argued that equipoise and cognate concepts central to the ethics of clinical research have been left unnecessarily vulnerable to criticism. We have suggested that the vulnerability lies in the conspicuous absence of an articulated foundation in (...) moral and legal theory of the physician-researcher's duty of care to the patient-subject. We have repeatedly suggested that the requisite foundation is in the ethics of trust and the law of fiduciaries.Curiously, despite the absence of a published thorough exposition of our position, some have preemptively criticized our suggestion that the relationship between physician-researcher and patient-subject is fiduciary. Others have offered their own accounts of the implications of fiduciary law for the relationship. (shrink)

When may a physician enroll a patient in clinical research? An adequate answer to this question requires clarification of trust-based obligations of the state and the physician-researcher respectively to the patient-subject. The state relies on the voluntarism of patient-subjects to advance the public interest in science. Accordingly, it is obligated to protect the agent-neutral interests of patient-subjects through promulgating standards that secure these interests. Component analysis is the only comprehensive and systematic specification of regulatory standards for benefit-harm evaluation by research (...) ethics committees (RECs). Clinical equipoise, a standard in component analysis, ensures the treatment arms of a randomised control trial are consistent with competent medical care. It thus serves to protect agent-neutral welfare interests of the patient-subject. But REC review occurs prior to enrolment, highlighting the independent responsibility of the physician-researcher to protect the agent-relative welfare interests of the patient-subject. In a novel interpretation of the duty of care, we argue for a “clinical judgment principle” which requires the physician-researcher to exercise judgment in the interests of the patient-subject taking into account evidence on treatments and the patient-subject‘s circumstances. (shrink)

The question "When are research risks reasonable in relation to anticipated benefits?" is at the heart of disputes in the ethics of clinical research. Institutional review boards are often criticized for inconsistent decision-making, a problem that is compounded by a number of contemporary controversies, including the ethics of research involving placebo controls, developing countries, incapable adults and emergency rooms. If this pressing ethical question is to be addressed in a principled way, then a systematic approach to the ethics of risk (...) in research is required. Component analysis provides such a systematic approach. (shrink)

: In response to the preceding commentary by Jerry Menikoff in this issue of the Journal , the authors argue that Fried's central concern is not that randomized clinical trials (RCTs) are conducted without consent, but rather that various aspects of the design and conduct of RCTs are in tension with physicians' duties of personal care to their patients. Although Fried does argue that the existence of equipoise cannot justify failure to obtain consent from research subjects, informed consent by itself (...) does not supplant ill subjects' rights to personalized judgment and care embodied in Fried's equipoise. (shrink)

Bringing together leading theorists to analyse critically important philosophical questions at the intersection of contract and fiduciary law, Contract, Status, and Fiduciary Law demonstrates that these two areas of law, while distinctive, are deeply intertwined.

(2002). Avoiding a Jekyll-And-Hyde Approach to the Ethics of Clinical Research and Practice. The American Journal of Bioethics: Vol. 2, No. 2, pp. 14-17.

Over the past 5 years, a series of articles in leading American newspapers has revealed the extent to which the conduct of clinical trials may be affected by inducements offered by corporate research sponsors and accepted by some unscrupulous physicians. The cases described were disturbing. They involved physicians engaged in excessive “enrollment activities” in exchange for money. Some of these physicians perpetrated fraud, falsifying their recruitment records in order to increase their profits. Others ignored exclusion criteria designed to ensure the (...) safety of subjects and the validity of research results, referring their patients to research investigating treatments for conditions from which they did not suffer. One of the articles reports that physicians focusing exclusively on commercial research regularly divulge annual incomes upwards of $1,000,000 with profits in excess of $300,000. Two physicians accumulated well over $10,000,000 through clinical trials activities in less than a decade. (shrink)

Earlier in the pages of this journal (p 481), Wendler and Miller offered the "net risks test" as an alternative approach to the ethical analysis of benefits and harms in research. They have been vocal critics of the dominant view of benefit-harm analysis in research ethics, which encompasses core concepts of duty of care, clinical equipoise and component analysis. They had been challenged to come up with a viable alternative to component analysis which meets five criteria. The alternative must (...) (1) protect research subjects; (2) allow clinical research to proceed; (3) explain how physicians may offer trial enrolment to their patients; (4) address the challenges posed by research containing a mixture of interventions and (5) define ethical standards according to which the risks and potential benefits of research may be consistently evaluated. This response argues that the net risks test meets none of these criteria and concludes that it is not a viable alternative to component analysis. (shrink)

: The authors respond to objections Fred Gifford has raised against their paper "Rehabilitating Equipoise." They situate this exchange in the wider context of recent debate over equipoise, highlighting substantial points of agreement between themselves and Gifford. The authors offer a brief restatement of "Rehabilitating Equipoise" in which they amplify some of its core arguments. They then assess Gifford's objections. Finding each to be unfounded, they argue that there is no justification for "pulling the plug" on clinical equipoise.

This chapter attempts to derive, define, and specify norms governing the relationship between physician-researcher and patient-subject, and to explore their interconnection. It argues that rooting the relationship between physician-researcher and patient-subject in a normative theory of trust is promising. It enables the derivation, definition, and specification of norms governing the relationship and appreciation of their interconnection.

Explores the interactions of fiduciary law and personal and political trust in private, public and international law.

Over the past 5 years, a series of articles in leading American newspapers has revealed the extent to which the conduct of clinical trials may be affected by inducements offered by corporate research sponsors and accepted by some unscrupulous physicians. The cases described were disturbing. They involved physicians engaged in excessive “enrollment activities” in exchange for money. Some of these physicians perpetrated fraud, falsifying their recruitment records in order to increase their profits. Others ignored exclusion criteria designed to ensure the (...) safety of subjects and the validity of research results, referring their patients to research investigating treatments for conditions from which they did not suffer. One of the articles reports that physicians focusing exclusively on commercial research regularly divulge annual incomes upwards of $1,000,000 with profits in excess of $300,000. Two physicians accumulated well over $10,000,000 through clinical trials activities in less than a decade. (shrink)

Fiduciary law is one of the most important areas of private law, governing a wide range of relationships that affect people in their daily lives. These new and innovative essays explore the foundations of fiduciary relationships and the duties fiduciaries owe to their beneficiaries.

Fiduciary law is one of the most important areas of law, governing a wide range of relationships that affect people in their daily lives. These new and innovative essays explore the foundations of fiduciary relationships and the duties of loyalty fiduciaries owe to their beneficiaries.

In lieu of an abstract, here is a brief excerpt of the content:Excited DeliriumWhat’s Psychiatry Got to do With It?Paul B. Lieberman, MDIf in life we are surrounded by death, so too in the health of our intellect by madness.—WittgensteinDelirium is a medical syndrome defined as “a relatively acute decline in cognition that fluctuates over hours or days” whose primary manifestation is a deficit of attention. It is common, estimated to occur in 10% to more than 50% of hospitalized (...) patients, with higher prevalence rates among people in nursing homes and at the end of life. It is often fatal, with a mortality rate in the hospital estimated to be 25% to 33%. Caused by a wide variety of conditions and frequently difficult to diagnose, it lacks characteristic postmortem pathology (Josephson & Miller 2018)‘Excited delirium,’ as Byju and Friesen forcefully argue (Byju & Friesen, 2023), is, if nothing else, an excuse. The ‘diagnosis’ has not been empirically validated and remains controversial (American Psychiatric Association, 2020). And while delirium is usually treated by internists and emergency medicine physicians, psychiatrists should also be concerned about the misuse of a putative medical diagnosis and join actively in discussion about it. For one thing, patients mis-diagnosed with this condition, as Byju and Friesen’s examples suggest, may actually have another psychiatric condition and, so, be people for whose safety we should advocate. Moreover, the kinds of police interventions which Byju and Friesen document as involving excited delirium also befall patients with other psychiatric problems in whom the issue of delirium does not arise.There are at least two broad ways in which psychiatrists are qualified and obligated to engage with this issue. As physicians, we should join our medical colleagues in carefully but persistently telling the scientific, medical truth. As psychiatrists, we should bring psychiatric knowledge into the discussion, for example, by explaining what can happen when people who do not, apparently, have a diagnosable mental disorder interact under stress with other people who, apparently, do.Delirium is a clinical diagnosis, made when characteristic signs and symptoms are present which should not be made ‘by exclusion’ when, as may happen, other causes are not found. There is no evidence of delirium in any of the three clinical descriptions Byju and Friesen provide. Perhaps such evidence exists which is not in their brief reports, but these three people appear to have had, either, another psychiatric condition, such as psychosis or drug intoxication, or perhaps no [End Page 353] diagnosis at all. Psychiatrists are particularly wellpositioned to make this point since patients with mental health problems are often misdiagnosed when they seek medical attention and are told, and treated as if, “it’s all (“just”!) psychological.”Excited delirium, if it exists, is fatal in 10% of cases (Gonin, Beysard, Hersin, & Carron, 2018) and, although this is lower than the rate for delirium in general, it is still high. Medical personnel must be available to evaluate and ensure the safety of patients in custody.The potential conflict between protecting the patient and protecting the public should not be overstated. Although physical trauma and excessive administration of medications, including ketamine 500 mg IV (Orhurhu, Vashicht, Claus, & Cohen, 2023) can be lethal, mechanical restraint by itself is not (Chieze et al., 2019; Gleerup et al., 2019): something else is necessary, such as asphyxiation (Evans, Wood, & Lambert, 2003). Nor is restraint necessary in many cases in which ‘de-escalation’ techniques can be equally effective (Garriga et al., 2016; Fernández-Costa, 2020). Perhaps these points are best made by law enforcement leaders—and they have been—but psychiatrists can add that safe management of potential violence can be provided for agitated people with psychiatric conditions.Although it is not clear what kind of strength ‘superhuman’ strength might be (certainly not medical), relative imperviousness to pain is clinically described. Its locus classicus is Beecher’s observation, during World War II, that injured soldiers awaiting return home from the front, required lower than usual doses of analgesics (Beecher, 1946). And it’s a common experience, scientifically confirmed, that physical trauma may not become painful until sometime after the injury (Melzack, Wall, & Ty, 1982). But pain is a warning. Its absence is not a license, but a caution... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Excited DeliriumWhat’s Psychiatry Got to do With It?Paul B. Lieberman, MDIf in life we are surrounded by death, so too in the health of our intellect by madness.—WittgensteinDelirium is a medical syndrome defined as “a relatively acute decline in cognition that fluctuates over hours or days” whose primary manifestation is a deficit of attention. It is common, estimated to occur in 10% to more than 50% of hospitalized (...) patients, with higher prevalence rates among people in nursing homes and at the end of life. It is often fatal, with a mortality rate in the hospital estimated to be 25% to 33%. Caused by a wide variety of conditions and frequently difficult to diagnose, it lacks characteristic postmortem pathology (Josephson & Miller 2018)‘Excited delirium,’ as Byju and Friesen forcefully argue (Byju & Friesen, 2023), is, if nothing else, an excuse. The ‘diagnosis’ has not been empirically validated and remains controversial (American Psychiatric Association, 2020). And while delirium is usually treated by internists and emergency medicine physicians, psychiatrists should also be concerned about the misuse of a putative medical diagnosis and join actively in discussion about it. For one thing, patients mis-diagnosed with this condition, as Byju and Friesen’s examples suggest, may actually have another psychiatric condition and, so, be people for whose safety we should advocate. Moreover, the kinds of police interventions which Byju and Friesen document as involving excited delirium also befall patients with other psychiatric problems in whom the issue of delirium does not arise.There are at least two broad ways in which psychiatrists are qualified and obligated to engage with this issue. As physicians, we should join our medical colleagues in carefully but persistently telling the scientific, medical truth. As psychiatrists, we should bring psychiatric knowledge into the discussion, for example, by explaining what can happen when people who do not, apparently, have a diagnosable mental disorder interact under stress with other people who, apparently, do.Delirium is a clinical diagnosis, made when characteristic signs and symptoms are present which should not be made ‘by exclusion’ when, as may happen, other causes are not found. There is no evidence of delirium in any of the three clinical descriptions Byju and Friesen provide. Perhaps such evidence exists which is not in their brief reports, but these three people appear to have had, either, another psychiatric condition, such as psychosis or drug intoxication, or perhaps no [End Page 353] diagnosis at all. Psychiatrists are particularly wellpositioned to make this point since patients with mental health problems are often misdiagnosed when they seek medical attention and are told, and treated as if, “it’s all (“just”!) psychological.”Excited delirium, if it exists, is fatal in 10% of cases (Gonin, Beysard, Hersin, & Carron, 2018) and, although this is lower than the rate for delirium in general, it is still high. Medical personnel must be available to evaluate and ensure the safety of patients in custody.The potential conflict between protecting the patient and protecting the public should not be overstated. Although physical trauma and excessive administration of medications, including ketamine 500 mg IV (Orhurhu, Vashicht, Claus, & Cohen, 2023) can be lethal, mechanical restraint by itself is not (Chieze et al., 2019; Gleerup et al., 2019): something else is necessary, such as asphyxiation (Evans, Wood, & Lambert, 2003). Nor is restraint necessary in many cases in which ‘de-escalation’ techniques can be equally effective (Garriga et al., 2016; Fernández-Costa, 2020). Perhaps these points are best made by law enforcement leaders—and they have been—but psychiatrists can add that safe management of potential violence can be provided for agitated people with psychiatric conditions.Although it is not clear what kind of strength ‘superhuman’ strength might be (certainly not medical), relative imperviousness to pain is clinically described. Its locus classicus is Beecher’s observation, during World War II, that injured soldiers awaiting return home from the front, required lower than usual doses of analgesics (Beecher, 1946). And it’s a common experience, scientifically confirmed, that physical trauma may not become painful until sometime after the injury (Melzack, Wall, & Ty, 1982). But pain is a warning. Its absence is not a license, but a caution... (shrink)

In this collection of provocative essays, historians and literary theorists assess the influence of Michel Foucault, particularly his History of Sexuality, on the study of classics. Foucault's famous work presents a bold theory of sexuality for both ancient and modern times, and yet until now it has remained under-explored and insufficiently analyzed. By bringing together the historical knowledge, philological skills, and theoretical perspectives of a wide range of scholars, this collection enables the reader to explore Foucault's model of Greek culture (...) and see how well his interpretation accounts for the full range of evidence from Greece and Rome. Not only do the essays bring to light the assumptions, ideas, and practices that constituted the intimate lives of men and women in the ancient Mediterranean world, but they also demonstrate the importance of the History of Sexuality for fields as diverse as Greco-Roman antiquity, women's history, cultural studies, philosophy, and modern sexuality. The essays include "Situating The History of Sexuality" (the editors), "Taking the Sex Out of Sexuality: Foucault's Failed History" (Joel Black), "Incipit Philosophia" (Alain Vizier), "The Subject in Antiquity after Foucault" (Page duBois), "This Myth Which Is Not One: Construction of Discourse in Plato's Symposium" (Jeffrey S. Carnes), "Foucault's History of Sexuality: A Useful Theory for Women?" (Amy Richlin), "Catullan Consciousness, the 'Care of the Self,' and the Force of the Negative in History" (Paul Allen Miller), "Reversals of Platonic Love in Petronius' Satyricon" (Daniel B. McGlathery), and an essay from Dislocating Masculinity (Lin Foxhall). (shrink)

Margaret Mohrmann, Paul Lauritzen, and Sumner Twiss raise questions about my account of basic interests, liberal theory, and the challenges of multiculturalism as developed in "Children, Ethics, and Modern Medicine." Their questions point to foundational issues regarding the justification and limitation of parental authority to make decisions on behalf of children in medical and other contexts. One of the central questions in that regard is whether adults' decisions deserve to be respected, especially when they seem contrary to a child's (...) or adolescent's basic interests. Questions about respect, in turn, focus attention on others' decisions about what seems good for families and children, decisions that may be paternalistic or utilitarian. Such decisions are further complicated by a child's or adolescent's budding autonomy and need for respect and recognition. Pediatric bioethics grounded in an account of a child's basic interests produces a theory of negative and positive rights for assessing adults' actions in relation to children, especially (but not only) when adults demand respect in their expressions of care. (shrink)

This article assays Paul Ramsey's influential attempt to conceive possible nuclear deterrents within the confines of just war tenets. I look first at Ramsey's construction of just war ideas according to a protection paradigm, one in which agape is deontically defined. I also note a subtle sub-theme in Ramsey's construction of just war ideas, what I call a preservation motif. I then assess Ramsey's discussion of nuclear deterrence, closing with a critique of his treatments of intention and proportionality. I (...) conclude by arguing that Ramsey's argument falters, and that the weaknesses of his argument can be rendered intelligible by noting how the full implications of the protection paradigm are attenuated by the preservation motif. (shrink)

Plato's account of the famous trial of Socrates in 399 b.c., appeals to historians, philosophers, political scientists, and classicists. It is also essential reading for students of ancient Greek. Paul Allen Miller and Charles Platter provide running commentary, glosses of unfamiliar words, introductions that address historical and philosophical issues, and thought-provoking essays on each chapter.

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 249 Girolamo Balduino: Ricerche sulla logica della Scuola di Padova nel Rinascimento. By Giovanni Papuli. (Bark Lacerta, Universith di Bari, Pubblicazioni dell'lstituto di filosofia, 12, 1967. Pp. 313. no price.) The philosophers at the University of Padua during the late Middle Ages and Renaissance arc attracting much renewed interest. This study makes accessible again the logical philosophy of Girolamo Balduino, professor at Padua during the second quarter (...) of the sixteenth century. Like other thinkers of his period, 13alduino follows the logic of Aristotle, and looks for progress within the ancient and mediaeval tradition, not for radically new doctrines. He continues the traditional interpretation of Aristotle by Averroes, for whom logic is only an instrumental habitus, a tool or method of demonstration. About the final contribution of the school of Padua to the improvement of Aristotelian logic was the doctrine of regressive demonstration, where demonstration terminates in or discloses the definition. Zabarella's well-known teaching on this point seems to be derived entirely from Balduino. Contrary to the interpretation of Cassirer, followed by Randall, this regressive demonstration is not a universal method of inquiry and is not at all like, and not the historical source of, the new method of Galileo. Papuli's book is solidly based on the original Latin texts, in notes, which are of great value in view of the fact that Balduino's works have been out of print since 1573. Not all of Papuli's interpretations are beyond criticism (e.g., p. 296), but he has done a service in enabling us to reestablish contact with one of the last significant commentators on Aristotle's logic. PAUL J. W. MILLER University of Colorado Documents sur la vie de Jules-Cdsar Vanini de Taurisano. By Emile Namer. (Bari: Adriatica Editrice, n.d.=Univcrsith degli Studi di Bari, Pubblicazioni delFIstituto di Filosofia, II serie, Testi e Documenti, I. Pp. 196+22 facsimile illustrations) Giulio Cesare Vanini (1585-1619) ranks with Giordano Bruno as a modern hero of freedom of philosophical expression. He was tortured and then burned at the stake in Toulouse at the age of thirty-four, because of the unorthodoxy of his views. For this reason, he has drawn more attention than is perhaps deserved on the basis of his rather mediocre writings, which are little more than a tissue of plagiarisms culled from Pomponazzi, Cardano, J. C. Scaliger, and others. In this volume, Emile Namer has collected the scattered documents dealing with Vanini's life and activities. This is a valuable service, for it should enable scholars to disentangle fact from fiction and reality from myth. There has been so much heated discussion regarding Vanini that it is now time that someone should attempt to establish the precise facts and to reevaluate Vanini's place in intellectual history. In the past, writings about him have been governed more often by emotion than by reason. Namer prints documents from Naples, London, Paris, Simancas, and Toulouse. Some of these have been printed before in various journal articles, but it is valuable to have them all together in a single volume. In addition, he prints relevant excerpts concerning--as one of them put it--le douzi~me apostre de Satan, including material from Mersenne, Garasse, and others. He also includes a series of facsimiles of sample pages from the documents which he prints. All in all Namer's work is competently 250 HISTORY OF PHILOSOPHY done, though perhaps a bit more annotation to put the documents in historical perspective would have been desirable. In any case this little volume must be one of the bases for any future serious biographical or interpretative studies dealing with Vanini. Moreover, it shouM also be useful for scholars dealing with more general questions of seventeenth-century intellectual, religious, and social history. Unfortunately, there is no index, nor bibliography of earlier literature on Vanini, and the Introduction is perhaps too brief to orient the reader who has little previous knowledge of Vanini. CHARLES B. SCHMITT University oJ Leeds Tommaso Campanella: Renaissance Pioneer o[ Modern Thought. By Bernardino M. Bonansea. (Washington: Catholic University of America Press, 1969. Pp. xi 421. $14.50) This excellent critical study of the life and... (shrink)

ABSTRACT In this essay, Paul Lauritzen examines Richard B. Miller's liberal account of pediatric ethics by asking if the duty to promote a child's basic interests is substantial enough to secure the well‐being of children. This question is raised in light of two case studies: daytime TV talk shows that broadcast interviews with sexually active children, and a medical study conducted to test the effect of growth hormone treatment on adult height in peripubertal children. In both cases, Lauritzen (...) argues, children are subjected to potential harms that are not easily explained, and therefore not easily prevented, by appeals to basic interests. (shrink)

In this essay, Paul Lauritzen examines Richard B. Miller's liberal account of pediatric ethics by asking if the duty to promote a child's basic interests is substantial enough to secure the well-being of children. This question is raised in light of two case studies: daytime TV talk shows that broadcast interviews with sexually active children, and a medical study conducted to test the effect of growth hormone treatment on adult height in peripubertal children. In both cases, Lauritzen argues, (...) children are subjected to potential harms that are not easily explained, and therefore not easily prevented, by appeals to basic interests. (shrink)

Exile in the Maghreb: Jews under Islam, Sources and Documents, 997–1912. By Paul B. Fenton and David G. Littman. Madison, NJ: FairLeigh Dickinson University Press, 2016. Pp. xxxv + 627. $60, £39.95 ; $57, £39.95.

In one of his most important books, Children, Ethics, and Modern Medicine, Richard B. Miller argues that medical ethicists have too frequently focused on abstract moral and legal principles in wrestling with the issues raised by contemporary medical practice. Drawing on the anthropologist, Clifford Geertz, Miller suggests that ethicists must attend to both the “experience-near” realities that patients and their families confront and the “experience-distant” work of connecting those realities to the theoretical principles that might help illuminate the (...) existential and ethical problems faced by patients and families. In a useful analogy, Miller argues that the best strategy is to tack back and forth between the near and the distant such that one artfully occupies the intermediate space between personal and impersonal perspectives. In this chapter, I follow Miller’s advice to seek out the intermediate space between the lived reality of the bedside and the reflective domain of the scholar’s office. For most bioethicists that space is found in one of three ways. One encounters patients and their families as a clinician or as an observer of the clinical encounter. One attends carefully to illness narratives as a source of experience-near material. Or one reflects on one’s own experience as a patient or family member encountering medical practice. This chapter suggests that it is possible to combine these approaches. Specifically, I draw on the experience of accompanying my wife through her illness and death from ovarian cancer, as well as on grief memoirs to illuminate a neglected area of health humanities scholarship. Drawing on Arthur Frank’s classic study of illness narratives in The Wounded Storyteller, this chapter delineates similarities and between grief narratives and illness narratives. A comparison of these two genres suggests why the grief of patients and families is so often overlooked in accounts of the clinical encounter. (shrink)

Rosanna Wannberg (2024) has given us a dense but helpful introduction to certain philosophical questions raised by the fact that many patients recovering from psychotic illnesses describe their recovery in terms of gaining or regaining a 'sense of self' and a 'sense of agency,' which often involves acceptance of the 'fact' of being mentally ill, for example, of 'having schizophrenia.' She raises two important questions: How should we understand what is going on in these accounts? and What are the implications (...) of these reports for our understanding of what it is to have a 'sense of self' or a 'sense of agency'—of 'subjectivity' generally—which might have, both, clinical and nonclinical implications?What does it mean... Read More. (shrink)

Don Ihde has characterized his philosophy as "phenomenology + pragmatism." This article argues that Ihde's pragmatism can be understood as consistency with two philosophical commitments from the first generation of American pragmatists (e.g. Peirce, James, Dewey and Addams). First, Ihde's notion of embodiment relations for tools and techniques is consistent with the organism-environment relational epistemology of these thinkers. Second, his desire to dissociate himself from romantic and neo-idealist readings of the phenomenological tradition link him with their naturalism.

The chapter discusses two points of intersection between the communication of science-based information about risk and philosophical ethics. The first is a logically unnecessary bias toward consequentialist ethics, and a corresponding tendency to overlook the significance of deontological and virtue based ways to interpret the findings of a scientific risk analysis. The second is a grammatical bias that puts scientific communicators at odds with the expectations of a non-scientific audience.

In this paper we describe the objectives of teaching medical ethics to undergraduates and the teaching methods used. We describe a workshop used in the University of Liverpool Department of Psychiatry, designed to enhance ethical sensitivity in psychiatry. The workshop reviews significant historical and current errors in the ethical practice of psychiatry and doctors' defence mechanisms against accepting responsibility for deficiencies in ethical practice. The workshop explores the student doctors' own group ethos in response to ethical dilemmas, and demonstrates how (...) the individual contributes to and is responsible for the group ethos through participation and also through nonparticipation. The student feedback about the workshop is reviewed. The Toronto Ethical Sensitivity Instrument was used to assess whether or not the workshop altered sensitivity. Compared to a control group the attenders' sensitivity was significantly increased (on Student's t-test p equals or is less than 0.002). (shrink)

The emergence of individuality during the evolutionary transition from single cells to multicellularity poses a range of problems. A key issue is how variation in lower‐level individuals generates a corporate (collective) entity with Darwinian characteristics. Of central importance to this process is the evolution of a means of collective reproduction, however, the evolution of a means of collective reproduction is not a trivial issue, requiring careful consideration of mechanistic details. Calling upon observations from experiments, we draw attention to proto‐life cycles (...) that emerge via unconventional routes and that transition, in single steps, individuality to higher levels. One such life cycle arises from conflicts among levels of selection and invokes cheats as a primitive germ line: it lays the foundation for collective reproduction, the basis of a self‐policing system, the selective environment for the emergence of development, and hints at a plausible origin for a soma/germ line distinction. (shrink)