In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Evil in Modern Thought: An Alternative History of PhilosophyPaul S. MiklowitzSusan Neiman. Evil in Modern Thought: An Alternative History of Philosophy. Princeton: Princeton University Press, 2002. Pp. xii + 358. Cloth, $29.95.Contemporary philosophy in America tends to regard epistemological questions as the most fundamental of the discipline, but Susan Neiman's Evil in Modern Thought sets itself against this assumption in an attempt to sketch "an alternative history of (...) philosophy." "It's possible to begin to worry about the difference between appearance and reality because... a dream is so vivid that you want to grasp one of its objects for a moment or two of sleepy half-consciousness," Neiman writes, but then "you wake up in your bed, slap your face if you have to... " (5). The problem of evil, in stark contrast to such skeptical speculations, is far more urgent and trenchant; it is "the place where philosophy begins, and threatens to stop" (ibid.). Moreover, the problem of evil, far from being merely a theological quandary, actually forms a link between metaphysics and epistemology by starkly posing questions about the intelligibility of the world: Why are things like that? wants the answer Because it's best that way. For the early modern period, these questions centered on the "theodicy" debates focused by the catastrophic Lisbon earthquake of 1755, while for us the holocaust threatens to explode all our hopes and expectations for the possibility of a world that is as it should be. Thus, Lisbon and Auschwitz frame for Neiman the historical topoi that ground discussion of the relation between natural and moral evils, the evolving philosophical understanding of which defines "who we have become in the three centuries that separate us from the early Enlightenment" (10).The problem of theodicy is introduced through the figure of Alfonso X, king of Castille in 1252, and "the first Enlightenment hero" (14), according to Neiman. Having studied astronomy under the guidance of learned Jews from Toledo, Alfonso scandalously remarked "If I had been of God's counsel at the Creation, many things would have been ordered better" (15). Serving as a paradigm of blasphemy for half a millennium, Alfonso's boast also expresses the inevitable dismay that must accompany the delighted wonder at natural order exploited by the argument from design: while Creation is surely miraculous in its manifestation of seemingly intelligent structure, it is just as surely astonishing that so much of that structure seems so wantonly destructive. Can this really be the best of all possible worlds if innocent lives are cut short by cruel diseases or natural disasters while vicious villains prosper into comfortable old age?! Alfonso's remark serves Neiman as a leitmotif around which she orders central figures in the canon of western philosophy into two camps: those who struggled to reconcile natural evil with God's goodness or with reason (Leibniz, Pope, Rousseau, Kant, Hegel and Marx), and those who skeptically condemned reason by appealing to "brute appearances" (Bayle, Voltaire, Hume, Sade and Schopenhauer). Because the very categories of natural and moral evil tend to break down as a result of the development of psychology as a "science of nature" (to the extent that human motives are regarded as natural processes subject to empirical explanation, they cease to manifest a unique ontology), Nietzsche and Freud fall outside the philosophical canon thus construed—although Neiman's discussion of these two thinkers is perhaps the most compelling of the book.No new interpretive ground is broken in the resulting exegesis of western philosophical history, but Neiman's treatment of each of these figures is intelligent and skillful. In discussing Kant, for example, a deep paradox at the center of his moral thought is brilliantly harnessed to the book's argument. Whereas theodicies from Leibniz onward had focused on attempts to show that Providence ultimately guaranteed a connection between virtue and happiness despite obvious evidence to the contrary, Kant took exactly the opposite tack. As Neiman puts it, "Solving the problem of evil is not only impossible but immoral. For knowing the connections between moral and natural evils would undermine the possibility of morality" (69). If we could be sure that good deeds... (shrink)

Examines the key role played by Nietzsche in the undoing of the Hegelian system of totality.

When reading Hegel, as it is a commonplace to observe, one is nearly always struck by an awesome and somehow pregnant ambiguity which no amount of study succeeds in completely dispelling, but which one gradually develops a knack for “interpreting” more or less coherently. Even Hegel’s commentators seem to face this problem: as J. N. Findlay puts it, “one at times [is] only sure that he [Hegel] is saying something immeasurably profound and important, but not exactly what it is.” Accordingly, (...) to read Hegel is necessarily to engage in an exercise of interpretation and, to the extent that “interpretation” is understood as a reasoned but ultimately subjective reduction, writing about Hegel has provoked an unusual number of apologies for providing yet another “reading.”. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 42.2 (2004) 226-227 [Access article in PDF] Will Dudley. Hegel, Nietzsche and Philosophy: Thinking Freedom. New York: Cambridge University Press, 2002. Pp. xvii + 326. Cloth, $60.00. Clear and concise statements are among the virtues of Hegel, Nietzsche and Philosophy: Thinking Freedom, beginning with its title. The book develops an account of human freedom through close attention to Hegel's and Nietzsche's thinking. That (...) account affirms philosophy as a liberating activity that makes freedom ever more "comprehensive" by overcoming external constraints, both actual and theoretical. Hegel takes the project of realizing freedom over from Kant, who had himself advanced it beyond the legacy of "liberalism," and Nietzsche is read here as advancing beyond Hegel's perspective. A very considerable clarification of the structure and content of Hegel's thought about freedom is offered in the first four chapters, and many plausible imputations are made in the second four that illuminate important dimensions of Nietzsche's work. Finally, the role of philosophy as liberating activity is revealed in both "systems," albeit in very different conceptions of what that philosophical activity is like.The greatest strength of the book lies in its erudite and lucid unpacking of Hegel's adamantine thought. Abstract expositions of arguments are often accompanied by helpful examples taken from simple, familiar contexts. Unfortunately, the scope of this review is entirely inadequate to even a summary account of the many dialectics which Dudley reveals [End Page 226] in structural transparency, from the freedom of willing in the Philosophy of Right to freedom beyond willing in absolute Spirit. The body of this book contributes an excellent new commentary on Hegel's conception of freedom, while in his footnotes Dudley offers a rich counterpoint to his own themes in frequently lengthy excurses on much of the relevant literature.However, although Dudley notes at the outset (10-11) that Hegel's and Nietzsche's styles are so different as to require a different style of interpretive treatment, he seems to have forgotten this promise by the time he reaches his discussion of Nietzsche. Instead, Dudley breaks arguments down into their various elements, revealing symmetries to obtain between and among these, in the service of a quasi-dialectical method that sees Nietzsche's thought advance by overcoming its own internal inadequacies. Such a method of analysis seems well suited to Hegel, but it is less persuasive in treating Nietzsche's much more amorphous work, especially as any chronological approach to Nietzsche, which might ground such a developmental claim, is explicitly eschewed. Frequent extended quotation of Nietzsche throughout makes that incongruity of styles particularly strident.Dudley's admittedly Hegelian reading (176) of Nietzsche describes an arc of development in strategies for obtaining freedom: from the enslavement to simple material needs in "disgregation" (a coinage of Werner Hamacher's, apparently, who is cited, but not as the source of this term), through the partial freedom of the moral will, to the self-determined noble will, which itself is aufgehoben by the tragic will. The dynamics of this process are complicated, and laying them out constitutes the lion's share of the analysis. One must forge one's own will, we read, by "giving birth to oneself as a living whole," something accomplished by "integrating the chaos that results from the destruction of the moral will." This feat of "integration" is itself first accomplished by giving oneself "customs" which, however, soon become a new form of unfreedom; what ultimately is needed is "a complementary combination of nobility and modernity, of setting oneself apart from and holding oneself open to the chaotic stimuli beyond one's measure" (177). These are just the barest bones on which Dudley hangs a lot of flesh—not all of which appears natural there. Dudley articulates Nietzsche's ideas in sentences like these: "Recall that the sovereign, noble will is the offspring of the genius of giving birth applied by the individual to herself. Now the transformative destruction of this will results from such a reflexive application of the genius of impregnation; the individual transgresses... (shrink)

The Existentialist Reader is a comprehensive anthology of classic philosophical writings from eight key existentialist thinkers: Sartre, Camus, Heidegger, de Beauvoir, Jaspers, Marcel, Merleau-Ponty, and Ortega y Gasset. These substantial and carefully selected readings consider the distinctive concerns of existentialism: absurdity, anxiety, alienation, death. A comprehensive introduction by Paul S. MacDonald illuminates the existentialist quest for individual freedom and authentic human experience with insight into the historical and intellectual background of these major figures. The Existentialist Reader is a valuable (...) guide to the provocative theories that shook the philosophical world in the 1930s and continue to profoundly shape the way we think about ourselves. (shrink)

This book is the fourth in a series of essay collections on defences in private law. It addresses defences to liability arising in equity. The essays range from those adopting a mainly doctrinal perspective to others that explore the law from a more philosophical perspective. Some essays concentrate on specific defences, while others are concerned with the links between defences, or with how defences relate to the structure of the law of equity generally. One aim of the book is to (...) shed light on equitable doctrines by analysing them through the lens of defences. The essays offer original contributions to this complex, important but neglected field of scholarly investigation. The contributors – judges, practitioners and academics – are all distinguished jurists. The essays are addressed to all of the major common law jurisdictions. (shrink)

Voluntariness of consent to research has not been sufficiently explored through empirical research. The aims of this study were to develop a more comprehensive approach to assessing voluntariness and to generate preliminary data on the extent and correlates of limitations on voluntariness. We developed a questionnaire to evaluate subjects’ reported motivations and constraints on voluntariness. 88 subjects in five different areas of clinical research—substance abuse, cancer, HIV, interventional cardiology, and depression—were assessed. Subjects reported a variety of motivations for participation. Offers (...) of financial incentives were common but not influential, pressures from others were rare, and no threats were reported. However, certain financial incentives and—paradoxically—altruistic motivations led some subjects to feel more constrained. Consistent with previous studies, no one pattern of motivation was common to all research subjects. There was little evidence of constrained voluntariness, but some suggestion of areas of concern. Voluntariness appears to be susceptible to systematic empirical investigation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ought We to Require Emotional Capacity as Part of Decisional Competence?Paul S. Appelbaum* (bio)AbstractThe preceding commentary by Louis Charland suggests that traditional cognitive views of decision-making competence err in not taking into account patients’ emotional capacities. Examined closely, however, Charland’s argument fails to escape the cognitive bias that he condemns. However, there may be stronger arguments for broadening the focus of competence assessment to include emotional capacities, centering (...) on the ways in which emotions aid humans in processing information. Before emotional capacities are added to the list of functions essential for decisional competence, though, the feasibility and utility of such a reorientation must be demonstrated.To what extent ought persons’ capacities to experience emotion be taken into account when determining whether they should be deemed competent to make their own decisions? In the previous article, Louis Charland (1998) argues that traditional models of decision-making competence—of which the MacArthur Competence Treatment Study is a typical example—are mistaken in focusing narrowly on persons’ cognitive abilities to the neglect of emotional factors. In contrast, he suggests, constructs of competence ought explicitly to require a capacity to experience emotions, which he believes is central to meaningful decision making, before deeming persons competent.Charland, as he acknowledges, is not the first to suggest that the presence of some degree of emotional capacity is a necessary element of competence, but his argument is among the most elaborate to date and is certainly worth closer examination. Looked at carefully, however, Charland’s argument does not make quite the case for the determination of emotional capacity in competence assessment that he claims for it. Indeed, as I demonstrate below, Charland may share the same “pernicious [End Page 377] cognitive bias” that he ascribes to more traditional approaches. However, despite what I identify as the problems in Charland’s argument, others have raised more disturbing questions about the lack of attention to emotional issues in competence assessment. Thus, I am not ready to reject entirely the possibility that determinations of decisional competence ought to consider emotional factors. I conclude by outlining the questions that remain to be answered to identify more clearly the potential benefits of such an approach.The Construct of Decision-Making CompetenceSome preliminary comments about the nature of the dominant construct of decision-making competence may provide a useful frame for my response to Charland’s paper. Contemporary ideas of competence are tied inextricably to the ideal of self-determination in modern Western societies. Such societies are committed to respect for individual choice, both as a good in its own right and on the grounds that each person knows best what choices will maximize his or her own welfare. In general, therefore, states will not intervene to prevent persons from acting on their decisions, even when the choices they make—like the decision to smoke or to refuse potentially life-saving medical care—may objectively be thought to be detrimental to them.In some cases, however, the presumption that people will act in their own interests, as well as the notion that there is something intrinsically valuable in respecting their choices, fails (Buchanan and Brock 1989). When people’s minds are so disordered that they cannot be said to be making meaningful choices, other values come into play. Such people are called “incompetent.” When persons reach that point, the state’s interest in protecting its citizens becomes primary and someone else must make decisions on their behalf. Note that the size of this group must be sharply limited, lest a liberal society’s commitment to self-determination be undermined: There is no more profound infringement of the rights of citizens than the determination that they are incompetent. Thus, the criteria for incompetence must be selected in a deliberately narrow fashion—alternately, one might say that the standards for competence are made intentionally broad—so that all but a tiny percentage of citizens will be permitted to make decisions on their own.In the Anglo-American world, the process of formulating criteria of competence by and large has been left to the common law courts. Over the course of centuries they have identified the capacities that are, in... (shrink)

Volume 19, Issue 5, May 2019, Page 22-24.

(2002). Clarifying the Ethics of Clinical Research: A Path toward Avoiding the Therapeutic Misconception. The American Journal of Bioethics: Vol. 2, No. 2, pp. 22-23.

Genomic research—including whole genome sequencing and whole exome sequencing—has a growing presence in contemporary biomedical investigation. The capacity of sequencing techniques to generate results that go beyond the primary aims of the research—historically referred to as “incidental findings”—has generated considerable discussion as to how this information should be handled—that is, whether incidental results should be returned, and if so, which ones.Federal regulations governing most human subjects research in the United States require the disclosure of “the procedures to be followed” in (...) the research as part of the informed consent process. It seems reasonable to assume—and indeed, many commentators have concluded—that genomic investigators will be expected to inform participants about, among other procedures, the prospect that incidental findings will become available and the mechanisms for dealing with them. Investigators, most of whom will not have dealt with these issues before, will face considerable challenges in framing meaningful disclosures for research participants.To help in this task, we undertook to identify the elements that should be included in the informed consent process related to incidental findings. We did this by surveying a large number of genomic researchers (n = 241) and by conducting in‐depth interviews with a smaller number of researchers (n = 28) and genomic research participants (n = 20). Based on these findings, it seems clear to us that routine approaches to informed consent are not likely to be effective in genomic research in which the prospect of incidental findings exists. Ensuring that participants’ decisions are informed and meaningful will require innovative approaches to dealing with the consent issue. We have identified four prototypical models of a consent process for return of incidental findings. (shrink)

: Responding to the paper by Miller and Joffe, we review the development of the concept of therapeutic misconception (TM). Our concerns about TM's impact on informed consent do not derive from the belief that research subjects have poorer outcomes than persons receiving ordinary clinical care. Rather, we believe that subjects with TM cannot give an adequate informed consent to research participation, which harms their dignitary interests and their abilities to make meaningful decisions. Ironically, Miller and Joffe's approach ends up (...) largely embracing the very position that they inaccurately attribute to us: the belief that, with some exceptions, it is only the prospect of poorer outcomes that should motivate efforts to dispel TM. In the absence of empirical studies on the steps required to dispel TM and the impact of such procedures on subject recruitment, it is premature to surrender to the belief that TM must be widely tolerated in clinical research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Examining the Ethics of Human Subjects ResearchPaul S. Appelbaum (bio)The work of the Advisory Committee on Human Radiation Experiments confirms once again the value of combining empirical and normative approaches to problems in clinical and research ethics. The Committee, like its predecessor, the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, spent relatively modest sums of money gathering targeted data to inform (...) its deliberations. The results of the Committee’s research, which are discussed by Nancy Kass and Jeremy Sugarman in this issue of the Kennedy Institute of Ethics Journal, enhance our understanding of the current ethical status of human subjects research, helping to focus attention on areas of particular concern, and lay the basis for future research and policy development.My comments here focus on the two major empirical studies conducted by the Committee—the Research Proposal Review Project and the Subject Interview Study. I will underscore just a few of the primary findings from these studies, consider their limitations, and explore their implications. Readers interested in the details of the studies should consult the Committee’s Final Report (ACHRE 1995), on which I rely in part and which provides additional information on the methodology and findings of the studies.Research Proposal Review ProjectWhat can be learned from the Committee’s review of 125 federally-funded human research studies? In answering that question, one cannot ignore the irony inherent in the Committee’s decision to review documents related to institutional review board (IRB) consideration of the selected protocols. The single most frequent complaint about the current system for protecting human subjects is that IRBs focus almost exclusively on review of consent forms and other research documents, as if they bore some close relationship to what actually transpires between investigators and potential research subjects. Only a small number of studies examine the research consent process. Nevertheless, existing data strongly [End Page 283] suggest that subject recruitment often involves an extended process of courtship, during which the information contained in consent forms is only a small part of the information passed between investigators and subjects (Benson, Roth, and Winslade 1985; Lidz et al. 1984).Indeed, the second of the Committee’s studies—the Subject Interview Study, which is discussed below—appears to confirm these findings. In-depth interviews with 99 individuals who reported that they were former or current research subjects suggest that “[f]or many, the decision to participate seemed to have been made before the consent form was given to them, and they signed it almost as a formality” (ACHRE 1995 [GPO, p. 742; Oxford, p. 471]). 1 Why, then, did the Committee focus its attention on documents that in many cases seem to play only a tangential role in the consent process? As is the case with IRBs around the country, the answer appears to be that consent forms and related documents are the only easily available window on consent transactions. In addition, under the current system, consent forms constitute the part of the process that IRBs can influence most easily. Consequently, it suits almost everyone’s needs—except perhaps those of the research subjects—to pretend that they reflect what actually transpires in the recruitment process. To the Committee’s credit, it was well aware of this dilemma. Nonetheless, it struggled to wring valid lessons from these limited data in its Final Report.Perhaps the most interesting finding from the Research Proposal Review Project is just how poor so many consent forms are. Given the disproportionate emphasis that many IRBs place on the content of the forms, one would expect that investigators by now would have learned to design documents that meet objective standards of adequacy, such as those applied by the Committee. Indeed, except in the most unusual circumstances, doing so would virtually guarantee that the IRB will ask no further questions about subject recruitment procedures. Although the data justify the inference that many investigators do not yet understand which information is essential to communicate to potential subjects, nor have learned how to do so effectively, they also force us to a still more radical conclusion. If the IRBs were doing their jobs, the Committee... (shrink)

This book is an inquiry into the motivation for altruistic behavior. It uncovers the condition that prompts or sometimes even compels us to act intentionally for the benefit of others. This condition, the pre-reflective experience of another person as a self-conscious individual just like oneself, finds its origin in the very structure of the mind. The essay is a synthesis of evidence from neuroscience, phenomenology, Eastern philosophy, analytic philosophy of mind, and cognitive psychology. Hence, it is an excellent example of (...) work in applied cognitive science. The book includes a critique of the several main approaches to the explanation of the motivation for altruistic behavior: biological, psychological, and philosophical. The path of the main inquiry produces several innovative proposals in the philosophy of mind in addition to the main conclusion. Included in these are a detailed account of the structure of the human mind, an ontological categorization of mental states, a naturalistic explanation of so-called mystical states, a proposal for the role of consciousness in the downward causation of physical events, a new interpretation of the Buddhist doctrine of no-self and a unique view of the nature of love. (shrink)

Liberal societies are built on a foundation of personal rights, including the right to make decisions about the medical treatment that one will receive or decline to receive. So essential to the liberal project is the power of individual choice that it will be abrogated only in the most extreme situations, in which persons seem to be unable to make rational decisions and thereby to protect their interests. A small number of decision-related abilities have been identified as relevant to the (...) determination of when a person will be deemed decisionally incapable: understanding, appreciation, reasoning, and choice. It would seem prudent to tinker with these standards cautiously—if at all.... (shrink)

Some years ago I received a phone call telling me that my mother, then in her eighties, had been found wandering the street outside her home. It was the first indication my wife and I had of Alzheimer's disease. We arrived to discover that my mother was incoherent, with the house in disorder, bills unpaid, and perishable food in the night table rather than the refrigerator. Having spent much of my career trying to improve the assessment of decisional capacity, in (...) part to avoid unnecessary deprivation of decision-making rights, I did not take lightly the step to have my mother declared incompetent. But it was necessary. This episode has been on my mind since I returned recently from a conference in Paris devoted to the United Nations Convention on the Rights of Persons with Disabilities. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 17-18, August 2011.

Reply to a commentary by Felicitas Holzer and Ignacio Mastroleoon “Models of Consent to Return of Incidental Findings in Genomic Research.”.

The ‘universal cell reaction’ (UCR), a coordinated biphasic response to external (noxious and other) stimuli observed in all living cells, was described by Nasonov and his colleagues in the mid‐20th century. This work has received no attention from cell biologists in the West, but the UCR merits serious consideration. Although it is non‐specific, it is likely to be underpinned by precise mechanisms and, if these mechanisms were characterized and their relationship to the UCR elucidated, then our understanding of the integration (...) of cellular function could be improved. As a step towards identifying such mechanisms, I review some recent advances in understanding cell mechanics and the stress response and I suggest potentially testable hypotheses. There is a particular need for time‐course studies of cellular responses to different stimulus doses or intensities. I also suggest a correspondence with hormesis; re‐investigation of the UCR using modern biophysical and molecular‐biological techniques might throw light on this much‐discussed phenomenon. BioEssays 29:324–333, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

In their article, Pickering, Newton-Howes, and Young argue that “a person who is considering or has already made a decision which appears seriously harmful to that person should in some case...