Pragmatism is a distinctive approach to clinical research ethics that can guide bioethicists and members of institutional review boards (IRBs) as they struggle to balance the competing values of promoting medical research and protecting human subjects participating in it. After defining our understanding of pragmatism in the setting of clinical research ethics, we show how a pragmatic approach can provide guidance not only for the day-to-day functioning of the IRB, but also for evaluation of policy standards, such as the one (...) that addresses acceptable risks for healthy children in clinical research trials. We also show how pragmatic considerations might influence the debate about the use of deception in clinical research. Finally, we show how a pragmatic approach, by regarding the promotion of human research and the protection of human subjects as equally important values, helps to break down the false dichotomy between science and ethics in clinical research. (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)

We are grateful to Jongsma et al 1 for their interest in our article analysing the case of ‘Mrs A’, a Dutch woman with Alzheimer’s disease who received euthanasia based on her advance euthanasia directive.2 Their commentary criticises two elements of our analysis. First, the authors believe our reasons for doubting that Mrs A had the capacity to write and revise an AED rely on ‘partial’ empirical data and rest on normative errors. Second, they use two of our statements to (...) suggest we must endorse some implausible claims, for example, that ‘… in all situations and for all people, current well-being should always take precedence over all other values’. Jongsma et al assert: ‘Miller et al argue that people with dementia are impaired to make decisions.’ This casts our probabilistic claim about Mrs A’s capacity as an absolute claim about persons with dementia in general. It also implies we are using an outdated diagnosis-based view of capacity. The accusation then becomes explicit : > … several empirical studies have shown that patients with dementia are able to actively participate in qualitative studies and can respond to open questions in a meaningful way,[2-8] as well that they are able to complete an advance directive in the early phases of dementia.[9, 10] One can therefore not simply conclude on the basis of the diagnosis of dementia …. (shrink)

The analysis of interacting relativistic many-particle systems provides a theoretical basis for further work in many diverse fields of physics. After a discussion of the nonrelativisticN-particle systems we describe two approaches for obtaining the canonical equations of the corresponding relativistic forms. A further aspect of our approach is the consideration of the constants of the motion.

Recent magnetic resonance imaging and pathological studies have indicated that axonal loss is a major contributor to disease progression in multiple sclerosis. 1 H magnetic resonance spectroscopy, through measurement of N -acetyl aspartate, a neuronal marker, provides a unique tool to investigate this. Patients with primary progressive multiple sclerosis have few lesions on conventional MRI, suggesting that changes in normal appearing white matter, such as axonal loss, may be particularly relevant to disease progression in this group. To test this hypothesis (...) NAWM was studied with MRS, measuring the concentration of N -acetyl derived groups. Single-voxel MRS using a water-suppressed PRESS sequence was carried out in 24 patients with primary progressive multiple sclerosis and in 16 age-matched controls. Ratios of metabolite to creatine concentration were calculated in all subjects, and absolute concentrations were measured in 18 patients and all controls. NA/Cr was significantly lower in NAWM in patients than in controls, as was the absolute concentration of NA. There was no significant difference in the absolute concentration of creatine between the groups. This study supports the hypothesis that axonal loss occurs in NAWM in primary progressive multiple sclerosis and may well be a mechanism for disease progression in this group. (shrink)

Despite the supreme political and economic significance of boundaries--and ongoing challenges to existing national boundaries--scant attention has been paid to their ethics. This volume explores how diverse ethical traditions understand the political and property rights reflected in territorial and jurisdictional boundaries. It is the first book to bring together thinkers from a range of traditions, both religious and secular, to discuss the ethics of boundaries. Each contributor represents a tradition's views on questions surrounding the use of boundaries to delimit property (...) and political rights. What does it mean to own something? What resources should not be privately owned? What justifies the erection of political boundaries between one people and another? How ''hard'' should such boundaries be? What rights extend to minorities within a state? Should territorial boundaries coincide with social ones? Does national autonomy have an ethical basis, or is it an aspect of modern power politics? Should we aim for a more inclusive community than that afforded by modern nation-states? Cross-chapter dialogue and a substantive conclusion draw out similarities and differences among the traditions represented, traditions that include Christianity, classical liberalism, Confucianism, international law, Islam, Judaism, liberal egalitarianism, and natural law. In addition to the editors, the contributors are Nigel Biggar, Joseph Boyle, Joseph Chan, Russell Hardin, Will Kymlicka, Loren Lomasky, Robert McCorquodale, Richard B. Miller, David Novak, Sulayman Nyang, Michael Nylan, Raul C. Pangalangan, Daniel Philpott, Jeremy Rabkin, Hillel Steiner, M. Raquibuz Zaman, and Noam J. Zohar. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

We argue that for theorists with a post-institutional conception of property, e.g., Rawlsians, there is no principled reason to limit the domain of distributive justice to tax and transfer-both tax policy and the rules of the private law are constructed in service to distributive aims. Such theorists cannot maintain a commitment to a normative conception of private law independent of their overarching distributive principles. In contrast, theorists with a pre-institutional conception of property can derive the private law from sectors of (...) morality independent of distributive justice. Nevertheless, we argue, this does not entail that the private law, for pre-institutional theorists, must be sanitized of equity-oriented values. Non-libertarian pre-institutional theorists holding principled commitments to equity-oriented values are free to invoke either tax and transfer or the rules of the private law to attain them. Footnotesa We are grateful to John G. Bennett, Harry Dolan, Edward McCaffery, and Ellen Frankel Paul for written comments on a previous draft and to Eric Mack, Fred Miller, Jeffrey Paul, A. John Simmons, and the other contributors to this volume for valuable discussions. (shrink)

The classical utilitarian legacy of Jeremy Bentham, J. S. Mill, James Mill, and Henry Sidgwick has often been charged with both theoretical and practical complicity in the growth of British imperialism and the emerging racialist discourse of the nineteenth century. But there has been little scholarly work devoted to bringing together the conflicting interpretive perspectives on this legacy and its complex evolution with respect to orientalism and imperialism. This volume, with contributions by leading scholars in the field, represents the first (...) attempt to survey the full range of current scholarly controversy on how the classical utilitarians conceived of 'race' and the part it played in their ethical and political programs, particularly with respect to such issues as slavery and the governance of India. The book both advances our understanding of the history of utilitarianism and imperialism and promotes the scholarly debate, clarifying the major points at issue between those sympathetic to the utilitarian legacy and those critical of it. (shrink)

Authorising euthanasia and assisted suicide with advance euthanasia directives is permitted, yet debated, in the Netherlands. We focus on a recent controversial case in which a Dutch woman with Alzheimer’s disease was euthanised based on her AED. A Dutch euthanasia review committee found that the physician performing the euthanasia failed to follow due care requirements for euthanasia and assisted suicide. This case is notable because it is the first case to trigger a criminal investigation since the 2002 Dutch euthanasia law (...) was enacted. Thus far, only brief descriptions of the case have been reported in English language journals and media. We provide a detailed description of the case, review the main challenges of preparing and applying AEDs for persons with dementia and briefly assess the adequacy of the current oversight system governing AEDs. (shrink)

The use of upper limb vibration during exercise and rehabilitation continues to gain popularity as a modality to improve function and performance. Currently, a lack of knowledge of the pathways being altered during ULV limits its effective implementation. Therefore, the aim of this study was to investigate whether indirect ULV modulates transmission along spinal and corticospinal pathways that control the human forearm. All measures were assessed under CONTROL and ULV conditions while participants maintained a small contraction of the right flexor (...) carpi radialis muscle. To assess spinal pathways, Hoffmann reflexes elicited by stimulation of the median nerve were recorded from FCR with motor response amplitudes matched between conditions. An H-reflex conditioning paradigm was also used to assess changes in presynaptic inhibition by stimulating the superficial radial nerve 37 ms prior to median nerve stimulation. Cutaneous reflexes in FCR elicited by stimulation of the SR nerve at the wrist were also recorded. To assess corticospinal pathways, motor evoked potentials elicited by transcranial magnetic stimulation of the contralateral motor cortex were recorded from the right FCR and biceps brachii. ULV significantly reduced H-reflex amplitude by 15.7% for both conditioned and unconditioned reflexes. Therefore, ULV inhibits cutaneous and H-reflex transmission without influencing corticospinal excitability of the forearm flexors suggesting increased presynaptic inhibition of afferent transmission as a likely mechanism. A general increase in inhibition of spinal pathways with ULV may have important implications for improving rehabilitation for individuals with spasticity. (shrink)

What determines whether an action is right or wrong? Morality, Rules, and Consequences: A Critical Reader explores for students and researchers the relationship between consequentialist theory and moral rules. Most of the chapters focus on rule consequentialism or on the distinction between act and rule versions of consequentialism. Contributors, among them the leading philosophers in the discipline, suggest ways of assessing whether rule consequentialism could be a satisfactory moral theory. These essays, all of which are previously unpublished, provide students in (...) moral philosophy with essential material and ask key questions on just what the criteria for an adequate moral theory might be. (shrink)

"The subject of this book is an extremely important one. The treatments are good, and the whole is considerably more than its parts. I strongly recommend it.

Too many patients are injured in the course of care. Clinicians may mistakenly cause new harm to a patient or fail to take established steps to improve the presenting condition. Medical institutions within which they work may lack mechanisms to reduce errors or prevent them from harming patients. Many, perhaps even most, injuries are preventable, probably numbering in the hundreds of thousands a year for hospital care alone. Long ignored by medical practitioners and health-care payers and little appreciated by the (...) public, the problem of medical injury is finally receiving high-level policy attention. Much credit goes to the Institute of Medicine for its landmark report of November 1999, which marshaled the evidence about medical injuries and highlighted new approaches to systematic improvement of safety within systems of care. (shrink)

Too many patients are injured in the course of care. Clinicians may mistakenly cause new harm to a patient or fail to take established steps to improve the presenting condition. Medical institutions within which they work may lack mechanisms to reduce errors or prevent them from harming patients. Many, perhaps even most, injuries are preventable, probably numbering in the hundreds of thousands a year for hospital care alone. Long ignored by medical practitioners and health-care payers and little appreciated by the (...) public, the problem of medical injury is finally receiving high-level policy attention. Much credit goes to the Institute of Medicine for its landmark report of November 1999, which marshaled the evidence about medical injuries and highlighted new approaches to systematic improvement of safety within systems of care. (shrink)

Despite the burgeoning literature on professionalism in other health professions, psychology lags behind in the level of attention given to this core competency. In this article, we review definitions from other health professions and how they address professionalism. Next, we review how this competency evolved within health service psychology (HSP), and we propose a definition. We offer an approach for assessing professionalism within HSP. Consideration is given to strategies and methods for providing effective education and training in this multifaceted competency. (...) Finally, recommendations are made for creating a culture of professionalism within HSP and honoring psychology’s social contract with multiple publics. (shrink)

BackgroundResearchers worry that patients in early-phase research experience unrealistic optimism about benefits and risks of participation. The standard measure of unrealistic optimism is the Comparative Risk/Benefit Assessment questionnaire, which asks people to estimate their chances of an outcome relative to others in similar situations. Such a comparative framework may not be a natural way for research participants to think about their chances.ObjectiveTo examine how people interpret questions measuring unrealistic optimism and how their interpretations are associated with their responses.MethodsUsing an early-phase (...) cancer trial vignette, we administered the CRBA to 297 adults from the general public. They estimated their comparative chances of risk and benefit, then provided rationales for their estimates.ResultsFor both CRBA benefit and risk questions, about 50% of respondents chose 0, and 50% chose a non-0 response. Respondents’ rationales for their estimates showed that overall only about 40%–44% gave comparative rationales, indicating that they interpreted the CRBA as intended. 68.7% of respondents who gave the ‘correct’ 0 rating gave comparative rationales, whereas only 11.6% of respondents who gave non-0 ratings did so. A similar trend was seen for chances of risk.ConclusionResearch participants may not understand comparative benefit and risk questions as intended; attributions of unrealistic optimism may require additional evidence that the respondents’ estimates are intended to be comparative. (shrink)

Late in 1990, the Center for the Study of Ethics in the Professions at Illinois Institute of Technology (lIT) received a grant of more than $200,000 from the National Science Foundation to try a campus-wide approach to integrating professional ethics into its technical curriculum.! Enough has now been accomplished to draw some tentative conclusions. I am the grant's principal investigator. In this paper, I shall describe what we at lIT did, what we learned, and what others, especially philosophers, can learn (...) from us. We set out to develop an approach that others could profitably adopt. I believe that we succeeded. (shrink)

A letter to the editor from Howard Brody, David Buchanan, and Franklin G. Miller in response to the recent article by Erik Malmqvist Understanding Exploitation," March-April 2011).

RAID-II is a high-bandwidth, network-attached storage server designed and implemented at the University of California at Berkeley. In this paper, we measure the performance of RAID-II and evaluate various architectural decisions made during the design process. We first measure the end-to-end performance of the system to be approximately 20 MB/s for both disk array reads and writes. We then perform a bottleneck analysis by examining the performance of each individual subsystem and conclude that the disk subsystem limits performance. By adding (...) a custom interconnect board with a high-speed memory and bus system and parity engine, we are able to achieve a performance speedup of 8 to 15 over a comparative system using only off-the-shelf hardware. (shrink)

The burden of this theorem, stated informally, is that when a hypothesis h is maximally independent of the evidence — that is, it goes wholly beyond the evidence —, then the probability p(h, e) increases when the evidence e is weakened; and hence, the weaker is the evidence, the greater is the probabilistic support.

In his epistemological system Mead begins with that which the chief philosophers rejected, the novel or exceptional, and makes it central. It is central in a respect which should be carefully explained. The novel or emergent is that with reference to which a present is defined, and a present is the seat of reality. In saying this Mead does not mean that “the past” and “the future” are meaningless terms. Nor does he reduce them to a present. Rather he holds (...) that neither the past nor the future exists. In fact, they are meaningful only in relation to a present and the various pasts and futures referred to in our statement of causal conditions and predictions belong to a present, which is their seat. Mead escapes the metaphysical problem as to whether the past or the future has some sort of being even now. Certainly in so far as he has a metaphysics at all it derives from his epistemology which is primary and represents a pioneering attempt to develop a theory of knowledge answering to experimental science. Consciously or unconsciously most contemporary scientists are still under the influence of bygone epistemological and metaphysical doctrines in their explicit statements of what constitutes reality and knowing. Yet in so far as they are successful in practice obviously they are free from the blind alleys and dead ends which these older theories lead to logically. However no one, not even the philosopher, has been able to formulate a consistent set of epistemological principles from which experimental scientific procedure follows logically. One thing, Mead contends, has been wholly neglected. It is the emergent. (shrink)

In a recent issue of Philosophy of Science Merrit H. Moore contends that it is not only possible but methodologically desirable to separate design in nature from purpose. The main part of his argument is devoted to a support of the proposition that “design” is objective, by which he means that design in the physical world is independent of mind. That which gives interest to Mr. Moore's argument is essentially the Kantian doctrine that the forms of the understanding, and consequently (...) of knowledge, are furnished by the mind and are, in a sense, imposed upon sense-experience thereby making them rational. In contrast to the Kantian view stands the Humean doctrine that knowledge is analyzable into and limited by sense-impressions. (shrink)

Saint Thomas More’s _Utopia_ is one of the most important works of European humanism and serves as a key text in survey courses on Western intellectual history, the Renaissance, political theory, and many other subjects. Preeminent More scholar Clarence H. Miller does justice to the full range of More’s rhetoric in this masterful translation. In a new afterword to this edition, Jerry Harp contextualizes More’s life and _Utopia_ within the wider frames of European humanism and the Renaissance. “Clarence H. (...) Miller’s fine translation tracks the supple variations of More’s Latin with unmatched precision, and his Introduction and notes are masterly. Jerry Harp’s new Afterword adroitly places More’s wonderful little book into its broader contexts in intellectual history.”—George M. Logan, author of _The Meaning of More’s “Utopia”_ “Sir Thomas More's _Utopia_ is not merely one of the foundational texts of western culture, but also a book whose most fundamental concerns are as urgent now as they were in 1516 when it was written. Clarence H. Miller's wonderful translation of More's classic is now happily once again available to readers. This is the English edition that best captures the tone and texture of More's original Latin, and its notes and introduction, along with the lively afterward by Jerry Harp, graciously supply exactly the kinds of help a modern reader might desire.”—David Scott Kastan, Yale University. (shrink)

In this paper we set out to explore the claims that corporate social responsibility (CSR) itself is little more than a complementary extension of the project of coloniality initiated by the Enlightenment (e.g. Banerjee 2019). We will not dispute that claim. Rather we will develop three points. First, we will apply a non-linear, systems approach to demonstrate how we all, of any color, ethnic origin or historical location are all part of an interconnected interrelated sets of systems—what some thinkers call (...) a complex adaptive system or systems (e.g., Miller and Page 2007) so that dismissing or degrading any particular ethnic, gender, or racial group is dismissing part of our history and origin. Secondly, we will argue that Enlightenment, coloniality, as well as neo-coloniality, and decoloniality sprung up from the Enlightenment projects themselves. Thus, the very critiques of Enlightenment, accurate as they may be, evolved from that perspective and have to be taken into account even in those critiques. Third, what appears to be an “either-or” – that is, that commerce should stick to business and not engage in political activities (forms of neocolonialism) or accept these business-political activities despite critiques – is not a simple choice. Rather, conceding that commerce and political systems cannot be nicely separated, we will provide some principles or ways to evaluate these activities, seemingly ubiquitous particularly in emerging economies. (shrink)

This is the first sustained, whole-Bible treatment on the theme of meeting God face to face. Starting with Genesis and ending with Revelation, the author systematically covers the major events in salvation history, all of which reveal the beauty of encountering God's grace in abundance.

Renaissance and Baroque, two terms unknown in the ages they describe, are now an integral part of the general public's cultural vocabulary. The first encompasses European civilization from the mid-fifteenth century to around 1550, and the second refers to developments in the seventeenth century, with the intervening fifty years forming a period of transition termed Mannerism. Beginning with the appearance of Heinrich Wölfflin's Kunst geschichtliche Grundbegriffe in 1915, these two great epochs of intellectual development have been described quite successfully by (...) juxtaposing the one with the other. Wölfffin, for example, saw five great categories of discrimination between the two, namely Linear and Painterly, Plane and Recession, Closed and Open Form (Tectonic and A-tectonic Form), Multiplicity and Unity (Multiple Unity and Unified Unity), and Clearness and Unclearness (Absolute and Relative Clearness). More recently, Wylie Sypher in Four Stages of Renaissance Style has extended the list with the polar characteristics of Cyclic-Broken (Cyclothym-Schizothym), Exact-Abstract (Representational-Nonrepresentational), Visual-Haptic, Nearseeing-Farseeing, Dark-Light, Horizontal/Vertical-Oblique/Spiraling, and Points/Lines-Planes/Volumes. (shrink)