This paper sketches an account of public health ethics drawing upon established scholarship in feminist ethics. Health inequities are one of the central problems in public health ethics; a feminist approach leads us to examine not only the connections between gender, disadvantage, and health, but also the distribution of power in the processes of public health, from policy making through to programme delivery. The complexity of public health demands investigation using multiple perspectives and an attention to detail that is capable (...) of identifying the health issues that are important to women, and investigating ways to address these issues. Finally, a feminist account of public health ethics embraces rather than avoids the inescapable political dimensions of public health. (shrink)

In this paper I argue that it is morally important for doctors to trust patients. Doctors' trust of patients lays the foundation for medical relationships which support the exercise of patient autonomy, and which lead to an enriched understanding of patients' interests. Despite the moral and practical desirability of trust, distrust may occur for reasons relating to the nature of medicine, and the social and cultural context within which medical care is provided. Whilst it may not be possible to trust (...) at will, the conscious adoption of a trusting stance is both possible and warranted as the burdens of misplaced trust fall more heavily upon patients than doctors. (shrink)

This article examines the implicit promises of fairness in evidence based medicine , namely to avoid discrimination through objective processes, and to distribute effective treatments fairly. The relationship between EBM and vulnerable groups is examined. Several aspects of EBM are explored: the way evidence is created , and the way evidence is applied in clinical care and health policy. This analysis suggests that EBM turns our attention away from social and cultural factors that influence health and focuses on a narrow (...) biomedical and individualistic model of health. Those with the greatest burden of ill health are left disenfranchised, as there is little research that is relevant to them, there is poor access to treatments, and attention is diverted away from activities that might have a much greater impact on their health. (shrink)

In this paper we consider the use of cases in medical ethics research and teaching. To date, there has been little discussion about the consent or confidentiality requirements that ought to govern the use of cases in these areas. This is in marked contrast to the requirements for consent to publish cases in clinical journals, or to use personal information in research. There are a number of reasons why it might be difficult to obtain consent to use cases in ethics. (...) Many cases concern people who are incompetent, and thus unable to give consent. Often the material is of a sensitive nature, it is not clear who should give consent, or the ethicist has no access to those involved. We argue that the use of cases in ethics research and teaching can be justified by appeal to the public interest argument, and suggest a number of areas for discussion and clarification. (shrink)

OBJECTIVES: To study and report the attitudes of patients and general practitioners (GPs) concerning the obligation of doctors to act for the good of their patients, and to provide a practical account of beneficence in general practice. DESIGN: Semi-structured interviews administered to GPs and patients. SETTING AND SAMPLE: Participants randomly recruited from an age and gender stratified list of GPs in a geographically defined region of South Australia. The sample comprised twenty-one general practitioners and seventeen patients recruited by participating GPs. (...) RESULTS: In practice, acting for the good of the patient not only accommodates the views of patients and GPs on expertise and knowing best, but also responds to the particular details of the clinical situation. Patients had a complex understanding of the expertise necessary for medical practice, describing a contextual domain in which they were expert, and which complemented the scientific expertise of their GPs. General practitioners identified multiple sources for their expertise, of which experience was the most significant. The role of the GP included responding to individual patients and particular clinical problems and ranged from the assumption of responsibility through to the proffering of medical advice. CONCLUSION: This study found that GPs acting for the good of their patients covered a variety of GP actions and patient preferences. Beneficence was not justified by presumed patient vulnerability or the inability of patients to understand medical problems, but furthered through a recognition of the different areas of expertise contributed by both parties to the consultation. (shrink)

Community-based healthcare organisations manage competing, and often conflicting, priorities. These conflicts can arise from the multiple roles these organisations take up, and from the diverse range of stakeholders to whom they must be responsive. Often such conflicts may be titled conflicts of interest; however, what precisely constitutes such conflicts and what should be done about them is not always clear. Clarity about the duties owed by organisations and the roles they assume can help identify and manage some of these conflicts. (...) Taking divisions of general practice in Australia as an example, this paper sets out to distinguish two main types of conflicts of interest, so that they may be more clearly identified and more effectively managed. (shrink)

This book addresses the problem of how to make democratically-legitimate public policy on issues of contentious bioethical debate. It focuses on ethical contests about research and their legitimate resolution, while addressing questions of political legitimacy. How should states make public policy on issues where there is ethical disagreement, not only about appropriate outcomes, but even what values are at stake? What constitutes justified, democratic policy in such conflicted domains? Case studies from Canada and Australia demonstrate that two countries sharing historical (...) and institutional characteristics can reach different policy responses. This book is of interest to policymakers, bioethicists, and philosophers, and will deepen our understanding of the interactions between large-scale socio-political forces and detailed policy problems in bioethics. (shrink)

Although a central construct for sociologists, the concept of institution continues to elude clear and full specification. One reason for this lack of clarity is that about 50 years ago empirical researchers in the field of sociology turned their gaze downward, away from macro-sociological constructs in order to focus their attention on middle-range empirical projects. It took almost 20 years for the concept of the institution to work its back onto the empirical research agenda of mainstream sociologists. The new institutional (...) project in organizational sociology led the way. Since then, scholars in this tradition have achieved a great deal but there is still much more to accomplish. Here, future directions for research are considered by reviewing how the concept of the institution has come to be treated by mainstream philosophers, sociologists of science and technology studies, and social network theorists. (shrink)

If within the borders of human life the truth is, as Vico has said, what is made, then the task of a student of human life can be and should be to find out from what human beings have made what manner of makers they are and what sorts of production their circumstance allows.

Aesthetics, hermeneutics, criticism -- Social Werktreue and the subjectivization of aesthetics -- From musike to metaphysics -- Formalist aesthetics and musical hermeneutics -- Deconstructing the disciplinary divide -- The question of metaphor -- Mimesis and the hermeneutics of music -- Political critique and the politics of music criticism -- Toward a hermeneutics of music criticism.

In the second edition of this groundbreaking text in non-Western philosophy, sixteen experts introduce some of the great philosophical traditions in the world. The essays unveil exciting, sophisticated philosophical traditions that are too often neglected in the western world. The contributors include the leading scholars in their fields, but they write for students coming to these concepts for the first time. Building on revisions and updates to the original, this new edition also considers three philosophical traditions for the first time—Jewish, (...) Buddhist, and South Pacific philosophy. (shrink)

In the past few years in the Netherlands and other multi-ethnic democratic states we hear sharp political and intellectual criticism on the philosophical idea of a ‘multicultural society’. In this article, the author questions the criticism of several liberal and conservative political philosophers, who in their approach give attention to the genealogy of multiculturalism. While a liberal as Brian Barry sees multiculturalism as a regression, the conservative Roger Scruton on the other hand considers this political and intellectual phenomenon as a (...) bridge too far, a symptom of the disintegration of the modern nation. The author argues that these criticisms are forcing us to abandon a form of multiculturalism that considers ‘toleration’ as the highest principle. The ‘toleration-multiculturalist’ gets entangled in inconsistencies and moral paradoxes, as soon as he wants to determine his position towards intolerant and immodest variations of the Volksgeist, the cultural homogeneity and identity. The underlying problem in the discussion among liberals, conservatives and multiculturalists is the ontological vulnerability of cultures. This vulnerability has to do with the fact that cultures, traditions and identities are dependant on the constructive work of autonomous interpreters. Therefore a permanent dialogue with the past is necessary. While nationalists and multiculturalists are inclined to eliminate this vulnerability by fixating and immunizing the cultural and national identity, the liberals are neutralizing the cultural loyalties of people through the privatisation of identities. In contrast to these positions the author pleads for a form of democracy in which the rituals of democracy mediate the permanent dissensus about the meaning of nevertheless being a national community. (shrink)

In the past few years in the Netherlands and other multi-ethnic democratic states we hear sharp political and intellectual criticism on the philosophical idea of a ‘multicultural society’. In this article, the author questions the criticism of several liberal and conservative political philosophers, who in their approach give attention to the genealogy of multiculturalism. While a liberal as Brian Barry sees multiculturalism as a regression, the conservative Roger Scruton on the other hand considers this political and intellectual phenomenon as a (...) bridge too far, a symptom of the disintegration of the modern nation. The author argues that these criticisms are forcing us to abandon a form of multiculturalism that considers ‘toleration’ as the highest principle. The ‘toleration-multiculturalist’ gets entangled in inconsistencies and moral paradoxes, as soon as he wants to determine his position towards intolerant and immodest variations of the Volksgeist, the cultural homogeneity and identity. The underlying problem in the discussion among liberals, conservatives and multiculturalists is the ontological vulnerability of cultures. This vulnerability has to do with the fact that cultures, traditions and identities are dependant on the constructive work of autonomous interpreters. Therefore a permanent dialogue with the past is necessary. While nationalists and multiculturalists are inclined to eliminate this vulnerability by fixating and immunizing the cultural and national identity, the liberals are neutralizing the cultural loyalties of people through the privatisation of identities. In contrast to these positions the author pleads for a form of democracy in which the rituals of democracy mediate the permanent dissensus about the meaning of nevertheless being a national community. (shrink)

Context Professionalism remains a challenging part of the medical curriculum to define, teach and evaluate. We suggest that one way to meet these challenges is to clarify the definition of professionalism and distinguish this from medical ethics. Methods Our analysis is two staged. First, we reviewed influential definitions of professionalism and separated elements relating to (a) ethico-legal competencies, (b) clinical competence and (c) professionalism. In reference to professionalism, we then distinguished between aspirational virtues/values and specific behaviours. From these, we develop (...) a working definition of medical professional behaviour consisting of six domains of behaviour: responsibility; relationships with and respect for patients; probity and honesty; self awareness and capacity for reflection; collaboration and team work; and care of colleagues. Second, we tested this working definition against empirical data concerning disciplinary action against practising doctors using (a) sources in the literature and (b) an original analysis of complaints received by the Medical Board of South Australia. Conclusion Our empirical analysis supports the relevance of four of the six potential domains: responsibility; relationships with and respect for patients; probity and honesty; self awareness and capacity for reflection. There are additional reasons for retaining ‘collaboration and team work’ in the medical professional behaviour curriculum but ‘care of colleagues’ may be better addressed in the ethico-legal curriculum. Our definition of professional behaviour is consistent with the theoretical literature, captures behaviours that predict future complaints against practitioners and is consistent with current complaints about professionalism in South Australian practitioners. This definition can further the teaching and assessing of professional behaviour in medical schools. (shrink)

Previous research conducted in 1999 highlighted ethical concerns behind challenge studies inducing psychosis with ketamine and made recommendations to enhance ethical standards. Recently, a plethora of clinical trials have evaluated the efficacy of ketamine to treat mood disorders, which lead to complex ethical issues. Pharmaceutical companies and researchers hope to profit by developing patentable variations on ketamine for treating depression. Media have labeled ketamine as a “miracle” antidepressant. Some clinics offer expensive off-label use of ketamine to treat mood disorders. This (...) article examines the ecological validity of ketamine trials, measures to protect patients, informed consent procedures, financial inducements to participants and conflict of interest of researchers, therapeutic misconception, concealment, and deception. Further recommendations are purposed to improve ethical standard of clinical research involving ketamine. (shrink)

In this paper, we suggest the likely effects of the application of Emmanuel Levinas’s philosophy to the care ethic, particularly as it is represented by the author Joan Tronto, one of the most cogent exponents of care ethics.Thus, we ask: does Levinas’s philosophy have enough in common with the care ethic to be able to overlap it and fruitfully address shared issues of pressing importance? And, is Levinas’s philosophy different enough to challenge the care ethic and help it grow in (...) the ways that it must to become a more philosophically recognized and viable perspective? Our answer is affirmative in both regards.This paper does not intend to criticize the philosophy of Levinas on the basis of care ethics but instead lends the care ethic a perspective with the philosophical legitimacy that it has been hitherto lacking.In terms of alterations to the care ethics, we believe first and foremost that, from a Levinasian point of departure, it would be necessary for the care ethic to adopt a greater awareness of asymmetry in the ethical relation, as well as become more future-oriented towards the consequences of the individual agent’s actions. (shrink)

(Report assembled for the Workshop of the AMIA Working Group on Formal Biomedical Knowledge Representation in connection with AMIA Symposium, Washington DC, 2005.) Best practices in ontology building for biomedicine have been frequently discussed in recent years. However there is a range of seemingly disparate views represented by experts in the field. These views not only reflect the different uses to which ontologies are put, but also the experiences and disciplinary background of these experts themselves. We asked six questions related (...) to biomedical ontologies to what we believe is a representative sample of ontologists in the biomedical field and came to a number conclusions which we believe can help provide an insight into the practical problems which ontology builders face today. (shrink)

The mentalist mind-brain model is defended against alleged weaknesses. I argue that the perceived failings are based mostly on misinterpretation of mentalism and emergent interaction. Considering the paradigmatic concepts at issue and broad implications, I try to better clarify the misread mentalist view, adding more inclusive detail, relevant background, further analysis, and comparing its foundational concepts with those of the new cognitive paradigm in psychology. A changed "emergent interactionist" form of causation is posited that combines traditional microdeterminism with emergent "top-down" (...) control. This emergent form of causation has wide application to causal explanation in general and is hypothesized to be the key common precursor for the consciousness revolution and subsequent boom in new worldviews, "systems thinking," emerging new paradigms, and other transformative developments of the 1970s and 1980s. (shrink)

Conceptual foundations for the changeover from behaviorism to mentalism are reviewed in an effort to better clarify frequently contested and misinterpreted features. The new mentalist tenets which I continue to support have been differently conceived to be a form of dualism, mind-brain identity theory, functionalism, nonreductive physical monism, dualist interactionism, emergent interactionism, and various other things. This diversity and contradiction are attributed to the fact that the new mentalist paradigm is a distinctly new position that fails to fit traditional philosophic (...) dichotomies. Formerly opposed features from previous polar alternatives become merged into a novel unifying synthesis, an unambiguous description of which demands redefinition of old terms or/and the invention of new terminology. The present analysis and interpretation are backed by statements from the early papers. (shrink)

THE MARKET AS AN ECONOMIC PROCESS by Ludwig M. Lachmann New York: Basil Blackwell, 1986. 173 pp., $29?95.

"Biodiversity prospecting" has been touted as a mechanism for both discovering new pharmaceutical products and saving endangered ecosystems. It is unclear what values may arise from such activities, however. Evidence from transactions is incomplete and existing theoretical models are flawed. We calculate an upper bound on the value of the "marginal species." Even under favorable assumptions this bound is modest. Slightly modified assumptions lead to drastically lower estimates. We extend our findings to the value of the marginal hectare of habitat (...) and find that the incentives for habitat conservation generated by private pharmaceutical research are also, at best, very modest. (shrink)

Roger Penrose's original and provocative ideas about the large-scale physics of the Universe, the small-scale world of quantum physics and the physics of the mind have been the subject of controversy and discussion. These ideas were set forth in his best-selling books The Emperor's New Mind and Shadows of the Mind. In this book, he summarises and brings up to date his current thinking in these complex areas. He presents a masterful summary of those areas of physics in which he (...) feels there are major unsolved problems. Through this, he introduces radically new concepts which he believes will be fruitful in understanding the workings of the brain and the nature of the human mind. These ideas are then challenged by three distinguished experts from different backgrounds - Abner Shimony and Nancy Cartwright as Philosophers of Science and Stephen Hawking as a Theoretical Physicist and Cosmologist. Finally, Roger Penrose responds to their thought-provoking criticisms. This volume provides an accessible, illuminating and stimulating introduction to Roger Penrose's vision of theoretical physics for the 21st Century. His enthusiasm, insight and good humour shine through this brilliant account of the problems of modern physics. (shrink)