As the General Medical Council (GMC) is currently in the process of reviewing its ethical guidance on confidentiality, it is a prescient time to consider the legal and ethical issues inherent in it. This paper examines the question of anonymized data, and highlights the fact that the legal position regarding whether it should be classed as confidential is unclear, with the possibility of a change in the law being very real. Indeed, the article argues that the notion that anonymized data (...) is not confidential can be challenged on both legal and ethical grounds, and thus that the GMC should take this into account in its new guidance. Although identifying the fact that this might have implications for epidemiological research, the article highlights an alternative approach that would allow the conduct of such research while not infringing patients' legally protected human rights. (shrink)

Some time ago, Ian Kennedy asked whether consent wasthe great bulwark of “patient's rights”? Is it a necessary nuisance granted as a concession to modish thinking? Is it simply a figment of some lawyer's imagination which practitioners know is meaningless in practice? Is it just part of the rhetoric of “patient power”, sent to try doctors' patience and challenge their authority?

Introduction -- Historical perspectives of medical ethics -- The medical ethics Renaissance: a brief assessment -- Risk disclosure/'informed consent' -- Consent, control and minors: Gillick and beyond -- Sterilisation/best interests: legislation intervenes -- The end of life: total abrogation -- Medical ethics in government-commissioned reports -- Conclusion.

Background Dynamic consent has been proposed as a process through which participants and patients can gain more control over how their data and samples, donated for biomedical research, are used, resulting in greater trust in researchers. It is also a way to respond to evolving data protection frameworks and new legislation. Others argue that the broad consent currently used in biobank research is ethically robust. Little empirical research with cohort study participants has been published. This research investigated the participants’ opinions (...) of adding a dynamic consent interface to their existing study. Methods Adult participants in the Extended Cohort for E-health, Environment and DNA longitudinal cohort study who are members of the EXCEED Public and Participant Engagement Group were recruited. Four focus groups were conducted and analysed for thematic content. Discussion topics were derived from a review of the current literature on dynamic consent. Results Participants were in favour of many aspects of a dynamic consent interface, such as being able to update their information, add additional data to their records and choose withdrawal options. They were supportive provided it was simple to use and not intrusive. Participants expressed a markedly high level of trust in the study and its investigators and were unanimously happy with their current participation. No strong support was found for adding a dynamic consent interface to EXCEED. Conclusions Trust in the study researchers was the strongest theme found. Openness and good data security were needed to retain their trust. While happy to discuss dynamic consent, participants were satisfied with the current study arrangements. There were indications that changing the study might unnecessarily disturb their trust. This raised the question of whether there are contexts where dynamic consent is more appropriate than others. This study was limited by the small number of participants who were committed to the study and biased towards it. More research is needed to fully understand the potential impact of adding a dynamic consent interface to an existing cohort study. (shrink)

In 2014, Lord Saatchi launched his ultimately unsuccessful Medical Innovation Bill in the UK. Its laudable aim was to free doctors from the shackles that prevented them from providing responsible innovative treatment. Lord Saatchi’s principal contention was that current law was the unsurmountable barrier that prevented clinicians from delivering innovative treatments to cancer patients when conventional options had failed. This was because doctors feared that they might be sued or tried and convicted of gross negligence manslaughter if they deviated from (...) standard practice. Concerns about fear of the law and potential negative effects on medical practice are not new. Fear of litigation has been suggested as the reason for doctors practising “defensive medicine,” by opting for treatments regarded as “grievance-resistant,” rather than clinically indicated, for example, by ordering diagnostic tests or performing certain procedures, which are not strictly medically necessary. Whilst this claim is plausible and apparently accepted by the courts, there is limited empirical evidence in support of it so far as practitioners in the UK are concerned. In this paper, we report on our empirical research which provides a snapshot of medical opinion to begin to rectify this gap. We ran focus groups of different medical specialties, asking what these medical practitioners thought the barriers to medical innovation to be. We found that fear of the law was not the principal barrier to be lowered, and that the answer was far more multifaceted. (shrink)

In the United Kingdom, the question of how much information is required to be given to patients about the benefits and risks of proposed treatment remains extant. Issues about whether healthcare resources can accommodate extended shared decision-making processes are yet to be resolved. COVID-19 has now stepped into this arena of uncertainty, adding more complexity. U.K. public health responses to the pandemic raise important questions about professional standards regarding how the obtaining and recording of consent might change or be maintained (...) in such emergency conditions, particularly in settings where equipment, medicines, and appropriately trained or specialized staff are in short supply. Such conditions have important implications for the professional capacity and knowledge available to discuss the risks and benefits of and alternatives to proposed treatment with patients. The government’s drive to expedite the recruitment to wards of medical students nearing the end of their studies, as well as inviting retired practitioners back into practice, raises questions about the ability of such healthcare providers to engage fully in shared decision-making.This article explores whether the legal duty on healthcare practitioners to disclose the material risks of a proposed medical treatment to a patient should be upheld during pandemic conditions or whether the pre-eminence of patient autonomy should be partly sacrificed in such exceptional circumstances. We argue that measures to protect public health and to respect autonomous decision-making are not mutually exclusive and that there are good reasons to maintain professional standards in obtaining consent to treatment even during acute pressures on public health systems. (shrink)

Hard cases make bad law. In a matter of months, two such cases involving assisted reproduction have appeared before the U.K. High Court and legislation has been enacted. The common threads between them are consent and fatherhood. The first case concerns a ‘mistake’ resulting in sperm from the wrong man being used to create an embryo for a couple and the second the revocation of consent by a man to his former partner being allowed to use an embryo they created (...) together. Furthermore, Parliament has intervened, passing legislation which sets out when sperm from a dead man may be used by his former partner to generate an embryo. This note argues that the three developments cannot be reconciled with one another and that the cases in particular, decided on a narrow legal basis, convey contradictory messages, leading in at least one instance to a gross injustice. (shrink)

This article seeks to identify a 'problem' in the interaction between medical law and ethics, which is that neither fully appreciates how the other works. In particular, it argues that medical law has not only failed to formulate a consistent conception of the role that medical ethics performs, but it does not adequately differentiate between categories of medical ethics discourse. Consequently, the ethical content of a case, if identified at all, will not be dealt with in a consistent manner. The (...) article further argues that medical ethics does not recognize the power that law gives to it, and that the result is a regulatory vacuum. It then uses the findings of the Bristol Royal Infirmary Report to demonstrate, by analogy, how this may lead to problems. (shrink)

This book explores the epistemic side of racial and sexual oppression. It elucidates how social insensitivities and imposed silences prevent members of different groups from listening to each other.

On knowledge and practices: a manifesto -- The web of practices -- Agents and frameworks -- Complementarity in mathematics -- Ancient Greek mathematics: a role for diagrams -- Advanced math: the hypothetical conception -- Arithmetic certainty -- Mathematics developed: the case of the reals -- Objectivity in mathematical knowledge -- The problem of conceptual understanding.

British Library MS Harley 7368 or The Book of Sir Thomas More presents a play by five hands in various states of revision. Scholars have identified Anthony Munday as the principal playwright and William Shakespeare as the author of three pages that portray Thomas More quelling a Mayday London riot against foreigners. Its manifold uncertainties notwithstanding, the playscript teaches us some things about Shakespeare and about Thomas More. It enables us to see the Bard in the act of creating and (...) revising, participating fully in the processes of collaboration typical in his time. Moreover, it presents More as a heroic wise man whom Protestants and Catholics can admire for his resolution, mirth and compassion, qualities that transcend confessional dispute. (shrink)

José L. Zalabardo defends a pragmatist account of what grounds the meaning of central semantic discourses--ascriptions of truth, of propositional attitudes, and of meanings. He argues that it is the procedures that regulate acceptance and rejection that give the sentences of these discourses their meanings, and explores the application of the pragmatist template to ethical discourse. The pragmatist approach is presented as an alternative to representationalist accounts of the meaning grounds of declarative sentences, according to which a sentence has (...) the meaning it has as a result of links with the bits of the world that it purports to represent. Zalabardo develops a version of the open-question argument to support the claim that the meaning grounds of the discourses he focuses on cannot receive representationalist accounts. It is generally assumed that a declarative sentence cannot perform the function of representing the world unless it has a representationalist meaning ground. Zalabardo rejects this assumption, arguing that sentences with pragmatist meaning grounds can represent the world in exactly the same sense that sentences with representationalist meaning grounds do. This requires that there are states of affairs that the target sentences represent as obtaining, and Zalabardo develops an account of the nature of the states of affairs that can play this role for sentences with pragmatist meaning grounds. Pragmatist Semantics concludes by developing the suggestion that the meaning grounds of all our representational discourses might be ultimately pragmatist. (shrink)

Legaz Lacamba, L. José Ignacio de Alcorta, filósofo de nuestro tiempo.--Semblanza del profesor Alcorta.--Rodríguez Resina, A. El realismo trascendental, introducción a la filosofía de J. I. de Alcorta.

While in agreement with Miranda Fricker’s context-sensitive approach to hermeneutical injustice, this paper argues that this contextualist approach has to be pluralized and rendered relational in more complex ways. In the first place, I argue that the normative assessment of social silences and the epistemic harms they generate cannot be properly carried out without a pluralistic analysis of the different interpretative communities and expressive practices that coexist in the social context in question. Social silences and hermeneutical gaps are misrepresented if (...) they are uniformly predicated of an entire social context, instead of being predicated of particular ways of inhabiting that context by particular people in relation to particular others. I contend that a more nuanced—polyphonic—contextualization offers a more adequate picture of what it means to break social silences and to repair the hermeneutical injustices associated with them. In the second place, I argue that the particular obligations with respect to hermeneutical justice that differently situated subjects and groups have are interactive and need to be determined relationally. That is, whether individuals and groups live up to their hermeneutical responsibilities has to be assessed by taking into account the forms of mutual positionality, relationality, and responsivity (or lack thereof) that these subjects and groups display with respect to one another. The central argument is developed through an examination of what in race theory and in contemporary epistemologies of ignorance has been termed “white ignorance”; that is, the kind of hermeneutical inability of privileged white subjects to recognize and make sense of their racial identities, experiences, and social positionality. (shrink)

Though Wittgenstein's On Certainty has been influential in analytic epistemology, its interpretation has been enormously controversial. It is true that exegesis has been mainly concerned with the proper characterization of Wittgenstein's very notion of ?certainty?; however, some important questions remain unanswered regarding this notion. On the one hand, I am above all referring to the study of the possibilities we have of retaining a certainty when it has seemingly been placed into question and, on the other hand, of regaining a (...) certainty once it has been lost. In this paper, I attempt to provide a detailed answer to both questions. In so doing, some important features of the picture of ourselves which emerges from Wittgenstein's On Certainty are also revealed. (shrink)

This book explores the epistemic side of oppression, focusing on racial and sexual oppression and their interconnections. It elucidates how social insensitivities and imposed silences prevent members of different groups from interacting epistemically in fruitful ways--from listening to each other, learning from each other, and mutually enriching each other's perspectives. Medina's epistemology of resistance offers a contextualist theory of our complicity with epistemic injustices and a social connection model of shared responsibility for improving epistemic conditions of participation in social practices. (...) Through the articulation of a new interactionism and polyphonic contextualism, the book develops a sustained argument about the role of the imagination in mediating social perceptions and interactions. It concludes that only through the cultivation of practices of resistance can we develop a social imagination that can help us become sensitive to the suffering of excluded and stigmatized subjects. Drawing on Feminist Standpoint Theory and Critical Race Theory, this book makes contributions to social epistemology and to recent discussions of testimonial and hermeneutical injustice, epistemic responsibility, counter-performativity, and solidarity in the fight against racism and sexism. (shrink)

This book explores the epistemic side of racial and sexual oppression. It elucidates how social insensitivities and imposed silences prevent members of different groups from listening to each other.

Background The Regional Committee for Africa of the World Health Organization (WHO) in 2001 expressed concern that some health-related studies undertaken in the Region were not subjected to any form of ethics review. In 2003, the study reported in this paper was conducted to determine which Member country did not have a national research ethics committee (REC) with a view to guiding the WHO Regional Office in developing practical strategies for supporting those countries. Methods This is a descriptive study. The (...) questionnaire was prepared and sent by diplomatic pouch to all the 46 Member States in the WHO African Region, through the WHO country representatives, for facilitation and follow up. The data were entered in Excel spreadsheet and subsequently exported to STATA for analysis. A Chi-Squared test (χ 2) for independence was undertaken to test the relationship between presence/absence of Research Ethics Committee (REC) and selected individual socioeconomic and health variables. Results The main findings were as follows: the response rate was 61% (28/46); 64% (18/28) confirmed the existence of RECs; 36% (10/28) of the respondent countries did not have a REC (although 80% of them reported that they had in place an ad hoc ethical review mechanism); 85% (22/26) of the countries that responded to this question indicated that ethical approval of research proposals was, in principle, required; and although 59% of the countries that had a REC expected it to meet every month, only 44% of them reported that the REC actually met on a monthly basis. In the Chi-Squared test, only the average population in the group of countries with a REC was statistically different (at 5% level of significance) from that of the group of countries without a REC. Conclusion In the current era of globalized biomedical research, good ethics stewardship demands that every country, irrespective of its level of economic development, should have in place a functional research ethics review system in order to protect the dignity, integrity and safety of its citizens who participate in research. (shrink)

Explores the stable core of Wittgenstein's philosophy as developed from the Tractatus to the Philosophical Investigations.

The subject matter of this paper is the view that it is correct, in an absolute sense, to believe a proposition just in case the proposition is true. I take issue with arguments in support of this view put forward by Nishi Shah and David Velleman.

This paper defends a contextualist approach to epistemic injustice according to which instances of such injustice should be looked at as temporally extended phenomena (having developmental and historical trajectories) and socially extended phenomena (being rooted in patterns of social relations). Within this contextualist framework, credibility excesses appear as a form of undeserved epistemic privilege that is crucially relevant for matters of testimonial justice. While drawing on Miranda Fricker's proportional view of epistemic justice, I take issue with its lack of attention (...) to the role that credibility excesses play in testimonial injustices. I depart from Fricker's view of the relation between credibility excesses and credibility deficits, and I offer an alternative account of the contributions that undeserved epistemic privileges make to epistemic injustices. Then, through the detailed analysis of To kill a mockingbird, I elucidate the crucial role played by the social imaginary in creating and sustaining epistemic injustices, developing an analysis of the kind of social blindness produced by an oppressive social imaginary that establishes unjust patterns of credibility excesses and deficits. (shrink)

El texto presenta la crítica heideggeriana a los conceptos de teoría y praxis, tal como han sido acuñados por la tradición filosófica. El artículo muestra el giro transformador que hace el filósofo alemán en el tratamiento de estas dos nociones, con el fin de delinear una nueva concepción de filosofía, a propósito de la crítica y transformación de estas concepciones. La crítica se centra en señalar cómo en la tradición filosófica ha preponderado la teoría, comprendida desde una visión lógico – (...) racional, y la comprensión de la praxis como una instancia a-teórica, lo que deja de lado las consideraciones prácticas centrales y primarias implicadas en el pensar, y el ejercicio práctico como instancia comprensiva y de pensamiento. En este sentido, se muestra la reivindicación de la praxis, de la cotidianidad y de la situación fáctica como aspectos de central importancia en el ser del Dasein; y se plantea una nueva comprensión de lo que implica la teoría y las nuevas relaciones que se establecen en el nexo teoría – praxis como posibilidades del ser del Dasein, sin caer en el primado de la una sobre la otra, lo que implica la transformación de sus modos de comprensión. Finalmente, se muestra cómo un ejercicio filosófico desde estas intuiciones se encuentra más cercano a la comprensión e interpretación práctica que al desarrollo de teorías en el sentido clásico del término. (shrink)

Posidonia oceanica is an endemic seagrass from the mediterranean that provides key ecosystem services. A protected species, its presence is regressing due to anthropogenic pressures, some associated to the tourism economy that much of the Mediterranean coast depends on. In 1992, the European Union declared it a priority habitat, and since the early 2000s, it has occupied a central space in marine conservation debates in the Balearic Islands. Popularly known as Posidonia, this seagrass went from being considered dirt that ruined (...) virgin Balearic beaches to become an emblematic species. This article takes this U-turn in policy and public perception as a study case to think of knowledge-making practices and restoration initiatives as a form of environmental care. The relational, situated and affective character of care ethics helps to understand the human and ecological labour embedded in knowledge-making and restoration practices and its inevitable engagement with the Balearic tourism industry. Drawing on those engagements, I reflect on environmental care practices of knowledge-making and restoration, arguing that they emerge ambivalently: they challenge management logics based on economic rationales while forced to develop and coexist inside those same rationales. I conclude by arguing that developing care-centric narratives for environmental conservation and restoration is essential to continue promoting more-than-human aquatic relations in which the needs of others are the ethical basis for action. (shrink)

In this essay I argue that epistemic injustices can be understood and explained as social pathologies of recognition, and that this way of conceptualizing epistemic injustices can help us develop proper diagnostic and corrective treatments for them. I distinguish between two different kinds of recognition deficiency—quantitative recognition deficits and misrecognitions—and I ague that while the rectification of the former simply requires more recognition, the rectification of the latter calls for a shift in the mode of recognition, that is, a deep (...) transformation of the recognition dynamics so that other forms of recognition can emerge. Arguing against incremental recognitional approaches that aim only at increasing social visibility/audibility, I examine communicative dysfunctions around the phenomenon of racist violence in order to show how problems of misrecognition persist and become recalcitrant even when quantitative recognition deficits disappear. (shrink)

Qual o lugar da política em nossas modernas sociedades capitalistas? De que política se trata? Como a democracia deve se haver com uma economia que provoca riqueza gerando desigualdades insalubres? Essas são algumas das questões sobre as quais se debruçam os filósofos José Arthur Giannotti e Luiz Damon Moutinho em Os limites da política. Instigado pelo alcance e profundidade do e-book A política no limite do pensar, de Giannotti, publicado pela Companhia das Letras em 2014, Luiz Damon reagiu escrevendo (...) um ensaio em que refletia sobre as bases filosóficas dos argumentos do colega. As provocações de Damon levaram Giannotti a acentuar ou corrigir algumas de suas ideias. Os limites da política nasceu de um intenso debate entre os dois filósofos, com réplicas e tréplicas, agora reunidas em um só volume juntamente ao ensaio original que deu origem à polêmica. (shrink)

The catalyst for much of classical pragmatist political thought was the great waves of migration to the United States in the early 20th century. José-Antonio Orosco examines the work of several pragmatist social thinkers, including John Dewey, W. E. B. Du Bois, Josiah Royce, and Jane Addams, regarding the challenges large-scale immigration brings to American democracy. Orosco argues that the ideas of the classical pragmatists can help us understand the ways in which immigrants might strengthen the cultural foundations of (...) the United States in order to achieve a more deliberative and participatory democracy. Like earlier pragmatists, Orosco begins with a critique of the melting pot in favor of finding new ways to imagine the civic role of our immigrant population. He concludes that by applying the insights of American pragmatism, we can find guidance through controversial contemporary issues such as undocumented immigration, multicultural education, and racialized conceptions of citizenship. (shrink)

José Luis Bermúdez introduces the philosophy of psychology as an interdisciplinary exploration of the nature and mechanisms of cognition. _Philosophy of Psychology_ charts out four influential 'pictures of the mind' and uses them to explore central topics in the philosophical foundations of psychology, including the relation between different levels of studying the mind/brain; the nature and scope of psychological explanation; the architecture of cognition; and the relation between thought and language. Chapters cover all the core concepts, including: models of (...) psychological explanation the nature of commonsense psychology arguments for the autonomy of psychology functionalist approaches to cognition computational models of the mind neural network modeling rationality and mental causation perception, action and cognition the language of thought and the architecture of cognition. _Philosophy of Psychology: A Contemporary Introduction_ is a very clear and well-structured textbook from one of the leaders in the field. (shrink)

Robert Kilwardby is a central figure in late medieval philosophy and theology, but key areas of his thought still remain unexamined in a systematic way. This book offers a comprehensive overview of his works, ranging from topics in logic to theology, done in a way that is accessible to non-specialists and to anyone interested in medieval thought.

Robert Kilwardby on the Human Soul examines Kilwardby’s role in conciliating Aristotelian and Augustinian views on the soul, soul-body relation, and cognition.