This paper defends stage theory against the argument from diachronic counting. It argues that stage theorists can appeal to quantifier domain restriction in order to accommodate intuitions about diachronic counting sentences. Two approaches involving domain restriction are discussed. According to the first, domains of counting are usually restricted to stages at the time of utterance. This approach explains intuitions in many cases, but is theoretically costly and delivers wrong counts if diachronic counting is combined with fission or fusion. On the (...) second approach, domains of counting are usually restricted in an indeterminate way, so as to include at most one member of any maximal class of counterpart-interrelated stages (with respect to a certain utterance). This view can accommodate all the relevant intuitions about counting sentences, and it fits well with a new stage-theoretic view of reference that allows speakers to refer to both present and past stages. (shrink)
Commentators often claim that medical research subjects are coerced into participating in clinical studies. In recent years, such claims have appeared especially frequently in ethical discussions of research in developing countries. Medical research ethics is more important than ever as we move into the 21st century because worldwide the pharmaceutical industry has grown so much and shows no sign of slowing its growth. This means that more people are involved in medical research today than ever before, and in the future (...) even more will be involved. However, despite the pressing need for reflection on research ethics, it is important to carefully identify the concerns we have about research. Otherwise we run the risk that the moral language we use, and which we hear other people use, may do our moral thinking for us. We argue that many recent claims about the occurrence of coercion in medical research are misguided and misuse the word "coercion." We try to identify the real problems, and urge people to attend carefully to the implications of their descriptions of moral problems in research. (shrink)
Traditionally, biomedical research has been devoted to improvement in the understanding and treatment or prevention of disease. Building on the knowledge generated by the long history of disease-oriented research, the next few decades will witness an explosion of biomedical enhancements to make people faster, stronger, smarter, less forgetful, happier, prettier, and live longer (Turner et al. 2003; Vastag 2004; Rose 2002). As with other biomedical interventions, research to assess the safety and efficacy of these enhancements in humans should be conducted (...) before their introduction into clinical practice.1 However, various concerns regarding the ethics of enhancement research could be raised. Those who .. (shrink)
Many guidelines for international research require that studies be responsive to host community health needs or health priorities. Although responsiveness possesses great intuitive and rhetorical appeal, existing conceptions are confusing and difficult to apply. Not only are there few examples of what research the responsiveness requirement permits and what it rejects, but its application can lead to contradictory results. Because of the practical difficulties in applying responsiveness and the danger that misapplying responsiveness could harm the interests of developing countries, we (...) argue that responsiveness should be refocused in three ways: in terms of (1) who enforces it, (2) under what standard, and (3) in what cases. We conclude that responsiveness should be applied by host country officials at the policy level with the exercise of judgment when externally funded research threatens to displace scarce local resources. (shrink)
1. The opinions expressed are the author's own. They do not reflect any position or policy of the National Institutes of Health, Public Health Service, Department of Health and Human Services, or any of the authors affiliated organizations.
Although for the last 50 years, ethicists dealing with human experimentation have focused primarily on the need to protect individual research subjects and vulnerable groups, biomedical research, especially in genetics, now requires the establishment of standards for the protection of communities. We have developed such a strategy, based on five steps. (i) Identification of community characteristics relevant to the biomedical research setting, (ii) delineation of a typology of different types of communities using these characteristics, (iii) determination of the range of (...) possible community protections, (iv) creation of connections between particular protections and one or more community characteristics necessary for its implementation, and (v) synthesis of community characteristics and possible protections to define protections appropriate for each type of community. Depending on the particular community, consent and consultation, consultation alone, or no added protections may be required for research. (shrink)
As genetic research increasingly focuses on communities, there have been calls for extending research protections to them. We critically examine guidelines developed to protect aboriginal communities and consider their applicability to other communities. These guidelines are based on a model of researcher-community partnership and span the phases of a research project, from protocol development to publication. The complete list of 23 protections may apply to those few non-aboriginal communities, such as the Amish, that are highly cohesive. Although some protections may (...) be applicable to less-cohesive communities, such as Ashkenazi Jews, analysis suggests substantial problems in extending these guidelines in toto beyond the aboriginal communities for which they were developed. (shrink)
All investigators funded by the National Institutes of Health are now required to receive training about the ethics of clinical research. Based on a course taught by the editors at NIH, Ethical and Regulatory Aspects of Clinical Research is the first book designed to help investigators meet this new requirement. The book begins with the history of human subjects research and guidelines instituted since World War II. It then covers various stages and components of the clinical trial process: designing the (...) trial, recruiting participants, ensuring informed consent, studying special populations, and conducting international research. Concluding chapters address conflicts of interest, scientific misconduct, and challenges to the IRB system. The appendix provides sample informed consent forms. This book will be used in undergraduate courses on research ethics and in schools of medicine and public health by students who are or will be carrying out clinical research. Professionals in need of such training and bioethicists also will be interested. (shrink)
In 2004 Emanuel et al. published an influential account of exploitation in international research, which has become known as the 'fair benefits account'. In this paper I argue that the thin definition of fairness presented by Emanuel et al, and subsequently endorsed by Gbadegesin and Wendler, does not provide a notion of fairness that is adequately robust to support a fair benefits account of exploitation. The authors present a procedural notion of fairness – the fair distribution of the (...) benefits of research is to be determined on a case-by-case basis by the parties involved in each study. The fairness of the distribution of benefits is not assessed against an independent normative standard. Emanuel et al.'s account of fairness provides a framework for objecting only to transactions that occur without the fully informed consent of the weaker party. As a result, a debate about exploitation collapses into a debate about consent. This is problematic because, as the proponents of the fair benefits framework acknowledge, neither the trial participants' consent nor the host community's consent preclude exploitation. Attempts to stipulate normative standards of fairness to protect research subjects in developing countries have been controversial and divisive, and it is therefore understandable that bioethicists would be tempted to develop accounts of exploitation that are independent of such prescriptive principles. I conclude, however, that the utility of the fair benefits model of exploitation as a policy tool will ultimately depend on whether a substantive principle of fairness can be developed to underpin it. (shrink)
When is clinical research ethical? The difficulty in answering this question lies in the dual nature of research on human subjects, which yields two somewhat conflicting sets of obligations. On the one hand, there is the traditional view of science that includes the idea of an obligation to learn about the world. On the other hand, there is the obligation of care on the part of researchers towards individual participants in the research ...
In Emanuel Adler's distinctive constructivist approach to international relations theory, international practices evolve in tandem with collective knowledge of the material and social worlds. This book - comprising a selection of his journal publications, a new introduction and three previously unpublished articles - points IR constructivism in a novel direction, characterized as 'communitarian'. Adler's synthesis does not herald the end of the nation-state; nor does it suggest that agency is unimportant in international life. Rather, it argues that what mediates (...) between individual and state agency and social structures are communities of practice, which are the wellspring and repositories of collective meanings and social practices. The concept of communities of practice casts new light on epistemic communities and security communities, helping to explain why certain ideas congeal into human practices and others do not, and which social mechanisms can facilitate the emergence of normatively better communities. (shrink)
Some things are _about_, or are _directed on_ , or _represent_, other things. For example, the sentence 'Cats are animals' is about cats (and about animals), this article is about intentionality, Emanuel Leutze's most famous painting is about Washington's crossing of the Delaware, lanterns hung in Boston's North Church were about the British, and a map of Boston is about Boston. In contrast, '#a$b', a blank slate, and the city of Boston are not about anything. Many mental states and (...) events also have "aboutness": the belief that cats are animals is about cats, as is the fear of cats, the desire to have many cats, and seeing that the cats are on the mat. Arguably some mental states and events are not about anything: sensations, like pains and itches, are often held to be examples. Actions can also be about other things: hunting for the cat is about the cat, although tripping over the cat is not. This -- rather vaguely characterized -- phenomenon of "aboutness" is called _intentionality_. Something that is about (directed on, represents) something else is said to "have intentionality", or (in the case of mental states) is said to be an "intentional mental state". (shrink)
Taking the lead from Susan Wolf's and Linda Emanuel's work on systems thinking, and developing ideas from Moberg's, Seabright's and my work on mental models and moral imagination, in this paper I shall argue that what is often missing in management decision-making is a systems approach. Systems thinking requires conceiving of management dilemmas as arising from within a system with interdependent elements, subsystems, and networks of relationships and patterns of interaction. Taking a systems approach and coupling it with moral (...) imagination, now engaged on the organizational and systemic as well as individual levels of decision-making, I shall conclude, is a methodology that encourages managers and companies to think more imaginatively and to engage in integrating moral decision-making into ordinary business decisions. More importantly this sort of thinking is a means to circumvent what often appear to be intractable problems created by systemic constraints for which no individual appears to be responsible. (shrink)
The American Medical Association enacted its Code of Ethics in 1847, the first such national codification. In this volume, a distinguished group of experts from the fields of medicine, bioethics, and history of medicine reflect on the development of medical ethics in the United States, using historical analyses as a springboard for discussions of the problems of the present, including what the editors call "a sense of moral crisis precipitated by the shift from a system of fee-for-service medicine to a (...) system of fee-for-system medicine, better known as 'managed care.'" The authors begin with a look at how the medical profession began to consider ethical issues in the 1800s and subsequent developments in the 1900s. They then address the sociological, historical, ethical, and legal aspects of the practice of medicine. Later chapters discuss current and future challenges to medical ethics and professional values. Appendixes display various versions of the AMA's Code of Ethics as it has evolved over time. Contributors: George J. Annas, J.D., M.P.H., Arthur Isak Applbaum, Ph.D., Robert B. Baker, Ph.D., Chester R. Burns, M.D., Ph.D., Arthur L. Caplan, Ph.D., Alexander Morgan Capron, J.D., Christine K. Cassel, M.D., Linda L. Emanuel, M.D., Ph.D., Eliot L. Freidson, Ph.D., Albert R. Jonsen, Ph.D., Stephen R. Latham, J.D., Ph.D., Susan E. Lederer, Ph.D., Florencia Luna, Ph.D., Edmund D. Pellegrino, M.D., Charles E. Rosenberg, Ph.D., Mark Siegler, M.D., Rosemary A. Stevens, Ph.D., Robert M. Tenery, Jr., M.D., Robert M. Veatch, Ph.D., John Harley Warner, Ph.D., Paul Root Wolpe, Ph.D. (shrink)
The allocation of scarce health care resources such as flu treatment or organs for transplant presents stark problems of distributive justice. Persad, Wertheimer, and Emanuel have recently proposed a novel system for such allocation. Their “complete lives system” incorporates several principles, including ones that prescribe saving the most lives, preserving the most life-years, and giving priority to persons between 15 and 40 years old. This paper argues that the system lacks adequate moral foundations. Persad and colleagues' defense of giving (...) priority to those between 15 and 40 leaves them open to the charge that they discriminate unfairly against children. Second, the paper contends that the complete lives system fails to provide meaningful practical guidance in central cases, since it contains no method for balancing its principles when they conflict. Finally, the paper proposes a new method for balancing principles of saving the most lives and maximizing life-years. (shrink)
One of the key ethical requirements for biomedical research is that it have an acceptable risk-benefit profile (Emanuel, Wendler, and Grady 2000). The International Conference of Harmonization guidelines mandate that clinical trials should be initiated and continued only if “the anticipated benefits justify the risks” (1996). Guidelines from the Council for International Organizations of Medical Sciences state that biomedical research is acceptable only if the “potential benefits and risks are reasonably balanced” (2002). U.S. federal regulations require that the “risks (...) to subjects” be “reasonable in relation to anticipated benefits, if any, to subjects and the importance of the knowledge” to be gained from the .. (shrink)
The relation between Emanuel Swedenborg and Immanuel Kant has been the subject of many discussions. The chief aim of this paper is not to elucidate this question from an historical point of view, but to compare the teachings of the two thinkers, as those teachings have come to us. Kant's "Träme eines Geistersehers" embodies a very unfavourable opinion about Swedenborg. It is a curious circumstance, that this judgement is not based on decisive arguments. On the contrary, Swedenborg's fundamental doctrines (...) about the existence of a spiritual world and the communication between the living and the dead, are accepted by Kant as plausible. Du Prel and others have concluded, that Kant was a Swedenborgian in his heart, and that his negative attitude was due to the fear of losing his scientific reputation. A careful consideration of the two philosophical systems does not tend to bear out this opinion; nevertheless, such a comparative study is very instructive. In the mental development of the two thinkers there are remarkable analogies. Both were occupied with the great problems of God and the human soul; and both were disappointed by the leading philosophical and theological doctrines of their days. To Swedenborg those doctrines seemed to lead straightforwardly to naturalism and atheism. Kant was struck by the diversity of the opinions expressed and by the succession of heterogeneous doctrines without lasting results. But the reactions of the two men in these circumstances were different. In his cosmological and anatomical works Swedenborg aims at acquiring a comprehensive view of the Universe, in which view God and the soul should obtain their proper places. When he had reached the age of about 55 years, a crisis set in, which he described as "the opening of his spiritual senses". From that time he could see the spiritual world and speak with its inhabitants; he could study the workings of God and of the soul with the help of living experience. Kant raised the question, whether there are departments of knowledge in which certainty is attainable, and what is the ground of this certainty. His answer is, that the fundamental propositions of mathematical physics are absolutely certain. The ground lies in the fact, that these propositions are not derived from experience, but that they are "synthetic judgments a priori". They express the workings of the "categories" and "forms of intuition". by means of which the mind constructs, out of a chaos of sense-impressions, the ordered universe of science. Of objects to which these propositions do not apply, e.g. God and the soul, no certain knowledge is possible. This precludes the knowledge of "another world", fundamentally different from our ordinary world. So there seems to be an irreconcilable opposition between the teachings of Kant and of Swedenborg, But further considerations tend to lessen this contrast. Notwithstanding his own teaching, Kant accepted a life after death and he even speculated on it. If we follow this example, we come to remarkable conclusions. It is reasonable to suppose, that the spirits, who have been men, use the same categories as we do. Then out of the impressions which reach them, they will construct a world built on the same pattern as our earthly world. So life before and after death will not be very different. And this is precisely Swedenborg's teaching. This may be confirmed by the experiences of our dream-life. In dreams, our mind out of different impressions builds a world closely resembling our ordinary world. The spiritual world, as described by Swedenborg, presents many analogies with the world of our dreams. Now it is a very remarkable circumstance, that modern physics has been under the necessity of modifying the system of categories as described by Kant. In quantum mechanics the connection between cause and effect is less stringent than in classical mechanics. This adds fresh interest to the study of a system like that of Swedenborg, where quantitative laws are largely replaced by qualitative laws. (shrink)
It is widely agreed that clinical research should satisfy a number of ethical requirements. These include requirements to address a valuable question, to select subjects fairly, and to pose appropriate risks. In contrast, there remains considerable debate over the ethical relevance of investigator intentions: Does it matter ethically whether investigators intend to collect generalizable knowledge or to benefit subjects, or both? Some commentators do not mention investigator intentions when evaluating what makes clinical research ethical (Emanuel, Wendler, and Grady 2000). (...) Others regard investigator intentions as central to the ethics of clinical research (Jonas 1969). These commentators argue that .. (shrink)
Preventing exploitation in human subjects research requires a benchmark of fairness against which to judge the distribution of the benefits and burdens of a trial. This paper proposes the ideal market and its fair market price as a criterion of fairness. The ideal market approach is not new to discussions about exploitation, so this paper reviews Wertheimer's inchoate presentation of the ideal market as a principle of fairness, attempt of Emanuel and colleagues to apply the ideal market to human (...) subjects research, and Ballantyne's criticisms of both the ideal market and the resulting benchmark of fairness. It argues that the criticism of this particular benchmark is on point, but the rejection of the ideal market is mistaken. After presenting a complete account of the ideal market, this paper proposes a new method for applying the ideal market to human subjects research and illustrates the proposal by considering a sample case. (shrink)
One important lesson of Roberts' target article may be potentially obscured for some by the title's reference to “self-experimentation.” At the core of this work, the key investigative resource is sustained and systematic observation, not experimentation, and it is deployed in a fashion not necessarily restricted to self-examination. There is an important reminder here of a strategically important, but neglected, relationship between observation and experiment.
I share the authors' stance on the dialogic or interactional character of language. The authors, however, have left actual interaction out of their conception of dialogue. I sketch a number of organizations of practices of talking and understanding that supply the basic arena for talk-in-interaction. It is by reference to these that mechanisms for speech production and understanding need to be understood.
This year is the 300th anniversary of the birth of Emanuel Swedenborg (1688 - 1772). Although he worked in the eighteenth century, his investigations into the nature of physical, physiological and spiritual processes are still relevant today, although they are not as widely known as they deserve. In this article, I will briefly describe the stages in Swedenborg's life, and outline his mature teachings with particular relevance to what is relevant to the concerns of contemporary science, and to the (...) concerns of those wishing to extend that science. (shrink)
Does strolling through an art museum, admiring the old masters, improve us morally and spiritually? Would government subsidies of "high art" (such as big-city opera houses) be better spent on local community art projects? In What Good are the Arts? John Carey--one of Britain's most respected literary critics--offers a delightfully skeptical look at the nature of art. In particular, he cuts through the cant surrounding the fine arts, debunking claims that the arts make us better people or that judgements about (...) art are anything more than personal opinion. Indeed, Carey argues that there are no absolute values in the arts and that we cannot call other people's aesthetic choices "mistaken" or "incorrect," however much we dislike them. Along the way, Carey reveals the flaws in the aesthetic theories of everyone from Emanuel Kant to Arthur C. Danto, and he skewers the claims of "high-art advocates" such as Jeannette Winterson. But Carey does argue strongly for the value of art as an activity and for the superiority of one art in particular: literature. Literature, he contends, is the only art capable of reasoning, and the only art that can criticize. Language is the medium that we use to convey ideas, and the usual ingredients of other arts--objects, noises, light effects--cannot replicate this function. Literature has the ability to inspire the mind and the heart towards practical ends far better than any work of conceptual art. Here then is a lively and stimulating invitation to debate the value of art, a provocative book that will pique the interest of anyone who loves painting, music, or literature. (shrink)
The malicious acts of terrorism in New York and Washington emphasized the need for states to combat terrorism. Likewise, Israel has suffered various terrorist attacks since its establishment. There are distinctive features in contemporary terrorism which call for a new assessment of its nature and the status of terrorists in domestic and international law. In October 2000, a violent conflict erupted between organizations operating within the territory of the Palestinian Authority--an entity that is not a state but is a sovereign (...) authority--and the State of Israel. This is a new type of armed conflict, one different from that treated in the international law of armed conflicts. No clear view exists as to the rules which should be applied in such a situation. This is one of the questions that shall be raised in this article. As a result of the violence against Israel, Israel initiated a policy which the media has called 'Israel's elimination policy', but which I believe may be more appropriately described as 'preventive action' taken by Israel within the framework of a military policy aimed at neutralizing terrorist organizations by targeting the perpetrators or their commanders. In this article I shall examine whether this policy is legitimate as a matter of law and morality. (shrink)
While phenomenologists have contributed to an understanding of the empirical origin and historical development of meaning and thought, they have, until recently, paid relatively little attention to significant problems surrounding meaning transmission, that is to say, problems in the process of education. Notably absent in phenomenological investigations has been the development of a fully thought-out phenomenology of education.’ While this task remains to be completed, it has certainly been well, if unexpectedly, begun. Surprisingly, many of the themes developed in Dewey’s (...) Experience and Nature parallel those of Husserl in The Crisis of European Sciences. These themes, spelled out below, appear as well in Dewey’s Democracy and Education. It is not our intention to rediscover Dewey as a closet phenomenologist. Instead, we hope to show how Dewey’s writings lend themselves to phenomenological understanding and reinterpretation....Our approach will be to compare Dewey and Husserl with regard to a number of shared themes that play a prominent role in their respective philosophies. Themes to be compared include: (1) the “life-world” or what Dewey calls everyday or existential experience: (2) the meaning “horizon”; (3) the origin of thought (or reflection) in everyday experience. One observation that will emerge in the course of our comparison is that Dewey frequently tends to go beyond Husserl in his departure from several key tenets currently popular in Anglo-American philosophy. (shrink)
La empatía ha sido foco de discusión en los círculos antipositivistas de la academia alemana de comienzos del siglo pasado, especialmente dentro del movimiento fenomenológico. El presente trabajo se concentra en el debate en torno a esta problemática que Alfred Schütz sostiene con Max Scheler en Der sinnhafte Aufbau der sozialen Welt. En el primer apartado se bosquejan los lineamientos principales de la teoría scheleriana de la Fremdwahrnehmung (percepción del otro), y en el segundo, se exponen las críticas que Schütz (...) le realiza a la misma sustentado en desarrollos teóricos de Edmund Husserl. La hipótesis que guía al escrito es que la confrontación con la teoría scheleriana de la Fremdwahrnehmung juega un rol fundamental en la configuración de la teoría del Fremdverstehen (comprensión del otro) del Schütz temprano. At the beginning of the 20th century the issue of empathy was subject of controversy within the phenomenological movement. The present paper deals with the debate on that topic that the young Alfred Schutz maintained with Max Scheler. Firstly, I outline the Schelerian theory of Fremdwahrnehmung (perception of the other), and secondly I present Schutz's criticism of the former, which is inspired by Husserl's insights on self-awareness and Einfühlung (empathy). My thesis is that in order to properly understand Schutz's theory of Fremdverstehen (understanding of the other) it is essential to take into account this early confrontation with Scheler. (shrink)
In this paper, we explore the desires that play a role at the palliative stage and relate them to various approaches to patient autonomy. What attitude can physicians and other caregivers take to the desires of patients at the palliative stage? We examine this question by introducing five physicians who are consulted by Jackie, an imaginary patient with metastatic lung carcinoma. By combining the models of the physician-patient relationship developed by Emanuel and Emanuel (1992) and the Hellenistic approaches (...) to desires analyzed by Nussbaum (1994), five different ways of dealing with desires in the context of palliative care are sketched. The story of Jackie shows that desires are to a certain extent responsive to reasoning. In the palliative process, that can be a reason to devote attention to the desires of patients and caregivers and to determine which desires need to be fulfilled, which are less important, and how they are linked to emotions the patient has. (shrink)
Tenure is designed to protect the academic freedom of faculty members by insulating them from arbitrary dismissal by administrative authorities external to their community of scholars. Therefore, the target article's focus on constraints that derive from peer pressures and academic politics is misplaced, rendering the results of the survey irrelevant to the issue of the value of tenure. (Published Online February 8 2007).
Au début du mois d'août 1934, Husserl fut invité par Emanuel Radl à prendre part au huitième Congrès international de philosophie qui devait se tenir à Prague du 2 au 7 septembre de la même année. La situation politique allemande interdisait que Husserl et d'autres philosophes se rendissent à l'étranger, aussi Radl demanda-t-il à Husserl de lui envoyer une communication épistolaire destinée à être lue lors des débats. Husserl rédigea donc une lettre, la « Lettre pragoise » — qu'on (...) lut en séance et qui fut publiée d'abord dans le quotidien Prager Tageblatt, puis dans les Actes du colloque² —, mais, outre cela, un texte plus long consacré au même thème : la tâche actuelle de la philosophie. C'est ce texte dont on lira ici la traduction. De multiples péripéties et des circonstances diverses ont empêché que Husserl envoie à temps ce texte plus achevé; quelques indications données par lui-même dans sa correspondance³, avec Patocka notamment, montreni qu'il n'en était pas entièrement satisfait et qu'il souhaitait revoir au moins le début. Ces remaniements vont peu à peu déboucher sur la célèbre conférence de 1935 (Vienne) sur la crise des sciences européennes, qui est fort proche du présent texte bien que le point de départ n 'en soit plus désormais l'interrogation sur le rôle de la philosophie, mais la critique des sciences. Quoi qu'il en soit, la « conférence de Prague » inaugure la série des textes qui aboutiront à la dernière grande œuvre de Husserl, La Crise des sciences européennes et la phénoménologie transcendantale dont l'essai qu'on va lire est, en quelque sorte, la toute première esquisse. (shrink)