Patients have received experimental pharmaceuticals outside of clinical trials for decades. There are no industry-wide best practices, and many companies that have granted compassionate use, or ‘preapproval’, access to their investigational products have done so without fanfare and without divulging the process or grounds on which decisions were made. The number of compassionate use requests has increased over time. Driving the demand are new treatments for serious unmet medical needs; patient advocacy groups pressing for access to emerging treatments; internet platforms (...) enabling broad awareness of compelling cases or novel drugs and a lack of trust among some that the pharmaceutical industry and/or the FDA have patients’ best interests in mind. High-profile cases in the media have highlighted the gap between patient expectations for compassionate use and company utilisation of fair processes to adjudicate requests. With many pharmaceutical manufacturers, patient groups, healthcare providers and policy analysts unhappy with the inequities of the status quo, fairer and more ethical management of compassionate use requests was needed. This paper reports on a novel collaboration between a pharmaceutical company and an academic medical ethics department that led to the formation of the Compassionate Use Advisory Committee. Comprising medical experts, bioethicists and patient representatives, CompAC established an ethical framework for the allocation of a scarce investigational oncology agent to single patients requesting non-trial access. This is the first account of how the committee was formed and how it built an ethical framework and put it into practice. (shrink)

Traditional pharmacy education emphasizes the biological processes of diseases and their pharmacological treatments. While the intense focus on biomedical aspects of disease is vital to educating pharmacy students, this focus is often insufficient in conveying what patients experience. The humanities, however, offer powerful characterizations of the disease experience for individuals as well as its impact on the human condition more generally. In this essay, I describe how using literary texts with pharmacy students provides them with a fuller appreciation of what (...) patients face with their diseases. The goal of this endeavor is to make students more effective as pharmacists in detecting and responding to their patients’ problems and needs by connecting their biomedical knowledge to depictions and meanings of illness experiences. (shrink)

Health care costs have been rising steadily in most industrialized countries. These increases are driven primarily by technological advances and, to a lesser degree, by aging of the population. Many factors make it unlikely that market forces alone will limit increases in the costs of health care. These unremitting increases make health care rationing appear both necessary and inevitable.One of the least controversial mechanisms for rationing could be to allow patients to make their own choices as to which kinds of (...) care they would be willing to forgo. This is appealing because it preserves individual freedom of choice regarding health care in a way that other rationing mechanisms often do not. Rationing by patient choice, however, can only happen if patients recognize that resources are limited and need to be conserved, and are willing to forgo marginal benefits. (shrink)

The present study was designed to explore the relationship between self-reported dissociative experiences and performance in tasks eliciting right-hemisphere processing load. Thirty-four participants performed a vigilance task in two conditions: with task-irrelevant negative-arousing pictures and task-irrelevant neutral pictures. Dissociation was assessed with the Dissociative Experience Scale. Consistent with theories positing right-hemisphere deregulation in high non-clinical dissociators, dissociative experiences correlated with greater vigilance decrement only in the negative picture condition. As both the vigilance task and negative picture processing are right lateralized, (...) this result provides support for a right-hemisphere dysfunction in high dissociators, at least in negative conditions. (shrink)

Drawing upon the experiences and insights of a diverse group of notable contributors, this volume is perhaps the most complete study available on clergy ethics. The topics discussed include the separation of church and state, clergy professionalization, ethical pastoral care, and many more.

The philosophical literature on sport and games has had little to say about boredom beyond presuming that sports and games can be important ways of overcoming or preventing it. But boredom is an interesting and often misunderstood phenomenon with overlooked implications in this context. Boredom has significant human value and motivates play in ways that contribute to well-being and culture, often through encouraging engaged agency and exploration of novelty. Understanding boredom can also help to clarify problems and tendencies in sports (...) and games that qualify them as havens from boredom. (shrink)

A well-known term in eighteenth-century literature and philosophy, the “beautiful soul” (die schöne Seele) has resurfaced in recent years. Deleuze refers to the beautiful soul’s “religiosity” and argues that aggressive “selection” is necessary as its antidote. However, in volatile contexts of social destabilization, such selection risks recoiling into reactionary violence. After first developing in more detail the beautiful soul’s background as a discursive figure, I argue that understanding Deleuze’s selection within a context of spiritual experience is necessary to mitigate this (...) worry. Exploration of this experience is pursued through juxtaposition of Deleuze’s thought with Nishida Kitarō’s investigation of the ontological structure of religious consciousness. The comparative resonances I develop suggest an ontological objectivity to the problems and structuring of the logos of religious consciousness and show how a more explicitly spiritual rendering of “selection,” developed through the Deleuze/Nishida encounter, intervenes into the broader beautiful soul problematic. (shrink)

We add texture to the conclusion of Duchon and Drake (Journal of Business Ethics, 85, 2009, 301) that extreme narcissism is associated with unethical conduct. We argue that the special features possessed by financial accounting facilitate extreme narcissism in susceptible CEOs. In particular, we propose that extremely narcissistic CEOs are key players in a recurring discourse cycle facilitated by financial accounting language and measures. Such CEOs project themselves as the corporation they lead, construct a narrative about the corporation and themselves (...) using financial accounting measures, and then reflect on how their accounting-constructed performance is perceived by stakeholders. We do not present empirical evidence about whether the use of accounting language and measures leads to unethical behaviour by extreme narcissistic CEOs — although the conclusions of Duchon and Drake (2009) suggest empirical support is probable. Rather, we focus on developing alertness to the potential for accounting, when engaged by an extremely narcissistic CEO, to be a precursor or implement of unethical behaviour. (shrink)

Over 40 years ago, Daniel Bell made the provocative claim that ideological polarization was diminishing in Western democracies, but new ideologies were emerging and driving politics in developing nations. This article tests the EndofIdeology thesis with a new wave of public opinion data from the World Values Survey (WVS) that covers over 70 nations representing more than 80 per cent of the world's population. We find that polarization along the Left/Right dimension is substantially greater in the less affluent and less (...) democratic societies than in advanced industrial democracies. The correlates of Left/Right orientations also vary systematically across regions. The twin pillars of economic and religious cleavages remain important in European states; cultural values and nationalism provide stronger bases of ideology in Asia and the Middle East. As Bell suggested, social modernization does seem to transform the extent and bases of ideological polarization within contemporary societies. (shrink)

This paper reviews the development of socially responsible investment (SRI) over recent years and highlights the prospects for an increasingly strong connection with the practice of corporate social responsibility. The paper argues that not only has SRI grown significantly, it has also matured. In particular, it has become an investment philosophy adopted by a growing proportion of large investment institutions. This shift in SRI from margin to mainstream and the position in which institutional investors find themselves is leading to a (...) new form of SRI shareholder pressure. Although this bears some resemblance to lobbying campaigns which might take advantage of shareholder rights, we seek to distinguish it as an important phenomenon in its own right — one to which corporate executives are likely to be paying increasing attention in the years to come. We further argue that this approach potentially meets some of the earlier ethical criticisms of certain forms of SRI but, ironically, probably owes its existence to those pioneering approaches. We conclude with some suggestions for further research to inform discussion of the issues highlighted in the paper. (shrink)

In this paper we examine how the use of robots in caring for elders can impact the meaningfulness of elders’ lives. We present a framework for understanding ‘meaningfulness in life’, and then apply that framework in discussing ways in which the use of robots to assist in activities of daily living can preserve, enhance or undermine the meaningfulness of elders’ lives. We conclude with a discussion of if and how having false beliefs about companion robots can affect meaningfulness in the (...) life of the person having those false beliefs. (shrink)

Two types of conception of a Way of Life are important for a consideration of the question of the forming and testing of ideals of conduct, and consequently for a consideration of our questions regarding the relation of ideals to practice. The one type is more, the other type less general. The one has reference to man as man, the other to particular classes of man, with relation to their specific function in society. The former issues in the idea of (...) a universal ethic, the latter in the idea of a professional code. Thus the former has a wider generality, the latter has a greater concreteness. Ethical progress seems to me to require that both types should be kept in view, and used to guide man's efforts. (shrink)

:This paper examines the transmediation of sacrifice in the Isuma “Fast Runner” trilogy, focusing in particular upon The Journals of Knud Rasmussen. In this film the impact of the introduction of Christianity upon traditional Inuit culture in the 1920s sets the stage for literal and metaphorical sacrifice, tied inexorably to the parallel threat of conversion and the transvaluation of traditional shamanistic beliefs. In the process, the film maintains a critical stance with respect to both the ethnographic perspective of the outsider, (...) which it incorporates, and to its own preferred Inuit perspective. My reading of the transmediation of sacrifice in The Journals rests upon the relation between sacrificial substitution and the notion of communion, in both doctrinaire and more secular senses. I argue that the film presents the Inuit characters negotiating a necessary détente with Christian culture, both at the cost of traditional beliefs and in the form of the co-optation and transmediation of ritual within the film's story, a process mirrored in the appropriation of the digital video medium in the fictional re-creation of these events. (shrink)

Two types of conception of a Way of Life are important for a consideration of the question of the forming and testing of ideals of conduct, and consequently for a consideration of our questions regarding the relation of ideals to practice. The one type is more, the other type less general. The one has reference to man as man, the other to particular classes of man, with relation to their specific function in society. The former issues in the idea of (...) a universal ethic, the latter in the idea of a professional code. Thus the former has a wider generality, the latter has a greater concreteness. Ethical progress seems to me to require that both types should be kept in view, and used to guide man's efforts. (shrink)

The transition from a vague generalization to an accurate statement is the first step on the road to science. It is a step of great importance. Vague generalizations find a ready entrance into many minds, and produce a comfortable sense of satisfaction that is easily mistaken for knowledge, and that stops further questioning. An exact statement of fact, on the other hand, draws attention to detail, and shows itself to be set in a mass of further detail that it challenges (...) you to explore. “Nature abhors a vacuum” sounds final; it explains why water will rise in an ordinary suction-pump rather than allow a vacuum to be produced; why the schoolboy’s “sucker” will lift a stone; and many other phenomena of a similar kind. It explains everything by a phrase and stimulates no inquiry. But when Galileo noted that the pump would raise water only to a height of about 32 feet, and pointed out that this gives a measure of the extent to which Nature abhors a vacuum in its dealings with water, new questions arose, stimulating further investigation. (shrink)