Research ethicists have recently declared a new ethical imperative: that researchers should communicate the results of research to participants. For some analysts, the obligation is restricted to the communication of the general findings or conclusions of the study. However, other analysts extend the obligation to the disclosure of individual research results, especially where these results are perceived to have clinical relevance. Several scholars have advanced cogent critiques of the putative obligation to disclose individual research results. They question whether ethical goals (...) are served by disclosure or violated by non-disclosure, and whether the communication of research results respects ethically salient differences between research practices and clinical care. Empirical data on these questions are limited. Available evidence suggests, on the one hand, growing support for disclosure, and on the other, the potential for significant harm. (shrink)
Recent magnetic resonance imaging (MRI) and pathological studies have indicated that axonal loss is a major contributor to disease progression in multiple sclerosis. 1 H magnetic resonance spectroscopy (MRS), through measurement of N -acetyl aspartate (NAA), a neuronal marker, provides a unique tool to investigate this. Patients with primary progressive multiple sclerosis have few lesions on conventional MRI, suggesting that changes in normal appearing white matter (NAWM), such (...) as axonal loss, may be particularly relevant to disease progression in this group. To test this hypothesis NAWM was studied with MRS, measuring the concentration of N -acetyl derived groups (NA, the sum of NAA and N -acetyl aspartyl glutamate). Single-voxel MRS using a water-suppressed PRESS sequence was carried out in 24 patients with primary progressive multiple sclerosis and in 16 age-matched controls. Ratios of metabolite to creatine concentration (Cr) were calculated in all subjects, and absolute concentrations were measured in 18 patients and all controls. NA/Cr (median 1.40, range 0.86–1.91) was significantly lower in NAWM in patients than in controls (median 1.70, range 1.27–2.14; P = 0.006), as was the absolute concentration of NA (patients, median 6.90 mM, range 4.62–10.38 mM; controls, median 7.77 mM, range 6.60–9.71 mM; P = 0.032). There was no significant difference in the absolute concentration of creatine between the groups. This study supports the hypothesis that axonal loss occurs in NAWM in primary progressive multiple sclerosis and may well be a mechanism for disease progression in this group. (shrink)
Machine generated contents note: Introduction Jon Miller; Part I. Textual Issues: 1. On the unity of the Nicomachean Ethics Michael Pakaluk; Part II. Happiness: 2. Living for the sake of an ultimate end Susan Sauve;; 3. Contemplation and Eudaimonia in the Nicomachean Ethics Norman O. Dahl; 4. Aristotle on Eudaimonia, Nous, and divinity A. A. Long; Part III. Psychology: 5. Aristotle, agents, and action Iakovos Vasilou; 6. Wicked and inappropriate passion Stephen Leighton; 7. Perfecting pleasures: the metaphysics of pleasure (...) in Nicomachean Ethics X Christopher Shields; 8. Aristotle's definition of non-rational pleasure and pain and desire Klaus Corcilius; 9. Non-rational desire and Aristotle's moral psychology Giles Pearson; Part IV. Virtues: 10. Beauty and morality in Aristotle T. H. Irwin; 11. Justice in the Nicomachean Ethics Book V Hallvard Fossheim. (shrink)
The 'Art of Life' is John Stuart Mill's name for his account of practical reason. In this volume, eleven leading scholars elucidate this fundamental, but widely neglected, element of Mill's thought. Mill divides the Art of Life into three 'departments': 'Morality, Prudence or Policy, and Æsthetics'. In the volume's first section, Rex Martin, David Weinstein, Ben Eggleston, and Dale E. Miller investigate the relation between the departments of morality and prudence. Their papers ask whether Mill is a rule utilitarian (...) and, if so, whether his practical philosophy must be incoherent. The second section contains papers by Jonathan Riley and Wendy Donner, who explore the relation between the departments of morality and aesthetics. They discuss issues ranging from supererogation to aesthetic pleasure and humanity's relationship with nature. -/- The papers in the third section consider the Art of Life's axiological first principle, the principle of utility. Elijah Millgram contends that Mill's own life refutes his claim that the Art of Life has a single axiological first principle. Philip Kitcher maintains that Mill has a dynamic axiology requiring us to continually refine our conception of the good. In the final section, three papers address what it means to put the Art of Life into practice. Robert Haraldsson locates an 'Art of Ethics' in On Liberty that is in tension with the Art of Life. Nadia Urbinati plumbs the classical roots of Mill's view of the good life. Finally, Colin Heydt develops Mill's suggestion that we regard our own lives as works of art. (shrink)
The separation, uniformization, and other properties of the Borel and projective hierarchies over hyperfinite sets are investigated and compared to the corresponding properties in classical descriptive set theory. The techniques used in this investigation also provide some results about countably determined sets and functions, as well as an improvement of an earlier theorem of Kunen and Miller.
In the Statesman , Plato brings together--only to challenge and displace--his own crowning contributions to philosophical method, political theory, and drama. In his 1980 study, reprinted here, Mitchell Miller employs literary theory and conceptual analysis to expose the philosophical, political, and pedagogical conflict that is the underlying context of the dialogue, revealing that its chaotic variety of movements is actually a carefully harmonized act of realizing the mean. The original study left one question outstanding: what specifically, in the metaphysical (...) order of things, motivated the nameless Visitor from Elea to abandon bifurcation for his consummating non-bifurcatory division of fifteen kinds at the end of the dialogue? Miller addressed in a separate essay, first published in 1999 and reprinted here. In it, he opens the horizon of interpretation to include the new metaphysics of the Parmenides , the Philebus , and the "unwritten teachings." "This study demonstrates how the Statesman is the culminating expression of Plato's lifelong effort, both in Athens and in the Academy, to bring metaphysical insight to the unending political crisis of his times."The Philosopher in Plato's Statesman a trail-blazing work. While not every reader will agree with the lessons Miller himself draws from this approach, none should fail to be impressed by its interpretive power. All this is exciting stuff. The interpretive pathway on which Miller has embarked has the potential for changing the face of scholarship on the late Platonic dialogues. Parmenides [Publishing] is to be commended for making these two important contributions available under a single cover." -- Kenneth Sayre, Professor of Philosophy, University of Notre Dame "Miller casts considerable light on virtually every aspect of the dialogue. . . . All in all, this book is an outstanding contribution to our understanding of the Statesman." -- Stanley Rosen, Borden Parker Bowne Professor of Philosophy, Boston University MITCHELL MILLER is Professor of Philosophy at Vassar College. He is the author of Plato's Parmenides. (shrink)
Pragmatism is a distinctive approach to clinical research ethics that can guide bioethicists and members of institutional review boards (IRBs) as they struggle to balance the competing values of promoting medical research and protecting human subjects participating in it. After defining our understanding of pragmatism in the setting of clinical research ethics, we show how a pragmatic approach can provide guidance not only for the day-to-day functioning of the IRB, but also for evaluation of policy standards, such as the one (...) that addresses acceptable risks for healthy children in clinical research trials. We also show how pragmatic considerations might influence the debate about the use of deception in clinical research. Finally, we show how a pragmatic approach, by regarding the promotion of human research and the protection of human subjects as equally important values, helps to break down the false dichotomy between science and ethics in clinical research. (shrink)
The analysis of interacting relativistic many-particle systems provides a theoretical basis for further work in many diverse fields of physics. After a discussion of the nonrelativisticN-particle systems we describe two approaches for obtaining the canonical equations of the corresponding relativistic forms. A further aspect of our approach is the consideration of the constants of the motion.
Controversies about the diagnosis and meaning of brain death have existed as long as the concept itself. Here we review the historical development of brain death, and then evaluate the various attempts to justify the claim that patients who are diagnosed as brain dead can be considered dead for all legal and social purposes, and especially with regard to procuring their vital organs for transplantation. While we agree with most commentators that death should be defined as the loss of integration (...) of the functioning of the organism as a whole, we conclude that patients diagnosed as brain dead have not, in fact, lost this integrated functioning. We close with reflections on the implications of this conclusion generally and particularly with regard to organ transplantation, and briefly make reference to alternative approaches to justifying the procurement of transplantable organs that do not depend upon a flawed approach to the diagnosis of death. (shrink)
Conventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life-sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life-sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of medication. We argue that the differential moral assessment of these two practices (...) is based on a series of moral fictions – motivated false beliefs that erroneously characterize withdrawing life-sustaining treatment in order to bring accepted end-of-life practices in line with the prevailing moral norm that doctors must never kill patients. When these moral fictions are exposed, it becomes apparent that conventional medical ethics relating to end-of-life decisions is radically mistaken. (shrink)
Investigation of neural and cognitive processes underlying individual variation in moral preferences is underway, with notable similarities emerging between moral- and risk-based decision-making. Here we specifically assessed moral distributive justice preferences and non-moral financial gambling preferences in the same individuals, and report an association between these seemingly disparate forms of decision-making. Moreover, we find this association between distributive justice and risky decision-making exists primarily when the latter is assessed with the Iowa Gambling Task. These findings are consistent with neuroimaging studies (...) of brain function during moral and risky decision-making. This research also constitutes the first replication of a novel experimental measure of distributive justice decision-making, for which individual variation in performance was found. Further examination of decision-making processes across different contexts may lead to an improved understanding of the factors affecting moral behaviour. (shrink)
Despite strong growth in scientific investigation of the placebo effect, understanding of this phenomenon remains deeply confused. We investigate critically seven common conceptual distinctions that impede clear understanding of the placebo effect: (1) verum/placebo, (2) active/inactive, (3) signal/noise, (4) specific/nonspecific, (5) objective/subjective, (6) disease/illness, and (7) intervention/context. We argue that some of these should be eliminated entirely, whereas others must be used with caution to avoid bias. Clearing away the conceptual underbrush is needed to lay down a path to understanding (...) and harnessing placebo effects in clinical medicine. (shrink)
Aristotle saw ethics as a habit that is modeled and developed though practice. Shelly's Victor Frankenstein, though well intentioned in his goals, failed to model ethical behavior for his creation, abandoning it to its own recourse. Today we live in an era of unfettered mergers and acquisitions where once separate and independent media increasingly are concentrated under the control and leadership of the fictitious but legal personhood of a few conglomerated corporations. This paper will explore the impact of mega-media mergers (...) on ethical modeling in journalism. It will diagram the behavioral context underlying the development of ethical habits, discuss leadership theory as it applies to management, and address the question of whether the creation of mega-media conglomerates will result in responsible corporate citizens or monsters who turn on their creators. (shrink)
Our objective is to understand how parents and children perceive their roles in decision making about research participation. Forty-five children (ages 4-15 years) with or without a chronic condition and 21 parents were the participants. A semistructured interview assessed perceptions of up to 4 hypothetical research scenarios with varying levels of risk, benefit, and complexity. Children were also administered the Peabody Picture Vocabulary Test, Third Edition, to assess verbal ability, as a proxy for the child's cognitive development. The audiotaped interviews (...) were transcribed and analyzed for themes related to parent and child decision-making roles. Both parents and children varied in their perceptions of decision-making roles. Child perceptions of parental influence on decision making as knowledge-based increased with cognitive development, whereas perceptions of parental influence as power-based decreased. Both children and parents commented that they would collaborate with each other when making decisions. Collaborative decision making appeared to increase with cognitive development. These findings suggest that approaches to child assent and parent permission should consider the parent-child relationship and how children and families typically make decisions. Future research is necessary to explain variation in the process of research decision making across children and families, explore the role of collaboration on children's decision-making skills, and understand developmental trajectories and mechanisms related to research decision making. (shrink)
Bioethics is a hybrid discipline. As a theoretical enterprise it stands for untrammeled inquiry and argument. Yet it aims to influence medical practice and policy. In this article we explore tensions between these two dimensions of bioethics and examine the merits and perils of a “Socratic” approach to bioethics that challenges “the conventional wisdom.”.
Hobbes promises to teach philosophers how to imitate God. With this bold claim as its basis, the paper questions the widely accepted view that Hobbes authored an early instance of a modern social science. It focuses on the constraints that Hobbes imposes on the language of philosophical practitioners. He restricts its truth-claims to the closed circle of language; he does not philosophize to describe, model, predict, or mirror empirical reality. He nevertheless makes claims for a useful science, (...) one that can construct a stable commonwealth. The restrictive claims concerning truth and Hobbes's claim to a practical philosophy are reconciled through an investigation of his distinction between 'a posteriori' and 'a priori' sciences. Hobbes teaches philosophers to imitate God as a creator : as a 're-creator' of divinely produced effects (a posteriori), or (like an architect) by manipulating matter to create things we design ourselves (a priori). The science of politics is a priori. It dictates the motions (of men) so as to create a well-ordered commonwealth, an artificial man, a creation made in our own image. (shrink)
Corporate executives, at the behest of Wall Street, have embraced the heresy of upsizing short-term shareholder profits by downsizing the long-term work force. This restructuring of corporate America, which views the corporation as an investment organization rather than a social organization, has created an ethical quandary by removing from the equation a sense of larger-purpose. This paper proposes a new paradigm, LIFESIZING, to address the issues raised by this ethical quandary. The paper will explore the effect the creation of fictitious (...) personhood (Corporations, Government, Wall Street, Unions, etc.) has had on the concept of personal responsibility and common good when responsible individuals are but transient members of such a legal entity. It will briefly recap the history of downsizing, the practice of treating workers as an expense rather than a capital asset, stakeholder theory, and the rise of a "me-first" culture. It will then define and apply LIFESIZING to both the individual and the corporation in an attempt to provide a sense of balance missing from current discourse. (shrink)
Media stories of ethical lapses in business are relentless. The general public vacillates between revulsion, impatience, cynicism, and apathy. The role of the Business School in Moral Development is debated by scholars, accrediting agencies, and Schools of Businesses. It is a question to which there is no easy answer and one with which Business Schools continue to grapple. This article places the concept of "moral imagination," theories of moral development, and ethics in a behavioral context. It then discusses a staple (...) of business education, the case study, as a form of ethics narrative that provides ethical modeling within that context. Finally, in discussing the narrative role of the classroom professor in ethical modeling, it provides a framework for further discussion of the role of business education in moral development. (shrink)
This book challenges fundamental doctrines of established medical ethics. It is argued that the routine practice of stopping life support technology causes the death of patients and that donors of vital organs (hearts, liver, lungs, and both kidneys) are not really dead at the time that their organs are removed for life-saving transplantation. Although these practices are ethically legitimate, they are not compatible with traditional medical ethics: they conflict with the norms that doctors must not intentionally cause the death of (...) their patients and that vital organs can be obtained only from dead donors. The aim of this book is to undertake an ethical examination that aims to honestly face the reality of medical practices at the end of life. This involves exposing the misconception that stopping life support merely allows patients to die from their medical conditions, that there is an ethical bright line separating withdrawal of life support from active euthanasia, and that determination of death of hospitalized patients prior to vital organ donation is consistent with the established biological conception of death. A novel ethical justification is required for procuring vital organs from still-living donors. It is contended that in the context of plans to withdraw life support, donors of vital organs are not harmed or wronged by organ procurement prior to death, provided that valid consent is obtained for stopping treatment and organ donation. In view of serious practical difficulties in facing the truth regarding organ donation, an alternative pragmatic account is developed for justifying current practices that relies on the concept of transparent legal fictions. In sum, it is the thesis of this book that to preserve the legitimacy of end-of-life practices, we need to reconstruct medical ethics. (shrink)
'Hobbes and the Imitation of God' ( Inquiry , 44, 223-6) is Eric Brandon's criticism of my article, 'Thomas Hobbes and the Constraints that Enable the Imitation of God' ( Inquiry , 42, 149-76). Brandon's criticisms are rooted in a misunderstanding of what is argued. Observations made concerning Hobbes's claims about prudence - a form of thinking Hobbes distinguishes from philosophic practice - are erroneously described by Brandon as a part of arguments concerning Hobbes's claims about philosophy. Brandon's own account (...) reaffirms a conventional interpretation by claiming that Hobbes envisioned philosophers discovering order, an interpretation challenged in the original argument. Hobbes privileged the creation of order over attempts to discover the order of the world, and this is reflected in his affinity for geometry over physics. (shrink)
Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the (...) circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (shrink)
In the past, hypothesis testing in medicine has employed the paradigm of the repeatable experiment. In statistical hypothesis testing, an unbiased sample is drawn from a larger source population, and a calculated statistic is compared to a preassigned critical region, on the assumption that the comparison could be repeated an indefinite number of times. However, repeated experiments often cannot be performed on human beings, due to ethical or economic constraints. We describe a new paradigm for hypothesis testing which uses only (...) rearrangements of data present within the observed data set. The token swap test, based on this new paradigm, is applied to three data sets from cardiovascular pathology, and computational experiments suggest that the token swap test satisfies the Neyman Pearson condition. (shrink)
Rose presents an important critique of the determinism and reductionism of modern biology. However, such trends are probably temporary aberrations in the development of science. Another form of determinism which has deeper roots is emerging from modern studies of brain dynamics. To reconcile this evidence with the concept of a “person” will require more radical rethinking of our received notion of natural law.
. In an era of downsizing and disposable ethics, there is a need to redefine the role of business in society. Central to such a discussion is the frame of reference of the entrepreneur. A traditional business model defines entrepreneurship based on endowing resources with new wealth producing capabilities. This paper defines entrepreneurship as a calling to endow resources with new value. In support of the impact such a distinction would have on repositioning the role of business in society, the (...) paper weaves together writings from the Pope, Drucker, and Lonergan, with emphasis on applying Lonergan’s discussion of bias to the discussion of ethics in business. Adapting the term, “lifesizing”, which was coined by the author in a previous article, to entrepreneurship, the paper takes the position that lifesized entrepreneurship can act as a catalyst similar to Lonergan’s cosmopolis and play a key role in countering bias and repositioning the role of business in society. (shrink)
It has been demonstrated that death certificates do not accurately record the actual cause of death in up to one-fourth of cases, as determined from subsequent autopsy findings. The purpose of this study was to explore the use of natural language autopsy data bases as an automated quality assurance mechanism. We translated the account of the major process leading to death, or the primary diagnosis, from all 45,564 narrative autopsy reports obtained at The Johns Hopkins Hospital between May 28, 1889, (...) and June 30, 1987, into the hierarchical system of Medical Subject Heading (MeSH) titles. We obtained a total of 125,772 MeSH title translations, 1,563 of them distinct (average 2.8 per case), ranging in frequency from 6,029 occurrences of LUNG to 1 occurrence apiece of 357 MeSH titles. The natural-language-to-MeSH translations showed expected trends over the past century: fewer infectious diseases; more cardiovascular and neoplastic disease among adults; and more respiratory diseases and congenital malformations in the pediatric age group. The greater availability of autopsy documents in electronic form should increase the value of this resource for quality assurance. (shrink)
The 2012 Varsity Medical Debate between Oxford University and Cambridge University provided a stage for representatives from these famous institutions to debate the motion “This house believes that trainee doctors should be able to use the developing world to gain clinical experience.” This article brings together many of the arguments put forward during the debate, centring around three major points of contention: the potential intrinsic wrong of ‘using’ patients in developing countries; the effects on the elective participant; and the effects (...) on the host community. The article goes on to critically appraise overseas elective programmes, offering a number of solutions that would help optimise their effectiveness in the developing world. (shrink)