In her valuable book Hiding from humanity: Disgust, shame and the law, Nussbaum says that she reaches many of the same practical conclusions as Mill. But she argues that Mill’s conceptions of liberty, justice, and respect for rival ideas of the good and for religious belief, are defective, and further that they do not provide as adequate a basis for the form of political liberalism she recommends. Actually, the alleged defects in Mill rest largely on misrepresentations, but more importantly, once (...) one understands the central role of Mill’s account of justice in shaping his view of liberty and morality, it becomes clear that he offers a better response to cultural pluralism. His way of relating the morality and the aesthetics of conduct embodies a kind of respect for diversity both deeper and more realistic than that claimed for political liberalism. Mill brings a heritage from the Enlightenment in the light of which political liberalism looks like a failure of nerve. (shrink) -/- John Stuart Mill in 19th Century Philosophy Justice, Misc in Social and Political Philosophy. (shrink)

This _Biographical Dictionary_ provides detailed accounts of the lives, works, influence and reception of thinkers from all the major philosophical schools and traditions of the twentieth-century. This unique volume covers the lives and careers of thinkers from all areas of philosophy - from analytic philosophy to Zen and from formal logic to aesthetics. All the major figures of philosophy, such as Nietzsche, Wittgenstein and Russell are examined and analysed. The scope of the work is not merely restricted to the major (...) figures in western philosophy but also covers in depth a significant number of thinkers from the near and far east and from the non-European Hispanic-language communities. The _Biographical Dictionary_ also includes a number of general entries dealing with important schools of philosophy, such as the Vienna Circle, or currents of thought, such as vitalism. These allow the reader to set the individual biographies in the context of the philosophical history of the period. With entries written by over 100 leading philosophy scholars, the _Biographical Dictionary_ is the most comprehensive survey of twentieth-century thinkers to date. _Structure_ The book is structured alphabetically by philosopher. Each entry is identically structured for ease of access and covers: * nationality * dates and places of birth and death * philosophical style or school * areas of interest * higher education * significant influences * main appointments * main publications * secondary literature * account of intellectual development and main ideas * critical reception and impact At the end of the book a _glossary_ gives accounts of the schools, movements and traditions to which these philosophers belonged, and thorough _indexes_ enable the reader to access the information in several ways: * by nationality * by major areas of contribution to philosophy e.g. aesthetics * by major influences on the thinker concerned e.g. Plato, Kant, Wittgenstein. (shrink)

BackgroundCritical public health measures implemented to mitigate the spread of the novel coronavirus disease (COVID-19) pandemic have disrupted health research worldwide, including HIV prevention research. While general guidance has been issued for the responsible conduct of research in these challenging circumstances, the contours of the dueling COVID-19 and HIV/aids pandemics raise some critical ethical issues for HIV prevention research. In this paper, we use the recently updated HIV Prevention Trials Network (HPTN) Ethics Guidance Document (EGD) to situate and analyze key (...) ethical challenges related to the conduct of HIV prevention research during the COVID-19 pandemic as well as identify potential areas for refinement of the guidance document based on this unprecedented state of affairs.Main bodyNecessary actions taken for HIV prevention research studies due to the COVID-19 pandemic involve an array of ethical issues including those related to: (1) risk mitigation; (2) behavior change; (3) compounding vulnerability; (4) community engagement; (5) trial reopening; and 6) shifting research priorities.ConclusionsIn the context of the dueling HIV and COVID-19 global pandemics, research teams and sponsors must be nimble in responding to the rapidly changing environment by being sensitive to the associated ethical issues. The HTPN EGD provides a rich set of tools to help identify, analyze and address many of these issues. At the same time, future refinements of the HPTN EGD and other research ethics guidance could be strengthened by providing explicit advice regarding the ethical issues associated with disrupted research and the reopening of studies. In addition, additional consideration should be given to appropriately balancing domains of risk (e.g., physical versus social), addressing the vulnerability of research staff and community partners, and responding to un-anticipatable ancillary care needs of participants and communities. Appropriately addressing these issues will necessitate conceptual work, which would benefit from the careful documentation of the actual ethical issues encountered in research, the strategies implemented to overcome them, and their success in doing so. Throughout all of these efforts, it is critical to remember that the HIV pandemic not be forgotten in the rush to deal with the COVID-19 pandemic. (shrink)

Mill's passion for individuality drives the protection in the harm principle, and the restriction of morality to the enforceable. This calls for compensating widening of the conception of harm. The result is a radical reshaping of the principle of utility as governing the art of life as whole, and of the whole conception of utilitarianism and of a utilitarian morality. His harm principle fully accepts that human relations occasion mutual harms, and turns, in the assessment of any restriction, to local (...) fact on whether it serves 'general utility'. It becomes extremely difficult to locate what fundamental principles of moral requirement Mill would actually accept, and to judge the extent they would differ from the common sense intuitions for which he shows such great respect. (shrink)

In nineteenth-century Europe …. [w]ith rare exceptions liberals approved of colonialism and provided it with a legitimizing ideology …. Liberalism became missionary, ethnocentric, and narrow, dismissing non-liberal ways of life and thought as primitive and in need of the liberal civilizing mission.This is the judgement passed by Professor Bhikhu Parekh in his 1994 essay “Decolonizing Liberalism.” His deference to John Stuart Mill is shown in his making Mill not one of the exceptions, but rather the central object of attack. (...) It would seem indeed that if the charges can be made good against Mill they will hold against nineteenth-century liberalism in general, and perhaps in some degree against twenty-first-century liberalism.Simple piety moves me to offer some defence of Mill's own good judgement, particularly in relation to India. But, in dealing with a phenomenon like liberalism, we need always to maintain a distinction which tends to blur. Doctrines and assertions are one thing. Historical movements and trends in a society are another. (shrink)

John Stuart Mill's Utilitarianism continues to serve as a rich source of moral and theoretical insight. This collection of articles by top scholars offers fresh interpretations of Mill's ideas about happiness, moral obligation, justice, and rights. Applying contemporary philosophical insights, the articles challenge the conventional readings of Mill, and, in the process, contribute to a deeper understanding of utilitarian theory as well as the complexity of moral life.

Background Institutional Review Boards (IRBs) are federally mandated to include both nonscientific and unaffiliated representatives in their membership. Despite this, there is no guidance or policy on the selection of unaffiliated or non-scientist members and reports indicate a lack of clarity regarding members’ roles. In the present study we sought to explore processes of recruitment, training, and the perceived roles for unaffiliated and non-scientist members of IRBs.Methods We distributed a self-administered REDCap survey of members of the Association for the Accreditation (...) of Human Research Protection Programs familiar with IRB member recruitment. The survey included closed and open-ended questions regarding: the operation of the HRPP/IRB(s), how unaffiliated and non-scientist members are recruited, whether they had faced challenges recruiting for these roles, and training and mentorship offered. The survey also collected information regarding the perceived value and roles of unaffiliated and non-scientist members.Results 76 responses were included in the analysis (38% completion rate). The most common approach for recruitment was referral from current IRB members, with almost half of respondents indicating challenges recruiting unaffiliated members. Over 75% indicated no additional training was provided to unaffiliated or non-scientist members compared to affiliated or scientist members. Most common supports provided were travel/parking expenses and honoraria. Commonly perceived roles were to provide an independent voice from the participant perspective, notably regarding consent processes and materials.Conclusions Respondents indicated challenges in defining unaffiliated and non-scientist members and limited practices toward recruitment and support. Future work should more closely examine the challenges in defining these roles and applying the definitions in practice, as well as strategies that may improve recruitment and retention of unaffiliated and non-scientist members. (shrink)

Volume 19, Issue 10, October 2019, Page 43-46.

Furthermore, adults with decision-making capacity, including pregnant women, can currently accept interventions with moderate net risks for themselves in other settings (e.g., open f...

In recent years we have seen a dramatic shift, in several different areas of communication studies, from an information-theoretic to a dynamic systems paradigm. In an information processing system, communication, whether between cells, mammals, apes, or humans, is said to occur when one organism encodes information into a signal that is transmitted to another organism that decodes the signal. In a dynamic system, all of the elements are continuously interacting with and changing in respect to one another, and an aggregate (...) pattern emerges from this mutual co-action. Whereas the information-processing paradigm looks at communication as a linear, binary sequence of events, the dynamic systems paradigm looks at the relation between behaviors and how the whole configuration changes over time. One of the most dramatic examples of the significance of shifting from an information processing to a dynamic systems paradigm can be found in the debate over the interpretation of recent advances in ape language research (ALR). To some extent, many of the early ALR studies reinforced the stereotype that animal communication is functional and stimulus bound, precisely because they were based on an information-processing paradigm that promoted a static model of communicative development. But Savage-Rumbaugh's recent results with bonobos has introduced an entirely new dimension into this debate. Shifting the terms of the discussion from an information-processing to a dynamic systems paradigm not only highlights the striking differences between Savage-Rumbaugh's research and earlier ALR studies, but further, it sheds illuminating light on the factors that underpin the development of communication skills in great apes and humans, and the relationship between communicative development and the development of language. Key Words: apes; ape language research (ALR); brain development; co-regulation; communication; dynamic systems; language development; symbols. (shrink)

Against the background assumptions that knowing what clinical ethics consultation represents to those with whom ethics consultants work most closely is a necessary component for being responsible in the practice of ethics consultation, and the complexities of soliciting and understanding colleague evaluations require another inherent responsibility for the methods by which ethics consultations are evaluated, in this article we report our experience soliciting, analyzing, and trying to understand retrospective evaluations of our Clinical Ethics Consultation Service. These evaluations were collected through (...) a quality assessment effort at our institution. Drawing from the qualitative elements of our survey instrument, we describe unexpected variations among the requests for ethics consultation and the retrospective reports from those colleagues making the requests. Focusing on just one aspect – the reason for request – raised several core questions about how we should evaluate those retrospective reports, what could be learned from the differences that we were now encountering, and what we could learn about the process of evaluating our practices. Working through these questions, we suggest several issues to consider in ongoing efforts to describe and evaluate clinical ethics consultation: the role of time and memory in evaluating retrospective evaluations, the importance of attending to the language of moral shift or disruption with which our colleagues describe their experiences, and how to understand the role of ethics consultation in creating ‘moral space’ for colleagues to process their moral experiences. (shrink)

“I beg of you, Doctor, please don’t let Dr. Moore see my mother again. My sisters and I do not want him talking with us anymore.”So concluded my first conversation with Samir Zadeh. Our meeting had been purely accidental; as I walked onto the elevator going down from the Surgical ICU, he and one of his sisters were already on, coming down from another one of our hospital’s ICUs, from a floor above. Samir was a man in his early 50s, (...) and his sister, whom I would learn was actually a few years older, appeared younger than he. They were talking quietly when the doors opened, but as is often the case in elevators, especially in a hospital, as soon as I entered, their conversation stopped. We rode down to the bottom floor in silence. As we exited, I let them go first, a courtesy I had been taught by my parents, and they both thanked me, in the usual social way, and walked out into the lobby and then out of the building. I walked the same way.It was when we were about 25 feet from the building that Mr. Zadeh and his sister stopped, so that I caught up to them. As I did, Mr. Zadeh, a large man, maybe 6 feet tall and 250 pounds, with thinning hair and a well-groomed mustache, turned and said my name aloud, “Dr. Finder, may you be so kind as to talk?”. (shrink)

In his article ‘The case against ethics review in the social sciences’, Schrag asserts that the social sciences should not be subject to ethical review. He recounts a number of examples where ethical review has seemingly failed. He further suggests some alternative models for dealing with ethical review in the social sciences. Finally, he concludes, and we concur, that there is a lack of empirical evidence as to the benefit of research ethics review.

Proposed changes to the Common Rule are proffered to save almost 7,000 reviews annually and consequently vast amounts of investigator and IRB-member time. However, the proposed changes have been subject to criticism. While some have lauded the changes as being imperfect, but nevertheless as improvements, others have contended that ‘neither the scientific community nor the public can be confident that improved practices will emerge from the regulatory changes mandated by the NPRM.’ In the present article, I discuss an important aspect (...) that has been overlooked: the question of whether benefits will emerge is demonstrably empirical, yet data upon which to draw conclusions are conspicuous by their absence. This is thrown into sharp relief when we consider the current environment in which health research is increasingly focused on providing evidence of need or benefit, where there is greater emphasis on evidence-based practice, and when we have the nascent field of implementation science. (shrink)

The past few years have seen greater attention directed toward important procedural elements associated with ethics consultation. Examples include considerations about how best to document consulta...

Clinical ethics literature typically presents ethics consultations as having clear beginnings and clear ends. Experience in actual clinical ethics practice, however, reflects a different characterization, particularly when the moral experiences of ethics consultants are included in the discussion. In response, this article emphasizes listening and learning about moral experience as core activities associated with clinical ethics consultation. This focus reveals that responsibility in actual clinical ethics practice is generated within the moral scope of an ethics consultant's activities as she or (...) he encounters the unique and specific features that emerge from interactions with a specific patient, or family, or practitioner within a given situation and over time. A long-form narrative about an ethics consultant's interactions is interwoven with a more didactic discussion to highlight the theme of responsibility and to probe questions that arise regarding follow-up within the practice of clinical ethics consultation. (shrink)

Newborn screening is the programme through which newborn babies are screened for a variety of conditions shortly after birth. Programmes such as this are individually oriented but resemble traditional public health programmes because they are targeted at large groups of the population and they are offered as preventive interventions to a population considered healthy. As such, an ethical tension exists between the goals of promoting the high uptake of supposedly ‘effective’ population-oriented programmes and the goal of promoting genuinely informed decision-making. (...) There is, however, a lack of understanding with regard to how parents experience the tension between promoting uptake and facilitating informed choice. This paper addresses this issue, and data are presented to show how aspects of the timing, presentation of information and procedural routinisation of newborn screening serves to impact on the decisions made by parents. (shrink)

This Open Access book about the Zadeh Project demonstrates and explores a core question in clinical ethics: how can ethics consultants be accountable in the face of a robust plurality of ethical standpoints, especially those that underwrite practices and methods for doing ethics consultation as well as those viewpoints and values encountered in daily clinical ethics practice? Underscoring this question is the recognition that the field of clinical ethics consultation has arrived at a crucial point in its maturation. Many efforts (...) are underway to more formally “professionalize” the field, with most aimed toward stabilizing a specific set of institutional considerations. Stretched between these institutional and practical initiatives resides a crucial set of of ethical considerations, chief among them the meaning and scope of responsibility for clinical ethics consultants. Developed around a long-form case scenario, the Zadeh Project provides a multi-layered series of “peer-reviews”: critique of the actions of the case scenario’s ethics consultant; reflection on clinical ethics method; examination of the many ways that commitments to method and practice can, and do, intersect, overlap, and alter one another. The design and format of this book thus models a key element for clinical ethics practice: the need and ability to provide careful and thoughtful explanation of core moral considerations that emerge among diverse standpoints. Specifically designed for those studying to become and those who are ethics consultants, this book, with its innovative and multi-layered approach, allows readers to share a peer-review-like experience that shows accountability to be what it is, an ethical, not merely procedural or administrative, undertaking. (shrink)

There are at least two fundamental questions in medical ethics: What constitutes the ethical components associated with medical practice?; and How are these components realized in daily medical practice? This dissertation is concerned with question . In particular, focus is on daily medical linguistic practices of physicians. Due to the entailment of question in question , however, a brief answer for is also provided. Specifically, it is argued that a tripartite theoretical ethical framework is associated with medical practice, consisting of (...) consequentialist, deontological, and virtue ethics components. Turning towards daily medical linguistic practices, two daily medical linguistic practices are examined: ways of referring to patients and referring to disease. Both are addressed as they occur in the context of physician-physician dialogues in a clinical, hospital setting. In light of a background argument concerning the theoretical connection between language, worldview, and ethical perspective, in which language is shown to play a role in defining both worldview and ethical perspective, the ethical perspective of physicians qua medical language users is addressed. It is suggested that although medical practice has the tripartite normative ethical foundation in theory, the practical influence of medical language used for diagnosis is to impose an essentially consequentialist framework within which patients are conceived. Consistent with this limited ethical framework, disease language is noted to suggest connotations of certainty. In light of the ambiguous and uncertain character of medical encounters between physicians and patients, the implication of certainty by disease language is problematic. Likewise, the limited, essentially consequentialist perspective of physicians is inappropriate. Physicians must therefore recognize the limitations of disease language and refrain from solely using the kind of medical language which conceptually reduces patients to mere disease loci. Physicians will thus be better able to account for the ethical implications of medical practice. (shrink)

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

Newborn bloodspot screening programs are some of the longest running population screening programs internationally. Debate continues regarding the need for parents to give consent to having their child screened. Little attention has been paid to how meanings of consent-related terminology vary among stakeholders and the implications of this for practice. We undertook semi-structured interviews with parents, healthcare professionals and policy decision makers in two Canadian provinces. Conceptions of consent-related terms revolved around seven factors within two broad domains, decision-making and information (...) attainment. Decision-making comprised: parent decision authority; voluntariness; parent engagement with decision-making; and the process of enacting choice. Information ascertainment comprised: professional responsibilities ; parent responsibilities; and the need for discussion and understanding prior to a decision. Our findings indicate that consent-related terms are variously understood, with substantive implications for practice. We suggest that consent procedures should be explained descriptively, regardless of approach, so there are clear indications of what is expected of parents and healthcare professionals. Support systems are required both to meet the educational needs of parents and families and to support healthcare professionals in delivering information in a manner in keeping with parent needs. (shrink)

To what extent does the case for exemptions from laws to accommodate religious commitments rest specifically on egalitarian arguments? To what extent should specifically egalitarian or anti-discrimination concerns be used to determine when such exemptions should be granted? This Article considers both of these questions. It argues that while egalitarian considerations have a role to play in both the general justification and case-by-case evaluation of exemption claims, neither the justification, nor the evaluation of exemptions, properly rests solely on specifically egalitarian (...) considerations. At the level of justification, there is an important, independent role for something akin to the principle of respect for conscience recently put forward by Martha Nussbaum; and, when citizens come to evaluate particular claims for exemptions, the anti-discrimination approach put forward by Christopher Eisgruber and Lawrence Sager in the context of the U.S. and its constitutional tradition is more plausibly seen as a complement to the “balancing test” which has been used historically rather than as an alternative to it. (shrink)

(2001). Activities, Not Rules: The Need for Responsive Practice (On the Way Toward Responsibility) The American Journal of Bioethics: Vol. 1, No. 4, pp. 52-54.

The UK has a long established programme of newborn bloodspot screening. This operates under a model of informed choice. Understanding is central to the `informed’ element of an informed choice yet it is rarely assessed. To date most research within the context of newborn bloodspot screening has focussed on parental recall of information. In this paper I argue that simplistic assessments of knowledge through recall fail to reflect more complex notions of understanding. In support of this contention I draw on (...) qualitative interviews with parents of children who have undergone newborn bloodspot screening. (shrink)

This paper presents the Functional/Emotional approach to language development, which explains the process leading up to the core capacities necessary for language; shows how this process leads to the formation of internal symbols; and how it shapes and is shaped by the child's development of language.

The Greeks had a ready answer for what happens when the mind suddenly finds the answer to a question for which it had been searching: insight was regarded as a gift of the Muses, its origins were divine. It served to highlight the Greeks'' belief that there are some things which are not meant to be scientifically explained. The essence of insight is that it comes from some supernatural source: unpredicted and unfettered. In other words, the origins of insight are (...) unconscious, and hence, unexplainable. Wittgenstein felt that, as long as there continues to be a noun expression like to have a moment of insight which functions in the same way as the expression to have a hunger pang, thereby inducing us to treat moment of insight as the name of an experience, then people will keep stumbling over the same puzzling difficulties and find themselves staring at something which no explanation seems capable of clearing up. To the founders of AI, this argument reeked of obscurantism. The moment of insight, they felt, is indeed a mystery, but it is one that begs to be explained in causal terms. Indeed, the problem of insight served as one of the leading problems in the evolution of AI. Hence anyone interested in the foundations of AI is compelled to examine the manner in which the early pioneers of the field sought to explain the eureka experience. In this paper I will look at some of the key conceptual developments which paved the way for Newell and Simon''s theory of GPS: the fundamental changes in the notion of the unconscious — the emergence of the cognitive unconscious — which took place in the nineteenth- and early twentieth-century. In so doing, I hope to clarify what Wittgenstein may have had in mind in his strictures against mechanist attempts to analyse the nature of insight. (shrink)

The twentieth century witnessed the birth of analytic philosophy. This volume covers some of its key movements and philosophers, including Frege and Wittgenstein's Tractatus.