This volume covers a wide range of conceptual, epistemological and methodological issues in the philosophy of science raised by reflection upon medical science and practice.

This paper critically examines a particular strategy for resolving the central ethical dilemma associated with randomized clinical trials — the “community equipoise” strategy . The dilemma is that RCTs appear to violate a physician's duty to choose that therapy which there is most reason to believe is in the patient's best interest, randomizing patients even once evidence begins to favor one treatment. The community equipoise strategy involves the suggestion that our judgment that neither treatment is to be preferred is to (...) be assessed according to a community rather than an individual standard. Thus, though a physician may personally believe that there is some reason to prefer one treatment, patients can legitimately be randomized if there remains disagreement in the community of medical professionals. Rationales in favor of this conception include the following: medical knowledge is best understood as residing in the community, the judgments of others count as evidence, and so should change one's own opinion, subjects would not be better off outside the trial, and the point of any trial is the resolution of dispute in the medical community. I critically examine these rationales and argue that they are insufficient. Amongst the problems are tensions between various of these underlying rationales, and important ambiguities in just what the CE criterion is to amount to. Finally, I argue that even if use of CE was justified, it would not justify carrying out RCTs anywhere near long enough to discharge our duty to gain reliable knowledge on which to base safe and effective medical practice. Hence, we need some different justification for carrying out RCTs. (shrink)

Recognizing that all traits are the result of an interaction between genes and environment, I offer a set of criteria for nevertheless making sense of our practice of singling out certain traits as genetic ones, in effect making a distinction between causes and mere conditions. The central criterion is that a trait is genetic if it is genetic differences that make the differences in that trait variable in a given population. A second criterion requires that genetic traits be individuated in (...) a way that matches what some genetic factors cause specifically. Clarifying our causal and classificatory language here can help us to avoid confusions of both theoretical and practical significance. (shrink)

The central dilemma concerning randomized clinical trials (RCTs) arises out of some simple facts about causal methodology (RCTs are the best way to generate the reliable causal knowledge necessary for optimally-informed action) and a prima facie plausible principle concerning how physicians should treat their patients (always do what it is most reasonable to believe will be best for the patient). A number of arguments related to this in the literature are considered. Attempts to avoid the dilemma fail. Appeals to informed (...) consent and mechanisms for minimizing the resulting harm are important for policy, but informed consent is problematic and mechanisms for minimization of harm do not address the dilemma. Appeals to some sort of contract model of justification are promising and illuminating. Keywords: randomized clinical trials, ethics CiteULike Connotea Del.icio.us What's this? (shrink)

This paper critically examines a particular strategy for resolving the central ethical dilemma associated with randomized clinical trials (RCTs) — the “community equipoise” strategy (CE). The dilemma is that RCTs appear to violate a physician's duty to choose that therapy which there is most reason to believe is in the patient's best interest, randomizing patients even once evidence begins to favor one treatment. The community equipoise strategy involves the suggestion that our judgment that neither treatment is to be preferred (that (...) there obtains a state of “equipoise”) is to be assessed according to a community rather than an individual standard. Thus, though a physician may personally believe that there is some reason to prefer one treatment, patients can legitimately be randomized if there remains disagreement in the community of medical professionals. Rationales in favor of this conception include the following: (i) medical knowledge is best understood as residing in the community, (ii) the judgments of others count as evidence, and so should change one's own opinion, (iii) subjects would not be better off outside the trial, and (iv) the point of any trial is the resolution of dispute in the medical community. I critically examine these rationales and argue that they are insufficient. Amongst the problems are tensions between various of these underlying rationales, and important ambiguities in just what the CE criterion is to amount to. Finally, I argue that even if use of CE was justified, it would not justify carrying out RCTs anywhere near long enough to discharge our duty to gain reliable knowledge on which to base safe and effective medical practice. Hence, we need some different justification for carrying out RCTs. (shrink)

In this article, I review and expand upon arguments showing that Freedman's so-called "clinical equipoise" criterion cannot serve as an appropriate guide and justification for the moral legitimacy of carrying out randomized clinical trials. At the same time, I try to explain why this approach has been given so much credence despite compelling arguments against it, including the fact that Freedman's original discussion framed the issues in a misleading way, making certain things invisible: Clinical equipoise is conflated with community equipoise, (...) and several versions of each are also conflated. But a misleading impression is given that, rather than distinct criteria being arbitrarily conflated, a puzzle is solved and a number of features unified. Various issues are pushed under the rug, hiding flaws of the "clinical equipoise" approach and thus deceiving us into thinking that we have a solution when we do not. Particularly significant is the ignoring of the crucial distinction between the individual patient decision and the policy decision. (shrink)

It is often claimed that a clinical investigator may ethically participate (e.g., enroll patients) in a trial only if she is in equipoise (if she has no way to ground a preference for one arm of the study). But this is a serious problem, for as data accumulate, it can be expected that there will be a discernible trend favoring one of the treatments prior to the point where we achieve the trial's objective. In this paper, I critically evaluate Benjamin (...) Freedman's 'clinical equipoise' solution to this dilemma. I argue that Freedman actually puts forth at least two distinct contrasts - one in terms of community vs. individual equipoise, and another concerning clinical vs. theoretical equipoise - and that neither of them resolves the dilemma. I then make a proposal for a more adequate account of how to think about the circumstances under which entering subjects in trials would be justified - a 'sliding-scale equipoise' that arises out of a discussion of patients' values. (shrink)

The units of selection problem is an issue within evolutionary theory (or the philosophy thereof) and concerns the question of what units or objects are acted upon by natural selection -- for example, whether these are genes, organisms or groups of organisms. One of the central theses of Elliot Sober’s recent book, The Nature of Selection, is that the philosophical problem of what it means for something to be a unit of selection is to be understood by applying the correct (...) account of what it is in general for a factor to be a cause in a population.The account of population-causation that Sober utilizes for this purpose comes from the recent literature on probabilistic causality. This account requires that for C to cause E in a population, a unanimity condition must be satisfied: C must raise the probability of E in each causal context. (shrink)

The public attitude to animal use in Australia and New Zealandcan be inferred from survey results and political activity. The publicis concerned about the rights of animals as far as any uses causing painare concerned, but takes a more utilitarian view of the taking of lifewhere no suffering is involved. Many of the participants in two recentANZCCART conferences fall short in their knowledge of and attitudetoward these concerns. Animal welfare legislation and standards need tobe reformed so that painful animal use (...) is eliminated, even if economicgrowth suffers as a result. (shrink)

This paper examines some criticisms that have been made of two standard genetic methodologies: heritability and path analysis. I conclude that the criticisms should be taken seriously, concerning both the accuracy of heritability measures and their significance. In light of the fact that such studies remain prominent in the literature, I consider what possible rationale they can retain consistent with these criticisms. In particular, I consider (1) a role in the identification of high-risk individuals and (2) a heuristic role in (...) the planning of research strategy. (shrink)

This paper is a preliminary exploration concerning how the ethics of research on human subjects may differ when we move from the well-discussed context of research on therapies to the less-discussed context of research on enhancements. A number of differences are described. There are some features that make such research more morally problematic in certain ways, but some of the features may actually ameliorate some of the moral tensions that exist in human subjects research. It is hoped that this analysis (...) will aid and encourage discussion of the topic that could help guide those who intend to carry out such this research. (shrink)

With both the cost and quality of health care under scrutiny, many in the health care industry have turned to outcomes research and practice guidelines for answers. But many physicians have resisted, claiming their clinical judgment is a better guide. Both camps may be right.

: As clinicians, researchers, bioethicists, and members of society, we face a number of moral dilemmas concerning randomized clinical trials. How we manage the starting and stopping of such trials—how we conceptualize what evidence is sufficient for these decisions—has implications for both our obligations to trial participants and for the nature and security of the resultant medical knowledge. One view of how this is to be done, "clinical equipoise," recently has been given an extended defense by Paul Miller and Charles (...) Weijer in their article "Rehabilitating Equipoise." The present paper critiques this position and Miller and Weijer's defense of it. I argue that their attempted rehabilitation fails. Their analysis suffers from a number of confusions, as well as a failure to make crucial distinctions, adequately to clarify key concepts, or to think through exactly what needs to be established to justify their claim. We are left with little reason to uphold the clinical equipoise criterion. (shrink)

Sober argues that the units of selection problem in evolutionary biology is to be understood and solved by applying the general analysis of what it means for C to cause E in a population. The account he utilizes is the unanimity account, according to which C causes E in a population when C raises the probability of E in each causal context. I argue that he does not succeed here, both because the unanimity account is not well grounded in the (...) general case, and because there are important differences between cases of population causation which do involve selection and those which do not. (shrink)

We are pleased to once again present to the readers of Theoretical Medicine and Bioethics papers from the Philosophy of Medicine Roundtable. Previous issues have followed the 3rd and 4th Roundtables, and the current issue presents a selection from the more than 20 papers presented at the 5th Philosophy of Medicine Roundtable, which took place in New York, at Columbia University, in November 2013. Like its predecessors, held in Birmingham, AL, Rotterdam, and San Sebastian, this Roundtable attracted speakers from around (...) the world. It also featured keynote presentations from Rita Charon of Columbia University and Ross Upshur of the University of Toronto.It may seem somewhat odd to feature a special issue on philosophy of medicine in a journal that effectively has philosophy of medicine in its title. However, a review of the contents of this journal and similar ones, such as the Journal of Medicine and Philosophy, will quickly reveal such an issue’s purpose. The dominant content of these j .. (shrink)

During the last few years two major volumes have been published, both greatly revised versions of earlier Gifford Lectures: Charles Taylor’s A Secular Age ( 2007 ) and Raimon Panikkar’s The Rhythm of Being ( 2010 ). The two volumes are similar in some respects and very dissimilar in others. Both thinkers complain about the glaring blemishes of the modern, especially the contemporary age; both deplore above all a certain deficit of religiosity. The two authors differ, however, both in (...) the details of their diagnosis and in their proposed remedies. Taylor views the modern age—styled as “secular age”—as marked by a slide into secular agnosticism, into “exclusive humanism”, and above all into an “immanent frame” excluding theistic “transcendence”. Although sharing the concern about “loss of meaning”, Panikkar does not find its source in the abandonment of (mono)theistic transcendence; on the contrary, both radical transcendence and agnostic immanence are responsible for the deficit of genuine faith. For him, recovery of faith requires an acknowledgment of our being in the world, as part of the “rhythm of being” happening in a holistic or “cosmotheandric” mode. In classical Indian terminology, while Taylor’s emphasis on the transcendence-immanence tension reflects ultimately a dualistic perspective (dvaita), Panikkar’s holistic notion of the rhythm of being captures the core of Advaita Vendanta. (shrink)

Recently, Fred Gifford attempted to explicate the meaning of the term genetic as applied to phenotypic traits. He takes as his primary goal the explication of how the term is used and tries to avoid conclusions about how it should be used. He proposes two independent criteria (DF and PI) which together capture much of what biologists mean when they describe traits as genetic. Although Gifford's approach is extremely insightful in many ways, I argue that his analysis (...) is not sufficiently critical concerning the adequacy of common usage.In particular, while DF is a perfectly legitimate and useful measure of heritability in populations, it is not necessarily a genetic one and should not be labeled as such. PI on the other hand, although very intuitive, depends on an extremely problematic distinction between causes and mere conditions (e.g., genes and epigenetic factors). Both criteria will be highly relative and both, via what I term the new problem of genetics, will inspire contradictory analyses based on the same data. (shrink)

: The authors respond to objections Fred Gifford has raised against their paper "Rehabilitating Equipoise." They situate this exchange in the wider context of recent debate over equipoise, highlighting substantial points of agreement between themselves and Gifford. The authors offer a brief restatement of "Rehabilitating Equipoise" in which they amplify some of its core arguments. They then assess Gifford's objections. Finding each to be unfounded, they argue that there is no justification for "pulling the plug" on (...) clinical equipoise. (shrink)

The disagreement over whether Aristotle recognized rights in some form unavoidably involves disagreement over what rights are, and the theory of rights itself is still highly contested. There is no consensus concerning how " right'? is to be defined, how rights are to be theoretically grounded, or how rights theory is to be applied in particular circumstances. This is not, however, a good reason to dismiss the issue of whether there are rights in Aristotle: for Aristotle, like modern rights theorists, (...) is concerned about the moral and legal status of the individual within the community, and he expresses this in terms of claims of justice. The issue is worthy of study not only because it can lead to a deeper understanding of Aristotle's conceptions of justice and the common good, but also because it may shed valuable light on the theoretical foundations of human rights, since he offers a theory of political justice which is based on a metaphysical theory of human nature. (shrink)

L'auteur décrit l'ambivalence du rapport qu'entretient E. Levinas avec la théologie, montre que la pensée de ce philosophe ne se réduit pas à une philosophie de l'autre, de l'extériorité mais qu'elle se pose comme une véritable défense de la subjectivité, et s'interroge sur l'utilisation de cette pensée dans le cadre d'une théologie chrétienne.

Critical Theory constitutes one of the major intellectual traditions of the twentieth century, and is centrally important for philosophy, political theory, aesthetics and theory of art, the study of modern European literatures and music, the history of ideas, sociology, psychology, and cultural studies. In this volume an international team of distinguished contributors examines the major figures in Critical Theory, including Horkheimer, Adorno, Marcuse, Benjamin, and Habermas, as well as lesser known but important thinkers such as Pollock and Neumann. The volume (...) surveys the shared philosophical concerns that have given impetus to Critical Theory throughout its history, while at the same time showing the diversity among its proponents that contributes so much to its richness as a philosophical school. The result is an illuminating overview of the entire history of Critical Theory in the twentieth century, an examination of its central conceptual concerns, and an in-depth discussion of its future prospects. (shrink)

"This anthology of writings by prominent black thinkers from antiquity to the present makes the case for a central tradition of black philosophy, rooted in Africa and distinct from the intellectual heritage of the West."--From publisher description.

Passages in Leibniz which have been understood to contain his statement of Leibniz law do not in fact contain any statement of that principle. Some of these passages contain a statement of the principle of the identity of indiscernibles, While others contain a statement of a principle about concept identity. The latter principle states that a concept, A, Is identical with a concept, B, If and only if a can be substituted for b in any proposition without change of truth (...) value. (shrink)

Ethnic cleansing and other methods of political and social exclusion continue to thrive in our globalized world, complicating the idea that unity and diversity can exist in the same society. When we emphasize unity, we sacrifice heterogeneity, yet when we stress diversity, we create a plurality of individuals connected only by tenuous circumstance. As long as we remain tethered to these binaries, as long as we are unable to imagine the sort of society we want in an age of diversity, (...) we cannot achieve an enduring solution to conflicts that continue unabated despite our increasing proximity to one another. By envisioning the public as a multivoiced body, Fred Evans offers a solution to the dilemma of diversity. The multivoiced body is both one and many: heterogeneous voices that at once separate and bind themselves together through their continuous and creative interplay. By focusing on this traditionally undervalued or overlooked notion of voice, Evans shows how we can valorize simultaneously the solidarity, diversity, and richness of society. Moreover, recognition of society as a multivoiced body helps resists the pervasive countertendency to raise a chosen discourse to the level of "one true God," "pure race," or some other "oracle" that eliminates the dynamism of contesting voices. To support these views, Evans taps the major figures and themes of analytic and continental philosophy as well as modernist, postmodernist, postcolonial, and feminist thought. He also turns to sources outside of philosophy to address the implications of his views for justice, citizenship, democracy, and collective as well as individual rights. Through the seemingly simple conceit of a multivoiced body, Evans straddles both philosophy and political practice, confronting issues of subjectivity, language, communication, and identity. For anyone interested in moving toward a just society and politics, _The Multivoiced Body_ offers an innovative approach to the problems of human diversity and ethical plurality. (shrink)

In this compilation of popular lectures delivered in 1964, Hoyle comments on the nature of the scientific enterprise, gives his view of life on Earth from the perspective of astronomy, and speculates about the future.

Ethnic cleansing and other methods of political and social exclusion continue to thrive in our globalized world, complicating the idea that unity and diversity can exist in the same society. When we emphasize unity, we sacrifice heterogeneity, yet when we stress diversity, we create a plurality of individuals connected only by tenuous circumstance. As long as we remain tethered to these binaries, as long as we are unable to imagine the sort of society we want in an age of diversity, (...) we cannot achieve an enduring solution to conflicts that continue unabated despite our increasing proximity to one another. By envisioning the public as a multivoiced body, Fred Evans offers a solution to the dilemma of diversity. The multivoiced body is both one and many: heterogeneous voices that at once separate and bind themselves together through their continuous and creative interplay. By focusing on this traditionally undervalued or overlooked notion of voice, Evans shows how we can valorize simultaneously the solidarity, diversity, and richness of society. Moreover, recognition of society as a multivoiced body helps resists the pervasive countertendency to raise a chosen discourse to the level of "one true God," "pure race," or some other "oracle" that eliminates the dynamism of contesting voices. To support these views, Evans taps the major figures and themes of analytic and continental philosophy as well as modernist, postmodernist, postcolonial, and feminist thought. He also turns to sources outside of philosophy to address the implications of his views for justice, citizenship, democracy, and collective as well as individual rights. Through the seemingly simple conceit of a multivoiced body, Evans straddles both philosophy and political practice, confronting issues of subjectivity, language, communication, and identity. For anyone interested in moving toward a just society and politics, _The Multivoiced Body_ offers an innovative approach to the problems of human diversity and ethical plurality. (shrink)

The most successful theory in all of science--and the basis of one third of our economy--says the strangest things about the world and about us. Can you believe that physical reality is created by our observation of it? Physicists were forced to this conclusion, the quantum enigma, by what they observed in their laboratories. Trying to understand the atom, physicists built quantum mechanics and found, to their embarrassment, that their theory intimately connects consciousness with the physical world. Quantum Enigma explores (...) what that implies and why some founders of the theory became the foremost objectors to it. Schrodinger showed that it "absurdly" allowed a cat to be in a "superposition" simultaneously dead and alive. Einstein derided the theory's "spooky interactions." With Bell's Theorem, we now know Schrodinger's superpositions and Einstein's spooky interactions indeed exist. Authors Bruce Rosenblum and Fred Kuttner explain all of this in non-technical terms with help from some fanciful stories and bits about the theory's developers. They present the quantum mystery honestly, with an emphasis on what is and what is not speculation. Physics' encounter with consciousness is its skeleton in the closet. Because the authors open the closet and examine the skeleton, theirs is a controversial book. Quantum Enigma's description of the experimental quantum facts, and the quantum theory explaining them, is undisputed. Interpreting what it all means, however, is controversial. Every interpretation of quantum physics encounters consciousness. Rosenblum and Kuttner therefore turn to exploring consciousness itself--and encounter quantum physics. Free will and anthropic principles become crucial issues, and the connection of consciousness with the cosmos suggested by some leading quantum cosmologists is mind-blowing. Readers are brought to a boundary where the particular expertise of physicists is no longer a sure guide. They will find, instead, the facts and hints provided by quantum mechanics and the ability to speculate for themselves. (shrink)