BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Evolutionary ethics - the application of evolutionary ideas to moral thinking and justification - began in the nineteenth century with the work of Charles Darwin and Herbert Spencer, but was subsequently criticized as an example of the naturalistic fallacy. In recent decades, however, evolutionary ethics has found new support among both the Darwinian and the Spencerian traditions. This accessible volume looks at the history of thought about evolutionary ethics as well as current debates in the subject, examining first the claims (...) of supporters and then the responses of their critics. Topics covered include social Darwinism, moral realism, and debunking arguments. Clearly written and structured, the book guides readers through the arguments on both sides, and emphasises the continuing relevance of evolutionary theory to our understanding of ethics today. (shrink)

In late September 1838, Darwin read Malthus's Essay on Population, which left him with “a theory by which to work.”115 Yet he waited some twenty years to publish his discovery in the Origin of Species. Those interested in the fine grain of Darwin's development have been curious about this delay. One recent explanation has his hand stayed by fear of reaction to the materialist implications of linking man with animals. “Darwin sensed,” according to Howard Gruber, “that some would object to (...) seeing rudiments of human mentality in animals, while others would recoil at the idea of remnants of animality in man.”116 With this link closed, Darwin hung the materialist chain around his own neck, where it rested most uncomfortably. Stephen Gould, supporting Gruber's argument, finds evidence for this reconstruction in Darwin's M and N notebooks, whichinclude many statements showing that he espoused but feared to expose something he perceived as far more heretical than evolution itself: philosophical materialism-the postulate that matter is the stuff of all existence and that all mental and spiritual phenomena are its by-products. No notion could be more upsetting to the deepest traditions of Western thought than the statement that mind-however complex and powerful-is simply a product of brain.117The proferred hypothesis suggests, then, that Darwin was acutely sensible of the social consequences of equating men with animals and therefore mind with brian, and that he thus shied from publically revealing his views until the intellectual climate became more tolerant.The history I have examined makes this hypothesis implausible. Even if Darwin warily explored the implications of his emerging theory in his notebooks, his subsequent study of Fleming, Wells, Brougham, and Kirby should have quieted any trepidation. If these natural theologians did not flinch at seeing human reason prefigured in the mind of a worm, should Darwin have? Moreover, he recognized in his M notebook that the thesis of evolutionary continuity between men and animals did not require an explicit avowal of his conviction that brain was the agent of thought.118 And in any case, his materialism was of a rather benign sort; at least he so expressed it in an annotation in Abercrombie's Inquiries concerning the Intellectual Powers (1838): “By materialism I mean, merely the intimate connection of thought with form of brain — like kind of attraction with nature of element.”119 This belief would have held little terror for British intellectuals, who were quite familiar — some even comfortable-with Locke's anti-Cartesian argument that there was nothing contradictory in supposing God could make matter to think.120 Finally, even if the intellectual atmosphere of early nineteenth-century Britain were inhospitable to Darwin's brand of materialism, there is little reason to believe he breathed a different air at mid-century while preparing his manuscript.That Darwin should not have feared suspicions of materialism, of course, does not mean that he did not. But I think there were other, more persistent sources of anxiety that kept him from rushing to publish: namely, the several conceptual obstacles he had to overcome if his theory of evolution by natural selection were to be made scientifically acceptable. Prominent among these were the problems surrounding his changing notions of instinct.The inertia of his older ideas about instinct at first made it hard for Darwin to gauge how far the theory of natural selection might be applied to behavior. By the early 1840s he finally felt ready to meet the challenge of the natural theologians by providing a naturalistic explanation for the wonderful instincts of animals. In his “Essays” of 1842 and 1844 one sort of instinct is, however, not considered-that of neuter insects. Yet Darwin seems to have appreciated the difficulties such instincts entailed at least by 1843, when he read Kirby and Spence. He simply required time to work out a solution to a problem he initially perceived as “fatal to my whole theory.” Even while writing the “Species Book” in the summer of 1857, he was still juggling several possible solutions compatible with natural selection. It was only a short time before he actually turned to work on the Origin of Species that he appears to have settled on a single explanation for the difficulties posed by the instincts of worker bees and ants. The force of his theory of community selection snapped the last critical support of the creationist hypothesis and, conveniently enough, also fractured the generalized Lamarckian account of the evolution of behavior. These results were worth waiting for. (shrink)

Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide (...) advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: impacts on healthcare costs, the outsourcing of expertise and issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries. (shrink)

History of science and philosophy of science are not perfectly complementary disciplines. Several important asymmetries govern their relationship. These asymmetries, concerning levels of analysis, evidence, theories, writing, and training show that to be a decent philosopher of science is more difficult than being a decent historian. But to be a good historian-well, the degree of difficulty is reversed.

Sale of Sperm, Health Records, Minimally Conscious States, and Duties of Candour Content Type Journal Article Category Recent Developments Pages 7-14 DOI 10.1007/s11673-011-9347-6 Authors Cameron Stewart, Centre for Health Governance, Law and Ethics, Sydney Law School, University of Sydney, Sydney, NSW, Australia 2006 Bernadette Richards, Law School, University of Adelaide, Adelaide, SA, Australia 5005 Richard Huxtable, Centre for Ethics in Medicine, University of Bristol, Bristol, BS8 1TH UK Bill Madden, School of Law, University of Western Sydney, Sydney, NSW, (...) Australia Tina Cockburn, School of Law, Queensland University of Technology, Brisbane, QLD, Australia Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 9 Journal Issue Volume 9, Number 1. (shrink)

Abstract Responding to recent calls from within critical MOS and organizational ethics studies to explore questions of difference and inclusion ‘beyond unity and fixity’, this paper seeks to enrich the debate on difference and its negotiation in organizations, thereby foregrounding difference as the contested and ever-changing outcome of power-invested configurations of practice. The paper presents an ethnographic study conducted in a psychosocial day-care centre that positions itself as a ‘space of multiplicity’ wherein ‘it is normal to be different’. Highlighting the (...) context-specific challenges and struggles encompassing mental ill-health as a category of difference deviating from the norm, our paper contributes to a critical-affirmative understanding of difference. We foster an approach that values normative orientations such as ‘egalitarian difference’ and ‘difference as multiplicity’ yet avoids idealising portrayals of an ethics of difference that challenges normalcy and unconditionally favours otherness and calls for ‘radically other kinds of difference’. (shrink)

Several scholars and many religiously conservative thinkers have recently charged that Hitler’s ideas about race and racial struggle derived from the theories of Charles Darwin (1809-1882), either directly or through intermediate sources. So, for example, the historian Richard Weikart, in his book From Darwin to Hitler , maintains: “No matter how crooked the road was from Darwin to Hitler, clearly Darwinism and eugenics smoothed the path for Nazi ideology, especially for the Nazi stress on expansion, war, racial struggle, and racial (...) extermination.” In a subsequent book, Hitler’s Ethic: The Nazi Pursuit of Evolutionary Progress, Weikart argues that Darwin’s “evolutionary ethics drove him [Hitler] to engage in behavior that the rest of us consider abominable.” Other critics have also attempted to forge a strong link between Darwin’s theory and Hitler’s biological notions. In the 2008 film “Expelled,” a documentary defense of Intelligent Design, the Princeton trained philosopher David Berlinski, in conversation with Weikart, confidently asserts: “If you open Mein Kampf and read it, especially if you can read it in German, the correspondence between Darwinian ideas and Nazi ideas just leaps from the page.” John Gray, former professor at the London School of Economics, does allow that Hitler’s Darwinism was “vulgar.” Hannah Arendt also appears to have endorsed the connection when she declared: “Underlying the Nazis’ belief in race laws as the expression of the law of nature in man, is Darwin’s idea of man as the product of a natural development which does not necessarily stop with the present species of human being.” Put “Darwin” and “Hitler” in a search engine and several million hits will be returned, most from religiously and politically conservative websites, articles, and books. (shrink)

The eminent historian and philosopher of biology, Michael Ruse, has written several books that explore the relationship of evolutionary theory to its larger scientific and cultural setting. Among the questions he has investigated are: Is evolution progressive? What is its epistemological status? Most recently, in "Darwin and Design: Does Evolution have a Purpose?," Ruse has provided a history of the concept of teleology in biological thinking, especially in evolutionary theorizing. In his book, he moves quickly from Plato and Aristotle to (...) Kant and such British thinkers as Paley and Whewell. His main focus, though, is on Darwin's theory and its subsequent fate. Ruse rests his history on some shaky historical and philosophic assumptions, particularly the unexamined notion that evolutionary theory is an abstract entity that is unproblematically realized in different historical periods. He also assumes that Darwin conceived nature as if it were a Manchester spinning loom -- a clanking, dispassionate machine. A more subtle analysis, which Ruse eschews, might discover that Darwin's conception of nature owed a strong debt to German Romanticism and that he contrived to infuse nature with moral and aesthetic values, not to suck them from nature. Ruse proves he is a thinker to contend with, and this essay is quite contentious. (shrink)

Legal theorists are familiar with John Finnis's book Natural Law and Natural Rights, but usually overlook his interventions in US constitutional debates and his membership of a group of conservative Catholic thinkers, the 'new natural lawyers', led by theologian Germain Grisez. In fact, Finnis has repeatedly advocated conservative positions concerning lesbian and gay rights, contraception and abortion, and his substantive moral theory derives from Grisez. Bamforth and Richards provide a detailed explanation of the work of the new natural lawyers (...) within and outside the Catholic Church - the first truly comprehensive explanation available to legal theorists - and criticize Grisez's and Finnis's arguments concerning sexuality and gender. New natural law is, they argue, a theology rather than a secular theory, and one which is unappealing in a modern constitutional democracy. This book will be of interest to legal and political theorists, ethicists, theologians and scholars of religious history. (shrink)

In a series of articles and in a recent book, What Darwin Got Wrong, Jerry Fodor has objected to Darwin’s principle of natural selection on the grounds that it assumes nature has intentions.1 Despite the near universal rejection of Fodor’s argument by biologists and philosophers of biology (myself included),2 I now believe he was almost right. I will show this through a historical examination of a principle that Darwin thought as important as natural selection, his principle of divergence. The principle (...) was designed to explain a phenomenon obvious to any observer of nature, namely, that animals and plants form a hierarchy of clusters. Theodosius Dobzhansky made this the motivating observation of his great synthesizing work, Genetics and the Origin of Species (1937): “the living world is not a single array of individuals in which any two variants are connected by a series of intergrades, but an array of more or less distinctly separate arrays, intermediates between which are absent or at least rare. . . Small.. (shrink)

This paper offers a positive suggestion for the management of a market in organs for transplant; and in doing so provides a useful opportunity for clarifying the structure of the Great Organ Sales Debate.The issue is in constant need of clarification, because it is usually aired as a political question of the For and Against variety: should organ selling be legal or not? This format usually encourages protagonists to collect into an unsorted heap whatever arguments look as though they might (...) have any persuasive force on their side, and because people may be on the same political side for different moral reasons, or have the same moral principles but reach different political conclusions, the political arguments tend to obscure both the real issues and the logical structure of the controversy.Although attitudes to organ selling seem to have relaxed somewhat since the subject first came to light about a dozen years ago, most professional and political opinion is still against it. But what is the moral basis of this opposition? If you think organ selling should remain illegal, what exactly is your reason? Is it that you regard selling body parts as wrong in itself, irrespective of consequences? Or is it because you think that although it is not wrong in itself, in practice the harms will usually or always outweigh the benefits? Either of these quite different views might support the same political conclusion.In practice, it is not clear that many opponents of organ selling have ever recognised the distinction. Most of …. (shrink)

The Origin of Species by Charles Darwin is universally recognized as one of the most important science books ever written. Published in 1859, it was here that Darwin argued for both the fact of evolution and the mechanism of natural section. The Origin of Species is also a work of great cultural and religious significance, in that Darwin maintained that all organisms, including humans, are part of a natural process of growth from simple forms. This Companion commemorates the 150th anniversary (...) of the publication of the Origin of Species and examines its main arguments. Drawing on the expertise of leading authorities in the field, it also provides the contexts - religious, social, political, literary, and philosophical - in which the Origin was composed. Written in a clear and friendly yet authoritative manner, this volume will be essential reading for both scholars and students More broadly, it will appeal to general readers who want to learn more about one of the most important and controversial books of modern times. (shrink)

The sciences of ethology and sociobiology have as premisses that certain dispositions and behavioural patterns have evolved with species and, therefore, that the acts of individual animals and men must be viewed in light of innate determinates. These ideas are much older than the now burgeoning disciplines of the biology of behaviour. Their elements were fused in the early constructions of evolutionary theory, and they became integral parts of the developing conception. Historians, however, have usually neglected close examination of the (...) role behaviour has played in the rise of evolutionary thought. (shrink)

Our image of Herbert Spencer is that of a bald, dyspeptic bachelor, spending his days in rooming houses, and fussing about government interference with individual liberties. Beatrice Webb, who knew him as a girl and young woman recalls for us just this picture. In her diary for January 4, 1885, she writes: Royal Academy private view with Herbert Spencer. His criticisms on art dreary, all bound down by the “possible” if not probable. That poor old man would miss me on (...) the whole more than any other mortal. Has real anxiety for my welfare—physical and mental. Told him story of my stopping cart horse in Hyde Park and policeman refusing to come off his beat to hold it. Want of public spirit in passers-by not stopping it before. “Yes, that is another instance of my first principle of government. Directly you get state intervention you cease to have public spirit in individuals; that will be a constantly increasing tendency and the State, like the policeman, will be so bound by red-tape rules that it will frequently leave undone the simplest duties.”1 Spencer appears a man whose strangled emotions would yet cling to a woman whose philosophy would be completely alien to his own, as Webb’s Fabian Socialism turned out to be. Our image of Darwin is more complex than our image of Spencer. We might think of him nestled in the bosom of his large family, kindly, and just a little sad. The photo of him taken by Julia Cameron reveals the visage of an Old Testament prophet, though one, not fearsome, but made wise by contemplating the struggle of life on this earth. These images have deeply colored our reaction to the ideas of each thinker. The pictures are not false, but they are cropped portraits that tend to distort our reactions to the theories of each. If we examine the major features of their respective. (shrink)

Free Speech and the Politics of Identity challenges the scholarly view as well as the dominant legal view outside the United States that the right of free speech may reasonably be traded off in pursuit of justice to stigmatized minorities. The book's innovative normative and interpretative methodology calls for a new departure in comparative public law, in which all states responsibly address their common problems, not only of inadequate protection of free speech, but also correlative failure to take seriously the (...) continuing political power of such evils as anti-Semitism, racism, sexism, and homophobia. (shrink)

In 1914, James Leuba, a psychologist at Bryn Mawr, conducted several surveys of scientists and college students regarding their religious beliefs, publishing his findings in a 1916 book titled The Belief in God and Immortality. Among scientists generally, 41.8 percent indicated they were believers in a personal God (defined as a being to whom one could pray, expecting a response), whereas 41.5 percent expressed disbelief in such a God and 16.7 percent declared themselves to be agnostic. Among elite scientists (those (...) with an asterisk by their names in James McKean Cattell's American Men of Science), the percentage of believers was lower, at 31.6 percent. Among elite biologists, the subset who believed in God was even smaller—16.9 percent. In 1996 and 1998, Edward Larson and Larry Witham replicated Leuba's study, publishing their findings in the April 23, 1997, and July 23, 1998, issues of Nature. Their surveys revealed that of all scientists questioned, 39.3 percent professed belief in a personal God, about the same as in the 1914 study. However, among elite scientists—now defined as members of the National Academy of Sciences—the proportion who were believers had plummeted to 7 percent, with biologists showing the least religious conviction at 5.5 percent. In the general population of the United States, some 86 percent profess belief in the existence of a personal God, according to a 1999 Gallup poll. These figures dramatically indicate the great no-mans land separating the religious convictions of ordinary citizens from those of the scientific community, especially its leading members. This dissensus has fueled many of the bitter battles recently fought over evolution and stem cells and has ignited explosive devices laid along several political byways. (shrink)

Though not the first to use the term "psychology" (psychologia), ' Christian Wolff did give it currency in the mid-eighteenth century. He was the first to mark off the discipline of empirical psychology and to distinguish it from rational, or theoretical, psychology. This distinction and his conception of the two corresponding methods of conducting psychological inquiry, especially his emphasis on the use of introspection, profoundly inffuenced the course of psychological..

Who can divine the intentions of the human heart, the motives that guide behavior? Some of the reasons for our actions lie on the surface of consciousness, whereas others are more deeply embedded in the recesses of the mind. Recovering motives and intentions is a principal job of the historian. For without some attribution of mental attitudes, actions cannot be characterized and decisions assessed. The same overt behavior, after all, might be described as “mailing a letter” or “fomenting a revolution.” (...) The recovery of intentions is crucial for the historian’s narrative. (shrink)

In a late reminiscence, Goethe recalled that during his close association with the poet Friedrich Schiller, he was constantly defending “the rights of nature" against his friend's “gospel of freedom.”1 Goethe’s characterization of his own view was artfully ironic, alluding as it did to the French Revolution's proclamation of the "Rights of Man." His remark implied that values lay within nature, values that had authority comparable to those ascribed to human beings by the architects of the Revolution. During the time (...) Goethe made his defense, he also faced another revolution, in which Schiller was a partisan—that of Kant in the intellectual sphere. Both upheavals had undermined the autonomy of nature, replacing her authority with that of human will and understanding. Previous papers in this volume have recorded the shifting fortunes of nature that brought her to this stage of jeopardy. In the early classical period, nature as a unified whole had not yet arisen. Animate and inanimate objects had natures— characteristic modes of action—but there was as yet, according Slatkin, no articulate concept of nature as a whole standing over against human beings. Park has described a long period of transition, when nature became personified in the form of a didactic female, a figure imaginatively based, it would seem, upon the system of a 1 natural philosophy that stood in contrast to the revealed wisdom of God. Nature in this guise yet derived her authority and nurturing capacity from that higher, divine power. During the seventeenth century, writers like Mandeville, as Allen has shown, began to suspect that nature might be a chimera, a fictive creature that disguised humanity's own hidden desires and inclinations. These doubts grew during the next century—with the likes of Hume accelerating the skepticism— till finally, in the two revolutions that so troubled Goethe, nature was completely stripped of her authority. Goethe had become confirmed in his defense of the rights of nature during his travels to Italy during the years 1786-1788. (shrink)

In Darwinian Heresies, which was originally published in 2004, prominent historians and philosophers of science trace the history of evolutionary thought, and challenge many of the assumptions that have built up over the years. Covering a wide range of issues starting in the eighteenth century, Darwinian Heresies brings us through the time of Charles Darwin and the Origin, and then through the twentieth century to the present. It is suggested that Darwin's true roots lie in Germany, not his native England, (...) that Russian evolutionism is more significant than many are prepared to allow, and that the true influence on twentieth-century evolution biology was not Charles Darwin at all, but his often-despised contemporary, Herbert Spencer. The collection was intended to interest, to excite, to infuriate, and to stimulate further work. (shrink)