Malaria is a disease of developing countries whose local health services do not have the time, resources or personnel to mount studies of drugs or vaccines without the collaboration and technology of western investigators. This investigative collaboration requires a unique bridging of cultural differences with respect to human investigation. The following debate, sponsored by The Institute of Medicine and The American Society of Tropical Medicine and Hygiene, raises questions concerning the conduct of trans-cultural clinical malaria research. Specific questions are raised (...) about the difficulties of informed consent in different cultural settings and whether there is any role for community involvement. Discussants debate whether drug and vaccine trials not approved in an industrialised country are ever defensible if performed in a third-world setting. Potential conflicting priorities between investigators are discussed and ideas regarding conflict resolution are offered. (shrink)

There is wide agreement that community engagement is important for many research types and settings, often including interaction with ‘representatives’ of communities. There is relatively little published experience of community engagement in international research settings, with available information focusing on Community Advisory Boards or Groups (CAB/CAGs), or variants of these, where CAB/G members often advise researchers on behalf of the communities they represent. In this paper we describe a network of community members (‘KEMRI Community Representatives’, or ‘KCRs’) linked to a (...) large multi-disciplinary research programme on the Kenyan Coast. Unlike many CAB/Gs, the intention with the KCR network has evolved to be for members to represent the geographical areas in which a diverse range of health studies are conducted through being typical of those communities. We draw on routine reports, self-administered questionnaires and interviews to: 1) document how typical KCR members are of the local communities in terms of basic characteristics, and 2) explore KCR's perceptions of their roles, and of the benefits and challenges of undertaking these roles. We conclude that this evolving network is a potentially valuable way of strengthening interactions between a research institution and a local geographic community, through contributing to meeting intrinsic ethical values such as showing respect, and instrumental values such as improving consent processes. However, there are numerous challenges involved. Other ways of interacting with members of local communities, including community leaders, and the most vulnerable groups least likely to be vocal in representative groups, have always been, and remain, essential. (shrink)

BackgroundThe potential contribution of community engagement to addressing ethical challenges for international biomedical research is well described, but there is relatively little documented experience of community engagement to inform its development in practice. This paper draws on experiences around community engagement and informed consent during a genetic cohort study in Kenya to contribute to understanding the strengths and challenges of community engagement in supporting ethical research practice, focusing on issues of communication, the role of field workers in 'doing ethics' on (...) the ground and the challenges of community consultation.MethodsThe findings are based on action research methods, including analysis of community engagement documentation and the observations of the authors closely involved in their development and implementation. Qualitative and quantitative content analysis has been used for documentation of staff meetings and trainings, a meeting with 24 community leaders, and 40 large public and 70 small community group meetings. Meeting minutes from a purposive sample of six community representative groups have been analysed using a thematic framework approach.ResultsField workers described challenges around misunderstandings about research, perceived pressure for recruitment and challenges in explaining the study. During consultation, leaders expressed support for the study and screening for sickle cell disease. In community meetings, there was a common interpretation of research as medical care. Concerns centred on unfamiliar procedures. After explanations of study procedures to leaders and community members, few questions were asked about export of samples or the archiving of samples for future research.ConclusionsCommunity engagement enabled researchers to take account of staff and community opinions and issues during the study and adapt messages and methods to address emerging ethical challenges. Field workers conducting informed consent faced complex issues and their understanding, attitudes and communication skills were key influences on ethical practice. Community consultation was a challenging concept to put into practice, illustrating the complexity of assessing information needs and levels of deliberation that are appropriate to a given study. (shrink)

Benefit sharing in health research has been the focus of international debates for many years, particularly in developing countries. Whilst increasing attention is being given to frameworks that can guide researchers to determine levels of benefits to participants, there is little empirical research from developing countries on the practical application of these frameworks, including in situations of extreme poverty and vulnerability. In addition, the voices of those who often negotiate and face issues related to benefits in practice - frontline researchers (...) and fieldworkers - are rarely included in these debates. Against this background, this paper reports on experiences of negotiating research participation and benefits as described by fieldworkers, research participants and researchers in two community based studies. (shrink)

The importance of communities in strengthening the ethics of international collaborative research is increasingly highlighted, but there has been much debate about the meaning of the term ‘community’ and its specific normative contribution. We argue that ‘community’ is a contingent concept that plays an important normative role in research through the existence of morally significant interplay between notions of community and individuality. We draw on experience of community engagement in rural Kenya to illustrate two aspects of this interplay: (i) that (...) taking individual informed consent seriously involves understanding and addressing the influence of communities in which individuals’ lives are embedded; (ii) that individual participation can generate risks and benefits for communities as part of the wider implications of research. We further argue that the contingent nature of a community means that defining boundaries is generally a normative process itself, with ethical implications. Community engagement supports the enactment of normative roles; building mutual understanding and trust between researchers and community members have been important goals in Kilifi, requiring a broad range of approaches. Ethical dilemmas are continuously generated as part of these engagement activities, including the risks of perverse outcomes related to existing social relations in communities and conditions of ‘half knowing’ intrinsic to processes of developing new understandings. (shrink)

Fieldworkers (FWs) are community members employed by research teams to support access to participants, address language barriers, and advise on culturally appropriate research conduct. The critical role that FWs play in studies, and the range of practical and ethical dilemmas associated with their involvement, is increasingly recognised. In this paper, we draw on qualitative observation and interview data collected alongside a six month basic science study which involved a team of FWs regularly visiting 47 participating households in their homes. The (...) qualitative study documented how relationships between field workers and research participants were initiated, developed and evolved over the course of the study, the shifting dilemmas FWs faced and how they handled them. Even in this one case study, we see how the complex and evolving relationships between fieldworkers and study participants had important implications for consent processes, access to benefits and mutual understanding and trust. While the precise issues that FWs face are likely to depend on the type of research and the context in which that research is being conducted, we argue that appropriate support for field workers is a key requirement to strengthen ethical research practice and for the long term sustainability of research programmes. (shrink)

Background: There is general consensus internationally that unfair distribution of the benefits of research is exploitative and should be avoided or reduced. However, what constitutes fair benefits, and the exact nature of the benefits and their mode of provision can be strongly contested. Empirical studies have the potential to contribute viewpoints and experiences to debates and guidelines, but few have been conducted. We conducted a study to support the development of guidelines on benefits and payments for studies conducted by the (...) KEMRI-Wellcome Trust programme in Kilifi, Kenya. Methods: Following an initial broad based survey of cash, health services and other items being offered during research by all programme studies (n = 38 studies), interviews were held with research managers (n = 9), and with research staff involved in 8 purposively selected case studies (n = 30 interviewees). Interviews explored how these ‘benefits’ were selected and communicated, experiences with their administration, and recommendations for future guidelines. Data fed into a consultative workshop attended by 48 research staff and health managers, which was facilitated by an external ethicist.FindingsThe most commonly provided benefits were medical care (for example free care, and strengthened quality of care), and lunch or snacks. Most cash given to participants was reimbursement of transport costs (for example to meet appointments or facilitate use of services when unexpectedly sick), but these payments were often described by research participants as benefits. Challenges included: tensions within households and communities resulting from lack of clarity and agreement on who is eligible for benefits; suspicion regarding motivation for their provision; and confusion caused by differences between studies in types and levels of benefits. Conclusions: Research staff differed in their views on how benefits should be approached. Echoing elements of international benefit sharing and ancillary care debates, some research staff saw research as based on goodwill and partnership, and aimed to avoid costs to participants and a commercial relationship; while others sought to maximise participant benefits given the relative wealth of the institution and the multiple community needs. An emerging middle position was to strengthen collateral or indirect medical benefits to communities through collaborations with the Ministry of Health to support sustainability. (shrink)

Objectives: Bronchoalveolar lavage obtained at bronchoscopy is useful for research on pulmonary defence mechanisms. Bronchoscopy involves some discomfort and risk to subjects. We audited the process of consent, experienced adverse effects and reasons for participation among research bronchoscopy volunteers.Design: 100 consecutive volunteer research subjects attending for bronchoscopy, repeat bronchoscopy or routine recruitment clinic were interviewed. Information was gathered about volunteer motivation, perception of the consent process and adverse effects of bronchoscopy. Suggestions for improvement were requested. Responses were themed by a (...) second investigator prior to data analysis.Results: 81 bronchoscopy-experienced subjects and 19 new volunteers were interviewed. 19 subjects reported adverse symptoms during or after bronchoscopy, but no symptoms were of sufficient severity that they would not repeat the procedure. The frequency of symptoms was not related to gender, the quality of the lavage or the HIV status of the subject. 76 subjects reported that the information given pre-procedure was useful and adequate but 43 had further questions mostly relating to their own results. The reasons given for research participation were access to health assessment , access to treatment when ill , desire to participate in research and remuneration . 7 subjects complained that the remuneration was inadequate.Conclusions: The main incentive to participation in research bronchoscopy was access to healthcare. Informed consent and procedure technique were adequate but subjects would value more feedback about individual and project results. (shrink)

BackgroundCarefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/aids, without increasing burdens. Such studies, however, must navigate a ‘vulnerability paradox’, since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/aids (ALH) in Kenya, we develop an account of researchers’ responsibilities towards young people, incorporating concepts of vulnerability, resilience, and agency (...) as ‘interacting layers’.MethodsUsing a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders’ perspectives on vulnerability and resilience of young people living with HIV/aids, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna’s layered account of vulnerability.ResultsALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences.ConclusionsThe most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabilities, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interpersonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers’ responsibilities to work within multi-sectoral partnerships to plan and implement studies involving ALH, share findings in a timely way and contribute to policies addressing known causes of vulnerabilities. (shrink)

A correspondência entre J. Locke e W. Molyneux é conhecida principalmente como a fonte da famosa questão relativa ao que pode ser aprendido por um homem cego de nascença e que depois ganha a visão. Curiosamente, a correspondência oferece muito pouco esclarecimento sobre a questão. Outros tópicos importantes, entretanto, são apontados e explorados: entusiasmo pela obra de Malebranche, liberdade e responsabilidade, identidade pessoal, etc. Além disso, a correspondência oferece um conhecimento profundo da recepção histórica do Ensaio de Locke, como (...) estes dois correspondentes, que tinham obviamente muita simpatia um para com o outro, discutem a tradução da obra de Locke, suas futuras edições, e as críticas feitas a ela por Synge, King, Sergeant, Stllingfleet, Leibniz, etc. (shrink)

Most of the New Theory of Vision is an argument for a negative answer to Molyneux's question.// re primacy of vision in spatial perception: "most rational philosopher on this topic is Berkeley, whose New Theory of Vision presents in cogent detail the argument" (from Bennett 1966, p. 30, in note cites 41ff.).// Berkeley's criticisms of Locke: "If we really abstract from colour and hardness and all that 'belongs to sensation', so far from being left with 'pure' notions of extension (...) and figure, we are left with nothing but words emptied of meaning" (from Strawson 1966, p. 61). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bishop Berkeley Exorcises the Infinite: Fuzzy Consequences of Strict Finitism1 David M. Levy Introduction It all began simply enough when Molyneux asked the wonderful question whether a person born blind, now able to see, would recognize by sight what he knew by touch (Davis 1960). After George Berkeley elaborated an answer, that we learn to perceive by heuristics, the foundations ofcontemporarymathematics wereinruin. Contemporary mathematicians waved their hands and (...) changed the subject.2 Berkeley's answer received a much more positive response from economists. Adam Smith,in particular, seizedupon Berkeley's doctrine that welearn to perceive distance tobuild anelaborate system in which one learns to perceive one's self-interest.3 Perhaps because older histories of mathematics are a positive hindrance in helping us understand the importance of Berkeley's argument against infinitesimals,4 its consequences for economics have passed unnoticed. If infinitesimal numbers are ruled out, and we wish to maintain an algebra, then we rule out infinite numbers. This implication of Berkeley's argumenthas a dramatic implication for our understanding ofthe history ofideas about rule-directed action. Let me motivate this claim with a well-known historical problem. The social doctrine set forth by John Locke outside the Two Treatises depends critically upon individual belief about possible states of infinite pain or pleasure. The critical issue for the intolerance of atheism in Locke's system is his claim that without beUefin the infinite bliss of heaven forgone by a criminal, there is no reason to think a calculating individual will avoid crime.5 Locke's discussion is so different from the discussion of religion by David Hume and Smith. Here, questions of the substance of belief—the infinite worth of Heaven—have largely vanished.6 What happened between Locke and Hume-Smith? One answer is Pierre Bayle and Bernard Mandeville. Berkeley's doctrine that only the finite is perceived is, I think, a better answer. Out of sight, out ofmind. In this paper I propose to give a close look at the content and consequences ofBishop Berkeley's once famous Towards a New Theory ofVision. While there are other aspects ofBerkeley's work that attract Volume XVIII Number 2 511 DAVID M. LEVY attention from historians ofeconomics,7 1 shall claim that Berkeley's insight into human perception in the Theory of Vision is central to Adam Smith's attempt to found economic behaviour on the self-awareness of systematic illusion. There is no doubt that Smith finds that much ofhuman behaviour is characterized by illusion.8 The difficulty arises, or so it seems to me, from modern unwilUngness to beheve that illusion can be systematic. There are four pieces to my argument. First, we consider Berkeley's statementofwhat we shall call his doctrine ofstrict finitism in perception.9 Berkeley puts forward two postulates: 1) there exists some minimum perceptible quantity, and 2) distance is not perceived directly but by experience. Second, we define strict finitism and demonstrate that it translates into the claim that perception is fuzzy in a technical sense. If Berkeleian perception is fuzzy, then some modern criticism of Berkeley's strict finitism is based upon a simple misunderstandingofthe propertiesoffuzzyrelations. Thisis quite easy to set right. (Getting right the doctrine of those who implicitly take perception to be fuzzy—Adam Smith is my prime candidate—will be muchharder.)Third, wereconsiderBerkeley's dispute withMandeville on the role ofinfinite gain in choice. Here, we find Mandeville putting forward the Berkeleian position that if infinite amounts mattered, people would not behave as they do. Berkeley's position against Mandeville, however, seems to depend upon the supposition that infinite distance is sensible.10 Earlier, however, the position that Mandeville argued for was defended by Berkeley. Fourth, we ask why all this isn't well known. The debate between Berkeley and Mandeville has been well studied, as has been the link between Berkeley and the Scots. In fact, our work focuses on one aspect of Berkeley's work that led to his challenge of the contemporary foundations of the calculus. If sense is a matter of perception, and infinitesimals cannot be perceived, then they are quite literally nonsense. Armed with this insight, Berkeley refuted contemporary mathematics. Nevertheless, the calculus was too... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bishop Berkeley Exorcises the Infinite: Fuzzy Consequences of Strict Finitism1 David M. Levy Introduction It all began simply enough when Molyneux asked the wonderful question whether a person born blind, now able to see, would recognize by sight what he knew by touch (Davis 1960). After George Berkeley elaborated an answer, that we learn to perceive by heuristics, the foundations ofcontemporarymathematics wereinruin. Contemporary mathematicians waved their hands and (...) changed the subject.2 Berkeley's answer received a much more positive response from economists. Adam Smith,in particular, seizedupon Berkeley's doctrine that welearn to perceive distance tobuild anelaborate system in which one learns to perceive one's self-interest.3 Perhaps because older histories of mathematics are a positive hindrance in helping us understand the importance of Berkeley's argument against infinitesimals,4 its consequences for economics have passed unnoticed. If infinitesimal numbers are ruled out, and we wish to maintain an algebra, then we rule out infinite numbers. This implication of Berkeley's argumenthas a dramatic implication for our understanding ofthe history ofideas about rule-directed action. Let me motivate this claim with a well-known historical problem. The social doctrine set forth by John Locke outside the Two Treatises depends critically upon individual belief about possible states of infinite pain or pleasure. The critical issue for the intolerance of atheism in Locke's system is his claim that without beUefin the infinite bliss of heaven forgone by a criminal, there is no reason to think a calculating individual will avoid crime.5 Locke's discussion is so different from the discussion of religion by David Hume and Smith. Here, questions of the substance of belief—the infinite worth of Heaven—have largely vanished.6 What happened between Locke and Hume-Smith? One answer is Pierre Bayle and Bernard Mandeville. Berkeley's doctrine that only the finite is perceived is, I think, a better answer. Out of sight, out ofmind. In this paper I propose to give a close look at the content and consequences ofBishop Berkeley's once famous Towards a New Theory ofVision. While there are other aspects ofBerkeley's work that attract Volume XVIII Number 2 511 DAVID M. LEVY attention from historians ofeconomics,7 1 shall claim that Berkeley's insight into human perception in the Theory of Vision is central to Adam Smith's attempt to found economic behaviour on the self-awareness of systematic illusion. There is no doubt that Smith finds that much ofhuman behaviour is characterized by illusion.8 The difficulty arises, or so it seems to me, from modern unwilUngness to beheve that illusion can be systematic. There are four pieces to my argument. First, we consider Berkeley's statementofwhat we shall call his doctrine ofstrict finitism in perception.9 Berkeley puts forward two postulates: 1) there exists some minimum perceptible quantity, and 2) distance is not perceived directly but by experience. Second, we define strict finitism and demonstrate that it translates into the claim that perception is fuzzy in a technical sense. If Berkeleian perception is fuzzy, then some modern criticism of Berkeley's strict finitism is based upon a simple misunderstandingofthe propertiesoffuzzyrelations. Thisis quite easy to set right. (Getting right the doctrine of those who implicitly take perception to be fuzzy—Adam Smith is my prime candidate—will be muchharder.)Third, wereconsiderBerkeley's dispute withMandeville on the role ofinfinite gain in choice. Here, we find Mandeville putting forward the Berkeleian position that if infinite amounts mattered, people would not behave as they do. Berkeley's position against Mandeville, however, seems to depend upon the supposition that infinite distance is sensible.10 Earlier, however, the position that Mandeville argued for was defended by Berkeley. Fourth, we ask why all this isn't well known. The debate between Berkeley and Mandeville has been well studied, as has been the link between Berkeley and the Scots. In fact, our work focuses on one aspect of Berkeley's work that led to his challenge of the contemporary foundations of the calculus. If sense is a matter of perception, and infinitesimals cannot be perceived, then they are quite literally nonsense. Armed with this insight, Berkeley refuted contemporary mathematics. Nevertheless, the calculus was too... (shrink)

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict were (...) higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

I show that the recursive structure of Leibniz's Law requires agents to perform infinitely many operations to psychologically identify the referents of phenomenal and physical concepts, even though the referents of ordinary concepts (e.g. Hesperus and Phosphorus) can be identified in a finite number of steps. The resulting problem resembles the hard problem of consciousness in the fact that it appears (and indeed is) unsolvable by anyone for whom it arises, and in the fact that it invites dualist and eliminativist (...) responses. Moreover, if this is the hard problem then we can predict that regardless of the strength of the argument for physicalism, and regardless of physicalism's truth, an ineliminable dissatisfaction is bound to accompany any physicalist theory of consciousness. Accordingly, I suggest that this is the hard problem of consciousness, and therefore that the hard problem arises from a recursively degenerate application of Leibniz's Law. (shrink)

The dominant account of welfare in medicine is an objective one; welfare consists of certain favoured health states, or in having needs satisfied, or in certain capabilities and functionings. By contrast, I present a subjective account of welfare, suggested initially by LW Sumner and called “authentic happiness”. The adoption of such an account of welfare within medicine offers several advantages over other subjective and objective accounts, and systematises several intuitions about patient-centredness and autonomy. Subjective accounts of welfare are unpopular because (...) of their implications for justice and the autonomy of the healthcare professional. This account of welfare, however, seems to have the resources to resist these criticisms. (shrink)

"Six Metaphysical Meditations" by René Descartes (translated by William Molyneux). Published by Good Press. Good Press publishes a wide range of titles that encompasses every genre. From well-known classics & literary fiction and non-fiction to forgotten−or yet undiscovered gems−of world literature, we issue the books that need to be read. Each Good Press edition has been meticulously edited and formatted to boost readability for all e-readers and devices. Our goal is to produce eBooks that are user-friendly and accessible to (...) everyone in a high-quality digital format. (shrink)

Eighty one years on, the Russian Revolution remains an event of unique significance for socialists, Marxists and historical materialists. It is the only occasion to date of which it can plausibly be claimed that the working class itself overthrew the capitalist state, established its own power and maintained it on a national scale for a significant period of time. Discount the Russian Revolution and we are left only with heroic but local and short-lived attempts and near-misses such as the Paris (...) Commune, the Hungarian Revolution of 1919, the Munich Soviet and Barcelona 1936, or the long list of seizures of power, usually by armed forces of one sort or another, in the name of the working class or Marxism. (shrink)

Advocates of the use of intuitions in philosophy argue that they are treated as evidence because they are evidential. Their opponents agree that they are treated as evidence, but argue that they should not be so used, since they are the wrong kinds of things. In contrast to both, we argue that, despite appearances, intuitions are not treated as evidence in philosophy whether or not they should be. Our positive account is that intuitions are a subclass of inclinations to believe. (...) Our thesis explains why intuitions play a role in persuasion and inquiry, without conceding that they are evidential. The account also makes predictions about the structure of intuitions that are confirmed by independent arguments. (shrink)

In recent years, there has been an increase in the establishment of biobanks for genetic and genomic studies around the globe. One example of this is the Human Heredity and Health in Africa Initiative (H3Africa), which has established biobanks in the sub‐region to facilitate future indigenous genomic studies. The concept of ‘broad consent’ has been proposed as a mechanism to enable potential research participants in biobanks to give permission for their samples to be used in future research studies. However, questions (...) remain about the acceptability of this model of consent. Drawing on findings from empirical research about the role of trust in decision‐making, we argue that an account of entrustment may be an appropriate way of addressing current challenges of seeking consent for biobank research in Africa. We propose a set of key points to consider that can support the proposed entrustment framework. (shrink)

For many decades, access to human biological samples, such as cells, tissues, organs, blood, and sub-cellular materials such as DNA, for use in biomedical research, has been central in understanding the nature and transmission of diseases across the globe. However, the limitations of current ethical and regulatory frameworks in sub-Saharan Africa to govern the collection, export, storage and reuse of these samples have resulted in inconsistencies in practice and a number of ethical concerns for sample donors, researchers and research ethics (...) committees. This paper examines stakeholders’ perspectives of and responses to the ethical issues arising from these research practices. (shrink)

According to orthodox views of philosophical methodology, when philosophers appeal to intuitions, they treat them as evidence for their contents. Call this “descriptive evidentialism.” Descriptive evidentialism is assumed both by those who defend the epistemic status of intuitions and by those, including many experimental philosophers, who criticize it. This article shows, however, that the idea that philosophers treat intuitions as evidence struggles to account for the way philosophers treat intuitions in a variety of philosophical contexts. In particular, it cannot account (...) for philosophers' treatment of a priori intuitions, for nonpropositional uses of intuition, and for philosophers' failure to use intuition to exclude the counterintuitive. The article concludes that alternatives to descriptive evidentialism (some of which are sketched) must be developed, and that much of the recent debate between traditionalists and skeptics from, for example, experimental philosophy is probably based on a false presupposition. (shrink)

Many philosophers claim that intuitions are evidential. Yet it is hard to see how introspecting one's mental states could provide evidence for such synthetic truths as those concerning, for example, the abstract and the counterfactual. Such considerations have sometimes been taken to lead to mentalism---the view that philosophy must concern itself only with matters of concept application or other mind-dependent topics suited to a contemplative approach---but this provides us with a poor account of what it is that philosophers take themselves (...) to be doing, for many of them are concerned with the extra-mental facts about the universe. Evidentialism therefore gestates a disaster for philosophy, for it ultimately demands an epistemology for the investigation into such matter as the abstract and the modal that simply will not be forthcoming. We make a different suggestion: That intuitions are inclinations to believe. Hence, according to us, a philosophical argument does well, as a socio-rhetorical matter of fact, when it is founded on premises philosophers are generally inclined to believe, whether or not those inclinations to believe connect appropriately to the extra-mental facts. Accordingly, the role of intuitions (inclinations to believe) in philosophical methodology is non-evidential, and the question of how they could be used as evidence falls away. (shrink)

BackgroundVerbal autopsy is a pragmatic approach for generating cause-of-death data in contexts without well-functioning civil registration and vital statistics systems. It has primarily been conducted in health and demographic surveillance systems (HDSS) in Africa and Asia. Although significant resources have been invested to develop the technical aspects of verbal autopsy, ethical issues have received little attention. We explored the benefits and burdens of verbal autopsy in HDSS settings and identified potential strategies to respond to the ethical issues identified.MethodsThis research was (...) based on a case study approach centred on two contrasting HDSS in Kenya and followed the Mapping-Framing-Shaping Framework for empirical bioethics research. Data were collected through individual interviews, focus group discussions, document reviews and non-participant observations. 115 participants were involved, including 86 community members (HDSS residents and community representatives), and 29 research staff (HDSS managers, researchers, census field workers and verbal autopsy interviewers).ResultsThe use of verbal autopsy data for research and public health was described as the most common potential benefit of verbal autopsy in HDSS. Community members mentioned the potential uses of verbal autopsy data in addressing immediate public health problems for the local population while research staff emphasized the benefits of verbal autopsy to research and the wider public. The most prominent burden associated with the verbal autopsy was emotional distress for verbal autopsy interviewers and respondents. Moral events linked to the interview, such as being unsure of the right thing to do (moral uncertainty) or knowing the right thing to do and being constrained from acting (moral constraint), emerged as key causes of emotional distress for verbal autopsy interviewers.ConclusionsThe collection of cause-of-death data through verbal autopsy in HDSS settings presents important ethical and emotional challenges for verbal autopsy interviewers and respondents. These challenges include emotional distress for respondents and moral distress for interviewers. This empirical ethics study provides detailed accounts of the distress caused by verbal autopsy and highlights ethical tensions between potential population benefits and risks to individuals. It includes recommendations for policy and practice to address emotional and moral distress in verbal autopsy. (shrink)

Williamson (2000) [Knowledge and its Limits, Oxford: Oxford University Press] argues that attempts to substitute narrow mental states or narrow/environmental composites for broad and factive mental states will result in poorer explanations of behavior. I resist Williamson.

The transparency argument concludes that we're directly aware of external properties and not directly aware of the properties of experience. Focusing on the presentation used by Michael Tye (2002) I contend that the argument requires experience to have content that it cannot plausibly have. I attribute the failure to a faulty account of the transparency phenomenon and conclude by suggesting an alternative understanding that is independently plausible, is not an error-theory and yet renders the transparency of experience compatible with mental-paint (...) style views. (shrink)

Ibn al-ʻArabī, 1165-1240; views on freedom; Sufism; Islamic philosophy.

"This is an extremely interesting and innovative collection with unusual empirical richness, with ethical and epistemological discussions cutting across ...

There is a growing interest in the ethics of Health Policy and Systems Research, and especially in areas that have particular ethical salience across HPSR. Hyder et al provide an initial framework to consider this, and call for more conceptual and empirical work. In this paper, we respond by examining the ethical issues that arose for researchers over the course of conducting three HPSR studies in Kenya in which health managers and providers were key participants. All three studies involved qualitative (...) work including observations and individual and group interviews. Many of the ethical dilemmas researchers faced only emerged over the course of the fieldwork, or on completion, and were related to interactions and relationships between individuals operating at different levels or positions in health/research systems. The dilemmas reveal significant ethical challenges for these forms of HPSR, and show that potential ‘solutions’ to dilemmas often lead to new issues and complications. Our experiences support the value of research ethics frameworks, and suggest that these can be enriched by incorporating careful consideration of context embedded social relations into research planning and conduct. Many of these essential relational elements of ethical practice, and of producing quality data, are given stronger emphasis in social science research ethics than in epidemiological, clinical or biomedical research ethics, and are particularly relevant where health systems are understood as social and political constructs. We conclude with practical and research implications. (shrink)

This open access edited book provides new thinking on scientific identity formation. It thoroughly interrogates the concepts of community and identity, including both historical and contemporaneous analyses of several scientific fields. Chapters examine whether, and how, today’s scientific identities and communities are subject to fundamental changes, reacting to tangible shifts in research funding as well as more intangible transformations in our society’s understanding and expectations of technoscience. In so doing, this book reinvigorates the concept of scientific community. Readers will discover (...) empirical analyses of newly emerging fields such as synthetic biology, systems biology and nanotechnology, and accounts of the evolution of theoretical conceptions of scientific identity and community. With inspiring examples of technoscientific identity work and community constellations, along with thought-provoking hypotheses and discussion, the work has a broad appeal. Those involved in science governance will benefit particularly from this book, and it has much to offer those in scholarly fields including sociology of science, science studies, philosophy of science and history of science, as well as teachers of science and scientists themselves. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 31-33, August 2011.

Increasing adoption of electronic health records in hospitals provides new opportunities for patient data to support public health advances. Such learning healthcare models have generated ethical debate in high-income countries, including on the role of patient and public consent and engagement. Increasing use of electronic health records in low-middle income countries offers important potential to fast-track healthcare improvements in these settings, where a disproportionate burden of global morbidity occurs. Core ethical issues have been raised around the role and form of (...) information sharing processes for learning healthcare systems, including individual consent and individual and public general notification processes, but little research has focused on this perspective in low-middle income countries. We conducted a qualitative study on the role of information sharing and governance processes for inpatient data re-use, using in-depth interviews with 34 health stakeholders at two public hospitals on the Kenyan coast, including health managers, providers and researchers. Data were collected between March and July 2016 and analysed using a framework approach, with Nvivo 10 software to support data management. Most forms of clinical data re-use were seen as an important public health good. Individual consent and general notification processes were often argued as important, but contingent on interrelated influences of the type of data, use and secondary user. Underlying concerns were linked to issues of patient privacy and autonomy; perceived risks to trust in health systems; and fairness in how data would be used, particularly for non-public sector re-users. Support for engagement often turned on the anticipated outcomes of information-sharing processes, as building or undermining trust in healthcare systems. As reported in high income countries, learning healthcare systems in low-middle counties may generate a core ethical tension between supporting a public good and respecting patient autonomy and privacy, with the maintenance of public trust acting as a core requirement. While more evidence is needed on patient and public perspectives on learning healthcare activities, greater collaboration between public health and research governance systems is likely to support the development of efficient and locally responsive learning healthcare activities in LMICs. (shrink)

I show how a robot with what looks like a hard problem of consciousness might emerge from the earnest attempt to make a robot that is smart and self-reflective. This problem arises independently of any assumption to the effect that the robot is conscious, but deserves to be thought of as related to the human problem in virtue of the fact that (1) the problem is one the robot encounters when it tries to naturalistically reduce its own subjective states (2) (...) it seems incredibly difficult from the robot’s own naturalist perspective and, most importantly, (3) it invites the robot to engage in the exact same metaphysical responses as humans offer to the problem of consciousness. Despite the fact that it invites the robot to consider extravagant metaphysical solutions, the problem I explore is purely algorithmic. The robot cannot complete its naturalist physicalist reduction as a matter of algorithmic fact, whether or not the naturalist physicalist reduction would be correct as a matter of metaphysical fact. It is hoped that by reproducing the familiar seeming problem in an artificial context, a greater understanding of the human problem of consciousness can be achieved. (shrink)