The present volume is one of a type we should soon expect to be seeing more of in philosophy of medicine. Philosophy of medicine has now been around long enough that entire careers, or at least substantial portions of careers, can and have been devoted to it. This is an important milestone in the field.This is true, even though, as the author indicates in the introduction, this is not solely a book of philosophy of medicine. Investigations in philosophy of medicine, (...) and the essays included in this volume in particular, can not only contribute to “the development of philosophy of medicine as a discipline” but can also “test and help revise some of [philosophy of science’s] views” . Thus, this book is intended as a contribution both to philosophy of medicine as a specific discipline and to philosophy of science generally. Both of these aspects of the book could attract the attention of the current audience.The book focuses .. (shrink)
Raffaella De Rosa discusses the theory of sensory perception, especially color perception, offered by Ren Descartes. She offers a detailed overview of the recent literature on the topic and provides a new reading of Descartes' theory; she also raises questions of great interest in the contemporary philosophy of mind and cognitive science.
Raffaella De Rosa discusses the theory of sensory perception, especially color perception, offered by René Descartes. She offers a detailed overview of the recent literature on the topic and provides a new reading of Descartes' theory; she also raises questions of great interest in the contemporary philosophy of mind and cognitive science.
In the last few decades, philosophy of science has increasingly focused on multilevel models and causal mechanistic explanations to account for complex biological phenomena. On the one hand, biological and biomedical works make extensive use of mechanistic concepts; on the other hand, philosophers have analyzed an increasing range of examples taken from different domains in the life sciences to test—support or criticize—the adequacy of mechanistic accounts. The article highlights some challenges in the elaboration of mechanistic explanations with a focus on (...) cancer research and neuropsychiatry. It jointly considers fields, which are usually dealt with separately, and keeps a close eye on scientific practice. The article has a twofold aim. First, it shows that identification of the explananda is a key issue when looking at dynamic processes and their implications in medical research and clinical practice. Second, it discusses the relevance of organizational accounts of mechanisms, and questions whether thorough self-sustaining mechanistic explanations can actually be provided when addressing cancer and psychiatric diseases. While acknowledging the merits of the wide ongoing debate on mechanistic models, the article challenges the mechanistic approach to explanation by discussing, in particular, explanatory and conceptual terms in the light of stances from medical cases. (shrink)
The Médecins Sans Frontières ethics review board has been solicited in an unprecedented way to provide advice and review research protocols in an ‘emergency’ mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, ranging from epidemiological research, to behavioural research, infectivity studies and clinical trials with investigational products at early development stages. This article examines the MSF ERB’s experience addressing issues related to both the process of review and substantive ethical issues (...) in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms. Having noticed different standards across ethics committees, we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the ‘optimal’ ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process. (shrink)
This article focuses on the assessment of mechanistic relations with specific attention to medicine, where mechanistic models are widely employed. I first survey recent contributions in the philosophical literature on mechanistic causation, and then take issue with Federica Russo and Jon Williamson’s thesis that two types of evidence, probabilistic and mechanistic, are at stake in the health sciences. I argue instead that a distinction should be drawn between previously acquired knowledge of mechanisms and yet-to-be-discovered knowledge of mechanisms and that both (...) probabilistic evidence and manipulation are essential with respect to newly discovered mechanisms. (shrink)
In medical research, the ethical principle of respect for persons is operationalized into the process of informed consent. The consent tools should be contextualized and adapted to the different socio-cultural environment, especially when research crosses the traditional boundaries and reaches poor communities. We look at the challenges experienced in the malaria Quinact trial, conducted in the Democratic Republic of Congo, and describe some lessons learned, related to the definition of acceptable representative, the role of independent witness and the impact of (...) socio-economic vulnerability. To ensure children's protection, consent is required by the parents or, in their absence, by a legally mandated representative. In our setting, children's responsibility is often entrusted permanently or temporarily to relatives or friends without a tribunal mandate. Hence, a notion of ‘culturally acceptable representative’ under supervision of the local Ethics Committee may be more suitable. To ensure protection of illiterate subjects, an independent witness is required to confirm that the consent was freely given. However, in low-literacy contexts, potential witnesses often don't have any previous relationship with patient and there may be power-unbalance in their relationship, rather than genuine dialogue. In poor communities, trial participation may be seen as an opportunity to secure access to healthcare. Poverty may also lead to ‘competition’ to access the research-related benefits, with a risk of disturbance at societal or household level. Adjusting consent procedures to sociocultural and socioeconomic realities is essential for fulfilling the underlying ethical principles. This requires a collaborative dialogue between researchers, regulators and ethics committees. (shrink)
Médecins Sans Frontières is one of the world’s leading humanitarian medical organizations. The increased emphasis in MSF on research led to the creation of an ethics review board in 2001. The ERB has encouraged innovation in the review of proposals and the interaction between the ERB and the organization. This has led to some of the advances in ethics governance described in this paper.
This contribution claims that the two fundamental notions of causation at work in the health sciences are manipulative and mechanistic, and investigates what kinds of evidence matter for the assessment of causal relations. This article is a development of our 2007 article, ?Plurality of Causality?, where we argue for a pluralistic account of causation with an eye to econometrics and a single medical example. The present contribution has a wider focus, and considers the notion of evidence within a whole range (...) of disciplines belonging to the health sciences. Section 1 addresses the relations between kinds of evidence and causal accounts, and it is shown how different notions of causation can be employed in various medical cases. Section 2 calls attention to issues crucial for any adequate epistemological theory of causation, such as the distinctions between types and tokens, observational and experimental regimes, explanation and prediction. Lastly, the notion of context is articulated, highlighted in its role in the assessment of causal links. All these issues are tackled in the framework of what we label a ?bottom?up? epistemology. (shrink)
This paper studies the influence of an organization’s time perspective on triple bottom line deployment through sustainable innovativeness. Although academics increasingly consider sustainable innovation to be an essential element in deploying the triple bottom line, the degree of an organization’s sustainable innovativeness remains limited. Using ten inductive case studies based on the triangulation of data from multiple-respondent interviews and secondary data, this study shows that an organization’s time perspective plays a crucial role in explaining the organization’s degree of sustainable innovativeness (...) and improvement of triple bottom line outcomes. Specifically, organizations with a longer planning horizon, higher tolerance of uncertainty, and greater ability to learn from the past develop a higher and increasing degree of sustainable innovativeness, allowing trade-offs between triple bottom line dimensions to be mitigated. (shrink)
Much of the recent philosophical debate on causation and causal explanation in the biological and biomedical sciences has focused on the notion of mechanism. Mechanisms, their nature and epistemic roles have been tackled by a range of so-called neo-mechanistic theories, and widely discussed. Without denying the merits of this approach, our paper aims to show how lately it has failed to give proper credit to processes, which are central to the field, especially of contemporary molecular biology. Processes can be summed (...) up in the notion of ‘pathway’, which is far from being just equivalent to that of ‘mechanism’ and has a profound epistemological and explanatory relevance. It is argued that an adequate consideration of pathways impels some rethinking of scientific explanation in molecular biology, namely its functional and contextual features. A number of examples are given to suggest that the focus of philosophical attention in this disciplinary field should shift from the notion of mechanism to the notion of pathway. (shrink)
Evidence has long suggested that ‘hardwiring’ is a poor metaphor for brain development. But the metaphor may be an apt one for the dominant paradigm for researching sex differences, which pushes most neuroscience studies of sex/gender inexorably towards the ‘discovery’ of sex/gender differences, and makes contemporary gender structures appear natural and inevitable. The argument we forward in this paper is twofold. In the first part of the paper, we address the dominant ‘hardwiring’ paradigm of sex/gender research in contemporary neuroscience, which (...) is built on broad consensus that there are important ‘original’ sex differences in brain structure and function, organized by sex-differentiating prenatal hormone exposures. We explain why this consensus is both unscientific and unethical. In the second part of the paper, we sketch an alternative research program focused not on the origins of sex/gender differences but on variability and plasticity of brain/behavior. We argue that interventional experiments based on this approach will address more tractable questions, and lead to much more satisfactory results than the brain organization paradigm can provide. (shrink)