This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they (...) are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different countries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a “bottom-up” perspective might give healthcare personnel opportunities to think and reflect more than a “top-down” perspective. A “bottom-up” approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a “top-down” approach risks removing such moral responsibility. (shrink)

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)

Some philosophers argue that we are justified in rejecting skepticism because it is explanatorily inferior to more commonsense hypotheses about the world. Focusing on the work of Jonathan Vogel, I show that this “abductivist” or “inference to the best explanation” response rests on an impoverished explanatory framework which ignores the explanatory gap between an object's having certain properties and its appearing to have those properties. Once this gap is appreciated, I argue, the abductivist strategy is defeated.

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)

Institutional investors are increasingly becoming active owners through voting their shares and engaging in dialogue with investee companies to improve corporate environmental, social and corporate governance (ESG) performance. This article applies a model of stakeholder salience to the shareholder context, analysing the attributes of power, legitimacy and urgency, to determine the factors that are likely to enhance shareholder salience. It is found that a strong business case and the values of the managers of investee companies are likely to be the (...) most important contributors to shareholder salience. (shrink)

We present some teaching materials for metaphysics which use the method of introducing issues via puzzles, paradoxes, problems, and conundrums in metaphysics. The method is motivated by the aim to increase student participation and engagement in metaphysical issues so that the student considers and understands philosophical theories based on specific metaphysical concepts. These materials are a result of distilling first and second year undergraduate academic materials into simple presentations that retain the core focus on salient concepts. The presented teaching methods (...) share the same approach as Raymond Smullyan's puzzle-first approach to teaching. Potential goals for the material are numerous; one main goal is the development of the individual student's independent, original, and creative philosophical thinking and analysis as applied to the area of metaphysics. Other goals include the appreciation of overlap between different subareas within metaphysics - overlaps that we note. The article finishes with a further consideration of the importance and utilization of the emotions elicited from materials of philosophical problems and how these can be best incorporated into the teaching methods. (shrink)

Cheryl Misak (2000; 2008a; 2008b; Misak and Talisse 2014; Misak and Talisse 2021) has presented an argument for democracy based on her analysis of the writings of Charles Sanders Peirce: If we care about the truth of our beliefs – as everyone does, according to Misak – then we ought to support democratic norms and democratic political institutions. We argue in the present paper that Misak’s argument does not adequately justify a democratic political system. Her argument does, however, justify a (...) rational commitment to the standard liberal-democratic values of freedom of expression, freedom of association, and the like. We demonstrate as well that Misak’s argument for the democratic values withstands well-known objections against her argument for a democratic political system. We also show that weaker premises involving every agent’s commitment to pursuing their own subjective ends can get us to Misak’s conclusions regarding liberal values using reasoning otherwise similar to Misak’s in that our alternative premises also get us to the commitment to taking the experiences of others seriously. These weaker premises avoid objections raised against Misak’s Peircean view and are acceptable even to those who reject Misak’s idea, taken from her reading of Peirce, that truth is a constitutive norm of belief. (shrink)

In this study, we discuss the colonial project as an eliminatory structure of indigenous ways of knowing and doing that is built into Canadian social and health institutions. We elaborate on the role nursing plays in maintaining systemic racism, marginalization and discrimination of Indigenous Peoples. Based on historical practices and present‐day circumstances, we argue that changing language in research and school curriculums turns decolonization into what Tuck and Yang call a ‘metaphor’. Rather, we propose decolonization as a political project where (...) nurses acknowledge their involvement in colonial harms and disrupt the assumptions that continue to shape how nurses interact with Indigenous people, including knowledge systems that perpetuate colonial interests and privilege. Decolonization requires nurses to understand the colonial practices that led to dispossession of land, erasure of knowledge, culture and identity, while upholding indigenous ways of knowing and doing in health, healing and living. As a political manifesto that liberates indigenous life from oppressive structures of colonialism and capitalism, The Red Deal is presented as a visionary platform for decolonization. The aim of this study is to articulate three dimensions of caretaking within The Red Deal as a framework to decolonize nursing knowledge development and practice. Based on the philosophical dimension embedded in The Red Deal that revoke norms and knowledge assumptions of capitalism that destroy indigenous ways of knowing and doing, we underscore an approach toward decolonizing nursing. Our approach rejects the apolitical nature of nursing as well as the unilateral western scientific knowledge approach to knowledge development and recognition. A critical emancipatory approach that addresses the socio‐political and historical context of health care, recognizes dispossession of land and adopts a ‘multilogical’ vision of knowledge that gives space for representation and voice is needed for true decolonization of nursing. (shrink)

Headmaster of King Edward's School in Birmingham for fourteen years, Edwin Hamilton Gifford also held a number of ecclesiastical posts, including select preacher at both Cambridge and Oxford. Better known for his biblical and patristic scholarship, he also prepared this edition of the Euthydemus, Plato's most comical dialogue. Thought to be an early work, depicting a discussion between Socrates and two sophists trained in eristic, it is among the earliest-known treatises on logic, satirising various fallacies that were subsequently categorised by (...) Aristotle. Published in 1905, a generation after Jowett's standard translation, this edition was intended for university and advanced school students. A thorough introduction is given in English, followed by the Greek text, extensive notes, and indexes of vocabulary and names. As such, this reissue illuminates the educational preoccupations of both early twentieth-century England and classical Athens. (shrink)

The relationship between alethic modality and indeterminacy is yet to be clarified. A modal argument—an argument that appeals to alethic modality—against vague objects given by Joseph Moore offers a potential clarification of the relationship; it is proposed that there are cases for which the following holds: if it is indeterminate whether A = B then it is possible that it is determinate that A = B. However, the argument faces three problems. The problems remove the argument’s threat against vague objects (...) and prompt a fuller scrutiny of Moore’s proposed relationship between alethic modality and indeterminacy. Such a scrutiny offers valuable lessons concerning the justification for claims of indeterminate identity, appeals to identity principles in contexts involving both alethic modality and indeterminacy, and how to identify the form of Gareth Evans’s argument against vague objects in other arguments. (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)

The stressful nature of caring for an older adult with a chronic disease, such as Alzheimer’s disease, can create barriers between the caregiver-care recipient, as they try to navigate their continuously changing social relationship. Interpersonal synchrony, is an innovative approach that could help to sustain caregiving relationship dynamics by promoting feelings of connection and empathy through shared behavior and experiences. This review investigates the current literature on interpersonal synchrony from an interdisciplinary perspective by examining interpersonal synchrony through psychological, neural, and (...) hormonal measures across the adult lifespan. We then present a case for examining the degree to which interpersonal synchrony can be used to facilitate affiliation and well-being in the caregiver-care recipient relationship. We find that there is significant evidence in healthy adult populations that interpersonal synchrony can support affiliative feelings, prosocial behavior, and well-being. Characterizing the psychological, neural, and hormonal mechanisms of interpersonal synchrony is a first step towards laying the groundwork for the development of tools to support relational closeness and empathy in the caregiving context. Finally, we explore the strengths and limitations of using interpersonal synchrony to support relational well-being, and discuss possible avenues for future research. (shrink)

The paper provides close commentary on an important but generally neglected passage in "Prior Analytics" B.21 where, in the course of solving a logical puzzle concerning our knowledge of universal statements, Aristotle offers his only explicit treatment of the Platonic doctrine of Recollection. I show how Aristotle defends his solution to the "Paradox of Knowing Universals", as we might call it, and why he introduces Recollection into his discussion of the puzzle. The reading I develop undermines the traditional view of (...) the passage and lends fresh insight into Aristotle's conception of Plato's particular version of innatism; more specifically, when understood as I recommend, the passage strongly suggests that, on Aristotle's view, Plato's theory of Recollection is specifically designed to explain our apprehension of universal truths. The reading I propose also enables us to see how the allegedly non-standard use of the technical term ἐπαγω³ή in B.21 can be understood in a perfectly straightforward fashion to refer to an inductive inference from singular statements to the universal truth they exemplify. Owing to this last point in particular, the paper carries serious consequences for our understanding of the purported doublet in the problematic opening chapter to the "Posterior Analytics" where Aristotle offers his only explicit attempt to solve Meno's Paradox. (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)

Retroviruses are unusual amongst animal viruses in their capacity to integrate into host genomes and be transmitted vertically to host progeny. Vertebrate genomes contain numerous and diverse retrovirus‐derived sequences reflecting a long co‐evolutionary history during which genome invasion has occurred repeatedly, with wide‐ranging evolutionary consequences. Over the past 10 years, a detailed picture of retroviral diversity throughout vertebrate genomes has emerged, revealing striking and informative patterns that differ markedly across species. The power of these data to deliver far‐reaching insights into (...) the biology and evolution of retroviruses has been significantly advanced by recent studies identifying ongoing genome invasion in wild populations,(1) and by the characterisation of conserved mechanisms of innate antiretroviral defence.(2,3) BioEssays 28: 1153–1156, 2006. © 2006 Wiley Periodicals, Inc. (shrink)

_Edward Bibring Photographs the Psychoanalysts of His Time_ provides us with a unique pictorial window into a fascinating period of psychoanalytic history. It is the gift of Edward Bibring, a passionate photographer who, Rolleiflex in hand, chronicled international psychoanalytic congresses from 1932 to 1938. The period in question spans the ascendancy of Hitler, the great exodus of analysts to England and the U.S., and the Anschluss of 1938. A year after the Paris Congress, the last meeting photographed by Bibring, Europe (...) would be in flames. At Wiesbaden in 1932, we find an ever dignified Ernest Jones relaxing aboard a sight-seeing ship, and Helene Deutsch and Heinz Hartmann delightfully at ease at a coffee shop. At the Lucerne Congress of 1934, Anna Freud, Ludwig Jekels, Wilhelm Reich, Grete Bibring, Max Eitingon, and Franz Alexander happily converse outside a hotel. At Marienbad in 1936, there are smiling new faces: Annie Reich, Ernst Kris, Otto Fenichel, Edward Glover, and others. At Budapest in1937 the women – Anna Freud, Vilma Kovacs, Dorothy Burlingham, and Elisabeth Geleerd – speak animatedly among themselves. A demure Margaret Mahler and a chic Marianne Kris make their appearance. In 1938, we see a series of table shots, where analysts, now with suit jackets removed and even a few collars loosened, relax with their food, wine, and cigars. Bracketed by Sanford Gifford’s brief introduction and biographical sketches of all the captured parties, Bibring’s photographs, digitized and enlarged, retain just enough graininess to evoke a different era in the history of psychoanalysis. It is heartening to see the paragons of “classical psychoanalysis” as warmly human, their analytic reserve supplanted by relaxed affability. But it is sobering to remember that the high spirit engendered by Congresses – in Bibring’s time no less than our own – may overlay the gravest political developments and the deepest personal anxieties. (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)