Background: Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees should evaluate the risks of comparative effectiveness research. Main text: We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when “nothing is known” about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. (...) Rather, we should focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative. We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. Conclusion: We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation. (shrink)
David, king in Hebron.—Battle near Gibeon.—Murder of Abner.—Jerusalem.—State of Hebrew industry.—Conquest of Moab.—First war with the Zobahites.—Conquest of Edom.—Prosperity of David.—Ammonite war.—Destruction of the Ammonites.—Career of Absalom.—Death of Absalom.—Disgrace of Mephibosheth.—Immolation of Saul’s descendants.—The pestilence.—Conspiracy of Adonijah.—Death of David.
Without any warning, in September 1999, DavidNewman was told he had a rare and life-threatening tumor in the base of his skull. In the compressed space of five weeks, he consulted with leading physicians and surgeons at four major medical centers. The doctors offered drastically differing opinions; several pronounced the tumor inoperable and voiced skepticism about the effectiveness of any nonsurgical treatment. _Talking with Doctors_ is the story of Newman's efforts, at a time of great stress (...) and even impending death, to wend his way through the dense thicket of medical consultations in search of a physician and a treatment that offered the possibility of survival. It is the story, especially, of the harrowing process of assessing conflicting "expert" opinions and, in so doing, of making sense of the priorities, personalities, and vulnerabilities of different doctors. All too often, he found, the leading specialists to whom he was sent were strangers in the consulting room-and strangers who became stranger still, both cognitively and emotionally, when ambiguous findings pushed them to the outer limits of their training and experience. Newman writes poignantly of his sense of powerlessness and desperation, of the painstaking means by which he ascertained what could be known about his tumor, and of the fortuitous events that finally led him to life-saving help. _Talking with Doctors_ is a compelling, absorbing, unsettling story that touches a collective raw nerve about the experience of doctors and medical care when life-threatening illness leads us to subspecialists at major medical centers. Probing the nature of medical authority and the grounds of a trusting doctor-patient relationship, Newman illuminates with grace and power what it now means for a patient to participate in life-and-death medical decisions. (shrink)
This editorial outlines the articles included in the special thematic symposium on corporate social responsibility and employees and highlights their contributions to the literature. In doing so, it highlights the novel theoretical and empirical insights provided by the articles, how the articles inform and expand the methods and research designs researchers can use to study phenomena in this area, and identifies promising directions for future research.
Although Mealey's account provides several interesting hypotheses, her integration across disparate samples renders the value of her explanation for psychopathy ambiguous. Recent evidence on Psychopathy Checklist-identified samples (Hare, 1991) suggests primary emotional and cognitive deficits inconsistent with her model. Whereas high-anxious psychopaths display interpersonal deficits consistent with Mealey's hypotheses, low-anxious psychopaths' deficits appear more sensitive to situational parameters than predicted.
Worldwide populations are aging with economic development as a result of public health initiatives and advances in therapeutic discoveries. Since 1850, life expectancy has advanced by 1 year for every four. Accompanying this change is the rapid development of anti‐aging science. There are three schools of thought in the field of aging science. One perspective is the life course approach, which considers that aging is a good and natural process to be embraced as a necessary and positive aspect of life, (...) where the aim is to improve the quality of existing lifespan and “compress” morbidity. Another view is that aging is undesirable, and that rejuvenation and indeed immortality are possible since the biological basis of aging is understood, and therefore, strategies are possible for engineering negligible senescence. Finally, a hybrid approach is that life span can be extended by anti‐aging medicines but with uncertain effects on health. While these advances offer much promise, the ethical perspectives are seldom discussed in cross‐disciplinary settings. This article discusses some of the key ethical issues arising from recent advances in biogerontology. (shrink)
Recent work in the Philosophy of Mind has suggested that alternatives to reduction are required in order to explain the relationship between psychology and biology or physics. Emergence has been proposed as one such alternative. In this paper, I propose a precise definition of emergence, and I argue that chaotic systems provide concrete examples of properties that meet this definition. In particular, I suggest that being in the basin of attraction of a strange attractor is an emergent property of any (...) chaotic nonlinear dynamical system. This shows that non-reductive accounts of inter-theoretic relations are necessary, and that non-reductive accounts of the mental are possible. Moreover, this work provides a foundation for future work investigating the nature of explanation, prediction, and scientific understanding of non-reductive phenomena. (shrink)
In this paper, I will examine a classof ethical problems that essentially involvescomputers. I will argue that this class of heretoforeunknown ethical problems arise in broadcastcommunication received with a device of some kind, andinvolve what I will call impersonal interaction. Ialso argue that the moral element in such problemslies in a conflict between property rights and freespeech rights. Finally, I will argue that the bestapproach to solving these problems requires thecreation of a new standard protocol for computercommunication rather than laws (...) governing the use ofcomputers. (shrink)
This essay examines several ethical and epistemological issues that arise when philosophers conduct empirical research focused on, or in collaboration with, community groups seeking to bring about systemic change. This type of research can yield important policy lessons about effective community-driven reform and how to incorporate the voices of marginalized citizens in public policy debates. Community-based reform efforts are also particularly ripe for philosophical analysis since they can demonstrate the strengths and shortcomings of democratic and egalitarian ideals. This type of (...) research also raises unique ethical dilemmas that challenge central tenets of research ethics. We focus on two foundational questions: What does informed consent mean in the context of community-based research (CBR) when CBR may dissolve differences between researcher and research participant, and its parameters can be hard to delineate? And what ethical, democratic, and epistemic issues arise when conducting research with and on community groups, given potentially competing commitments to respect the epistemological contributions of all participants while also meeting research norms to warrant findings and conclusions? Our examination has two aspects: we grapple with these issues through examples from our work to reveal their significance in our own philosophic practice, and more broadly, to reveal their significance as problems within traditional research ethics. We believe that this approach will demonstrate the utility of philosophic engagement with dilemmas in research ethics as a reflective matter, and in the course of empirical research itself. (shrink)
Do the rich descriptions and narrative shapings of literature provide a valuable resource for readers, writers, philosophers, and everyday people to imagine and confront the ultimate questions of life? Do the human activities of storytelling and complex moral decision-making have a deep connection? What are the moral responsibilities of the artist, critic, and reader? What can religious perspectives—from Catholic to Protestant to Mormon—contribute to literary criticism? Thirty well known contributors reflect on these questions, including iterary theorists Marshall Gregory, James Phelan, (...) and Wayne Booth; philosophers Martha Nussbaum, Richard Hart, and Nina Rosenstand; and authors John Updike, Charles Johnson, Flannery O'Connor, and Bernard Malamud. Divided into four sections, with introductory matter and questions for discussion, this accessible anthology represents the most crucial work today exploring the interdisciplinary connections between literature, religion and philosophy. (shrink)
John Henry Newman was an English priest and theologian, whose highly publicised and controversial conversion to Catholicism helped to dispel prejudice towards Catholics in Victorian society. After graduating from Trinity College, Oxford, Newman was ordained as an Anglican deacon in 1824. He gradually became more conservative in his beliefs, becoming a member of the Oxford Movement before converting to Catholicism and being received into the Roman Catholic Church in 1845; he was made a cardinal in 1879. This volume, (...) first published in 1864, contains Newman's classic religious autobiography. Writing in response to a perceived attack on Catholicism by historian and novelist Charles Kingsley, Newman describes his changing religious beliefs between 1833 and 1845 and discusses his spiritual motivations for converting. Newman's emotional sensitivity and clear style ensured the popularity of this volume, which was extremely influential in establishing him as the leading exponent of Catholicism in Victorian England. (shrink)
While one of John Henry Newman's principal aims in the Grammar of Assent is to explain how men can give a ‘real assent’ to the existence of God, the major part of the actual phenomenology of religious belief in the work is concentrated in the fifth of its ten chapters. Unfortunately, this section of the essay has been overshadowed by the preliminary distinction between real and notional apprehension and by the later invocation of the illative sense; but perhaps the (...) time is now ripe for a closer examination of this central part of Newman's philosophy of religion, which is in many ways the key to the successes and failures of Newman's new method in philosophical theology. (shrink)
This article examines a particular debate between Eamonn Callan and William Galston concerning the need for a civic education which counters the divisive pull of pluralism by uniting the citizenry in patriotic allegiance to a single national identity. The article offers a preliminary understanding of nationalism and patriotism before setting out the terms of the debate. It then critically evaluates the central idea of Callan that one might be under an obligation morally to improve one''s own patriotic inheritance, pointing to (...) the ineliminable tension between the valuation of one''s own patria by its own terms and a detached critical reason. It concludes by suggesting that we are, in advance of our education, members of a particular patria and that any education must be particularistic. Finally, the danger is noted of presuming that, in each case, there is a single, determinate national tradition. (shrink)
The Philistines.—Hebrew monotheism.—Administration of Samuel.—Early Hebrew psalmody.—Exterior marks of the Prophet.—Modes of divination.—Foreigndangers of Israel.—Appointment of Saul.—Romantic Philistine campaign.—Ammonite inroad.—Enmity with Amalek.—Massacre of the Amalekites.—David, anointed by Samuel.—David, Saul’s armour-bearer.—David, Saul’s son-in-law. —David, a freebooter.—David with Achish of Gath.—David reinforced from Israel.—David’s return to Ziklag.—Battle of Mount Gilboa.