BackgroundCountries are increasingly devoting significant resources to creating or strengthening research ethics committees, but there has been insufficient attention to assessing whether these committees are actually improving the protection of human research participants.DiscussionResearch ethics committees face numerous obstacles to achieving their goal of improving research participant protection. These include the inherently amorphous nature of ethics review, the tendency of regulatory systems to encourage a focus on form over substance, financial and resource constraints, and conflicts of interest. Auditing and accreditation programs (...) can improve the quality of ethics review by encouraging the development of standardized policies and procedures, promoting a common base of knowledge, and enhancing the status of research ethics committees within their own institutions. However, these mechanisms focus largely on questions of structure and process and are therefore incapable of answering many critical questions about ethics committees' actual impact on research practices.The first step in determining whether research ethics committees are achieving their intended function is to identify what prospective research participants and their communities hope to get out of the ethics review process. Answers to this question can help guide the development of effective outcomes assessment measures. It is also important to determine whether research ethics committees' guidance to investigators is actually being followed. Finally, the information developed through outcomes assessment must be disseminated to key decision-makers and incorporated into practice. This article offers concrete suggestions for achieving these goals.ConclusionOutcomes assessment of research ethics committees should address the following questions: First, does research ethics committee review improve participants' understanding of the risks and potential benefits of studies? Second, does the process affect prospective participants' decisions about whether to participate in research? Third, does it change participants' subjective experiences in studies or their attitudes about research? Fourth, does it reduce the riskiness of research? Fifth, does it result in more research responsive to the local community's self-identified needs? Sixth, is research ethics committees' guidance to researchers actually being followed? (shrink)

Background In 2001 a report on the provision of clinical ethics support in UK healthcare institutions identified 20 clinical ethics committees. Since then there has been no systematic evaluation or documentation of their work at a national level. Recent national surveys of clinical ethics services in other countries have identified wide variation in practice and scope of activities. Objective To describe the current provision of ethics support in the UK and its development since 2001. Method A postal/electronic questionnaire survey administered (...) to the chairs of all 82 clinical ethics services registered with the UK Clinical Ethics Network in July 2010. Results Response rate was 62% with the majority of responding services situated in acute trusts. All services included a clinical ethics committee with one service also having a clinical ethicist. Lay members were present in 72% of responding committees. Individual case consultation has increased since 2001 with 29% of chairs spending more than 50% of their time on this. Access to and involvement in the process of case consultation is less for patients and families than for clinical staff. There is wide variation in committee processes and levels of institutional support. Over half of the responding committees undertook some form of evaluation. Conclusion Clinical ethics services in the UK are increasing as is their involvement in case consultation. However, the significant variation in committee processes suggests that further qualitative research is needed to understand how these committees function and the role they play in their institution. (shrink)

My paper challenges an influential distinction between pain and suffering put forward by physician-ethicist, Eric Cassell. I argue that Cassell’s distinction is philosophically untenable because he contrasts suffering with an outdated theory of pain. In particular, Cassell focuses on one type of pain, the interpretation of nociception induced by noxious stimuli such as heat or sharp objects; yet since the late 1970s, pain scientists have rendered both nociception and noxious stimuli unnecessary for pain. I argue that this discrepancy between Cassell’s (...) distinction and pain science produces three philosophical problems for his distinction: first, he frames his distinction too generally, concentrating on only one type of pain to the neglect of others, such as neuropathy; second, it is possible that Cassell’s understanding of pain may include suffering; and third, Cassell gives examples of pain and suffering manifesting independently of each other, but it is possible that these cases may instead exemplify differences between nociceptive and non-nociceptive types of pain. Due to these problems, I conclude that Cassell’s distinction currently lacks a difference. I call for new efforts to articulate the differences, if any, between pain and suffering. (shrink)

We reflect, using a vignette, on conceptual tensions and the value judgements that lie behind difficult decisions about whether or not the older person with dementia should return home or move into long-term care following hospital admission. The paper seeks, first, to expose some of the difficulties arising from the assessment of residence capacity, particularly around the nature of evaluative judgements and conceptual tensions inherent in the legal approach to capacity. Secondly, we consider the assessment of best interests around place (...) of residence, which demonstrates significant conceptual tensions. In addition, ‘best interests’ raise issues around the perception of risk and the perceptions of the family and crucially involve the notions of autonomy and trust. Finally, we not only gesture at some practical considerations based on insights from values-based medicine, but also make the suggestion that we require tighter functional assessments of residence capacity coupled with broader judgements about best interests. (shrink)

The aim of this study is to enhance the understanding of how sport dressage riders describe rider-horse communication when riding, and to relate these descriptions to current research on human-horse communication. Interviews with 15 amateur dressage riders were analyzed using a qualitative approach. The study shows that the interviewed riders describe the communication with the horses partly in a behavioristic way, applying concepts based on learning theory, which deviate from the description of riders as lacking understanding of these concepts put (...) forth by some researchers. The riders connect the timing of their aids to equestrian feel, which they describe as the most difficult yet the most awarding aspect of the interspecies communication that riding is. Simultaneously, they acknowledge that horses are fully capable of choosing to listen to and cooperate with their requests. (shrink)

My paper challenges an influential distinction between pain and suffering put forward by physician-ethicist, Eric Cassell. I argue that Cassell’s distinction is philosophically untenable because he contrasts suffering with an outdated theory of pain. In particular, Cassell focuses on one type of pain, the interpretation of nociception induced by noxious stimuli such as heat or sharp objects; yet since the late 1970s, pain scientists have rendered both nociception and noxious stimuli unnecessary for pain. I argue that this discrepancy between Cassell’s (...) distinction and pain science produces three philosophical problems for his distinction: first, he frames his distinction too generally, concentrating on only one type of pain (interpreted nociception) to the neglect of others, such as neuropathy; second, it is possible that Cassell’s understanding of pain may include suffering; and third, Cassell gives examples of pain and suffering manifesting independently of each other, but it is possible that these cases may instead exemplify differences between nociceptive and non-nociceptive types of pain. Due to these problems, I conclude that Cassell’s distinction currently lacks a difference. I call for new efforts to articulate the differences, if any, between pain and suffering. (shrink)

The provision of informed consent is a prerequisite for inclusion of a patient in a clinical research project. In some countries, the legislation on clinical research authorizes a third person to provide informed consent if the patient is unable to do so directly . This is the case during acute stroke, when the symptoms may prevent the patient from providing informed consent and thus require a third party to be approached. Identification of factors associated with the medical team’s decision to (...) resort to surrogate consent may help the care team during the inclusion process and enable the patient’s family circle to be better informed about providing surrogate consent. (shrink)

The close friendship between Charlotte Brontë and Mary Taylor began in boarding school and lasted for the rest of their lives. It was Mary Taylor, in fact, who inspired Brontë to leave her oppressive parsonage home and go to Brussels, the eventual setting for her novel, Villette. Mary herself led a much less restricted life, especially in her later years as a feminist essayist who strongly urged women to consider their "first duty" to be working to support themselves. In (...) Miss Miles, her only novel, Taylor breaks with tradition by creating a profoundly feminist and morally intense work which depicts women's friendships as sustaining life and sanity through all of the vicissitudes of Victorian womanhood. She also introduces an innovative narrative form which Janet Murray calls a "feminist bildungsroman": the story of the education of several heroines which emphasizes their friendship and economic and mental well-being rather than their love lives. Set in the small Yorkshire village of Repton against the backdrop of starvation in the wool districts and the rise of Chartism in the 1830s, this recovered feminist classic chronicles the lives of four disparate and individually ambitious women as they learn to find their own voices and support one another. The novel's emphasis on the healing power of women's friendships echoes the relationship between Brontë and Taylor herself. Originally published in 1890, Miss Miles has been unavailable for decades. Its reappearance will delight all lovers of fine literature. (shrink)

Virginia Woolf, in A Room of One’s Own, asked why there were no women writers before 1800. If she had been thinking about philosophers instead of writers in the traditional women’s areas of plays and fiction, she might have asked why there were no women philosophers at all, for I suspect that most people would find it very hard to name a woman philosopher before the present day. To help her in answering her question, she invented a fictional character, Judith (...) Shakespeare, a sister to William Shakespeare. The conditions of Judith’s life made it impossible for her to write, and so Woolf speculated that the women who would have been writers did not lead the kinds of lives that permitted them to realize their talents. Woolf’s image of Judith Shakespeare is a very powerful one but her speculation is only half right. There undoubtedly were many women in the past who would have been talented writers or philosophers if their lives had been different, but Judith Shakespeare’s image can also blot out our knowledge of women who, contrary to Woolf’s speculation, did exist and did write. Indeed, we know now there were even women who wrote philosophy. These women were in many ways exceptional, for Woolf is quite right that most women did not live either with enough privacy or with enough income to allow them to write. Often, they were members of the aristocracy, whose position enabled them to behave eccentrically, sometimes to be able to demand privacy, and sometimes to be able to invite contacts with leading intellectuals. Quite often, these women were childless, which in an age before birth control made them exceptions to the general rule, and at a time when many women were bearing their last child in their forties, was the only thing that could have given them private time. Nevertheless, research in the last ten or fifteen years has uncovered the work of quite a number of these women: for example, Princess Elizabeth of Bohemia, the Electress Sophie, Queen Christina of Sweden, Queen Sophie Charlotte of Prussia, Anne, Lady Conway, Mary Astell, Damaris, Lady Masham, Catharine Trotter Cockburn, Emilie du Chatelet, Catherine Macaulay, Lady Mary Shepherd, and many more. Woolf’s question then comes up again in a slightly different form. Why is it that the work of these women was for so long unknown? Why do so many people even today remain ignorant of the existence of women philosophers before the present day? I am not going to answer this question directly; in fact, I suspect it has multiple answers. Instead, I am going to present a case study from amongst all the cases of all of these women. I hope by considering the history of this woman, and, in particular, considering the way in which she was read, it will be possible to gain some insights into the ways in which women have failed to be incorporated into philosophical history. The woman I am going to discuss is Lady Mary Shepherd. Mary Shepherd actually falls outside of Woolf’s target date of 1800, since she flourished in the first half of the nineteenth century, but this merely reflects my point about the greater ignorance that prevails about women in philosophy. (shrink)

‘Writing Pain’ argues that Anna Seward‘s Letters and Mary Robinson‘s letters create alternative models of sensibility from the suffering poet of Charlotte Smith‘s Elegiac Sonnets. Immensely popular, Smith‘s sonnets made feminine suffering a source of poetic agency by aestheticizing and privatizing it. However, despite their sincerity, her sonnets effaced the physical, nervous body of sensibility on which Seward‘s and Robinsons early poetic reputations had depended and for which they had been mocked. The popularity of Smith‘s model made it an (...) important model for women poets, but, by the end of the eighteenth century, sensibility was also associated with sickness and artifice. For Seward and Robinson, who wanted to build their literary reputations but were living with disabled bodies, Smiths example needed to be reimagined to account for the reciprocity of body and mind as they struggled to write through pain. (shrink)

Feminist theory is a central strand of cultural studies. This book explores the history of feminist cultural studies from the early work of Mary Wollstonecraft, Charlotte Perkins Gilman, Virginia Woolf, Simone de Beauvoir, through the 1970s Women's Liberation Movement. It also provides a comprehensive introduction to the contemporary key approaches, theories and debates of feminist theory within cultural studies, offering a major re-mapping of the field. It will be an essential text for students taking courses within both cultural studies (...) and women's studies departments. (shrink)

Much has been done to establish a body of scholarly work on women pragmatists since Mary Jo Deegan and Charlene Haddock Seigfried first stressed the importance of the contribution of Jane Addams, Florence Kelley, Anna Julia Cooper, Charlotte Perkins Gilman and others to the foundations of the pragmatist tradition of thought. Nevertheless, it took decades to fully correct the gender and race bias of the genealogies: that is, to overcome the temptation of reducing pragmatism to the writings of a (...) few white male professional philosophers living in the areas of Boston or Chicago a century ago. The reconstruction of pragmatism might also require a rethinking of the philosophical canon itself, the ways in... (shrink)

Charlotte Wolff was born in Riesenburg, West Prussia into a middle-class Jewish family. She studied philosophy and then medicine at several German universities, completing her doctorate in Berlin in 1926. Working in various institutions over the next few years, she was also interested in psychotherapy and had a small private medical and psychotherapeutic practice. In 1933 she was forced to leave Germany because of the Nazi regime, and settled for a few years in Paris. As a German refugee she (...) was unable to practice medicine, so she began her research into the correlation between hand traits and personality. In 1936 she went to London to continue her research work and lived there until her death. An active lesbian from an early age, her later research turned to sexology and her writing on lesbianism and bisexuality were influential early works in the field. This is a great opportunity to rediscover her early work, including her first autobiography. (shrink)

In this paper we ask whether liberal egalitarians can endorse workfare policies that require that welfare recipients should work in return for their welfare benefits. In particular, we focus on the fairness-based case for workfare, which holds that people should be responsible for their own welfare since they would otherwise impose unfair costs on others. Two versions of the fairness-based case are considered: The first defends workfare on the grounds that it would form part of an unemployment insurance scheme that (...) individuals would endorse under certain hypothetical conditions that are salient for the purposes of determining just public policy. The second appeals to the notion of reciprocity in order to justify the requirement that people work for their benefits. We cast doubt on both of these arguments for workfare. Neither argument shows that the unconditional provision of welfare benefits is unjust; hence, the fairness case for workfare is inconclusive. (shrink)

The past 25 years have seen an upsurge of interest in the figure of Mary Magdalene, whose image has been transformed through feminist scholarship from penitent prostitute to prominent disciple of Jesus. This article documents another, non-academic, interpretation of Mary Magdalene – the image of Mary as goddess or embodiment of the female divine. The most influential proponent of this view is Margaret Starbird, who hypothesizes that Mary was both Jesus’ wife and his divine feminine counterpart. The author suggests that (...) feminist theologians/thealogians should be aware of this popular understanding of Mary; and consider what it is about Mary Magdalene as the sacred feminine/bride of Jesus/sophia that captures the public imagination in a way that other feminist christologies do not. (shrink)

Feared and admired in equal measure, Mary Midgely has carefully, yet profoundly challenged many of the scientific and moral orthodoxies of the twentieth century. The Essential Mary Midgley collects for the first time the very best of this famous philosopher's work, described by the Financial Times as "commonsense philosophy of the highest order." This anthology includes carefully chosen selections from her best-selling books, including Wickedness, Beast and Man, Science and Poetry and The Myths We Live By . It provides a (...) superb and eminently accessible insight into questions she has returned to again and again in her renowned sharp prose, from the roots of human nature, reason and imagination to the myths of science and the importance of holism in thinking about science and the environment. It offers an unrivalled introduction to a great philosopher and a brilliant writer, and also includes a specially written foreword by James Lovelock. (shrink)