In March 1996, the General Accounting Office (GAO) issued the reportScientific Research: Continued Vigilance Critical to Protecting Human Subjects.It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always cleartoclinicians. Controversy (...) exists regarding whether certain medical procedures should be categorized as research.”This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health (NIH) Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy. (shrink)

In March 1996, the General Accounting Office (GAO) issued the reportScientific Research: Continued Vigilance Critical to Protecting Human Subjects.It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always cleartoclinicians. Controversy (...) exists regarding whether certain medical procedures should be categorized as research.”This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health (NIH) Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy. (shrink)

In March 1996, the General Accounting Office issued the report Scientific Research: Continued Vigilance Critical to Protecting Human Subjects. It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always clear (...) to clinicians. Controversy exists regarding whether certain medical procedures should be categorized as research.”This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy. (shrink)

"The fixed person for fixed duties, who in older societies was such a godsend, in the future ill be a public danger." Twenty years ago, a single legal metaphor accurately captured the role that American society accorded to physicians. The physician was "c- tain of the ship." Physicians were in charge of the clinic, the Operating room, and the health care team, responsible - and held accountabl- for all that happened within the scope of their supervision. This grant of responsibility (...) carried with it a corresponding grant of authority; like the ship's captain, the physician was answerable to no one regarding the practice of his art. However compelling the metaphor, few would disagree that the mandate accorded to the medical profession by society is changing. As a result of pressures from a number of diverse directions - including technological advances, the development of new health professionals, changes in health care financing and delivery, the recent emphasis on consumer choice and patients' rights - what our society expects phy- cians to do and to be is different now. The purpose of this volume is to examine and evaluate the conceptual foundations and the moral imp- cations of that difference. Each of the twelve essays of this volume assesses the current and future validity of the "captain of the ship" metaphor from a different perspective. The essays are grouped into four sections. In Section I, Russell Maulitz explores the physician's role historically. (shrink)

When a patient visits his doctor there is, as well as a spoken dialogue, also an unspoken, or tacit, dialogue between them. This may not be evident unless that dialogue breaks down when the psychological or moral terms of reference of each are seen to be different. The author of this paper tries to elucidate the framework in which physician and patient think, and in so doing allow an understanding of why the physician may appear to be rigid and authoritarian (...) in his dealing with his patients and the patient uncooperative. (shrink)

The crux of the dispute between formalism and intuitionism, it is held, is not whether certain entities exist or not, but how the term function shall be used in mathematics. The identification of effective definition with general recursion fails because an undefined function lies concealed beneath the requirement of a finite number of substitutions, and a fresh characterization of effective definition is sought in terms of a hierarchy of ordinal recursions.A correspondence exists between primitive recursive properties and direct proofs, of (...) irrationality and transcendence for instance, and between general recursive properties and indirect proofs.Mathematics is a concept creating activity and the distinction between a formal mathematics devoid of meaning, at one level, and a meaningful metamathematics at the next is considered to be untenable.RésuméLa controverse entre les formalistes et les intuitionistes ne repose pas, considére‐t‐on, sur l'existence ou la non‐existence de certaines entités, mail sur l'usage du terme fonction en mathématiques. L'identification de la définition effective avec la récursion générate n'est pas valable parce qu'une fonction indéfinié est dissimulée sous la nécessité d'un nombre fini de substitutions, et une nouvelle caractérisation de définition effective est recherchée sous forme de hiérarchie de récursions ordinates.II existe, d'une part, une correspondance entre les propriétés primitives récursives et les preuves directes, d'irrationalité et de transcendance par exemple, et, d'autre part, entre les propriétés récursives générates et les preuves par l'absurde.Les mathématiques sont une activité créatrice de concepts, et la distinction entre les mathématiques formelles dépourvues de sens et, sur le plan supérieur, une méta‐mathématique chargée de sens, ne semble pas justifiée. (shrink)

This graduate-level_text by a master in the field builds a function theory of the rational field that combines aspects of classical and intuitionist analysis. Topics include recursive convergence, recursive and relative continuity, recursive and relative differentiability, the relative integral, elementary functions, and transfinite ordinals. 1961 edition.

Alberto Cortes, in [1], attempts to show that Leibniz's Principle of The Identity of Indiscernibles is a principle restricted to individuals, and that photons appear to violate L. L is stated by Leibniz as “no two substances are completely similar, or differ solo numero.” In second-order quantification theory with identity L becomes.

This paper explores the use of advance directives in clinical dementia research. The focus is on advance consent to participation of demented patients in non-therapeutic research involving more than minimal risks and/or burdens. First, morally relevant differences between advance directives for treatment and care, and advance directives for dementia research are discussed. Then attention is paid to the philosophical issue of dementia and personal identity, and the implications for the moral authority of research advance directives. Thirdly, a number of practical (...) shortcomings of advance directives for non-therapeutic dementia research are explored and attention is paid to the role of proxies. It is concluded that upon a closer look the initial attractiveness of advance directives for dementia research is lessened, and that it is doubtful whether these instruments can compensate for the lack of subject consent in case of non-therapeutic dementia research involving more than minimal risks and/or burdens for the incompetent demented subject. (shrink)

The notion that metaphorical statements are strictly false suggests that all statements, even those that seemed ‘literal’, are false, as none can ‘literally’ reflect reality. Statements about what we perceive or could perceive rely on evoking sensory images of such ‘visibles’, even though we have no direct access to what others, may perceive. In addition to what is visible, we must also deal with ‘invisibilia’ (both the fantasms that respectable moderns now reject and the realities that lie beyond or before (...) all sentient experience). Talking about such distant or long-ago realities must always be ‘metaphorical’, as they cannot have any of the merely ‘subjective’ properties of experience, nor do they explain those latter properties. Is there some way of confirming the brute conviction that there is a ‘real and intelligible world’, and that we can find it out or describe it ‘literally’? May ‘Reason’ be a route to understanding? But this too is an illusion: we seem never in practice to escape contradictions and had perhaps better turn again to consider the worlds of experience to which we are confined. What we experience is conditioned by our imagination: whether that metaphorical imagination points beyond experience remains uncertain. (shrink)

This paper attempts to explore a number of conceptual issues surrounding genetic testing. It looks at the meaning of the terms, genetic information and genetic testing in relation to the definition set out by the Advisory Committee on Genetic Testing in the UK, and by the Task Force on Genetic Testing in the USA. It argues that the special arrangements that may be required for the regulation of genetic tests should not be determined by reference to the nature or technology (...) of the test, but by considering those morally relevant features that justify regulation. Failure to do so will lead to the regulation of genetic tests that need not be regulated, and would fail to cover other tests which should be regulated. The paper also argues that there is little in the nature of the properties of gene tests, using DNA or chromosomes, that in itself justifies a special approach. (shrink)

Many religious people are alarmed about features of the current age - violence in the media, a pervasive hedonism, a marginalization of religion, and widespread abortion. These concerns influence politics, but just as there should be a separation between church and state, so should there be a balance between religious commitments and secular arguments calling for social reforms. Robert Audi offers a principle of secular rationale, which does not exclude religious grounds for action but which rules out restricting freedom except (...) on grounds that any rational citizen would accept. The book describes the essential commitments of free democracy, explains how religious and secular moral considerations can be integrated to facilitate co-operation in a world of religious pluralism, and proposes ideals of civic virtue that express the mutual respect on which democracy depends. Audi offers a balanced and sophisticated treatment of the relations between religion and politics in a modern, secular society. (shrink)

The notion of autonomy commonly employed in medical ethics literature and practices is inadequate on three fronts: it fails to properly identify nonautonomous actions and choices, it gives a false account of which features of actions and choices makes them autonomous or nonautonomous, and it provides no grounds for the moral requirement to respect autonomy. In this paper I offer a more adequate framework for how to think about autonomy, but this framework does not lend itself to the kinds of (...) practical application assumed in medical ethics. A general problem then arises: the notion of autonomy used in medical ethics is conceptually inadequate, but conceptually adequate notions of autonomy do not have the practical applications that are the central concern of medical ethics. Thus, a revision both of the view of autonomy and the practice of “respect for autonomy” are in order. (shrink)