The authors are members of the British Association Committee on Social Concern and Biological Advances. Following earlier discussions of legal and social problems arising from certain medical advances, they undertook, independently, to examine the Law Commission's study.

The motivation of someone who is locked-in, that is, paralyzed and mute, is to find relief for their loss of function. The data presented in this report is part of an attempt to restore one of those lost functions, namely, speech. An essential feature of the development of a speech prosthesis is optimal decoding of patterns of recorded neural signals during silent or covert speech, that is, speaking “inside the head” with output that is inaudible due to the paralysis of (...) the articulators. The aim of this paper is to illustrate the importance of both fast and slow single unit firings recorded from an individual with locked-in syndrome and from an intact participant speaking silently. Long duration electrodes were implanted in the motor speech cortex for up to 13 years in the locked-in participant. The data herein provide evidence that slow firing single units are essential for optimal decoding accuracy. Additional evidence indicates that slow firing single units can be conditioned in the locked-in participant 5 years after implantation, further supporting their role in decoding. (shrink)

Adherence to a few basic principles of textbook reading compilation have made this one of the more worthwhile introductory philosophy texts. In the first place, the editors have given lengthy and frequently complete texts. Anselm's Proslogium, Descartes' Meditations, Plato's Phaedo, and Kant's Prolegomena are given complete or nearly complete; there is a ninety-one page extract from Locke's Essay, over fifty pages of James and nearly forty pages from Whitehead. This still leaves room for ample primary material by Leibniz, Hume, and (...) Schopenhauer. The plan of the book is to frame the important primary text with intellectually contemporaneous discussion of the problems treated in the primary text, and then to bracket each section with a prologue and epilogue drawn—except in the final section where Plato has the last word—from twentieth-century literature relevant to the issues under discussion in each section. The authors are thus able to provide an historical and thematic introduction to philosophy, which together cannot help but impress the beginning student with the unity of philosophical experience. Obviously no single textbook will ever escape the need for supplementation; this one in particular will require those who would like their students to be exposed to more phenomenology and existentialism, and, to a lesser degree, analytical philosophy, to introduce additional reading. But Epstein and Kennedy have provided the basic skeleton to which may be added as much flesh as the instructor desires.—E. A. R. (shrink)

Reconstructive allografts using Vascularized Composite Allotransplantation are providing individuals living with upper limb loss and facial disfigurement with new opportunities for a sensate, esthetically acceptable, and functional alternative to current treatment strategies. Important research attention is being paid to how best to assess and screen candidates for VCA, measure optimal patient outcomes, and support patient adherence to lifelong behaviors and medical regimens. Far less attention, however, has been dedicated to the team science required for these complex VCA teams to form, (...) prepare, and provide the highest quality clinical and psychosocial care to those receiving VCA. VCA teams are unique in that they require specialized team members whose scope of practice may not otherwise overlap. The team also needs to constantly negotiate balancing patient safety with multiple risks throughout the transplant process. This study aimed to elucidate the team science needed for this highly innovative and complex area of medicine. Using in-depth qualitative interviews with 14 VCA team members and observations at team meetings, we found that careful consideration of team composition, team structure, and organizational commitment influences team performance and patient outcomes, but that to be efficient and truly effective, teams need to commit to developing processes that foster collaboration. These processes are action-oriented, strategic and interpersonal. Dedication and commitment to team science allows teams to manage conflict under stress and exercise ways to leverage strengths to provide optimal performance or patient psychosocial and clinical outcomes. This study can provide insight into quality improvement efforts for VCA teams and guidance for other transplant programs that wish to consider expansion into VCA. (shrink)

This article shows how there is a great kinship between Polanyi's thought and that of Bernard Haring, "the father of modern moral theology" in the Roman Catholic Church. Haring advocated an ethics of personal responsibility that calls for an epistemology such as Polanyi developed for history and social sciences in The Study of Man.

Consideration of the property of action is proposed to provide a more meaningful definition of efficient energy use and sustainable production in ecosystems. Action has physical dimensions similar to angular momentum, its magnitude varying with mass, spatial configuration and relative motion. In this article, the relationship of action to thermodynamic processes such as the spontaneous increase in entropy of the second law is explained and the utility of action for measuring changes in energy and material distribution is promoted. In particular, (...) the view that increases in entropy and action are equivalent to disorder is challenged. Given that the development of action states may be assigned an economic value and the various sources of free energy assigned a price, action theory may provide a novel mechanism for the economic allocation of resources. The importance of the diversity and redundancy of energy resources and work processes to optimize action is highlighted. (shrink)

Informed by the critical humanisms of Hannah Arendt, Frantz Fanon, and Paul Gilroy, the authors argue for an orientation to teaching and learning that troubles the continuing effects of dehumanizing race logic. Reflecting on Paul Haggis's Oscar award winning film Crash from 2004, they suggest that the metaphor of racial 'crashing' captures what happens when we act out from experiences of racial injury instead of being touched by it. They propose a psychoanalytic pedagogy of emotions as a method for reading (...) representation beyond the limits of detached rational critique. Learning from the affect of racial injury as it is made manifest in representation, they suggest, is an important ethical starting point for generating new insights into what it might mean to live within and beyond contemporary legacies of racial hatred. (shrink)

ObjectiveTo compare techniques for computing clustering and switching scores in terms of agreement, correlation, and empirical value as predictors of incident cognitive impairment.MethodsWe transcribed animal and letter F fluency recordings on 640 cases of ICI and matched controls from a national epidemiological study, amending each transcription with word timings. We then calculated clustering and switching scores, as well as scores indexing speed of responses, using techniques described in the literature. We evaluated agreement among the techniques with Cohen’s κ and calculated (...) correlations among the scores. After fitting a base model with raw scores, repetitions, and intrusions, we fit a series of Bayesian logistic regression models adding either clustering and switching scores or speed scores, comparing the models in terms of several metrics. We partitioned the ICI cases into acute and progressive cases and repeated the regression analysis for each group.ResultsFor animal fluency, we found that models with speed scores derived using the slope difference algorithm achieved the best values of the Watanabe–Akaike Information Criterion, but with good net reclassification improvement only for the progressive group. For letter fluency, different models excelled for prediction of acute and progressive cases. For acute cases, NRI was best for speed scores derived from a network model, while for progressive cases, the best model used clustering and switching scores derived from the same network model. Combining variables from the best animal and letter F models led to marginal improvements in model fit and NRI only for the all-cases and acute-cases analyses.ConclusionSpeed scores improve a base model for predicting progressive cognitive impairment from animal fluency. Letter fluency scores may provide complementary information. (shrink)

The Patient Self-Determination Act (PSDA) requires hospitals to ask patients upon admission whether they have an advance directive. Although the PSDA has received extensive criticism, little attention has been paid to the cost of the law, either during its legislative course or following its implementation. Nonetheless, several tangible and intangible costs are associated with the PSDA. Such costs may be incurred by different parties. This paper examines the costs and benefits of the PSDA and illustrates the extent of some of (...) its tangible costs. The incremental start-up cost for one institution's response to the PSDA is estimated to be $49,304 ($1.31 per admission) and the total implementation cost of the program to be $114,528. In addition, the national incremental start-up cost for hospitals to implement the PSDA is estimated to be between $43,625,114 and $101,569,922. Finally, the potential implications of the PSDA for future governmental health care ethics regulation are discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Books ReceivedThe Ambitions of Curiosity: Understanding the World in Ancient Greece and China. By G.E.R. Lloyd. Cambridge: Cambridge University Press, 2002. Pp. xvi + 175. Price not given.The Art of the Han Essay: Wang Fu's Ch'ien-Fu Lun. By Anne Behnke Kinney. Tempe: Center for Asian Studies, Arizona State University, 1990. Pp. xi + 154. Paper $10.00.The Autobiography of Jamgön Kongtrul: A Gem of Many Colors. By Jamgön Kongtrul Lodrön (...) Thayé and translated by Richard Barron (Chökyi Nyima). Ithaca, New York: Snow Lion Publications, 2003. Pp. xxii + 549. Price not given.Awesome Nightfall: The Life, Times, and Poetry of Saigyō. By William R. LaFleur. Boston: Wisdom Publications, 2003. Pp. xiii + 173. Paper $14.95.Becoming the Compassion Buddha: Tantric Mahamudra for Everyday Life. By Lama Thubten Yeshe, edited by Robina Courtin, and foreword by Geshe Lhundub Sopa. Boston: Wisdom Publications, 2003. Pp. xi + 194. Paper $14.95.Between Two Worlds East and West: An Autobiography. By J. N. Mohanty. New Delhi: Oxford University Press, 2002. Pp. ix + 134. Hardcover RS 525.00.The Chinese Face of Jesus Christ. Edited by Roman Malek, S.V.D. Sankt Augustin, Germany: Institut Monumenta Serica and China-Zentrum; and Nettetal, Germany: Steyler Verlag, 2002. Pp. 391. EUR 40.00.Chinese Medicine in Contemporary China: Plurality and Synthesis. By Volker Scheid. Durham and London: Duke University Press, 2002. Pp. xiv + 407. Hardcover $69.95. Paper $23.95.Confucian Feminist: Memoirs of Zeng Baosun (1893-1978). Translated and adapted by Thomas L. Kennedy. Philadelphia: American Philosophical Society, 2002. Pp. xxi + 170. Price not given.Consciousness Studies: Cross-Cultural Perspectives. By K. Ramakrishna Rao. Jefferson (North Carolina) and London: McFarland and Company, 2002. Pp. 367. Hardcover $65.00.Constituting Communities: Theravāda Buddhism and the Religious Cultures of South and Southeast Asia. Edited by John Clifford Holt, Jacob N. Kinnard, and Jonathan S. Walters. Albany: State University of New York Press, 2003. Pp. viii + 224. Hardcover $65.50. Paper $21.95.Developments in Indian Philosophy from Eighteenth Century Onwards: Classical and Western. By Daya Krishna. Volume X Part 1 of History of Science, Philosophy and Culture in Indian Civilization, edited by D. P. Chattopadhyaya. New [End Page 110] Delhi: Centre for Studies in Civilizations, 2001. Pp. xxiii + 417. Hardcover RS 1200.East and West: Identità e dialogo interculturale. By Giangiorgio Pasqualotto. Venezia: Marsilo Editori, 2003. Pp. 210. EUR 16.00.Effortless Action: Wu-wei as Conceptual Metaphor and Spiritual Ideal in Early China. By Edward Slingerland. New York: Oxford University Press, 2003. Pp. xii + 352. Price not given.Encountering Kā lī: In the Margins, at the Center, in the West. Edited by Rachel Fell McDermott and Jeffrey J. Kripal. Berkeley and Los Angeles: University of California Press, 2003. Pp. xviii + 321. Hardcover $55.00, £37.95. Paper $21.95, £15.95.Encyclopedia of Chinese Philosophy. Edited by Antonio S. Cua. New York and London: Routledge, 2003. Pp. xx + 1020. Hardcover $150.00.Essays on Indian Philosophy. By J. N. Mohanty and edited by Purushottama Bilimoria. New Delhi: Oxford University Press, 2002. Pp. xxxvii + 347. Paper RS 525.00.Faith, Humor, and Paradox. By Ignacio L. Götz. Westport, Connecticut: Praeger Publishers, 2002. Pp. 136. Hardcover $61.95.Four Illusions: Candrakīrti's Advice for Travelers on the Bodhisattva Path. Translated by Karen C. Lang. New York: Oxford University Press, 2003. Pp. xv + 240. Price not given.The Great Awakening: A Buddhist Social Theory. By David R. Loy. Boston: Wisdom Publications, 2003. Pp. 223. Paper $16.95.The Hidden History of The Tibetan Book of the Dead. By Bryan J. Cuevas. New York: Oxford University Press, 2003. Pp. xi + 328. Price not given.Huang Di nei jing su wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. By Paul U. Unschuld. Berkeley and Los Angeles: University of California Press, 2003. Pp. xii + 520. Hardcover $75.00, £52.00.In Dewey's Wake: Unfinished Work of Pragmatic Reconstruction. Edited by William J. Gavin. Albany: State University of New York Press, 2003. Pp. vi + 249. Hardcover $71.50. Paper $23.95.Knowledge and Freedom in Indian Philosophy. By Tara Chatterjea. Lanham, Maryland: Lexington Books, 2002. Pp. xvi + 159. Hardcover... (shrink)

A crisis continues to brew within the pharmaceutical research and development (R&D) enterprise: productivity continues declining as costs rise, despite ongoing, often dramatic scientific and technical advances. To reverse this trend, we offer various suggestions for both the expansion and broader adoption of modeling and simulation (M&S) methods. We suggest strategies and scenarios intended to enable new M&S use cases that directly engage R&D knowledge generation and build actionable mechanistic insight, thereby opening the door to enhanced productivity. What M&S requirements (...) must be satisfied to access and open the door, and begin reversing the productivity decline? Can current methods and tools fulfill the requirements, or are new methods necessary? We draw on the relevant, recent literature to provide and explore answers. In so doing, we identify essential, key roles for agent-based and other methods. We assemble a list of requirements necessary for M&S to meet the diverse needs distilled from a collection of research, review, and opinion articles. We argue that to realize its full potential, M&S should be actualized within a larger information technology framework—a dynamic knowledge repository—wherein models of various types execute, evolve, and increase in accuracy over time. We offer some details of the issues that must be addressed for such a repository to accrue the capabilities needed to reverse the productivity decline. (shrink)

: Research involving the dead, especially heart-beating cadavers, may facilitate the testing of potentially revolutionary and life-saving medical treatments. However, to ensure that such research is conducted ethically, it is essential to: (1) identify appropriate standards for this research and (2) assign institutional responsibility and a mechanism for oversight. Protocols for research involving the dead should be reviewed by a special committee and assessed according to nine standards intended to ensure scientific merit, to protect deceased patients and their families, and (...) to promote institutional integrity and responsibility. Federal regulation of research involving the dead will foster appropriate standards and, equally importantly, help establish the acceptability of such research. (shrink)

Offers both theoretical and practical insights into the dialogue between adults and children as a democratic model for schooling.

In lieu of an abstract, here is a brief excerpt of the content:Principles and PragmatismR. Alta Charo (bio)Openly, privately, or implicitly, every public ethics committee struggles with its mandate. Is its job to identify a moral ideal?; a morally acceptable minimum that, realistically, could be adopted as policy?; or an optimal political compromise that can arguably meet ethical analysis? The answer appears to be different for each committee, depending upon its subject matter, its sponsoring political body, and the details of (...) its legal mandate. What is universal, however, is that even the most well-intentioned committee is likely to experience dissension over the interpretation of its task and that this dissension will often be played out in debates over particular policy recommendations.Ruth Macklin’s description of disagreement and moral integrity in the context of the Advisory Committee on Human Radiation Experiments demonstrates this phenomenon quite clearly (Macklin 1996). The epistemological debates concerning the evidence of past practices illuminate differing visions of the Committee’s mandate. For some it was to render moral judgment on past acts, without necessarily concluding that, if the acts were immoral, the individuals involved were themselves immoral. For others it was to use moral judgments to determine appropriate forms of restitution, thus balancing the reputational risks to past actors against the need for and feasibility of restitution to the victims. Still others appeared to focus on crafting specific political responses, and the historical data needed only be sufficient to bolster the policy recommendations.In this respect, the composition of any advisory committee becomes crucial. As fact-finders, committee members must determine the kind of evidence they will find persuasive. This determination, in turn, depends upon whether the committee sees itself primarily as (1) informational, in which case the standards employed by professional historians are probably the most appropriate, or (2) judgmental, in which case something closer to legal standards of proof might be better. The dilemma is not limited to committees looking at history; those rendering advice on science policy need to determine if they will use standards of proof prevalent in the scientific community (consensus following peer review) or the public (scientific consensus coupled with credibility of the scientific community as a whole). [End Page 319]When a committee is asked to base its judgments on ethical analysis, the conflicts only deepen. The “ethics” of policy recommendations are invariably balanced against the desire to see one’s work yield a concrete political response, the perception of political constraints on implementing an ethically “ideal” solution, and the subtle pressures exerted by the sponsoring political body to respond to the specific committee mandate, which was written with the needs of the sponsoring body in mind, not the needs of a wide-ranging ethics discussion.Another complication arises because ethics committees derive their credibility from the perception that moral truth is discoverable and unassailable. To horse trade among these moral truths undermines the credibility of their entire endeavor and can render bioethics advisory committees not only ineffective but even offensive. After all, if a moral truth exists, how ethical is it for “ethicists” to abandon it in the name of strategic concerns? If, on the other hand, no moral truth exists, then by what right do these “ethics” committees claim persuasive authority beyond that of any citizen advisory committee?This is a deep dilemma that relates to the discipline of bioethics itself. Lacking a core methodology or doctrine, bioethics has yet to justify itself to either its proponents or to the public. Bioethics scholars acknowledge that there are a variety of theories drawn from moral philosophy that could be used to guide the resolution of dilemmas that arise in the context of medical care and biomedical research. Such theories include utilitarianism, deontology, teleology, virtue theory, and justice theory, with no one theory being universally adopted by bioethics scholars and no one methodology being available to resolve conflicts among their respective conclusions. While deductivism is the predominant analytical style in the field, “[t]he central difficulty with deductivism is that there is no single comprehensive moral theory, nor even theories or principles of more limited scope, which is agreed to be true or correct” from which defensible conclusions will flow (Brock 1995).But if public ethics bodies cannot... (shrink)

There are important similarities between moral thought and talk and thought and talk about gender: disagreements about gender, like disagreements about morality, seem to be intractable and to outstrip descriptive agreement; and it seems coherent to reject any definition of what it is to be a woman in terms of particular social, biological, or other descriptive features, just as it seems coherent to reject any definition of what it is to be good or right in terms of any set of (...) descriptive properties. These similarities give us reason to investigate the idea that, like moral thought and talk, gender thought and talk is inherently normative. This paper proposes a normative account of gender thought and talk in terms of fitting treatment. On this fitting treatment account, to judge that A is gender G is just to judge that it is fitting to treat A as a G. This account is a descriptive or hermeneutical account of our gender thought and talk rather than an ameliorative account of our gender concepts or a metaphysical account of gender properties in social metaphysics. This paper argues that other descriptive accounts of gender thought and talk face problems that the fitting treatment account overcomes. (shrink)

: Catholic teaching has no moral difficulties with research on stem cells derived from adult stem cells or fetal cord blood. The ethical problem comes with embryonic stem cells since their genesis involves the destruction of a human embryo. However, there seems to be significant promise of health benefits from such research. Although Catholic teaching does not permit any destruction of human embryos, the question remains whether researchers in a Catholic institution, or any researchers opposed to destruction of human embryos, (...) could participate in research on cultured embryonic stem cells, or whether a Catholic institution could use any therapy that ultimately results from such research. This position paper examines how such research could be conducted legitimately in a Catholic institution by using an ethical analysis involving a narrative context, the nature of the moral act, and the principle of material cooperation, along with references to significant ethical assessments. It also offers tentative guidelines that could be used by a Catholic institution in implementing such research. (shrink)

A test was administered to 102 engineering students to ascertain how engineering education influences their environmental knowledge and attitudes. Answers to definitional and factual questions in a forced-answer section demonstrated that students were improving their technical knowledge, but responses to more subtle questions were mixed. Answers to attitudinal questions exhibited a trend towards increased environmental awareness. For open-ended questions, posttest results showed an increase in knowledge of engineering work. Over 80% of the students considered themselves to have a caring attitude (...) toward the environment, with the “three R’s” and green transportation choices most commonly cited. Engagement in research, education, or advocacy doubled from pretest to posttest. Air pollution and solid waste disposal most frequently influenced students’ attitudes toward the environment. Outdoor experiences were the most frequently mentioned source of information; university courses rose from 4% to 15% on the posttest. Only 40% of the students could name an environmental role model. (shrink)

This article focuses on two possible missions for a national bioethics commission. The first is handling differences of worldview, political orientation, and discipline. Recent work in political philosophy emphasizes regard for the dignity of difference manifested in "conversation" that seeks understanding rather than agreement. The President's Council on Bioethics gets a mixed review in this area. The second is experimenting with prophetic bioethics. "Prophetic bioethics" is a term coined by Daniel Callahan to describe an alternative to compromise-seeking "regulatory bioethics." It (...) involves a critique of modern medicine. In the contemporary context, the areas of biotechnology and access to health care cry out for prophetic attention. The Council has addressed biotechnology; unfortunately, that experience suggests that the kind of prophecy that it practices poses risks to conversation. With regard to access issues, the article proposes an effort that unites themes of human dignity, solidarity, and limits in support of reform, while highlighting, rather than papering over, differences. (shrink)

The misuse of alcohol inflicts a major toll on individual users, their families, and the wider society. This includes disruptions of family life, violence, absenteeism and problems in the workplace, child neglect and abuse, and excess morbidity and mortality. The World Health Organization estimates that alcohol ranks eighth among global risk factors for death and is the third leading global risk factor for disease and disability. In the United States, alcohol dependence affects four to five percent of the population at (...) any given time. Alcohol dependence also exacts a significant financial toll.... (shrink)

Pragmatic comparative effectiveness randomized controlled trials evaluate the effectiveness of one interventions under real-world clinical conditions. The results of ceRCTs are often directly generalizable to everyday clinical practice, providing information critical to decision-making by patients, clinicians, and healthcare policymakers. The PRECIS-2 framework identifies nine domains that serve to score a trial on a continuum between very explanatory to very pragmatic. According to the framework, pragmatic trials may have one or more of the following features: there are fewer eligibility criteria for (...) participants, in an... (shrink)

Epistemic decision theorists aim to justify Bayesian norms by arguing that these norms further the goal of epistemic accuracy—having beliefs that are as close as possible to the truth. The standard defense of Probabilism appeals to accuracy dominance: for every belief state that violates the probability calculus, there is some probabilistic belief state that is more accurate, come what may. The standard defense of Conditionalization, on the other hand, appeals to expected accuracy: before the evidence is in, one should expect (...) to do better by conditionalizing than by following any other rule. We present a new argument for Conditionalization that appeals to accuracy‐dominance, rather than expected accuracy. Our argument suggests that Conditionalization is a rule of coherence: plans that conflict with Conditionalization don't just prescribe bad responses to the evidence; they also give rise to inconsistent attitudes. (shrink)

Casuistry is a traditional method of interpreting and resolving moral problems. It focuses on the circumstances of particular cases rather than on the application of ethical theories and principles. After a brief history of casuistry, the method is explained and its relation to theory and principles is discussed.

A popular argument is that peer disagreement about controversial moral topics undermines justified moral belief in a way that peer disagreement about non-moral topics does not undermine justified non-moral belief. Call this argument the argument for moral skepticism from peer disagreement. Jason Decker and Daniel Groll have recently made a companions in guilt response to this argument. Decker and Groll argue that if peer disagreement undermines justified moral belief, then peer disagreement undermines much non-moral justified belief; if the argument for (...) moral skepticism from peer disagreement succeeds, then a kind of non-moral skepticism holds too. And we should not hold that the status of such non-moral beliefs are undermined by peer disagreement. In this paper, I shows that Decker and Groll’s companions in guilt argument fails. I then draw out the implications of my argument for the epistemology of disagreement and the epistemology of moral disagreement more generally. For instance, I then argue that peer disagreement about morality does not undermine all justified moral belief but that peer disagreement about morality does preclude most moral beliefs from being justified and constituting knowledge in a way that peer disagreement about non-moral topics does not preclude most non-moral beliefs from being justified and constituting knowledge. (shrink)

The transition of novel and potentially promising medical therapies into their initial human clinical trials can engender conflicting pressures. On the one side, because Phase I trials raise greater ethical and human protection challenges than later stage clinical trials, there is a need to proceed cautiously. This is particularly the case for Phase I trials with a novel therapy being tested in humans for the first time, usually termed first-in-human (FIH) trials, especially if the FIH trial involves significant risks. On (...) the other side, scientists interested in having their research validated, corporations with a financial interest in the field, and potential patients and patient support groups desirous of having .. (shrink)