While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology, there is often a disconnect in the perception of value between a technology’s promoters and those responsible for the ultimate decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five Canadian medical device manufacturers, via their websites, frame the corporate “value proposition” of their innovation and seek to respond to what (...) they consider the key expectations of their customers. Our analysis shows that the manufacturers’ framing strategies combine claims that relate to valuable socio-technical goals and features such as prevention, efficiency, sense of security, real-time feedback, ease of use and flexibility, all elements that likely resonate with a large spectrum of health care system stakeholders. The websites do not describe, however, how the innovations may impact health care delivery and tend to obfuscate the decisional trade-offs these innovations represent from a health care system perspective. Such framing strategies, we argue, tend to bolster physicians’ and patients’ expectations and provide a large set of stakeholders with powerful rhetorical tools that may influence the health policy arena. Because these strategies are difficult to counter given the paucity of evidence and its limited use in policymaking, establishing sound collective health care priorities will require solid critiques of how certain kinds of medical devices may provide a better (i.e., more valuable) response to health care needs when compared to others. (shrink)
lecting statistics about missing bindings and macros, and other errors. This guides debugging and development eﬀorts, leading to iterative improvements in both the tools and the quality of the converted corpus. The build system thus serves as both a production conversion engine and software test harness. We have now processed the complete arχiv collection through 2006 consisting of more than 400,000 documents (a complete run is a processor-yearsize undertaking), continuously improving our success rate. We are now able to convert more (...) than 90% of these documents to XHTML+MathML. We consider over 60% to be successes, converted with no or minor warnings. While the remaining 30% can also be converted, their quality is doubtful, due to unsupported macros or conversion errors. (shrink)
Initial responses to questionnaires used to assess participants' understanding of informed consent for malaria vaccine trials conducted in the United States and Mali were tallied. Total scores were analyzed by age, sex, literacy (if known), and location. Ninety-two percent (92%) of answers by United States participants and 85% of answers by Malian participants were correct. Questions more likely to be answered incorrectly in Mali related to risk, and to the type of vaccine. For adult participants, independent predictors of higher scores (...) were younger age and female sex in the United States, and male sex in Mali. Scores in the United States were higher than in Mali (P = 0.005). Despite this difference participants at both sites were well informed overall. Although interpretation must be qualified because questionnaires were not intended as research tools and were not standardized among sites, these results do not support concerns about systematic low understanding among research participants in developing versus developed countries. (shrink)
Varieties of Ethical Reflection brings together new cultural and religious perspectives—drawn from non-Western, primarily Asian, philosophical sources—to globalize the contemporary discussion of theoretical and applied ethics.
Background: Expanded newborn screening generates incidental results, notably carrier results. Yet newborn screening programmes typically restrict parental choice regarding receipt of this non-health serving genetic information. Healthcare providers play a key role in educating families or caring for screened infants and have strong beliefs about the management of incidental results. Methods: To inform policy on disclosure of infant sickle cell disorder (SCD) carrier results, a mixed-methods study of healthcare providers was conducted in Ontario, Canada, to understand attitudes regarding result management (...) using a cross-sectional survey (N = 1615) and semistructured interviews (N = 42). Results: Agreement to reasons favouring disclosure of SCD carrier results was high (65.1%–92.7%) and to reasons opposing disclosure was low (4.1%–18.1%). Genetics professionals expressed less support for arguments favouring disclosure (35.3%–78.8%), and more agreement with arguments opposing disclosure (15.7%–51.9%). A slim majority of genetics professionals (51.9%) agreed that a reason to avoid disclosure was the importance of allowing the child to decide to receive results. Qualitatively, there was a perceived “duty” to disclose, that if the clinician possessed the information, the clinician could not withhold it. Discussion: While a majority of respondents perceived a duty to disclose the incidental results of newborn screening, the policy implications of these attitudes are not obvious. In particular, policy must balance descriptive ethics (ie, what providers believe) and normative ethics (ie, what duty-based principles oblige), address dissenting opinion and consider the relevance of moral principles grounded in clinical obligations for public health initiatives. (shrink)
Earlier in the pages of this journal (p 481), Wendler and Miller offered the "net risks test" as an alternative approach to the ethical analysis of benefits and harms in research. They have been vocal critics of the dominant view of benefit-harm analysis in research ethics, which encompasses core concepts of duty of care, clinical equipoise and component analysis. They had been challenged to come up with a viable alternative to component analysis which meets five criteria. The alternative must (...) (1) protect research subjects; (2) allow clinical research to proceed; (3) explain how physicians may offer trial enrolment to their patients; (4) address the challenges posed by research containing a mixture of interventions and (5) define ethical standards according to which the risks and potential benefits of research may be consistently evaluated. This response argues that the net risks test meets none of these criteria and concludes that it is not a viable alternative to component analysis. (shrink)
Did the Gulf War defend moral principle or Western oil interests? Is violent pornography an act of free speech or an act of violence against women? In _Casuistry and Modern Ethics_, Richard B. Miller sheds new light on the potential of casuistry—case-based reasoning—for resolving these and other questions of conscience raised by the practical quandaries of modern life. Rejecting the packaging of moral experience within simple descriptions and inflexible principles, Miller argues instead for identifying and making sense of (...) the ethically salient features of individual cases. Because this practical approach must cope with a diverse array of experiences, Miller draws on a wide variety of diagnostic tools from such fields as philosophy of science, legal reasoning, theology, literary theory, hermeneutics, and moral philosophy. Opening new avenues for practical reasoning, Miller's interdisciplinary work will challenge scholars who are interested in the intersections of ethics and political philosophy, cultural criticism, and debates about method in religion and morality. (shrink)
Richard B. Miller aims to stimulate new work in religious ethics through discussions of ethnography, ethnocentrism, relativism, and moral criticism; the ethics of empathy; the meaning of moral responsibility in relation to children and friends; civic virtue, loyalty, war, and alterity; the normative and psychological dimensions of memory; and religion and democratic life.
Religious violence may trigger feelings of repulsion and indignation, especially in a society that encourages toleration and respect, but rejection contradicts the principles of inclusion that define a democracy and its core moral values. How can we think ethically about religious violence and terrorism, especially in the wake of such atrocities as 9/11? Known for his skillful interrogation of ethical issues as they pertain to religion, politics, and culture, Richard B. Miller returns to the basic tenets of liberalism to (...) divine an ethical response to religious extremism. He questions how we should think about the claims and aspirations of political religions, especially when they conflict so deeply with liberal norms and practices, and he suggests how liberal critics can speak confidently in ways that respect cultural and religious difference. Miller explores other concerns within these investigations as well, such as the protection of human rights and a liberal democratic commitment to multicultural politics. In relating religion and ethics, he develops a new lens for viewing political religions and their moral responsibilities. This probing inquiry also forces us to rethink our response to 9/11. (shrink)
Let κ B be the least cardinal for which the Baire category theorem fails for the real line R. Thus κ B is the least κ such that the real line can be covered by κ many nowhere dense sets. It is shown that κ B cannot have countable cofinality. On the other hand it is consistent that the corresponding cardinal for 2 ω 1 be ℵ ω . Similar questions are considered for the ideal of measure zero sets, other (...) ω 1 saturated ideals, and the ideal of zero-dimensional subsets of R ω 1. (shrink)
Tested the hypothesis that the younger the child the more perceptual and concrete are the concepts used. Differences were examined between children and adults (a) in using both concrete and abstract concepts as opposed to only one kind of concept, and (b) in using either concrete or abstract concepts for the 1st of 2 different kinds (concrete or abstract) of concepts. Equivalence tasks of a forced-choice type were employed to test the use of concrete and abstract concepts by 45 1st (...) graders and 45 undergraduates. Only in a minority of cases were significant differences obtained between the groups. (French summary). (shrink)
This article aims to place the work of R.D. Laing into the context of Scottish history of ideas. It is possible to clarify and strengthen Laing’s arguments by situating them alongside the work of Scottish philosophers such as David Hume, J. B. Baillie and John Macmurray. In particular, it can be shown that Laing is not philosophically naïve. Philosophy – and this is readily apparent in Hume’s account of human nature – tends to say that we are indeed divided selves. (...) The work of Baillie and Macmurray helps to defend Laing from the charge that the "divided self" is, in truth, the logically inevitable account of human being. The study of Laing’s Scottish precursors also has a further consequence. The side of Laing that values social relations emerges in greater clarity, and in greater consonance with his sympathy for the marginalised and the alienated. (shrink)
Athens or Jerusalem? By Tertullian.--Philosophy the handmaid of theology, by Clement of Alexandria.--Faith in search of understanding, by St. Augustine.--Revelation and analogy, by St. Thomas Aquinas.--The mystic way, by M. Eckhart.--The darkened intellect, by J. Calvin.--The reasons of the heart, by B. Pascal.--Faith, reason, and enthusiasm, by J. Locke.--Miracles and the skeptic, by D. Hume.--The limits of reason, by I. Kant.--Truth and subjectivity, by S. Kierkegaard.--In justification of faith, by W. James.--Religion as poetry, by G. Santayana.--Faith and symbols, by P. (...) Tillich.--Three parables on falsification, by A. Flew, R. M. Hare, and B. Mitchell.--For further reading (p. 233-235). (shrink)
The radical psychiatrist R. D. Laing's first book, The Divided Self (1960), is informed by the work of Christian thinkers on scriptural interpretation — an intellectual genealogy apparent in Laing's comparison of Karl Jaspers's symptomatology with the theological tradition of `form criticism'. Rudolf Bultmann's theology, which was being enthusiastically promoted in 1950s Scotland, is particularly influential upon Laing. It furnishes him with the notion that schizophrenic speech expresses existential truths as if they were statements about the physical and organic world. (...) It also provides him with a model of the schizoid position as a form of modern-day Stoicism. Such theological recontextualization of The Divided Self illuminates continuities in Laing's own work, and also indicates his relationship to a wider British context, such as the work of the `clinical theologian' Frank Lake. (shrink)
B. R. Frieden uses a single procedure, called extreme physical information, with the aim of deriving 'most known physics, from statistical mechanics and thermodynamics to quantum mechanics, the Einstein field equations and quantum gravity'. His method, which is based on Fisher information, is given a detailed exposition in this book, and we attempt to assess the extent to which he succeeds in his task.