Background: The process of obtaining informed consent continues to be a contentious issue in clinical and public health research carried out in resource-limited settings. We sought to evaluate this process among human research participants in randomly selected active research studies approved by the School of Medicine Research and Ethics Committee at the College of Health Sciences, Makerere University. Methods: Data were collected using semi-structured interviewer-administered questionnaires on clinic days after initial or repeat informed consent procedures for the respective clinical studies (...) had been administered to each study participant. Results: Of the 600 participants interviewed, two thirds (64.2 %, 385/600) were female. Overall mean age of study participants was 37.6 (SD = 7.7) years. Amongst all participants, less than a tenth (5.9 %, 35/598) reported that they were not given enough information before making a decision to participate. A similar proportion (5.7 %, 34/597) reported that they had not signed a consent form prior to making a decision to participate in the study. A third (33.7 %, 201/596) of the participants were not aware that they could, at any time, voluntarily withdraw participation from these studies. Participants in clinical trials were 50 % less likely than those in observational studies [clinical trial vs. observational; (odds ratio, OR = 0.5; 95 % CI: 0.35-0.78)] to perceive that refusal to participate in the parent research project would affect their regular medical care. Conclusions: Most of the participants signed informed consent forms and a vast majority felt that they received enough information before deciding to participate. On the contrary, several were not aware that they could voluntarily withdraw their participation. Participants in observational studies were more likely than those in clinical trials to perceive that refusal to participate in the parent study would affect their regular medical care. (shrink)

First published in 2003. Routledge is an imprint of Taylor & Francis, an informa company.

ABSTRACT As bioethics emerged in the 1960s and 1970s and began to have enormous impacts on the practice of medicine and research – fuelled, by broad socio‐political changes that gave rise to the struggle of women, African Americans, gay men and lesbians, and the antiauthoritarian impulse that characterised the New Left in democratic capitalist societies – little attention was given to the question of the ethics of public health. This was all the more striking since the core values and practices (...) of public health, often entailing the subordination of the individual for the common good, seemed opposed to the ideological impulses of bioethics. Of what relevance is autonomy‐focused bioethics for public health, with its mix of justifications including those that are either implicitly or explicitly paternalistic or that seek to impose strictures on individuals and communities in the name of collective welfare? To examine the deep divide between the central commitments of bioethics and the values that animate the practice of public health, we focus on a series of controversies implicating the concepts of privacy, liberty, and paternalism. Recognising the role of moral values in decision‐making was a signal contribution of bioethics in its formative period. Over the past three decades a broad array of perspectives emerged under the rubric of bioethics but individualism remains central. As we commence the process of shaping an ethics of public health, it is clear that bioethics is the wrong place to start when thinking about the balances required in defence of the public's health. (shrink)

Meaning and communication -- Mighty dead: Kant and Hegel -- Scorekeeping -- Sentence meaning, term meaning, Anaphora -- Empirical content and empirical knowledge -- Logical discourse -- Representation and communication -- Objectivity and phenomenalism about norms.

Legal scholarship exploring the nature of evidence and the process of juridical proof has had a complex relationship with formal modeling. As evident in so many fields of knowledge, algorithmic approaches to evidence have the theoretical potential to increase the accuracy of fact finding, a tremendously important goal of the legal system. The hope that knowledge could be formalized within the evidentiary realm generated a spate of articles attempting to put probability theory to this purpose. This literature was both insightful (...) and frustrating. Much light was shed on the legal system, but it also quickly became evident that the tools of probability theory were in many ways ill-constructed for the task. Fundamental incompatibilities between the structure of legal decision making and the extant formal tools were identified, and it became evident that many of the purported explanations of legal phenomena were internally inconsistent. As a consequence, interest in this type of formal modeling declined, and attention was directed toward different kinds of explanations of the phenomena. Perhaps under the influence of a recent trend toward various types of formal modeling in legal scholarship, a recent burst of articles, rather than attempting to explain the macro structure of trials, which was the previous object of interest, attempts to quantify the probative value of various items of evidence in ways consistent with the formal features of various probability theories, and then to study decision making from that perspective. For example, the value of evidence is often purported to be its likelihood ratio, that is, the probability of discovering or receiving the evidence given a hypothesis (e.g., the defendant did it) divided by the probability of discovering or receiving the evidence given the negation of the hypothesis (the defendant didn't do it). Alternatively, the value of evidence is purported (more contextually) to be the information gain it provides, defined as the increase in probability it provides for a hypothesis above the probability of the hypothesis based on the other available evidence. Both conceptions then assume that all of the various probability assessments conform or ought to conform to the dictates of Bayes' theorem (that maintains consistency among such assessments); empirical studies are then done testing the extent to which this is so and proposing how the law can increase the probability that it is so. The general criticisms of using Bayes' theorem as a formal model of juridical proof are well known and were integral to the last wave of interest in formal modeling of the evidentiary process. This paper thus for the most part puts aside that more general issue, and focuses specifically on mathematical modeling of the value of particular items of evidence. The paper demonstrates that formal modeling has only limited value in explaining the value of legal evidence, much more limited than those constructing and discussing the models assume, and thus that the conclusions they draw about the value of evidence are unwarranted. This is done through a discussion of four recent examples that attempt to quantify evidence relating to, respectively, carpet fibers, infidelity, DNA random-match evidence, and character evidence used to impeach a witness. This article thus makes two contributions. First, and most importantly, it is another demonstration of the complex relationship between algorithmic tools and legal decision making. Second, at a minimum it points out serious pitfalls for analytical or empirical studies of juridical proof. (shrink)

I Several years ago, when the Carter administration announced that it would support congressional action to end the public fund ing of abortions, the President was asked at a press conference whether he thought that such a policy was unfair; he responded, "Life is unfair." His remarks provoked a storm of controversy. For other than those who, for principled reasons, opposed abor tion on any grounds, it seemed that the President's comments were cruel, violating what was thought to be an (...) American com mitment to providing equal access to health services to all citi zens, regardless of their capacity to pay. Those sentiments had, in fact, been reflected in public opinion polls that had, for at least three decades, indicated that Americans supported the propo sition that the government should guarantee health care to all. Ultimately, those beliefs had been translated into the oft-ex 1 pressed political demand for a one-class system of health care. This commitment to equality is rather remarkable. American society evidences a striking willingness to tolerate vast inequal ities with regard to income and wealth. While it guarantees ed ucation to all children, there is not even a pretense that the children of the wealthy and the children of the poor ought to get precisely the same kind of schooling. While some commitment 'Hazel Erskine. "The Polls: Health Insurance," Public Opinion Quarterly, XXXIX (Spring, 1975), 128-143. (shrink)

In The Stillborn God, Mark Lilla illuminates why “political theology” remains relevant today, in a world we might have assumed was thoroughly secularized. Lilla suggests that political theology is the norm, and that Christianity inadvertently gave birth to an exception. But the exception—liberal theology, or a separation of church and state that would give full play to religious impulses—was doomed. Religious impulses were not satisfied by mere moral sentiment, as offered by Rousseau and Kant; and Hegel opened the door to (...) messianism—and eventually to Hitler—by bringing a philosophical version of redemption into liberal theology. (shrink)

One of the paradoxes of the Culture War is that opposites conspire with each other against the rest of us. We are offered an impoverished, narrow conception of reason and knowledge, proposing a stark choice to the rest of us: approach life’s important questions through science, or turn to religion. This was a false choice two hundred years ago, and it remains so today.

The conventional history of the ancient Near East at large, including Egypt and the eastern Mediterranean basin, contains several “Dark Ages,” poorly documented transitional periods of uncertain length. James et al. 1991 have argued that the most significant of these Dark Ages—the transition from the Late Bronze to the Iron Age during the last two centuries of the second millennium BCE—is largely an artifact of an overly long reconstruction of the Egyptian Third Intermediate Period, and that this Dark Age presents (...) itself in every chronology linked to the Egyptian. A wide variety of often seemingly contradictory scientific, archaeological, art-historical, and philological evidence has been adduced to argue for the status quo, or to lengthen or to shorten by up to several centuries the relative chronology for this period. This review article comments on the papers presented at the Third BICANE Colloquium held at Sidney Sussex College, Cambridge, summarizing a variety of recent positions taken in the ongoing evaluation of James et al. 1991, testing the specific proposition that the tenth century BCE biblical Egyptian King Shishak is to be distinguished from the historical Egyptian King Shoshenq I, who is now to be situated about a century later in the latter half of the ninth century BCE. the wider historical implications of this proposed distinction are examined in new detail. (shrink)

This paper critically appraises the applied action-guide approach to bioethics and finds it wanting in two ways: it is tethered to a social contract view of the doctor-patient relationship that is largely incompatible with experiences of illness and care; and, as a formalist doctrine, it lacks critical edge and tends toward accommodationism. An alternative approach is recommended that involves interpreting moral experience by means once associated with the rhetorical arts — practical reasoning, hermeneutics, casuistry, and thick description.

Philosophy of Communication Ethics is a unique and timely volume that creatively examines communication ethics, philosophy of communication, and the 'Other.'.

The Black Book of Communism: Crimes, Terror, Repression by Stéphane Courtois The Passing of an Illusion: The Idea of Communism in the Twentieth Century by François Furet The Burden of Responsibility: Blum, Camus, Aron, and the French Twentieth Century by Tony Judt Le Siècle des communismes by Michel Dreyfus.

Ours is a vacuumless universe - Character and Potential pervade The spatio-temporal manifold! The manifold is discretely divided As the ancients foretold By atomicity, by discreteness amid continuity! Atomicity embedded within atomic occasions Events emerging as a confluence of Antecedent events! The character and relations within that nexus Constituent of an occasion’s causal past Determine the characteristics and relations Which ingress within the atomic event! As character ingresses into an atomic occasion, Bounded by spatial magnitude and temporal duration, The character (...) and potentiality Within the event’s causal future Emerge, Begat as an occasion’s progeny. Co-Director, International Center for Process Philosophy, Science and Education. (shrink)

With higher education around the world in a period of extreme flux, this volume explores its underlying philosophy, a core element of the ongoing debate. Offering a diverse range of perspectives from an international selection of renowned scholars of higher education, the book is full of imaginative insights that add up to a substantive contribution to the discussion. As universities attempt to adapt to a new environment characterized by stiff international competition, networked remote learning, burgeoning student numbers, and comparative performance (...) assessment, how we conceptualize the purpose and ethos of our higher learning institutions is more important than ever. This publication features a multitude of distinctive approaches that illuminate potential solutions to the complex issues universities must grapple with in these uncertain times. Rather than espousing a singular philosophical approach, the editors have assembled views from across the spectrum and from differing national contexts, representing a multidisciplinary response to the situation. This collection of papers aims thus to inspire fresh developments in the way we think about the complexities of, and options available to, higher education. (shrink)

Rhetorician Kenneth Burke’s theory of identification usefully demonstrates how communities are able to engage with difficult, opposing viewpoints as they develop or maintain a sense of shared identity. Identification, “establishing a shared sense of values, attitudes, and interests with [an audience],” is promoted dialogically in the modern national museum in a way that it is difficult for classrooms to emulate. This article examines dialogic national identification particularly through the focus in museums on certain key objects that serve as what Burke (...) termed “mythic images” that ambiguously unify multiple perspectives and translate their debates from the abstract to the concrete. By promoting the reflective identification of one’s personal memories with the collective memory of nationhood, national museums provide an aesthetic/pragmatic space for the dialogical embrace of a public identity that is not merely reflected in its exhibits but also continually reshaped by its visiting individuals. I end with the possibilities, or cautions, these mythic images suggest for varying types of communal identification—a tension inherent as well in Gert Biesta’s arguments for the meaning of a “good” education. (shrink)

One can learn a great deal about the relative priorities in any moral theory by understanding how these priorities are conveyed in the perpetually vexing challenge of moral education. Rousseau and Kant are two thinkers whose distinctly modern retrieval of classical virtue was animated by overlapping yet diverging grievances with classical philosophy. One common enemy of Rousseauian and Kantian virtue found in classical thought is the moral vice of envy. This essay argues that whereas Rousseau chastises the vice of envy, (...) replacing it with the central virtue of pity, Kant redirects the vice of envy towards the more salutary virtue of magnanimity during adolescence and beneficence in the adult. The consideration of sympathy in its full moral and educational context in Kant-over and against Rousseau’s emphasis on pity as the central corrective to the vice of envy-underscores the extent of the differences between Rousseau and Kant on this issue. The common criticism of Rousseau and Kant on the problem of envy is animated by some common concerns, but their understandings of it as a problem require responses that are deceptively different in their substance. (shrink)

This book reviews the spectrum of economic methods that have been developed from themid-1970s to the mid-1980s to analyze the feasibility of solar systems and shows how the use ofthese techniques has influenced federally sponsored research, development, and demonstrationprograms.

These comments seek to take issue with the contention that society has a responsibility to provide its members with any needed health care. In order to deal with this claim, we must first make clear exactly what it meant by the proposition. I take it that those who embrace this view mean considerably more than that each of us has a moral obligation to contribute to those in need of medical attention who are unable, for one reason or another, to (...) afford the necessary care. This is a moral proposition and is traditionally dealt with under the heading of charity. But the contention, as here used, means considerably more since its main implications are not moral but primarily political. (shrink)