Over the past thirty-odd years, the feminist contribution of the ethic of care has changed the way in which scholars and ‘lay people’ think about and approach ethical practices in our contemporary society. These changes are important in two significant ways. First, the contribution of feminist work to the body of ethics as a whole is a valuable addition. Second, by drawing attention to the concrete context of moral decision-making, particularly the notion of care, feminist scholars have opened the (...) door for meaningful discussion and understanding of the word care as it is involved in moral decision-making. The latter is where Lonergan’s theory of ethics is most beneficial.The article is written in four sections. It begins with a brief review of a feminist perspective on the ethic of care; a second section explores Lonergan’s identification of levels of consciousness as relevant to feminist notions of care; a third section explores the influence of Aquinas on Lonergan’s theory of ethics and richly applies this fuller context (linking feelings, plans, actions and decisions) to feminist contributions; a final section enlarges significantly on the meaning of the word care by introducing Lonergan’s idea of functional specialization as an ‘ethic of ethics’ that will care about the field of ethics in a radically new way. (shrink)

Historically, society has not had a robust, institutionalized ethic for how animals should be treated. Before the Animal Welfare Act, the only laws constraining animal use in society were the anticruelty laws forbidding sadistic, deviant, purposeless, deliberate, unnecessary infliction of pain and suffering on animals, or outrageous neglect. These laws, both by statute and by judicial interpretation, did not apply to socially accepted animal uses such as research or agriculture. Because the overwhelming use of animals in society was in agriculture, (...) aimed at providing food, fiber, locomotion, and power, and because the key to agricultural success was having healthy animals, good husbandry and good care were enforced by the most powerful sanction, self‐interest; the anticruelty laws were only there for society to manage sadists and psychopaths unmoved by self‐interest. But with the emergence of new kinds of “normal” animal use—such as intensive agriculture and animal research, both of which caused animal pain and suffering that did not fall under the anticruelty ethic—society was forced to create a new ethic for animals that went “beyond cruelty.” The Animal Welfare Act was a start, but it did not address all of the ethical concerns that society has had about the treatment of animals. As evidence of the need for a new ethic for animals, thousands of bills pertaining to animal welfare have been promulgated across the United States in the last decade. The new ethic for animals essentially applies much of our social ethic for humans, mutatis mutandis, to the treatment of animals and embodies the desired protections in the legal system. (shrink)

The problem of interdependence is crucial for understanding the climate, with its interactions between land, water and atmosphere, as well as with human activities, past and future. The concept of interdependence expresses two types of relationship, that of causality and that of responsibility. For the problems of climate governance as understood as a statistical average in the Conferences of the parties (COP), causal dependence is impossible to reconstruct precisely, notably because of the complexity of these phenomenons. However, dependence does not (...) only concern the domain of being, falling within the natural sciences and social sciences and human descriptivo-predictive. It also concerns the ought-to-be and therefore the normative sciences (ethics, political thery, law and normative economy). Here interdependence is much more problematic since it is opposed to freedom. The article discusses the various interdependencies and political solutions that are offered to take care of this needs, architectures for discussing climate change politically: systems (N. Luhmann) and deliberation (J. Habermas). He proposes then another solution, that of the moral and political consediration. (shrink)

The problem of interdependence is crucial for understanding the climate, with its interactions between land, water, and atmosphere, as well as with human activities, past and future. The concept of interdependence expresses two types of relationship, that of causality and that of responsibility. For the problems of climate governance as understood as a statistical average in the Conferences of the parties (COP), causal dependence is impossible to reconstruct precisely, notably because of the complexity of these phenomena. However, dependence does not (...) only concern the domain of being, falling within the natural sciences, the social sciences, and the human descriptive predictive. It also concerns the ought-to-be and therefore the normative sciences (ethics, political theory, law, and normative economy). Here interdependence is much more problematic since it is opposed to freedom. This article discusses the various interdependencies and political solutions that are offered to take care of this needs, architectures for discussing climate change politically: systems (N. Luhmann) and deliberation (J. Habermas). It then proposes another solution, that of moral and political consideration. (shrink)

This paper highlights a number of ethical dilemmas encountered in a pilot study with a hard-to-reach group of research participants with harmful childhood histories. Drawing on a project exploring black teenage mothers' understandings of their own childhood experiences of abuse, it is argued that in asking young mothers to talk about such an emotionally sensitive topic as their own harmful childhood, a number of challenges are posed about how to deal with number of key ethical principles. The paper begins by (...) outlining the context of the pilot study, including the research literature on this subject. It then discusses three key ethical principles that were considered during the process of the research: issues of gaining consent; and when the principle of confidentiality ought to be breached when a duty of care prerogative emerges. The paper explores these tensions in operationalising these principles when dealing with the competing needs and rights of gatekeepers, the young women and their carers, using occasional extracts from research findings to illustrate these tensions. The paper concludes with a discussion of the ethical challenges in accessing marginal voices in social research. (shrink)

Presents Bernard Lonergan's five "verbum" articles that originally appeared in Theological studies. For Thomist students and scholars this "verbum" study offers a careful appraisal of the Thomist theory of knowledge as well as an introduction to the concepts found in Father Lonergan's "Insight". Since the concept of "verbum" dynamically affects the thought of Aquinas, it is necessary to grasp this concept to understand Thomist metaphysics and rational psychology. Lonergan has carefully analyzed and explicitly outlined "verbum"--An integral (...) part of the Thomist theory of knowledge. "Verbum" is examined as a tool of definition and for its impact on understanding, logical thought procession and related ideas stemming from "verbum". Discusses "the word" and its relation to abstraction. Focusses on St. Thomas' immediate concern in finding in Aristotle the point of insertion for Augustinian thought and in fusing a phenomenology of the subject with a psychology of the soul. (shrink)

This volume is an edited version, recreated from tapes and auditors' notes, of the ten lectures that Canadian Jesuit, Bernard Lonergan, delivered on his Insight.

ABSTRACT This paper reports on a multidisciplinary meeting held to discuss ethical issues in medical research in the developing world. Many studies, including clinical trials, are conducted in developing countries with a high burden of disease. Conditions under which this research is conducted vary because of differences in culture, public health, political, legal and social contexts specific to these countries. Research practices, including standards of care for participants, may vary as a result. It is therefore not surprising that ethical issues (...) emerge. This meeting sought to identify and discuss these issues from the perspectives of the many actors in such research, including community representatives, with a view to finding ethical and pragmatic solutions to these issues. Dialogue between these actors was also promoted, with a view to identifying the need to develop such dialogue in future. Drawing from the experiences of the speakers, the colloquium attempted to outline some answers to several key questions characterising the field today. Experiences related to epidemiologic research, vaccine trials, drug trials, diagnostic tests and to some fundamental ethical issues in health research. Speakers were from different countries, disciplines and professions. The meeting provided a forum for consultation and debate between different ethics actors. Both encouraging findings and challenges emerged. (shrink)

The perspectives of the dominant Western ethical theories, have dominated the concepts of autonomy and informed consent for many years. Recently this dominant understanding has been challenged by ethics of care which, although, also emanates from the West presents a more nuanced concept: relational autonomy, which is more faithful to our human experience. By paying particular attention to relational autonomy, particularity and Process approach to ethical deliberations in ethics of care, this paper seeks to construct a concept of (...) informed consent from the perspective of ethics of care which is here called relational autonomy-in-informed consent. Thus, providing a broader theoretical basis for informed consent beyond the usual theoretical perspectives that are particularly Western. Care ethics provides such a broader basis because it appeals to a global perspective that encompasses lessons from other cultures, and this will help to enrich the current ideas of bioethics principles of autonomy and informed consent. This objective will be achieved by exploring the ethics of care emphasis on relationships based on a universal experience of caring; and by contrasting its concept of autonomy as relational with the understanding of autonomy in the approaches of the dominant moral theories that reflect rational, individualistic, and rights-oriented autonomy of the American liberalism. (shrink)

In psychiatry, caregivers try to get free and informed consent of patients, but often feel required to restrict freedom and to use coercion. The present article develops ethical advice given by an Ethics Committee for Mental Health Care. The advice recommends an ethical ideal of shared deliberation, consisting of information, motivation, consensus and evaluation. For the exceptional use of coercion, the advice develops three criteria, namely incapacity to deliberate, threat of serious harm and proportionality between harm and coercion.The article (...) also discusses the viewpoints of the ethical advice and of the European Convention on Human Rights and Biomedicine: is the advice in agreement with the Convention and can the advice refine the guidelines of the Convention for the particular context of psychiatry? Although the Convention emphasises the autonomy of the individual patient, whereas the advice focuses on the relationships between the partners involved, the advice enjoys a complementary and supportive function in the application of the Convention. (shrink)

Kenneth Melchin states two objectives for his book Living with Other People: 1) to present the main elements of a study of Christian ethics based on the work of Bernard Lonergan; and 2) to provide readers with tools for moral self-understanding and deliberation.

Philip McShane explores the implications of Bernard Lonergan’s compacted account of ‘what questions’ and ‘what-to-do questions’ for understanding deliberation. The essay provides a fascinating and instructive glimpse into McShane’s own long-continued struggle and dialogue with Lonergan’s achievement.

This essay asks why Aristotle, certainly no friend to unlimited democracy, seems so much more comfortable with unconstrained rhetoric in political deliberation than current defenders of deliberative democracy. It answers this question by reconstructing and defending a distinctly Aristotelian understanding of political deliberation, one that can be pieced together out of a series of separate arguments made in the Rhetoric, the Politics, and the Nicomachean Ethics.

Clinical trials for acute conditions such as myocardial infarction and stroke pose challenges related to informed consent due to time limitations, stress, and severe illness. Consent processes shou...

Since the advent of democracy in South Africa, there has been a concerted effort at reviving the notion of ubuntu. Variously conceived, it is seen as the authentic African ethical concept, a way of life, an authentic mode of being African, an individual ideal, the appropriate public spirit, a definition of life itself and the preferred manner of conducting public and private business. Thus, among other public displays of the spirit of ubuntu, the government of the day has deliberately chosen (...) its service delivery mantra and its public slogan as Batho Pele to animate, or perhaps pay obeisance to, ubuntu. In this paper we seek to advance arguments that question such a public, widespread, and concerted ‘ubuntu-isation’ of the intellectual, business, public and private lives. Our project follows two main lines of reasoning. We seek to show that the aggressive promotion of ubuntu in post-apartheid South Africa is an elitist project so conceived by the new black elite. It is conceived both as a restorative move that is aimed at securing the dignity of the black masses as well as an attempt at forging a so-called black identity. This line of reasoning will rely on similar historical cases on the continent that sought to aggressively promote an African mode of being, which coincided with both the end of colonialism and the rise of black elitism. We note that such attempts always ended in very public social and political failure. We seek to question the desirability of ubuntu as a mark/guide of the spirit of the nation. Here our critique shall be concentrated on the disjunct that exists between the metaphysical conditions necessary for the attainment of ubuntu and the stark ontological and ethical crisis facing the new elite and ‘our people’. (shrink)

This essay asks why Aristotle, certainly no friend to unlimited democracy, seems so much more comfortable with unconstrained rhetoric in political deliberation than current defenders of deliberative democracy. It answers this question by reconstructing and defending a distinctly Aristotelian understanding of political deliberation, one that can be pieced together out of a series of separate arguments made in the Rhetoric, the Politics, and the Nicomachean Ethics.

Randomized Clinical Trials in the medical community are generally lasting longer due to a number of factors, including an increase in the total volume of biomedical research, expanded federal regulatory requirements, and a rise in patient interest in participating as research subjects. Leading national and international initiatives promote clinical research in children. The primary impetus for these initiatives is the need for adequate data for clinical application of new products and treatment approaches in the pediatric population. Clinical investigations must maintain (...) ethical conduct as an essential component of pediatric research.Ethical issues associated with clinical research in general have received prominent public and scientific attention. Of particular interest is informed consent, or assent, as applied to pediatrics. There is little practical guidance concerning pediatric assent from legal and ethical disciplines; the law has played only a small role in few cases. (shrink)

Highlights of this edition include: / Important new material addressing federal privacy regulations, disclosure of medical errors, limits on residents'...

This volume tackles the burden of judgment and the challenges of ethical disagreements, organizes the cohabitation of scientific and ethical argumentations in such a way they find their appropriate place in the political decision. It imagines several forms of agreements and open ways of conflicts resolution very different compared with ones of the majority of political philosophers and political scientists that are macro-social and general. It offers an original contribution to a scrutinized interpretation of the precautionary principle, as structuring the (...) decision in interdisciplinary contexts, to make sure to arrive this time to the "Best of the Worlds". (shrink)

Managed care has brought wide-ranging changes to the health care system. Some of these changes have been well publicized. Among them are the financial pressures that have resulted in numerous mergers of health care institutions, the restriction on the ability of patients to select their physician of choice, and the ever diminishing number of days that patients are permitted to stay in the hospital. Individual physicians, too, have been affected. For example, they are under pressure to see more patients per (...) unit time and to use fewer resources. Utilization review and payment methods may make them reluctant to undertake the full set of diagnostic tests and therapeutic interventions when they might otherwise have done so. (shrink)

Managed care has brought wide-ranging changes to the health care system. Some of these changes have been well publicized. Among them are the financial pressures that have resulted in numerous mergers of health care institutions, the restriction on the ability of patients to select their physician of choice, and the ever diminishing number of days that patients are permitted to stay in the hospital. Individual physicians, too, have been affected. For example, they are under pressure to see more patients per (...) unit time and to use fewer resources. Utilization review and payment methods may make them reluctant to undertake the full set of diagnostic tests and therapeutic interventions when they might otherwise have done so. (shrink)

This book is the result of over 30 years of collaboration among its authors. It uses the systematic account of our common morality developed by one of its authors to provide a useful foundation for dealing with the moral problems and disputes that occur in the practice of medicine. The analyses of impartiality, rationality, and of morality as a public system not only explain why some bioethical questions, such as the moral acceptability of abortion, cannot be resolved, but also provide (...) a method for determining the correct answer for those occasions when a bioethical question has a unique correct answer. This new edition includes an entire chapter that has been added to address the controversial issue of abortion within the authors' distinct framework. This book presents the latest revisions of the authors' orignial analyses of the concepts of death and disease, analyses that have had a significant impact on the field of bioethics. It also includes an added chapter on mental disorders, where the authors' definition influenced what psychiatry classifies as a mental disorder, and so has had an impact that reveals beyond the field of bioethics. In this edition, the authors also offer a new, more developed perspective on the concept of valid or informed consent by considering what information physicians should be required to know before proposing screening, diagnostic testing, prescribing medications, or performing surgery. The book also integrates some of the important insights of the field of clinical epidemiology into its discussion of valid consent. Its account of paternalism and its justification, perhaps the most ubiquitous moral problem in medical ethics, has had considerable influence. Its discussion of euthanasia and physician assisted suicide challenges the standard views that have been put forward by both proponents and opponents of physician assisted suicide and voluntary active euthanasia. (shrink)

BackgroundWithholding and withdrawing treatment are deemed ethically equivalent by most Bioethicists, but intensivists often find withdrawing more difficult in practice. This can lead to futile treatment being prolonged. Time-limited trials have been proposed as a way of promoting timely treatment withdrawal whilst giving the patient the greatest chance of recovery. Despite being in UK guidelines, time-limited trials have been infrequently implemented on Intensive Care Units. We will explore the role of time in Intensive Care Unit decision-making and provide a UK (...) perspective on debates surrounding time-limited trials.MethodsThis qualitative study recruited 18 participants (nine doctors, nine nurses) from two Intensive Care Units in North West England for in-depth, one-to-one semi-structured interviews. A thematic analysis was performed of the data.ResultsOur findings show time is utilised by Intensive Care Unit staff in a variety of ways including managing uncertainty when making decisions about a patient’s prognosis or the reversibility of a disease, constructing relationships with patients’ relatives, communicating difficult messages to patients’ relatives, justifying resource allocation decisions to colleagues, and demonstrating compassion towards patients and their families.ConclusionsTime shifts the balance towards greater certainty in Intensive Care Unit decision-making, by demonstrating futility, and can ease the difficult transition for staff and families from active treatment to palliation. However, this requires clear and open communication, both within the Intensive Care Unit team and with the family, being prioritised when time is used in decision-making. (shrink)

BackgroundWe assessed potential consent bias in a cohort of > 40,000 adult patients asked by mail after hospitalization to consent to the use of past, present and future clinical and biological data in an ongoing ‘general consent’ program at a large tertiary hospital in Switzerland.MethodsIn this retrospective cohort study, all adult patients hospitalized between April 2019 and March 2020 were invited to participate to the general consent program. Demographic and clinical characteristics were extracted from patients’ electronic health records (EHR). Data (...) of those who provided written consent (signatories) and non-responders were compared and analyzed with R studio.ResultsOf 44,819 patients approached, 10,299 (23%) signed the form. Signatories were older (median age 54 [IQR 38–72] vs. 44 years [IQR 32–60], p <.0001), more comorbid (2614/10,299 [25.4%] vs. 4912/28,676 [17.1%] with Charlson comorbidity index ≤ 4, p <.0001), and more often of Swiss nationality (6592/10,299 [64%] vs. 13,813/28,676 [48.2%], p <.0001).ConclusionsOur results suggest that actively seeking consent creates a bias and compromises the external validity of data obtained via ‘general consent’ programs. Other options, such as opt-out consent procedures, should be further assessed. (shrink)

: The answer to the question of what health care services should be covered by a managed care plan is straightforward; the plan should cover whatever the consumer is willing to pay for. From the plan's perspective, the consumer is the payer, that is, the employer who negotiates the plan; not the individual patient whose personal preferences and interests may be quite different. Since managed care organizations contract with payers to arrange for health care services within a defined set of (...) benefits, there is a broader question as well: Within the benefits chosen by the payer, what actually is covered? Criteria for determining "medical necessity," which managed care plans frequently use as the basis for coverage, are discussed. (shrink)

This chapter considers the difficulties inherent in judgment, and focuses on differences of an ethical variety, shot through with the normative reality of the ethical pluralism of values, from relativisms to monisms, and some of their characteristics conditionality, incompatibility, and incommensurability. It also considers the type of commitments made in relation to these values and different types of conflict. The chapter explains five types of burdens of judgment listed by John Rawls. Rawls' solution for avoiding the general fact of State (...) oppression has collateral effects on moral philosophy and on ethics. Unlike pluralism, relativism questions, in a variety of ways, the possibility of discussion, of justification and of a critique of values. There are at least three distinct types of relativism: radical relativism, conventionalist relativism, and perspectivist relativism. The most notable fact is reasonable pluralism, described as “the diversity of religious, philosophical, and moral doctrines found in modern democratic societies”. (shrink)

This chapter considers the question of ordinary judgment in ethics, followed by certain criticisms and forms of skepticism with regard to attempts at theorization in moral philosophy. It then presents the principal ethical theories. These are used to support more general forms of pluralism in practical reasoning. The chapter outlines an analytical approach to the fullest possible form of ethical pluralism, in relation to ethical evaluation in a context of justification. This pluralism applies to participatory technology assessment (PTA), responsible (...) research and innovation (RRI) and, beyond that, to any ethical evaluation. From these essential bases, forming part of ethical judgments and evaluations, the chapter considers the rapprochement between ethical theories and ethical argument in the conclusion. Meta‐ethics is involved in developing other areas of interest, and may enter into relation with other areas of science, such as psychology, epistemology, metaphysics or linguistics. (shrink)

This chapter presents a new version of the theory of deliberative democracy, focusing on its specificity as a future genre, and based on arguments used to defend plausibility. Moral philosophy of ethical theories is applied in this context as a form of casuistics, involving probabilities, and not limited to case studies within the framework of applied ethics. The chapter then considers relationships between the sciences, scientific practices and ethics; the interweaving of facts and values; the quarrels that exist (...) between coexisting disciplines; the competing approaches of epistemic pluralism, in both inter‐ and intra‐disciplinary forms; and argumentative coexistence in interdisciplinary contexts. It outlines the possible solution pathways, notably that of dialogical co‐argumentation. The chapter explores the question of pluralism of ethical theories with a focus on relevant elements that may modify an evaluation. In France, the precautionary principle has been enshrined in the Constitution since 2005, within the framework of the Environment Charter. (shrink)

The interdisciplinary aspect of collective deliberation, involved in participatory technology assessment (PTA) and responsible research and innovation (RRI), raises issues in relation to the cohabitation of disciplines. In ethics, the choice of which path to take is rarely clear or simple. Without falling into relativism, descriptions of the same actions may vary. Faced with the hard and apparently inevitable reality of misunderstandings, loyalties, interests and requirements, which are mutually incompatible, ethics offers one way of delimiting a conflict in (...) order to maintain relationships. This chapter considers the difficulties involved in judgment, the fact of pluralism, the ethical pluralism of values, ethical theories and their place in practical reasoning between monism and relativism, and finally the potential and the limitations of deliberative democracy. Reaching an ethical judgment on a question, or simply reaching judgment on a question, is a difficult task for any individual. (shrink)

Expert's independence is often highlighted in order to ensure the successful conduct of a scientific and technological evaluation. This chapter considers the attempt of the unusual science sociologist Bruno Latour to discover the functions to be summoned to form a new “parliament”, which will work as much on facts as on values to build a common world made of humans and non‐humans. His essay, involving the descriptive and normative dimensions of knowledge, is significant for the innovating participatory technology assessment (PTA) (...) and emerging responsible research and innovation (RRI) experiences. With the famous philosopher and historian Thomas Kuhn, the chapter explores the crucial role played by epistemic values not only in choosing scientific theories, but also in producing scientific facts, as the philosopher Hilary Putnam defended. Finally, the chapter shows what would be the possible links between epistemic values and ethical values. (shrink)

Bernard Lonergan is a Jesuit philosopher-theologian whose work is having an increasing influence, particularly on those concerned with identifying the nature of theological reflection and its relation to other areas of human inquiry. The purpose of this volume is to introduce a broader philosophical and theological audience to the world of Lonergan's thought. This world is principally characterized by Lonergan's notion of horizon-analysis. Perhaps the best way to explain what this means is to link it to (...) Lonergan's view that man is a being who can ask questions. Questions that he can raise and answer constitute the known. Questions that he can raise but cannot answer as yet constitute the known unknown, the docta ignorantia. There are still other questions, meaningful in themselves. that man, because of his historical situation, cannot even raise simply because they are not meaningful for him, and these constitute the unknown unknown, the indocta ignorantia. An horizon marks the boundary between the known unknown and the unknown unknown, that is, it provides the maximum field of knowledge available within the range of questions possible within a given methodological structure. A new horizon, that is, a new field of knowledge, emerges when a new kind of consciousness with an implicit new kind of method which makes it possible for a man to ask questions that previously were meaningless for him. Lonergan's work has been a careful attempt, based on horizon-analysis, to investigate the possibilities for metaphysical and theological understanding. Tracy, in setting forth as comprehensively as possible the full range of Lonergan's work, shows how his early studies of Thomas Aquinas focused on the centrality in the Thomistic noetic of the dynamic character of the act of knowing, an act that is not one of confrontation with an object but one of identity-in-being, of a deepening interiority making it possible for new questions to become meaningful. In his major epistemological study, Insight, Lonergan sought to show how the scientific method and the critical movement in philosophy were of crucial significance in providing new horizons for the question-asking being, man, whose dynamic interiority grounds a metaphysics and whose dynamism prolonged into doing grounds an ethics. The later Lonergan, the Lonergan of the post-Insight period, is the Lonergan who is seeking to discover how a new historical consciousness, a consciousness distinct from that of "classical" man, provides a new horizon for asking questions of philosophical and theological import. Thus Lonergan's major concern today is with method, that is, with a normative pattern of recurrent operations resulting in cumulative and progressive results. Through horizon-analysis Lonergan is currently seeking "to move fully and coherently from... a notion of theology as 'reason illuminated by faith' to 'method illuminated by faith'." Because Lonergan has significant things to say about human knowledge and because his highly original approach has affinities to developments in phenomenology and linguistic analysis, this patient and painstaking introduction to his thought should be of value to many contemporary philosophers.--W. E. M. (shrink)

This chapter talks about ethical deliberations that may be individual, potentially based on thought experiences or overhanging and discusses a real confrontation of evaluations and the deliberations of other individuals. This is one of the new elements introduced by participatory technology assessment (PTA), particularly in Europe. Stakeholder participation has been promoted by European agencies as a pillar of responsible research and innovation (RRI), confirming the need to consider the risks of exposure to the deliberations of others. The chapter describes the (...) resources offered by certain political philosophers who considered proposing the best possible systems for managing pluralism. It discusses the criteria of one of the most promising political theories: deliberative democracy. The qualification of this theory will prove useful in managing the cohabitation of individual and collective evaluation. The chapter considers a number of possible improvements to this theory, notably with regard to one of its major components: ethical arguments. (shrink)

Financial relationships between physicians and industry are widespread. Highly publicized financial relationships between physicians and industry raised disturbing questions about the trustworthiness of clinical research, practice guidelines, and clinical care decisions. Recent incidents spurred calls for stricter conflict of interest policies and led to new federal laws and NIH regulations. These stricter policies have evoked praise, concerns, and objections. Because these new federal requirements need to be interpreted and implemented, spirited discussions of conflicts of interest in medicine will continue.

Medical ethics should show how an adequate description of morality is helpful in dealing with the problems that arise in the context of medical care. However none of the standard moral theories provide such a description. Further, all of these theories assume that there must be a unique correct answer to every moral question, though this answer may be that it is indifferent which of the proposed solutions one picks. The failure to recognize that there are unresolvable moral disagreements (...) leads many philosophers to think that their moral theories will enable them to determine which policies ought to be adopted. However, the correct role for moral theories is more limited: to rule out morally unacceptable policies. Moral theories almost never can settle disputes about which of two well supported health care policies ought to be adopted. (shrink)

Volume 20, Issue 8, August 2020, Page W12-W13.

Clinical trials of stem cell transplantation raise ethical issues that are intertwined with scientific and design issues, including choice of control group and intervention, background interventions, endpoints, and selection of subjects. We recommend that the review and IRB oversight of stem cell clinical trials should be strengthened. Scientific and ethics review should be integrated in order to better assess risks and potential benefits. Informed consent should be enhanced by assuring that participants comprehend key aspects of the trial. For the (...) trial to yield generalizable knowledge, negative findings and serious adverse events must be reported. (shrink)

This dissertation studies how Aristotle understands and justifies his Rhetorical Art. It proceeds by explicating the Art in its intellectual context. Rhetoric emerges as a dynamic investigation of human affairs working through the "given" in speech and thought to a plausible account, while giving consideration to the opinions and characters of both speaker and audience within the horizon of a particular occasion. The basic dynamic determines a structure which is comparable to Socrates' requirements in the Phaedrus. That this is the (...) structure and dynamic is supported by considering the fundamentally contingent nature of human experience, understanding the inference types , common sense principles and starting points by which such experience is explicated, and placing such experience in three mutually exclusive genres. Aristotle's art is essentially the resulting plausible account while actual composition is supplementary. ;Aristotle limits the art by reference to dialectic and ethical life. When it is seen that Aristotle's Organon is not a science of logic and the Posterior Analytics is a rarely applicable mode of presentation, the point of dialectic becomes accessible. It too involves strenuous grappling with speech and thought, but its highest purpose lies in peirastic. Peirastic and sophistry are uses of dialectic which have a contrasting moral color. Peirastic aims at the discovery of ignorance and, at the same time, the difference between accident and essence and knowledge and opinion: Being educated is essentially knowing what one does not know. ;What Socrates only alludes to as political art, Aristotle attempts to expound as praxis perfected into phronesis. Even Aristotle does no more than suggest the nature of phronesis negatively as simultaneously a seeking, a finding and an act which is both self-determination and self-knowledge, and none of these separately; it is profoundly disruptive of existing opinion and most clearly to be seen in the rejection of the laws and rules upon which, as deliberation, it is dependent. The Art differs from Gorgias' rhetoric in its emphasis on the plausible and in its subordination to an ethical self-determination that gains the weight of experience appropriated by intelligence and virtue. (shrink)

The author presents his view of the start of clinical medical ethics and ideas on where the broader field of bioethics is heading. In addition to clinical medical ethics, people with training in clinical ethics can enlarge the scope of their work in order to have additional real-world impact. Important opportunities abound in empirical research on medical ethics, the ethics of healthcare institutions, ethical issues regarding biomedical research, and public policy. Three topics for bioethics scholars (...) to address are artificial intelligence in clinical care, health disparities, and communicating persuasively to broader audiences beyond academia. (shrink)

This chapter discusses epistemic pluralism for the purposes of transparency and more specifically by stressing two quality criteria specific to the PTA: the inter‐ and intra‐disciplinary epistemic pluralisms. The epistemic pluralism relates more particularly to the plurality of beliefs in relation to truth. In practice, citizens convened to a participatory technology assessment (PTA) experience must play it by ear, and manage to personally deliberate whilst respecting certain constraints of collective deliberation, without being tightly guided by certain principles helping to conduct (...) an ethical evaluation. The roles such as evaluation of technical consequences and options, extension of the perspective for research and development policy, scheduling, evaluation of consequences and options, mapping of the public scientific controversies, more interactive surveys, reframing the debate, mediation, opinions about policies dedicated to new technological fields, new compared forms of governance facilitate or select certain argumentative designs as appropriate. (shrink)

The precautionary principle may offer an appropriate framework for conducting in‐depth participatory technology assessment (PTA)‐type evaluations. It also holds considerable promise for responsible research and innovation (RRI). The precautionary principle is made up of several different elements and principles. This chapter considers these components, noting from the outset that they relate essentially to scientific evaluation. Probabilities are not particularly helpful in the context of the precautionary principle due to the levels of uncertainty with regard to knowledge of phenomena. In this (...) context, various forms of scenarios, narratives and unjustified inferences are particularly relevant. The chapter also considers more precise ways of identifying decision pathways in uncertain situations, where there is a risk of causing serious and/or irreversible damage, to use the terms given in various definitions of the precautionary principle. This decision can be made using: a utility‐based criterion, right‐based criteria, technology‐based criteria, and hybrid criteria. (shrink)

Human Research Ethics Committee (HREC) reviewers often provide similar feedback across applications, which suggests that the problem lies in researcher awareness of key issues rather than novel, unsolvable challenges. If common problems can be addressed before lodgement by applicants referencing clear evidence-based supports (e.g., FAQs on common application shortcomings), it would improve efficiency for HREC members and expedite approvals. We aim to inform such supports by analysing the patterns in the most frequent feedback made by HREC members during review (...) processes. We collected every instance (N = 4,195) of feedback made on N = 197 ‘low-risk’ protocols by all HREC staff (N = 16) at one institution over the course of a full year (2019). Reflexive thematic analysis to identify themes (and content analysis to determine relative frequency) revealed that the top three themes are consistent with existing literature: Consent, Administrative, and Methodological concerns. However, we identified important new themes that are not captured in previous research, including ‘Risk to Researchers’, ‘Commercial benefit, scope and scale’, ‘Diversity’ (covering issues of cultural sensitivity, language and accessibility), as well as fair right to a complaints process. Our thorough exploration of information-rich primary data marks an important methodological improvement over previous studies and offers a theoretical contribution to understanding themes that have heretofore been overlooked in the ethics review process. By identifying the common challenges experienced in HREC review we can better inform tailored supports to applicants (by extension reducing workload burdens on HREC systems) and reduce their perceived barriers to engaging in challenging but meaningful research. (shrink)