This chapter contains sections titled: The Unqualified Value of Knowledge and Understanding Bad Truth and Pointless Truth Basic Research and Pointless Truth Intellectualist Positions Conclusion.

In spite of these efforts in the 1920s and 1930s to initiate ongoing research on contraception, the subject of birth control remained a problem of concern primarily to the social activist rather than to the research scientist or practicing physician.80 In the 1930s, as has been shown, American scientists turned to the study of other aspects of reproductive physiology, while American physicians, anxious to eliminate the moral and medical dangers of contraception, only reluctantly accepted birth control as falling (...) within their professional domain.As a result, the problem of cheap, effective, and safe contraception was not solved by these earliest attempts. Consideration of the subject was initiated afresh by private philanthropy after World War II, sparked by a new wave of interest in population studies.81 Summarizing such efforts to support research in the reproductive sciences, a recent Ford Foundation study has noted: “To initiate and sustain serious research in the reproductive sciences has required for more than half a century concerted effort by interested individuals and private organizations, mainly from outside the mainstreams of the biomedical research community.”82The early laboratory research on chemical contraception described in this paper was but one important outcome of the concerted effort made by reformers in the 1920s to eliminate a variety of social problems thought to derive from excessive fertility. Scientific arguments and expertise were employed to advocate reform as well as to define the appropriate solution to such social problems. Scientists were recruited as advocates for the movement, but they were also employed as researchers in laboratory investigations sponsored by these same reformers.Sponsors of these early laboratory studies noted the difficulty of obtaining first-class investigators.83 The routine analyses necessary for such research, as well as the traditional scientific aversion to applied problems, provide only a partial explanation for this response. The real difficulty lay in recruiting investigators to a field that had previously been taboo. Once opened up — first as socially relevant, and finally as scientifically sound — there was much interest in this area, and the appeal to researchers of the scientific issues surrounding fertility and reproduction soon surpassed that of the reforming value of birth control.A survey of the kinds of experimental investigations sponsored by birth control advocates indicates the range of physiological problems explored by contraceptive research. The most definitive work was done on the efficacy and safety of spermicides, but the potential of other contraceptive methods was also examined. Investigators attempted to develop spermatoxins that would effectively immunize women against sperm, and they also tried to elucidate the mechanism of hormonal control of reproduction. In fact, speculations about the possible hormonal manipulation of fertility were expressed at the Seventh International Birth Control Conference held in Zurich in 1930.84In the 1920s, clinical studies were undertaken to assess the effectiveness of the various birth control methods. Laboratory investigators complemented this work by screening spermicides for safety and testing for their ability to kill sperm. There were a variety of birth control preparations on the market, but no one really knew whether these were effective or even safe.85 Although the physiology of other major organ systems was well advanced, the scientific study of reproductive physiology and contraceptive technology was clearly in its infancy in this period. Routine analyses simply could not be conducted, because the fundamental research establishing baselines had not yet been done. Scientists used this fact to redirect attention to basic research on reproduction.Laboratory research on contraception indicated important unexplored areas for physiological investigation. Social activists, who had encouraged prominent scientists to become interested in both the social value and the genetic implications of birth control, found these investigators revising the goals of their research. The biologists had formed their own network and had begun to seek out funding, reformulating the justification for sponsorship of further investigations. The eugenic motivations underlying these studies, which had initially made them theoretically attractive to biologists, were gradually eroded. Concern with “human evolution” ceded its place to interest in physiological mechanisms. Crew and others began to note that the use of biological theory to justify essentially political decisions had serious limitations. Biologists had become uncomfortable with those very arguments which had originally captured their interest. Recognition of the potential political abuse wrought by applying scientific principles to society was expressed by Crew just one year after the Zurich meeting. Referring to previous assessments of the role of sex in reproduction, he generalized: “In the past the biologist has justified feudalism, Manchester Liberalism, socialism and every other type of social organization and political programme by reference to selected biological phenomena.”86 By 1932 Crew had also begun to question the biological logic of regulated breeding, and had made it clear to his American sponsor that there was no simple correspondence between the practice of birth control and the genetic improvement of the human race.87Biologists further began to recognize, however, that although the hopeful genetic solution to human problems was probably an illusion, contraception still remained one tangible means to alleviate, human misery. Some laboratory scientists, like Crew, acknowledged the applicability of their own particular skills to this problem. For a few brief years, social needs and scientific goals were mutually supportive and closely intertwined. But as laboratory researchers gained interest in the study of reproduction and established their own priorities in this field, they temporarily withdrew from the arena of debate over birth control as an important mechanism for social reform.With the rise of Hitler, the genetic arguments for birth control rapidly lost their appeal. But by that time the scientific problem of how to achieve effective contraception had entered the professional consciousness. Both physicians and scientists began to be aware of birth control as a subject within their domain of expertise, although outside the principal focus of their research. Scientific discussion of birth control permanently altered from a question of justification to a problem of method: How could one achieve reliable and safe contraception? This had been Sanger's and Dickinson's goal from the beginning. Laboratory scientists had indeed been persuaded to undertake this work; this research had in turn affected biologists' perceptions of the whole field of reproductive physiology, encouraging further study of reproductive mechanisms. The promise of new knowledge provided for continued funding of this research, despite the caution by scientists that the social benefits would not be as immediate or as far-reaching as advocates and they themselves had first argued.The activities of birth control activists and their supporting agencies, and the financial backing of private contributors and foundations, notably the Rockefeller philanthropies, provided an important new stimulus to the development of research on the biology of reproduction in the late 1920s and early 1930s. Biologists were able to claim an enlarged realm of issues for scientific study through their activities as advocates and as investigators for the birth control movement. At the same time, they promised as-yet-undiscovered possibilities for regulating human reproduction once its physiology was understood. The knowledge and control that they promised lay in understanding the whole reproductive cycle — not merely in evaluating the toxic effects of presumptive spermicides.Chemical spermicides never summoned the interest of scientists as the contraceptive pill was to do, yet that research did reinforce the widespread perceptions of scientific research as essential to social reform. Spermicide investigations focused research efforts in reproductive biology by challenging traditional taboos, defining problems for further study, and providing laboratory investigators the opportunity to assert the social and scientific value of their own skills. Crew echoed this attitude as he observed in 1934:Man has turned from the adventurous conquest of his environment to the conquest of himself. To-day is the day of biological invention, eagerly used for the control of the undesirable and the unwanted. Sex and reproduction are no longer hedged around by myth and taboo; they are no longer accepted as mysteries that defy understanding. They are matters inviting examination and explanation; they are regarded as expressions of physico-chemical forces, the nature of which is to be displayed. It is accepted that when knowledge is sufficient, control will be absolute, and, though knowledge is not yet sufficient, readers... must be persuaded to the view that this will not always be so.88The synergism between reproductive biology and social needs has been temporary and sporadic, but recurring, since the 1920s. Scientific research programs have clearly been influenced by issues raised by public debate. Nevertheless, reproductive biologists have continued to assert their own professional goals. For the most part, they have rejected problems without inherent scientific interest and have spurned applied research except as it has had a direct bearing on current research themes. This attitude, apparent among American and British investigators in the 1930s, created the intellectual context for the invention and acceptance of the technically sophisticated oral contraceptive pill. It did not foster the production and improvement of the simple, safe, effective, and cheap vaginal contraceptive desired by early birth control advocates. (shrink)

For the past half-century, issues relating to the ethical conduct of human research have focused largely on the domain of medical, and more recently social–psychological research. The modern regime of applied ethics, emerging as it has from the Nuremberg trials and certain other historical antecedents, applies the key principles of: autonomy, respect for persons, beneficence, non-maleficence, and justice to human beings who enter trials of experimental drugs and devices :168–175, 2001). Institutions such as Institutional Review Boards and Ethics (...) Committees oversee most governmentally-funded medical research around the world, in more than a hundred nations that are signers of the Declaration of Helsinki. Increasingly, research outside of medicine has been recognized to pose potential risks to human subjects of experiments. Ethics committees now operate in the US, Canada, the U.K. and Australia to oversee all governmental-funded research, and in other jurisdictions, the range of research covered by such committees is expanding. Social science, anthropology, and other fields are falling under more clear directives to conduct a formal ethical review for basic research involving human participants. The legal and institutional response for protecting human subjects in the course of developing non-medical technologies, engineering, and design is currently vague, but some universities are establishing ethics committees to oversee their human subjects research even where the experiments involved are non-medical and not technically covered by the Declaration of Helsinki. In The Netherlands, as in most of Europe, Asia, Latin America, or Africa, no laws mandate an ethical review of non-medical research. Yet, nearly 2 years ago we launched a pilot ethics committee at our technical university and began soliciting our colleagues to submit their studies for review. In the past year, we have become officially recognized as a human subjects ethics committee for our university and we are beginning the process of requiring all studies using human subjects to apply for our approval. In this article, we consider some of the special problems relating to protecting human participants in a technology context, and discuss some of our experiences and insights about reviewing human subjects research at a technical university, concluding: that not less than in medical studies, human participants used in technology research benefit from ethical committees’ reviews, practical requirements for publications, grants, and avoiding legal liability are also served by such committees, and ethics committees in such contexts have many similarities to, but certain other special foci than medical ethics committees. We believe that this experience, and these observations, are helpful for those seeking to establish such committees in technology research contexts, and for framing the particular issues that may arise in such contexts for the benefit of researchers, and nascent committees seeking to establish their own procedures. (shrink)

“Basic research” is often used in science policy. It is commonly thought to refer to research that is directed solely toward acquiring new knowledge rather than any more practical objective. Recently, there has been considerable concern about the future of basic research because of purported changes in the nature of knowledge production and increasing pressures on scientists to demonstrate the social and economic benefits of their work. But is there really something special about (...) class='Hi'>basic research? The author argues here that “basic research” is a flexible and ambiguous concept that is drawn on by scientists to acquire prestige and resources. She shows that it is used for boundary work and gives examples of the work it does in different situations by drawing on interviews with scientists and policy makers on the category of basic research and the changes they have seen in it over time. (shrink)

The scientific challenges and ethical controversies facing human embryonic stem cell (hESC) research continue to command attention. The issues posed by patenting hESC technologies have, however, largely failed to penetrate the discourse, much less result in political action. This paper examines U.S. and European patent systems, illustrating discrepancies in the patentability of hESC technologies and identifying potential negative consequences associated with efforts to make available hESC research tools for basic research purposes while at same time strengthening (...) the position of certain patent-holders' rights. Differences between the U.S. and the European contexts may in part explain why the course of hESC research in those jurisdictions ultimately diverges. Nevertheless, questions about whether and how patenting, related agreements, and licensing practices progress and shape the field of hESC research in both the U.S., Europe, and elsewhere must no longer be marginalised. These questions are fundamentally important in determining what benefits are likely to result from hESC research. Assuring these benefits is the moral issue with which patent systems are most intrinsically concerned, and that governments must begin to directly address rather than assume or ignore. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:330 BOOK REVIEWS is the power through which the Holy Spirit creates and nurtures the church, which is the source of all authority in the church, and which is the norm for all that the church teaches and practices. Only then will the use and abuse of power within the contemporary church be addressed in theologically sound and healthy ways. Only then will ecclesiastical divisions be healed and the (...) common mission of the church pursued with faithful commitment. Lutheran School of Theology at Chicago Chicago, Illinois KURT K. HENDEL The Church in Latin America 1492-1992. Edited by ENRIQUE DussEL. Maryknoll, N.Y.: Orbis Books, 1992. Pp. x + 501. $49.95 (cloth). This volume is the result of an exemplary effort to stimulate the study of the history of Latin American churches, to communicate the results of historical scholarship across national lines, and to bring many persons of diverse tendencies and religious backgrounds together in a unified enterprise. Cooperation at the Latin American level has been made difficult at times due to repression, internal wars, and opposition by conservative church leaders. Heroic efforts by Enrique Dussel and the Commission for the Study of Church History in Latin America brought forth an eleven-volume General History of the Church in Latin America. The present volume benefits from this magnanimous enterprise and includes many contributors to the larger series. The result is a singlevolume history of the churches, Catholic and Protestant, with many strengths and weaknesses. The editor structured the work to provide a chronological survey of the region in its first section, one which is succinct and useful for understanding the distant roots of the Catholic church. The middle section takes up regional histories and generally succeeds in conveying well the history up to the contemporary period. Including the treatment of the church in Chile, however, with that in Argentina, Paraguay, and Uruguay does not work well. Their civic cultures and ecclesiastical histories differ greatly, especially in this century. The final part devotes itself to special topics and becomes less historical than descriptive and evaluative. Here themes such as theology of liberation, Afro-American slavery, and religious orders receive special attention. This section offers much less reliable guidance to Latin American history, in my view. BOOK REVIEWS 331 One of the distinctive marks of the collaboration has been a determined effort (although not uniformally carried out) to recount history from the underside, from the point of view of the poor and oppressed, as well as from the perspective of religious and secular elite members who are thought to make history. This is an admirable and egalitarian ideal, but much basic research from this point of view has not been done. Within this section, Moises Sandoval provides a view of Hispanic Catholicism in the United States. He manages to sustain a view from the grassroots. The chapter, one of the best in the volume, could be required reading for any student of Nor,th American history. A few chapters may be marred by revisionist frameworks. The chapter on Protestantism is one. In my view, Jean Pierre Bastian's ideo· logical simplification does not allow him to give adequate consideration to the contemporary theological iand ecclesiological convictions behind notably diverse Protestant positions. Pentecostals account for 75-90 percent of Protestants in most Latin American countries; yet much of the history of Protestant churches in Latin America, as Bastian has re· counted it, has been irrelevant for explaining Pentecostal growth. This is not a minor consideration, since,the volume lacks a sense that Pentecostal churches are major religious organizations within Latin America. Similar tendencies mar the work of some Catholic writers who are wedded to the discourse of the " historical process of liberation." Such discourse leads to extravagant characterizations, as by Jose Comblin. He writes in the chapter on the church and human rights: "New democracies are totally unstable. Development has stagnated. There is no future in sight " (pp. 452-453). Comblin, a highly regiarded theologian, not a social scientist or historian, does not account for the great expansion (more than 2,000) of human rights organizations in Latin America. Many of these groups are tied to the church and came into existence largely... (shrink)

In Executive Order No. 10521, March 17, 1954, President Eisenhower stated: “…only a small fraction of the Federal Funds is being used to stimulate and support the vital basic research which makes possible our practical scientific progress. I believe strongly that this Nation must extend its support of research in basic science.”.

Emergency medicine research requires the enrollment of subjects with varying decision-making capacities, including capable adults, adults incapacitated by illness or injury, and children. These different categories of subjects are protected by multiple federal regulations. These include the federal Common Rule, the Department of Health and Human Services (DHHS) regulations for pediatric research, and the Food and Drug Administration's (FDA) Final Rule for the Exception from the Requirements of Informed Consent in Emergency Situations. Investigators should be familiar with the (...) relevant federal research regulations to optimally protect vulnerable research subjects, and to facilitate the institutional review board (IRB) review process. IRB members face particular challenges in reviewing emergency research. No regulations exist for research enrolling incapacitated subjects using proxy consent. The wording of the Final Rule may not optimally protect vulnerable subjects. It is also difficult to apply conflicting regulations to a single study that enrolls subjects with differing decision-making capacities. This article is intended as a guide for emergency researchers and IRB members who review emergency research. It reviews the elements of Federal Regulations that apply to consent, subject selection, privacy protection, and the analysis of risks and benefits in all emergency research. It explores the challenges for IRB review listed above, and offers potential solutions to these problems. (shrink)

: The schools of fiqh applied different methods to eliminate contradictions between narrations. In fact, this difference in methodology directly led to fiqh disagreement. Thus, a school explains within the framework of its own procedural system which of the contradictory narratives it uses as evidence, the reason for using this narrative, how they interpret other narrations about the subject or the reason for not using these reports as evidence. This article aims to chronologically examine the theory that the Ḥanafī developed (...) about antithetical narratives based on ‘Īsā ibn Abān, al-Karkhī, al-Jaṣṣāṣ, al-Dabūsī, al-Pazdawī and al-Sarakhsī. Moreover, the criticisms and contributions made by the scholars of the principles of jurisprudence are determined. Frequently repeated approach in some research that the Hanafis first used the abrogation to fulfill the contradiction between the narrations is questioned within the framework of the aforementioned scholars’ viewpoints Summary: The theory of contradictory narratives, developed as part of the narration theory, has an important position in the sense of the school’s approach to the Sunnah. This is because the system that a school of jurisprudence implements to fulfill the contradiction between narrations has an important influence in scholars’ juridical opinion. In some studies carried out today, the system developed by the Ḥanafī to eliminate the contradiction between narratives is presented in two different ways as abrogation, preference, conciliation and not to use as evidence or abrogation, conciliation and applying principles. The common point of the two hierarchies of solution is placing abrogation in first rank. In order to test the accuracy of this information in this research, we studied the system that the Ḥanafi scholars who lived in the first five centuries of the Hijra followed to eliminate the contradiction between the narrations. The development of this theory in the five centuries of the Hijra was examined on the basis of the views of ‘Īsā ibn Abān, al-Karkhī, al-Jaṣṣāṣ, al-Dabūsī and al-Sarakhsī. It is an indisputable fact that the construction and development of a theory requires a process. In this context, the present study investigated when and on which principles the theory of contradictory narratives on Ḥanafīan theory of narrative/Sunnah is started to be instituted; who and for what reasons contributed to it during this evolution process and how; and how it is instituted the way of solution hierarchy in theearly period which makes a differentiation in comments between Ḥanafīan later. This theory was enriched by principles that were developed with different perspectives during a long process and its comprehensibility was boosted using new concepts and systematic expression. Ḥanafī legal theorists benefited from the opinions of masters of the jurisprudence school to enrich this theory in terms of principles. This suggests that the theory is a scientific effort aimed at discovering how masters of the jurisprudence school are following a method in the face of contradictory narratives. As far as known, Isā ibn Abān is the first theoretician to have detailed methodological explanations related to contradictory narratives between the Hanafi scholars. This shows that the theory related to contradictory narratives was established at the beginning of the third century of the hegira. 'Isā ibn Abān divides the opposite narratives into hadiths that are compatible with consensus and hadiths that are contrary to consensus on the basis of consensus. He accepts the hadith in the first group and he evaluates the hadith in the second group as the abrogated if it is authentic. It must be stated that this solution path which Isā ibn Abān put forth is of high practical value. There is no practical value in fıqh to eliminate the contradiction between the hadith which is compatible with the consensus and the hadith contrary to this consensus by the conciliation method. Moreover, giving an active role to the consensus in the determination of the abrogating and abrogated also prevents easy access to the method of abrogation. ‘Isā ibn Abān divides hadiths that are without consensus about their provisions into two: the appearance date is known and unknown. He first applied the conciliation method to fulfill the contradictions between the narrations in both groups. If the problem is not solved by the conciliation method, Isā applies the abrogation method for narrations whose the appearance date is known. The ones that the date is not known can be acceptable in accordance with the originals, and if this is not possible, he says that both narrations cannot be used as evidence. al-Jaṣṣāṣ, who is one of the people who convey mostly al-Karkhī's views on fiqh methodology, does not convey the views of al-Karkhī on contradictory narratives in integrity that we see in the transmission of 'Isā ibn Abān’s theory and its interpretation. It is understood that al-Jaṣṣāṣ benefited from the views of al-Karkhī to improve the system of Isā ibn Abān. This suggests that al-Karkhī basically accepted the system of contradictory narratives established by Isā ibn Abān. al-Jaṣṣāṣ 's most important role in the theory of contradictory narratives is based on the principles laid down by ‘Isā ibn Abān and al-Karkhī. The person who mostly contributed to this theory after al-Karkhī is al-Dabūsī. It is understood from al-Dabūsī’s accounts that he divides the contradiction into two parts, the truth and the apparent. al-Dabūsī stipulated for evaluating a contradiction as a real contradiction. These conditions are, in essence, solutions for the elimination of the contradiction. When it comes to al-Sarakhsī, he dealt with this issue more precisely with concepts such as “evidence”, “judgement”, “state”, “date is clear in the text”, “date is not clear in the text”. In the system of al-Sarakhsī, the last option is the abrogation to eliminate the contradiction. (shrink)

The establishment of a Research Ethics Committee (REC) is a significant step to ensure the standard procedures in ethics review process that protect human participants. However, in instances when RECs are not yet established, surrogate activities are practiced by some institutions. The objective of this study was to identify prevailing research ethical practices of research directors and faculty researchers in the absence of a research ethics committee in their respective academic institutions. Specifically, it aimed to explore (...) the participants’ 1) experiences in research subject protection and 2) challenges when there is no existing REC in the institution. Participants were selected from universities in Manila City whose institutions did not have RECs at the time of the conduct of this study. Key informant interviews and focus group discussions were used as approaches for data collection. The authors used NVivo to organize data from the transcribed audio-recorded interviews and were analyzed utilizing a basic interpretive qualitative approach. Based on the results, surrogate practices of participants involved (1) providing “informed consent forms” to target participants and the (2) roles of different personalities in the evaluation/conduct of the research paper. Implications of this study and recommendations were likewise discussed in this paper. (shrink)

The purpose of this chapter is to offer an ethical investigation into whether researchers have a duty to share pre-published bio-medical data with the scientific community. The central questions of the chapter are the following: do researchers have a prima facie duty to share pre-published data? And if so, what stakes and aspects of a concrete situation need to be taken into consideration in order to assess whether and to what extent researchers’ prima facie duty to share data applies? We (...) will argue that based upon their basic duties to benefit society and to promote scientific knowledge, researchers have a prima facie duty to share data. We will also argue that in order to determine whether the prima facie duty applies in practice it is indispensable to take into account the stakes of the persons concerned as well as context dependent aspects. The chapter’s overall goal is to build an analytical and ethical framework that helps to assess with regard to concrete situations whether researchers’ duty to share data applies. To this end we analyse the concept of data sharing and clarify what data sharing might imply in practice. To offer an overview of the different stakeholders’ concerns we will analyse the normative-informational environment in which data producing researchers (to whom the prima facie duty to share data applies) are usually situated. In the last step we focus on the ethically relevant context dependent aspects and illustrate how they affect researchers’ prima facie duty to share data and stakeholders’ potentially conflicting stakes. (shrink)

Patients rely on, benefit from, and are strongly influenced by physicians’ recommendations. In spite of the centrality and importance of physicians’ recommendations to clinical care, there is only a scant literature describing the conceptual process of forming a clinical recommendation, and no discrete professional standards for making individual clinical recommendations. Evidence-based medicine and shared decision making together are intended to improve medical decision making, but there has been limited attention to how a recommendation is discretely formulated from either of (...) those processes or how patients’ preferences ought to be considered and how much weight they should hold. Moreover, physicians’ bias has been reported to strongly influence how a recommendation is derived, thereby undermining the quality of healthcare decisions and patients’ trust. To demonstrate a potential for improving the quality of decisions, this article proposes a conceptual framework for how physicians should reach a clinical recommendation and apply the process in practice. For preference-sensitive clinical decisions—that is, clinical decisions when patients’ values and preferences are relevant—the process for reaching a recommendation should be transparent to patients and should be based solely on the medical evidence and patients’ values and preferences. When patients’ preferences for care do not prioritize health, physicians decide whether their recommendation will prioritize a welfare-enhancing versus an autonomy-enhancing approach. When there are gaps in understanding how physicians derive their clinical recommendations and how to further improve the quality of the decisions, the author calls for further empiric research. (shrink)

The article is an overview of the events of the International Online Conference on Philosophical Practice, which took place on July 28-31 on the electronic platform of the South Ural State University, organized by the University Department of Philosophy and the Association of Practical Philosophers “Ratio” with the support of the Russian Foundation for Basic Research (project No. 20- 011-22002).

We surveyed 1005 postdoctoral fellows by questionnaire about ethical matters related to biomedical research and publishing; 33% responded. About 18% of respondents said they had taken a course in research ethics, and about 31% said they had had a course that devoted some time to research ethics. A substantial majority stated willingness to grant other investigators, except competitors, access to their data before publication and to share research materials. Respondents’ opinions about contributions justifying authorship of (...) class='Hi'>research papers were mainly consistent but at variance with those of many biomedical journal editors. More than half said they had observed what they considered unethical research practices. To increase the chances of getting a grant funded, 27% said they were willing to select or omit data to improve their results; to make publication of their work more likely or to benefit their career, 15% would select or omit data and 32% would list an undeserving author. Of respondents who thought they had been unfairly denied authorship on a paper, or been listed with or asked to list an undeserving author, 75% said they would be willing to list an undeserving author (P<0.001). Having taken a course dealing with research ethics had no effect on stated willingness to select or omit data or to fabricate data in the future, but was positively associated with willingness to grant undeserved authorship (P<0.04). Although these results do not controvert research demonstrating the effectiveness of ethics courses during professional education, they indicate that the research environment is a powerful component of a trainee’s experience and ethical development. (shrink)

In many Western science systems, funding structures increasingly stimulate academic research to contribute to practical applications, but at the same time the rise of bibliometric performance assessments have strengthened the pressure on academics to conduct excellent basic research that can be published in scholarly literature. We analyze the interplay between these two developments in a set of three case studies of fields of chemistry in the Netherlands. First, we describe how the conditions under which academic chemists (...) work have changed since 1975. Second, we investigate whether practical applications have become a source of credibility for individual researchers. Indeed, this turns out to be the case in catalysis, where connecting with industrial applications helps in many steps of the credibility cycle. Practical applications yield much less credibility in environmental chemistry, where application-oriented research agendas help to acquire funding, but not to publish prestigious papers or to earn peer recognition. In biochemistry practical applications hardly help in gaining credibility, as this field is still strongly oriented at fundamental questions. The differences between the fields can be explained by the presence or absence of powerful upstream end-users, who can afford to invest in academic research with promising long term benefits. (shrink)

This guide accompanies the following article(s): ‘Full Disclosure of the “Raw Data” of Research on Humans: Citizens’ Rights, Product Manufacturer’s Obligations and the Quality of the Scientific Database.’Philosophy Compass 6/2 (2011): 90–99. doi: 10.1111/j.1747‐9991.2010.00376.x Author’s Introduction Securing consent (and informed consent) from patients and research study participants is a key concern in patient care and research on humans. Yet, the legal doctrines of consent and informed consent differ in their applications. In patient care, the judicial doctrines of (...) consent and informed consent are disclosure doctrines based on the obligation of physicians to inform their patients of the following types of information: the nature of the procedure the physician is recommending in the patent’s care (P), the alternatives to the physician‐recommendation (A), and the risks of procedure and its alternatives (R). In addition, the physician must provide truthful answers to the patient’s questions (Q) to the best of the physician’s abilities. In research on humans, the onus of disclosure by study sponsors and principal investigators is much greater than in patient care precisely because the purpose of research is not patient care. The purpose of research is the identification and development of new generalizable knowledge. Thus, participation in a research study or trial may not benefit the study volunteer at all. In addition, the participant may carry a heavy risk burden in relationship to any testing of a newly designed drug or device as part of their experiences in the research study. Presently, despite the risks borne by the research study participant, the raw data collected from volunteers in research trials are treated by courts as if they were the private property of the study sponsor rather than generally owed to the public as would be expected by an effort like research participation aimed at contributing to the development of generalizable knowledge. This paper reviews the obligations that study sponsors owe to their study participants based on the very definition of research as a systematic activity whose purpose is to develop generalizable knowledge to help all humans. Author Recommends Court cases Canterbury v. Spence, United States Court of Appeals, District of Columbia Circuit 464 F.2d 772 (1972). (Federal appellate decision heard in the District of Columbia, USA) Reibl v. Hughes, 2 S.C.R. 880 (1980). (Supreme Court of Canada) Rogers v. Whitaker, 175 C.L. R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Canterbury v. Spence is the landmark Federal informed consent case in the United States heard in the District of Columbia. In this case, Judge Spottswood Robinson articulated the reasonable person standard of informed consent. This standard was subsequently adopted by the Supreme Court of Canada (Reibl v. Hughes, 2 S.C.R. 880 (1980)) and the High Court of Australia (Rogers v. Whitaker, 175 C.L. R. 479 (1992)). The House of Lords rejected the reasonable person standard in England in Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985). Book Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. This book is a detailed guide for the review of scientific and ethical aspects of research on humans contained in the research study protocols and research informed consent forms which need to be submitted by study sponsors and principal investigators to institutional review boards (IRBs) for IRB review before a research study can receive approval to be conducted within a human study population in those institutions over which the IRB has authority. It also presents basic definitions in the area of research on humans and basic approaches to help conduct a deep review of the underlying scientific and ethical issues that are present within a research study protocol and its accompanying research informed consent form. Report National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). This U.S. National Commission in the Belmont Report argued for the necessity of a reasonable volunteer standard in research on humans in the United States. Arguing that the professional standard and the reasonable person standard of consent and informed consent were insufficient to base a disclosure standard in research on humans, this National Commission developed the reasonable volunteer standard where a study participant is to be approached in research informed consent with that information that a reasonable volunteer would want to know. Online Materials Belmont Report: Syllabus Topics for Lecture and Discussion Week I: Introduction and Overview Readings: Rogers v. Whitaker, 175 C.L.R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week II: The Different Standards of Consent and Informed Consent Readings: Canterbury v. Spence, 464 F.2d 772 (1972). (Federal appellate opinion heard in the District of Columbia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week III: Definition of Research Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 2 and 3) Week IV: How to Review a Research Study Protocol and Research Informed Consent Form Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 4–6, 10, and 12–14) Week V: Obligations in Research of Humans Versus Patient Care Reading: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). Focus Questions • How do the judicial doctrines of consent in England and Australia compare to the judicial doctrines of informed consent in the United States and Canada? • How does a professional standard of disclosure differ from a reasonable person standard of disclosure? • What is the definition of research? • How is a research study (study proposal and research informed consent form) reviewed from scientific and ethical bases for considerations of approval by an IRB? • How do the obligations of a study sponsor, a principal investigator, and a research team conducting a research trial on human study participants differ from the obligations of a physician caring for a patient? • Should all raw data of research derived from humans be made available to the public for use in developing generalizable knowledge to help others, or should raw data be considered the private property of the study sponsors (for example, prescription drug manufacturers), who fund the research trials? Seminar/project Idea Draw a timeline of the development of the basic concepts of consent and informed consent in patient care and in patient research. On this timeline, first place the dates of the key court cases in England, the United States, Canada, and Australia on consent and informed consent. Then place the date of the development of the Belmont Report. Why do differences exist between these four countries in terms of the legal requirements of informedness of a patient (in medical care) and a study participant (in medical research)? What roles if any do the concepts of self‐determination and self‐decision have in consent and informed consent in patient care and in informed consent in research on humans among the four countries of interest? What are the realities of research on human participants that require a new standard of informed consent, the reasonable volunteer standard, to be developed beyond the two standards in patient care, the professional standard, and the reasonable person standard? Counterpoint Arguments The following are counterpoint arguments that need to be appreciated to more fully understand the concepts that impact the thesis that ‘raw data’ should be open to the public to allow the opportunity of checking of the results of its associated scientific paper and for further analysis. De‐Identified (Anonymized) Raw Data A current approach to identifying (anonymizinig) raw data is based on the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L.104‐191). HIPAA was enacted by the U.S. Congress in 1996 to keep a person’s medical information private. In a research study, a person’s private medical information can become research data. HIPAA’s Privacy Rule allows a covered entity to de‐identify data by removing all 18 elements that could be used to identify the individual or the individual’s relatives, employers, or household members; these elements are enumerated in the Privacy Rule. The covered entity must also have no actual knowledge that the remaining information could be used alone or in combination with other information to identify the individual who is the subject of the information. Under this method, the identifiers that must be removed are the following: 1 Names. 2 All geographic subdivisions smaller than a state, including street address, city, county, precinct, ZIP Code, and their equivalent geographical codes, except for the initial three digits of a ZIP Code if, according to the current publicly available data from the Bureau of the Census: 2a. The geographic unit formed by combining all ZIP Codes with the same three initial digits contains more than 20,000 people. 2b. The initial three digits of a ZIP Code for all such geographic units containing 20,000 or fewer people are changed to 000. 3 All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, and date of death, and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older. 4 Telephone numbers. 5 Facsimile numbers. 6 Electronic mail addresses. 7 Social security numbers. 8 Medical record numbers. 9 Health plan beneficiary numbers. 10 Account numbers. 11 Certificate/license numbers. 12 Vehicle identifiers and serial numbers, including license plate numbers. 13 Device identifiers and serial numbers. 14 Web universal resource locators (URLs). 15 Internet protocol (IP) address numbers. 16 Biometric identifiers, including fingerprints and voiceprints. 17 Full‐face photographic images and any comparable images. 18 Any other unique identifying number, characteristic, or code, unless otherwise permitted by the Privacy Rule for re‐identification. Even though ‘raw data’ can be de‐identified (anonymized) so that there is no way to trace back the data to the study participant from which it was drawn, there are still questions whether the ‘de‐identified raw data’ can be given to other researchers or made public without the original study participant’s approval. It may be the case that this approval could be done at the start of any research study where the individual considering study participation would be counseled on what the process of de‐identification consists of and would be asked whether the participant would allow use of the data by other researchers or made available to the public in a de‐identified state. However, there may be questions of the study participants as to whether the data are truly de‐identified and untraceable back to the study participant since the participant would not be able to see the process actually being carried out in detail in all relevant circumstances. Using Raw Data in Context Simply being in possession of raw data is never enough to build on that data from a research perspective. Researchers need to understand the context of the scientific research study in which the data were collected. This research context includes (but is not limited to): (i) the scientific hypothesis of the research study, (ii) the inclusion and exclusion criteria selected by the research designers of the study to determine which study participants were included and which were excluded from the study, (iii) the methods used to collect the data and possibilities of errors in the data collection processes, and (iv) answers to questions regarding whether any data were excluded from the study data and why these data were excluded. Ownership Rights Over Data There are ownership rights over data. Ownership rights include court decision making related to the question which parties are to be considered as the owners of the data. Possible owners here include (but are not limited to) (i) the study sponsor whose only role was to fund that study, (ii) the principal investigator(s) who developed the scientific hypothesis, and (iii) individual study participants through special contracts made by individual participants who negotiate such contracts with study sponsors and principal investigators to share in the ownership of data. Examples of such data are participant sources of unique gene lines or unique cell lines to be used in future research. Objections to Data Sharing Finally, individual researchers may simply object to sharing data. A researcher’s arguments here may be simply stating that he or she has a right to fully analyze the data since the collection of the data was the researchers’ idea in the first place. These researchers may argue that they have the right to mine the data as fully as they can before deciding to make the data open to the public for others to analyze. Works Cited 1 Kaiser, J. ‘Making Clinical Data Widely Available.’Science 322.5899 (10 Oct. 2008): 217–8. 2 de Lusignan, S., J.F. Metsemakers, P. Houwink, V. Gunnarsdottir, and J. van der Lei. ‘Routinely Collected General Practice Data: Goldmines for Research? A Report of the European Federation for Medical Informatics Primary Care Informatics Working Group (EFMI PCIWG) from MIE2006, Maastricht, The Netherlands.’Informatics in Primary Care 14.3 (2006): 203–9. 3 Sim, I. ‘Human Studies Database Project’, CTSA Data Repositories Symposium (17 Oct. 2008). 23 Nov. 2010. 4 Sim, I., C.G. Chute, H. Lehmann, R. Nagarajan, M. Nahm, and R.H. Scheuermann. ‘Keeping Raw Data in Context.’Science 323.5915 (6 Feb. 2009): 713. 5 U.S. Department of Health and Human Services, National Institutes of Health, HIPAA Privacy Rule, Information for Researchers. 13 Nov. 2010. 6 Wilczynski, N.L., R.B. Haynes, and Hedges Team. ‘EMBASE Search Strategies for Identifying Methodologically Sound Diagnostic Studies for Use by Clinicians and Researchers.’BMC Medicine 29.3 (March 2005): 7. (shrink)

:In a recent paper in Cambridge Quarterly of Healthcare Ethics on the necessary conditions for morally responsible animal research David DeGrazia and Jeff Sebo claim that the key requirements for morally responsible animal research are an assertion of sufficient net benefit, a worthwhile-life condition, and a no-unnecessary-harm condition. With regards to the assertion of sufficient net benefit, the authors claim that morally responsible research offers unique benefits to humans that outweigh the costs and harms to (...) humans and animals. In this commentary we will raise epistemic, practical, and ethical challenges to DeGrazia and Sebo’s emphasis on benefits in the prospective assessment of research studies involving animals. We do not disagree with DeGrazia and Sebo that, at the theoretical level, the benefits of research justify our using animals. Our contribution intends to clarify, at the practical level, how we should understand benefits in the prospective assessment and moral justification of animal research. We argue that ASNB should be understood as an assessment of Expectation of Knowledge Production in the prospective assessment and justification of animal research. EKP breaks down into two further claims: that morally responsible research generates knowledge worth having and that morally responsible research is designed and executed to produce generalizable knowledge. We understand the condition called knowledge worth having as scientists’ testing a hypothesis that, whether verified or falsified, advances an important interest, and production of generalizable knowledge in terms of scientific integrity. Generalizable knowledge refers to experimental results that generalize to a larger population beyond the animals studied. Generalizable scientific knowledge is reliable, replicable, and accurately descriptive. In sum, morally responsible research will be designed and carefully executed to successfully test a hypothesis that, whether verified or falsified, advances important interests. Our formulation of EKP, crucially, does not require further showing that an experiment involving animals will produce societal benefits. (shrink)

Este estudo é uma reflexão sobre o discurso e a prática nas comunidades Eclesiais de Base no Brasil e na Itália. Buscamos demonstrar, a partir de uma pesquisa empírica e teórica, as relações entres duas Comunidades Eclesiais de Base, a Comunidade San Paolo (Roma-IT) e a Prelazia de São Félix (Mato Gross-BR), demonstrando que estas baseiam-se em dois elementos: resultam das discussões advindas do Concílio Vaticano II e estão fortemente ligadas a seus líderes. E, ainda, que tais comunidades ligam-se por (...) fortes laços simbólicos. Este fato permitiu-nos concluir que a Teologia da Libertação empenhou-se em promover mudanças sociais e em criar um corpo simbólico que a corroborasse. Tais análises foram sustentadas pela teoria da transformação social de Max Weber e, ainda, pelos estudos de Karl Mannheim e de Glock e Stark. Palavras-chaves : Transformação social, Teologia da Libertação, prática, discurso.This study is a reflection of the discourse and practice on the Basic Ecclesial communities in Brazil and Italy. We try to show, from an empirical and theoretical research, the relations between two Christian Base Communities: the San Paolo Community (Rome – IT) and the Prelature of São Félix (BR – Mato Grosso), based on two factors: the result of discussions arising out of Vatican II, and the strong link to its leaders. Such communities bind by strong symbolic ties that really allowed us to conclude that Liberation Theology endeavored to promote social changes and to create a symbolic body that corroborates it. Such analysis was supported by the theory of social transformation of Max Weber, by the studies of Karl Mannheim and Glock and Stark. Keywords : Social Transformation; Liberation Theology, Practice, Discourse. (shrink)

Purpose The purpose of this paper is to review current practice in sharing and mining medical data revealing benefits, costs and ethical issues. Based on stakeholder perspectives and values, the authors create an ethical code to regulate the sharing and mining of medical information. Design/methodology/approach The framework is based on a review of academic, practitioner and legal research. Findings Owing to the inability of current safeguards to protect consumers from risks related to the disclosure of medical information, the authors (...) develop a framework for ethical sharing and mining of medical data, security, transparency, respect, accountability, community and quality, which espouses security, transparency, respect, accountability, community and quality as the basic tenets of ethical data sharing and mining practice. Research limitations/implications The STRACQ framework is an original, previously unpublished contribution that will require modification over time based on discussion and debate within and among the academy, medical community and public policymakers. Social implications The framework for sharing borrows from the Fair Credit Reporting Act, allowing the collection and dissemination of identified medical data but placing strict limitations on use. Following this framework, benefits of shared and mined medical data are freely available with appropriate safeguards for consumer privacy. Originality/value Mandates for adoption of electronic health-care records require an understanding of medical data mining. This paper presents a review of data mining techniques and reasons for engaging in the practice of identifying benefits, costs and ethical issues. The authors create an original framework, STRACQ, for ethical sharing and mining of medical information, allowing knowledge exploration while protecting consumer privacy. (shrink)

There is a growing interest in researching the plight, health, and social care needs of forced migrants and the complex ethical issues related to researching this vulnerable group. Conducting health and social care research with forced migrants is a sensitive and complex issue and can place emotional demands on contributors, requiring high ethical and moral standards which safeguard participants, researchers and the integrity of the study. Researchers and those who review research need to be sensitive to the needs, (...) privacy and fears of participants. In addition to the medical and personal benefits that can be obtained from undertaking research with forced migrants, there comes the risk of stigmatization, exploitation and harm. This paper identifies some, but by no means all, key ethical issues confronting researchers, these dilemmas include the complex issues of language and translation, immigration status, contextual issues, lack of familiarity with the research process, issues of informed consent and safeguarding anonymity. Confidentiality, sensitivity to cultural traditions and values, and avoiding re-traumatization also need to be considered as this knowledge can minimize research risks and protect the rights and welfare of research participants. This paper will draw upon experience of working with refugees and asylum seekers for many years and from experience gained from small-scale qualitative research undertaken with Somali and Ethiopian forced migrants. It argues for the need for a consistent, robust, ethical framework to ensure that the ‘researcher’ does not inadvertently ‘do harm’ by infringing on the security, privacy and well-being of the subjects of the research. This paper in turn adds to the knowledge base on good practice and research ethics and is hoped that it will provide useful guidance for those undertaking the ethical review for this type of research. (shrink)

When does benefiting from others’ wrongdoing effectively make one a moral accomplice in their evil deeds? If stem cell research lives up to its therapeutic promise, this question (which has previously cropped up in debates over fetal tissue research or the use of Nazi research data) is likely to become a central one for opponents of embryo destruction. I argue that benefiting from wrongdoing is prima facie morally wrong under any of three conditions: (1) when the wrongdoer (...) is one’s agent; (2) when acceptance of benefit directly encourages the repetition of the wrongful deed (even though no agency relationship is involved); and (3) when acceptance of a benefit legitimates a wrongful practice. I conclude by showing that, because of the ways in which most embryonic stem cell lines come into being, people who oppose embryo destruction may use human embryonic stem cells without incurring moral blame. (shrink)

Traditionally, surgical practice has been experiential and based on the contemporary understanding of basic mechanisms of disease. It was both a science and an art and depended to far too great an extent on the individualism and self belief of its main exponents. “Evidence based medicine” emerged in the 1980s and a new gospel of “Rules of Evidence” was introduced. There is no doubt that the net effect of EBM has been beneficial, but over reliance on randomised controlled trials (...) and the lack of generalisability of scientific evidence to individual patients has perhaps led to less enthusiasm for its tenets among surgeons. There are valid and spurious reasons for this that are discussed. The situation is improving but inevitable tensions remain between the surgeon committed to the individual patient here and now, and the clinical researcher whose focus is the benefit of future patients in the larger community. (shrink)

John Dewey coined the imperative that what we do in philosophy «must take effects in conduct» if it is not to be a sentimental indulgence for a few. This article asks whether it suffices when an insight only makes a difference in someone’s mind, to make it a legitimate aim of research. Four kinds of insights are distinguished: meta- physical insights, ethical insights, practical insights, and trivial insights. Metaphysical insights are those that bring us purely cognitive benefits – (...) no other benefits than a change in our thoughts. This article argues that metaphysical insights, properly demarcated, entail a particular kind of significance, which makes them worthy of pursuit, despite only yielding cognitive benefits. The article also points out, however, that we need to think carefully about how these cognitive benefits are socially distributed, and how we make the decision about which metaphysical inquiries are to be pursued. (shrink)

ABSTRACT Most pharmaceutical research carried out today is focused on the treatment and management of the lifestyle diseases of the developed world. Diseases that affect mainly poor people are neglected in research advancements in treatment because they cannot generate large financial returns on research and development costs. Benefit sharing arrangements for the use of indigenous resources and genetic research could only marginally address this gap in research and development in diseases that affect the poor. (...) Benefit sharing as a strategy is conceptually problematic, even if one, as we do, agrees that impoverished indigenous communities should not be exploited and that they should be assisted in improving their living conditions. The accepted concept of intellectual property protection envisages clearly defined originators and owners of knowledge, whereas the concept of community membership is fluid and indigenous knowledge is, by its very nature, open, with the originator(s) lost in the mists of time. The delineation of ‘community’ presents serious conceptual and practical difficulties as few communities form discrete, easily discernable groups, and most have problematic leadership structures. Benefit sharing is no substitute for governments’ responsibility to uplift impoverished communities. Benefit sharing arrangements may be fraught with difficulties but considerations of respect and equity demand that prior informed consent and consultation around commercialisation of knowledge take place with the source community and their government.1. (shrink)

Our society has long sanctioned, at least tacitly, a degree of conflict of interest in medical practice and clinical research as an unavoidable consequence of the different interests of the physician or clinical investigator, the patient or clinical research subject, third party payers or research sponsors, the government, and society as a whole, to name a few. In the past, resolution of these conflicts has been left to the conscience of the individual physician or clinical investigator and (...) to professional organizations. The public is no longer willing to allow health care providers to wholly govern their own conflicts of interest for several reasons. These include: new forms of health care financing and delivery that provide innovative and lucrative opportunities for physician or insurer enrichment at patient expense; the increased importance of commercial research support as peer-reviewed governmental research support has decreased; evidence that physicians and clinical investigators too frequently resolve conflicts of interest in their own favor; and a general societal mistrust of authority. This volume represents a multidisciplinary effort, drawing from philosophy, medicine, law, economics and public policy to identify and categorize conflicts of interest in medical practice and clinical research, and, where possible, to offer a mechanism for resolving them. Part I addresses conflicts of interest from a theoretical perspective, offering basic concepts and analytical frameworks. The second part discusses two topics prominent in current health care policy debates--self-referral and financial incentives to limit care. Part III examines conflicts of interest generated by pharmaceutical industry involvement in clinical practice and research. The final section deals with conflicts of interest in clinical research in several contexts, including institutional reviews boards, clinical trials, Cooperative Research and Development Agreements between government and private researchers, brokerage of research subjects by Contract Research Organizations, and cost-effectiveness studies. (shrink)

Traditionally, medicine has been considered a practical art. It seeks the patient’s well-being through technical means and specific skills in healing. On the other hand, healing means are connected to the life sciences, through which knowledge has developed systematically. Due to research and technological development, we can easily reveal the true meaning of medicine as science. Hippocratic practice and Aristotelian ethics have offered us a humanitarian approach, oriented to the sick person, which set the virtuous human character of (...) each person who practices the virtues. The medicine people approached to the medicine preserving an ancient picture of the practice. They have know-how of the practice, recognize the characteristics of each field of art or science appreciating its utility and benefits, but often they don’t know why or where the boundary between the two fields, science and art, falls. They are scientists and artists, too. In this article I intend to fix what science means and what art means, based on Aristotelian arguments, which lead to a perspective of a virtuous professional life. Also, it is relevant to find its common issues. No physicians can successfully practice their profession without respecting the rigor of science and training their creativity. I plead for a moral practice, for the understanding of humanity's state in any medical act. Medicine is the moral community where practice meets science and arts merge both. Medicine is not between practice and science; it is the art itself of medical practice and science. (shrink)

The central thesis of this essay is that basic income experiments are justified if their expected benefits in terms of justice exceed their expected costs in terms of justice. The benefits are a function of basic income’s effect on the level of justice attained in the context in which it is implemented, and the experiment’s impact on future policy-making. The costs comprise the sacrifices made as a result of the experiment’s interventional character, as well as the study’s opportunity (...) costs. In light of the proposed standard of justification for basic income experiments, the factors that play a role in it, and the way these interact with one another, this essay provides some practical recommendations for researchers hoping to conduct such an experiment. (shrink)

This review of issues and research is in two parts: 1) practical problems surrounding patient-held records and 2) ethical arguments for and against patient-held records. We argue that research on patient-held records indicates that there are no substantial practical drawbacks and considerable ethical benefits to be derived from giving patients custody of their medical records.

BackgroundAlthough the Covid-19 epidemic challenged existing medical care norms and practices, it was no excuse for unlawful conduct. On the contrary, legal compliance proved essential in fighting the pandemic. Within the European legal framework for the pandemic, patients were still entitled to be treated equally, by a specialized physician, with the possibility of seeking a second medical opinion, in a confidential setting, following prior and informed consent. This study examines physicians’ practices regarding patients’ rights during the Covid-19 pandemic and the (...) effects of age, experience, and specialty on physicians’ behavior and preferences. Additionally, it explores the nexus of malpractice complaints, malpractice fear, and legal compliance.MethodsA cross-sectional study was conducted on a convenience sample of attending physicians and general practitioners to assess compliance with patients’ rights regulations. Respondents were physicians practicing in private and public settings in Southwestern Romania from July 2021 to May 2022.Results396 attending physicians and 109 general practitioners participated in the research. Attending physicians acknowledged patients’ rights in 55.7% of statements, while general practitioners showed a slightly higher level of compliance at 59.9%. Emergency and Anesthesia and Intensive Care physicians showed the lowest compliance. There were no significant behavioral differences based on physicians’ age, years in practice, work sector, or location. However, when faced with the question of prioritizing treatment for patients with similar medical conditions, 46.2% of attending physicians reported favoring the younger patients. This preference was common among physicians under 39. Additionally, over half of the attending physicians reported working outside their area of expertise due to staff shortages. Malpractice fear was high among physicians, although unrelated to patients’ claims, legal compliance, or working outside the scope of practice. It resulted in pressure and behavioral changes.ConclusionAdherence to patients’ rights was low during the Covid-19 pandemic. Physicians could benefit from educational and administrative support to ensure better legal compliance. Further research is needed to determine if this behavior persists beyond the pandemic context. (shrink)

To select as the subject of a study of limited size a topic as fundamental and, additionally, one so long discussed as has been the case with literary practice greatly risks—and we are fully aware of this—appearing to be an undertaking which is both presumptuous (how many studies, sometimes major ones, have been devoted to this question during recent decades?) and doomed to failure (is it serious to presume, in a few pages, to deal, even partially, with so vast and (...) so complex a subject?). However, one precise reason causes us to think that it is time, today, to re-examine this ancient problem in new terms. The field of French literary research is at present characterized by a major institutional and ideological fact, the massive reality of which certain particular or collective efforts, no matter how remarkable these might be, cannot cover over. An airtight seal continues to separate, globally, traditional literary research from recent studies produced by certain linguists and speech historians in the domain of linguistic practices. Whence this scientifically paradoxical consequence: studies dealing with fundamentally similar objects—discursive practices—are presently being conducted in parallel, on the basis of theoretical premises which are radically opposed in most cases, with each one almost absolutely ignorant of the others. This situation, we believe, is exceedingly harmful to literary research. By making all interdisciplinary relation impossible as well as inhibiting certain questioning necessary within the realm of this research, it contributes to blocking progress in large measure. Need we point out that we nourish no naive hopes of overturning within the space of a few pages a situation whose roots, both institutional and ideological, are so deep? Nor does one distinguish oneself more by providing definitive answers for these basic problems which we propose discussing here, answers which one might even believe possible to guarantee as fully correct. We would only like to attempt to prove, by re-examining in new terms some fundamental problems of literary theory, the advantage which this theory might be able to find in certain data drawn from linguistics and the “analysis of discourse”, and inversely to propose certain theoretical readjustments which a specific reflection on literary practice seems to make necessary in the field of these two disciplines, particularly in that of the second. The pages which follow should, therefore, only be taken for what they are: an attempt, limited in its scope and problematic in its conclusions, to break down some barriers and to open a breach at certain critical points. (shrink)

Our study considers the governance, ethics and operational challenges associated with the acquisition, manipulation and commodification of ‘big data’ in the financial services sector. To the best of our knowledge, there are no published studies describing empirical research undertaken within companies in this sector to understand how they are responding to such challenges: our field-based research is a significant initial contribution in this respect. We describe the results of a micro-ethnographic study undertaken in a small-to-medium-sized company developing disruptive, (...) technology-related platforms and services in the banking and retail sectors based on big data and associated analytics: these are used to derive commercially valuable insights from personal customer data in exchange for cash back and targeted rewards. The company was found to employ a multi-level innovation governance approach, underpinned by an ethical strategy based on a principle of mutual benefit. Opt-in and informed consent for using data for specific purposes was supported by principles of data minimisation and anonymisation, with unrestricted use of secondary, anonymised and aggregated data to develop insights. Governance, which included contextual data protection legislation, payment-card industry data usage standards and internal corporate controls, presented as bespoke organisational practices relating to data security and privacy. These in total set the governance and ethics frame for big data innovation at the company within which it has had to be both adaptive and responsive under conditions of normative and regulatory uncertainty. (shrink)

The purpose of this essay is to critically review the design of methods for ethically robust forms of technology appraisal in the regulation of research and innovation in synthetic biology. It will focus, in particular, on the extent to which cost‐benefit analysis offers a basis for informing decisions about which technological pathways to pursue and which to discourage. A further goal is to consider what (if anything) the precautionary principle might offer in enabling better decisions. And this, in (...) turn, raises questions about why mention of precaution can excite accusations of unscientific bias or irrational, “anti‐innovation” extremism. What does the polarized debate tell us about the politics around synthetic biology? In seeking more rigorous, timely, and practical ways to govern these remarkable new technologies, what might we be missing?The sophistication, diversity, and scope of synthetic biology may seem to make it a rather idiosyncratic area for exploring these general issues. It may seem to be a special case, with the bewildering pace of change amplifying the difficulties. But at root, some of the trickiest issues are just specific instances of familiar and long‐standing conundrums in the governance of science and technology. The basic challenge is how to weigh up, for a wide range of potential options, the various pros and cons, as viewed from divergent perspectives, and find a way to justify the best course of action on behalf of society as a whole. This is the central problem addressed by a number of techniques in CBA. On the face of it, synthetic biology seems to present just one more application of these well‐established and self‐confident prescriptive methods.But there do emerge several obstinate, even prohibitive, difficulties for CBA. Although they are well acknowledged by the scholarly literature on and around this topic, they are often sidelined in practice. Yet all are central to the case for applying the concept of precaution to a field like synthetic biology. This essay will briefly explore multicriteria mapping, an appraisal method for exploring contrasting perspectives on emerging technologies, as one practical way to address them. The essay focuses on MCM, not because it presents any sort of panacea for appraisal, but because it is illustrative of the concrete implications of precaution. Setting out even just one among potentially many practical alternative methods at least refutes the last‐ditch argument that CBA is the only operational choice. (shrink)

ABSTRACT I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments. INTRODUCTION In contrast to the classic model of randomized-control trials, often with a large number of (...) subjects enrolled, precision medicine attempts to optimize therapeutic outcomes by focusing on the individual.[i] A recent publication highlights the strengths and weakness of both traditional evidence-based medicine and precision medicine.[ii] Plus, it outlines a tension in the shift from evidence-based medicine’s inductive reasoning style (the collection of data to postulate general theories) to precision medicine’s abductive reasoning style (the generation of an idea from the limited data available).[iii] The paper’s main example is the application of precision medicine for the treatment of cancer.[iv] I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. As the name suggests, brain-computer interfaces are a significant advancement in neurotechnology that directly connects someone’s brain to external or implanted devices.[v] Among the various kinds of brain-computer interfaces, adaptive deep brain stimulation devices require numerous personalized adjustments to their settings during the implantation and computation stages in order to provide adequate relief to patients with treatment-resistant disorders. What makes these devices unique is how adaptive deep brain stimulation integrates a sensory component to initiate the stimulation. While not commonly at the level of sophistication as self-supervising or generative large language models,[vi] they currently allow for a semi-autonomous form of neuromodulation. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments.[vii] ANALYSIS I. The State of Precision Medicine in Oncology and the Epistemological Shift While a thorough overview of precision medicine for the treatment of cancer is beyond the scope of this article, its practice can be roughly summarized as identifying clinically significant characteristics a patient possesses (e.g., genetic traits) to land on a specialized treatment option that, theoretically, should benefit the patient the most.[viii] However, in such a practice of stratification patients fall into smaller and smaller populations and the quality of evidence that can be applied to anyone outside these decreases in turn.[ix] As inductive logic helps to articulate, the greater the number of patients that respond to a particular therapy the higher the probability of its efficacy. By straying from this logical framework, precision medicine opens the treatment of cancer to more uncertainty about the validity of these approaches to the resulting disease subcategories.[x] Thus, while contemporary medical practices explicitly describe some treatments as “personalized”, they ought not be viewed as inherently better founded than other therapies.[xi] A relevant contemporary case of precision medicine out of Norway focuses on the care of a patient with cancer between the ventricles of the heart and esophagus, which had failed to respond to the standard regimen of therapies over four years.[xii] In a last-ditch effort, the patient elected to pay out-of-pocket for an experimental immunotherapy (nivolumab) at a private hospital. He experienced marked improvements and a reduction in the size of the tumor. Understandably, the patient tried to pursue further rounds of nivolumab at a public hospital. However, the hospital initially declined to pay for it given the “lack of evidence from randomised clinical trials for this drug relating to this [patient’s] condition.”[xiii] In rebuttal to this claim, the patient countered that he was actually similar to a subpopulation of patients who responded in “open‐label, single arm, phase 2 studies on another immune therapy drug” (pembrolizumab).[xiv] Given this interpretation of the prior studies and the patient’s response, further rounds of nivolumab were approved. Had the patient not had improvements in the tumor’s size following a round of nivolumab, then pembrolizumab’s prior empirical evidence in isolation would have been insufficient, inductively speaking, to justify his continued use of nivolumab.[xv] The case demonstrates a shift in reasoning from the traditional induction to abduction. The phenomenon of ‘cancer improvement’ is considered causally linked to nivolumab and its underlying physiological mechanisms.[xvi] However, “the weakness of abductions is that there may always be some other better, unknown explanation for an effect. The patient may for example belong to a special subgroup that spontaneously improves, or the change may be a placebo effect. This does not mean, however, that abductive inferences cannot be strong or reasonable, in the sense that they can make a conclusion probable.”[xvii] To demonstrate the limitations of relying on the abductive standard in isolation, commentators have pointed out that side effects in precision medicine are hard to rule out as being related to the initial intervention itself unless trends from a group of patients are taken into consideration.[xviii] As artificial intelligence (AI) assists the development of precision medicine for oncology, this uncertainty ought to be taken into consideration. The implementation of AI has been crucial to the development of precision medicine by providing a way to combine large patient datasets or a single patient with a large number of unique variables with machine learning to recommend matches based on statistics and probability of success upon which practitioners can base medical recommendations.[xix] The AI is usually not establishing a causal relationship[xx] – it is predicting. So, as AI bleeds into medical devices, like brain-computer interfaces, the same cautions about using abductive reasoning alone should be carried over. II. Responsive Neurostimulation, AI, and Personalized Medicine Like precision medicine in cancer treatment, computer-brain interface technology similarly focuses on the individual patient through personalized settings. In order to properly expose the intersection of AI, precision medicine, abductive reasoning, and implantable neurotechnologies, the descriptions of adaptive deep brain stimulation systems need to deepen.[xxi] As a broad summary of adaptive deep brain stimulation, to provide a patient with the therapeutic stimulation, a neural signal, typically referred to as a local field potential,[xxii] must first be detected and then interpreted by the device. The main adaptive deep brain stimulation device with premarket approval, the NeuroPace Responsive Neurostimulation system, is used to treat epilepsy by detecting and storing “programmer-defined phenomena.”[xxiii] Providers can optimize the detection settings of the device to align with the patient’s unique electrographic seizures as well as personalize the reacting stimulation’s parameters.[xxiv] The provider adjusts the technology based on trial and error. One day machine learning algorithms will be able to regularly aid this process in myriad ways, such as by identifying the specific stimulation settings a patient may respond to ahead of time based on their electrophysiological signatures.[xxv] Either way, with AI or programmers, adaptive neurostimulation technologies are individualized and therefore operate in line with precision medicine rather than standard treatments based on large clinical trials. Contemporary neurostimulation devices are not usually sophisticated enough to be prominent in AI discussions where the topics of neural networks, deep learning, generative models, and self-attention dominate the conversation. However, implantable high-density electrocorticography arrays (a much more sensitive version than adaptive deep brain stimulation systems use) have been used in combination with neural networks to help patients with neurologic deficits from a prior stroke “speak” through a virtual avatar.[xxvi] In some experimental situations, algorithms are optimizing stimulation parameters with increasing levels of independence.[xxvii] An example of neurostimulation that is analogous to the use of nivolumab in Norway surrounds a patient in the United States who was experiencing both treatment-resistant OCD and temporal lobe epilepsy.[xxviii]Given the refractory nature of her epilepsy, implantation of an adaptive deep brain stimulation system was indicated. As a form of experimental therapy, her treatment-resistant OCD was also indicated for the off-label use of an adaptive deep brain stimulation set-up. Another deep brain stimulation lead, other than the one implanted for epilepsy, was placed in the patient’s right nucleus accumbens and ventral pallidum region given the correlation these nuclei had with OCD symptoms in prior research. Following this, the patient underwent “1) ambulatory, patient-initiated magnet-swipe storage of data during moments of obsessive thoughts; (2) lab-based, naturalistic provocation of OCD-related distress (naturalistic provocation task); and (3) lab-based, VR [virtual reality] provocation of OCD-related distress (VR provocation task).”[xxix] Such signals were used to identify when to deliver the therapeutic stimulation in order to counter the OCD symptoms. Thankfully, following the procedure and calibration the patient exhibited marked improvements in their OCD symptoms and recently shared her results publicly.[xxx] In both cases, there is a similar level of abductive justification for the efficacy of the delivered therapy. In the case study in which the patient was treated with adaptive deep brain stimulation, they at least had their neural activity tested in various settings to determine the optimum parameters for treatment to avoid them being based on guesswork. Additionally, the adaptive deep brain stimulation lead was already placed before the calibration trials were conducted, meaning that the patient had already taken on the bulk of the procedural risk before the efficacy could be determined. Such an efficacy test could have been replicated in the first patient’s cancer treatment, had it been biopsied and tested against the remaining immunotherapies in vitro. Yet, in the case of cancer with few options, one previous dose of a drug that appeared to work on the patient may justify further doses. However, as the Norwegian case presents, corroboration with known responses to a similar drug (from a clinical trial) could be helpful to validate the treatment strategy. (It should be noted that both patients were resigned to these last resort options regardless of the efficacy of treatment.) There are some elements of inductive logic seen with adaptive deep brain stimulation research in general. For example, abductively the focus could be that patient X’s stimulation parameters are different from patient Y’s and patient Z’s. In contrast, when grouped as subjects who obtained personalized stimulation, patients X, Y, and Z demonstrate an inductive aspect to this approach’s safety and/or efficacy. The OCD case holds plenty of abductive characteristics in line with precision medicine’s approach to treating cancer and as more individuals try the method, there will be additional data. With the gradual integration of AI into brain-computer interfaces in the name of efficacy, this reliance on abduction will continue, if not grow, over time. Moving forward, if a responsive deep brain stimulation treatment is novel and individualized (like the dose of nivolumab) and there is some other suggestion of efficacy (like clinical similarities to other patients in the literature), then it may justify insurance coverage for the investigative intervention, absent other unrelated reasons to deny it. III. Ethical Implications and Next Steps While AI’s use in oncology and neurology is not yet as prominent as its use in other fields (e.g., radiology), it appears to be on the horizon for both.[xxxi] AI can be found in both the functioning of the neurotechnologies as well as the implementation of precision medicine. The increasing use of AI may serve to further individualize both oncologic and neurological therapies. Given these implications and the handful of publications cited in this article, it is important to have a nuanced evaluation of how these treatments, which heavily rely on abductive justification, ought to be managed. The just use an abductive approach may be difficult as AI infused precision medicine is further pursued. At baseline, such technology relies on a level of advanced technology literacy among the general public and could exclude populations who lack access to basic technological infrastructure or know-how from participation.[xxxii] Even among nations with adequate infrastructure, as more patients seek out implantable neurotechnologies, which require robust healthcare resources, the market will favor patient populations that can afford this complex care.[xxxiii] If patients already have the means to pay for an initial dose/use of a precision medicine product out of pocket, should insurance providers be required to cover subsequent treatments?[xxxiv] That is, if a first dose of a cancer drug or a deep brain stimulator over its initial battery life is successful, patients may feel justified in having the costs of further treatments covered. The Norwegian patient’s experience implies there is a precedent for the idea that some public insurance companies ought to cover successful cancer therapies, however, insurance companies may not all see themselves as obligated to cover neurotechnologies that rely on personalized settings or that are based on precision/abductive research more than on clinical trials. CONCLUSION The fact that the cases outlined above rely on abductive style of reasoning implies that there may not be as strong a justification for coverage by insurance, as they are both experimental and individualized, when compared to the more traditional large clinical trials in which groups have the same or a standardized protocol (settings/doses). If a study is examining the efficacy of a treatment with a large cohort of patients or with different experimental groups/phases, insurance companies may conclude that the resulting symptom improvements are more likely to be coming from the devices themselves. A preference for inductive justification may take priority when ruling in favor of funding someone’s continued use of an implantable neurostimulator. There are further nuances to this discussion surrounding the classifications of these interventions as research versus clinical care that warrant future exploration, since such a distinction is more of a scale[xxxv] than binary and could have significant impacts on the “right-to-try” approach to experimental therapies in the United States.[xxxvi] Namely, given the inherent limitations of conducting large cohort trials for deep brain stimulation interventions on patients with neuropsychiatric disorders, surgically innovative frameworks that blend abductive and inductive methodologies, like with sham stimulation phases, have traditionally been used.[xxxvii] Similarly, for adaptive brain-computer interface systems, if there are no large clinical trials and instead only publications that demonstrate that something similar worked for someone else, then, in addition to the evidence that the first treatment/dose worked for the patient in question, the balance of reasoning would be valid and arguably justify insurance coverage. As precision approaches to neurotechnology become more common, frameworks for evaluating efficacy will be crucial both for insurance coverage and for clinical decision making. ACKNOWLEDGEMENT This article was originally written as an assignment for Dr. Francis Shen’s “Bioethics & AI” course at Harvard’s Center for Bioethics. I would like to thank Dr. Shen for his comments as well as my colleagues in the Lázaro-Muñoz Lab for their feedback. - [i] Jonathan Kimmelman and Ian Tannock, “The Paradox of Precision Medicine,” Nature Reviews. Clinical Oncology 15, no. 6 (June 2018): 341–42, https://doi.org/10.1038/s41571-018-0016-0. [ii] Henrik Vogt and Bjørn Hofmann, “How Precision Medicine Changes Medical Epistemology: A Formative Case from Norway,” Journal of Evaluation in Clinical Practice 28, no. 6 (December 2022): 1205–12, https://doi.org/10.1111/jep.13649. [iii] David Barrett and Ahtisham Younas, “Induction, Deduction and Abduction,” Evidence-Based Nursing 27, no. 1 (January 1, 2024): 6–7, https://doi.org/10.1136/ebnurs-2023-103873. [iv] Vogt and Hofmann, “How Precision Medicine Changes Medical Epistemology,” 1208. [v] Wireko Andrew Awuah et al., “Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications,” World Neurosurgery, May 22, 2024, S1878-8750(24)00867-2, https://doi.org/10.1016/j.wneu.2024.05.104. [vi] Mark Riedl, “A Very Gentle Introduction to Large Language Models without the Hype,” Medium (blog), May 25, 2023, https://mark-riedl.medium.com/a-very-gentle-introduction-to-large-language-models-without-the-hype-5 f67941fa59e. [vii] David E. Burdette and Barbara E. Swartz, “Chapter 4 - Responsive Neurostimulation,” in Neurostimulation for Epilepsy, ed. Vikram R. Rao (Academic Press, 2023), 97–132, https://doi.org/10.1016/B978-0-323-91702-5.00002-5. [viii] Kimmelman and Tannock, 2018. [ix] Kimmelman and Tannock, 2018. [x] Simon Lohse, “Mapping Uncertainty in Precision Medicine: A Systematic Scoping Review,” Journal of Evaluation in Clinical Practice 29, no. 3 (April 2023): 554–64, https://doi.org/10.1111/jep.13789. [xi] Kimmelman and Tannock, “The Paradox of Precision Medicine.” [xii] Vogt and Hofmann, 1206. [xiii] Vogt and Hofmann, 1206. [xiv] Vogt and Hofmann, 1206. [xv] Vogt and Hofmann, 1207. [xvi] Vogt and Hofmann, 1207. [xvii] Vogt and Hofmann, 1207. [xviii] Vogt and Hofmann, 1210. [xix] Mehar Sahu et al., “Chapter Three - Artificial Intelligence and Machine Learning in Precision Medicine: A Paradigm Shift in Big Data Analysis,” in Progress in Molecular Biology and Translational Science, ed. David B. Teplow, vol. 190, 1 vols., Precision Medicine (Academic Press, 2022), 57–100, https://doi.org/10.1016/bs.pmbts.2022.03.002. [xx] Stefan Feuerriegel et al., “Causal Machine Learning for Predicting Treatment Outcomes,” Nature Medicine 30, no. 4 (April 2024): 958–68, https://doi.org/10.1038/s41591-024-02902-1. [xxi] Sunderland Baker et al., “Ethical Considerations in Closed Loop Deep Brain Stimulation,” Deep Brain Stimulation 3 (October 1, 2023): 8–15, https://doi.org/10.1016/j.jdbs.2023.11.001. [xxii] David Haslacher et al., “AI for Brain-Computer Interfaces,” 2024, 7, https://doi.org/10.1016/bs.dnb.2024.02.003. [xxiii] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 103–4; “Premarket Approval (PMA),” https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P100026. [xxiv] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 104. [xxv] Burdette and Swartz, 126. [xxvi] Sean L. Metzger et al., “A High-Performance Neuroprosthesis for Speech Decoding and Avatar Control,” Nature 620, no. 7976 (August 2023): 1037–46, https://doi.org/10.1038/s41586-023-06443-4. [xxvii] Hao Fang and Yuxiao Yang, “Predictive Neuromodulation of Cingulo-Frontal Neural Dynamics in Major Depressive Disorder Using a Brain-Computer Interface System: A Simulation Study,” Frontiers in Computational Neuroscience 17 (March 6, 2023), https://doi.org/10.3389/fncom.2023.1119685; Mahsa Malekmohammadi et al., “Kinematic Adaptive Deep Brain Stimulation for Resting Tremor in Parkinson’s Disease,” Movement Disorders 31, no. 3 (2016): 426–28, https://doi.org/10.1002/mds.26482. [xxviii] Young-Hoon Nho et al., “Responsive Deep Brain Stimulation Guided by Ventral Striatal Electrophysiology of Obsession Durably Ameliorates Compulsion,” Neuron 0, no. 0 (October 20, 2023), https://doi.org/10.1016/j.neuron.2023.09.034. [xxix] Nho et al. [xxx] Nho et al.; Erik Robinson, “Brain Implant at OHSU Successfully Controls Both Seizures and OCD,” OHSU News, accessed March 3, 2024, https://news.ohsu.edu/2023/10/25/brain-implant-at-ohsu-successfully-controls-both-seizures-and-ocd. [xxxi] Awuah et al., “Bridging Minds and Machines”; Haslacher et al., “AI for Brain-Computer Interfaces.” [xxxii] Awuah et al., “Bridging Minds and Machines.” [xxxiii] Sara Green, Barbara Prainsack, and Maya Sabatello, “The Roots of (in)Equity in Precision Medicine: Gaps in the Discourse,” Personalized Medicine 21, no. 1 (January 2024): 5–9, https://doi.org/10.2217/pme-2023-0097. [xxxiv] Green, Prainsack, and Sabatello, 7. [xxxv] Robyn Bluhm and Kirstin Borgerson, “An Epistemic Argument for Research-Practice Integration in Medicine,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 43, no. 4 (July 9, 2018): 469–84, https://doi.org/10.1093/jmp/jhy009. [xxxvi] Vijay Mahant, “‘Right-to-Try’ Experimental Drugs: An Overview,” Journal of Translational Medicine 18 (June 23, 2020): 253, https://doi.org/10.1186/s12967-020-02427-4. [xxxvii] Michael S. Okun et al., “Deep Brain Stimulation in the Internal Capsule and Nucleus Accumbens Region: Responses Observed during Active and Sham Programming,” Journal of Neurology, Neurosurgery & Psychiatry 78, no. 3 (March 1, 2007): 310–14, https://doi.org/10.1136/jnnp.2006.095315. (shrink)

Paying research participants in developing countries like Uganda raises ethical concerns over potential for undue inducement. This article, based on an exploratory study, reviewed 49 research protocols from a national HIV/AIDS research ethics committee database. Payments mainly adhered to the reimbursement and compensation payment models. Offers made were diverse but basic in order to limit undue inducement. Implications in terms of undue inducement and possible impact on participants and research are discussed. We end by recommending (...) standardization across comparable studies in the interests of promoting high-quality research, altruism, voluntariness, and restraining unfair reimbursement practices in research. (shrink)

(1) What may be gained by applying concepts generalised from economics to methodological problems? The perspective of cost-benefit analysis ('CBA' for short) may help the researcher to see what sorts of questions he should take into account when dealing with particular methodological problems. This claim is supported by applying generalised CBA-thinking to two standard problems of methodology. (2) In the practice of research the handling of basic statements does not normally constitute any problem, and no conscious decision (...) is involved. In the methodological reconstruction the key questions are: 'How can a particular basic statement be criticised?' and 'What are the costs of defending a statement that is "problematic"?' The problem of the empirical 'base' is an investment problem: whether or not to invest time and effort into processing a particular basic statement into a falsifying hypothesis for the theory we wish to test. The valuation of the costs of rejecting or, as the case may be, of defending a basic statement, are objective. (3) With respect to theories, in basic science, the issue is not one of acceptance or rejection of a single theory, but rather of theory preference. Both the rational response to a falsification and rational theory preference are governed by CBA-considerations. The option for one of two competing theories is based upon a CBA where the valuation of benefits and costs is objective. Theory change is an objective process, at least in those fields, where theorising is closely controlled by empirical testing: the better theory drives out the less good theory. The costs of defending a theory that is less good than its competitor are mainly epistemic resources forgone. The use of CBA in methodology not only is compatible with Popper's position, but it may pay to view Popper's methodology as an application of CBA to epistemic situations. (shrink)

The authors offer a fresh look at the debate about the use of assisted nutrition and hydration in advanced dementia. The philosophical and ethical issues are presented. The importance of distinguishing basic care from medical acts is explained. A key question is addressed: Does ANH nourish and hydrate the patient with dementia? The ANH debate is placed in its cultural context and contrasted with the Catholic response. A clinical analysis of the evidence for benefit and harm of ANH (...) in advanced dementia is given. The authors point out the lack of hard evidence against ANH, discuss questions that need further clinical research, and argue that there is sufficient evidence for a presumption, in principle, in favor of ANH in patients with advanced dementia. National Catholic Bioethics Quarterly 14.1 : 53–63. (shrink)

Interdisciplinarity is strongly promoted in science policy across the world. It is seen as a necessary condition for providing practical solutions to many pressing complex problems for which no single disciplinary approach is adequate alone. In this article we model multi- and interdisciplinary research as an instance of collective problem solving. Our goal is to provide a basic representation of this type of problem solving and chart the epistemic benefits and costs of researchers engaging in different forms (...) of cognitive coordination. Our findings suggest that typical forms of interdisciplinary collaboration are unlikely to find optimal solutions to complex problems within short time frames and can lead to methodological conservatism. This provides some grounds for both reflecting on current science policy and envisioning more effective scientific practices with respect to interdisciplinary problem solving. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Beyond EngelClinical Pragmatism as the Foundation of Psychiatric PracticeDavid H. Brendel (bio)Keywordsbiopsychosocial model, pluralism, pragmatism, psychiatryFor many years now, there has been growing recognition of the powerful role of pragmatic reasoning in numerous disciplines, including bioethics, medicine, law, political science, and philosophy (Dickstein 1998; Rosenthal, Hausman, and Anderson 1999). But until recently, philosophical pragmatism was neglected by scholars exploring the clinical challenges and theoretical underpinnings of psychiatry. In his (...) noteworthy article The Biopsychosocial Model and Philosophic Pragmatism: Is George Engel a Pragmatist?, Bradley Lewis offers a significant contribution to the small but gradually increasing literature in this area. Lewis appropriately presents Engel as a major figure in twentieth-century American medicine and psychiatry, a critic and a visionary who dared to question the dominant paradigm of biomedical reductionism (Engel 1977)—a paradigm that led to important scientific advances, but also restricted the physician’s understanding of the patient as a complex individual with an inner world and interpersonal relationships. Lewis argues that medicine and psychiatry a generation after Engel’s seminal 1977 paper can be revitalized by reinterpreting Engel in the intellectual tradition of classical American pragmatism and neo-pragmatism. Placing Engel in the pragmatic tradition, Lewis suggests, could enhance the biopsychosocial model and have substantial benefits for both individual patients and society as a whole.There is no disputing Lewis’s argument that a pragmatic philosophy of medicine and psychiatry is a noble goal. In fact, in my book Healing Psychiatry: Bridging the Science/Humanism Divide (Brendel 2006), I present philosophical pragmatism as the most compelling theoretical approach to clinical psychiatry in the twenty-first century—the approach that is most likely to empower the clinician and the patient to collaboratively develop a treatment plan that heeds the multidimensional complexity of the patient’s life, recognizes the confusion and uncertainty that grows out of this complexity, and aims for a favorable therapeutic outcome. Drawing on work of the classical American pragmatists and contemporary pragmatic bioethicists, I identify four dimensions of philosophical pragmatism that provide a sound foundation for clinical work, which I call the “four ps”: (1) diagnostic formulations and treatment plans in psychiatry are practical insofar as they focus on results rather than a commitment to any particular theory; (2) they are pluralistic [End Page 311] insofar as they incorporate explanatory concepts that span the biopsychosocial spectrum; (3) they are participatory and collaborative, not imposed authoritatively by the clinician; and (4) they are provisional, open-ended, and malleable to newly acquired information and evolution of the patient’s condition.Lewis casts Engel as a philosophical pragmatist who battled the Goliath of biomedical reductionism that had come to dominate American medicine and psychiatry in the latter half of the twentieth century. Unfortunately, however, regardless of how elegantly Lewis reinterprets Engel, he cannot render him a full-blown pragmatist for the medicine and psychiatry of the twenty-first century. Lewis provides quotations to suggest that Engel valued a results-oriented clinical sensibility, for example “the value of a scientific model is measured not by whether it is right or wrong but by how useful it is” (Engel 1980). But Engel was not fully committed to clinical outcome as the supreme judge of theory in medicine and psychiatry. Lewis notes that Engel understood the biopsychosocial model as less “a matter of compassion and humanity” and more a matter of “rigorous application of the principles and practices of science”; he was a man of his time who could not fully escape the scientism of the day. Working within this scientistic world, he distinguished himself by reintroducing psychological, sociological, and humanistic concepts into clinical medicine, which had become obsessed with the power and robustness of the natural sciences but had neglected the suffering human subject and the social context of illness. Engel undoubtedly hoped the biopsychosocial model would lead to better clinical results but, unlike the classical American pragmatists and contemporary pragmatic bioethicists, he did not make a systematic case for privileging clinical outcome above strict adherence to scientific theory.In fact, Engel’s biopsychosocial model runs the risk of becoming a reified end in itself; those who unquestioningly espouse its basic tenets are in danger of... (shrink)

BackgroundMany of the important elements of a valid informed consent – comprehension, voluntariness, and capacity – can be compromised or unmet in the context of psychiatric research. The inability to protect their own interests puts mentally ill subjects at an increased likelihood of being wronged or harmed and makes them particularly vulnerable in the context of clinical research. Therefore, they are due extra protection. Sometimes, these additional safeguards can significantly limit the possibilities for research involving subjects deemed (...) unable to consent due to their mental illness. Montenegro, a middle-income country in Southern-Eastern Europe, goes so far in their policy to protect these subjects from harms of research, as to ban all biomedical research on mentally ill persons who are unable to provide consent.Main bodyMental health research is often neglected and very low on the list of health research priorities, especially in low- and middle-income countries. Despite the fact that mental health disorders are among leading causes of disability, the need for evidence-based services and interventions for those affected remains unmet.To exclude all members of a certain group of subjects seems extremely restrictive and unnecessary. Such a policy is discriminatory and unethical, because it inflicts further harms and exclusion of those patients from participation in society. This unjust exclusion policy obstructs research of certain psychiatric disorders and implies that new treatments for conditions that directly affect these incapacitated subjects will not be developed.ConclusionsScientific and clinical development must not be precluded by overly restrictive, discriminatory and unjust practices, such as the normative ban on research on decisionally-impaired mentally ill subjects. Rather, there should be a regulative framework that ensures that those who cannot consent for themselves are respected and protected in research, the anticipated benefits maximized, risks minimized, their autonomy recognized and extended. These patient-subjects must be appropriately included unless there is a clear and compelling rationale and justification that inclusion is inappropriate with respect to the health of the participants or the purpose of the research. (shrink)

_Relevance_. The starting point for embedding CSR as part of the management culture is the vision and values. But first, you need to understand what 'values' means in CSR terms. Companies spend time and effort in creating their mission, vision and values statements, but these are often only from a commercial and internal viewpoint. To achieve CSR values, managers need to take an objective external vie", identifying their various stakeholders, and the company's impacts upon them [1]. Management culture is part (...) of an organizational culture that includes both formal and informal elements of the organizational culture. Management culture reflects the level of the organization’s managerial system development, modernity, efficiency and functionality. It depends on this level how innovations will be implemented in the organization’s management and whether they will be implemented at all, and how effectively the objectives will be solved and the aims will be implemented [2]. Summarizing the results of various research made in different countries, it becomes clear that large companies are not always inclined to coordinate their activities with stakeholders because of their institutional weakness. Research aim: assess the level of cultural and social responsibility of organisational management and discuss their links. Research methods. Analysis of scientific literature, questionnaire survey. Research results. The findings of the research carried out in other countries proved that organizations evaluate not all aspects of corporate social responsibility, and this is influenced by the lack of the employees, as one part of the stakeholders, strong institutional capacity. The quantitative research found that the administration of both groups of companies inadequately evaluate corporate social responsibility activities, there is no feedback guaranteed, there is insufficient care about the relations with employees who are one part of stakeholders, their physical environment and psychological condition. There is no effective internal audit system of social responsibility which should be developed to guarantee feedback, and corporate social responsibility has not become an inseparable part of organizational culture. Having evaluated the weaknesses and the positive trends of management culture and social responsibility characteristics of groups of companies, it should be stated that firstly, management culture expression has influence when aiming for corporate social responsibility; secondly, corporate social responsibility can be regarded as an integral derivative of management culture realized in organizations’ management practice. However, there are also significant differences. There were set personal managerial personnel culture and management knowledge significant amounts of estimates, associated with different approaches to other management work criteria according to which the management culture condition is diagnosed. The clearer dynamics of indicator estimates of the second group of companies leads to the conclusion that the management culture is still being formed, but without clear direction vector. Processes are not clearly focused and uncoordinated. The standards, regulations existing in the second group are not sufficiently linked to the activities practice, so they do not guarantee the optimality of processes, unlike in the first group of companies, where there is a standard peculiar management culture, although the estimates of indicators diagnosing it are not particularly high. In such a situation, the questions of investment in the modernization of management, optimization of working processes remain relevant, unresolved, but the effectiveness of their payoff remains uncertain. Human resources in management policy of both groups of companies are under-estimated; in order to create favorable conditions for their effective use, communication and the interrelationship functionality problems are acute. Organizations (larger problems fixed in the second group of companies) are not adequately prepared to implement corporate social responsibility organization-wide, as management work is not optimally organized, the managerial personnel lacks knowledge and skills working with human resources. Even in the evaluation of formal aspects of corporate social responsibility standards implementation possibilities, the situation existing in groups of companies and organizational abilities of leaders would not allow to realize them systematically and effectively. In this case, corporate social responsibility values would remain more as a declarative form and not the organization’s management culture inseperable part, and a natural, balanced way of functioning of processes based on this philosophy. Though in the second group of companies there is clearer dynamics according to separate management culture parameters, the apparent orientation to modernization of activities shows more open to innovation, in which the elimination of drawbacks and purposeful development can serve the realization of corporate social responsibility more effectively. In both groups of companies the highlighted declarative corporate social responsibility policy trends contradict the actual practice of social responsibility in relations with the organization's internal and external stakeholders. This partly confirms theoretical insights presented in Lithuanian scientific works, which emphasize marketing direction of corporate social responsibility as a general cultural dominant. However, this aspect has not been developed yet in the case of the discussed groups of companies, and the research results lead to the conclusion that organizations lack basic knowledge of corporate social responsibility and motivation to realize them in practice, and the high level of clustering and internal corruption impedes social responsibility transfer to the strategic level. The lack of development of dialogue culture between stakeholders (subjects) became apparent in management culture problem areas and can become a formidable obstacle to the implementation of both individual social responsibility initiatives and installing in complex. This is true in the sense that the organizations do not have universal support from employees, and the procedures are carried out in a superficial manner and have a formal character. Corporate social responsibility is a valuable organization's internal culture category, but this base is not strong enough and balanced. Corporate social responsibility in the activities of both groups of companies (and especially - the first) can be considered still developing and has not taken clear shapes yet. According Hoskins (2006) CSR is a means of developing a management culture. However, the fundamental CSR success factor is that it is a living management process. The strategy needs to be reviewed regularly, and implemented across business units and all CSR components. The delivery of CSR practice is a critical activity. If any of the components are weak, then they detract from the effectiveness of the other components. Like all cultural aspects, CSR is only as strong as its weakest link A CSR management system is essential for CSR to become embedded within the business culture. CSR should not be a separate central activity, but become part of the business process and practice for all business units. (shrink)

Doing phenomenological research entails a complex process that is only minimally published in scientific journals. What is often missing reflects how being in research calls into question the researchers themselves. Anyone who has conducted qualitative empirical research knows that personal engagement does not come at no cost; there are multiple pedagogical and professional practice gains. This article’s aim is to share the phenomenology behind phenomenology: the reflection and personal experience of doing/being in phenomenological research and the (...) personal narrative of what this experience has meant concerning the authors' own context: health care and nursing. Taking advantage of a conducted research exploring the lived experience of family caregivers of hematological patients assisted at home, we propose considerations about the perceived epistemic and cognitive gains, the formative and personal/professional sequels of having been reflective participants of phenomenologically oriented research. (shrink)

Photo ID 279661800 © Sidewaypics|Dreamstime.com ABSTRACT Decolonization is complex, vast, and the subject of an ongoing academic debate. While the many efforts to decolonize or dismantle the vestiges of colonialism that remain are laudable, they can also reinforce what they seek to end. For decolonization to be impactful, it must be done with epistemic and cultural humility, requiring decolonial scholars, project leaders, and well-meaning people to be more sensitive to those impacted by colonization and not regularly included in the discourse. (...) INTRODUCTION Decolonization is complex. To successfully achieve decolonization, projects should incorporate the voices of those subjugated or silenced. Including such voices requires sincerely exploring who has been affected by colonialism or neocolonialism and how, as well as cultural sensitivity. In its basic use, decolonization refers to countries under colonial rule gaining independence or freedom from forms of subjugation. Additionally, scholars use the term to refer to efforts to dismantle neocolonialism and vestiges of colonialism. The process includes de-silencing subjugated voices.[1] I use decolonization in the latter way to refer to countries with technical independence. While arguably colonization ended formally with independence from colonizing powers, neocolonialism is the indirect, informal, and sometimes subtle control of the people, their economy, and political life despite formal independence from colonizing authorities. I conceptualize neocolonialism as a system that involves direct and involuntary control of another’s political, economic, or social life, impacting their worldview and ways of encountering the world. Decolonization may target actions, places, or systems like health care or AI to overcome the ills of colonialism and neocolonialism. It also may target knowledge and require rethinking how people develop their knowledge base. For example, if people grew up seeing an outside colonizer as superior, they would need to change their knowledge of superiority. Decolonization may target power, for example, changing who owns and distributes COVID-19 vaccines and who distributors exclude in the distribution of vaccines. Decolonization could require looking at those disempowered in the distribution process. Additionally, decolonization may target autonomy of persons by freeing people, ensuring human and individual rights, and respecting cultural traditions. Decolonization projects that try to de-silence by including the voices of those affected by colonialism and neocolonialism must examine inclusiveness in the context of the culture of the subrogated individuals. Examples of decolonization projects include making datasets inclusive of diverse peoples and places, returning to traditional food and eating practices, making sure hospitals in developing countries are led by locals and respectful of cultural traditions, returning unethically obtained artefacts or objects. Another project would be laying the groundwork for equality in formerly colonized countries to ensure that business ownership, education, and financial success will flow fairly to those previously victimized by colonization. Summarily, there are many strategies for decolonizing. However, it is worth asking whether the strategies have risks that undermine the goal of decolonization. I. Understanding Decolonization Discourses Many fields, from AI to politics, economics, health care, aviation, and academia, discuss decolonization. The content of the discourse on decolonization depends on the region and field discussing it. Rather than just reporting on decolonization, the discussions may be calls to action. For example, decolonization discourses reflect activism for cognitive justice, such as equal consideration of Indian or African knowledge systems in global health discourses.[2] In politics and political science, some scholars frame decolonization as an anti-western, anti-colonial movement by Africans to emancipate Africa/ns from subjugation or shift the continent to postcolonialism and post-neo-colonialism. This framing walls off non-African participants and may undermine their capacity to benefit the conversation.[3] There are other political scientists who actively support decolonization and see it as a field of activism in support of anyone and countries where colonization harmed people and development.[4] The point is that two ways of conceptualizing decolonization in politics and political science are discernible. One conceptualization is less inclusive since it alienates scholars and professionals from Western, high-income, or developed countries. The other is more inclusive. In humanitarian studies, including philosophy, some decolonization articles and conversations are efforts to end the destructive force of colonization. They focus on either the form, such as ecocide, genocide, and many others, or the geographic location, such as Africa, Asia, Latin America, and Oceania.[5] Finally, the feelings one brings into this conversation can adversely impact how one engages in them and who they listen to or are willing to hear from. For example, anger, rage, bitterness, and hatred are emotions that are not uncommon in spaces of decolonization conversations. Decolonization conversations that originate from a place of negativity risk deepening the psychological state of victimhood and prevent people from disrupting constructively or critically engaging in the conversation.[6] II. Understanding Decolonization Strategies Decolonization strategies mainly aim to de-silence victims of domination or subjugation. People have proposed many strategies for decolonizing. These strategies may be informed by what the target is for decolonization. Decolonization can target power relations in global health. For example, during the COVID-19 pandemic, public health organizations noted the power imbalance in vaccine distribution. Decolonization could involve de-silencing those affected by neocolonialism to bring about a more balanced distribution of power and a more fair distribution of the vaccine. By analyzing who was adversely impacted by the distribution and who ought to wield power, those engaged in decolonizing advocated for positive change and equitable power relations. Equally, when being is the target of decolonization, the language of unlearning or relearning and mental decolonization take centre stage in the decolonization discourse. For example, the quest to decolonize colonized minds aims to demythologize African inferiority and Western superiority. Demythologizing African inferiority enables those engaged in the decolonization discourse to cultivate and foster African agency.[7] Finally, when knowledge production is the target of decolonization, scholars use inclusion and cognitive justice. For example, they try to alter the knowledge that underlies global health ethics.[8] “[D]decolonizing researchers aim to respectfully understand and integrate theory from Other(ed) perspectives, while also critically examining the underlying assumptions that inform their Western research framework.”[9] One common strategy that scholars use in decolonization is inclusion. It is worth asking, does including people who have been subrogated foster decolonization? Whether that is effective depends on whether included people are more heard or whether the strategies to include them create new forms of silencing. III. Inclusion and the Quest to Decolonize Evaluating how effective inclusion is in the quest to de-silence subjugated voices is important. First, inclusive strategies are not neutral. They are epistemically situated. This situatedness constrains meaning-making in different ways: how and what questions are asked, how social roles are constructed, organized or assigned, and who is admitted to the room where these conversations occur.[10] Inclusion strategies may reinforce (unchallenged) assumptions. For example, to address prejudices and stereotypes in global health images, Arsenii Alenichev and his colleagues[11] successfully inverted “one stereotypical global health image” by prompting a generative AI to produce “an image of a traditional Indian or African healer healing a White Child.” Although there were some problems with the image of the White child, this innovation is a significant, useful effort to de-embed or strip global health images of problematic pictures that mythologize White superiority and Black inferiority. Yet it is possible that using categories like traditional Indian or African reinforces unchallenged assumptions, raising key questions regarding how language and words create new stereotypes. It is common to define traditional as non-conventional, unorthodox, and informal. Yet studies continue to reveal that non-scientifically appraised healing approaches in India or Africa are not only effective but also real, meaningful, fundamental, and primary care-seeking behaviours in many communities in these regions.[12] Suppose inclusive strategies are not un-situated. These conversations may be had within the structures, language, and spaces built by or connected to colonialism. The spaces, language, places, and structures in which these conversations occur can limit who can participate and how they participate. Importantly, some conditions are not conducive to participation as equals. The allocated time for the discussion could also constrain how individuals express themselves. It is unclear who is ultimately heard. Furthermore, epistemic situatedness of inclusion can impact decolonization conversations when participants are beneficiaries of, products of, and trained by structures and systems they seek to dismantle. To enhance the decolonization project and its goals, a pressing task is to unveil and question how the circumstances may inhibit activism. If the vestiges of colonialism continue to structure the decolonization discourse invisibly, the vestiges may undermine decolonization. For example, a public health discussion that includes white Western doctors and Western pharmaceutical executives in Africa may have many local Africans at the table but could still effectively devalue their input based on built-in assumptions and biases that are vestiges of colonialism. Second, exclusion and inclusion are also not binary. Individuals may experience exclusion, even while included (the phenomenon called internal exclusion). In other words, inclusion can fail to be substantial or become a means of enhancing optics, “a way of (un)consciously weakening the radical claims being pursued.”[13] For example, in South Africa, many institutions have made significant efforts to diversify their faculties due to the promulgation of the Employment Equity Act 55.[14] The act requires South African institutions to implement employment equity that redresses the history of harmful discrimination in the country. The act further requires transforming departments and institutional administrations. Although many recognize and support the need to transform departments in South Africa, the rhetoric of transformation departs sharply from the lived experiences.[15] This misalignment between the plan and practice is evident in the underrepresentation of black people and females in senior management teams, professorships in many universities and health departments, and positions of power in some South African institutions. Those selected in the transformation of the departments have also complained of being overworked. The burden of extra work undermines their ability to develop agency and voice in the space they now occupy or fulfil key requirements that have implications for their career trajectory.[16] This is called the minority tax. Notably, "the minority tax… is the burden of extra responsibilities [placed] on faculty of colour to achieve diversity and inclusion and contributes to attrition and impedes academic promotion."[17] One challenge for decolonializing projects will be for decolonial scholars and those selected for decolonization objectives to have the humility to decline invitations, requests, roles, and platforms for which they are either unqualified or lack the capacity to fulfil. At its heart, decolonization strategies must empower those included rather than weaken them. Finally, inclusion can lead to a phenomenon known as elite capture.[18] Elite capture occurs when socially advantaged individuals in a group monopolize or exploit activism to their own benefit at the expense of the larger, struggling group. Elite capture weakens decolonization efforts from within, revealing that those likely to benefit from global inclusive efforts are those who fulfil globally constructed standards, those “already present in the room.” There is no better strategy to weaken decolonial movements than weakening the project from within by strategically positioning individuals who share physical properties with the victims of exclusion and silencing but intellectually, behaviourally, psychologically, and emotionally share more common ground with the colonizer. Such insiders may be unaware they are furthering neocolonial conditions rather than decolonizing. In relation to decolonization, particularly in global health, elite capture reveals that those whose voices are loudest in the room are not necessarily those more impacted by colonialism. They may benefit more from reinforcing colonialism. Opportunism weakens meaningful activism from within, preventing good initiatives and strategies from having their intended impact or taking substantive root.[19] This paper cannot do justice to elite capture, but it is worth noting its negative impacts. IV. Improving the Impact of Decolonization To end neo-colonialism, it is important to understand how it manifests and what to do at each level. Beyond the academic discourse, many tangible efforts exist to decolonize through de-silencing. Examples of these efforts include the ME2 movement that seeks to centre the concerns and experiences of sexually abused or harassed victims in the public discourse. At the funding level, many grant-awarding agencies like Wellcome Trust have dedicated huge budgets to studies that help them understand how they may have perpetrated colonialism or neocolonialism and what they can do differently going forward.[20] In South Africa, promulgating the Employment Equity Act 55 was a tangible attempt to entrench decolonization concerns in a country's regulatory framework. Yet, these decolonization efforts could fail to be substantive if they do not reflect cultural sensitivity. Two key components of cultural sensitivity are worth highlighting here: epistemic and cultural humility. Epistemic humility is an intellectual virtue described as knowing one’s limitations and the limitations of the learning methods employed. At its simplest, it is the ability to admit when one is wrong. Cultural humility includes genuine attempts to learn about and embrace other cultures. Epistemic and cultural humility are signs of academic excellence and strength. Epistemic and cultural humility seriously acknowledge how the state of our knowledge, cognitive limitations, experiences, and backgrounds, while constraining us, also invite us to listen, learn, grow, and change. The limitations-owing account of epistemic and cultural humility suggests that “a person who is aware of her cognitive limitations and owns them is much better positioned to achieve such epistemic goods as true beliefs and understanding than someone who… simply has insight into the epistemic status of her beliefs.”[21] Epistemic and cultural humility may help prevent decolonization projects that unintentionally reinforce what they seek to dismantle. Epistemic humility calls on decolonizers to defer tasks for which they are not qualified to suitably qualified persons. Beyond this, humility supports brave scholarship that imagines and reimagines how featuring the same voices, faces, and perspectives possibly introduces new forms of domination or silencing. Cultural knowledge can lead to a more intentional way of seeking out the right people or a more diverse group than those frequently featured in decolonization conversations. This would give others more opportunities to navigate these spaces and should do so in ways that are familiar to them. One ought to be more sensitive to those who would ordinarily not be included in these conversations. Unless we radically and boldly reimagine these discussions, we risk alienating those most negatively impacted by neocolonialism. CONCLUSION Decolonization conversations are complex and the subject of academic debate. The strategies employed to decolonize can harm or help the victims of neo-colonialism. Inclusion of previously silenced individuals may not be enough to overcome the vestiges of colonialism, leading to a false inclusion, where those included feel excluded or contribute in ways reflecting their own biases and circumstances. Inclusion of an elite or people who do not truly represent the subjugated can lead to elite capture. For decolonization strategies to be impactful, for example, in the context of global health, project leaders and participants must engage in conversations employing epistemic and cultural humility. In many ways, epistemic and cultural humility can help us demythologize our assumptions of any cultural superiority or cognitive authority, allowing for diverse voices, cultures, and perspectives to emerge without domination. - [1] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [2] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [3] Anye-Nkwenti Nyamnjoh 2023. Is decolonisation Africanisation? The politics of belonging in the truly African university. Social Dynamics, 1-20. [4] Rianna Oelofsen 2015. Decolonisation of the African mind and intellectual landscape. Phronimon, 16, 130-146. [5] Caesar Atuire & Olivia Rutazibwa. 2021. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization. An African Reading of the Covid-19 Pandemic and the Stakes of Decolonization [Online]. Available from: https://law.yale.edu/yls-today/news/african-reading-covid-19-pandemic-and-stakes-decolonization [Accessed July 29, 2021 2021]. [6] Pedro Alexis Tabensky 2008. The Postcolonial Heart of African Philosophy. South African Journal of Philosophy, 27, 285-295. [7] Nicholas M. Creary 2012. African Intellectuals and Decolonization, Ohio, Ohio University Press. [8] Bridget Pratt & Jantina De Vries 2023. Where is knowledge from the Global South? An account of epistemic justice for a global bioethics. Journal of Medical Ethics, medethics-2022-108291. [9] Vivetha Thambinathan & Elizabeth Anne Kinsella 2021. Decolonizing Methodologies in Qualitative Research: Creating Spaces for Transformative Praxis. International Journal of Qualitative Methods, 20, 16094069211014766. [10] Abimbola Seye 2023. Knowledge from the global South is in the global South. Journal of Medical Ethics, 49, 337. [11] A. Alenichev, P. Kingori & K. P. Grietens 2023. Reflections before the storm: the AI reproduction of biased imagery in global health visuals. Lancet Glob Health. [12] Jonathan K. Burns & Andrew Tomita 2015. Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 50, 867-877. [13] Anye-Nkwenti Nyamnjoh & Cornelius Ewuoso 2023. What type of inclusion does epistemic injustice require? Journal of Medical Ethics, jme-2023-109091. [14] 1998. Employment Equity Act. In: GOVERNMENT, S. A. (ed.) 19370. [15] Dina Zoe Belluigi & Gladman Thondhlana 2019. ‘Why mouth all the pieties?’ Black and women academics’ revelations about discourses of ‘transformation’ at an historically white South African university. Higher Education, 78, 947-963. [16] Juliet Ramohai & Khomotso Marumo 2016. Women in Senior Positions in South African Higher Education: A Reflection on Voice and Agency. 231, 135-157. [17] J. Trejo 2020. The burden of service for faculty of color to achieve diversity and inclusion: the minority tax. Mol Biol Cell, 31, 2752-2754. [18] Olufemi Taiwo 2020. Being-in-the-Room Privilege: Elite Capture and Epistemic Deference. The Philosopher, 108, 7. [19] Margarita Kurbatova & Elena Kagan 2016. Opportunism of University Lecturers As a Way to Adaptate the External Control Activities Strengthening. Journal of Institutional Studies, 8, 116-136. [20] Jeremy Farrar. 2022. An update on Wellcome's anti-racist programme. An update on Wellcome's anti-racist programme [Online]. Available from: https://wellcome.org/news/update-wellcomes-anti-racism-programme [Accessed August 10, 2022 2022]. [21] Katherine Dormandy 2018. Does Epistemic Humility Threaten Religious Beliefs? Journal of Psychology and Theology, 46, 292-304. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Husserl and Mathematics by Mirja HartimoAndrea StaitiMirja Hartimo. Husserl and Mathematics. Cambridge: Cambridge University Press, 2021. Pp. 214. Hardback, $99.99.Mirja Hartimo has written the first book-length study of Husserl's evolving views on mathematics that takes his intellectual context into full consideration. Most importantly, Hartimo's historically informed approach to the topic benefits from her extensive knowledge of Husserl's library. Throughout the book, she provides references to texts and articles (...) that Husserl read, marked, and annotated, although regrettably, very few of these sources are quoted explicitly in his published works. The overall picture that emerges from Hartimo's book shows that Husserl continued to read and engage with mathematics throughout his career, and, even though extensive discussions of mathematical issues are not frequent in his later works, some of the ideas he develops, for instance, in The Crisis of the European Sciences and Transcendental Phenomenology, can be read against the backdrop of the developments of mathematics in his time.Chapter 1 sets the method for the rest of the book. Hartimo emphasizes the importance of a methodological device that takes center stage in Husserl's work from the 1920s onward: Besinnung. Hartimo claims that Besinnung is a method to reactivate the "goals and purposes" (21) that originally motivated scientists engaging in a particular line of research. According to Husserl, as specialized research progresses and becomes standard practice, such original goals and purposes might be blurred by other concerns. When applied to mathematics, Besinnung thus amounts to a reflection "on what mathematicians should do, on what the genuine goal of their activities should be" (21–22). Hartimo argues that this kind of approach to mathematics comes close to Penelope Maddy's naturalism, which takes its departure from what mathematicians are actually doing and then proceeds to inquire into the ontological status of mathematical objects and theories. Hartimo identifies particularly in David Hilbert, a colleague of Husserl's at Göttingen, a vivid embodiment of what Husserl considered to be exemplary work oriented toward the ideal goal of mathematics.In chapters 2 and 3, Hartimo expands upon Husserl's conception of what the true goal of mathematics should be. She does so, first, by addressing the classical topic of Husserl's psychologism in his first (and only) work entirely devoted to mathematics, The Philosophy of Arithmetic, and Frege's well-known critical review of it. In Hartimo's rendition, Husserl criticizes Frege for his attempt to provide formal definitions of basic notions, such as equality. For Husserl, such basic notions are intuitively available and require no definition—rather, they should be put to work to clarify vague notions. Frege, in return, attacks what he takes to be Husserl's wishy-washy psychological account of numbers, which revolves around the concrete act of collecting items and abstracting from their specific contents. Ultimately, Hartimo argues, Husserl takes Frege's criticism to heart and in his later Prolegomena no longer pursues a psychological foundation of number, but rather emphasizes the distinction between the subjective and the objective sides of mathematics, with philosophers studying the former and mathematicians focusing on the latter. While Hartimo's verdict on the philosophical yield of the debate is in line with the standard interpretation of Frege's review as prompting Husserl's antipsychologistic turn, she makes a remark that might be worthy of further discussion: "While for Husserl the debate was about logicism, Frege shifts the debate to be about psychologism and here commentators have followed Frege's example" (50). It would be interesting to imagine what a Fregean reply to Husserl's view about the uselessness of formal definitions for basic notions like equality might look like. In any case, Hartimo's reconstruction makes it clear that, however motivated, Husserl's rejection of psychologism does not amount to an acceptance of logicism.In chapter 3, Hartimo puts forward two of her central claims: (1) Husserl was a structuralist about mathematics; and (2) for Husserl, the goal of modern mathematics is encapsulated in the concept of definiteness. According to (1), mathematics is about the formal structures of systems, which can be isolated and compared. Definiteness, in turn, is the property of systems... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Blue Pearl: The Efficacy of Teaching Mindfulness Practices to College StudentsDeborah J. Haynes, Katie Irvine, and Mindy BridgesBetween fall 2003 and spring 2011 I integrated contemplative practices into ten courses with a total of 877 students. Nine of these courses carried credit for the core undergraduate curriculum, either in literature and arts or ideals and values, and students elected my courses from a menu of options. Individual courses (...) ranged from 12 to 409 students. During two of these years, I conducted detailed human subject research using a number of surveys, gathering both quantitative and qualitative data with first-year undergraduates on their experiences with contemplative pedagogy. These courses dealt specifically with art and religion, focusing on traditions where the visual arts are intricately connected to religious practice. I gathered more subjective data in all of the other courses, including large lecture courses on world art from 1500 to the present. In general, my students were not majors in art or religious studies, but came from many disciplines within the arts, social sciences, and sciences, including business and engineering. This essay describes the process and results of the research I conducted with two undergraduate assistants, Katie Irvine and Mindy Bridges. Besides summarizing the findings, I also describe student responses to teaching a specific mindfulness practice—the bow—within a large lecture course with undergraduates. It is notable how little actual data exists about student experiences, and this prompted me to undertake the research that forms the basis for this essay.1I begin with a few comments on my understanding of contemplative or mindfulness practice and my role as researcher. There is no single way to describe or engage in contemplative practice. The Latin contemplari means to observe, consider, or gaze attentively. This definition gives clues about the varied forms of contemplative practice, which include sitting, standing, walking, and lying down; using attitudes of not doing; deep listening, pondering, and radical questioning; guided imagery and active imagination; exercises with the body; focusing techniques such as those developed by Eugene Gendlin; concentrated language experiments with freewriting, poetry, and journals; beholding; and creation of visual images to represent such experiences.2 The [End Page 63] word mindfulness is often used to describe contemplative practice. In its most basic form, it means moment-by-moment present awareness, which is available to everyone, regardless of religious or spiritual orientation.Broadly understood as methods to develop concentration, to deepen understanding and insight, and to cultivate awareness and compassion, these practices can have a profound impact on a student’s experience both in college and beyond. Specifically, teaching students techniques of awareness, concentration, and means of disciplining their attention is absolutely essential in our era of fragmentation, ever-increasing speed, multitasking, and continuously interrupted attention. While contemplative practices are rooted in the world’s religious traditions, I often tell parents and students that the application of these practices in a secular educational context can enhance the educational experience in unique ways. Students develop new techniques of awareness, they learn to refine their perceptual and observational skills, and they are encouraged to take chances and to foster attitudes such as curiosity and wonder rather than cynicism about the world in which we live.Contemplative PedagogyIntroducing contemplative practices into the classroom results in new educational practices and pedagogies. For example, in a course titled The Dialogue of Art and Religion my students learn about Russian Orthodox icons, Himalayan Buddhist thangkas, and Navajo sand paintings through studying cultural and social history, religion, formal visual analysis, and creative processes. I define this interdisciplinary teaching as a form of comparative visual studies. I normally teach this class to eighteen or twenty first-year college students. Students also learn about the practices of prayer and meditation that are central to Christian, Buddhist, and Native American traditions through sustained reading and discussion. They read accessible books about contemplative practice such as Thich Nhat Hanh’s The Miracle of Mindfulness.3 In each class, we practice simple techniques such as bowing, sitting in silence, breath awareness, and daily writing exercises.Over the past decade my students have talked about how these mindfulness exercises help to foster an atmosphere of respect, noting... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mild Cognitive Impairment:Where Does It Go From Here?John Bond (bio) and Lynne Corner (bio)Keywordsbiomedicalization, dementia, mild cognitive impairment, subjectivityThe joy of formal interdisciplinary discussion of this kind is the way that ideas presented through the gaze of social scientists stimulate such exciting thoughts and responses from other disciplines such as philosophy and psychology. We would like to thank Sabat and Thornton for their supportive and provocative reactions to our (...) paper. In the spirit of their responses, it is not our intention to respond to their thoughts directly; rather, we take the opportunity to theorize sociologically about this new category of psychiatry that has come to be known simply as mild cognitive impairment (MCI). In reviewing the responses of Sabat and Thornton, three thoughts emerged. First, together we have covered ontologic, epistemologic, methodologic, and theoretical questions about MCI, but none of us has posed basic political questions, such as: Why has MCI emerged as a new psychiatric label at this particular time? Second, this discussion brings together social scientists with a psychologist and a philosopher, but important constituents are missing. Consequently we are missing "insider" views on the importance of MCI to clinical practice. Third, this discussion highlights for us even more acutely the central question: Is MCI a real entity? In the following, we reflect on the first of these because our response also addresses the third. We first revisit the "evidence" about the importance of MCI for clinical practice.The notion of MCI as the transitional state between normal aging and Alzheimer's disease and other dementias has existed in a number of guises for many years, with benign senescent forgetfulness (Kral 1962) being the forerunner of a number of other terms, including questionable dementia, incipient dementia, isolated memory impairment, mild neurocognitive decline, age-associated memory impairment, age-associated cognitive decline, and cognitive-impairment-not-demented (Geda et al. 2004). Given that psychiatric labels implying the existence of MCI have been part of the practice landscape for over forty years, it is perhaps not surprising that its reinvention in the form of MCI has not, it appears, raised much attention outside specialist centers in North America and Europe. The reaction from grassroots clinical practice has been similar in intensity to their subdued reaction to the antipsychiatry movement in the 1960s. But for specialist clinics like the Mayo Clinic in Rochester, Minnesota, it has been an expanding [End Page 29] industry with numerous published papers, international conference presentations, and research funding opportunities.MCI can be distinguished from similar diagnostic categories that preceded its appearance in 1991. A key diagnostic criteria is the requirement for a subjective memory complaint by the person subsequently diagnosed as having MCI. Other diagnostic criteria include normal general cognitive function, normal activities of daily living, and memory being impaired for age, but not being demented (Petersen et al. 1999; Petersen and Morris 2003). To our knowledge, the idea of subjectivity being an important diagnostic criterion, as opposed to a means of identifying signs and symptoms, is a first in medical science. We know of no other medical category or diagnosis where subjectivity plays such a significant role, other than perhaps severe health phobias. Broadly speaking, two kinds of clinical evidence for MCI exist: first, that originating from studies (some quite small) applying the diagnostic criteria in specialist clinic populations; and, second, that found in large population studies. The main distinction between these two sets of evidence is that one is based on selected clinic populations and the other on unselected community populations. Most studies conclude that people whose memory is impaired for their age, as measured by similar cognitive tests such as the Mini-Mental State Examination, show decline in cognition that often leads to Alzheimer's disease and other kinds of dementia in the future. This finding is not remarkable given that it has long been known that age is a predictor of cognitive impairment. However, the population studies suggest a lower conversion rate than those for specialist clinics (Ritchie, Artero, and Touchon 2001).Petersen (2005) provides a robust defense as to why MCI might be a useful category in research and also indicates the potential benefits of treating MCI... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:632 Feminist Studies 42, no. 3. © 2016 by Feminist Studies, Inc. Nikki Lane Bringing Flesh to Theory: Ethnography, Black Queer Theory, and Studying Black Sexualities As Dorothy Hodgson tells us, the most common features of an ethnographic project involve “talking to, participating with, and observing the people who produce... texts, exploring the contexts of their ideas and actions, and often studying how their situations, ideas, and actions change (...) over time.”1 Practically, this often involves spending months, and more often years, in a particular field site, where one develops relationships with members of the group, community, or institution being studied. Ethnographers are positioned in a place to observe, but also place their bodies on the line—participating, when possible, in the quotidian practices of the group. This observation and participation is captured in the form of “field notes” that may relay in the form of “thick description,” what the ethnographer sees as she observes and participates in various cultural and social practices.2 As such, ethnography requires reflexivity because the ethnographer must constantly consider how her body is affecting and is effected by the communities and institutions in which she is embedded. The benefit of this reflexive ethnographic approach is that, as Faye Ginsburg notes, it “has the capacity to reveal the fault lines in 1. Dorothy Louise Hodgson, “Of Modernity/Modernities, Gender, and Ethnography,” in Gendered Modernities: Ethnographic Perspectives, ed. Dorothy Louise Hodgson (New York: Palgrave, 2001), 17. 2. Clifford Geertz, The Interpretation of Cultures: Selected Essays (New York: Basic Books, 1973). Nikki Lane 633 communities, social movements, and institutions, which frequently run along class, race, and generational lines, and that might easily be missed by more deductive and quantitative methodologies.”3 MarlonM.Bailey’s ButchQueensUpinPumps, Jafari S. Allen’s ¡Venceremos?, Mignon Moore’s Invisible Families, and Mireille Miller-Young’s A Taste for Brown Sugar represent an exciting trend within an interdisciplinary body of research that I am referring to as Black sexuality studies. What links these projects is their use of ethnographic methodologies to understand how Blackness informs racialized gender and sexuality in the everyday experiences of their interlocutors. In relying on ethnography, to varying degrees, they are in conversation with and expand upon methodological trends within Black feminist studies and Black queer studies. Further, the Black sexuality studies projects reviewed here question the (hetero)normative bent within the field of African American studies, the normatively white subject position that exists within queer theory, and the lack of attention to issues of sexual pleasure within Black feminist theory. They also challenge theorists of race and sexuality to move 3. Faye Ginsburg, “Ethnography and American Studies,” Cultural Anthropology 21, no. 3 (2006), 492. Books Discussed in This Essay¡Venceremos? The Erotics of Black Self-making in Cuba. By Jafari S. Allen. Durham, NC: Duke University Press, 2011. Butch Queens Up in Pumps: Gender, Performance, and Ballroom Culture in Detroit. By Marlon M. Bailey. Ann Arbor: University of Michigan Press, 2013. Invisible Families: Gay Identities, Relationships, and Motherhood among Black Women. By Mignon Moore. Oakland: University of California Press, 2011. A Taste for Brown Sugar: Black Women in Pornography. By Mireille Miller-Young. Durham, NC: Duke University Press, 2014. 634 Nikki Lane in the direction of interrogating the flesh, because they go to the site— the place where the body acts, feels, and engages the world—asking the simple question articulated best by E. Patrick Johnson: “What is the utility of queer [or feminist] theory on the front lines, in the trenches, on the street, or anyplace where the racialized and sexualized body is beaten, starved, fired, cursed—indeed, where the body is the site of trauma?”4 In my discussion of these texts, I will focus on how each utilizes ethnographic methodologies in distinct ways. I will argue that regardless of how they employ ethnography’s methods, they make two very important contributions to fields of Black feminist theory and Black queer theory. First, they add information about the lived experiences of Black sexual subjectivity to the ethnographic record. By adding these experiences to the record, they become part of the limited but growing body of available knowledge about the everyday experiences of Black people within the African... (shrink)

In this new collection of previously unpublished papers, Daoism is a philosophy, and it is presented not exclusively as a religion but as a practical way of life related to all aspects of human beings and the natural environment. Since its origins in China thousands of years ago, Daoism has meant harmony with nature and other human beings. Its principles may be applied successfully by those with any or no religion who seek a world of greater understanding, harmony, and (...) peace. Addressed to a broad audience ranging from newcomers to seasoned professionals, this book introduces the concepts of Dao, Daoism, and its pioneering philosophers (e.g., Laozi, Zhuangzi, and Liezi). The book describes the importance of Dao and Daoist ideas for scientists, humanists, and practitioners while offering practical steps and guidance for our lives today. Like the familiar taiji (also known as tai chi) symbol associated with Daoism, this book is divided into two complementary sections. The first explores how Dao and Daoist ideas are related to science, humanities, and the arts. The second part focuses on Daoist practices and applications. The essays, written by experts in their fields of study, address a number of topics, including the Dao of sciences (e.g., statistics) and arts, similarities between natural Dao and Darwin's evolutionary science, and Daoist contribution to sciences and technology. Other subjects include the growing interest in Daoist ideas in the West, Daoist cognitive science and the yin-yang dialectical mind, Daoism's relationship to peace psychology and ecology psychology (via self-observation and self-understanding), and Zhuangzhou's aesthetic view on the naturalness of things (i.e., the most beautiful entities are those that are naturally created by the Dao). In addition to these theoretical explorations, the book offers abundant practical applications of Daoist ideas to our lives and work. Practical guidance is offered in applying Daoist principles to physical and mental health, meditation and dantian cultivation, classroom learning, and diversity management. Clear-cut directions offer insight into applying Daoist ideas to leadership training, clinical therapy, and administration. The book provides readers with the universal applicability of Daoist principles and the benefit of living in harmony with nature, Dao, and others. This book is unique in its appeal to a wide range of readers. On the one hand, it provides an introduction for those with minimal knowledge of Daoism. On the other hand, sophisticated Daoist scholars, researchers, or practitioners may also be enriched and enlightened by its presentation of recent research findings, scholarly discussions, and hands-on applications. Years in the making, this book project represents a milestone of achievement for its writers and editors. Nova Science Publishers is pleased to offer readers this long-overdue compendium of Daoist wisdom, from basic information to tools for transformation in the 21st century. Happy reading! (shrink)

Bad philosophy is responsible for the climate and nature crises, and other global problems too that threaten our future. That sounds mad, but it is true. A philosophy of science, or of theatre or life is a view about what are, or ought to be, the aims and methods of science, theatre or life. It is in this entirely legitimate sense of “philosophy” that bad philosophy is responsible for the crises we face. First, and in a blatantly obvious way, those (...) institutions, organizations, corporations, businesses, endeavours, and activities of humanity that cause the crises and global problems we face, do so because of the aims they pursue (profit perhaps, or power, or heat and light for homes), and the methods adopted in pursuit of those aims – the philosophy in other words, built into the institution, organization, business, human activities, or whatever it may be. It is the philosophy of these institutions, organizations and activities that we need to change to put a stop to, or at least lessen the severity of, the crises we face, the global problems that confront us, above all the climate and nature crises. One institution has an especially crucial role in this respect: our universities. They are dominated in a multitude of ways by a particularly disastrous philosophy, a philosophy of inquiry which may be called knowledge-inquiry. This holds that the basic aim of the university is to acquire and apply knowledge. First, knowledge is to be acquired; once acquired, it can be applied to help solve social problems. But this philosophy of knowledge-inquiry is an intellectual disaster. As a result, universities are, in devastating and almost entirely unrecognized ways, humanitarian disasters too. Judged from the standpoint of helping to promote human welfare, the university shaped by the philosophy of knowledge-inquiry violates THREE of the four most elementary rules of rational problem solving conceivable in a wholesale, structural fashion, and it is this gross, wholesale, structural irrationality of the university, unnoticed by all but a few scientists and scholars, that is in part responsible for the creation of our grave global problems, and our current incapacity to learn how to solve them. The pursuit of knowledge, conducted in universities, within the framework of knowledge-inquiry over the decades and centuries, has produced much of great benefit to humanity. It has made the modern world possible. It has led to modern power production, modern industry and armaments, modern agriculture, modern hygiene and medicine, modern travel and communications, and the internet. But these very successes have also created many of our most serious current global problems: the climate crisis; the destruction of natural habitats, the catastrophic loss of wild life, and impending mass extinction of species (the nature crisis); the lethal character of modern war; the impact on the natural world of the rapid growth of the human population; the menace posed by nuclear weapons; pollution of earth, sea and air; threats to democracy caused in part by the internet and social media. All these grave global problems have been made possible by modern science and technology, pursued largely in universities within the framework of knowledge-inquiry. Nevertheless, it is not science and technology as such that are the problem, but science pursued in a way that is dissociated from a more fundamental task of the university to help humanity resolve conflicts and problems of living in increasingly cooperatively rational ways, so that progress may be made to a better world. Science and technology, pursued within the framework of knowledge-inquiry, create for some of us the power to act, but not the power to act wisely – not the power to learn how to resolve conflicts and problems of living in increasingly cooperatively rational ways. For that, we need our institutions of learning, above all our universities, to take as their primary task to help humanity learn how to do it. In order to do that, the philosophy of inquiry put into practice by universities needs to be dramatically transformed. We urgently need to bring about a revolution in the overall aims and methods of academic inquiry – a revolution in the philosophy of the university, all around the world, wherever possible, so that the basic aim becomes to seek and promote wisdom, construed to be the capacity, active endeavour, and perhaps desire, to realize what is of value in life, for oneself and others, wisdom in this sense including knowledge, understanding and technological know-how, but much else besides, methods being dramatically modified too so as to help achieve the new academic aim. The basic task of the university would be, not to solve problems of knowledge, but rather to help people in the social world beyond the university to resolve conflicts and problems of living so that what is of value in life may be realized by everyone, insofar as that is possible. The pursuit of knowledge would be vital, but not intellectually fundamental. The intellectual and institutional revolution we so urgently need in our universities would affect every discipline and aspect of the university; it would dramatically affect both research and education, and the whole way the university is related to the rest of the social world. The revolution, from knowledge-inquiry to wisdom-inquiry would dramatically enhance the intellectual integrity and rationality of natural science, social inquiry, the humanities and technology, the character of these disciplines and the relationships they have with one another. University education throughout the university would be dramatically improved. And academic inquiry as a whole would do what, on the whole, it fails to do at present: it would help humanity resolve conflicts and problems of living in increasingly cooperatively rational and, as a result, increasingly successful ways, progress at last being made to a genuinely good, civilized world – a world in which there is peace, justice, liberal democracy, individual freedom, education, reasonable equality, sustainable prosperity and worthwhile opportunities in life, all of these for everyone, insofar as this is possible. Why, it may be asked, has academic philosophy not noticed that we urgently need to transform the current bad philosophy of inquiry of knowledge-inquiry into the far more intellectually rigorous and humanly valuable philosophy of wisdom-inquiry, so that we can begin to do what so far we have failed to do so lamentably: learn how to avoid impending disasters, and even make progress to a better world, something that seems at present almost unthinkable given the horrors of war, poverty, political enslavement of the 20th century, and the horrors of this century so far too? The answer is that academic philosophy is in a particularly pitiful state, as philosophers themselves, are just beginning to realize and lament. That is why academic philosophers are blind to the intellectual and humanitarian disaster of the bad philosophy that dominates universities today, and inconceivable to them to them that they might have, as a disciplinary task, to ensure academic inquiry implements a good philosophy of inquiry, and advocate and argue for change if it does not. Once upon a time, in Europe at least, philosophy was an intellectual power in the world. In the 17th century it created modern science which massively increased and improved our knowledge and understanding of the world, which in turn led to the Enlightenment, the industrial revolution, and the modern world. Philosophy was once so intellectually powerful and influential that it changed the course of history. But philosophy also made in the past three disastrous intellectual blunders: the post-Cartesian blunder, the post-Newtonian blunder, and the Enlightenment blunder. Never acknowledged and corrected by subsequent philosophy right down to the present, these unrecognized intellectual blunders rendered academic philosophy the esoteric, pathetic, and powerless discipline it is today, so that throughout the last century and, so far, throughout this one, academic philosophy has remained blind to the intellectual disaster of knowledge-inquiry, and thus failed entirely to take up its proper disciplinary task of warning fellow academics of the structural irrationality of the philosophy that prevails in the university, and of proposing what steps need to be taken to put things right. Instead of performing such an urgently needed philosophical task, so-called analytic philosophy was reduced to analysing the meaning of words. Since then, there has been hardly any discernible improvement, even if analysis of concepts no longer dominates the scene. Bad academic philosophy is indeed responsible for intellectual and humanitarian failures of the university. What the three past intellectual blunders of philosophy are, why their persistence so dramatically reduces academic philosophy to a triviality, and why, furthermore, this results in the failure of scientists and scholars to see what is so blatantly bad about the philosophy prevailing in universities around the world – the failure to see what so urgently needs to be done to put right what has been wrong for so long: all this is made clear in this book. A new kind of philosophy emerges during the course of the argument, critical fundamentalism, which has as its task to keep alive imaginative and critical – that is rational – thinking about our fundamental problem: How can our human world, the world we experience and live in – the world of living things, people, consciousness, free will, meaning and value – how can all of this exist and best flourish embedded as it is in the physical universe? That problem encompasses all others of life, science and thought. Critical fundamentalism tries to improve answers to aspects of this problem; but it also seeks to encourage everyone to think about the problem, from time to time, and think about how it interacts, in both directions, with more urgent particular and specialized problems of life and thought. Critical fundamentalism sets out to help improve bad philosophy wherever it is to be found: in social, political, commercial, legal, financial, and international life; and especially in academia, in institutions of learning, so that they become devoted to enhancing the capacity of people to learn how to achieve what is of genuine value in this brief life of a few decades if we are fortunate. Critical fundamentalism does everything it can to bring about the revolution in our universities we so urgently need. If taken up by mainstream philosophy, it might really have an impact, and begin to transform universities for the better, in both intellectual and humanitarian terms, and thus, enable humanity to learn how, after the grim failures and horrors of the last century and this one, to make progress to a better world. -/- . (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 26.2 (2002) 443-455 [Access article in PDF] Romanticism's Gray Matter Nancy Easterlin British Romanticism and the Science of Mind, by Alan Richardson; xx & 243 pp. Cambridge: Cambridge University Press, 2001, $55.00. THE ANTAGONISM BETWEEN science and the humanities is an old story, one whose basic themes were inspired by a new understanding of the utility of science that emerged from the Enlightenment. If faith (...) in the efficacy of human reason to renew human society was no longer quite so robust after Robespierre's Reign of Terror, science itself did not suffer but instead assumed the central place in intellectual inquiry. Half a century later, the opposition between humanistic inquiry and science not only carried over into the conception of literary studies in its embryonic phase as an academic discipline; the rise of science provided, ironically, a primary impetus for the institutionalization of English studies, since the study of language and literature was envisioned as an arena of spiritual values and social polish. But according to Gerald Graff, the picture is even more complicated than this: the oppositions between literature and science are largely matched by those within English/literary studies from the very beginning. If English was envisioned as a repository of value and cultivation on the one hand, it was driven, under the influence of science, to professionalize and develop a research industry on the other—which itself fostered a divide between criticism and academic research, areas that have only recently come together. 1 [End Page 443]Since conflicted attitudes toward science were thus at the heart of literary studies from the very beginning, it is hardly surprising that debates about the relevance of science to literary theory and criticism are vital today. These debates are the healthy result of the twentieth century's attempts to apply scientific research and models to literature, for early efforts at scientific criticism help locate both the potential benefits and possible drawbacks of interdisciplinary approaches. Yet some humanistic research paradigms have remained largely immune to the influence of science, maintaining the two-cultures tradition by virtue of the body of knowledge they adopt—and therefore by what they implicitly exclude—to frame our understanding of written works. Chief among these are literary history and the history of ideas, which have drawn principally on the fellow humanities of philosophy and history, and only superficially or sporadically on the history and philosophy of science. (Interestingly, despite differences in theory, method, and values, recent projects like the new historicism are in this respect generally continuous with traditional literary historical practice.) In British Romanticism and the Science of Mind, Alan Richardson expands the parameters of the history-of-ideas approach within literary criticism, rendering it more fully congenial to developments within scientific thought. With great diplomacy, Richardson points to the limited conception of context that has informed historical accounts of British literary romanticism, and proceeds to demonstrate what a knowledge of romantic-era brain science can bring to our understanding of the ideas and works of a selection of romantic-era writers. The result is a book that, in providing a detailed account of the major theories of brain-mind and in constructing the plausible grounds of influence on several major literary figures, largely succeeds in the difficult task of appealing to an interdisciplinary audience.As Richardson notes in his preface and first chapter, the overlap between literary and scientific representations of mind has been generally neglected in romantic scholarship. Work on the romantic mind has, for the most part, drawn selectively on Hartleyan associationism, psychoanalysis, and the German idealist tradition within epistemology, even though the historical period of British literary romanticism (roughly 1789-1832) corresponds with an unprecedented development of theories of the brain and nervous system, many of which were vigorously discussed—in no small part for their ideologically inflammatory implications—in the major literary periodicals of the day. To [End Page 444] remedy the neglect of contemporaneous science, Richardson supplies a discussion of the major brain scientists in his first chapter, following this with four chapters on major figures and works of literary romanticism (Coleridge... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Keiji Nishitani and Karl Rahner: A Response to NihilityHeidi Ann RussellIn his essay “Kenosis and Emptiness,” Buddhist scholar Masao Abe states that “the necessity of tackling the Buddhist-Christian dialogue not merely in terms of interfaith dialogue, but also as an inseparable part of the wider sociocultural problem of religion versus irreligion has become more and more pressing in the past few decades.” 1 From Keiji Nishitani’s perspective a culture (...) of self-centeredness has developed out of the inability of many people to move beyond a sense of nihilism in their lives. Furthermore, technological advances and an increased understanding of the laws of nature have allowed humans to manipulate those laws for their own purposes. In this development, Nishitani believes that “the perversion that occurred in the original relationship of man to the laws of nature has taken the shape of a fundamental intertwining of the mechanization of man and his transformation into a subject in pursuit of its desires, at the ground of which nihility has opened up as a sense of the meaninglessness of the whole business.” 2Both Nishitani and Karl Rahner see in the development of science and technology a tendency to manipulate the laws of nature for one’s own benefit in a way that increases the self-centeredness and self-absorption of humankind while at the same time devaluing humanity and engendering an attitude of meaninglessness. In a world today that is confronted with issues such as war and global warming and in which religious communities are trying to make sense out of scientific issues such as stem cell research and cloning, the ability to address a nihilistic standpoint that sees the surrounding world as simply being at human disposal has never been more crucial. So how does one confront this crisis of a nihilistic culture? Abe recommends that both Buddhism and Christianity need “to pursue a fundamental reorganization in characterizing their faith such that the prevailing basic assumptions are drastically changed—for example, a revolutionary reinterpretation of the concept of God in Christianity and the concept of Emptiness in Buddhism—thereby allowing a new paradigm or model of understanding to emerge.” 3 The concept of emptiness or nothingness in Keiji Nishitani’s Religion and Nothingness and the concept of God as incomprehensible mystery in the theology of Karl Rahner 4 could allow for the [End Page 27] emergence of a model of understanding that addresses the problem of irreligion or nihility from an interreligious perspective.5 While in no way negating the very real dissimilarities between the concepts of Nishitani and Rahner or the respective religious traditions of which they are a part, one need not think of their concepts as diametrically opposed to one another in such a way that dialogue is impossible. To that effect, this essay will explore the common ground between Nishitani’s concept of śūnyatā6 (often translated or defined as ku /emptiness or mu /nothingness) and Rahner’s incomprehensible God 7 based on their interpretations of the human experience of meaninglessness and the need for a surrender of the self that manifests itself in one’s loving relationship with others. Common human experience, such as the experience of death or meaninglessness, and the interpretations of that experience found in various religions can provide ground from which to begin interreligious dialogue. One can search for a connection between the religious concepts by looking at the way they make sense out of a common affective experience without requiring an absolute identity between the cognitive religious concepts themselves.8 The important point of comparison is not manufacturing a false identity between the concepts, but the way the concepts work within the living communities to move one to volitive action. In this way the practical or ethical implications of the concepts and how they are lived out in the world become the focus. In the work of Nishitani and Rahner, that common human experience is the meaninglessness encountered in the world today and the call for a selfless love that will transcend such meaninglessness. In their roles as philosopher-theologians, both Nishitani and Rahner have probably had more influence on individuals or leaders within certain Buddhist and Christian... (shrink)