There is currently no consensus from the relevant stakeholders regarding the operational and construct definitions of child assent for research. As such, the requirements for assent are often construed in different ways, institutionally disparate, and often conflated with those of parental consent. Development of a standardized operational definition of assent would thus be important to ensure that investigators, institutional review boards, and policy makers consider the assent process in the same way. To this end, we describe a Delphi study that (...) provided consensus from a panel of expert stakeholders regarding the definitions of child assent for research. Based on current guidelines, a preliminary definition of assent was generated and sent out for review to a Delphi panel including pediatric bioethicists and researchers, Institutional Review Board members, parents, and individuals with regulatory/legal expertise. For each subsequent review, the process of summarizing and revising responses was repeated until consensus was achieved. Panelists were also required to rank order elements of assent that they believed were most important in defining the underlying constructs of the assent process. In providing these rankings, panelists were asked to frame their responses in the contexts of younger and adolescents/older children in non-therapeutic and therapeutic trials. Summary rankings of the most important identified elements were then used to generate written construct definitions which were sent out for iterative reviews by the expert panel. Consensus regarding the operational definition was reached by 14/18 of the panel members. Seventeen panelists agreed with the definitions of capacity for assent, elements of disclosure for younger children, and the requirements for meaningful assent, respectively. Fifteen members agreed with the elements of disclosure for adolescents/older children. It is hoped that this study will positively inform and effect change in the way investigators, regulators, and IRBs operationalize the assent process, respect children’s developing autonomy, and in concert with parental permission, ensure the protection of children who participate in research. (shrink)

Informed consent is central to the bioethical principle of respect for persons, a process that involves a discussion between the physician and patient with disclosure of information sufficient to allow the patient to make an informed decision about her or his care. However, despite the importance of informed consent in clinical practice, the process is often ritualized, perfunctory, and performed by individuals with little or no training in the consent process. This article discusses the lack of medical students’ and residents’ (...) training in informed consent and questions the practice of allowing untrained residents and surrogates to obtain consent from patients. (shrink)

In 'Philosophy and the Mirror of Nature' Richard Rorty presented his provocation and influential vision of the post-philosophical culture, calling upon professional philosophers to accept that epistemology is dead, that the analytic method is a myth, and that philosophy and science are merely forms of literature.

'The New Pragmatism' explains what it is about Pragmatism that makes it such an attractive prospect to so many thinkers, even in previously hostile traditions. This work sets out the guiding thoughts behind the Pragmatist approach to philosophy & shows how these thoughts have faired in the hands of those responsible for the revival.

In this paper I examine the interconnections between two paradigms of technology, nature, and social life, and their associated environmental impacts. The dominant technocratic philosophy which now guides policy and technological power is mechanistic. It conceptualizes nature as a resource to be controlled fully for human ends and it threatens drastically to alter the integrity of the planet’s ecosystems. Incontrast, the organic, person-planetary paradigm conceptualizes intrinsic value in all beings. Deep ecology gives priority to community and ecosystem integrity and seeks (...) to guide the design and applications of technology according to principles which follow from ecological understanding. I describe this shift in paradigms and how it affects our perceptions, values, and actions. (shrink)

The truthmaker objection to presentism (the view that only what exists now exists simpliciter) is that it lacks sufficient metaphysical resources to ground truths about the past. In this paper I identify five constraints that an adequate presentist response must satisfy. In light of these constraints, I examine and reject responses by Bigelow, Keller, Crisp, and Bourne. Consideration of how these responses fail, however, points toward a proposal that works; one that posits God’s memories as truthmakers for truths about the (...) past. I conclude that presentists have, in the truthmaker objection, considerable incentive to endorse theism. (shrink)

The past 25 years have seen an increasing interest in later medieval logic and in the theory of supposition. a review of literature reveals, however, wide differences of interpretation of supposition-theory. taking the theory in the widest sense as a contribution to semiotic or the theory of signs, this study shows how supposition has been variously treated as a syntactical, semantical and even pragmatical theory. the main views of p. boehner, e. moody, p. geach, d. p. henry, w. c. kneale (...) and l. m. de rijk are examined, compared and appraised with respect to overall progress in the elucidation of supposition-theory. (shrink)

Richard Rorty is notorious for contending that the traditional, foundation-building and truth-seeking ambitions of systematic philosophy should be set aside in favour of a more pragmatic, conversational, hermeneutically guided project. This challenge has not only struck at the heart of philosophy but has ricocheted across other disciplines, both contesting their received self-images and opening up new avenues of inquiry in the process. Alan Malachowski provides an authoritative overview of Rorty's considerable body of work and a general assessment of his (...) impact both within philosophy and in the humanities more broadly. He begins by explaining the genesis of Rorty's central ideas, tracking their development from suggestions in his early papers through their crystallization in his groundbreaking book, "Philosophy and the Mirror of Nature". Malachowski evaluates some of the common criticisms of Rorty's position and his ensuing pragmatism. The book examines the subsequent evolution of his ideas, focusing particularly on the main themes of his second major work, Contingency, Irony, and Solidarity. The political and cultural impact of Rorty's writings on such diverse fields as feminism, cultural and literary theory, and international relations are also considered, and the author explores why Rorty's work has generally found its warmest reception in these areas rather than among mainstream philosophers. (shrink)

Mr. T. H. Mcpherson has given, in a recent article in PHILOSOPHY , various reasons for supposing that there was a development in Butler's ethics from the Sermons to the Analogy . He argues that Butler was in the Sermons a “rational egoist” or “Ethical Eudaemonist,” and in the Analogy an Intuitionist. By “Ethical Eudaemonism” he seems1 to mean that “the ground or criterion of rightness is conduciveness to the agent's interest” or that “it is the happiness-producing character of acts (...) that makes them right” . I shall use the phrase “McPherson's view” to denote the theory that this was Butler's view in the Sermons. (shrink)

The ArgumentMany associations have recently been discovered between phenotypic variation and genetic loci, causing some to advocate what Robert Sinsheimer has called “a new eugenics” that would treat genetic “defects” in individuals prone to a disease. The first premise of this vision is that genetic association studies reveal the biological cause of the phenotypic variation. Once the responsible genes are known, the second premise is that we should focus upon changing “nature” rather than “nurture” by correcting the “defective” genes.The first (...) premise is flawed because associations between genetic markers and phenotypes can be spurious, as shown by an example. Moreover, it is shown that using non-causative but associated genetic markers one at a time (the normal practice) can lead to incorrect predictions of disease risk for many individuals. Going from association to causation is a non-trivial step scientifically that has rarely been done in much of the human genetic research.Even when a particular locus does contribute to the phenotypic variation of interest, the first premise remains flawed because phenotypes in general arise from complex interactions among genes and between genes and environments as shown for genes associations with coronary artery disease (CAD). The ability of current molecular genetic tools to “fix” defective genotypes is extremely limited, but even if the technological problems could be overcome, the studies on CAD reveal no obvious “defective” gene to fix because the genetic effects are so context dependent (upon both other genes and environmental factors). Contrary to the second premise of the new eugenics, the more we learn about how different genotypes show variable responses to environments, themoreimportant the environment becomes for individual treatment.The paradigm of a “defective gene” may work for classical Mendelian genetic diseases that are due to loss-of-function mutations. However, such mutations affect only a small portion of humanity. When the focus is changed to common disease and behavioral phenotypes, the “defective gene” paradigm is biologically meaningless and often harmful when applied to individuals. Thus, even when genes clearly do influence common phenotypic variation, the premises of the “new eugenics” are biologically indefensible. (shrink)