Persons with serious and disabling medical conditions have traveled abroad in search of stem cell treatments in recent years. However, weak or nonexistent oversight systems in some countries provide insufficient patient protections against unproven stem cell treatments, raising concerns about exposure to harm and exploitation. The present article, the first of two, describes and analyzes stem cell tourism in Russia and India and addresses several scientific/medical, ethical, and policy issues raised by the provision of unproven stem cell-based treatments within them. (...) The distinction between treatment based on proven clinical research and "innovative treatment" is addressed and the authors conclude that the innovations at issue constitute neither. Regulatory measures need to be developed or strengthened in accord with internationally accepted standards in such countries to protect those seeking stem cell treatments. (shrink)

Clinics and hospitals around the globe are offering stem cell treatments to persons with serious conditions for whom no effective therapies are available in their home countries. Many of these treatments, which are touted as cures for such conditions as Parkinson's and Alzheimer's Diseases, multiple sclerosis, and spinal cord injuries, have not gone through clinical trials that establish their safety and efficacy. Indeed, it is unclear whether some of them even utilize stem cells. State regulation of these therapies tends to (...) be weak or nonexistent in some of the countries in which they are offered. This puts those who believe they must travel abroad for stem cell treatments at risk of injury from procedures that .. (shrink)

Purpose: Explore public attitudes towards the trade-offs between justice and medical outcome inherent in organ allocation decisions.Background: The US Task Force on Organ Transplantation recommended that considerations of justice, autonomy and medical outcome be part of all organ allocation decisions. Justice in this context may be modeled as a function of three types of need, related to age, clinical urgency, and quality of life.Methods: A web-based survey was conducted in which respondents were asked to choose between two hypothetical patients who (...) differed in clinical urgency , age, pretransplant and post-transplant quality of life, and life expectancy.Results: A pool of 1600 people were notified via email about the survey; 623 responded. Respondents preferred giving organs to younger people up to an age difference of <15.4 years and more clinically urgent people up to a difference in urgency of <2.54 months . Priority varied with the quality of life of the worst-off patient and the relative status of the patients. If both had worse than average quality of life, respondents preferred the better-off patient. When both had better than average quality of life, they preferred the worse-off patient. In analysis according to age versus clinical urgency, the older the patient, the more urgency needed to receive priority. In quality of life versus clinical urgency, the better the control’s quality of life, the more urgency the competing patient required. The worse the patient’s post-transplant outcome, the more urgency needed to receive priority.Conclusions: It appears that clinical urgency is only one of many factors influencing attitudes about allocation decisions and that respondents may invoke different principles of fairness depending the relative clinical status of patients. (shrink)

Aim: To examine how physicians’ life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making.Methods: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland and Australia received structured questionnaires on end-of-life care, which included questions about their life stance. Response rates ranged from 53% in Australia to 68% in Denmark. General attitudes, intended behaviour with respect to two hypothetical patients, and actual behaviour were compared between all large (...) life-stance groups in each country.Results: Only small differences in life stance were found in all countries in general attitudes and intended and actual behaviour with regard to various end-of-life decisions. However, with regard to the administration of drugs explicitly intended to hasten the patient’s death , physicians with specific religious affiliations had significantly less accepting attitudes, and less willingness to perform it, than non-religious physicians. They had also actually performed PAD less often. However, in most countries, both Catholics and Protestants reported ever having made such a decision.Discussion: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients and circumstances. Physicians seem to embrace religious belief in a non-imperative way, allowing adaptation to particular situations. (shrink)

Recently various gedankenexperiments have been formulated which argue that the assumption that “elements of reality” are Lorentz invariant cannot be reconciled with standard quantum mechanics. Two of these gedankenexperiments were subsequently analyzed using the notion of pre- and postselected quantum systems, and it was claimed that elements of reality can be made Lorentz invariant if the “product rule” of standard quantum mechanics is abandoned. In this paper we show that the apparent violations of the product rule in these gedankenexperiments are (...) not as significant as they appeared to be in the previous analysis. We conclude that the problems with Lorentz invariance which arise in these gedankenexperiments are essentially unrelated to the product rule violations. (shrink)

We examine, in the context of the Einstein-Podolsky-Rosen-Bohm gedankenexperiment, problems associated with state reduction and with nonlocal influences according to different interpretations of quantum mechanics, when attempts are made to apply these interpretations in the relativistic domain. We begin by considering the significance of retrodiction within four different interpretations of quantum mechanics, and show that three of these interpretations, if applied in a relativistic context, can lead to ambiguities in their description of a process. We consider ways of dealing with (...) these ambiguities, in particular focussing on the “preferred frame” hypothesis. We then re-examine an argument involving nonlocal measurements which claimed that the preferred frame hypothesis is not tenable, and show that this argument does not in fact necessitate a rejection of the preferred frame. We then suggest that, to avoid confusion, the preferred frame could be extended to cover unitary interactions as well as state reductions. We conclude with a brief examination of a proposal that state reduction should take effect across the backward light cone of a measurement event. (shrink)

: The transplantation of adult human neural stem cells into prenatal non-humans offers an avenue for studying human neural cell development without direct use of human embryos. However, such experiments raise significant ethical concerns about mixing human and nonhuman materials in ways that could result in the development of human-nonhuman chimeras. This paper examines four arguments against such research, the moral taboo, species integrity, "unnaturalness," and human dignity arguments, and finds the last plausible. It argues that the transfer of human (...) brain or retinal stem cells to nonhuman embryos would not result in the development of human-nonhuman chimeras that denigrate human dignity, provided such stem cells are dissociated. The article provides guidelines that set ethical boundaries for conducting such research that are consonant with the requirements of human dignity. (shrink)

This paper is intended to stimulate debate amongst stakeholders in the international research community on the topic of returning individual genetic research results to study participants. Pharmacogenetics and disease genetics studies are becoming increasingly prevalent, leading to a growing body of information on genetic associations for drug responsiveness and disease susceptibility with the potential to improve health care. Much of these data are presently characterized as exploratory (non‐validated or hypothesis‐generating). There is, however, a trend for research participants to be permitted (...) access to their personal data if they so choose. Researchers, sponsors, patient advocacy groups, ethics committees and regulatory authorities are consequently confronting the issue of whether, and how, study participants might receive their individual results. Noted international ethico‐legal guidelines and public policy positions in Europe and the United States are reviewed for background. The authors offer ‘Points‐to‐Consider’ regarding returning research results in the context of drug development trials based on their knowledge and experience. These considerations include: the clinical relevance of data, laboratory qualifications, informed consent procedures, confidentiality of medical information and the competency of persons providing results to participants. The discussion is framed as a benefit‐to‐risk assessment to balance the potential positive versus negative consequences to participants, while maintaining the integrity and feasibility of conducting genetic research studies. (shrink)

ABSTRACT This paper is intended to stimulate debate amongst stakeholders in the international research community on the topic of returning individual genetic research results to study participants. Pharmacogenetics and disease genetics studies are becoming increasingly prevalent, leading to a growing body of information on genetic associations for drug responsiveness and disease susceptibility with the potential to improve health care. Much of these data are presently characterized as exploratory (non‐validated or hypothesis‐generating). There is, however, a trend for research participants to be (...) permitted access to their personal data if they so choose. Researchers, sponsors, patient advocacy groups, ethics committees and regulatory authorities are consequently confronting the issue of whether, and how, study participants might receive their individual results. Noted international ethico‐legal guidelines and public policy positions in Europe and the United States are reviewed for background. The authors offer ‘Points‐to‐Consider’ regarding returning research results in the context of drug development trials based on their knowledge and experience. These considerations include: the clinical relevance of data, laboratory qualifications, informed consent procedures, confidentiality of medical information and the competency of persons providing results to participants. The discussion is framed as a benefit‐to‐risk assessment to balance the potential positive versus negative consequences to participants, while maintaining the integrity and feasibility of conducting genetic research studies. (shrink)

Neokantismes: la marque du pluriel indique d'emblee que le mot d'ordre des annees 1865 Retour a Kant! regroupe differentes ecoles. Les auteurs dont les textes inedits en francais se trouvent ici rassembles et traduits, appartiennent en effet soit a l'ecole de Marbourg (H. Cohen, P. Natorp et E. Cassirer) soit a l'ecole de Bade (W. Windelband, H. Rickert, E. Lask, J. Cohn). Le point commun du neokantisme logique des premiers et du neokantisme axiologique des seconds consiste en une volonte (...) d'asseoir le positivisme sur un fondement philosophique respectueux de l'attitude phenomenologique. Kant apparut donc a tous ces penseurs comme science rigoureuse a condition toutefois de ne considerer le sujet transcendantal que comme une fonction logique de la pensee qui elabore la forme et le contenu de la connaissance. A condition egalement de ne pas limiter l'entreprise critique a la physique, mais de l'etendre au fondement de toutes les sciences de l'esprit. (shrink)

When ethics committees are consulted about patients who have or need court-appointed guardians, they lack empirical evidence about several common issues, including the relationship between guardianship and prolonged, potentially medically unnecessary hospitalizations for patients. To provide information about this issue, we conducted quantitative and qualitative analyses using a retrospective cohort from Veterans Healthcare Administration. To examine the relationship between guardianship appointment and hospital length of stay, we first compared 116 persons hospitalized prior to guardianship appointment to a comparison group (n (...) = 348) 3:1 matched for age, diagnosis, date of admission, and comorbidity. We then compared 91 persons hospitalized in the year following guardianship appointment to a second matched comparison group (n = 273). Mean length of stay was 30.75 days (SD = 46.70) amongst those admitted prior to guardianship, which was higher than the comparison group (M = 7.74, SD = 9.71, F = 20.75, p. (shrink)

Willey emphasizes the social-political context as the source of problems which neo-Kantian thought had to—and largely failed to—cope with. "I believe the neo-Kantians expressed the tentative and unsuccessful efforts of a segment of the upper bourgeoisie to make peace with the proletariat and to retain an attitude of cultural community with the West". The first of these two themes refers to the rapprochement of academic philosophy and socialism which is mainly associated with "the Marburg School," above all, F. A. Lange (...) and Hermann Cohen, which led to diverse practical extensions in Karl Vorländer, Kurt Eisner, and Eduard Bernstein. (shrink)

Who blows the whistle — a loner or a well-liked team player? Which of them is more likely to lead a successful opposition to perceived organizational wrongdoing? The potential influence of co-worker pressures to conform on whistle-blowing activity or the likely effects of whistle-blowing on the group have not been addressed. This paper presents a preliminary model of whistle-blowing as an act of nonconformity. One implication is that the success of an opposition will depend on the characteristics of the whistle-blower (...) and how the complaint is pursued. Specific hypotheses and general suggestions for future research and practice are offered. (shrink)

The New Evil Demon problem has been hotly debated since the case was introduced in the early 1980’s (e.g. Lehrer and Cohen 1983; Cohen 1984), and there seems to be recent increased interest in the topic. In a forthcoming collection of papers on the New Evil Demon problem (Dutant and Dorsch, forthcoming), at least two of the papers, both by prominent epistemologists, attempt to resist the problem by appealing to the distinction between justification and excuses. My primary aim (...) here is to critically evaluate this new excuse maneuver as a response to the New Evil Demon problem. -/- Their response attempts to give us reason to reject the idea that victims of the New Evil Demon have justification for believing as they do. I shall argue that this approach is ultimately unsuccessful, however much of value can be learned from these attempts. In particular, progress in the debate can be made by following those who advance the excuse maneuver and make explicit the connection between epistemic justification and epistemic norms. By doing so, the questions being debated are clarified, as is the methodology being used to attempt to answer them. (shrink)

Major Philosophers of Jewish Prayer in the Twentieth Century addresses the troubling questions posed by the modern Jewish worshiper, including such obstacles to prayer as the inability to concentrate on the words and meanings of formal liturgy, the paucity of emotional involvement, the lack of theological conviction, the anthropomorphic and particularly the masculine emphasis of prayer nomenclature, and other matters. In assessing these difficultites, Cohen brings to the reader the writings on prayer of some seminal 20th century Jewish theologians. (...) These include Herman Cohen, Franz Rosenzweig, Avraham Yitzhak, Hoakohen Kook, Mordecai M. Kaplan, R. Arele, Aaron Rote, Elie Munk, Abraham J. Heschel, Jakob J. Petuchowski, Eugene B. Borowitz, and Lawrence A. Hoffman. (shrink)

Artificial social intelligence (ASI) agents have great potential to aid the success of individuals, human–human teams, and human–artificial intelligence teams. To develop helpful ASI agents, we created an urban search and rescue task environment in Minecraft to evaluate ASI agents’ ability to infer participants’ knowledge training conditions and predict participants’ next victim type to be rescued. We evaluated ASI agents’ capabilities in three ways: (a) comparison to ground truth—the actual knowledge training condition and participant actions; (b) comparison among different ASI (...) agents; and (c) comparison to a human observer criterion, whose accuracy served as a reference point. The human observers and the ASI agents used video data and timestamped event messages from the testbed, respectively, to make inferences about the same participants and topic (knowledge training condition) and the same instances of participant actions (rescue of victims). Overall, ASI agents performed better than human observers in inferring knowledge training conditions and predicting actions. Refining the human criterion can guide the design and evaluation of ASI agents for complex task environments and team composition. (shrink)

As Post observes, accounting firms are unique among multinationals. They are more likely than firms in almost any other category to go abroad. They also have less choice in location as their expansion is determined largely by the desired locations of their clients. Given the widespread global presence of such firms, it can be argued that the global audit firm is uniquely at risk from variations in ethical perceptions across nations. This study extends the U.S. accounting literature on determinants of (...) cheating among accounting students to the U.K. Based on the work of Cohen et al. it develops a model that suggests that students in lower "uncertainty avoidance" countries will be both less likely to cheat, and when they do cheat, will be driven by internal rather than external mode. Our results supported the model as proposed as our results indicated that U.S. students were more likely to cheat and were more responsive to external stimuli than were the U.K. students. (shrink)

We argue that Cohen’s concept of inductive or ampliative probability facilitates proper explication of sufficient strength for non-demonstrative arguments conforming to the Toulmin model. The data and claims of such arguments are singular statements. We may epistemically classify the warrants of such arguments as empirical (either physical or personal), institutional, or evaluative. Backing evidence and rebutting considerations vary with the epistemic type of warrant, but in each case the notion of ampliative probability for arguments with warrants of that type (...) can be characterized. We may then use ampliative probability to define sufficient strength and related notions for Toulmin arguments. (shrink)

We perceive relevance by virtue of inference habits, which may be expressed as Pierce's leading principles or as Toulmin's warrants. Hence relevance in a descriptive sense is a ternary relation between two statements and a set of inference rules. For a normative sense, the warrants must be properly backed. Different types of warrant to empirical generalizations, we introduce L.J. Cohen's notion of inductive support. A to empirical generalizations, we introduce L.J. Cohen's notion of inductive support. A generalization H (...) is supported by evidence E to degree i/in iff E indicates that H passes canonical test i, where there are n canonical tests. In a canonical test, one or more relevant variables, factors which may falsify H, are varied. H passes a test if it is not falsified. The tests are cumulative. Degree of support is relative to the canonical test, and may be modeled as relative to a point in a dialectical situation. A value of a variable at which H is falsified is a rebutting value. A is normatively relevant to B with respect to W iff sup[associated generalization(W), E] = i/n and for j > i, there is a presumption that the values of j are non-rebuting. (shrink)

In this paper, we want to explore the connection between premises' being acceptable and their being in some sense justified. The equivalence of premise acceptability and justification seems intuitively correct. But to argue for such a connection, we need to analyze the concepts of acceptability and justification. Such an analysis also seems necessary if this equivalence is to advance our understanding of premise acceptability. Following L. J. Cohen, we may say S believes that p when S is disposed to (...) feel it true that p, while S accepts that p when S takes that p as a premise for further deliberation or action. Reasons for belief are reasons for acceptance, and epistemological (as opposed to pragmatic) reasons for acceptance are reason for belief. Following William P. Alston, we may explicate being a justifying reason for belief through the notion of an adequate ground on which the belief is based. In turn, adequacy of ground means that the mechanism grounding the belief is reliable. Given these notions, we may define a concept of justification in terms of presumptive adequacy. (shrink)

Reasoning under uncertainty, that is, making judgements with only partial knowledge, is a major theme in artificial intelligence. Professor Paris provides here an introduction to the mathematical foundations of the subject. It is suited for readers with some knowledge of undergraduate mathematics but is otherwise self-contained, collecting together the key results on the subject, and formalising within a unified framework the main contemporary approaches and assumptions. The author has concentrated on giving clear mathematical formulations, analyses, justifications and consequences of the (...) main theories about uncertain reasoning, so the book can serve as a textbook for beginners or as a starting point for further basic research into the subject. It will be welcomed by graduate students and research workers in logic, philosophy, and computer science as a textbook for beginners, a starting point for further basic research into the subject, and not least, an account of how mathematics and artificial intelligence can complement and enrich each other. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Oversight of Stem Cell Research in the United StatesCynthia B. Cohen (bio) and Mary A. Majumder (bio)Human pluripotent stem cell research, meaning research into cells that can multiply indefinitely and differentiate into almost all the cells of the body, has become a minefield in which science, ethics, and politics have collided over the last decade in the United States. President Barack Obama entered this highly (...) charged territory when he indicated during his campaign that once in office he would issue an executive order expanding federally funded human embryonic stem cell (hESC) research and introduce rigorous oversight of it (Obama 2008a & b). Candidate Obama stated that he would require that the hESC lines involved were derived with donor consent from early embryos that otherwise would be discarded following in vitro fertilization (IVF) treatment. However, in contrast with the policy of President George W. Bush, he would do so without regard to the date of their derivation. He added that he would call upon the director of the National Institutes of Health (NIH) to develop guidelines for federally funded hESC and other pluripotent stem cell research that would draw from the guidelines developed in 2005 by the National Academies of Science (NAS) for privately funded research (National Research Council 2005).A similar policy was written into the 2008 version of the Stem Cell Research Enhancement Act, which reiterates the policy enunciated in earlier versions of this bill, passed twice by the Congress but vetoed by President Bush each time (House of Representatives, 110th Congress 2008).1 Depending on how one reads the 2008 version of the act, it could also apply in certain respects to hESC research that is not federally funded. We proceed on the assumption that the act applies at least to federally funded stem cell research. Therefore, it appears that the president or the Congress, or both, will approve of an expanded policy of federal funding of hESC research, as well as other forms of human pluripotent stem cell research. [End Page 79]This policy would make the guidelines developed by a committee appointed by NAS, a prestigious private body of American scientists and related experts, the primary basis for the development of new federal guidelines for oversight of hESC research in the United States. This would have certain advantages in that those familiar with the relevant scientific issues are likely to address them accurately and stem cell investigators are apt to accept restrictions on their research written by fellow scientists and ethics and policy experts whom they perceive as strong supporters of stem cell research. However, it also would have certain disadvantages. Chief among these is that the NAS committee appointed to write guidelines for this research, in its concern to see stem cell science move forward after a period in which many scientists and others maintained that it had been unduly restricted, might have overlooked or deferred consideration of some pressing ethical and policy issues. We maintain that this is the case—although we also maintain that the NAS guidelines provide a responsible foundation for developing NIH guidelines for stem cell research. Consequently, we propose that an NIH task force charged by the director of NIH with writing new guidelines for hESC and other stem cell research should revise and expand the NAS guidelines in ways that we propose below, as well as others that it considers necessary, and make it obligatory for those seeking federal funding of such research to follow these new guidelines.We highlight certain areas in which an ethical case can be made for strengthening the existing NAS guidelines and certain areas in which more fundamental ethical reflection—and building on that, additional guideline/policy development—seems warranted. Among the sections of the NAS guidelines that need clarification and reworking, we include those regarding consent to embryo donation, which provide one of their central focuses, and the development of human-nonhuman chimeras, which they address relatively briefly. In addition, we maintain that new guidelines need to be written to address the nascent ethical and policy issues raised by the possibility that human gametes will be induced from pluripotent stem cells in the next few years and that... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Oversight of Stem Cell Research in the United States: An UpdateMary A. Majumder (bio) and Cynthia B. Cohen (bio)On 9 March 2009, President Barack Obama (2009a) signed an executive order revoking the statement issued by President George W. Bush during a televised speech in August 2001, in which the latter had sharply restricted the scope of federally funded human embryonic stem cell (hESC) research to (...) cell lines derived (without federal funding) prior to 9:00 P.M. EDT on 9 August 2001. Action by President Obama to remove the cut-off date had been expected. It came as a surprise, however, that he gave authority to determine the scope of eligible research to the Director of the National Institutes of Health (NIH), referencing only general concerns of responsibility, scientific worth, and legality.1 This contrasted not only with the approach of former President Bush, but also with that of former President Clinton, who had expressed personal opposition to the creation of embryos for research and had a distinction between hESCs derived from embryos created for research and those derived from spare embryos enshrined in NIH policy.President Obama’s remarks upon signing the executive order give some insight into the thinking behind his approach. Implicit in them are the views that earlystage human embryos outside the womb do not have full moral status and that the destruction of human embryos in the effort to care for and ease the suffering of human beings who do have full moral status does not devalue human life. The President also stressed that the decision to pursue hESC research reflected not only his opinion, but also a broad social consensus. He concluded with strong ethical commitments on two fronts:We will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.(Obama 2009b)The specific guarantee that President Obama gave against government support for the development of cloning techniques for human reproductive purposes made his silence on the use of cloning for research seem significant. Comments he had made in the course of the campaign (Obama 2008) suggested that he would affirm [End Page 195] the Clinton-era policy of limiting federal funding to hESCs derived from spare embryos. Did this silence mean that President Obama was opening the door to federal funding of research cloning when and if scientists might manage that feat?2009 NIH GuidelinesThe answer to this question and several others came on 17 April, when Raynard Kington, the acting director of NIH, released Draft NIH Guidelines for Human Stem Cell Research (NIH 2009), developed by an NIH Stem Cell Task Force, along with a request for public comment within 30 days of their publication in the Federal Register.2 The 2009 Draft Guidelines exclude from federal funding the derivation of hESCs, a restriction mandated by the reenactment of the Dickey-Wicker Amendment as part of the 2009 Omnibus Appropriations Act (Public Law 111-8, Division F, Title V, § 509). The 2009 Draft Guidelines also exclude the use of hESCs derived from embryos created for research purposes, and so represent a refusal to open the funding door as broadly as the NIH interpretation of the Dickey-Wicker Amendment might allow, at least for the time being.It appears that the drafters used as their starting point the 2000 NIH Guidelines for Research Using Human Pluripotent Stem Cells (NIH 2000) dating from the Clinton Administration, rather than more recent guidelines from the National Academy of Sciences (National Research Council 2005; 2007; 2008) and other private bodies. Both the format and content of the 2000 and 2009 NIH efforts are similar, making the departures in the latter stand out in high relief. We highlight departures related to informed consent to embryo donation, creation of human-nonhuman chimeras, and the role of an NIH task force, updating our original comment (Cohen and Majumder 2009).Informed Consent to Embryo DonationThe 2009 NIH Draft Guidelines require that certain statements... (shrink)