The essays collected together in this volume, many of them written by leading scholars in the field, explore the commonsensical fact that our presence as..

This paper analyses how security affects well-being. Security is understood as someone’s sureness of enjoying some good in the future; well-being is treated as a matter of human flourishing. Security can contribute to our well-being in various ways: if we are in fact bound to enjoy a good, in principle this is positive for our flourishing in the future; if we also believe that we will enjoy this good, we can be more efficient in pursuing our well-being; if we also (...) feel secure, this supports our enjoyment of our physical and mental capacities. For some of these benefits to obtain fully, however, it is important that our beliefs and feelings align with the facts. Furthermore, mirroring security’s upsides, there are also ways in which security can hamper our flourishing: it can obstruct the change, surprise, and pleasurable fear that are sometimes required for a good life too. (shrink)

Introduction: In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. Methods: 300 GPs, 150 consultants and 27 members of review committees were sent a questionnaire with patient descriptions. Besides a “standard case” of a patient with physical suffering and limited life expectancy, the descriptions included cases in (...) which the request was mainly rooted in psychosocial or existential suffering, such as fear of future suffering or dependency. For each case, respondents were asked whether they recognised the case from their own practice and whether they considered the suffering to be unbearable. Results: The cases were recognisable for almost all respondents. For the “standard case” nearly all respondents were convinced that the patient suffered unbearably. For the other cases, GPs thought the suffering was unbearable less often (2–49%) than consultants (25–79%) and members of the euthanasia review committees (24–88%). In each group, the suffering of patients with early dementia and patients who were “tired of living” was least often considered to be unbearable. Conclusions: When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient’s suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia. (shrink)

This collective paper on radicalization and violent extremism part of the ‘Philosophy of education in a new key’ initiative by Educational Philosophy and Theory brings together some of the leading contemporary scholars writing on the most pressing epistemological, ethical, political and educational issues facing post-9/11 scholarship on radicalization and violent extremism. Its overall aim is to move beyond the ‘conventional wisdom’ associated with this area of scholarly research best represented by its many slogans, metaphors and other thought-terminating clichés. By providing (...) conceptual lenses on issues previously compartmentalized primarily [or even exclusively] in security and intelligence studies or at the fringes of scholarly interest, radicalization and violent extremism turn out to be much more complex than ‘radicalization studies’ has been eager to acknowledge. (shrink)

The considerable attention to financial interests in clinical research has focused mostly on academic medical centers, even though the majority of clinical research is conducted in community practice settings. To fill this gap, this article maps the practices and policies in 73 community hospitals and several hundred specialized facilities around the country for reviewing clinical investigators’ financial relationships with research sponsors. Community hospitals face a substantially different mix of issues than academic medical centers do because their physician researchers are usually (...) not employees, and more of their studies are later-phase, multicenter trials. Accordingly, community physicians stand to benefit personally from per capita payments, but they tend to have less direct influence over research findings when compared with their academic peers. These and other contrasts require separate guidance for community-based organizations that takes into account their particular needs, circumstances, and institutional capacities. (shrink)

Transplantation research on samples and organs from deceased donors in England, Wales and Northern Ireland is under threat. The key problems relate to difficulties encountered in gaining consent for research projects, as distinct from consent to donation for clinical transplantation. They are due partly to the terms of the Human Tissue Act 2004 (the 2004 Act), and partly to its interpretation by the Human Tissue Authority (HTA). They include excessive interaction with donor representatives regarding ‘informed consent’ to research projects, uncertainty (...) as to the scope and duration of a donor's ‘authority’ over an organ, and restrictions caused by the apparent need for licensing of transplantation research under the 2004 Act, combined with lack of certainty, or guidance, as to the distinction between ‘research’, which requires a licence, and ‘service development’, which does not. In our view this confusion hinders and deters Specialist Nurses for Organ Donation in approaching donor representatives and discussing possible research projects with them. It has also, as we have reported elsewhere, led to abandonment of research projects for fear of liability, despite both Research Ethics Committee (REC) approval and donor consent. Such problems do not seem to occur under the transplant laws of most other comparable jurisdictions. The Transplantation Ethics Symposium, ‘The ethics of organ retrieval: goals, rights and responsibilities’, hosted by the MRC Centre for Transplantation at King's College London in December 2010, revealed that many senior clinicians and researchers, administrators, and lawyers are both unclear and in disagreement concerning the effects of the 2004 Act and the extent to which it is adhered to or ignored in practice. In this paper we examine the difficulties encountered and suggest solutions based on a less restrictive interpretation of the 2004 Act, or, more probably, a regulatory change under its authority. We propose that, in the long term, a law which includes consent for REC-approved research within the general consent for organ donation and transplantation seems preferable to the present system, both ethically and in practical terms. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

A study found that women participating in mammography screening were content with the programme and the paternalistic invitations that directly encourage participation and include a pre-specified time of appointment. We argue that this merely reflects that the information presented to the invited women is seriously biased in favour of participation. Women are not informed about the major harms of screening, and the decision to attend has already been made for them by a public authority. This short-circuits informed decision-making and the (...) legislation on informed consent, and violates the autonomy of the women. Screening invitations must present both benefits and harms in a balanced fashion, and should offer, not encourage, participation. It should be stated clearly that the choice not to participate is as sensible as the choice to do so. To allow this to happen, the responsibility for the screening programmes must be separated from the responsibility for the information material. (shrink)

In a previous article an elementary semantic analysis showed that, logically, analogical terms and expressions must be treated as homonyms, though of a special type. The latter qualification is necessitated by the concomitant element of similarity that is found to be involved in all comparisons of the analogical type. Further, it was pointed out that the special types of similarity in question cannot be isolated through a purely semantic analysis. This is, in particular, a consequence of the fact that analogy (...) is itself an analogical notion and term. The kind of similarity involved may, therefore, vary in the different forms of analogy and it may prove impossible to abstract from these something like a common element, e.g., a particular type of resemblance. This implies that the full philosophical significance of a particular form of analogy can be gleaned only from a contextual examination of its rôle in relation to a particular problem. Nevertheless, some significant conclusions may emerge from a partial analysis of certain forms of resemblance which are usually associated with analogy. (shrink)

The commentary of the Italian physician and philosopher Pietro d'Abano on Bartholomew of Messina's Latin translation of Pseudo-Aristotle's 'Problemata Physica', published in 1310, constitutes an important historical source. In a section of the corpus Aristotelicum that was not part of the standard curriculum at the medieval university, the commentary of Pietro d'Abano investigates the complex relationship between text, translation, and commentary. The eight articles in this volume provide valuable insights into the manner in which Pietro d'Abano deals with the problems (...) of a translated text. They emphasize the idiosyncrasy of his approach in comparison to his contemporaries and successors, the particularities of his commentary in light of the habitual exegetical practices applied in the teaching of curricular texts, as well as the influence of philosophical traditions outside the strict framework of the medieval arts faculty. (shrink)

Recent studies showing that pontine burst cells carry a monocular code for rapid eye movements raise questions about the organisation of signals at more central levels. Evidence that the superior colliculus may also be involved in the coding of movements in depth is reviewed. Recent work showing that the global effect is a property of refixations in 3-D space is another indication that the oculomotor systems for direction and depth are centrally coupled.