Volume 19, Issue 6, June 2019, Page 28-29.

Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly fund (...) access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long-term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations. (shrink)

This interdisciplinary selection of essays represents the explosion of scholarly interest since the 1960s in the pioneering feminist, philosopher, novelist and political theorist, Mary Wollstonecraft. Organized by theme and genre, the collection deals with the full range of her work, reproduces the most important modern Wollstonecraft scholarship, tracks the development of the author's reputation from the nineteenth century and demonstrates Wollstonecraft's importance in contemporary social, political and sexual theory and in Romantic studies.

Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide (...) advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: impacts on healthcare costs, the outsourcing of expertise and issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries. (shrink)

This paper examines potential ethical and legal issues arising during the research, develop- ment and clinical use of a proposed strategy in personalized medicine (PM): using human induced pluripotent stem cell (iPSC)-derived tissue cultures as predictive models of individ- ual patients to inform treatment decisions. We focus on epilepsy treatment as a likely early application of this strategy, for which early-stage stage research is underway. In relation to the research process, we examine issues associated with biological samples; data; health; vulnerable (...) populations; neural organoids; and what level of accuracy justifies using the iPSC-derived neural tissue system. In relation to clinical use, we examine potential uses in pre-natal screening, and effects on clinical decision-making. Although our focus is providing recommendations for researchers developing work in this area, we identify the novel issue of deciding on an acceptable accuracy level for the system. We also emphasize an issue thus far neglected in the ethics of PM: PM tends to represent treatment decisions as though they should be directed solely by biomedical information, but this in itself could be detri- mental to best personalizing treatment decisions in the clinic. (shrink)

Clothing is central to the worlds described in early modern utopian texts: of twenty-three utopian texts written and published in England between 1516 and 1656, 91 percent mention dress, and 82 percent contain more extensive description or comment upon clothing. Written by elite authors for elite readers, these texts assign clothing a leading role in the establishment and maintenance of social order in a range of areas, including governance, social and religious control, personal expression, and ideological stance. Separated from the (...) material constraints of the physical world, dress in these worlds has meaning rather than substance; we see how the authors think about dress and fashion—not how... (shrink)

Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship . Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren (...) Holm in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities , was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric , were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …. (shrink)

Placebo-controlled surgical trials can provide important information about the efficacy of surgical interventions. However, they are ethically contentious as placebo surgery entails the risk of harms to recipients, such as pain, scarring or anaesthetic misadventure. This has led to claims that placebo-controlled surgical trials are inherently unethical. On the other hand, without placebo-controlled surgical trials, it may be impossible to know whether an apparent benefit from surgery is due to the intervention itself or to the placebo effect.

This article works in a recursive manner by using the tools of a food regime approach to reinterpret the nutrition transition that has been underway internationally for 100 years, and then describing the contributions of nutrition science to the 1st and 2nd Food Regimes and the passages between Food Regimes. The resulting history—from the ‘imperial calorie’ through the ‘protective’ vitamin to the ‘empty calorie’—illuminates a neglected dimension to food regime theorising: the role of socio-technical systems in shaping a set of (...) value relations that are central to class relations. Contestation over one such system, nutritionalisation, currently involves an ungovernable array of actors. In describing the protagonists to the system of nutritionalisation, a classic confrontation emerges between technical and lifeworld rationality. Representing the former approach are actor networks responsible for the ‘trade-in-health’ sector which produces foods and nutritional values aimed at both over-nourished and under-nourished populations. Clinging to a lifeworld rationality are ‘culture eaters’ worldwide, for whom nutrition value relations are secondary to communal and ecological relations. This dynamic appears within wealthier Asian states which are emerging as central to the trade-in-nutritional health sector while acting to protect their own customary dietary practices. (shrink)

The development and deployment of medical devices, along with most areas of healthcare, has been significantly impacted by the COVID-19 pandemic. This has had variable ethical implications, two of which we will focus on here. First, medical device regulations have been rapidly amended to expedite approvals of devices ranging from face masks to ventilators. Although some regulators have issued cessation dates, there is inadequate discussion of triggers for exiting these crisis standards, and evidence that this may not be feasible. Given (...) the relatively low evidence standards currently required for regulatory approval of devices, this further indefinite reduction in standards raises serious ethical issues. Second, the pandemic has disrupted the usual operations of device representatives in hospitals, providing an opportunity to examine and refine this potentially ethically problematic practice. In this paper we explain and critically analyse the ethical implications of these two pandemic-related impacts on medical devices and propose suggestions for their management. These include an endpoint for pandemic-related adjustments to device regulation or a mechanism for continued refinement over time, together with a review of device research conducted under crisis conditions, support for the removal and replacement of emergency approved devices, and a review of device representative credentialling. (shrink)

_BMC Medical Ethics_ is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies. _BMC __Medical Ethics _is part of the _BMC_ series which publishes subject-specific journals focused on the needs of individual research communities across all areas of biology and medicine. We do not make editorial decisions on the basis of the interest of a study or (...) its likely impact. Studies must be scientifically valid; for research articles this includes a scientifically sound research question, the use of suitable methods and analysis, and following community-agreed standards relevant to the research field. Specific criteria for other article types can be found in the submission guidelines. _BMC series - open, inclusive and trusted_. (shrink)

Community psychologists address social inequalities and problems by employing ecological principles, multiple methodologies, and participatory approaches to empower individuals, organizations, and communities to organize action and systems change. This article aims to contribute to mixed methods literature by presenting three models of mixed methods participatory research across a variety of geographic and sociocultural contexts. The models outline participatory processes and points of qualitative and quantitative data integration. Challenges related to the interplay between participatory approaches and mixed methods studies as well (...) as implications on social science research are discussed. (shrink)

This welcome volume offers a rich presentation of the ideas of Jane Addams, with emphases upon her contributions to the Pragmatic movement. It is divided into two parts. Chapters 1–4 “provide a historical and theoretical foundation for Addams’s social philosophy,” and chapters 5–9 “discuss how Addams applied her social theories to a variety of social issues” including pacifism, race and diversity, socialism, education broadly conceived, and religion. There is also an introduction, an afterword, and an extensive bibliography. It is (...) the author’s hope that his study will spur further work on the role of Addams, and other women, in the history of Pragmatism and American philosophy; and I anticipate.. (shrink)

In this paper I offer a model-theoretic interpretation of Autonomy Theory as defended by Moreno, Mossio, Montévil and Bich. I address accusations that Autonomy Theory is excessively liberal, such as those made by Garson (2017), arguing that these misunderstand the role of strategic abstractions and generalizations in theory construction. Conceiving of closure of constraints as a model-building effort that emphasizes generality – in the spirit of Levins (1966) – also clarifies its potential for application in empirical contexts.

The Second World War put an end to America's historical isolationism. Three American thinkers--Reinhold Niebuhr, Hans Morgenthau, and Kenneth Waltz--developed a modern strategic framework that sought to introduce Americans to the harsher realities of international politics. Yet even as the United States began to embrace this new Realism, atomic weaponry threatened to make it absurd. This engrossing story of how the three chief architects of a powerful ideology struggled with the implications of their own creation offers crucial context for contemporary (...) debates about the resort to war and weapons of mass destruction. (shrink)

Since the collapse of the Soviet Union, the United States has faced the challenge of reorienting its foreign policy to address post-Cold War conditions. In this new edition of a groundbreaking work -- one of the first to bring critical theory into dialogue with more traditional approaches to international relations -- David Campbell provides a fundamental reappraisal of American foreign policy, with a new epilogue to address current world affairs and the burgeoning focus on culture and identity in the (...) study of international relations. Extending recent debates in international relations, Campbell shows how perceptions of danger and difference work to establish the identity of the United States. He demonstrates how foreign policy, far from being an expression of a given society, constitutes state identity through the interpretation of danger posed by others. Copyright © Libri GmbH. All rights reserved. (shrink)

This paper explores the idea that wellbeing and healthy development should be the central goal of school music programs. After establishing a framework of student wellbeing, the metaphor of rites of passage experiences is employed—through Joseph Campbell's hero's journey and Jane McGonigal's analysis of the benefits of online gaming—as one way to think about high school music programs as potential sites for contributing to optimal adolescent wellbeing. Writing at the nexus of practice and theory the authors analyze two (...) rites of passage examples from their high school music classrooms. Musicking experiences that offer students openings for embarking upon rites of passage hold potential for addressing students' needs for autonomy, relatedness, and competence—needs Richard Ryan and Edward Deci document as predictive of psychological wellbeing in all cultures and that Dissanayake argues are evolved psychobiological needs. (shrink)

Background/purpose: Research from other disciplines demonstrates that ethical position, idealism, or relativism predicts ethical decision-making. Individuals from diverse cultures ascribe to various religious beliefs and studies have found that religiosity and culture affect ethical decision-making. Moreover, little literature exists regarding undergraduate nursing students’ ethical position; no studies have been conducted in the United States on students’ ethical position, their self-identified culture, and intrinsic religiosity despite an increase in the diversity of nursing students across the United States. Participants and Research Context (...) Objectives: The study’s two aims were to determine the relationship of self-identified culture, religiosity, and ethics position of undergraduate nursing student and whether students’ level of education and past ethics courses taken related to idealism. Two hundred and twelve volunteer undergraduate students participated. Research design: A descriptive cross-sectional study was designed for participants who completed the Ethical Position Questionnaire, The intrinsic subscale of the Religious Orientation Scale, and a Demographic, Cultural, Ethnicity Form. To test the five hypotheses, analyses included t-tests, correlations, and ANOVA. Ethical Considerations: The study was approved by the Institutional Review Board at Adelphi University. Results: Idealism and intrinsic religiosity were significantly related. Differences were observed for intrinsic religiosity and idealism for cultural identity and cultural dimensions such as parents’ place of birth, and if participants were US born. Students’ level of education or participation in past courses on ethics did not influence idealism. Conclusions: The study’s findings were similar to most of the research from other disciplines on culture, ethics position, and religiosity. Generic courses on ethics taken prior to clinical work may not assist nursing students in integrating principles into complex ethical dilemmas. Self-identified culture, religion, and intrinsic religiosity related to ethics position; completing ethics courses and level of education, juniors compared with seniors, did not influence idealism. Faculty should consider integrating students’ culture, religious orientation, and ethics position into teaching ethics for all levels of nursing education. (shrink)

The context for these interviews was a seminar [Peter Gratton] conducted on speculative realism in the Spring 2010. There has been great interest in speculative realism and one reason Gratton surmise[s] is not just the arguments offered, though [Gratton doesn't] want to take away from them; each of these scholars are vivid writers and great pedagogues, many of whom are in constant contact with their readers via their weblogs. Thus these interviews provided an opportunity to forward student questions about their (...) respective works. Though each were conducted on different occasions, the interviews stand as a collected work, tying together the most classical questions about “realism” to ancillary movements about the non-human in politics, ecology, aesthetics, and video gaming—all to point to future movements in this philosophical area. (shrink)

Three main issues are of cardinal interest in this paper. The first issue relates to the canons of discourse—the parameters that inform and guide any discussion—in African philosophy. These canons are accepted in one form or the other by the philosophers who have actually formulated some of them and those who have devoted their academical careers to the promotion of the positive study of African philosophy. Consequently this paper should be viewed in the same light as C.E.M. Joad's A Critique (...) of Logical Positivism in which the “Great Tradition” in philosophy is classically expounded and defended against the onslaught of the philosophical exuberance and extraordinary claims of the logical positivists in the sense that it is a rejoinder to the attack on African philosophy by those who actually may want to be known as African logical neo-positivists. (shrink)

Drawing on a qualitative study of women who cared for their elderly mothers, this article explores women's experiences of feeling responsible for elderly relatives. The minimal provision of public services for old people and the relative absence of brothers and husbands from family caregiving emerge as material constraints shaping women's sense of obligation. This is affirmed by ideologies and assumptions about women's association with caring and family ties that permeate subjects' accounts of their situations. Translating their sense of obligation into (...) their lives is a contradictory process characterized by ambivalence and guilt that stifle complaint. Further exploration of the social processes that sustain the inequitable division of caring labor can contribute to interpretations, practices, and policies that benefit rather than constrain women. (shrink)

Notes on Contributors • Preface • Christopher Peacocke, Introduction: The Issues and their Further Development I OBJECTIVE THOUGHT • John Campbell, Objects and Objectivity Commentaries • Bill Brewer, Thoughts about Objects, Places and Times • John O'Keefe, Cognitive Maps, Time and Causality II OBJECTIVITY AND THE UNITY OF CONSCIOUSNESS • Susan Hurley, Unity and Objectivity Commentaries • Anthony Marcel, What is Relevant to the Unity of Consciousness? • Michael Lockwood, Issues of Unity and Objectivity III UNDERSTANDING THE MENTAL:THEORY OR (...) SIMULATION • MARTIN DAVIES, The Mental Simulation Debate Commentaries • Jane Heal, Simulation vs. Theory Theory: What is at Issue? • Josef Perner, The Necessity and Impossibility of Simulation. (shrink)

Philosophers often discuss altruism, how it is to be understood, explained, justified, evaluated, etc. Few refer to any experimental data on helping behaviour. I will argue that some of these data seem at least initially to present a challenge to various philosophical accounts of altruism. Put very broadly, when one looks at various philosophical accounts of altruism in light of various data on helping behaviour, one might wonder whether many philosophical accounts fall prey to the 'fundamental attribution error', overestimating people's (...) character and personal dispositions as the basis of their actions and underestimating the role of persons' situations and their construals of them in determining what they do. (shrink)

This paper seeks to highlight the benefits of prioritizing moderate African communitarian principles as partly demonstrated in the HIV prevention strategies implemented in Uganda in the late 1980s. Pertinent lessons could be drawn so as to achieve the HIV prevention targets envisioned in the post-2015 development era. Communitarianism emphasizes the importance of communities as part of healthy human existence. Its core ethical values include the virtues of generosity, compassion, and solidarity. Persuasion through communication, consensus through dialogue, and the awareness and (...) commitment to responsibilities towards other members of the community, are chief practices relied upon to achieve appropriate social behaviour. All these elements signify individual rootedness in communities and contribute to the healthy existence of its members. Communitarianism is usually classified as either authoritarian/radical or responsive/moderate, depending on the primacy given to either community interests or the individual will and rights. Moderate communitarianism recognizes the individual's capacity for moral reasoning, virtue and free choice. The ensuing form of society is deemed more ethical as it relies on education in the virtues, moral persuasion and informal social controls, without stifling individual identity, agency, and capacity for self-determination. If moderate African communitarianism, in particular, can to a certain extent be associated with the significant aspects of Uganda's HIV prevention strategies in the stated period, then its present-day relevance for HIV prevention and other public health interventions may be emphasized accordingly. This applies especially in view of the ongoing efforts to achieve a balance between individual and collective interests in bioethics. (shrink)

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

The so-called “Levelling Down Objection” is commonly believed to occupy a central role in the debate between egalitarians and prioritarians. Egalitarians think that equality is good in itself, and so they are committed to finding value even in such equality as may only be achieved by “levelling down”–i.e., by merely reducing the better off to the level of the worse off. Although egalitarians might deny that levelling down could ever make for an all-things-considered improvement, they cannot deny that it may (...) make things better in at least one respect. Prioritarians, on the other hand, do deny this; according to them, levelling down cannot make things better in any respect. In this paper I argue that the Levelling Down Objection leans far too heavily on a heretofore unanalysed notion: namely, the notion of “being better in this or that respect.” I propose what I take to be a plausible analysis of that notion, and show that, given the proposed analysis, the prioritarian is no less vulnerable to the Levelling Down Objection than is the egalitarian. I conclude that proponents of the Levelling Down Objection need either to suggest a better analysis or abandon the Levelling Down Objection altogether. (shrink)

In this paper I shall argue that if the Parfitian psychological criterion or theory of personal identity is true, then a good case can be made out to show that the psychological theorist should accept the view I call “psychological sequentialism”. This is the view that a causal connection is not necessary for what matters in survival, as long as certain other conditions are met. I argue this by way of Parfit’s own principle that what matters in survival cannot depend (...) upon a trivial fact. (shrink)

BackgroundImplementation of recommendations from clinical practice guidelines is essential for evidence based clinical practice. However, the most effective methods of implementation are unclear. We conducted a national, cluster-randomised, blinded implementation trial to determine if midwife or doctor local implementation leaders are more effective in implementing a guideline for use of oral dextrose gel to treat hypoglycaemic babies on postnatal wards. To prevent any conscious or unconscious performance bias both the doctor and midwife local implementation leaders were kept unaware of the (...) trial. This paper reports the ethical dilemmas and practical challenges of ensuring clinicians remained unaware of their involvement in an implementation trial.MethodsWe sought approval from the National Health and Disability Ethics committee to keep clinicians unaware of the trial by waiving the standard requirement for locality approval usually required for each district health board. The ethics committee did not approve a waiver of consent but advised that we approach the chief executive of each district health board to ask for provisional locality approval. Ultimately it was necessary to seek ethics approval for three separate study designs to keep clinicians unaware of the trial.ResultsThe median time for chief executive approval was 16 days and for locality approval was 57 days. We completed 21 different locality approval forms for 27 hospitals.ConclusionsKeeping clinicians unaware of their involvement in a national implementation cluster-randomised trial is feasible. However, despite a national ethics committee, significant logistical challenges were time consuming and delayed trial completion. Co-ordination of the locality approval process would help facilitate multi-centre trials. (shrink)

In 1984, Arthur C. Danto wrote two essays, both with enormously provocative themes. One, “The Philosophical Disenfranchisement of Art,” chronicles aggressive strategies of philosophy to contain and control art, and calls for art's re‐enfranchisement. The second, “The End of Art,” offers a Hegelian model of art history in which art necessarily comes to an end with its own philosophical self‐consciousness. This chapter argues that “The End of Art” is an astonishing confirmation of Danto's thesis in “The Philosophical Disenfranchisement of Art.” (...) Plato's definition of art as mere appearance, then, is less a theory of art than it is a strategy for showing art to be metaphysically defective. Each artistic movement generated a theory of art as it explored art's nature in greater and greater depth. Danto's characterization of philosophy includes an assumption that only the elements form the appropriate methodology for the task of self‐understanding. (shrink)

The great Western political and social philosophers had no doubts about the importance of education. Feminist philosophers of the past also understood the significance for their own projects of educational theory and philosophy. Today, however, there is an education gap in the feminist philosophy text. Books in the field pay little attention to the subject of education and rarely cite feminist research in this area. Widely circulated bibliographies of feminist philosophy and overviews of the field have tended, in turn, to (...) make this whole area of feminist philosophical research invisible. The feminist theorist/activist Charlotte Bunch once wrote that feminist theory must, among other things, hypothesize how to change what is to what there should be. She did not say – nor would I – that every feminist who puts forward an account of what there should be must also address the practical issue of how to achieve the hoped‐for results. One wonders, however, if it is possible to achieve the transformations of marriage, family, reproduction, workplace, science, society, not to mention gender itself, that feminist philosophers espouse without effecting a correspondingly great transformation of this culture's educational theory and philosophy. (shrink)