Within the research community, it is generally accepted that consent processes for research should be culturally appropriate and tailored to the context, yet researchers continue to grapple with what valid consent means within specific stakeholder groups. In this study, we explored the consent practices and attitudes regarding essential information required for the consent process within hospital-based trial communities from four referral hospitals in Vietnam. We collected surveys from and conducted semi-structured interviews with study physicians, study nurses, ethics committee members, and (...) study participants and family members regarding their experiences of participating in research, their perspectives toward research, and their views about various elements of the consent process. In our findings, we describe three interrelated themes related to the consent process: words and regulation; reimbursement, suspicions, and joining; and responsibilities. In general, stakeholders had highly varied perspectives of nghiên cứu and researchers used varying levels of detail regarding all aspects of the study in the consent process to build trust with and/or promote potential research participants’ choices about taking part in research. Findings additionally highlight how researchers felt that offering financial reimbursements in a hospital setting, where payment for services was routine, would be unfamiliar to participants and could raise suspicions about the research. Participants, however, focused their discussions on reimbursement or alternative reasons for joining the study, such as health related benefits or altruism. Finally, participants often relied on their physician to help them decide about joining a study or not. Further research is needed to understand how researchers and participants make sense of and practice consent, and how that impacts participants’ decision-making about research participation. To promote valid consent within this context, it is important to engage with hospital-based trial communities as a whole. The data from this study will inform future research on consent, guide the revisions of consent related policies within our research sites and point to several larger issues surrounding researcher-participant expectations, communication, and trust. (shrink)

Community engagement has been recognised as an important aspect of the ethical conduct of biomedical research, especially when research is focused on ethnically or culturally distinct populations. While this is a generally accepted tenet of biomedical research, it is unclear what components are necessary for effective community engagement, particularly in the context of genomic research in Africa.

Background Achieving meaningful consent can be challenging, particularly in contexts of diminished literacy, yet is a vital part of participant protection in global health research. Method We explored the challenges and potential solutions of achieving meaningful consent through a qualitative study in a predominantly hill tribe ethnic minority population in northern Thailand, a culturally distinctive population with low literacy. Semi-structured interviews were conducted with 37 respondents who had participated in scrub typhus clinical research, their family members, researchers and other key (...) informants. A thematic analysis was conducted. Results Our analysis identified four interrelated themes surrounding participants’ ability to give consent: varying degrees of research understanding, limitations of using informal translators, issues impacting decisions to join research, and voluntariness of consent. Suggestions for achieving more meaningful consent included the use of formal translators and community engagement with research populations. Conclusions Participant’s agency in decision making to join research should be supported, but research information needs to be communicated to potential participants in a way that they can understand. We found that improved understanding about the study and its potential benefits and harms goes beyond literacy or translation and requires attention to social and cultural factors. (shrink)

Emotion recognition skills and the ability to understand the mental states of others are crucial for normal social functioning. Conversely, delays and impairments in these processes can have a profound impact on capability to engage in, maintain, and effectively regulate social interactions. Therefore, this study aimed to compare the performance of 42 autistic children, 45 unaffected siblings, and 41 typically developing controls on the Affect Recognition and Theory of Mind subtests of the Developmental Neuropsychological Assessment Battery. There were no significant (...) differences between siblings and TD controls. Autistic children showed significantly poorer performance on AR when compared to TD controls and on TOM when compared to both TD controls and unaffected siblings. An additional comparison of ASD, unaffected sibling and TD control subsamples, matched on full-scale IQ, revealed no group differences for either AR or TOM. AR and TOM processes have received less research attention in siblings of autistic children and remain less well characterized. Therefore, despite limitations, findings reported here contribute to our growing understanding of AR and TOM abilities in siblings of autistic children and highlight important future research directions. (shrink)

This July 2020 issue of JME introduces a new section, “COVID-19 Current Controversies,” which will be a recurring section in each issue for the foreseeable future. This issue reflects on some of the most pressing ethical issues that have arisen roughly 6 months into the pandemic. Kathleen Liddell and colleagues examine important legal considerations at play in ventilator allocation decisions raised by the pandemic.1 They point out that ethics-based triage protocols that argue from the principle of “saving the most lives” (...) by withholding or withdrawing ventilators from certain patients could violate the law (U.K. and elsewhere). Patients’ legal rights are not suspended during this crisis, they remind us. The mere action of ventilator removal (extubation and proning) may constitute battery without consent, for example. Moreover, there may be problems with “evidentiary weakness” in some of the prognostic models used to inform such decisions. And, decisions that are inconsistent, subjective, and/or discriminatory may be deemed illegal. Those developing policies need to consider and consult various areas of law including criminal law (eg, murder, battery, negligence, manslaughter), human rights law, civil law (eg, battery, negligence, duty of care, consent), public and administrative law (eg, discrimination, case law), law on decision-making for incapacitated adults, professional regulations, and derogations from current law (eg, immunities and indemnities). Liddell et al offer 10 concrete, legally informed recommendations for those developing triage-policies to consider. Michael Parker and colleagues take on the issue of contact tracing using mobile apps and point out that such apps can enable people to emerge more safely from lockdowns, which provides a strong autonomy-based argument in favour …. (shrink)

Lloyd (2009) contends that climate models are confirmed by various instances of fit between their output and observational data. The present paper argues that what these instances of fit might confirm are not climate models themselves, but rather hypotheses about the adequacy of climate models for particular purposes. This required shift in thinking—from confirming climate models to confirming their adequacy-for-purpose—may sound trivial, but it is shown to complicate the evaluation of climate models considerably, both in principle and in practice.

How can a subjective experience claim universal validity? This question, posed by Kant in his Critique of Judgment, is also at the heart of Hegel's aesthetic project as I understand it. This article seeks to corroborate this proposition by analyzing how works of art transmit knowledge according to Hegel. I argue that one of the things that works of art can show according to Hegel are the apparently private subjective mental states that accompany our experience of worldly objects. Thus, art (...) has the capacity to make structures of the mind that we usually understand as internal to subjectivity and, as such, only accessible to the activity of reflection, accessible objects external to and capable of being perceived. In my view, this thesis is closely linked to the social character of Hegel's theory of mind. By making subjective mental states visible, artworks have, according to Hegel, the capacity to exert an influence on how viewers will perceive the world after encountering such works. Thus, artworks are also crucial sites for understanding how rational minds construct their perceptual world together. I first develop this interpretation abstractly, then apply it to the specific fields of poetry and architecture, before discussing the question of the poetics of architecture in the work of contemporary author Renee Gladman. (shrink)

European Journal of Philosophy, EarlyView.

The practice of medicine frequently involves the unconsented restriction of liberty. The reasons for unilateral liberty restrictions are typically that being confined, strapped down, or sedated are necessary to prevent the person from harming themselves or others. In this paper, we target the ethics of chemical restraints, which are medications that are used to intentionally restrict the mental states associated with the unwanted behaviors, and are typically not specifically indicated for the condition for which the patient is being treated. Specifically, (...) we aim to identify the conditions under which chemical restraints are ethically permissible. It is wrong to assume that what is morally true of physical restraints is also true of chemical restraints. Our aim is thus to identify the conditions under which chemical restraints are permissible while distinguishing these conditions from those of the application of physical restraints. (shrink)

According to an adequacy-for-purpose view, models should be assessed with respect to their adequacy or fitness for particular purposes. Such a view has been advocated by scientists and philosophers...

Philosophers of language have long recognized that in opaque contexts, such as those involving propositional attitude reports, substitution of co-referring names may not preserve truth value. For example, the name ‘Clark Kent’ cannot be substituted for ‘Superman’ in a context like:1. Lois believes that Superman can flywithout a change in truth value. In an earlier paper, Jennifer Saul demonstrated that substitution failure could also occur in ‘simple sentences’ where none of the ordinary opacity-producing conditions existed, such as:2. Superman leaps (...) more tall buildings than Clark Kent does.Accounts focusing on opacity were unable to explain our ‘anti-substitution intuitions’ in such cases.In Simple Sentences, Substitution, and Intuitions, Saul extends her earlier work. She provides a comprehensive presentation and criticism of recent accounts of simple sentence substitution failure, and proposes a new approach drawing on psychological evidence about cognitive processing. Saul's purpose is not merely to solve the substitution puzzle cases, but to make …. (shrink)

A number of recent discussions comparing computer simulation and traditional experimentation have focused on the significance of “materiality.” I challenge several claims emerging from this work and suggest that computer simulation studies are material experiments in a straightforward sense. After discussing some of the implications of this material status for the epistemology of computer simulation, I consider the extent to which materiality (in a particular sense) is important when it comes to making justified inferences about target systems on the basis (...) of experimental results. (shrink)

A comprehensive and systematic reconstruction of the philosophy of Charles S. Peirce, perhaps America's most far-ranging and original philosopher, which reveals the unity of his complex and influential body of thought. We are still in the early stages of understanding the thought of C. S. Peirce (1839-1914). Although much good work has been done in isolated areas, relatively little considers the Peircean system as a whole. Peirce made it his life's work to construct a scientifically sophisticated and logically rigorous philosophical (...) system, culminating in a realist epistemology and a metaphysical theory ("synechism") that postulates the connectedness of all things in a universal evolutionary process. In The Continuity of Peirce's Thought, Kelly Parker shows how the principle of continuity functions in phenomenology and semeiotics, the two most novel and important of Peirce's philosophical sciences, which mediate between mathematics and metaphysics. Parker argues that Peirce's concept of continuity is the central organizing theme of the entire Peircean philosophical corpus. He explains how Peirce's unique conception of the mathematical continuum shapes the broad sweep of his thought, extending from mathematics to metaphysics and in religion. He thus provides a convenient and useful overview of Peirce's philosophical system, situating it within the history of ideas and mapping interconnections among the diverse areas of Peirce's work. This challenging yet helpful book adopts an innovative approach to achieve the ambitious goal of more fully understanding the interrelationship of all the elements in the entire corpus of Peirce's writings. Given Peirce's importance in fields ranging from philosophy to mathematics to literary and cultural studies, this new book should appeal to all who seek a fuller, unified understanding of the career and overarching contributions of Peirce, one of the key figures in the American philosophical tradition. (shrink)

The National Health Service (NHS) was the first healthcare system globally to declare ambitions to become net carbon zero. To achieve this, a shift away from metered-dose inhalers which contain powerful greenhouse gases is necessary. Many patients can use dry powder inhalers which do not contain greenhouse gases and are equally effective at managing respiratory disease. This paper discusses the ethical issues that arise as the NHS attempts to mitigate climate change. Two ethical issues that pose a barrier to moving (...) away from metered-dose inhalers are considered: patients who decline an inhaler with a smaller carbon footprint and increased cost. I argue that while a patient is not morally justified in refusing a more environmentally sustainable inhaler due to the expected harms, a doctor may still prescribe a metered-dose inhaler if they believe that switching without consent might undermine trust or substantially worsen the patient’s health. Turning to cost, I argue that the imperative to combat climate change means the NHS should accept small increased financial costs for lower carbon inhalers, even though this provides no additional direct benefit for the patient. I then go on to consider the implications of the preceding analysis for policy and practice. I argue for a policy that minimises the impact of inhalers on the climate by advocating for a principle of environmental prescribing and explore decision-making in practice. While the arguments here pertain primarily to inhalers, the discussion has broader implications for debates around healthcare’s responsibility to be environmentally sustainable. (shrink)

In this paper we discuss ethical implications of the use of mobile phone apps in the control of the COVID-19 pandemic. Contact tracing is a well-established feature of public health practice during infectious disease outbreaks and epidemics. However, the high proportion of pre-symptomatic transmission in COVID-19 means that standard contact tracing methods are too slow to stop the progression of infection through the population. To address this problem, many countries around the world have deployed or are developing mobile phone apps (...) capable of supporting instantaneous contact tracing. Informed by the on-going mapping of ‘proximity events’ these apps are intended both to inform public health policy and to provide alerts to individuals who have been in contact with a person with the infection. The proposed use of mobile phone data for ‘intelligent physical distancing’ in such contexts raises a number of important ethical questions. In our paper, we outline some ethical considerations that need to be addressed in any deployment of this kind of approach as part of a multidimensional public health response. We also, briefly, explore the implications for its use in future infectious disease outbreaks. (shrink)

To study Earth’s climate, scientists now use a variety of computer simulation models. These models disagree in some of their assumptions about the climate system, yet they are used together as complementary resources for investigating future climatic change. This paper examines and defends this use of incompatible models. I argue that climate model pluralism results both from uncertainty concerning how to best represent the climate system and from difficulties faced in evaluating the relative merits of complex models. I describe how (...) incompatible climate models are used together in ‘multi-model ensembles’ and explain why this practice is reasonable, given scientists’ inability to identify a ‘best’ model for predicting future climate. Finally, I characterize climate model pluralism as involving both an ontic competitive pluralism and a pragmatic integrative pluralism. (shrink)

We call attention to an underappreciated way in which non-epistemic values influence evidence evaluation in science. Our argument draws upon some well-known features of scientific modeling. We show that, when scientific models stand in for background knowledge in Bayesian and other probabilistic methods for evidence evaluation, conclusions can be influenced by the non-epistemic values that shaped the setting of priorities in model development. Moreover, it is often infeasible to correct for this influence. We further suggest that, while this value influence (...) is not particularly prone to the problem of wishful thinking, it could have problematic non-epistemic consequences in some cases. (shrink)

As the science and technology of the brain and mind develop, so do the ways in which brains and minds may be surveilled and manipulated. Some cognitive libertarians worry that these developments undermine cognitive liberty, or “freedom of thought.” I argue that protecting an individual’s cognitive liberty undermines others’ ability to use their own cognitive liberty. Given that the threatening devices and processes are not relevantly different from ordinary and frequent intrusions upon one’s brain and mind, strong protections of cognitive (...) liberty may proscribe neurotechnological intrusions, but also ordinary intrusions. Thus, the cognitive libertarian position “hog-ties” others’ use of their own liberties. This problem for the cognitive libertarian is the same problem that ordinary libertarianism faces in protecting individual rights to property and person. But the libertarian strategies for resolving the problem don’t work for the cognitive libertarian. I conclude that the right to mental privacy is weaker than what cognitive libertarians want it to be. (shrink)

This is a book about two stories of education. In one story there is a vocabulary of means, efficiency, bureaucracy, inspection and science; in the other, one of autonomy, democracy, emancipation and action research. One is the story of positivist managerialist approaches to education, the other is the story of reflective teaching. This book displaces both of these stories. By applying the techniques of deconstruction, Stuart Parker overturns the assumptions common to both of these positions and, in doing so, (...) jettisons some widely cherished beliefs about education, autonomy and rationality. Moving beyond current debates, this book articulates a new manifesto for education in postmodernity and highlights the implications for educational practices and institutions. (shrink)

The Open Corporation, originally published in 2002, set out a blueprint for effective corporate self-regulation, offering practical strategies for managers, stakeholders and regulators to build successful self-regulation management systems. Christine Parker examined the conditions under which corporate self-regulation of social and legal responsibilities were likely to be effective, covering a wide range of areas - from consumer protection to sexual harassment to environmental compliance. Focusing on the features that make self-regulation or compliance management systems effective, Parker argued that (...) law and regulators needed to focus much more on 'meta-regulating' corporate self-regulation if democratic control over corporate action was to be established. (shrink)