No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

Benjamin Libet has argued that electrophysiological signs of cortical movement preparation are present before people report having made a conscious decision to move, and that these signs constitute evidence that voluntary movements are initiated unconsciously. This controversial conclusion depends critically on the assumption that the electrophysiological signs recorded by Libet, Gleason, Wright, and Pearl are associated only with preparation for movement. We tested that assumption by comparing the electrophysiological signs before a decision to move with signs present before a (...) decision not to move. There was no evidence of stronger electrophysiological signs before a decision to move than before a decision not to move, so these signs clearly are not specific to movement preparation. We conclude that Libet’s results do not provide evidence that voluntary movements are initiated unconsciously. (shrink)

Background Conducting clinical trials with pre-term or sick infants is important if care for this population is to be underpinned by sound evidence. Yet, approaching the parents of these infants at such a difficult time raises challenges to obtaining valid informed consent for such research. In this study, we asked, What light does the analytical literature cast on an ethically defensible approach to obtaining informed consent in perinatal clinical trials? -/- Methods In a systematic search, we identified 30 studies. We (...) began our analysis by applying philosophical frameworks, which were then refined as concepts emerged from the analytical studies, to present a coherent picture of a broad literature. -/- Results Between them, the studies addressed four themes. The first three were the ethical basis for parental informed consent for neonatal and/or perinatal research, the validity of parental consent in this context, and the range of possible options in methods for gaining consent. The last was the issue of risk and the possibility of a double-standard or asymmetry in the current approaches to the requirement for consent for research and consent for clinical treatment. -/- Conclusions In addressing these issues, the analysed studies showed that, whilst there are a variety of possible defences for seeking parental ‘consent’ to neonatal and/or perinatal clinical trials, these are all consistent with the strongly and widely held view that it is important that parents do give (or decline) consent for such research. So far as the method of obtaining consent is concerned, none of the existing consent processes reviewed by the research is satisfactory, and there are philosophical reasons for supposing that at least some parents will fail to give valid consent in a neonatal context. Furthermore, in giving parental ‘consent’ in a perinatal context, parents are authorising infant participation, not giving ‘proxy consent’. Finally, there are reasons for giving weight to both parental ‘consent’ and the infant’s best interests in both research and clinical treatment. However, there are also reasons to treat these factors differently in the two contexts, and this may be partly due to the differing relevance of risk in each case. A significant gap is the lack of any detailed discussion of a process of emergency and/or urgent ‘assent’, in which parents assent or refuse their baby’s participation as best they can during the emergency and later give full consent to continuing participation and follow-up. (shrink)

This book addresses a very real gap in existing introductory texts that define, explore, and apply key theoretical concepts within the field of film studies.' Alison L. McKee, Assistant Professor, Department of Television-Radio-Film-Theatre, San Jose State University, USA 'This is the book that film students have long been waiting for: a clear, well-written and accessible introduction to film theory. Lucid theoretical exposition and case study film analysis offer readers the most intelligible summary of theory that I have yet encountered.' Paul (...) Sutton, Head of Media, Culture and Language, Roehampton University Film theory has a reputation for being difficult. It is challenging, it takes time and it can frequently leave students feeling inadequate and frustrated. Furthermore, theory can often seem intimidating and oldfashioned and therefore it can be difficult to appreciate its modern-day relevance. Understanding Film Theory aims to disassociate theory from these negative connotations and bring a fresh, modern and accessible approach to the discipline. Each of the fifteen chapters provides an insight into the main areas of debate by introducing key ideas and thinkers. Taking the application of theory as its central theme, the book incorporates a number of exciting and innovative features: 'Reflect and Respond' sections encourage readers to engage critically with theoretical concepts, while seminal texts are concisely summarized without oversimplifying key points. Throughout the book the authors illustrate why theory is important and demonstrate how it can be applied in a meaningful way, with relevant case studies drawn from both classic and contemporary cinema including: Once Upon a Time in the West (1968), Run Lola Run (1998), Moulin Rouge! (2001), Rabbit-Proof Fence (2002), Old Boy (2003), Brokeback Mountain (2005), Mamma Mia! (2008) and Avatar (2009). Additional case studies address key genres ('swashbucklers' and the film musical), film movements (Dogme 95), individual actors (Christian Bale, Judi Dench and Amitabh Bachchan) and directors (Alfred Hitchcock and Guillermo del Toro). Understanding Film Theory is an accessible and comprehensive introduction to film theory. It is the ideal entry point for any student studying film, using clear definitions and explaining complex ideas succinctly. Christine Etherington-Wright is a Senior Lecturer in Film Studies at University of Portsmouth (UK) where she teaches a course on Film Theory. She is the author of Gender, Professions, Discourse (Palgrave, 2008). Ruth Doughty is a Senior Lecturer in Film Studies at University of Portsmouth (UK). She is one of the co-founding editors of the journal Transnational Cinemas and co-edited Sound and Music in Film and Visual Media (2008). (shrink)

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was (...) used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

Introduction to a special issue of the Journal of Consciousness Studies on Pain and the Experience of Pain.

Stimulated by our conversations at the 2018 International Philosophy of Nursing Society Conference and our shared interests, the coauthors present an argument for augmenting the broader discussion of “missed care” with our synthesized concept called structural missingness. We take the problem of missed care to be largely grounded on a particular economic construction of the healthcare system within an era of what some are calling the Capitalocene, capturing the pervasive influence of capitalism on nature, humanity and the world order. Our (...) perspective is that of the United States, however, extrapolations can be made to the social and healthcare systems in other countries. We are concerned with the underlying conditions that structurally reify inequality and ultimately undermine nursing practice. To situate the discussion, we briefly review existing literature on the contextualization of missed care. We understand contemporary circumstances of missed care as a function of the neoliberalization of healthcare, including the idea of nursing as a commodity. From this, we discuss the implications of missed care, which forms the basis of our critique. Synthesizing the term “structural missingness, we locate a moral imperative in the professional and disciplinary commitments of nursing to consider who and what have been left out. This moral imperative for the nursing profession, along with other social and health related professions, underscores our obligation to be involved in uncovering inequities and conceptualizing upstream solutions for structural missingness. (shrink)

" In 'Vagueness and Alternative Logic' (Realism and Reason, Cambridge 1983, pp. 271-86, especially 285-6), Hilary Putnam puts forward a suggestion for a formal treatment of the logic of vagueness. … Putnam admits that, at the time of writing, he had not thought this idea through. What will already be apparent to the alert reader is that, in order to disclose serious difficulties for the proposal, Putnam would not have had to think far.".

This paper proposes a framework for an ethical impact assessment which can be performed in regard to any policy, service, project or programme involving information technology. The framework is structured on the four principles posited by Beauchamp and Childress together with a separate section on privacy and data protection. The framework identifies key social values and ethical issues, provides some brief explanatory contextual information which is then followed by a set of questions aimed at the technology developer or policy-maker to (...) facilitate consideration of ethical issues, in consultation with stakeholders, which may arise in their undertaking. In addition, the framework includes a set of ethical tools and procedural practices which can be employed as part of the ethical impact assessment. Although the framework has been developed within a European context, it could be applied equally well beyond European borders. (shrink)

Persons with dementia often prefer to participate in decisions about their health care, but may be prevented from doing so because healthcare decision-making law facilitates use of advance directives or surrogate decision makers for persons with decisional impairments such as dementia. Federal and state disability law provide alternative decision-making models that do not prevent persons with mild to moderate dementia from making their own healthcare decisions at the time the decision needs to be made. In order to better promote autonomy (...) and wellbeing, persons with dementia should be accommodated and supported so they can make their own healthcare decisions. (shrink)

Dummett's objections to the coherence of the strict finitist philosophy of mathematics are thus, at the present time at least, ill-taken. We have so far no definitive treatment of Sorites paradoxes; so no conclusive ground for dismissing Dummett's response — the response of simply writing off a large class of familiar, confidently handled expressions as semantically incoherent. I believe that cannot be the right response, if only because it threatens to open an unacceptable gulf between the insight into his own (...) understanding available to a philosophically reflective speaker and the conclusions available to one confined to observing the former's linguistic practice; for an observer of our linguistic practice could never justifiably arrive at the conclusion that ‘red’, ‘child’, etc., are governed by inconsistent rules. But the Sorites is not the subject of this paper. The points I hope to have made plausible are: that a generalized intuitionist position cannot be so much as formulated and that even a most local intuitionism, argued for the special case of arithmetic, is hard pressed effectively to stabilize and defend itself; that strict finitism remains the natural outcome of the anti-realism which Dummett has propounded by way of support for the intuitionist philosophy of mathematics; that it is powerfully buttressed by the ideas of the latter Wittgenstein on rule-following; and that there is no extant compelling reason to suppose that its involvement with predicates of surveyability calls its coherence into question. The correct philosophical assessment of strict finitism, and its proper mathematical exegesis, remain absolutely open, almost virgin issues. This is not a situation which philosophers of mathematics should tolerate very much longer. (shrink)

David Hume's A Treatise of Human Nature presents the most important account of skepticism in the history of modern philosophy. In this lucid and thorough introduction to the work, John P. Wright examines the development of Hume's ideas in the Treatise, their relation to eighteenth-century theories of the imagination and passions, and the reception they received when Hume published the Treatise. He explains Hume's arguments concerning the inability of reason to establish the basic beliefs which underlie science and morals, (...) as well as his arguments showing why we are nevertheless psychologically compelled to accept such beliefs. The book will be a valuable guide for those seeking to understand the nature of modern skepticism and its connection with the founding of the human sciences during the Enlightenment. (shrink)

The connections between science and civic culture in the Victorian period have been extensively, and intensively, investigated over the past several decades. Limited attention, however, has been paid to Irish urban contexts. Roman Catholic attitudes towards science in the nineteenth century have also been neglected beyond a rather restricted set of thinkers and topics. This paper is offered as a contribution to addressing these lacunae, and examines in detail the complexities involved in Catholic engagement with science in Victorian Belfast. The (...) political and civic geographies of Catholic involvement in scientific discussions in a divided town are uncovered through an examination of five episodes in the unfolding history of Belfast's intellectual culture. The paper stresses the importance of attending to the particularities of local politics and scientific debate for understanding the complex realities of Catholic appropriations of science in a period and urban context profoundly shaped by competing political and religious factions. It also reflects more generally on how the Belfast story supplements and challenges scholarship on the historical relations between Catholicism and science. (shrink)

Humanism, modernity, and scientific rationality are examined critically in these collected essays.

In this article, we review the intrinsic democratic flaws in electoral representation, lay out a set of principles that should guide the construction of a sortition chamber, and argue for the virtue of a bicameral system that combines sortition and elections. We show how sortition could prove inclusive, give citizens greater control of the political agenda, and make their participation more deliberative and influential. We consider various design challenges, such as the sampling method, legislative training, and deliberative procedures. We explain (...) why pairing sortition with an elected chamber could enhance its virtues while dampening its potential vices. In our conclusion, we identify ideal settings for experimenting with sortition. (shrink)

he design-based approach is a methodology for investigating mechanisms capable of generating mental phenomena, whether introspectively or externally observed, and whether they occur in humans, other animals or robots. The study of designs satisfying requirements for autonomous agency can provide new deep theoretical insights at the information processing level of description of mental mechanisms. Designs for working systems (whether on paper or implemented on computers) can systematically explicate old explanatory concepts and generate new concepts that allow new and richer interpretations (...) of human phenomena. To illustrate this, some aspects of human grief are analysed in terms of a particular information processing architecture being explored in our research group. We do not claim that this architecture is part of the causal structure of the human mind; rather, it represents an early stage in the iterative search for a deeper and more general architecture, capable of explaining more phenomena. However even the current early design provides an interpretative ground for some familiar phenomena, including characteristic features of certain emotional episodes, particularly the phenomenon of perturbance (a partial or total loss of control of attention). The paper attempts to expound and illustrate the design-based approach to cognitive science and philosophy, to demonstrate the potential effectiveness of the approach in generating interpretative possibilities, and to provide first steps towards an information processing account of `perturbant', emotional episodes. (shrink)

Written over the last 18 months of his life and inspired by his interest in G. E. Moore's defence of common sense, this much discussed volume collects Wittgenstein's reflections on knowledge and certainty, on what it is to know a proposition for sure.

This research addresses a lack of evidence on the positive and negative health outcomes of competitive online gaming and esports, particularly among young people and adolescents. Well-being outcomes, along with mitigation strategies were measured through a cross sectional survey of Australian gamers and non-gamers aged between 12 and 24 years, and parents of the 12–17-year-olds surveyed. Adverse health consequences were associated with heavy gaming, more so than light/casual gaming, suggesting that interventions that target moderated engagement could be effective. It provides (...) timely insights in an online gaming landscape that has rapidly evolved over the past decade, and particularly during the COVID-19 pandemic, to include the hyper-connected, highly commercialized and rapidly growing online gaming and esports sector. (shrink)

Psychoneural reductionists sometimes claim that sufficient amounts of lower-level explanatory achievement preclude further contributions from higher-level psychological research. Ostensibly, with nothing left to do, the effect of such preclusion on psychological explanation is extinction. Reductionist arguments for preclusion have recently involved a reorientation within the philosophical foundations of neuroscience---namely, away from the philosophical foundations and toward the neuroscience. In this chapter, I review a successful reductive explanation of an aspect of reward function in terms of dopaminergic operations of the mesocorticolimbic (...) system in order to demonstrate why preclusion/extinction claims are dubious. (shrink)

Women’s health activists laid the groundwork for passage of the law that created the U.S. Food and Drug Administration in 1906. The pharmaceutical and food industries fought regulatory reforms then and continue to do so now. We examine public health activism in the Progressive Era, the postwar era and the present day. The women’s health movement began in the 1960s, and criticized both the pharmaceutical industry and the medical establishment. In the 1990s, patient advocacy groups began accepting industry funds; thousands (...) of commercially-funded groups now dominate the advocacy landscape. As pharma funding became normalized, concerns arose regarding a) the lack of transparency and public accountability regarding funding, b) the distortion of groups’ agendas, and c) the ability of pharma-funded groups to dominate the discourse and override less well-resourced patient and health advocacy groups. Although industry-funded groups argue that funding allows them to provide useful services, the trade-off in health risks, exorbitant prices and distorted information is far too high. Sincerity is beside the point; patients and the industry have differing interests when it comes to drug safety and efficacy, drug information and drug prices. A growing resistance movement is asserting the values of its activist predecessors and opposing the prevailing culture of pharma-funded advocacy. (shrink)

The general-case glass ceiling hypothesis states that not only is it more difficult for women than for men to be promoted up levels of authority hierarchies within workplaces but also that the obstacles women face relative to men become greater as they move up the hierarchy. Gender-based discrimination in promotions is not simply present across levels of hierarchy but is more intense at higher levels. Empirically, this implies that the relative rates of women being promoted to higher levels compared to (...) men should decline with the level of the hierarchy. This article explores this hypothesis with data from three countries: the United States, Australia, and Sweden. The basic conclusion is that while there is strong evidence for a general gender gap in authority—the odds of women having authority are less than those of men—there is no evidence for systematic glass ceiling effects in the United States and only weak evidence for such effects in the other two countries. (shrink)

First published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

Ethical questions about information and communications technologies have been debated since World War II. Western democracies have had more than 50 years of experience in addressing and organising the ethical, social and legal aspects of scientific and technological developments. However, this expertise, tradition and experience are not enough to manage the most urgent ethical and social issues and contemporary challenges involving ICT. A systematic and institutional organisation of social values in the context of modern ICT tools is needed.This paper focuses (...) on four major areas: developing a specific approach to ethical issues raised by ICT; describing in more detail the age-related digital divide in Europe; identifying technology trends and emerging challenges; and defining the legal framework for inclusion of senior citizens in the digital society. The paper then concludes with a summary of its key points on the basis of which it makes three proposals as a contribution to efforts aimed at overcoming the exclusion of senior citizens from today's Information Society. (shrink)

One of the most successful physicians I have ever known, has assured me, that he used more bread pills, drops of colored water, and powders of hickory ashes, than of all other medicines put together. It was certainly a pious fraud.Clinicians and other health-care practitioners have known for hundreds of years that different procedures with unclear mechanisms of action or efficaciousness can still result in subjective improvement of clinical symptoms. Many scholars have attempted to define the placebo effect. This has (...) resulted in the development of multiple frameworks and models that help explain and further explore placebo effects and responses. After providing some definitions and clarifications of terminology... (shrink)