Clinical research has at least three problematic features: it tends to be redundant, secretive, and isolated.1 Research with these features not only wastes resources and causes harm, it also fails to meet a basic ethical requirement of research: scientific validity. As bioethicists, we should be asking why, if research with these three features is ethically unjustified, it has been so routinely approved by research ethics committees over the past half century. In what follows, I provide one answer to this question. (...) The first section of this paper outlines empirical evidence for the redundant, secretive, and isolated nature of much contemporary clinical research. Next, I argue that a lack of clarity .. (shrink)

Healthcare organisations are hierarchical; almost all are organised around the ranking of individuals by authority or status, whether this be based on profession, expertise, gender or ethnicity. Hierarchy is important for several reasons; it shapes the delivery of care, what is prioritised and who receives care. It also has an impact on healthcare workers and how they work and communicate together in organisations. The purpose of this scoping review is to explore the qualitative evidence related to hierarchy in healthcare organisations (...) defined broadly, to address gaps in macro‐level healthcare organisational research, specifically focusing on the (1) impact of hierarchy for healthcare workers and (2) how hierarchy is negotiated, sustained and challenged in healthcare organisations. After a search and screening, 32 papers were included in this review. The findings of this review detail the wide‐reaching impacts that hierarchy has on healthcare delivery and health workers. The majority of studies spoke to hierarchy's impact on speaking up, that is, how it shaped communication between staff with differential status: not only what was said, but how it had an impact on what was acceptable to say, by whom and at what time. Hierarchy was also noted to have substantial personal costs, impacting on the well‐being of those in less powerful positions. These findings also provide insight into the complex ways in which hierarchy was negotiated, challenged and reproduced. Studies not only detailed the way in which hierarchy was navigated day to day but also spoke to the reasons as to why hierarchy is often entrenched and difficult to shift. A number of studies spoke to the impact that hierarchy had in sustaining gender and ethnic inequalities, maintaining historically discriminatory practices. Importantly, hierarchy should not be reduced to differences between or within the professions in localised contexts but should be considered at a broad organisational level. (shrink)

Because they contain idealizations, scientific models are often considered to be misrepresentations of their target systems. An important question is therefore how models can explain the behaviours of these systems. Most of the answers to this question are representationalist in nature. Proponents of this view are generally committed to the claim that models are explanatory if they represent their target systems to some degree of accuracy; in other words, they try to determine the conditions under which idealizations can be made (...) without jeopardizing the representational function of models. In this article, we first outline several forms of this representationalist view. We then argue that this view, in each of these forms, omits an important role of idealizations: that of facilitating the identification of the explanatory components within a model. Via examination of a case study from contemporary astrophysics, we show that one way in which idealizations can do this is by creating a comparison case that s... (shrink)

Low levels of public trust in data practices have led to growing calls for changes to data-driven systems, and in the EU, the General Data Protection Regulation provides a legal motivation for such changes. Data management is a vital component of data-driven systems, but what constitutes ‘good’ data management is not straightforward. Academic attention is turning to the question of what ‘good data’ might look like more generally, but public views are absent from these debates. This paper addresses this gap, (...) reporting on a survey of the public on their views of data management approaches, undertaken by the authors and administered in the UK, where departure from the EU makes future data legislation uncertain. The survey found that respondents dislike the current approach in which commercial organizations control their personal data and prefer approaches that give them control over their data, that include oversight from regulatory bodies or that enable them to opt out of data gathering. Variations of data trusts – that is, structures that provide independent stewardship of data – were also preferable to the current approach, but not as widely preferred as control, oversight and opt out options. These features therefore constitute ‘good data management’ for survey respondents. These findings align only in part with principles of good data identified by policy experts and researchers. Our findings nuance understandings of good data as a concept and of good data management as a practice and point to where further research and policy action are needed. (shrink)

When the editorial to the first philosophy thematic edition of this journal was published in 2010, critical questioning of underlying assumptions, regarding such crucial issues as clinical decision making, practical reasoning, and the nature of evidence in health care, was still derided by some prominent contributors to the literature on medical practice. Things have changed dramatically. Far from being derided or dismissed as a distraction from practical concerns, the discussion of such fundamental questions, and their implications for matters of practical (...) import, is currently the preoccupation of some of the most influential and insightful contributors to the on‐going evidence‐based medicine debate. Discussions focus on practical wisdom, evidence, and value and the relationship between rationality and context. In the debate about clinical practice, we are going to have to be more explicit and rigorous in future in developing and defending our views about what is valuable in human life. (shrink)

Despite its potential hazards, the activity of questioning theoretical frameworks and and proposing solutions is necessary if progress is even to be possible. Intellectual history has by no means ended so we cannot expect to have all the answers, and from time to time the activity of critical questioning will be frustrating. But intellectual progress requires us to continue the process of asking fundamental questions. The alternative to thinking in this way is indeed unthinkable.

This conversation offers a discussion of the meaning, sense and social function of school, both as an institution and as a time-space for the practice of schole . It also discusses the different types of Greek time : Schole is, as aion or childhood, a further emergence, a radicalization of school as an experimental zone of subjectivity and of collectivity. Schole is, as aion or childhood, a further emergence, a radicalization of school as an experimental zone of subjectivity and of (...) collectivity. The source of this radicalization is philosophy, to the extent that the philosophical impulse turns us inward upon ourselves in the interest, not of techniques for the enhancement of productive time, but of an emergent new brain: in the interest of new values, new sensibilities, new capacities, new connections, new centers of meaning, new bodies. Today we are in a global situation—the situation of late capitalism and late empire—in which school turns upon and ruthlessly suppresses schole, which distorts their relation almost beyond recognition. There is a struggle between school as a more efficient, far-reaching vehicle for the technical transformation of the chore curriculum, and schole as utopia. The paper also examines the place of childhood in educational discourse, and some critiques of the practice of community of philosophical inquiry in schools are considered as well as the role of questions and questioning in both philosophy and schooling. Finally, it problematizes the role of philosophy in school and in scholé: if the role of philosophy in schole is an active one, even an activist one, then the role of the child in producing dikaiosyne in school as scholé should be no less active. The conversation ends with some questions: in what way is the philosophical life preferable to the political life? Why are the politics of philosophy worth any more than the politics of the political order? (shrink)

In the Australian context, all teachers are obliged, in accordance with the national curriculum, to engage students in critical and creative thinking in the classroom. Yet teachers often wonder ‘How do we facilitate the development of (critical and creative) thinking skills in our students?’ In our specific local context, a large-scale community consultation highlighted a need for a thorough, concerted strategic approach in relation to this obligation. In this paper we spell out our response to this need: the establishment of (...) a Centre for Critical Thinking and Ethics to implement a two-pronged strategic approach. It is our contention that the best way to cater for students’ growth in critical and creative thinking is to combine deliberative use of explicit critical thinking materials with the norms/tools/activities and strategies of the Philosophy in Schools pedagogy. Our innovation consists primarily in our 'detached' and 'embedded' approaches to critical thinking at Newington College. We aim to contribute to the ongoing discussion of best practice in critical and creative thinking, to improve capacity both in and beyond our own school. (shrink)

A crisis continues to brew within the pharmaceutical research and development (R&D) enterprise: productivity continues declining as costs rise, despite ongoing, often dramatic scientific and technical advances. To reverse this trend, we offer various suggestions for both the expansion and broader adoption of modeling and simulation (M&S) methods. We suggest strategies and scenarios intended to enable new M&S use cases that directly engage R&D knowledge generation and build actionable mechanistic insight, thereby opening the door to enhanced productivity. What M&S requirements (...) must be satisfied to access and open the door, and begin reversing the productivity decline? Can current methods and tools fulfill the requirements, or are new methods necessary? We draw on the relevant, recent literature to provide and explore answers. In so doing, we identify essential, key roles for agent-based and other methods. We assemble a list of requirements necessary for M&S to meet the diverse needs distilled from a collection of research, review, and opinion articles. We argue that to realize its full potential, M&S should be actualized within a larger information technology framework—a dynamic knowledge repository—wherein models of various types execute, evolve, and increase in accuracy over time. We offer some details of the issues that must be addressed for such a repository to accrue the capabilities needed to reverse the productivity decline. (shrink)

This book explores the shapes and boundaries of the emergent field of philosophy of childhood, and its intersections with the history of philosophy, education, pedagogy, literature and film, psychoanalysis, family studies, developmental theory, ethics, history of subjectivity, history of culture, and evolutionary theory.

The articles in this volume offer a fresh perspective on the important role of the concept of law (lex) in the moral and political philosophy of the 'School of Salamanca'.

A revision of George Kennedy's translation of, introdution to, and commentary on Aristotle's On Rhetoric. His translation is most accurate, his general introduction is the most thorough and insightful, and his brief introductions to sections of the work, along with his explanatory footnotes, are the most useful available.

Most phase III clinical trials today are explanatory. Because explanatory, or efficacy, trials test hypotheses under “ideal” conditions, they are not well suited to providing guidance on decisions made in most clinical care contexts. Pragmatic trials, which test hypotheses under “usual” conditions, are often better suited to this task. Yet, pragmatic, or effectiveness, trials are infrequently carried out. This mismatch between the design of clinical trials and the needs of health care professionals is frustrating for everyone involved, and explains some (...) of the challenges inherent in attempts to enhance knowledge translation and encourage evidence-based practice. The situation is more than simply frustrating, however; it is potentially unethical. Clinical trials must be socially valuable in order to (1) warrant the risks they impose on human research subjects and (2) fairly and efficiently assess new clinical interventions. Most bioethicists would agree that trials that have no social value, for instance, because their results do not have the potential to advance clinical care, should not be performed. What is less widely appreciated is that given limited research resources, trials that are more socially valuable should be preferred to trials that are less socially valuable when all else is equal. With respect to clinical trial design, I argue that while explanatory trials often have some social value, many have less social value than their pragmatic counterparts. On the basis of this general ethical assessment, I provide a preliminary defense of the position that clinical researchers should aim to conduct pragmatic trials, that is, that researchers face a burden of justification related to any idealizing elements added to trial designs. (shrink)

In their paper, “Think Pragmatically: Investigators’ Obligations to Patient-Subjects When Research is Embedded in Care,” Stephanie Morain and Emily Largent (2023) argue that investigators, and poss...

In Science as Social Knowledge in 1990 and The Fate of Knowledge in 2002, Helen Longino develops an epistemological theory known as Critical Contextual Empiricism (CCE). Knowledge production, she argues, is an active, value-laden practice, evidence is context dependent and relies on background assumptions, and science is a social inquiry that, under certain conditions, produces social knowledge with contextual objectivity. While Longino’s work has been generally well-received, there have been a number of criticisms of CCE raised in the philosophical literature (...) in recent years. In this paper I outline the key elements of Longino’s theory and propose modifications to the four norms offered by the account. The version of CCE I defend, which draws on lessons learned by medical researchers in recent years, gives principles of epistemic diversity a central role and also provides greater specification of three of the four norms. Further, it offers additional resources for defending CCE against Alvin Goldman’s suggestion that there is a need for a “healthy dogmatism” in science, as well as a concern about “manufactured uncertainty” arising out of recent work by David Michaels. Finally, the modified version proposed here is also well positioned to respond (negatively) to a suggestion from Kristen Intemann that CCE needs to be adapted to incorporate a central insight from feminist standpoint theory. In light of the variety of social pressures influencing contemporary scientific research, and the role of science in shaping public policy, I argue that a rigorous social epistemology such as CCE is indispensable for understanding and assessing contemporary scientific practice. (shrink)

It now seems technically feasible to culture human embryos beyond the “fourteen‐day limit,” which has the potential to increase scientific understanding of human development and perhaps improve infertility treatments. The fourteen‐day limit was adopted as a compromise but subsequently has been considered an ethical line. Does it remain relevant in light of technological advances permitting embryo maturation beyond it? Should it be changed and, if so, how and why? What justifications would be necessary to expand the limit, particularly given that (...) doing so would violate some people's moral commitments regarding human embryos? Robust stakeholder engagement preceded adoption of the fourteen‐day limit and should arguably be part of efforts to reassess it. Such engagement could also consider the need for enhanced oversight of human embryo research. In the meantime, developing and implementing reliable oversight systems should help foster high‐quality research and public confidence in it. (shrink)

Volume 20, Issue 2, February 2020, Page 25-27.

In this article, we posit that a cross-scale perspective is valuable for studies of organizational resilience. Existing research in our field primarily focuses on the resilience of organizations, that is, the factors that enhance or detract from an organization’s viability in the face of threat. While this organization level focus makes important contributions to theory, organizational resilience is also intrinsically dependent upon the resilience of broader social-ecological systems in which the firm is embedded. Moreover, long-term organizational resilience cannot be well (...) managed without an understanding of the feedback effects across nested systems. For instance, a narrow focus on optimizing organizational resilience from one firm’s perspective may come at the expense of social-ecological functioning and ultimately undermine managers’ efforts at long-term organizational survival. We suggest that insights from natural science may help organizational scholars to examine cross-scale resilience and conceptualize organizational actions within and across temporal and spatial dynamics. We develop propositions taking a complex adaptive systems perspective to identify issues related to focal scale, slow variables and feedback, and diversity and redundancy. We illustrate our theoretical argument using an example of Unilever and palm oil production in Borneo. (shrink)

The volume of clinical research is increasing exponentially—far beyond our ability to process and absorb the results. Given this situation, it may be beneficial to consider reducing the flow at its source. In what follows, I will motivate and critically evaluate the following proposal: researchers should conduct fewer clinical trials. More specifically, I c onsider whether researchers should be permitted to conduct only clinical research of very high quality and, in turn, whether research ethics committees should prohibit all other, lower-quality (...) research, even when it might appear to meet some minimal ethical standard. Following a close analysis of the social-value requirement of ethical clinical research, I argue that this proposal is defensible. The problem identified in this paper has two parts, quantity and quality, and some clarification is needed about the latter because “quality” is a highly contested term in the medical literature. When some scholars advocate for high-quality trials, they mean large-scale, simple, explanatory randomized controlled trials. Others, including myself, have defended a different characterization of high-quality research that tends more toward pragmatic trial design and the use of methods other than RCTs. Pragmatic trials aim to provide evidence that directly supports clinical decision-making in “usual” care settings. Unlike explanatory trials, which aim to abstract away from particular settings and patients, in the hopes of creating ideal conditions for the success of an intervention, pragmatic trials deliberately pursue knowledge of high applicability, through the use of representative subjects, clinically important questions, flexible treatment protocols, patient-oriented outcome measures, and so on. I see applicability as a marker of high-quality research. The context in which research is meant to be applied should be the context in which new interventions are evaluated. (shrink)

Amending and Defending Critical Contextual Empiricism: Lessons from Medical Research In Science as Social Knowledge (1990) and The Fate of Knowledge (2002), Helen Longino develops a social epistemological theory known as Critical Contextual Empiricism (CCE). While Longino’s work has been generally well-received, there have been a number of criticisms of CCE raised in the philosophical literature in recent years. In this paper I outline the key elements of Longino’s theory and propose several modifications to the four norms offered by the (...) account. The revisions I propose are shaped by a number of developments in the medical context in recent years. The modified norms, which determined whether a particular community produces objective knowledge, are thus: 1. Avenues for Criticism – there must be recognized avenues for criticism, and these avenues must be publicly accessible and require transparent disclosure of all relevant information (including competing interests) from those who present their ideas. It must also be a community requirement that all members present their ideas for critical scrutiny if they wish them to be recognized as knowledge. 2. Responsiveness to Criticism – the community must be responsive to criticism. 3. Shared Public Standards – there must be some shared standards that determine community membership. Outsiders to a particular community are welcome to engage in critical debates as long as they share at least one of the community standards with the target community. 4. Cultivation of Diverse Perspectives – communities must cultivate diverse perspectives, that is, the perspectives of those who express strong dissent. The version of CCE I defend gives the principle of diversity a more central role than the original and provides greater specification of two of the other norms in light of challenges faced by medical researchers in recent years. The medical context provides us with a number of cautionary tales in which knowledge production that appears to meet the original four norms has been seriously compromised by particular social interests. The proposed modifications attempt to address these ‘loopholes’ in a way that is not ad hoc. I argue that the modifications I suggest are in line with the underlying assumptions and goals of CCE. The modified version of CCE also offers resources for defending CCE against the criticisms leveled against it by Miriam Solomon & Alan Richardson, Alvin Goldman and Philip Kitcher as well as one general concern arising out of a recent work by David Michaels. I provide responses to these criticisms in the final section of the paper. Throughout the paper I connect the theoretical work done in social epistemology to the real practice of knowledge-production as is occurs in the medical context. In light of the variety of social pressures influencing contemporary scientific research, and the role of science in shaping public policy, I argue that a rigorous social epistemology such as CCE is indispensable for understanding and assessing contemporary scientific practice. (shrink)

It now seems technically feasible to culture human embryos beyond the “fourteen‐day limit,” which has the potential to increase scientific understanding of human development and perhaps improve infertility treatments. The fourteen‐day limit was adopted as a compromise but subsequently has been considered an ethical line. Does it remain relevant in light of technological advances permitting embryo maturation beyond it? Should it be changed and, if so, how and why? What justifications would be necessary to expand the limit, particularly given that (...) doing so would violate some people's moral commitments regarding human embryos? Robust stakeholder engagement preceded adoption of the fourteen‐day limit and should arguably be part of efforts to reassess it. Such engagement could also consider the need for enhanced oversight of human embryo research. In the meantime, developing and implementing reliable oversight systems should help foster high‐quality research and public confidence in it. (shrink)

`Being sensitive' in nursing was explored using Schwartz-Barcott and Kim's hybrid model of concept development, producing a tentative definition of the concept. Three phases were employed: theoretical, empirical/fieldwork and analytical. An exploration of the literature identified where the common idea of `being sensitive' as a nurse was embedded and demonstrated that a theoretical development of this fundamental aspect of nursing was absent. The empirical phase was conducted using semistructured interviews with nine expert palliative care and cancer nurses. This method was (...) particularly useful for the exploration of this concept because of its firm grounding in practical example. A definition of what the concept `being sensitive' means in nursing, and subsequent clarification of `being insensitive', have been posed from the research process undertaken. The essential nature of this concept being integral to nursing practice is emphasized. Potential implications for the development of nursing practice through teaching of this concept were identified. (shrink)

Suicide is a complex act whose meanings, while sometimes tragic, vary widely. This chapter surveys the ethical landscape surrounding algorithmic methods of suicide prevention especially as it pertains to social media activity and to the moderation of online suicide communities. We begin with a typology of suicide, distinguishing between varied goals in which suicide may factor as a means. Suicides should be understood as an act with varied eliciting desires, meanings, consequences, and ethics. Further,while many suicides may be grounded on (...) irrational desire, we argue that a desire to suicide may nonetheless be rational in some cases. We then offer a survey of the attempts by social media corporations to create suicide prediction algorithms and launch interventions aimed at preventing suicide as well as an overview of the current ethical debate. We argue that the values embedded within algorithmic suicide prevention nudges are “thick” in a substantive sense and deserving of scrutiny. Given that debates about the rationality, meaning, and permissibility of suicide are common and subject to intracultural and cross-cultural differences, we maintain that the task of suicide prediction is ill-suited to algorithmic approaches. Despite an algorithm’s ability to quantify a complex phenomenon like suicide risk and its appearance of objectivity, any suicide prediction algorithm is thoroughly subjective and involves moral judgments all the way down. Any such algorithm would necessarily impose a normative stance on suicide onto its user base that is subject to reasonable intra and cross-cultural disagreement. (shrink)

Proponents of evidence-based medicine have recently suggested a “4S” approach to clinical decision making in which physicians are advised to rely on increasingly abstract summaries of the available research evidence. This retreat from the original data of medical research is ill-advised: it extends an unjustified evidence hierarchy, overestimates the role of computer systems, divides communities, discards evidence, ignores contexts, and devalues broad critical evaluation. I draw upon feminist social epistemology to evaluate the 4S approach to EBM and to suggest means (...) for improving the evidence base of medical research and practice. (shrink)

Community of philosophical inquiry (CPI) is a way of practicing philosophy in a group that is characterized by conversation; that creates its discussion agenda from questions posed by the conversants as a response to some stimulus (whether text or some other media); and that includes discussion of specific philosophers or philosophical traditions, if at all, only in order to develop its own ideas about the concepts under discussion. The epistemological conviction of community of philosophical inquiry is that communal dialogue, facilitated (...) by a philosophically educated person, recapitulates and reconstructs the major elements—and even the positions or claims—of the tradition, in one form or another, through the distributed thinking characteristic of dialogical discourse. The pedagogical locus of control of CPI is the group as a whole, which is understood as potentially self‐regulating through a process of ongoing dialectical transformation. The role of the facilitator is to act, among other things, from the Socratic “position of ignorance” as a bridge between concepts and arguments and as a trigger for conceptual system transformation. (shrink)

Ectogenesis technology would make it possible to support the complete gestational development of a human being outside the female body. Proponents argue that this technology offers a welcome opportunity to expand reproductive options for those unable or unwilling to gestate. However, by completely bypassing pregnancy, the use of ectogenesis prevents the formation of gestational family ties. Consequently, it has faced criticism for perpetuating a patriarchal view of the family that undermines the moral significance of gestation. The concern is that the (...) introduction of this technology might result in the loss of reproductive autonomy for those who desire to experience pregnancy, as they face pressures to opt for ectogenesis instead. Existing accounts of family values define parents' rights to rear a child, but they fail to establish a right to gestate that can protect an individual's interest in bearing a child. To provide a more comprehensive account of family values, I argue that pregnancy involves a unique quality of intimacy and can make distinct contributions to one's flourishing. Based on this premise, I defend a fundamental moral right to gestate that can help safeguard the option of pregnancy for those who desire it. In conclusion, I consider how a prospective gestator need not provide optimal conditions for fetal development in the way that ectogenesis promises in order for their choice of pregnancy to be justified. (shrink)

The Psychic Home: Psychoanalysis of Consciousness and the Human Soul develops, from a number of different viewpoints, the significance of home in our lives. Roger Kennedy puts forward the central role of what he has termed a 'psychic home' as a vital psychic structure, which gathers together a number of different human functions. Kennedy questions what we mean by the powerfully evocative notion of the human soul, which has important links to the notion of home and he suggests (...) that what makes us human is that we allow a home for the soul. As an illustration of this concept he explores how it can help to understand a vital element of William Wordsworth's development as a poet. The word soul is both abstract and yet also powerfully emotive. Kennedy shows that it can be approached from a number of different angles, from psychoanalysis, philosophy, religion, sociology, literature and neuroscience. The Psychic Home, discusses the mysteries and complexities of the soul, and aims to evoke some restoration of its place in our thinking. It illustrates how the word soul and similar key words, such as spirit and inwardness, express so much that is essential for humans, even if we cannot be too precise about their meanings. Insightful, enlightening and broad reaching, The Psychic Home brings the concept of the soul centre stage as an entity that is elemental, an essence, irreducible, and what makes us human as subjects of experience. It will be essential reading for psychoanalysts, psychotherapists, neuroscientists, philosophers and those interested in spirituality and religion. (shrink)

This paper seeks to reconstruct the role of schooling in a moment of accelerated social, political, economic, geo-political, climatic, indeed planetary crisis. It identifies the school as a potentially prefigurative institution, an evolutionary social frontier, capable of nurturing the democratic social character, a form of sensibility apart from which authentic political democracy is not possible. As theorized by Herbert Marcuse and Richard Hart and Antonio Negri, the “new sensibility” or “multitude” is characterized by greater psychological freedom, individuality, social creativity and (...) self-rule, comprising a “whole of singularities” that “acts in common”. It suggests a human subject with a vital, biological drive for liberation, with a consciousness capable of breaking through the material as well as ideological veil of a society based on hierarchy and domination, and is associated politically with democracy and social-anarchism, or what Murray Bookchin called “communalism”. This paper identifies three main characteristics of an institution informed by this form of modal subjectivity, all of them based on student-teacher dialogue: an emergent, project-based curriculum, whole-school direct democratic governance on all levels of the community, and the regular practice of communal philosophical inquiry, through which we problematize the concepts we live by, in the interest of their ongoing reconstruction. (shrink)