There were individuals in the vegetarian movement in Britain who believed that to refrain from eating flesh, fowl, and fish while continuing to partake of dairy products and eggs was not going far enough. Between 1909 and 1912, The Vegetarian Society's journal published a vigorous correspondence on this subject. In 1910, a publisher brought out a cookery book entitled, No Animal Food. After World War I, the debate continued within the Vegetarian Society about the acceptability of animal by-products. It centered (...) on issues of cruelty and health as well as on consistency versus expediency. The Society saw its function as one of persuading as many people as possible to give up slaughterhouse products and also refused journal space to those who abjured dairy products. The year 1944 saw the word "vergan" coined and the breakaway Vegan Society formed. (shrink)

This essay introduces and discusses four musical works that extensively treat Ruth and Naomi's relationship: two late nineteenth-century oratorios, and two twentieth-century operas. Both music and librettos are treated as midrash—a creative retelling through both altered text and in the language of music.

_K. al-Manām_ by Ibn Abī al-Dunyā is a compendium of 350 Muslim dream narratives in Arabic. The English introduction examines the function of dreams in classical Arabic literature with a focus on dreams as a means of edification.

Bioethicists influence practices and policies in medicine, science, and public health. However, little is known about bioethicists’ views. We recently surveyed 824 U.S. bioethicists on a wide range of ethical issues, including topics related to abortion, medical aid in dying, and resource allocation, among others. We also asked bioethicists about their demographic, religious, academic, and professional backgrounds. We find that bioethicists’ normative commitments predict their views on bioethical issues. We also find that, in important ways, bioethicists’ views do not align (...) with those of the U.S. public: for instance, bioethicists are more likely than members of the public to think abortion is ethically permissible but are less likely to believe compensating organ donors is. Our demographic results indicate the field of bioethics is far less diverse than the U.S. population—less diverse even than other academic disciplines—suggesting far more work needs to be done to build an inclusive field. (shrink)

Hierarchical Bayesian models (HBMs) provide an account of Bayesian inference in a hierarchically structured hypothesis space. Scientific theories are plausibly regarded as organized into hierarchies in many cases, with higher levels sometimes called ‘paradigms’ and lower levels encoding more specific or concrete hypotheses. Therefore, HBMs provide a useful model for scientific theory change, showing how higher‐level theory change may be driven by the impact of evidence on lower levels. HBMs capture features described in the Kuhnian tradition, particularly the idea that (...) higher‐level theories guide learning at lower levels. In addition, they help resolve certain issues for Bayesians, such as scientific preference for simplicity and the problem of new theories. *Received July 2009; revised October 2009. †To contact the authors, please write to: Leah Henderson, Massachusetts Institute of Technology, 77 Massachusetts Avenue, 32D‐808, Cambridge, MA 02139; e‐mail: [email protected]. (shrink)

Two of the most influential theories about scientific inference are inference to the best explanation and Bayesianism. How are they related? Bas van Fraassen has claimed that IBE and Bayesianism are incompatible rival theories, as any probabilistic version of IBE would violate Bayesian conditionalization. In response, several authors have defended the view that IBE is compatible with Bayesian updating. They claim that the explanatory considerations in IBE are taken into account by the Bayesian because the Bayesian either does or should (...) make use of them in assigning probabilities to hypotheses. I argue that van Fraassen has not succeeded in establishing that IBE and Bayesianism are incompatible, but that the existing compatibilist response is also not satisfactory. I suggest that a more promising approach to the problem is to investigate whether explanatory considerations are taken into account by a Bayesian who assigns priors and likelihoods on his or her own terms. In this case, IBE would emerge from the Bayesian account, rather than being used to constrain priors and likelihoods. I provide a detailed discussion of the case of how the Copernican and Ptolemaic theories explain retrograde motion, and suggest that one of the key explanatory considerations is the extent to which the explanation a theory provides depends on its core elements rather than on auxiliary hypotheses. I then suggest that this type of consideration is reflected in the Bayesian likelihood, given priors that a Bayesian might be inclined to adopt even without explicit guidance by IBE. The aim is to show that IBE and Bayesianism may be compatible, not because they can be amalgamated, but rather because they capture substantially similar epistemic considerations. 1 Introduction2 Preliminaries3 Inference to the Best Explanation4 Bayesianism5 The Incompatibilist View : Inference to the Best Explanation Contradicts Bayesianism5. 1 Criticism of the incompatibilist view6 Constraint - Based Compatibilism6. 1 Criticism of constraint - based compatibilism7 Emergent Compatibilism7. 1 Analysis of inference to the best explanation7. 1. 1 Inference to the best explanation on specific hypotheses7. 1. 2 Inference to the best explanation on general theories7. 1. 3 Copernicus versus Ptolemy7. 1. 4 Explanatory virtues7. 1. 5 Summary7. 2 Bayesian account8 Conclusion. (shrink)

The authors respond to a letter by Mitchell Berger in the March‐April 2024 issue of the Hastings Center Report concerning their essay “Securing the Trustworthiness of the FDA to Build Public Trust in Vaccines.”.

There has been considerable puzzlement over how to respond to higher-order evidence. The existing dilemmas can be defused by adopting a ‘two-dimensional’ representation of doxastic attitudes which incorporates not only substantive uncertainty about which first-order state of affairs obtains but also the degree of conviction with which we hold the attitude. This makes it possible that in cases of higher-order evidence the evidence sometimes impacts primarily on our conviction, rather than our substantive uncertainty. I argue that such a two-dimensional representation (...) is naturally developed by making use of imprecise probabilities. (shrink)

Psychological studies show that the beliefs of two agents in a hypothesis can diverge even if both agents receive the same evidence. This phenomenon of belief polarisation is often explained by invoking biased assimilation of evidence, where the agents’ prior views about the hypothesis affect the way they process the evidence. We suggest, using a Bayesian model, that even if such influence is excluded, belief polarisation can still arise by another mechanism. This alternative mechanism involves differential weighting of the evidence (...) arising when agents have different initial views about the reliability of their sources of evidence. We provide a systematic exploration of the conditions for belief polarisation in Bayesian models which incorporate opinions about source reliability, and we discuss some implications of our findings for the psychological literature. (shrink)

Most public and non-profit organisations that fund health research provide the majority of their funding in the form of grants. The calls for grant applications are often untargeted, such that a wide variety of applications may compete for the same funding. The grant review process therefore plays a critical role in determining how limited research resources are allocated. Despite this, little attention has been paid to whether grant review criteria align with widely endorsed ethical criteria for allocating health research resources. (...) Here, we analyse the criteria and processes that ten of the largest public and non-profit research funders use to choose between competing grant applications. Our data suggest that research funders rarely instruct reviewers to consider disease burden or to prioritise research for sicker or more disadvantaged populations, and typically only include scientists in the review processes. This is liable to undermine efforts to link research funding to health needs. (shrink)

The no miracles argument is one of the main arguments for scientific realism. Recently it has been alleged that the no miracles argument is fundamentally flawed because it commits the base rate fallacy. The allegation is based on the idea that the appeal of the no miracles argument arises from inappropriate neglect of the base rate of approximate truth among the relevant population of theories. However, the base rate fallacy allegation relies on an assumption of random sampling of individuals from (...) the population which cannot be made in the case of the no miracles argument. Therefore the base rate fallacy objection to the no miracles argument fails. I distinguish between a “local” and a “global” form of the no miracles argument. The base rate fallacy objection has been leveled at the local version. I argue that the global argument plays a key role in supporting a base-rate-fallacy-free formulation of the local version of the argument. (shrink)

Patient-reported outcome measures (PROMs) are increasingly used to assess multiple facets of healthcare, including effectiveness, side effects of treatment, symptoms, health care needs, quality of care, and the evaluation of health care options. There are thousands of these measures and yet there is very little discussion of their theoretical underpinnings. In her 2008 Presidential address to the Society for Quality of Life Research (ISOQoL), Professor Donna Lamping challenged researchers to grapple with the theoretical issues that arise from these measures. In (...) this paper, I attempt to do so by arguing for an analogy between PROMs and Hans-Georg Gadamer’s logic of question and answer. While researchers readily admit that the constructs involved in PROMs are imperfectly understood and lack a gold standard, they often ignore the consequences of this fact. Gadamer’s work on questions and their importance to philosophical hermeneutics helps to show that the questions researchers ask about such constructs are also imperfectly understood. I argue that these questions should not be standardized, and I instead propose a theoretical framework that understands PROMs as posing genuine questions to respondents—questions that are open to reinterpretation. (shrink)

BackgroundFunctional neurodiagnostics could allow researchers and clinicians to distinguish more accurately between the unresponsive wakefulness syndrome and the minimally conscious state. It remains unclear how it informs surrogate decision-making.ObjectiveTo explore how the next of kin of patients with disorders of consciousness interpret the results of a functional neurodiagnostics measure and how/why their interpretations influence their attitudes towards medical decisions.Methods and SampleWe conducted problem-centered interviews with seven next of kin of patients with DOC who had undergone a functional HD-EEG examination at (...) a neurological rehabilitation center in Germany. The examination included an auditory oddball paradigm and a motor imagery task to detect hidden awareness. We analyzed the interview transcripts using structuring qualitative content analysis.ResultsRegardless of the diagnostic results, all participants were optimistic of the patients’ meaningful recovery. We hypothesize, that participants deal with the results of examinations according to their belief system. Thus, an unfavorable evaluation of the patient’s state had the potential to destabilize the participant’s belief system. To re-stabilize or to prevent the destabilization of their belief system, participants used different strategies. Participants accepted a “positive” HD-EEG result since it stabilized their belief system.ConclusionWe hypothesize, that a group of next of kin of patients with DOC deals with functional neurodiagnostics results on the basis of the result’s value and their high hope that the patient will recover meaningfully. A psychological mechanism seems to moderate the impact of functional neurodiagnostics on surrogate treatment decisions. (shrink)

The need for greater privacy protections in the United States has never been greater. In their work, “Ethical Responsibilities for Companies That Process Personal Data”, McCoy et al. (2023) correct...

Epistemic injustice sits at the intersection of ethics, epistemology, and social justice. Generally, this philosophical term describes when a person is wrongfully discredited as a knower; and within the clinical space, epistemic injustice is the underlying reason that some patient testimonies are valued above others. The following essay seeks to connect patterns of social prejudice to the clinical realm in the United States: illustrating how factors such as race, gender identity, and socioeconomic status influence epistemic credence and associatively, the quality (...) of healthcare a person receives. After describing how epistemic injustice disproportionately harms already vulnerable patients, I propose a narrative therapy intervention. This intervention can help providers re-frame their relationships with patients, in such that they come to view patients as valuable sources of unique knowledge. Though I identify this intervention as a valuable step in addressing clinical epistemic injustice, I call upon medical educators and practitioners to further uplift the voices, perspectives, and stories of marginalized patients. (shrink)

Expanding the scope of existential discourse beyond the Western tradition, this book engages Asian philosophies to reassess vital questions of life's purpose, death's imminence, and our capacity for living meaningfully in conditions of uncertainty. Inspired by European existentialism in theory, the book explores concrete techniques for existential practice via the philosophies of East Asia. The investigation begins with the provocative existential writings of twentieth-century Korean Buddhist nun Kim Iryop, who asserts that meditative concentration conducts a potent energy outward throughout the (...) entire karmic network, enabling the radical transformation of our shared existential conditions. Understanding her claim requires a study of East Asian traditions more broadly. Considering practices as diverse as Song-dynasty Chinese views on mental cultivation, Buddhist merit-making ceremonies, the ritual memorization and recitation of texts, and Yijing divination, the book concludes by advocating a speculative turn. This 'speculative existentialism' counters the suspicion toward metaphysics characteristic of twentieth-century European existential thought and, at the same time, advances a program for action. It is not a how-to guide for living, but rather a philosophical methodology that takes seriously the power of mental cultivation to transform the meaning of the life that we share. (shrink)

The claim that listening to extreme music causes anger, and expressions of anger such as aggression and delinquency have yet to be substantiated using controlled experimental methods. In this study, 39 extreme music listeners aged 18–34 years were subjected to an anger induction, followed by random assignment to 10 min of listening to extreme music from their own playlist, or 10 min silence (control). Measures of emotion included heart rate and subjective ratings on the Positive and Negative Affect Scale (PANAS). (...) Results showed that ratings of PANAS hostility, irritability, and stress increased during the anger induction, and decreased after the music or silence. Heart rate increased during the anger induction and was sustained (not increased) in the music condition, and decreased in the silence condition. PANAS active and inspired ratings increased during music listening, an effect that was not seen in controls. The findings indicate that extreme music did not make angry participants angrier; rather, it appeared to match their physiological arousal and result in an increase in positive emotions. Listening to extreme music may represent a healthy way of processing anger for these listeners. (shrink)

Recent advances in natural language generation (NLG), such as public accessibility to ChatGPT, have sparked polarised debates about the societal impact of this technology. Popular discourse tends towards either overoptimistic hype that touts the radically transformative potentials of these systems or pessimistic critique of their technical limitations and general ‘stupidity’. Surprisingly, these debates have largely overlooked the exegetical capacities of these systems, which for many users seem to be producing meaningful texts. In this paper, we take an interdisciplinary approach that (...) combines hermeneutics—the study of meaning and interpretation—with prompt engineering—task descriptions embedded in input to NLG systems—to study the extent to which a specific NLG system, ChatGPT, produces texts of hermeneutic value. We design prompts with the goal of optimising hermeneuticity rather than mere factual accuracy, and apply them in four different use cases combining humans and ChatGPT as readers and writers. In most cases, ChatGPT produces readable texts that respond clearly to our requests. However, increasing the specificity of prompts’ task descriptions leads to texts with intensified neutrality, indicating that ChatGPT’s optimisation for factual accuracy may actually be detrimental to the hermeneuticity of its output. (shrink)

ObjectivesTo explore the objectives and outcomes most appropriate for evaluating clinical ethics support services (CESs) in the USA.MethodsA three-round e-Delphi was sent to two professional medical ethics listservs (Medical College of Wisconsin-Bioethics and American Society for Bioethics and Humanities) as well as 19 individual experts. The survey originally contained 15 objectives and 9 outcomes. In round 1, participants were asked to validate the content of these lists. In round 2, we had 17 objectives and 10 outcomes, and participants were asked (...) to rank them for appropriateness in a top 10 list of objectives and a top 5 list of outcomes.ResultsParticipants came to a high(at least 70%) level of agreement on seven objectives: mediate, educate, develop policy, improve the moral quality of a decision or action, counsel, create a moral space and manage moral distress. Participants came to a moderate (at least 51%) level of agreement on three objectives: empower, awareness of ethics and preventative ethics. Participants also came to a moderate (at least 51%) level of agreement on five outcomes: ethical justification, transformation of institution, improvement of quality of life, principled consensus and satisfaction with the expertise of a CES.ConclusionThis e-Delphi identified 10 objectives and 5 outcomes that are a good starting point for developing outcome measures to evaluate CESs in the USA, while reminding us of the diversity of perspectives still evident in the field. (shrink)

Does the Buddhist doctrine of no-self imply, simply put, no-other? Does this doctrine necessarily come into conflict with an ethics premised on the alterity of the other? This article explores these questions by situating Emmanuel Levinas’s ethics in the context of contemporary Japanese philosophy. The work of twentieth-century Japanese philosopher Watsuji Tetsurō provides a starting point from which to consider the ethics of the self-other relation in light of the Buddhist notion of emptiness. The philosophy of thirteenth-century Zen Master Dōgen (...) casts doubt on Watsuji’s commitment to reciprocal self-other relationality, showing that the idea of self-emptiness disrupts any conventional understanding of reciprocity and promotes instead other-oriented compassion. Despite interesting similarities between the ethics of alterity and Buddhist compassion, a Buddhist-influenced understanding of alterity differs from Levinas on important points, by making possible the claim that all others—human, animal, plant, and mineral—are ethical others. (shrink)

Philosophers and others have questioned whether or not expertise in morality is possible. This debate is not only theoretical, but also affects the perceived legitimacy of clinical ethicists. One argument against moral expertise is that in a pluralistic society with competing moral theories no one can claim expertise regarding what another ought morally to do. There are simply too many reasonable moral values and intuitions that affect theory choice and its application; expertise is epistemically uniform. In this article, we discuss (...) how similar concerns have recently threatened to undermine expertise in medicine and science. In contrast, we argue that the application of values is needed to exercise medical, scientific, and moral expertise. As long as these values are made explicit, worries about a pretense to authority in the context of a liberal democracy are ill-conceived. In conclusion, we argue for an expertise that is epistemically diverse. (shrink)

Solid organ transplant has revolutionized the treatment of certain diseases, providing hope where there were once only terminal diagnoses. Yet transplantation is ethically fraught, chiefly because...

Journal of Political Philosophy, EarlyView.

Jeff Bub has developed an information-theoretic interpretation of quantum mechanics on the basis of the programme to reaxiomatise the theory in terms of information-theoretic principles. According to the most recent version of the interpretation, reaxiomatisation can dissolve some of the demands for explanation traditionally associated with the task of providing an interpretation for the theory. The key idea is that the real lesson we should take away from quantum mechanics is that the ‘structure of in- formation’ is not what we (...) thought it was. In particular a feature of the new structure is intrinsic randomness of measurement, which allegedly dissolves a significant part of the measurement problem. I argue that it is difficult to find an appropriate argument to support the claim that measurement is intrinsically random in the relevant sense. (shrink)

Health-related quality of life measures aim to assess patients’ subjective experience in order to gauge an increasingly wide variety of health care issues such as patient needs; satisfaction; side effects; quality of care; disease progression and cost effectiveness. Their popularity is undoubtedly due to a larger initiative to provide patient-centered care. The use of patient perspectives to guide health care improvements and spending is rooted in the idea that we must respect patients as self-determining agents. In this paper I look (...) at the two main orientations to quality of life measurement: standardized and individualized measures. I argue that while these measures are attempts to provide for patient self-determination, they both fail to do so. In their place I suggest a new approach which overcomes their respective difficulties: a dialogic approach. (shrink)

This article tells the story of the oil and gas origins of the Gaia hypothesis, the theory that the Earth is a homeostatic system. It shows how Gaia’s key assumption—that the climate is a fundamentally stable system, able to withstand perturbations—emerged as a result of a collaboration between the theory’s progenitor, James Lovelock, and Royal Dutch Shell in response to Shell’s concerns about the effects of its products on the climate. The article explains how Lovelock elaborated the Gaia hypothesis and (...) gave it evidential depth through a series of Royal Dutch Shell-funded research projects meant to identify organisms whose biological activities might double as climate-regulating mechanisms. The article goes on to show how this research subsequently laid the foundation for a distinct genre of climate change denialism, in which corporations sowed doubt not by denying the phenomenon of global warming but by naturalizing it. (shrink)

A short, concise book in favor of honoring doubt and admitting when the answer is: I don’t know. From the acclaimed author of No Book but the World and 2019's searing new novel Strangers and Cousins. In a tight, enlightening narrative, Leah Hager Cohen explores why, so often, we attempt to hide our ignorance, and why, in so many different areas, we would be better off coming clean. Weaving entertaining, anecdotal reporting with eye-opening research, she considers both the ramifications (...) of and alternatives to this ubiquitous habit in arenas as varied as education, finance, medicine, politics, warfare, trial courts, and climate change. But it’s more than just encouraging readers to confess their ignorance—Cohen proposes that we have much to gain by embracing uncertainty. Three little words can in fact liberate and empower, and increase the possibilities for true communication. So much becomes possible when we honor doubt. (shrink)

Whoever writes in blood and aphorisms does not want to be read, but rather to be learned by heart.Here's what is necessary: one blow with a club, one scar; one slap on the face, a handful of blood. Your reading of what other people write should be just like this. Don't be lax!In several recent articles, Leigh Kathryn Jenco questions the use of Eurocentric methodologies in conducting cross-cultural research within and about Chinese traditions.3 As she says, "postcolonial and 'non-Western' societies (...) can be positioned as particularly challenging case studies, offering 'alternative' views of self, culture, and society. However, their rich traditions of historical, political, and literary scholarship can play no role in... (shrink)

Shenker has claimed that Von Neumann's argument for identifying the quantum mechanical entropy with the Von Neumann entropy, S() = – ktr( log ), is invalid. Her claim rests on a misunderstanding of the idea of a quantum mechanical pure state. I demonstrate this, and provide a further explanation of Von Neumann's argument.

It is commonly thought that there is some tension between the second law of thermodynam- ics and the time reversal invariance of the microdynamics. Recently, however, Jos Uffink has argued that the origin of time reversal non-invariance in thermodynamics is not in the second law. Uffink argues that the relationship between the second law and time reversal invariance depends on the formulation of the second law. He claims that a recent version of the second law due to Lieb and Yngvason (...) allows irreversible processes, yet is time reversal invariant. In this paper, I attempt to spell out the traditional argument for incompatibility between the second law and time reversal invariant dynamics, making the assumptions on which it depends explicit. I argue that this argument does not vary with different versions of the second law and can be formulated for Lieb and Yngvason's version as for other versions. Uffink's argument regarding time reversal invariance in Lieb and Yngvason is based on a certain symmetry of some of their axioms. However, these axioms do not constitute the full expression of the second law in their system. (shrink)

Robert Fogelin has argued that in deep disagreements, resolution cannot be achieved by rational argumentation. In response, Richard Feldman has claimed that deep disagreements can be resolved in a similar way to more everyday disagreements. I argue that Feldman’s claim is based on a relatively superficial notion of “resolution” of a disagreement whereas the notion at stake in Fogelin’s argument is more substantive. Furthermore, I argue that Feldman’s reply is based on a particular reading of Fogelin’s argument. There is an (...) alternative reading, which takes the central concern to be the role of common ground in argumentation. Engaging with this version of Fogelin’s argument is also a worthwhile endeavour. (shrink)

Journal Name: Philologus Issue: Ahead of print.

Patient-reported outcomes are increasingly used as dependent variables in studies regarding the effectiveness of clinical interventions. But patient-reported outcome measures (PROMs) do not provide intuitively meaningful data. For instance, it is not clear what a five point increase or decrease on a particular scale signifies. Establishing ‘interpretability’ involves making changes in outcomes meaningful. Attempts to interpret PROMs have led to the development of methods for identifying a minimum important difference (MID). In this paper, however, I draw on Charles Taylor’s distinction (...) between weak and strong evaluations to suggest that identifying a MID, specifically, a MID that uses a patient-reported reference group, may not provide an adequate interpretation of these measures. Moreover, I argue that the difficulty with interpreting these measures is tied to a larger problem concerning their validity. If researchers wish to interpret PROMs, they may first need to know more about the constructs they attempt to measure, namely, quality of life. (shrink)

In a world surrounded by smart objects from sensors to automated medical devices, the ubiquity of ‘smart’ seems matched only by its lack of clarity. In this article, we use our discussions with expert stakeholders working in areas of implantable medical devices such as cochlear implants, implantable cardiac defibrillators, deep brain stimulators and in vivo biosensors to interrogate the difference facets of smart in ‘implantable smart technologies’, considering also whether regulation needs to respond to the autonomy that such artefacts carry (...) within them. We discover that when smart technology is deconstructed it is a slippery and multi-layered concept. A device’s ability to sense and transmit data and automate medicine can be associated with the ‘sting’ of autonomy being disassociated from human control as well as affecting individual, group, and social environments. (shrink)

These essays engage Jin Y. Park’s recent translation of the work of Kim Iryŏp, a Buddhist nun and public intellectual in early twentieth-century Korea. Park’s translation of Iryŏp’s Reflections of a Zen Buddhist Nun was the subject of two book panels at recent conferences: the first a plenary session at the annual meeting of the Society for Asian and Comparative Philosophy and the second at the Eastern Division of the American Philosophical Association on a group program session sponsored by the (...) International Society for Buddhist Philosophy. This exchange also includes a response from Park. (shrink)

In his recent article “Ethical Criteria for Health-Promoting Nudges: A Case-by-Case Analysis,” Bart Engelen (2019) develops a useful framework for evaluating health-related nudges in an attempt to...

Twelve years ago the British media got wind of a London gynecologist who performed an elective reduction on a twin pregnancy reducing it to a singleton. Perhaps not surprisingly, opinion on the moral status of twin reductions was divided. But in the last few years new evidence regarding the medical risks of twin pregnancies has emerged, suggesting that twin reductions are relevantly similar to the reductions performed on high‐end multi‐fetal pregnancies. This evidence has appeared to resolve the moral debate.In this (...) paper I look at the role of clinical evidence in medical ethics. In particular I examine the role of clinical evidence in determining what counts as a significant harm or risk. First, I challenge the extent to which these empirical claims are descriptive, suggesting instead that the evidence is to some degree normative in character. Second, I question whether such empirical claims should count as evidence for what are essentially difficult ethical decisions – a role they appear to play in the case of elective reductions. I will argue that they should not, primarily because the value‐laden nature of this evidence conceals much of what is ethically at stake. It is important to recognize that empirical evidence cannot be a substitute for ethical deliberation. (shrink)

This volume introduces readers to the main philosophical issues of measurement in medicine, illustrating the connections between the natural and social sciences by integrating essays on causation, measuring instruments and issues of measurement and policy.

Failings in patient care and quality in NHS Trusts have become a recurring theme over the past few years. In this paper, we examine the Care Quality Commission’s Guidance about Compliance: Essential Standards of Quality and Safety and ask how NHS Trusts might be better supported in fulfilling the regulations specified therein. We argue that clinical ethics committees (CECs) have a role to play in this regard. We make this argument by attending to the many ethical elements that are highlighted (...) in the Commission’s Regulations and by providing practical examples of how CECs can (and in some case already do) provide ethics support to health professionals and trusts. Although CECs have been traditionally associated with case consultation, i.e., discrete problems caused by individual circumstances, in the previous 10 years the literature suggests that clinical ethics services have become more integrated into the life of the health care organization and are increasing construed as proactive agents of systematic change. We provide evidence from a recent survey of UK clinical ethics services that this trend is present in the UK. (shrink)

Quality improvement mechanisms increasingly use outcome measures to evaluate health care providers. This move toward outcome measures is a radical departure from the traditional focus on process measures. More radical still is the proposal to shift from relatively simple and proximal measures of outcome, such as mortality, to complex outcomes, such as quality of life. While the practical, scientific, and ethical issues associated with the use of outcomes such as mortality and morbidity to compare health care providers have been well (...) rehearsed, the specific concerns associated with the use of quality of life measures in quality of care research have received little attention. As with much research on quality of life there is a tendency to assume that the disadvantages are outweighed by the general virtue of “listening” to patients. In this paper we disagree with this assumption and argue that quality of life is a process, not an outcome. (shrink)

We respond to open peer commentaries on our target article, "Health Research Priority Setting: The Duties of Individual Funders".

There has been much philosophical interest regarding the ‘hierarchy of evidence’ used to determine which study designs are of most value for reporting on questions of effectiveness, prognosis, and so on. There has been much less philosophical interest in the choice of outcome measures with which the results of, say, an RCT or a cohort study are presented. In this paper, we examine the FDA’s recently published guidelines for assessing the psychometric adequacy of patient-reported outcome measures. We focus on their (...) recommendations for demonstrating content validity and also for how researchers should weigh up the sum of psychometric evidence when choosing these measures. We argue that questions regarding judgment and understanding meaning of these measures should play a more central role in determining their adequacy. (shrink)