In the philosophical literature, it is customary to think of perception as being assessable with respect to epistemic norms. E.g., the whole discussion around disjunctivism, which is now often considered to be the dominant, if not the default position in philosophy of perception, is, by and large, framed and motivated by epistemological concerns about truth and falsity. This book argues that perception is normative in another, more fundamental sense. Perception is governed by norms that Doyon calls perceptual, that is, immanent (...) to its own structure. This does not mean that perceptual norms are cut-off from external facts; it rather means that they are constitutive moments of our experience of these facts. Perceptual norms are, in that sense, constitutive or enabling norms in that they establish what perception is. To articulate this view, he draws in the repertoire of the phenomenological tradition, in the work of Edmund Husserl and Maurice Merleau-Ponty in particular. Like Kant, both phenomenologists were concerned with the question of the unity of experience and sought to identify the conditions of possibility for having a perception, which they conceive not as a mere sensible experience of the outer world, but as a continuous and meaningful experience of reality. Unlike Kant, however, neither phenomenologist immediately identified these conditions with cognition or epistemic criteria. For both phenomenologists, perception has its own standards, its own conditions of possibility. Perception obtains when it unfolds concordantly or coherently; and when the perceptual progression corresponds to or is in harmony with one's goal or interest, perception can also be said to be optimal. From the phenomenological point of view, concordance (Einstimmigkeit) and optimality (Optimalität) are the two basic perceptual norms governing over perceptual experience, and much of the book is devoted to clarifying their meaning and to address the philosophical consequences that follow from this insight. (shrink)

The review analyzes the book The Conscience’s Double by Georgy Chernavin. I focus on the concepts of false twins of conscience, guilt, and duty in the extended context of philosophical and artistic discourse. The problem of the difference between conscience and its ersatz forms, which give rise to a distorted ethical consciousness, is considered. The main emphasis is opportunistic conscience, neurotic guilt, and false debt. The review suggests that Chernavin’s book studies the “sad theory” of moral disorientation and requires the (...) supplementation with a hypothetical “cringe theory.” In this case, the “sad theory” makes it possible to expand the phenomenological discourse by including a discussion of conscience, illustrating the uncertainty of the boundaries between the phenomenological and the symbolic, and highlighting the subject’s dependence on what they are not. In this work, there is a potential for developing an original ontology of the relationship between conscience and its evil counterpart, especially between a “spiritually sighted” and a “blindly corporeal” person. The scrutinized guilt for the lost absence of guilt is an experience that, although not lived, is important for the subject’s self-constitution. This experience, like the inner side of the subject, determines its conscious functioning and forms something like a Mobius strip. An Evil Genius makes this bond, and I am trying to conceptualize their “weakened” being. (shrink)

This contribution focuses on legal issues raised by the audiovisual broadcasting of performing arts, which has significantly increased due to the SARS-CoV-2 pandemic. First, we contextualize this practice and briefly present the emergence and evolution of the practice of “filmed theater”, as well as any other form of performances (e.g., concert, ballet, opera) originally conceived for the stage but subsequently diffused through other channels. Secondly, we address the current legal issues that have arisen because of the increase of such practice (...) due to the containment measures taken by government. Two axes are of particular attention: the matter of copyrights and related rights, on the one hand, and the question of public financing, on the other. Concerning intellectual property, audiovisual broadcasting leads to several legal consequences and issues: effectiveness of related rights, emergence of new modes of exploitation and new authors, recognition of the recording as an original work, etc. This new practice is, moreover, likely to disrupt the categories established by public funding legal mechanisms, which are often poorly adapted to hybrid artistic objects. The objective of this part is therefore to analyze the new legal issues raised by the audiovisual distribution of performances. Finally, we go beyond exclusively legal issues to examine the very specificities of performing arts and, more specifically, the possible loss that would result from a fixation of a production on a reproducible medium, making its diffusion possible beyond the stage. (shrink)

The presence of stigmatizing language in the electronic health record (EHR) has been used to measure implicit biases that underlie health inequities. The purpose of this study was to identify the presence of stigmatizing language in the clinical notes of pregnant people during the birth admission. We conducted a qualitative analysis on N = 1117 birth admission EHR notes from two urban hospitals in 2017. We identified stigmatizing language categories, such as Disapproval (39.3%), Questioning patient credibility (37.7%), Difficult patient (21.3%), (...) Stereotyping (1.6%), and Unilateral decisions (1.6%) in 61 notes (5.4%). We also defined a new stigmatizing language category indicating Power/privilege. This was present in 37 notes (3.3%) and signaled approval of social status, upholding a hierarchy of bias. The stigmatizing language was most frequently identified in birth admission triage notes (16%) and least frequently in social work initial assessments (13.7%). We found that clinicians from various disciplines recorded stigmatizing language in the medical records of birthing people. This language was used to question birthing people's credibility and convey disapproval of decision‐making abilities for themselves or their newborns. We reported a Power/privilege language bias in the inconsistent documentation of traits considered favorable for patient outcomes (e.g., employment status). Future work on stigmatizing language may inform tailored interventions to improve perinatal outcomes for all birthing people and their families. (shrink)

Four well-known claims about the nature of scientific knowledge can be conjoined to challenge the traditional value-neutrality thesis. These are the Duhem-Quine thesis, the Kuhnian thesis, the "publicity of science" claim, and the "reflexivity of social inquiry" claim. Maximal objectivity reqnires not value-neutrality, but a commitment by the researcher to certain social values—namely those which tend to equalize political advantage in a community. This is an epistemological, not an ethical, argument.

In this paper, missing attribute values in incomplete data sets have three possible interpretations: lost values, attribute-concept values and ‘do not care’ conditions. For rule induction, we use characteristic sets and generalized maximal consistent blocks. Therefore, we apply six different approaches for data mining. As follows from our previous experiments, where we used an error rate evaluated by ten-fold cross validation as the main criterion of quality, no approach is universally the best. Thus, we decided to compare our six approaches (...) using complexity of rule sets induced from incomplete data sets. We show that the smallest rule sets are induced from incomplete data sets with attribute-concept values, while the most complicated rule sets are induced from data sets with lost values. The choice between interpretations of missing attribute values is more important than the choice between characteristic sets and generalized maximal consistent blocks. (shrink)

In this article, we argue that YouTube’s algorithm should be programmed to make a modest but significant percentage (e.g. 2%) of recommendations for the climate. Just as a librarian has a (meta-editorial) responsibility to highlight certain titles and not others, we believe that so should YouTube’s algorithm. The company, we argue, has duties of content moderation, reparation and meta-editing, as well as strong consequentialist reasons to program its algorithm to do so. With 2 billion users, our proposed intervention could be (...) an effective contribution to mitigating the climate crisis in a transparent and accountable way. We consider different setups, with varying degrees of transparency and centralization. We then address the worries that such a project may raise: the risk of manipulation, the threat of a slippery slope, and the concerns for freedom of expression. We conclude that none of these elements seriously undermine the desirability of our proposal. (shrink)

Lainie Friedman Ross suggests that clinicians increase our efforts to meet children’s most basic needs in several ways. These include prioritizing, to a greater extent, children’s present and future feelings; placing greater decisional weight on other family members’ needs; spotting earlier threats from surrogate decision makers so that we can better prevent these threatened harms; and finding ways to intervene earlier so that we can allow parental surrogate decision makers to remain in this role. I offer some practical ways in (...) which Ross’s ideas might be applied. (shrink)

This article demonstrates the unique role of the Russian philosophical tradition in the formation of an individual’s self-consciousness and attempts to overcome the limitati...

In this paper incomplete data sets, or data sets with missing attribute values, have three interpretations, lost values, attribute-concept values and ‘do not care’ conditions. Additionally, the process of data mining is based on two types of probabilistic approximations, global and saturated. We present results of experiments on mining incomplete data sets using six approaches, combining three interpretations of missing attribute values with two types of probabilistic approximations. We compare our six approaches, using the error rate computed as a result (...) of ten-fold cross validation as a criterion of quality. We show that for some data sets the error rate is significantly smaller (5% level of significance) for lost values, for some data sets the smaller error rate is associated with attribute-concept values, and sometimes with ‘do not care’ conditions. Again, for some approaches the error rate is significantly smaller for saturated probabilistic approximations than for global probabilistic approximations, while for some approaches it is the other way around. Thus, for an incomplete data set, the best approach to data mining should be chosen by trying all six approaches. (shrink)

Changes in healthcare financing increasingly rely upon patient cost-sharing to control escalating healthcare expenditures. These changes raise new challenges for physicians that are different from those that arose either under managed care or traditional indemnity insurance. Historically, there have been two distinct bases for arguing that physicians should not consider costs in their clinical decisions—an “aspirational ethic” that exhorts physicians to treat all patients the same regardless of their ability to pay, and an “agency ethic” that calls on physicians to (...) be trustworthy advisors to their patients. In the setting of greater patient cost-sharing, physicians' aspiration and agency roles increasingly conflict. Satisfactorily navigating the new terrain of consumer-driven healthcare requires physicians to consider these two roles and how they can best be reconciled so as to maximize quality of care while respecting the heterogeneity of patients' financial resources and willingness to pay. (shrink)

I suggest that classical General Relativity in four spacetime dimensions incorporates a Principal of Maximal Tension and give arguments to show that the value of the maximal tension is $\frac{{c^4 }}{{4G}}$ . The relation of this principle to other, possibly deeper, maximal principles is discussed, in particular the relation to the tension in string theory. In that case it leads to a purely classical relation between G and the classical string coupling constant α′ and the velocity of light c which (...) does not involve Planck's constant. (shrink)

Una crítica a los contraejemplos tipo-Frankfurt, presentada por David Widerker y conocida como la "Defensa-W", ha persistido a través de los años como uno de los retos más difíciles que estos han de enfrentar. En este texto defiendo los contraejemplos tipo-Frankfurt de este ataque de Widerker presentando un dilema en el que su premisa fundamental, el Principio de expectativas alternativas, se ve envuelta: o bien la plausibilidad de este principio depende de la máxima kantiana "deber" implica "poder", lo cual haría (...) que el principio mismo, y con él todo el argumento de Widerker, sea redundante y prescindible; o bien no se basa en esta máxima, pero entonces no hay ninguna razón de fuerza por la cual se pudiera defender que este principio debe ser aceptado como válido. A critique presented by David Widerker on Frankfurt-counterexamples and known as the "W-defense" has persisted for years and has been considered one of the most difficult challenges these counterexamples have to face. This paper aims to defend Frankfurt counterexamples against Widerker's attack. For doing this, the paper presents a dilemma addressed to the main premise of Widerker's attack: The Principle of Alternative Expectations. The dilemma states: either this principle rests on the Kant's maxim, "ought" implies "can", and then this makes redundant and unnecessary the principle and Widerker's whole argument; or the principle does not rest on such maxim and then there is no good reason to accept it as valid. (shrink)

In the debates surrounding the ethical dimensions of interventions in the human genome, much attention is paid to determining whether—and if so, how—market access to these technologies ought to be managed in order to maximize social benefit. There are those who advocate a “laissez-faire” free-market approach to the development and use of genetic and genomic interventions. We are sympathetic to this view insofar as we understand the workings of the market stimulus effect. We use the term “market stimulus effect” to (...) refer to the outcome of a set of mechanisms whereby early adoption of a new technology by wealthy consumers promotes the development of versions of this product that are cheaper to produce, or are simply .. (shrink)

Radzikowska and Kerre developed L-fuzzy rough set as a fuzzy generalisation of the notion of rough sets. Specifically, they have taken a residuated lattice L as the underlying set of truth degrees. However, in real life, we may encounter situations where truth degrees are not always linear, or where the existence of the least upper bound of two elements is no longer required. Instead, there may be the possibility of having minimal upper bounds, and dually, maximal lower bounds, multilattices have (...) become a suitable algebraic structure for addressing such cases. Our aim is to extend Radzikowska and Kerre's work by replacing a residuated lattice with a multilattice M, thereby obtaining a more flexible structure. We define M-fuzzy rough sets using operators derived from adjoint pairs within the multilattice M. For a tolerance and an equivalence M-fuzzy relation, we define an appropriate M-fuzzy rough set and investigate its properties. (shrink)

A novel and versatile polarization-entanglement scheme is adopted to investigate the violation of the EPR local realism for a non-maximally entangled two-photon system according to the recent nonlocality proof by Lucien Hardy. In this context the adoption of a sophisticated detection method allows direct determination of any element of physical reality (viz., determined with probability equal to unity in the words of Einstein, Podolsky and Rosen) for the pair system within complete measurements that are largely insensitive to the detector quantum-efficiencies (...) and noise. (shrink)

In quantum field theory, coherent states can be created that have negative energy density, meaning it is below that of empty space, the free quantum vacuum. If no restrictions existed regarding the concentration and permanence of negative energy regions, it might, for example, be possible to produce exotic phenomena such as Lorentzian traversable wormholes, warp drives, time machines, violations of the second law of thermodynamics, and naked singularities. Quantum Inequalities have been proposed that restrict the size and duration of the (...) regions of negative quantum vacuum energy that can be accessed by observers. However, QIs generally are derived for situations in cosmology and are very difficult to test. Direct measurement of vacuum energy is difficult and to date no QI has been tested experimentally. We test a proposed QI for squeezed light by a meta-analysis of published data obtained from experiments with optical parametric amplifiers and balanced homodyne detection. Over the last three decades, researchers in quantum optics have been trying to maximize the squeezing of the quantum vacuum and have succeeded in reducing the variance in the quantum vacuum fluctuations to \ dB. To apply the QI, a time sampling function is required. In our meta-analysis different time sampling functions for the QI were examined, but in all physically reasonable cases the QI is violated by much or all of the measured data. This brings into question the basis for QI. Possible explanations are given for this surprising result. (shrink)

A market may be defined as a set of competitive relationships in which agents strive, within limits set by ground rules, to better their own economic positions, not necessarily at the expense of other people, but not necessarily not at their expense either. A degree of indifference to the market fates of others is, manifestly, an inevitable feature of the market practice, so defined. But though indifference is clearly logically endemic to markets, it has been denied that selfishness is necessarily (...) involved in the raw competition of market activity. Thus, Hayek maintains that market behaviour is not selfish on the grounds that the market is a competitive non zero-sum ‘wealth-creating game’ in which individuals ‘use their own knowledge for their own ends’ in a system whose operations,viathe ‘Invisible Hand’, also produce unintended benefits for others. But for behaviour to be selfish it clearly need not necessarily disbenefit other people; it is enough that it is pursued, or persisted in, regardless of its effects upon others. And this is precisely what the institutional ‘indifference’ of market activity amounts to. Admittedly individuals who understand the Hayekian logic of the market know that the long-run chances of everyone's benefiting are maximized by acting in a rigorously competitive manner, and so they at least in one sense act with a ‘regard for others’. Butipso factothis category of market agents has an even stronger reason than the ignorantly selfish for disregarding thespecificinterests of all theparticularindividuals with whom they have economically to do. ‘Market selfishness’, the disregard for others' market interests, is thus a logically inevitable feature of market activity. (shrink)

Jim Joyce has presented an argument for Probabilism based on considerations of epistemic utility [Joyce, 1998]. In a recent paper, I adapted this argument to give an argument for Probablism and the Principal Principle based on similar considerations [Pettigrew, 2012]. Joyce’s argument assumes that a credence in a true proposition is better the closer it is to maximal credence, whilst a credence in a false proposition is better the closer it is to minimal credence. By contrast, my argument in that (...) paper assumed (roughly) that a credence in a proposition is better the closer it is to the objective chance of that proposition. In this paper, I present an epistemic utility argument for Probabilism and the Principal Principle that retains Joyce’s assumption rather than the alternative I endorsed in the earlier paper. I argue that this results in a superior argument for these norms. (shrink)

The fundamental tenet of modern empiricism is the view that all non-analytic knowledge is based on experience. Let us call this thesis the principle of empiricism. [1] Contemporary logical empiricism has added [2] to it the maxim that a sentence makes a cognitively meaningful assertion, and thus can be said to be either true or false, only if it is either (1) analytic or self-contradictory or (2) capable, at least in principle, of experiential test. According to this so-called empiricist (...) criterion of cognitive meaning, or of cognitive significance, many of the formulations of traditional metaphysics and large parts of epistemology are devoid of cognitive significance--however rich some of them may be in non-cognitive import by virtue of their emotive appeal or the moral inspiration they offer. Similarly certain doctrines which have been, at one time or another, formulated within empirical science or its border disciplines are so contrived as to be incapable of test by any conceivable evidence; they are therefore qualified as pseudo- [p. 42:] hypotheses, which assert nothing, and which therefore have no explanatory or predictive force whatever. This verdict applies, for example, to the neo-vitalist speculations about entelechies or vital forces, and to the "telefinalist hypothesis" propounded by Lecomte du Noüy. (shrink)

: The "difference position" holds that clinical research and therapeutic medical practice are sufficiently distinct activities to require different ethical rules and principles. The "similarity position" holds instead that clinical investigators ought to be bound by the same fundamental principles that govern therapeutic medicine—specifically, a duty to provide the optimal therapeutic benefit to each patient or subject. Some defenders of the similarity position defend it because of the overlap between the role of attending physician and the role of investigator in (...) a research trial. This overlap is maximal when the same physician occupies both roles with respect to a particular patient-subject. We address the ethical tensions inherent in that role conflict and argue that the tensions are real but manageable. The difference position provides a sound ethical framework within which to manage those tensions, while the similarity position is unsatisfactory because it seeks to deny the existence of the tensions. (shrink)

Theories that use expected utility maximization to evaluate acts have difficulty handling cases with infinitely many utility contributions. In this paper I present and motivate a way of modifying such theories to deal with these cases, employing what I call “Direct Difference Taking”. This proposal has a number of desirable features: it’s natural and well-motivated, it satisfies natural dominance intuitions, and it yields plausible prescriptions in a wide range of cases. I then compare my account to the most plausible alternative, (...) a proposal offered by Arntzenius :31–58, 2014). I argue that while Arntzenius’s proposal has many attractive features, it runs into a number of problems which Direct Difference Taking avoids. (shrink)

Virtue ethics, the authors believe, is distinct and superior to other options because it considers, in the first place, which preferences are worth pursuing, rather than just blindly maximizing preferences, and it takes into account intuitions, emotions and experience, instead of acting solely on abstract universal principles. Moreover, virtue ethics is seen as firmly rooted in human biology and psychology, particularly in our freedom, rationality, and sociability. Work, business, and management are presented as vital areas for the development of virtues, (...) not the least with a view to human flourishing. We conclude by introducing the articles included in this special issue. (shrink)

_Winner of the Fabian Dorsch ESA Essay Prize._ Julian Dodd defends the view that, in musical work-performance practice, interpretive authenticity is a more fundamental value than score compliance authenticity. According to him, compliance with a work’s score can be sacrificed in cases where it conflicts with interpretative authenticity. Stephen Davies and Andrew Kania reject this view, arguing that, if a performer intentionally departs from a work’s score, she is not properly instantiating that work and hence not producing an authentic performance (...) of it. I argue that this objection fails. A detailed analysis of work-performance practice reveals, first, that the normative scope of interpretive authenticity encompasses the practice of composing musical versions and that, second, when performers sacrifice score compliance to maximize interpretive authenticity, they are performing the target work by means of performing a version of it. By means of the nested types theory, I then show how performances produced in this way can be properly formed instances, and hence authentic performances, of their target work. (shrink)

The purpose of this paper is to show how a MacIntyre-inspired business school could contribute to developing practical wisdom in students through its curriculum, methods, faculty, student selection criteria, and governance. Despite MacIntyre's critiques, management can be presented, in MacIntyrean terms, as a second-order, domain-relative practice, with practical wisdom as corresponding virtue. Management education consists in developing practical wisdom. How? Primarily by initiating students and enabling them to participate in communal traditions of inquiry focused on, although not limited to, the (...) purposes and ends of business. The transmission of objective knowledge, analytical skills, and techniques is subordinated to the end goal. We consider traditions centered on shareholder value maximization, the balancing of stakeholder interests, and the fulfillment of the common good of firms. Each gives rise to a particular kind of business school. A MacIntyrean business school is one that seeks the common good of firms. (shrink)

The 3Rs, or the replacement, reduction, and refinement of animal research, are widely accepted as the best approach to maximizing high-quality science while ensuring the highest standard of ethical consideration is applied in regulating the use of animals in scientific procedures. This contrasts with the muted scientific interest in the 3Rs when they were first proposed in The Principles of Humane Experimental Technique. Indeed, the relative success of the 3Rs has done little to encourage engagement with their original text, which (...) remains little read and out of print. By adopting a historical perspective, this article argues that one explanation for this disjunction may be found in another, more celebrated, event of 1959: C. P. Snow’s Rede lecture on The Two Cultures. The moral outlook of The Principles of Humane Experimental Technique derived from an earlier ethos wherein humanistic and scientific values occupied a shared culture. While the synthetic style of The Principles has hindered its readership, this article concludes that there is value to recovering the notion that the humanities and social sciences can contribute to the improvement of animal research. (shrink)

Expected utility maximization problem is one of the most useful tools in mathematical finance, decision analysis and economics. Motivated by statistical model selection, via the principle of expected utility maximization, Friedman and Sandow (J Mach Learn Res 4:257–291, 2003a) considered the model performance question from the point of view of an investor who evaluates models based on the performance of the optimal strategies that the models suggest. They interpreted their performance measures in information theoretic terms and provided new generalizations of (...) Shannon entropy and Kullback–Leibler relative entropy and called them U-entropy and U-relative entropy. In this article, a utility-based criterion for independence of two random variables is defined. Then, Markov’s inequality for probabilities is extended from the U-entropy viewpoint. Moreover, a lower bound for the U-relative entropy is obtained. Finally, a link between conditional U-entropy and conditional Renyi entropy is derived. (shrink)

Revisionist interpretation of Mill needs to be extended to deal with a residue of puzzles about his moral theory and its connection with his theory of liberty. The upshot shows his reinterpretation of his Benthamite tradition as a form of ‘philosophical utilitarianism’; his definition of the art of morality as collective self-defence; his ignoring of maximization in favour of ad hoc dealing in utilities; the central role of his account of the justice of punishment; the marginal role of the internal (...) sanction in his criterion of moral wrong; his deep respect for common-sense morality; and his restriction of the scope of morality so as to claim for the utilitarian tradition the whole realm of the aesthetics of conduct as part of a general theory of practical reason. (shrink)

In some sense, survival seems to be an intrinsic matter. Whether or not you survive some event seems to depend on what goes on with you yourself —what happens in the environment shouldn’t make a difference. Likewise, being a person at a time seems intrinsic. The principle that survival seems intrinsic is one factor which makes personal fission puzzles so awkward. Fission scenarios present cases where if survival is an intrinsic matter, it appears that an individual could survive twice over. (...) But it’s well known that standard notions of “intrinsicality” won’t do to articulate the sense in which survival is intrinsic, since ‘personhood’ appears to be a maximal property. We formulate a sense in which survival and personhood (and perhaps other maximal properties) may be almost intrinsic—a sense that would suffice, for example, to ground fission arguments. It turns out that this notion of almost-intrinsicality allows us to formulate a new version of the problem of the many. (shrink)

We initiate the reverse mathematics of general topology. We show that a certain metrization theorem is equivalent to Π2 1 comprehension. An MF space is defined to be a topological space of the form MF(P) with the topology generated by $\lbrace N_p \mid p \in P \rbrace$ . Here P is a poset, MF(P) is the set of maximal filters on P, and $N_p = \lbrace F \in MF(P) \mid p \in F \rbrace$ . If the poset P is countable, (...) the space MF(P) is said to be countably based. The class of countably based MF spaces can be defined and discussed within the subsystem ACA0 of second order arithmetic. One can prove within ACA0 that every complete separable metric space is homeomorphic to a countably based MF space which is regular. We show that the converse statement, "every countably based MF space which is regular is homeomorphic to a complete separable metric space," is equivalent to Π2 1-CA0. The equivalence is proved in the weaker system Π1 1-CA0. This is the first example of a theorem of core mathematics which is provable in second order arithmetic and implies Π2 1 comprehension. (shrink)

Driven by competitive pressure, organizations are empowering employees to use their judgment, creativity, and ideas in pursuit of enhanced organizational performance and both employee and shareholder satisfaction. This empowerment offers both benefits and potential harm. This article explores the benefits and harm associated with role, reward, process and governance empowerment and makes recommendations for minimizing the harm while maximizing the benefits.

BackgroundThis paper discusses the contentious issue of reuse of stored biological samples and data obtained from research participants in past clinical research to answer future ethical and scientifically valid research questions. Many countries have regulations and guidelines that guide the use and exportation of stored biological samples and data. However, there are variations in regulations and guidelines governing the reuse of stored biological samples and data in Sub-Saharan Africa including Malawi.DiscussionThe current research ethics regulations and guidelines in Malawi do not (...) allow indefinite storage and reuse of biological samples and data for future unspecified research. This comes even though the country has managed to answer pertinent research questions using stored biological samples and data. We acknowledge the limited technical expertise and equipment unavailable in Malawi that necessitates exportation of biological samples and data and the genuine concern raised by the regulatory authorities about the possible exploitation of biological samples and data by researchers. We also acknowledge that Malawi does not have bio-banks for storing biological samples and data for future research purposes. This creates room for possible exploitation of biological samples and data collected from research participants in primary research projects in Malawi. However, research ethics committees require completion and approval of material transfer agreements and data transfer agreements for biological samples and data collected for research purposes respectively and this requirement may partly address the concern raised by the regulatory authorities. Our concern though is that there is no such requirement for biological samples and data collected from patients for clinical or diagnostic purposes.SummaryIn conclusion, we propose developing a medical data and material transfer agreement for biological samples and data collected from patients for clinical or diagnostic purposes in both public and private health facilities that may end up in research centers outside Malawi. We also propose revision of the current research ethics regulations and guidelines in Malawi in order to allow secondary use of biological samples and data collected from primary research projects as a way of maximizing the use of collected samples and data. Finally, we call for consultation of all stakeholders within the Malawi research community when regulatory authorities are developing policies that govern research in Malawi. (shrink)

Shared decision making (SDM) is the state of the art for clinicians’ communication with patients and surrogate decision makers. SDM involves give and take, in which all parties interact to maximize the autonomy of patients. In this article I summarize the core steps of SDM and explore ways to use it to benefit patients to the greatest extent. I review three articles included in this issue of The Journal of Clinical Ethics that highlight additional approaches we can use to help (...) patients and parents to see what may be in their own or their child’s best interest. I describe how these approaches can be used in most other medical fields. I explore ways to share information with patients that are outside the usual scope of SDM. Finally, I discuss how we might look, together with patients, at what all parties are feeling before we begin the process of SDM. (shrink)