In lieu of an abstract, here is a brief excerpt of the content:Women and Health Research:A Report from the Institute of MedicineAnna C. Mastroianni (bio), Ruth Faden (bio), and Daniel Federman (bio)In recent years, claims have been made by segments of the research community and by women's health advocacy groups that clinical research practices and policies have not benefitted women's health to the same extent as men's health. Central to these claims has been an assertion that women have been inadequately (...) represented as subjects of clinical studies and that as a result neither health conditions unique to women—e.g., menopause—nor women's manifestations of health problems affecting both sexes—e.g., heart disease—have been investigated sufficiently.The scientific community, including federal agencies that sponsor and regulate clinical studies, is increasingly responsive to these claims and is taking steps to raise the level of women's participation in clinical studies. Controversy and concern have surrounded these actions, however. Two of the claims that have been made are: (1) that women are more difficult to study than men because of their cyclical hormonal changes; and (2) that conducting gender-specific subgroup analyses would increase the size of study populations, raise the cost of studies, and thereby reduce the number of studies that could be performed with the limited resources available. In addition, controversy over the inclusion of women of childbearing potential and pregnant women has been particularly salient. Concerns have been expressed about avoiding potential harm to existing or potential fetuses and about the possible legal and financial ramifications of such harm. A further concern involves the perceived difficulties in enrolling women in studies and retaining them for the duration of the studies.Against this backdrop, the Office of Research on Women's Health at the National Institutes of Health (NIH) asked the Institute of Medicine (IOM) in October 1992 to establish the Committee on the Ethical and Legal Issues Relating to the Inclusion of Women in Clinical Studies. The Committee's charge was to: (1) consider the ethical and legal implications of including women, particularly pregnant women and women of childbearing potential, in clinical studies; (2) examine known instances of litigation regarding injuries to research subjects [End Page 55] and describe existing legal liabilities and protections; and (3) provide practical advice on these issues for consideration by NIH, institutional review boards (IRBs), and clinical investigators.The 16 Committee members came from diverse backgrounds: bioethics, law, epidemiology and biostatistics, public health policy, obstetrics and gynecology, clinical research, pharmaceutical development, social and behavioral sciences, and clinical evaluative sciences.1 Chaired by two of the authors of this article, Ruth Faden and Daniel Federman, and coordinated by the third, IOM Study Director Anna Mastroianni, the Committee met five times over a fourteen-month period, convened a one-and-one-half day invitational workshop, and commissioned several background papers. The Committee's deliberations were complicated by the announcement of new federal policies late in its term. Specifically, the Food and Drug Administration (FDA) issued guidelines (FDA 1993) to replace its 1977 guidelines, which prohibited the inclusion of women of childbearing potential in early phases of most clinical drug trials. In addition, Congress passed the NIH Revitalization Act of 1993 (P.L. 103-43), which contains provisions mandating the inclusion of women and racial and ethnic minorities in NIH-sponsored clinical research. In February 1994, the IOM Committee publicly issued its final report and recommendations, Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies, publishing the workshop presentations and commissioned papers in a separate volume.Deliberations of the CommitteeA number of issues arose at the outset as the Committee considered its charge. A few members initially believed that verification of the underrepresentation of women relative to men in clinical studies as a whole was a prerequisite to providing policy recommendations. Others believed that such an examination would be an important contribution to the knowledge base, but that it was not necessary for addressing the Committee's charge. As summarized in the Committee's report, the Committee's research indicated that firm conclusions about the relative underrepresentation of women could not be drawn from the available data because of the lack of systematic information... (shrink)

There is significant evidence that the health needs of women and minorities have been neglected by a medical research community whose agendas and protocols tend to focus on more advantaged segments of society. In response, the National Institutes of Health and Food and Drug Administration in the United States have recently issued new policies aimed at increasing the utilization of women in clinical studies. As well, the U.S. Congress passed the NIH Revitalization Act of 1993, which specifically mandates increased (...) inclusion of women and racial and ethnic groups in clinical studies. On the face of it, such gender and race-specific policies would appear to be morally problematic because traditionally ethics opposes the use of sex or race as legitimate criteria for distributions of benefits or burdens in social policies. Hence, these policies pose some significant moral questions. Feminist ethics provides us with a framework for evaluating such policies because of its readiness to recognize that socially and politically significant factors such as sex and race are morally relevant in setting public policy. Of course, feminist ethics does not simply endorse all appeals to sex and race but only the policies in which attention to such factors will contribute to social justice. In this essay, I Identify some of the Important ethical questions that a feminist ethics perspective raises about research policies devised to promote the Inclusion of women in clinical studies. (shrink)

Gender-medicine has been very successful in discovering gaps in medical knowledge, disclosing biases in earlier research, and generating new results. It has superseded a more androcentric and sexist medicine. Yet, its development should not be understood in terms of a further approximation of value-freedom. Rather, it is a case of better value-laden science due to an enhanced pluralism in medicine and society. This interpretation is based on an account of the origins of gender-medicine in the feminist women’s health movement and (...) an analysis of the debate on inclusion of women in clinical trials. Consequently, the history of gender-medicine provides support for a procedural account of objectivity that stresses the importance of a diversity of perspectives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical Bioethics at NIH:History and A New VisionJohn C. Fletcher (bio)On July 3, 1995, Dr. John I. Gallin, Director of the Magnuson Clinical Center of the National Institutes of Health (NIH), convened a one-day "Conference on the Future of Clinical Bioethics at the National Institutes of Health Intramural Program." Conferees included NIH officials and a panel of consultants from bioethics programs around the nation.1 The subject was the future (...) of NIH's intramural bioethics program and specifically a vision of a new multi-component program, presented by Dr. Gallin, the first speaker. Dr. Harold Varmus, Director of NIH, was there to assure his support for Dr. Gallin's vision. This author, honored to be second speaker, was invited to sketch a brief history of bioethics at NIH. The present article reviews some of this history and then reports on Dr. Gallin's proposal, points of consensus among speakers and conferees, and the search for a Chief of the Clinical Bioethics Program.History of Bioethics at NIHIt is often said that NIH is a well-kept secret as the nation's leading biomedical research facility. Also, few people know that NIH has a long history in bioethics. Some key events in that history are shown in Figure 1, beginning with two that occurred prior to the birth of bioethics. NIH made an early policy response to protect human subjects of research and to find acceptable limits for scientific freedom. The Clinical Center (CC), a 550-bed research hospital, opened in 1953. A subcommittee of the Medical Board, the Clinical Research Committee (CRC), was formed for prior group review of all studies with normal volunteers. The traditional practice was for researchers themselves to decide when studies would begin, which subjects to recruit, and whether informed consent would be sought. The CRC intervention bit into this tradition. In addition, patient studies that posed significant risks or departed widely from medical practice were reviewed by referral from the Clinical Directors of the various Institutes. Was this CRC an early institutional review [End Page 355] board (IRB)? As a guest researcher, I was permitted to observe the CRCs meetings between 1966 and 1969. It functioned much like an IRB but had no community or non-scientist members. Other IRB-like review groups undoubtedly existed prior to the CRC. Robert Levine (personal communication, September 7, 1995) recalls that Beth Israel Hospital in Boston had one in 1938. Historical research is clearly needed on the earliest forms of research review.Table 1. Bioethics at NIHEventYearClinical Research Committee1953Surgeon-General's PPO #1291966NIGMS funds Hastings Genetics Group1973OPRR's Mission1974NLM's grant to KennedyInstitute for Bibliography of Bioethics1974Recombinant DNA Advisory Committee1974STEP Series Bioethics Speakers1975Pre-IRBs at the CC1975-76Assistant for Bioethics to Director, CC1977RAC-Human Gene Therapy Subcommittee1983Lipsett Proposal (ICD)1983Liaison Group, CC1983Bioethics Program, CC1985Durable Power of Attorney for Researchwith Incapacitated Subjects1985-86NLM funds National Reference Centerfor Bioethics Literature1985National Institute for Nursing Research1986Bioethics Post-Doctoral Fellows Program1989ELSI Program1989Bioethicists on CC-IRBs1989CC-Ethics Committee1990Office of Human Subjects Research1992 [End Page 356]Between 1963 and 1967, the media exposed instances of ethically troubling research, and Beecher (1966) and Pappworth (1967) published sharp criticisms of the weak state of research ethics. In 1966, Surgeon-General William Stewart and NIH Director James Shannon issued a policy requiring local group review of all research involving human subjects before making an application for NIH peer review (Surgeon General 1966). The policy was the first in any nation to mandate ethics committees for clinical research. However, it did not apply to the NIH intramural program until Congress passed the National Research Act in 1974 (Public Law 93-348; 202, 88 Stat. 342, 1974). This lag permitted NIH intramural investigators the luxury of feeling above the norms imposed on ordinary mortals and guaranteed more resistance to the inevitable change to come. Resistance to change marked the intramural program from the mid-1960s to the mid-1970s... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Blossoming of Bioethics at NIHEzekiel J. Emanuel (bio)The establishment of the Department of Clinical Bioethics at the Warren G. Magnuson Clinical Center of the National Institutes of Health (NIH) has coincided with a burgeoning of interest and activity related to bioethical issues at NIH. The department has precipitated a reexamination and revitalization of existing bioethics activities in the Clinical Center and has launched new programs especially in (...) the areas of education and research. In addition, the department contributes to the work of others throughout NIH who address bioethical issues.The Organizational Location of the Department of Clinical BioethicsBefore describing the history and current activities of the Department of Clinical Bioethics, I will say something about it administrative location. Comprehension of the department’s organizational location is essential to understanding its history, role, and function. Prior to interviewing for the position of chair of the department, I did not—and, if truth be told, still do not fully—understand the details of the organizational structure of NIH. I therefore assume that many other bioethicists outside of the Institutes, especially those who do not regularly receive NIH funding, may not fully grasp its organizational intricacies.The Department of Clinical Bioethics is a department within the Warren G. Magnuson Clinical Center, which is NIH’s “hospital.” Hospital is in quotes because all of the patients at the Clinical Center must be enrolled in a research protocol and, therefore, are research subjects. The Clinical Center is where NIH’s clinical researchers admit their research subjects or see them in the out-patient setting. The Department of Clinical Bioethics reports directly to the Director of the Clinical Center, John I. Gallin, M.D., and receives its finances, space, and other resources from the Clinical Center.In this way, the department is part of NIH’s intramural (“inside”) program. People employed by NIH conduct intramural research, training, and other initiatives. The extramural program, which receives approximately 87 percent of NIH’s budget, funds research at institutions outside NIH. The extramural program awards grants and contracts for research, training, and conferences conducted [End Page 455] by investigators who are not affiliated with NIH. The National Human Genome Research Institute’s ELSI (Ethical, Legal, and Social Implications) program, for example, is part of NIH’s extramural program. As part of the NIH intramural program, the Department of Clinical Bioethics is not empowered to fund independent initiatives of people outside of NIH through grants and contracts. However, the department can collaborate with bioethicists and others on research, educational, and other programs outside of NIH and has some funds to support these collaborations.In addition, it is important for bioethicists to understand that NIH is a collection of 24 institutes and centers. Although there is coordination and collaboration between the institutes and centers, each is funded separately, and each has its own scope, programs, administrative structures, research agendas, training priorities, boards of advisors, and so forth. In this sense, NIH is more like a university that has many distinct schools, each with its own dean, faculty, budget, and fund raising office, than one that is tightly integrated and centrally-administered. Within NIH’s diffuse administrative structure, the Department of Clinical Bioethics is located within one of the centers (the Clinical Center) and has defined authority and responsibility only for bioethics within that center; in addition, because the Clinical Center’s mission is to support clinical research at other institutes, the department’ mission includes supporting the work of those institutes as well. Intellectual exchanges and relationships with other institutes and centers are neither pre-ordained nor administratively established; such relationships must be developed case-by-case, topic-by-topic, and initiative-by-initiative.The History and the Development of the Department of Clinical BioethicsThe Department of Clinical Bioethics was launched in late 1996. Although the department’s creation marked a major commitment to bioethics by the Clinical Center, and especially by its director, Dr. Gallin, it was formed on a pre-existing foundation of bioethics activities at NIH. 1In 1977, John Fletcher, Ph.D., was appointed by then Director Mortimer Lipsett as the bioethicist at the Clinical Center; his official title was Assistant for Bioethics... (shrink)

I argue that, in one sense, collective wisdom can save civilization. But in a more important sense, collective wisdom should be understood as a form of civilization, as the result and expression of a moral civilizing-process that comes about through the creation and transmission of collective interpretations of human experience and human nature. Collective wisdom traditions function in this manner by providing an interpretation of what it means to be human and what thoughts, skills, and actions are required to live (...) a successful human life at the most general level of analysis. Collective wisdom can have a civilizing effect on individuals, and indirectly on societies, by providing a type of orienting framework for understanding the proper relationship between the self, others, and the world. Such traditions in effect provide a “blueprint” for the successful human life as such, by providing guidance on thought and action, on what is appropriate to think, feel, desire, and do in theoretical and practical contexts. A wise individual will be a 'civilized' individual in this moral sense, an individual who is properly habituated and educated so as to now reflectively endorse and desire thinking and acting in virtuous ways. However, this understanding of collective wisdom and civilization is in many ways today controversial and met with justified critiques and skeptical criticisms. To defend this way of approaching and answering our question against these critiques, I turn to ancient wisdom traditions from ancient India, China, and Greece as paradigms for understanding exactly how collective wisdom can achieve the end of civilizing humanity. Based on this analysis, I sketch the outlines of a revitalized ancient wisdom tradition able to civilize individuals today, but such a tradition must be updated to reflect the advancement of modern natural science and to meet the demands of living in our diverse, pluralistic, and globalized world. (shrink)

For over four decades, Richard Schwartz has engaged with two ethically rich ways of living that, as he charts in this book, he came to appreciate in middle age: Judaism and veganism. Having been born into a secular Jewish family, it was his marriage and an increasing commitment to social justice that propelled him to study and rediscover the essence of his Jewish faith. That sense of social justice further raised his awareness of the environmental movement, and, ultimately, to animal (...) rights and veganism. In Vegan Revolution: Saving Our World, Revitalizing Judaism, Schwartz shows how, now perhaps more than ever, veganism offers a pathway for all of us of whatever faith (or no faith) to reduce hunger, conserve the environment, save water, reinstitute justice, and care for animals and the Earth. It is no coincidence, as Schwartz demonstrates, that many of these ideas are mandates in Jewish scripture, and that reincorporating a care for the world (tikkun olam) can itself reinvigorate the spirit of a faith and galvanize its practitioners to act. (shrink)

The 21st Century Cures Act is a major act of legislation that contains numerous changes to drug and device regulation. The House of Representatives passed the Act after considerable interest group lobbying, but the bill and the key changes made during its drafting remain controversial. Using publicly disclosed records of written comments on the bill, we reviewed the key areas of lobbying activity and the compromises made in the final text. We focused on legislative provisions relating to management of the (...) National Institutes of Health, incentives for medical product development, and approval standards for new drugs and devices. By the end of the first comment period, the Committee received 118 comments. Most respondents were patient organizations, professional societies, and pharmaceutical and device companies. Overall, the majority of public comments were positive, although public health and consumer organizations were underrepresented in the number of submitted comments. As the legislative process continued, the draft bill underwent several changes relating to NIH funding, market exclusivity provisions, and scrutiny of regulatory evidentiary standards. Understanding the key statutory provisions and how they have evolved could help patients, researchers, and advocates make more informed comments on the bill and future health care legislation. (shrink)

This issue’s “Legal Briefing” column covers recent legal developments involving the Patient Self-Determination Act . Enacted in the wake of the U.S. Supreme Court’s Cruzan decision in 1990, the PSDA remains a seminal event in the development of U.S. bioethics public policy, but the PSDA has long been criticized as inadequate and ineffective. Finally, recent legislative and regulatory changes promise to revitalize and rejuvenate it. The PSDA has been the subject of recent articles in The Journal of Clinical Ethics.I categorize (...) new legal developments concerning the PSDA into the following eight sections:1. Background and History2. Rules and Requirements3. Criticism and Challenges4. Failed Efforts to Amend the PSDA5. Personalize Your Care Act of 20136. New Regulations7. New Regulatory Guidance8. Expanded Enforcement. (shrink)

The U.S. Food and Drug Administration's rationale for supporting the development and approval of BiDil for heart failure specifically in black patients was based on under-powered, post hoc subgroup analyses of two relatively old trials , which were further complicated by substantial covariate imbalances between racial groups. Indeed, the only statistically significant difference observed between black and white patients was found without any adjustment for potential confounders in samples that were unlikely to have been adequately randomized. Meanwhile, because the accepted (...) baseline therapy for heart failure has substantially improved since these trials took place, their results cannot be combined with data from the more recent trial amongst black patients alone. There is therefore little scientific evidence to support the approval of BiDil only for use in black patients, and the FDA's rationale fails to consider the ethical consequences of recognizing racial categories as valid markers of innate biological difference, and permitting the development of group-specific therapies that are subject to commercial incentives rather than scientific evidence or therapeutic imperatives. This paper reviews the limitations in the scientific evidence used to support the approval of BiDil only for use in black patients; calls for further analysis of the V-HeFT I and II data which might clarify whether responses to H-I vary by race; and evaluates the consequences of commercial incentives to develop racialized medicines. We recommend that the FDA revise the procedures they use to examine applications for race-based therapies to ensure that these are based on robust scientific claims and do not undermine the aims of the 1992 Revitalization Act. (shrink)

This chapter contains sections titled: The Moral Critique of Research on Animals The Uses of Animals in Research The Response of the Research Community to the Moral Critique of Animal Research Practical Resolution References Further reading.

Pieper’s originality and interest in contemporary thought are to be found above all in his having revitalized precious insights about the true being of man contained in classical wisdom. The structure of the philosophical act and the human spirit share a fundamental characteristic, that both are open to the whole of being. Thus, Pieper suggests that authentic philosohizing must consider all aspects of a question, including theological ones.

The False Claims Act, 31 U.S.C. § 3729, a post-Civil War law inspired by cases of defense contracting fraud, was revitalized in 1986. Since then it has been used to sue both manufacturers and providers of pharmaceuticals. In some cases, these suits were meant to target offlabel marketing of pharmaceuticals. In 2009, the 11th Circuit rendered a decision in Hopper v. Solvay Pharmaceuticals that dramatically limits the ability of private plaintiff whistle-blowers to bring qui tam suits under the FCA for (...) such marketing. In June 2010, the Supreme Court denied certiorari, making the Circuit court decision final. The Solvay decision creates a significant barrier to certain kinds of qui tam suits, requiring the plaintiff to demonstrate the intent to market off-label, including by showing specific prescriptions that were written as a result of efforts to do so. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Oversight of Stem Cell Research in the United StatesCynthia B. Cohen (bio) and Mary A. Majumder (bio)Human pluripotent stem cell research, meaning research into cells that can multiply indefinitely and differentiate into almost all the cells of the body, has become a minefield in which science, ethics, and politics have collided over the last decade in the United States. President Barack Obama entered this highly charged (...) territory when he indicated during his campaign that once in office he would issue an executive order expanding federally funded human embryonic stem cell (hESC) research and introduce rigorous oversight of it (Obama 2008a & b). Candidate Obama stated that he would require that the hESC lines involved were derived with donor consent from early embryos that otherwise would be discarded following in vitro fertilization (IVF) treatment. However, in contrast with the policy of President George W. Bush, he would do so without regard to the date of their derivation. He added that he would call upon the director of the National Institutes of Health (NIH) to develop guidelines for federally funded hESC and other pluripotent stem cell research that would draw from the guidelines developed in 2005 by the National Academies of Science (NAS) for privately funded research (National Research Council 2005).A similar policy was written into the 2008 version of the Stem Cell Research Enhancement Act, which reiterates the policy enunciated in earlier versions of this bill, passed twice by the Congress but vetoed by President Bush each time (House of Representatives, 110th Congress 2008).1 Depending on how one reads the 2008 version of the act, it could also apply in certain respects to hESC research that is not federally funded. We proceed on the assumption that the act applies at least to federally funded stem cell research. Therefore, it appears that the president or the Congress, or both, will approve of an expanded policy of federal funding of hESC research, as well as other forms of human pluripotent stem cell research. [End Page 79]This policy would make the guidelines developed by a committee appointed by NAS, a prestigious private body of American scientists and related experts, the primary basis for the development of new federal guidelines for oversight of hESC research in the United States. This would have certain advantages in that those familiar with the relevant scientific issues are likely to address them accurately and stem cell investigators are apt to accept restrictions on their research written by fellow scientists and ethics and policy experts whom they perceive as strong supporters of stem cell research. However, it also would have certain disadvantages. Chief among these is that the NAS committee appointed to write guidelines for this research, in its concern to see stem cell science move forward after a period in which many scientists and others maintained that it had been unduly restricted, might have overlooked or deferred consideration of some pressing ethical and policy issues. We maintain that this is the case—although we also maintain that the NAS guidelines provide a responsible foundation for developing NIH guidelines for stem cell research. Consequently, we propose that an NIH task force charged by the director of NIH with writing new guidelines for hESC and other stem cell research should revise and expand the NAS guidelines in ways that we propose below, as well as others that it considers necessary, and make it obligatory for those seeking federal funding of such research to follow these new guidelines.We highlight certain areas in which an ethical case can be made for strengthening the existing NAS guidelines and certain areas in which more fundamental ethical reflection—and building on that, additional guideline/policy development—seems warranted. Among the sections of the NAS guidelines that need clarification and reworking, we include those regarding consent to embryo donation, which provide one of their central focuses, and the development of human-nonhuman chimeras, which they address relatively briefly. In addition, we maintain that new guidelines need to be written to address the nascent ethical and policy issues raised by the possibility that human gametes will be induced from pluripotent stem cells in the next few years and that... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:At the Vortex of Controversy:Developing Guidelines for Human Embryo ResearchRonald M. Green (bio)Because of the unavoidable time delay between the submission and publication of this article, its readers will have a significant advantage over its writer: You will know whether the recommendations of the Report of the Human Embryo Research Panel, on which I have served as a member since its inception in January of this year, are progressing (...) smoothly as the basis for evaluating future, federally-funded embryo research—or whether any of the recommendations has become stalled in controversy and political dispute. Staid journals like Science already are predicting that the Panel's Report is likely to create a stormy autumn for the National Institutes of Health.The Panel formally presented its Report to NIH Director Harold Varmus on September 27. The Panel's recommendations will be reviewed by the Advisory Committee to the Director (ACD) until the ACD's next meeting in early December. At that time, the ACD will make formal recommendations to Dr. Varmus, who then will initiate the process of drafting federal regulations that could go into effect by Spring 1995.Historical BackgroundControversy is not new to the area of human embryo research. In the United States, federal regulations enacted in the mid-1970s required any research on the human embryo to be approved by a federally mandated Ethics Advisory Board (EAB). The EAB drafted a significant report that provided ethical guidelines for research on the early, ex utero, human embryo. However, before the report could be acted upon, a new administration, which was opposed to abortion and anything remotely viewed as threatening to prenatal life, came to office, and when the EAB's charter expired in 1980, it was not renewed. In this manner, the Reagan and Bush administrations forestalled any federal support for embryo research in the United States. The next 13 years saw a significant expansion of infertility services in this country, but in the absence of federal funding and [End Page 345] review, there was very little systematic research on either infertility procedures or the human embryo.In January 1993, the U.S. political environment changed again when the Clinton administration fulfilled a campaign promise to remove a nearly five-year-old ban on fetal tissue transplantation research. Although fetal tissue research, which uses the remains of an aborted fetus, significantly differs from embryo research, which involves the developing conceptus ex utero before its transfer to and implantation in a womb, the changed political environment stimulated public discussion of embryo research as well. As a result, in June 1993, Congress nullified the federal regulations requiring EAB review for embryo research. Although this presumably left NIH free to fund embryo research without restrictions, NIH officials felt that guidelines were needed to ensure that such research was conducted in an ethically and socially responsible manner. Accordingly, in January 1994, NIH formed the Human Embryo Research Panel to propose such guidelines.The Panel Begins its WorkChaired by Steven Muller, President emeritus of the Johns Hopkins University, the Panel's 19 members included 7 basic and clinical scientists, 4 ethicists, 2 lawyers, and 6 individuals representing various backgrounds relevant to the making of public policy. Patricia King of the Georgetown University Law Center and Brigid Hogan, a cell biologist at Vanderbilt University, were appointed policy and science co-chairs respectively. Meeting for the first time in early February, the Panel was told by its chair and co-chairs that NIH's need for guidance in the face of pending proposals meant that it had approximately six months—including five one- to two-day meetings each month in Washington—in which to complete its work.In his charge, Dr. Varmus asked the Panel to place the possible areas of research into three categories: (1) acceptable for federal funding; (2) warranting additional review; and (3) unacceptable for federal support. In addition, he asked the Panel to draft guidelines for the review and conduct of the research deemed acceptable.Looking back after months of work, I vividly recall a sense of the enormity of the task facing us. We were being asked, in a short period of time, not only to master... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Office of Scientific IntegrityDavid P. Hamilton (bio)For most of the 1980s, the specter of scientific fraud popped into public view every few years, usually only to submerge again. Faced with several well-publicized cases of scientists who blatantly faked their data—among the best-known being Harvard cardiologist John Darsee (whose colleagues watched him forge data) (Broad and Wade 1982, p. 14) and Sloan-Kettering Institute immunologist William Summerlin (who painted black (...) spots on white mice to simulate tissue grafts) (Broad and Wade 1982, p. 155)—the scientific community as a whole tended to dismiss the phenomenon as the work of a few deviants. Called in 1981 to testify before then-Representative Albert Gore Jr.'s subcommittee on investigations and oversight, Philip Handler, then-president of the National Academy of Sciences, told the panel that science was perfectly capable of regulating itself, and that the problem of scientific fraud had been "grossly exaggerated" by the press (Broad and Wade 1982). The message was clear: Congress should stick to its knitting, and science would take care of itself.Now, however, scientists are faced with a very different situation: a permanent federal bureaucracy, known as the Office of Scientific Integrity (OSI), devoted to the investigation of alleged scientific wrongdoing. The transition from the days of laissez-faire, when universities were entrusted with all investigations unless they were handled so badly that the federal government was forced to take notice, has been an uncomfortable one for many researchers. Lately, this discomfort has taken shape as a vocal protest against OSI. Largely as a result of this protest, federal officials recently promoted a plan to restructure OSI and change some of its operating procedures, a move with unpredictable consequences for universities and researchers alike.OSI was born largely because of investigations by two influential congressmen: Representatives John Dingell of Michigan and Ted Weiss of New York. While both claimed they acted mainly to make sure taxpayer dollars were not spent on fraudulent research, both also maintained a strong interest in protecting "whistleblowers," the often vulnerable, and usually junior, scientists who first raise questions about bad research. And Dingell seemed to take special pleasure in pointing up the deficiencies of investigations run by universities and by the National Institutes of Health (NIH) itself. (For reasons that are not well understood, [End Page 171] biomedical research seems far more prone to fraud than any other field of science. As a result, NIH, which funds most biomedical research in the United States, has held ultimate responsibility for most prominent cases of fraud.) Plagued as they often were by conflicts of interest, shoddy methodologies, and, in some cases, a willingness to believe any excuse by the accused, no matter how far-fetched, these investigations made easy targets. And the notion that science could "govern itself" grew harder to sustain.In late 1988, Dingell and other congressmen began circulating draft bills that would have created a new office for investigating scientific fraud. Dingell would have placed such an office under the aegis of the Inspector General of the Department of Health and Human Services, raising the possibility that scientific fraud might be probed by the same criminal investigators who unravel Medicare fraud. Unsettled by this vision of the "science police," NIH officials moved quickly to pre-empt Congress. On March 16, 1989, they published a notice in the Federal Register announcing the creation of OSI, an office with responsibility for ensuring thorough university investigations of misconduct and the authority to conduct its own investigations when necessary.From the beginning, OSI took an unusual approach to its work. For one thing, the office had a broad mandate: Although located within NIH, it was responsible for research funded throughout the entire Public Health Service, including the Food and Drug Administration, the Alcohol, Drug, and Mental Health Administration, and the Centers for Disease Control. Furthermore, it was not restricted to scientific fraud. Departmental lawyers, wishing to avoid the legal connotations of the term "fraud"—in particular, a requirement that fraudulent actions not only mislead others but also cause them noticeable harm—decided instead to adopt the term "scientific misconduct," defined as "fabrication, falsification, plagiarism, or other practices that deviate... (shrink)

Changing environment requires not just creativity, but disruptive creativity. The traditional planning paradigm within business organizations heavily relies on long- and short-term forecasting in order to predict the future and plan accordingly. However, a large share of business development is now characterized by rapid changes, inconsistency and unpredictability. Taking that into account a key task for managers is to explore and innovate in chaotic conditions, but how can owner–managers, business leaders and the employees respond to such rapid changes without the (...) appropriate skillset and educational background? This study calls for the modernization of enterprise education systems in order to provide students and graduates with tools relevant to the changing requirements of the business environment. We argue that such needed mastery of unconventional innovative thinking and acting “as if” rather have a lot in common with art education concepts and theatrical skills. Using videography as an example, we illustrate how advances in digital technology can help incorporate such theatrical concepts into enterprise education. As a contribution we provide insights and falsifiable propositions toward a renewal and revitalization of enterprise education pedagogy. (shrink)

According to some proponents and critics of research using animals, the greatest hope for improved conditions for laboratory animals is to be found in the system of self-regulation called for by recent legislation and the NIH's revised policy. This article explores advantages and disadvantages of relying on "Institutional Animal Care and Use Committees" to subject research proposals to ethical scrutiny. Among the advantages discussed are: institutional dialogue concerning the ethics of research; inclusion of perspectives of nonscientists in such dialogues; and (...) the possibility of improved research proposals. Despite these advantages, I argue that serious problems with the committee system may limit the degree to which conditions for animals are actually improved. Disadvantages discussed include: limitations in the scope of the review process, and built-in bias in favor of certain philosophical stances in the composition of the committees. Keywords: laboratory animals, ethics review committees, self-regulation, NIH policy, Animal Welfare Act CiteULike Connotea Del.icio.us What's this? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Protecting Human Research SubjectsThe Office for Protection from Research RisksJoan Paine Porter (bio)The office for Protection from Research Risks (OPRR), located within the National Institutes of Health, has two divisions: Human Subject Protections and Animal Welfare. This article will address the overall responsibilities and current projects relating to human subject protections.OPRR implements the Department of Health and Human Services' (HHS) regulations for the protection of human subjects (45 CFR (...) 46 (1991)). These regulations fulfill the responsibilities set forth in the Public Health Service (PHS) Act with regard to institutional review boards (IRB) and other protections for human subjects involved in biomedical and behavioral research conducted or supported by HHS. The PHS Act also mandates a program to clarify ethical issues in biomedical research involving human subjects and to address violations of the rights of human subjects of research (P.L. 99-158 (1985)).OPRR staff negotiate assurances of compliance with institutions conducting Federally-supported research involving human subjects. The assurances describe the policies and procedures each institution will follow to fulfill the requirements of the regulations, including specific IRB composition and functions.In addition, OPRR cosponsors with the Food and Drug Administration and awardee institutions a series of regional workshops that address human subject protections issues. These are attended by IRB members, institutional officials, research investigators, and others involved with human subject protections.Current ActivitiesNumerous activities are underway in OPRR. The following describes only a few of the initiatives and studies aimed at helping develop policies and procedures to protect human subjects of research."Points to Consider" DocumentsOPRR is currently working with the National Center for Human Genome Research (NCHGR) to develop a "points to consider" document for IRBs and others involved in large genetic pedigree studies. Many questions have emerged [End Page 279] on topics such as how subjects should be recruited, with whom information should be shared about others in the family, social risks of disclosure in employment and insurance, the circumstances and timing of informing subjects about study results, and involvement of children. OPRR and NCHGR hope to assemble a group this fall to review and refine the points that are now being developed jointly. A conference in South Carolina organized by the American Association for Advancement in the Sciences entitled "Project on the Ethical and Legal Implications of Genetic Testing," helped generate advice, and identified some of the more controversial issues in design and conduct of genetic research that involves large groups of family members.Another "points to consider" effort concerns enrollment of women and minorities in research. The PHS has established a policy that members of these groups must be included in research projects unless there are valid scientific justifications for their exclusion which can be made on a project by project basis (ADAMHA/NIH Policy 1990; NIH/ADAMHA Policy 1990). OPRR has commissioned several scholarly papers to help in developing "points to consider" for IRBs as they balance issues of equitable selection of subjects and protection of these selected individuals. Concerns about enrolling women of childbearing age in research that may be harmful to a fetus, and liability issues frequently dominate discussion in this area. The papers will address ethical, legal, and statistical aspects of enrollment of minorities and women as well as provide a description of various practices and roles of IRBs in addressing goals of fair selection of participants and appropriate protections.OPRR is also working with the PHS Panel on Women, Adolescents and Children to produce a document, also in the form of "points to consider" guidance, concerning enrollment of children who are wards of the state in HIV-related research. Subpart D of the regulations for the protection of human subjects (45 CFR 46) specifically addresses research involving children who are wards of the state, including the special protections that must be provided. State and local officials who have authority to enroll foster care children in research have indicated a desire to obtain advice in this area.The IRB GuidebookA major project that is now being completed under contract to the Poynter Center at Indiana University is the IRB Guidebook. It will revise and expand the current IRB Guidebook produced in the 1980s... (shrink)

In our contemporary and futuristic times, immortality is slowly being extracted from the divine/spiritual arena by means of science and technology. There is the optimism that through the scientific and technological revitalization of human nature, humans would probably attain eternal existence in this world. This optimism, and its underlying philosophy, is based on something known as transhumanism. In this chapter, we examine the implications of transhumanism for the question of life’s meaning, especially from an African perspective. Specifically, we pit (...) transhumanism against three dominant traditional African notions of meaning viz. the God’s purpose theory, the vital force theory and the communal normative function theory in a bid to decipher which theory, amongst the three, best undergirds a meaningful transhuman existence. We conclude that the communal view is the most attractive of the three theories in terms of answering the question of how to live meaningfully as a transhuman/post-human being. According to the communal view, a meaningful life is one that strives to acquire personhood of the highest level by performing those acts that ensure harmonious living, communal flourishing, and the common good. Attaining personhood, thus, presents itself as one plausible overarching purpose for a transhuman existence. (shrink)

Commemoration of a field service held by 1200 Jewish soldiers protected by their gentile comrades on Yom Kippur of 1870 during the siege of Metz in the Franco-Prussian war played an important role among German Jews as a symbol of acceptance and integration into the society as citizens with equal rights. Based on a short note in several newspapers it became very fast a very common commemoration among Jews. But it was a pious fraud of an act that never happened (...) in the described way. Although this was known and already published in late 1870 it did not hamper the spreading. In recent years this tradition of commemoration was revitalized. This time even in combination with a wrong date: the day when the French garrison of Metz surrendered. Moreover, it is described even by officials as an act of traditional religious tolerance in the German armed forces. (shrink)

The playful manipulation of ritual, literary, and legal elements marks the Festival of Laughter in Book 3 of the Metamorphoses (1–11) as one of the most innovative episodes of Apuleius’ novel. This article examines the rhetorical and judicial strategy adopted by the prosecutor and the defendant in the mock-trial. It also argues that Lucius’ defense speech is modeled on Cicero’s Pro Milone. By revitalizing the portrait of Cicero acting in defense of Milo, the learned novelist devises a new, amusing form (...) of entertainment, increasing the fictionality of the oratorical-theatrical performance and making Lucius-Cicero producer, performer, and victim of the collective hoax. (shrink)

In his Realism, Mathematics, and Modality, Hartry Field attempted to revitalize the epistemological case against mathematical platontism by challenging mathematical platonists to explain how we could be epistemically reliable with regard to the abstract objects of mathematics. Field suggested that the seeming impossibility of providing such an explanation tends to undermine belief in the existence of abstract mathematical objects regardless of whatever reason we have for believing in their existence. After more than two decades, Field’s explanatory challenge remains among the (...) best available motivations for mathematical nominalism. This paper argues that Field’s explanatory challenge misidentifies the central epistemological problem facing mathematical platonism. Contrary to Field’s suggestion, inexplicability of epistemic reliability does not act as an epistemic defeater. The failure to explain our epistemic reliability with respect to the existence and properties of abstract mathematical objects is simply one aspect of a broader failure to establish that we are epistemically reliable with respect to abstract mathematical objects in the first place. Ultimately, it is this broader failure that is the source of mathematical platonism’s real epistemological problems. (shrink)

This article offers a commentary on some passages of the Introduction to the second volume of the Antropología trascendental, where Polo proposes the act of human being according to the character of además, which is equivalent to the personal living in view of its conversion, on a transcendental level, with the personal freedom and the intimacy as higher transcendentals than those of principial being. In addition, the decrease of essential level proceeding from these personal transcendentals is equivalent to the essential (...) human life increasing without restriction, in which natural organic individual life is actively received, and which is thereby spiritually revitalized. (shrink)

Scientific misconduct includes the fabrication, falsification, and plagiarism (FFP) of concepts, data or ideas; some institutions in the United States have expanded this concept to include “other serious deviations (OSD) from accepted research practice.” It is the absence of this OSD clause that distinguishes scientific misconduct policies of the past from the “research misconduct” policies that should be the basis of future federal policy in this area. This paper introduces a standard for judging whether an action should be considered research (...) misconduct as distinguished from scientific misconduct: by this standard, research misconduct must involve activities unique to the practice of science and must have the potential to negatively affect the scientific record. Although the number of cases of scientific misconduct is uncertain (only the NIH and the NSF keep formal records), the costs are high in terms of the integrity of the scientific record, diversions from research to investigate allegations, ruined careers of those eventually exonerated, and erosion of public confidence in science. Existing scientific misconduct policies vary from institution to institution and from government agency to government agency; some have highly developed guidelines that include OSD, others have no guidelines at all. One result has been that the federal False Claims Act has been used to pursue allegations of scientific misconduct. As a consequence, such allegations have been adjudicated in federal courts, rather than judged by scientific peers. The federal government is now establishing a first-ever research misconduct policy that would apply to all research funded by the federal government regardless of which agency funded the research or whether the research was carried out in a government, industrial or university laboratory. Physical scientists, who up to now have only infrequently been the subject of scientific misconduct allegations, must nonetheless become active in the debate over research misconduct policies and how they are implemented since they will now be explicitly covered by this new federal wide policy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Medicine-Based Values?Åge Wifstad (bio)KeywordsEthics committees, judgment, common moralityToulmin's DiagnosisIn his classical article with the unforgettable title "How medicine saved the life of ethics" (Toulmin 1982), Stephen Toulmin claims that medicine saved ethics by giving the philosophers a positive reality check through medical challenges: (1) Ethics in medicine is a serious topic, not just something to discuss at seminars. If, for example, both A and B need treatment and there (...) are only enough resources for one, the fundamental interests of these two people compete against each other. (2) In clinical medicine, the individual case might demand a different approach than that suggested by theory. Similarly, an ethicist who is confronted by a diversity of medical cases becomes aware of the fact that solutions drawn from ethical theory can be irrelevant in practice. (3) The moral philosopher has often focused on the individual and his or her universal commitments. The fact that ethical dilemmas can have deep roots in practical challenges and must be understood within a certain context has been "forgotten." (4) In clinically relevant ethics, it is important to find solutions that all involved parties find reasonable. This revitalizes central Aristotelian schools of thought on, for example, ethical judgment and situational understanding.Today, there is a common understanding that in both the education of doctors and in the implementation of medical knowledge and technology there needs to be ethical guidelines and control. Toulmin wants us to see that the background for this agreement is multifaceted. It was not just the ethicists who saved the doctors. The doctors helped the ethicists to escape their academic isolation.Ethics CommitteesThe establishment of ethics committees is perhaps the most interesting example of this. Here it is especially clear how ethical judgment establishes a basis for decision making: Each case presented to an ethics committee is special because one cannot reference decisions made in similar cases. At the same time, we are expected to handle similar cases equally. Consideration of the concrete, individual case must be balanced with the principle of similar treatment. Second, as a committee member, one must interpret and respect ethical principles that cannot be easily defined. Every principle must be interpreted and implemented within a specific and concrete context. Third, one must consider the law, but seen isolated, the implications of relevant rules can be difficult to determine. Fourth, the status of principles and rules are open for interpretation. The most important example of this is the Declaration of Helsinki, which was established through cooperation between the worlds' doctors unions. The strength and end result of such a document can be discussed. Fifth, multiple but partly conflicting juridical and ethical considerations can be [End Page 179] relevant at the same time. An example: Decisions about confidentiality can prevent data gathering that is crucial in ensuring that a research project is scientifically acceptable. Two important ethical considerations are then put up against one another. As a sixth and final point, it can be mentioned that the ethics committee is expected to make a qualitative, scientific judgment. But what kind of quality judgment and how detailed it should be is up for discussion.Two Definitions of Ethical JudgmentThe fact that the committee must base their holistic decision on ethical judgment means that the committee, in an important sense of the word, stands freely: It can be difficult to refer to specific ethical rules or laws when making an external review of the committee's decision. Unless the committee has clearly not followed known principles and rules, then the committee is able to confront criticism by replying that the decision is based on holistic considerations, where many views have been taken into account. In this way, the usage of ethical judgment makes sure that the committee has freedom to act. The catch here is that the committee's responsibility becomes even more obvious. One cannot simply say that the decision is made based on rules and principles formulated by others, such as the state. The committee must, as a unit, be able to defend their decision.The complexity of the work of the committee can, however, make it more tempting to think about ethics in... (shrink)

ABSTRACT Born in periods of crises, utopias adopt a threefold structure: a critique of society, a spatial arrangement, and a new society sustained by this spatial arrangement. Accordingly, space and architecture are recognized as spatial levers to address crises and change societies. However, three problematic characteristics emerge from an analysis of past and contemporary utopias. First, utopias do not always advocate for new societal orders, as some tend to consolidate the existing ones. Second, they have evolved to be increasingly tangible. (...) Third, while appearing as collective narratives, they are written by a single hand, allowing little variations. To address these issues and revitalize their critical potency, utopias could act as beacons rather than concrete projects, work on processes rather than goals, and build collective narratives rather than monologues. Eventually, the article illustrates architecture’s twofold rationale: a means to physically build space and a critical tool to reflect on society. (shrink)

The new National Institutes of Health (NIH) Policy on the Use of a Single Institutional Review Board (sIRB) for Multi-Site Research was adopted primarily to simplify and speed the review of complex multisite clinical trials. However, speeding review requires overcoming a number of obstacles. Perhaps the most substantial obstacle is the time and effort needed to develop reliance agreements among the participating sites. We conducted 102 semistructured interviews with sIRB personnel, including directors, chairs, reviewers, and staff, from 20 IRBs that (...) acted as sIRBs for multisite research, including 6 commercial/independent sIRBs, and 10 university-based academic and 4 federal sIRBs. Almost without exception, the interviewees agreed that reliance agreements were complex, difficult to develop, and time-consuming. A major problem for relying sites was that different agreements specified different responsibilities for the relying sites. Attitudes differed about whether these problems will be resolved as IRB staff and managers become more experienced with sIRBs. However it is clear that the process of developing reliance agreements must be simplified. Federal assistance in standardizing at least some sections of reliance agreements might reduce the difficulties involved. (shrink)

Over 100 million Americans suffer from chronic pain, which causes more disability than any other medical condition in the United States at a cost of $560–$635 billion per year. Opioid analgesics are frequently used to treat CP. However, long term use of opioids can cause brain changes such as opioid-induced hyperalgesia that, over time, increase pain sensation. Also, opioids fail to treat complex psychological factors that worsen pain-related disability, including beliefs about and emotional responses to pain. Cognitive behavioral therapy can (...) be efficacious for CP. However, CBT generally does not focus on important factors needed for long-term functional improvement, including attainment of personal goals and the psychological flexibility to choose responses to pain. Acceptance and Commitment Therapy has been recognized as an effective, non-pharmacologic treatment for a variety of CP conditions. However, little is known about the neurologic mechanisms underlying ACT. We conducted an ACT intervention in women with chronic musculoskeletal pain. Functional magnetic resonance imaging data were collected pre- and post-ACT, and changes in functional connectivity were measured using Network-Based Statistics. Behavioral outcomes were measured using validated assessments such as the Acceptance and Action Questionnaire, the Chronic Pain Acceptance Questionnaire, the Center for Epidemiologic Studies Depression Scale, and the NIH Toolbox Neuro-QoLTM scales. Results suggest that, following the 4-week ACT intervention, participants exhibited reductions in brain activation within and between key networks including self-reflection, emotion, and cognitive control. These changes in connectivity strength were correlated with changes in behavioral outcomes including decreased depression and pain interference, and increased participation in social roles. This study is one of the first to demonstrate that improved function across the DMN, SN, and FPN may drive the positive outcomes associated with ACT. This study contributes to the emerging evidence supporting the use of neurophysiological indices to characterize treatment effects of alternative and complementary mind-body therapies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Oversight of Stem Cell Research in the United States: An UpdateMary A. Majumder (bio) and Cynthia B. Cohen (bio)On 9 March 2009, President Barack Obama (2009a) signed an executive order revoking the statement issued by President George W. Bush during a televised speech in August 2001, in which the latter had sharply restricted the scope of federally funded human embryonic stem cell (hESC) research to cell (...) lines derived (without federal funding) prior to 9:00 P.M. EDT on 9 August 2001. Action by President Obama to remove the cut-off date had been expected. It came as a surprise, however, that he gave authority to determine the scope of eligible research to the Director of the National Institutes of Health (NIH), referencing only general concerns of responsibility, scientific worth, and legality.1 This contrasted not only with the approach of former President Bush, but also with that of former President Clinton, who had expressed personal opposition to the creation of embryos for research and had a distinction between hESCs derived from embryos created for research and those derived from spare embryos enshrined in NIH policy.President Obama’s remarks upon signing the executive order give some insight into the thinking behind his approach. Implicit in them are the views that earlystage human embryos outside the womb do not have full moral status and that the destruction of human embryos in the effort to care for and ease the suffering of human beings who do have full moral status does not devalue human life. The President also stressed that the decision to pursue hESC research reflected not only his opinion, but also a broad social consensus. He concluded with strong ethical commitments on two fronts:We will develop strict guidelines, which we will rigorously enforce, because we cannot ever tolerate misuse or abuse. And we will ensure that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong, and has no place in our society, or any society.(Obama 2009b)The specific guarantee that President Obama gave against government support for the development of cloning techniques for human reproductive purposes made his silence on the use of cloning for research seem significant. Comments he had made in the course of the campaign (Obama 2008) suggested that he would affirm [End Page 195] the Clinton-era policy of limiting federal funding to hESCs derived from spare embryos. Did this silence mean that President Obama was opening the door to federal funding of research cloning when and if scientists might manage that feat?2009 NIH GuidelinesThe answer to this question and several others came on 17 April, when Raynard Kington, the acting director of NIH, released Draft NIH Guidelines for Human Stem Cell Research (NIH 2009), developed by an NIH Stem Cell Task Force, along with a request for public comment within 30 days of their publication in the Federal Register.2 The 2009 Draft Guidelines exclude from federal funding the derivation of hESCs, a restriction mandated by the reenactment of the Dickey-Wicker Amendment as part of the 2009 Omnibus Appropriations Act (Public Law 111-8, Division F, Title V, § 509). The 2009 Draft Guidelines also exclude the use of hESCs derived from embryos created for research purposes, and so represent a refusal to open the funding door as broadly as the NIH interpretation of the Dickey-Wicker Amendment might allow, at least for the time being.It appears that the drafters used as their starting point the 2000 NIH Guidelines for Research Using Human Pluripotent Stem Cells (NIH 2000) dating from the Clinton Administration, rather than more recent guidelines from the National Academy of Sciences (National Research Council 2005; 2007; 2008) and other private bodies. Both the format and content of the 2000 and 2009 NIH efforts are similar, making the departures in the latter stand out in high relief. We highlight departures related to informed consent to embryo donation, creation of human-nonhuman chimeras, and the role of an NIH task force, updating our original comment (Cohen and Majumder 2009).Informed Consent to Embryo DonationThe 2009 NIH Draft Guidelines require that certain statements... (shrink)

The number of women living with HIV/AIDS is increasing worldwide, and there is an urgent public health need to develop new user-initiated HIV prevention methods, including microbicides. Although funding for microbicide development has increased since 2000, financial support is provided predominantly by governmental agencies and private foundations. Many donors, including the US Agency for International Development (USAID) and the US National Institutes of Health (NIH), have policies that restrict how research funds may be used. Among these are the now-rescinded Mexico (...) City Policy, elements of the US Foreign Assistance Act, and restrictions on non-study-related care. The effect of these restrictions on the design and conduct of clinical research is poorly understood. As part of a recent mapping exercise conducted by the Global Campaign for Microbicides, we reviewed the impact of donor restrictions on seven HIV prevention trials. We found considerable confusion within the HIV prevention field as to whether and how Mexico City and other policies affect the use of research funds. We also found that these donor-imposed policies limited the level of care provided to trial participants and the types of capacity building projects undertaken. (shrink)

This dossier article contains four short and varied contributions from activists and other service and healthcare providers who have been agitating and working on the frontlines of HIV/AIDS in Ireland since the early 1980s. The dossier contains: (1) a history, by Bill Foley, of the early collective efforts of a group of gay men to provoke government action and healthcare under the umbrella of Gay Health Action (GHA) (2) a speech delivered by Dr. Erin Nugent to government officials on the (...) re-branding of HIV Ireland in 2015; (3) a brief history, recounted by Noel Donnellan, of ACT UP Dublin since it was revitalized in 2016 by a small cohort of dedicated activists from a dormant group into a vibrant collective that has achieved great legislative change with regards to pre-exposure prophylaxis (PrEP); and (4) a polemic, written by Thomas Strong, on living with HIV as a queer man in Ireland that demonstrates the ways in which HIV stigma not only thrives in but molds and shapes twenty-first-century gay men’s communities, both in real life and online. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:I Am Food: The Mass in Planetary PerspectiveMaria Reis HabitoI Am Food: The Mass in Planetary Perspective. By Roger Corless. Eugene, OR: Wipf and Stock, 2004. 104 pp.In this timely reprint of I Am Food: The Mass in Planetary Perspective (originally published by Crossroad in 1981), the late Roger Corless demonstrates the potential for spiritual and intellectual creativity contained within a stance of dual religious belonging. Corless passed (...) away in January 2007, but this book remains as a way for us to know him and to appreciate, as he did, the possibilities for spiritual revitalization and transformation that may be generated at the intersection and interpenetration of Christian and Buddhist traditions.Corless was raised as a Protestant but as a teenager became deeply engaged with the study of world religions and claimed Buddhism in particular as his own. Eventually he would become a scholar of Chinese Buddhism and a practitioner within the Gelugpa lineage of Tibetan Buddhism. At the same time, however, that the young Corless was being drawn to Buddhism, his connection to his Christian faith was also deepening; his profound experiences of the loving power of God could not be denied even if Christianity's theism could not be easily reconciled with Buddhism's doctrine of emptiness. Instead of leaving one religion for the other, he deepened his engagement with both. He did not seek to synthesize or reconcile Christianity and Buddhism but rather held these traditions together in a dynamic, creative tension and lived each one fully in its turn. When asked about his religious affiliation, Corless would respond playfully that he was "a Buddhist on Mondays, Wednesdays, and Fridays, a Christian on Tuesdays, Thursdays, and Saturday, and a Gaia worshipper on Sundays." In I Am Food, however, Corless shows us that on some Sundays, specifically at the celebration of the Mass, he was both Christian and Buddhist at the same time. The great contribution of this book is in its offering of a fresh and transformative approach to the Mass through the application of the symbolic structures of Tibetan Buddhist mandala visualization as a template for active participation in the communion ritual. [End Page 161]Corless's focus in this book is the ritual of the Mass as celebrated within the Roman Catholic tradition. His conversion from Anglicanism to Catholicism occurred much to his "own surprise," prompted by his discovery in Catholicism of "a curious growing center which had great power and potential." This center "brought together many insights which I had picked up from other religions, and moved them to a new synthesis. This synthesis was concentrated in the oddly named 'Mass' " (p. 13). I Am Food offers a scholarly and personal meditation on the meaning, symbolism, and power contained in this central ritual of Catholicism. This project is signaled in the grammatically awkward but intriguing title of the book's first chapter, "Why Is the Mass?" Corless knows that many routine churchgoers never think or dare to ask this question, and the few who do ask it rarely find satisfactory answers. His book seeks to encourage such questioning among those who are in search of a personal religious experience "away from the dullness of minimalist routine" (p. 34). His very lively, humorous, and slightly irreverent style is intended to take the boredom out of the Mass, providing a very personal and original guide to it, different from the series of "excellent, but ultimately claustrophobic, devotional books on 'the spiritual meaning of the Mass'" (p. 13).Among Christian writings that were influential for his understanding of the Mass, Corless names The Mass in Slow Motion (1948) by Ronald Knox, which attempts to describe the inner meaning of the Mass, and Pierre Teilhard de Chardin's Hymn of the Universe (1965), which describes a vision of the world as sacrament and celebrates Mass as a cosmic event. While Teilhard de Chardin inspires Corless's "planetary perspective" on the Mass, Nicholas Casabilas's A Commentary on the Divine Liturgy (1978) sharpens the focus on "the mystical significance of each and every act of the priest and people" (p. 13).Corless argues that what makes the Mass seem stifling is the notion of... (shrink)

Photo ID 222412412 © US Navy Medicine | Dreamstime.com ABSTRACT In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. INTRODUCTION Medical resources in an austere environment without quick recourse for resupply or casualty evacuation are often (...) limited. The shortage extends not only to supplies like blood products and drugs, but physicians and other medical personnel. In the midst of a mass casualty scenario, such as a battle that includes intense ground fighting, the medical staff will stretch scarce resources and triage casualties according to specific criteria. Typically, they proceed by providing care for the most severely wounded first, referred to here as conventional triage. At times, though, the staff may reverse the triage so that soldiers with minor wounds can return to the fight. In a mass casualty situation, when medical personnel apply conventional triage and treat casualties from opposing forces, a dilemma may arise. We argue that it can be permissible for military physicians to prioritize their own soldiers over enemy combatants in a mass casualty triage, where reverse triage does not apply. The case we will focus on is as follows: Battlefield Triage: During combat operations on a remote island in the Pacific Ocean, a compatriot soldier and an enemy combatant arrive at the compatriot soldier country’s medical treatment facility. Both have similar gunshot wounds to the abdomen, and they arrive with similar conditions. Both have low oxygen saturation and excessive blood loss. The sole physician only has enough time to stabilize one person. The scenario is brief, and we are aware that medical rules of eligibility will most often dictate how the physician proceeds,[1] but this scenario is useful in setting up the question we focus on in this paper: would it be wrong to favor the stabilization of a soldier just because the soldier is the physician’s compatriot? In other words, can nationality serve as an ethically justified tiebreaker in a situation such as Battlefield Triage?[2] In a non-military setting, the answer is clear: it would be unethical to treat someone based on non-medical considerations such as nationality. The AMA’s Code of Medical Ethics asserts that physicians have “ethical obligations to place patients’ welfare above their self-interest and above obligations to other groups.”[3] The World Medical Association’s Declaration of Tokyo affirms that “no motive, whether personal, collective or political, shall prevail against this higher purpose” of alleviating distress.[4] Physicians are taught early on that triage decisions must be medically indicated and made without consideration of factors such as race, ethnicity, religion, social status, and nationality. They are taught that public trust and obligations of justice grounded in equality demand that only medical indications be considered. But military physicians in a military setting are beholden to obligations, duties, and responsibilities as members of the military, and when these obligations, duties, and responsibilities conflict, as they do in Battlefield Triage, which loyalties win out and why?[5] Critics of partiality on national grounds argue that partiality undermines public trust in medicine and justice because everyone should be treated equally regardless of nationality.[6] Proponents of partiality argue that military obligations supersede equality and that justice requires partiality in such cases.[7] Despite the critics’ disagreement, both agree that there is a morally right, perhaps even blameless, course of action. Drawing on insights from virtue ethics, we argue that Battlefield Triage is a moral tragedy in which justice is unattainable and there is no action without moral cost. The assumption that there is a morally right choice is flawed. We argue that while no decision in this scenario is free from moral blame, there are reasons to favor treating one’s soldiers over enemy combatants. I. The Case Against Partiality There is a common assumption that there is a morally right or just decision in Battlefield Triage. A number of organizations and scholars claim that it is wrong for military physicians to favor their own soldiers on the grounds of nationality or some form of ‘group membership.’ (In a conflict involving service members from multiple nations working as a coalition, a soldier from an allied country may receive the same priority as the US service member due to ‘group membership.’) The World Medical Association’s WMA Declaration of Lisbon on the Rights of the Patient, which was reaffirmed in 2015, posits that, “[i]n circumstances where a choice must be made between potential patients for a particular treatment that is in limited supply, all such patients are entitled to a fair selection procedure for that treatment. That choice must be based on medical criteria and made without discrimination.”[8] This echoes what was set forth in Article 12 of the Geneva Conventions, which states that “[o]nly urgent medical reasons will authorize priority in the order of treatment to be administered.”[9] The argument for impartiality in Battlefield Triage is that every person is morally equal, and equality entails that medical distribution is, “based on a combination of medical need and urgency.”[10] This is in keeping with the bioethical principles that are generally applied.[11] II. The Case for Partiality On the other side, there are arguments that favoritism is the ethically right decision in Battlefield Triage.[12] The argument asserts that members of the military form a morally significant community of friends and participation in these relationships demands partiality. Just as parents have strong ethical duties to their children and not just any children, military personnel have ethical duties to their group, a group that involves an affirmation of mutual aid and support. Some have termed these ‘associative duties. According to Michael Gross, obligations of friendship, care, and solidarity “leave very little room for generally applicable principles of justice that would obligate a medic to treat enemy or non-compatriot wounded ahead of their compatriots.”[13] This is true in Battlefield Triage, but it may also be true even if the enemy’s soldier were more seriously wounded: “the ethics of small group cohesion, largely an ethics of care, mostly replaces the demands of impartial justice.”[14] In a more recent article, Gross explains that preferential treatment is ethically justified based on fighting capability and “the special obligations people owe friends, family, and, no less, comrades-in-arms.”[15] To not show partiality to the US soldier would be morally wrong on the grounds of friendship and mutual care.[16] III. The Moral Tragedy of Battlefield Triage Defenders and critics of Battlefield Triage favoritism based on nationality both frame their position as just or fair. For example, Justin List argues that physicians are “bound to practice medical neutrality,”[17] Marcus Adams denies that physicians “possess special ethical obligations” to enemy combatants because of their profession.[18] These perspectives assume that there is a morally right decision and that justice is attainable. The assumption that there is or can be a morally right Battlefield Triage decision, and we need to put our heads together to figure it out, remains strongly entrenched. However, the facts of the situation should give us pause; there are too many people and too few resources, and this demands a decision-making process that determines who will receive scarce resources. By its very nature, a battlefield triage decision has to be made based on some characteristic or value, a characteristic or value that will inevitably favor some at the expense of others. This is precisely why competing analyses “in the military context struggle to resolve these conflicts satisfactorily.”[19] Drawing on the insights of virtue ethics, we suggest that Battlefield Triage is a moral tragedy. Virtue ethics suggests that morality is about acting virtuously, which is to say that we should do what a virtuous person would do in the situation. Ethics is about figuring out how a just, wise, compassionate, loving, and fair person would act, and then doing that, as one grows in virtue. But life is not always clear cut, and it is possible that virtuous people may find themselves in a moral tragedy, a situation in which, through no fault of one’s own, a person must make a morally objectionable decision. After the action the virtuous person “emerges having done a terrible thing, the very sort of thing that the callous, dishonest, unjust, or in general vicious agent would characteristically do.”[20] Stated differently, a moral tragedy presents a virtuous person with two or more courses of action, all of which have a moral cost.[21] In Battlefield Triage, no matter how the physician goes about deciding, there is going to be defensible concern from those not saved. The fact that there are more people than can be helped fosters competing values in battlefield triage: maximize lives saved, treat people equally, treat the worse off, and support the war effort. Treating people equally may create tension between treating the worse off, maximizing lives saved, and supporting the war effort. Reverse triage is a case in point, as supporting the war effort conflicts with treating the worse off first, as is a fair lottery system since deploying a lottery may not maximize lives saved or support the war effort. There can be reasons why one person is selected over another, to be sure. Yet, there are reasons for making a decision, and that the decision is subject to legitimate moral concern is another. To recognize the moral tragedy of Battlefield Triage is to recognize the impossibility of acting blamelessly in the situation. In this situation, the virtuous military physician is going to have to sacrifice important values such as justice, compassion, and respect for others, even with a defensible criterion in hand. The physician will grieve this sacrifice accordingly. The physician may find her decision difficult or stressful, and rightly so, because of what her circumstances require of her. This kind of moral tragedy results “in actions which betray and violate the rights of persons to whom there may be a strong duty of care. When this happens, it properly triggers an appropriate moral emotion since our moral integrity has been violated and this affects how we think of ourselves and what we have become.”[22] Rather than view her triage decision as the morally superior choice, the virtuous military physician will view her decisions in these circumstances in a different light: it is the least bad option in a terrible situation, and she did something ethically problematic, something that is contrary to her moral character. She deeply regrets the circumstances in which she had to act. IV. Virtue Ethics A virtue ethicist has insight into how one should go about deciding what to do in a moral tragedy, although virtue ethics may not be as helpful as one may hope. The goal of the virtuous military physician in Battlefield Triage is to adopt the best course of action or the action that she feels she ought to do, all things considered. This does not make her choice devoid of serious wrongdoing—a decision must be made, but that does not make it just. The virtuous military physician will approach the situation with courage, responsibility, and insight. She will think about the decision carefully, wisely, and conscientiously; she will weigh the goods and harms of the choices before her, in conjunction with a proper conception of the good life, human worth, and understanding of her obligations to others—including chain of command, fellow soldiers, and the medical community. She is attuned to the value of human life and has a reasonable idea of the various ways her decisions will affect others. She recognizes that she is in this non-ideal situation through no fault of her own: she is not the one fighting in battles; she is serving her country as a physician, whose job it is to save lives, treat everyone justly, and promote military objectives. She regrets the decision she is forced to make in battlefield triage, acting “with immense regret and pain,” Hursthouse explains, “instead of indifferently or gladly.”[23] This is because, no matter what decision is made, the virtuous military physician “does something terrible or horrible,” something she otherwise would not do and is contrary to her values.[24] V. A Resolvable Moral Tragedy Instead of asking whether there is a morally right decision, in which a decision is morally blameless and above reproach, the virtue ethicist asks whether there is a decision with a convincing rationale, knowing that a decision can have a clear rationale but still be morally tragic. It is perfectly reasonable to think that different virtuous persons will arrive at different courses of action: “two virtuous agents, in the same situation,” Hursthouse writes, “may act differently” in irresolvable moral tragedies, in cases in which there is no clear course of action.[25] Because a person must act in a moral tragedy, one goal is to identify reasons for choosing the chosen action. Some decisions are clearly indefensible—treating neither the compatriot soldier nor the enemy combatant in Battlefield Triage would be wrong—and some decisions are more problematic than others. If the military physician selects to treat the soldier because she does not like the enemy combatant’s skin color, such a reason would be deeply problematic. But much of the debate over how to act in a moral tragedy is not over clearly indefensible or problematic criteria. Instead, the literature is largely about different standards or implementations of justice. Some scholars defend nation-impartial triage as right, while others defend nation-aware triage as right, and each argues that the other side is promoting an unjust or otherwise wrong solution to Battlefield Triage. We suggest that Battlefield Triage is a resolvable moral tragedy and that virtue ethics offers convincing reasons to prefer the treatment of the compatriot soldier rather than the enemy combatant on the grounds of national identity. Virtues are integral to living a good life, a flourishing life, but as Aristotle observed long ago, human beings are inherently social, interdependent and interconnected in profound ways.[26] This goes beyond the obvious fact that we need each other to survive day to day (one person makes clothes, another farms, and another makes tools); the claim is that a good or flourishing life depends in large part on one’s social network or community. This is why many of Aristotle’s moral virtues are other facing: justice, friendship, generosity, and magnanimity, to name a few. Courage, a typically self-facing virtue, is understood by Aristotle to be the virtue that regards one’s fear of death in battle, a battle fought on behalf of one’s city.[27] All of this remains true today. Namely, there is an important sense in which our community matters to our lives: it is easier to live a good, flourishing life if one is part of a good, flourishing community. Our community is made up of smaller groups, and it is more accurate to say that we are simultaneous members of different groups within a broader community. A person may be part of a family, friend group, research team, large state university, city, state, and nation. Groups can function well or not, as we all have experienced, and this suggests that there are virtues or excellences that groups can instantiate. Good groups are unified in purpose, with each member doing their duty alongside others for the attainment of that purpose. Good groups manifest solidarity among their members. Although Aristotle does not list solidarity as a virtue, a number of modern-day virtue ethicists have begun examining how group solidarity can be a virtue that contributes to a good or flourishing life.[28] Solidarity is not conceptualized as an individual virtue, a virtue possessed by a person in isolation of others; instead, it is a collective virtue, a virtue that is shared among members of a defined group with particular ends.[29] “A group has solidarity to the extent that its members are disposed to: (1) share values, aims, or goals; (2) care about those values, aims, or goals; (3) act in accordance with those values, aims, or goals; (4) trust the testimony of other group members with respect to those values, aims, and goals; and (5) feel a sense of belonging to the group.”[30] The virtue of collective or group solidarity involves individuals having special concern for each other, shared aims and values, trust, loyalty, and a sense of belonging with these specific others. There is a oneness to the group in the pursuit of a definite goal or purpose, involving mutual support and affirmation of each member. As such, the group has ends and goods above and beyond the good of each individual person. Sometimes solidarity requires personal sacrifice for the collective (for example, a father sacrificing food so his child can eat). The virtue of collective or group solidarity is important to the military and medical community at every level, and for clear reasons. In the military, there is a clear hierarchy of command, unity of purpose and end, mutual trust and support in complex settings, and so on. Soldiers need to know they can count on one another, and solidarity grounds a soldier’s ability to trust others and be assured of mutual aid. In medicine, solidarity maintains self-regulation of the profession, shared values and goals, as well as public support, not to mention that day-to-day operations require physician trust, engagement, and effort toward the ends of clinical care. Physicians need to work together, along with others, in pursuit of health, and disunity is sowed when there is mistrust, selfishness, or disengagement among the healthcare team and organization. Importantly, just as we are all members of various groups and hence may manifest group solidarity in different settings, the virtuous military physician instantiates collective solidarity with both the medical profession and the military. Her dual loyalty contributes to the moral difficulty of acting in Battlefield Triage. The military physician has competing obligations to distinct groups and cannot satisfy all obligations in Battlefield Triage. Solidarity with the military supports the consideration of favoring the soldier for reasons of national identity, whereas solidarity with the medical community does not. Something has to give, which is why it is a moral tragedy. The virtuous military physician, therefore, must weigh the costs of each course of action. To fulfill her obligations to the medical community would require that she does not use nationality and other non-medical considerations in Battlefield Triage. Since the soldier and enemy combatant are equally injured, justice would demand a random process, perhaps a flip of the coin. Although this may satisfy obligations the military physician has to the medical community, this would be costly to the physician’s military group. If word gets out that the physician decides who to treat based on a coin toss, soldiers, families, and citizens may become frustrated and angry. Soldier morale may go down if it becomes known that a coin flip led to the preventable death of a soldier and the saving of an enemy combatant who had killed (or attempted to kill) other soldiers. As Gross highlights, military solidarity involves a mutual aid promise that military personnel promise to help one another.[31] A military physician is part of the military and, as such, is part of the mutual aid promise, which would appear to be violated if the physician flips a coin. Treating a member of one’s own team may be psychologically more beneficial than treating an enemy combatant and may lead to less moral distress.[32] Finally, treating soldiers rather than enemy combatants promotes broader military and social aims, including returning soldiers to health, maintaining unity of purpose, and minimizing community suffering from a soldier’s death. Favoring members of one’s group, that is, triage based on nationality in Battlefield Triage, would fulfill obligations of military group loyalty, which is contrary to the values and duties of medicine. It does not seem as though showing favoritism in this particular situation is very costly to the medical community or general public, but this is because there is recognition that the physician is in the military. Medicine is impartial to non-medical indications partly because of fairness and to promote public trust in medicine. However, Battlefield Triage is unique, as medicine is being practiced in a non-public, wartime setting. In ordinary circumstances, a patient’s identity is irrelevant, and physicians ought not play favorites. Since Battlefield Triage is not an ordinary circumstance, decisions based on patient identity may not undermine public trust in medicine. In addition, it is contestable that fairness in Battlefield Triage requires that no consideration be paid to one’s nationality. Fairness is about giving each person their due, what is owed to them, and the case can be made that soldiers who place themselves in danger for the sake of the common good or a just cause are owed special attention when they suffer harm in the line of duty. In other words, soldiers voluntarily undergo risk to themselves for the greater good, and society owes them for this sacrifice. This plausibly includes preferential treatment in a situation such as Battlefield Triage. So, while the medical community affirms justice demands non-preferential treatment, the military community can affirm the opposite. The demands of fairness are unclear at best or in conflict in this situation: demands of physician justice decry favoritism, while demands of military justice support favoritism. Triage not based on nationality is arguably unfair and triage based on nationality may not undermine public trust, after all. All things considered, there is a clear rationale for favoring nationality-based preferential treatment in Battlefield Triage. Adopting a nationality-based preference in this situation is more defensible than not. This does not make such a decision ethically right or just. Preference based on nationality is the least bad decision, but it is not morally blameless. It involves one in a serious moral wrong, a wrong otherwise avoided and contrary to one’s character. The virtuous military physician is in a situation in which obligations conflict, and we disagree with Gross, who posits that care of fellow soldiers “is important to the near exclusion of all else.”[33] Gross fails to appreciate the collective virtue of solidarity as applied to those in medicine. The military physician has duties to fellow soldiers but also to fellow physicians, to the medical community, and humanity. To favor a soldier on grounds of nationality violates her duties and responsibilities to this latter group. She is involved in a moral tragedy and can only seek the most just action given the circumstances, yet, at least in virtue ethics, the action remains far from blameless. CONCLUSION We argue that Battlefield Triage is a moral tragedy, meaning that it is a situation in which there is no morally blameless decision and that the demands of justice cannot be satisfied. As such, the virtuous military physician incurs a moral cost to acting as she does—there is a moral residue. However, despite being a moral tragedy, there are clear reasons to act in favor of treating one’s own, considering group solidarity. As such, these kinds of tragedies are resolvable: virtuous military physicians should favor treatment of their own, although they would do so with sorrow. - [1] Militaries set forth medical rules of eligibility or guidelines used to determine whether a person qualifies for specific medical interventions or treatments in certain circumstances, and these guidelines are binding for a military physician. For example, despite opposition from medical organizations, militaries have adopted reverse triage guidelines for military physicians to follow. For ethical discussion, see Falzone, Elisabeth, P. Pasquier, C. Hoffmann, O. Barbier, M. Boutonnet, A. Salvadori, A. Jarrassier, J. Renner, B. Malgras, and S. Mérat. "Triage in military settings." Anaesthesia Critical Care & Pain Medicine 36, no. 1 (2017): 43-51. https://doi.org/10.1016/j.accpm.2016.05.004 [2] There are issues that are related to this, including the triage of civilians and allied soldiers. We set related issues aside for purposes of this paper [3] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [4] American Medical Association, Code of Medical Ethics: Current Opinions with Annotations, 2004–2005 ed. (Chicago, IL: AMA, 2004), 300. [5] This is termed the “dual loyalty” dilemma in military medicine and has been described at length elsewhere: Institute of Medicine (US) Board on Health Sciences Policy. Military Medical Ethics: Issues regarding Dual Loyalties: Workshop Summary. Washington (DC): National Academies Press (US); 2008. Toward a Framework for Resolving Dual Loyalties. Available from: https://www.ncbi.nlm.nih.gov/books/NBK214853/ [6] See Kenneth G. Swan and K.G. Swan, Jr., “Triage: The Past Revisited,” Military Medicine 161:8 (1996): 448–452. https://doi.org/10.1093/milmed/161.8.448; Jerome A. Singh, “American Physicians and dual loyalty obligations in the ‘war on terror,’” BMC Medical Ethics 4.4 (2003): 1–10. https://doi.org/10.1186/1472-6939-4-4; Beam, Thomas E. "Medical Ethics on the Battlefield." Military Medical Ethics: Sect. IV. Medical ethics in the military. Medical ethics on the battlefield: the crucible of military medical ethics 2 (2003): 369-402; Hereth, Blake. "Health justice for unjust combatants." Journal of Military Ethics 20, no. 1 (2021): 67-81. https://doi.org/10.1080/15027570.2021.1949782. [7] See Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. Gross, Michael L. "Comradery, community, and care in military medical ethics." Theoretical medicine and bioethics 32 (2011): 337-350. https://doi.org/10.1007/s11017-011-9189-6. Gross, Michael L. "The limits of impartial medical treatment during armed conflict." In Military medical ethics for the 21st century, pp. 71-84. Routledge, 2016. [8] World Medical Association, WMA Declaration of Lisbon on the Rights of the Patient. 5 December 2022, https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/ [9] Geneva Convention for the Amelioration of the Condition of Wounded, Sick in Armed Forces in the Field. 12 August 1949. https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.30_GC-I-EN.pdf. [10] List, Justin M. "Medical neutrality and political activism: physicians' roles in conflict situations." In Physicians at war: The dual-loyalties challenge, pp. 237-253. Dordrecht: Springer Netherlands, 2008. 240 [11] Beauchamp, T., and J. Childress. 2013. Principles of Biomedical Ethics, 7th ed. Oxford, United Kingdom: Oxford University Press. [12] Adams, Marcus P. "Triage priorities and military physicians." In Physicians at war: The dual-loyalties challenge, pp. 215-236. Dordrecht: Springer Netherlands, 2008. [13] Gross, "Comradery, community, and care in military medical ethics," 347. [14] Gross, “Comradery, community, and care in military medical ethics,” 349. [15] Gross, Michael L. "When medical ethics and military ethics collide." Narrative inquiry in bioethics 13, no. 3 (2023): 199-204. 202 https://dx.doi.org/10.1353/nib.2023.a924191 [16] Our argument draws on virtue ethics, from which care ethics derives, and it is worth clarifying how our argument relates to Gross’s. We do not think that the virtue of friendship grounds triage decisions, for we think it is unlikely that the physician and wounded soldier are friends. Instead, as explained below, we think the collective virtue of group solidarity better captures the moral significance of group loyalty and that Gross would agree with us. But since military physicians are part of distinct groups, with competing obligations, the military physician will be forced to sacrifice a value in battlefield triage cases. In other words, we think Gross downplays the dual group membership of a military physician. [17] List,”Medical neutrality and political activism,” 250. [18] Adams,”Triage priorities and military physicians,” 235. [19] London, Leslie, Leonard S. Rubenstein, Laurel Baldwin-Ragaven, and Adriaan Van Es. "Dual loyalty among military health professionals: human rights and ethics in times of armed conflict." Cambridge Quarterly of Healthcare Ethics 15, no. 4 (2006): 381-391. 383. [20] Hursthouse, R. On Virtue Ethics. OUP 1999. 74 [21] Nussbaum, Martha C. "The costs of tragedy: Some moral limits of cost-benefit analysis." The Journal of Legal Studies 29, no. S2 (2000): 1005-1036, 1007. [22] De Wijze, S. (2005). Tragic-remorse–the anguish of dirty hands. Ethical theory and moral practice, 7(5), 453-471, 457. https://doi.org/10.1007/s10677-005-6836-x [23] Hursthouse, 73 [24] Hursthouse, 81 [25] Hursthouse, 72 [26] Aristotle, Politics 1253a8. Reeve, C. D. C., Indianapolis: Hackett Publishing Co., 2017 [27] Aristotle, Nicomachean Ethics. III.6.114a, 34-35. 2002, Nicomachean Ethics, Christopher Rowe (trans.), Oxford: Oxford University Press [28] Byerly, T. Ryan, and Meghan Byerly. "Collective virtue." The Journal of Value Inquiry 50, no. 1 (2016): 33-50. https://doi.org/10.1007/s10790-015-9484-y; Federico, Veronica. "Conclusion: solidarity as a public virtue." Solidarity as a Public Virtue (2018): 495-542. https://doi.org/10.5771/9783845290058. Rehg, William. "Solidarity and the common good: An analytic framework." Journal of Social Philosophy 38, no. 1 (2007): 7-21. https://doi.org/10.1111/j.1467-9833.2007.00363.x [29] Byerly and Byerly. "Collective virtue." 43 [30] Battaly, Heather. "Solidarity: Virtue or vice?." In Social virtue epistemology, pp. 303-324. Routledge, 2022. 304 [31] Ibid., 2011: 341 [32] It might be thought that displaying altruism by helping an enemy combatant at the expense of one’s fellow soldier may be psychologically satisfiying. For evidence that military physicians find it difficult to treat enemy combatants, see Lundberg, Kristina, Sofia Kjellström, Anders Jonsson, and Lars Sandman. "Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties." Military medicine 179, no. 8 (2014): 821-826. https://doi.org/10.7205/MILMED-D-14-00038. Lamblin, Antoine, Clément Derkenne, Marion Trousselard, and Marie-Ange Einaudi. "Ethical challenges faced by French military doctors deployed in the Sahel (Operation Barkhane): a qualitative study." BMC Medical Ethics 22 (2021): 1-13. https://doi.org/10.1186/s12910-021-00723-2 [33] Ibid., 2011: 344. (shrink)

The nature of this book is fourfold: First, it provides comprehensive education in ontology, epistemology, logic, and ethics. From this perspective, it can be treated as a philosophical textbook. Second, it provides comprehensive education in mathematical analysis and analytic geometry, including significant aspects of set theory, topology, mathematical logic, number systems, abstract algebra, linear algebra, and the theory of differential equations. From this perspective, it can be treated as a mathematical textbook. Third, it makes a student and a researcher in (...) philosophy and/or mathematics capable of developing a holistic approach to reality, of undertaking interdisciplinary endeavors, of understanding (and possibly contributing to) advances and research projects in different academic disciplines, and of having more sources of inspiration and pleasure. From this perspective, it can be treated as a contribution to pedagogy and as an attempt to refresh and, indeed, revitalize modern philosophy. Fourth, it seeks to defend, refresh, and enrich philosophical and scientific structuralism and dynamical philosophy (known also as dynamism). From this perspective, this book can be treated as a research monograph on structuralism and dynamism, tackling the fundamental problems of reality, truth, and consciousness. In this context, Nicolas Laos expounds and proposes: (i) the concepts of dynamized time and dynamized space; (ii) a theory and method that he calls the "dialectic of rational dynamicity"; and (iii) his attempt to consider the fundamental problems of philosophy and science from the perspective of the dialectic of rational dynamicity. Thus, this book pertains to every field that is controlled by the function of consciousness, namely, being, knowing, and acting. The philosophy of rational dynamicity, as the author explains in this book, is a way of contemplating the laws of motion of nature, history, and spirit. (shrink)

This paper engages with the artistic practice and work of Vanessa Dion Fletcher from my perspective as a non-Indigenous academic and curator. Dion Fletcher and I have worked together over the past several years through discussions about her work, studio visits, and various events. In her art practice, Dion Fletcher uses porcupine quills and menstrual blood to inquire into a range of issues and concepts including Indigenous language revitalization, feminist Indigenous corporeality, Land as pedagogy, decolonization, and neurodiversity. In particular (...) her work confronts the ways that Indigeneity, the queer and gendered body, and disability are rendered expendable. In this paper I engage with Dylan Robinson’s “sovereign sense”: a transcorporeal mode of perception that is affective, land-based, and formed through relations between human and non-humans. Dion Fletcher’s work makes palpable this sense of sovereignty through its unruly and mutating feltness. Further, her work makes visible feminist Indigenous artistic acts of resurgence alongside the frictions at the intersections of settler colonialism and disability. Following Karyn Recollet, I contend that Dion Fletcher’s work activates an Indigenous affective experience of futurity and creative intimacy that in turn imagines disability and Indigeneity as sites through which new pedagogical relations can be formed. (shrink)

This volume, which is rooted in biogeophysical studies, addresses conceptions of political action in the Anthropocene and the tension between a desire to accomplish the Promethean project of modernity and a post-Promethean approach. This work explores the idea of ​​an anthropological mutation of political consolidation from a “post-Promethean togetherness”, to creating the capacity to act together. The political thinking of the human condition developed by Hannah Arendt is important here as a resource for thinking about humanity in terms of human (...) adventure. This has three dimensions: hubris, the world and coexistence referring respectively to the logic of profit of the homo oeconomicus, the logic of responsibility of the homo collectivus and the logic of the hospitality of the homo religatus. The intellectual and political attitude outlined in this book is an extension of critical theory: the work also puts forward a critique of what poses a problem in our relationship to the world and suggests how to overcome it, the ultimate goal being social transformation. The author propose an uprising and an anthropological consolidation of politics based on the revitalization that is brought about by the sharing of a conviviality both between humans and with what is non-human. The identification of conviviality as an educational paradigm to survive the Anthropocene gives us the much needed reason for hope despite this heritage of the Anthropocene. In addition to Arendtian thinking, this critical theory for the Anthropocene draws on the political thinking of several contemporary authors including Maurice Bellet, Hartmut Rosa, Andreas Weber, Dominique Bourg, and Christian Arnsperger. This volume is of interest to researchers in the Anthropocene. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.1 (2002) 95-102 [Access article in PDF] Bioethics Inside the Beltway Some Initial Reflections on NBAC Eric M. Meslin and Harold T. Shapiro On 3 October 2001, Executive Order 12975 expired, and with it so too did the National Bioethics Advisory Commission (NBAC). Established by President Bill Clinton in 1995, NBAC was the fifth national committee since 1974 created to advise the U.S. government (...) on bioethics policy. In the long political tradition in this country that national bioethics policy advice should use temporary rather than permanent bodies, NBAC followed in the footsteps of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974-78); the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1980-83); the Ethics Advisory Board (1978-80); and the Biomedical Ethics Advisory Committee (1988-89). Arguably, other distinguished panels could lay claim to recognition as a "national bioethics committee" including the Advisory Committee on Human Radiation Experiments (ACHRE) (1994-95); the Fetal Tissue Transplantation Research Panel (1988); the Human Embryo Research Panel (1994); and the National Institutes of Health (NIH) Recombinant DNA Advisory Committee (RAC), which continues to function.These committees and commissions form a kind of a continuum, albeit occasionally interrupted by periods during which no such bodies existed. Each arose from a particular confluence of events and circumstances. NBAC was no different; its history can be traced both to a series of discussions within the White House Office of Science and Technology Policy beginning in 1993 (NBAC 1998a, p. 3), and to a specific recommendation from ACHRE that called for a national committee to address ethical issues in human subjects research (ACHRE 1995, p. 817). Nbac's Impact In his useful comparison of the accomplishments of the National Commission and the President's Commission, Brad Gray concluded that seven lessons were learned, the sixth of which was that "nothing substitutes for having a perceptible impact on either policy or practice" (Gray 1995, p. 304). Assessing NBAC's [End Page 95] impact on "policy or practice" is difficult, particularly given the fact that it so recently completed its work. More time may be needed before a full assessment can be undertaken of the impact of its six reports (and their total of 120 recommendations). Instead, in this essay we offer some reflections on NBAC's initial impact, using some specific examples of how bioethics gets done Inside the Beltway. Eliciting Reaction If immediate reaction by the White House is any measure of impact, then Cloning Human Beings (NBAC 1997) had a significant one. The day after he received this report in a Rose Garden ceremony, President Clinton submitted a bill to Congress that would have extended the moratorium on federal funding to create a child using somatic cell nuclear transfer. This bill never passed, nor has any other bill emerged that has enjoyed the support of the House and the Senate. Five states have enacted legislation to date, but these vary in their permissibility from bans on all forms of cloning to bans similar to the one proposed by NBAC, which recommended a time-limited prohibition only on somatic cell transfer to create a child (reproductive cloning).If the Cloning report elicited speedy action from the White House, this paled in comparison to the reaction that led to and, in turn, was created by Ethical Issues in Human Stem Cell Research (NBAC 1999a). Those who believe that government moves slowly need only be reminded of the events of 8-14 November 1998 (and, as we shall mention below, the further events of 14 July 1999). Some will recall that early in the second week of November 1998, James Thomson and his colleagues published in Nature and John Gearhart and his colleagues published in the Proceedings of the National Academy of Sciences that they had isolated and cultured human primordial stem cells and germ cells respectively. Within days of these remarkable reports, Advanced Cell Technology (ACT) announced via an article written by Nicholas Wade in the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:PHARAOH'S.MAGICIANS: THE ETHICS AND EFFICA:CY OF HUMAN FETAiL TISSUE TRANSPLANTS ROBERT BARRY, O.P. Program for the Study of Religion University of Illinois, Champaign-Urbana DARREL KESLER Department of Animal Sciences University of Illinois, Champaign-Urbana. IN RECENT YEARS increasing attention ha;s been given to v:rurious types of scientific riese,arch involving the human fetus. In the 1970s, :a tremendous amount of concern was expres1 sed IJ.'egiaroing the fetus,a;.s a rSU!bject of e~erimenrtation. (...) In this debate, the announced " research impeiiat:i:ve " was pos,ed against other moral imperativ;es.1 Following much soctiet :JaJl drebarte, protootlive meiaisumeis 1 WeIDe il!dopited 1by oompireihensive regiutatiions in 1975 estaiblishiing protections foT a number of research sUibjects. These regulrutions protect the fetus from non-beneficiail experimentation. that iworuild pose more than minima;l risk rto the fetus. Current debates in science and ethics now swirl arlOiund a new topic regarding human '.fetal life: the fetus as a sourrce of tissue for triansplaintation into other persons ais run e~erimental thempy. It is an issue that is rapidly moving torward the same Jevel of" research imperative" as did the earlier debate on the 1 See Paul Ramsey, The Ethics of Fetal Research (New Haven: Yale University Press, 1975): "Today one often hears statements like' Fetal Research must be done,' or 'It would be immoral not to do this research'" (P. xv). The validity of such opinions and utterances entirely depends on a netbenefits ethics, and the validity of that moral universe has been called increasingly into question in recent years. 575 576 ROBERT BARRY, O.P. AND DARREL KESLER ~etus as subject. Recently,,a new level of intensity was added to this deharte rby the imposition of an indefinite moratorium on federal support for research on transplantrution experiments inv;olving human.fetirul tissue and other!humans. 1Thls " :indefinite moratorium " w1as a result of a process that 1 began with research p110posaJs considered rby the National In- 'stituites of Health (NIH) in October 1987. In Marich 1988 a momtorium wa;g plaioed on the r:eseareh, and an 1advisory panel was summoned to consider the ethical issues involved. This panel presented 1a cveoommendation for the procedures. However, the Secretary of the Department of Health and Ruman Se1wfoes (HHS), Dr. Louis Sullivan, decided against the research proposal on etmcal grounds. His decision w:as with the 'concU'l'Tenoe of the Assistant Secretary :£m.· Health of HHS, Dr. James Mason, who has Tespons~bility for the NIH. Secretary SulliV1an's decision was oommumcarted to the Acting Director of the NIH, Dr. William Raub, in Nov,ember 1989. A :firestorm of criticism erupted from,rudv;ocates of this research, including the Council of Judicial and Ethical Affairs of tihe American Medical Association, which 5.n June 1989 called for an end to the:ban.2 In this article, we wish to question both the science and the ethics of the rproposed fotal tissue transplantation therapy. We!Will 1support the £edeml funding moratorium and surggest new pmtections for the fetuses (whether po,ssibly living or de2 " Medical Applications of Fetal Tissue Transplantation", JAMA, Vol. 263, No. 4, January 26, 1990, 'PP· 565-570. There has been a.great deal of public debate, not only in the U.S. but also in Europe over whether human embryo research should be supported with public funds. Many Catholic countries in Europe have prohibited such research, while a number of other nations have allowed it. Dickson, D., "Europe Split on Embyro Research", Science, Vol. 242, November 21, 1988, pp. 1117-1118. The most interesting controversy is in West Germany where there is a strong movement to prohibit it because many there believe such an experimentation requires judgments that there are certain forms of human life that do not deserve to survive. Ibid., p. 1117. Many Germans regard these sorts of judgments as too close to those made by Nazis, and there is strong sentiment to prohibit such research altogether. Ibid. HUMAN FETAL TISSUE TRANSPLANTS 577 oea:sed) of elective a.bortfons. We will also describe new reseaooh directions in t~apy.for the diseases in which it is claimed that fetal... (shrink)

Open peer commentary on the target article “From Objects to Processes: A Proposal to Rewrite Radical Constructivism” by Siegfried J. Schmidt. Upshot: In the 1990s the emergence of radical constructivism as a meta-theory inspired many scientific disciplines. Since more or less simple realistic concepts of the media as mirroring the world prevailed, communication science was challenged to re-think the relation of media and reality as well. Recently, criticism of constructivist media theory has grown, while those constructivst approaches have not developed (...) any further. Thus, the commentary examines the potential for Schmidt”s process-oriented constructivism, which is interpreted as part of a non-dualistic paradigm, to revitalize the debate. I will argue that the idea of acting as a perpetual process of positings and presuppositions [Setzungen und Voraussetzungen] can especially be related to current research on media and memory. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Cloning without Prior Approval:A Response to Recent Disclosures of NoncomplianceRuth Macklin (bio)Editor's note: In September 1994, the Kennedy Institute of Ethics Journal published a special issue on the ethics of embryo splitting or "cloning," which included papers originally prepared for a workshop on embryo splitting sponsored by the National Advisory Board on Ethics in Reproduction (NABER) and NABER's report, Human Cloning through Embryo Splitting. The impetus for the project (...) was embryo-splitting research conducted by Drs. Jerry L. Hall, Robert J. Stillman, and others, at George Washington University and presented in October 1993 at a joint meeting of the American Fertility Society and the Canadian Fertility and Andrology Society. Media coverage at the time reported that the research had been approved by the university's formal review committees. However, it came to light in December 1994 that the researchers had not obtained approval from the university's institutional review board prior to conducting the research. Following a university investigation, the researchers were disciplined and instructed to destroy their data. The university also voluntarily forwarded the records of the incident to the Office for Protection from Research Risks at the National Institutes of Health. Dr. Hall resigned from George Washington University in September 1994.In the following postscript to her article on the ethics of embryo splitting (KIEJ, September 1994), Ruth Macklin discusses these events. The letters and memoranda that she cites were obtained from NIH through the Freedom of Information Act.My article, "Splitting Embryos on the Slippery Slope: Ethics and Public Policy" (KIEJ, September 1994), included a brief assessment of the ethics of the Hall-Stillman embryo-splitting experiment conducted at George Washington University (GWU). The article reviewed the researchers' stated purpose ("to help infertile couples by reproducing nature's ability to reproduce twins"), the features of the research itself (splitting embryos that never could become viable and with no plan to implant either the original or the split embryos), and the review procedures surrounding the experiment. I said that the researchers might be [End Page 57] faulted for not waiting until embryo research guidelines had been established at the national level; on the other hand, they surely could not fail to conform to such national guidelines when none existed.My conclusions were based on information that had been reported in the print media. Dr. Robert J. Stillman's statement that the experiment "had been approved by the university's formal review committees and peer reviewed by colleagues" was reported in the Washington Post on October 25, 1993, (Sawyer 1993). However, in light of the recent disclosure that the researchers had not obtained approval from George Washington University's IRB before proceeding with the research (Schwartz 1994), I now draw a sharply different conclusion about the ethics of the researchers' behavior.The most glaring flaw was the researchers' failure to submit a protocol to their institution's IRB in advance of embarking on the research. Following an investigation of the matter, the Office for Protection from Research Risks (OPRR) made the further determination that "the failure on the part of GWU research investigators and administrators to notify the IRB promptly about noncompliance in this research constitutes additional serious noncompliance" with research regulations (J. Thomas Puglisi, Chief of the Compliance Oversight Branch, Division of Human Subject Protections, OPRR, letter to Stephen J. Trachtenberg, President of George Washington University, 23 August 1994). Is it reasonable to suppose that these researchers were unaware of their obligations (a) to obtain prior review and approval from the IRB and (b) to notify the IRB promptly about their noncompliance? Regarding the latter item, Dr. Puglisi's letter to the President of GWU states that "the notification requirement has been a longstanding element of the GWU MPA [multiple project assurance], which should have been familiar to all members of the GWU research community." I shall concentrate on the researchers' more glaring ethical omission, failure to obtain prior review and approval from the IRB.Did either or both of these researchers contend that they were unaware of any review requirements for their research? Hall blames Stillman, Director of the Division of Reproductive Endocrinology, Fertility, and IVF Programs, for not making the requirement... (shrink)

Electronic institutional review board systems (eIRBs) have become an integral component in ensuring compliance with Human Research Protection Program (HRPP) and IRB requirements. Despite this, few of these systems are configured to administer the single IRB (sIRB) process mandated by the National Institutes of Health (NIH) for multisite research. We interviewed 103 sIRB administrators, chairs, members, and staff members about their experiences with sIRB multisite research review. We observed three main obstacles to adapting existing eIRB systems to accommodate the sIRB (...) process: (1) Existing systems are not designed for sIRBs and are not configured to administer sIRB responsibilities, (2) they are not interoperable, and (3) resources to improve existing systems are lacking. Our findings suggest that IRBs that act as an sIRB will need major changes to their electronic systems in order to accommodate sIRB processes. These difficulties threaten both the ability of IRBs to focus on ethical rather than bureaucratic problems and the efficiency of multisite trials. (shrink)

Substantial progress in handling scientific misconduct cases has been made since the first cases were investigated by the NIH Office of Scientific Integrity in 1989. The successor Office of Research Integrity (ORI) has simultaneously reduced the backlog of cases and increased the professionalism with which they are handled. However, a spate of lawsuits against universities, particularly those brought under the federal False Claims Act, threatens to undermine the ORI by encouraging use of the courts as an alternate route for resolving (...) claims of research misconduct. Next steps should include establishing a government-wide definition of scientific misconduct, providing immunity from lawsuits for institutions that follow proper procedures in investigating charges of scientific misconduct, and participating in the development of international guidelines for maintaining scientific integrity. (shrink)

We members of settler colonial culture—the latest form of what novelist and cultural critic Daniel Quinn calls Taker culture—are constrained by myriad institutions that leave us with little choice but to engage in practices that are profoundly damaging to the planet, to others, and to ourselves. Our path to living otherwise, Andrew Frederick Smith argues, lies in the threefold struggle, which is inspired by Quinn's focus on the interweaving roots of ecological, social, and personal wellbeing. These three forms of wellbeing (...) are co-implicated. We cannot enjoy one without equally enjoying the others; they are a package deal. As such, what works for people individually and collectively works for the planet, and vice versa. Reclaiming our lives and revitalizing our human and more-than-human communities are salient acts of resistance against Taker culture. They offer means of escape from our cultural captivity and an opportunity for full-spectrum wellbeing. (shrink)

This article explores union attempts to control pension fund investment for the debate on financial restructuring in the United States. It puts popular control of finance into comparative and historical perspective and argues that laws and politics help explain why the flow of finance is corporate controlled. First, changes in the legal regime—the Taft-Hartley Act of 1947 and the Employee Retirement Income Security Act of 1974—put constraints on labor’s ability to influence investment decisions. This is evident when comparing single- and (...) multi-employer plans, where the laws had different consequences. Second, attempts to reform these laws failed. Had they been successful, Carter’s proposed economic revitalization plan in the run-up to his failed reelection in 1980 would have created new ways for unions to control and redirect retirement investment for social purposes. The reform failure is treated as a “suppressed historical alternative” through a comparison with a successful reform in Quebec, Canada, which gave unions broad controls over the Solidarity Fund in 1983. The findings suggest, somewhat counter-intuitively, that legal restrictions need to be loosened for democratic control of finance to be possible. For pension funds, more regulations led to more corporate control, not less. (shrink)

In the last two decades, we have seen an increasing display of gestures and language of forgiveness in the public realm. Forgiveness has become a secular phenomenon. What do we mean by forgiveness? What is the role of forgiveness in the public place? Does it have the capacity to enhance the political life and well-being of a community? In The Human Condition, first published in 1958, Hannah Arendt offers an unapparelled reading of political forgiveness, described as a quintessential human faculty (...) for the revitalization of the public and political realm. This paper seeks to investigate the implications of Arendt’s understanding of action and forgiveness for the life of the polis, in particular the promotion of a more hospitable public space. Situated within human capacity to act and to love the other in their uniqueness and despite their trespasses and failures, forgiveness contributes, as this paper seeks to demonstrate, to the enhancement of the political sphere by opening this space to “new beginnings.”. (shrink)

Paul Ricoeur's early appreciation of hermeneutics introduced a dynamic interaction between a reader and a text. Employing both explanation and understanding, aided by the catalyst of Kantian creative imagination, Ricoeur revitalized hermeneutics from being simply a method of interpreting the literal meaning of a text. Such an openness to the text, as a form of otherness, initiated new insights into human ways of being and acting. In time, however, Ricoeur became disheartened by the unmerited suffering that he witnessed human beings (...) were inflicting on other beings. He qualified his hermeneutic foundations so as to introduce compassion and justice as modes of action towards rejected and mistreated others. (shrink)

1 Introduction1 In the 1980s, hermeneutics was often incorporated into deconstructionism and literary theory. Rather than focus on authorial intentions, the nature of writing itself including codes used to construct meaning, socio-economic contexts and inequalities of power,2 Gadamer introduced a different perspective; the interplay between effects of history on a reader’s understanding and the tradition(s) handed down in writing. This interplay in which a reader’s prejudices are called into question and modified by the text in a fusion of understanding and (...) topic revitalized the study of the printed word. Gadamer’s turn to language for understanding the meaning of Being also appealed to the post-modern antipathy toward modernity and metaphysics.3 If the truth and validity of interpretations are limited to communities of language, then our mode of being in history cannot but be historical. This point of view rendered Gadamer’s phenomenological hermeneutics vulnerable to the critique of moral and epistemological relativism. However, Gadamer’s theory of interpretation also stems from re-examination of the beginning of knowledge in the Pre-Socratics and Plato, and on this basis, is receptive to another dimension of inquiry than that which was trending in North America. -/- At the East-West Center, University of Hawai’i at Manoa in 1982, Chung-ying Cheng for the first time introduced onto-hermeneutics to an audience of esteemed philosophers including Li Zehou, Ren Jiyu, Feng Youlan, and Zhang Liwen.4 In contrast to schools of deconstruction and literary theory that had disengaged the interpreter from trans-historical sources of meaning and truth, Cheng explained that interpreters exist within a cosmological order inextricable from responsibility to harmonize Heaven and Earth in creative acts of interpretation. By integrating Chinese cosmology into hermeneutics through ontology, he tacitly challenged philosophers in the West to re-examine assumptions about humanity’s place in nature and by implication, Gadamer’s recovery of the beginnings of knowledge in Western philosophy. -/- Cheng’s Neo-Confucianism is inspired by the method and goals of Thomé H. Fang. The following words by Fang seem to prefigure, although in an indistinct and bundled way, aspects of Cheng’s philosophy including a Mencian theory of human nature, comprehensive observation, and creativity: “In the very process of living in concord with creative Nature, Man is charged with an ideal to be fully realized in the light of the principle of comprehensive harmony.”5 Like Fang, Cheng reinvigorates Chinese culture and language, but not solely in order to vindicate the insights of Neo-Confucianism. He has studied Western thought, from pragmatism and the analytic school to German idealism and phenomenology, to unlock and clarify philosophical concepts within the Yijing tradition and thereby render them intelligible to Anglophones. The result has been an awakening of Western scholars to the moral and cultural consequences of decoupling their thought from metaphysical foundations that are neither dogmatic nor doctrinal. -/- Not unlike the dialectic of Gadamer’s dialogue form, onto-generative hermeneutics integrates contrary positions on the same topic in order to blend both sides into a world philosophy, or as Cheng says, a “totalizing or integrative theory,”6 not to be confused with a theoretical rewording of a theory. On the contrary, the universal scope and relevance of hermeneutics stems from personal experience. Just as Gadamer, in response to faction and strife, immersed himself in Plato during the war years, and developed a method with which to harmonize opposites, so too, according to On-cho Ng, was Cheng moved by faction, strife and political persecution to develop a path toward unity.7 Gadamer taught at McMaster University in Hamilton, Ontario, and Cheng at the University of Hawai’i at Manoa among other institutions in North America. They facilitated trans-continental educational and cultural ties. Similar experiences yield similar insights irrespective of differences of time and place. Hence, authors in this issue who reside in Europe, China and North America, delineate the differences between Gadamer and Cheng, yet also, in light of Cheng’s onto-generative method and cosmology, develop integrative theories. Due to the page-budget restriction of the publisher, certain articles of this special theme will be subsequently published in the next issue. -/- 2 Integrative Theory This special issue of The Journal of Chinese Philosophy confirms a dimension of hermeneutics that Cheng has both motivated and inspired. The contributors do not abide by the conviction that since thought is mediated by language, interpretations cannot transcend culture. On the contrary, their research exemplifies the fruits of trans-historical onto-dialogical hermeneutics within limits defined by their field inquiry, organized into Parts I and II, around three themes: language, the philosophy of history and ethics. -/- Andrew Fuyarchuk introduces the theme of ontology in relation to Gadamer’s turn to language. Fuyarchuk argues that Chung-ying Cheng’s criticism of Gadamer’s hermeneutics is informed by Heidegger’s concept of Dasein and thereby overlooks how Gadamer’s Platonic-Pythagorean problem of the division between the One and Many is harmonized in the event of language, which in turn positions Gadamer in proximity to the presupposed grounds of receptivity in Cheng’s onto-generative hermeneutics. Lauren Pfister’s contributing article addresses the year 2000 meeting between Cheng and Gadamer in Heidelberg and expands the transhistorical grounds of meaning in Gadamer to matters of theology. Pfister’s summary of the written Chinese record of their conversation indicates that Cheng does not address the role of Christian philosophy and hence, the role of the inner word in Gadamer’s hermeneutics. This is important not only for detecting changes in Cheng’s philosophical development, but also for modifying his hermeneutics along the lines of a living conversation, possibilities explored by Pfister in a sequel to the article submitted to this issue. Nevertheless, by raising the issue of how Gadamer’s turn to language for understanding the meaning of Being extends possibilities in Cheng’s thought, Pfister anticipates the article by Katarina Gajdosova. She returns to the roots of Chinese thought during the Warring States period and broadens the meaning of names in recently excavated texts. Contrary to the conventions about how to understand terms, she appeals to both Heidegger’s ontology and Cheng’s notion of receptivity and creativity to reinterpret naming in relation to cosmology. Along the same lines, insofar as the event of Being is lingual, Jay Goulding captures its emergent structure in an evolving community of scholars and scholarship. He recalls his philosophical journey toward Cheng’s philosophy that begins in conversations with Gadamer at McMaster University in Hamilton, leads to Heidegger and Asian thought, expands into turning points with teachers and colleagues from various backgrounds that by increments contributed to Goulding’s formulation of “Daoist phenomenology.” -/- Although differing traditions guide their inquiries and research, Cheng and Gadamer recall the wisdom of the past to ameliorate the fragmentation in contemporary life. This leads them to re-examine the origins of philosophy; historical roots and thus sources of creative re-interpretations East and West whose affinities are developed in contributions by Hyun Höchsmann and Friederike Assandri. Höchsmann assesses convergences and divergences in the origins of Chinese and Western philosophy (Confucius and Socrates, the Yijing and Pre-Socratics) that culminates in pairing Gadamer’s understanding of paideia in the context of Plato’s political cosmology in the Timaeus with moral and social cultivation in The Western Inscription. She delineates the limits of this comparison which in turn justifies introducing Vattimo’s notion of locality. Assandri’s comparative analysis moves between India and China, Buddhism and Tang Daoism. Based on Gadamer’s argument that writing detaches concepts from their cultural moorings, she defines and applies three levels of understanding in onto-generative hermeneutics to Buddhist terms that were assimilated into the Benji Jing and in so doing clarifies essential dimensions of Daoism. -/- Contributions by Stephen Palmquist and Nicholas Brasovan position Cheng in relation to Kant and Gadamer by way of Aristotle’s ethics respectively. On the one hand, Palmquist plots Cheng’s evolving criticism of Kant’s moral philosophy and draws on crucial dimensions of Gadamer’s hermeneutics to reposition that criticism in a constructive relation to Kant’s emphasis on the philosophical conditions of morality while also indicating how religious dimensions of his thought answer Cheng’s concerns for lived moral action. For Palmquist, Gadamer enables a constructive criticism of Cheng. On the other hand, Brasovan compares Cheng’s Yijing-based account of moral deliberation with Gadamer’s Aristotelian-based ethics and reasons that in contrast to Cheng, Gadamer’s hermeneutical consciousness is disengaged from practical knowledge. For Brasovan, Cheng is a constructive critic of Gadamer. Palmquist and Brasovan’s divergent angles on Gadamer and Cheng map onto a dialectic of contrast and complementarity that constitutes the inner logic of Cheng’s philosophy. In other words, Gadamer and Cheng ought to be read alongside one another for the sake of removing discrepancies and contradictions, which constitutes the organic structure of their thinking. -/- 3 Our Mode of Being in History Is Not Historical The conversations between Cheng and Gadamer in this issue of The Journal of Chinese Philosophy pivot on language, philosophy of history and ethics within a comparative framework of analysis, but also explore the grounds that make the comparisons possible. Those grounds are informed by Chinese cosmology, and function to wrest Gadamer from the shadow of Heideggerian facticity and reposition him within the range of Cheng’s ideas about our place in nature that is embedded in his question about how mind emerges from inorganic matter.8 -/- For Gadamer scholars of Heidegger, human finitude, our ownmost individuating death ensures that hermeneutics is always open to the other as other, always on the way toward understanding the meaning of Being. To arrest the process in a concept of “the Absolute” cannot but represent someone’s point of view, and thereby render hermeneutics indistinguishable from ideology. However, insofar as finitude is defined by them in terms of an onto-theological concept of immorality, finitude is a metaphysical concept consistent with epistemologies and confuse beings with the meaning of Being. As a result, the celebrated political value of hermeneutics to always be on the way toward an understanding of the meaning of Being admits subtle variations on the same worldview that are insufficiently self-critical. -/- Gadamer scholars of Heidegger are right. A transformation in ethos and opening to the meaning of Being depends on awareness of finitude. Yet this awareness does not yield openness to more of the same, i.e., discourse structurally incapable of coming to unity but instead, for both Gadamer and Cheng, openness to a distinctly different ontological dimension of reality. As Sandra Wawrytko and So-Seong Park indicate,9 this ontological dimension is prefigured in the experience of being-as-a-whole or the totality of all possible relations in both Chinese totemic shamanistic rituals,10 and Greek Dionysian festivals.11 Through these religious experiences human ethos and therefore consciousness is expanded and elevated from being centered on one’s ownmost concerns toward an affinity with all sentient beings from insects and plants to animals. The channel for this affinity is an auditory disposition and hence, the emotions, compassion, and feeling response. -/- The capacity for an auditory disposition, or as Gadamer calls it, listening consciousness to respond to the inter-relationality and therefore inherent balance of nature is developed through music, song and dance of the religious rituals and festivals. They facilitate the unity of mind with nature. This use of music, that transforms ordinary consciousness, explains Cheng’s emphasis on the receptivity of feeling response in comprehensive observation, and Gadamer’s emphasis on openness to the other in attunement. However, an auditory disposition characteristic of pre-literate oral cultures that reveals the “All” need not rely on religion. As theorists about the evolution of language have explained,12 modern languages preserve their pre-historical past in music or prosody. That is to say, the song and dance that revealed the totality of inter-related beings to an ethos of comprehensive observation and attunement toward beings in classical civilizations is retained in the back-and-forth movement or rhythm of the dialogue form. Our mode of being in history is a mode of being in nature – through the music of language. -/- While alerting the reader to the limits of a nominalist interpretation, Gadamer expresses the inner law of the nature as follows: “in perishing there is always becoming, and in becoming there is always perishing.”13 Considered in process, opposites generate and blend into each other. This law of nature applies to everything.14 Hence, in a manner comparable to Pfister’s concluding insights, onto-dialogical hermeneutics is not only open to discrete events of otherness but moreover, to the moving structure of reality expressed, as Gajdosova suggests, in the existential moment of naming. Considered as interplay of tension and resolution with a life of its own, the dialectic of a dialogue is self-similar to the way in which an organism grows (by instinct). There is, therefore, a sense in which the art of interpretation extends the human mind into the eternal cycles of nature such that we participate in the articulation of the inner telos/homeostasis toward which all beings strive and importantly for Gadamer scholars of Heidegger, within the material limits of energy to which our embodied minds are self-evidently subject. In mortality there is always immortality. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Why Theory?Oscar Martín (bio) and Simone Pinet (bio)Theory is, of course, a medieval word, brought from Greek into Latin from a common root (theastai) that also gives us theater, linked through shared meanings related to speculation, contemplation, and so forth. It is used in the Bible, and its English modern use, according to the Oxford english dictionary, probably comes from a medieval Latin translation of Aristotle. The dictionary does (...) not direct us to any specific translation, but prompts us to compare with Italian and, of course, French usage. In French, however, the word théorie was not used until quite late. In fact, it appeared for the first time in French in a 1584 translation of Antonio de Guevara, the famous Spanish court preacher and man of letters whose oeuvre was translated, imitated, and plagiarized in France, Italy, Germany, and England during the sixteenth century. In Spanish, the word theoria had begun its vernacular life a few years before in the writings of Fernando de Herrera.Theoria is already documented by Antonio de Nebrija’s Vocabulario español-latino of 1495, listed between “speculation” and “species” and designating the contemplative and the art of speculation, from theory to the perception of its quality. It is appropriate that Spanish would give theory to the West, sharing with it a point of view or, better, a series of perspectives or miradores, as María Rosa Menocal would call them, from which to look back into or beyond cultural and literary practices [“Visions of al-Andalus”]. For Medieval Iberia was, as this collection of essays purports to be, not a space or a history but a shifting and fluid gaze on the conflicting world surrounding the different literary and cultural works dealt with in this issue.Reluctant at best, and most of the time resentful of theoretical approaches to the study of literature and culture, medievalism found in Hispanism a surprising and most loyal ally. If in most Spanish departments critical theory pushed its way into the study of later periods, to the point that today even the mourning itself (or celebration) of the agony of theory is done from a theoretical standpoint, Hispanomedievalism remained suspicious longer, and sharpened its words on statistics and “scientific” claims to authority. Its close relationship to historical research, however, also made this philology vulnerable to the practices of interpretation. And it is as a will to interpretation that theory has managed to place itself within and outside the criticism of medieval Iberian literature and culture in insightful and renewing ways—including collective projects similar to the present one. Marina Brownlee’s contribution to this volume in this sense offers a most telling guiding thread of this continued approach to the discipline, which she helped revitalize through her participation in the project the new Medievalism. More recently, Josiah Blackmore and Gregory Hutcheson, also contributing to the present volume, sparked a lively debate, as showcased in a forum published by La corónica, with their project Queer iberia: sexualities, cultures, and crossing from the Middle ages to the renaissance. But a host of monographs and single-authored books in recent years have come to inhabit and enliven medieval studies as Hispanism has grown into the most important area of foreign language studies. [End Page 3]Theories find themselves in the articles for this special issue by way of a development from within. There is no application, no rigid use of conceptual frameworks to revisit texts, but an interior process of thought on and through the texts and cultural practices analyzed that produces theoretical insights. While a variety of methodologies and theoretical positionings can be identified, both explicitly and not, from speech-act theory to deconstruction, from Žižek to Badiou, postcolonialism to politics, these seem to emerge from within, as if the obvious result of the need to think questions posed from slightly different standpoints than they have been up until now. All of the articles reflect on very well-known texts and periods, pondering about a discipline, its methodologies, even the nature of its object of study. These articles do not dismiss previous work, but they do bring it under a new light.At a... (shrink)

The early history of German patriotism is complex and illuminates many of patriotism’s potential virtues as well as its dangers. Throughout the late eighteenth and early nineteenth centuries, patriotism’s overarching connotation was devotion to the greater good, but whether that greater was local, national, or global varied dramatically. Early uses of patriotism were devoid of national or military connotations and instead denoted local engagement in public projects and willingness to aid to those in need. The patriot moreover worked for enlightened (...) political reform, convinced that good government could convert subjects into citizens. Patriotism also had distinct cosmopolitan connotations, indicating someone who had humanity’s good generally as a goal. In the early aftermath of the French Revolution, acting in the interest of humanity’s development meant supporting the revolutionaries as the best hope for furthering political progress. As the Revolution dissolved into the Terror, German intellectuals hoped that Germany could assume the mantle of progress: being a patriot meant supporting German culture as a means of furthering humanity’s enlightenment. The Napoleonic Wars, however, shifted Germans’ attitude significantly: years of French occupation culminated in patriotism being defined as favoring German culture and unity in the interest of defeating the French. Patriotism’s nationalist connotations from that point intensify significantly. But its early history argues for remembering and revitalizing its potential to unite the local with the global and to promote enlightened civic engagement in the pursuit of political progress. (shrink)