Following the conclusion of a period of educational expansion during the last two decades, developing nations are now focusing attention upon adjusting some of those innovations made during the recent period of quantitative expansion. The paper examines how Trinidad and Tobago has responded to the need for adjustments in education provision during the current post‐expansionist period. In particular the paper analyzes Trinidad and Tobago's current reaction to the nation's system of double‐shift schooling, a device instituted during the 1970s as part (...) of Government's strategy for universal secondary education. Arguments both for and against the shift‐system are presented, and Trinidad and Tobago's insistence that the mechanism should be dismantled is critically examined. Explanations for the approach taken by Trinidad and Tobago towards the nation's double‐shift schooling are drawn from two sources: arguments about the state of the nation's economy, and policies regarding approaches to educational development planning in developing nations. (shrink)

Using longitudinal, ethnographic data, the authors examine how the pursuit of self-sufficiency in the context of welfare reform may unintentionally encourage some women to develop alternative dangerous dependencies on abusive or potentially abusive men. In this article, the authors document how women ended up relying on men who have been abusive to them either for instrumental assistance or for more direct financial assistance as they struggled to move from welfare to work. The authors also document how some extremely disadvantaged and (...) vulnerable women became enmeshed in even more dangerous dependencies as they hit time limits and fell through public and private safety nets into drug addiction and sex work. The authors frame this discussion of dangerous dependencies with the recognition that dependency relations are necessary and inevitable components of carework. They argue that the discourse of self-sufficiency should acknowledge the fact that careworkers are productive citizens to the same extent as paid laborers and grapple with the question of the means through which they can support that productivity when personal resources are limited and paid labor is temporarily or permanently impossible. (shrink)

In crafting our paper on addressing the ethical challenges in HIV prevention research with people who inject drugs,1 we had hoped to stimulate further discussion and deliberation about the topic. We are pleased that three commentaries on our paper have begun this process.2 3 4 The commentaries rightly bring up important issues relating to community engagement and problems in translating research into practice in the fraught environments in which PWID face multiple risks. These risks include acquisition of HIV as well (...) as criminalisation, stigma and lack of access to needed healthcare, prevention and social services. We take this opportunity to respond to the excellent points raised by the commentators. All of the commentaries support our emphasis on robust community engagement with PWID and other stakeholders in designing and conducting HIV prevention research, but urge us to go farther. Wolfe highlights the difficulty of even engaging with community members in oppressive settings, where authorities severely restrict civil liberties of PWID so that even discussing issues related to drug use and enforcement may place individuals at risk. To overcome such limitations, he appropriately suggests interviewing confidentially those who have previously been detained in closed settings as part of the community engagement process. Similarly, Wolfe observes that critical issues can be overlooked with a narrow focus on study procedures if contextual factors before, during or after a study are ignored. For example, he cites the risk of overdose for study participants who have been abstinent during a study and subsequently resume injecting when the study concludes. These kinds of risks may not be obvious …. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

These range from merely good reads to really outstanding books. A raw ranking of them would be of little use to others, unless I explained why I gave them the ranks I did, and anyway I'd probably give different rankings by the time your read this. (When I know of an on-line review about a book which I agree with --- e.g., because I wrote it --- I've included a link; also some exceedingly short remarks about interesting cases.).

La mayoría de interpretaciones sobre la noción de comunidad en Hannah Arendt, han pasado por alto el esfuerzo por parte de la autora de deslindarse de lo que ella considera -la tradición de la filosofía política-. Arendt encuentra que dicha tradición ha sido incapaz de reconocer la pluralidad y contingencia propias de los asuntos humanos. Este libro se propone buscar en el pensamiento de la autora una posible noción de Comunidad que conciba la pluralidad como -ley de la tierra-, y (...) vea en la acción esa puesta en escena de dicha pluralidad. (shrink)

The truth-conditional theory of sense holds that a theory of truth for a natural language can serve as a theory of sense: if knowledge of a theory of truth for a language L is sufficient for understanding utterance of L-sentences, the T-sentences of the theory 'show' the sense of the uttered object-language sentences. In this paper I aim to show that indexicals create a serious problem for this prima facie attractive theoretical option. The so-called 'instantiation problem' is that a truth-theory (...) for indexical languages needs to contain universal statements that show how the reference of indexicals depends on features of the utterance context. Now one can deduce from such statements T-sentences that do not show the sense of an indexical sentence on an occasion of use. I survey proposed solutions to the instantiation problem by Evans and Sainsbury and, unfortunately, find them all wanting. Perhaps there is nothing like the sense-giving truth-condition for an indexical sentence. (shrink)

Within international development [1], public health [2], and clinical medicine [3]–[5], there is increasing interest in determining whether cash payments or other economic incentives can be used to influence the choices and behavior of individuals and groups in order to promote desired health goals. However, a number of complex issues affect the review and approval by research ethics committees of research studying the effectiveness of using financial incentives to promote desired health goals. Current ethical and regulatory frameworks regard the provision (...) of gifts or cash payments to participants in human research as potentially problematic. Specifically, these frameworks imply that such incentives may undermine the autonomy of participant choice, hinder the disclosure of medical information, exacerbate social inequalities, or result in the exploitation or degradation of vulnerable populations [6]–[9]. Typically, these frameworks provide guidance about payment to research participants to reimburse expenses, to compensate for time and effort, to provide insurance coverage, or as an incentive to participate in the research itself. However, the issue of payment as a component of the research intervention is relatively new. RECs thus lack explicit guidance about ethical issues surrounding research that evaluates the use of financial incentives as an intervention to promote health. (shrink)

Before participants can be enrolled in a clinical trial, an institutional review board must determine that the risks that the research poses to participants are ‘reasonable.’ This paper examines the two dominant frameworks for assessing research risks and argues that each approach suffers from significant shortcomings. It then considers what issues must be addressed in order to construct a framework for risk assessment that is grounded in a compelling normative foundation and might provide more operationally precise guidance to the deliberations (...) of various stakeholders. The paper concludes by sketching the outlines of what is referred to as the ‘Integrative Approach’ to risk assessment and by highlighting some of the ways in which this approach may be more promising than current alternatives. (shrink)

In this paper we distinguish two competing conceptions of dignity, one recognizably Hobbesian and one recognizably Kantian. We provide a formal model of how decision-makers committed to these conceptions of dignity might reason when engaged in an economic transaction that is not inherently insulting, but in which it is possible for the dignity of the agent to be called into question. This is a modified version of the ultimatum game. We then use this model to illustrate ways in which the (...) Kantian evaluative standpoint enjoys a kind of internal stability that the Hobbesian framework lacks. Our interpersonal argument shows that, under certain conditions, Hobbesians prefer to cultivate Kantian commitments in others and promote the presence of Kantians in the population. Our intrapersonal argument shows that agents who are conflicted between Kantian and Hobbesian commitments have powerful reasons not to resolve this commitment in favour of Hobbesian values. Our emulation argument illustrates that in repeated versions of the ultimatum game, the Hobbesian chooses to behave like a Kantian, including publicly repudiating her Hobbesian commitments. Here again, however, the Hobbesian is able to achieve a desired benefit only on the condition that there are genuine Kantians in the population. Finally, our social planning argument explores the reasons why a community of Hobbesians would opt to enshrine a Kantian conception of dignity into law. The paper concludes with some remarks about the policy implications of this work. The value or worth of a man is, as for all other things, his price, that is to say, so much as would be given for the use of his power; and therefore is not absolute, but a thing dependent on the need and judgement of another... The public worth of a man, which is the value set on him by the Common-wealth, is that which men commonly call DIGNITY. Hobbes, _Leviathan X_, 16. (shrink)

Regulators rely on clinical trials for drug approval and labeling decisions. Health systems and clinicians rely on the evidence from trials to determine treatment, and patients rely on it to decide which courses of care to undertake. Many of these stakeholders presume that the careful review of individual studies is enough to address the ethical and scientific questions that arise in clinical trials. In what follows, however, we demonstrate that explicit consideration of trial portfolios—series of trials that are interrelated by (...) a common set of objectives—is crucial. the ethical acceptability and evidentiary probity of individual trials can change depending on the characteristics of the portfolios in which they are embedded. Second, how trial portfolios are composed, how well they are coordinated, and how efficiently they use information determines the balance of risks and benefits they present as well as their different prospects for generating socially valuable information; these three factors also raise distinct questions of justice. (shrink)

To judge from the rash of recent law review articles, it is a miracle that research with human subjects in the U.S. continues to draw breath under the asphyxiating heel of the rent-seeking, creativity-stifling, jack-booted bureaucrethics that is the current system of research ethics oversight and review. Institutional Review Boards, sometimes called Research Ethics Committees, have been accused of perpetrating “probably the most widespread violation of the First Amendment in our nation's history,” resulting in a “disaster, not only for academics, (...) but for the whole nation.” One member of the President's Council on Bioethics went so far as to assert, “There has been no greater damage to academic freedom in the United States in my lifetime. And my lifetime encompasses McCarthy and it encompasses political correctness, both.” Locked in the bureaucratic “iron cage” of IRB oversight, critics charge that researchers have been transformed into a vulnerable, exposed population, subject to domination, that has been likened in one case to a kind of “Tuskegee in reverse.”. (shrink)

The 2016 CIOMS International ethical guidelines for health‐related research involving humans states that ‘health‐related research should form an integral part of disaster response’ and that, ‘widespread emergency use [of unproven interventions] with inadequate data collection about patient outcomes must therefore be avoided’ (Guideline 20). This position is defended against two lines of criticism that emerged during the 2014 Ebola outbreak. One holds that desperately ill patients have a moral right to try unvalidated medical interventions (UMIs) and that it is therefore (...) unethical to restrict access to UMIs to the clinical trial context. The second holds that clinical trials in contexts of high‐mortality diseases are morally suspect because equipoise does not exist between a standard of care that offers little prospect of clinical benefit and a UMI that might offer some clinical advantage. (shrink)

Global debates in approaches to HIV/AIDS control have recently moved away from a uniformly strong human rights-based focus. Public health utilitarianism has become increasingly important in shaping national and international policies. However, potentially contradictory imperatives may require reconciliation of individual reproductive and other human rights with public health objectives. Current reproductive health guidelines remain largely nonprescriptive on the advisability of pregnancy amongst HIV-positive couples, mainly relying on effective counselling to enable autonomous decision-making by clients. Yet, health care provider values and (...) attitudes may substantially impact on the effectiveness of nonprescriptive guidelines, particularly where social norms and stereotypes regarding childbearing are powerful, and where providers are subjected to dual loyalty pressures, with potentially adverse impacts on rights of service users. Data from a study of user experiences and perceptions of reproductive and HIV/AIDS services are used to illustrate a rights analysis of how reproductive health policy should integrate a rights perspective into the way services engage with HIV-positive persons and their reproductive choices. The analysis draws on recognised tools developed to evaluate health policies for their human rights impacts and on a model developed for health equity research in South Africa to argue for greater recognition of agency on the part of persons affected by HIV/AIDS in the development and content of policies on reproductive choices. We conclude by proposing strategies that are based upon a synergy between human rights and public health approaches to policy on reproductive health choices for persons with HIV/AIDS. (shrink)

The prevailing discourse around AI ethics lacks the language and formalism necessary to capture the diverse ethical concerns that emerge when AI systems interact with individuals. Drawing on Sen and Nussbaum’s capability approach, we present a framework formalizing a network of ethical concepts and entitlements necessary for AI systems to confer meaningful benefit or assistance to stakeholders. Such systems enhance stakeholders’ ability to advance their life plans and well-being while upholding their fundamental rights. We characterize two necessary conditions for morally (...) permissible interactions between AI systems and those impacted by their functioning, and two sufficient conditions for realizing the ideal of meaningful benefit. We then contrast this ideal with several salient failure modes, namely, forms of social interactions that constitute unjustified paternalism, coercion, deception, exploitation and domination. The proliferation of incidents involving AI in high-stakes domains underscores the gravity of these issues and the imperative to take an ethics-led approach to AI systems from their inception. (shrink)

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study (...) was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)

The foundations of research ethics are riven with fault lines emanating from a fear that if research is too closely connected to weighty social purposes an imperative to advance the common good through research will justify abrogating the rights and welfare of study participants. The result is an impoverished conception of the nature of research, an incomplete focus on actors who bear important moral responsibilities, and a system of ethics and oversight highly attuned to the dangers of research but largely (...) silent about threats of ineffective, inefficient, and inequitable medical practices and health systems. -/- In For the Common Good: Philosophical Foundations of Research Ethics, Alex John London defends a conception of the common good that grounds a moral imperative with two requirements. The first is to promote research that generates the information necessary to enable key social institutions to effectively, efficiently, and equitably safeguard the basic interests of individuals. The second is to ensure that research is organized as a voluntary scheme of social cooperation that respects its various contributors' moral claims to be treated as free and equal. Connecting research to the goals of a just social order grounds a framework for assessing and managing research risk that reconciles these requirements and justifies key oversight practices in non-paternalistic terms. Reconceiving research ethics as resolving coordination problems and providing credible assurance that these requirements are being met expands the issues and actors that fall within the purview of the field and provides the foundation for a more unified and coherent approach to domestic and international research. -/- This is an open access title available under the terms of a CC BY-NC-ND 4.0 license. It is free to read at Oxford Scholarship Online and offered as a free PDF download from OUP and selected open access locations. (shrink)

Innovation is disruptive and a deeply social phenomenon. As a result, discussions of innovation in the Anglo-American philosophical tradition are often tightly bound up with concerns about individual freedom and pluralism, including pluralism about ethical values. In response, stakeholders looking to evaluate and assess ethical aspects of the innovation ecosystem are often driven to pragmatic approaches that utilize a set of ethical values that can be regarded as “free-standing,” or “thin” in the sense that they are not tied to any (...) particular, substantive conception of the good. This set often includes values such as beneficence, nonmaleficence, respect for autonomy, fairness, and justice. Discussions focused on justice, however, are the least extensive and least well-developed. As a result, most approaches are well-suited to surfacing first-order or direct effects of the discrete activities of a relatively narrow set of stakeholders. Paradoxically, however, such analyses are often not well-suited to identifying and evaluating (a) quintessentially social or higher-order effects (such as network-level or institutional level effects), (b) the role of a larger number of stakeholders who shape the innovation ecosystem in more indirect ways, and (c) some of the positive ethical claims of individuals that are relevant to evaluating innovation. After articulating these shortcomings, I argue that they might be overcome by adopting a justice-led framework for evaluating innovation. (shrink)

This book argues that the Fourth Gospel offers a potentially transformative response to the question of suffering and the human compulsion to blame. By engaging with the symbols of light, vision, and the Good Shepherd, readers can experience a theodical spirituality that transforms resentment and rage through divine forgiveness.

This paper, located in the traditions of Interactional Sociolinguistics (Gumperz 1982) and Social Constructionism (Berger and Luckmann 1966), explores code-switching and identity practices amongst British-born Greek-Cypriots. The speakers, members of a Greek-Cypriot youth organization, are fluent in English and (with varying levels of fluency) speak the Greek-Cypriot Dialect. Qualitative analyses of recordings of natural speech during youth community meetings and a social event show how a new ‘third space’ becomes reified through code-switching practices. By skillfully manipulating languages and styles, speakers (...) draw on Greek-Cypriot cultural resources to accomplish two inter-related things. First, by displaying knowledge of familiar Greek-Cypriot cultural frames, they establish themselves as different from mainstream British society and establish solidarity as an in-group. Secondly, by using these frames in non-serious contexts, and at times mocking cultural attitudes and stereotypes, they challenge and re-appropriate their inherited Greek-Cypriot identity, thereby constructing the identity of British-born Greek-Cypriot youth. (shrink)

Although decision‐making algorithms are not new to medicine, the availability of vast stores of medical data, gains in computing power, and breakthroughs in machine learning are accelerating the pace of their development, expanding the range of questions they can address, and increasing their predictive power. In many cases, however, the most powerful machine learning techniques purchase diagnostic or predictive accuracy at the expense of our ability to access “the knowledge within the machine.” Without an explanation in terms of reasons or (...) a rationale for particular decisions in individual cases, some commentators regard ceding medical decision‐making to black box systems as contravening the profound moral responsibilities of clinicians. I argue, however, that opaque decisions are more common in medicine than critics realize. Moreover, as Aristotle noted over two millennia ago, when our knowledge of causal systems is incomplete and precarious—as it often is in medicine—the ability to explain how results are produced can be less important than the ability to produce such results and empirically verify their accuracy. (shrink)