This article shows how there is a great kinship between Polanyi's thought and that of Bernard Haring, "the father of modern moral theology" in the Roman Catholic Church. Haring advocated an ethics of personal responsibility that calls for an epistemology such as Polanyi developed for history and social sciences in The Study of Man.

Informed by the critical humanisms of Hannah Arendt, Frantz Fanon, and Paul Gilroy, the authors argue for an orientation to teaching and learning that troubles the continuing effects of dehumanizing race logic. Reflecting on Paul Haggis's Oscar award winning film Crash from 2004, they suggest that the metaphor of racial 'crashing' captures what happens when we act out from experiences of racial injury instead of being touched by it. They propose a psychoanalytic pedagogy of emotions as a method for reading (...) representation beyond the limits of detached rational critique. Learning from the affect of racial injury as it is made manifest in representation, they suggest, is an important ethical starting point for generating new insights into what it might mean to live within and beyond contemporary legacies of racial hatred. (shrink)

The authors are members of the British Association Committee on Social Concern and Biological Advances. Following earlier discussions of legal and social problems arising from certain medical advances, they undertook, independently, to examine the Law Commission's study.

Consideration of the property of action is proposed to provide a more meaningful definition of efficient energy use and sustainable production in ecosystems. Action has physical dimensions similar to angular momentum, its magnitude varying with mass, spatial configuration and relative motion. In this article, the relationship of action to thermodynamic processes such as the spontaneous increase in entropy of the second law is explained and the utility of action for measuring changes in energy and material distribution is promoted. In particular, (...) the view that increases in entropy and action are equivalent to disorder is challenged. Given that the development of action states may be assigned an economic value and the various sources of free energy assigned a price, action theory may provide a novel mechanism for the economic allocation of resources. The importance of the diversity and redundancy of energy resources and work processes to optimize action is highlighted. (shrink)

Reconstructive allografts using Vascularized Composite Allotransplantation are providing individuals living with upper limb loss and facial disfigurement with new opportunities for a sensate, esthetically acceptable, and functional alternative to current treatment strategies. Important research attention is being paid to how best to assess and screen candidates for VCA, measure optimal patient outcomes, and support patient adherence to lifelong behaviors and medical regimens. Far less attention, however, has been dedicated to the team science required for these complex VCA teams to form, (...) prepare, and provide the highest quality clinical and psychosocial care to those receiving VCA. VCA teams are unique in that they require specialized team members whose scope of practice may not otherwise overlap. The team also needs to constantly negotiate balancing patient safety with multiple risks throughout the transplant process. This study aimed to elucidate the team science needed for this highly innovative and complex area of medicine. Using in-depth qualitative interviews with 14 VCA team members and observations at team meetings, we found that careful consideration of team composition, team structure, and organizational commitment influences team performance and patient outcomes, but that to be efficient and truly effective, teams need to commit to developing processes that foster collaboration. These processes are action-oriented, strategic and interpersonal. Dedication and commitment to team science allows teams to manage conflict under stress and exercise ways to leverage strengths to provide optimal performance or patient psychosocial and clinical outcomes. This study can provide insight into quality improvement efforts for VCA teams and guidance for other transplant programs that wish to consider expansion into VCA. (shrink)

Mixed results regarding the role of gender in moral reasoning prompted an investigation of an alternative characteristic that may be more influential in the process: sex role orientation. We present an empirical assessment of the relationship between an individual’s moral reasoning level and his/her sex role orientation, gender, and several academic factors. Our results indicate that sex role orientation is not related to moral reasoning level. Gender is related to moral reasoning in our study, women reasoning at higher levels than (...) men. We found a positive relationship between education and moral reasoning level, and moral reasoning levels differed across academic institutions. Our results also show business students have lower moral reasoning levels than students in other fields, although this result did not reach statistical significance. (shrink)

ObjectiveTo compare techniques for computing clustering and switching scores in terms of agreement, correlation, and empirical value as predictors of incident cognitive impairment.MethodsWe transcribed animal and letter F fluency recordings on 640 cases of ICI and matched controls from a national epidemiological study, amending each transcription with word timings. We then calculated clustering and switching scores, as well as scores indexing speed of responses, using techniques described in the literature. We evaluated agreement among the techniques with Cohen’s κ and calculated (...) correlations among the scores. After fitting a base model with raw scores, repetitions, and intrusions, we fit a series of Bayesian logistic regression models adding either clustering and switching scores or speed scores, comparing the models in terms of several metrics. We partitioned the ICI cases into acute and progressive cases and repeated the regression analysis for each group.ResultsFor animal fluency, we found that models with speed scores derived using the slope difference algorithm achieved the best values of the Watanabe–Akaike Information Criterion, but with good net reclassification improvement only for the progressive group. For letter fluency, different models excelled for prediction of acute and progressive cases. For acute cases, NRI was best for speed scores derived from a network model, while for progressive cases, the best model used clustering and switching scores derived from the same network model. Combining variables from the best animal and letter F models led to marginal improvements in model fit and NRI only for the all-cases and acute-cases analyses.ConclusionSpeed scores improve a base model for predicting progressive cognitive impairment from animal fluency. Letter fluency scores may provide complementary information. (shrink)

The motivation of someone who is locked-in, that is, paralyzed and mute, is to find relief for their loss of function. The data presented in this report is part of an attempt to restore one of those lost functions, namely, speech. An essential feature of the development of a speech prosthesis is optimal decoding of patterns of recorded neural signals during silent or covert speech, that is, speaking “inside the head” with output that is inaudible due to the paralysis of (...) the articulators. The aim of this paper is to illustrate the importance of both fast and slow single unit firings recorded from an individual with locked-in syndrome and from an intact participant speaking silently. Long duration electrodes were implanted in the motor speech cortex for up to 13 years in the locked-in participant. The data herein provide evidence that slow firing single units are essential for optimal decoding accuracy. Additional evidence indicates that slow firing single units can be conditioned in the locked-in participant 5 years after implantation, further supporting their role in decoding. (shrink)

Adherence to a few basic principles of textbook reading compilation have made this one of the more worthwhile introductory philosophy texts. In the first place, the editors have given lengthy and frequently complete texts. Anselm's Proslogium, Descartes' Meditations, Plato's Phaedo, and Kant's Prolegomena are given complete or nearly complete; there is a ninety-one page extract from Locke's Essay, over fifty pages of James and nearly forty pages from Whitehead. This still leaves room for ample primary material by Leibniz, Hume, and (...) Schopenhauer. The plan of the book is to frame the important primary text with intellectually contemporaneous discussion of the problems treated in the primary text, and then to bracket each section with a prologue and epilogue drawn—except in the final section where Plato has the last word—from twentieth-century literature relevant to the issues under discussion in each section. The authors are thus able to provide an historical and thematic introduction to philosophy, which together cannot help but impress the beginning student with the unity of philosophical experience. Obviously no single textbook will ever escape the need for supplementation; this one in particular will require those who would like their students to be exposed to more phenomenology and existentialism, and, to a lesser degree, analytical philosophy, to introduce additional reading. But Epstein and Kennedy have provided the basic skeleton to which may be added as much flesh as the instructor desires.—E. A. R. (shrink)

The Patient Self-Determination Act (PSDA) requires hospitals to ask patients upon admission whether they have an advance directive. Although the PSDA has received extensive criticism, little attention has been paid to the cost of the law, either during its legislative course or following its implementation. Nonetheless, several tangible and intangible costs are associated with the PSDA. Such costs may be incurred by different parties. This paper examines the costs and benefits of the PSDA and illustrates the extent of some of (...) its tangible costs. The incremental start-up cost for one institution's response to the PSDA is estimated to be $49,304 ($1.31 per admission) and the total implementation cost of the program to be $114,528. In addition, the national incremental start-up cost for hospitals to implement the PSDA is estimated to be between $43,625,114 and $101,569,922. Finally, the potential implications of the PSDA for future governmental health care ethics regulation are discussed. (shrink)

Offers both theoretical and practical insights into the dialogue between adults and children as a democratic model for schooling.

: Research involving the dead, especially heart-beating cadavers, may facilitate the testing of potentially revolutionary and life-saving medical treatments. However, to ensure that such research is conducted ethically, it is essential to: (1) identify appropriate standards for this research and (2) assign institutional responsibility and a mechanism for oversight. Protocols for research involving the dead should be reviewed by a special committee and assessed according to nine standards intended to ensure scientific merit, to protect deceased patients and their families, and (...) to promote institutional integrity and responsibility. Federal regulation of research involving the dead will foster appropriate standards and, equally importantly, help establish the acceptability of such research. (shrink)

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

Review of a Thomist critique of the Reformed Epistemology of Alvin Plantinga and Nicholas Wolterstorff. The authors contend that P & W misunderstand Aquinas and that their own project of Reformed epistemology is either inadequate or mistaken.

A test was administered to 102 engineering students to ascertain how engineering education influences their environmental knowledge and attitudes. Answers to definitional and factual questions in a forced-answer section demonstrated that students were improving their technical knowledge, but responses to more subtle questions were mixed. Answers to attitudinal questions exhibited a trend towards increased environmental awareness. For open-ended questions, posttest results showed an increase in knowledge of engineering work. Over 80% of the students considered themselves to have a caring attitude (...) toward the environment, with the “three R’s” and green transportation choices most commonly cited. Engagement in research, education, or advocacy doubled from pretest to posttest. Air pollution and solid waste disposal most frequently influenced students’ attitudes toward the environment. Outdoor experiences were the most frequently mentioned source of information; university courses rose from 4% to 15% on the posttest. Only 40% of the students could name an environmental role model. (shrink)

This collection, the first of its kind, brings together specially commissioned academic essays to mark fifty years since the death of John Kennedy Toole.

In lieu of an abstract, here is a brief excerpt of the content:Books ReceivedThe Ambitions of Curiosity: Understanding the World in Ancient Greece and China. By G.E.R. Lloyd. Cambridge: Cambridge University Press, 2002. Pp. xvi + 175. Price not given.The Art of the Han Essay: Wang Fu's Ch'ien-Fu Lun. By Anne Behnke Kinney. Tempe: Center for Asian Studies, Arizona State University, 1990. Pp. xi + 154. Paper $10.00.The Autobiography of Jamgön Kongtrul: A Gem of Many Colors. By Jamgön Kongtrul Lodrön (...) Thayé and translated by Richard Barron (Chökyi Nyima). Ithaca, New York: Snow Lion Publications, 2003. Pp. xxii + 549. Price not given.Awesome Nightfall: The Life, Times, and Poetry of Saigyō. By William R. LaFleur. Boston: Wisdom Publications, 2003. Pp. xiii + 173. Paper $14.95.Becoming the Compassion Buddha: Tantric Mahamudra for Everyday Life. By Lama Thubten Yeshe, edited by Robina Courtin, and foreword by Geshe Lhundub Sopa. Boston: Wisdom Publications, 2003. Pp. xi + 194. Paper $14.95.Between Two Worlds East and West: An Autobiography. By J. N. Mohanty. New Delhi: Oxford University Press, 2002. Pp. ix + 134. Hardcover RS 525.00.The Chinese Face of Jesus Christ. Edited by Roman Malek, S.V.D. Sankt Augustin, Germany: Institut Monumenta Serica and China-Zentrum; and Nettetal, Germany: Steyler Verlag, 2002. Pp. 391. EUR 40.00.Chinese Medicine in Contemporary China: Plurality and Synthesis. By Volker Scheid. Durham and London: Duke University Press, 2002. Pp. xiv + 407. Hardcover $69.95. Paper $23.95.Confucian Feminist: Memoirs of Zeng Baosun (1893-1978). Translated and adapted by Thomas L. Kennedy. Philadelphia: American Philosophical Society, 2002. Pp. xxi + 170. Price not given.Consciousness Studies: Cross-Cultural Perspectives. By K. Ramakrishna Rao. Jefferson (North Carolina) and London: McFarland and Company, 2002. Pp. 367. Hardcover $65.00.Constituting Communities: Theravāda Buddhism and the Religious Cultures of South and Southeast Asia. Edited by John Clifford Holt, Jacob N. Kinnard, and Jonathan S. Walters. Albany: State University of New York Press, 2003. Pp. viii + 224. Hardcover $65.50. Paper $21.95.Developments in Indian Philosophy from Eighteenth Century Onwards: Classical and Western. By Daya Krishna. Volume X Part 1 of History of Science, Philosophy and Culture in Indian Civilization, edited by D. P. Chattopadhyaya. New [End Page 110] Delhi: Centre for Studies in Civilizations, 2001. Pp. xxiii + 417. Hardcover RS 1200.East and West: Identità e dialogo interculturale. By Giangiorgio Pasqualotto. Venezia: Marsilo Editori, 2003. Pp. 210. EUR 16.00.Effortless Action: Wu-wei as Conceptual Metaphor and Spiritual Ideal in Early China. By Edward Slingerland. New York: Oxford University Press, 2003. Pp. xii + 352. Price not given.Encountering Kā lī: In the Margins, at the Center, in the West. Edited by Rachel Fell McDermott and Jeffrey J. Kripal. Berkeley and Los Angeles: University of California Press, 2003. Pp. xviii + 321. Hardcover $55.00, £37.95. Paper $21.95, £15.95.Encyclopedia of Chinese Philosophy. Edited by Antonio S. Cua. New York and London: Routledge, 2003. Pp. xx + 1020. Hardcover $150.00.Essays on Indian Philosophy. By J. N. Mohanty and edited by Purushottama Bilimoria. New Delhi: Oxford University Press, 2002. Pp. xxxvii + 347. Paper RS 525.00.Faith, Humor, and Paradox. By Ignacio L. Götz. Westport, Connecticut: Praeger Publishers, 2002. Pp. 136. Hardcover $61.95.Four Illusions: Candrakīrti's Advice for Travelers on the Bodhisattva Path. Translated by Karen C. Lang. New York: Oxford University Press, 2003. Pp. xv + 240. Price not given.The Great Awakening: A Buddhist Social Theory. By David R. Loy. Boston: Wisdom Publications, 2003. Pp. 223. Paper $16.95.The Hidden History of The Tibetan Book of the Dead. By Bryan J. Cuevas. New York: Oxford University Press, 2003. Pp. xi + 328. Price not given.Huang Di nei jing su wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. By Paul U. Unschuld. Berkeley and Los Angeles: University of California Press, 2003. Pp. xii + 520. Hardcover $75.00, £52.00.In Dewey's Wake: Unfinished Work of Pragmatic Reconstruction. Edited by William J. Gavin. Albany: State University of New York Press, 2003. Pp. vi + 249. Hardcover $71.50. Paper $23.95.Knowledge and Freedom in Indian Philosophy. By Tara Chatterjea. Lanham, Maryland: Lexington Books, 2002. Pp. xvi + 159. Hardcover... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Aelius Théon: ProgymnasmataGeorge A. KennedyMichel Patillon, ed., avec l'assistance pour l'Arménien de Giancarlo Bolognesi. Aelius Théon: Progymnasmata. Paris: Les Belles Lettres, 1997. clvii + 229 pp. ( 1-120 double). Price not stated. (Editions Budé)Progymnasmata, handbooks of preliminary exercises in composition, are important sources for understanding Greek and Roman education and rhetoric and equally important in that the exercises they describe, including narrative, [End Page 476]fable, chria, encomium, ekphrasis, (...) synkrisis, prosopopoeia, and others, provided topics for literary genres in prose and poetry. Of the four surviving Greek treatises on progymnasmata, by or attributed to Theon, Hermogenes, Aphthonius, and Nicolaus, Pseudo-Hermogenes and Aphthonius were the most influential. There are good editions of them by Hugo Rabe and of Nicolaus by Joseph Felton, all in the Teubner series. Theon's work is the earliest treatment and in some ways the most interesting, for it shows the system of rhetorical education in a developing stage and, since it is addressed to teachers rather than to students, it has much to say about pedagogical method. It has, however, been available only in reprints of Leonard Spengel's Rhetores Graeci(II 59-130), originally published in 1854, and in copies of a dissertation by James R. Butts (Claremont Graduate School, 1986). The new Budé Theon, with its lengthy introduction, French translation, and extensive learned notes, at last makes the work accessible to scholars in its full form.The Greek manuscripts of Theon's treatise break off abruptly in the discussion of the exercise for and against a law and lack chapters at the end where Theon discussed reading aloud, listening, paraphrase, elaboration, and contradiction. In addition, the original order of chapters was altered by some editor in late antiquity to conform better to what is found in Pseudo-Hermogenes and Aphthonius. Forty years ago Italo Lana projected a new edition, restoring the original sequence, and published a valuable study of the Greek textual tradition (Turin 1959), but he never completed the edition. The probable reason is that about that time the existence of a full translation of the work into classical Armenian had come to be known from two manuscripts in the State Library in Erivan, Armenia. Butts was aware of the existence of the Armenian translation but had no direct access to the contents.The Armenian translation was made from a Greek text before the rearrangement of the chapters and before the loss of the concluding pedagogical chapters. Patillon, in collaboration with Bolognesi, has reconstructed the Greek text on which the translation was based. It was so literal as to be almost incomprehensible in itself, but by comparison with the Greek in the large part of the work where both survive it has proved possible to reconstruct the Greek original with some probability. Patillon makes much use of this reconstruction throughout his text and apparatus and prints the Armenian text of the otherwise lost chapters, with French translation but without the Greek reconstruction.On the basis of a notice in the SoudaTheon is probably to be identified with Aelius Theon of Alexandria. There is reference in a newly discovered part of the text (Patillon, p. 106) to Dionysius of Halicarnassus, which gives us a date after the first century B.C., and a possible reference to Theon in Quintilian (9.3.76), suggesting Theon may have been writing in the first century after Christ. The name Aelius might indicate a Hadrianic date but probably came into use in Egypt after the prefecture of Aelius Gallus in the Augustan period. [End Page 477]In any event, the work is clearly the earliest of the four major progymnasmatic treatises and has similarities to the Latin discussions of the exercises by Quintilian (1.9) and in Suetonius' De Grammaticis et Rhetoribus.Although there is much that deserves attention in the introduction and notes of this edition, readers will perhaps most want to know about passages where new readings in the Greek make a difference to the meaning and interpretation of passages, and also about the contents of the chapters that survive only in Armenian, here published for the first time. References are to page and line... (shrink)

: Catholic teaching has no moral difficulties with research on stem cells derived from adult stem cells or fetal cord blood. The ethical problem comes with embryonic stem cells since their genesis involves the destruction of a human embryo. However, there seems to be significant promise of health benefits from such research. Although Catholic teaching does not permit any destruction of human embryos, the question remains whether researchers in a Catholic institution, or any researchers opposed to destruction of human embryos, (...) could participate in research on cultured embryonic stem cells, or whether a Catholic institution could use any therapy that ultimately results from such research. This position paper examines how such research could be conducted legitimately in a Catholic institution by using an ethical analysis involving a narrative context, the nature of the moral act, and the principle of material cooperation, along with references to significant ethical assessments. It also offers tentative guidelines that could be used by a Catholic institution in implementing such research. (shrink)

Pragmatic comparative effectiveness randomized controlled trials evaluate the effectiveness of one interventions under real-world clinical conditions. The results of ceRCTs are often directly generalizable to everyday clinical practice, providing information critical to decision-making by patients, clinicians, and healthcare policymakers. The PRECIS-2 framework identifies nine domains that serve to score a trial on a continuum between very explanatory to very pragmatic. According to the framework, pragmatic trials may have one or more of the following features: there are fewer eligibility criteria for (...) participants, in an... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Informed Consent and Clinical ResearchRuth Faden (bio)Informed consent is a powerful symbol of the commitment and impact of the new, interdisciplinary field of biomedical ethics that the Kennedy Institute has been so instrumental in developing. In the early years of biomedical ethics, there was considerable discussion about the nature of the doctor-patient relationship, about how it ought to be structured, and about how competing values within that relationship (...) ought to be accommodated. By the 1970s and 1980s, the answer was for all practical purposes in. Biomedical ethics was engaged in a clearly reformist project, in step with the values of the times, to right a wrongful imbalance of power and control between physicians and patients.The agenda was clear—to establish the moral authority of the patient to participate in medical decision making by placing respect for the autonomy of patients on the moral map of the medical community. The chief strategy that biomedical ethics adopted to accomplish this agenda was, of course, informed consent. Theories of autonomous action as well as informed consent were intentionally crafted to advance this reformist agenda.In this paper, I examine how the theory of informed consent has fared in one particular realm of “the clinic” where, arguably, there has been considerable success. This is the realm of clinical research; research at the bedside where the patient is also the subject.I rely heavily on the work of President Clinton’s Advisory Committee on Human Radiation Experiments, which I chaired. The Advisory Committee was established in response to exposés in the press about alleged secret experiments during World War II and the Cold War in which patients had been injected with plutonium without their apparent knowledge or consent. As part of its work, the Advisory Committee undertook an oral history project in which we interviewed eminent physicians about the norms and practices of human research in the 1940s and 1950s.Drawing on these interviews, I argue here for two seemingly inconsistent conclusions. First, that the ethical standards for clinical research have changed dramatically in the last 50 years—particularly with respect to informed consent. Second, that despite these important changes, the human dynamics of clinical research in many respects remain unchanged.How the World of Clinical Research Has ChangedDuring the forties and fifties, duties to obtain informed consent, whether for treatment or for research, were simply not part of the doctor-patient experience. [End Page 356]As one physician told us:In 1945, ‘50, the doctor... was king or queen. It never occurred to a doctor to ask for consent for anything. Doctors weren’t in the habit of telling the patients anything (either). They were in charge and nobody questioned their authority.(Advisory Committee on Human Radiation Experiments 1996, p. 83)This unquestioned authority extended to all decisions about the management of the patient, including whether patients were to receive experimental therapies or otherwise become the subjects of research or experimentation. Physicians were trained to be concerned with risk, and harm, and benefit, in keeping with the Hippocratic tradition. But in most institutions, the permission to try something new and to take unknown risks came, not from the patient, but from the chairman of the department.In part, this broad license reflected the very newness of scientifically grounded medical practice. In the forties and fifties, many potentially therapeutic interventions were newly discovered and in this sense considered experimental, or at least innovative. The level of uncertainty about whether a treatment would work was generally high, whether the treatment was part of a research project or not. Moreover, the formalizing of medical science at the bedside was itself still in its infancy—it was not until 1948 that the first modern clinical trial in which patients were randomized to different treatment and control groups was reported in the literature. Much of the research of this period was informal and unsystematic.Thus, it is not surprising that the physician’s authority to make treatment decisions extended to treatments that were innovative or experimental, regardless of whether these innovative treatments were the subject of formal scientific investigation. What is perhaps more surprising is that physicians often acted the same way—that... (shrink)

How can a system of criminal punishment be justified? In particular can it be justified if the moral demand that we respect each other as autonomous moral agents is taken seriously? Traditional attempts to justify punishment as a deterrent or as retribution fail, but Duff suggests that punishment can be understood as a communicative attempt to bring a wrong-doer to repent her crime. This account is supported by discussions of moral blame, of penance, of the nature of the law's demands, (...) and of the proper meaning and purpose of the criminal process of trial and verdict: it deals both with the ideals that should inform a system of criminal law and the extent to which those ideals are actualised in existing institutions and practices. The conclusion is pessimistic: punishment cannot be justified within our legal system; and this gap between the ideal and the actual presents us with serious moral dilemmas. (shrink)

How can a system of criminal punishment be justified? In particular can it be justified if the moral demand that we respect each other as autonomous moral agents is taken seriously? Traditional attempts to justify punishment as a deterrent or as retribution fail, but Duff suggests that punishment can be understood as a communicative attempt to bring a wrong-doer to repent her crime. This account is supported by discussions of moral blame, of penance, of the nature of the law's demands, (...) and of the proper meaning and purpose of the criminal process of trial and verdict: it deals both with the ideals that should inform a system of criminal law and the extent to which those ideals are actualised in existing institutions and practices. The conclusion is pessimistic: punishment cannot be justified within our legal system; and this gap between the ideal and the actual presents us with serious moral dilemmas. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Principles and PragmatismR. Alta Charo (bio)Openly, privately, or implicitly, every public ethics committee struggles with its mandate. Is its job to identify a moral ideal?; a morally acceptable minimum that, realistically, could be adopted as policy?; or an optimal political compromise that can arguably meet ethical analysis? The answer appears to be different for each committee, depending upon its subject matter, its sponsoring political body, and the details of (...) its legal mandate. What is universal, however, is that even the most well-intentioned committee is likely to experience dissension over the interpretation of its task and that this dissension will often be played out in debates over particular policy recommendations.Ruth Macklin’s description of disagreement and moral integrity in the context of the Advisory Committee on Human Radiation Experiments demonstrates this phenomenon quite clearly (Macklin 1996). The epistemological debates concerning the evidence of past practices illuminate differing visions of the Committee’s mandate. For some it was to render moral judgment on past acts, without necessarily concluding that, if the acts were immoral, the individuals involved were themselves immoral. For others it was to use moral judgments to determine appropriate forms of restitution, thus balancing the reputational risks to past actors against the need for and feasibility of restitution to the victims. Still others appeared to focus on crafting specific political responses, and the historical data needed only be sufficient to bolster the policy recommendations.In this respect, the composition of any advisory committee becomes crucial. As fact-finders, committee members must determine the kind of evidence they will find persuasive. This determination, in turn, depends upon whether the committee sees itself primarily as (1) informational, in which case the standards employed by professional historians are probably the most appropriate, or (2) judgmental, in which case something closer to legal standards of proof might be better. The dilemma is not limited to committees looking at history; those rendering advice on science policy need to determine if they will use standards of proof prevalent in the scientific community (consensus following peer review) or the public (scientific consensus coupled with credibility of the scientific community as a whole). [End Page 319]When a committee is asked to base its judgments on ethical analysis, the conflicts only deepen. The “ethics” of policy recommendations are invariably balanced against the desire to see one’s work yield a concrete political response, the perception of political constraints on implementing an ethically “ideal” solution, and the subtle pressures exerted by the sponsoring political body to respond to the specific committee mandate, which was written with the needs of the sponsoring body in mind, not the needs of a wide-ranging ethics discussion.Another complication arises because ethics committees derive their credibility from the perception that moral truth is discoverable and unassailable. To horse trade among these moral truths undermines the credibility of their entire endeavor and can render bioethics advisory committees not only ineffective but even offensive. After all, if a moral truth exists, how ethical is it for “ethicists” to abandon it in the name of strategic concerns? If, on the other hand, no moral truth exists, then by what right do these “ethics” committees claim persuasive authority beyond that of any citizen advisory committee?This is a deep dilemma that relates to the discipline of bioethics itself. Lacking a core methodology or doctrine, bioethics has yet to justify itself to either its proponents or to the public. Bioethics scholars acknowledge that there are a variety of theories drawn from moral philosophy that could be used to guide the resolution of dilemmas that arise in the context of medical care and biomedical research. Such theories include utilitarianism, deontology, teleology, virtue theory, and justice theory, with no one theory being universally adopted by bioethics scholars and no one methodology being available to resolve conflicts among their respective conclusions. While deductivism is the predominant analytical style in the field, “[t]he central difficulty with deductivism is that there is no single comprehensive moral theory, nor even theories or principles of more limited scope, which is agreed to be true or correct” from which defensible conclusions will flow (Brock 1995).But if public ethics bodies cannot... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Environmental Genome Project and BioethicsRichard R. Sharp (bio) and J. Carl Barrett (bio)Eight years ago, the Kennedy Institute of Ethics Journal published a brief selection by Eric Juengst (1991) entitled “The Human Genome Project and Bioethics.” That essay introduced and described the Ethical, Legal, and Social Implications (ELSI) Program at the National Center for Human Genome Research. 1 Since that time, the ELSI program has grown to (...) become one of the largest and most well regarded bioethics programs in the country, sponsoring the work of hundreds of researchers and coordinating bioethics activities both nationally and internationally (Marshall 1996; Meslin, Thomson, and Boyer 1997). In 1991, however, Juengst, the first director of the ELSI program, had no way of anticipating these developments. Juengst’s goal in his essay was simply to highlight some of the moral and social issues that were emerging as focal points for the ELSI program. Looking back, the issues he outlined may seem vague and overly broad. At the time, however, the essay served an important purpose, to identify areas requiring additional study and thereby to serve as a guide to others interested in joining in these discussions.In many ways, Juengst’s article serves as an inspiration to those of us working on a new bioethics project. The National Institute of Environmental Health Sciences (NIEHS) recently launched a multi-year project aimed at better understanding genetic influences on environmentally associated diseases (Albers 1997; Brown and Hartwell 1998; Cannon 1997; Kaiser 1997). This project, known as the Environmental Genome Project (EGP), plans to identify and study a number of common genetic variants that may play an important role in determining how individuals respond to environmental exposures. NIEHS hopes that the information learned through the EGP will be instrumental in developing more effective disease-prevention strategies and intervention programs. Following the precedent developed in connection with the Human Genome Project, NIEHS also plans to address the moral and social implications of the EGP. Efforts in this regard include sponsoring workshops and conferences to address such issues, as well as supporting research on the ethical, legal, and social implications of the EGP. Through this work, NIEHS hopes to anticipate potential problems before [End Page 175] they arise and to develop policies that maximize the benefits of the research while avoiding potential misuses of the information learned.In exploring the social implications of the EGP, we at NIEHS are very fortunate to be able to draw upon the work being done by the ELSI program at the National Human Genome Research Institute (NHGRI), as well as the ever-expanding bioethics literature that has been sparked by the ELSI program. Still, there is much to be done and this is an exciting time for those of us involved with the EGP. Many of the ethical, legal, and social implications of the project are only beginning to become clearer, and several of these issues appear quite different from the sorts of concerns that have previously been discussed in connection with other types of genetic research.This essay highlights some of the ethical, legal, and social implications that are emerging as important focal points for the Environmental Genome Project. Like Juengst’s 1991 paper, the goal of this article is to provide an overview of current areas of interest and to encourage others to join us in thinking about these difficult issues.The Environmental Genome ProjectIndividuals differ greatly in their responses to chemicals, drugs, radiation, smoking, alcohol, and other environmental exposures. These differential responses are the result of complex interactions between many factors, including an individual’s genetic make-up, age, sex, nutritional status, and overall health. The EGP aims to better understand the genetic basis of differential responses to environmental exposures. The vast majority of diseases, many forms of cancer, for example, are the consequence of both environmental and genetic contributions (Perera 1997). Hence, understanding the relationships between genetic variation and response to environmental exposure is important for understanding the causes of human disease and is crucial for the development of effective disease-prevention strategies.The EGP and projects like it represent a new stage of genomic research. It is expected that the Human Genome Project will complete... (shrink)

The article by Baker and McCullough in this issue posits that bioethics has generally applied moral theories to practical problems. They propose that, rather than this "application," bioethicists should "appropriate" aspects of ethical theory. This article disagrees that bioethical writing is primary "application." It agrees that "appropriation" is the most suitable approach to bioethical analysis but claims that the description of appropriation provided by Baker and McCullough is inadequate. It must be supplemented by the rhetorical concept of "invention.".