In this paper, I argue that the role of values in theory selection is an important issue within medical education. I review the underdetermination argument, which is the idea within philosophy of science that the data serving as evidence for theories are by themselves not sufficient to support a theory to the exclusion of alternatives. There are always various explanations compatible with the data, and we ultimately appeal to certain values as our grounds for choosing one theory over another. I (...) explore some of the ways contemporary feminist philosophers have chosen to grapple with the problem of underdetermination and proposed solutions to systematize how values might be incorporated into theory choice, drawing primarily from the work of Helen Longino and Elizabeth Anderson. I conclude by discussing how value‐laden inquiry should be incorporated within medical education to promote reflection towards medicine’s normative underpinnings. (shrink)

Multiple groups, including the National Bioethics Advisory Commission, the American Society of Clinical Oncology, the National Coalition of Comprehensive Cancer Centers, Workgroup 6 of the Summit Series on Cancer, PRIM&R, the Bell Report, and prominent ethicists have called for replacing the current system of local institutional review with central review for multisite national trials. We argue that this need is particularly acute in pediatric oncology, as shown by the experience of the Children's Oncology Group.

In general, we endorse Aggleton & Brown's thesis that the neuroanatomy of amnesia comprises two functionally distinct systems, but we are disappointed in the lack of detail regarding the critical functional contribution of the hippocampus. We also take issue with the characterization of the cortical areas surrounding the hippocampus, particularly the decreased emphasis on the cortical input to the hippocampus.

BackgroundAlthough patient advocates have developed templates for standard consent forms, evaluating patient preferences for first in human (FIH) and window of opportunity (Window) trial consent forms is critical due to their unique risks. FIH trials are the initial use of a novel compound in study participants. In contrast, Window trials give an investigational agent over a fixed duration to treatment naïve patients in the time between diagnosis and standard of care (SOC) surgery. Our goal was to determine the patient-preferred presentation (...) of important information in consent forms for these trials.MethodsThe study consisted of two phases: (1) analyses of oncology FIH and Window consents; (2) interviews of trial participants. FIH consent forms were analyzed for the location(s) of information stating that the study drug has not been tested in humans (FIH information); Window consents were analyzed for the location(s) of information stating the trial may delay SOC surgery (delay information). Participants were asked about their preferred placement of the information in their own trial’s consent form. The location of information in the consent forms was compared to the participants’ suggestions for placement. Results34 [17 FIH; 17 Window] of 42(81%) cancer patients approached participated. 25 consents [20 FIH; 5 Window] were analyzed. 19/20 FIH consent forms included FIH information, and 4/5 Window consent forms included delay information. 19/20(95%) FIH consent forms contained FIH information in the risks section 12/17(71%) patients preferred the same. Fourteen (82%) patients wanted FIH information in the purpose, but only 5(25%) consents mentioned it there. 9/17(53%) Window patients preferred delay information to be located early in the consent, before the “Risks” section. 3/5(60%) consents did this.ConclusionsDesigning consents that reflect patient preferences more accurately is essential for ethical informed consent; however, a one-size fits all approach will not accurately capture patient preferences. We found that preferences differed for FIH and Window trial consents, though for both, patients preferred key risk information early in the consent. Next steps include determining if FIH and Window consent templates improve understanding. (shrink)

Access to investigational drugs is a concern to patients and regulatory agencies. In order to determine potential trial participants’ views on access to investigational drugs, we surveyed one hundred people who had been referred to a phase I clinical trial. Most respondents indicated that patients had a right to investigational drugs, that the drugs should be offered only in the context of research, that getting access to these drugs is too hard, and that knowing the right people and being persistent (...) increased the likelihood of gaining access. Respondents did not think that investigational drugs should be given to anyone who wanted them, or that physicians were aware of the latest investigational agents. They most frequently recommended two allocation criteria: offering investigational drugs to those who would benefit most or were most needy; and allocating them to maximize scientific advancement. Respondents who understood the purpose of the trial were more likely to choose the second criterion. (shrink)

Some research is too risky to be conducted on anyone whose life expectancy is more than a few hours. Yet sometimes, the research can still be carried out using subjects who are brain dead or are soon to undergo a terminal wean, and who have articulated values that inclusion in the study can honor. So argues a team of ethicists and researchers at M.D. Anderson Cancer Center, where such research was recently undertaken.

The child was 2 years, 8 months old and weighed 25 pounds, one-fifth the weight of her mother, for whom she was to be the bone marrow donor. The mother had suffered a relapse of acute myelogenous leukemia; her physicians recommended a bone marrow transplant. The child was the closest human leukocyte antigen match and thus the best donor candidate for her mother's transplant.

Even appropriate, ethically sound recommendations can generate angst. In this case, the principal investigator is concerned about the ethics consult recommendation to not inform the participan...

In the Critique of Pure Reason, Immanuel Kant offers a revolutionary approach to cognition, wherein cognition can be understood as an action carried out by a cognitive agent. But giving the subject such an active role raises questions about Kant’s ability to account for objective cognition. In this paper, I will argue that the cognitive autonomy thesis central to Kant’s model renders it unable to account for the normativity required for objective cognition, and that G.W.F. Hegel makes just this criticism (...) in the Desire section of his Phenomenology of Spirit. Hegel proposes an alternative: some basic intersubjective structure must be built into cognition on a fundamental level. For Hegel, the possibility of disagreement is an a priori requirement for objective cognition in general. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

The development of technologies for the biopreservation of infectious organisms requires careful analysis of benefits and risks. This article reviews the regulatory landscape and oversight responsibilities in the United States in respect to pathogen biopreservation. Focused on two globally significant pathogens, Cryptosporidium and Plasmodium, the article explores advantages and potential risks of biopreservation concerning biosafety, biosecurity and biocontainment.

Volume 20, Issue 8, August 2020, Page W12-W13.

Research involving recently deceased humans that are physiologically maintained following declaration of death by neurologic criteria—or ‘research involving the recently deceased’—can fill a translational research gap while reducing harm to animals and living human subjects. It also creates new challenges for honouring the donor’s legacy, respecting the rights of donor loved ones, resource allocation and public health. As this research model gains traction, new empirical ethics questions must be answered to preserve public trust in all forms of tissue donation and (...) in the practice of medicine while respecting the legacy of the deceased and the rights of donor loved ones. This article suggests several topics for immediate investigation to understand the attitudes and experiences of researchers, clinical collaborators, donor loved ones and the public to ensure research involving the recently deceased advances ethically. (shrink)

... Geoffrey Underwood (University of Nottingham) Francisco Varela (CREA, Ecole Polytechnique. Paris) Volume 2 Ralph D. Ellis Questioning Consciousness ...

Phase 1 healthy volunteer clinical trials—which financially compensate subjects in tests of drug toxicity levels and side effects—appear to place pressure on each joint of the moral framework justifying research. In this article, we review concerns about phase 1 trials as they have been framed in the bioethics literature, including undue inducement and coercion, unjust exploitation, and worries about compromised data validity. We then revisit these concerns in light of the lived experiences of serial participants who are income-dependent on phase (...) 1 trials. We show how participant experiences shift attention from discrete exchanges, behaviors, and events in the research enterprise to the ongoing and dynamic patterns of serial participation in which individual decision-making is embedded in collective social and economic conditions and shaped by institutional policies. We argue in particular for the ethical significance of structurally diminished voluntariness, routine powerlessness in setting the terms of exchange, and incentive structures that may promote pharmaceutical interests but encourage phase 1 healthy volunteers to skirt important rules. (shrink)

This essay describes and critically evaluates a co-operative educational program to train Ugandan health care workers in bioethics. It describes one bottom-up effort, a week-long intensive workshop in bioethics provided by the authors to health care professionals in a developing country—Uganda. We will describe the background and circumstances that led to the organization of the workshop, and review its planning, design, curriculum, and outcome. We will focus especially on measures taken to make the workshop relevant for the audience of Ugandan (...) professionals, and describe lessons learned after two presentations of the workshop. Finally, we will discuss the strengths and weaknesses of such a format, and its potential value in raising bioethical expertise in developing countries. (shrink)

What motivates the voluntary suffering of training for a long-distance run – or any other difficult athletic skill? Long-term pleasure cannot adequately explain this seemingly masochistic activity. On the contrary, I argue that pleasure, or “reinforcement,” is not the only ultimate motivator of behavior. Each of the emotion systems defines its own intrinsic values, including an innate “play” system and an innate “exploratory drive” that is included in what neuropsychologist Jaak Panksepp calls the “SEEKING system” of the emotional brain. Panksepp’s (...) description of the conscious dimension of SEEKING is remarkably similar to Otto Rank’s descriptions of his “love of life” dimension of motivation, which actually conflicts with the pleasure principle. The desire for pleasure is a desire to reduce consummatory drives, which means reducing the energy level of our bodily systems. Complete reduction would be death. If there were no competing motivation in the other direction, there would be nothing to keep us alive. The SEEKING system is what does that. It motivates a higher energy level. In the case of athletic training, we do not have to “force ourselves” to this higher energy level. The SEEKING system is an innate natural drive. If we were to deliberately try to just sit on a couch indefinitely, at some point we would fail. (shrink)

With growing awareness of a crisis in pollinator health, the practice of urban hobbyist beekeeping has grown in Canada with practitioners arguing that this activity can help to foster healthier honey bees and more mindful beekeeping practices. However, urban hobbyist beekeepers have been critiqued for encouraging improper beekeeping practices and over-saturation of honey bees in cities. Drawing on a multispecies ethnography based in London, Ontario and Toronto, including participant observation with the Toronto Beekeeping Collective and the London Urban Beekeeping Collective (...) and interviews with 26 urban beekeepers, I argue that urban hobbyist beekeepers develop a sensuous and embodied relationship with honey bees that typifies playful work. By integrating participant perspectives with social reproduction theory, I demonstrate that the playful work of urban hobbyist beekeeping allows practitioners to engage with non-human nature outside of the constraints of capitalist labour regimes, enabling the expression of delight, enchantment, and curiosity. This relationship between beekeepers and honey bees encourages the development of bee-centred practices in which the preferences and physiological needs of the bees are consciously put ahead of the needs of the beekeeper. The possibility for honey bee flourishing is increased significantly when bee-centred beekeeping is coupled with integrated pest management. (shrink)

Art perception offers action affordances for the self-generated movement of the eyes, the mind, and the emotions; thus some scenes are ’easy to look at', and evoke different kinds of moods depending on what kind of affordances they present for the eyes, the brain, and the action schemas that further the dynamical self-organizing patterns of activity toward which the organism tends, as reflected in its ongoing emotional life. Art can do this only because perception is active rather than passive, and (...) begins with efferent activity in emotional brain areas (e.g. hypothalamus, amygdala, hippocampus and anterior cingulate) which then motivates afferent processing (parietal imaging activity which finally, after a 1/3-second motivational/selective process is complete, resonates with occipital patterns, resulting in perceptual consciousness). The limbic system ’categories’ that motivate the ’looking-for’ of selective attention are categories of utility, to be understood in terms of emotional affordances and whole-organism affective meanings. Art plays with this looking-for, using it to make us engage in different afforded actions that relate to different limbic (emotional) categories. The drawings of children and of the artistically untutored reveal this structure when we fail to ’draw what we see’, drawing instead what we conceptualize that we ought to be seeing. Art teaches us to get beyond this almost complete dominance of habitual categories, and to see things more freshly -- both in the perceptual and in the emotive sphere. Rather than reinforcing our preconceptions, it forces us to see how they affect our view of reality. -/- Because neither perceptions nor emotional responses are really passive ’responses’ at all, art does not cause us to feel a certain way. Instead, we ’use’ art for the purpose of symbolizing our emotions. Our most important feelings are not directly ’about’ the perceptual objects that trigger them. The object in conscious attention during the feeling of an emotion is normally not the intentional object of the emotion, i.e., it is not the object in relation to which our actions could serve the purpose of the emotion. Emotions are not even triggered by simple ’stimuli’, but rather by the meaning for us of a stimulus in a total context determined by ongoing and dynamical organismic purposes. Emotions arise from the total life process, which is a dynamical system -- not as an isolated chemical event or a causal result of a simple stimulus. For this reason, emotions call not just for satiation or pleasure, but for explication; this is why art is different from entertainment or pretty decoration. Visual art affords not only a meaningful, self-directed dance of the eyes, but also a meaningful dance of this emotional explicating process. (shrink)

Pushing back against the potential trivialization of moral psychology that would reduce it to emotional preferences, this book takes an enactivist, self-organizational, and hermeneutic approach to internal conflict between a basic exploratory drive motivating the search for actual truth, and opposing incentives to confabulate in the interest of conformity, authoritarianism, and cognitive dissonance, which often can lead to harmful worldviews. The result is a new possibility that ethical beliefs can have truth value and are not merely a result of ephemeral (...) altruistic or cooperative feelings. It will interest moral and political psychologists, philosophers, social scientists, and all who are concerned with inner emotional conflicts driving ethical thinking beyond mere emotivism, and toward moral realism, albeit a fallibilist one requiring continual rethinking and self-reflection. It combines 'basic emotion' theories with hermeneutic depth psychology. The result is a realist approach to moral thinking emphasizing coherence rather than foundationalist theory of knowledge. (shrink)

Open peer commentary on the article “Exploring the Depth of Dream Experience: The Enactive Framework and Methods for Neurophenomenological Research” by Elizaveta Solomonova & Xin Wei Sha. Upshot: A neurophenomenological approach to the enactive account of consciousness in general is supported by an account of how the brain functions in creating imagery of non-present objects and situations. Three types of non-sensory imagery are needed to ground our consciousness of sensory imagery: proprioceptive imagery, motor imagery, and what Eugene Gendlin calls the (...) “felt sense” of a situation. Dreams show clearly how we image situations without sensory input, a process that is clearly enactive rather than reactive. This enactive account of imagery then supports Gendlin’s method of interpreting dreams by comparing their “felt sense” to the felt sense of waking situations. (shrink)

As globalized corporations are traded intemationally, with investors and workers from many countries, nation-states have diminishing interest in fighting wars promoting competitive profit interests of intemational companies. Theoretically, this trend could prompt diminution in the role of warfare. Militarism continues to serve corporations that are globally owned, operated, and controlled, fought by the very workers who then must compete against the resulting unregulated and often cormpt intemational labor and resource markets—driving down the real wages of domestic and foreign workers. But (...) if philosophical attitudes eventually catch up with the new thinking about wars that are fought in the context of such complete globalization of labor and resource markets, it seems inevitable that voters will understand that the interests of the people within nation-states no longer coincide with any one global corporation any more than with any other—reducing incentives to sacrifice national blood and treasure defending the interests of nationless entities. (shrink)

While much of contemporary psychology preserves the legacy of behaviorism and consummatory drive-reductionism, this paper by contrast grounds itself in an "enactivist" approach to emotion and motivation, and goes on to consider the implications of this view for the psychology of inspiration, especially as applied to love and religion. Emotions are not responses to stimuli, but expressions of an active system. The tendency of complex systems is to prefer higher-energy basins of attraction rather than settle into satiation and dull comfort. (...) Given this understanding of the emotions in complex animals, there is a fundamental need for inspiration to fuel the self-initiated activation of the system; lack of this basic inspiration is depression. In sophisticated conscious beings, the need for inspiration is exacerbated by awareness of the problems of finitude; love, the arts and religion are meant to address this heightened need for inspiration. Fundamentalist approaches, however, contend with the problem of finitude in an inauthentic way-by simply denying them. This fundamentalist approach leads to corresponding distortions of ethical and political attitudes. (shrink)