Patient or public involvement in health research is increasingly expected as a matter of policy. In theory, PPI can contribute both to the epistemic aims intrinsic to research, and to extrinsically valued features of research such as social inclusion and transparency. In practice, the aims of PPI have not always been clear, although there has been a tendency to encourage the involvement of so-called ordinary people who are regarded as representative of an assumed patient perspective. In this paper we focus (...) on the epistemic potential of PPI, using theoretical work in epistemology to develop a nuanced account of patients’ experiential knowledge and how this might contribute directly to conceptual development, hypothesis generation and data interpretation. We also consider how some features of health research pose barriers to this kind of epistemic contribution. Drawing on Miranda Fricker’s idea of testimonial injustice, we explore how disciplinary indicators of credibility in clinical and academic health research contexts might be wrongly applied to those involved in PPI, undermining their potential to contribute. Finally we argue for a range of strategies to maximize opportunities for patients to engage with research teams and make epistemologically significant contributions to research. (shrink)

This paper raises questions about the epistemological foundations of evidence-based medicine . We argue that EBM is based upon reliabilist epistemological assumptions, and that this is appropriate - we should focus on identifying the most reliable processes for generating and collecting medical knowledge. However, we note that this should not be reduced to narrow questions about which research methodologies are the best for gathering evidence. Reliable processes for generating medical evidence might lie outside of formal research methods. We also question (...) the notion of the knower that is assumed by EBM. We argue that EBM assumes an enlightenment conception of knowers as autonomous, substitutable individuals. This conception is troubled by the way that clinicians learn the role of anecdote in health care and the role of patient choice, all of which bring into play features of clinicians and patients as situated individuals with particular backgrounds and experiences. EBM's enlightenment conception of the knower is also troubled by aspects of the way evidence is produced. Given these limitations, we argue that EBM should retain its reliabilist bent, but should look beyond formal research methodologies in identifying processes that yield reliable evidence for clinical practice. We suggest looking to feminist epistemology, with its focus on the standpoints of individual situated knowers, and the role of social context in determining what counts as knowledge. (shrink)

OBJECTIVES: This article presents an original definition of surgical innovation and a practical tool for identifying planned innovations. These will support the responsible introduction of surgical innovations. BACKGROUND: Frameworks developed for the safer introduction of surgical innovations rely upon identifying cases of innovation; oversight cannot occur unless innovations are identified. However, there is no consensus among surgeons about which interventions they consider innovative; existing definitions are vague and impractical. METHODS: Using conceptual analysis, this article synthesizes findings from relevant literature, and (...) from qualitative research with surgeons, to develop an original definition of surgical innovation and a tool for prospectively identifying planned surgical innovations. The tool has been developed in light of feedback from health care professionals, surgeons, and policy makers. RESULTS: This definition of innovation distinguishes between variations, introduction of established interventions, and innovations in surgical techniques or use of devices. It can be applied easily and consistently, is sensitive to the key features of innovation, is prospective, and focuses on features relevant to safety and evaluation. The accompanying tool is deliberately broad so that appropriate supports may, if necessary, be provided each time that a surgeon does something "new". CONCLUSIONS: The definition presented in this article overcomes a number of practical challenges. The definition and tool will be of value in supporting responsible surgical innovation, in particular, through the prospective identification of planned innovations. (shrink)

Placebo-controlled surgical trials can provide important information about the efficacy of surgical interventions. However, they are ethically contentious as placebo surgery entails the risk of harms to recipients, such as pain, scarring or anaesthetic misadventure. This has led to claims that placebo-controlled surgical trials are inherently unethical. On the other hand, without placebo-controlled surgical trials, it may be impossible to know whether an apparent benefit from surgery is due to the intervention itself or to the placebo effect.

A beautifully illustrated reminder that God paints his love on every face he creates.

This paper draws attention to gendered dimensions of surgical device failure, focusing on two case studies—hernia repair mesh for pelvic organ prolapse, and metal-on-metal hip implants. We explore possible reasons for higher rates of harms to women, including systematic biases in health research and device regulation. Given that these factors are readily identifiable, we look to feminist scholarship to understand what might maintain them, including the role of cultural factors within surgery, such as gendered communication patterns and sexism. We then (...) canvas potential measures to mitigate the increased risk of harms faced by women who use implanted devices. (shrink)

Surgical advances can provide great benefits to patients but can come at a cost. The successes are often matched by failures that cause harm to patients. The risks of surgery create a strong ethical imperative for research to establish the safety and efficacy of new treatments. Surgical research is, however, challenging for a number of reasons including the lack of a clear boundary between variations in practice, innovation and research, its irreversible nature, the difficulty of performing placebo-controlled randomised trials, confounding (...) factors such as surgeon learning curves and conflicts of interest. In this chapter the ethical issues raised by surgical innovation are explored with the use of a case study based on the uptake of vaginal mesh to treat vaginal prolapse to highlight these issues (Sects. 12.1 and 12.2). In Sect. 12.3 the argument for the value of a structured approach to introducing innovations, such as that developed by the IDEAL Collaboration, which clarifies both ethical and methodological issues at each stage of research is proposed. This chapter recognises that ethical challenges extend beyond adequate ethical evaluation of the innovation in the care of individual patients to include broader issues such as justice in access to any new interventions. (shrink)

As the price of pharmaceuticals and biologicals rises so does the number of patients who cannot afford them. In this article, we argue that physicians have a moral duty to help patients access affordable medicines. We offer three grounds to support our argument: (i) the aim of prescribing is to improve health and well-being which can only be realized with secure access to treatment; (ii) there is no morally significant difference between medicines being unavailable and medicines being unaffordable, so the (...) steps physicians are willing to take in the first case should extend to the second; and (iii) as the primary stakeholder with a duty to put the individual patient’s interests first, the medical professional has a duty to address cost-barriers to patient care. In articulating this duty, we take account of important epistemic and control conditions that must be met for the attribution of this duty to be justified. (shrink)

Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide (...) advice. However, device representatives have a dual role: functioning as commissioned sales representatives at the same time as providing advice on approaches to treatment. This duality raises the concern that clinical decision-making may be unduly influenced by commercial imperatives. In this paper, we identify three key ethical concerns raised by the relationship between device representatives and health professionals: impacts on healthcare costs, the outsourcing of expertise and issues of accountability and informed consent. These ethical concerns can be addressed in part through clarifying the boundary between the support and sales aspects of the roles of device representatives and developing clear guidelines for device representatives providing support in clinical spaces. We suggest several policy options including hospital provision of expert support, formalising clinician conduct to eschew receipt of meals and payments from industry and establishing device registries. (shrink)

Volume 19, Issue 6, June 2019, Page 28-29.

The development and deployment of medical devices, along with most areas of healthcare, has been significantly impacted by the COVID-19 pandemic. This has had variable ethical implications, two of which we will focus on here. First, medical device regulations have been rapidly amended to expedite approvals of devices ranging from face masks to ventilators. Although some regulators have issued cessation dates, there is inadequate discussion of triggers for exiting these crisis standards, and evidence that this may not be feasible. Given (...) the relatively low evidence standards currently required for regulatory approval of devices, this further indefinite reduction in standards raises serious ethical issues. Second, the pandemic has disrupted the usual operations of device representatives in hospitals, providing an opportunity to examine and refine this potentially ethically problematic practice. In this paper we explain and critically analyse the ethical implications of these two pandemic-related impacts on medical devices and propose suggestions for their management. These include an endpoint for pandemic-related adjustments to device regulation or a mechanism for continued refinement over time, together with a review of device research conducted under crisis conditions, support for the removal and replacement of emergency approved devices, and a review of device representative credentialling. (shrink)

The article presents the author's perspectives regarding the book "The Significance and Basic Postulates of Economic Theory," by Terence Wilmot Hutchison. He emphasizes two important general themes that emerge from the symposium in total, the great breadth of Hutchison's contribution to economic methodology and a brief introduction on the four individual papers. He mentions some people including Roger Backhouse, John Hart and Ross Emmett as well as the comments of each about Hutchison's works.

In a recent paper, Keith Hutchison has advanced the thesis that the Mechanical Philosophy represents a shift towards supernaturalism in our conception of the physical world. This paper concentrates on one of the great problems of seventeenth-century biological theory — animal generation — to illustrate (and modify) Hutchison's thesis, thereby also serving to locate one role of the life sciences in the Scientific Revolution. This choice of focus enables us to draw heavily on Jacques Roger's seminal work (...) on animal generation to illuminate the change that occurs, within the Mechanical Philosophy, between Descartes and Malebranche. Once the necessary distinctions have been drawn, it is argued, it will be seen that (in one important sense) this is a shift from naturalism to supernaturalism, brought about largely by problems native to the life sciences. (shrink)

This paper is a plea for hedonism to be taken more seriously. It begins by charting hedonism's decline, and suggests that this is a result of two major objections: the claim that hedonism is the 'philosophy of swine', reducing all value to a single common denominator, and Nozick's 'experience machine' objection. There follows some elucidation of the nature of hedonism, and of enjoyment in particular. Two types of theory of enjoyment are outlined-intemalism, according to which enjoyment has some special 'feeling (...) tone'. and externalism, according to which enjoyment is any kind of experience to which we take some special attitude, such as that of desire. lnternalism-the traditional view--is defended against current externalist orthodoxy. The paper ends with responses to the philosophy of swine and the experience machine objections. (shrink)

I treat you as a thermometer when I use your belief states as more or less reliable indicators of the facts. Should I treat myself in a parallel way? Should I think of the outputs of my faculties and yours as like the readings of two thermometers the way a third party would? I explore some of the difficulties in answering these questions. If I am to treat myself as well as others as thermometers in this way, it would appear (...) that I cannot reasonably trust my own convictions over yours unless I have antecedent reason to suppose that I am more likely than you to get things right. I appeal to some probabilistic considerations to suggest that our predicament as thermometers might not actually be as bad as it seems. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

This paper argues for a treatment of belief as essentially sensitive to certain features of context. The first part gives an argument that we must take belief to be context-sensitive in the same way that assertion is, if we are to preserve appealing principles tying belief to sincere assertion. In particular, whether an agent counts as believing that p in a context depends on the space of alternative possibilities the agent is considering in that context. One and the same doxastic (...) state may amount to belief that p in one context but not another. The second part of the paper gives a formal treatment of doxastic states, according to which belief is context-sensitive along just these lines. The model is applied to characterize (but not to refute) skeptical arguments. (shrink)

Can we justify our most basic beliefs about morality, religion and the nature of the world? Can there be a rational and objective way of choosing between alternative societies, modes of life or world-views? Dr Trigg shows how philosophical analysis is relevant to these questions and criticizes the tendency to emphasize notions of commitment and convention at the expense of truth and reason. He draws parallels between issues that are often too isolated from each other and identifies a cluster of (...) related ideas, all of which stress the notion of self-contained conceptual systems that define their own standards of rationality. First published in 1973, this book will interest professional philosophers as a vigorous and distinctive exposition of several fundamental philosophical problems and more especially it can be used as an introduction for students to a wide range of philosophical problems. (shrink)

According to the thesis of Strong Predictionism, we typically have stronger evidence for a theory if it was used to predict certain data, than if it was deliberately constructed to accommodate those same data, even if we fully grasp the theory and all the evidence on which it was based. This thesis faces powerful objections and the existing arguments in support of it are seriously flawed. I offer a new defence of Strong Predictionism which overcomes the objections and provides a (...) deeper understanding of the epistemic importance of prediction. I conclude by applying this account to strategies for defending scientific realism. (shrink)

To solve the problem of induction we had first better know what it is. Some ways of formulating the worry about induction are underwhelming as they depend on assumptions that don’t survive much scrutiny. Perhaps the most disturbing argument for inductive skepticism appeals to the claim that we could not possibly be justified in taking our inductive methods to be reliable independently of our use of those methods. And the use of inductive methods cannot give us justification to suppose that (...) they are reliable. I argue for a new way to escape the first horn of this dilemma. (shrink)

Despite its place in the humanities, the career prospects and numbers of women in philosophy much more closely resemble those found in the sciences and engineering. This book collects a series of critical essays by female philosophers pursuing the question of why philosophy continues to be inhospitable to women and what can be done to change it. By examining the social and institutional conditions of contemporary academic philosophy in the Anglophone world as well as its methods, culture, and characteristic commitments, (...) the volume provides a case study in interpretation of one academic discipline in which women's progress seems to have stalled since initial gains made in the 1980s. Some contributors make use of concepts developed in other contexts to explain women's under-representation, including the effects of unconscious biases, stereotype threat, and micro-inequities. Other chapters draw on the resources of feminist philosophy to challenge everyday understandings of time, communication, authority and merit, as these shape effective but often unrecognized forms of discrimination and exclusion. Often it is assumed that women need to change to fit existing institutions. This book instead offers concrete reflections on the way in which philosophy needs to change, in order to accommodate and benefit from the important contribution women's full participation makes to the discipline. (shrink)

Examines the role of experience within Adorno’s philosophy of language and epistemology.

THE OBJECTIVITY OF REALITY Reality and Mind We cannot talk or think about reality without talking or thinking about it. This is a truism which seems almost ...

John Stuart Mill's Utilitarianism is one of the most important, controversial, and suggestive works of moral philosophy ever written. Published in the Oxford Philosophical Texts series, this new edition of Mill's key text has been designed to suit both the beginning and more advanced student. The text is supplemented by an extensive editorial introduction, an analysis of the text, substantial endnotes, suggestions for further reading, and a full bibliography.

Over the last twenty years, John Rawls has developed an approach to political philosophy which appeals to the notion of reflective equilibrium. This notion has proven suggestive to those attracted to coherence approaches to justification, in ethics and in other domains as well. In this paper, I explore the question whether Rawls’s approach provides a model for a coherentist account of justification, concluding that although the discussion of reflective equilibrium has provided helpful insights it has not produced a coherentist model (...) of justification. (shrink)

In this article, I describe how gender bias can affect the design, testing, clinical trials, regulatory approval, and clinical use of implantable devices. I argue that bad outcomes experienced by women patients are a cumulative consequence of small biases and inattention at various points of the design, testing, and regulatory process. However, specific instances of inattention and bias can be difficult to identify, and risks are difficult to predict. This means that even if systematic gender bias in implant design is (...) an ethical issue, it is one with no clearly blameworthy player. From a practical perspective, there is no single obvious point at which to intervene. Philosophers working in other areas have explored structurally similar moral problems—sometimes referred to as “moral aggregation problems”—such as the type of environmental harm caused by small actions of many players. I describe key features of these type of problems and strategies to address them. I then draw on these to suggest an approach to gender bias in medical implant design and use. (shrink)

Journal of Philosophy of Education, Volume 56, Issue 2, Page 342-355, April 2022.

An international line-up of fourteen distinguished philosophers present new essays on topics relating to well-being and morality, prominent themes in contemporary ethics and particularly in the work of James Griffin, White's Professor of Moral Philosophy at Oxford, in whose honour this volume has been produced. Professor Griffin offers a fascinating development of his own thinking on these topics in his replies to the essays.

Parkinson's disease (PD) is characterized by the loss of the dopaminergic nigrostriatal pathway which has led to the successful development of drug therapies that replace or stimulate this network pharmacologically. Although these drugs work well in the early stages of the disease, over time they produce side effects along with less consistent clinical benefits to the person with Parkinson's (PwP). As such there has been much interest in repairing this pathway using transplants of dopamine neurons. This work which began 50 (...) years ago this September is still ongoing and has now moved to first in human trials using human pluripotent stem cell‐derived dopaminergic neurons. The results of these trials are eagerly awaited although proof of principle data has already come from trials using human fetal midbrain dopamine cell transplants. This data has shown that developing dopamine cells when transplanted in the brain of a PwP can survive long term with clinical benefits lasting decades and with restoration of normal dopaminergic innervation in the grafted striatum. In this article, we discuss the history of this field and how this has now led us to the recent stem cell trials for PwP. (shrink)

Among other interesting proposals, Juan Comesaña’s _Being Rational and Being Right_ makes a challenging case that one’s evidence can include falsehoods. I explore some ways in which we might have to rethink the roles that evidence can play in inquiry if we accept this claim. It turns out that Comesaña’s position lends itself to the conclusion that while false evidence is possible and not even terribly uncommon, I can be rationally sure that I don’t currently have any and perhaps also (...) that I won’t get any, and (absent certain evidence to the contrary) you are not afflicted with any either. This conclusion might seem too good to be true. I finish by raising a puzzle about one of the main motivations for Comesaña’s view. (shrink)

This contribution to the adaptationism debate elaborates the nature of constraints and their importance in evolutionary explanation and argues that the adaptationism debate should be limited to the issue of how to privilege causes in evolutionary explanation. I argue that adaptationist explanations are deeply conceptually dependent on developmental constraints, and explanations that appeal to constraints are dependant on the results of natural selection. I suggest these explanations should be integrated into the framework of historical causal explanation. Each strategy explicitly appeals (...) to some aspect of the evolutionary process, while implicitly appealing to others. Thus, adaptationists and anti-adaptationists can offer complementary causal explanations of the same explanandum. This eliminates much of the adaptationism debate and explains why its adversaries regularly agree with each other more than they would like. The adaptationism issue that remains is a species of the general issue of how to privilege causes in explanation. I show how a proposed solution to this general problem might be brought to bear on evolutionary explanations, and investigate some difficulties that might arise due to the nature of the evolutionary process. (shrink)