The capacity-building strategy used by a US-based research organisation, the Pacific Institute for Research and Evaluation , to strengthen the system for the protection of human research subjects and the infrastructure of its international collaborating partner, the University of Liberia, are discussed. To conduct the much-needed biomedical and social science-based research-related activities in the future, this partnership is expected by PIRE to gradually evolve over time to strengthen the capacity of the local investigators and administrators of the University of Liberia. (...) Accordingly, a unique opportunity to share technology and resources with a post-conflict, resource-constrained country is created by this partnership. This capacity-building model to strengthen the protection of human subjects in research can also be replicated in similar resource-constrained international settings and, accordingly, our experiences and limitations are shared in this paper. (shrink)

Clozapine is a very effective drug with both significant benefits and significant risks in treatment-resistant schizophrenia. Informed consent is generally accepted as both desirable and necessary in order to ensure that the patient’s human rights and dignity are respected. Disclosure is a key element of informed consent. It is unclear if the adequate documentation of disclosure is standard practice before initiation of clozapine. The aim of this study was to assess the adequacy of the documentation of disclosure in consent to (...) clozapine treatment in an adult mental health service and to develop guidelines on disclosure. The method was a retrospective analysis of charts of patients given clozapine who received the drug through the pharmacy of a single North Dublin psychiatric hospital. Results show that current practice has evident gaps. The professional, ethical and legal issues are discussed. (shrink)

The concept of interactional expertise – characterized by sociologists Harry Collins and Robert Evans as the ability to speak the language of a discipline without the corresponding ability to practice – can serve as a powerful way of breaking down expert/non-expert dichotomies and providing a role for new voices in specialist communities. However, in spite of the vast uptake of this concept and its potential to fruitfully address many important issues related to scientific expertise, there has been surprisingly little critical (...) analysis of it. We seek to remedy this situation by considering potential benefits of interactional expertise and the ways in which the current conception can – and cannot – realize those benefits. In particular, we argue that interactional expertise hasn’t reached its full potential for addressing who ought to be involved in scientific research and decision-making, largely owing to an unnecessarily restrictive way of operationalizing the concept. In its place, we offer a broader, more pluralistic account of interactional expertise – one that is in line with the original spirit of the concept, but also captures the diversity that we see as being an important aspect of interactional experts and the value they can bring to the table. (shrink)

Chloroquine-resistant plasmodium falciparum malaria is a serious public health threat that is spreading rapidly across Sub-Saharan Africa. It affects over three quarters (80%) of malarial endemic countries. Of the estimated 300-500 million cases of malaria reported annually, the vast majority of malarial-related morbidities occur among young children in Africa, especially those concentrated in the remote rural areas with inadequate access to appropriate health care services. In Liberia, in vivo studies conducted between 1993 and 2000 observed varying degrees of plasmodium falciparum (...) malaria infections that were resistant to chloroquine, including sulfadiazine-pyrimethamine. As the country emerges from a prolonged civil war, the health care delivery system may not be adequately prepared to implement an effective nation-wide malarial control strategy. As a result, the management of uncomplicated malaria in Liberia poses a significant public health challenge for the government-financed health care delivery system. Therefore, based on extensive literature review, we report the failure of chloroquine as an effective first-line drug for the treatment of uncomplicated plasmodium falciparum malaria in Liberia and recommend that national health efforts be directed at identifying alternative drug(s) to replace it. (shrink)

Cet ouvrage, composé de huit chapitres et de neuf appendices (qui contiennent des précisions utiles sur la méthode proposée), présente une thèse originale et controversée selon laquelle une structure musicale sous-tend les dialogues platoniciens, et en permet une plus riche compréhension. J. B. Kennedy s'appuie sur deux dialogues, le Banquet et l'Euthyphron pour la démontrer. Avant d'introduire sa méthodologie, il prend soin de tracer l'origine de ce type d'interprétation pour en défendre la pertinence. (…) - 12. Plato 12 (2012).

This introduction to one of the liveliest and most popular fields in philosophy is written specifically for a beginning readership with no background in philosophy or science. Step-by-step analyses of the key arguments are provided and the philosophical heart of the issues is revealed without recourse to jargon, maths, or logical formulas. The book introduces Einstein's revolutionary ideas in a clear and simple way, along with the concepts and arguments of philosophers, both ancient and modern that have proved of lasting (...) value. Specifically, the theories of the ancient Greek philosophers, Zeno, Euclid and Parmenides are considered alongside the ideas of Newton, Leibniz and Kant as well as the giants of twentieth-century physics, Einstein and Lorentz. The problems at the heart of the philosophy of space and time, such as change, motion, infinity, shape, and inflation, are examined and the seismic impact made by relativity theory and quantum theory is assessed in the light of the latest research. The writing is lucid and entertaining, allowing a beginning readership to grasp some difficult concepts while offering the more experienced reader a succinct and illuminating presentation of the state of the debate. "Space, Time and Einstein" shows the reader the excitement of scientific discovery and the beauty of theory in the search for answers to these fundamental questions. (shrink)

In April 1741 there appeared a slim volume entitled An Apology for the Life of Mrs Shamela Andrews by a certain Mr Conny Keyber, whose name is generally supposed to conceal that of the novelist Henry Fielding. Shamela, to give the book its more familiar title, was a parody of Samuel Richardson's epistolary novel Pamela: or Virtue Rewarded, which had been published to great acclaim the previous year. In a series of letters purportedly sent to each other by the main (...) characters, the story unfolds of the honest servant-girl Pamela, her efforts to avoid seduction by her master Mr B., and her eventual marriage to him. Fielding's chief target was the morality of the book , but in passing he drew cruel attention to some of the pitfalls of the epistolary form as a vehicle for narrative. One passage in particular deserves quotation, from Letter VI, which Shamela writes to her mother at twelve o'clock on Thursday night: Mrs Jervis and I are just in Bed, and the Door unlocked; if my Master should come – Odsbods! I hear him just coming in at the Door. You see I write in the present Tense, as Parson Williams says. Well, he is in Bed between us, we both shamming a Sleep, he steals his Hand into my Bosom, which I, as if in my Sleep, press close to me with mine…. (shrink)

Adults and infants display a robust ability to perceive the unity of a center-occluded object when the visible ends of the object undergo common motion (e.g. Kellman, P.J., Spelke, E.S., 1983. Perception of partly occluded objects in infancy. Cognitive Psychology 15, 483±524). Ecologically oriented accounts of this ability focus on the primacy of motion in the perception of segregated objects, but Gestalt theory suggests a broader possibility: observers may perceive object unity by detecting patterns of synchronous change, of which common (...) motion is a special case. We investigated this possibility with observations of adults and 4-month-old infants. Participants viewed a center-occluded object whose visible surfaces were either misaligned or aligned, stationary or moving, and unchanging or synchronously changing in color or bright- ness in various temporal patterns (e.g. ¯ashing). Both alignment and common motion con- tributed to adults' perception of object unity, but synchronous color changes did not. For infants, motion was an important determinant of object unity, but other synchronous changes and edge alignment were not. When a stationary object with aligned edges underwent syn- chronous changes in color or brightness, infants showed high levels of attention to the object, but their perception of its unity appeared to be indeterminate. An inherent preference for fast over slow ¯ash rates, and a novelty preference elicited by a change in rate, both indicated that infants detected the synchronous changes, although they failed to use them as information for object unity. These ®ndings favor ecologically oriented accounts of object perception in which surface motion plays a privileged role. Ó 1999 Elsevier Science B.V. All rights reserved. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:AN ITALIAN VIEW OF THE DEBATE ON VIRTUE TERENCE KENNEDY, C.Ss.R. Accademia Alfonsiana Rome, Italy FATHER GIUSEPPE ABBA, S.B.D., professor of moral philosophy at the Pontifical Salesian University in Rome, has written two volumes of prime importance for the theory of the moral virtues. Although writing in Italian, he has entered into the thick of debate in other languages, especially English. The first, Lex et Virtus: Studi sull'evoluzione (...) delta dottrina morale di san Tommaso d'Aquino (Las-Roma, 1983, 293 pp.) is every bit as wide ranging as its title suggests. His thesis is that St. Thomas's moral thought underwent a long and radical evolution that issued in "a new science" in the Secunda Pars of the Summa Theologiae totally centered in the virtues. His book is neatly divided in two parts: humanity under the regime of law and humanity under the regime of virtue. He argues that the Scriptum super Sententiis presents virtue as the capacity to put law into practice in life. Here law has priority because it is conceived as participation in the divine rectitude, and virtue is derivative in as far as it facilitates compliance with God's law, making our response easy, pleasurable and spontaneous by restraining the disorderly influence of passion on our moral response. The De V eritate, he maintains, follows the same descending schema. Truth is communicated downwards through the hierarchy of intellectual beings so that the human virtues are seen mainly in terms of how they reflect the divine truth, especially in the moral knowledge involved in free choice or liberum arbitrium. The Summa Contra Gentiles III classifies morality under the rubric of the law as rational submission to divine government through 123 124 TERENCE KENNEDY, c.ss.R. Providence. In this vision, our return to God as final end is given focal emphasis before being considered the fruit of our effort. Abba makes a strong case that in the Secunda Pars St. Thomas passes from a conception of morality based in law to one founded in the virtues. Morality assumes deeper significance in its own right because the human person is no longer viewed mainly as a direct reflection of divine truth but truly as imago Dei having dominion over his acts in freedom and deliberation. God, the subjectum of theology, is known through his effects in creation and the motus hominis in Deum provides matter for the speculative discipline of theology as the study of God. Morality unveils the mystery of God through how He works in our free activity drawing us to Himself. St. Thomas thus has very little in common with those contemporary moralists who are wholly taken up with the rightness of actions in normative ethics. Abba maintains that in the Summa St. Thomas was the first to afford morality its rightful place as an integral part in his theological synthesis. This involved a reworking of the idea of virtue beginning, with a fresh approach to habitus in the Ia!Jae. The determination of a habit ad unum is necessary because of the way a specifically human form is received in particular matter. This determination means not just a further specification of the matter, but the coming into being of new abilities, a creative enablement. of our nature with original energies so that it can reach its enc(' efficaciously. Virtue now has priority over law, because facility, pleasure and spontaneity are only the effects of this new interior transformation of our nature. Thus the originality of virtue arises not from our mode of acting firmiter, faciliter, delectabiliter, but from the new interior capacities by which we can realize our moral selves, naturally and supernaturally. Law is thereafter thought of in relation to its service of virtue as an external command promulgated for the government of a collectivity. It is given precisely so as to educate the collectivity to virtue. In the community governed by God's divine law it is not possible to follow His law without being enlivened by the infused virtues. The eternal law is not exhausted by our understanding of the precepts of divine law THE DEBATE ON VIRTUE 125 but it embraces God's complete idea... (shrink)

Single units that are not related to the desired task can become related to the task by conditioning their firing rates. We theorized that, during conditioning of firing rates to a tone, (a) unrelated single units would be recruited to the task; (b) the recruitment would depend on the phase of the task; (c) tones of different frequencies would produce different patterns of single unit recruitment. In our mute locked-in participant, we conditioned single units using tones of different frequencies emitted (...) from a tone generator. The conditioning task had three phases: Listen to the tone for 20 s, then silently sing the tone for 10 s, with a prior control period of resting for 10 s. Twenty single units were recorded simultaneously while feedback of one of the twenty single units was made audible to the mute locked-in participant. The results indicate that (a) some of the non-audible single units were recruited during conditioning, (b) some were recruited differentially depending on the phase of the paradigm (listen, rest, or silent sing), and (c) single unit firing patterns were specific for different tone frequencies such that the tone could be recognized from the pattern of single unit firings. These data are important when conditioning single unit firings in brain-computer interfacing tasks because they provide evidence that increased numbers of previously unrelated single units can be incorporated into the task. This incorporation expands the bandwidth of the recorded single unit population and thus enhances the brain-computer interface. This is the first report of conditioning of single unit firings in a human participant with a brain to computer implant. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Sextus Empiricus: Against the Grammarians (Adversus Mathematicos I)George A. KennedyD[avid] L. Blank, trans. Sextus Empiricus: Against the Grammarians (Adversus Mathematicos I). With an introduction and commentary. Oxford: Clarendon Press, 1998. lvi + 436 pp. Cloth, $105. (Clarendon Later Ancient Philosophers).Sextus was a Greek physician whose "empirical" medical studies seem to have led him to an enthusiastic commitment to what he calls "Pyrrhonian" skepticism, though it perhaps has rather (...) little debt to Pyrrho, who lived in the fourth century B.C. When and where Sextus himself lived and worked is unknown: certainly during the time of the Roman Empire, probably in the second, possibly in the third century, maybe in Alexandria, or Rome, or elsewhere. His extensive writings are a major source for the skeptical tradition in ancient philosophy--a kind of anti-foundationalism that has some appeal in our own age--but their importance goes beyond that, since Sextus explicates in detail the dogmas and theories he seeks to counteract. Against the Grammarians, as Blank notes, is second only to the textbook attributed to Dionysius Thrax for information on the teaching of grammar and is important for knowledge of Epicureanism as well.Blank's introduction, translation (the Greek text is not included), and line-by-line commentary (the first ever published) is a work of great learning and, I would think, of great patience. The volume as a whole greatly facilitates understanding of Sextus, his sources, and the traditions to which he subscribed or which he resisted. Blank has adopted "expertise" as a translation for the somewhat troublesome word techne, and "expert" for technites. This seems a reasonable rendering of Sextus' usage. What he attacks is not grammar (or, in subsequent books, rhetoric and the other arts) as practiced in ordinary life, but the claims to expert, scientific knowledge on the part of doctrinaire teachers of the arts, as well as some physicians and philosophers.This leads us, however, to a general problem in Sextus' writings. At the beginning of Against the Grammarians (chapters 5-7) (and elsewhere) he claims to have discovered difficult problems in the claims of specialists in philosophy and the arts which lead him to suspension of judgment. He will attempt "without any spirit of competitiveness to select and put the effective arguments against the liberal studies." Implicitly, an equal amount might be said in their defense. In what follows, however, he repeatedly claims to have "demolished" dogmas, leading to what has been called "negative dogmatism," the dogmatic denial of dogma. Blank devotes a section of his introduction to this problem, concluding that Sextus' intent throughout is in fact "equipollence." That is probably what Sextus himself would claim. Assuming it is, Sextus must, however, be charged with the fault of expressing himself poorly, for he repeatedly exults at his conclusive refutations of the claims of others.Throughout the work Blank strives, often with considerable success, to provide a sympathetic explanation and logical justification for Sextus' arguments, [End Page 166] many of which may initially strike a reader as blatant sophistries. Sextus was no fool, but he had blind spots and obsessions--infinite regress being one--and he often fails to take into account lines of argument obvious to a modern reader. Blank's objectivity does not extend to blanket approval of all of Sextus' arguments; indeed, he criticizes and even rejects the validity of arguments on a number of occasions. His treatment can be described as generally even-handed, but giving his author the benefit of the doubt more often than I would be inclined to do.Blank's extended introduction considers what is known about Sextus' life and works; the history of attacks on the arts, which go back to the fifth century b.c.; evidence for empiricist attacks on grammar; Against the Grammarians in relation to the other writings of Sextus; and negative dogmatism; then a few concluding remarks on the translation. Both here and in the commentary he convincingly demonstrates that Sextus' primary source is a lost Epicurean treatise--something like the writings of Zeno of Sidon, the teacher of Philodemus, though Blank stops short of claiming Zeno as the source. This Epicurean work contained a detailed attack... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Invention of Greek Ethnography from Homer to Herodotusby Joseph E. SkinnerRebecca F. KennedyJ osephE. S kinner. The Invention of Greek Ethnography from Homer to Herodotus. Greeks Overseas. Oxford: Oxford University Press, 2012. xii + 343 pp. Numerous black-and-white figs. Cloth, $85.In his welcome book on the invention of ethnography, Skinner challenges the focus in mainstream scholarship on the Greek prose genre that was first defined by Jacoby (...) in his influential Die Fragmente der griechischen Historiker(discussed in detail, 30–34) and on a notion that the “Greekness” the genre embodies was [End Page 287]supposedly invented in the fifth century as a response to the Persian wars. Skinner also advocates a break from the structuralist frameworks favored by scholars such as F. Hartog and E. Hall. Thus, the book has two distinct focuses. First, Skinner seeks to demonstrate that the origins of the prose genre can be found in other literary genres, sub-literary engagements, and material artifacts that should be considered as part of the “thought-world from which the early prose accounts emerged” (17). Second, Skinner shows that structuralist binaries are not the best method for understanding ethnographic thinking and frames his study instead with the discourse theories found in the works of historian J. Clifford and anthropologist/sociologist P. Bourdieu that emphasize “practice” and process. Skinner argues that the genre of Greek ethnography is not synonymous with the practice of Greek identity nor can any functional, homogenous Greek identity claim to be embedded within the genre (18). Rather, he emphasizes the “ethnographic concerns” of the Greeks and attempts to contextualize the emergence of the prose genre by exploring evidence of ethnographic “practice” in the material of everyday life. Ethnographic thought is further defined as positioning in relation to both non-Greeks and other Greeks. Although the title of the book suggests that the timeframe of the study includes evidence from Homer down to the time of Herodotus’ Histories(ca. 430 b.c.e.), most of the evidence he musters comes from the archaic period with occasional recourse to Pindar and the historical fragments of the post–Persian war period. This fits in with a secondary aim of the book to show that the Persian wars did not serve as the impetus for ethnographic thinking or for the emergence of a notion of “Greekness,” a position emphasized most vigorously by J. Hall.Chapter 1 is a long and dense explanation of Skinner’s theoretical approach and the debates among which Skinner situates his study. Despite a number of scholarly efforts over the last decade or so in rethinking identity and ethnicity in antiquity, it is still necessary to combat the ghosts of Jacoby and the structuralists, and Skinner musters a theoretically equipped army for the battle. He finds inherently problematic Jacoby’s “invention” of genres and our adherence to them (a legacy from the earlier academic enterprise, especially in Germany, of prioritizing and ranking ancient cultures based on their “firsts”). Structuralist views are represented by Edith Hall’s Inventing the Barbarian(Oxford 1989), one of the most influential voices in the study of ancient ethnicity. Although she is prominent throughout the book, Skinner ironically never addresses the fact that Hall’s own evidence is the performative, public practice of Athenian drama. Hall herself, although a structuralist, reflects in choice of evidence the type of discursive practice Skinner himself wishes to invoke (in fact, he entirely excludes drama from his evidence). Skinner’s theoretical apparatus is complex and rarely appears explicitly in later chapters (except in the conclusion).In “Populating the Imaginaire” (chap. 2), Skinner catalogues some foreign and/or mythical peoples whom the Greeks deployed in their texts and art as part of their process of self-identification. The peoples discussed are, as Skinner admits, selective, but I could not find a principle behind the selection. The discussion of the Cyclopes is restricted to Homer, and the Arimaspians make a brief appearance. [End Page 288]The Scythians, Amazons, Lydians, Egyptians, and Ethiopians receive extensive treatment in text and iconography (although his presentation of Archaic literary representations of Thrace is slightly abbreviated). Also included are the Pelasgians and peoples of... (shrink)

This is the first book to offer the best essays, articles, and speeches on ethics and intelligence that demonstrate the complex moral dilemmas in intelligence collection, analysis, and operations. Some are recently declassified and never before published, and all are written by authors whose backgrounds are as varied as their insights, including Robert M. Gates, former Director of the Central Intelligence Agency; John P. Langan, the Joseph Cardinal Bernardin Professor of Catholic Social Thought at the Kennedy Institute of Ethics, (...) Georgetown University; and Loch K. Johnson, Regents Professor of Political Science at the University of Georgia and recipient of the Owens Award for contributions to the understanding of U.S. intelligence activities. Creating the foundation for the study of ethics and intelligence by filling in the gap between warfare and philosophy, this is a valuable collection of literature for building an ethical code that is not dependent on any specific agency, department, or country. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 14.1 (2004) 97-114 [Access article in PDF] Stem Cell Research in the U.S. after the President's Speech of August 2001 Cynthia B. Cohen On 9 August 2001, in a nationally televised speech, President Bush addressed the contentious question of whether to provide federal funds for human embryonic stem cell research (White House 2001).1 This research involves taking the primordial cells found in embryos (...) and transforming them into certain specialized cells, such as those of the heart, nerves, and muscles, with the ultimate goal of transferring these cells into patients to repair damaged cells and tissues. In his remarks, the President authorized funding for research only on stem cells already harvested from remaining embryos at in vitro fertilization (IVF) centers as of 9 August 2001, the date of the speech. In a "Fact Sheet" about embryonic stem cell research, he added the ethical requirements that (1) the donors of embryos gave informed consent to the derivation of stem cells from their embryos, (2) the embryos were created solely for reproductive purposes, and (3) no financial inducements were given to the embryo donors. The President also prohibited federally funded research on embryonic stem cells derived from embryos after 9 August 2001, as well as the creation of embryos for research purposes and the cloning of human embryos for both reproductive and research purposes. He did not seek to ban the pursuit of embryonic stem cell research with private funds. "This allows us to explore the promise and potential of stem-cell research without crossing a fundamental moral line by providing taxpayer funding that would sanction or encourage further destruction of embryos," the President stated (White House 2001).The President's speech stirred intense controversy. Many applauded the new policy because it allowed some embryonic stem cell research to proceed, thereby raising hope that treatments might be developed for those suffering from such conditions as Parkinson's disease, Alzheimer's disease, and diabetes. Others supported it on grounds that it would discourage the future destruction of embryos in stem cell research. They maintained that although it was wrong to have derived stem cells from embryos, this wrong was no longer remediable and it therefore was justifiable to allow research using such embryos to proceed. Some, however, objected to the new policy because they held that it unduly limited the [End Page 97] number of embryonic stem cells available for federally funded research. Still others opposed it on grounds that it made the federal government complicit in what they took to be the wrongful destruction of human embryos that had taken place prior to 9 August 2001. The President established the President's Council on Bioethics by executive order in November 2001 and charged it, among other tasks, with monitoring stem cell research and recommending guidelines and regulations for biomedical innovations.Questions about the moral status of human embryos have so captured public attention since the President issued his remarks that other significant ethical and policy issues raised about stem cell research inside the Beltway have remained in the shadows. A number of individuals and organizations—legislators, scientists, patient groups, the President's Council on Bioethics, ethicists, religious task forces, and social commentators—have attempted to bring these other issues to legislative and public attention. They also have revisited the more publicly prominent question of what sorts of protections we owe to human embryos. In response, Congress has attempted to address several of these newly emerging issues at hearings and in legislation. I review these efforts, consider developing issues and arguments, and conclude by exploring possible future directions for federal and private sector stem cell policy. The Availability of Embryonic Stem Cell Lines to Federally Funded Researchers President Bush, in developing his stem cell research policy, accepted a distinction between the "derivation" and the "use" of embryos enunciated by the General Counsel of the Department of Health and Human Services toward the end of the Clinton administration. This distinction was adopted to avoid contravening the Dickey-Wicker Amendment (added... (shrink)

The best things in my Ufe have come to me by accident and this book results from one such accident: my having the opportunity, out of the blue, to go to work as H. Tristram Engelhardt, Jr. 's, research assistant at the Institute for the Medical Humanities in the University of Texas Medi cal Branch at Galveston, Texas, in 1974, on the recommendation of our teacher at the University of Texas at Austin, Irwin C. Lieb. During that summer Tris "lent" (...) me to Chester Bums, who has done important schol arly work over the years on the history of medical ethics. I was just finding out what bioethics was and Chester sent me to the rare book room of the Medical Branch Library to do some work on something called "medical deontology. " I discovered that this new field of bioethics had a history. This string of accidents continued, in 1975, when Warren Reich (who in 1979 made the excellent decisions to hire me to the faculty in bioethics at the Georgetown University School of Medicine and to persuade Andre Hellegers to appoint me to the Kennedy Institute of Ethics) took Tris Engelhardt's word for it that I could write on the history of modem medical ethics for Warren's major new project, the Encyclopedia of Bioethics. Warren then asked me to write on eighteenth-century British medical ethics. (shrink)

Ethical dilemmas are often not discussed in the dissemination of educational research. While the ethical guidelines for research seem clear at first glance, a closer look at the intimate nature of qualitative research reveals that there are many ambiguities or ‘grey’ areas where researchers must rely on their personal value systems. This article discusses the challenges faced by an experienced educator, although novice researcher, in considering the ethical parameters of her own research with adolescents with hearing loss. In particular, the (...) grey ethical areas identified by the researcher include: (a) vulnerable population; (b) researcher role confusion; (c) consent; (d) privacy, confidentiality, and anonymity; as well as (e) the nature of risk. Based on the author’s own reflections on beginning the research process, the article presents possible pitfalls and ways of overcoming the possibility of becoming immobilized by the ethical enigmas of research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Human Cloning by Embryo Splitting:After the HullabalooCynthia B. Cohen (bio)In October 1993, a paper entitled, "Experimental Cloning of Human Polyploid Embryos Using an Artificial Zona Pellucida," was presented at a joint meeting of the American Fertility Society and the Canadian Fertility and Andrology Society. Although it was awarded a prize, its authors, who are affiliated with George Washington University, decided against calling a press conference to (...) announce their findings. Word of their experiment soon leaked out, however, and the New York Times blazoned on its front page that human embryo cloning had been achieved. The story was accompanied by a diagram of cloning by nuclear transplantation.Newspapers and television networks around the world picked up the story and embellished it. The idea of unlimited, xeroxed copies of human beings gripped the public imagination. Wild scenarios of hundreds of Hitlers plotting to take over the world and of clones giving birth to their own twins enlivened media reports. Only gradually did it become clear that the term "polyploid" in the title of the paper referred to abnormal embryos that could never develop into living human beings and that "cloning" referred to embryo splitting or twinning, not to nuclear transplantation or the transfer of a donor nucleus into an enucleated egg. Once this sank into public consciousness, the "hullabaloo," as Dr. Howard W Jones, Jr., called it, died down.It left in its wake unanswered questions about the ethics of splitting embryos. During the height of the publicity given to the George Washington experiment, newspaper and TV stories had not delved in any depth into the ethical issues it raised. Ethicists, given limited time to discuss the ethical questions at stake, had been quoted in quick, simplistic responses. Some had offered little analysis of the rights and wrongs of embryo splitting, but, revealing tremendous creative talent, had spun out [End Page 187] imaginary and frightening applications of the procedure. This was a story essentially about ethics in which ethics was never really discussed.The National Advisory Board on Ethics in Reproduction* (NABER), an independent, multidisciplinary group that addresses ethical issues in modern reproductive science, technology, and care, became concerned about the sparsity of reflective ethical debate about embryo splitting. NABER's chair, Albert Jonsen, observed that "reporters phoning ethicists for comment and ethicists appearing on talk shows do not a debate make. Debate requires face to face (or at least essay to essay) argument among persons sharing the same information. This has yet to take place." Consequently, NABER decided to convene a workshop on human cloning by embryo splitting at the National Academy of Sciences in February 1994. The board invited participants who would provide a broad range of opinion about the ethical and public policy issues entailed by human embryo splitting. Embryologists, ethicists, reproductive biologists, public policy experts, staff from the National Institutes of Health (NIH), legal scholars, journalists, and infertility specialists were among those who participated. The feature articles in this issue of the Kennedy Institute of Ethics Journal derive from that workshop. Their authors were given free rein to take whatever stance they deemed ethically supportable.The first article is designed to provide some understanding of the science of human cloning as a basis for exploring the ethical issues raised by this set of techniques. Jacques Cohen, a leading reproductive embryologist, and Giles Tomkin, a science writer, both of Cornell University Medical School, explain, in a way that is clear to laypersons and biologists alike, the meaning, nature, and function of cloning. They discuss recent: advances in this area and offer an assessment of feasible uses of human cloning procedures, hoping to dispel what they view as mistaken fears about its future applications. Dr. Howard W Jones, Jr., a pioneer infertility specialist, briefly comments on Cohen and Tomkin's paper, pointing out that embryo splitting may not improve pregnancy results if genetic heterogeneity is required for successful embryo transfer and implantation.In the next article, three major ethical arguments against human cloning by embryo splitting are analyzed and rejected by Ruth Macklin, an expert in reproductive ethics from Albert Einstein College of Medicine. She finds the first argument, that the worth of individuals... (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)

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:IntroductionCynthia B. CohenThe explosion of genetic information in recent years raises a fundamental question for us as individuals and as members of various communities: Have we an obligation to know as much as possible about our genes—or should we bypass genetic information, leaving it hidden? A terrible ambivalence grips us when it comes to our genes. We want to respond to the Socratic call to know ourselves by learning (...) what lies on the minute threads of the chromosomes spun into the nuclei of our cells. At the same time, we fear obtaining that information, for it seems functionally equivalent to the oracle at Delphi, revealing a distinct and dangerous knowledge we would rather not have.What is it about genetic knowledge that creates such ambivalence in us? Genetic knowledge is empowering. It offers us the freedom to shape the contours of our lives and those of our families. At the same time, genetic knowledge is disempowering. It bears a peculiar mark of inevitability, telling us that we have no control over our present or future in important respects. Better to hide from such overbearing information than to suffer the assaults on our freedom it seems to create.We can see this ambivalence about genetic knowledge appearing again and again as the field of genetics has grown. Initially, genetics emerged as a tool for understanding how traits and diseases are passed from generation to generation. We used genetic testing mostly to enhance our personal decision making about reproductive matters. It was at this time that our hesitancy about pursuing such testing first arose, for we feared being put into a position of asking such painful questions as, “Knowing what we do about our genes, should we have children?” As the scope of genetic information expanded, we learned to test for genes that could signal the development of such terrible conditions as Huntington’s disease. The possibility of gaining access to such disturbing information exacerbated our fear of genetic knowledge—to some, the certainty of knowing seemed worse than the uncertainty of not knowing. As genetic research has disclosed genes associated with conditions that might, but not necessarily will occur, the uncertainty of knowing, to some, seems worse than that of not knowing. Further, questions focused on individuals, although still pertinent, are being supplanted by broader questions about families and [End Page vii] social groups. When added to the personal agony that genetic information can engender, the specter of egregious discrimination seems to some to outweigh the value of knowing. As the net is cast further and further from the initial genetic inquiries, the call to halt or control certain kinds of genetic testing is growing increasingly loud.Ambivalence about whether to obtain genetic information hovers over the pages of this issue of the Kennedy Institute of Ethics Journal. The authors address both the promise and the threat of the information to be derived from genetic tests. Each examines a different facet of the problem of knowing that vexes the terrain of genetic technology and proposes blueprints for resolving it.Cynthia B. Cohen opens by examining whether genetic testing should be used to unearth information about conditions children might develop later in life. She challenges the current trend within the professional genetics community to keep such information hidden, claiming that the putative psychosocial burdens of receiving that information are outweighed by the psychosocial benefits. Moreover, Cohen maintains that having such information can enhance, rather than impair, the adult autonomy of children. She offers a framework for assessing whether to test in individual cases and maintains that it is the responsibility of parents to make the final decision for their children.A similar response to our ambivalence about obtaining genetic knowledge is given by Robert Wachbroit. In discussing the dilemma caused by pleiotropic genetic tests—those in which a single gene mutation is involved in several apparently unrelated diseases—he favors fully disclosing their dual nature to patients before testing. Wachbroit’s emphasis on openness extends beyond informed consent recommendations, for he maintains that patients have an obligation to know as much about their genetic proclivities as possible. He goes on to confute the common wisdom that genetic information is... (shrink)

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

Biesta states at the beginning of his intervention that he will speak “as an educationalist” outside not only of “philosophical work with children” but “outside of philosophy”. What are the implications of these assumptions in terms of “what is philosophy?” and “what is education?” Can we really speak about “philosophical work with children” outside philosophy? What are the consequences of taking this position? From this initial questioning, in this response some other questions are offered to Biesta’s presentation: is philosophical work (...) with children about asking better questions or asking questions better as he states in his presentation? Finally, pfc risks as presented by Biesta are examined: a) being reduce to critical thinking, i.e., “to keep a clear head”; b) even being extended to creative and caring thinking, it could “stay in the head” and “not touch the soul”; c) that through the building of communities of inquiry in the classroom, we establish a kind of artificial setting where “we end up living in an idea about the world rather than the world”. The response ends with a last reference to Biesta’s approach of education in terms of “growing” and existence in terms of a “grown-up way” of being in the world. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Laying Medicine Open: Understanding Major Turning Points in the History of Medical EthicsLaurence B. McCullough (bio)AbstractAt different times during its history medicine has been laid open to accountability for its scientific and moral quality. This phenomenon of laying medicine open has sometimes resulted in major turning points in the history medical ethics. In this paper, I examine two examples of when the laying open of medicine has generated such (...) turning points: eighteenth-century British medicine and late twentieth-century American medicine. In the eighteenth century, the Scottish physician-philosopher, John Gregory (1724–1773), concerned with the unscientific, entrepreneurial, self-interested nature of then current medical practice, laid medicine open to accountability using the tools of ethics and philosophy of medicine. In the process, Gregory wrote the first professional ethics of medicine in the English-language literature, based on the physician’s fiduciary responsibility to the patient. In the late twentieth century, the managed practice of medicine has laid medicine open to accountability for its scientific quality and economic cost. This current laying open of medicine creates the challenge of developing medical ethics and bioethics for population-based medical science and practice.Reading the Histories of Medicine, Bioethics, and Medical EthicsThere are many ways in which to read the history of medi-cine and therefore of medical ethics and bioethics. For example, the history of medicine can be usefully understood in terms of successive advances or revolutions in biomedical science and its clinical applications, with medical ethics understood as a moral response to scientific and technological change. On this reading, which has been common in the history of bioethics for the past three decades, moral response is required to address scientific and technological changes that are unprecedented and therefore threaten to outstrip society’s moral capacities [End Page 7] to understand and manage those changes well. Much recent work on the ethical, legal, and social issues raised by the genome project appeals to this reading. The history of medicine can also be read in social terms, with medicine understood as a major social institution shaped by various factors, not limited to science. In this perspective, medicine and society are understood in terms of a complex and dynamic synergy. Bioethics and medical ethics become part of this synergy and are to be explained—perhaps even explained away—by social historical factors. There are, of course, other ways to read the history of medicine and therefore of bio-ethics and medical ethics—e.g., in terms of key figures and movements that are thought to have shaped developments in crucial ways.I want to suggest another way to read these histories, namely, the successive laying open of medicine to accountability that sometimes results in key turning points in the development of medical ethics and bioethics. On this reading, ethics is understood as an intellectual and practical discipline that makes medicine as a social institution and its practitioners, physicians, morally accountable for their clinical judgment, decision making, and behavior. This differs from Robert Veatch’s (1981) reading of the history of medical ethics either as particular—informed by intellectual, moral, and experiential resources thought to be available only to physicians—or universal—informed by intellectual, moral, and experiential resources generally available in the culture (present and past). Veatch sees medical ethics as open when it is universal and closed, and unacceptable, when it is particular. I read the history of medical ethics as always universal and medicine as a social institution and practice as sometimes closed—i.e, not accountable for its scientific and moral integrity—and sometimes as open, accountable for such integrity. When medicine is “laid open,” medical ethics itself is sometimes transformed. The same may well be the case for the other health care professions. The histories of medical ethics and bioethics, therefore, can be usefully read as responses to the laying open of medicine and the health care professions generally at various times in their histories. In what follows, I examine two important examples of laying medicine open that create key turning points in the history of medical ethics—Scottish medicine from the eighteenth century and American medicine from the end of the twentieth century.The... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Private Bioethics Forums:Counterpoint to Government BodiesCynthia B. Cohen (bio) and Elizabeth Leibold McCloskey (bio)Ethical issues associated with reproductive technologies quickly gain public attention. The front pages of newspapers have featured stories about grandmothers giving birth to their own grandchildren, couples "renting" wombs from surrogates, and researchers prepared to transplant fetal ovaries into women unable to produce viable eggs. With each new and bolder foray into reproductive realms, the question (...) of whether to set limits on the use of such technologies surfaces. An ancillary debate inevitably ensues about the proper forum for discussing and deciding such limits. The recent announcement of human embryo splitting or cloning research is no exception to this pattern. Articles in both the popular press and academic circles in the wake of the reported research contain lamentations about the absence of a national ethics body that could address the ethical issues raised by the cloning experiment. This research also breathed new life into congressional calls to create a government bioethics commission.1At times, it appears that the substantive questions raised by a procedure like cloning are subsumed under the debate about whether this ethics group or that should be convened to study the matter. But the forum in which options are discussed is as crucial to the development of sound ethical thought and public policy as are the conclusions themselves. Thus, we address the question of whether a private, as opposed to a public, bioethics body provides a distinctively useful forum for reaching an understanding of issues such as cloning that have significant ethical and public policy implications.A 1993 Office of Technology Assessment report, in which the authors suggest that a new federal bioethics commission might be useful, has helped to frame recent discussions about the value of government-sponsored bioethics bodies (Office of Technology Assessment 1993). To most people, the question of whether a national forum for bioethics is needed is synonymous with the question of whether a new federal body should be convened. Yet the existence of the National Advisory Board on Ethics in Reproduction (NABER) suggests that the scope of the question should be broadened. [End Page 283]NABER was born in 1992, in part as a response to an Institute of Medicine report on infertility. That document endorsed the formation of a nongovernment body to develop guidelines for assisted reproductive measures and fetal research in the event that a government body was not forthcoming (Institute of Medicine 1989). NABER, which was founded by the American College of Obstetricians and Gynecologists and the American Fertility Society, now functions wholly independently of those groups and is supported by private foundations including the Ford, Greenwall, and Josiah Macy, Jr., Foundations and the Walter and Elise Haas Fund. NABER has issued a report on ethical issues related to the use of fetal tissue (Cohen and Jonsen 1993), is about to publish a report and background papers on oocyte donation, and presents a report on human cloning in this issue of the Kennedy Institute of Ethics Journal. In addition, it has developed a protocol for NABER review of research proposals from federal agencies subject to federal guidelines on the use of human subjects in research.Thus, in function and form, NABER was envisioned as a substitute for a government body, and it now functions in a manner similar to several types of government bioethics groups. Like the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (National Commission) and the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (President's Commission), NABER functions primarily through the publication of reports intended for a broad audience of practitioners, patients, policymakers, and the general public. Just as the Ethics Advisory Board of the late 1970s examined ethical issues related to specific protocols or types of research as they arose, NABER's purposes include scrutinizing the ethics of various research efforts in the reproductive area.NABER also parallels past government bodies in form. Like these groups, NABER is a multidisciplinary board that meets regularly and is supplemented by consultants and staff who provide research and writing for the board. Its members are nationally recognized in... (shrink)

Ghost-Managed Medicine exposes the conspiracy to conceal all of the players in the marketing of drugs, including ghostwriters, key opinion leaders, patient advocacy organizations, contract research organizations, publication planners, and even medical journal editors and publishers. The credibility of the claims conveyed by the industry depends on the invisibility of these players.

: Gill and Sade, in the preceding article in this issue of the Kennedy Institute of Ethics Journal, argue that living individuals should be free from legal constraints against selling their organs. The present commentary responds to several of their claims. It explains why an analogy between kidneys and blood fails; why, as a matter of public policy, we prohibit the sale of human solid organs, yet allow the sale of blood; and why their attack on Kant's putative argument (...) against the sale of human body parts is misplaced. Finally, it rejects the claim that the state is entitled to interfere with the actions of individuals only if such actions would harm others. We draw certain lines grounded in what Rawls has termed "public reason" beyond which we do not give effect to the autonomous self-regarding decisions of individuals. Public resistance to the sale of human body parts, no matter how voluntary or well informed, is grounded in the conviction that such a practice would diminish human dignity and our sense of solidarity. A system of organ donation, in contrast, conveys our respect for persons and honors our common humanity. (shrink)

In "Against the Indicative," AUSTRALASIAN JOURNAL OF PHILOSOPHY 72 (1994): 17-26, and more recently in "Classifying `Conditionals': the Traditional Way is Wrong", ANALYSIS 60 (2000): 147, V.H. Dudman argues that (a) `If Oswald didn't shoot Kennedy then someone else did' and (b) `If Oswald doesn't shoot Kennedy then someone else will' should not be classified together as "indicative conditionals." Dudman relies on the assumption that (a) is entailed by (c) `Someone shot Kennedy', whereas (b) is not entailed (...) by (d) `Someone will shoot Kennedy'. I argue that the same reasoning which shows that (d) does not entail (b) also shows that (c) does not entail (a). One upshot is that Dudman's and Mellor's respective interpretations of so-called past indicative conditionals cannot be correct. (shrink)

Rhetoric is widely regarded by both its detractors and advocates as a kind of antithesis to reason. In this book Thomas B. Farrell restores rhetoric as an art of practical reason and enlightened civic participation, grounding it in its classical tradition—particularly in the rhetoric of Aristotle. And, because prevailing modernist world views bear principal responsibility for the disparagement of rhetorical tradition, Farrell also offers a critique of the dominant currents of modern humanist thought. Farrell argues that rhetoric is not antithetical (...) to reason but is a manner of posing and answering questions that is distinct from the approaches of analytic and dialectical reason. He develops this position in a number of ways: through a series of bold reinterpretations of Aristotle's _Rhetoric_; through a detailed appraisal of traditional rhetorical concepts as seen in modern texts from the Army-McCarthy hearings to Edward Kennedy's memorial for his brother, Mario Cuomo's address on abortion, Betty Friedan's _Feminine Mystique_, and Vaclav Havel's inaugural address; and through a fresh appraisal of theories on the character of language and discourse found in contemporary philosophy, literary criticism, anthropology, deconstructionism, Marxism, and especially in Habermas's critical theory of communicative action. (shrink)

: Medical ethics often is treated as applied ethics, that is, the application of moral philosophy to ethical issues in medicine. In an earlier paper, we examined instances of moral philosophy's influence on medical ethics. We found the applied ethics model inadequate and sketched an alternative model. On this model, practitioners seeking to change morality "appropriate" concepts and theory fragments from moral philosophy to valorize and justify their innovations. Goldilocks-like, five commentators tasted our offerings. Some found them too cold, since (...) they had already abandoned applied ethics; others too hot, since they still find the applied ethics model to their taste. We reply that the appropriation model offers an empirically testable account of the historical relationship between moral philosophy and medical ethics that explains why practitioners appropriate concepts and fragments from moral philosophy. In contrast, the now fashionable common morality theory neither explains moral change nor why practitioners turn to moral philosophy. (shrink)

Clinics and hospitals around the globe are offering stem cell treatments to persons with serious conditions for whom no effective therapies are available in their home countries. Many of these treatments, which are touted as cures for such conditions as Parkinson's and Alzheimer's Diseases, multiple sclerosis, and spinal cord injuries, have not gone through clinical trials that establish their safety and efficacy. Indeed, it is unclear whether some of them even utilize stem cells. State regulation of these therapies tends to (...) be weak or nonexistent in some of the countries in which they are offered. This puts those who believe they must travel abroad for stem cell treatments at risk of injury from procedures that .. (shrink)

: The authors respond to objections Fred Gifford has raised against their paper "Rehabilitating Equipoise." They situate this exchange in the wider context of recent debate over equipoise, highlighting substantial points of agreement between themselves and Gifford. The authors offer a brief restatement of "Rehabilitating Equipoise" in which they amplify some of its core arguments. They then assess Gifford's objections. Finding each to be unfounded, they argue that there is no justification for "pulling the plug" on clinical equipoise.

: When may a physician legitimately offer enrollment in a randomized clinical trial (RCT) to her patient? Two answers to this question have had a profound impact on the research ethics literature. Equipoise, as originated by Charles Fried, which we term Fried's equipoise (FE), stipulates that a physician may offer trial enrollment to her patient only when the physician is genuinely uncertain as to the preferred treatment. Clinical equipoise (CE), originated by Benjamin Freedman, requires that there exist a state of (...) honest, professional disagreement in the community of expert practitioners as to the preferred treatment. FE and CE are widely understood as competing concepts. We argue that FE and CE offer separable and, in themselves, incomplete justifications for the conduct of clinical trials. FE articulates conditions under which the fiduciary duties of physician to patient may be upheld in the conduct of research. CE sets out a standard for the social approval of research by institutional review boards. Viewed in this way, FE and CE are not necessarily competing notions, but rather address complementary moral concerns. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Rhetoric in History as Theory and Praxis: A Blast from the PastThomas B. FarrellPhilosophies of history have fallen on hard times. Grand comic metanarratives were the first casualty, auguring ironically in the futility of their own pronouncements. Positive and negative teleologies were next to fall. But if finalized themes and Utopian schemes are not exactly in vogue, it remains the case that history—as systematic documentation and reminiscence about the (...) past—is and must be ongoing. This is transparently because things that matter continue to happen: with ideas, cultures, nature itself. And even if we never really learn from history, all other things being equal, history has shown that it is helpful to keep careful records. In an age that personalizes nearly everything, it is easy enough to recognize the familiar dissociation of act and accountability on a personal scale. What may appear as nothing more serious than petty truancy for a person may become amnesia, revisionism, and much worse when the zone of accountability is widened, the deeds are deepened, the stakes are increased. In each case, the argument is the same: identification through a sort of opaque empathy. In short, you had to be there.I intend this essay to be a meditation on some of the ways my amorphousarea of study, rhetorical theory, finds itself implicated with history, some possible avenues it may open for invention and judgment in history. Time permitting, I will also hazard a speculation on that great chimera [End Page 323] that dangles before fields of scholarship and historical projects alike: that of progress.Aristotle’s famous definition of rhetoric, “that its function is not to persuade but to see the available means of persuasion in each case” (1991, 35), begins my inquiry in a productively ambiguous way. For one thing, the definition locates the function of rhetoric directly within the sphere of human history, through the terms available and in each case. For unless we believe that means of persuasion are fixed and that cases are eternally recurring, what the rhetorician “sees” must vary with the times. A second note maybe in order here. For Aristotle’s term for seeing, theoresai, also happens to be the Greek root term for what we call “theory.” In its most fundamental sense, then, the ocular-centered aesthetic of Greek tradition gives us theory as a mode of “seeing.” I could add at this point that this “seeing” needs to be shared with others and that there are many ways of “seeing,” but this maybe a less-than-productive ambiguity, given my aims here.Instead, I wish to consider three distinct construals of what sort of practice rhetoric is, along with some implications of these construals for the place of rhetoric as theory and practice in human history. These three construals are rhetoric as productive art, rhetoric as constitutive art, and rhetoricas inventional art.We begin with the conception of rhetoric as productive art. Simply put, this means that rhetoric makes things, prototypically speeches. Such a conception, like the other two I will be discussing, has ebbed and flowed throughout the long history of rhetorical tradition. The Sophists, when not purporting to teach virtue, did profess their competence in instructing other show to create persuasive documents. Such a preoccupation also appears in rhetorics of belles lettres and elocution. Today it can be found in modern composition curricula and in the rather different world of the professional speechwriter.There have been very few attempts to link an exclusively productive art conception of rhetoric to Aristotle and still fewer successful attempts. To view the matter this way, one would need to think of the Rhetoric and the Poetics as essentially parallel documents (one makes poems; the other, speeches). One would also have to ignore a wealth of disconfirming evidence. Nonetheless, Alan G. Gross is able to write (in the aptly titled collection Rereading Aristotle’s “Rhetoric”), “‘What did Aristotle mean by rhetoric?’ At this juncture, I can do little more than reiterate my claim that rhetoric is a productive art, and only a productive art” (2000, 35). George Kennedy, the translator of our earlier passage, sees the matter rather differently: “What [End Page 324] kind of... (shrink)

: National bioethics commissions have struggled to develop ethically warranted methods for conducting their deliberations. The National Bioethics Advisory Commission in its report on stem cell research adopted an approach to public deliberation indebted to Rawls in that it sought common ground consistent with shared values and beliefs at the foundation of a well-ordered democracy. In contrast, although the research cloning and stem cell research reports of the President's Council on Bioethics reveal that it broached two different methods of public (...) deliberation—balancing goods and following an overarching moral principle—it adopted neither. Thereupon its prime mover, Leon Kass, influenced particularly by the approach of Leo Strauss, sought to develop a method of public deliberation guided by tradition and practical wisdom. When this failed, the Council fell back on a method that took account of shared fundamental values of a free democracy—a method remarkably akin to that employed by the National Bioethics Advisory Commission. Respect for diverse reasonable conceptions of the good in a democratic polity requires national bioethics commissions to seek and incorporate that which is valuable in opposing positions. (shrink)

This guide is intended to be a comprehensive survey of Dewey's work. It consists of ten essays by Dewey scholars surveying an area of Dewey's work. Each essay is followed by a checklist of articles and books. The topics include divisions such as Dewey's Psychology, Philosophy and Philosophic Method, Logic and Theory of Knowledge, Ethics, etc. Contributors include Schneider, Hahn, Kennedy, Rucker, Leys, among others. Despite the enormous amount of work that must have gone into producing this volume, its (...) value is questionable. One reason for this is that Dewey's thought does not lend itself into such convenient divisions--it is difficult to think of a standard "topic" that isn't intertwined with some other. The novice may be bewildered by the rapid surveys and checklists. And scholars of Dewey and American philosophy may detect other groupings which they consider more illuminating. Although one can appreciate the desire not to reproduce the type of bibliography prepared by M. H. Thomas, a complete annotated bibliography would have been a much more helpful guide than the present one. Nevertheless the present guide does help the novice and the scholar to see important connections among the more than thousand items that make up the Dewey corpus.--R. J. B. (shrink)

From the title, Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Healthcare, Peter Gøtzsche makes the thesis of his book very clear. Not only does the pharmaceutical industry contribute to detrimental health outcomes through biased research, deceptive marketing, and disease mongering, but the industry’s business model meets the criteria of an organized criminal operation. Gøtzsche argues for this in two parts. First, he defines organized crime by drawing upon the United States Organized Crime Control Act of 1970, the (...) centerpiece of which is the Racketeer Influenced and Corrupt Organizations Act. RICO prohibits deriving income from a pattern of racketeering... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bioethics in the Twenty-First Century: Why We Should Pay Attention to Eighteenth-Century Medical EthicsLaurence B. McCullough (bio)Those of us who work in the field of bioethics tend to think that, because the word “bioethics” is new, so too the field is new in all respects, but we are not the first to do bioethics. John Gregory (1724–1773) did bioethics just as we do it, at least two centuries before (...) we thought to do it (Gregory 1772). He deployed philosophical methods as sophisticated as our own. Indeed, Gregory took up the very best moral philosophy available to thinkers of the Scottish Enlightenment, namely, David Hume’s moral philosophy and its core concept of sympathy. Gregory also responded in a conceptually powerful and clinically applicable way to the problems of his time, just as we do. I want here to outline Gregory’s accomplishment and to identify some aspects of its importance for bioethics in the twenty-first century.Gregory’s “Problem List”Gregory wrote his medical ethics as a response to the then current state of medicine in Britain. We now follow Gregory in our writing of bioethics and clinical ethics in response to the problems of our time. A great deal that we now take for granted did not then exist. 1There was not, as there is now, any uniform pathway into medicine. Nor did there exist universal licensure. The Royal Colleges did attempt to assert, but failed to achieve, monopoly control of medical practice. The concepts of health and disease were themselves contested and therefore competed for their success in the market place. There was a marked oversupply of practitioners who competed fiercely—very fiercely indeed—in the medical market place for their concepts of health and disease, their treatments, and therefore their livelihoods. Patients had their own concepts of health and disease, engaged in “self-physicking” or self-care, and often traded physician’s prescriptions.Medicine exhibited little scientific discipline in its accounts of disease and in determining the efficacy of treatments, a fact that Gregory (1743) laments as a [End Page 329] medical student. There was no marked improvement when he began to give his medical ethics lectures nearly a quarter of a century later. Treatments failed as often, perhaps more often, than they succeeded in benefiting patients. The sick usually sought out the help of a physician after trying self-physicking.Physicians, Gregory taught, could not hope to control human biology, though they could aim to manage its processes well. When nature underresponds to disease the physician should assist her processes; when nature overresponds, the physician should tamp down nature’s responses, to lessen their “violence”—in both cases always attentive to the limits of medicine’s capacities in treating disease.Physicians attended the well-to-do sick at home, and the sick person summoned and dismissed physicians, surgeons, or apothecaries at will. A physician therefore might find himself—no women had yet been admitted to the ranks of university-trained physicians—summoned before, after, or simultaneously with a competitor, with his concepts and diagnosis and treatment put to the acid test. In this setting, there existed only a patient-physician relationship, not a physician-patient relationship.Physicians left off the care of dying patients, a practice that was made a matter of duty by Friederich Hoffmann (1749). One would suffer punishing economic consequences if one had a high mortality rate. Better, then, to label the patient incurable, withdraw, and turn matters over to clergy. Gregory attacks this practice as intellectual fraud and calls for the physician to continue to attend the dying. Indeed, he says, “It is as much the business of a physician to alleviate pain, and to smooth the avenues of death, when unavoidable, as to cure diseases” (Gregory 1772, p. 35). He does not explicitly address what we now call physician-assisted suicide; neither does he condemn it, and he is quick to condemn some things—e.g., sexual abuse of female patients or “sporting” with patients in the Royal Infirmary by using experiments as the first line of treatment.The Royal Infirmary was established to care for the deserving, working poor, who received free care... (shrink)

In Truthfulness and Tragedy Stanley Hauerwas provides an account of moral existence and ethical rationality that shows how Christian convictions operate, or should operate, to form and direct lives. In attempting to conceptualize the basis of Christian ethics in a manner that will render Christian convictions morally intelligible, the author casts fresh light on traditional theoretical issues and articulates the distinctive Christian response to contemporary concerns such as suicide, medical ethics, and child care. The first section of the book deals (...) with methodological issues: the meaning and nature of practical reason, obligation claims, natural law, and self deception, and the affinity of story and ethics. It focuses on the relation of truthfulness and tragedy and the need for a story--a set of religious convictions or "grammar of theology"--that does justice to the tragic character of human existence. The second section addresses substantive issues: suicide, euthanasia, and the value of survival; the moral limits of population growth; the definition of "person" for medical reasons; and social involvement and Christian ethics. The overall theme is the need for a community in which truthfulness is a way of life. In the final section, devoted to the problem of how to care for retarded children, the implications of the author's ethical position are given concrete expression. He discusses the assumptions underlying the willingness to have children, criteria for humanness, medical ethics, and how truthful communities deal with suffering. In Truthfulness and Tragedy Stanley Hauerwas extends and clarifies the ethical position set forth in his earlier books Character and the Christian Life and Vision and Virtue. He is associate professor of theology at the University of Notre Dame. He was a senior fellow in Christian medical ethics at the Joseph and Rose Kennedy Institute for the Study of Reproduction and Bioethics, and taught medical ethics at the University of Texas medical branch in Galveston. (shrink)

: In response to the preceding commentary by Jerry Menikoff in this issue of the Journal , the authors argue that Fried's central concern is not that randomized clinical trials (RCTs) are conducted without consent, but rather that various aspects of the design and conduct of RCTs are in tension with physicians' duties of personal care to their patients. Although Fried does argue that the existence of equipoise cannot justify failure to obtain consent from research subjects, informed consent by itself (...) does not supplant ill subjects' rights to personalized judgment and care embodied in Fried's equipoise. (shrink)

Laws requiring autopsies have generated little controversy. Yet it is considered unconscionable to take organs without consent for transplantation. We think an organ draft is justified if mandatory autopsies are. We reject the following five attempts to show why a mandatory autopsy policy is legitimate, but organ conscription is not: (1) The social contract gives the state a greater duty to protect its citizens from each other than from disease. (2) There is a greater moral obligation to prevent murders than (...) disease-caused deaths because killing people is morally worse than allowing people to die. (3) Autopsies do not confiscate body parts, but organ transplants do. (4) The citizenry's knowledge that their organs are very likely to be taken will generate more anxiety than the remote possibility of a mandatory autopsy. (5) A religious conviction that one's organs will be needed in order to be resurrected is threatened by organ transplantation but not by autopsies that "return" body parts. (shrink)