: The "difference position" holds that clinical research and therapeutic medical practice are sufficiently distinct activities to require different ethical rules and principles. The "similarity position" holds instead that clinical investigators ought to be bound by the same fundamental principles that govern therapeutic medicine—specifically, a duty to provide the optimal therapeutic benefit to each patient or subject. Some defenders of the similarity position defend it because of the overlap between the role of attending physician and the role of investigator in (...) a research trial. This overlap is maximal when the same physician occupies both roles with respect to a particular patient-subject. We address the ethical tensions inherent in that role conflict and argue that the tensions are real but manageable. The difference position provides a sound ethical framework within which to manage those tensions, while the similarity position is unsatisfactory because it seeks to deny the existence of the tensions. (shrink)

A special report of The Hastings Center and the Association of American Medical Colleges addressed the ethical oversight of learning health systems, which seek to combine high‐quality patient care with routine data collection aimed at improving patient outcomes. The report contained two position papers, authored by a number of distinguished bioethicists, and several commentaries. The position papers urged two changes. First, they urged a rethinking of our approach to the regulation of human subjects research, so as to make it easier (...) in the future for learning health systems to function well. Second, they argued that the rethinking required dispensing with a strict distinction between research and therapy, which has been a major tenet of bioethics since the Belmont Report, which explicated basic ethical principles governing human subjects research. We fully support the objectives of the authors, and we agree that the learning health system is an important advance that serves patients well. Unnecessary regulatory burden ought not impede this progress. We disagree, however, that the best way to bring about these needed changes in the regulatory environment is to reject the basic distinction between research and treatment. Unfortunately, we find the arguments in favor of that strategy to be, in places, reminiscent of what we take to be basic conceptual errors that hampered the ethical understanding of human subjects research prior to adoption of the Belmont Report. To see why one need not reject the research‐treatment distinction in order to promote learning health systems, we first investigate in some detail the arguments offered for eliminating the distinction. We next turn to an issue not addressed by those authors, namely, the relationship between the physician or investigator and the patient or subject, to illustrate why the distinction is important and what is lost if it is jettisoned. (shrink)

Some ethical issues facing contemporary medicine cannot be fully understood without addressing medicine's internal morality. Medicine as a profession is characterized by certain moral goals and morally acceptable means for achieving those goals. The list of appropriate goals and means allows some medical actions to be classified as clear violations of the internal morality, and others as borderline or controversial cases. Replies are available for common objections, including the superfluity of internal morality for ethical analysis, the argument that internal morality (...) is merely an apology for medicine's traditional power and authority, and the claim that there is no single, "core" internal morality. The value of addressing the internal morality of medicine may be illustrated by a detailed investigation of ethical issues posed by managed care. Managed care poses some fundamental challenges for medicine's internal morality, but also calls for thoughtful reflection and reconsideration of some traditionally held moral views on patient fidelity in particular. (shrink)

A predominant ethical view holds that physician‐investigators should conduct their research with therapeutic intent. And since a physician offering a therapy wouldn't prescribe second‐rate treatments, the experimental intervention and the best proven therapy should appear equally effective. "Clinical equipoise" is necessary. But this perspective is flawed. The ethics of research and of therapy are fundamentally different, and clinical equipoise should be abandoned.

This paper addresses the extent to which both Julian Barbour‘s Machian formulation of general relativity and his interpretation of canonical quantum gravity can be called timeless. We differentiate two types of timelessness in Barbour‘s (1994a, 1994b and 1999c). We argue that Barbour‘s metaphysical contention that ours is a timeless world is crucially lacking an account of the essential features of time—an account of what features our world would need to have if it were to count as being one in which (...) there is time. We attempt to provide such an account through considerations of both the representation of time in physical theory and in orthodox metaphysical analyses. We subsequently argue that Barbour‘s claim of timelessness is dubious with respect to his Machian formulation of general relativity but warranted with respect to his interpretation of canonical quantum gravity. We conclude by discussing the extent to which we should be concerned by the implications of Barbour‘s view. (shrink)

The practice of voluntary physician‐assisted death as a last resort is compatible with doctors' duties to practice competently, to avoid harming patients unduly, to refrain from medical fraud, and to preserve patients' trust. It therefore does not violate physicians' professional integrity.

Cosmetic surgery is a fast-growing medical practice. In 1997 surgeons in the United States performed the four most common cosmetic procedures443,728 times, an increase of 150% over the comparable total for 1992. Estimated total expenditures for cosmetic surgery range from $1 to $2 billion. As managed care cuts into physicians' income and autonomy, cosmetic surgery, which is not covered by health insurance, offers a financially attractive medical specialty.

Much current debate in the metaphysics of time is between A-theorists and B-theorists. Central to this debate is the assumption that time exists and that the task of metaphysics is to catalogue time’s features. Relatively little consideration has been given to an error theory about time. Since there is very little extant work on temporal error theory the goal of this paper is simply to lay the groundwork to allow future discussion of the relative merits of such a view. The (...) paper thus develops a conceptual framework from within which to evaluate claims about the actual existence, or not, of temporality as that notion appears in folk discourses about time, and from there to examine claims about the counterfactual existence, or not, of temporality so conceived. We subsequently apply this framework to three extant positions drawn from physics and metaphysics that deny the existence of time. We show that only one of these positions is a folk temporal error theory; that is, a view that denies the existence of time as that notion is operative in our everyday thought and talk. (shrink)

"Unlike most photographs of Eads Bridge, which are taken from a distance, Quinta Scott's intimate photographic essay shows the subtleties of form and texture that give this structure its remarkable aesthetic impact. Howard Miller's text complements the photos, explaining the place of James Eads's unorthodox design in the history of American architecture and aesthetics. Miller also explains the bridge's place in local and national economic history, describes its innovative engineering, and brings to life its unique creator."--Jacket.

The leading ethical position on placebo-controlled clinical trials is that whenever proven effective treatment exists for a given condition, it is unethical to test a new treatment for that condition against placebo. Invoking the principle of clinical equipoise, opponents of placebo-controlled trials in the face of proven effective treatment argue that they (1) violate the therapeutic obligation of physicians to offer optimal medical care and (2) lack both scientific and clinical merit. We contend that both of these arguments are mistaken. (...) Clinical equipoise provides erroneous ethical guidance in the case of placebo-controlled trials, because it ignores the ethically relevant distinction between clinical trials and treatment in the context of clinical medicine and the methodological limitations of active-controlled trials. Placebo controls are ethically justifiable when they are supported by sound methodological considerations and their use does not expose research participants to excessive risks of harm. (shrink)

A basic question of medical ethics is whether the norms governing medical practice should be understood as the application of principles and rules of the common morality to medicine or whether some of these norms are internal or proper to medicine. In this article we describe and defend an evolutionary perspective on the internal morality of medicine that is defined in terms of the goals of clinical medicine and a set of duties that constrain medical practice in pursuit of these (...) goals. This perspective is developed by means of a critical examination of the essentialist conception of the internal morality of medicine advocated by Edmund Pellegrino and the critique of internal morality approaches by Robert Veatch and Tom Beauchamp. (shrink)

In this paper, we explore locative grounding harmony, according to which the location of the grounds mirrors the location of the grounded. We proceed in three stages. First, we clarify the notion of locative harmony and describe different locative harmony principles. Second, we offer two arguments for the claim that grounding between physically located entities obeys principles of locative harmony. Third, we consider and respond to a range of cases that seem to show that grounding relations between physically located entities (...) do not obey such principles. We conclude that grounding between such entities obeys locative harmony. (shrink)

The idea that time does not exist is, for many, unthinkable: time must exist. Almost every experience we have tells us so. There has been plenty of debate around what time is like, but not whether it exists. The goal of this book is to make the absence of time thinkable. Time might not exist. Beginning with an empirically flavoured examination of the 'folk' concept of time, the book explores the implications this has for our understanding of agency, and the (...) extent to which our best physics and best metaphysics are compatible with a timeless conception of reality. (shrink)

The doctrine of clinical equipoise is appealing because it appears to permit physicians to maintain their therapeutic obligation to offer optimal medical care to patients while conducting randomized controlled trials (RCTs). The appearance, however, is deceptive. In this article we argue that clinical equipoise is defective and incoherent in multiple ways. First, it conflates the sound methodological principle that RCTs should begin with an honest null hypothesis with the questionable ethical norm that participants in these trials should never be randomized (...) to an intervention known to be inferior to standard treatment. Second, the claim that RCTs preserve the therapeutic obligation of physicians misrepresents the patient-centered orientation of medical care. Third, the appeal to clinical equipoise as a basic principle of risk-benefit assessment for RCTs is incoherent. Finally, the difficulties with clinical equipoise cannot be resolved by viewing it as a presumptive principle subject to exceptions. In the final sections of the article, we elaborate on the non-exploitation framework for the ethics clinical research and indicate issues that warrant further inquiry. (shrink)

It has seemed, to many, that there is an important connection between the ways in which some theoretical posits explain our observations, and our reasons for being ontologically committed to those posits. One way to spell out this connection is in terms of what has become known as the explanatory criterion of ontological commitment. This is, roughly, the view that we ought to posit only those entities that are indispensable to our best explanations. Our primary aim is to argue that (...) the moral nonnaturalist places herself in an invidious position if she simply accepts that the nonnatural moral facts that she posits are not explanatory. Instead, we offer the nonnaturalist an alternative strategy for dealing with moral explanations. The strategy is to retain the explanatory criterion of ontological commitment and maintain that moral properties are, in fact, explanatory. The explanations they provide are not causal explanations; instead, moral properties make a non-causal difference to the physical facts. (shrink)

With breathtalung speed, traditional criminal prohibitions against assisted suicide have been declared unconstitutional in twelve states, including California and New York. This poses great promise and great peril. The promise is that competent terminally ill patients, as a compassionate measure of last resort, will have the option of putting an end to their suffering by physician-assisted suicide. More sigmficant, legally permitting this controversial option may be a catalyst for doctors, health care institutions, and society to improve the care of the (...) dying. PAS should be limited only to those relatively few competent patients who continue to suffer intolerably despite unrestrained efforts to palliate and who face a continued existence that they regard as worse than death. When dying patients know they will not be abandoned to miserable and pointless suffering if palliative care fails, they will be fortified to cope better with the process of dying.The immediate peril is that PAS will become a quick fix, available on demand to any patient diagnosed as terminally ill, thus bypassing palliative care and producing premature deaths. (shrink)

*The opinions expressed are the views of the author and do not necessarily reflect the policy of the National Institutes of Health, the Public Health Service, or the U.S. Department of Health and Human Services.

The anglophone philosophy profession has a well-known problem with gender equity. A sig-nificant aspect of the problem is the fact that there are simply so many more male philoso-phers than female philosophers among students and faculty alike. The problem is at its stark-est at the faculty level, where only 22% - 24% of philosophers are female in the United States (Van Camp 2014), the United Kingdom (Beebee & Saul 2011) and Australia (Goddard 2008).<1> While this is a result of the (...) percentage of women declining at each point through-out the standard career trajectory, recent large-scale studies in the United States (Paxton et al. 2012) and Australia (Goddard et al. 2008) have identified a key drop-off point as the transi-tion between taking introductory classes and majoring in philosophy. So why do dispropor-tionately few female students choose to major in philosophy? (shrink)

Why is there female under-representation among philosophy majors? We survey the hypotheses that have been proposed so far, grouping similar hypotheses together. We then propose a chronological taxonomy that distinguishes hypotheses according to the stage in undergraduates’ careers at which the hypotheses predict an increase in female under-representation. We then survey the empirical evidence for and against various hypotheses. We end by suggesting future avenues for research.

Why does female under- representation emerge during undergraduate education? At the University of Sydney, we surveyed students before and after their first philosophy course. We failed to find any evidence that this course disproportionately discouraged female students from continuing in philosophy relative to male students. Instead, we found evidence of an interaction effect between gender and existing attitudes about philosophy coming into tertiary education that appears at least partially responsible for this poor retention. At the first lecture, disproportionately few female (...) students intended to major. Further, at the first lecture, female students were less interested in philosophy, were less self-confident about philosophy, and were less able to imagine themselves as philosophers. Similarly, female students predicted they would feel more uncomfortable in philosophy classes than male students did. Further study with a control is warranted to determine whether this interaction effect is peculiar to philosophy, or whether it is indicative of a more general gendered trend amongst first year undergraduate students. (shrink)

Realism in international relations theory is frequently understood to entail the abandonment or cynical manipulation of moral rules and principles. But realism has always been more than an amoral or immoral doctrine. More interesting versions of realism offer moral justifications for limiting the role of morality. We argue for a version of realism that flows from the function of the liberal democratic state as an indispensable condition of value. After setting out its central characteristics, we also argue that this liberal (...) democratic realism can adequately address four severe criticisms typically raised against realism in general. (shrink)

30th Nov. and 1st Dec. 2013 at Kyoto University. Organizer: Takeshi Sakon.

We are drowning in information, while starving for wisdom.Are the smartest people also the wisest? Not necessarily. While traditional intellectual reasoning and procedural knowledge have helped build the communities we live in, there is a growing scientific understanding that we need emotionally balanced and better-fitting prosocial frameworks for coping with the uncertainties and complexities of life and addressing new challenges of the modern world. We are now poised on the edge of a new science of wisdom.The concept of wisdom, long (...) considered the “pinnacle of insight into the human condition”, has been that of an intangible, subjective, culturally specific entity—an unscientific... (shrink)

Freud proposes that in unconscious processing, logical connections are also (heavily) based upon phonological similarities. Repressed concerns, for example, would also be expressed by way of phonologic ambiguity. In order to investigate a possible unconscious influence of phonological similarity, 31 participants were submitted to a tachistoscopic subliminal priming experiment, with prime and target presented at 1ms. In the experimental condition, the prime and one of the 2 targets were phonological reversed forms of each other, though graphemically dissimilar (e.g., “nice” and (...) “sign”); in the control condition the targets were pseudo-randomly attributed to primes to which they don’t belong. The experimental task was to “blindly” pick the choice most similar to the prime. ERPs were measured with a focus on the N320, which is known to react selectively to phonological mismatch in supraliminal visual word presentations. The N320 amplitude-effects at the electrodes on the midline and at the left of the brain significantly predicted the participants’ net behavioral choices more than half a second later, while their subjective experience is one of arbitrariness. Moreover, the social desirability score (SDS) significantly correlates with both the behavioral and the N320 brain responses of the participants. It is proposed that in participants with low SDS the phonological target induces an expected reduction of N320 and this increases their probability to pick this target. In contrast, high defensive participants have a perplexed brain reaction upon the phonological target, with a negatively peaking N320 as compared to control and this leads them to avoid this target more often. Social desirability, which is understood as reflecting defensiveness, might also manifest itself as a defense against the (energy-consuming) ambiguity of language. The specificity of this study is that all of this is happening totally out of awareness and at the level of very elementary linguistic distinctions. (shrink)

Varieties of Ethical Reflection brings together new cultural and religious perspectives—drawn from non-Western, primarily Asian, philosophical sources—to globalize the contemporary discussion of theoretical and applied ethics.