Involving service users and carers in clinical research can help to improve its quality and relevance. By defining the limits of ethical acceptability, improving research design and management, ensuring information for participants is accessible and ensuring the views of participants are properly respected, user involvement can also improve the ethical conduct of research. But research proposals with good quality user involvement have experienced difficulties in obtaining ethical approval. Not all Research Ethics Committees (RECs) fully understand the active role of service (...) user/carer researchers and the current review system can act as a barrier to involving service users and carers in research. This problem urgently needs to be addressed because it is actually in the interests of RECs to promote and support user involvement. This will require adapting the systems of ethical approval, providing further training for REC members and involving service users and carers in developing and implementing these changes. (shrink)

In The Servile Mind: How Democracy Erodes the Moral Life, Kenneth Minogue explores the intelligentsia’s love affair with social perfection and reveals how ...

Over a 20-year period, the United States has developed a consensus of legal opinion concerning living wills and other advance directives. At the heart of this consensus are two interconnected principles. First, the state should minimally interfere with the wishes of patients and surrogates and the decisions of physicians about foregoing life-sustaining treatments. Second, state interference is permissible for the sake of protecting a compelling state interest. The overwhelming majority of states with advance directive laws have attained this balance of (...) minimal interference and compelling state interest in developing their laws. (shrink)

Quentin Skinner's The Foundations of Modern Political Thought is primarily of interest to philosophers not for its excellent account of European thought about the state but for the self–conscious philosophy which has gone into it. It is a rare historian who pauses to get his philosophy in order before he embarks on a major enterprise, though such a policy is possibly less unusual in intellectual history than in other fields. In Skinner's case, however, this order of doing things has been (...) pushed so far that he counts as a philosopher in his own right, rather than as merely someone who is unusually careful to think about what he is doing. The publication of this major work thus provides a convenient opportunity to make a few remarks about the relation between historical theory and practice. (shrink)

This volume consists of fourteen chapters selected from papers presented at the conference 'Ethics, Medicine and Health Care: An Appraisal of the Thought of H. Tristram Engelhardt, Jr.' along with a response to those chapters by Engelhardt and a Foreword by Laurence B. McCullough. The chapters direct primary attention to various aspects of Engelhardt's philosophy of medicine and bioethics as presented in The Foundations of Bioethics and Bioethics and Secular Humanism: The Search for a Common Morality. Among the topics treated (...) are the economics of health care and the medical profession, the libertarian and communitarian aspects of Engelhardt's thought, the moral status of children, abortion, the moral foundations for a health care system, feminism and clinical epistemology, and the relation between secular and religious moralities. In response to the various challenges posed by the authors, Engelhardt considers the implications of the failure of the modern philosophical project, the role of reason in ethics, and the resolution of conflict among communities that do not share the same moral vision. The book will be of interest to professionals in medicine, philosophy, theology, health policy, and law, and to graduate students in those disciplines. (shrink)

The type II phosphatidylinositol 4-kinases produce the lipid phosphatidylinositol 4-phosphate and participate in a confusing variety of membrane trafficking and signaling roles. This review argues that both historical and contemporary evidence supports the function of the PI4KIIs in numerous trafficking pathways, and that the key to understanding the enzymatic regulation is through membrane interaction and the intrinsic membrane environment. By summarizing new research and examining the trafficking roles of the PI4KIIs in the context of recently solved molecular structures, I highlight (...) how mechanisms of PI4KII function and regulation are providing insights into the development of cancer and in neurological disease. I present an integrated view connecting the cell biology, molecular regulation, and roles in whole animal systems of these increasingly important proteins. The type II phosphatidylinositol 4-kinases are versatile mediators of membrane trafficking, controlling pathways that impact on disease. Recent advances suggest that the membrane lipid environment regulates enzyme activity and that the complexity of trafficking routes can be explained by the ability of these kinases to promote membrane trafficking in different directions. (shrink)

Past research (Lawson, 2004; Nonis & Swift, 2001) has revealed a correlation between academic and business ethics. Using a sample survey, this study extends this inquiry by examining the role of dispositional variables (neuroticism, extraversion, and conscientiousness) and academic honesty on business ethics perceptions. Results indicate that (1) neuroticism and conscientiousness were positively related to more ethical perceptions in a work context, and (2) academic honesty partially mediated the relationship between conscientiousness and business ethics. Implications to business practitioners and educators (...) are discussed as well as directions for future research. (shrink)

This essay explores some concerns about the quality of informed consent in patients whose autonomy is diminished by fatal illness. It argues that patients with diminished autonomy cannot give free and voluntary consent, and that recruitment of such patients as subjects in human experimentation exploits their vulnerability in a morally objectionable way. Two options are given to overcome this objection: (i) recruit only those patients who desire to contribute to medical knowledge, rather than gain access to experimental treatment, or (ii) (...) provide prospective subjects the choice to participate in standard doubleblind study or receive the experimental treatment. Either option would guarantee that patients in desperate conditions are given a more meaningful choice and a richer freedom, and thus a higher quality of informed consent, than under standard randomized trials. (shrink)

Virginia Held assesses the ethics of care as a promising alternative to the familiar moral theories that serve so inadequately to guide our lives. The ethics of care is only a few decades old, yet it is by now a distinct moral theory or normative approach to the problems we face. It is relevant to global and political matters as well as to the personal relations that can most clearly exemplify care. This book clarifies just what the ethics of (...) care is: what its characteristics are, what it holds, and what it enables us to do. It discusses the feminist roots of this moral approach and why the ethics of care can be a morality with universal appeal. Held examines what we mean by "care," and what a caring person is like. Where other moral theories demand impartiality above all, the ethics of care understands the moral import of our ties to our families and groups. It evaluates such ties, focusing on caring relations rather than simply on the virtues of individuals. The book proposes how such values as justice, equality, and individual rights can "fit together" with such values as care, trust, mutual consideration, and solidarity. In the second part of the book, Held examines the potential of the ethics of care for dealing with social issues. She shows how the ethics of care is more promising than Kantian moral theory and utilitarianism for advice on how expansive, or not, markets should be, and on when other values than market ones should prevail. She connects the ethics of care with the rising interest in civil society, and considers the limits appropriate for the language of rights. Finally, she shows the promise of the ethics of care for dealing with global problems and seeing anew the outlines of international civility. (shrink)

Background: An ongoing challenge for clinical ethics consultation is learning how colleagues in other healthcare professions understand, make use of, and evaluate clinical ethics consultation services. Aim: In pursuing such knowledge as part of clinical ethics consultation service quality assessment, clinical ethics consultation services can learn important information about the issues and concerns that prompt colleagues to request ethics consultation. Such knowledge allows for greater outreach, education, and responsiveness by clinical ethics consultation services to the concerns of clinician colleagues. Design: (...) This quality assessment project explores consultation requests and follow-up questionnaire responses voluntarily submitted from nurses who requested clinical ethics consultation. We present qualitative data analyzed using content analysis and constant comparison methods to identify key concerns that prompted requests as well as common themes among nurse requestors’ evaluations of what was most important in clinical ethics consultations. Participants and context: A total of 41 nurses requesting clinical ethics consultation and 15 who returned the follow-up questionnaire. Ethical considerations: Our Office of Research Compliance and Quality Improvement determined that our project was not considered human subjects research and so did not require institutional review board approval or exemption. However, efforts were made to avoid any sense of coercion and all data were de-identified prior to analysis. Findings: Our analysis revealed six main categories of issues that prompted nurses’ requests for ethics consultation, as well as unifying themes around nurses’ experiences, advocacy, and family support while caring for patients in the intersections of patients, families, and physicians. Discussion: The insights gained from analyzing nurses’ requests for and responses to clinical ethics consultation may serve as a resource for clinical ethics consultation services seeking to identify, respond to, and educate regarding issues of importance to nurse colleagues and may be a resource for nursing administrators and leadership seeking to identify and address common ethical issues nurses face. Conclusion: Ongoing work on clinical ethics consultation service quality improvement and engagement with our nursing colleagues about their concerns prompting—and their evaluations of—clinical ethics consultation are necessary. (shrink)

How is feminism changing the way women and men think, feel, and act? Virginia Held explores how feminist theory is changing contemporary views of moral choice. She proposes a comprehensive philosophy of feminist ethics, arguing persuasively for reconceptualizations of the self of relations between the self and others and of images of birth and death, nurturing and violence. Held shows how social, political, and cultural institutions have traditionally been founded upon masculine ideals of morality. She then identifies a distinct (...) feminist morality that moves beyond culturally embedded notions about motherhood and female emotionality. Examining the effects of this alternative moral and ethical system on changing social values, Held discusses its far-reaching implications for altering standards of freedom, democracy, equality, and personal development. Ultimately, she concludes, the culture of feminism could provide a fresh perspective on--even solutions to--contemporary social problems. Feminist Morality makes a vital contribution to the ongoing debate in feminist theory on the importance of motherhood. For philosophers and other readers outside feminist theory, it offers a feminist moral and social critique in clear and accessible terms. (shrink)

My aim in this essay is to distinguish and comment on a specific movement of thought which I shall call “democracy as a telos.” This expression refers to a conception of democracy, cultivated by normative political philosophers, in which all democratic potentialities have at last been realized. The result is thought to be a perfected political community. Democracy as a telos must thus be distinguished from the actual liberal democracies we enjoy at the end of the twentieth century. Indeed, democracy (...) as a telos takes off from a specific rejection of such familiar institutions as elections, political parties, oppositions, a free press, and the rest, which are regarded, according to taste, as individualistic, bourgeois, atomistic, formal, and abstract. Democracy as a telos refers to the theories of reformers who, dissatisfied with our present condition, argue that only a radically transformed democracy can generate a real political community. (shrink)

Bas van Fraassen has formulated a semantical or model theoretic analysis of the structure of scientific theories. He contrasts his semantical approach with the syntactic approach of the logical positivists and argues that his theory is preferable on a number of grounds. The aims of this paper are threefold. First, a brief description of van Fraassen's approach is presented. Secondly, his theory is compared with that of the logical positivists and, in so doing, the virtues that van Fraassen believes recommend (...) his theory over the positivist theory are identified. Finally, an objection that is positivist in spirit is raised which suggests that, epistemically, his account is indistinguishable from classical historicism. (shrink)

In this paper, I examine the notion of accountability and its historical evolution in health care. Using medical mistakes and adverse patient outcomes as my focus, I examine the interests served by particular models of accountability and argue for a model of collective fiduciary responsibility in U.S. health care today.

The term “ideology” can cover almost any set of ideas, but its power to bewitch political activists results from its strange logic. It is part philosophy, part science, and part spiritual revelation, all tied together in leading to a remarkable paradox—that the modern Western world, beneath its liberal appearance, is actually the most systematically oppressive system of despotism the world has ever seen. In Alien Powers, Kenneth Minogue takes this complex intellectual construction apart, analyzing its logical, rhetorical, and psychological (...) devices, and thus opening it up to critical analysis. This new, ISI Books’ Background edition of Alien Powers includes a new introduction to the text by Martyn P. Thompson and critical essays on the text by political theorist Paul Gottfried and philosopher Stephen A. Erickson. (shrink)

In this book, the author examines the ethical implications of Artificial Intelligence systems as they integrate and replace traditional social structures in new sociocognitive-technological environments. She discusses issues related to the integrity of researchers, technologists, and manufacturers as they design, construct, use, and manage artificially intelligent systems; formalisms for reasoning about moral decisions as part of the behavior of artificial autonomous systems such as agents and robots; and design methodologies for social agents based on societal, moral, and legal values. Throughout (...) the book the author discusses related work, conscious of both classical, philosophical treatments of ethical issues and the implications in modern, algorithmic systems, and she combines regular references and footnotes with suggestions for further reading. This short overview is suitable for undergraduate students, in both technical and non-technical courses, and for interested and concerned researchers, practitioners, and citizens. (shrink)

Clinical Ethics Committees (CECs), as distinct from Research Ethics Committees, were originally established with the aim of supporting healthcare professionals in managing controversial clinical ethical issues. However, it is still unclear whether they manage to accomplish this task and what is their impact on clinical practice. This systematic review aims to collect available assessments of CECs’ performance as reported in literature, in order to evaluate CECs’ effectiveness. We retrieved all literature published up to November 2019 in six databases (PubMed, Ovid (...) MEDLINE, Scopus, Philosopher’s Index, Embase and Web of Science), following PRISMA guidelines. We included only articles specifically addressing CECs and providing any form of CECs performance assessment. Twenty-nine articles were included. Ethics consultation was the most evaluated of CECs’ functions. We did not find standardized tools for measuring CECs’ efficacy, but 33% of studies considered “user satisfaction” as an indicator, with 94% of them reporting an average positive perception of CECs’ impact. Changes in patient treatment and a decrease of moral distress in health personnel were reported as additional outcomes of ethics consultation. The highly diverse ways by which CECs carry out their activities make CECs’ evaluation difficult. The adoption of shared criteria would be desirable to provide a reliable answer to the question about their effectiveness. Nonetheless, in general both users and providers consider CECs as helpful, relevant to their work, able to improve the quality of care. Their main function is ethics consultation, while less attention seems to be devoted to bioethics education and policy formation. (shrink)

Virginia Held's Feminist Morality defends the idea that it is possible to transform the "public" sphere by remaking it on the model of existing "private" relationships such as families. This paper challenges Held's optimism. It is argued that feminist moral inquiry can aid in transforming the public sphere only by showing just how much the allegedly "private" realms of families and personal relationships are shaped-and often misshapen-by public demands and concerns.

Nearly two hundred years ago, Mary Wollstonecraft wrote what is considered to be the first major work of feminist political theory: A Vindication of the Rights of Women . Much has been written about this work, and about Wollstonecraft as the intellectual pioneer of feminism, but the actual substance and coherence of her political thought have been virtually ignored. Virginia Sapiro here provides the first full-length treatment of Wollstonecraft's political theory. Drawing on all of Wollstonecraft's works and treating them (...) thematically rather than sequentially, Sapiro shows that Wollstonecraft's ideas about women's rights, feminism, and gender are elements of a broad and fully developed philosophy, one with significant implications for contemporary democratic and liberal theory. The issues raised speak to many current debates in theory, including those surrounding interpretation of the history of feminism, the relationship between liberalism and republicanism in the development of political philosophy, and the debate over the canon. For political scientists, most of whom know little about Wollstonecraft's thought, Sapiro's book is an excellent, nuanced introduction which will cause a reconsideration of her work and her significance both for her time and for today's concerns. For feminist scholars, Sapiro's book offers a rounded and unconventional analysis of Wollstonecraft's thought. Written with considerable charm and verve, this book will be the starting point for understanding this important writer for years to come. (shrink)

Previous research has investigated the links between Mergers and Acquisitions (M&As) and the monetary magnitude of executive compensation, but failed to inquire how the adoption of specific attributes of compensation contacts relates to M&A activities. We address this gap in the literature by examining the impacts of some M&A characteristics and acquirers' features on the adoption of executive compensation protection provisions and new Long-Term Incentive Plans (LTIPs). The study adopts a longitudinal design before after M&A deals for 80 Canadian acquiring (...) companies that engaged in M&A activities between 1995 and 2001. Our findings suggest that both transactional and organisational characteristics significantly explain the executive compensation arrangements' adoption around M&A transactions, but that the adoption of new LTIPs is subjected to a different set of determinants than the adoption of compensation protection provisions. We interpret these results in the light of the agency, political and institutional perspectives. (shrink)

Because psychotherapists are not moral teachers, they ought not to advise their clients about evaluative questions. This means that their advice must be limited to a concern with the client''s view of reality. It happens that in our times, there are prefabricated views of reality on offer from a variety of ideologies-Marxism and feminism being currently the most influential. Ideologists not only offer prefabricated realities-called consciousness- but also present a set of arguments to show that because choice is unreal, consciousness (...) is all that matters. Adopting the ideological concept of consciousness thus becomes a backdoor variant of the ultimate sin against scientific method: namely smuggling unsubstantiated, indeed undiscussed, values into therapy. (shrink)

The goal of this paper is to review and describe the characteristics and outcomes of ethics consultations on a gastrointestinal oncology service and to identify areas for systems improvement and staff education. This is a retrospective case series derived from a prospectively-maintained database of the ethics consultation service at Memorial Sloan Kettering Cancer Center. The study analyzed all ethics consultations requested for patients on the gastrointestinal medical oncology service from September 2007 to January 2016. A total of 64 patients were (...) identified. The most common primary ethical issue was the DNR order, followed by medical futility. The most common contextual issues were dispute/conflict between staff and family, dispute/conflict intra-family, and cultural/ethnic/religious issues. The majority of ethical issues leading to consultation were resolved ; i.e., the patient, surrogate, and/or healthcare team followed the recommendation of the ethics consultant. 22% had a DNR order prior to the ethics consult and 69% had a DNR order after the consult. In this population of patients on a gastrointestinal oncology service, ethics consultations are most often called regarding patients with advanced cancers and the most common ethical conflicts arose between families and the health care team over goals of care at the end of life, specifically related to the DNR order and perceived futility of continued/escalation of treatment. Ethics consultations assisted with conflict resolution. Conflicts might be reduced with improved communication about prognosis and earlier end of life care planning. (shrink)

Intellectuals such as William James and Aldous Huxley have thought it possible to develop a technique to apply to this world the mystical-type insights gained during drug-enabled experiences. Particularly, Huxley claimed that the visionary experience triggered by psychedelics could help us rethink our relationship with technology and promote a much-needed cultural change. In this article, we explore this hypothesis. To do so, we build a philosophical framework based on Günther Anders's philosophy of technique, presenting human beings as morally blind when (...) facing technological development. Mystical experiences are then proposed as a means to improve our moral faculties—and psychedelic drugs as tools to enable them. We finally explore the empirical feasibility of such a hypothesis by thoroughly reviewing the recent scientific literature on the nature of the psychedelic experience, concluding that the long-term effects in the personality domain openness and in nature relatedness point to the emergence of a morally improved agent, thus providing substance to an application of mysticism. (shrink)

Rather than using literary texts to evidence an analytic argument, within this piece we read Julia McNair Wright's (US, 1840?1902), Sidonie-Gabrielle Colette's (France, 1873?1954), and Willa Cather's (US, 1873?1947) texts through theoretical lenses that expose their educational meaning and value and that create conversation among them concerning girls? and women's educations. While we do not claim that one can generalize these women's works and lessons to every life, we contend that these women and the literary products they created offer girls (...) and women powerful lessons about resistance, subversion, and nurturing one's intellect, lessons that in some ways transcend class and race in particular. First, we define and explain Bruner's concept of the more using Rosenblatt, Gallagher, and Gardner's theories and findings to illuminate his concept. Next, we identify and examine three themes that emerge across these authors? texts?subverting through the everyday, becoming one's own steward, and moving from survival to self-actualization. Establishing these themes first in Wright's texts, we then use them to frame Colette's and Cather's fiction and support these themes by focusing on one lesson that emerges from each author's work(s). Finally, we ask what one might learn about educating girls and women from these texts and others whose educative meaning and value remain hidden. (shrink)

How Terrorism is Wrong collects essays by Virginia Held that examine terrorism and other forms of political violence. Held assesses popular attitudes that glorify some kinds of violence and vilify others, and discusses the kinds of moral evaluation appropriate for terrorism, war, violent political change, or repression. This collection suggests ways of improving how we understand and deal with violence.

A modern form of narrative, comic books are used to communicate, discuss, and critique issues in business ethics and social issues in management. A description of comic books as a legitimate medium is followed by a discussion of the pedagogical uses of comic books and assessment techniques. The strengths of the pedagogy include crossing cultural barriers, understanding the complexity of individual decision-making and organizational influences, and the universality of dilemmas and values. We provide an initial source for educators on the (...) topics, comic books, plotlines, and other commentary for consideration of use in the classroom from high school to graduate business ethics and social issues in management courses. (shrink)

In The Structure of Scientific Inference, Mary Hesse has argued for a realist interpretation of science. Her realism, however, is not to be understood in the context of the traditional realist/instrumentalist debate within the philosophy of science. That debate focused on the question of whether or not science did anything other than systematize the empirical data given in our experience. The traditional realist answered “yes” and most frequently described the theoretical statements of science, not only as true, but also as (...) providing descriptions of the world. The instrumentalist on the other hand answered “no” and ascribed no descriptive force to the theoretical statements of science. However, according to Hesse, neither party in the contemporary realism debate assumes the notion of an empirical given. Consequently, the present dispute must be understood as taking place on a level which is logically prior to its predecessor. (shrink)

The productive use of English past tense morphology in school-aged children (N= 74; 3 years, 8 months to 13 years, 5 months) is explored using on elicited production task. Errors represented 20% of the responses overall. Virtually all of the children demonstrated productivity with regular (e.g., good) and irregular patterns (zero-marking, e.g., sit + sit; vowel-change, e.g., ride -+ rid). Overall frequency of errors decreased with age, yet the tendency for certain types of irregularizations increased in the older groups. Analyses (...) across items indicated that all error types were predicted by combinations of item frequency, phonological chamcteristics of stems and past tense forms, and aspects of phonological past tense “neighborhoods.” Contrary to “hybrid” or dual-mechanism models incorporating a phonologically-insensitive default mechanism (e.g., Prasada & Pinker, 1993), these results suggest that children’s productivity with regular and irregular patterns is consistent with a phonologically-based constraint satisfaction system similar to that implemented in connectionist models (Daugherty & Seidenberg, 1992; Plunkett 81 Marchman, 1991,1993). (shrink)

. Morality is often dismissed as irrelevant in what is seen as the global anarchy of rival states each pursuing its national interest. When morality is invoked, it is usually the morality of justice with its associated moral conceptions of individual rights, equality, and universal law. In the area of moral theory, an alternative moral approach, the ethics of care, has been developed in recent years. It is beginning to influence how some see their global responsibilities.

We explored the comprehension of the informed consent in 77 cancer patients previously enrolled in randomised phase II or phase III clinical trials, between March and July 2011, at the San Raffaele Scientific Institute in Milano. We asked participants to complete an ad hoc questionnaire and analysed their answers. Sixty-two per cent of the patients understood the purpose and nature of the trial they were participating in; 44% understood the study procedures and 40% correctly listed at least one of the (...) major risks or complications related to their participation in the trial. We identified three factors associated with comprehension of the informed consent: age, education and type of tumour/investigator team. We suggest several possible improvements of how to obtain informed consent that will increase patient awareness, as well as the validity and effectiveness of the clinical trials. (shrink)

Two studies investigated the development of infants' visual preferences for the human body shape. In Study 1, infants of 12,15 and 18 months were tested in a standard preferential looking experiment, in which they were shown paired line drawings of typical and scrambled bodies. Results indicated that the 18-month-olds had a reliable preference for the scrambled body shapes over typical body shapes, while the younger infants did not show differential responding. In Study 2, 12- and 18-month-olds were tested with the (...) same procedure, except that the typical and scrambled body stimuli were photographic images. The results of Study 2 again indicated that only the 18-month-olds had a reliable preference for the scrambled body shapes. This finding contrasts sharply with infants' precocious preferences for human faces, suggesting that infants' learning about human faces and human bodies follow different developmental trajectories. (C) 2002 Elsevier Science B.V. All rights reserved. (shrink)

Following the guiding thread given by the metaphors used in the title of this paper and which are recurrent in the texts of the philosopher Immanuel Kant himself as well as in most of his commentators’, I selected some themes that the Critique of the Power of Judgment offers us to think about and which remain relevant today: system, critique, reflection, the sublime, and a certain concept of humanity. I have prioritized both Portuguese and Brazilian interpreters without disregarding French authors, (...) everlasting allies, who inspire me since the beginning of my studies. (shrink)