The dominant, individualistic understanding of autonomy that features in clinical practice and research is underpinned by the idea that people are, in their ideal form, independent, self-interested and rational gain-maximising decision-makers. In recent decades, this paradigm has been challenged from various disciplinary and intellectual directions. Proponents of ‘relational autonomy’ in particular have argued that people’s identities, needs, interests – and indeed autonomy – are always also shaped by their relations to others. Yet, despite the pronounced and nuanced critique directed at (...) an individualistic understanding of autonomy, this critique has had very little effect on ethical and legal instruments in clinical practice and research so far. In this article, we use four case studies to explore to what extent, if at all, relational autonomy can provide solutions to ethical and practical problems in clinical practice and research. We conclude that certain forms of relational autonomy can have a tangibl... (shrink)

Many drugs used in paediatric medicine are off-label. There is a rising call for the use of adaptive clinical trial designs in responding to the need for safe and effective drugs given their potential to offer efficiency and cost-effective benefits compared with traditional clinical trials. ADs have a strong appeal in paediatric clinical trials given the small number of available participants, limited understanding of age-related variability and the desire to limit exposure to futile or unsafe interventions. Although the ethical value (...) of adaptive trials has increasingly come under scrutiny, there is a paucity of literature on the ethical dilemmas that may be associated with paediatric adaptive designs. This paper highlights some of these ethical concerns around safety, scientific/social value and caregiver/guardian comprehension of the trial design. Against this background, the paper develops a non-static conceptual lens for understanding PADs. It shows that ADs are epistemically open and reduce some of the knowledge-associated uncertainties inherent in clinical trials as well as fast-track the time to draw conclusions about the value of evaluated drugs/treatments. On this note, the authors argue that PADs are ethically justifiable given they have multiple layers of safety, exposing enrolled children to lesser potential risks, create social/scientific value generally and for paediatric populations in particular, specifically foster the flourishing of paediatric populations and can significantly improve paediatric trial efficiency when properly designed and implemented. However, because PADs are relatively new and their regulatory, ethical and logistical characteristics are yet to be clarified in some jurisdictions, the cooperation of various public and private stakeholders is required to ensure that the interests of children, their caregivers and parents/guardians are best served while exposing paediatric research subjects to the most minimal of risks when they are enrolled in paediatric trials that use ADs. Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable. (shrink)

This article deals with the relationship between the thought of Michel Foucault and that of Axel Honneth, arguing in favour of the former against the latter. I begin by considering Honneth’s early engagement in The Critique of Power with Foucault’s thought. I rebut Honneth’s criticisms of Foucault here as a misreading, one which prevents Honneth from coming to grips with Foucault’s position and hence the challenge that it poses to Honneth’s project. I then move on to offer a Foucauldian critique (...) of Honneth’s own position, arguing for a Foucauldian alternative to Critical Theory. (shrink)

ExcerptIn 2021, in the pages of this journal, I contended that a coalition of interests in the United States had coalesced in opposition to the presidency of Donald Trump and duly taken power through the vehicle of Joe Biden.1 This coalition includes the Democratic Party, corporate elites, the media, academia, and—the subject of the present article—the national security (natsec) state. In that earlier piece, I focused on particular components of this coalition: legacy and social media. I went on in a (...) subsequent Telos piece to examine another of its elements: the academy.2 These fractions all appear, however, to be relatively minor players. While I argue that the legacy media have staged a counterrevolution to seize back control of the public sphere, this exhausts their parochial, pecuniary agenda; beyond this, they are simply part of a wider activist liberal cause. Contemporary liberal activism is in turn ideologically rooted in ideas propagated by sectors of the academy and hegemonic within it, but this has not, on my analysis, empowered the academy so much as the forces that make it increasingly redundant. (shrink)

IntroductionAs we near the semicentennial of the 1976 publication of the first volume of Foucault’s History of Sexuality, for all its influence in the interim, this work remains today extraordinarily challenging in relation to our sexual mores. In this article, I will attempt to reapply its insights to analyze contemporary trends in sexuality and gender. Questions that I will consider include the continuing applicability of Foucault’s analyses, to what extent and how they may need to be revised in light of (...) historical developments, and what reading Foucault can tell us about our contemporary conjuncture. I will argue that volume 1 of The History of Sexuality remains highly relevant in this regard, although I will also indicate some ways in which things have moved on since Foucault’s time, and thus in which his thesis might be modified. Despite Foucault having apparently been extremely influential on academic thinking about sex, we seem nonetheless to have become or remained “other Victorians,” perversely mimicking the nineteenth-century sexology that Foucault pilloried. I will argue that we have continued to believe exactly the great myths about sex that Foucault sought to dispense with: namely, that sexuality has primarily been shaped by historic “repression,” that sexuality needs to be “liberated” from this repression, and that there is a “truth of sex” that is on the side of freedom. These beliefs have all mutated, however, to the extent that questions of sex (like many other social questions) are increasingly oriented around individual identities and the supposed sovereignty of the individual to determine their own truth. (shrink)

In this response, while agreeing with Balibar’s substantive positive position, I take issue with the way he situates it. Specifically, he casts it as a via negativa in relation to all previously existing thought. I suggest that it would be more accurate to say he is positioning the notion of the transindividual as a via media between two alleged extremes, individualism and organicism. I argue that the idea that there is an opposite and equal error to individualism is mistaken, and (...) that in actuality Balibar’s concept of the transindividual is not a radical departure from a long history of anti-individualism. (shrink)

In this article, I review recent findings in cognitive neuroscience in learning, particularly in the learning of mathematics and of reading. I argue that while cognitive neuroscience is in its infancy as a field, theories of learning will need to incorporate and account for this growing body of empirical data.