The increasing use of cluster randomised trials in low-resource settings raises unique ethical issues. The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomised Trials is the first international ethical guidance document specific to cluster trials, but it is unknown if it adequately addresses issues in low-resource settings. In this paper, we seek to identify any gaps in the Ottawa Statement relevant to cluster trials conducted in low-resource settings. Our method is to analyse a prototypical cluster trial conducted (...) in a low-resource setting with the Ottawa Statement; to identify ethical issues in the design or conduct of the trial not captured adequately and to make recommendations for issues needing attention in forthcoming revisions to the Ottawa Statement. Our analysis identified six ethical aspects of cluster randomised trials in low-resource settings that require further guidance. The forthcoming revision of the Ottawa Statement should provide additional guidance on these issues: streamlining research ethics committee review for collaborating investigators who are affiliated with other institutions; the classification of lay health workers who deliver study interventions as health providers or research participants; the dilemma experienced by investigators when national standards seem to prohibit waivers of consent; the timing of gatekeeper engagement, particularly when researchers face funding constraints; providing ancillary care in health services or implementation trials when a routine care control arm is known to fall below national standards and defining vulnerable participants needing protection in low-resource settings. (shrink)

Martin E. Rosenberg -/- The Gift of Silence: Towards an Anthropology of Jazz Improvisation as Neuro-Resistance. -/- ABSTRACT: -/- This essay addresses how the complex processes that occur during jazz improvisation enact behaviors that resemble the logic of gift exchange first described by Marcel Mauss. It is possible to bring to bear structural, sociological, political economical, deconstructive or even ethical approaches to what constitutes gift exchange during the performance of jazz. Yet, I would like to shift from focusing this (...) analysis of jazz improvisation with reference to the language of music as symbolic action (which all of these approaches require), to grounding improvisation in embodied and distributed cognition, the performance of which begins with a ritual gift of silence. By silence, I refer to the embodied, yet shared pure duration as felt synchrony within an individual performer, that extends to the members of an ensemble. Thus, I refer to both aesthetic and micro-political implications of embodied, yet also distributed musical cognition in real time. -/- For jazz musicians, embodied silence becomes the initial condition for processes of cognitive bifurcation. For it is bifurcation that attracts us to jazz in the first place. Here I expand my previous work establishing similarities in the behavior of bifurcating systems in physical and cognitive sciences to the unfolding of ambiguity in real time during improvisation with respect to polyphony, polytonality and polyrhythms in the history of jazz from Charlie Parker to Ornette Coleman. We can therefore re-conceptualize jazz improvisation as a subversive antidote for processes of determination identified in a sub-discipline of cultural studies called “cognitive capitalism.” By examining silence from this anthropological perspective, we can conceive of jazz performance as a ritualized resistance to top-down cognitive control immanent with social and digital networks. The ritual enactment that is jazz improvisation points towards an aesthetics of bifurcation that is simultaneously a micro-politics of neuro-resistance. In other words, I argue that freedom of thought requires freedom from thought as an initial condition. -/- Yet, I emphasize the empirical rather than mystical grounds to this gift of silence. The valorization of silence by jazz musicians is not simply etiquette, an ethics of reciprocity for performers exchanging “riffs,” but an initial condition that jazz performers (and, I would argue, listeners) experience in their bodies, thus linking embodied cognition to a collective field of cultural production that emerges from each embodied individual, and yet also pervades the ensemble in ways reminiscent of feedback loops in complex systems. The recent and remarkable research on music and the brain has demonstrated that it is now possible to describe jazz improvisation as possessing both embodied and distributed cognitive properties. The emergent neuronal ensemble behavior within the individual that is visible in jazz improvisors, discovered by the neuroscientists at Johns Hopkins led by Charles Limb, bears striking resemblance to the interactive behaviors of the jazz ensemble itself. Thus, it is by recourse to recent research by myself and others into the cognitive neuroscience of music generally, and jazz improvisation specifically, that the empirical grounds for an anthropology of neuro-resistance become visible. (shrink)

Uses interviews with one hundred twenty-five leading male executives to determine how companies can be managed both profitably and ethically.

Charles Rosenberg’s latest book is a collection of ten essays spanning twelve years’ work on the history of American medicine, and seeks to provide both the historian and the practicing physician with an understanding of the framework that lies beneath our modern medical system. He states his cause explicitly in the opening chapter: “Insofar as I have a personal agenda, it is a desire to underline the need...for physicians to think and act on an understanding of [their] unique (...) social and moral identity. It means thinking critically about...the world that informs and constrains clinical choices” (p. 11). (shrink)

Larmore aims to recover three forms of moral complexity that have often been neglected by moral and political philosophers. First, he argues that virtue is not simply the conscientious adherence to principle. Rather, the exercise of virtue apply. He argues - and this is the second pattern of complexity - that recognizing the value of constitutive ties with shared forms of life does not undermine the liberal ideal of political neutrality toward differing ideals of the good life. Finally Larmore agrues (...) for what he calls the heterogeneity of morality. Moral thinking need not be exclusively deontological or consequentialist, and we should recognize that the ultimate sources of moral value are diverse. The arguments presented here do not attack the possibility of moral theory. But in addressing some of the central issues of moral and political thinking today thay attempt to restore to that thinking greater flexibility and a necessary sensitivity to our common experience. (shrink)

A new understanding of political philosophy from one of its leading thinkers What is political philosophy? What are its fundamental problems? And how should it be distinguished from moral philosophy? In this book, Charles Larmore redefines the distinctive aims of political philosophy, reformulating in this light the basis of a liberal understanding of politics. Because political life is characterized by deep and enduring conflict between rival interests and differing moral ideals, the core problems of political philosophy are the regulation (...) of conflict and the conditions under which the members of society may thus be made subject to political authority. We cannot assume that reason will lead to unanimity about these matters because individuals hold different moral convictions. Larmore therefore analyzes the concept of reasonable disagreement and investigates the ways we can adjudicate conflicts among people who reasonably disagree about the nature of the human good and the proper basis of political society. Challenging both the classical liberalism of Locke, Kant, and Mill, and more recent theories of political realism proposed by Bernard Williams and others, Larmore argues for a version of political liberalism that is centered on political legitimacy rather than on social justice, and that aims to be well suited to our times rather than universally valid. Forceful and thorough yet concise, What Is Political Philosophy? proposes a new definition of political philosophy and demonstrates the profound implications of that definition. The result is a compelling and distinctive intervention from a major political philosopher. (shrink)

The essays collected in this volume all explore the problem of the relation between moral philosophy and modernity. Charles Larmore addresses this problem by attempting to define the way distinctive forms of modern experience should orientate our moral thinking. Charles Larmore wonders whether the dominant forms of modern philosophy have not become blind to important dimensions of the moral life. The book argues against recent attempts to return to the virtue-centered perspective of ancient Greek ethics. As well as (...) exploring the differences between ancient and modern ethics, the author examines such topics as the roles of reason and history in our moral understanding, the inadequacy of philsophical naturalism, and the foundations of modern liberalism. There are also extended discussions of a number of leading contemporary philosophers: Rawls, Habermas, Williams and Rorty. (shrink)

An examination of split-brain syndrome, and whether split-brain patients have two minds.

This paper explores the notions of hope and how individual patient autonomy can trump carefully reasoned ethical concerns and policies intended to regulate stem cell transplants. We argue that the same limits of knowledge that inform arguments to restrain and regulate unproven treatments might also undermine our ability to comprehensively dismiss or condemn them. Incautiously or indiscriminately reasoned policies and attitudes may drive critical information and data underground, impel patients away from working with clinical researchers, and tread needlessly on hope, (...) the essential motivator of patients, advocates and researchers alike. We offer recommendations to clinicians and health care providers to help balance the discourse with individuals seeking treatment while guarding against fraud, misconception, and patient harm. (shrink)

During the past few decades, engineering ethics has been oriented towards protecting the public from professional misconduct by engineers and from the harmful effects of technology. This “preventive ethics” project has been accomplished primarily by means of the promulgation of negative rules. However, some aspects of engineering professionalism, such as (1) sensitivity to risk (2) awareness of the social context of technology, (3) respect for nature, and (4) commitment to the public good, cannot be adequately accounted for in terms of (...) rules, certainly not negative rules. Virtue ethics is a more appropriate vehicle for expressing these aspects of engineering professionalism. Some of the unique features of virtue ethics are the greater place it gives for discretion and judgment and also for inner motivation and commitment. Four of the many professional virtues that are important for engineers correspond to the four aspects of engineering professionalism listed above. Finally, the importance of the humanities and social sciences in promoting these virtues suggests that these disciplines are crucial in the professional education of engineers. (shrink)

In this book, Charles Larmore develops an account of morality, freedom, and reason that rejects the naturalistic metaphysics shaping much of modern thought. Reason, Larmore argues, is responsiveness to reasons, and reasons themselves are essentially normative in character, consisting in the way that physical and psychological facts - facts about the world of nature - count in favor of possibilities of thought and action that we can take up. Moral judgments are true or false in virtue of the moral (...) reasons there are. We need therefore a more comprehensive metaphysics that recognizes a normative dimension to reality as well. Though taking its point of departure in the analysis of moral judgment, this book branches widely into related topics such as freedom and the causal order of the world, textual interpretation, the nature of the self, self-knowledge, and the concept of duties to ourselves. (shrink)

"... stimulating and insightful... a thoroughly researched and timely contribution to the secondary literature of ethics... " —Library Journal "His important new work establishes Scott... as one of the foremost interpreters of the Continental philosophical tradition of the US.... Necessary for anyone working in ethics or the Continental tradition." —Choice "... a provocative discourse on the consequences of the ethical in the thought of Nietzsche, Foucault, and Heidegger." —The Journal of Religion Charles E. Scott's challenging book advances the broad (...) claim that ethics as a way of judging and thinking has come into question as philosophers have confronted suffering and conflicts that arise from our traditional systems of value. (shrink)

This essay begins by providing a new account of wittgenstein's private language argument. Wittgenstein's rejection of a "cartesian" account of mind is examined, And it is argued that this rejection carries no commitment to behaviorism, Or to the view that sensation terms have public meanings and private references. Part ii of the essay attempts to forge a link between the two parts of the "philosophical investigations", By arguing that wittgenstein's discussion of "seeing-As" reinforces and illuminates his account of how sensation (...) language is mastered. (shrink)

Sartre as guide -- Bad faith and sincerity -- The example of Stendhal -- Reflection and being like another -- Being natural -- The ubiquity of convention -- Being like another -- Authenticity and the democratic age -- Mimetism and equality -- Being oneself amid conventions -- Authenticity and the nature of the self -- Foundations of a theory of cognitive reflection -- Psychological interpretation -- The structure of cognitive self-reflection -- The self in cognitive reflection -- Representing and reasoning (...) -- A critique of autonomy -- Obligations and avowals -- A defense of first-person authority -- The persistence of the cartesian model -- The key to the mystery -- A final problem -- Ways of being oneself -- The domain of authenticity -- The instability of practical reflection -- Authenticity and conversion -- How to be virtuous -- The ends of reflection -- Reflection and its problems -- The self and time -- The importance of unexpected goods -- Socrates' mistake -- The limits of prudence -- Wisdom. (shrink)

Having a deaf student in class can pose a tremendous challenge for both the professor and the student, but it can also be an incredibly rewarding experience. To help make it so, this article briefly covers the differences between American Sign Language and English and then identifies aspects of linguistic skills where the deaf student may encounter difficulty in dealing with Philosophy. Those discussed are inadequate vocabulary, problems in reading and writing, insufficient background or “life” information, and difficulty in dealing (...) with abstractions. Since English will most likely be a second language for deaf students, there is also a brief discussion of similarities and differences between them and ESL students. An appendix to the article presents a collection of techniques that I developed to accommodate the needs of a profoundly deaf student who took an introductory Philosophy and an upper level Religion course with me. Among them are suggestions for lectures, class discussions, testing, written assignments, student-teacher conferences, and audio-visual materials. Finally, there are some useful on-line resources together with some tips for working with interpreters. (shrink)

One of the major intellectual figures of the twentieth century, Paul Ricoeur has influenced a generation of thinkers.