As clinical trials end, little is understood about how participants exiting from clinical trials approach decisions related to the removal or post-trial use of investigational brain implants, such as deep brain stimulation (DBS) devices. This empirical bioethics study examines how research participants experience the process of exit from research at the end of clinical trials of implanted neural devices. Using a modified grounded theory study design, we conducted semi-structured, in-depth interviews with 16 former research participants from clinical trials of DBS (...) and responsive neurostimulation (RNS). Open-ended questions elicited motivations for joining the trial, understanding of study procedures at the time of initial informed consent, the process of exiting from research, and decisions about device removal or post-trial device use. Thematic analysis identified categories related to: limited preparedness for the end of research participation, straightforwardness of decisions to explant or keep the device, reconciling with the end of research participation, reconciling post-trial expectations, and achieving a sense of closure after exit from research. A preliminary theoretical model describes contextual factors influencing the process and experience of exit from research. Experiences of clinical trial participants should guide research practices to enhance the ethical design and conduct of clinical trials in DBS and other brain devices. (shrink)

On Advaita philosophy; Sanskrit text with commentary and translation.

The ethical recruitment of participants with neurological disorders in clinical research requires obtaining initial and ongoing informed consent. The purpose of this study is to characterize barriers faced by research personnel in obtaining informed consent from research participants with neurological disorders and to identify strategies applied by researchers to overcome those barriers. This study was designed as a web-based survey of US researchers with an optional follow-up interview. A subset of participants who completed the survey were selected using a stratified (...) purposeful sampling strategy and invited to participate in an in-depth qualitative interview by phone or video conference. Data were analyzed using a mixed methods approach, including content analysis of survey responses and thematic analysis of interview responses. Over 1 year, 113 survey responses were received from US research personnel directly involved in obtaining informed consent from participants in neurological research. Frequently identified barriers to informed consent included: cognitive and communication impairments (e.g. aphasia), unrealistic expectations of research participants, mistrust of medical research, time constraints, literacy barriers, lack of available social support, and practical or resource-related constraints. Strategies to enhance informed consent included: involving close others to support participant understanding of study-related information, collaborating with more experienced research personnel to facilitate training in obtaining informed consent, encouraging participants to review consent forms in advance of consent discussions, and using printed materials and visual references. Beyond conveying study-related information, researchers included in this study endorsed ethical responsibilities to support deliberation necessary to informed consent in the context of misconceptions about research, unrealistic expectations, limited understanding, mistrust, and/or pressure from close others. Findings highlight the importance of training researchers involved in obtaining informed consent in neurological research to address disease-specific challenges and to support the decision-making processes of potential research participants and their close others. (shrink)

While the phenomenon of ‘moral distress’ has been of interest to the nursing community since Jameton first described it in 1984, moral distress is now understood to effect healthcare professionals...

In recent years, the phenomenon of moral distress has been critically examined—and for a good reason. There have been a number of different definitions suggested, some that claimed to be consistent with the original definition but in fact referred to different epistemological states. In this paper, we re‐examine moral distress by exploring its relationship with moral agency. We critically examine three conceptions of moral agency and argue that two of these conceptions risk placing nurses' values at the center of moral (...) action when it ought to be the patient's values that shape nurses' obligations. We propose that the conception of moral agency advanced by Aimee Milliken which re‐centers patient values, should be more broadly accepted within nursing. We utilize a case example to demonstrate a situation in which the values of a patient's parents (surrogates) justifiably constrained nurses' moral agency, creating moral distress. Through an examination of constraints on nurse agency in this case, we illustrate the problematic nature of ‘narrow' moral distress and the value of re‐considering moral distress. Finally, we provide an action‐oriented proposal identifying mediating steps that we argue have utility for nurses (and other healthcare professionals) to mediate between experiences of narrow moral distress and the exercise of moral agency. (shrink)

While Jameton’s (1984) definition of moral distress has been embraced by researchers and scholars for recognizing the many constraints that nurses experience on their moral agency, it has also been...

Herrera-Ferrá et al.’s (2023) attention to the cultural context of the neurorights movement contributes to the growing conversation on establishing neurorights in response to advancements in neuros...

Moral distress is a pervasive phenomenon in healthcare for which there is no straightforward “solution.” Rhetoric surrounding moral distress has shifted over time, with some scholars arguing that moral distress needs to be remedied, resolved, and eradicated, while others recognize that moral distress can have some positive value. The authors of this paper recognize that moral distress has value in its function as a warning sign, signaling the presence of an ethical issue related to patient care that requires deeper exploration, (...) rather than evidencing identification of the “right” course of action. Once the experience of moral distress is identified, steps ought to be taken to clarify the moral issue, and, if possible and reasonable, the patient’s values ought to be prioritized. This paper offers concrete actions steps, drawn from theory, which can be used in clinical practice to provide peer support or to facilitate self-reflection for morally distressed individuals. This approach empowers morally distressed individuals to explore ethical issues, identify concrete steps that can be taken, and mitigate feelings of powerlessness that are often associated with moral-constraint distress. The questions guide individuals and peers to reflect first on the micro-space and then more broadly on the institutional culture, facilitating meso- and macro-reflection and action. (shrink)

Supported decision making, as outlined by Peterson et al. highlights real-world challenges in the messy context of clinical care. We agree with Peterson et al. that patients...

Complex clinical ethics cases require a blend of compassion, sensitivity, and tenacity in order to navigate the hard work required of stakeholders. Each person comes to the table with rich historie...

Russell articulates compelling reasons that bioethicists and health care professionals should take individual responsibility for deconstructing structural injustices in healthcare through in...

Layers of complexity arise when a person arrives in an Intensive Care Unit (ICU) due to self-harm intended to end their life and when there is known past personal trauma. We highlight three importa...

Sankary et al. (2022) report the results of an empirical study on research participant experiences of exiting research at the end of clinical trials of deep-brain-stimulation (DBS) and responsive n...

In their article, Sankary et al. (2022) provided important preliminary findings on how research participants exiting from clinical trials engage in decisions related to the removal or post-trial us...

Reason and Value collects 15 new papers by leading contemporary philosophers on themes from the work of Joseph Raz. Raz has made major contributions in a wide range of areas, including jurisprudence, political philosophy, and the theory of practical reason; but all of his work displays a deep engagement with central themes in moral philosophy. The subtlety and power of Raz's reflections on ethical topics make his writings a fertile source for anyone working in this area. Especially significant are his (...) explorations of the connections between practical reason and the theory of value, which constitute a sustained and penetrating treatment of a set of issues at the very center of moral philosophy as it is practiced today. The contributors to the volume acknowledge the importance of Raz's contributions by engaging critically with his positions and offering independent perspectives on the topics that he has addressed. The volume aims both to honour Raz's accomplishments in the area of ethical theorizing, and to contribute to an enhanced appreciation of the significance of his work for the subject. (shrink)

The Essay In This Book Deal With Such Topics As Silence As A Constituent Of Language, Justification Of Kant`S Antological Principles, Hegel`S Concept Of Reason, Total Man And The Role Of Revolution, A Meta-Physical Analysis Of Freedom, Dimensions Of Self-Expression, Love As A Form Of Authentic Expression, Radical Education In Institutionalized Surroundings Etc. In Honour Of S.N. Ganguly.

The Nature of God explores a perennial problem in the philosophy of religion.

Despite All Critique (2014) -- World Politics and Western Reason (1980) -- The Doubled Outsides of the Modern International (2005) -- The Subject of Security (1995) -- The Protection of Nature and the Nature of Protection (2005) -- Social Movements/World Politics (1994) -- Europe is Not Where It is Supposed to Be (2000) -- They Seek it Here, They Seek it There : Looking for Politics in Clayoquot Sound (2003) -- Violence, Modernity, Silence : From Weber to International Relations (1993) (...) -- Hobbes, Origins, Limits (2011) -- War, Terror, Judgement (2002) -- International, Imperial, Exceptional (2005) -- Which Democracy for Which Demos? (2013) -- The Political Theory of Boundaries and the Boundaries of Political Theory : Interview With Raia Prokhovnik (2012). (shrink)

How do we access the authentic self in order to live fulfilling, meaningful lives? In straightforward terms, The Heart of the Matter: Gifts in Strange Wrapping Paper explains a simple but extraordinarily powerful technique called the See, Feel, Hear Challenge that enables people to easily gain entry into the storehouse of their subconscious core beliefs. In the process, it cracks the coded messages that those beliefs release in the form of disease, suffering, addictions, unhappy relationships, and victimized circumstances. Based in (...) the latest findings in neuroscience and neurocardiology, this book guides readers to an uncomplicated understanding of the astounding power of our emotions and how life automatically delivers experiences that trigger negative reactions that subconsciously impact us. These emotions form the foundation of core beliefs that create unhealthy attitudes and dis-ease patterns that keep us from experiencing the authentic, satisfying lives we desire. Using clear examples and true stories from clients, Dr. Weissman’s latest work demonstrates how we can release these stored emotions and their wisdom via the See, Feel, Hear Challenge. It then explains how to use this simple method to evoke feelings that positively impact the quantum field, remolding our bodies, minds, and everyday lives into purposeful expressions of inner joy and radiant well-being. Whether you’re dealing with addictions, dysfunctional relationships, or illness, or are focused on becoming an Olympic champion, The Heart of the Matter gives you a potent tool for positive change and transformation that you can use for the rest of your life. (shrink)

Elliot R. Wolfson intervenes in the debate over Martin Heidegger and Nazism from a unique perspective, as a scholar of Jewish mysticism and philosophy who has been profoundly influenced by Heidegger's work. He reveals crucial aspects of Heidegger's thinking that betray an affinity with dimensions of Jewish thought.

In this era of globalisation, different legal systems and structures no longer operate within their own jurisdictions. The effects of decisions, policies and political developments are having an increasingly wide-reaching impact. Nowhere is this more keenly felt than in the sphere of European Union law. This collection of essays contributes to the co-operative search for interpretative and normative grids needed in charting the contemporary legal landscape. Written by leading lawyers and legal philosophers, they examine the effects of law's de-nationalisation by (...) placing European law in the context of transnational law and demonstrate how it forces us to rethink our basic legal concepts and propose an approach to transnational law beyond the dichotomy of national and international law. (shrink)

This book focuses upon the perennial question of the existence and nature of an obligation to obey the law. Leading writers have, at one time or another, emphasized considerations such as gratitude, 'divine ordering, ' prudence, contract, autonomy, and utility in seeking to justify, or to deny any justification for, some sort of obligation to obey the positive law. The book provides relevant selections from a sampling of the historical approaches to legal obligation taken by writers such as Plato, Augustine, (...) Aquinas, Hobbes, Locke, Hume, Rousseau, Thoreau, Bentham, Marx and Engels, and Martin Luther King, Jr. These classical discussions are augmented by critical questions and commentary, by independent discussions of the question of legal obligation by a wide range of contemporary writers, and by relevant judicial cases discussing matters such as conscientious objection and civil disobedience. (shrink)

The concept of yinyang lies at the heart of Chinese thought and culture. The relationship between these two opposing, yet mutually dependent, forces is symbolized in the familiar black and white symbol that has become an icon in popular culture across the world. The real significance of yinyang is, however, more complex and subtle. This brilliant and comprehensive analysis by one of the leading authorities in the field captures the richness and multiplicity of the meanings and applications of yinyang, including (...) its visual presentations. Through a vast range of historical and textual sources, the book examines the scope and role of yinyang, the philosophical significance of its various layers of meanings and its relation to numerous schools and traditions within Chinese philosophy. By putting yinyang on a secure and clear philosophical footing, the book roots the concept in the original Chinese idiom, distancing it from Western assumptions, frameworks and terms, yet also seeking to connect its analysis to shared cross-cultural philosophical concerns. (shrink)

Information can be public among a group. Whether or not information is public matters, for example, for accounts of interdependent rational choice, of communication, and of joint intention. A standard analysis of public information identifies it with (some variant of) common belief. The latter notion is stipulatively defined as an infinite conjunction: for p to be commonly believed is for it to believed by all members of a group, for all members to believe that all members believe it, and so (...) forth. This analysis is often presupposed without much argument in philosophy. Theoretical entrenchment or intuitions about cases might give some traction on the question, but give little insight about why the identification holds, if it does. The strategy of this paper is to characterize a practical-normative role for information being public, and show that the only things that play that role are (variants of) common belief as stipulatively characterized. In more detail: a functional role for “taking a proposition for granted” in non-isolated decision making is characterized. I then present some minimal conditions under which such an attitude is correctly held. The key assumption links this attitude to beliefs about what is public. From minimal a priori principles, we can argue that a proposition being public among a group entails common commitment to believe among that group. Later sections explore partial converses to this result, the factivity of publicity and publicity from the perspective of outsiders to the group, and objections to the aprioricity of the result deriving from a posteriori existential presuppositions. (shrink)

This volume gathers together for the first time are all the key texts in a crucial debate in modern philosophy, centered on Leibniz's famous 1695 essay, the "New System of the Nature of Substances and their Communication," in which he introduced his strikingly original theory of metaphysics. His "system" became increasingly famous and drew him into discussion and development of these ideas, both in public and in private, with a variety of thinkers, most notably the great French philosopher Pierre Bayle. (...) Woolhouse's and Francks's new English edition gives the only full representation of this debate, and will therefore be essential reading for anyone who wishes to gain a proper understanding of Leibniz's philosophy and its intelletual context. All the texts are newly translated and extensively annotated; many appear in English for the first time. (shrink)

A defence of the idea that there are sui generis duties of love: duties, that is, that we owe to people in virtue of standing in loving relationships with them. I contrast this non-reductionist position with the widespread reductionist view that our duties to those we love all derive from more generic moral principles. The paper mounts a cumulative argument in favour of the non-reductionist position, adducing a variety of considerations that together speak strongly in favour of adopting it. The (...) concluding section connects this debate with larger issues in moral theory concerning the general idea of obligation. (shrink)

The reference of the postmodern task of thinking is Auschwitz, the abyss and discontinuity separating us from the world of our ancestors. As inhabitants of Planet Auschwitz our point of reference lacks all transcendental warrants; it is not a non-referable reference which constitutes the abyss we must enter, endure, and in which our intellectual and cultural tradition must be transformed. The private/public transformations which constitute the texts of this book attempt to depart from the dystopic individuality and public life resulting (...) from business-as-usual after Auschwitz. The three parts of the book are progressive reworkings of traditional metaphysics as adapted and modified by a modernism that refuses to grapple with its complicity. It is precisely that complicity which postmodern thinking takes up in its attempt to signify otherwise than the easy modernist translations and images of tradition. Thus it is a series of uneasy images imaging otherwise but never apart from modernity that take us away from complicity toward a transformed tradition. The uneasy images of this book are photogrammic combinations of photographs and texts, mutual supplements, pulling tradition through the Event against the persistent and murderous forces of contemporary idolatry and repression. (shrink)