I am an academically trained philosopher who has taught and written about medical ethics for three decades, who has done extra-mural ethics consultation in clinical and other settings for two decades, and who has served as an expert ethics witness in the courts for more than ten years. Trained as a traditional academic, none of these three pursuits have come easily. Like most philosophers, my education did not prepare me for such responsibilities. Indeed, regardless of a bioethicist's initial background - (...) i.e., health care, law, theology or philosophy - it is invariably necessary to build upon foundational knowledges and abilities in gearing up for work as a health care ethics consultant.Edward J. Imwinkelreid has prepared a remarkable overview of the work of the expert ethics witness from the point of view of the law of evidence. My perspective as a philosopher, an ethicist, and an expert witness, stands in contrast with his. (shrink)

I am an academically trained philosopher who has taught and written about medical ethics for three decades, who has done extra-mural ethics consultation in clinical and other settings for two decades, and who has served as an expert ethics witness in the courts for more than ten years. Trained as a traditional academic, none of these three pursuits have come easily. Like most philosophers, my education did not prepare me for such responsibilities. Indeed, regardless of a bioethicist's initial background - (...) i.e., health care, law, theology or philosophy - it is invariably necessary to build upon foundational knowledges and abilities in gearing up for work as a health care ethics consultant.Edward J. Imwinkelreid has prepared a remarkable overview of the work of the expert ethics witness from the point of view of the law of evidence. My perspective as a philosopher, an ethicist, and an expert witness, stands in contrast with his. (shrink)

Introduction: Vulnerability is a poorly understood concept in research ethics, often aligned to autonomy and consent. A recent addition to the literature represents a taxonomy of vulnerability developed by Kipnis, but this refers to the conduct of clinical trials rather than qualitative research, which may raise different issues. Aim: To examine issues of vulnerability in cancer and palliative care research obtained through qualitative interviews. Method: Secondary analysis of qualitative data from 26 black Caribbean and 19 white British patients with (...) advanced cancer. Results: Four domains of vulnerability derived from Kipnis’s taxonomy were identified and included: (i) communicative vulnerability, represented by participants impaired in their ability to communicate because of distressing symptoms; (ii) institutional vulnerability, which referred to participants who existed under the authority of others—for example, in hospital; (iii) deferential vulnerability, which included participants who were subject to the informal authority or the independent interests of others; (iv) medical vulnerability, which referred to participants with distressing medical conditions; and (v) social vulnerability, which included participants considered to belong to an undervalued social group. Participants from both ethnic groups populated all these domains, but those who were black Caribbean were more present among the socially vulnerable. Conclusions: Current classifications of vulnerability require reinterpretation when applied to qualitative research at the end of life. We recommend that researchers and research ethics committees reconceptualise vulnerability using the domains identified in this study and consider the research context and interviewers’ skills. (shrink)

Both living donor transplantation and human subjects research expose one set of individuals to clinical risks for the clinical benefits of others. In the Belmont Report, the National Commission for the Protection of Human Subjects of Biomedical and Behavior Research articulated three principles to serve as the basis for a research ethics framework: respect for persons, beneficence and justice. In contrast, living donor transplantation lacks a framework. In this manuscript, we adapt the three principles articulated in the Belmont Report to (...) serve as the foundation for an ethics framework for living donor transplantation which we supplement with the principles of vulnerability and responsibility. The National Commission supported additional protections for vulnerable groups of potential research participants. In 2001, Kenneth Kipnis effectively argued that the concept of vulnerable groups failed to explore in what ways particular groups of people were vulnerable, thereby risking unnecessary protections for some and inadequate protections for others. He proposed a taxonomy that explored different types of vulnerabilities that all research participants may experience to provide a more robust framework for human subjects protections, which we adapt to living donors. Robert Goodin claims that health professionals, who stand in special relationship with patients, are responsible for promoting and protecting their well-being. In living donor transplantation, the donor transplant team is responsible for empowering prospective donors to address their vulnerabilities and/or for protecting those who cannot by disqualifying them from donation. (shrink)

Reductive intellectualists hold that knowledge-how is a kind of knowledge-that. For this thesis to hold water, it is obviously important that knowledge-how and knowledge-that have the same epistemic properties. In particular, knowledge-how ought to be compatible with epistemic luck to the same extent as knowledge-that. It is argued, contra reductive intellectualism, that knowledge-how is compatible with a species of epistemic luck which is not compatible with knowledge-that, and thus it is claimed that knowledge-how and knowledge-that come apart.

Aristotle is widely regarded as the greatest of all philosophers; indeed, he is traditionally referred to simply as `the philosopher'. Today, after more than two millennia, his arguments and ideas continue to stimulate philosophers and provoke them to controversy. In this book J.L. Ackrill conveys the force and excitement of Aristotle's philosophical investigations, thereby showing why contemporary philosophers still draw from him and return to him. He quotes extensively from Aristotle's works in his own notably clear English translation, and a (...) picture emerges of a lucid, lively, subtle and tough-minded thinker of astonishing range and penetration. Professor Ackrill identifies many striking connections between Aristotle's ideas and ideas in recent philosophy; he also raises philosophical questions of his own, and exemplifies the way in which Aristotle can still be argued with and learned from. (shrink)

It is broadly held that confidentiality may be breached when doing so can avert grave harm to a third party. This essay challenges the conventional wisdom. Neither legal duties, personal morality nor personal values are sufficient to ground professional obligations. A methodology is developed drawing on core professional values, the nature of professions, and the justification for distinct professional obligations. Though doctors have a professional obligation to prevent public peril, they do not honor it by breaching confidentiality. It is shown (...) how the protective purpose to be furthered by reporting is defeated by the practice of reporting. Hence there is no conflict between confidentiality and the professional responsibility to protect endangered third parties. (shrink)

Most recent thinking about thevulnerability of research subjects uses a``subpopulation'' focus. So conceived, theproblem is to work out special standards forprisoners, pregnant women, the mentally ill,children, and similar groups. In contrast, an``analytical'' approach would identifycharacteristics that are criteria forvulnerability. Using these criteria, one couldsupport a judgment that certain individuals arevulnerable and identify needed accommodationsif they are to serve as research subjects.Seven such characteristics can be evident inchildren: they commonly lack the capacity tomake mature decisions; they are subject to theauthority of (...) others; they (and their parents)may be deferential in ways that can maskunderlying dissent; their rights and interestsmay be socially undervalued; they may haveacute medical conditions requiring immediatedecisions not consistent with informed consent;they may have serious medical conditions thatcannot be effectively treated; and they (andtheir parents) may lack important sociallydistributed goods. Each of thesevulnerabilities can call for special care inthe design and implementation of researchprotocols. (shrink)

The paper describes the author's experience in using the history of science in teaching physics to science teachers. lt was found that history becomes more useful to teachers when explicitly combined with 'investigative' experimentation, which, in turn. can benefit from various uses of the history of science.

A historical investigation of the exclusion of Africa and Asia from modern histories of philosophy.

This comprehensive and important volume includes contributions by activists, journalists, lawyers and scholars from twenty-one countries. The essays map the directions the movement for women's rights is taking--and will take in the coming decades--and the concomittant transformation of prevailing notions of rights and issues. They address topics such as the rapes in former Yugoslavia and efforts to see that a War Crimes Tribunal responds; domestic violence; trafficking of women into the sex trade; the persecution of lesbians; female genital mutilation; and (...) reproductive rights. (shrink)

At the time of this writing, a widely publicized, waived-consent trial is underway. Sponsored by Northfield Laboratories, Inc. (Evanston, IL) the trial is intended to evaluate the emergency use of PolyHeme®, an oxygen-carrying resuscitative fluid that might prevent deaths from uncontrolled bleeding. The protocol allows patients in hemorrhagic shock to be randomized between PolyHeme® and saline in the field and, still without consent, randomized between PolyHeme® and blood after arrival at an emergency department. The Federal regulations that govern the waiver (...) of consent restrict its applicability to circumstances where proven, satisfactory treatments are unavailable. Blood - the standard treatment for hemorrhagic shock - is not available in ambulances but is available in hospitals. The authors argue that the in-hospital stage of the study fails to meet ethical and regulatory standards. (shrink)

The aim of this essay is to describe and reflect upon the concrete particulars of one academician's work as an expert ethics witness. The commentary on my practices and the narrative descriptions of three cases are offered as evidence for the thesis that it is possible to act honorably within a role that some have considered to be inherently illicit. Practical measures are described for avoiding some of the best known pitfalls. The discussion concludes with a listing of the distinctive (...) competencies and understandings that are useful in serving as an expert ethics witness. (shrink)

Galvani's discovery provoked an animated debate that lasted for about a decade. So far, historians have studied only the controversy between Volta and Galvani. I show that a more extensive examination of the response to Galvani's treatise reveals a number of important issues that were characteristic of the contemporary physics and physiology but have not much attracted the attention of historians. In particular, the analysis shows the need to reappraise Galvani's role in establishing animal electricity.

A medical device manufacturer pays a surgeon to demonstrate a novel medical instrument in a live broadcast to an audience of specialists in another city. The surgical patient is unaware of the broadcast and unaware of the doctor's relationship with the manufacturer. It turns out that the patient required a different surgical approach to her condition—one that would not have allowed a demonstration of the instrument—and she later dies. The paper is an exploration of whether the manufacturer shares, along with (...) the doctor, responsibility for the death of the patient. Three arguments for corporate responsibility are considered; two are criticized and the third is offered as sound. (shrink)

Presents general information about meteorology, weather, and climate and includes more than thirty activities to help study these topics, including making a ...

This paper discusses a way of introducing a scientific controversy, which emphasizes objective aspects of such issues as multiple theoretical interpretation of phenomena, choosing a theory, insistence on the chosen theory, and others. The goal is to give students a better insight into the workings of science and provide guidelines for building theories in their own research.

This paper argues that for the purposes of any sort of serious discussion about immoral conduct in sport very little is illuminated by claiming that the conduct in question is cheating. In fact, describing some behavior as cheating is typically little more than expressing strong, but thoroughly vague and imprecise, moral disapproval or condemnation of another person or institution about a wide and ill-defined range of improper advantage-seeking behavior. Such expressions of disapproval fail to distinguish cheating from many other types (...) of immoral conduct. The discussion shows that we should set the concept aside and assess the moral disapproval implied by claims of cheating by reference to the moral and other principles that underlie the practice of sport. This allows us to consider carefully the complexity of the issues that are raised when allegations of cheating are made and not be distracted by the emotionally loaded, conversation-stopping tendency of the concept. This means that some types of disputes in sport will be messy and demand more effort to resolve, but the payoff will be better informed and more thoughtful discussions and greater awareness of the moral complexity of sport and of its principled underpinnings. (shrink)

The prelims comprise: Background: The Concept of Information Management Clearing the Ground: What Professional Obligations are Not The Concept of a Professional Obligation The Duty to Diminish Risks to Third Parties A Defense of Unqualified Confidentiality Final Thoughts Notes.

There is a broadly held view that neonatologists are ethically obligated to act to override parental nontreatment decisions for imperiled premature newborns when there is a reasonable chance of a good outcome. It is argued here that three types of uncertainty undercut any such general obligation: (1) the vagueness of the boundary at which an infant’s deficits become so intolerable that death could be reasonably preferred; (2) the uncertainty about whether aggressive treatment will result in the survival of a reasonably (...) healthy child or, alternatively, the survival of a child with intolerable deficits; and (3) the inability to determine an acceptable ratio between the likelihoods of those two outcomes. It is argued that the broadly held view accords insufficient weight to the fact that newborn intensive care increases the likelihood of harm to the child by effecting survival with intolerable deficits. Though treatment may offer a reasonable chance of a good outcome, it is argued that there are situations in which neonatologists should nonetheless defer to parental nontreatment decisions. (shrink)

Discussing theories at length, including their origin, development, and replacement by other theories, can help students in understanding of both objective and subjective aspects of the scientific process. Presenting theories in the form of- models helps in this undertaking, and the history of science provides a number of suitable models. The paper describes specific examples that have been used in in-service courses for science teachers.

Isaac Newton wrote the manuscript Questiones quaedam philosophicae at the very beginning of his scientific career. This small notebook thus affords rare insight into the beginnings of Newton's thought and the foundations of his subsequent intellectual development. The Questiones contains a series of entries in Newton's hand that range over many topics in science, philosophy, psychology, theology, and the foundations of mathematics. These notes, written in English, provide a very detailed picture of Newton's early interests, and record his critical appraisal (...) of contemporary issues in natural philosophy. Written predominantly in 1664-5, they give a significant perspective on Newton's thought just prior to his annus mirabilis, 1666. This volume provides a complete transcription of the Questiones, together with an 'expansion' into modern English, and a full editorial commentary on the content and significance of the notebook in the development of Newton's thought. It will be essential reading for all those interested in Newton and the intellectual foundations of science. (shrink)

The New Orleans catastrophe and the subsequent allegation of homicides at Memorial Medical Center have complicated our thinking about end-of-life care. Can the conditions in a collapsed health care system ever excuse euthanasia? Following a review of current legal and ethical standards for the causation of death in the clinical setting, and an assessment of the most common argument for euthanasia — the argument from intractable suffering — a different argument is set out for the excusability of euthanasia, one based (...) on forced abandonment. While more familiar in battlefield medicine, this line of reasoning may have applied in post-Katrina New Orleans. When health care professionals are compelled to leave a hazardous clinical setting, and where it is impossible to evacuate patients who are not expected to survive, clinicians must choose between abandoning these patients to die unattended and unmedicated, or euthanizing them before leaving themselves. Because each of these options stands as an egregious violation of an important health care norm, and because there is no third option, neither violation can be rightly condemned. (shrink)