Raanan Gillon is a noted defender of the four principles approach to healthcare ethics. His general position has always been that these principles are to be considered to be both universal and prima facie in nature. In recent work, however, he has made two claims that seem to present difficulties for this view. His first claim is that one of these four principles, respect for autonomy, has a special position in relation to the others: he holds that it is first (...) among equals. We argue that this claim makes little sense if the principles are to retain their prima facie nature. His second claim is that cultural variation can play an independent normative role in the construction of our moral judgments. This, he argues, enables us to occupy a middle ground between what he sees as the twin pitfalls of moral relativism and moral imperialism. We argue that there is no such middle ground, and while Gillon ultimately seems committed to relativism, it is some form of moral imperialism that will provide the only satisfactory construal of the four principles as prima facie universal moral principles. (shrink)

Recent policy in relation to clinical research proposals in the UK has distinguished between two types of review: scientific and ethical. This distinction has been formally enshrined in the recent changes to research ethics committee structure and operating procedures, introduced as the UK response to the EU Directive on clinical trials. Recent reviews and recommendations have confirmed the place of the distinction and the separate review processes. However, serious reservations can be mounted about the science/ethics distinction and the policy of (...) separate review that has been built upon it. We argue here that, first, the science/ethics distinction is incoherent, and, second, that RECs should not only be permitted to consider a study’s science, but that they have anobligation do so. (shrink)

From ancient times to the present, the discovery and presentation of new proofs of previously established theorems has been a salient feature of mathematical practice. Why? What purposes are served by such endeavors? And how do mathematicians judge whether two proofs of the same theorem are essentially different? Consideration of such questions illuminates the roles that proofs play in the validation and communication of mathematical knowledge and raises issues that have yet to be resolved by mathematical logicians. The Appendix, in (...) which several proofs of the Fundamental Theorem of Arithmetic are compared, provides a miniature case study. (shrink)

The obligations of organisations associated with policy formation and implementation of international mass public health programmes are explored. Lines of responsibility are considered to become unclear because of the large number of agencies associated with such programmes. A separation of the relevant obligations among the bodies responsible for the formulation and those responsible for the implementation of the policies is suggested. The continuing oral polio vaccine campaign against poliomyelitis in India is used to illustrate the general argument. Although the aim (...) of the programme is legitimate and laudable, unnecessary harm is currently being caused to some children as a result of elements of the policy and this should be rectified immediately. Such mass programmes should take care to ensure that people are not unnecessarily sacrificed in the drive to attain the desirable ends of the policy. (shrink)

The Report of the Ad Hoc Adivisory Group on the Operation of NHS Research Ethics Committees has resulted in a strange mixture of the timid, the revolutionary, and the bizarre.The Report of the Ad Hoc Advisory Group on the Operation of NHS Research Ethics Committees is a curious document.1 The remit of the review was focused on the workings and effectiveness of NHS research ethics committees and the multicentre committees ). The Group was primarily set up in response to a (...) series of complaints from medical researchers about the new research governance regime in the UK as a result of the Clinical Trials Directive2 and the Governance Arrangements for NHS Research Ethics Committees.3 The opportunity was also taken to consider the role of research ethics committees in a wider context, and take account of recent developments in relation to the ethics review of social care research,4 student projects,5 as well as recent legislation such as the Human Tissue Act,6 and the Mental Capacity Act.7 However, the resulting report is a strange mixture of the timid, the revolutionary, and the bizarre.A good example of the report’s timidity is its reluctance to propose fundamental change to the process of review or seriously limit the type of research that requires REC review. To its credit AHAG does suggest that some research ‘especially surveys and many studies on NHS staff, could normally be conducted safely without a requirement for REC review’ .1 This is, of course, to be welcomed. However, the report ultimately seems dismissive of the general complaint from researchers that the current process is inappropriately uniform. For example, in section 3.2, it is argued that the ‘common perception that the NHS REC system is dominated …. (shrink)

We question the role given to depiction in Clark and Fischer's account of interaction with social robots. Specifically, we argue that positing a unique cognitive process for handling depiction is evolutionarily implausible and empirically redundant because the phenomena it is intended to explain are not limited to depictive contexts and are better explained by reference to more general cognitive processes.

This article provides an English translation of a historic discussion on the foundations of mathematics, during which Kurt GÖdel first announced his incompleteness theorem to the mathematical world. The text of the discussion is preceded by brief background remarks and commentary.

The pipeline framework for identifying ethical issues in machine learning healthcare applications outlined by Char et al. is a very useful starting point for the systematic consideration...

ABSTRACT This essay is an attempt to examine the idea that a professional code of practice can entail ethical conduct. It is focused around two differing perspectives on ethics. It will be argued that the professions have, perhaps too hastily, adopted one theory without considering the merits, or the objections offered by the alternative account. This alternative, a ‘cognitivist’ theory, is sketched, and the possible advantages of such an approach are discussed. Such a perspective means adopting a radically different approach (...) to the nature of ethics and what it is to be a moral agent, and could have interesting consequences for professional practice. Even if a cognitivist account is ultimately unconvincing, it does provide a number of worrying arguments for those professionals who believe that ethical conduct is generated by following a code of practice, and these arguments need to be addressed. (shrink)

As initially envisioned, Gödel's Collected Works were to include transcriptions of material from his mathematical workbooks. In the end that material, as well as some other manuscript items from Gödel's Nachlass, had to be left out. This note describes some of the unpublished items in the Nachlass that are likely to attract the notice of scholars and surveys the extent of shorthand transcription efforts undertaken hitherto. Some examples of sources outside Gödel's Nachlass that may be of interest to Gödel scholars (...) are also indicated. (shrink)

Are there worthwhile values and ideals which flourish in the procedures of the state but wither in the transactions of the market? Are there equitable and fulfilling social relationships which are nurtured in the economic sphere but crumble in the political world? There is clearly some truth in the claim that at least in certain circumstances market systems inculcate in people not only ‘honesty and diligence, but also sensitivity to the needs and preferences of others’ . On the other hand, (...) it is difficult to deny the appeal of a tradition of thought which attaches moral superiority to the non-market ideals and values epitomised in the gift relationship. Titmuss , for example, objected to treating blood as a commodity in part because it undermined the sense of fraternity or community which a system of voluntary blood donors enhanced. A contemporary statement of this position holds that gift values differ from commodity values in being ‘tokens of love, admiration, respect, honor, and so forth, and consequently lose their value when they are provided for merely self-interested reasons’. (shrink)

The general question to which this paper is addressed is whether knowledge and rationality carry within themselves the seeds of their own destruction. Some of those who set out in search of knowledge come to believe as a result of their inquiries that the object of their quest is not what they had taken it to be; seeking to discover the way the world actually is, they are led to conclude that all they can hope to find is a reflection (...) of their own needs and interests; the grail is but a beaker. Similarly, some of those whose aim is to formulate the principles of rational thought are led by reason to deny that any beliefs can be rationally justified; reasons are never reasons for believing but mere epiphenomena, produced by but not producing events whose only begetter is the passions; the quest is just another power struggle. The particular question I wish to ask is whether this picture is an accurate representation of social inquiry. (shrink)

El artículo, tras validar la importancia de las organizaciones de derechos humanos y las de familiares de las víctimas en Chile, y del realce de este tema en los gobiernos de la Concertación, se centra en analizar el rol de las universidades frente a este tema, argumentando la necesidad de que estas desempeñen la noble tarea de formar profesionales ciudadanos, es decir personas con una formación basada en los derechos humanos. Para ello se focaliza en los objetivos y contenidos transversales (...) y postula un nuevo método pedagógico. (shrink)

Though regarded today as one of the most important results in logic, the compactness theorem was largely ignored until nearly two decades after its discovery. This paper describes the vicissitudes of its evolution and transformation during the period 1930-1970, with special attention to the roles of Kurt Gödel, A. I. Maltsev, Leon Henkin, Abraham Robinson, and Alfred Tarski.

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as clinical phronesis, i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of virtue ethics, yet one that is informed by the exigencies of moral (...) discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their disengaged form (reflecting the malaise of modern medicine). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the silent world of doctor and patient — provides may deny or refuse any given connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of calculative reasoning only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can save the life of medical ethics — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can prevent the death of medical ethics. (shrink)

This is a reproduction of a book published before 1923. This book may have occasional imperfections such as missing or blurred pages, poor pictures, errant marks, etc. that were either part of the original artifact, or were introduced by the scanning process. We believe this work is culturally important, and despite the imperfections, have elected to bring it back into print as part of our continuing commitment to the preservation of printed works worldwide. We appreciate your understanding of the imperfections (...) in the preservation process, and hope you enjoy this valuable book. (shrink)

In September of 2002, without fanfare, Ivor Grattan-Guinness retired from the faculty of Middlesex University. His scholarly activity, however, has continued unabated, his time now no longer fetter...

This study evaluated the biological dimension of meditation and self-transcendent states. A convenience sample of 513 participants was drawn from attendees at a 4-day guided meditation workshop. Half were randomly assigned to an active placebo control intervention. All were assessed on a variety of measures, both psychological [anxiety, pain, posttraumatic stress disorder, positive emotions, and transcendent states], and physiological. Additional biological assessments including salivary immunoglobulin-A, cortisol, and Quantitative Electroencephalography were obtained from subset of the Experimental group. No significant difference in (...) psychological symptoms or positive emotions was observed between Experimental and placebo groups at baseline. At post-test, significant improvements were noted in the Experimental group, including a 49.5% median increase in SIgA, though cortisol remained unchanged. qEEG z-score analysis identified sustained stress reduction, including delta frequency band amplitude increases, high beta decreases, and faster acquisition of sustained alpha states. Psychological symptoms also improved on all measures. At 6-month follow-up, PTSD and somatic symptoms significantly improved from baseline, and post-test versus 6-month follow-up results indicated significant increases in happiness and spiritual and physical oneness, along with decreases in depressive symptoms. These findings suggest that autonomic self-regulation and transcendent states may be measured in both biological and psychological dimensions and are associated with pervasive health benefits. (shrink)

A number of ethical frameworks have been proposed to support decision-making in public health and the evaluation of public health policy and practice. This is encouraging, since ethical considerations are of paramount importance in health policy. However, these frameworks have various deficiencies, in part because they incorporate substantial ethical positions. In this article, we discuss and criticise a framework developed by James Childress and Ruth Bernheim, which we consider to be the state of the art in the field. Their framework (...) distinguishes aims, such as the promotion of public health, from constraints on the pursuit of those aims, such as the requirement to avoid limitations to liberty, or the requirement to be impartial. We show how this structure creates both theoretical and practical problems. We then go on to present and defend a more practical framework, one that is neutral in avoiding precommitment to particular values and how they ought to be weighted. We believe ethics is at the very heart of such weightings and our framework is developed to reflect this belief. It is therefore both pluralist and value-based. We compare our new framework to Childress and Bernheim’s and outline its advantages. It is justified by its impetus to consider a wide range of alternatives and its tendency to direct decisions towards the best alternatives, as well as by the information provided by the ranking of alternatives and transparent explication of the judgements that motivate this ranking. The new framework presented should be useful to decision-makers in public health, as well as being a means to stimulate further reflection on the role of ethics in public health. (shrink)

The word “euthanasia” is hopelessly overloaded with emotional connotations. It means so many things to many different people. The implications of euthanasia associated with the Second World War have often rendered the term unsuitable for discussions of a rational manner. As far as I am concerned, what happened in Germany under Hitler had nothing to do with the classic meaning of a gentle and easy death but was rather simply a policy of mass murder.

This paper argues that qualitative research is both useful and necessary, as it provides an essential means of gaining a richer understanding of patients' perceptions, social processes and meanings. In their paper in this edition of Clinical Ethics, Hallowell and Lawton raise many issues relating to the way that qualitative research is treated by RECs in the UK. In this paper I discuss just three key topics stimulated by their paper: the way that methodology relates to ethics, the experience and (...) character of the researcher, and the normative/descriptive distinction. I strongly support Hallowell and Lawton's appeal for greater communication between qualitative researchers and RECs. In other respects, I would argue that they do not go far enough. The recent review of research ethics structures and the review process provides an opportunity to move away from the present 'one size fits all' approach to ethical review. I would argue that this change could only benefit qualitative research and researchers. (shrink)

This article briefly reviews the various papers contained in this volume. They were originally presented at a research workshop held at Keele University in the UK in February 2003. It is suggested that the different papers raise a series of related legal, social and ethical issues and can be collectively seen to demonstrate the fact that policy formation in relation to reproductive matters is highly contested. It is concluded that ethical policy formation in this area needs to be based on (...) actual evidence of harm rather than assumed harm and that this therefore entails more empirical research into reproductive matters. (shrink)

Narrative is increasingly being recognised as an important tool both to manage and understand organisations. In particular, narrative is recognised to have an important influence on the perception of environmental issues in business, a particularly contested area of modern management. Management literature is, however, only beginning to develop a framework for evaluating the quality and legitimacy of narratives. Due to the highly fluid nature of narratives, the traditional notion of truth as reflecting ' objective reality' is not useful here. In (...) this article, an alternative approach that evaluates a narrative in two stages is developed. First, a horizontal reading investigates the surface of the narrative, its textual features, instrumental devices and its integrity as a text, to assess the quality of a narrative. Second, a more philosophical or vertical reading makes explicit the underlying value assumptions that author and reader bring to the writing and reading of the narrative to assess the narrative's claim to legitimacy. The framework is then tested against a narrative on the relationship between business and environment as espoused by a supply chain manager of a UK-based manufacturing company. (shrink)

It will be argued that Wittgenstein did not outright reject the law of excluded middle for mathematics or the proof-techniques that constructivists reject in connection with the law of excluded middle. Wittgenstein can be seen to be critical of the dogmatic claims of Brouwer and Weyl concerning how proofs should be constructed. Rather than himself laying down a requirement concerning what is and is not a proof, Wittgenstein can be read as exploring the differences between constructive and non-constructive proofs. I (...) will read Wittgenstein as arguing that Brouwer’s rejection of excluded middle is based upon an over-extension from examples that Wittgenstein reads as special cases. Wittgenstein is certainly interested in the difference between constructive and non-constructive proof but only for the purposes of exploring the easily-missed differences between the two, not in order to reject non-constructive approaches. (shrink)

Two lines of evidence indicate that there exists a reciprocal inhibitory relationship between opposed brain networks. First, most attention-demanding cognitive tasks activate a stereotypical set of brain areas, known as the task-positive network and simultaneously deactivate a different set of brain regions, commonly referred to as the task negative or defaultmode network. Second, functional connectivity analyses show that these same opposed networks are anti-correlated in the resting state. Wehypothesize that these reciprocally inhibitory effects reflect two incompatible cognitive modes, each of (...) which may be directed towards understanding the external world. Thus, engaging onemode activates one set of regions and suppresses activity in the other.Wetest this hypothesis by identifying two types of problem-solving task which, on the basis of prior work, have been consistently associated with the task positive and task negative regions: tasks requiring social cognition, i.e., reasoning about the mental states of other persons, and tasks requiring physical cognition, i.e., reasoning about the causal/mechanical properties of inanimate objects. Social and mechanical reasoning tasks were presented to neurologically normal participants during fMRI. Each task type was presented using both text and video clips. Regardless of presentation modality, we observed clear evidence of reciprocal suppression: social tasks deactivated regions associated with mechanical reasoning and mechanical tasks deactivated regions associated with social reasoning. These findings are not explained by self-referential processes, task engagement, mental simulation,mental time travel or external vs. internal attention, all factors previously hypothesized to explain default mode network activity. Analyses of resting state data revealed a close match between the regions our tasks identified as reciprocally inhibitory and regions of maximal anti-correlation in the resting state. These results indicate the reciprocal inhibition is not attributable to constraints inherent in the tasks, but is neural in origin. Hence, there is a physiological constraint on our ability to simultaneously engage two distinct cognitive modes. Furtherwork is needed tomore precisely characterize these opposing cognitive domains. (shrink)

ABSTRACT In recent years there has been intense debate regarding the level of medical care provided to ‘standard care’ control groups in clinical trials in developing countries, particularly when the research sponsors come from wealthier countries. The debate revolves around the issue of how to define a standard of medical care in a country in which many people are not receiving the best methods of medical care available in other settings. In this paper, we argue that additional dimensions of the (...) standard of care have been hitherto neglected, namely, the structure and efficiency of the national health system. The health system affects locally available medical care in two important ways: first, the system may be structured to provide different levels of care at different sites with referral mechanisms to direct patients to the appropriate level of care. Second, inefficiencies in this system may influence what care is available in a particular locale. As a result of these two factors locally available care cannot be equated with a national ‘standard’. A reasonable approach is to define the national standard of care as the level of care that ought to be delivered under conditions of appropriate and efficient referral in a national system. This standard is the minimum level of care that ought to be provided to a control group. There may be additional moral arguments for higher levels of care in some circumstances. This health system analysis may be helpful to researchers and ethics committees in designing and reviewing research involving standard care control groups in developing country research. (shrink)

Often regarded simply as a nuisance in clinical drug trials in which the aim is to separate drug response from placebo response in a statistically significant manner, the placebo response has important implications. These implications relate to the nature of illness, the study of non-specific factors in the treatment setting that are related to clinical improvement, methods of enhancing these non-specific sources of benefit, and the neurobiology that is associated with the placebo response. Specific sources of clinical improvement in medical (...) and psychological treatment generally consist of drugs or clear interventions that appear to directly contribute to the desired treatment. Non-specific factors, on the other hand, include the clinician–patient relationship, installation of hope, relationship with authority, and other such factors that are more implicit to treatment and may contribute to the placebo response. Our understanding of how these non-specific aspects of treatment relate to clinical improvement and ways of enhancing these non-pharmacological elements of therapy may form important aspects of treatment. Furthermore, an important, albeit potentially overlooked element of the placebo response are clinical-trial designs and methodologies, themselves. Specific neurobiological changes also appear to be associated with the placebo response in at least some cases. Finally, it is suggested that the placebo response may in some instances represent a type of brain plasticity in which expectation and desire — agency — can result in specific changes in brain function that either may mirror or differ from the effects of certain drugs. (shrink)

Singer and Dawson point out that two arguments against abortion, that the embryo is entitled to protection because from fertilization it is (1) a human being or (2) a potential human being, are also used by opponents of embryo experimentation. They focus on the second argument, evaluating the notion of potentiality as it applies to gametes, to the unimplanted embryo, to the implanted developing embryo, and to the embryo created by in vitro fertilization (IVF). They argue that there is (...) a crucial distinction between natural reproduction, in which all that is needed for the embryo to have a prospect of reaching its potential is for those involved to refrain from stopping it, and IVF, in which the embryo cannot develop into a person without a deliberate human act. Reproductive techniques necessitate our rethinking of established views about potentiality, and how it should be applied to the embryo in a laboratory. (KIE abstract). (shrink)

ABSTRACT In the present study, we examined how the perceived attainability and relatability of moral exemplars predicted moral elevation and pleasantness among both adult and college student participants. Data collected from two experiments were analyzed with Bayesian multilevel modeling to explore which factors significantly predicted outcome variables at the story level. The analysis results demonstrated that the main effect of perceived relatability and the interaction effect between attainability and relatability shall be included in the best prediction model, and thus, were (...) deemed to predict the outcome variables significantly. The main effect of relatability as well as its interaction with attainability positively predicted elevation and pleasantness. We discussed educational implications of the findings in terms of how relatability may be the first point of emphasis for moral educators to focus on and attainability can then bolster the effectiveness. These relatable and attainable moral exemplars can be sources for moral elevation and pleasantness, which promote motivation to emulate moral behavior presented by the exemplars. (shrink)

This second edition represents a wide-ranging critical introduction to the psychology of Carl Jung, one of the founders of psychoanalysis. Including two new essays and thorough revisions of most of the original chapters, it constitutes a radical assessment of his legacy. Andrew Samuels' introduction succinctly articulates the challenges facing the Jungian community. The fifteen essays set Jung in the context of his own time, outline the current practice and theory of Jungian psychology and show how Jungians continue to question and (...) evolve his thinking and apply it to aspects of modern culture and psychoanalysis. The volume includes a full chronology of Jung's life and work, extensively revised and up to date bibliographies, a case study and a glossary. It is an indispensable reference tool for both students and specialists, written by an international team of Jungian analysts and scholars from various disciplines. (shrink)