`Being sensitive' in nursing was explored using Schwartz-Barcott and Kim's hybrid model of concept development, producing a tentative definition of the concept. Three phases were employed: theoretical, empirical/fieldwork and analytical. An exploration of the literature identified where the common idea of `being sensitive' as a nurse was embedded and demonstrated that a theoretical development of this fundamental aspect of nursing was absent. The empirical phase was conducted using semistructured interviews with nine expert palliative care and cancer nurses. This method was (...) particularly useful for the exploration of this concept because of its firm grounding in practical example. A definition of what the concept `being sensitive' means in nursing, and subsequent clarification of `being insensitive', have been posed from the research process undertaken. The essential nature of this concept being integral to nursing practice is emphasized. Potential implications for the development of nursing practice through teaching of this concept were identified. (shrink)

The concept of alienation: Hegelian themes in modern social thought -- Creative activity and alienation in Hegel and Marx -- The concept of labour -- The individual and society -- Freedom and the "realm of necessity" -- Alienation as a critical concept -- Private property and communism -- The division of labour and its overcoming -- Marx's concept of communism.

When cognitive scientists are looking for the neural basis of consciousness or the computational processes underlying vision, what are they looking to find? I argue for a new account of this explanatory project in cognitive science (and the special sciences more generally) on which it is best understood on close analogy with causal explanation in the special sciences. Causal explanations cite causal difference-makers: they explain how certain events causally depend on other events. Generative explanations cite generative difference-makers: they explain how (...) certain events obtain in virtue of (and so are generated by) other events. I show how that this generative difference-making account (GDM) extends well regarded developments in philosophical work on causal explanation, helps to usefully clarify and expands the hypothesis space of a key project in cognitive science – that of understanding how underlying nonmental processes give rise to the mental, including consciousness. In section 2, I develop GDM by close analogy with causal explanation, and locate both of them as species of a more general project in the special sciences: that of discovering what makes a difference to what. In section 3, I motivate GDM by contrasting it with other rival accounts, including correlationist, identity, and grounding accounts, as well as Carl Craver’s constitutive relevance account. In section 4, I tie all of the strands of the preceding discussion together to show how GDM provides a new and compelling response to the so-called hard problem of consciousness. (shrink)

Between the years 1643 and 1649, Princess Elisabeth of Bohemia and René Descartes exchanged fifty-eight letters—thirty-two from Descartes and twenty-six from Elisabeth. Their correspondence contains the only known extant philosophical writings by Elisabeth, revealing her mastery of metaphysics, analytic geometry, and moral philosophy, as well as her keen interest in natural philosophy. The letters are essential reading for anyone interested in Descartes’s philosophy, in particular his account of the human being as a union of mind and body, as well as (...) his ethics. They also provide a unique insight into the character of their authors and the way ideas develop through intellectual collaboration. Philosophers have long been familiar with Descartes’s side of the correspondence. Now Elisabeth’s letters—never before available in translation in their entirety—emerge this volume, adding much-needed context and depth both to Descartes’s ideas and the legacy of the princess. Lisa Shapiro’s annotated edition—which also includes Elisabeth’s correspondence with the Quakers William Penn and Robert Barclay—will be heralded by students of philosophy, feminist theorists, and historians of the early modern period. (shrink)

The articles in this volume offer a fresh perspective on the important role of the concept of law (lex) in the moral and political philosophy of the 'School of Salamanca'.

This paper argues that a priori justification is, in principle, compatible with naturalism—if the a priori is understood in a way that is free of the inessential properties that, historically, have been associated with the concept. I argue that empirical indefeasibility is essential to the primary notion of the a priori ; however, the indefeasibility requirement should be interpreted in such a way that we can be fallibilist about apriori-justified claims. This fallibilist notion of the a priori accords with the (...) naturalist’s commitment to scientific methodology in that it allows for apriori-justified claims to be sensitive to further conceptual developments and the expansion of evidence. The fallibilist apriorist allows that an a priori claim is revisable in only a purely epistemic sense. This modal claim is weaker than what is required for a revisability thesis to establish empiricism, so fallibilist apriorism represents a distinct position. (shrink)

This book offers a balanced and comprehensive account of philosophical thought from the middle of the fourteenth century to the emergence of modern philosophy at the turn of the seventeenth century.

Melds philosophical analysis with early cinematic history to develop a fresh theory of the notion of comedy.

Research ethics committees are charged with providing an opinion on whether research proposals are ethical. These committees are overseen by a central office that acts for the Department of Health and hence the State. An advisory group has recently reported back to the Department of Health, recommending that it should deal with inconsistency in the decisions made by different RECs. This article questions the desirability and feasibility of questing for consistent ethical decisions.

Body care is considered a key aspect of nursing and imperative for the health, wellbeing, and dignity of older people. In Scandinavian countries, body care as a professional practice has undergone considerable changes, bringing new understandings, values, and dilemmas into nursing. A systematic mapping review was conducted with the aims of identifying and mapping international nursing research on body care of older people in different institutionalized settings in the healthcare system and to critically discuss the dominant assumptions within the research (...) by adapting a problematization approach. Most identified papers reported on empirical research with a biomedical approach focusing on outcome and effectiveness. Conceptual papers, papers with a focus on the perspectives of the older people, or contextual and material aspects were lacking. The research field is dominated by four dominant assumptions: Body care as an evidence‐based practice, body care as a relational ethical practice, the body as a body‐object and a body‐subject, the objects in the body care practices as nonrelational materialities. Given the complexities of professional body care practices, there is a need for other research designs and theoretical perspectives within nursing that expand our understanding of body care taking into consideration the multiple social and material realities. (shrink)

Sexual exploitation and abuse (SEA) by United Nations (UN) peacekeepers causes severe physical and psychological consequences. Where SEA leads to pregnancy and childbirth, peacekeepers typically absolve themselves of their paternal responsibilities and paternity suits are largely unsuccessful. The lack of support for peacekeeper-fathered children (PKFC) tarnishes the image of the UN who fails to implement a victim-centred approach to SEA. Analysing shortcomings in the provision of support, this article presents an evaluation of the UN’s accountability system from the perspective of (...) PKFC families. In-depth interviews with thirty-five PKFC and sixty mothers demonstrate local barriers to child support and paternity claims in eastern Democratic Republic of Congo. We discuss PKFC’s need for assistance and their mothers’ attempts to navigate an opaque international legal system. The findings cast light on their limited access to UN subsidies and offer recommendations to better implement existing UN goals of justice and victim-oriented policies. (shrink)

What is it to base a belief on reasons? Existing attempts to give an account of the basing relation encounter a dilemma: either one appeals to some kind of neutral process that does not adequately reflect the way basing is a content‐sensitive first‐personal activity, or one appeals to linking or bridge principles that over‐intellectualize and threaten regress. We explain why this dilemma arises, and diagnose the commitments that are key obstacles to providing a satisfactory account. We explain why they should (...) be rejected anyway, and then offer a new, knowledge‐first virtue epistemological theory of the basing relation that shows how we can substantially theorize about mental processes without these commitments. The resulting view plausibly captures the way in which basing is an inherently mental and content‐sensitive process. (shrink)

This classic, with a new introduction by Madeleine L'Engle, is by turns an entrancing mediation on language a piercing commentary on the nature of art and why so much of what we read, hear, and see falls short and a brilliant examination of the fundamental tenets of Christianity. The Mind of the Maker will be relished by those already in love with Dorothy L. Sayers and those who have not yet met her. A mystery writer, a witty and perceptive (...) theologian, culture critic, and playwright, Dorothy Sayers sheds new,unexpected light on a specific set of statements made in the Christian creeds. She examines anew such ideas as the image of God, the Trinity, free will, and evil, and in these pages a wholly revitalized understanding of them emerges. The author finds the key in the parallels between the creation of God and the human creative process. She continually refers to each in a way that illuminates both. (shrink)

This article analyses the two main rhetorical techniques of “argumentation” and “persuasion” employed in politico-philosophical debates recorded in early Chinese argumentative texts of the Warring States period. Through the analysis of pertinent case studies drawn from the received literature, the contribution explores the formal, structural, and grammatical features of these techniques, with attention paid to the wide selection of rhetorical and literary devices they make use of. It also further provides an overview of the historical and socio-cultural background against which (...) such techniques developed among so called “wandering persuaders”, who were travelling from court to court to offer their services as political advisors and diplomats to the local rulers of the time. (shrink)

Broadly speaking, a naturalistic approach to epistemology seeks to explain human knowledge – and justification in particular – as a phenomenon in the natural world, in keeping with the tenets of naturalism. Naturalism is typically defined, in part, by a commitment to scientific method as the only legitimate means of attaining knowledge of the natural world. Naturalism is often thought to entail empiricism by virtue of this methodological commitment. However, scientific methods themselves may incorporate a priori elements, so empiricism does (...) not follow from the methodological commitments of naturalism alone. And given a suitably-naturalistic conception of the a priori, a priori forms of justification may be compatible with naturalism generally. A priori justification is, in principle, compatible with naturalism – and hence naturalistic epistemologies – if the a priori is understood in a way that is free of some of the inessential properties that have been associated with the concept. I argue that some of the more prominent strategies for accommodating normative notions within a naturalistic framework allow for the possibility of a priori justification. These include reliabilism, instrumental rationality, and nonfactualism about justification. A priori justification thus need not be seen as standing in opposition to all naturalistic epistemologies. It is only with nonnormative naturalistic epistemologies that a priori justification per se is incompatible, and this only because the notion of justification itself has no role to play within a nonnormative approach to epistemology. (shrink)

It now seems technically feasible to culture human embryos beyond the “fourteen‐day limit,” which has the potential to increase scientific understanding of human development and perhaps improve infertility treatments. The fourteen‐day limit was adopted as a compromise but subsequently has been considered an ethical line. Does it remain relevant in light of technological advances permitting embryo maturation beyond it? Should it be changed and, if so, how and why? What justifications would be necessary to expand the limit, particularly given that (...) doing so would violate some people's moral commitments regarding human embryos? Robust stakeholder engagement preceded adoption of the fourteen‐day limit and should arguably be part of efforts to reassess it. Such engagement could also consider the need for enhanced oversight of human embryo research. In the meantime, developing and implementing reliable oversight systems should help foster high‐quality research and public confidence in it. (shrink)

Applying Aesthetics to Everyday Life surveys current debates in the field of everyday aesthetics, examining its history, methodology and intersections with cognate research areas. Lisa Giombini and Adrián Kvokacka bring together an international team of renowned scholars who are shaping the present and future of the discipline. They demonstrate how the historical origins of everyday aesthetics emerges across the history of Western aesthetic thought, from Renaissance thinkers to the modern German philosophers Baumgarten, Kant and Heidegger. Chapters shed light on (...) the field's methodological underpinnings, tracing its theoretical foundations back to epistemology and ethics and assess the potential of everyday aesthetics as a theoretical tool. They reveal its interdisciplinary nature and how it assists various fields of inquiry, including environmental and urban aesthetics, conservation ethics and the philosophy of art. Through fresh explorations of its origins, background and contemporary developments, this collection advances a new definition of everyday aesthetics and provides a cutting edge reflection on the world we inhabit today. (shrink)

I argue that epistemic failings are a significant and underappreciated moral hazard in the financial services industry. I argue further that an analysis of these epistemic failings and their means of redress is best developed by identifying policies and procedures that are likely to facilitate good judgment. These policies and procedures are “best epistemic practices.” I explain how best epistemic practices support good reasoning, thereby facilitating accurate judgments about risk and reward. Failures to promote and adhere to best epistemic practices (...) contributed to the 2008 financial crisis. I identify and discuss some of the ways in which best epistemic practices were violated in the events that led to the crisis, with a focus on the role of the credit rating agencies. I go on to discuss some of the ways in which these failings have been redressed. I conclude by observing how proactive regulation for best epistemic practices might help us to anticipate and avoid future crises. (shrink)

Advance refusals of life-sustaining treatment involve three potentially conflicting interests: those of the patient; those of the doctor; and those of the law. The state's interest in protecting life can clash with the patient's right to self determination which, in turn, can conflict with the doctor's desire to act in the patient's best interests. Against this background, we present the case of a patient who was treated (arguably) contrary to his advance refusal but in accordance with English law.

This edited volume evaluates how sport organizations in the public, private, and non-profit sectors define responsible management and sustainability and what these mean in their daily operations. Using country-specific cases, the chapters provide an empirical investigation of sport organizations in each sector, analyzing managerial decisions and policies through a sustainability lens. All chapters are structured in the same way, providing a truly comparative approach. Offering insights for scholars interested in responsibility and sustainability in different context, this volume will be important (...) to undergraduate and postgraduate sport management, event management, sport science, and sport study programs around the globe. (shrink)

Here’s a nice, simple view. Knowing that p is the sole fundamental aim and achievement in the epistemic domain. It is a manifestation of epistemic competence, and we can metaphysically explain both the existence and the normative status of all other epistemic states in terms of knowledge and the competence it manifests. In this paper I will defend this view from a challenge from Ernest Sosa that knowledge is too weak and primitive to do the work the Simple View asks (...) it to do. He claims that we not only need knowing that p, but also reflectively knowing that p and knowing full well that p. I argue that Sosa is mistaken. Good old knowledge, what Sosa calls animal knowledge, when properly understood, can do all of the work that reflective knowledge and knowing full well are supposed to do. Knowledge, at least in the epistemic domain, is all you need. In section 1, I explain in more detail the challenge that Sosa poses for the Simple View, and consequently my direct virtue epistemology. I then explain Sosa’s accounts of reflective knowledge and knowing full well, further clarifying the debate. In sections 2, 3, and 4, I consider Sosa’s arguments that reflective knowledge and knowing full well are distinctive epistemic achievements. Section 2 addresses his argument from the epistemic evaluability of suspending belief. Section 3 addresses his arguments for the claim that a variety of cases can only be adequately accounted for by invoking these other states. Section 4 addresses his arguments about the role of reflective knowledge in rebutting dream skepticism. Responding to Sosa’s arguments also helps to clarify certain features of knowledge and epistemic competence. I conclude by reviewing these features. (shrink)

A new theory of how the brain constructs emotions that could revolutionize psychology, health care, law enforcement, and our understanding of the human mind Emotions feel automatic, like uncontrollable reactions to things we think and experience. Scientists have long supported this assumption by claiming that emotions are hardwired in the body or the brain. Today, however, the science of emotion is in the midst of a revolution on par with the discovery of relativity in physics and natural selection in biology--and (...) this paradigm shift has far-reaching implications for us all. Leading the charge is psychologist and neuroscientist Lisa Feldman Barrett, whose theory of emotion is driving a deeper understanding of the mind and brain, and shedding new light on what it means to be human. Her research overturns the widely held belief that emotions are housed in different parts of the brain and are universally expressed and recognized. Instead, she has shown that emotion is constructed in the moment, by core systems that interact across the whole brain, aided by a lifetime of learning. This new theory means that you play a much greater role in your emotional life than you ever thought. Its repercussions are already shaking the foundations not only of psychology but also of medicine, the legal system, child-rearing, meditation, and even airport security. Why do emotions feel automatic? Does rational thought really control emotion? How does emotion affect disease? How can you make your children more emotionally intelligent? How Emotions Are Made answers these questions and many more, revealing the latest research and intriguing practical applications of the new science of emotion, mind, and brain. (shrink)

Objectives—To study the value of taking an ethics history as a means of assessing patients' preferences for decision making and for their relatives' involvement.Design—Questionnaire administered by six junior doctors to 56 mentally competent patients, admitted into general and geriatric medical beds.Setting—A large district general hospital in the United Kingdom.Main measures—To establish whether patients were adequately informed about their illness and whether they minded the information being communicated to their relatives. To establish their preference regarding truthful disclosure and participation in decision (...) making with risk attached. To establish whether they wished to be involved in CPR decision making, and if not, who should make the decision. To establish whether they knew of living wills and whether they had any advance directives.Results—Twenty-four were inadequately informed of their illness.Forty-six said they would want to know were something serious to be found. Twenty-eight wanted to make their own decision if requiring risky treatment and 11 wanted family members involved. Thirty-one wanted to make a cardiopulmonary resuscitation decision and five of these decisions differed from those made by the doctors. Twenty-five preferred the doctors to decide. Eleven of the patients had heard of living wills but only one had executed such a will. Seven of the patients wished to provide advance directives. Three did not find the history taking helpful but none were discomforted.Conclusion—Taking an ethics history is a simple means of obtaining useful information about patients' preferences. (shrink)

Objectives: To compare non-treatment decision making by general practitioners and geriatricians in response to vignettes. To see whether the doctors’ decisions were informed by ethical or legal reasoning.Design: Qualitative study in which consultant geriatricians and general practitioners randomly selected from a list of local practitioners were interviewed. The doctors were asked whether patients described in five vignettes should be admitted to hospital for further care, and to give supporting reasons. They were asked with whom they would consult, who they believed (...) ought to make such decisions, and whether the relatives’ preferences would influence their decision making.Main measures: To analyse the factors influencing the doctors’ decisions not to admit otherwise terminally ill patients to hospital for life prolonging treatment.Results: Seventeen GPs and 18 geriatricians completed the interview. All vignettes produced strong concordance in decision making between both groups. Ten per cent of the doctors would provide life prolonging treatment to patients with severe brain damage. Most would admit a surgical patient regardless of age or disability. Medical reasons were largely used to explain decision making. The wishes of relatives were influential and resource considerations were not. There was variability regarding decision making responsibility.Conclusions: Little attempt was made to link decision making with ethical or legal concepts and there may have been non-recognition, or denial, of the ethical consequences of failure to admit. The process of decision making may involve deception. This may be conscious, because of the illegality of euthanasia, or unconscious , because of deepseated medical and societal reluctance to accept that intentionally withholding life prolonging treatment may equate with intentionally causing death. (shrink)

When it originated in the late 19th century, psychometrics was a field with both a scientific and a social mission: psychometrics provided new methods for research into individual differences, and at the same time, these psychometric instruments were considered a means to create a new social order. In contrast, contemporary psychometrics - due to its highly technical nature and its limited involvement in substantive psychological research - has created the impression of being a value-free discipline. In this article, we develop (...) a contrasting characterization of contemporary psychometrics as a value-laden discipline. We expose four such values: that individual differences are quantitative (rather than qualitative), that measurement should be objective in a specific sense, that test items should be fair, and that utility of a model is more important than its truth. Our goal is not to criticize psychometrics for employing these values, but rather to bring them into the open and to show that these values are not inevitable and are in need of systematic evaluation. (shrink)

When two actors have the same mental state but one happens to harm another person (unlucky actor) and the other one does not (lucky actor), the latter elicits a milder moral judgement. To understand how this outcome effect would affect post-harm interactions between victims and perpetrators, we examined how the social role from which transgressions are perceived moderates the outcome effect, and how outcome effects on moral judgements transfer to agentic and communal interpersonal goals. Three vignette experiments (N = 950) (...) revealed similar outcome effects on moral judgement across social roles. In contrast, outcome effects on agentic and communal goals varied by social role: victims exhibited the strongest outcome effects and perpetrators the weakest, with bystanders falling in between. Moral judgement did not mediate the effects of outcome severity on interpersonal goals. We discuss the possibility that outcome severity raises normative expectations regarding post-harm interactions that are unrelated to moral considerations. (shrink)

The paper by Szasz is about mental illness and its meaning, and like Procrustes, who altered hapless travellers to fit his bed, Szasz changes the meanings of words and concepts to suit his themes.1 Refuting the existence of “mental illness”, he suggests that the term functions in an apotropaic sense. He submits that in this sense it is used to avert danger, protect society, and hence justify preventive detention of “dangerous” people.But his arguments misrepresent the precise meaning of the term (...) “apotropaic”, which is an adjective, defined in Webster’s, Chambers and the New Shorter Oxford dictionaries as averting or turning aside evil. It is possible that amulets and incantations ward off evil, in the same way as garlic repels vampires, but evil and danger are different concepts. Yet Szasz talks of using phrases like ‘“dangerousness to self and others’ as apotropaics to ward off dangers we fear”, and the word “evil” does not appear in his paper.I will argue that “dangerousness to self and others” and “psychiatric treatment” have a prosaic rather than an apotropaic function.The word “danger” is familiar rather than arcane, and includes many risks. A predatory paedophile is usually both dangerous and evil, but many dangerous people are not evil. For example, a child who plays with a box of matches is dangerous, as is a demented person who drives a car, or a schizophrenic who, acting on delusional beliefs, arms herself with a knife and roams the streets believing she is an avenging angel.Suppose …. (shrink)

Essays discuss euthanasia and the medical, legal, and ethical controversies surrounding it.

In Science as Social Knowledge in 1990 and The Fate of Knowledge in 2002, Helen Longino develops an epistemological theory known as Critical Contextual Empiricism (CCE). Knowledge production, she argues, is an active, value-laden practice, evidence is context dependent and relies on background assumptions, and science is a social inquiry that, under certain conditions, produces social knowledge with contextual objectivity. While Longino’s work has been generally well-received, there have been a number of criticisms of CCE raised in the philosophical literature (...) in recent years. In this paper I outline the key elements of Longino’s theory and propose modifications to the four norms offered by the account. The version of CCE I defend, which draws on lessons learned by medical researchers in recent years, gives principles of epistemic diversity a central role and also provides greater specification of three of the four norms. Further, it offers additional resources for defending CCE against Alvin Goldman’s suggestion that there is a need for a “healthy dogmatism” in science, as well as a concern about “manufactured uncertainty” arising out of recent work by David Michaels. Finally, the modified version proposed here is also well positioned to respond (negatively) to a suggestion from Kristen Intemann that CCE needs to be adapted to incorporate a central insight from feminist standpoint theory. In light of the variety of social pressures influencing contemporary scientific research, and the role of science in shaping public policy, I argue that a rigorous social epistemology such as CCE is indispensable for understanding and assessing contemporary scientific practice. (shrink)

This essay is part of a dossier on Cristina Lafont's book Democracy without Shortcuts.

In their paper, “Think Pragmatically: Investigators’ Obligations to Patient-Subjects When Research is Embedded in Care,” Stephanie Morain and Emily Largent (2023) argue that investigators, and poss...

Arguments in favor of greater research-practice integration in medicine have tended to be ethical, political, or pragmatic. There are good epistemic reasons to pursue greater integration, and it is important to think through these reasons in order to avoid inadvertently designing new systems in ways that replicate the epistemic elitism common within current systems. Meaningful transformation within health care is possible with close attention to all reasons in favor of greater research-practice integration, including epistemic reasons.

In the last few decades, religious and secular thinkers have tackled the world's escalating environmental crisis by attempting to develop an ecological ethic that is both scientifically accurate and free of human-centered preconceptions. This groundbreaking study shows that many of these environmental ethicists continue to model their positions on romantic, pre-Darwinian concepts that disregard the predatory and cruelly competitive realities of the natural world. Examining the work of such influential thinkers as James Gustafson, Sallie McFague, Rosemary Radford Ruether, John Cobb, (...) Peter Singer, and Holmes Rolston, Sideris proposes a more realistic ethic that combines evolutionary theory with theological insight, advocates a minimally interventionist stance toward nature, and values the processes over the products of the natural world. (shrink)

The volume of clinical research is increasing exponentially—far beyond our ability to process and absorb the results. Given this situation, it may be beneficial to consider reducing the flow at its source. In what follows, I will motivate and critically evaluate the following proposal: researchers should conduct fewer clinical trials. More specifically, I c onsider whether researchers should be permitted to conduct only clinical research of very high quality and, in turn, whether research ethics committees should prohibit all other, lower-quality (...) research, even when it might appear to meet some minimal ethical standard. Following a close analysis of the social-value requirement of ethical clinical research, I argue that this proposal is defensible. The problem identified in this paper has two parts, quantity and quality, and some clarification is needed about the latter because “quality” is a highly contested term in the medical literature. When some scholars advocate for high-quality trials, they mean large-scale, simple, explanatory randomized controlled trials. Others, including myself, have defended a different characterization of high-quality research that tends more toward pragmatic trial design and the use of methods other than RCTs. Pragmatic trials aim to provide evidence that directly supports clinical decision-making in “usual” care settings. Unlike explanatory trials, which aim to abstract away from particular settings and patients, in the hopes of creating ideal conditions for the success of an intervention, pragmatic trials deliberately pursue knowledge of high applicability, through the use of representative subjects, clinically important questions, flexible treatment protocols, patient-oriented outcome measures, and so on. I see applicability as a marker of high-quality research. The context in which research is meant to be applied should be the context in which new interventions are evaluated. (shrink)

Most phase III clinical trials today are explanatory. Because explanatory, or efficacy, trials test hypotheses under “ideal” conditions, they are not well suited to providing guidance on decisions made in most clinical care contexts. Pragmatic trials, which test hypotheses under “usual” conditions, are often better suited to this task. Yet, pragmatic, or effectiveness, trials are infrequently carried out. This mismatch between the design of clinical trials and the needs of health care professionals is frustrating for everyone involved, and explains some (...) of the challenges inherent in attempts to enhance knowledge translation and encourage evidence-based practice. The situation is more than simply frustrating, however; it is potentially unethical. Clinical trials must be socially valuable in order to (1) warrant the risks they impose on human research subjects and (2) fairly and efficiently assess new clinical interventions. Most bioethicists would agree that trials that have no social value, for instance, because their results do not have the potential to advance clinical care, should not be performed. What is less widely appreciated is that given limited research resources, trials that are more socially valuable should be preferred to trials that are less socially valuable when all else is equal. With respect to clinical trial design, I argue that while explanatory trials often have some social value, many have less social value than their pragmatic counterparts. On the basis of this general ethical assessment, I provide a preliminary defense of the position that clinical researchers should aim to conduct pragmatic trials, that is, that researchers face a burden of justification related to any idealizing elements added to trial designs. (shrink)

Do you love animals? Do you enjoy making sure animals and people are safe? Read this book to learn about becoming an animal control officer.