There has been a growing concern over establishing norms that ensure the ethically acceptable and scientifically sound conduct of clinical trials. Among the leading norms internationally are the World Medical Association's Declaration of Helsinki, guidelines by the Council for International Organizations of Medical Sciences, the International Conference on Harmonization's standards for industry, and the CONSORT group's reporting norms, in addition to the influential U.S. Federal Common Rule, Food and Drug Administration's body of regulations, and information sheets (...) by the Department of Health and Human Services. There are also many norms published at more local levels by official agencies and professional groups.Any account of international standards should cover both scientific and ethical norms at once – the two are conceptually intertwined. Recent sources recognize that “[s]cientifically unsound research on human subjects is unethical in that it exposes research subjects to risks without possible benefit.”. (shrink)

Objectives: Machine learning (ML) has the potential to facilitate “continual learning” in medicine, in which an ML system continues to evolve in response to exposure to new data over time, even after being deployed in a clinical setting. In this article, we provide a tutorial on the range of ethical issues raised by the use of such “adaptive” ML systems in medicine that have, thus far, been neglected in the literature. -/- Target audience: The target audiences for this tutorial (...) are the developers of ML AI systems, healthcare regulators, the broader medical informatics community, and practicing clinicians. -/- Scope: Discussions of adaptive ML systems to date have overlooked the distinction between 2 sorts of variance that such systems may exhibit—diachronic evolution (change over time) and synchronic variation (difference between cotemporaneous instantiations of the algorithm at different sites)—and underestimated the significance of the latter. We highlight the challenges that diachronic evolution and synchronic variation present for the quality of patient care, informed consent, and equity, and discuss the complex ethical trade-offs involved in the design of such systems. (shrink)

The topical theme of this paper explores the ethical principles of Mahayana Buddhism, based on Bodhicaryavatara(BC) of Santideva(7thcentury A.D.). According to him, only generation of enlightened mind (bodhicitta-intellect) and virtuous actions are not sufficient to attain the main objective i.e. Buddha-hood, the state of perfect enlightenment. But, for the fulfillment of this goal one must have to gain perfection to engage in the performance of six actions, termed as –Sadparmitas. It is necessary to stop present and future sufferings, and (...) to bring eternal pleasure, for all sentient beings. For this self-attitude and behavior in everyday affairs towards other beings is necessary. Thus, the ethics in Buddhism is directly associated with theory of Karman (action). Here, ethics means not only pure observance of virtuous actions but also good performance of one’s own duty and good actions in all affairs. It means while we work and act must be abstain from negative thinking doing harm for other beings. Therefore, Santideva emphasizes on applied form of teachings of the ethical theory. According to him, who has proper vision and understanding can act, of the work of compassionate, beyond the ethical code of conduct prescribed by the scriptures as warranted by circumstances and conditions for the sake of others. Thus, the ethical theory is based on good or bad intention of mind of an individual. This is so as what is virtuous and non-virtuous actions are not so easy to understand because it depends on purity of mind. In fact, nothing is good and nothing is bad, circumstances and intentions make it so. (shrink)

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and exercise (...) scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

The impermanence of human affairs is a major theme in Spinoza’s discussions of political histories, and from our present-day perspective it is both intriguing and ironic to see how this very theme has played out in the evolving fate of Spinoza’s association with atheism. While Spinoza’s contemporaries charged him with atheism in order to impugn his philosophy (and sometimes his character), in our times many lay readers and some scholars portray Spinoza as an atheist in order to commemorate (...) his role as a founder of modern secularism. In this paper, I will argue that Spinoza deserves neither vilification nor praise for being an atheist, for the simple reason that he was not one (unless one employs the term ‘atheism’ in a very peculiar sense). I have chosen the current topic as my contribution to a volume focused on the TTP, the Ethics, and their interrelations because it is precisely these two books which brought about the common reactionary accusation of atheism by Spinoza’s contemporaries. Addressing Spinoza’s 1663 book, Descartes’ Principles of Philosophy, Bayle writes: “Spinoza appears as orthodox in that book about the nature of God.” As we shall shortly see, Descartes too was accused of atheism by some of his contemporaries (though not so by Bayle). The latter designates his target quite explicitly: “[Spinoza’s] Tractatus Theologico Politicus, printed in Amsterdam, in the year 1670, is a pernicious and execrable book which contains all the seeds of the Atheism he plainly discovered in his Opera Posthuma.” François Lamy, in his 1696 Le nouvel athéisme renversé, also focused on the Ethics and the TTP in his attack on Spinoza’s atheism. Bayle’s reference to the Opera Posthuma is ostensibly targeting the Ethics at least primarily, if not uniquely. Even the most suspicious and distrustful mind would have to labor hard in order to find atheism in the Hebrew Grammar, or even in the Tractatus Politicus where Spinoza argues that it is not within the power, and hence right, of the commonwealth to induce people to adopt utterly absurd beliefs, such as “that the whole is greater than its part or that God does not exist.” The TTP and the Ethics are the works where Spinoza launches his merciless attack on anthropocentric thinking and anthropomorphic religion. Spinoza’s panentheism (“quicquid est, in Deo est”) constitutes the metaphysical foundation of the Ethics, and it is repeatedly and clearly alluded to in the TTP. Since it is these two elements – (1) Spinoza’s open assertions of panentheism and (2) his critique of andromorphic conceptions of God – which are the historical grounds for the atheism charge, it seems natural that the merit of this charge should be decided primarily by examination of these two foundational works. I will proceed in the following manner. In the first part of the paper, we will make our first acquaintance with the imputation of atheism by Spinoza’s contemporaries and Spinoza’s response to the charge (or lack thereof). In the second part, I discuss three broad strategies, or hermeneutic avenues, that have been pursued to impute atheism to Spinoza. The first of the three was dominant in Spinoza’s time, while the latter two were employed more recently. These strategies are not mutually exclusive and we can find occasionally various combinations of different shades of these three strategies. In this part, I will also raise some preliminary questions about the cogency of the hermeneutics employed by each strategy. In the third and fourth parts of the paper, I will discuss a small selection of key texts from the Ethics and the TTP, respectively, and argue that the atheist readings fail to make sense of these key passages (unless one adopts an extreme hermeneutics of suspicion which could allegedly find any view harbored in any text). Let me stress that this selection of passages is far from comprehensive, and that dozens of other passages can be adduced to establish the very same point. I hope by the end of the fourth part to convince the reader of the deep problems besetting the atheist readings. In the fifth and last part, I show that both panentheism and the critique of anthropomorphic religion and anthropomorphic conceptions of providence were quite common within rabbinic discourse. Thus, I will argue that if we are not in the business of announcing that both Maimonides and the Kabbalists were atheists, we should avoid the same imputation to Spinoza. Underlying my argument in this final part is the claim that at least some perceptions of Spinoza as an atheist are instances of what could be termed conceptual colonialism, i.e. the enforcement of the categories of a hegemonic culture (in this case, Western Christianity ) on minority cultures (in the current case, rabbinic Judaism). To be clear, this attitude need not be motivated by ill intentions or racism. It is always tempting and easy to explain the unfamiliar through the familiar, but conceptual stagnation and insistence on imposing the categories of the familiar on other cultures may quickly lead to deep distortion and blindness, despite one’s best intentions. Unless one is exceedingly careful to avoid the – completely natural – temptation to impose one’s own categories on a foreign culture (and to look for the coin only under the street light), one is likely to end up with distorted conceptions of the relevant alien culture, despite one’s best intentions. (shrink)

Review of British Medical Association handbook on human rights and doctors.

Rationale and objectives: Medical humanities are becoming increasingly recognized as positively impacting medical education and medical practice. However, the extent of medical humanities teaching in medical schools is largely unknown. We reviewed medical school curricula in Canada, the UK and the US. We also explored the relationship between medical school ranking and the inclusion of medical humanities in the curricula. -/- Methods: We searched the curriculum websites of all accredited medical schools (...) in Canada, the UK and the US to check which medical humanities topics were taught, and whether they were mandatory or optional. We then noted rankings both by Times Higher Education and U.S. News and World Report and calculated the average rank. We formally explored whether there was an association between average medical school ranking and medical humanities offerings using Spearman's correlation and inverse variance weighting meta-analysis. -/- Results: We identified 18 accredited medical school programmes in Canada, 41 in the UK, and 154 in the US. Of these, nine (56%) in Canada, 34 (73%) in the UK and 124 (80%) in the US offered at least one medical humanity that was not ethics. The most common medical humanities were medical humanities (unspecified), history, and literature (Canada); sociology and social medicine, medical humanities (unspecified), and art (UK); and medical humanities (unspecified), literature and history (US). Higher ranked medical schools appeared less likely to offer medical humanities. -/- Conclusions: The extent and content of medical humanities offerings at accredited medical schools in Canada, the UK and the US varies, and there appears to be an inverse relationship between medical school quality and medical humanities offerings. Our analysis was limited by the data provided on the Universities' websites. Given the potential for medical humanities to improve medical education and medical practice, opportunities to reduce this variation should be exploited. (shrink)

Recent studies show that racism still exists in the American medical profession, the fact of which legitimizes the historically long-legacy of mistrust towards medical profession and health authorities among African Americans. Thus, it was suspected that the participation of black patients in end-of-life care has always been significantly low stemmed primarily from their mistrust of the medical profession. On the other hand, much research finds that there are other reasons than the mistrust which makes African Americans (...) feel reluctant to the end-of-life care, such as cultural-religious difference and genuine misunderstanding of the services. If so, two crucial questions are raised. One is how pervasive or significant the mistrust is, compared to the other factors, when they opt out of the end-of-life care. The other is if there is a remedy or solution to the seemingly broken relationship. While no studies available answer these questions, we have conducted an experiment to explore them. The research was performed at two Philadelphia hospitals of Mercy Health System, and the result shows that Black patients’ mistrust is not too great to overcome and that education can remove the epistemic obstacles as well as overcome the mistrust. (shrink)

Recent developments in the field of forensic medicine and the judicial practice are both factors influencing considerably toward an increasing role of toxicologists in court hearings and litigation processes. The role of forensic toxicologist has been until a few decennia before a prerogative of the medico-legal specialists, but meanwhile a subspecialty of the general toxicology seems to have been created. Vis-à-vis the increasing presence of toxicologists in penal procedures of poisoning and intoxications, Albanian courts have created their own precedents (...) and bylaws, regulating the presence, the opinion taking, and the relative importance such an expert opinion will have on the final sentence. Due to a multiplicity of factors, legal terminology with regard to drugs of abuse needs to be revised and parallel to such a revision a better defining of the role of expert toxicologist as a collector and interpreter of the scientific proofs seems necessary. Overlapping competencies with judicial bodies and confusing legislative measures will do nothing else but complicate issues that should be and can be easily resolved, through simple and appropriate interventions at different levels. (shrink)

Background: Use of patients’ medical data for secondary purposes such as health research, audit, and service planning is well established in the UK. However, the governance environment, as well as public understanding about this work, have lagged behind. We aimed to systematically review the literature on UK and Irish public views of patient data used in research, critically analysing such views though an established biomedical ethics framework, to draw out potential strategies for future good practice guidance and inform (...) class='Hi'>ethical and privacy debates. Methods: We searched three databases using terms such as patient, public, opinion, and electronic health records. Empirical studies were eligible for inclusion if they surveyed healthcare users, patients or the public in UK and Ireland and examined attitudes, opinions or beliefs about the use of patient data for medical research. Results were synthesised into broad themes using a framework analysis. Results: Out of 13,492 papers and reports screened, 20 papers or reports were eligible. While there was a widespread willingness to share patient data for research for the common good, this very rarely led to unqualified support. The public expressed two generalised concerns about the potential risks to their privacy. The first of these concerns related to a party’s competence in keeping data secure, while the second was associated with the motivation a party might have to use the data. Conclusions: The public evaluates trustworthiness of research organisations by assessing their competence in data-handling and motivation for accessing the data. Public attitudes around data-sharing exemplified several principles which are also widely accepted in biomedical ethics. This provides a framework for understanding public attitudes, which should be considered in the development in any guidance for regulators and data custodians. We propose four salient questions which decision makers should address when evaluating proposals for the secondary use of data. (shrink)

The practice of medicine frequently involves the unconsented restriction of liberty. The reasons for unilateral liberty restrictions are typically that being confined, strapped down, or sedated are necessary to prevent the person from harming themselves or others. In this paper, we target the ethics of chemical restraints, which are medications that are used to intentionally restrict the mental states associated with the unwanted behaviors, and are typically not specifically indicated for the condition for which the patient is being treated. Specifically, (...) we aim to identify the conditions under which chemical restraints are ethically permissible. It is wrong to assume that what is morally true of physical restraints is also true of chemical restraints. Our aim is thus to identify the conditions under which chemical restraints are permissible while distinguishing these conditions from those of the application of physical restraints. (shrink)

Current challenges in medical practice, research, and administration demand physicians who are familiar with bioethics, health law, and health economics. Curriculum directors at American Association of Medical Colleges-affiliated medical schools were sent confidential surveys requesting the number of required hours of the above subjects and the years in which they were taught, as well as instructor names. The number of relevant publications since 1990 for each named instructor was assessed by a PubMed search.In sum, teaching (...) in all three subjects combined comprises less than two percent of the total hours in the American medical curriculum, and most instructors have not recently published articles in the fields they teach. This suggests that medical schools should reevaluate their curricula and instructors in bioethics, health law, and health economics. (shrink)

As the title of the article suggests, “The Burqa Ban”: Legal Precursors for Denmark, American Experiences and Experiments, and Philosophical and Critical Examinations, the authors embark on a factually investigative as well as a reflective response. More precisely, they use The 2018 Danish “Burqa Ban”: Joining a European Trend and Sending a National Message (published as a concurrent but separate article in this issue of INTERNATIONAL STUDIES JOURNAL) as a platform for further analysis and discussion of different perspectives. These (...) include case-law at the international level while focusing attention on recent rulings and judicial reasoning by the ECtHR and the ECJ; critical thought-experiments in religion, morality, human rights, and the democratic public space; a contextualized account of burqa-wearing interventions by federal and state governments and, moreover, various courts in the United States; and philosophical commentary and, in some instances, criticism of the Danish and/or European (French, etc.) approach. The different contributions have different aims. The section on case-law at the international level reports on those central judgments that, in effect, helped to pave the path for the Kingdom of Denmark’s burqa ban. Concerning the concurring judges at the ECtHR, the opinions served to uphold a preexisting ban and to grant a wide margin of appreciation to the national authorities, thereby limiting the Court’s own review. -/- As regards to the ECJ, the legality of company rules that contain a policy of neutrality for the workplace was examined, with a similar outcome. The authors who discuss religion, morality, human rights and the democratic public space are endeavoring to, respectively, appeal to ethics as a testing stone for law and to both challenge and address several forms of “expressivist worry” in connection with face veils. In doing so, the authors ask a number of thought-provoking questions that hopefully will inspire public policymakers to careful analysis. While the section that is devoted to American perspectives highlights a comprehensive survey of political and legal responses to, in particular, full-face veils like the burqa, the relevant author also incorporates public perceptions and, in the course of examining these, draws a parallel to “the fate” of the hoodie. The constitutionality of burqa-wearing in America, so it also appears, is partially an open question, but differentiating between religious, political, or personal reasons is a de jure premise. Given that the Danish legislators who drafted law L 219 to ban burqa-wearing in public places rely on a reference to political Islam, they relegate religious and personal reasons to the private domain, thereby also adopting secularism as a premise. This is explored in the last author response of the article, more precisely, in an account of the underlying materialism that, in turn, is applied to Muslim women. If policymakers and legislators engaged in Thinking Things Through exercises, they could, as a minimum, avoid law-making strategies that are not in the spirit of the theory they themselves invoke, albeit tacitly. While the aim of, as it were, arresting culturally self-contradicting legislators is unique for the section in question, all the authors who contribute to the joint research project have one end-goal in common, namely to inform about important perspectives while at the same time opening up for parameters for (more) fruitful, constructive and (if need be) critical debate in the future. With this in mind, four recommendations are presented by the research director for the project. Legally, politically, socially and culturally, conflict-resolution should not translate the relationship between rulers and the ruled into a separation ideology, an instance of controllers versus the controlled. All things being equal, that is the objective limit for a democratic society. (shrink)

In medical ethics, business ethics, and some branches of political philosophy (multi-culturalism, issues of just allocation, and equitable distribution) the literature increasingly combines insights from ethics and the social sciences. Some authors in medical ethics even speak of a new phase in the history of ethics, hailing "empirical ethics" as a logical next step in the development of practical ethics after the turn to "applied ethics." The name empirical ethics is ill-chosen because of its associations with "descriptive ethics." (...) Unlike descriptive ethics, however, empirical ethics aims to be both descriptive and normative. The first question on which I focus is what kind of empirical research is used by empirical ethics and for which purposes. I argue that the ultimate aim of all empirical ethics is to improve the context-sensitivity of ethics. The second question is whether empirical ethics is essentially connected with specific positions in meta-ethics. I show that in some kinds of meta-ethical theories, which I categorize as broad contextualist theories, there is an intrinsic need for connecting normative ethics with empirical social research. But context-sensitivity is a goal that can be aimed for from any meta-ethical position. (shrink)

This paper outlines ethical problems with the regional quota systems used in Japanese medical schools from the perspective of the autonomous choice of doctors and medical students. “Regional quotas” have been established in university medical schools in Japan to cultivate doctors for rural areas, and the percentage of such quotas has been significantly increasing in recent years. This study mainly focuses on the regional quota systems for medical schools whereby medical students receive scholarships on (...) the condition that they work in community medicine for a certain period after graduating and are exempt from repaying the scholarship depending on the fulfillment of their obligations. In many cases, the regional quota systems impose penalties on those who leave to prevent withdrawal, and some claim that it is morally impermissible to withdraw from the contract. Thus, the study reviews regional quota systems and argues that these systems contain contracts that restrict the signatory’s freedom of residence and professional choice for more than a decade, and that it is difficult to withdraw from the contract because of the penalties. Consequently, it demonstrates that these contracts are morally unjust as they severely restrict the autonomous choice of doctors and medical students. In conclusion, the current regional quota systems are morally impermissible and local authorities should recruit new doctors without using such systems. (shrink)

The burgeoning literature on the ethical issues raised by climate engineering has explored various normative questions associated with the research and deployment of climate engineering, and has examined a number of responses to them. While researchers have noted the ethical issues from climate engineering are global in nature, much of the discussion proceeds predominately with ethical framework in the Anglo-American and European traditions, which presume particular normative standpoints and understandings of human–nature relationship. The current discussion on (...) the ethical issues, therefore, is far from being a genuine global dialogue. The aim of this article is to address the lack of intercultural exchange by exploring the ethics of climate engineering from a perspective of Confucian environmental ethics. Drawing from the existing discussion on Confucian environmental ethics and Confucian ethics of technology, I discuss what Confucian ethics can contribute to the ethical debate on climate engineering. (shrink)

The 2017 story of Charlie Gard is revisited. Upon the British High Court’s ruling in favor of the physicians that the infant should be allowed to die without the experimental treatment, the view of the public as well as the opinions of bioethicists and Catholic bishops are divided, interestingly along with a cultural line. American bioethicists and Catholic bishops tend to believe that the parents should have the final say while British/European bioethicists and Catholic bishops in general side with (...) the court’s decision. The paper explores the place of culture in bioethical reasoning between the UK/Europe and the US while claiming that cultural differences are more important than geopolitical or religious differences to understand the bioethical positions of a group. In addition, the authors introduce a decision-making program for handicapped neonates which is developed by the American Jesuit Bioethicist, Richard McCormick, and modified further by the contemporary American Jesuit Bioethicist, Peter A. Clark, in an attempt to see if the program’s normatizing categories can contribute to the culture-laden ethical discussions on Charlie’s case. However, it is admitted that the McCormick-Clark device is borne out of the American and Catholic theological context. (shrink)

Background: Smart sensors have been developed as diagnostic tools for rehabilitation to cover an increasing number of geriatric patients. They promise to enable an objective assessment of complex movement patterns. -/- Objective: This research aimed to identify and analyze the conflicting ethical values associated with smart sensors in geriatric rehabilitation and provide ethical guidance on the best use of smart sensors to all stakeholders, including technology developers, health professionals, patients, and health authorities. -/- Methods: On the basis of (...) a systematic literature search of the scientific databases PubMed and ScienceDirect, we conducted a qualitative document analysis to identify evidence-based practical implications of ethical relevance. We included 33 articles in the analysis. The practical implications were extracted inductively. Finally, we carried out an ethical analysis based on the 4 principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice. The results are reported in categories based on these 4 principles. -/- Results: We identified 8 conflicting aims for using smart sensors. Gains in autonomy come at the cost of patient privacy. Smart sensors at home increase the independence of patients but may reduce social interactions. Independent measurements performed by patients may result in lower diagnostic accuracy. Although smart sensors could provide cost-effective and high-quality diagnostics for most patients, minorities could end up with suboptimal treatment owing to their underrepresentation in training data and studies. This could lead to algorithmic biases that would not be recognized by medical professionals when treating patients. -/- Conclusions: The application of smart sensors has the potential to improve the rehabilitation of geriatric patients in several ways. It is important that patients do not have to choose between autonomy and privacy and are well informed about the insights that can be gained from the data. Smart sensors should support and not replace interactions with medical professionals. Patients and medical professionals should be educated about the correct application and the limitations of smart sensors. Smart sensors should include an adequate representation of minorities in their training data and should be covered by health insurance to guarantee fair access. (shrink)

Winner of the American Philosophical Association’s 2019 Essay Prize in Latin American Thought | Western imperialism has received many different types of moral-political justifications, but one of the most historically influential justifications appeals to an allegedly universal form of human nature. In the early modern period this traditional conception of human nature—based on a Western archetype, e.g. Spanish, Dutch, British, French, German—opens up a logical space for considering the inhabitants of previously unknown lands as having a ‘less-than-human’ (...) nature. This appeal to human nature originally found its inspiration in the philosophy of Aristotle, whose ethical thought pervaded the work of European philosophers at the outset of the early modern period and the modern age of empire. Indeed some Spanish writers—most famously, Juan Ginés de Sepúlveda (b. 1494)—explicitly appealed to Aristotle’s moral-political philosophy in order to justify the conquest of the Americas in the early sixteenth century, for instance to justify war against the Aztecs and other indigenous peoples. At the time of European arrival, the Aztec civilization was easily the greatest in Mesoamerica—and yet the Europeans generally considered the Aztec people to be ‘barbaric,’ i.e. less-than-fully-human. (shrink)

The legacy of George W. Bush will probably be associated with the President’s infallibly certain style of visionary leadership and his specific vision of a ‘Freedom Agenda’. According to this vision, the United States must spread democracy to all people who desire liberty and vanquish those tyrants and terrorists who despise it. Freedom is universally valued, and the United States is everywhere perceived as freedom’s protector and purveyor. So, the mission of the Freedom Agenda is to guard existing freedoms as (...) well as spread the democratic political system to those countries lacking comparable freedoms. Recent analyses of the Bush Freedom Agenda examine its roots in realist foreign policy and neoconservative political thought. In this paper, I take a different approach, connecting the Freedom Agenda to the ideas of two philosophers: (i) Isaiah Berlin’s notion of positive-negative liberty and (ii) John Dewey’s concept of freedom as a function of culture. My central claim is that when compared with the ideas of Berlin and Dewey, the Freedom Agenda is a faulty construct, both conceptually and practically, for understanding America’s role in global affairs. The Freedom Agenda proves to be neither conservative nor universal. Nevertheless, it constitutes an essential element of George W. Bush’s legacy, a vision of American purpose in a threatening and divisive world. (shrink)

Definition of the problem The umbrella term “explicability” refers to the reduction of opacity of artificial intelligence (AI) systems. These efforts are challenging for medical AI applications because higher accuracy often comes at the cost of increased opacity. This entails ethical tensions because physicians and patients desire to trace how results are produced without compromising the performance of AI systems. The centrality of explicability within the informed consent process for medical AI systems compels an ethical reflection (...) on the trade-offs. Which levels of explicability are needed to obtain informed consent when utilizing medical AI? Arguments We proceed in five steps: First, we map the terms commonly associated with explicability as described in the ethics and computer science literature, i.e., disclosure, intelligibility, interpretability, and explainability. Second, we conduct a conceptual analysis of the ethical requirements for explicability when it comes to informed consent. Third, we distinguish hurdles for explicability in terms of epistemic and explanatory opacity. Fourth, this then allows to conclude the level of explicability physicians must reach and what patients can expect. In a final step, we show how the identified levels of explicability can technically be met from the perspective of computer science. Throughout our work, we take diagnostic AI systems in radiology as an example. Conclusion We determined four levels of explicability that need to be distinguished for ethically defensible informed consent processes and showed how developers of medical AI can technically meet these requirements. (shrink)

The conceptual model of United Nations reform - "UN 3.0" includes the General Program of Action on UN Reform, consisting of two stages. The first stage for 2020-2025 envisages the transformation of the main organs of the UN - the General Assembly and the Security Council with measures to improve the effectiveness of the management system, address the "veto problem", problem of financing, improve staff work and administrative and financial control, strengthen UN media, improvement of work with the global (...) civil society. The General Assembly is converted into the General All-Parliamentary Assembly of the UN. In the structure of the Assembly, the Council for Law is being established, which coordinates the activities of UN structures in the field of law. To coordinate the activities of the UN in the field of human rights and civil society, ethical issues, the General all-parliamentary Assembly creates the Council on ethics, human rights and civil society and transforms the Committee on information into the Council on public information and communication with civil society. The structure of the Council includes all UN media. The reform of the UN Security Council is carried out in three sub-stages. At the 1st sub-stage (2020-2021) the Security Council is transformed into the Council of Existential Security (CES). The membership of the CES is increased to 25 member countries, of which five countries have the right of the unconditional (absolute, eternal) veto: Great Britain, France, China, Russian Federation, USA. The General All-Parliamentary Assembly elects 15 new permanent members of the Council of Existential Security with the right of the conditional (limited) veto: Argentina, Australia, Brazil, Canada, Egypt, Germany, India, Indonesia, Italy, Mexico, South Africa, Nigeria, Pakistan , Turkey, Japan (if they fulfill the mandatory restrictive conditions). At this sub-stage, the CES elects also five non-permanent members with the right of a conditional (limited) veto when they meet the mandatory restrictive conditions, with a rotation period of 2 years from geographical regions (or regional unions): Africa, Latin America and the Caribbean, Asia and the Pacific Ocean (2 places), Eastern Europe. On the second sub-stage (2022-2023), subject to the effective activity of the CES of the enlarged composition and compliance with mandatory restrictive conditions, new permanent members of the "Existential Security Council" are elected with the right of a conditional (limited) veto: Iran, Spain, Poland, Saudi Arabia. Members of the CES may be regional unions, whose member countries are not represented in the CES, but still have one vote with the right of a conditional (limited) veto. -/- Two essential levels of the veto: 1. Unconditional (absolute, eternal) veto is the historical right of veto of the five permanent members of the Council of Existential Security - Great Britain, China, Russia, USA, France; 2. Сonditional (limited) veto is the veto of other permanent and non-permanent members of the Council of Existential Security. The right of veto is a unique international school for the achievement of consensus, a school of high democracy for Humanity, a reliable guarantee of the viability of the UN structure. The Council for Existential Security centralises the management of the UN subsidiary bodies with the expansion of their security functions: the Military Staff Committee, the Counter-Terrorism Committee, the Committee for the Prevention of the Spread of Nuclear, Chemical and Biological Weapons, the Sanctions Committees and other committees. On the basis of the decision of the Council of Existential Security, the General All-Parliamentary Assembly creates permanent contingents of UN peacekeeping and counter-terrorism forces. In addition, two Centers are being created in the structure of the Council for Existential Security: the World Center for the Elimination of the Effects of Technogenic and Natural Disasters with branches on all continents and the World Center for the Analysis of Existential Risks and the Overall Security Strategy. The Center is developing the Programs of research and monitoring of global existential threats and risks. In order to increase the level of legitimacy and authority of the Secretary General of the United Nations, the Rules of procedure for elections to this post are changing. Each member country of the Council for Existential Security represents one of the most authoritative candidates for election to the post of Secretary General at the session of the General All-Parliamentary Assembly, with the possibility of nominating candidates from other countries, including those not members of the Council for Existential Security. Elections are held in two rounds during one day of the session of the Assembly. The Legal Committee of the UN General Assembly is developing a Program for the Reform of the Judicial System of the United Nations, which takes into account the proposals of the previous international discussion and determines the scope and terms of the reform of the courts. In accordance with the Program of Action on UN Reform for 2020-2025, reforms are under way in the structure of the Economic and Social Council. The central task of the reform is to strengthen the coordinating role of ECOSOC in the entire system of UN-related specialized agencies, funds and programs related to the Council. The key task of the UN reform is the solution of the financing problem. A unified "UN Open Budget "Solidarity XXI" is being created, including the financing of peacekeeping operations and other expenses. Each country, a member of the United Nations, lists in an established period, once a year, an Existential contribution - the Earth Tax. The Earth Tax for each UN member state is established on the basis of four scales of calculation: Scale I - for 5 permanent members of the Council of Existential Security, who have the right of absolute (absolute) veto; Scale II - for the permanent members of the SEB, who have the right to a conditional (limited) veto; Scale III - for non-permanent members of the SEB, who have the right to a conditional (limited) veto; Scale IV - for all other UN member countries. The program of action on UN reform includes a set of measures to ensure transparent work of the International Civil Service Commission with the involvement of the UN media. To strengthen control functions in the sphere of personnel policy, administrative and financial management, the General All-Parliamentary Assembly of the United Nations establishes the Permanent Commission on Ethics and Administrative and Financial Control. All members of the Commission, members of the Committees and auditors are independent in their activities from the leadership of the United Nations, its funds and programs. The General All-Parliamentary Assembly completes the first stage of the Program of Action on UN Reform in 2025 and, following an open discussion, introduces a single language of international communication - Esperanto and approves it as the official language of the United Nations. With a view to more effective work of the central UN governing bodies in the face of increasing existential threats and risks, reducing the current expenses for the maintenance of the central bodies of the UN, the Council for Existential Security and the General All-Parliamentary Assembly decide on the relocation of the UN headquarters to Iceland. The UN building complex in New York is transferred to preferential use of non-governmental organizations, which contribute to the implementation of the goals of the United Nations. At the second stage of the UN reform in the period 2026-2028, additional necessary transformations are being made in the UN system. At the end of the first stage of the reform, taking into account the reforms carried out by the main organs of the United Nations and the internal improvement of the work of all its structures, the United Nations Program of Action for the years 2026-2028 is being developed. (shrink)

Objective: This main aim of the study is to explore COVID-19 pandemic problems from the perspective of public health-clinical care ethics through online mediareports in Turkey. Method: This research was designed as a descriptive and qualitative study that assesses COVID-19 through online media reports on critics between the periods of March 11, 2020 and April 2 2020 as a quantitative as number of reports and qualitative study, across Turkey. Reports were from Turkish Medical Association websites which included newspaper (...) reports. Study data were presented as statistically and qualitative data case and headlines. No ethical or ofTicial permission was sought as the study was conducted through open access internet news sites. Results: This online reports analysis retrieved about 6723 articles about the COVID-19. According to study data, information about COVID-19 were themed as follows: general deTiciencies in taking action and isolation, lack of isolation, passengers and transport vehicles not quarantined ; insufTicient diagnostic tests, decision to test after healthcare professionals become infected, lack of equipment, lack of evaluation outbreak countries [Table 2]. Conclusion and Suggestions: COVID-19 is a pandemic and is a global public health problem that concerns every individual and needs to be handled carefully. This requires a multi-faceted preparation and education. In this context, healthcare professionals should be well trained in this aspect and have all the necessary equipment throughout the process. Additionally, it should work systematically with the cooperation of all health organizations, the Ministry of Health, local governments and of course the media, in order to inform society, fairly distribute the resources and to implement the safety measures effectively. BrieTly, lack of transparency, insufTicient information, limited resources, lack of public health protection measures such as partial quarantine decision, partial implementation of the scientiTic board's re c ommenda ti on s fo r e c on omi c rea s on s, and contradiction of the explanations are revealed as serious ethical problems. (shrink)

This paper assesses the state of research ethics in low- and middle-income countries and the achievements of the Fogarty International Center's bioethics training program since 2000. The vision of FIC for the next decade of research ethics education is encapsulated in four proposed goals: (1) Ensure sufficient expertise in ethics review by having someone with long-term training on every high-workload REC; (2) Develop LMIC capacity to conduct original research on critical ethical issues by supporting doctoral and postdoctoral training and (...) career paths for research ethicists; (3) Make research training and review at LMIC institutions sustainable by identifying additional funding mechanisms and models; (4) Make institutional research systems more ethical and efficient through context-specific training integrated into all levels of scientific training. (shrink)

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical (...) support for gender diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

Williams Syndrome provides a striking test case for discourses on disability, because the characteristics associated with Williams Syndrome involve a combination of “abilities” and “disabilities”. For example, Williams Syndrome is associated with disabilities in mathematics and spatial cognition. However, Williams Syndrome individuals also tend to have a unique strength in their expressive language skills, and are socially outgoing and unselfconscious when meeting new people. Children with Williams are said to be typically unafraid of strangers and show a greater interest in (...) contact with adults than with their peers. This apparently keen social knowledge is a counterexample to the discussion of disability among academic philosophers, especially philosophers of the early modern period. Locke infamously used the example of disability to claim that Descartes’ arguments in favor of innate ideas were incorrect. On the contrary, Williams Syndrome may stand as an example of innate social knowledge; something that could benefit current discourse in philosophy, disability theory, and medical ethics. (shrink)

Integrating medical imaging with computing technologies, such as Artificial Intelligence (AI) and its subsets: Machine learning (ML) and Deep Learning (DL) has advanced into an essential facet of present-day medicine, signaling a pivotal role in diagnostic decision-making and treatment plans (Huang et al., 2023). The significance of medical imaging is escalated by its sustained growth within the realm of modern healthcare (Varoquaux and Cheplygina, 2022). Nevertheless, the ever-increasing volume of medical images compared to the availability of imaging (...) experts. Biomedical experts and radiologists have resulted in a widening disparity, causing an excess and overwhelming workload on these healthcare professionals (Chen et al., 2021). Several studies indicate that the present-day biomedical radiologist is now saddled with the daunting task of interpreting an image almost every 10 seconds to keep pace with the burgeoning clinical demands (McDonald et al., 2015; Hosny et al., 2018; Lantsman et al., 2022). This cognitive drain has invariably led to inevitable consequences such as delays in diagnosis and an amplified risk of diagnostic errors – thus, the biomedical imaging aspect is in dire need of methods that would aid accurate diagnostics and analytics for improved decision making. In this review, the importance of AI-related technologies such as ML and/or DL methods are reviewed in relation to the processing of medical or biomedical images along with their potentials, challenges, and possible suggestions for future studies in the health landscape. The focus will be on machine learning methods associated with the medical field of image classification. (shrink)

Machine intelligence already helps medical staff with a number of tasks. Ethical decision-making, however, has not been handed over to computers. In this proof-of-concept study, we show how an algorithm based on Beauchamp and Childress’ prima-facie principles could be employed to advise on a range of moral dilemma situations that occur in medical institutions. We explain why we chose fuzzy cognitive maps to set up the advisory system and how we utilized machine learning to train it. We (...) report on the difficult task of operationalizing the principles of beneficence, non-maleficence and patient autonomy, and describe how we selected suitable input parameters that we extracted from a training dataset of clinical cases. The first performance results are promising, but an algorithmic approach to ethics also comes with several weaknesses and limitations. Should one really entrust the sensitive domain of clinical ethics to machine intelligence? (shrink)

In the United States, prohibitionist policies are used as the primary approach to combat the negative effect of substance use on society. An extensive academic literature spanning the disciplines of economics, political science, and multiculturalism documents the great social costs of the United States’ “War on Drugs” both nationally and internationally. These costs come with at best marginal effect on substance abuse and other crimes linked to the drug trade. In many cases, there is a reason to believe that these (...) policies exacerbate the problems they aim to address. This article explores psychologists’ ethical commitments to social change concerning such drug policy, given the field of psychology’s expanding commitment to social justice. We examine arguments regarding the boundaries between psychologists’ personal and professional ethics with regard to political participation. Using drug prohibition as an exemplar, we suggest that many psychologists’ political actions and professional ethics may be misaligned. Ultimately, we conclude that the endorsement of prohibitionist drug policies is in direct conflict with the guiding ethical principles put forth by the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct. (shrink)

In 2018 Academic Placement Data and Analysis ran a survey of doctoral students and recent graduates on the topics of diversity and inclusivity in collaboration with the Graduate Student Council and Data Task Force of the American Philosophical Association. We submitted a preliminary report in Fall 2018 that describes the origins and procedure of the survey [1]. This is our final report on the survey. We first discuss the demographic profile of our survey participants and compare it (...) to the United States general population, its doctoral students, and APA membership, finding several areas of underrepresentation (i.e. gender, race/ethnicity, socioeconomic, and veteran status). We then discuss the results of questions regarding diversity and inclusivity. We find, for instance, that participant comfort in philosophy depends on gender, sexuality, race/ethnicity, disability, and language status and that participants most often mentioned the theme of diversity when asked how philosophy could be more inclusive. Finally, we discuss the results of questions related to graduate program and placement. We find, for example, that underrepresented graduates are both less likely to recommend their graduate program to others and less likely to prefer an academic job. We close by making some recommendations for the APA and for the discipline based on our findings. (shrink)

What factors affect judicial decision-making? The legal system is of utmost importance because of its impact on our lives. Judges appear to have the most power among any social workers seeing as the precedents set in their decisions are tantamount to written law. Nevertheless, judges may be subject to certain biases, moral and cognitive alike, which influence their rulings. Looking into how morality and cognitive biases affect judges may also reveal how we as individuals handle combining morals with ethics- (...) as well as whether any discrepancies among ourselves are justifiable. An investigation into relevant moral and jurisprudential theories revealed much about the inner workings of a judge’s mindset- whether he or she recognizes it or not. Coupling this with corroborated research on a select few heuristics present specifically for judges sets the foundation for an array of possible solutions in order to ensure the most impartial judicial proceedings. Plausible remedies include conducting premortems, implicit association tests, and a revised ruling procedure. (shrink)

After an intensive 4-year process, the World Medical Association (WMA) has revised its International Code of Medical Ethics (ICoME). In their report outlining this process, Parsa-Parsi et al not only describe how the WMA sought to ‘cultivat[e] international agreement’ on a ‘global medical ethos’, but also outline the philosophical framework of the ICoME: how the WMA, as the ‘global representation of the medical profession’, created and revised the ICoME through the process of international professional self-regulation.1 (...) However, there is a significant tension to be found in this framework—one which contrasts the international scope of the ICoME with the supposed source of its legitimacy. Here, we seek to characterise this tension and the doubt which it casts on the legitimacy of the ICoME. (shrink)

*North American Society for Social Philosophy (NASSP) Book Award 2019.* -/- *International Studies Association (ISA) - International Ethics Section Book Award 2021.* -/- Although military mores have relied primarily on just war theory, the ethic of cooperation in warfare (ECW)—between enemies even as they are trying to kill each other—is as central to the practice of warfare and to conceptualization of its morality. Neither game theory nor unilateral moral duties (God-given or otherwise) can explain the explicit language of (...) cooperation in developing and enforcing principles of military ethics and the law of armed conflict. -/- The ethic of cooperation is borne of various motivations: reciprocity, self-preservation, and efficiency, to be sure, but also a sense of warrior honor and concern with human rights. This shared morality can persist despite making it more difficult for one side or the other to win and, unfortunately, its well-meaning motivations often lead to unintended tragic consequences. -/- This book explores three manifestations of this significant yet overlooked ethic of cooperation in warfare: (1) for a “fair fight,” (2) to protect classes of individuals (e.g., non-combatants or prisoners of war), and (3) to end the war quickly. Such cooperation can take unexpected forms, from ad hoc decisions on the battlefield to institutionalization in international law, and is the source of some critical tensions in one of the most significant developments in warfare in recent years: namely, how to handle terrorism or other forms of warfare that lie outside the purview of international law. -/- Each type of ECW raises questions internal to that ethic, such as inconsistencies in the concept of “parity” across different weapons bans, contradictions within the warrior ethic that heavily influence—and therefore confuse—notions of the “fair fight,” the disconnect between what protections a person receives and his responsibility for the war (e.g., political leaders), or the limited decisiveness of outcomes generated by very short wars. -/- Their simultaneous application also generates significant tensions and raises questions about the proper relationship of ECW to the immediate goal of war itself, which is to win, and thus yield either a political settlement or a justicial decision. For example, the ECWs for a “fair fight” and to protect classes of individuals can make it harder to win the war, but even more concerning is that they can also kill more people, which in the latter case contravenes its very purpose. -/- Human history is in some ways the story of trying to concurrently wage and tame war, and the architecture of warfare itself is informed by the ECW, in particular: (a) the political nature of war, (b) the abdication from jus ad bellum judgments in order to concentrate on justice within war (jus in bello), and (c) the ways in which modern nation-states collude to define “legitimacy” in war. -/- The combination of these three features leave questions of justicial right and responsibility for war disturbingly unresolved, it also generates new challenges in a geopolitical context in which cooperative and non-cooperative (e.g. contemporary terrorism) forms of warfare clash. (shrink)

"Why are there 'transsexuals' but not 'transracials'?" "Why is there an accepted way to change sex, but not to change race?" I have repeatedly heard these questions from theorists puzzled by the phenomenon of transsexuality. Feminist thinkers, in particular, often seem taken aback that in the case of category switching the possibilities appear to be so different. Behind the question is sometimes an implicit concern: Does not the (hypothetical or real) example of individual “transracialism” seem politically troubling? And, if it (...) is, does not the case of transsexuality merit equivalent critique? Or, conversely, if one accepts transsexuals as people with legitimate demands (e.g., on medical resources or single-sex spaces), then would one not also be committed to accepting the putative transracial in analogous ways? Understanding the ontological constraints and possibilities with regard to transforming one’s identity is, I suggest, a project that should accompany ethical evaluation of those transformations. Under what circumstances is it (un)ethical to leave behind a gender or racial group with which one has once been affiliated? This question is, again, especially pressing for radical thinkers who endorse the claims that race and gender taxonomies are internally hierarchical and constituted through relations of oppression, domination, and normalization. Changing one’s identity under these circumstances will surely always be linked, however tenuously, to consideration of the larger political and cultural milieu in which such changes are advantageous or disadvantageous, complicit with oppressive norms and/or resistant to them. To illuminate these larger questions, in this paper, I first provide three examples of the analogy thesis in feminist thinking about race and sex change, each of which draws ethical conclusions about individual motivation, political strategy, or public policy, premised on the assumption that race and sex change are equivalent phenomena. None of these accounts consider the genealogy of each category as significant to contemporary possibilities. I next offer a descriptive analysis that highlights different norms at play in contemporary North American understandings: Sex–gender, I argue, is essentialized as a property of the individual’s body, while race is essentialized with reference to both the body and ancestry. This analysis, I conclude, shows politically significant disanalogies between the categories, and reveals the importance of genealogical accounts of race and sex in thinking ethically about changing ourselves. (shrink)

During their educational life, medical students encounter several challenges, the origins and causes of which vary. This paper explores and attempts to scrutinize two of these challenges, before eventually introducing the concept of responsibility. First, this paper describes the general characteristics of medical schools, medical students, and medical education. Second, two different ethical challenges that medical students confront are then delineated: the anxiety of continuously questioning ‘while being trained, do I cause patients to receive (...) suboptimal health care?’ and occasionally feeling obligated, consequently, to breach the ethical boundaries to practice procedures on patients. Finally, the faculty of responsibility and its components are introduced and discussed as a model that can overcome these ethical challenges. (shrink)

Techniques from behavioral economics—nudges—may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate. This article rejects a principle to which parties on both sides of this debate sometimes seem (...) committed: that nudges are morally permissible only if they are consistent with autonomy. Instead, I argue that, at least in the case of pediatric vaccination, some autonomy-undermining nudges may be morally justified. This is because parental autonomy in pediatric decision-making is not as morally valuable as the autonomy of adult patients, and because the interests of both the vaccinated child and other members of the community can sometimes be weighty enough to justify autonomy-infringing pediatric vaccination nudges. This article concludes with a set of worries about the effect of pediatric vaccination nudges on parent-physician relationships, and it calls on the American Academy of Pediatrics to draw on scientific and bioethics research to develop guidelines for the use of nudges in pediatric practice and, in particular, for the use of pediatric vaccination nudges. (shrink)

Increased participation in public affairs by the U.S. Conference of Catholic Bishops during the highly contentious 2012 Presidential election has seemingly brought the traditions of Catholic social teaching and socialism into a high profile conflict. While it is clear that President Obama is not what most academics would consider a “socialist,” modern discourse still presents what I argue is a false dichotomy- one can be either endorse natural law (especially of the Catholic variety) or socialism, but not both. While (...) my goal in this article is to refute the alleged incompatibility, not to determine its historical roots, some speculation about its origin may be illuminating. Recent work on religious identity in the United States suggests that Americans largely identify Christianity with the right wing of the American culture war. Additional research is required to fully grasp where this perception comes from, but one can venture several guesses: the rise of the “Christian Right” in Republican Party politics of the late 1990s and early 2000s, the concept of “social justice” being lampooned by Right-wing talk show hosts, and decades of a Catholic Church that firmly opposed Cold War-era Soviet Communism. The contrast between left-wing and right-wing thought on social issues (same-sex marriage, abortion, etc.) is very well documented and widely discussed. Differences between leftists and natural lawyers on economic issues, however, are more often assumed than argued for. Perhaps this is a matter of “guilt by association,” with those arguing that leftist social policy is at odds with natural law simply assuming that the same must be the case with leftist economic policy as well. Thus, natural law, long tied to Christianity throughout its history, is gratuitously appropriated by right-wing political ideology. Against this claim of incompatibility, I argue that one can rationally hold both socialism and natural law to be true. In his landmark Natural Law and Natural Rights, John Finnis offers what is arguably the twentieth century’s most complete theory of natural law. I will argue that the conception of socialism laid out by G.A. Cohen in hisWhy Not Socialism? is compatible with Finnis’s account of the human goods, and that natural lawyers can therefore reasonably endorse Cohen’s prescription for socialism. (shrink)

According to Steven Nadler's novel interpretation of Spinoza's much discussed ‘free man’, the free man is not an unattainable ideal. On this reading, the free man represents an ideal condition not because he is passionless, as has often been claimed, but because even though he experiences passions, he ‘never lets those passions determine his actions’. In this paper, I argue that Nadler's interpretation is incorrect in taking the model of the free man to be an attainable ideal within our reach. (...) Furthermore, I show that Spinoza's moral philosophy has room for another ideal yet attainable condition, which is represented by the wise man. On my reading, becoming a wise man consists not in surmounting human bondage, but in understanding ourselves as finite expressions of God's power and, thereby, coming to terms with the ineliminability of bondage for us due to our very human or modal condition in the Spinozistic universe. (shrink)

This paper addresses the recent rise of the use of alternative medicine in Western countries. It offers a novel explanation of that phenomenon in terms of cognitive and economic factors related to the free-market and patient-centric approach to medicine that is currently in place in those countries, in contrast to some alternative explanations of this phenomenon. Moreover, the paper addresses this troubling trend in terms of the serious harms associated with the use of alternative medical modalities. The explanatory theory (...) defended here is then predicated on the idea that an extreme patient-centric model of medical practice that treats largely ignorant patients as consumers of medical products and services endowed with an essentially unrestricted power of freedom to choose treatments predictably leads serious and avoidable harms. Some important moral and epistemological consequences of this model are then articulated and corrective measures are suggested. (shrink)

The European project European and Latin American Systems of Ethics Regulation of Biomedical Research Project (EULABOR) has carried out the first comparative analysis of ethics regulation systems for biomedical research in seven countries in Europe and Latin America, evaluating their roles in the protection of human subjects. We developed a conceptual and methodological framework defining ‘ethics regulation system for biomedical research’ as a set of actors, institutions, codes and laws involved in overseeing the ethics of biomedical research on humans. (...) This framework allowed us to develop comprehensive national reports by conducting semi-structured interviews to key informants. These reports were summarised and analysed in a comparative analysis. The study showed that the regulatory framework for clinical research in these countries differ in scope. It showed that despite the different political contexts, actors involved and motivations for creating the regulation, in most of the studied countries it was the government who took the lead in setting up the system. The study also showed that Europe and Latin America are similar regarding national bodies and research ethics committees, but the Brazilian system has strong and noteworthy specificities. (shrink)

The purpose of college and university ranking mainly resides to assist with the students in choosing their schools and programs at the level they wish to study. The US News and World Report (USNWR) graduate programs ranking is notable that evaluates the graduate level programs uniquely and in contrast with other general subject rankings. Along with the reputation of source, this specificity enables to enjoy a number of subscribers in making an application decision about which school or program is competitive (...) and personally fits. Given the study of national research council is most exhaustive and authoritative ranking source on research doctorates, called Ph.Ds, the ranking of professional schools, for instance, law schools, medical schools, nursing schools and on, as presented to the students in USNWR is very determinative in deciding which school I choose. In this light, the following tables show a ranking that has been yielded on the diversity and quality of graduate and research doctorate programs as well as law studies specifically. Therefore, the tables can be referred to a vast of interested people on the graduate studies in the United States. The last part of reference can be referred not only by JD students, but also by researchers in the graduate law programs. Since some small or exclusively JD-oriented law schools are not available of LL.M or graduate study, the users of table are expected to read consciously. The ranking table has a threshold to qualify so as to be enlisted that the top 44 law schools in all specialties exclusively had been selected and ranked according to the average of two subjects. As said, it could be used secondarily to refer in deciding the schools on the application of general LL.M program. Given the junior scholarly nature of LL.M. or graduate law programs, it is considered that the legal writing program is half factored to select the schools. The column 1 and 2 transcribes the US ranking, which are added for a sum in column 3. Least number is placed at top and less number attains a high ranking correspondingly thorough the end of institution. The first and second parts of this work show the top universities according to the number of programs, whose possible highest rating is placed within the range 1st -17th in either R or S rank of most recent 2010 NRC assessment and roughly same range in the USNWR graduate programs ranking. They are prepared from the revised NRC report published in 2011, which is most recent as well as based on the 2021 version of USNWR. Both data will be incorporated into my current project concerning the American higher education and graduate studies. (shrink)

Abstract: In Vacco v. Quill, 521 U.S. 793 (1997), the Supreme Court for the first time in American case law explicitly applied the principle of double effect to reject an equal protection claim to physician-assisted suicide. Double effect, traced historically to Thomas Aquinas, proposes that under certain circumstances it is permissible unintentionally to cause foreseen evil effects that would not be permissible to cause intentionally. The court rejected the constitutional claim on the basis of a distinction marked out by (...) the principle, i.e., between directly intending the death of a terminally ill patient as opposed to merely foreseeing that death as a consequence of medical treatment. The Court held that the distinction comports with fundamental legal principles of causation and intent. Id. at 802. -/- Critics allege that the principle itself is intrinsically flawed and that, in any event, its employment in Vacco is without legal precedent. I argue in response to contemporary objections that double effect is a valid principle of ethical reflection (Part II); claims to the contrary notwithstanding, double effect analysis is a pervasive, albeit generally unacknowledged principle employed regularly in American case law (Part III); and drawing on the preceding two sections, Vacco's application of the principle of double effect is appropriate (Part IV). -/- My conclusion is that [o]peration of some form of the principle, by whatever name, is inevitable. In an imperfect world where duties and interests collide, the possibility of choices of action foreseen to have both good and evil consequences cannot be avoided. In rare circumstances, ethics and the law require that a person refrain from acting altogether. More often, however, they provide that a determination of whether an actor may pursue a good effect although knowing it will or may unintentionally cause an harmful effect requires a more complex analysis - a double effect analysis. -/- Keywords: Equal protection, double effect, intention, physician-assisted suicide, Constitutional Law, Bioethics. (shrink)

Introduction In 2013, Dr. J. Muizelaar and Dr. R. Schrot, two neurosurgeons at the University of California Davis Medical Center (UCDMC), were found guilty of research misconduct due to failure to comply with institutional policies as well as Food and Drug Administration (FDA) regulations governing human subjects research. At issue here, however, is the difference between research and innovative therapy in the clinical setting of patient care where clinical judgment is reasonably to be privileged. Methods The UCDMC investigative document (...) is reviewed along with standard literature on clinical ethics and clinical data about glioblastoma multiforme (GBM) cancer. Results In this paper I argue that, by tendentiously focusing on policies, regulations, and procedures governing human subjects research, the UCDMC investigation failed to account for the centrality of clinical judgment and clinical ethics pertinent to judicious review of this matter, especially given the unique clinical context of terminally ill patients having exhausted standard care treatment options for glioblastoma multiforme (GBM) cancer. Conclusions The UCDMC investigation raises serious problems for clinicians who are engaged in innovative therapy in the clinical setting, requiring a regulatory framework separate from the normal Institutional Review Board (IRB) process. (shrink)

Introduction: The Faculty of Medicine, University of Moratuwa, established during the COVID-19 pandemic, was compelled to conduct the teaching activities online for the first intake of students until their first bar examination. Online learning is known to be linked to several health issues. This study aims to explore the academic performance and perceived health effects related to online learning in the Faculty of Medicine, Moratuwa. Methods: A descriptive cross-sectional study was conducted among all 104 first-intake students using an anonymous online (...) self-administered questionnaire to explore health effects and academic performance after ethical clearance. Results: Out of 104 students, 82 students responded (response rate=78.85%). Majority participated from home using their own laptop (74.4%) and personal Wi-Fi (69.5%) and spent 5-10 hours daily for online academic activities (72%). Majority complained of related physical (86.6%), and psychological (81.7%) health issues: eye problems (69.5%), headache (47.6%), backache (43.9%), stress (46.3%) and concentration difficulties (45.1%). The first bar examination was cleared by 84.1% with the majority (52.4%) obtaining classes. There was a statistically significant positive association (p< .05) between physical and psychological health concerns with the average screen-time spent on academic activities, but not with the academic performance. There was also no statistically significant association between screen-time and academic performance. Conclusions: Majority of students using online learning had related physical and psychological health issues which were positively associated with the screen-time though not with academic performance. Designing online activities with less screen time may be considered as a strategy to minimise health effects related to online learning. (shrink)

The recent successful conversion of adult cells into induced pluripotent stem (iPS) cells through direct reprogramming opens a new chapter in the study of disease and the development of regenerative medicine. It also provides a historic opportunity to turn away from the ethically problematic use of embryonic stem cells isolated through the destruction of human embryos. Moreover, because iPS cells are patient specific, they render therapeutic cloning unnecessary. To maximize therapeutic benefit, adult stem cell research will need to be pursued (...) in parallel with studies using iPS cells. Among the four alternative methods presented by the President’s Council on Bioethics, direct reprogram- ming is the most ethically acceptable. Nonetheless, iPS cells are tainted by their association with the human embryonic stem cell lines, derived in the past, which will be required for their validation. This concern is one that can be resolved. Human iPS cells will serve to stem the tide of human embryonic stem cell research, changing it and diverting stem cell research in a more ethical direction. (shrink)

Excerpt: 1. Introduction This chapter provides insight into the diverse ethical debates on genetics and epigenetics. Much controversy surrounds debates about intervening into the germline genome of human embryos, with catchwords such as genome editing, designer baby, and CRISPR/Cas. The idea that it is possible to design a child according to one’s personal preferences is, however, a quite distorted view of what is actually possible with new gene technologies and gene therapies. These are much more limited than the editing (...) and design metaphors suggest. Such metaphors are therefore highly problematic phrases in the context of new gene technologies, for two reasons. On one hand, to design a child of choice by modifying the genome would require modifying any gene of choice, which is more than can be done with current gene technologies, such as CRISPR/Cas. On the other hand, a modification of genes would need to be enough to create any characteristic of choice in the future child. The latter presupposes the assumption of genetic determinism. Moreover, the CRISPR/Cas technology can not only be used in a potentially therapeutic manner at the germline level. In addition, there is the (more likely) scenario of a future clinical therapeutic use of these new gene technologies for modifying the DNA sequence of other cells of the body (somatic genome editing). There is also the option of modifying the epigenome, that is, the spatial configuration of DNA (epigenome editing) (see table 1). Like genetics and genome editing, epigenetics has been at the center of recent popular scientific and ethical discourse as well as scientific debates. The concept of epigenetics has given rise to very different notions of inheritability and responsibility for health, which, however, are oftentimes based on scientifically controversial basic assumptions. That there continues to be covert genetic determinism in the form of epigenetic determinism (see table 2) in debates about epigenetics has been pointed out in ethical analyses of epigenetics. Neither genetic determinism nor epigenetic determinism has been confirmed scientifically. It is therefore important to recognize the concepts that are discussed (and sometimes harshly criticized) in debates about genome editing and epigenetics—for example, concepts about the causal role of DNA for our own life course. This importance is based on the fact that if we understand such controversial concepts, we will be able to remain critical when evaluating scientific knowledge and ethical arguments about genome editing and epigenetics. This chapter, therefore, explains some of these concepts. For an ethical analysis of epigenetics as well as of genome editing, it is necessary to understand and critically reflect upon the underlying concepts of genetic determinism and other, related -isms. The following section offers a detailed introduction to these -isms (section 2; see also table 2). Section 3 provides an ethical analysis of genome editing and epigenetics based on the explanations in section 2. Section 3 focuses on inheritability and responsibility, justice, safety, the problem of consent, and the effects of genome editing and epigenetics on embryos and future generations. This section does not discuss in detail further points that can be found in ethical debates about epigenetics as well as in ethical debates about genome editing. These points include (among others): • fear that the findings of epigenetics and that the methods of genome editing are misused—this also with respect to eugenics and enhancement; • naturalness—an issue we mention in passing a few times in the following analysis; • a possible connection between the genome/epigenome and the concept of human dignity, and the derived danger of instrumentalization and infringement of autonomy when intervening in the genome or epigenome. Since current discourse about ethical issues associated with genome editing focuses mainly on germline interventions, which are, for instance, interventions into a human embryo’s genome, we mainly focus on germline interventions when comparing the debates on genome editing and on epigenetics in section 3. (shrink)

In "Frailty Triage: Is Rationing Intensive Medical Treatment on the Grounds of Frailty Ethical?," Wilkinson (2021) argues that the use of frailty scores in ICU triage does not necessarily involve discrimination on the basis of disability. In support of this argument, he claims, “it is not the disability per se that the score is measuring – rather it is the underlying physiological and physical vulnerability." While we appreciate the attention Wilkinson explicitly pays to disability in this piece, we (...) find the distinction between disability and underlying vulnerability untenable both theoretically and practically. In this peer commentary, we begin with a brief overview of research in philosophy of disability concerning the meaning of the concept itself. We argue that this research demonstrates that many forms of disability do not involve underlying vulnerabilities, and, furthermore, that Wilkinson equivocates between "disability" understood as a medical category vs. "disability" understood as a feature of lived experience. We reject Wilkinson’s distinction on these grounds and offer further considerations to avoid disability discrimination in emergency and crisis standards of care contexts. (shrink)

James Rachels’s distinction between killing and letting die maintains that there is morally no difference between killing a terminally ill patient and letting him/her die. Therefore, active and passive euthanasia dichotomy is a distinction without a difference. Hence, if passive euthanasia is allowed, active euthanasia should be permitted too. The paper demonstrated that the distinction between killing and letting die is: (1) irrelevant to euthanasia(2) extraneous to the medical profession, and (3) methodologically degressive. Furthermore, the paper demonstrated invalidity of (...) the bare difference argument of Rachels based on the distinction because of four reasons: (1) irrelevance to American Medical Association’s statement; (2) differences between the cases such as intentionality, causality, and agency; (3) straw man fallacy, (4) and weak analogy. Therefore, the paper concluded that relating the distinction between killings and letting die to bioethics and euthanasia is unjustifiable. (shrink)

Žižek has argued in his books on Christianity and modernity that institutional Catholic Christianity has placed its members in a double bind by insisting on belief in a nonexistent God of Being. The laws of this God of the Symbolic are perverse in that they impose impossible requirements on all believers. By the mid-twentieth century, however, Catholicism was experiencing the revolutionary reforms of the Second Vatican Council. Dogmatic Law at this time gave way to a renewed emphasis on the (...) community of love associated in early Christianity with the Holy Spirit. This God of the Real is inherently Trinitarian: God-Father-Thing, Spirit as community of believers, and Christ as the imaginary Real gap between them. The American gothic writer Flannery O’Connor in her short story “A Temple of the Holy Ghost” provides a meditation on this Real Trinity. In O’Connor’s story a hermaphroditic circus freak becomes an emblem of the deadlock of sexual difference and a monstrous Christ-figure in the Žižekian sense. Its place is theologically incoherent and represents the passion for the Real emerging out of the perverse situation of mid-century Catholic orthodoxy. (shrink)

Since the last ice age, when ice enveloped most of the northern continents, the earth has warmed by about five degrees. Within a century, it is likely to warm by another four or five. This revolution in our climate will have immense and mostly harmful effects on the lives of people not yet born. We are inflicting this harm on our descendants by dumping greenhouse gases into the atmosphere. We can mitigate the harm a little by taking measures to control (...) our emissions of these gases, and to adapt to the changes by, for instance, building sea walls around coastlines threatened by rising sea levels. But these measures will be very expensive, and the costs will be born by us, the present generation, whereas the benefits will come to future generations. How much should we sacrifice for the sake of the future? Economists and philosophers have independently worked on the question of our responsibility to future generations. This book brings their work together and applies it to global warming. It suggests a programme for future research on the economic and ethical issues. The book is intended for economists, and for philosophers and other social scientists who have a little knowledge of economic methods. (shrink)