The rule of rescue describes the powerful human proclivity to rescue identified endangered lives, regardless of cost or risk. Deciding whether or not to perform a decompressive craniectomy as a life-saving or ‘rescue’ procedure for a young person with a severe traumatic brain injury provides a good example of the ethical tensions that occur in these situations. Unfortunately, there comes a point when the primary brain injury is so severe that if the patient survives they are likely to remain severely (...) disabled and fully dependent. The health resource implications of this outcome are significant. By using a web-based outcome prediction model this study compares the long-term outcome and designation of two groups of patients. One group had a very severe injury as adjudged by the model and the other group a less severe injury. At 18 month follow-up there were significant differences in outcome and healthcare requirements. This raises important ethical issues when considering life-saving but non-restorative surgical intervention. The discussion about realistic outcome cannot be dichotomised into simply life or death so that the outcome for the patient must enter the equation. As in other ‘rescue situations’, the utility of the procedure cannot be rationalised on a mere cost–benefit analysis. A compromise has to be reached to determine at what point either the likely outcome would be unacceptable to the person on whom the procedure is being performed or the social utility gained from the rule of rescue intervention fails to justify the utilitarian value and justice of equitable resource allocation. (shrink)

Decompressive craniectomy is a technically straightforward procedure whereby a large section of the cranium is temporarily removed in cases where the intracranial pressure is dangerously high. While its use has been described for a number of conditions, it is increasingly used in the context of severe head injury. As the use of the procedure increases, a significant number of patients may survive a severe head injury who otherwise would have died. Unfortunately some of these patients will be left severely disabled; (...) a condition likened to the RUB, an acronym for the Risk of Unacceptable Badness. Until recently it has been difficult to predict this outcome, however an accurate prediction model has been developed and this has been applied to a large cohort of patients in Western Australia. It is possible to compare the predicted outcome with the observed outcome at 18 months within this cohort. By using predicted and observed outcome data this paper considers the ethical implications in three cases of differing severity of head injury in view of the fact that it is possible to calculate the RUB for each case. (shrink)

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is the (...) contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization. (shrink)

Error is protean, ubiquitous and crucial in scientific process. In this paper it is argued that understanding scientific process requires what is currently absent: an adaptable, context-sensitive functional role for error in science that naturally harnesses error identification and avoidance to positive, success-driven, science. This paper develops a new account of scientific process of this sort, error and success driving Self-Directed Anticipative Learning (SDAL) cycling, using a recent re-analysis of ape-language research as test example. The example shows the limitations of (...) other accounts of error, in particular Mayo’s (Error and the growth of experimental knowledge, 1996) error-statistical approach, and SDAL cycling shows how they can be fruitfully contextualised. (shrink)

This book has been prompted by the dishonesty of much contemporary treatment of the Bible. It is not a 'debunking' of the Bible, but an attempt to show what qualities and what preliminary assumptions are needed for the Bible to be genuinely understood and interpreted. Honest scholarship and honest interpretations must acknowledge that a revolution has taken place in the understanding of the Bible during the last two hundred years and that to try to deny or play down or disguise (...) the results of this revolution is to be faithful neither to God nor to ourselves. With that conviction, and with their customary panache, the authors then go on to look at the facts about the Bible; the New Testament interpretation of scripture; the interpretation of the Bible in the early church; historical criticism; fundamentalism; and prophecy. 'They analyse the books of the Bible, examine the canon and the Bible as norm and as the church's book, consider the role of faith and conclude with a chapter 'In Praise of the Bible'. Here, in the last book together, the Professors Hanson are indeed on top of their form. (shrink)

Autobiographical memory and the self are closely linked. AM retrieval in depression is characterized by a lack of specificity, suggesting an impairment of episodic AM. Autonoetic consciousness and self-perspective, which are critical to episodic AM, have never been addressed in depression. Twenty-one depressed inpatients and 21 matched controls were given an episodic AM task designed to assess positive and negative memories regarding specificity, autonoetic consciousness , and self-perspective . For specificity, “remember”, and “field” responses, ANOVAs revealed a main group effect (...) and a group × valence interaction. Between groups, patients showed lower scores than controls for positive memories. Within groups, patients showed greater scores for negative memories, and controls showed greater scores for positive memories. There is a global episodic AM impairment of positive memories in depression regarding specificity, autonoetic consciousness, and self-perspective. Our results suggest new cognitive interventions to improve the self-relevance of positive memories in depression. (shrink)

We have examined only a few of the basic questions about causal inference that result from Reichenbach's two principles. We have not considered what happens when the probability distribution is a mixture of distributions from different causal structures, or how unmeasured common causes can be detected, or what inferences can reliably be drawn about causal relations among unmeasured variables, or the exact advantages that experimental control offers. A good deal is known about these questions, and there is a good deal (...) more to find out. (shrink)