This paper presents four arguments in favour of respecting Ulysses Contracts in the case of individuals who suffer with severe chronic episodic mental illnesses, and who have experienced spiralling and relapse before. First, competence comes in degrees. As such, even if a person meets the usual standard for competence at the point when they wish to refuse treatment, they may still be less competent than they were when they signed the Ulysses Contract. As such, even if competent at time 1 (...) and time 2, there can still be a disparity between the levels of competence at each time. Second, Ulysses Contracts are important to protect people’s most meaningful concerns. Third, on the approach defended, the restrictions to people’s liberty would be temporary, and would be consistent with soft paternalism, rather than hard paternalism: the contracts would be designed in such a way that individuals would be free to change their minds, and to change or cancel their Ulysses Contracts later. Finally, even if one rejects the equivalence thesis, this is still consistent with the claim that, in particular cases, it can be as wrong to allow a harm as to do a harm. Nevertheless, controversies remain. This paper also highlights several safeguards to minimise risks. Ultimately, we argue that people who are vulnerable to spiralling deserve a way to protect their autonomy as far as possible, using Ulysses Contracts when necessary. (shrink)

On 6 September 1966, the prime minister of South Africa, Dr HF Verwoerd was killed by Mr Tsafendas, a Portuguese national of Greek descent, in parliament by stabbing him in the chest. Mr Tsafendas was a messenger in parliament. At the enquiry trial of Mr Tsafendas, he was found unfit to stand trial on the ground that he suffered from schizophrenia. The psychiatric evidence during the enquiry trial was reviewed and discussed under the following headings: Diagnosis (...) of schizophrenia; Consideration of cultural factors in forensic psychiatric settings; Delusional infestation v. extreme overvalued beliefs; Simulation of psychosis; Ethical considerations in criminal capacity and trial competency assessments. Lessons from the Mr Tsafendas enquiry trial for forensic psychiatrists where a defendant previously diagnosed with schizophrenia commits a prominent political murder, are summarised. It is emphasised that the personhood of an accused referred for forensic observation should be respected and protected, instead of focusing exclusively on a specific diagnosis. (shrink)

On June 16, 2003, the Supreme Court ruled that forced administration of antipsychotic drugs to a defendant facing serious criminal charges is appropriate in order to render that defendant competent to stand trial, but only in limited circumstances. The treatment must be medically appropriate, substantially unlikely to have side effects that may undermine the fairness of the trial, and necessary to significantly further important government interests, after taking account of less-intrusive alternatives.Charles Sell, a former dentist, had a (...) long history of mental illness. He had been hospitalized twice, in 1982 and 1984, after expressing paranoid ideas to law enforcement officials. In May 1997, Sell was charged with fifty-six counts of mail fraud, six counts of Medicaid fraud, and one count of money laundering. He was released on bail after a magistrate determined that he was currently competent to stand trial. (shrink)

On June 16, 2003, the Supreme Court ruled that forced administration of antipsychotic drugs to a defendant facing serious criminal charges is appropriate in order to render that defendant competent to stand trial, but only in limited circumstances. The treatment must be medically appropriate, substantially unlikely to have side effects that may undermine the fairness of the trial, and necessary to significantly further important government interests, after taking account of less-intrusive alternatives.Charles Sell, a former dentist, had a (...) long history of mental illness. He had been hospitalized twice, in 1982 and 1984, after expressing paranoid ideas to law enforcement officials. In May 1997, Sell was charged with fifty-six counts of mail fraud, six counts of Medicaid fraud, and one count of money laundering. He was released on bail after a magistrate determined that he was currently competent to stand trial. (shrink)

Direct brain intervention based mental capacity restoration techniques-for instance, psycho-active drugs-are sometimes used in criminal cases to promote the aims of justice. For instance, they might be used to restore a person's competence to stand trial in order to assess the degree of their responsibility for what they did, or to restore their competence for punishment so that we can hold them responsible for it. Some also suggest that such interventions might be used for therapy or reform in (...) criminal legal contexts-i.e. to make non-responsible and irresponsible people more responsible. However, I argue that such interventions may at least sometimes fail to promote these responsibility-related legal aims. This is because responsibility hinges on other factors than just what mental capacities a person has-in particular, it also hinges on such things as authenticity, personal identity, and mental capacity ownership-and some ways of restoring mental capacity may adversely affect these other factors. Put one way, my claim is that what might suffice for the restoration of competence need not necessarily suffice for the restoration of responsibility, or, put another way, that although responsibility indeed tracks mental capacity it may not always track restored mental capacities. (shrink)

Informed consent is valid only if the person giving it is competent. Although allegedly informed consents are routinely tendered, there are nonetheless serious problems with the concept of competence as it stands. First, conceptual work upon competence is incomplete: the concept is unanalyzed and no logic of competence has been identified. It is thus virtually impossible to reliably discern who is competent. ;Traditional work on competence has explicated three dichotomies from which the necessary conditions for the possibility of competence will (...) be identified, viz., that competence is either a global or a specific notion; is present in varying degrees or in virtue of a threshold; and may or not include appeals to consequences. Past efforts have failed to notice a fourth dichotomy: competence as an affective or cognitive notion. Failure to designate the appropriate arms of these dichotomies is responsible for there being, at present, no reliable test for competence. The inadequacies of a highly regarded particular test for competence, the mental status examination, are examined in light of this failure. ;Competence is located within the rule-governed practice of informed consent. That practice and hence, competence, is justified through a Kantian analysis of respect for persons. This analysis reveals that the logic of competence requires assessment in terms of specific rather than global concerns; degrees of ability rather than a threshold; both cognitive and affective abilities; and no appeal to consequences. ;Based upon the analyses of consent as an example of decision making within the practice of informed consent and of respect for persons, the capacities which jointly comprise competence are identified. These are the capacities to receive, recognize, and retrieve information; to reason about, relate to oneself, and rank options; to choose among alternatives; and, under certain circumstances, to defend one's choice. ;Identification of the logic of competence and explication of and justification for the capacities that comprise competence to consent provide a conceptual foundation for the crucial concept of competence that the informed consent process currently lacks. It should facilitate construction of a test for competence. (shrink)

The important question of the legality of the state obliging trial incompetent defendants to receive competency-restoring treatment against their wishes, is one that has received much attention by legal scholars. Surprisingly, however, little attention has been paid to the, in many ways more fundamental, moral question of whether the state ought to administer such treatments. The aim of this paper is to start filling this gap in the literature. I begin by offering some reasons for thinking it morally (...) acceptable to, at least sometimes, oblige trial-incompetent defendants to receive competency-restoring treatments. The paper then discusses whether three prominent arguments (and their variations) offered by legal scholars against using non-consensual treatment to restore trial competence provide grounds for thinking there to be a general moral prohibition against these treatments. I argue that they do not. (shrink)

Dissociative identity disorder is a dissociative disorder that gained a significant rise in the past few decades. There has been less than 50 DID cases recorded between 1922 and 1972, while 20,000 cases are recorded by 1990. Therefore, it becomes of great significant to assess the various concepts related to DID to further understand the disorder. The current review has a goal of understanding whether an individual suffering from DID is legally responsible for the committed crime, and whether or not (...) he or she can be considered competent to stand trial. These two questions are to be raised in understanding DID, by first shedding a light on the nature of the disorder and second by examining the past legal case examples. Despite the very nature of the disorder is characterized by dissociative amnesia and the fact that the host personality may have limited or no contact with the alters, there is no consensus within the legal system whether the DID patients should be responsible for their actions. Further to that, courts generally deny the insanity claims for DID suffering patients. In conclusion, more studies in the field are suggested to incorporate primary data into research, as the extensive reliance on secondary data forces us to believe the conclusions that were previously made, and no opportunity to verify those conclusions is present. (shrink)

The insanity defense presents many difficult questions for the legal system. It attracts attention beyond its practical significance (it is seldom used successfully) because it goes to the heart of the concept of legal responsibility. “Not guilty by reason of insanity” generally requires that as a result of mental illness the defendant was unable to distinguish right from wrong at the time of the crime. The many difficult and complex questions presented by the insanity defense have led some in the (...) legal community to hope that neuroscience might help resolve some of these problems, but that hope is not likely to be realized. (shrink)

Existing justifications for exclusionary rules and stays of proceedings in response to pre-trial wrongdoing by police officers and prosecutors are often thought to be counter-productive or disproportionate in their consequences. This article begins to explore whether the concept of standing to blame can provide a fresh justification for such responses. It focuses on a vice related to standing—hypocrisy—and a related vice concerning inconsistent blame. It takes seriously the point that criminal justice agencies, although all part of the State, are (...) in real terms separated from each other, and analyses the so-called separation thesis (or theses). It concludes that hypocrisy and inconsistent blame arguments could plausibly justify exclusion and stays only in relation to lower-level offending, and even there only indirectly. This is in the sense that exclusion and stays are expressions of judicial frustration with other bodies for their failure to take pre-trial wrongdoing seriously. (shrink)

Journal Name: Cognitive Linguistics Issue: Ahead of print.

Behavioural variant frontotemporal dementia (bvFTD) is a subtype of frontotemporal dementia characterized by changes in personality, social behaviour, and cognition. Although neural abnormalities cause bvFTD patients to struggle with inhibiting problematic behaviour, they are generally considered fully autonomous individuals. Subsequently, bvFTD patients demonstrate understanding of right and wrong but are unable to act in accordance with moral norms. To investigate the ethical, legal, and social issues associated with bvFTD, we conducted a scoping review of academic literature with inclusion & exclusion (...) criteria and codes derived from our prior work. Among our final sample of fifty-six articles, four mentioned bvFTD patient-offenders as unfit to stand trial by insanity, and sixteen mentioned the use of dementia evidence in a court of law to better understand the autonomy of bvFTD patients. Additional emergent issues that were discovered include: training police officers to handle situations involving bvFTD patients and educating healthcare providers on how to help caregivers navigate bvFTD. The current literature highlights the inadequacy of traditional applications of medico-legal categories such as autonomy, capacity and competence, in informing cognitive capacity assessments in clinical and legal settings and deserves consideration by neuroethicists. (shrink)

In three parts, this volume in the AP-LS series explores the phenomena of captivity and risk management, guided and informed by the theory, method, and policy of psychological jurisprudence. The authors present a controversial thesis that demonstrates how the forces of captivity and risk management are sustained by several interdependent "conditions of control." These conditions impose barriers to justice and set limits on citizenship for one and all. Situated at the nexus of political/social theory, mental health law and jurisprudential ethics, (...) the book examines and critiques constructs such as offenders and victims; self and society; therapeutic and restorative; health; harm; and community. So, too, are three "total confinement" case law data sets on which this analysis is based. The volume stands alone in its efforts to systematically "diagnose" the moral reasoning lodged within prevailing judicial opinions that sustain captivity and risk management practices impacting: (1) the rights of juveniles found competent to stand criminal trial, the mentally ill placed in long-term disciplinary isolation, and sex offenders subjected to civil detention and community re-entry monitoring; (2) the often unmet needs of victims; and (3) the demands of an ordered society. Carefully balancing sophisticated insights with concrete and cutting-edge applications, the book concludes with a series of provocative, yet practical, recommendations for future research and meaningful reform within institutional practice, programming, and policy. (shrink)

I begin by discussing the ways in which a would-be blamer's own prior conduct towards the person he seeks to blame can undermine his standing to blame her. This provides the basis for an examination of a particular kind of 'bar to trial' in the criminal law – of ways in which a state or a polity's right to put a defendant on trial can be undermined by the prior misconduct of the state or its officials. The examination (...) of this often neglected legal phenomenon illuminates some central features of the criminal law and the criminal process, and some of the preconditions for the legitimacy of the criminal law in a liberal republic. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 11.4 (2001) 391-400 [Access article in PDF] Bioethics Inside the Beltway A Shooting on Capitol Hill: "The Ruby Satellite System," Mental Illness, and Failure of the American Legal System Peter J. Cohen On 24 July 1998, Russell Eugene Weston, Jr., stormed the United States Capitol, forced his way through a security checkpoint, bypassed a metal detector, and entered the office complex of Representative Tom (...) DeLay (R-TX), the House Majority Whip (Weil 1998). During this period of terror, he shot and killed two officers of the Capitol Police and seriously wounded another as they attempted to end his foray. 1 Weston was severely wounded by several Capital police officers and taken into custody. After being treated for his injuries, he was incarcerated in the District of Columbia. 2On 5 May 1999, Weston was transferred to the Federal Correctional Institute in Butner, North Carolina (United States v. Weston, 69 F. Supp. 2d 99 (D.D.C. 1999), 103), where he remains to this day. He has neither been brought to trial nor received appropriate psychiatric therapy, but continues to be warehoused "in solitary confinement under constant observation... in a psychotic state (United States v. Weston, 255 F.3d 873; LEXIS 16851 (U.S. App. 2001b), 3-4 [LEXIS]). I will briefly detail the legal events responsible for this mad situation and suggest alternative actions that should have been taken at the very onset of the case. Early Chronology Although overtly the crime appeared to be senseless and without any conceivable motivation, Weston believed that his acts were justified and necessary. The story he told to the court-appointed forensic psychiatrist, Sally C. Johnson, M.D., 3 was that while working for NASA in the early 1980s, he had developed a "Ruby Satellite System," a powerful machine that could reverse time. With access to this system, nothing was permanent--the user could simply reverse time and exit from the current scene. However, the "System" was now controlled by cannibals who were developing and spreading "Black Heva," the deadliest disease known to [End Page 391] humankind, similar to HIV or the plague. It resulted from human corpses rotting and turning black. Time was running out, and Weston believed he had to return to override the "Ruby Satellite System" in the Capitol so that he could stem the spread of "Black Heva" and prevent world calamity. He believed that if he were tried, convicted, and even executed, he could simply time reverse himself, place himself in a safe within the Capitol, and subsequently resume his life at whatever point he chose (United States v. Weston, 206 F.3d 9 (D.C. Cir. 2000), 19-20).On 22 April 1999, the district court accepted Dr. Johnson's diagnosis that Weston suffered from paranoid schizophrenia, the symptoms of which were so severe that he would be incapable of understanding the proceedings against him and of assisting in his own defense. On this basis, the court had no difficulty in finding him incompetent to stand trial (U.S. v. Weston 1999, 102).At Weston's initial hearing, Dr. Johnson had testified that medication would be efficacious in treating Weston's delusions: [T]he standard of care in someone suffering from this type of symptom picture would be to treat them with medication.... [T]here is a good likelihood that he'll have a positive response, positive in the sense that his symptoms will diminish in response to treatment.... The potential benefits to treating the defendant far outweigh the risks.... (U.S. v. Weston 1999, 108) The defense presented no expert testimony refuting Dr. Johnson's presentation. The district court then ordered that Weston begin receiving medication in order to render him nondangerous and competent for trial (U.S. v. Weston 1999, 108-9). The Problem Weston refused to be medicated! 4 He has continued to claim that the administration of antipsychotic drugs against his will would violate his Fifth Amendment due process liberty interest in avoiding unwanted bodily intrusion and implicated... (shrink)

The British journalist Christopher Hitchens has recently noted that the extraordinary excitement created by l’affaire Pound, an excitement sustained for now some forty years, is partly the result of having no fewer than three debates going on whenever the poet’s legal situation and his consequent hospitalization are discussed. As Hitchens says, those questions are: “First, was Pound guilty of treason? If not, or even if so, was he mad? Third, was he given privileged treatment for either condition?”1 I propose to (...) discuss all three issues in a way that fairly reflects the fact that I am neither a physician nor a lawyer. What I know of the state of medical expertise, both today and in the period of time from 1943 to 1958 , leads me, as a layman, to believe that there is an enormous latitude of understanding among medical professionals as to the precise meaning of “insanity.” At one extreme, for some distinguished physicians, the term means almost nothing. They see it as a legal term and as therefore irrelevant to them; some of them follow the line of reasoning developed by Thomas Szasz over his long writing career, namely that “mental illness” if not illness in any ordinary sense of the term.2 For other medical practitioners, it does mean something, but only when it is redefined into much smaller subcategories and enriched with much more precise terminology, and when the given patient and his full range of circumstances are considered.What I know of the legal understanding of insanity is that there has been and is now little firm agreement about “insanity” or “madness.” Equally competent juries and courts have been able to set down findings that are more or less plausible on their face but do not seem to comport at all with each other. I tentatively conclude that whatever “insanity” now is in the United States, and whatever it was when Pound was found unfit to stand trial in 1945, the standard is not the lucid simplicity of the M’Naghten test, namely, the ability of the accused to understand the difference between “right” and “wrong.” Human mind, self-awareness, and motivations are vastly more complicated than such a test would imply. 1. Christopher Hitchins, “American Notes,” Times Literary Supplement, 21 Oct. 1983, p. 1160.2. See Thomas Szasz, Insanity for a synthesis of his ideas as formulated in some eighteen books. William M. Chace is professor of English and Vice Provost for Academic Planning and Development at Stanford University. He is author of The Political Identities of Ezra Pound and T. S. Eliot , Lionel Trilling: Criticism and Politics , and scholarly essays on writers including Wyndham Lewis, D. H. Lawrence, T. E. Lawrence, and James Joyce. He is now working on a study of the ways in which American culture in this century has been subjected to critical analysis. (shrink)

Objectives: To review the performance of research ethics committees in Spain in assessing multicentre clinical trial drug protocols, and to evaluate if they would comply with the requirements of the new EU Directive to be implemented by May 2004.Design and setting: Prospective study of applications of MCT submitted to RECs.Main measurements: Protocol related features and evaluation process dynamics.Results: 187 applications to be performed in 114 centres, were reviewed by 62 RECs. RECs had a median number of 14 members, of (...) which three were lay members. All applications were approved except four which were however approved by the other RECs involved. The median times from submission to approval and from submission to reception at the sponsor’s offices were 48 and 62 days, respectively. In 55% of all applications approved, 41 RECs raised 307 queries, 40% of these were protocol related issues, and 38% related to the patients’ information sheets. RECs charging an evaluation fee in advance and applications with no queries raised were statistically significantly associated with shorter evaluation times. However, there is a gap of at least 1.5 weeks between the date of the meeting and the reception of the approval letter in the sponsor’s office.Conclusions: Evaluating MCT protocols by RECs is a time consuming process. Needing 1.5 weeks for communicating the decision taken by RECs to the sponsor suggests serious administrative shortcomings within most RECs. By significantly reducing the time for communication of their decisions, the majority of RECs would comply with the Directive requirement of a maximum 60 day period for the assessment of MCT. (shrink)

I begin by discussing the ways in which a would‐be blamer's own prior conduct towards the person he seeks to blame can undermine his standing to blame her (to call her to account for her wrongdoing). This provides the basis for an examination of a particular kind of ‘bar to trial’ in the criminal law – of ways in which a state or a polity's right to put a defendant on trial can be undermined by the prior misconduct (...) of the state or its officials. The examination of this often neglected legal phenomenon illuminates some central features of the criminal law and the criminal process, and some of the preconditions for the legitimacy of the criminal law in a liberal republic. (shrink)

Standing is a peculiar norm, allowing for deflecting that is rejecting offhand and without deliberation interventions such as directives. Directives are speech acts that aim to give directive-reasons, which are reason to do as the directive directs because of the directive. Standing norms, therefore, provide for deflecting directives regardless of validity or the normative weight of the rejected directive. The logic of the normativity of standing is, therefore, not the logic of invalidating directives or of competing with directive-reasons but of (...) ‘exclusionary permission’. That is, standing norms provide for permission to exclude from practical deliberation directive-reasons if given without the requisite standing, regardless of their normative weight. As such, standing is a type of second-order norm. Numerous everyday practices involve the deflection of directives, such as pervasive practices of deflecting hypocritical and officious directives. Of various possible models, the one that best captures the normative structure of these practices of deflection is the standing model. Accordingly, the normativity of standing is pervasive in our everyday practices. Establishing that standing, although a neglected philosophical idea, is a significant and independent normative concept. (shrink)

It is not uncommon for multiple clinical trials at the same institution to recruit concurrently from the same patient population. When the relevant pool of patients is limited, as it often is, trials essentially compete for participants. There is evidence that such a competition is a predictor of low study accrual, with increased competition tied to increased recruitment shortfalls. But there is no consensus on what steps, if any, institutions should take to approach this issue. In this article, we argue (...) that an institutional policy that prioritises some trials for recruitment ahead of others is ethically permissible and indeed prima facie preferable to alternative means of addressing recruitment competition. We motivate this view by appeal to the ethical importance of minimising the number of studies that begin but do not complete, thereby exposing their participants to unnecessary risks and burdens in the process. We then argue that a policy of prioritisation can be fair to relevant stakeholders, including participants, investigators and funders. Finally, by way of encouraging and helping to frame future debate, we propose some questions that would need to be addressed when identifying substantive ethical criteria for prioritising between studies. (shrink)

Decision-Making Capacity First published Tue Jan 15, 2008; substantive revision Fri Aug 14, 2020 In many Western jurisdictions the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own medical decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This question has to do with (...) what is commonly called “decisional capacity”, a central concept in health care law and ethics, and increasingly an independent topic of philosophical inquiry. -/- Decisional capacity can be defined as the ability of subjects to make their own medical decisions. Somewhat similar questions of capacity arise in other contexts, such as capacity to stand trial in a court of law and the ability to make decisions that relate to personal care and finances. However, the history behind the more general legal notions of capacity to stand trial and capacity to manage one’s life is different and operates somewhat differently in law (Roth, Meisel, & Litz 1977; Zapf & Roesch 2005). For the purposes of this discussion the notion of decisional capacity will be limited to medical contexts only; most notably, those where decisions to consent or to refuse treatment or participation in clinical research are concerned. (shrink)

A position that appears to be growing in popularity in atheist and rationalist circles is known as ‘mythicism’. According to this position we have no adequate reason to believe that the gospels refer to a historical figure called Jesus at all. This position of strong scepticism holds that the gospels are entirely mythological texts and that we are mistaken in reading them as embellished accounts of a man who lived and preached in the Middle East around 2000 years ago. I (...) disagree with this position for a number of reasons. In particular, I contend that the apocalyptic material found on Jesus' lips and the hopes for a very real earthly historical transformation strongly suggest that there is an underlying historical basis to the claims that a man named Jesus made ‘prophetic’ statements about events that were expected to happen within his lifetime, and that this historical figure was considered by his band of followers to be the long awaited Messiah. The fact that hopes for eschatological transformation and claims of the coming of a Messiah are nothing more than religious mythological notions does not preclude there having been a historical figure to which these hopes were attached. (shrink)

Crowdsourcing has attracted increasing attention as a means to enlist online participants in organisational activities. In this paper, we examine crowdsourcing from the perspective of its ethical use in the support of open innovation taking a broader system view of its use. Crowdsourcing has the potential to improve access to knowledge, skills, and creativity in a cost-effective manner but raises a number of ethical dilemmas. The paper discusses the ethical issues related to knowledge exchange, economics, and relational aspects of crowdsourcing. (...) A guiding framework drawn from the ethics literature is proposed to guide the ethical use of crowdsourcing. A major problem is that crowdsourcing is viewed in a piecemeal fashion and separate from other organisational processes. The trend for organisations to be more digitally collaborative is explored in relation to the need for greater awareness of crowdsourcing implications. (shrink)

The position underlying this article is that while pilots are not strictly required to justify moving in the direction of a basic income system, nevertheless they can play several useful functions in the debate. These include rebutting common preconceptions, for instance that basic income will make people ‘lazy’, indicating non-monetary benefits such as improved health and wellbeing, and testing how a basic income might best be introduced in a given region, country or city. In that context the article goes on (...) to present 19 guiding principles for the design, implementation and evaluation of basic income pilots, with examples of selected experiments and pilots past and present. (shrink)

This article offers a justification for the continued use of jury trials. I shall critically examine the ability of juries to render just verdicts, judicial impartiality, and judicial transparency. My contention is that the judicial system that best satisfies these values is most preferable. Of course, these three values are not the only factors relevant for consideration. Empirical evidence demonstrates that juries foster both democratic participation and public legitimation of legal decisions regarding the most serious cases. Nevertheless, juries are costly (...) and, therefore, economically less efficient than competing modes of trial. I do not argue that all human beings possess an inalienable legal right to be tried by a jury. However, it is my hope that this analysis will make clear what we might gain or lose when we propose jury reforms. (shrink)

The Editor, Jack Mahoney, has the tables turned on him by being interviewed on his appointment this month to the new Dixons Chair of Business Ethics and Social Responsibility at London Business School. Interviewing him is the businessman and well‐known consultant, John Drummond, who is an Associate Editor and Managing Director of Integrity Works and Crime Prevention Consulting.

The present paper deals with the problem of evaluating empirical evidence for therapeutic decisions in medicine. The article discusses the views of Nancy Cartwright and John Worrall on the function that randomization plays in ascertaining causal relations with reference to the therapies applied. The main purpose of the paper is to present a general idea of alternative method of evaluating empirical evidence. The method builds on data analysis that makes use of rough set theory. The first attempts to apply the (...) method show that it is an interesting alternative to randomized controlled trials. (shrink)

Teaching research methods is especially challenging because we not only wish to convey formal knowledge and encourage critical thinking, as with any course, but also to enable our students dream up meaningful research projects, translate them into logical steps, conduct the research in a professional manner, analyze the data, and write up the project in APA style. We also wish to spark interest in the topics of research papers, and in the intellectual challenge of creating a research report, but we (...) have learned just how difficult these goals can be from teaching undergraduates and from serving as journal reviewers: many submissions contain flaws such as elementary errors of logic (e.g., using a null control condition instead of a placebo or dummy treatment), tangled statistics, a lack of graphs, and ungrammatical, unclear writing that violates APA rules. Yet these manuscripts are written by university faculty, often with doctorates and years of experience. Even published papers may contain egregious faults (Standing & McKelvie, 1986). And although we have both published widely, we still hone our skills. It requires optimism to expect that a typical undergraduate will do better, on the basis of just a year or two of studies in psychology. In this paper, we describe a systematic set of methodology courses and two specific practices that we think can help. Methodology Courses as the Backbone of our Psychology Program How can methodology courses promote undergraduate involvem... (shrink)

Attention is a finite, morally significant good. Attention is a precondition for healthy human relationships, and its absence can wrong others by cutting them off from vital human goods. At the same time, human persons have limited powers of attention. And so the question arises, when does someone legitimately command my attention? In Conversational Pressure, Sanford Goldberg argues that the competent speaker has a default entitlement to normatively expect the addressee to attend, even if only for a short while. If (...) the addressee fails to attend, the speaker is wronged. I argue that the conditions under which attention is owed to another are more restricted than Goldberg allows, and are sensitive to context and standing. (shrink)

Individual and institutional conflict of interests in biomedical research have becomes matters of increasing concern in recent years. In the United States, the growth in relationships — sponsored research agreements, consultancies, memberships on boards, licensing agreements, and equity ownership — between for-profit corporations and research universities and their scientists has made the problem of conflicts, particularly financial conflicts, more acute. Conflicts can interfere with or compromise important principles and obligations of researchers and their institutions, e.g., adherence to accepted research norms, (...) duty of care to patients, and open exchange of information. Disclosure is a key component of a successful conflict policy. Commitments which conflict with a faculty member's primary obligations to teaching, research, administrative responsibilities, or patient care also need attention. Institutional conflict of interests present different problems, some of which are discussed in an analysis of an actual problem posed by two proposed clinical trials. (shrink)

During the recent Ebola epidemic, some commentators and stakeholders argued that it would be unethical to carry out a study that withheld a potential treatment from affected individuals with such a serious, untreatable disease. As a result, the initial trials of experimental treatments did not have control arms, despite important scientific reasons for their inclusion. In this paper, we consider whether the duty to rescue entails that it would be unethical to withhold an experimental treatment from patient-participants with serious diseases (...) for which there are no effective treatments, even when doing so is scientifically necessary to test the effectiveness of the treatment. We argue that the duty to rescue will rarely apply. The context of medical research also throws new light on the content of the duty to rescue, since the interests of future patients—who stand to benefit from the fruits of medical research—are relevant to whether the duty applies. (shrink)

Ethics consultation has become an integral part of the fabric of U.S. health care delivery. This article summarizes the second edition of the Core Competencies for Health Care Ethics Consultation report of the American Society for Bioethics and Humanities. The core knowledge and skills competencies identified in the first edition of Core Competencies have been adopted by various ethics consultation services and education programs, providing evidence of their endorsement as health care ethics consultation (HCEC) standards. This revised report was prompted (...) by thinking in the field that has evolved since the original report. Patients, family members, and health care providers who encounter ethical questions or concerns that ethics consultants could help address deserve access to efficient, effective, and accountable HCEC services. All individuals providing such services should be held to the standards of competence and quality described in the revised report. (shrink)

Supervised injectable opioid assisted treament prescribes injectable opioids to individuals for whom other forms of addiction treatment have been ineffective. In this article, we examine arguments that opioid-dependent people should be assumed incompetent to voluntarily consent to clinical research on siOAT unless proven otherwise. We agree that concerns about competence and voluntary consent deserve careful attention in this context. But we oppose framing the issue solely as a matter of the competence of opioid-dependent people and emphasize that it should be (...) considered in the context of inequities in access to siOAT as a medical treatment. Consequently, we suggest that bioethics literature on nonexploitation, which focuses on clinical research in low-income countries, is helpful due to locating ethical issues within systemic social conditions. Finally, we consider the implications of our argument for the ethics of clinical research on siOAT. (shrink)

In this case study I argue that experts, to gain relevance in a jury trial, need to fit into a manifold division of knowing. They do so by borrowing and sharing diverse knowledges. These exchanges place the modest expert testimony right into an authoritative and powerful decision-making apparatus. This argument derives from an ethnographic study of a ‘‘sleepwalking defense.’’ The division of knowing embraces the certified facts, the instructed case, the competing expertise, and the common sense. As a conclusion, (...) I identify the experts’ twofold relevance. Experts perform the case as undecided and decidable. They provide exclusive knowledge and affirm a set of other knowledges. By ‘‘knowing’’ and ‘‘not knowing,’’ the experts perform individual modesty and systemic immodesty by the same token. (shrink)

The death of Jesse Gelsinger in 1999 during a gene therapy trial raised many questions about the ethical review of medical research. Here, the author argues that the principle of justice is interpreted too narrowly and receives insufficient emphasis and that what we permit in terms of bodily invasion affects the value we place on individuals. Medical research is a societally supported activity. As such, the author contends that justice requires that invasive medical research demonstrates sufficiently compelling societal benefit. (...) Many consider this societal benefit to be self evident. However, medical research is a complex activity; it yields new treatments but also creates financial rewards and affects health resource allocation. As research evolves into a multibillion pound, multinational enterprise, justice requires a much broader analysis of societal benefit. Without such evaluation we risk undermining the value of bodily integrity and of research participants. (shrink)

PREFACE WORD The Tanzimat period, which was the starting point of reform movements in many areas such as social, political, economic, military, etc., in which steps were taken towards Westernization, is considered to be an important milestone in drawing the fate of the Ottoman Empire. In this longest century of the empire, when many things were rushed, education partially received its share of change and reform. However, since the field of education was under the control of religious institutions such as (...) the Şeyhülislâmlık and the Nezâresi Evkâf-ı Hümâyun, the changes and reforms in this field remained limited. Regarding philosophy, which is the subject of our study, we can say in advance that philosophical movements in the West, the ideas of philosophers and philosophical education in the Western sense began to enter our country in the post-Tanzimat period. It is noteworthy that during this period when the Ottoman Empire became acquainted with Western philosophy, philosophy in the West experienced a period of crisis. In the period preceding this acquaintance, philosophy education in our country was carried out in a style loyal to the tradition of Islamic philosophy, and the break in this tradition occurred with the Tanzimat. One of the most widely debated issues from the Tanzimat to the present day has been whether or not a philosophical tradition unique to us can be established. Issues such as whether a philosophy built on our own culture and values can provide us with the opportunity to raise philosophers who are considered philosophers in the Western sense, and the level of competence and proficiency of Turkish in terms of creating a philosophical language on the way to realizing this opportunity, and efforts to establish a deep-rooted tradition continue to stand before us. In this study, from a holistic perspective, the changes in philosophical paradigms in certain periods from Tanzimat to the present day have been tried to be determined chronologically and problematically. The fact that the movements that emerged with Tanzimat were broken in certain periods, such as 1915, 1933 and 1960, and left their place to different movements, and the changes in our country in parallel with the change in the perception of philosophy in the world have been tried to be revealed in this study, and as a result of the study, results that have not been expressed so far have been reached. Again, whether the perception of philosophy has changed in society along with the change in philosophy in higher education is among the topics investigated in this study. For example, the fact that professors such as Mehmet İzzet, Niyazi Berkes and Necati Öner, who studied philosophy, regretfully admitted that it was embarrassing to say "I am studying philosophy", and instead took refuge in evasive answers such as "I am studying at the Faculty of Literature, I am studying at the Faculty of Language and History", clearly shows how the difficulty of doing philosophy in Turkey is at a high level with these prejudices. From the times when philosophy was identified with irreligion and atheism, and philosophers were seen as useless people who only criticized and did not produce solutions, to the present situation, the paths taken and the obstacles overcome make us hopeful for the bright future of philosophy in Turkey. In the Dârülfünun, which was de facto established in 1863 and opened and closed many times, philosophy courses were able to find a wide place in the curriculum after 1900 and especially after 1916. However, the contribution of philosophy courses and departments, which have been a significant part of the academy since 1916 both as a field of research and education, to the establishment and development of the longed-for original philosophical thought is currently the subject of a separate discussion. Indeed, philosophy departments have never escaped the criticism that they teach Western thought, transfer Western intellectual currents, ignore social values, and provide an exclusively Western and unproductive education. Our study, which deals with the processes of change and transition in philosophy education in Turkey and the debates on these processes, consists of three chapters and three appendices. In the first part, the studies in the field of philosophy from Tanzimat to the Republic are discussed theoretically and a general framework is tried to be drawn about the establishment of philosophy in Turkey. The topics covered in this section are mainly philosophy education until the establishment of the first university in 1863 under the name Dârülfünun and its closure and reopening in 1900 under the name Dârülfünun-ı Şâhâne. As is known, after a long period of trial and error, Dârülfünun was reformed under the name "Dârülfünun-ı Osmânî" in 1908 during the Second Constitutional Monarchy. Reforms in the field of education continued unabated, and with the university reforms in 1915 and 1933, philosophy departments also underwent significant change and transformation. Especially German faculty members, who were influential in these reforms, played an active role in the restructuring of the philosophy department. Apart from universities, philosophical activities were also carried out in non-governmental organizations, newspapers and journals. In particular, the philosophers who tried to become an association under the name of the Turkish Philosophical Society are today actively working under the name of the Philosophical Society of Turkey and the Turkish Philosophical Association. In this part of our study, in addition to these issues, the philosophers of the Republican period, which we have identified as four generations, and their philosophical attitudes and behaviors are evaluated together with the aspects reflected and not reflected in their works, and the interaction between the similarities and differences between the general characteristics of the generations and the philosophical atmosphere in the country is tried to be analyzed. The similarities and differences between the generations are analyzed since they are the main factors that determine and govern the course of philosophy in Turkey. The second chapter is devoted to "Philosophical Disciplines in Purgatory in the Republican Era". In this section, the disciplines of history of science, logic, Islamic philosophy and philosophy of religion, which we characterize as disciplines in limbo because their place in philosophy departments has always been controversial, are analyzed. In the third and final chapter, under the title "Philosophical Problems and Movements in the Republican Era", the problem of establishing the practical implications of the philosophical issues discussed in the first two chapters on the theoretical level, the question of whether Turkish can be the language of philosophy, Western philosophical movements in Turkey and their representatives are discussed. This chapter concludes with the main purpose of the study, which is to discuss the problems of philosophy in Turkey, suggestions for solutions and future perspectives. We have tried to enrich our research with three appendices that are considered to be complementary to these three chapters. The first appendix contains interviews with twelve senior professors who retired after teaching philosophy in Turkey for many years. These senior professors were asked questions about the changes in the view of philosophy in Turkey, philosophy education in higher education, their perceptions of philosophy, etc., and an important historical note was made with their answers based on their experiences. In this respect, we believe that these interviews will serve as an important source and reference for future generations and the social sciences community. Although the speeches of these professors contain many important discourses, messages and references, we have chosen one motto phrase to carry in the title. On this occasion, we would like to express our gratitude to our esteemed professors for sharing their vast knowledge and experience in the field of philosophy with us. In the second appendix, the short life stories and works of about a hundred professors in the field of philosophy in the Republican period are included. Although this information is sometimes easily obtained through the internet, biographical books or the works of the professors themselves, sometimes, after a very long and laborious work, original information has been reached, which is expressed for the first time in this study. Sometimes the capture of a very small detail required great efforts. In the third and final appendix, the names and periods of the senior philosophers of the Republican period are listed chronologically. (shrink)

Moral theories, such as the variations on virtue ethics, deontological ethics, contractualism, and consequentialism, are expected – inter alia – to explain the basic orientation of morality, give us principles and directives, justify those, and thereby guide our actions. I examine some functions and characteristics of the extant moral theories from a moral metatheoretical point of view, in order to clarify the generally assumed rivalry between them. By thinking of moral theories in analogy to languages it is argued that different (...) moral theories are neither simply competing nor simply complementary; their respective orientations justify using them, in virtue of the problems they help to solve. But even if considerations about the functionality of a theory and the context in which it is created play an important role, they can neither be sufficient to determine these theories’ relations to one other nor for choosing between them. The challenge is to set criteria for the quality of a moral theory on a moral metatheoretical level and, in particular, to make room for future views on morality. (shrink)

I extend my direct virtue epistemology to explain how a knowledge-first framework can account for two kinds of positive epistemic standing, one tracked by externalists, who claim that the virtuous duplicate lacks justification, the other tracked by internalists, who claim that the virtuous duplicate has justification, and moreover that such justification is not enjoyed by the vicious duplicate. It also explains what these kinds of epistemic standing have to do with each other. I argue that all justified beliefs are good (...) candidates for knowledge, and are such because they are exercises of competences to know. However, there are two importantly different senses in which a belief may be a good candidate for knowledge, one corresponding to an externalist kind of justification and the other corresponding to an internalist one. I show how the account solves the new evil demon problem in a more satisfactory way than existing accounts. We end up with a view of knowledge, justification, and rationality that is plausible, motivated, and theoretically unified. (shrink)

Research ethics committees (RECs) evaluate whether the risk-benefit ratio of a study is acceptable. Decentralized clinical trials (DCTs) are a novel approach for conducting clinical trials that potentially bring important benefits for research, including several collateral benefits. The position of collateral benefits in risk-benefit assessments is currently unclear. DCTs raise therefore questions about how these benefits should be assessed. This paper aims to reconsider the different types of research benefits, and their position in risk-benefit assessments. We first propose a categorization (...) of research benefits, based on the types of benefits that can be distinguished from the literature and ethical guidelines. Secondly, we will reconsider the position of collateral benefits. We argue that these benefits are not fundamentally different from other benefits of research and can therefore be included in risk-benefit assessments of DCTs. (shrink)

In recent years, science and technology have made great progress towards a better understanding of fundamental biological mechanisms of the diseases. Physicians, relying just on their own clinical experience, have long recognized that each patient is different from every other patient in many aspects. It is a matter of simple facts that many patients die without responding to any treatment, while others with the same disease survive. In oncology, the variability of treatment response has been a long-standing problem. Nowadays, thanks (...) to genomics and post-genomics advancements, we have identified an indication for that individual variability: tumor heterogeneity. Each tumor has a different genomic basis... (shrink)

Objective: To assess whether continuous consent, a process in which information is given to research participants at different stages in a trial, and clinician training in that process were effective when used by clinicians while gaining consent to the Total Body Hypothermia (TOBY) trial. The TOBY trial is a randomised controlled trial (RCT) investigating the use of whole-body cooling for neonates with evidence of perinatal asphyxia. Obtaining valid informed consent for the TOBY trial is difficult, (...) but is a good test of the effectiveness of continuous consent. Methods: Semistructured interviews were conducted with 30 sets of parents who consented to the TOBY trial and with 10 clinicians who sought it by the continuous consent process. Analysis was focused on the validity of parental consent based on the consent components of competence, information, understanding and voluntariness. Results: No marked problems with consent validity at the point of signature were observed in 19 of 27 (70%) couples. Problems were found mainly to lie with the competence and understanding of the parents: mothers, particularly, had problems with competence in the early stages of consent. Problems in understanding were primarily to do with side effects. Problems in both competence and understanding were observed to reduce markedly, particularly for mothers, in the post-signature phase, when further discussion took place. Randomisation was generally understood but unpopular. Information was not always given by clinicians in stages during the short period available before parents gave consent. Most clinicians, however, were able to give follow-up information. Discussion: Consent validity was found to compare favourably with similar trials examined in the Euricon study. Conclusion: Adopting the elements of the continuous consent process and clinician training in RCTs should be considered by researchers, particularly when they have concerns about the quality of consent they are likely to obtain by using a conventional process. (shrink)

Successful clinical trials are important for all of us, but they can be extremely complicated to design and run, so work must be done to consider what commonly goes wrong and how these issues can be addressed. Gelinas et al suggest an ethical argument for institutional prioritisation of clinical trials conducted among limited populations. This is to ensure successful recruitment and prevent competing trials rendering each other irrelevant through lack of statistical power. But they overlook the fact that effective prioritisation (...) already occurs, and their suggestion produces yet another hurdle for researchers to overcome. Their argument hinges around the claim that allocation of participants to trials represents an inevitable rationing scenario and, like all rationing scenarios, the best methods should be used for objectively determining how limited resources are distributed to achieve the end goal.1 Although they acknowledge that both individuals and clinicians may have preferences as to which trial a patient participates in, trial interventions are by definition experimental, and therefore choosing between trials is not really analogous to choosing between alternative clinical interventions. Here it seems that although clinical instinct is important when determining treatment options, a clinical trial is a specific attempt to create systematic justified knowledge and thus individual patient/clinician autonomy …. (shrink)

Our aims are to set forth a multiprinciple system for selecting among clinical trials competing for limited space in an immunotherapy production facility that supplies products under investigation by scientific investigators; defend this system by appealing to justice principles; and illustrate our proposal by showing how it might be implemented. Our overarching aim is to assist manufacturers of immunotherapeutic products and other potentially breakthrough experimental therapies with the ethical task of prioritizing requests from scientific investigators when production capacity is limited.

A dearth of clinical research involving children has resulted in off-licence and sometimes inappropriate medications being prescribed to the paediatric population. In this environment, recent years have seen the introduction of a raft of regulation aimed at increasing the involvement of children in clinical trials research and generating evidence-based medicinal preparations for their use. However, this regulation pays scant attention to the autonomy of competent minors. In particular, it makes no provision for the ability of competent minors to consent to (...) participate in medical research and is therefore at odds with best ethical practice. This article explores the tensions between law and ethics in relation to clinical research involving minors and concludes that greater respect should be given to the autonomy of those minors who are competent to decide for themselves. (shrink)

The European framework surrounding clinical trials on medicinal products for human use is going to change as demonstrated by the large debate at European institutional level. One of the major challenges is to overcome the lack of harmonisation of clinical trial procedures among countries. This aspect is gaining more and more importance, considering the increasing number of multicentre and multinational studies. In this work, the actual European rules governing the Clinical Trial Application have been analysed throughout the different (...) steps including the registration of the trial in the European database; the preparation of documents to be submitted and their contents; the preparation of documents related to the information and consent process; the submission to competent bodies. Specific issues related to paediatric research and trials involving non EU/EEA countries have been addressed as well. Results reveal that the European legislation offers a well defined set of European rules covering different aspects of a Clinical Trial Application. However, these are not suitable to meet the challenges from multicentre and multinational clinical studies. A stronger set of rules, such as is available in a composite European Regulation has been adopted and is expected to harmonise practices and enable sponsors to carry out well conducted trials. But will the new regulation overcome the existing criticisms of Directive 2001/20/EC? (shrink)

Background Researchers are required to determine whether a person has capacity to consent to a research study before they are able to participate. The Mental Capacity Act and accompanying Code of Practice for England and Wales provide some guidance on this process, but researchers have identified that it can be difficult to determine capacity to consent when a person has complex cognitive or communication needs. This study aimed to understand the experiences and opinions of researchers who recruit people with dementia (...) to research projects, to inform the future development of training resources. Methods A mixed method, cross-sectional, electronic survey was circulated via social media and research networks in England and Wales. The survey remained open for ten weeks and included open and closed questions exploring respondents’ confidence in determining capacity in the context of recruiting people with dementia to consent, their views on training and support they have experienced and their suggestions for future training and support needs. Results 60 respondents completed the survey from across England and Wales. Although 75% of respondents had experience of determining capacity to consent with people with dementia to research, only 13% rated themselves as feeling ‘very confident’ in this. Qualitative content analysis of open responses led to the generation of six themes, explaining researchers’ confidence, competence and future training needs in this area: (1) Researcher uncertainties, (2) Lack of time, (3) Balancing information complexity with accessibility, (4) Gatekeepers, (5) Existing enablers and (6) Envisioning future training. Conclusions Researchers would benefit from specific training in undertaking conversations around consent with people with dementia. People with dementia may have fluctuating capacity, and despite support from caregivers, researchers have little practical guidance on methods of determining a person’s ability to understand or appreciate the information they have provided during the consent process. Given the development of large complex trials within dementia research, there is an urgency to develop specific and practical guidance and training for researchers working with people with dementia and their families. (shrink)

Competent patients’ refusals of nursing care do not yet have the legal or ethical standing of refusals of life-sustaining medical therapies such as mechanical ventilation or blood products. The case of a woman who refused turning and incontinence management owing to pain prompted us to examine these situations. We noted several special features: lack of paradigm cases, social taboo around unmanaged incontinence, the distinction between ordinary versus extraordinary care, and the moral distress experienced by nurses. We examined this case on (...) the merits and limitations of five well-known ethical positions: pure autonomy, conscientious objection, paternalism, communitarianism, and feminism. We found each lacking and argue for a ‘negotiated reliance’ response where nurses and others tread as lightly as possible on the patient’s autonomy while negotiating a compromise, but are obligated to match the patient’s sacrifice by extending themselves beyond their usual professional practice. (shrink)