Citizens today are increasingly expected to be knowledgeable about and prepared to engage with biomedical knowledge. In this article, I wish to reframe this ‘public understanding of science’ project, and place fresh emphasis on public understandings of research: an engagement with the everyday laboratory practices of biomedicine and its associated ethics, rather than with specific scientific facts. This is not based on an assumption that non-scientists are ‘ignorant’ and are thus unable to ‘appropriately’ use or debate science; rather, it is (...) underpinned by an empirically-grounded observation that some individuals may be unfamiliar with certain specificities of particular modes of research and ethical frameworks, and, as a consequence, have their autonomy compromised when invited to participate in biomedical investigations. Drawing on the perspectives of participants in my own sociological research on the social and ethical dimensions of neuroscience, I argue that public understanding of biomedical research and its ethics should be developed both at the community level and within the research moment itself in order to enhance autonomy and promote more socially robust science. Public bioethics will have to play a key role in such an endeavour, and indeed will contribute in important ways to the opening up of new spaces of symmetrical engagement between bioethicists, scientists and wider publics—and hence to the democratisation of the bioethical enterprise. (shrink)

The British National Institute for Health and Clinical Excellence has recently released new guidelines for the diagnosis, treatment and prevention of the psychiatric category antisocial personality disorder. Evident in these recommendations is a broader ambiguity regarding the ontology of ASPD. Although, perhaps, a mundane feature of much of medicine, in this case, ontological uncertainty has significant ethical implications as a product of the profound consequences for an individual categorised with this disorder. This paper argues that in refraining from emphasising uncertainty, (...) NICE risks reifying a controversial category. This is particularly problematical given that the guidelines recommend the identification of individuals “at risk” of raising antisocial children. Although this paper does not argue that NICE is “wrong” in any of its recommendations, more emphasis should have been placed on discussions of the ethical implications of diagnosis and treatment, especially given the multiple uncertainties associated with ASPD. It is proposed that these important issues be examined in more detail in revisions of existing NICE recommendations, and be included in upcoming guidance. This paper thus raises key questions regarding the place and role of ethics within the current and future remit of NICE. (shrink)

This is a study of a crucial and controversial topic in metaphysics and the philosophy of science: the status of the laws of nature. D. M. Armstrong works out clearly and in comprehensive detail a largely original view that laws are relations between properties or universals. The theory is continuous with the views on universals and more generally with the scientific realism that Professor Armstrong has advanced in earlier publications. He begins here by mounting an attack on the orthodox and (...) sceptical view deriving from Hume that laws assert no more than a regularity of coincidence between instances of properties. In doing so he presents what may become the definitive statement of the case against this position. Professor Armstrong then goes on to establish his own theory in a systematic manner defending it against the most likely objections, and extending both it and the related theory of universals to cover functional and statistical laws. This treatment of the subject is refreshingly concise and vivid: it will both stimulate vigorous professional debate and make an excellent student text. (shrink)

In recent years, we have seen a new concern with ethics training for research and development professionals. Although ethics training has become more common, the effectiveness of the training being provided is open to question. In the present effort, a new ethics training course was developed that stresses the importance of the strategies people apply to make sense of ethical problems. The effectiveness of this training was assessed in a sample of 59 doctoral students working in the biological and social (...) sciences using a pre–post design with follow-up and a series of ethical decision-making measures serving as the outcome variable. Results showed not only that this training led to sizable gains in ethical decision making but also that these gains were maintained over time. The implications of these findings for ethics training in the sciences are discussed. (shrink)

While much has been written on the cultural and intellectual antecedents that gave rise to Carolus Linnaeus?s herbarium and his Systema Naturae, the tools that he used to transform his raw observations into nomenclatural terms and categories have been neglected. Focusing on the Philosophia Botanica, the popular classification handbook that he published in 1751, it can be shown that Linnaeus cleverly ordered and reordered the work by employing commonplacing techniques that had been part of print culture since the Renaissance. Indeed, (...) the functional adaptability of commonplace heads allowed him to split and combine the book?s chapters and tables and played a notable conceptual role in the way in which he spatialized words and, to a certain extent, specimens. (shrink)

Objective: The field of clinical ethics is relatively new and expanding. Best practices in clinical ethics against which one can benchmark performance have not been clearly articulated. The first step in developing benchmarks of clinical ethics services is to identify and understand current practices.Design and setting: Using a retrospective case study approach, the structure, activities, and resources of nine clinical ethics services in a large metropolitan centre are described, compared, and contrasted.Results: The data yielded a unique and detailed account of (...) the nature and scope of clinical ethics services across a spectrum of facilities. General themes emerged in four areas—variability, visibility, accountability, and complexity. There was a high degree of variability in the structures, activities, and resources across the clinical ethics services. Increasing visibility was identified as a significant challenge within organisations and externally. Although each service had a formal system for maintaining accountability and measuring performance, differences in the type, frequency, and content of reporting impacted service delivery. One of the most salient findings was the complexity inherent in the provision of clinical ethics services, which requires of clinical ethicists a broad and varied skill set and knowledge base. Benchmarks including the average number of consults/ethicist per year and the hospital beds/ethicist ratio are presented.Conclusion: The findings will be of interest to clinical ethicists locally, nationally, and internationally as they provide a preliminary framework from which further benchmarking measures and best practices in clinical ethics can be identified, developed, and evaluated. (shrink)

Recent studies using functional magnetic resonance imaging of patients in a vegetative state have raised the possibility that such patients retain some degree of consciousness. In this paper, the ethical implications of such findings are outlined, in particular in relation to decisions about withdrawing life-sustaining treatment. It is sometimes assumed that if there is evidence of consciousness, treatment should not be withdrawn. But, paradoxically, the discovery of consciousness in very severely brain-damaged patients may provide more reason to let them die. (...) Although functional neuroimaging is likely to play an increasing role in the assessment of patients in a vegetative state, caution is needed in the interpretation of neuroimaging findings. (shrink)

The following questions arising in connection with the géométrisation of modern physics are discussed: is the physical theory a bicomponent one or everything can be reduced to space? Whether the hypothesis of the macroscopic nature of space and time deals with the theoretical or empirical structure of physical theory? Is there géométrisation of quanta or quantisation of geometry?

D. M. Armstrong; II—Does Knowledge Entail Belief?, Proceedings of the Aristotelian Society, Volume 70, Issue 1, 1 June 1970, Pages 21–36, https://doi.org/10.109.

The political philosophy of health care has been characterized by considerable conceptual inflation in recent years. First, the concept of health that lies at its core has come to encompass ever-increasing aspects of individuals’ existences. And second, the emergence of the public health perspective has increased the range of resources relevant to health equity. This expansion has not been without cost. The decision to include more rather than less within the ambit of "health" is ultimately a moral/political rather than an (...) ontological or metaphysical one, and there are several ethical reasons to define the scope of theories of distributive justice in health narrowly. (shrink)

The imbalance between supply of organs for transplantation and demand for them is widening. Although the current international drive to re-establish procurement via non-heart beating organ donation/donor is founded therefore on necessity, the process may constitute a desirable outcome for patient and family when progression to brain stem death does not occur and conventional organ retrieval from the beating heart donor is thereby prevented. The literature accounts of this practice, however, raise concerns that risk jeopardising professional and public confidence in (...) the broader transplant programme. This article focuses on these clinical, ethical, and legal issues in the context of other approaches aimed at increasing donor numbers. The feasibility of introducing such an initiative will hinge on the ability to reassure patients, families, attendant staff, professional bodies, the wider public, law enforcement agencies, and the media that practitioners are working within explicit guidelines which are both ethically and legally defensible. (shrink)

This book studies the interfaces of ethics, economics, and politics. Public policy issues involve all three of these subjects. Although it may be seen as suggesting the nucleus of a joint university course, the book is accessible to and should interest all those concerned with political decisions. Any such decision needs a criterion for judging whether one action or outcome is better than another. Even a dictator must to some extent be concerned about the economic elfare of the citizens; and (...) a democratic government more so. But how is a person's economic welfare to be judged? Furthermore, any political decision affects the economic welfare of different people differently. How then is the welfare of a community to be judged? This is an ethical question. Underlying any coherent public policy there must be a relevant moral code. (shrink)

This book studies the interfaces of ethics, economics, and politics. Public policy issues involve all three of these subjects. Although it may be seen as suggesting the nucleus of a joint university course, the book is accessible to and should interest all those concerned with political decisions. Any such decision needs a criterion for judging whether one action or outcome is better than another. Even a dictator must to some extent be concerned about the economic welfare of the citizens; and (...) a democratic government more so. But how is a person's economic welfare to be judged? Furthermore, any political decision affects the economic welfare of different people differently. How then is the welfare of a community to be judged? This is an ethical question. Underlying any coherent public policy there must be a relevant moral code. (shrink)

In the 18th century, the concept of ‘affinity’, ‘principle’ and ‘element’ dominated chemical discourse, both inside and outside the laboratory. Although much work has been done on these terms and the methodological commitments which guided their usage, most studies over the past two centuries have concentrated on their application as relevant to Lavoisier's oxygen theory and the new nomenclature. Kim's affinity challenges this historiographical trajectory by looking at several French chemists in the light of their private thoughts, public disputations and (...) communal networks. In doing so, she tells a complex story which points to the methodological and practical importance of industrial and medical chemistry. The following review highlights the advantages and snares of such an approach and makes a few historiographical points along the way. (shrink)

In this paper we investigate AGM belief contraction operators by using the tools of algebraic logic. We generalize the notion of contraction to arbitrary finitary propositional logics, and we show how to switch from a syntactic-based approach to a semantic one. This allows to build a solid bridge between the validity of AGM postulates in a propositional logic and specific algebraic properties of its intended algebraic counterpart. Such a connection deserves particular attention when we deal with maxichoice contractions, as studied (...) in the final part of the paper. (shrink)

This essay addresses mineral water as a medical, experimental and economic material. It focuses on the career of the Reverend Dr William Laing , a physician and cleric who wrote two pamphlets about the water of provincial spa located in Peterhead, a town on the north-east coast of Scotland. I begin by outlining his education and I then reconstruct the medical theory that guided his efforts to identify tonics in the well’s water. Next, I explain why Laing and several other (...) local inhabitants thought themselves to be authorities on the palliative power of the water and I close by showing how such effects were commodified by local entrepreneurs. Although I concentrate primarily upon Peterhead Spa, this study touches upon several issues relevant to the types of medical theory and chemical experimentation that were being used in provincial Scotland during the late eighteenth and early nineteenth centuries. (shrink)

Many studies examine a stressors-professional burnout (PB) relation, but only few consider the role of ethical conflicts (ECs) in this context. The aim of this study was to characterize ECs' frequency and level of burden with them among nurses and to establish the relations between ECs' frequency, burden and PB. One hundred nurses participated in this study. ECs' frequency and burden were tested with an originally developed questionnaire. PB was examined with Maslach Burnout Inventory. Most frequent ECs concerned a nurse-patient (...) relationship. PB was positively related to ECs' frequency (r = .54; p = .001) and burden (r = .22; p = .03). Frequency of specific conflict did not imply burden with it and vice versa. ECs' frequency seems more important for PB than a level of burden with them. The most frequent and the most burdening conflicts may lead to development of PB but the less frequent and less burdening ones are also dangerous. (shrink)

Legislation that authorises controversial organ procurement strategies but ignores respect for autonomy is flawed in principle and predictably unworkable in practiceThe UK Human Tissue Act 2004,1 designed to regulate all activity involving human tissue, organs, or bodies, was introduced in the House of Commons in December 2003, received Royal Assent on 15 November 2004,2 and has been partially implemented by Commencement Orders from April 2005. The new act, which repeals and replaces the Human Tissue Act 1961, the Anatomy Act 1984, (...) and the Human Organ Transplants Act 1989, has its origins in events of serious public concern, namely the retained organs scandals at Bristol Royal Infirmary3 and the Royal Liverpool Childrens’ Hospital.4 The act is correspondingly dominated by regulation of postmortem examinations and retention of human tissue, with consistent emphasis on the need for fully informed consent. Compliance with these requirements is now mandatory with the threat of up to three years’ imprisonment and/or fines for any deviation.The impact of the original proposals within the bill on research and the clinical practice of pathology have been carefully considered and documented,5 with subsequent amendments to ameliorate professional concerns.6 The act, however, also carries significant implications for medical practice in areas where donor recruitment for transplantation can take place, and representations on these aspects during readings of the bill7 have produced neither clarification, justification, nor amendment within the final legislation.Section 43 will make it lawful for hospital authorities “to take steps for the purpose of preserving the part for use for transplantation and to retain the body for that purpose”. The original explanatory notes for the bill8 while it proceeded through parliament implied that such action, prior to consent to transplantation being sought, was then lawful, clause 44 as section 43 …. (shrink)

Written with poignancy and compassion, ____Do We Still Need__ ____Doctors?__ is a personal account from the front lines of the moral and political battles that are reshaping America's health care system.

The editorial in the September 1982 issue of this journal and many articles before and since have addressed the problem of informed consent. Is it possible? Is it a useful concept? Is there anything new to be said about it? In this article the basic rationale of the rule (patient autonomy) is explained and the extent of the rule explored. Various exceptions have been offered by the law and an attempt is made to catalogue the chief of these. A number (...) of specially vulnerable groups are then identified, the most important, and vexed, being children. How can informed consent be secured in the case of young patients? Finally, a few problems are mentioned in an attempt to get this subject back to reality. The appeal to the principle primum non nocere may be medical paternalism in disguise. Informed consent is the competing principle that reminds us of the primacy of human autonomy. A pointer is given to the future: even the use of sound recordings to explain medical procedures and to activate informed consent so that it may become a reality and not just a lawyer's myth, should be considered. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)