Sham surgery is a controversial and rarely used component of randomised clinical trials evaluating surgical interventions. The recent use of sham surgery in trials evaluating efficacy of intracerebral fetal tissue grafts in Parkinson’s disease has highlighted the ethical concerns associated with sham surgery controls. Macklin, and Dekkers and Boer argue vigorously against use of sham surgery controls. Macklin presents a broad argument against sham surgery controls while Dekkers and Boer present a narrower argument that sham surgery is unnecessary in the (...) specific setting of fetal tissue engraftment for Parkinson’s disease. I defend sham surgery controls against both these criticisms. Appropriate clinical trial design, sometimes including sham surgery, is needed to ensure that false positive trial results do not occur and endanger public safety. Results of a completed trial of fetal tissue grafting for Parkinson’s disease are used to illustrate the potential benefits of, and problems associated with, sham surgery controls. Sham surgery controls, however, should be employed only when absolutely necessary. I suggest criteria for appropriate use of sham surgery controls. (shrink)

Debate continues about the ethics of sham surgery controls. The most powerful argument for sham surgery controls is that rigorous experiments are needed to demonstrate safety and efficacy of surgical procedures. Without such experiments, there is danger of adopting worthless procedures in clinical practice. Opponents of sham surgery controls argue that sham surgery constitutes unacceptable violation of the rights of research subjects. Recent philosophical discussion has used two thought experiments—the transplant case and the trolley problem—to explore the circumstances under which (...) individuals may be harmed to benefit a larger group. The transplant case is felt to exemplify circumstances that forbid harming some to benefit a larger group while the trolley problem exemplifies circumstances that permit harming some to benefit others. I argue that sham surgery controls satisfy criteria derived from the trolley problem and are morally permissible. (shrink)

Background Clients are invited to play a role in decisions about their care. Collaborative deliberation comprises constructive engagement, recognition of alternative actions, comparative learning, construction and elicitation of preferences and preference integration. Collaborative deliberation between clients and professionals is a process that requires an interest in each other, sharing of views on alternatives and preferences and integrating into decisions. The aim is to gain insight into collaborative deliberation in consultations and the clients’ perception of arranging long-term care. Design A descriptive (...) qualitative study to explore collaborative deliberation in consultations between clients and professionals. Six organisations providing long-term care were included. Data collection of nine clients involved observations of consultation with field notes and audio-records, interviews with clients and professionals shortly and 3–6 months after the consultation and questionnaires to collect background information. The data were analysed by deductive content analysis. Findings Constructive engagement was visible in all consultations. Clients and professionals showed respect, empathy and curiosity towards each other. In most consultations, two or more alternative actions are recognised and discussed. Comparative learning appears to be two sided, the client and the professional learn from each other's knowledge and experiences. Construction and elicitation of preference, and preference integration, seems to be present, but difficult to recognise in all consultations. Discussion/conclusion Although all propositions could be identified, there seems room for improvement in preference elicitation and integration of these preferences in the discussions on courses of action. Assistance seems needed with preference elicitation, both for the clients and for the professional. (shrink)

Each stage has its difficulties and its points of interest, and I will examine each in turn.

This paper attempts to explore a number of conceptual issues surrounding genetic testing. It looks at the meaning of the terms, genetic information and genetic testing in relation to the definition set out by the Advisory Committee on Genetic Testing in the UK, and by the Task Force on Genetic Testing in the USA. It argues that the special arrangements that may be required for the regulation of genetic tests should not be determined by reference to the nature or technology (...) of the test, but by considering those morally relevant features that justify regulation. Failure to do so will lead to the regulation of genetic tests that need not be regulated, and would fail to cover other tests which should be regulated. The paper also argues that there is little in the nature of the properties of gene tests, using DNA or chromosomes, that in itself justifies a special approach. (shrink)

The notion of autonomy commonly employed in medical ethics literature and practices is inadequate on three fronts: it fails to properly identify nonautonomous actions and choices, it gives a false account of which features of actions and choices makes them autonomous or nonautonomous, and it provides no grounds for the moral requirement to respect autonomy. In this paper I offer a more adequate framework for how to think about autonomy, but this framework does not lend itself to the kinds of (...) practical application assumed in medical ethics. A general problem then arises: the notion of autonomy used in medical ethics is conceptually inadequate, but conceptually adequate notions of autonomy do not have the practical applications that are the central concern of medical ethics. Thus, a revision both of the view of autonomy and the practice of “respect for autonomy” are in order. (shrink)

The proposition that a decreasing sequence of ordinals necessarily terminates has been given a new, and perhaps unexpected, importance by the rôle which it plays in Gentzen's proof of the freedom from contradiction of the “reine Zahlentheorie.” Gödel's construction of non-demonstrable propositions and the establishment of the impossibility of a proof of freedom from contradiction, within the framework of a certain type of formal system, showed that a proof of freedom from contradiction could be found only by transcending the axioms (...) and proof processes of that formal system. Gentzen's proof succeeds by utilisingtransfinite inductionto prove that certain sequences of reduction processes, enumerated by ordinals less than ε (the first ordinal to satisfy ε = ὡ) are finite. Were it possible to provethe restricted ordinal theorem, that a descending sequence of ordinals, less thanε, is finite, in Gentzen's “reine Zahlentheorie,” then it would be possible to determine a contradiction in that number system. In his paper, Gentzen proves the theorem of transfinite induction, which he requires, by an intuitive argument. There is also a method of reducing transfinite induction, for ordinals less than ε, to a number-theoretic principle given by Hilbert and Bernays, and a similar method by Ackermann. None of these proofs of transfinite induction isfinitist. (shrink)

I propose to begin with some fairly unexciting and uncontroversial remarks about possibility-statements, and then in their light to examine two problems philosophers have raised about certain statements of this kind which might be made in Christian theology where it touches on the doctrine of the Incarnation.

Mr D. H. Mellor, in his article of this title in Religious Studies , Vol. 5 , distinguishes three senses of words such as ‘probable’ which might be used in a religious context, especially in that of attempted theistic proofs: statistical, subjective, and inductive probability. In each case he concludes that it is misleading to use these words in such contexts at all. With his discussion of the second I do not wish to quarrel; but there seem to me to (...) be serious defects in his discussions of the first and third. (shrink)

Alberto Cortes, in [1], attempts to show that Leibniz's Principle of The Identity of Indiscernibles is a principle restricted to individuals, and that photons appear to violate L. L is stated by Leibniz as “no two substances are completely similar, or differ solo numero.” In second-order quantification theory with identity L becomes.

The ‘traditional’ view among philosophical theologians, that God is eternal not merely in the sense of being everlasting but in the sense of being outside time altogether, has come under sharp criticism in recent years, both from biblical theologians and from philosophers. It is against the latter form of attack, particularly as represented by the detailed criticisms of Professor Nelson Pike, that I wish to try and defend the notion of a divine timelessness.

‘Jason…chosen leader because his superior declines the honour, subordinate to his comrades, except once, in every trial of strength, skill, or courage, a great warrior only with the help of magical charms, jealous of honour but incapable of asserting it, passive in the face of crisis, timid and confused before trouble, tearful at insult, easily despondent, gracefully treacherous in his dealings with the love-sick Medea but cowering before her later threats and curses, coldly efficient in the time-serving murder of an (...) unsuspecting child , reluctant even in marriage.’ So Carspecken put the case against Jason's heroism. In the face of such an indictment, Lawall's plea in mitigation, ‘it must be admitted that [Jason] often reveals the qualities of a true gentleman’, seems somehow inadequate. Criticism since Carspecken has found various overlapping categories for Jason which both take account of the earlier negative judgements and preserve the centrality of his ‘personality’ and character in the poem: Jason is the quiet diplomat who works through consensus rather than force, his is a heroism of sex-appeal, he is an anti-hero, the embodiment of Sceptic ‘suspension of judgement’, or, alternatively, he is ‘one of us’, credible and lifelike. Carspecken himself tried a different tack: the poem is concerned not with individual heroism but with the heroism of the group. (shrink)

When philosophers approach philosophy of religion, they typically ask two questions: are there any sound arguments to prove the existence of God; and is talk about God even rationally intelligible? Theologians, for their part, primarily expound the meaning and relevance of Christianity. I am by profession a philosopher, but apart from Secs. VI and VII I am here writing as a puzzled twentieth-century man. My prime worry is whether we philosophers and theologians are beginning with the right questions.