Informed consent to medical intervention is fundamental in both ethics and law. But in practice it is often not taken seriously in developing countries. This paper provides an appraisal of informed consent practices in Bangladesh. Following a review of the ethical and legal principles of informed consent, it assesses the degree to which doctors adhere to it in Bangladesh. Based on findings of non-compliance, it then investigates the reasons for such non-compliance through an appraisal of informed consent practices in Bangladesh (...) and provides recommendations aimed at improving such practices. The significance of this paper lies in unveiling the interdependence between the ethical and legal traits of informed consent and their ramifications on strengthening the patient-oriented approach of duty to care. (shrink)

Developing an intellectualist account of skill, Stanley and Williamson define skill as a kind of disposition to action-guiding knowledge. The present paper challenges their definition of skill. While we don’t dispute that skill may consist of a cognitive, a dispositional, and an action-guiding component, we argue that Stanley and Williamson’s account of each component is problematic. In the first section, we argue, against Stanley and Williamson, that the cognitive component of skill is not a case of propositional knowledge-wh, which is (...) typically indexical. In the second section, we seek to show that Stanley and Williamson face difficulties in arguing for a generic claim about skill as a kind of disposition, and they fail to defend intellectualism about skill based on the dispositional account. In the third section we argue that Stanley and Williamson need a more detailed account of the action-guiding aspect of skill to avoid several difficulties, including a threat of a regress. We close with some lessons for the debate over intellectualism and anti-intellectualism about skill. (shrink)

Both the recent 'Warner' review of the UK research ethics committee (REC) system and the subsequent consultation document produced by the Central Office for Research Ethics Committees (COREC) emphasize the need to distinguish 'research' from what might be termed 'non-research'. This is to be determined through a process of filtering or 'triage', the intention being that RECs will avoid considering proposals with 'no material ethical issues'. In this paper we argue that trying to distinguish 'true' research from other projects is (...) counterproductive, misleading and potentially unethical. Our case is built around three assertions: (1) the distinction between research and non-research is imprecise; (2) both medical research and non-research can generate similar ethical issues; and (3) projects should be judged according to what they involve, not how they are labelled. (shrink)

Online education lacks the moral and ethical engagement as well as the empathic interactions that are essential and integral to true liberal education, including business. While the online venue can provide useful information and put libraries at the hands of the student or employee, there is an implicit lack of focus on the sacredness and centrality of the person, his or her values, attitudes, needs, and expectations. The focus of online education is on the delivery of data, not the student’s (...) engagement with the material or the process. Critically absent from online education is the ability to explore the transformation of data as it changes, first to information, then to knowledge, and finally to wisdom, within each person. Finally, absent is the ability to raise the level of abstraction. Since all needs to be measurable in concrete terms in online education, we are left with the language of metrics, such as deliverables, outcomes, inputs, and outputs. Where is the person in all of this? Where is the focus on the moral compass that is so necessary in any type of education? (shrink)

[full article, abstract in English; abstract in Lithuanian] Armstrong’s theory of laws and causation may be articulated as something like the following, which we may refer to as the received view: “Laws are intrinsic higher-order relations of ensuring between properties. The instantiation of laws is identical with singular causation. This identity is a posteriori.” Opponents and advocates of this view, believe that it may fairly and correctly be attributed to Armstrong. I do not deny it; instead I seek to reconsider (...) the received view, specifically by treating it as a part of Armstrong’s metaphysics. The main features that should concern us are truthmaker theory and the formal account of the constitutive parts of states of affairs. I also discuss Bird’s ultimate argument against Armstrong and show how its impact is weakened by this proper reading. (shrink)

In a previous article an elementary semantic analysis showed that, logically, analogical terms and expressions must be treated as homonyms, though of a special type. The latter qualification is necessitated by the concomitant element of similarity that is found to be involved in all comparisons of the analogical type. Further, it was pointed out that the special types of similarity in question cannot be isolated through a purely semantic analysis. This is, in particular, a consequence of the fact that analogy (...) is itself an analogical notion and term. The kind of similarity involved may, therefore, vary in the different forms of analogy and it may prove impossible to abstract from these something like a common element, e.g., a particular type of resemblance. This implies that the full philosophical significance of a particular form of analogy can be gleaned only from a contextual examination of its rôle in relation to a particular problem. Nevertheless, some significant conclusions may emerge from a partial analysis of certain forms of resemblance which are usually associated with analogy. (shrink)

Recent policy developments in the area of livestock husbandry have suggested that, from the perspective of optimizing animal welfare, new animal husbandry systems should be developed that provide opportunities for livestock animals to be raised in environments where they are permitted to engage in “natural behavior.” It is not known whether consumers regard animal husbandry issues as important, and whether they differentiate between animal husbandry and other animal welfare issues. The responsibility for the development of such systems is allocated jointly (...) between farmers, regulators, different actors in the food chain, and consumers. This research focuses on understanding consumer attitudes and preferences regarding the development and introduction of such systems, to ensure that they are acceptable to consumers as well as producers, regulators, and scientists. Consumer perceptions of animal welfare and animal husbandry practices were evaluated using quantitative consumer survey, which focused on two animal husbandry issues – farmed pigs and farmed fish. Following pilot work, 1000 representative Dutch consumers were sampled about their attitudes to either pig or fish husbandry. The results indicated that consumers think about animal welfare in terms of two broad categories related to their health and living environment, but do not think about welfare issues at a more detailed level. Greater concern was expressed about the welfare of pigs compared to fish. Consumer trust in labeling also emerged as an important issue, since consumers need to trust different food chain actors with responsibility for promoting animal welfare, and are reluctant to consider the details of animal husbandry systems. As a consequence, a transparent, enforceable, and traceable monitoring system for animal welfare friendly products is likely to be important for consumers. (shrink)

Recent policy developments in the area of livestock husbandry have suggested that, from the perspective of optimizing animal welfare, new animal husbandry systems should be developed that provide opportunities for livestock animals to be raised in environments where they are permitted to engage in “natural behavior.” It is not known whether consumers regard animal husbandry issues as important, and whether they differentiate between animal husbandry and other animal welfare issues. The responsibility for the development of such systems is allocated jointly (...) between farmers, regulators, different actors in the food chain, and consumers. This research focuses on understanding consumer attitudes and preferences regarding the development and introduction of such systems, to ensure that they are acceptable to consumers as well as producers, regulators, and scientists. Consumer perceptions of animal welfare and animal husbandry practices were evaluated using quantitative consumer survey, which focused on two animal husbandry issues – farmed pigs and farmed fish. Following pilot work, 1000 representative Dutch consumers were sampled about their attitudes to either pig or fish husbandry. The results indicated that consumers think about animal welfare in terms of two broad categories related to their health and living environment, but do not think about welfare issues at a more detailed level. Greater concern was expressed about the welfare of pigs compared to fish. Consumer trust in labeling also emerged as an important issue, since consumers need to trust different food chain actors with responsibility for promoting animal welfare, and are reluctant to consider the details of animal husbandry systems. As a consequence, a transparent, enforceable, and traceable monitoring system for animal welfare friendly products is likely to be important for consumers. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

One of the most important theoretical and ideological tasks of Marxist philosophy is the critical study of the philosophical thought of the West. In the second half of the 1970s and beginning of the 1980s, the ideological struggle on the international arena entered a new stage. It was characterized by the turn of the forces of imperialist reaction away from the politics of detente to the politics of the "cold war," to the active opposition to the forces of peace, democracy, (...) and socialism. The struggle of ideas has swung back and forth in the context of, on the one hand, a resurgence of reactionary anticommunist tendencies, and the stimulation and expansion of antimilitary movements and the struggles of the peoples for peace and socialism on the other. (shrink)

Peirce’s doctrine of God has scarcely been studied at all. This is surprising because his own naturally religious temperament, his desire for philosophical completeness and the influence of Kant, all led him to give an important place to theistic speculation in his philosophy. It is true that few parts of his philosophy reveal more than the fragmentary and unfinished nature of his thinking. This however does not take away from its importance both for the interpretation of his philosophy and for (...) the evaluation of its contribution. In this paper I want to examine his doctrine of God mainly in order to discover and outline what views he held in the matter. Such examination is an essential preliminary to any consideration of the value of his theistic thinking. Moreover, an objective exposition is already the best beginning of evaluation. However it is impossible to undertake this kind of examination without a careful search into various corners of his writings and a meticulous and slightly laboured presentation of one’s findings. But I think that the patience involved in such research has a rich reward. (shrink)

Recent policy in relation to clinical research proposals in the UK has distinguished between two types of review: scientific and ethical. This distinction has been formally enshrined in the recent changes to research ethics committee structure and operating procedures, introduced as the UK response to the EU Directive on clinical trials. Recent reviews and recommendations have confirmed the place of the distinction and the separate review processes. However, serious reservations can be mounted about the science/ethics distinction and the policy of (...) separate review that has been built upon it. We argue here that, first, the science/ethics distinction is incoherent, and, second, that RECs should not only be permitted to consider a study’s science, but that they have anobligation do so. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

This paper proposes a Cournot game organized by three competing firms adopting bounded rationality. According to the marginal profit in the past time step, each firm tries to update its production using local knowledge. In this game, a firm’s preference is represented by a utility function that is derived from a constant elasticity of substitution production function. The game is modeled by a 3-dimensional discrete dynamical system. The equilibria of the system are numerically studied to detect their complex characteristics due (...) to difficulty to get an explicit form for those equilibria. For the proposed utility function, some cases with different value parameters are considered. Numerical simulations are used to provide an experimental evidence for the complex behavior of the evolution of the system. The obtained results show that the system loses its stability due to different types of bifurcations. (shrink)

In this paper, we propose a new concept named the uniform single valued neutrosophic graph. An illustrative example and some properties are examined. Next, we develop an algorithmic approach for computing the complement of the single valued neutrosophic graph. A numerical example is demonstrated for computing the complement of single valued neutrosophic graphs and uniform single valued neutrosophic graph.

The approach used by physics is based on the identification and study of ideal objects, which is also the basis of biophysics, in combination with von Neumann heuristic modeling and functional fractionation according to R.Rosen is discussed as a tool for studying the properties of consciousness. The object of the study is a kind of line of analog systems: the human brain, the vertebrate brain, the invertebrate brain and artificial neural networks capable of reflection, which is a key property characteristic (...) of consciousness. Reflection in the broad sense of the word, understood as an internal representation of the external world, is characteristic of a wide range of animals, and some of them (bumblebees, fish) even demonstrate reflection in the narrow sense of the word, understood as an inner self-representation. This complex behavior is realized by miniature brains of ~1 million neurons. The use of simple recurrent neural networks (RNNs) to obtain answers to general questions is illustrated. For example, it has been shown a small RNS is able to pass delayed matching to sample (DMTS) test, forming an individual dynamic representation of the received stimulus, allowing decoding by a special external neural detector.. It has been demonstrated in the reflexive game “even-odd”, the RNS has a huge advantage over a multi-layered neural network, with the same and a larger number of neurons – reflection defeats regression. It was found that the asymmetry of outcomes in the odd-even game, which was explained by various causes, including psychological ones – “it’s easier to catch up than to run away”, is reproduced in the game of two RNNs. Obviously, there are no psychological causes here and the advantage of the player playing for “even” is explained by the more complex strategy of the “odd” player – he needs to predict the opponent’s move and choose the opposite one. (shrink)

In this paper we define Martin-L¨of complexes to be algebras for monads on the category of (reflexive) globular sets which freely add cells in accordance with the rules of intensional Martin-L¨of type theory. We then study the resulting categories of algebras for several theories. Our principal result is that there exists a cofibrantly generated Quillen model structure on the category of 1-truncated Martin-L¨of complexes and that this category is Quillen equivalent to the category of groupoids. In particular, 1-truncated Martin-L¨of complexes (...) are a model of homotopy 1-types. In order to establish these facts we give a proof-theoretic analysis, using a modified version of Tait’s logical predicates argument, of the propositional equality classes of terms of identity type in the 1-truncated theory. (shrink)

Anna J Dare,1 Anthony RJ Phillips,1–3 Michael Chu,1 Anthony JR Hickey,2 Adam SJR Bartlett1–31Department of Surgery, 2Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; 3New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New ZealandBackground: Hepatic steatosis is increasingly encountered among organ donors. Currently, there is no consensus guideline as to the type or degree of donor steatosis considered acceptable for liver transplantation, and little is known about local practices in this area. The aim of this survey (...) was to evaluate current clinical practices amongst liver transplant surgeons in Australia and New Zealand in the evaluation and use of steatotic donor livers in LT.Methods: An anonymous online twelve-question survey was emailed to all practicing LT surgeons in ANZ in January 2010.Results: The response rate was 83%. Estimated prevalence of steatosis in donor livers was between 40% and 60%. In determining suitability for LT, 90% of respondents reported rejecting organs with "severe" steatosis based on visual and palpation grounds alone. A total of 68% sought further histological assessment if the donor liver looked bad and there were risk factors for steatosis. The majority of respondents performed only one biopsy of the liver, using hematoxylin and eosin staining for fat assessment. There was wide variation in the upper limit of steatosis considered to be acceptable for LT. A total of 21% of respondents still considered microvesicular steatosis a risk factor for primary graft nonfunction.Conclusion: This survey highlights the significant variation in the appraisal and use of steatotic grafts by LT surgeons in ANZ. Accurate evaluation and judicious use of mild and moderately steatotic grafts is required if we are to utilize the available donor pool best.Keywords: liver transplantation, steatosis, fatty liver, organ donors. (shrink)

This paper explores the psychological foundations of the 'Willingness to Pay/Willingness to Accept' discrepancy. Using a qualitative approach we find that the two response modes appear to invoke different strategies for completion. An examination of the heuristics used by respondents to answer questions concerning the buying and selling of the chance to play a straightforward lottery shows that only some could be taken as supporting current theories which aim to explain the discrepancy.