In a thought-provoking article – or how she herself named it, ‘a thought experiment’ – the philosopher-medical ethicist Anna Smajdor analyzed in this journal the idea of whole-body gestational donation (WBGD) in brain-dead female patients, as an alternative means of gestation for prospective women who cannot or prefer not to become pregnant themselves. We have serious legal, economical, medical and ethical concerns about this proposal. First, consent for eight months of ICU treatment can never be assumed to be derived from (...) consent for post-mortem organ donation; these two are of an incomparable and entirely different medical and ethical order. Moreover, the brain-dead woman is very likely to be medically unfit for high-tech surrogacy and the brain-dead state poses a high risk for deficient embryo/fetal development. Second, from a scarcity perspective, occupying an ICU bed for eight months appears to be unjust. The costs for eight months of ICU treatment are far too high compared to the costs of surrogacy for a living, selected, and healthy woman. Neither insurance companies nor prospective parents will want to pay these exceptionally high costs for a dead woman if a living surrogate mother can be hired for a considerably lower amount. Third, there is an increased risk for harm of the child to be in WBGD. And finally, WBGD risks violating the brain-dead woman’s dignity and harming the interests of her loved ones. In short, there is simply no need for brain-dead women as surrogates. (shrink)

Severe Traumatic Brain Injury (TBI) remains a major cause of death and disability afflicting mostly young adult males and elderly people, resulting in high economic costs to society. Therapeutic approaches focus on reducing the risk on secondary brain injury. Specific ethical issues pertaining in clinical testing of pharmacological neuroprotective agents in TBI include the emergency nature of the research, the incapacity of the patients to informed consent before inclusion, short therapeutic time windows, and a risk-benefit ratio based on concept that (...) in relation to the severity of the trauma, significant adverse side effects may be acceptable for possible beneficial treatments. Randomized controlled phase III trials investigating the safety and efficacy of agents in TBI with promising benefit, conducted in acute emergency situations with short therapeutic time windows, should allow randomization under deferred consent or waiver of consent. Making progress in knowledge of treatment in acute neurological and other intensive care conditions is only possible if national regulations and legislations allow waiver of consent or deferred consent for clinical trials. (shrink)

Background The European Union aims to optimize patient protection and efficiency of health-care research by harmonizing procedures across Member States. Nonetheless, further improvements are required to increase multicenter research efficiency. We investigated IRB procedures in a large prospective European multicenter study on traumatic brain injury, aiming to inform and stimulate initiatives to improve efficiency. Methods We reviewed relevant documents regarding IRB submission and IRB approval from European neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury. (...) Documents included detailed information on IRB procedures and the duration from IRB submission until approval. They were translated and analyzed to determine the level of harmonization of IRB procedures within Europe. Results From 18 countries, 66 centers provided the requested documents. The primary IRB review was conducted centrally or locally and primary IRB approval was obtained after one, two or three review rounds with a median duration of respectively 50 and 98 days until primary IRB approval. Additional IRB approval was required in 55% of countries and could increase duration to 535 days. Total duration from submission until required IRB approval was obtained was 114 days and appeared to be shorter after submission to local IRBs compared to central IRBs. Conclusion We found variation in IRB procedures between and within European countries. There were differences in submission and approval requirements, number of review rounds and total duration. Research collaborations could benefit from the implementation of more uniform legislation and regulation while acknowledging local cultural habits and moral values between countries. (shrink)

We anticipate a further decline of patients who eventually will become brain dead. The intensive care unit (ICU) is considered a last resort for patients with severe and multiple organ dysfunction. Patients with primary central nervous system failure constitute the largest group of patients in which life-sustaining treatment is withdrawn. Almost all these patients are unconscious at the moment physicians decide to withhold and withdraw life-sustaining measures. Sometimes, however competent ICU patients state that they do not want to live anymore (...) because of the severity of their illness or the poor prognosis and ask for withdrawal of life-sustaining measures like mechanical ventilation. Do we consider the unconscious patient as potential organ donor before withdrawal of mechanical ventilation? This is paradoxically rare in the case of the conscious ICU patient. Is it practically possible and ethically feasible to obtain consent for organ donation from this group of patients? (shrink)

Locked-in syndrome (LIS) is one of the most dramatic neurological outcomes and has a profound impact on patients and their families. Most patients have intact cognition and intellectual ability and perception. Communication is possible with eyelid and/or eyeball movement. According to the literature, the wish to die is not an important issue in acute and chronic LIS. This study describes and analyses the ethical decision-making process in two opposite cases of LIS in the intensive care unit. One patient expressed the (...) wish to prolong her life for as long as possible; the other patient asked for deliberate termination of life. Both wishes were honoured. In conclusion, most patients with LIS are competent and intellectually intact. In The Netherlands the autonomy of the patient is respected by law. In respecting this autonomy, medical choices can be different in comparable patients. (shrink)

Moral philosophers tend to discriminate, explicitly or implicitly, three types of action from the point of view of moral worth. First, they recognize actions that are a duty, or obligatory, or that we ought to perform, treating these terms as approximately synonymous; second, they recognize actions that are right in so far as they are permissible from a moral standpoint and not ruled out by moral considerations, but that are not morally required of us, like the lead of this or (...) that card at bridge; third, they recognize actions that are wrong, that we ought not to do. (shrink)

Philosophical Analysis Its Development between the Two World Wars.

Aristotle's doctrine of the mean is not a counsel to perform mean or moderate actions. It states that excellence of character is a mean state with regard to the having and displaying of emotions. All emotions are morally neutral; character is shown by displaying emotions on the right occasions, Not too often or too rarely, Not too strongly or too weakly, For sufficient and only sufficient reasons, Etc. The difficulties for such a view presented by justice and such bad emotions (...) as envy are discussed. The conclusion is that basically aristotle's theory can resist critical scrutiny. (shrink)

Malaysia had its first four patients with COVID-19 on 25 January 2020. In the same week, the World Health Organization declared it as a public health emergency of international concern. The pandemic has since challenged the ethics and practice of medicine. There is palpable tension from the conflict of interest between public health initiatives and individual’s rights. Ensuring equitable care and distribution of health resources for patients with and without COVID-19 is a recurring ethical challenge for clinicians. Palliative care aims (...) to mitigate suffering caused by a life-limiting illness, and this crisis has led to the awareness and urgency to ensure it reaches all who needs it. We share here the palliative care perspectives and ethical challenges during the COVID-19 pandemic in Malaysia. (shrink)

Peter Kivy argues that Handel was the first composer to be regarded as a genius and that only in the eighteenth century was the philosophical apparatus in place that would enable any composer to be conceived of as a musical genius. According to Kivy, a Longinian conception of genius transformed Handel into a genius. A Platonic conception of genius was used to classify Mozart as a genius. Then Kant adopted a Longinian conception of genius and this shaped the perception of (...) Beethoven. Kivy is wrong on all counts. Composers were thought to be geniuses long before Handel. The emergence of philosophical aesthetics in the eighteenth century did little to shape conceptions of musical genius. More specifically, Kivy misrepresents Kant's conception of genius and the role that it plays in the recognition of Beethoven as a musical genius. (shrink)

J. O. Urmson; VIII*—A Defence of Intuitionism, Proceedings of the Aristotelian Society, Volume 75, Issue 1, 1 June 1975, Pages 111–120, https://doi.org/10.1093/.

Instrumentalism is an approach to science that treats a theory as a tool and only as a tool for computation; it dispenses with the concept of truth.Conventionalism treats a theory as true by convention if it forms a pattern of observations from which correct predictions can be made.Operationalism denies meaning to the concepts of a theory unless they can be defined operationally. It is argued in this paper that truth-value is indispensable to science, because a theory can be rejected only (...) if an empirical consequence is false and if falsity of a conclusion entails falsity of a premise. This undermines the above positions. The fourth interpretation isinduction. Induction, by contrast, uses the notion of truth-value. What is focused on here is its reliance on the ultimacy ofobservation. The present thesis is that instrumentalism, conventionalism, and induction are different attempts to handle observations. The common problem is the gap between data and theory.All these interpretations share a philosophy of observationalism. The aim of this paper is to show that the several orthodox interpretations of science all fail to solve the problem of the data-theory gap, and to show that they all presuppose a philosophy of observation. (shrink)