The purpose of the present study was to examine whether or not strong values might influence physicians' estimations of future events. In an empirical study about physicians' attitudes towards physician assisted suicide (PAS) we asked about the physicians' main reasons for being pro, doubtful or contra PAS and also asked them to estimate what would happen with patients' trust if PAS were to be legally accepted in Swedish society. Finally we asked the physicians about their own trust in healthcare in (...) the event of PAS being legally accepted. We found that in contrast to those who were pro PAS and doubtful, the group who were against PAS did not discriminate between their own opinion and their estimation of what they thought might happen with patients' trust in the future. Against the backdrop of the present study, we present a hypothesis maintaining that feeling strongly against controversial medical procedures is associated with being inclined to let one's own beliefs influence our capacity to interpret and estimate empirical results. We think this hypothesis merits closer examination. (shrink)

The goal of the present study was to elucidate what influences medical students’ attitudes and interests in medical ethics. At the end of their first, fifth and last terms, 409 medical students from all six medical schools in Sweden participated in an attitude survey. The questions focused on the students’ experience of good and poor role models, attitudes towards medical ethics in general and perceived effects of the teaching of medical ethics. Despite a low response rate at some schools, this (...) study indicates that increased interest in medical ethics was related to encountering good physician role models, and decreased interest, to encountering poor role models. Physicians involved in the education of medical students seem to teach medical ethics as role models even when ethics is not on the schedule. The low response rate prevents us from drawing definite conclusions, but the results could be used as hypotheses to be further scrutinised. (shrink)

Information is usually supposed to be a prerequisite for people making decisions on whether or not to participate in a clinical trial. Previously conducted studies and research ethics scandals indicate that participants have sometimes lacked important pieces of information. Over the past few decades the quantity of information believed to be adequate has increased significantly, and in some instances a new maxim seems to be in place: the more information, the better the ethics in terms of respecting a participant’s autonomy. (...) The authors hypothesise that the dose-response curve from pharmacology or toxicology serves as a model to illustrate that a large amount of written information does not equal optimality. Using the curve as a pedagogical analogy when teaching ethics to students in clinical sciences, and also in engaging in dialogue with research institutions, may promote reflection on how to adjust information in relation to the preferences of individual participants, thereby transgressing the maxim that more information means better ethics. (shrink)

The aim of this pilot study was to develop a realistic clinical case for identifying Knobe's asymmetric effect, ie, the tendency to ascribe intentions to a larger extent when an act is considered wrong, as well as to compare medical students at the beginning and end of their curriculum. A vignette about a critically ill 72-year-old patient in need of an operation was used, with two different outcomes: the patient dies or the patient recovers. Approximately half of the students received (...) the ‘recovery case’ and half the ‘death case’. The questions asked were whether it was right to perform the risky operation and whether the head of the clinic brought about the patient's death/recovery intentionally. Among students in their first term an asymmetry in response pattern was identified. This asymmetry was not found among students in their final term. The difference between term 1 and term 11 students is believed to be due to the socialisation of medical students towards clinical reasoning regarding the moral role of intentions. Although no Knobe effect could be detected among term 11 students, a related adaptation effect was detected, indicating that students at the end of their medical school also tend to adapt their ascription of intentions to their moral evaluation of the act. By using clinically relevant cases a new effect has thus been identified that might be useful when investigating experienced clinicians and their views on intentions. The cases and effect merit further investigation. (shrink)

OBJECTIVES: To study and describe how a group of senior researchers and a group of postgraduate students perceived the so-called "grey zone" between normal scientific practice and obvious misconduct. DESIGN: A questionnaire concerning various practices including dishonesty and obvious misconduct. The answers were obtained by means of a visual analogue scale (VAS). The central (two quarters) of the VAS were designated as a grey zone. SETTING: A Swedish medical faculty. SURVEY SAMPLE: 30 senior researchers and 30 postgraduate students. RESULTS: Twenty (...) of the senior researchers and 25 of the postgraduate students answered the questionnaire. In five cases out of 14 the senior researchers' median was found to be clearly within the interval of the grey zone, compared with three cases for the postgraduate students. Three examples of experienced misconduct were provided. Compared with postgraduate students, established researchers do not call for more research ethical guidelines and restrictions. CONCLUSION: Although the results indicate that consensus exists regarding certain obvious types of misconduct the response pattern also indicates that there is no general consensus on several procedures. (shrink)

Are fake diagnoses and false or misleading certificates permissible means of helping patients? This question is examined in relation to four examples from Swedish health care: the sterilisation case, the asylum case, the virginity case, and the adoption case.We argue that both consequentialist and deontological ethical theories, to be reasonable, need to balance values, principles, and interests such as wellbeing, truthfulness, autonomy, personal integrity, trust in the medical profession, and abidance by national legislation.We conclude that it can be justifiable for (...) physicians to fake diagnoses and write false or misleading certificates in order to help patients when not doing so has dire consequences. However, physicians must also consider the long-term effects of making exceptions to honest, non-deceitful behaviour based on the best empirical evidence available. Otherwise valuable social practices might erode and public confidence in physicians be threatened. (shrink)

Objectives To explore attitudes and reasoning among Swedish physicians and the general public regarding the withdrawal of life-sustaining treatment at a competent patient's request. Design A vignette-based postal questionnaire including 1202 randomly selected individuals in the county of Stockholm and 1200 randomly selected Swedish physicians with various specialities. The vignettes described patients requesting withdrawal of their life-sustaining treatment: (1) a 77-year-old woman on dialysis; (2) a 36-year-old man on dialysis; (3) a 34-year-old ventilator-dependent tetraplegic man. Responders were asked to classify (...) the act of terminating treatment and to prioritise arguments for/against. Results A majority in both groups prioritised arguments in favour of terminating treatment and classified the act as defensible in all vignettes. However, among the general public, 16% classified the act as euthanasia in all vignettes; among physicians this view was most expressed regarding ventilator treatment (26%). Some who classified the act as euthanasia prioritised arguments in favour of terminating treatment: among physicians 18% in vignette 1, 19% in vignette 2 and 34% in vignette 3; among the general public 35% in vignette 1, 20% in vignette 2 and 48% in vignette 3. Conclusion There is a widespread consensus regarding competent patients' right to abstain from life-sustaining treatment. An association between the hastening of death, caused by the withdrawal of life-sustaining treatment and the concept of euthanasia is proposed. The results also suggest that classifying the withdrawal of life-sustaining treatment as ‘euthanasia’ does not necessarily mean that the act is interpreted as ethically unacceptable. (shrink)

The aim of this study was to investigate patients' experiences of not being treated well in medical health care in Stockholm County, Sweden. The study was conducted by implementing qualitative content analysis using categorization of empirical material for 2006 and 2007 provided by the Patients' Advisory Committee (Patientnämnden) in Stockholm. Complaints about not being treated well accounted for 13% of all complaints to the Patients' Advisory Committee. A sample of those who complained about their medical treatment shows that about 30% (...) of these complaints also involved experiences of being badly received. Categorization of the complaints about being badly treated resulted in the following 11 categories: (1) rude, aggressive or arrogant behaviour; (2) being ignored; (3) being denied examinations or treatments; (4) lack of empathy among personnel; (5) lack of respect for personal integrity; (6) lack of time/waiting time; (7) personnel not separating private issues from their professional role; (8) injustice and discrimination; (9) sexual harassment; (10) coercion and violence and (11) unspecified bad treatment. In relation to the total number of patients, women were over-represented in all categories. In conclusion, what patients react most strongly against is when health-care personnel treat them disrespectfully by not abiding by established social norms. The results indicate that the combination of failure in medical treatment and not receiving an apology often leads patients to complain to the Patients' Advisory Committee. (shrink)

Two questionnaires directed to Swedish physicians and a sample of the Swedish population investigated attitudes towards physician-assisted suicide (PAS). The aim of the present work was to analyse qualitative data from these questionnaires in order to explore how respondents reason about PAS. Data were analysed in two steps. First, we categorized different kinds of responses and identified pro and con arguments. Second, we identified general conclusions from the responses. The data reflect the differences in attitudes towards PAS among the public (...) and physicians, with the former mainly in favour of PAS and the latter mainly against. There was, however, considerable agreement about what requirements must be met before PAS could be considered ethical. Many arguments against PAS concerned the professional role of physicians, which indicates that it may not be assisted suicide as such that many PAS opponents disagree with, but rather that it is handled by physicians in the regular health-care system. (shrink)

The aim of the present study was to compare and examine how medical students on term one and nine understand and adopt ideas and reasoning when estimating death-causes. Our hypothesis was that compared to students in the beginning of their medical curriculum, term nine students would be more inclined to adopt ideas about causality that allows physicians to alleviate an imminently dying patient, without being suspected for manslaughter—a practice referred to as proficiency creativity. We used a questionnaire containing two similar (...) cases describing an imminently dying patient who receive a drug in order to treat seizures. The treatment has the foreseen effect of shortening the patient’s life. In one version of the vignette the patient dies immediately and in the other one the patient dies 5 h after having received the drug. We asked medical students in their first term (n = 149) and ninth term (n = 106) to fill in the two randomly distributed questionnaires. We used a χ2 test to examine our hypothesis and choose as significance level 0.05. A majority of term-one students (53 %) stated that the patient died because of the provided drugs when dying immediately after and 32 % stated it when the patient died 5 h after providing the drug. The difference was significant (p = 0.007). A minority of term-nine students (20 vs. 16 %) stated the patient died because of the provided drug. The difference was not significant. The study indicates that term-nine students have espoused the idea that death-causes in such cases should always be classified as the underlying disease—even though another straightforward explanation could be the drug provided. To clinicians this might be a proficiency-creative strategy for managing a difficult legal dilemma. As hypothetical explanation we suggest that experienced clinicians might have transformed a normative issue of shortening life into an empirical issue about death-causes and tacitly transferred this strategy to term-nine students. If our hypothesis is supported by future studies, this kind of transferring proficiency creativity tacitly might impede changing the Penal Code even though it may be needed. (shrink)

Aim To examine the hypothesis that knowledge about physician-assisted suicide (PAS) and euthanasia is associated with a more restrictive attitude towards PAS. Design A questionnaire about attitudes towards PAS, including prioritisation of arguments pro and contra, was sent to Swedish veterinary surgeons. The results were compared with those from similar surveys of attitudes among the general public and physicians. Participants All veterinary surgeons who were members of the Swedish Veterinary Association and had provided an email address (n=2421). Main outcome measures (...) Similarities or differences in response pattern between veterinary surgeons, physicians and the general public. Results The response pattern among veterinary surgeons and the general public was almost similar in all relevant aspects. Of the veterinarians 75% (95% CI 72% to 78%) were in favour of PAS, compared with 73% (95% CI 69% to 77%) among the general public. Only 10% (95% CI 5% to 15%) of the veterinary surgeons were against PAS, compared with 12% (95% CI 5% to 19%) among the general public. Finally, 15% (95% CI 10% to 21%) of veterinarians were undecided, compared with 15% (95% CI 8% to 22%) among the general public. Physicians had a more restrictive attitude to PAS than the general public. Conclusions Since veterinary surgeons have frequent practical experience of euthanasia in animals, they do have knowledge about what euthanasia really is. Veterinary surgeons and the general public had an almost similar response pattern. Accordingly it seems difficult to maintain that knowledge about euthanasia is unambiguously associated with a restrictive attitude towards PAS. (shrink)

The doctrine of simple individuals has its equal and opposite reaction in the view that an individual is simply a bundle of properties, that the identity of an individual is entirely dependent on the identity of its properties. This view also seems to me to be in some sense wrong and I shall attack it in passing. If all my remarks have seemed excessively polemical it is because I have been anxious to make it as clear as possible what the (...) motivation behind this paper is. I am mainly concerned with the problem concerning the "it" which underlies or has properties and I shall want to argue that the identity of an individual--what it is that makes an individual that individual--does not depend merely on its being that individual or having that piece of substratum, but it depends partially and in a complicated way on the identity of its properties. The analysis will have to exhibit the nature of that dependence. Most of the discussion will revolve around proper names and their function since it is through linguistic considerations, I think, that we get the clearest illumination. The result, in case any one is interested, will be Absolute Idealism, or something like it. (shrink)

Context: Immunity includes cognitive concepts: the organism is thought to specifically recognize foreign materials and develop a memory of these encounters. Vaccines are thought to work by enhancing this immunological memory. Lymphocytes are key cells and specific antibodies are key molecules in immune recognition. Antibodies are blood proteins called “immunoglobulins.” Spontaneously formed immunoglobulins are seen as “natural” antibodies to dietary components and commensal bacteria. Immune cognition is used simply as a didactic metaphor. Problem: Do the cognitive aspects of immunology stem (...) from the activities of cells and molecules, or are they ascribed by the immunologist operating as a human observer? (1) An immense variety of immunoglobulins may bind to the same antigen with different binding energies. It is the immunologist who arbitrates the boundary between those that are specific (and declared antibodies) and those that are not. Specific antibodies serve as functional labels pasted onto natural immunoglobulins, as if they were recognizing elements. Is this “arbitration” the true cognitive event ascribed to immunoglobulins and lymphocytes? (2) A major impasse exists between progress in experimental immunology and its translation into clinical results. A proper understanding of immunological activity demands a wider view of an organism’s biology and, also, of the interference of human observers in delineating experimental realities, such as the specificity of immune recognition. Maturana’s biology of cognition and language provides one such approach. Method: Use of Maturana’s biology of cognition and language concepts to describe immunological activity. Results: A whole new understanding of immunological activity is suggested. Implications: A major change in the way of seeing is proposed that may eventually help the translation of this knowledge into clinical results. Furthermore, the immune system may also become a proper model for cognitive analyses. (shrink)

The british Medical Association wants to criminalise all boxing. This article examines the logic of the arguments it uses and finds them wanting. The move from medical evidence about the risk of brain damage to the conclusion that boxing should be banned is not warranted. The BMA's arguments are a combination of inconsistent paternalism and legal moralism. Consistent application of the principles implicit in the BMA's arguments would lead to absurd consequences and to severe limitations being put on individual freedom.

Contextualist theories of knowledge have received a lot of attention in the contemporary epistemological literature. The central idea of such theories is that contextual factors play an important role in determining whether a particular knowledge sentence is true or false. Thus, on contextualist theories of knowledge it might be the case that a particular subject knows a proposition in one context but fails to know that same proposition in another context—while the only thing that has changed is the context. Of (...) the extant contextualist theories of knowledge, attributer contextualism has been discussed the most. The papers in the present collection continue this focus on attributer contextualism, and offer a fairly critical treatment of this theory. Nevertheless, a number of papers also outline new types of contextualism. What results is a collection of papers that, though negative towards attributer contextualism, for the most part is sympathetic towards contextualism in general. (shrink)

Contributed seven papers presented at National Seminar on Śrāvakācāra held at Dept. of Jainology, University of Madras in 2005 and two lectures on Muniacara presented on the eve of the Mahāsati Tārābāiswāmi Endowment Lecture 2005.

Upshot: According to Biology of Cognition and Language (Maturana’s approach) the immune system is not a cognitive system and defining of a cognitive paradigm is not what we understand as a Maturanian approach to immunology. The true cognitive actions in immunology are performed by immunologists acting as observers, not by body organs or systems. Stimuli and responses are not adequate concepts in the description of systems. As a closed network of cellular/molecular interactions, the immune system yields patterns of activity as (...) is transparent in robust conserved profiles of reactivity of natural immunoglobulins, as investigated by Nóbrega et al. and Cohen et al., which offer the opportunity to unravel its natural, spontaneous activity. Dietary materials, products of the commensal microbiome are the most abundant and common elements continuously incorporated to the network activity and, thus, also represent an important avenue of investigation. (shrink)

The paper is concerned with the question of the existence of moral dilemmas, conceived of as situations involving a subject in a conflict of non‐overridden moral obligations. I reject some of the presuppositions underlying discussions of this question and argue that certain morally relevant choices cannot be evaluated in relation to an all‐things‐considered moral obligation as permissible or impermissible, right or wrong. In arguing for the inadequacy of our ordinary moral predicates for fully capturing the nature of such choices, I (...) argue that they are, in certain respects, inexpressible. (shrink)

This paper examines in some detail the chief reasons for the low ethical standards in public administration today. References have been made to the concept of dharma and the principles for ethics in public adminis tration as reflected in our tradition in the Vedanta, Upanishads, Manu and the Bhagwad Gita. Several radi cal, legal and systemic remedies are suggested and defended at length. The leitmotif of all this is an earnest call to return to and practise the ancient principles of (...) dharma to manage the polity on the basis of enduring verities. The suggestions offered by the author are all anchored in such permanent principles. (shrink)