Goldberg notes that the relationship is a component of Conflicts of Interests. Networks of relationships and the simultaneous presence of several interests are not negative per se but become so when they generate a conflict that undermines impartiality. The solution to the problem of COIs, therefore, cannot be to abolish relationships and the interests that they necessarily express but rather to verify whether those relationships are such as to unduly affect an individual’s judgement. The evolution of an Italian legislation about (...) COIs is eloquent in this regard. (shrink)

Public health emergencies such as pandemics can put health systems in a position where they need to ration medical equipment and interventions because the resources available are not sufficient to meet demand. In public health management, the fair allocation of resources is a permanent and cross-sector issue since resources, and especially economic resources, are not infinite. During the COVID-19 pandemic resources need to be allocated under conditions of extreme urgency and uncertainty. One very problematic aspect has concerned intensive care medicine (...) and age discrimination has been among the most hotly discussed issues, as age has been touted as a probable criterion for selection. In this paper we analyse some documents originating from scientific societies and medical associations, mainly related to EU sphere and available in English, French, Spanish and Italian, concerning the criteria for admission to the intensive care units. We highlights how, in most of these documents, it is explicitly stated that “age itself” is not a criterion for patient selection. Our conclusion is that these criteria should be defined in advance of a crisis situation and be grounded in clinical indicators. Establishing “cut-off” policies with regard to criteria such as age or chronic disability is definitely an unjustifiable form of discrimination even in the context of a public health emergency. (shrink)

After three proceedings in which neuroscience was a relevant factor for the final verdict in Italian courts, for the first time a recent case puts in question the legal relevance of neuroscientific evidence. This decision deserves international attention in its underlining that the uncertainty still affecting neuroscientific knowledge can have a significant impact on the law. It urges the consideration of such uncertainty and the development of a shared management of it.

PurposeThe aim of this paper is to assess the complex issue of responsibility in clinical practice. The paper focuses mainly on the relationship between personal- and medical-professional responsibility of practitioners and clinical guidelines.MethodsAfter a theoretical review of the different definitions of responsibility in selected bioethical and biojuridical literature, two recent juridical proceedings concerning medical responsibility from Italian Courts are discussed. Subsequently, a theoretical analysis of the definition of clinical practice guidelines is proposed in order to show their feasibility to assess (...) personal- and medical-professional responsibility.ResultsThe definitions of responsibility and the two Italian cases show the theoretical and practical difficulties of shared assessments of both personal-professional and medical-professional responsibility in clinical practice. Clinical practice guidelines cannot be assumed as an objective code of action stating exactly a rule of conduct in all situations, but as a tool suggesting how to decide what to do in different conditions.ConclusionsResponsibility in clinical practice is such a complex issue to deserve a special ethical assessment. The clinician’s personal-professional responsibility cannot be replaced or reduced by clinical practice guidelines, because medicine is as such a relationship focused on the expertize of practitioners. Nonetheless, a shared approach to different clinical conditions is needed in order to avoid a relativist outcome and protect patients’ and even clinicians’ rights. Formal guidelines (that describe not exactly what to do but how to decide what to do) are proposed as potential useful tool to achieve this aim. (shrink)

The American Journal of Bioethics, Volume 12, Issue 1, Page 37-38, January 2012.

According to Howick (2009a), the three main reasons for believing that placebo-controlled trials (PCTs) are methodologically superior to active-controlled trials (ACTs)—sensitivity, absolute effect...

Translational research is a main focus of current health policy (Albani and Prakken 2009; PLoS Medicine 2008). Translation of biomedical research knowledge to effective clinical treatment is essential to the public good (Lavis et al. 2003). Only 5% of basic science studies showing significant therapeutic promise are successfully translated into clinical application (Contopoulos-Ioannidis, Ntzani, and Ionannidis 2003; FDA 2004). As Hall (2001) observes, this is a problem: "When too many important discoveries lie dormant, the public good suffers" (p. G1127). Recent (...) health policy initiatives intended to foster the translation of basic science into clinical advances must consider the unique bioethical issues raised by .. (shrink)

Increases in international travel and migratory flows have enabled infectious diseases to emerge and spread more rapidly than ever before. Hence, it is increasingly easy for local infectious diseases to become global infectious diseases (GIDs). National governments must be able to react quickly and effectively to GIDs, whether naturally occurring or intentionally instigated by bioterrorism. According to the World Health Organisation, global partnerships are necessary to gather the most up-to-date information and to mobilize resources to tackle GIDs when necessary. Communicable (...) disease control also depends upon national public health laws and policies. The containment of an infectious disease typically involves detection, notification, quarantine and isolation of actual or suspected cases; the protection and monitoring of those not infected; and possibly even treatment. Some measures are clearly contentious and raise conflicts between individual and societal interests. In Europe national policies against infectious diseases are very heterogeneous. Some countries have a more communitarian approach to public health ethics, in which the interests of individual and society are more closely intertwined and interdependent, while others take a more liberal approach and give priority to individual freedoms in communicable disease control. This paper provides an overview of the different policies around communicable disease control that exist across a select number of countries across Europe. It then proposes ethical arguments to be considered in the making of public health laws, mostly concerning their effectiveness for public health protection. (shrink)

Alzheimer’s disease is a very common, progressive and still incurable disease. Future possibilities for its cure lie in the promotion of research that will increase our knowledge of the disorder’s causes and lead to the discovery of effective remedies. Such research will necessarily involve individuals suffering from Alzheimer’s disease. This raises the controversial issue of whether patients with Alzheimer’s disease are competent to give their consent for research participation.

Clinical ethics refers to an emerging field in clinical medicine that focuses on the process of ethical decision-making in a clinicalsetting. It has developed as a result of a growing awareness that modern medicine – characterized by technological progress, culturaldiversity and social challenges – is posing a range of new “ethical dilemmas” that medical science alone cannot solve. For thisreason, clinical ethics is often linked to “ethics consultation,” which consists of services provided by an individual ethicist, ethicsteam or committee to (...) address the ethical issues involved in a specific clinical case. Although clinical ethics developed in the beginningmainly as a methodological analysis to arrive at a justification for clinical ethical decisions, it quickly has become clear thatthe difficulty in clinical decision-making is only one aspect of wider ethical problems pertaining to the doctor-patient relationshipas a whole and, most likely, to the core value of the medical profession. The principles method is usually presented as the mostpopular methodological approach to an analysis of clinical cases. However, strong criticism of this model has been voiced, and otheralternative approaches are referred to, such as the casuistry model. Recently, significant contributions have been made by narrativemedicine and virtue ethics. According to these methodologies, sound anthropology and a good relationship with the sick person arekey elements required of any person engaged in medical practice who aims to be genuinely appropriate from an ethical perspective. DOI: 10.5294/pebi.2016.20.1.3. (shrink)

The use of human biological materials involves a number of issues from both an ethical and a legal point of view. In recent decades, the purposes for which this material has been used have i...

Notwithstanding fundamental methodological advancements, scientific information about disorders of consciousness (DOCs)—e.g. Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) and Minimally Conscious State (MCS)—is incomplete. The possibility to discriminate between different levels of consciousness in DOC states entails treatment strategies and ethical concerns. Here we attempted to investigate Italian clinicians’ and basic scientists’ opinions regarding some issues emerging from the care and the research on patients with DOCs. From our survey emerged that Italian physicians working with patients with DOCs give a central role (...) to ethics. Current Italian regulation regarding basic research conducted in patients with DOCs apparently risks to be inadequate to support scientific advancement, and would deserve a different assessment compared to ordinary treatments. We think the results of our survey deserve attention from an international audience because they exemplify the difficulty to define a shared approach to the issues related to patients with DOCs and the necessity to better assess both the ordinary and experimental treatment of patients with DOCs at the ethical and legal level. (shrink)

Background On December 2017 the Italian Parliament approved law n. 219/2017 “Provisions for informed consent and advance directives” regarding challenging legal and bioethical issues related to healthcare decisions and end-of-life choices. The law does not contain an explicit reference to Ethics Committees (ECs), but they could still play a role in implementing the law. Methods A questionnaire-based survey was performed among the ECs of the Italian Institute for Research and Care belonging to the Network of neuroscience and neurorehabilitation, with the (...) aim of (1) knowing whether the ECs participated and, if so, how in the process of implementation of law n. 219/2017 in the referring institutes; (2) investigating the point of view of the ECs regarding their possible involvement in the process; (3) exploring the contribution ECs can provide to give effective implementation to the law principles and provisions. Results Seventeen ECs out of thirty took part in the survey; the characteristics of the responding and non-responding committees are similar, so the responding ECs can be regarded as representative of all ECs in the Network. Nine ECs did not discuss the law in anyway: the main reason for this is that the referring institutions (6) and the health care professionals (3) did not ask for an EC intervention. Nevertheless, the large majority of the ECs believe that their involvement in the implementation of the law as a whole is appropriate (8) or absolutely appropriate (6), while 3 of them are neutral. No EC believes that the involvement is inappropriate. The aspect of the law on which the 14 ECs converge in considering the EC involvement appropriate/absolutely appropriate is the one related to the health facilities obligation to guarantee the full and proper implementation of the principles of the law. Conclusions Our survey confirms that ECs believe they can play a role in the implementation of law n. 219/2017, although this does not entirely correspond to what the committees have actually done in reality. This role could be better exercised by ECs specifically established for clinical practice, which would have a composition, functioning and a mandate better suited to the purpose. This supports the call for a national regulation of ECs for clinical practice. (shrink)

The majority of literature on Slow Food focuses on the organization or actors involved in the movement. There is a dearth of material analyzing Carlo Petrini’s aspirations for Slow Food, particularly in light of his desire within Slow Food Nation (2007) and Terra Madre (2010) to make “freewill giving a part of economic discourse.” This essay corrects the literature gap through historicizing and critiquing Petrini’s alternative to global capitalism while rooting it in actually existing practices. First, (...) class='Hi'>Petrini’s problematic conceptualization of freewill giving will be compared to feminist theorizations and documentations of the gift economy. Second, Petrini’s avoidance of the toxic mimic of the gift, its subsumption to capitalism, will be amended by discussing how the gifting of food aid and emergency food networks actually reproduces inequality, poverty, and hunger. Third, Petrini’s example of gifting by a Trappist Monastery will be juxtaposed to the ongoing direct action strategies of Food Not Bombs, a much stronger example of an oppositional gift economy, one that is subsequently repressed by the state. In doing so, this essay seeks to expand discussion of the gift economy within the alternative food movement while amending many of the theoretical, historical, and political problems embedded within Petrini’s work, which performs a strong disservice to the politics of possibility embedded within gifting. (shrink)

As a result of the coronavirus (COVID‐19) pandemic, health professionals are faced with situations they have not previously encountered and are being forced to make difficult ethical decisions. As the first group to experience challenges of caring for patients with coronavirus, Chinese nurses endure heartbreak and face stressful moral dilemmas. In this opinion piece, we examine three related critical questions: Whether society has the right to require health professionals to risk their lives caring for patients; whether health professionals have the (...) right to refuse to care for patients during the coronavirus pandemic; and what obligations there are to protect health professionals? Value of care, community expectations, legal obligations, professional and codes of practice may compel health professionals to put themselves at risks in emergency situations. The bioethical principles of autonomy, justice, beneficence and non‐maleficence, as well as public health ethics, guide nurses to justify their decisions as to whether they are entitled to refuse to treat COVID‐19 patients during the pandemic. We hope that the open discussion would support the international society in addressing similar ethical challenges in their respective situations during this public health crisis. (shrink)

This paper extends earlier work by its authors on formal aspects of the processes of contracting a theory to eliminate a proposition and revising a theory to introduce a proposition. In the course of the earlier work, Gardenfors developed general postulates of a more or less equational nature for such processes, whilst Alchourron and Makinson studied the particular case of contraction functions that are maximal, in the sense of yielding a maximal subset of the theory (or alternatively, of one of (...) its axiomatic bases), that fails to imply the proposition being eliminated. In the present paper, the authors study a broader class, including contraction functions that may be less than maximal. Specifically, they investigate "partial meet contraction functions", which are defined to yield the intersection of some nonempty family of maximal subsets of the theory that fail to imply the proposition being eliminated. Basic properties of these functions are established: it is shown in particular that they satisfy the Gardenfors postulates, and moreover that they are sufficiently general to provide a representation theorem for those postulates. Some special classes of partial meet contraction functions, notably those that are "relational" and "transitively relational", are studied in detail, and their connections with certain "supplementary postulates" of Gardenfors investigated, with a further representation theorem established. (shrink)

Interferon stimulated gene 15 (ISG15) encodes a ubiquitin‐like protein that is highly induced upon activation of interferon signaling and cytoplasmic DNA sensing pathways. As part of the innate immune system ISG15 acts to inhibit viral replication and particle release via the covalent conjugation to both viral and host proteins. Unlike ubiquitin, unconjugated ISG15 also functions as an intracellular and extra‐cellular signaling molecule to modulate the immune response. Several recent studies have shown ISG15 to also function in a diverse array of (...) cellular processes and pathways outside of the innate immune response. This review explores the role of ISG15 in maintaining genome stability, particularly during DNA replication, and how this relates to cancer biology. It puts forth the hypothesis that ISG15, along with DNA sensors, function within a DNA replication fork surveillance pathway to help maintain genome stability. (shrink)

One of the world's most renowned theoretical physicists, Carlo Rovelli has entranced millions of readers with his singular perspective on the cosmos. In Helgoland, Rovelli examines the enduring enigma of quantum theory. The quantum world Rovelli describes is as beautiful as it is unnerving. Helgoland is a treeless island in the North Sea where the 21-year-old Werner Heisenberg first developed quantum theory, setting off a century of scientific revolution. Full of alarming ideas (ghost waves, distant objects that seem to (...) be magically connected, cats that appear both dead and alive), quantum physics has led to countless discoveries and technological advancements. Today our understanding of the world is based on this theory, yet it is still profoundly mysterious. As scientists and philosophers continue to fiercly debate the theory's meaning, Rovelli argues that its most unsettling contradictions can be explained by seeing the world as fundamentally made of relationships, not substances. We and everything around us exist only in our interactions with one another. This bold idea suggests new directions for understanding the structure of reality and even the nature of consciousness. Rovelli makes learning about quantum mechanics an almost psychedelic experience. Shifting our perspective once again, he takes us on a riveting journey through the universe so we can better understand our place in it. (shrink)

In this article, Carlos Pereda introduces the concept of “colonial reason” and explores how philosophical practices and modes of thought are entwined with colonial political structures of exploitation, exclusion, and oppression. Pereda argues that philosophy in Latin America risks perpetuating and reinforcing the colonial gesture, either by turning to the European centers of thought (thus pursuing debates that always take place elsewhere) or by isolating itself and idealising the “own.” According to Pereda, both approaches fail to dismantle colonial violence within (...) philosophy. In his alternative approach, Pereda outlines principles and methodological criteria for the decolonisation of reason and philosophy. He emphasises the importance of methodological prudence that discerns between innocent, paralysing, and strategic uses of identity expressions and advocates for modes of reading and argumentation that conceive philosophy as an inclusive and ongoing dialogue. In Pereda’s terminology, this entails fostering “permeable reason” that manifests itself through “nomadic thinking,” a form of thinking that is capable of questioning itself and being questioned. (shrink)

Minding Time: A Philosophical and Theoretical Approach to the Psychology of Time offers an innovative philosophical account of the most fundamental kinds of time representation.

Many of the computing systems programmed using Machine Learning are opaque: it is difficult to know why they do what they do or how they work. Explainable Artificial Intelligence aims to develop analytic techniques that render opaque computing systems transparent, but lacks a normative framework with which to evaluate these techniques’ explanatory successes. The aim of the present discussion is to develop such a framework, paying particular attention to different stakeholders’ distinct explanatory requirements. Building on an analysis of “opacity” from (...) philosophy of science, this framework is modeled after accounts of explanation in cognitive science. The framework distinguishes between the explanation-seeking questions that are likely to be asked by different stakeholders, and specifies the general ways in which these questions should be answered so as to allow these stakeholders to perform their roles in the Machine Learning ecosystem. By applying the normative framework to recently developed techniques such as input heatmapping, feature-detector visualization, and diagnostic classification, it is possible to determine whether and to what extent techniques from Explainable Artificial Intelligence can be used to render opaque computing systems transparent and, thus, whether they can be used to solve the Black Box Problem. (shrink)

Edmund Husserl’s engagement with Bertrand Russell’s paradox stands in a continuum of reciprocal reception and discussions about impossible objects in the School of Brentano. Against this broader context, we will focus on Husserl’s discussion of Russell’s paradox in his manuscript A I 35α from 1912. This highly interesting and revealing manuscript has unfortunately remained unpublished, which probably explains the scant attention it has received. I will examine Husserl’s approach in A I 35α by relating it to earlier discussions of relevant (...) topics in his manuscripts and the broader historical context of the School of Brentano and early phenomenology. (shrink)

The use of genetic testing and neuroscientific evidence in legal trials raises several issues. Often their interpretation is controversial: the same evidence can be used to sustain both the prosecution’s and defense’s argument. A recent Italian case confirms such concerns and stresses other relevant related questions.

The importance of epistemic values in science is universally recognized, whereas the role of non-epistemic values is sometimes considered disputable. It has often been argued that non-epistemic values are more relevant in applied sciences, where the goals are often practical and not merely scientific. In this paper, we present a case study concerning earthquake engineering. So far, the philosophical literature has considered various branches of engineering, but very rarely earthquake engineering. We claim that the assessment of seismic hazard models is (...) sensitive to both epistemic and non-epistemic values. In particular, we argue that the selection and evaluation of these models are justified by epistemic values, even if they may be contingently influenced by non-epistemic values. By contrast, the aggregation of different models into an ensemble is justified by non-epistemic values, even if epistemic values may play an instrumental role in the attainment of these non-epistemic values. A careful consideration of the different epistemic and non-epistemic values at play in the choice of seismic hazard models is thus practically important when alternative models are available and there is uncertainty in the scientific community about which model should be used. (shrink)

The received view of dynamical explanation is that dynamical cognitive science seeks to provide covering law explanations of cognitive phenomena. By analyzing three prominent examples of dynamicist research, I show that the received view is misleading: some dynamical explanations are mechanistic explanations, and in this way resemble computational and connectionist explanations. Interestingly, these dynamical explanations invoke the mathematical framework of dynamical systems theory to describe mechanisms far more complex and distributed than the ones typically considered by philosophers. Therefore, contemporary dynamicist (...) research reveals the need for a more sophisticated account of mechanistic explanation. (shrink)

Models developed using machine learning are increasingly prevalent in scientific research. At the same time, these models are notoriously opaque. Explainable AI aims to mitigate the impact of opacity by rendering opaque models transparent. More than being just the solution to a problem, however, Explainable AI can also play an invaluable role in scientific exploration. This paper describes how post-hoc analytic techniques from Explainable AI can be used to refine target phenomena in medical science, to identify starting points for future (...) investigations of causal relationships, and to generate possible explanations of target phenomena in cognitive science. In this way, this paper describes how Explainable AI—over and above machine learning itself—contributes to the efficiency and scope of data-driven scientific research. (shrink)