This paper examines the concept of ‘openness with patients’ from the stand-point of the limitations of biomedical ethics. Initially we review contemporary critiques of bioethics and, in particular, of principlism; we relate how other; somewhat neglected, forms of medical ethics can yield useful information and provide moral guidance.The main section of the paper then shows how a bioethical approach to openness misses the social context in our example, the viewpoints of patients; we present some of the increasing wealth of research (...) evidence which points towards patients wanting more information and a greater degree of openness.Finally we put forward that a principlist’s objection to active encouragement of openness might be based on the risk of infringing upon the ‘right not to know’. We reject this by arguing how rights can be trumped. (shrink)

The goal of improving public health involves the use of different tools, with the law being one way to influence the activities of institutions and individuals. Of the regulatory mechanisms afforded by law to achieve this end, criminal law remains a perennial mechanism to delimit the scope of individual and group conduct. However, criminal law may promote or hinder public health goals, and its use raises a number of complex questions that merit exploration. This examination of the interface between criminal (...) law and public health brings together international experts from a variety of disciplines, including law, criminology, public health, philosophy and health policy, in order to examine the theoretical and practical implications of using criminal law to improve public health. (shrink)

A study was undertaken of the views of users of two genitourinary medicine (GUM) clinics in England on unlinked anonymous testing (UAT) for HIV. The UAT programme measures the prevalence of HIV in the population, including undiagnosed prevalence, by testing residual blood (from samples taken for clinical purposes) which is anonymised and irreversibly unlinked from the source. 424 clinic users completed an anonymous questionnaire about their knowledge of, and attitudes towards, UAT. Only 1/7 (14%) were aware that blood left over (...) from clinical testing may be tested anonymously for HIV. A large majority (89%) said they would agree to their blood being tested, although 74% wanted the opportunity to consent. These findings indicate broad support for UAT of blood in a group of patients whose samples are included in the HIV surveillance programme. The findings suggest the need for greater attention to be given to the provision of information and, if replicated in a larger survey, may justify a reappraisal of UK policy on UAT. (shrink)

This paper examines the concept of ‘openness with patients’ from the stand-point of the limitations of biomedical ethics. Initially we review contemporary critiques of bioethics and, in particular, of principlism; we relate how other; somewhat neglected, forms of medical ethics can yield useful information and provide moral guidance. The main section of the paper then shows how a bioethical approach to openness misses the social context in our example, the viewpoints of patients; we present some of the increasing wealth of (...) research evidence which points towards patients wanting more information and a greater degree of openness. (shrink)

Este manuscrito apresenta um ponto de vista sobre o conhecimento da origem do cosmos. A ciência afirma que o Universo teve um começo com o tempo, mas também declara que nenhuma lei natural pode ser aplicada no tempo inicial. Considerando que se trata de algo exclusivo da ciência divina, sugere-se então a instrumentalidade da fé para se conhecer aquilo que de fato é relevante sobre o início da história.

Séculos de intenso trabalho no discurso da origem da vida levaram a ciência a nenhuma descoberta significativa. As teorias mais progressivas se estagnaram no problema central da origem da informação genética, inimaginavelmente distante de qualquer concepção humana. Aparentemente o Criador reservou para si o conhecimento absoluto deste extraordinário acontecimento. Mas há algo surpreendente nessa investigação que está ao alcance do homem.

The similarity of documents in a large database of published Fractals articles was examined for redundancy. Three different text matching techniques were used on publisheds to identify redundancy candidates, and predictions were verified by reading full text versions of the redundancy candidate articles. A small fraction of the total articles in the database was judged to be redundant. This was viewed as a lower limit, because it excluded cases where the concepts remained the same, but the text was altered substantially.Far (...) more pervasive than redundant publications were publications that did not violate the letter of redundancy but rather violated the spirit of redundancy. There appeared to be widespread publication maximization strategies. Studies that resulted in one comprehensive paper decades ago now result in multiple papers that focus on one major problem, but are differentiated by parameter ranges, or other stratifying variables. This ‘paper inflation’ is due in large part to the increasing use of metrics (publications, patents, citations, etc) to evaluate research performance, and the researchers’ motivation to maximize the metrics. (shrink)

Sarah A. Mattice develops a comparative intervention in contemporary metaphilosophy. Drawing on resources from hermeneutics, cognitive linguistics, aesthetics, and Chinese philosophy, she explores how philosophical language is deeply intertwined with the definition and practice of the discipline.

The ability to reason independently from one's own goals or beliefs has long been recognised as a key characteristic of the development of formal operational thought. In this article we present the results of a study that examined the correlates of this ability in a group of 10-year-old children ( N = 61). Participants were presented with conditional and relational reasoning items, where the content was manipulated such that the conclusion to the arguments were either congruent, neutral, or incongruent with (...) beliefs, and either logically valid or logically invalid. Participants also received a measure of working memory capacity (the counting span task) and a measure of inhibitory control (the stop signal task). Indices of belief bias and logical reasoning on belief-based problems were predicted independently by both measures. In contrast logical reasoning on belief neutral problems was predicted by working memory alone. The findings suggest that executive functions play a key role in the development of children's ability to decontextualise their thinking. (shrink)

The use of placebo in clinical trials has been repeatedly challenged as being unacceptable from an ethical point of view. The present paper responds to this criticism by taking up the issue in the light of the pertinent provisions of the Helsinki Declaration. Examples from different therapeutic areas are given that highlight the importance of placebo in situations in which its use is acceptable according to the Declaration. Particular emphasis is given to the question of active control trials, which, under (...) conditions of low assay sensitivity, may become an ethically less acceptable approach than the use of a placebo control. (shrink)

Die demografische Entwicklung und der medizinische Fortschritt werden die Problematik der Ressourcenknappheit im deutschen Gesundheitswesen in Zukunft weiter verschärfen. Soll nicht nur kurzfristig akuten Sparzwängen ausgewichen werden, steht – wie in verschiedenen Ländern bereits geschehen – auch Deutschland auf Dauer eine Prioritätensetzung im Gesundheitswesen bevor. Diese sollte in möglichst transparenter Weise nach klaren Kriterien erfolgen. Eines der seit einiger Zeit häufig öffentlich zitierten Kriterien der Verteilung von Mitteln in der Gesundheitsversorgung ist die Eigenverantwortung von Patienten. Deren Berücksichtigung in der Allokation (...) von Ressourcen birgt allerdings zahlreiche Probleme. Der vorliegende Beitrag untersucht die gerechtigkeitstheoretischen Grundlagen und die praktischen Probleme bzw. die möglichen Konsequenzen von Eigenverantwortung als Verteilungskriterium im Gesundheitswesen. Auf der Grundlage eines alternativen gerechtigkeitstheoretischen Vorschlags werden drei Möglichkeiten skizziert, Eigenverantwortung von Patienten im deutschen Gesundheitswesen in gerechter Weise stärker zu betonen. (shrink)

This article critically engages with Mandeville et al.'s case discussion of using social networking services for the purposes of contact tracing in infectious disease outbreaks. It will be argued that their discussion may be overstating the utility of such approaches, while simultaneously underestimating the ethical concerns that arise from this method of contact tracing. The article separates between ethical and technological concerns and suggests that due to the particular design of networking sites such as Facebook and the usage patterns of (...) subscribers, the positive effect of contact tracing through such services may be overstated. At the same time, using social networking sites raises serious concerns regarding the privacy of patients and the ownership of information posted online. (shrink)

Este artigo contém um estudo sobre a Ciência a partir do ponto de vista bíblico, por meio da fé na revelação divinamente inspirada. A Bíblia revela a origem e a plenitude da Ciência no ato da criação do Universo e a apresenta como uma dádiva especial de Deus aos homens. As Escrituras também demonstram que a Ciência genuína existe para glorificar a Deus, sendo a sua instrumentalidade uma forma excelente de comunicação divina.

This paper examines some of the possible legal implications of the production, marketing and use of expert systems. The relevance of a legally useful definition of expert systems, comprising systems designed for use both by laymen and professionals, is related to the distinctions inherent in the legal doctrine underlying provision of goods and provision of services. The liability of the sellers and users of, and contributors to, expert systems are examined in terms of professional malpractice as well as product liability. (...) A recurring theme indicates that legislators may be inclined to restrict possibilities of liability suits in order to avoid disincentives to the creation of expert systems. (shrink)

Under the impact of cultural, economic and legislative forces the traditional role of the university health center is changing. The academic health center is rapidly evolving from a relatively undifferentiated general hospital, primarily responsible for the education of undergraduate students of medicine, into a center of clinical research, caring for very specialized mixes of patients, and having as its primary educational mission the training of subspecialists. The nature of the forces responsible for this change are analyzed, and some of its (...) possible consequences for the definition of quality health care, for the shape of medical practice and medical education, and for the allocation of resources for health care are explored. This exploration suggests that the functional separation of the medical school from the highly technical, clinical research center is inevitable. This in turn may exacerbate tensions within medicine between the physician as scientist and as healer, between curative and preventive practice and between personal and public health. Although the effects of this separation on medical education remain obscure, it has already occasioned the most comprehensive review of the medical curriculum since the time of Flexner. Out of this is likely to develop a more generalist view of the education of future physicians. (shrink)

Spontaneous mirror self-recognition is achieved by only a limited number of species, suggesting a sharp “cognitive Rubicon” that only few can pass. But is the demarcation line that sharp? In studies on monkeys, who do not recognize themselves in a mirror, animals can make a difference between their mirror image and an unknown conspecific. This evidence speaks for a gradualist view of mirror self-recognition. We hypothesize that such a gradual process possibly consists of at least two independent aptitudes, the ability (...) to detect synchronicity between self- and foreign movement and the cognitive understanding that the mirror reflection is oneself. Pigeons are known to achieve the first but fail at the second aptitude. We therefore expected them to treat their mirror image differently from an unknown pigeon, without being able to understand that the mirror reflects their own image. We tested pigeons in a task where they either approached a mirror or a Plexiglas barrier to feed. Behind the Plexiglas an unknown pigeon walked at the same time toward the food bowl. Thus, we pitched a condition with a mirror-self and a foreign bird against each other, with both of them walking close toward the food bowl. By a detailed analysis of a whole suit of behavioral details, our results make it likely that the foreign pigeon was treated as a competitor while the mirror image caused hesitation as if being an uncanny conspecific. Our results are akin to those with monkeys and show that pigeons do not equal their mirror reflection with a conspecific, although being unable to recognize themselves in the mirror. (shrink)

Contemporary scholarship interprets Sergej Bulgakov’s sophiology as an engagement of Orthodox theology with the modern world and as being on its way to becoming a political theology. In this paper I undertake a re-evaluation of the kind of engagement sophiology was and was intended to be, and of the kind of world it was destined for. It will be argued that sophiology was not so much a political-theological engagement with the world concentrating on the relation of religion and politics or (...) state and church, but rather an economic-theological engagement in the tradition of oikonomia theology that tried to understand the world in its relation to and as part of divine oikonomia. Furthermore, the world sophiology promotes engagement with is not only the real contemporary world, or the sociological ideal type of modernity, but primarily the world as such, this secular and human world over and against the divine and transcendent world. (shrink)

A great variety of medical conditions are subject to the placebo effect. Although there is mounting evidence to suggest that the placebo effect is related to the expectation of clinical benefit, little is still known about the biochemical bases underlying placebo responses. Positron emission tomography studies have recently shown that the placebo effect in Parkinson’s disease, pain, and depression is related to the activation of the limbic circuitry. The observation that placebo administration induces the release of dopamine in the ventral (...) striatum of patients with Parkinson’s disease suggests a link between the placebo effect and reward mechanisms. In addition to Parkinson’s disease, the placebo-reward model may also apply to other disorders. However, the relative contribution of the different neurotransmitters and neuropeptides that are known to be involved in modulating the activity of the limbic system may be disease-specific. Thus, while the placebo-induced clinical benefit observed in Parkinson’s disease would mostly reflect the release of dopamine in the dorsal striatum, the activation of opioid and serotonin pathways could be particularly implicated in mediating placebo responses encountered in pain and depression, respectively. (shrink)