Background: Despite the expansion of ethics consultation services, questions remain about the aims of clinical ethics consultation, its methods and the expertise of those who provide such services.Objective: To describe physicians’ expectations regarding the training and skills necessary for ethics consultants to contribute effectively to the care of patients in intensive care unit .Design: Mailed survey.Participants: Physicians responsible for the care of at least 10 patients in ICU over a 6-month period at a 921-bed private teaching hospital with an established (...) ethics consultation service. 69 of 92 eligible physicians responded.Measurements: Importance of specialised knowledge and skills for ethics consultants contributing to the care of patients in ICU; need for advanced disciplinary training; expectations regarding formal-training programmes for ethics consultants.Results: Expertise in ethics was described most often as important for ethics consultants taking part in the care of patients in ICU, compared with expertise in law , religious traditions , medicine and conflict-mediation techniques . When asked about the formal training consultants should possess, however, physicians involved in the care of patients in ICU most often identified advanced medical training as important.Conclusions: Although many physicians caring for patients in ICU believe ethics consultants must possess non-medical expertise in ethics and law if they are to contribute effectively to patient care, these physicians place a very high value on medical training as well, suggesting a “medicine plus one” view of the training of an ideal ethics consultant. As ethics consultation services expand, clear expectations regarding the training of ethics consultants should be established. (shrink)
In this article I will argue first that if ignorance poses a problem for valid consent in medical contexts then framing effects do too, and second that the problem posed by framing effects can be solved by eliminating those effects. My position is thus a mean between two mistaken extremes. At one mistaken extreme, framing effects are so trivial that they never impinge on the moral force of consent. This is as mistaken as thinking that ignorance is so trivial that (...) it never impinges on the moral force of consent. At the other mistaken extreme, framing effects are so serious that their existence shows that consent has no independent moral force. This is as mistaken as the idea that ignorance is so serious that its existence shows that consent has no independent moral force. I will argue that, instead of endorsing either of these mistaken extreme views, we should instead endorse a moderate view according to which framing effects sometimes pose a serious challenge for the validity of consent, just as ignorance does, but one which we can solve by eliminating the effect, just as we can solve the problem of ignorance by eliminating it. (shrink)
Is God's foreknowledge compatible with human freedom? One of the most attractive attempts to reconcile the two is the Ockhamistic view, which subscribes not only to human freedom and divine omniscience, but retains our most fundamental intuitions concerning God and time: that the past is immutable, that God exists and acts in time, and that there is no backward causation. In order to achieve all that, Ockhamists distinguish ‘hard facts’ about the past which cannot possibly be altered from ‘soft facts’ (...) about the past which are alterable, and argue that God's prior beliefs about human actions are soft facts about the past. (shrink)
The U.S. Code of Federal Regulations governing federally funded research on human subjects assumes that harmful research is sometimes morally justifiable because the beneficiaries of that research share a particular vulnerability with its subjects. In this article, I argue against this assumption, which occurs in every subpart of the Code of Federal Regulations that deals with specific vulnerable populations . I argue that shared vulnerability is no exception to the general principle that harming one person in order to benefit another (...) is no more justifiable if the two people have traits in common. Further, shared vulnerability is not a reasonable proxy for any morally relevant desideratum of research, in particular the desire to benefit the worst off, the desire to avoid exploitation, and the desire to use vulnerable populations in research only when necessary. (shrink)
Wittgenstein’s concepts shed light on the phenomenon of schizophrenia in at least three different ways: with a view to empathy, scientific explanation, or philosophical clarification. I consider two different “positive” wittgensteinian accounts―Campbell’s idea that delusions involve a mechanism of which different framework propositions are parts, Sass’ proposal that the schizophrenic patient can be described as a solipsist, and a Rhodes’ and Gipp’s account, where epistemic aspects of schizophrenia are explained as failures in the ordinary background of certainties. I argue that (...) none of them amounts to empathic-phenomenological understanding, but they provide examples of how philosophical concepts can contribute to scientific explanation, and to philosophical clarification respectively. (shrink)
Subsequent consent can be morally efficacious. First, it licenses nostalgia and dismissiveness no more than its prior cousin does. Second, it's coherent because linked to the mental state of not minding. Third, it's just as vulnerable to bilking as prior consent is, as is clear once we distinguish between basing moral assessments on expectations versus on actual outcomes. Fourth, mind control is illegitimate because it short circuits the subject's will, not because its consent is subsequent. Finally, our intuitions about rape (...) show that dissent sometimes outweighs consent in matters of sex, not that subsequent consent is always inefficacious. (shrink)
In this paper I argue, against the current consensus, that the right to withdraw from research is sometimes alienable. In other words, research subjects are sometimes morally permitted to waive their right to withdraw. The argument proceeds in three major steps. In the first step, I argue that rights typically should be presumed alienable, both because that is not illegitimately coercive and because the general paternalistic motivation for keeping them inalienable is untenable. In the second step of the argument, I (...) consider three special characteristics of the right to withdraw, first that its waiver might be exploitative, second that research involves intimate bodily access, and third that it is irreversible. I argue that none of these characteristics justify an inalienable right to withdraw. In the third step, I examine four considerations often taken to justify various other allegedly inalienable rights: concerns about treating yourself merely as a means as might be the case in suicide, concerns about revoking all your future freedoms in slavery contracts, the resolution of coordination problems, and public interest. I argue that the motivations involved in these four types of situations do not apply to the right to withdraw from research. (shrink)
So long as a ban is enforceable, large private athletic institutions—such as Major League Baseball and the National Collegiate Athletic Association—should not allow their athletes to take performance-enhancing drugs. The argument I present is game-theoretic: though each athlete prefers unilateral permission to dope over a universal ban, he also prefers a universal ban over universal permission to dope. That is because, while doping improves absolute measures of performance, it does not improve relative performance if many athletes dope. Large private athletic (...) institutions should honour their athletes' preferences and should not enact any policy that gives only some athletes but not others permission to dope. Thus, they should ban doping. My paper examines and defends this game-theoretic argument. After explaining the argument, I compare it to other arguments for the same conclusion. I then discuss whether the game-theoretic argument counterintuitively fails to justify banning some forms of doping, and whether it counterintuitively justifies banning things other than doping. After arguing that a doping ban on game-theoretic grounds is neither wrongly paternalistic or nor wrongfully coercive, I end by discussing some limitations of the argument. (shrink)
An important contribution to the foundations of probability theory, statistics and statistical physics has been made by E. T. Jaynes. The recent publication of his collected works provides an appropriate opportunity to attempt an assessment of this contribution.
In this paper, I will examine a puzzling discrepancy between the way clinicians are allowed to treat their patients and the way researchers are allowed to treat their subjects: in certain cases, researchers are legally required to disclose quite a bit more information when obtaining consent from prospective subjects than clinicians are when obtaining consent from prospective patients. I will argue that the proper resolution of this puzzling discrepancy must appeal to a pragmatic criterion of disclosure for informed consent: that (...) what needs to be disclosed in order for consent to be valid depends on what the patient/subject needs to know in order to make a decision. I will then use this pragmatic criterion of disclosure to argue that when obtaining consent researchers should be permitted to omit the same information clinicians are, given certain qualifications. I will also examine how this puzzle forces us to confront some perhaps surprising truths about valid consent. My broader aim in this paper is to examine, not so much the puzzle itself, but rather what this particular puzzle can teach us about more theoretical issues surrounding informed consent. (shrink)
In this paper I shall venture into an area with which I am not very familiar and in which I feel far from confident; namely into phenomenology. My main motive is not to get away from standard, boring, methodological questions like those of induction and demarcation; but the conviction that a phenomenological account of the empirical basis forms a necessary complement to Popper's falsificationism. According to the latter, a scientific theory is a synthetic and universal, hence unverifiable proposition. In fact, (...) in order to be technologically useful, a scientific hypothesis must refer to future states-of-affairs; it ought therefore to remain unverified. But in order to be empirical, a theory must bear some kind of relation to factual statements. According to Popper, such a relation can only be one of potential conflict. Thus a theory T will be termed scientific if and only if T is logically incompatible with a so-called basic statement b, where b is both empirically verifiable and empirically falsifiable. In other words: T is scientific if it entails ¬b; where b, hence also ¬b, is an empirically decidable proposition. (shrink)
The Code of Federal Regulations permits harmful research on children who have not agreed to participate, but I will argue that it should be no more permissive of harmful research on such children than of harmful research on adults who have not agreed to participate. Of course, the Code permits harmful research on adults. Such research is not morally problematic, however, because adults must agree to participate. And, of course, the Code also permits beneficial research on children without needing their (...) explicit agreement. This sort of research is also not problematic, this time because paternalism towards children may be justifiable. The moral problem at the center of this paper arises from the combination of two potential properties of pediatric research, first that it might be harmful and second that its subjects might not agree to participate. In Section 2 of this article I explain how the Code permits harmful research on non-agreeing children. Section 3 contains my argument that we should no more permit harmful research on non-agreeing children than on non-agreeing adults. In Section 4, I argue that my thesis does not presuppose that pediatric assent has the same moral force that adult consent does. In Section 5, I argue that the distinction between non-voluntary and involuntary research is irrelevant to my thesis. In Section 6, I rebut an objection based on the power of parental permission. In Section 7 I suggest how the Code of Federal Regulations might be changed. (shrink)
É bem conhecida a oposição estabelecida por Kant entre experiência possível e dialética, na medida em que esta última é caracterizada como a lógica da ilusão. Ao mesmo tempo, o modo de pensar metafísico, que ocorre dialeticamente, em sentido kantiano, é uma tendência inevitável da razão, expressa na exigência formal de completude das categorias. Como o pensar, enquanto exercício livre da razão, é em si mesmo mais amplo do que a atividade de conhecer, própria do entendimento, o pensar contém o (...) conhecimento, embora este se qualifique pelas regras e pelos limites determinantes da objetividade. A pergunta que tentaremos formular é se essa relação continente-conteúdo não poderia configurar também uma dependência da experiência em relação ao raciocínio dialético, que estaria de algum modo indicada na função reguladora das idéias da razão. Nesse caso, a oposição formal entre conhecer e pensar seria inseparável da inclusão estrutural (dependência) da experiência no âmbito da razão. Na raiz do problema estaria talvez a tensão (dialética) entre a aspiração subjetiva de totalidade e as exigências objetivas de limitação e segmentação da experiência e a forma da experiência teria de ser finalmente concebida a partir de um fundo de inteligibilidade problemática. Dialectics and experienceThe separation of possible experience as objective knowledge and dialetics as a non-objective or non-theoretical knowledge is one of the most important aspects of kantian critical philosophy. But Kant also says that the activity of reason, as a pure thinking, has more amplitude than understanding knowledge. So we could say that theoric knowledge would depend on rational ( and non-theoretical) knowledge, as something contained in it. If we accept that, the consequence would be a relation of dependence between the form of objective knowledge and the background of a problematic even doubtful inteligible knowledge. (shrink)
What is a natural kind ? As we shall see, the concept of a natural kind has a long history. Many of the interesting doctrines can be detected in Aristotle, were revived by Locke and Leibniz, and have again become fashionable in recent years. Equally there has been agreement about certain paradigm examples: the kinds oak, stickleback and gold are natural kinds, and the kinds table, nation and banknote are not. Sadly agreement does not extend much further. It is impossible (...) to discover a single consistent doctrine in the literature, and different discussions focus on different doctrines without writers or readers being aware of the fact. In this paper I shall attempt to find a defensible distinction between natural and non-natural kinds. (shrink)
In this philosophy classic, which was first published in 1951, E. R. Dodds takes on the traditional view of Greek culture as a triumph of rationalism. Using the analytical tools of modern anthropology and psychology, Dodds asks, "Why should we attribute to the ancient Greeks an immunity from 'primitive' modes of thought which we do not find in any society open to our direct observation?" Praised by reviewers as "an event in modern Greek scholarship" and "a book which it would (...) be difficult to over-praise," _The Greeks and the Irrational _was Volume 25 of the Sather Classical Lectures series. (shrink)
Futility is easily defined as uselessness. The mistaken appearance that it cannot be defined is explained by difficulties applying it to particular cases. This latter problem is a major goal of clinical training and cannot be solved in a pithy statement.
ABSTRACTThe 2006 Institute of Medicine report, ‘Ethical Considerations for Research Involving Prisoners’, recommended five main changes to current US Common Rule regulations on prisoner research. Their third recommendation was to shift from a category‐based to a risk‐benefit approach to research review, similar to current guidelines on pediatric research. However, prisoners are not children, so risk‐benefit constraints on prisoner research must be justified in a different way from those on pediatric research. In this paper I argue that additional risk‐benefit constraints on (...) prisoner research are unnecessary: the current Common Rule regulations, omitting category‐based restrictions but conjoined with the IOM report's other four main recommendations, ensure that prisoner research is as ethical as non‐prisoner research is. I explain why four problems which which may be more prevalent in prisons and which risk‐benefit constraints may seem to address – coercion, undue inducements, exploitation, and protection from harm – are in fact not solved by adding further risk‐benefit constraints on prisoner research. (shrink)
How could the self be a substance? There are various ways in which it could be, some familiar from the history of philosophy. I shall be rejecting these more familiar substantivalist approaches, but also the non-substantival theories traditionally opposed to them. I believe that the self is indeed a substance—in fact, that it is a simple or noncomposite substance—and, perhaps more remarkably still, that selves are, in a sense, self-creating substances. Of course, if one thinks of the notion of substance (...) as an outmoded relic of prescientific metaphysics—as the notion of some kind of basic and perhaps ineffable stuff —then the suggestion that the self is a substance may appear derisory. Even what we ordinarily call ‘stuffs’—gold and water and butter and the like—are, it seems, more properly conceived of as aggregates of molecules or atoms, while the latter are not appropriately to be thought of as being ‘made’ of any kind of ‘stuff’ at all. But this only goes to show that we need to think in terms of a more sophisticated notion of substance—one which may ultimately be traced back to Aristotle's conception of a ‘primary substance’ in the Categories , and whose heir in modern times is W. E. Johnson's notion of the ‘continuant’. It is the notion, that is, of a concrete individual capable of persisting identically through qualitative change, a subject of alterable predicates that is not itself predicable of any further subject. (shrink)
The strong weak truth table (sw) reducibility was suggested by Downey, Hirschfeldt, and LaForte as a measure of relative randomness, alternative to the Solovay reducibility. It also occurs naturally in proofs in classical computability theory as well as in the recent work of Soare, Nabutovsky, and Weinberger on applications of computability to differential geometry. We study the sw-degrees of c.e. reals and construct a c.e. real which has no random c.e. real (i.e., Ω number) sw-above it.