Book reviewed in this article: Informed Consent in Medical Therapy and Research. By Bernard Barber.

The title of this presentation may suggest that the subject is homocystinuria. It is not. Rather, the subject is how our epistemology influences our concept of disease, which in turn determines our ability to help patients.

sirAt a recent health authority meeting Professor Stacey, the NHSE Head of Research Ethics, was quoted as stating that for multicentre trials rapid responses were required ….

Moral responsibility theorists and legal theorists both worry about what negligence is, and how it might be a ground of blameworthiness. In this paper I argue that negligence suitably understood, can be an appropriate grounds for mens rea in rape cases. I am interested in cases where someone continues with sex in the mistaken belief that the other person consents. Such a mistaken belief is often unreasonable: a wilfully blind agent, one who deliberately ignores evidence that there is no consent, (...) is clearly not exculpated by his ignorance. However, there may be circumstances in which a man’s mistaken belief in consent is reasonable in the circumstances, then he is not culpable. Thus it is important to be clear about what we mean by a reasonable mistake. Many critics (e.g. Duff, Baron and others) have argued that it is not possible to make a reasonable mistake about consent, that any such mistake must involve culpable carelessness. Consent is so important that we should always double check. Not to do so is reckless, and in that case there is clearly culpability. In this paper I argue that it is possible to make a mistake that is reasonable, at least in one sense. Someone in the grip of sexist ideology might not understand how important consent is, and not through carelessness, but through sexist ideology that they have non-culpably and non-voluntarily absorbed. In that case it is not obvious that the man is culpable. I go on to argue that so far as the law is concerned, there is good reason to hold that even those who have ‘reasonable’ beliefs culpable. Having a reasonable belief in consent may be, but is not always exculpatory. We usually think a reasonable mistake does not count as negligence because a reasonable mistake is not failing to know something that you should have known. I argue that we should understand negligence—not knowing something you should have known—in a moralized sense, so that people who are ignorant through being ideologically blinded can be held to have the mens rea requisite for rape conviction. -/- . (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

Inspired by the work of intellectual historian J. G. A. Pocock, this 1993 collection explores the political ideologies of early modern Britain.

sirFollowing Dr Barber's letter1 relating to the mechanism for approval of Local Research Ethics Committees , I have also had concerns over the intense pressure for a fast turn around for local approval. Projects may have been six months or more in the Multicentre Research Ethics Committe process and then arrive on my desk with multiple telephone calls requiring ….

This work is, in large part, a series of refutations; it is also the author's Ph.D. thesis. First to be refuted is Russell's vicious circle principle as a general remedy for the solution of the paradoxes. The author rejects the classification of paradoxes into syntactic and semantic, since in his view there are no purely syntactic paradoxes. The distinction in logic between the uninterpreted syntactical aspect of a system and the system when given a determinate interpretation is held to be (...) untenable. Tarski's distinction between object-language and meta-language and his concept of semantically closed language are considered irrelevant for the solution of the Liar paradox. The author claims that the usual versions of the Liar paradox have the same structure as the Barber paradox, viz., [S ↔ ~S]. The author solves the Liar paradox by pointing out that it does not have a proper reference. Cantor's diagonal argument for the indenumerability [[sic]] of the real numbers is labeled as unsatisfactory. Since the diagonal number is dependent upon the real numbers in the constructed list, the author claims that this makes the diagonal number to be of a different nature and status than the real numbers in the list; thus we have what the author calls the dependence fallacy. The author also refuses to accept Cantor's nested interval proof of the indenumerability [[sic]] of the real numbers. Within the proof, two infinite sequences are constructed, each of which converges to a limit. Because the proof does not give a "definite rule of convergence," the author is not satisfied that the infinite sequences converge. Also rejected is Cantor's theorem. Other paradoxes analyzed are the Berry, Richard, heterological, "Richardian", Russell, Cantor, and Burali-Forti paradoxes.--T. G. N. (shrink)

The sources of the Sicilian narrative have been recently investigated by Barber and Laqueur. The former has suggested a comparison of Plutarch's Lives of Dion and Timoleon with the narrative of Diodorus as an avenue of approach to the problem; such a comparison will be applied later in order to check the conclusions reached by a survey of Diodorus' narrative. The latter has exploited the argument from detail, a method which has already been criticized in Article I. Space will (...) not allow an examination of each point made by Laqueur; it must be left to the reader to judge between our investigations of the same problem. (shrink)

For Quine, a paradox is an apparently successful argument having as its conclusion a statement or proposition that seems obviously false or absurd. That conclusion he calls the proposition of the paradox in question. What is paradoxical is of course that if the argument is indeed successful as it seems to be, its conclusion must be true. On this view, to resolve the paradox is (1) to show either that (and why) despite appearances the conclusion is true after all, or (...) that the argument is fallacious, and (2) if the former, to explain away the deceptive appearances. Quine divides paradoxes into three groups. A veridical paradox is one whose proposition or conclusion is in fact true despite its air of absurdity. We decide that a paradox is veridical when we look carefully at the argument and it convinces us, i.e., it manages to show us how it is that the conclusion is true after all and appearances to the contrary were misleading. Quine’s two main examples of this are the puzzle of Frederic in The Pirates of Penzance (who has reachError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMaped the age of twenty-one after passing only five birthdays), and the Barber Paradox, which Quine considers simply a sound proof that there can be no such barber as is described.1 A falsidical paradox is one whose proposition or conclusion is indeed obviously false or self-contradictory, but which contains a fallacy that is detectably responsible for delivering the absurd conclusion. We decide that a paradox is falsidical when we look carefully at the argument and spot the fallacy. Quine’s leading example here is De Morgan’s trick argument for the proposition that 2 = 1. (shrink)

La educación cívica se encuentra en la misma base de la democracia . T odo sistema democrático que prescinda de esta necesidad acabará haciendo de s v anecerse la racionalidad democrática de sus instituciones. La democracia liberal es un buen ejemplo de este debilitamiento pr o g res i v o de las estructuras democráticas. Benjamin R. Barber no tarda en referirse a ella como "democracia débil". La democracia carece de plenitud sin ciudadanos fo r mados cívicamente. Educación y (...) democracia están indisol u b lemente unidas. P or eso, para este autor la r e generación de la democracia, con sus contenidos reales de pa r ticipación política, pasa necesariamente por la educación. Enseñar democracia es se r vir a la comuni dad. (shrink)

Dans quelles circonstances et pourquoi Robert K. Merton a-t-il rencontré l’idée de serendipity? Quelle place occupe-t-elle dans son œuvre? Cet article propose de reconstituer pas à pas l’histoire de cette rencontre, qui ne manque pas d’ironie ni de piquant. En elle-même « sérendipienne », la découverte accidentelle mais tellement féconde du mot serendipity ouvrit à Merton nombre de pistes de recherche au cours des années 1940. Le concept intrigant de la découverte fortuite qui – entre autres vertus – engendre des (...) résultats de nature à transformer la théorie promettait d’enrichir et de renouveler la connaissance objective. Mais la serendipity était plus qu’une recette heuristique à appliquer en science. Chez Merton, c’était aussi l’objet privilégié et « auto-exemplifiant » d’une sémantique sociologique des concepts, dont l’ambition est d’étudier les itinéraires des terminologies dans la culture. En retraçant la genèse de la recherche qu’il mena avec Elinor Barber sur l’histoire du mot et des significations parfois volatiles de la serendipity, on parviendra à saisir pourquoi ce thème revêtait pour Merton un double intérêt stratégique, à la fois épistémologique et autobiographique. On comprendra aussi pourquoi une nouvelle traduction en français du premier fragment d’article dans lequel le sociologue conceptualise la serendipity en 1948 est de bonne méthode sérendipienne. (shrink)

Aristotle argued that you need some wealth to live well. The Stoics argued that you could live well with or without wealth. But the Cynics argued that wealth is a hinderance. For the Cynics, a good life consists in self-sufficiency, or being able to rule and help yourself. You accomplish this by living simply and naturally, and by subjecting yourself to rigorous philosophical exercises. Cynics confronted people to get them to abandon extraneous possessions and positions of power to live better. (...) And while the Cynics were experts in living in this way, their ascetic lifestyles made their message curious to some audiences. This paper reflects on Cynic ascetic practices and the ways others perceived them. (shrink)

Research has demonstrated that employee reactions to monitoring systems depend on both the characteristics of the monitoring system and how it is implemented. However, little is known about the role individual differences may play in this process. This study proposes that individuals have generalized attitudes toward organizational control and monitoring activities. We examined this argument by assessing the relationship between employees’ baseline attitudes toward a set of monitoring and control techniques that span the employment relationship. We further explore the effects (...) of employees’ generalized attitudes toward monitoring and their individual ethical orientations on their attitudinal reactions to an Internet monitoring system implemented in their workplace. Results of a longitudinal study indicate that as expected, prior beliefs and ethical orientation interact to affect employees’ reactions to monitoring systems. Implications for research and practice are discussed. (shrink)

The problems of this passage were concisely stated by M. Platnauer more than thirty years ago and his suggestions for their solution have been adopted and developed in A. S. F. Gow's magnum opus. Its authority—so the present writer suspects—is liable at this point to eclipse the meaning of the text.

The conceptual framework of behaviorism is reconstructed in a logical scheme rather than along chronological lines. The resulting reconstruction is faithful to the history of behaviorism and yet meets the contemporary challenges arising from cognitive science, psycholinguistics, and philosophy. In this reconstruction, the fundamental premise is that psychology is to be a natural science, and the major corollaries are that psychology is to be objective and empirical. To a great extent, the reconstruction of behaviorism is an elaboration of behaviorist views (...) of what it is for a science to be objective and empirical. The reconstruction examines and evaluates behaviorist positions on observation and the rejection of introspection, the behavioral data language, theory construction, stimulus-response psychology, the organization of behavior, complex processes, agency, and the interpretation of mentalistic language. The resulting reconstruction shows behaviorism to be a pragmatic psychological version of positivism based on a behavioral epistemology. (shrink)

This article offers an alternative approach to paradigms that cast culture solely as a nurturing influence on children's language development. It proposes a dimensional model of Child-Directed Communication to delineate ways in which a community's habitus may impede the communicative potential of children with neuro-developmental conditions such as severe autism. It argues that certain features of Euro-American CDC are illadapted for autistic children. Due to inertia, caregivers often find themselves unable to transcend the limitations of CDC habitus. Yet, occasionally, a (...) transformation in CDC emerges that more effectively engages children with impairments. The article analyzes one such transformation forged in the niche of a unique mother–son relationship in India and then introduced in the USA. (shrink)

Mathematical modeling is a convenient way for characterization of complex ecosystems. This approach was applied to study the dynamics of zooplankton in Lake Sevan (Armenia) at different stages of anthropogenic eutrophication with the use of a novel method called discrete modeling of dynamical systems with feedback (DMDS). Simulation demonstrated that the application of this method helps in characterization of inter- and intra-component relationships in a natural ecosystem. This method describes all possible pairwise inter-component relationships like “plus–plus,” “minus–minus,” “plus–minus,” “plus–zero,” “minus–zero,” (...) and “zero–zero” that occur in most ecosystems. Based on the results, a working hypothesis was formulated. It was found that the sensitivity to weak external influence in zooplanktons was the greatest during the mid period of eutrophication in Lake Sevan, whereas in the final stages of eutrophication, an outbreak in the biomass production of cyanobacteria was evident. To support this approach, a weak external disturbance in the form of magnetic storm was used to see its effect on species Daphnia longispina sevanica. A statistically significant correlation between the frequency of magnetic storms and the number of this species was revealed and an increase in the number of toxic cyanobacteria species as a consequence of eutrophication. This paper, for the first time, suggests a DMDS method, to diagnose impact of anthropogenic eutrophication on environment. (shrink)

In the article "The Epistemological Nature of Information Modeling" [Gnoseologicheskaia priroda informatsionnogo modelirovaniia], Voprosy filosofii, 1963, No. 10, Academician V. M. Glushkov examines two important methodological aspects of the modeling of natural objects and phenomena in the contemporary natural sciences. The first consists of the informational nature of the models created, and the second of their dynamism. The dynamic nature of today's models in the natural sciences means that it is not so much the material structure of the object that (...) is modeled as its behavior and functions in some sphere of natural phenomena. In this sense, the models under examination may also be termed functional, as distinct from the structural models pertaining to a static description of objects. (shrink)

Wegner (2002) fails to (1) distinguish conscious will and voluntariness; (2) account for everyday willed acts; and (3) individuate thoughts and acts. Wegner incorrectly implies that (4) we experience acts as willed only when they are caused by unwilled thoughts; (5) thoughts are never true causes of actions; and (6) we experience ourselves as first performing mental acts which then cause our intentional actions.

This chapter offers an essay on the evolution of evolvability. It investigates the most frequently cited arguments against the possibility that the evolution of evolvability might be the result of selection favoring more evolvable genotypes. The chapter argues that all these arguments have not been rigorously analyzed by their proponents, and are thus a self-inflicted blind spot in evolutionary biology, and indicates that there are no deep conceptual obstacles for population genetic theory to explain the evolution of evolvability. The very (...) focus on this subject will help shift the perspective of evolutionary biology toward a more holistic, systemic view of evolution. (shrink)

This paper examines an issue that is becoming increasingly relevant as the pressures of a warming planet, changing climate and changing ecosystems ramp up. The broad context for the paper is the intragenerational, intergenerational, and interspecies equity implications of changing the climate and the value orientations of adapting to such change. In addition, the need to stabilize the planetary climate by urgent mitigation of change factors is a foundational ethical assumption. In order to avoid further animal and plant extinctions, or (...) at the very least, their increased vulnerability to becoming rare and endangered; the systematic assisted colonization of “at risk” species is being seriously considered by scientists and managers of biodiversity. The more practical aspects of assisted colonization have been covered in the conservation biology literature; however, the ethical implications of such actions have not been extensively examined. Our discussion of the value issues, using a novel case study approach, will rectify the limited ethical analysis of the issue of assisted colonization of species in the face of climate change pressures. Beyond sustainability ethics, both animal and environmental ethical approaches will be used and intrinsic versus instrumental value orientations in the literature shall form the basis of our discussion. After the application of all the ethical approaches to the case studies, we conclude that without mitigation and the prospect of a future stable climate, assisted colonization will be involved in an inherently unethical process and a “move and lose it” outcome. With mitigation, there is wide-ranging ethical support for assisted colonization. (shrink)