OBJECTIVES: To compare the practices of local research ethics committees and the time they take to obtain ethical approval for a multi-centre study. DESIGN: A retrospective analysis of outcome of applications for a multi-centre study to local research ethics committees. SETTING: Thirty-six local research ethics committees covering 38 district health authorities in England. MAIN MEASURES: Response of chairmen and women, the time required to obtain approval, and questions asked in application forms. RESULTS: We received replies from all 36 chairmen contacted: (...) four (11%) granted their approval, and 32 (89%) required our proposal to be considered by their local research ethics committee. Three committees asked us to attend their meetings. The application was approved by all 36 local research ethics committees but the time to obtain ethical approval varied between six to 208 days. One third of the committees did not approve the project within three months, and three took longer than six months. There was considerable variation in the issues raised by local research ethics committees and none conformed exactly to the Royal College of Physicians' guidelines. CONCLUSION: Obtaining ethical approval for a multi-centre study is time-consuming. There is much diversity in the practice of local research ethics committees. Our data support the recommendation for a central or regional review body of multi-centre studies which will be acceptable to all local research ethics committees. (shrink)
Recent data indicate that under a specific posthypnotic suggestion to circumvent reading, highly suggestible subjects successfully eliminated the Stroop interference effect. The present study examined whether an optical explanation could account for this finding. Using cyclopentolate hydrochloride eye drops to pharmacologically prevent visual accommodation in all subjects, behavioral Stroop data were collected from six highly hypnotizables and six less suggestibles using an optical setup that guaranteed either sharply focused or blurred vision. The highly suggestibles performed the Stroop task when naturally (...) vigilant, under posthypnotic suggestion not to read, and while visually blurred; the less suggestibles ran naturally vigilant, while looking away, and while visually blurred. Although visual accommodation was precluded for all subjects, posthypnotic suggestion effectively eliminated Stroop interference and was comparable to looking away in controls. These data strengthen the view that Stroop interference is neither robust nor inevitable and support the hypothesis that posthypnotic suggestion may exert a top-down influence on neural processing. (shrink)
BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals and Ethical Decision Making Climate Questionnaire were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. ResultsThree hundred forty-five nurses, (...) 40 intensivists, and 103 supporting staff completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses and intensivists compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. (shrink)
Health-care professionals in end-of-life care are frequently confronted with patients who seem to be ‘ambivalent’ about treatment decisions, especially if they express a wish to die. This article investigates this phenomenon by analysing two case stories based on narrative interviews with two patients and their caregivers. First, we argue that a respectful approach to patients requires acknowledging that coexistence of opposing wishes can be part of authentic, multi-layered experiences and moral understandings at the end of life. Second, caregivers need to (...) understand when contradictory statements point to tensions in a patient’s moral experience that require support. Third, caregivers should be careful not to negatively label or even pathologize seemingly contradictory patient statements. (shrink)
There are a number of problematic features within the current treatment of time in physical theories, including the “timelessness” of the Universe as encapsulated by the Wheeler–DeWitt equation. This paper considers one particular investigation into resolving this issue; a conditional probability interpretation that was first proposed by Page and Wooters. Those authors addressed the apparent timelessness by subdividing a faux Universe into two entangled parts, “the clock” and “the remainder of the Universe”, and then synchronizing the effective dynamics of the (...) two subsystems by way of conditional probabilities. The current treatment focuses on the possibility of using a realistic clock system; namely, a coherent-state description of a damped harmonic oscillator. This clock proves to be consistent with the conditional probability interpretation; in particular, a standard evolution operator is identified with the position of the clock playing the role of time for the rest of the Universe. Restrictions on the damping factor are determined and, perhaps contrary to expectations, the optimal choice of clock is not necessarily one of minimal damping. (shrink)
Members of the Clinical Ethics Consultation Affairs Standing Committee of the American Society for Bioethics and Humanities present a collection of insights and recommendations developed from their collective experience, intended for those engaged in the work of healthcare ethics consultation.
In this work R. M. Martin carries his semiotical studies into the fields of intensional semantics and pragmatics, dealing with such philosophically important concepts as meaning, preference, reasonableness and indifference. The crucial notion is that of the meaning or intension of an expression. Two major categories are distinguished, objective intensions and subjective intensions. To deal with objective intensions an intensional semantics is developed as an extension of denotational semantics in the tradition of Tarski, Carnap and Martin's earlier Truth and Denotation. (...) In the treatment of subjective intensions Martin makes an advance over his earlier study of pragmatics by utilizing the work of von Neumann and Morgenstern in their Theory of Games and Economic Behavior.—R. H. K. (shrink)
BackgroundThe boundaries between health-related research and practice have become blurred as initiatives traditionally considered to be practice increasingly use the same methodology as research. Further, the application of different ethical requirements based on this distinction raises concerns because many initiatives commonly labelled as “non-research” are associated with risks to patients, participants, and other stakeholders, yet may not be subject to any ethical oversight. Accordingly, we sought to develop a tool to facilitate the systematic identification of risks to human participants and (...) determination of risk level across a broad range of projects and health-related contexts. This paper describes the development of the Public Health Ontario Risk Screening Tool.MethodDevelopment of the PHO Risk Screening Tool included: preparation of a draft risk tool ; expert appraisal; internal stakeholder validation; external validation; pilot testing and evalution of the draft tool; and revision after 1 year of testing.ResultsA risk screening tool was generated consisting of 20 items organized into five risk domains: Sensitivity; Participant Selection, Recruitment and Consent; Data/Sample Collection; Identifiability and Privacy Risk; and Commercial Interests. The PHO Risk Screening Tool is an electronic tool, designed to identify potential project-associated risks to participants and communities and to determine what level of ethics review is required, if any. The tool features an easy to use checklist format that generates a risk score associated with a suggested level of ethics review once all items have been completed. The final score is based on a threshold approach to ensure that the final score represents the highest level of risk identified in any of the domains of the tool.ConclusionsThe PHO Risk Screening Tool offers a practical solution to the problem of how to maintain accountability and appropriate risk oversight that transcends the boundaries of research and practice. We hope that the PHO Risk Screening Tool will prove useful in minimizing the problems of over and under protection across a wide range of disciplines and jurisdictions. (shrink)
Context: Many recent research areas such as human cognition and quantum physics call the observer-independence of traditional science into question. Also, there is a growing need for self-reflexivity in science, i.e., a science that reflects on its own outcomes and products. Problem: We introduce the concept of second-order science that is based on the operation of re-entry. Our goal is to provide an overview of this largely unexplored science domain and of potential approaches in second-order fields. Method: We provide the (...) necessary conceptual groundwork for explorations in second-order science, in which we discuss the differences between first- and second-order science and where we present a roadmap for second-order science. The article operates mainly with conceptual differentiations such as the separation between three seemingly identical concepts such as Science II, Science 2.0 and second-order science. Results: Compared with first-order science, the potential of second-order science lies in 1. higher levels of novelty and innovations, 2. higher levels of robustness and 3. wider integration as well as higher generality. As first-order science advances, second-order science, with re-entry as its basic operation, provides three vital functions for first-order science, namely a rich source of novelty and innovation, the necessary quality control and greater integration and generality. Implications: Second-order science should be viewed as a major expansion of traditional scientific fields and as a scientific breakthrough towards a new wave of innovative research. Constructivist content: Second-order science has strong ties with radical constructivism, which can be qualified as the most important root/origin of second-order science. Moreover, it will be argued that a new form of cybernetics is needed to cope with the new problems and challenges of second-order science. (shrink)
In this phenomenological approach to meaning, the author defines his task as one of taking account of the kinds of relations the logical order can have to the preconceptual order. This preconceptual order is represented by a pre-logical activity which is called "experiencing." There is experiencing of meaning as well as of things. This "experienced or felt meaning" is said to be as important a dimension of meaning as the traditional modes distinguished by philosophers, e.g., denotation, connotation. Apparent throughout is (...) the author's concern as a psychotherapist to find theoretical foundations for clinical methods.--R. H. K. (shrink)
The essays in this Journal issue offer examples of how textual analysis, literary theory, and the reading and writing of literature can contribute to an understanding of ethical issues in medicine. The editors' purpose in such an issue is to stimulate discussion between philosopher-ethicists and literary scholars whose work concerns this topic. With the concluding essays by editors Clouser and Hawkins, this discussion begins.
This paper presents some important issues on misidentification of human interlocutors in text-based communication during practical Turing tests. The study here presents transcripts in which human judges succumbed to theconfederate effect, misidentifying hidden human foils for machines. An attempt is made to assess the reasons for this. The practical Turing tests in question were held on 23 June 2012 at Bletchley Park, England. A selection of actual full transcripts from the tests is shown and an analysis is given in each (...) case. As a result of these tests, conclusions are drawn with regard to the sort of strategies which can perhaps lead to erroneous conclusions when one is involved as an interrogator. Such results also serve to indicate conversational directions to avoid for those machine designers who wish to create a conversational entity that performs well on the Turing test. (shrink)
The volume presents essays on the philosophical explanation of the relationship between body and soul in antiquity from the Presocratics to Galen. The title of the volume alludes to a phrase found in Plato, Aristotle and Plotinus, referring to aspects of living behaviour involving both body and soul, and is a commonplace in ancient philosophy, dealt with in very different ways by different authors.