Prehospital ambulance based research has unique ethical considerations due to urgency, time limitations and the locations involved. We sought to explore these issues through interviews with experts in this research field. We undertook semi-structured interviews with expert informants, primarily based in the UK, seeking their views and experiences of ethics in ambulance based clinical research. Participants were questioned regarding their experiences of ambulance based research, their opinions on current regulations and guidelines, and views about their general ethical considerations. Participants were (...) chosen because they were actively involved in, or in their expert capacity expressed an interest in, ambulance based research. Fourteen participants were interviewed including principal investigators, researchers, ethicists and medical lawyers. Five major themes were identified: Capacity, Consent, Clinical Considerations, Consultation and Regulation. Questions regarding consent and capacity were foremost in the discussions as all participants highlighted these as areas for concern. The challenges and use of multiple consent models reflected the complexity of research in this environment. The clinical theme referred to the role of paramedics in research and how research involving ambulance services is increasingly informing improvements to patient care and outcomes and reducing the burden on hospital services. Most felt that, although current regulations were fit for purpose, more specific guidance on implementing these in the ambulance setting would be beneficial. This related closely to the theme of consultation, which examined the key role of ethics committees and other regulatory bodies, as well as public engagement. By interviewing experts in research or ethics in this setting we were able to identify key concerns and highlight areas for future development such as improved guidance. (shrink)

Price’s :157–176, 1991; 44:187–203, 1993 ; 2007, 2017) agency theory of causation has takes itself to provide a use-theory of our causal discourse. The theory’s aim is to describe the rules implicit to our linguistic behaviour when we describe things in causal terms. According to this theory, the rules governing our use of the concept of causation are based on our perspective as agents and our associated experiences of manipulating events. I argue that the observed relation between agency and our (...) concept of causation cannot exhaustively describe the conditions under which we enter into causal discourse. In particular, I demonstrate that the agency theory faces familiar problems with accounting for causal ascriptions to token cases. (shrink)

Recently, David Lewis’ counterfactual theory of causation has been attacked by context-relativists, who point to a number of intuitively absurd consequences of Lewis’ view – e.g. that my birth is a cause of my death – in order to argue that whether or not an event c is a cause of some distinct event e varies relative to certain contextual factors. Not all ; Schaffer ; Maslen ; Northcott ) agree on how contexts should be fixed; but all argue that (...) context-relative analyses better account for our intuitions about causes. In defense of his invariantist account, Lewis argues that the intuitions by which the relativist-accounts purport to be informed are, in fact, intuitions about contrastive explanation rather than causes. That is to say, Lewis accepts that my birth is a cause of my death, and argues that it is odd to say so precisely because the pragmatics of explanation deem saying so inappropriate in most cases. I will examine a definitive objection from Peter Menzies to Lewis’ proposed defence and argue that the former reveals that the true locus of the relativist-invariantist debate lies in the question of how we ought to order possible worlds. (shrink)