Background: Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing (...) the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making.Methods/DesignDyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the end of the intervention and 6 months later to assess improvement in predictive accuracy and cost savings, if any. Copies of completed guides are made at the time of these assessments.DiscussionThis study will determine whether the tested intervention guides proxies in making decisions that concur with those of older adults, motivates the latter to record their wishes in writing, and yields savings for the healthcare system.Trial RegistrationISRCTN89993391. (shrink)
This paper suggests that certain traditional ways of analysing the self start off in situations that are abstract or detached from normal experience, and that the conclusions reached in such approaches are, as a result, inexact or mistaken. The paper raises the question of whether there are more contextualized forms of self- consciousness than those usually appealed to in philosophical or psychological analyses, and whether they can be the basis for a more adequate theoretical approach to the self. First, we (...) develop a distinction between abstract and contextualized actions and intentions by drawing on evidence from studies of rehabilitation after brain damage, and we introduce the notion of intentional attitude. Second, we discuss several interesting conclusions drawn from theoretically and experimentally abstract approaches. These conclusions raise some important issues about both the nature of the self and reflexive consciousness. At the same time they indicate the serious limita- tions concerning what we can claim about self and self-consciousness within such abstract frameworks. Such limitations motivate the question of whether it is possible to capture a sense of self that is more embedded in contextualized actions. Specifically, our concern is to focus on first-person approaches. We identify two forms of self-consciousness, eco- logical self-awareness and embedded reflection, that (1) function within the kinds of contextualized activity we have indicated, and (2) can be the basis for a theoretical account of the self. Both forms of self-consciousness are closely tied to action and promise to provide a less abstract basis for developing a theoretical approach to the self. (shrink)
Do laypeople think that moral responsibility is compatible with determinism? Recently, philosophers and psychologists trying to answer this question have found contradictory results: while some experiments reveal people to have compatibilist intuitions, others suggest that people could in fact be incompatibilist. To account for this contradictory answers, Nichols and Knobe (2007) have advanced a ‘performance error model’ according to which people are genuine incompatibilist that are sometimes biased to give compatibilist answers by emotional reactions. To test for this hypothesis, we (...) investigated intuitions about determinism and moral responsibility in patients suffering from behavioural frontotemporal dementia. Patients suffering from bvFTD have impoverished emotional reaction. Thus, the ‘performance error model’ should predict that bvFTD patients will give less compatibilist answers. However, we found that bvFTD patients give answers quite similar to subjects in control group and were mostly compatibilist. Thus, we conclude that the ‘performance error model’ should be abandoned in favour of other available model that best fit our data. (shrink)
Two models of consciousness are contrasted with regard to their treatment of subjective timing. The standard Cartesian Theater model postulates a place in the brain where "it all comes together": where the discriminations in all modalities are somehow put into registration and "presented" for subjective judgment. In particular, the Cartesian Theater model implies that the temporal properties of the content-bearing events occurring within this privileged representational medium determine subjective order. The alternative, Multiple Drafts model holds that whereas the brain events (...) that discriminate various perceptual contents are distributed in both space and time in the brain, and whereas the temporal properties of these various events are determinate, none of these temporal properties determine subjective order, since there is no single, constitutive "stream of consciousness" but rather a parallel stream of conflicting and continuously revised contents. Four puzzling phenomena that resist explanation by the standard model are analyzed: two results claimed by Libet, an apparent motion phenomenon involving color change (Kolers and von Grunau), and the "cutaneous rabbit" (Geldard and Sherrick) an illusion of evenly spaced series of "hops" produced by two or more widely spaced series of taps delivered to the skin. The unexamined assumptions that have always made the Cartesian Theater model so attractive are exposed and dismantled. The Multiple Drafts model provides a better account of the puzzling phenomena, avoiding the scientific and metaphysical extravagances of the Cartesian Theater. (shrink)
The starting point of this work is the gap between two distinct traditions in information engineering: knowledge representation and data-driven modelling. The first tradition emphasizes logic as a tool for representing beliefs held by an agent. The second tradition claims that the main source of knowledge is made of observed data, and generally does not use logic as a modelling tool. However, the emergence of fuzzy logic has blurred the boundaries between these two traditions by putting forward fuzzy rules as (...) a Janus-faced tool that may represent knowledge, as well as approximate non-linear functions representing data. This paper lays bare logical foundations of data-driven reasoning whereby a set of formulas is understood as a set of observed facts rather than a set of beliefs. Several representation frameworks are considered from this point of view: classical logic, possibility theory, belief functions, epistemic logic, fuzzy rule-based systems. Mamdani's fuzzy rules are recovered as belonging to the data-driven view. In possibility theory a third set-function, different from possibility and necessity plays a key role in the data-driven view, and corresponds to a particular modality in epistemic logic. A bi-modal logic system is presented which handles both beliefs and observations, and for which a completeness theorem is given. Lastly, our results may shed new light in deontic logic and allow for a distinction between explicit and implicit permission that standard deontic modal logics do not often emphasize. (shrink)
This paper discusses the critical necessity of teaching students about the social and ethical responsibilities of scientists. Both a university scientist and a middle school science teacher reflect on the value of teaching the ethical issues that confront scientists. In the development of the atomic bomb in the US-led Manhattan Project, scientists faced the growing threat of atomic bombs by the Germans and Japanese and the ethical issues involved in successfully completing such a destructive weapon. The Manhattan Project is a (...) prime example of the types of ethical dilemmas and social responsibilities that scientists may confront. (shrink)
Expressing doubts about death criteria can serve healthy purposes, but can also cause a number of harms, including decreased organ donation rates and distress for donor families and health care staff. This paper explores the various causes of doubts about death criteria—including religious beliefs, misinformation, mistrust, and intellectual questions—and recommends responses to each of these. Some recommended responses are relatively simple and noncontroversial, such as providing accurate information. However, other responses would require significant changes to the way we currently do (...) business. Policymakers should establish minimum national standards for determining death to foster a trustworthy system; academics and publishers have a duty to publish only materials that substantially engage and advance the debate to minimize the harm caused by divided expert opinion; and opposition to the dead donor rule should be conceptually separated from doubts about death criteria. (shrink)
Evidence exists that behavioral and social science researchers have been frustrated with regulations and institutional review boards (IRBs) from the 1970s through today. Making matters worse, many human participants protection instruction programs - now mandated by IRBs - offer inadequate reasons why researchers should comply with regulations and IRBs. Promoting compliance either for its own sake or to avoid penalties is contrary to the developmental aims of moral education and may be ineffective in fostering the responsible conduct of research. This (...) article explores the concept of professional virtue and argues that compliance is capable of becoming a professional virtue like scientific honesty. This requires, however, that regulatory and IRB demands contribute to human well-being and to the aims of research as a profession and that researchers, therefore, internalize the norms that underlie regulatory and IRB demands. This, in turn, requires a series of changes in the way society develops, promulgates, and enforces regulatory and IRB rules. The challenge is, simply put, to embed compliance into the world of living morality. (shrink)
Monshi and Zieglmayer's case study presents Sri Lankan participants as having views on the privacy of health information that differ radically from those commonly found in Western nations. This article explores 2 questions that their case study raises for the ethical review of research in international settings: First, are allegedly universal ethical principles - of the sort promulgated in the Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978) - useful in international settings?, (...) and second, how should research oversight bodies address the challenges that arise in international behavioral and social science research? (shrink)
This short paper about fuzzy set-based approximate reasoning first emphasizes the three main semantics for fuzzy sets: similarity, preference and uncertainty. The difference between truth-functional many-valued logics of vague or gradual propositions and non fully compositional calculi such as possibilistic logic (which handles uncertainty) or similarity logics is stressed. Then, potentials of fuzzy set-based reasoning methods are briefly outlined for various kinds of approximate reasoning: deductive reasoning about flexible constraints, reasoning under uncertainty and inconsistency, hypothetical reasoning, exception-tolerant plausible reasoning using (...) generic knowledge, interpolative reasoning, and abductive reasoning (under uncertainty). Open problems are listed in the conclusion. (shrink)
This paper investigates simple syntactic methods for revising prioritized belief bases, that are semantically meaningful in the frameworks of possibility theory and of Spohn''s ordinal conditional functions. Here, revising prioritized belief bases amounts to conditioning a distribution function on interpretations. The input information leading to the revision of a knowledge base can be sure or uncertain. Different types of scales for priorities are allowed: finite vs. infinite, numerical vs. ordinal. Syntactic revision is envisaged here as a process which transforms a (...) prioritized belief bases into a new prioritized belief base, and thus allows a subsequent iteration. (shrink)
Numerous countries are heading toward digital infrastructures. In particular this new technology promises to help support methods for elections. However, one should be careful that such an infrastructure does not hinder the voting and representation issues. On the contrary, it should support those issues and help citizens have a clearer picture of the underlying mechanisms. This paper deals with the limits of voting procedures as they are described in classical collective choice theory and reflects on ways to aggregate electronic votes (...) stemming from various individuals that would be at the same time democratic, decisive and rational which is not feasible when candidate rankings alone are taken into account. This paper shows how electronic voting procedures could improve the situation by introducing preference-based votes. (shrink)
Here we describe the five steps of evidence-based practice as applied to research ethics review and apply these steps to three exemplar dilemmas: incentive payments in substance abuse research; informed consent for biobanking; and placebo-controlled trials involving pregnant women in order to demonstrate the potential of empirical data to inform and improve IRB decision-making.
In this article we describe our approach to understanding wrongdoing in medical research and practice, which involves the statistical analysis of coded data from a large set of published cases. We focus on understanding the environmental factors that predict the kind and the severity of wrongdoing in medicine. Through review of empirical and theoretical literature, consultation with experts, the application of criminological theory, and ongoing analysis of our first 60 cases, we hypothesize that 10 contextual features of the medical environment (...) (including financial rewards, oversight failures, and patients belonging to vulnerable groups) may contribute to professional wrongdoing. We define each variable, examine data supporting our hypothesis, and present a brief case synopsis from our study that illustrates the potential influence of the variable. Finally, we discuss limitations of the resulting framework and directions for future research. (shrink)
This article examines the clergy sexual abuse crisis in the Roman Catholic Church from an ethical point of view. The article uses the RRICC values model of ethical decision making (i.e., responsibility, respect, integrity, competence, concern) to review the behavior of Catholic bishops and other religious superiors as they have tried to manage clergy sex offenders and their victims. Hopefully, the recent press attention and resulting policy changes on these matters from the U.S. Council of Catholic Bishops will increase the (...) chances that future decisions will be ethical ones. (shrink)
This paper presents and discusses several methods for reasoning from inconsistent knowledge bases. A so-called argued consequence relation, taking into account the existence of consistent arguments in favour of a conclusion and the absence of consistent arguments in favour of its contrary, is particularly investigated. Flat knowledge bases, i.e., without any priority between their elements, are studied under different inconsistency-tolerant consequence relations, namely the so-called argumentative, free, universal, existential, cardinality-based, and paraconsistent consequence relations. The syntax-sensitivity of these consequence relations is (...) studied. A companion paper is devoted to the case where priorities exist between the pieces of information in the knowledge base. (shrink)
The significance of consciousness in modern science is discussed by leading authorities from a variety of disciplines. Presenting a wide-ranging survey of current thinking on this important topic, the contributors address such issues as the status of different aspects of consciousness; the criteria for using the concept of consciousness and identifying instances of it; the basis of consciousness in functional brain organization; the relationship between different levels of theoretical discourse; and the functions of consciousness.
