Karolinska Institutet, Stockholm, Sweden Mats G. Hansson Uppsala University, Sweden Jan Carlstedt-Duke Karolinska Institutet, Stockholm, Sweden Martin Ritzen Karolinska Institutet, Stockholm, Sweden Ingemar Persson Karolinska Institutet, Stockholm, Sweden Helle Kieler Karolinska Institutet, Stockholm, Sweden * Corresponding author: Christina M. Hultman, Department of Medical Epidemiology and Biostatistics, Box 281, SE-171 77 Stockholm, Sweden. Tel.: +46 8 52483893; +46 70 3621031; Fax: +46 8 314975; Email: Christina.Hultman{at}ki.se ' + u + '@' + d + ' '//--> Abstract Since the 1970s, (...) estrogen have sometimes been used in adolescent girls to reduce very tall adult expected height. Worries about long-term effects have led to a proposal to link treatment data with cancer registers. How should one deal with informed consent for such a study? We designed a qualitative study with semi-structured telephone interviews. From 1200 women who were to be followed-up in cancer registers, we randomly selected 22 women. Major themes were a wish to be involved and a positive attitude to the proposed register research. The women did not express worry after reading the study protocol, but did convey considerable frustration that this research had not been initiated earlier. Active consent was not seen as crucial. We found strong interest in a high participation rate and a concern over missing data. The selection of information and consent or the decision to go ahead without consent in register follow-up is a delicate balancing act. Study participants wish to be contacted, but acknowledge the primary goal of answering important questions. Our study provides support for safeguarding privacy in epidemiological linkage studies and in follow-up of medical treatment without losing the scientific value by requesting for informed consent. CiteULike Connotea Del.icio.us What's this? (shrink)
Although stability is a central notion in several academic disciplines, the parallelsremain unexplored since previous discussions of the concept have been almostexclusively subject-specific. In the literature we have found three basic conceptsof stability, that we call constancy, robustness, and resilience. They are all foundin both the natural and the social sciences. To analyze the three concepts we introducea general formal framework in which stability relates to transitions between states. Itcan then be shown that robustness is a limiting case of resilience, (...) whereas neitherconstancy nor resilience can be defined in terms of the other. Hence, there are twobasic concepts of stability, both of which are used in both the social and the naturalsciences. This congruence in the concepts of stability is of particular interest forendeavours to construct models that represent both natural and social phenomena. (shrink)
In this paper we will argue: (1) that scholars, regardless of their normative stand against or for genetic enhancement indeed have a moral/professional obligation to hold on to a realistic and up-to-date conception of genetic enhancement; (2) that there is an unwarranted hype surrounding the issue of genetic enhancement in general, and gene doping in particular; and (3) that this hype is, at least partly, created due to a simplistic and reductionist conception of genetics often adopted by bioethicists.
Queen Christina of Sweden was unconventional in her time, leading to hypotheses on her gender and possible hermaphroditic nature. If genetic analysis can substantiate the latter claim, could this bring the queen into disrepute 300 years after her death? Joan C. Callahan has argued that if a reputation changes, this constitutes a change only in the group of people changing their views and not in the person whose reputation it is. Is this so? This paper analyses what constitutes change and (...) draws out the implications to the reputation of the dead. It is argued that a reputation is a relational property which can go through changes. The change is “real” for the group changing their views on Queen Christina and of a Cambridge kind for the long dead queen herself. Cambridge changes result in new properties being acquired, some of which can be of significance. (shrink)
Background Time and communication are important aspects of the medical consultation. Physician behavior in real-life pediatric consultations in relation to ethical practice, such as informed consent (provision of information, understanding), respect for integrity and patient autonomy (decision-making), has not been subjected to thorough empirical investigation. Such investigations are important tools in developing sound ethical praxis. Methods 21 consultations for inguinal hernia were video recorded and observers independently assessed global impressions of provision of information, understanding, respect for integrity, and participation in (...) decision making. The consultations were analyzed for the occurrence of specific physician verbal and nonverbal behaviors and length of time in minutes. Results All of the consultations took less than 20 minutes, the majority consisting of 10 minutes or less. Despite this narrow time frame, we found strong and consistent association between increasing time and higher ratings on all components of ethical practice: information, (β = .43), understanding (β = .52), respect for integrity (β = .60), and decision making (β = .43). Positive nonverbal behaviors by physicians during the consultation were associated particularly with respect for integrity (β =.36). Positive behaviors by physicians during the physical examination were related to respect for children's integrity. Conclusion Time was of essence for the ethical encounter. Further, verbal and nonverbal positive behaviors by the physicians also contributed to higher ratings of ethical aspects. These results can help to improve quality of ethical practice in pediatric settings and are of relevance for teaching and policy makers. (shrink)
In Sweden, most patients are recruited into biobank research by non-researcher doctors. Patients' trust in doctors may therefore be important to their willingness to participate. We suggest a model of trust that makes sense of such transitions of trust between domains and distinguishes adequate trust from mistaken trust. The unique position of doctors implies, we argue, a Kantian imperfect duty to compensate for patients' mistaken trust. There are at least three kinds of mistaken trust, each of which requires a different (...) set of countermeasures. First, trust is mistaken when necessary competence is lacking; the competence must be developed or the illusion dispelled. Second, trust is irrational whenever the patient is mistaken about his actual reasons for trusting. Care must therefore be taken to support the patient's reasoning and moral agency. Third, some patients inappropriately trust doctors to recommend only research that will benefit them directly. Such trust should be counteracted by nurturing a culture where patients expect to be asked occasionally to contribute to the common good. (shrink)
The empirical basis for this article is threeyears of experience with ethical rounds atUppsala University Hospital. Three standardapproaches of ethical reasoning are examined aspotential explanations of what actually occursduring the ethical rounds. For reasons given,these are not found to be satisfyingexplanations. An approach called ``imaginativeethics'', is suggested as a more satisfactoryaccount of this kind of ethical reasoning. Theparticipants in the ethical rounds seem to drawon a kind of moral competence based on personallife experience and professional competence andexperience. By listening to (...) other perspectivesand other experiences related to one particularpatient story, the participants imaginealternative horizons of moral experience andexplore a multitude of values related toclinical practice that might be at stake. Inhis systematic treatment of aesthetics in theCritique of Judgement, Kant made use ofan operation of thought that, if applied toethics, will enable us to be more sensitive tothe particulars of each moral situation. Basedon this reading of Kant, an account ofimaginative ethics is developed in order tobring the ethical praxis of doctors and nursesinto sharper relief. The Hebraic and theHellenic traditions of imagination are used inorder to illuminate some of the experiences ofethical rounds. In conclusion, it is arguedthat imaginative ethics and principle-basedethics should be seen as complementary in orderto endow a moral discourse with ethicalauthority. Kantian ethics will do the job if itis remembered that Kant suggested only amodest, negative role of principle-baseddeliberation. (shrink)
Today, certain rule-violating behaviours, such as doping, are considered to be an issue of concern for the sport community. This paper underlines and examines the affective dimensions involved in moral responses to, and attitudes towards, rule-violating behaviours in sport. The key role played by affective processes underlying individual-level moral judgement has already been implicated by recent developments in moral psychological theories, and by neurophysiological studies. However, we propose and discuss the possibility of affective processes operating on a social level which (...) may influence athletes' individual-level attitudes. We conclude that one-sided focus on individual rule-violating behaviour and individual sanctions may prove to be ineffective in coming to terms with the issue. In this regard we recommend a twofold approach by addressing underlying social dimensions, along with preventive measures through affect-oriented education. (shrink)
It is not contoversial to state that acts of fraud do not belong in the academic world. What is debated is the best way to minimise the risk of fraudulent behaviour. Broadly speaking there are two different approaches to this problem. They differ with regard to whether the main focus is on internal or external control. In this article I argue that the main emphasis should be on internal structures in order to achieve the desired end. Only when the internal (...) structures are in place is it meaningful to adopt external, supportive means to the same end. Invitation to the academic project as such, education and training in research ethics and good research practice, the implementation of good documentation procedures and the implementation of a procedure for investigation of suspicions of fraud which is characterised by efficiency, impartiality and competence are the four primary ingredients in the cure. The first three are suggested to build up the necessary foundation before a structure of investigation procedures are established. (shrink)
A new possible world semantics for deontic logic is proposed. Its intuitive basis is that prohibitive predicates (such as wrong and prohibited) have the property of negativity, i.e. that what is worse than something wrong is itself wrong. The logic of prohibitive predicates is built on this property and on preference logic. Prescriptive predicates are defined in terms of prohibitive predicates, according to the well-known formula ought = wrong that not. In this preference-based deontic logic (PDL), those theorems that give (...) rise to the paradoxes of standard deontic logic (SDL) are not obtained. (E.g., O(p & q) Op & Oq and Op O(p v q)) are theorems of SDL but not of PDL. The more plausible theorems of SDL, however, can be derived in PDL. (shrink)
Theoria , the international Swedish philosophy journal, was founded in 1935. Its contributors in the first 75 years include the major Swedish philosophers from this period and in addition a long list of international philosophers, including A. J. Ayer, C. D. Broad, Ernst Cassirer, Hector Neri Castañeda, Arthur C. Danto, Donald Davidson, Nelson Goodman, R. M. Hare, Carl G. Hempel, Jaakko Hintikka, Saul Kripke, Henry E. Kyburg, Keith Lehrer, Isaac Levi, David Lewis, Gerald MacCallum, Richard Montague, Otto Neurath, Arthur N. (...) Prior, W. V. Quine, Nicholas Rescher, Ernest Sosa, Robert C. Stalnaker, P. F. Strawson, Patrick Suppes, Johan van Benthem, Georg Henrik von Wright and many others. Hempel's confirmation paradoxes, Ross's deontic paradox, Montague's universal grammar and Lindström's theorem are among the contributions to philosophy that were first published in Theoria. (shrink)
We can often specify how we would contract by a certain sentence by saying that this contraction would coincide with some other contraction that we know how to perform. We can for instance clarify that our contraction by p&q would coincide with our contraction by p, or by q, or by {p, q}. In a framework where the set of potential outcomes is known, some contractions are “self-evident” in the sense that there is only one serious candidate that can be (...) the outcome of such a contraction. Contraction by a specific contractee (sentence or set of sentences to be contracted) is bootstrapped if it is specified by saying that it coincides with some such self-evident contraction. For a wide range of (multiple) contraction operators, contractions by any contractee can be bootstrapped. This means that the selection mechanism (selection function, incision function, etc.) can be replaced by a function called a bootstrapping selector that assigns to each contractee some “self-evident” contractee that yields the same outcome. With bootstrapping we can eliminate traditional extralogical components in contraction (e.g., selection functions) and replace them by bootstrapping selectors that reflect more closely the ways in which we actually reason and argue about belief contraction. (shrink)
Lewis, D. Semantic analyses for dyadic deontic logic.--Salomaa, A. Some remarks concerning many-valued propositional logics.--Chellas, B. F. Conditional obligation.--Jeffrey, R.C. Remarks on interpersonal utility theory.--Hintikka, J. On the proper treatment of quantifiers in Montague semantics.--Mayoh, B.H. Extracting information from logical proofs.--Åqvist, L. A new approach to the logical theory of actions and causality.--Pörn, I. Some basic concepts of action.--Bouvère, K. de. Some remarks concerning logical and ontological theories.--Hacking, I. Combined evidence.--Äberg, C. Solution to a problem raised by Stig Kanger and (...) a set theoretical statement equivalent to the axiom of choice.--Lindström, P. On characterizing elementary logic.--Scott, D. Rules and derived rules.--Hansson, B. A program for pragmatics.--Hermerén, G. Models.--Fenstad, J.E. Remarks on logic and probability.--Stenlund, S. Analytic and synthetic arithmetical statements. (shrink)
Hintikka, J. Knowing how, knowing that, and knowing what: observations on their relation in Plato and other Greek philosophers.--Hedenius, I. The concept of punishment.--Marc-Wogau, K. On the concept of dialectial development in Marxism.--Ekelöf, P. O. Definitions and concept formation in the law.--Hermerén, G. The existence of aesthetic qualities.--Regnéll, H. Explanation in analytical philosophy.--Furberg, M. On questions and pseudo-problems.--Moritz, M. Imperative implication and conditional imperatives.--Sosa, E. Standard conditions.--Danielsson, S. On the strength of commitments.--Aqvist, L. The emotive theory of ethics in the (...) light of recent developments in formal semantics and pragmatics.--Von Wright, G. H. Truth as modality. A contribution to the logic of sense and nonsense.--Hansson, B. and Gärdenfors, P. A guide to intentional semantics.--Kanger, S. Entailment.--Edman, M. Adding independent pieces of evidence.--Lindström, P. A characterization of elementary logic.--Woodruff, P. W. On constructive nonsense logic.--Segerberg, K. Halldén's theorem on Post completeness.--Philosophical works by Sören Halldén (p. 210-211). (shrink)
